ICU与非ICU感染铜绿假单胞菌的分布及耐药性对比分析

目的对比重症监护病房（ICU）与非ICU感染铜绿假单胞菌的临床分布状况,分析比较两个病区的细菌耐药情况,为临床合理选用抗菌药物和控制院内感染提供依据。方法采用法国梅里埃公司生产的ATB-expmssion细菌鉴定仪对细菌进行鉴定,K-B纸片扩散法进行药敏试验,用WHONTE5．4软件分析病原菌的分离率及耐药率。结果美罗培南在ICU的耐药率（61．3％）显著高于非ICU的耐药率（27．0%）（P〈0．01）,庆大霉素、头胞他啶、丁胺卡钠、氨曲南、哌拉西林、哌拉西林／它唑巴坦、替卡西林／克拉维酸、头孢曲松、头孢噻肟在ICU的耐药率显著高于非ICU的耐药率（P〈0．01）,头孢吡肟在ICU的耐药率高于非ICU的耐药率（P〈0．05）,ICU与非ICU对抗菌药物的耐药率差异有统计学意义（P〈0．05）。结论ICU铜绿假单胞菌的耐药率显著高于非ICU的耐药率,尤其是碳青酶烯类抗菌药物,应引起临床高度重视。     

非ICU住院患者利奈唑胺的临床用药合理性调查

目的： 评价中山大学附属第一医院非ICU住院患者使用利奈唑胺的临床合理性及其疗效和安全性,为非ICU科室的临床合理用药提供参考。方法：采用回顾性研究方法,选取我院非ICU科室2015年1月-2015年12月使用利奈唑胺注射剂或片剂的患者病例,根据药品说明书和相关指南,分析利奈唑胺的临床应用合理性,并统计有效率及不良反应发生率。结果：调查共纳入有效病例112例,其中用药合理为77例（68.75%）,用药不合理35例（31.25%）：用药无指征6例（5.36%）,用药疗程不适宜15例（13.39%）,联合用药不当11例（9.82%）,8.04%的患者联用了4种以上抗菌药物。治疗结果痊愈72例,无效33例,因不良反应难以耐受停用5例,因缺药停用2例,临床治疗有效率为68.57%。用药后出现不良反应的有26例（23.21%）。结论：利奈唑胺在治疗非ICU科室患者的革兰氏阳性球菌感染时临床疗效较好,但存在不合理使用情况,使用过程中需关注其不良反应的发生。     

Pharmacologic Prophylaxis of Stress Ulcer in Non-ICU Patients: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials

PurposeAcid-suppressive medications are widely used in non–intensive care unit (non-ICU) patients for stress ulcer (SU) prophylaxis. However, SU prophylaxis in this population is still controversial. The purpose of this study was to systematically evaluate the efficacy and tolerability of these agents for SU prophylaxis in non-ICU patients.MethodsElectronic databases including Cochrane, ClinicalTrials.gov, Ovid-Medline, Embase, Chinese CNKI, and Wanfang Data were systematically searched on July 10, 2019, for randomized controlled trials (RCTs) that evaluated acid-suppressive medications in non-ICU patients. Network meta-analysis and pairwise meta-analysis were performed to calculate odds ratios (ORs) and 95% CIs. A random-effects model was used for generating pooled estimates. The primary outcome was occurrence of SU bleeding, and the adverse drug events (ADEs) were described as the secondary outcome.FindingsA total of 17 RCTs involving 1985 patients were eligible. Meta-analysis results indicated that the occurrence of SU bleeding was significantly decreased with all acid-suppressive medications compared with placebos (gastric mucosa protectants, OR = 0.29 [95% CI, 0.14–0.61]; H2-receptor antagonists, OR = 0.3 [95% CI, 0.18–0.50]; proton pump inhibitors [PPIs]: OR = 0.08 [95% CI, 0.04–0.16]). The occurrence of SU bleeding was significantly decreased with PPIs compared with gastric mucosa protectants (OR = 0.29; 95% CI, 0.12–0.72) and H2-receptor antagonists (OR = 0.28; 95% CI, 0.16–0.48). There was no significant difference between any 2 classes of PPIs on SU bleeding or any 2 acid-suppressive medications on ADEs.ImplicationsPPIs could significantly decrease SU bleeding risk without increasing ADEs than other acid-suppressive medications for SU prophylaxis in non-ICU patients. However, RCTs of high quality were required to confirm the findings of this investigation.     

ICU与非ICU病房不动杆菌耐药率对比

目的比较ICU病区患者与非ICU病区患者不动杆菌耐药性差异,指导临床合理用药。方法回顾性分析2008年我院ICU和非ICU住院患者送检标本中分离的不动杆菌对临床常用抗菌药物的耐药性情况。结果 ICU不动杆菌对大多数抗菌药物的耐药率明显高于非ICU的分离株,两者对氨苄西林、头孢唑啉、呋喃妥因的耐药率无显著性差异,对氨苄西林、头孢唑啉的耐药率均为100%,而其他检测的抗生素则存在显著性差异（P〈0.01）。结论合理使用抗生素和加强医院感染管理是减少不动杆菌多耐药菌株在医院感染的主要途径。