抗菌薇乔缝线对脊柱后路手术切口感染的预防作用

正手术切口感染(surgical site infection,SSI)是一种严重的术后并发症。由于骨科手术中骨及骨髓组织在术中显露以及骨科内植物的广泛使用,SSI时有发生。感染一旦发生,其结果可能是灾难性的。据统计,虽然骨科术后切口感染发生率与其他专业相比并不高,约为0.6%～1.8%,但在脊柱融合术中的发生率却相对较高,达到4.15%~([1])。SSI伴随着住院时间延长,死亡风险增加2～11倍~([2])。尽管大部分患者的SSI均可治愈,不会遗留长期不良后果,但SSI患者     

Fragment of the all-Ukrainian investigation of the microflora sensitivity to antibacterial preparations in patients with intra-abdominal surgical infection

All-Ukrainian investigation of microflora sensitivity to antibacterial preparations in patients with intraabdominal infection (IAI) have included studying of microbial landscape of the abdominal cavity content in IAI, and the causing agents sensitivity to main antibacterial preparations was determined, including those, manufactured by corporation "Arterium" (Ukraine).     

临床感染病原菌的变迁及其与抗菌药物应用的关系

目的:分析医院病原菌的结构和耐药的变迁趋势,探讨病原菌的变迁与临床抗菌药物使用的关系。方法:对解放军总医院第一附属医院1995年以来11年临床标本病原菌的分离鉴定结果进行统计分析,结合同期临床抗菌药物的使用强度,分析病原菌变迁与抗菌药物使用的相关性。结果:11年间从临床标本中共分离出病原菌15914株。①G 菌中金黄色葡萄球菌(金葡菌)和耐甲氧西林金葡菌(MRSA)的构成比上升趋势明显,凝固酶阴性葡萄球菌(CNS)和肠球菌属的构成比波动幅度较大,但变化趋势不明显。G-菌中,铜绿假单胞菌的构成比虽有波动,但始终维持在高水平;大肠杆菌和变形杆菌的构成比明显下降,不动杆菌的构成比明显上升。②1995年构成比最高的3种病原菌依次为大肠杆菌、铜绿假单胞菌和金葡菌,2005年变为铜绿假单胞菌、金葡菌和不动杆菌。③我院抗菌药物的使用强度在2005年达70DDD/100人天,使用最多的药物种类为喹诺酮类、二代头孢菌素和含酶抑制剂的三代头孢菌素;单一品种药物为左氧氟沙星、头孢呋辛和阿奇霉素。④大环内酯类、糖肽类、碳青霉烯类和3代头孢/抑制剂等药物的使用强度变化与多种病原菌构成比的变化呈显著正相关,MR-SA构成比的变化与多种药物使用强度变化呈显著正相关。结论:常见病原菌的耐药水平逐渐升高,将会增大抗感染治疗的难度;抗菌药物使用强度的变化有可能导致病原菌结构和耐药水平的变化。     

Rapid determination of microbial sensitivity to antibiotics by using laser spectroscopy

A method of express-determination of the susceptibility of microbes to antibiotics is presented based upon the registration by the method of laser spectroscopy of changes of optic properties of cultures at early terms of their incubation in liquid nutrient media with addition of antibiotics. The method was elaborated in 13 standard strains of Staphylococcus aureus and Escherichia coli with antibiotics of different classes, tested on the microflora of pus of patients with sepsis, verified by the method of serial dilutions of the antibiotic. The method makes it possible to obtain the minimum inhibiting concentration of antimicrobial preparations 1 h after the moment of obtaining the native material.     

Local multilevel monitoring of resistance of pathogens of surgical infection

Results of bacteriological investigations of patients with pyo-inflammatory surgical diseases and complications, environmental tests have been analyzed. The local multilevel monitoring of resistance was used as an instrument of permanent control of changes in the resistance of surgical infection pathogens to antibodies and for a decision on the schemes empiric antibacterial chemotherapy.     

抗菌肽天蚕素B对铜绿假单胞菌感染小鼠创面的抗菌作用

目的观察抗菌肽天蚕素B对小鼠铜绿假单胞菌感染创面的抗菌效果。方法于30只ICR小鼠背部切除全层皮肤(创面为1 cm×1 cm),将铜绿假单胞菌菌液涂抹于创面制成感染模型,并随机分为对照组、磺胺米隆组、抗菌肽组,伤后3 h分别用含等渗盐水、100 g／L磺胺米隆溶液、1g／L天蚕素B的纱布湿敷,每组10只。伤后1～4 d对各组小鼠创面行大体观察;伤前和伤后4 d测量体温,抽取血液观察白细胞变化;伤后4 d检测痂下肌肉组织细菌定量和观察存活情况。结果对照组创面分泌物多、创面潮湿;磺胺米隆组、抗菌肽组创面结痂、干燥、无明显分泌物。各组小鼠术后体温多数上升、白细胞计数均减少。抗菌肽组痂下肌肉组织细菌定量为(42±50)集落形成单位(CFU)／g,明显少于磺胺米隆组(886±804)CFU／g(P<0．05),两组均明显低于对照组(41±28)×105CFU／g(P<0．01)。对照组小鼠伤后4 d存活数明显少于抗菌肽组、磺胺米隆组(P<0．05)。结论天蚕素B对ICR小鼠铜绿假单胞菌感染创面有明显的抗感染作用,可明显降低其死亡率。     

Hepatic resection: The logical approach to surgical management of major trauma to the liver

Recent reports on the management of hepatic trauma have discouraged hepatic resection and supported hepatic artery ligation, “resectional debridement” and even packing. These nonresectional procedures are based on misguided principles and should never replace resection. Traditional methods of conducting hepatic resection in an emergency as used in the West probably cause delay in achieving immediate hemostasis, thus contributing to mortality. Compared with Western reports, our mortality for major hepatic resections is considerably low. This is probably due to faster resection and achievement of hemostasis by our clamping techniques. We conclude that it is quite logical to perform resection as the first line of treatment in major hepatic trauma.     

Antimicrobial effect of propolis and other substances against selected endodontic pathogens.

OBJECTIVE: The aim of this study was to determine the antimicrobial effect of ethanol extract of propolis (EEP) and intracanal medicaments calcium hydroxide, camphorated paramonochlorophenol, and formocresol by means of the macrodilution method using the reinforced clostridial medium (RCM) and brucella and brain heart infusion media. STUDY DESIGN: The antimicrobial agents were sequentially diluted and tested against anaerobic bacteria Prevotella nigrescens, Fusobacterium nucleatum, Actinomyces israelii, and Clostridium perfringens and against Enterococcus faecalis, with the 5 x 10(5) CFU/mL standardized inocula. The tubes were anaerobically incubated and the minimum inhibitory concentration was detected. Blood agar RCM subcultures were performed to provide minimum bactericidal concentration. The results were analyzed by analysis of variance test. RESULTS: All drugs were effective against all tested strains, without statistical differences. E. faecalis was the less susceptible strain, and RCM broth promoted faster bacterial growth, but there were no significant differences in these results. Ethanol did not influence the antimicrobial effect of EEP.     

外科手术部位感染目标性监测对抗生素合理使用的影响

目的探讨手术部位感染目标性监测对相关科室抗生素使用的影响。方法按时间顺序将2009年三季度9种外科手术病例346例设为对照组,2010年三季度的同类病例642例设为观察组;对照组采用常规方法干预;观察组实施外科手术部位感染目标性监测,成立监测小组,严格按监测程序施行。结果两组不同类别切口抗生素使用情况、抗生素合理使用情况、手术部位感染、微生物送检和药敏试验情况比较,差异有统计学意义(P<0.05,P<0.01)。结论开展外科手术部位目标性监测能促进相关科室抗生素的合理使用。     

Targeted monitoring of surgical site infection for rational use of antibiotics

目的 探讨手术部位感染目标性监测对相关科室抗生素使用的影响.方法 按时间顺序将2009年三季度9种外科手术病例346例设为对照组,2010年三季度的同类病例642例设为观察组;对照组采用常规方法干预;观察组实施外科手术部位感染目标性监测,成立监测小组,严格按监测程序施行.结果 两组不同类别切口抗生素使用情况、抗生素合理使用情况、手术部位感染、微生物送检和药敏试验情况比较,差异有统计学意义(P＜0.05,P＜0.01).结论 开展外科手术部位目标性监测能促进相关科室抗生素的合理使用.     

Prevention of surgical wound infection: prophylactic antibiotics in colorectal surgery

Surgical wound infection in colorectal surgery represents a significant cause of poor patient outcome. Adequate prophylaxis requires timely administration; topical gentamicin can significantly reduce infection in poorly perfused areas.