Risk factors and mortality associated with Clostridium difficile-associated diarrhoea at a VA hospital

The objective of this study was to evaluate the risk of certain patient co-morbidities and antibiotics in the development of Clostridium difficile-associated diarrhoea (CDAD). Hospitalized patients developing CDAD during a specified period were compared with a cohort of patients, matched by age, without a diagnosis of CDAD, who were hospitalized during the same time period. Data collection included demographics, hospital ward, co-morbid conditions, antibiotics received, and mortality. Gender and age were similar in both groups. Co-morbid conditions significantly associated with the case group included cancer and COPD. The most commonly prescribed antibiotics in the case versus control group included levofloxacin, intravenous vancomycin, clindamycin, and piperacillin/tazobactam. The case group was associated with a higher mortality rate.     

天津市2001年-2004年流感病原学监测分析

目的：观察天津市流感病毒流行特点以及发生禽流感疫情时的情况。方法：2001年10月-2004年3月3个冬春季的类流感患者咽拭子标本采用MDCK细胞和鸡胚双腔法分离流感病毒，用鸡红细胞和豚鼠红细胞凝集试验（HA）证实是否存在病毒，再用红细胞凝集抑制试验（HI）进行型和亚型的鉴定。2004年用RT—PCR方法检测禽流感疫情区发热患者咽拭子标本。结果：3个监测周期共采集类流感样患者咽拭子标本953份．分离出流感毒株285株，总检出率为29、9％，男女比例为1．06：1，其中A（H1Nl）亚型4．6％（13／285株），A（H3N2）亚型59．6％（170／285株），B型35．8％（102／285株）。285株流感病毒都能适应MDCK细胞，但阳性标本液直接接种鸡胚阳性率极低，仅为2．1％（6／285）。21份禽流感监测咽拭子标本H5亚型RT—PCR结果为阴性。结论：天津地区同时存在A（H1N1）、A（H3N2）和B型流感病毒，12月为发病高峰。天津市2004年发生禽流感时未发现人感染H5亚型禽流感病毒。     

Antibiotic-associated diarrhoea and Clostridium difficile in the community

BACKGROUND: Clostridium difficile is the main cause of nosocomial infectious diarrhoea and the causative agent of antibiotic-associated colitis. The involvement of C. difficile infection in antibiotic-associated diarrhoea in the community is poorly documented. METHODS: We studied prospectively 266 adult out-patients in the Paris (France) area who were prescribed a 5-10-day course of antimicrobial chemotherapy. Stools were screened for C. difficile before and 14 days after the start of treatment by standard culture, toxigenic culture and testing for the cytopathic effect of toxin B. Patients were requested to note daily stool frequency and consistency. Diarrhoea was defined as the passage of at least three loose stools per day. RESULTS: Forty-six (17.5%) of the 262 assessable patients had diarrhoea during the study period. Diarrhoea was mild and self-limited in all patients, and lasted for only 1 day in 65.6% of cases. C. difficile was isolated before and after treatment from one patient, who did not develop diarrhoea. C. difficile was detected only on day 14 in 10 patients (3.8%). The isolate was toxin producing in seven patients. Four of these seven patients had mild self-limited diarrhoea. Toxin-producing C. difficile was isolated significantly more frequently from patients who had diarrhoea than from those who were diarrhoea free (8.7% vs. 1.4%, P = 0.02). CONCLUSION: The acquisition of toxin-producing C. difficile appears to be frequent during antimicrobial chemotherapy in the community [estimated rate of 2700 (1150-5400) cases per 100 000 exposures to antibiotics]. However, C. difficile is not the main agent of mild antibiotic-associated diarrhoea in out-patients.     

我院2004-2008年洋葱伯克霍尔德菌耐药性分析

目的了解我院2004-2008年洋葱伯克霍尔德菌耐药状况,为临床有效治疗洋葱伯克霍尔德菌感染提供帮助。方法从各类标本中分离出洋葱伯克霍尔德菌株,并利用API系统鉴定,采用Kirby-Bauer法和微量肉汤稀释法进行药敏试验。结果共分离出599株洋葱伯克霍尔德菌。该菌的耐药率呈逐年上升趋势,其对哌拉西林/他唑巴坦和米诺环素的耐药率最低,2008年分别为8.6%和11.2%。结论洋葱伯克霍尔德菌作为院内感染的重要致病菌之一,对临床上常用的抗生素高度耐药。哌拉西林/他唑巴坦和米诺环素可作为治疗洋葱伯克霍尔德菌感染的首选。     

2001-2004年我院抗过敏滴眼液使用情况分析

目的客观分析我院抗过敏滴眼液的使用情况及发展趋势,为临床合理用药提供依据.方法用DDD分析法对我院2001-2004年4年间抗过敏滴眼液的使用情况进行统计和分析.结果4年来我院抗过敏滴眼液在用药金额、用药频度和销售量方面都呈上升趋势.DDDs排序前5位的是复方萘甲唑啉、萘扑维、新乐敦、色甘酸钠、那素达滴眼液.按销售金额排序为洛度沙胺、复方萘甲唑啉、萘扑维、新乐敦、吡嘧司特钾滴眼液.结论我院抗过敏滴眼液使用合理,临床以使用减轻充血剂-组胺受体阻断药的复方制荆占抗过敏滴眼液市场的主导地位.     

2001年~2004年我院抗高血压药利用分析

目的:评价我院抗高血压药应用现状及趋势。方法:对2001年~2004年我院抗高血压药的出库数据利用Microsoft Excel2000进行统计、分析。结果:抗高血压药用量呈增长趋势,其中90%左右为《国家基本医疗保险药品目录》中的品种;钙拮抗药、利尿药、血管紧张素转换酶抑制药、β受体阻滞药为临床一线药;血管紧张素Ⅱ受体拮抗药用量逐年大幅增长。结论:我院抗高血压药的使用结构基本合理;开发质优价廉的复方抗高血压药对控制高血压及其并发症具有重要的意义。     

广州地区2000-2004年淋球菌对抗菌药物耐药性的变迁

目的监测广州地区2000-2004年分离的淋球菌对5种抗菌药物的最小抑菌浓度(MIC),分析淋球菌的耐药趋势。方法采用纸片酸度法测定菌株是否产β内酰胺酶,采用琼脂稀释法测定淋球菌株对抗菌药物的MIC。结果共测定527株淋球菌,检出产β内酰胺酶淋球菌(PPNG)105株(19.9%),未见大观霉素和头孢曲松耐药菌株出现,但头孢曲松的低敏率由2000年的20%上升到2004年的66.1%,两者的MIC50和MIC90均在敏感范围。大观霉素的MIC90由8mg·L-1上升到32mg·L-1;青霉素、四环素、环丙沙星的MIC50和MIC90变化较大,且都超过了耐药标准,其耐药率分别由2000年的80%、88.6%、85.7%升至2004年的93.5%、93.5%和96.8%。结论2000-2004年期间大观霉素和头孢曲松对淋球菌敏感性较好,但后者的低敏率呈逐年升高趋势,两者仍可作为治疗淋病的首选药物;对青霉素、四环素和环丙沙星耐药率逐年增高,提示对淋病的治疗作用差。     

2001-2004年我院抗过敏滴眼液使用情况分析

目的客观分析我院抗过敏滴眼液的使用情况及发展趋势,为临床合理用药提供依据。方法用DDD分析法对我院2001-2004年4年间抗过敏滴眼液的使用情况进行统计和分析。结果4年来我院抗过敏滴眼液在用药金额、用药频度和销售量方面都呈上升趋势。DDD s排序前5位的是复方萘甲唑啉、萘扑维、新乐敦、色甘酸钠、那素达滴眼液。按销售金额排序为洛度沙胺、复方萘甲唑啉、萘扑维、新乐敦、吡嘧司特钾滴眼液。结论我院抗过敏滴眼液使用合理,临床以使用减轻充血剂-组胺受体阻断药的复方制剂占抗过敏滴眼液市场的主导地位。     

2001—2004年我院抗过敏滴眼液使用情况分析

目的客观分析我院抗过敏滴眼液的使用情况及发展趋势，为临床合理用药提供依据。方法用DDD分析法对我院2001—2004年4年间抗过敏滴眼液的使用情况进行统计和分析。结果4年来我院抗过敏滴眼液在用药金额、用药频度和销售量方面都呈上升趋势。DDDs排序前5位的是复方萘甲唑啉、萘扑维、新乐敦、色甘酸钠、那素达滴眼液。按销售金额排序为洛度沙胺、复方萘甲唑啉、萘扑维、新乐敦、吡嘧司特钾滴眼液。结论我院抗过敏滴眼液使用合理，临床以使用减轻充血剂．组胺受体阻断药的复方制剂占抗过敏滴眼液市场的主导地位。     

Clostridium difficile-associated disease: an emerging threat to patient safety: insights from the Society of Infectious Diseases Pharmacists

A formerly infrequently isolated strain of Clostridium difficile known as BI/NAP1 has resulted in geographically diverse outbreaks of C. difficile-associated disease. Such rapid dissemination and distribution of an outbreak strain of C. difficile are unprecedented, with many regions across North America, as well as several countries in Europe, being affected, all in such a short period of time. Also of note is that nontraditional hosts (e.g., otherwise healthy, noninstitutionalized persons residing in the community, some without antimicrobial exposure) have been reported to have severe disease. Data suggest that certain virulence characteristics may be responsible for more severe clinical presentations and poor outcomes. These factors (e.g., hypertoxin production, hypersporulation, antimicrobial resistance) possessed by a previously uncommon strain of C. difficile, in conjunction with particular host and environmental factors, may have precipitated the now widespread establishment of this pathogen. Antimicrobial intervention has traditionally been a mainstay of combating C. difficile-associated disease. Efforts to combat BI/NAP1 should include good antimicrobial stewardship in addition to effective infection control and environmental intervention.     

北京市基层医疗机构儿童抗菌药物使用及合理性分析

目的 了解北京市社区卫生服务机构处方点评机制下基层医疗机构儿童抗菌药物使用情况及合理性,为促进基层医疗机构合理使用抗菌药物提供参考.方法 提取北京市社区卫生服务机构处方点评系统中基层医疗机构2019年的全部儿童处方数据,根据世界卫生组织与国际合理用药网络(WHO/INRUD)的相关指标描述抗菌药物使用情况,根据药品的解...     

我院2001～2004年口服抗糖尿病药物应用分析

目的了解我院口服抗糖尿病药的用药情况及发展趋势,为临床合理用药提供参考。方法采用金额排序法和频度分析法对我院2001～2004年口服抗糖尿病药物应用情况进行统计分析。结果我院口服抗糖尿病药物用药金额2004年是2001年的3.58倍,用药频率2004年是2001年的2.22倍,以阿卡波糖、格列吡嗪、格列齐特、格列喹酮和盐酸二甲双胍的临床使用为最多。结论口服抗糖尿病药在2型糖尿病的临床治疗中占有重要地位。该类药物近年来发展较快,合理用药十分重要。     

Harms from alcohol consumption by strangers in five Indian states and policy implications

Introduction and Aims . India has a checkered history of alcohol prohibition; however, alcohol use is becoming more prevalent. We assessed the reporting of tangible and intangible harms from strangers' alcohol consumption by respondents' sex and how respondents' drinking and sociodemographic characteristics were associated with the reporting of these alcohol‐related harms by strangers. Design and Methods . We analysed cross‐sectional data from household interviews administered in five Indian states from October 2011 to May 2012. We analysed data among 7332 adults who responded to all 12 questions on alcohol‐related harms from strangers' drinking and for whom data were available on drinking status and sex. Result . In this sample, 63.2% reported experiences of one or more harms from strangers' drinking in the past year, with 47.4% reporting at least one tangible harm. Nearly one‐fifth reported being physically harmed from strangers' alcohol consumption. Drinking by women did not predict reports of alcohol‐related harms from strangers, while drinking by men was associated with at least 1.9 greater odds of reporting these harms compared with non‐drinkers. Living in rural areas was associated with reduced odds of reporting psychological harms from strangers' drinking among women but greater odds of reporting physical and sexual harms among men. Discussion and Conclusions . In five Indian states, both drinkers and non‐drinkers report being harmed by strangers' alcohol consumption. Greater implementation and enhanced enforcement of multilevel interventions may effectively reduce these alcohol‐related harms, such as regulating the density of alcohol outlets, screening and brief interventions in health settings and community empowerment initiatives. [Esser MB, Gururaj G, Rao GN, Jayarajan D, Sethu L, Murthy P, Jernigan DH, Benegal V. Harms from alcohol consumption by strangers in five Indian states and policy implications. Drug Alcohol Rev 2016;00:000‐000]     

长江流域五城市5家儿童医院2001～2003年抗肿瘤药物用药分析

目的：分析儿童医院抗肿瘤药物的应用现状,预测其发展趋势,为合理用药提供依据。方法：采用金额排序法对长江流域五大城市5家儿童医院2001～2003年抗肿瘤药物购药情况进行统计、分析与比较。结果：5家儿童医院抗肿瘤药物用药金额增长缓慢,抗代谢药和抗肿瘤抗生素用药金额各年稳居一、二名,阿糖胞苷、甲氨煤呤、L-广门冬酰胺酶、长春新碱、柔红霉素等药物的用药金额排名靠前。结论：儿童医院抗肿瘤药物应用集中稳定;抗肿瘤药物在国内民族企业有良好的市场份额,进口企业的市场份额也存在迅速增长的趋势;儿童用抗肿瘤药物正向多环节作用的新型药物发展。     

2001年～2004年四川广安市6家医院抗感染药利用分析

目的:为抗感染药的应用、管理提供参考依据。方法:对四川广安市6家医院2001年～2004年抗感染药的销售金额、用药频度(DDDs)等数据进行统计、分析。结果:口服洛美沙星DDDs连续4年均居口服用药的前1、2位;异烟肼、利福平DDDs连续4年分别居前4、5位;注射用青霉素DDDs(2001年～2003年)居注射剂的首位。左氧氟沙星不论是销售金额,还是DDDs都呈后来居上之势。结论:该地区医疗机构抗感染药销售金额与药品销售总金额的比例同西南地区其它医疗机构接近,新品种较少,用药档次偏低。     

某院2009～2011年细菌耐药率变化与抗菌药物使用量关系的研究

目的了解2009年1月～2011年12月笔者所在医院医院感染常见病原菌的耐药变化趋势及抗菌药物使用量,探讨抗菌药物使用量与病原菌耐药率之间的相关性。方法对3年间13种抗菌药物使用量与医院感染常见病原菌对目标抗菌药物耐药率进行统计分析,计算各药的用药频度,对耐药率与DDDs进行相关性分析。结果 3年期间病原菌耐药率逐步上升,期间笔者所在医院有9种抗菌药物DDDs的变化与治疗目标菌的耐药率变迁呈显著相关。结论抗菌药物的广泛使用或使用不当与加速细菌耐药的产生和发展可能有着密切联系,规范抗菌药物的使用对延缓细菌耐药性的发展有着重要意义。     

Alcohol consumption and rates of alcoholism in Greece

It appears that the incidence of alcoholism is relatively low in Greece, in spite of high consumption of alcohol and absence of restrictive measures for its use. This may be related to the traditional integration of alcohol use in the social ritualistic structures and to family and social support of susceptible individuals in the small Greek communities.The differences between urban and rural areas support these assumptions but should perhaps be taken as a danger signal. In order to establish effective measures of prevention, epidemiological studies are needed to confirm the trends and identify the risk factors.     

2001年～2004年我院口服抗高血压药物应用分析

目的了解我院口服抗高血压药物临床应用情况,供临床用药参考。方法统计分析我院2001年~2004年口服抗高血压药物的应用品种、销售金额、用药频度、日均费用等数据。结果口服抗高血压药物销售金额各年均为心血管类药物最高;二氢吡啶类钙拮抗药和血管紧张素转换酶抑制药销售金额各年均居前2位;单品种排序硝苯地平缓释片和苯磺酸氨氯地平各年均居前2位。结论我院口服抗高血压药物的应用情况与国内外总体用药情况基本相符,符合目前的抗高血压用药原则。