Effect of a single mass antibiotic distribution on the prevalence of infectious trachoma

Context  The World Health Organization recommends mass antibiotic distributions in its strategy to eliminate blinding trachoma as a public health concern. Some hypothesize that a single distribution is sufficient to control the ocular strains of chlamydia that cause trachoma. Others believe infection will inevitably return and periodic treatments or other measures are essential. Objective  To determine whether ocular chlamydial infection returns to the community up to 24 months after a single mass antibiotic distribution in a hyperendemic region of Ethiopia. Design, Setting, and Participants  Longitudinal cohort study conducted March 2003 to March 2005 in the Gurage Zone of Ethiopia. Eight randomly selected villages were assessed for ocular chlamydial infection. Fifteen untreated villages were randomly chosen at 12 months to allow assessment of a secular trend. Intervention  A single dose of oral azithromycin was offered to all residents of the 8 selected villages who were aged 1 year or older. Main Outcome Measure  Prevalence of ocular chlamydial infection in all children aged 1 to 5 years from each intervention village prior to treatment and 2, 6, 12, 18, and 24 months after mass antibiotic treatment, and also in untreated villages enrolled at 12 months. Results  Five hundred fifteen children were examined for ocular chlamydial infection at baseline. For the follow-up examinations, the mean participation rate was 83%. The mean prevalence of infection in children aged 1 to 5 years decreased from 43.5% (95% confidence interval [CI], 35.0%-52.0%) to 5.1% (95% CI, 1.1%-9.2%) after treatment. On average, infection returned gradually over 24 months to 11.3% (95% CI, 4.5%-18.1%; P = .001). In 7 of 8 villages, infection was higher at 24 months than at 2 months. In the remaining village, no infection could be identified at any point after treatment. Villages enrolled at 12 months had significantly fewer infections than those enrolled 12 months earlier, suggesting a secular trend (P<.001). Conclusions  Ocular chlamydial infection was not eliminated in children aged 1 to 5 years after a single mass azithromycin distribution; it slowly returned over 24 months, although not to baseline levels. Repeated treatments or other effective measures will be necessary for elimination.      

Impact of annual targeted treatment on infectious trachoma and susceptibility to reinfection

Context  The World Health Organization developed the SAFE strategy (Surgery for trichiasis; Antibiotics for Chlamydia trachomatis infection; Facial cleanliness; and Environmental improvement) to eliminate blinding trachoma globally by the year 2020. Despite a number of studies using various intervals of treatment for different prevalence rates, there has been a lack of sufficient follow-up beyond the final treatment point to determine rates of recurrence of disease and infection and the risk factors that may contribute to each. Objective  To evaluate the impact of 2 annual targeted azithromycin treatments on active trachoma and C trachomatis infection rates over 3 years in Vietnam. Design, Setting, and Participants  Three communes were randomly selected for a longitudinal study in Vietnam from November 2000 through November 2003. Individuals (n = 3186) were graded for trachoma followed by conjunctival sampling to detect chlamydiae by commercial polymerase chain reaction. Grading and chlamydial detection were repeated every 6 months for 3 years. Intervention  Azithromycin was given to children aged 5 through 15 years with active trachoma and their household members in SAFE and SA communes at baseline and 12 months; these communes were compared with the S-only control commune that did not receive azithromycin targeted treatment. Main Outcome Measures  Prevalence and incidence of active trachoma and C trachomatis infection in all communes at baseline, 6, 12, 18, 24, and 36 months. Subgroup analysis evaluated new infection, continuing infection, and reinfection at 6, 12, 18, 24, and 36 months and risk factors for each. Results  Reinfection rates increased significantly between 12 and 36 months for SAFE (from 1.6 to 29.3 per 1000; P<.001) and SA (5.1 to 25.3 per 1000; P = .002) communes but not for the S-only commune (13.4 to 6.7 per 1000; P = .55) after 24 months. Compared with the S-only commune, mixed-effects and generalized estimating equations (GEE) logistic models showed that reinfection risk was significantly higher for SAFE (odds ratio [OR], 4.1; 95% confidence interval [CI], 1.5-9.8; P = .005) and SA (OR, 4.2; 95% CI, 1.1-17.3; P = .04) communes at 36 months. Conclusions  Increasing reinfection rates suggest that treatment may interrupt the duration of infection required for developing immunity, increasing the number of individuals susceptible to reinfection and adversely affecting disease prevalence over time. Additional research is needed to determine optimal trachoma control strategies, including evaluation of the "F" and "E" components. Trial Registration  www.actr.org.au Identifier: 12606000360516      

Effectiveness of azithromycin mass drug administration on trachoma: a systematic review

Backgrounds:Azithromycin mass drug administration (MDA) is a key part of the strategy for controlling trachoma. This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma; provide an overview of the impact of azithromycin MDA on trachoma in different districts; and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts.Methods:PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov were searched up to February 2021 with no language restriction. Studies reporting the effect of azithromycin MDA on trachoma were included. Mathematical modeling studies, animal studies, case reports, and reviews were excluded. The trachomatous inflammation-follicular (TF) <5.0% was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem. Two researchers independently conducted the selection process and risk of bias assessment.Results:A total of 1543 studies were screened, of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included. The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts. For the districts with baseline prevalence between 5.0% and 9.9%, a single round of MDA achieved a TF <5.0%. For the districts with baseline between 10.0% and 29.9%, annual MDA for 3 to 5 years reduced TF <5.0%. However, for the districts with high level of baseline prevalence (TF >30.0%), especially with baseline TF >50.0%, annual MDA was unable to achieve the TF <5.0% even after 5 to 7 years of treatment. Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts.Conclusions:Azithromycin MDA for controlling trachoma depends on the baseline prevalence. The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline >10.0% is not appropriate for all eligible districts.     

农村集体服药后肠道线虫感染情况调查

目的了解深圳市龙岗区居民集体服药驱除肠道线虫效果。方法于2006年9月对肠道线虫感染高的龙岗区区居民集体服甲苯咪唑糖片驱虫,2007年1月经盐水漂浮法和改良加藤氏法粪检调查550名居民的感染情况,分析驱虫效果。结果肠道线虫卵总检出率为18．73％（103／550）。单虫阳性率以鞭虫卵最高,为9．27％,钩虫卵次之,为6．36％,蛔虫卵最低,为4．00％。用饱和盐水漂浮法检出率为8．18％;改良加藤氏法检出率为10．36％,经统计学处理（x^2=1．296,P〉0．05）,无统计学意义。从单虫检出情况看,盐漂法检出钩虫卵阳性21人,加藤法为13人,经统计学处理无统计学意义（x^2=3．379,P〉0．05）。蛔虫卵分别检出16人和6人,显示盐漂法明显高于加藤法（x^2=4．638,P〈0．05）。鞭虫卵检出分另0为12人和39人,显示加藤法明显高于盐漂法（x^2=29．987,P〈0．01）。结论甲苯咪唑糖片对人体肠道线虫有良好的驱除效果。通过集体驱虫后当地肠道线虫感染率大副下降。     

住院肺炎患者细菌感染现况及耐药谱分析

目的 探讨住院肺炎患者的病原菌分布及其耐药状况.方法 选择新疆维吾尔自治区人民医院儿科诊断住院的1381例肺炎患者,采取下呼吸道痰液标本,进行细菌培养及药敏试验.结果 258例(18.68%)患者被确诊为细菌性肺炎且有明确的病原体.其中革兰阴性菌感染20例(77.91%),且以克雷伯氏菌属、不动杆菌属、大肠埃希菌多见;...     

鲍曼不动杆菌医院感染分布及耐药性分析

目的探讨孝感市中心医院鲍曼不动杆菌医院感染的临床分布特点及耐药现状,为临床合理应用抗菌药物提供依据。方法对临床各科室分离出的鲍曼不动杆菌用ATB Expression半自动细菌鉴定仪进行菌种鉴定,采用纸片扩散法进行药物敏感试验。以中华人民共和国卫生部颁布的《医院感染的诊断标准(试行)》为医院感染诊断标准。结果鲍曼不动杆菌以呼吸道标本检出率最高,占67.8%;临床科室中以呼吸科病房及呼吸重症监护室检出率最高,占33.7%。鲍曼不动杆菌对亚胺培南的耐药率最低(2.0%);对头孢哌酮/舒巴坦、阿米卡星、头孢吡肟、米诺环素及头孢他啶有较好的抗菌活性,耐药率较低(≤40.0%);对第1、2代头孢菌素、头孢噻肟、头孢哌酮及氨曲南耐药率均较高(>60.0%);对头孢哌酮/舒巴坦的耐药率(20.0%)低于头孢哌酮(64.4%);对氨基糖甙类中阿米卡星的耐药率(29.3%)低于庆大霉素(73.7%)。结论鲍曼不动杆菌耐药十分严重,应引起临床高度重视。合理使用抗生素,加强医院感染管理,防止耐药菌株导致的爆发流行。     

Cost comparison of intravenous antibiotic administration

The cost of preparing and administering intravenous antibiotics in an Australian teaching hospital was determined. The costs associated with acquisition, delivery (administration system, ancillary equipment, labour), and laboratory monitoring for potential toxicity were calculated. Standard regimens based on antibiotic guidelines were used to compile the daily total cost. The results indicate that these components affect the daily total cost of individual antibiotics in different ways. Acquisition cost is often a poor predictor of total cost, which ranges from 1.2 times to almost eight times the acquisition cost. Less frequent administration reduces total costs substantially, as does slow injection compared with infusion. Laboratory costs constitute between 3.6% and 23% of the daily total cost and are most pronounced with antibiotics that have low acquisition costs. Antibiotic cost containment should not focus on acquisition cost alone. Daily total cost to administer antibiotics is a more appropriate and accurate costing method. Hospitals must acknowledge the need for innovative resource allocation methods which recognise this fact.     

重症监护病房抗菌药物应用现状的分析

目的分析重症监护病房(ICU)的主要致病菌及抗菌药物使用情况,为临床治疗提供依据。方法抽取2010年1～3月ICU收治的患者病历23份,从抗菌药物的使用情况及病原学检查等方面进行总体分析评价;从中随机抽取4份病例分析其用药合理性。结果 ICU患者使用的抗菌药物主要有7类,使用最多的是亚胺培南/西司他丁、哌拉西林/他唑巴坦和万古霉素。ICU致病菌主要有革兰阴性杆菌,如铜绿假单胞菌、大肠埃希菌、嗜麦芽假单胞菌及肺炎克雷伯菌;革兰阳性菌主要有溶血性葡萄球菌;厌氧菌与真菌感染也时有发生。结论定期进行病原学检查和细菌耐药动态监测对ICU的感染控制至关重要。     

两种抗生素对新生儿感染性肺炎的疗效观察及对肠道微生态影响研究

目的 考察常用抗生素对新生儿肺炎的治疗效果以及抗生素使用对新生儿肠道微生态的影响.方法 选取杭州市第一人民医院2011年12月～2012年12月收治的无并发症的新生儿肺炎患者130例作为研究对象,依据使用不同抗生素分为头孢组30例,青霉素组29例,联合用药组31例,另选40名健康新生儿作为对照组,比较各组的治愈率、治愈时间.考察使用抗生素5d后肠道菌群数量,评价抗生素对新生儿肠道微生态的影响.结果 头孢组治愈率为76.7％;青霉素组治愈率为72.4％;联合用药组治愈率为71.2％;三组治愈率之间相比较,差异无统计学意义（P＞0.05）.头孢组治愈时间为（5.3±0.2）d,青霉素组治愈时间为（5.5±0.2）d,联合用药组治愈时间为（5.2±0.3）d,三组治愈时间比较,差异无统计学意义（P＞0.05）.用药组与对照组相比较,双歧杆菌数量明显降低（P＜0.01）,肠杆菌、肠球菌以及消化链球菌数量显著增加（P＜ 0.01或P＜ 0.05）,类杆菌数量差异无统计学意义（P＞ 0.05）.结论 抗生素治疗新生儿肺炎偏向于联合用药,抗生素会破坏新生儿肠道微生态失去平衡.     

1668例住院患者抗生素使用分析

目的对1668例住院患者抗生素使用情况进行分析,为制定合理使用抗生素规范提供依据.方法采用整群随机抽样法对我院2003年1-12月1668例住院患者抗生素使用情况进行分析.结果 1668例中使用抗生素者1247例,使用率为74.76%,送细菌药物敏感试验76例,占使用抗生素人数的6.09%,使用抗生素过程中发生医院感染39例,占3.12%.不合理使用抗生素共297例,占23.81%;其中无指征或指征不强131例(38.04%);抗生素联用过多93例(31.31%);抗生素使用时间过长27例(9.09%);抗生素使用过程中更换频繁24例(8.08%);同类抗生素联用不合理22例(7.40%).结论住院患者中有抗生素使用不当情况,应提高临床医务工作人员对正确使用抗生素的认识.     

儿童感染金黄色葡萄球菌的临床特点与耐药状况

目的：了解本地区儿童感染金黄色葡萄球菌的临床特点和耐药状况,为临床诊治提供参考。方法：对桂林医学院附属医院感染金黄色葡萄球菌（SAU）的患儿的临床特点进行调查,采用VITEK32全自动微生物分析仪GPS药敏板,检测SAU分离株对20种抗菌药物的敏感性。结果：分离SAU 42株,检出SAU较多的标本是脓液和分泌物,检出SAU的患儿中0-3岁28例（66.67%）。SAU对青霉素、红霉素、克林霉素、四环素和苯唑西林的耐药率分别为100.0%、76.2%、66.7%、66.7%和47.6%,对头孢唑林、头孢呋辛、头孢噻肟、头孢唑肟、复方新诺明、诺氟沙星的敏感率超过85.0%,未发现对左旋氧氟沙星、米诺环素、万古霉素、替考拉宁、利福平、夫西地酸、呋喃妥因、达福普汀耐药的菌株。结论：在脓液和分泌物标本中、在皮肤软组织感染和婴幼儿的标本中检出的SAU占总数的比例较大。本地区儿童感染的SAU对青霉素类、大环内酯类抗菌药的耐药率较高,头孢菌素类、复方新诺明、夫西地酸、呋喃妥因可以考虑用于治疗本地区SAU引起的儿童感染。     

Prophylactic antibiotic administration for prevention of surgical site infection in urological laparoscopic surgeries

Background: The purpose of this study is to investigate the occurrence of surgical site infection (SSI) in our cases after laparoscopic surgery with prophylactic antibiotics administration (PAA) of 1-2 days or 3 days duration. Methods: Two hundred and nine patients were enrolled in this study. SSIs were categorized as urinary tract and/or wound infection. Laboratory data relating to infection such as serum white blood cell (WBC) and C-reactive protein (CRP) were investigated after surgeries and compared to the data before surgeries. Data were collected and analyzed retrospectively. Results: There were 4 SSI patients in total. SSI was 4/125 (3.2 %) cases of PAA of 1-2 days (shorter) duration patients and there was 0/84 (0 %) of PAA of 3 days (longer) duration. Longer group showed the tendency of lower SSI ratio even though the difference did not reach statistically significant (p=0.0978) because of small number of SSI cases and ratios. Change of serum WBC at 4th day from pre-surgery was significantly suppressed in longer group than shorter group. Conclusions: Our data showed 3-days of PAA might be better to be selected according to the cases especially such as, for instance, immune-compromised hosts. Future prospective study with more number of patients may be necessary for further evaluation.     

感染性疾病的微生物宏基因组测序结果判读的比较

目的 分析感染性疾病的微生物宏基因组测序结果,比较两个数据库注释结果的一致性.方法 收集感染性疾病患者的不同类型临床标本,进行宏基因组二代测序,分别采用NCBI NR数据库和MetaPhlAn2数据库注释测序结果,并进行一致性检验.结果 2019年6月—2020年10月,在上海市4家医院内收集疑似感染性疾病患者174份...     

Serotypes and antibiotic sensitivity of Moraxella bovis isolated from an outbreak of infectious bovine keratoconjunctivitis

Samples of conjunctival fluid of four calves, from a herd with infectious bovine keratoconjunctivitis, were collected five times at monthly intervals and from another 16 calves in the initial stages of the disease, were collected only once. Moraxella bovis was recovered from 82.3% of the samples. Twenty-six isolates were typed with polyvalent sera and 25 with monovalent sera. The antibiotic sensitivity of 13 isolates was also studied. Twenty of the 26 isolates reacted with polyvalent sera and 16 of 25 tested isolates, reacted with monovalent sera. The isolates recovered from the same animal in a different collection or from a different animal in the same collection did not always belong to the same serogroup. Different serotypes were prevalent in each collection. Differences in the antibiotic sensitivity of the isolates were also detected.     

The impact of emergency antibiotic administration time on patients with sepsis

Objectives:To assess the mortality benefits of timely antibiotic treatment of adults present at the emergency department with sepsis and compare one-hour administration and 3-hour administration starting from the time of triage.Methods:In this retrospective study, we used secondary data analysis to investigate the utility of the National Early Warning Score as a predictor of mortality in sepsis patients between July 2018 and June 2019, at the Emergency Department, King Saud Medical City, Riyadh, Saudi Arabia. The patients were grouped into 2 based on the time interval from triage to the first antibiotic administration: the immediate group received antibiotics within the first hour, and the early group received antibiotics between one and 3 hours. The primary outcome of interest was in-hospital mortality.Results:Out of 495 septic patients, only 292 patients (mean age of 56.3 ± 23.6 years) met the inclusion criteria. Two hundred fifty (85.6%) patients received antibiotics within one hour of triage (immediate), while 42 (14.4%) patients received antibiotics between one and 3 hours (early). Overall, in-hospital mortality was 31.8%. The mortality rates among patients who received early antibiotic was 31.6% and who received immediate antibiotic was 33.3%, with a p-value of 0.823.Conclusion:Our findings did not support immediate antibiotic administration over early administration in patients with sepsis. However, further studies are recommended to investigate the effects of antibiotic timing on the outcome of severe sepsis patients.     

残数法计算单室模型药物血管外多剂量给药的吸收和清除动力学参数

目的建立单室模型药物血管外多剂量给药的吸收和清除药动学的残数法计算方法.方法将残数法原理用于单室模型药物血管外多剂量给药的药动学参数计算,以数学分析和模型药物数据处理进行方法学研究.结果建立了单室模型药物血管外多剂量给药的药动学参数的残数法,其与单剂量的残数法有一定的相关性.结论残数法适用于评价单室模型药物血管外多剂量给药的药动学参数,以评价多剂量给药的吸收和清除特征是否发生变化,并据此指导临床用药.