儿童尿路感染的短、长程抗生素疗法的随机对照研究

疗程从单次剂量到 3d的短程抗生素疗法是治疗成年妇女下尿路感染的标准疗法。尽管许多的小规模的研究表明短程 (≤ 3d)与长程 (7～ 14d)的疗法在儿童尿路感染的治疗中没有差别 ,人们还是担心存在隐匿性肾盂肾炎和肾脏的疤痕形成 ,这使得医生治疗儿童尿路感染也采用标准的 7～ 14d的疗程。本文通过分析已有的研究结果 ,确定是否长程抗生素疗法治疗儿童尿路感染比短程更有效。方法 :检索MEDLINE和Cochrane临床试验登记中比较儿童尿路感染的随机对照研究。用于荟萃分析的文章的入选标准是 :比较门诊短程 (≤ 3d)和长程 (7～ 14d)抗生素治疗…     

三种抗生素治疗急性淋病性尿道炎150例的临床观察

报告150例急性淋病性尿道炎的药物治疗效果,其中50例采用Trobicin治疗,50例用青霉素G治疗,50例用氟哌酸治疗,除3例治疗期间再接触感染外,余147例全部治愈。表明:三种抗生素均有较高治愈率,其中以氟哌酸最好,应予推广。并对患本病的孕妇及婴幼儿的治疗作了讨论。     

Meta分析抗生素对TURP术后感染性并发症的预防效果

目的　分析预防性抗生素能否减少术前为清洁尿、行经尿道前列腺切除术 (TURP)患者的术后感染性并发症。　方法　制定原始文献的纳入标准、排除标准及检索策略 ,在美国医学索引(MEDLINE)、荷兰医学文摘 (EMBASE)药理学分册、中国生物医学文摘 (CBMA)、及Cochrane图书馆(CL)内进行相关的随机对照试验的检索、质量评价和资料提取。应用RevMan软件进行数据处理 ;计数资料的效应尺度以相对危险度 (RR)及其 95 %可信区间 (95 %CI)表示 ;计量资料的效应尺度以加权均数差 (WMD)及其 95 %CI表示。　结果　共检索到相关随机对照试验 5 3篇 ,排除 2 6篇 ,符合纳入标准 2 7篇进入Meta分析。结果表明 :术前清洁尿的患者 ,预防性抗生素能显著降低TURP术后 1周内菌尿、术后发热、菌血症的发生率和术后需继续抗生素治疗的比率 ,RR值及其 95 %CI分别为 0 .36(0 .2 8～ 0 .4 6 )、0 .83(0 .71～ 0 .97)、0 .4 3(0 .2 2～ 0 .86 )及 0 .2 6 (0 .2 0～ 0 .33) ;但尚不能确定预防性抗生素能否缩短患者住院时间 ,其WMD及 95 %CI为 - 0 .31(- 0 .78～ 0 .35 )。　结论　术前为清洁尿的患者 ,预防性应用抗生素能减少TURP术后菌尿、发热、菌血症的发生率和术后需继续抗生素治疗的比率 ;尚不能确定能否缩短术后住院时间。     

复发性溃疡的预防和处理

胃大部切除术后复发性溃疡的发生率一般认为较低 ,在国内约为 1%～ 2 % ,国外约为 1%～ 3% ,但也有文献报道国内达6 2 .4% ,国外则为 32 .2 %～ 49.7% ,ＢｉｌｌｒｏｔｈⅡ式手术多于Ｂｉｌｌ ｒｏｔｈⅠ式 ,且多位于吻合口附近的空肠内 ,也可发生在吻合口。其特点为上腹部周期性发作性疼痛、消化道出血。病因和预防一、胃切除量不足 :切除量少于 5 0 % ,保留了较多的胃体部是复发性溃疡的主要原因。在我国 ,不少外科医生根据病人的年龄、溃疡部位、重建方式、胃酸高低 ,以及工作性质和食量等具体情况 ,决定胃切除的范围 ,故常常导致切除量…     

雌三醇阴道软膏预防绝经后妇女复发性尿路感染的疗效观察

目的探讨阴道内使用雌三醇软膏对绝经后妇女复发性尿路感染的预防作用。方法80例有复发性尿路感染病史的绝经后妇女随机法进入实验组和对照组。实验组40例使用雌三醇软膏，对照组40例使用安慰剂软膏，疗程6个月。结果实验组中发生尿路感染事件5例（13％）明显低于对照组31例（77．5％），且实验组患者实验过程中首次出现尿路感染复发的时间较对照组明显延后；治疗后实验组阴道分泌物检出乳酸杆菌的例数为22例，对照组无乳酸杆菌检出，两者具有显著性差异（P〈O．05）；实验组雌三醇软膏治疗前后阴道pH值分别平均为7．8±0．4及5．3±0．2，对照组为7．9±0．81及7．7±0．6，两组相比具有显著性差异（P〈0．05）。结论阴道局部用雌三醇软膏能有效延长绝经后妇女复发性尿路感染的复发间隔时间，降低复发率，而且使用方便、安全可靠，可作为预防用药。     

胆道手术抗生素的预防应用

１９８６年１月～１９９２年１２月，对２２４例慢性结石性胆囊炎患者行胆囊切除．其中７８例胆囊内胆汁普通培养，１６．７％出现细菌，而２４１例急性胆管炎的胆汁细菌培养阳性率高达７４．３％．胆汁中细菌对抗生素的敏感度依次为头孢菌素族、氨基甙类和半合成青霉素．本研究资料表明，为了预防胆道手术后并发感染，短期和超短期的用药方式是合理的．     

抗生素透入组织的药效学与预防外科感染

近年来尽管在外科技术、抗生素的应用和改变机体免疫状态等方面均有很多进展,但外科感染率仍无明显改善。本文重点复习抗生素预防外科感染。     

抗生素预防择期腹腔镜胆囊切除术后感染性并发症的研究

目的:探讨择期腹腔镜胆囊切除术预防性使用抗生素的必要性和影响。方法:麻醉诱导后,A组患者(n=141)予以1g先锋V号,B组患者(n=136)则不予抗生素,比较分析两组患者的手术过程和治疗结果。结果:277例患者的总感染率为1.1%(A组0.7%,B组1.5%),组间无统计学差异。研究中未发现任何危险因素可导致外科部位感染发生率升高。结论:预防性使用抗生素并不能降低择期腹腔镜胆囊切除术感染性并发症的发生率。     

Use and duration of antibiotic prophylaxis and the rate of urinary tract infection after radical cystectomy for bladder cancer: Results of a multicentric series

Objectives

To assess the rate of urinary tract infection (UTI), the characteristics of the bacterial aetiological agents involved, the type and duration of antibiotics used, and the clinical risk factors of UTI in a multi-institutional cohort of patients who had undergone radical cystectomy (RC).

Postoperative urinary tract infections (UTIs) following single-dose intraoperative antibiotic prophylaxis in colposuspension patients

The records of 196 women who underwent colposuspension for genuine stress incontinence at the Leicester General Hospital, England, between June 1991 and May 1996 were reviewed for evidence of urinary tract infection (UTI). Variables analyzed include age, type of anbibiotic, timing of a positive culture, organism(s) responsible and antibiotic sensitivity. Forty-six patients (23.47%) developed urinary infection; of these, 42 had received single-dose antibiotic prophylaxis with suprapubic catheterization. Thirty-two (76%) of those who developed UTI received augmentin (amoxycillin and clavulanic acid), whereas 10 (24%) were given cefuroxime and metronidazole. Positive cultures were obtained between postoperative days 3 and 28, with a mean of 9.6 days, and 81% occurred after the 7th day. Coliform organisms were responsible for nearly 70% of the infections. UTI is still common after colposuspension, despite single-dose antibiotic prophylaxis. Further studies looking at longer or alternative courses of antibiotics or clean intermittent self-catheterization are essential to establish the best way of curbing UTI in urogynecology patients.Editorial Comment: The authors present a summary of their experience with symptomatic urinary tract infection (UTI) after colposuspension, the patients having received a single dose of antibiotics preoperatively. Symptomatic urinary tract infections are described with regard to time of onset, length of suprapubic catheterization, pathogen and antibiotic sensitivity. One of the most interesting findings in this cohort of patients is the incidence of UTI over time, with the majority of infections occurring in the second postoperative week, and falling off dramatically thereafter. This is in contrast to the incidence of urinary tract infections with transurethral catheterization, where published experience suggests at 5%–10% increase in positive cultures for every day of transurethral catheterization, and almost universal positive cultures by 30 days. The results question the utility of preoperative single-dose antibiotic therapy in the prevention of UTI following colposuspension. Further investigation is needed to clarify what prophylactic antibiotic regimen is useful in preventing post-colposuspension infection of the lower urinary tract.     

Norfloxacin prophylaxis for acute recurrent uncomplicated urinary tract infection in women

Long-term low dose antimicrobial prophylaxis is effective for the prevention of recurrent uncomplicated urinary infections in women. The fluoroquinolone antimicrobials, including norfloxacin, have an in vitro spectrum effective for most uropathogens, and generally achieve high concentrations in the urine. In addition, they are effective for eradication of aerobic Gram-negative flora from the gut. These features suggest these antimicrobials should be effective agents for antimicrobial prophylaxis for urinary infection. Only norfloxacin has been studied in clinical trials to date. In two of the three studies reported, norfloxacin was effective for prophylaxis compared to placebo. In the third study, it was as effective as nitrofurantoin macrocrystals. Infections which occurred during prophylaxis were with organisms resistant to norfloxacin, particularly Enterococcus faecalis and Pseudomonas aeruginosa. Norfloxacin is effective for the prevention of recurrent uncomplicated urinary infections in women. Further studies comparing it to standard regimens are required to identify its specific niche in the management of this common problem.     

A randomized trial of antibiotic prophylaxis for the prevention of surgical site infection after open mesh-plug hernia repair

Background

The efficacy of antibiotic prophylaxis for the prevention of surgical-site infection (SSI) after open tension-free inguinal hernia repair remains controversial.

Methods

A double-blind, randomized, placebo-controlled trial was conducted. Patients who underwent elective open mesh-plug hernia repair were eligible for randomization. In the antibiotic prophylaxis group, 1.0 g cefazolin was intravenously administrated 30 minutes before the incision. In the placebo group, an equal volume of sterile saline was administered. The primary end point was the incidence of SSI.

Results

A total of 200 patients were enrolled. SSI developed in 2 of 100 patients (2%) in the antibiotic prophylaxis group and 13 of 100 patients (13%) in the placebo group, indicating a significant difference between the 2 groups (relative risk ratio, 0.25; 95% confidence interval, 0.070 to 0.92; P = .003). Other complications occurred in 23 patients: 7 (7%) in the antibiotic prophylaxis group and 16 (16%) in the placebo group (P = .046).

Conclusions

This study indicates that antibiotic prophylaxis is effective for the prevention of SSI after open mesh-plug hernia repair.     

Effective postcoital prophylaxis of recurrent urinary tract infections in premenopausal women: A review

A total of 77 sexually active premenopausal women, susceptible to recurrent urinary tract infections (UTI) but otherwise healthy, were subjected to postcoital prophylaxis consisting of a single oral dose of either cotrimoxazole (80 mg trimethoprim+400 mg sulfamethoxazole), 50 mg nitrofurantoin macrocrystals, 500 mg nalidixic acid, 250 mg cinoxacin or 250 mg cephalexin. Postcoital prophylaxis reduced the incidence of recurrent UTI from 5-8 UTI per patient/year prior to prophylaxis, to a mere 0.03 UTI per patient/ year following prophylaxis. The differences in the incidence of UTI prior to and following institution of postcoital prophylaxis were statistically highly significant. A mean of 106–120 antibacterial tablets per patient were administered per year.Postcoital prophylaxis of recurrent UTI in premenopausal women is highly effective because of easy compliance, the high urinary concentration achieved and the minimal induction of resistance in the introital Gram-negative bacterial flora, irrespective of the length of time this prophylaxis is used. Furthermore, postcoital prophylaxis is significantly more effective than daily, as it achieves the same effect but requires only one third or fewer of the antibacterial tablets used in daily prophylaxis. At present, postcoital prophylaxis with cotrimoxazole, nitrofurantoin macrocrystals or cephalexin is recommended.     

The usefulness of antibiotic prophylaxis in invasive urodynamics in postmenopausal female subjects

This study aims to define the usefulness of antibiotic prophylaxis of urinary tract infection (UTI) in postmenopausal female undergoing invasive urodynamics (IU). Two hundred sixty-two postmenopausal females underwent IU. Before urodynamics, all females were double blindly randomized in two age stratified groups. Group 1 (130 patients) received oral antibiotic prophylaxis with a single 400-mg dose of norfloxacin. Group 2 (132 patients) received norfloxacin placebo. Statistical analysis was performed by a chi (2) test to evaluate differences between groups for UTI incidence rate. Fifty-four patients of 262 (20.6%) resulted affected by UTI [24 of 130 subjects who received antibiotic prophylaxis (18.4%) and 30 of 132 subjects who received placebo (22.7%)]. There was no statically significant difference (P = 0.242) regarding UTI incidence rate between patients who received and those who did not received antibiotic prophylaxis. UTI incidence rate in postmenopausal women undergoing urodynamics is not affected by administration of antibiotic prophylaxis at the desired level of efficacy.     

Current antibiotic prophylaxis in pancreatoduodenectomy in Japan

Background/Purpose The aim of this study was to investigate the current use of antibiotic prophylaxis (AP) in association with pancreatoduodenectomy (PD) in Japan, and to determine its surgical implications.Methods We surveyed 2331 patients who underwent PD for treatment of disease in the periampullary region. Data, obtained during the period January 2002 through December 2003, from 111 major surgical services associated with the Japanese Society for Pancreatic Surgery, were analyzed with regard to patient characteristics, preoperative complications, AP, and postoperative morbidities.Results Eighty-five (78.7%) of the 108 eligible institutions chose a first- or second-generation cephalosporin for AP, given for a mean duration of 4.3 days. At all but 1 institution, the first dose was administered prior to surgical incision of the skin. At 42% of the institutions, an additional antibiotic was administered during surgery. The overall rate of wound infection was 6.8% of the 2266 patients for whom data were available. Preoperative jaundice was found in 55.3% of these 2266 patients, and 92.6% of these jaundiced patients were suffering from preoperative infections. In addition, those with preoperative infections were also diagnosed as having biliary infections. The number of patients with preoperative jaundice in combination with preoperative infections was significantly related to the rate of postoperative morbidity (P < 0.0001).Conclusions Administration of AP in association with PD in Japan seems appropriate. Icteric patients with biliary infections are at high risk for postoperative morbidities and need careful monitoring after surgery.A summary of this survey was presented, in part, at the 31st Annual Meeting of the Japanese Society for Pancreatic Surgery, May 2004, Osaka, Japan     

An evidence-based clinical guideline for antibiotic prophylaxis in spine surgery

Background context

The North American Spine Society's (NASS) Evidence-Based Clinical Guideline on Antibiotic Prophylaxis in Spine Surgery provides evidence-based recommendations to address key clinical questions regarding the efficacy and the appropriate antibiotic prophylaxis protocol to prevent surgical site infections in patients undergoing spine surgery. The guideline is intended to address these questions based on the highest quality clinical literature available on this subject as of June 2011.

Purpose

Provide an evidence-based educational tool to assist spine surgeons in preventing surgical site infections.

Study design

Systematic review and evidence-based clinical guideline.

Methods

This guideline is a product of the Antibiotic Prophylaxis in Spine Surgery Work Group of NASS Evidence-Based Guideline Development Committee. The work group consisted of neurosurgeons and orthopedic surgeons who specialize in spine surgery and are trained in the principles of evidence-based analysis. A literature search addressing each question and using a specific search protocol was performed on English language references found in MEDLINE (PubMed), ACP Journal Club, Cochrane Database of Systematic Reviews Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, EMBASE (Drugs and Pharmacology), and Web of Science to identify articles published since the search performed for the original guideline. The relevant literature was then independently rated using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final recommendations to answer each clinical question were developed via work group discussion, and grades were assigned to the recommendations using standardized grades of recommendation. In the absence of Levels I to IV evidence, work group consensus statements have been developed using a modified nominal group technique, and these statements are clearly identified as such in the guideline.

Results

Sixteen clinical questions were formulated and addressed, and the answers are summarized in this article. The respective recommendations were graded by the strength of the supporting literature, which was stratified by levels of evidence.

Conclusions

The clinical guideline for antibiotic prophylaxis in spine surgery has been created using the techniques of evidence-based medicine and best available evidence to aid practitioners in the care of patients undergoing spine surgery. The entire guideline document, including the evidentiary tables, suggestions for future research, and all the references, is available electronically on the NASS Web site at http://www.spine.org/Pages/PracticePolicy/ClinicalCare/ClinicalGuidlines/Default.aspx and will remain updated on a timely schedule.     

抗生素对降低聚丙烯材料植入疝修补术后手术部位感染的价值探讨

目的评价预防性使用抗生素能否降低聚丙烯材料植入疝修补术后外科手术部位感染的发生率。方法 2011年1～12月我院择期聚丙烯材料植入疝修补术治疗成人腹股沟疝患者396例,选择年龄≤75岁,未合并糖尿病、肺部感染、肾脏功能不全、肝功能不全、免疫功能低下的患者339例,分成未用抗生素组(A组)165例,应用抗生素组(B组)174例,比较二组术后外科手术部位感染率。结果二组患者全部获得3个月以上的随访,A组术后发生局部血清肿4例,B组术后发生局部血清肿5例,均在严格无菌条件下局部抽吸及加压包扎后缓解。二组均无外科手术部位感染。结论预防性使用抗生素对降低聚丙烯材料植入疝修补术后外科手术部位感染的发生率并无价值。