Feasibility and tolerability of probiotics for prevention of antibiotic‐associated diarrhoea in hospitalized US military veterans

Background: Probiotics may be efficacious for the prevention of antibiotic‐associated diarrhoea. The tolerability and acceptability of probiotics in an elderly US veteran population has not been assessed. Purpose: To undertake a randomized trial to determine the tolerability and acceptability of a probiotic, Florajen^® in an elderly population with multiple comorbidities. Methods: Pilot randomized double‐blind trial comparing a probiotic, Florajen^® to placebo for the prevention of antibiotic‐associated diarrhoea in elderly hospitalized patients receiving antibiotics. Results: Forty patients were enrolled and randomized. Antibiotic‐associated diarrhoea occurred in 6/16 (37%) in the placebo group and 4/23 (17%) patients in the Florajen^® group, (RR 1·63, 95% CI 0·73–3·65, P = 0·15). Florajen^® was well tolerated in the study population with no major side effects that necessitated discontinuation. Conclusions: In this pilot study, Florajen^® was well tolerated in an elderly population, all of whom were taking several other medications. A larger study is needed to determine the effect of Florajen^® on antibiotic‐associated diarrhoea and Clostridium difficile infection.     

粤北地区铜绿假单胞菌的临床分布和耐药性特点

目的分析粤北地区临床分离的铜绿假单胞菌株分布特点和对常用抗菌药物的耐药特点,为临床合理选用抗菌药物治疗、预防感染及防止耐药菌株的产生提供参考依据。方法按常规方法从粤北地区临床标本中分离培养铜绿假单胞菌,应用WHONET5.6和SPSS19.0统计软件分析2013-2014年的药敏试验数据,分析铜绿假单胞菌的耐药特点。结果 584株铜绿假单胞菌感染主要来自于重症医学科、骨科和呼吸内科,以呼吸道标本和伤口分泌物标本为主;铜绿假单胞菌对药敏试验的12种抗菌药物具有不同程度的耐药性,其中耐药率最高的是庆大霉素,对喹诺酮类、碳青霉烯类、加酶抑制剂类耐药率相对较低,头孢吡肟、环丙沙星、左氧氟沙星和头孢哌酮/舒巴坦的耐药性呈下降趋势。结论铜绿假单胞菌主要引起肺部和伤口感染,尤其在重症医学科、骨科和呼吸内科的老年患者多见;该菌对临床常用抗菌药物的耐药率相对较低,但临床仍需规范使用抗菌药物,以减少耐药菌株、尤其是多重耐药株和泛耐药株的产生。     

Antibiotic Prophylaxis in Pacemaker Surgery; A Prospective Trial With Local or Systemic Administration of Antibiotics at Generator Replacements

To evaluate the effect of short-term antibiotic prophylaxis at pacemaker surgery, consecutive patients scheduled for routine generator replacements were randomly assigned to a double blind study. One group received systemic prophylactic (SP) antibiotics and one group was given local prophylactic (LP) antibiotics. One-hundred and eight patients entered the study, but three were subsequently excluded. The SP group received flucloxacillin 2 gm intravenously 1 hour before surgery, then 1 gm orally every 8 hours for the following 5 days. In the LP group, 10 ml of a dextran emulsion with 5% cloxacillin was instilled in the generator pocket at the end of the operation. Infection developed in 0/53 in the SP group and 2/52 in the LP group. Tissue fluid was drawn 24 hours postoperatively from the generator pocket for determination of pocket concentration of antibiotics and culture tests. The concentration of flucloxacillin in tissue fluid from the pacemaker pocket 1 day postoperatively could be measured in 29 patients in the SP group with a median of 7.2 μg/ml. Median level of pocket fluid concentration of cloxacillin was 58.5 μg/ml in 31 patients in the LP group. Bacteriological cultures were positive in 1/32 patients in the SP group and in 1/33 in the LP group, but none of these patients developed infection. In conclusion, there was a low infection rate, both with systemic prophylaxis with flucloxacillin for a short period of time and with local prophylaxis with cloxacillin perioperatively.     

Antibiotic use in pulmonology wards of Chinese children's hospitals: 2002–2006

Purpose:  To investigate the pattern of antibiotic use in the pulmonology wards of four children's hospitals in China from 2002 to 2006.
Methods:  The Anatomical Therapeutic Chemical Classification/Defined Daily Doses (ATC/DDD) methodology was used. Aggregate data on antibiotic use (ATC code-J01) were expressed in numbers of DDD/100 bed-days for inpatients.
Results:  The overall consumption of antibiotic drugs in the pulmonology wards of the four children's hospitals were 83·7, 49·9, 53·6 and 79·3 DDD/100 bed-days, respectively. Injectables were among the most widely used antibiotics. In addition, there was a considerable variation in both the amount and the pattern of antibiotics used in the respective hospitals' pulmonology wards.
Conclusions:  Wide variations were found between the four hospitals studied in the amount and type of antibiotics prescribed although the diseases treated appeared the same. This variation may have been due to differences in disease severity, regional diversity in bacterial resistance or variations in empiric treatment regimens. Despite the introduction of Chinese Ministry of Health Antibiotic Guidelines in 2004, the pattern of antibiotic use in individual hospitals remained unchanged from 2002 to 2006. Antibiotic utilization studies need be taken to the next level; comparing drugs used to treat specific diseases with guideline recommendations. In addition, educational and other interventions to ensure better compliance with guidelines are urgently required.     

C‐reactive protein point of care testing and physician communication skills training for lower respiratory tract infections in general practice: economic evaluation of a cluster randomized trial

Rationale, aims and objectives An economic evaluation of general practitioner (GP) use of C‐reactive protein (CRP) point of care test, GP communication skills training, and both GP use of CRP and communication skills training on antibiotic use for lower respiratory tract infections (LRTIs) in general practice. Methods Cost‐effectiveness analysis with a time horizon of 28 days alongside a factorial, cluster randomized trial in 431 patients with LRTIs recruited by 40 GPs. Interventions: usual care (control group), GP use of CRP point of care test, GP communication skills training, and both CRP use and communication skills training. Main outcome measure: health care costs. Cost‐effectiveness, using the primary outcome measure antibiotic prescribing at index consultation, was assessed by incremental cost‐effectiveness ratios (ICER). To adjust for skewed data and clustering, we used non‐parametric bootstrapping re‐sampling to derive percentile intervals for the mean difference in total costs and the mean difference in effectiveness between the groups. Various implementation scenarios according to GP preference were modelled with corresponding net monetary benefit (NMB) curves based on a given willingness‐to‐pay (λ) for a 1% lower antibiotic prescribing rate. Results The total mean cost per patient in the usual care group was €35.96 with antibiotic prescribing of 68%, €37.58 per patient managed by GPs using CRP tests (antibiotic prescribing 39%, ICER €5.79), €25.61 per patient managed by GPs trained in enhanced communication skills (antibiotic prescribing 33%, dominant) and €37.78 per patient managed by GPs using both interventions (antibiotic prescribing 23%, ICER €4.15). The interventions are cost‐effective in any combination (yielding NMB at no willingness‐to‐pay), taking into account GPs' preferences where at least 15% of GPs chose to implement the communication skills training. Conclusions The two strategies, both singly and combined, are cost‐effective interventions to reduce antibiotic prescribing for LRTI, at no, or low willingness‐to‐pay. Taking GP preferences into account will optimize investment in strategies to reduce antibiotic prescribing for LRTI.     

1268例围手术期抗菌药物应用的调查分析

目的:了解成都地区抗菌药物的使用现状,分析围手术期抗感染用药情况,并作出客观评价。方法:根据《抗菌药物临床应用基本原则》,回顾性分析2004年12月至2006年12月成都地区8家医院1268份围手术期病历。结果:围手术期患者使用抗菌药物用于预防术后感染的时间超过了抗菌药物临床应用指导原则规定的比例占91.40%,联合用药的比例占总病历数的53.56%,7.81%的患者在手术过程中应用去甲万古霉素、庆大霉素等冲洗伤口以预防感染。结论:围手术期抗菌药物的使用基本合理,但是存在频繁且长时间应用的问题,应当加强抗菌药物应用的管理。     

Determination of antibiotic resistance and high‐performance liquid chromatography profiles for Mycobacterium species

Background

Incidence of mycobacterial infections has been increasing. However, diagnosis and treatment of mycobacterial infections can be difficult. The aim of this study was to investigate high‐performance liquid chromatography (HPLC) analysis of the mycolic acids for rapid identification and dendrogram cluster analysis of mycobacterium species.

Methods

Clinical specimens received for mycobacterial culture and antimicrobial susceptibility test were processed by standard laboratory protocols. Positive cultures were analyzed with HPLC method. Mycolic acid analysis with HPLC was used for diagnosis of tuberculosis and other mycobacterial infections. These reports were compared with Sherlock Library mycobacterial species, and the similarity index was analyzed. This value was formed by a software in multidimensional space that was the calculation of the average distance between the nearest library profile and unknown profile.

Results

The ninety‐two samples were identified as M. tuberculosis. (similarity index between 0.593 and 0.994). One of the other strains was identified as M. avium intracellulare (strain No. 82) (SI = 0.906); one of them was identified as M. interjectum (strain no. 89) (SI = 0.644). Total 94 samples were identified, and dendrogram was applied to these samples. Profile A (10.6%), profile B (59.6%), profile C (11.7%), profile D (3.2%), and other profiles as single different profiles were identified. Rates for each as 1% (89, 94, 1, 82, 26, 42, 32, 41, 100, 43, 47, 44, 40, 35).

Conclusion

High‐performance liquid chromatography is a useful, rapid, reliable, and practical method for diagnosis of mycobacterium species.