A clinical and microbiological study of venous catheterization

In a prospective study of 210 intravenous catheters and needles 31 (15%) swabs yielded 34 microbial isolates. Twenty-eight were “non-pathogenic” skin commensals and six were “pathogenic” organisms. Commensals were isolated predominantly from catheters left in situ for only a short time (up to two days) and pathogenic organisms most frequently from specimens left in situ for a longer time. Correlation was not confirmed between colonization and infection, antibiotic therapy or phlebitis. All samples of IV fluids were sterile on culture. Changing the IV catheter at least every two days is recommended.     

不同菌种血流感染患者降钙素原水平的差异

目的 探讨分别由革兰阳性菌、革兰阴性菌及真菌所致血流感染患者中血清降钙素原（PCT）动态水平的差异。方法 纳入2013年2月~2014年12月绵阳市中心医院重症医学科血培养结果阳性且为单一菌株感染的患者52例,并于感染第1、2、3、5、7、10天同步检测血清PCT。比较在革兰阳性（G⁺）菌、革兰阴性（G^-）菌及真菌所致血流感染患者之间PCT达峰时间、峰值水平、平均值、变化幅度的差异,并采用受试者工作曲线（ROC）评估PCT峰值水平对诊断及区分不同菌种所致血流感染的临床价值。结果 有效入选的血流感染患者共52例：G^-菌组29例,G⁺菌组17例及真菌组6例。3组患者PCT峰值水平、平均值和变化幅度以革兰阴性菌患者最高,真菌感染者最低,革兰阳性菌患者介于两者之间。3组PCT峰值水平中位数分别为38.52ng/ml、14.23ng/ml、3.14ng/ml,两两比较,G^-组峰值高于G⁺组及真菌组,差异有统计学意义（P<0.05）。根据ROC曲线,当界值为6.93ng/ml时,血清峰值PCT区分细菌所致血流感染的敏感度为97.8%,特异性为100%;当界值为33.44ng/ml时,血清峰值PCT区分G^-与G⁺菌所致血流感染的敏感度为65.5%,特异性为82.4%;当界值为7.60ng/ml时,血清峰值PCT区分G^-菌与真菌所致血流感染的敏感度为100%,特异性为100%;当界值为6.93ng/ml时,血清峰值PCT区分G⁺菌与真菌所致血流感染的敏感度为94.1%,特异性为100%。结论 血清PCT水平对鉴别G^-菌与G⁺菌或真菌引起的血流感染有一定的临床应用价值。     

鼠抗人hMIC-l单克隆抗体抑制裸鼠移植人胰腺癌体内研究

目的初步研究鼠抗人hMIC-l单克隆抗体对胰腺癌体内给药的抗肿瘤活性,为hMIC-l抗体应用于肿瘤治疗提供实验依据。方法 2种人胰腺癌细胞株PANC-1和SW1990各腋窝皮下接种24只Balb/c裸鼠,共计48只皮下接种荷瘤裸鼠分别随机共分为8组,每组6只荷瘤鼠。模型对照组荷瘤裸鼠腹腔注射0.9%氯化钠注射液(10 mL/kg,NS,Biw,ip×8),阳性对照组荷瘤裸鼠腹腔注射键择(50 mg/kg,qw,ip×4),鼠抗人hMIC-l单克隆抗体组分别荷瘤鼠尾静脉内注射鼠抗人hMIC-l单克隆抗体(10 mg/kg,Biw,ip×8)共4周或(2 mg/kg,Biw,ip×8)共4周。观察荷瘤裸鼠日常表现、肿瘤生长、实验后肿瘤组织切片HE染色后光镜下的组织形态学改变。结果荷瘤裸鼠尾静脉内注射鼠抗人hMIC-l单克隆抗体组裸鼠(10 mg/kg,Biw,iv×8)肿瘤生长缓慢,瘤体明显小于模型对照组,并呈现量效关系。镜下观察鼠抗人hMIC-l单克隆抗体组实验后肿瘤组织切片胰腺结构破坏,有大量淋巴细胞浸润,肿瘤细胞明显坏死,细胞溶解。结论尾静脉内注射鼠抗人hMIC-l单克隆抗体(10 mg/kg,Biw,iv×8)能有效抑制裸鼠移植人胰腺癌PANC-1肿瘤生长,使瘤组织坏死、结构破坏。     

血液肿瘤患者肛拭子耐碳青霉烯类肠杆菌目主动筛查情况及继发血流感染的影响因素

目的 探讨血液肿瘤患者肛拭子耐碳青霉烯类肠杆菌（CRE）主动筛查情况及继发血流感染的影响因素。方法 选取2020年9月—2022年6月在苏州大学附属第一医院治疗的血液肿瘤患者1 258例,所有患者行肛拭子CRE主动筛查,分析CRE定植分布、血流感染情况及其影响因素。结果 共检出CRE 109株,以肺炎克雷伯菌、大肠埃希菌为主;10例患者发生CRE血流感染;CRE酶型分布中,主要以NDM、KPC为主;有中性粒细胞缺乏患者CRE定植发生率高于无中性粒细胞缺乏患者（P<0.05）;有消化道症状患者CRE定植发生率高于无消化道症状患者（P<0.05）;多因素逐步Logistic回归分析结果显示,中性粒细胞缺乏■是血液肿瘤患者CRE定植发生的影响因素（P<0.05）。不同性别、年龄、疾病类型及有无中性粒细胞缺乏、消化道症状患者的血流感染发生率比较,差异均无统计学意义（P>0.05）。结论 血液肿瘤患者肛拭子CRE主动筛查能有效筛出CRE感染者,CRE定植感染与中性粒细胞缺乏有关,临床应加以重视。     

Anterior segment changes on ultrasound biomicroscopy after intravitreal anti vascular endothelial growth factor injection

BackgroundIntravitreal injections are standard of care today and have the potential to change the anatomy of the anterior segment of the eye. This research was undertaken to evaluate the changes in anterior segment anatomy after intravitreal anti vascular endothelial growth factor (anti VEGF) injections.MethodsWe conducted a prospective interventional case series at a quaternary care center where patients undergoing intravitreal injection had pre and post injection ultrasound biomicroscopy (UBM) and intraocular pressure (IOP) measurement after intravitreal anti VEGF injection of 0.05 ml volume.Results75 eyes of 75 patients as per inclusion criteria were studied. A transient rise in IOP post intravitreal injection was found immediately after the injection. The mean rise from baseline was 17 mmHg immediately after injection and IOP returned to normal within 30 min in all cases. Angle measurement done as per established techniques revealed no significant changes in the angles and anterior chamber.ConclusionIntravitreal anti VEGF injections had no readily apparent short term concerns. IOP rise was transient and no case was found to have IOP high enough to cause concern for interruption of the optic nerve perfusion or statistically significant narrowing of the anterior chamber angle.     

RCA-CRRT无创监测游离钙方式的探索

目的 探索在RCA-CRRT治疗时,利用管路动脉端直接采血来替代频繁外周静脉穿刺取样法。方法 借助新型双腔股静脉导管代替目前在用的导管（静脉内回血孔与静脉内血吸入孔的距离合理延长,防止局部再循环）,用含枸橼酸前置换液,无钙、无碳酸氢盐、低钠。在置换液前动脉端、外周静脉同步采血,测两组的iCa浓度,比对两组iCa水平之间的差异,同时观测RCA的抗凝作用及其并发症。结果 配对t检验显示两组iCa值比较,差异无统计学意义（P=0.600）,动脉端血液iCa浓度与外周静脉血高度一致。未出现枸橼酸盐中毒症状和代谢性碱中毒,无诱发出血或出血加重,无明显凝血,血钙浓度波动在理想范围内。结论 借助新型双腔股静脉导管,可利用动脉端iCa值替代外周静脉的数据,从而实现RCA-CRRT时iCa无创监测,节省医疗资源。     

中西医结合治疗糖尿病周围血管病变临床疗效观察

[目的]观察中西医结合治疗糖尿病周围血管病变的临床疗效。[方法]将入选的糖尿病周围血管病变患者60例,随机分为治疗组30例和对照组30例,两组均常规治疗。治疗组给予复荣通脉胶囊口服及黄芪注射液静脉点滴联合西洛他唑口服,对照组单用西洛他唑片口服,观察两组临床症状、足背温度、踝肱动脉指数(ABI)的变化。[结果]治疗组在改善临床症状、足背温度、ABI等方面明显优于对照组(P0.05,P0.01),且未见明显不良反应。[结论]中西医结合治疗糖尿病周围血管病变,疗效优于单用西洛他唑组。     

Prevalence of Opportunistic Pathogens and Diversity of Microbial Communities in the Water System of a Pulmonary Hospital

Objective Our objective was to investigate the occurrence of opportunistic pathogens and characterize the bacterial community structures in the water system of a pulmonary hospital.Methods The water samples were collected from automatic and manual faucets in the consulting room, treatment room, dressing room, respiratory ward, and other non-medical rooms in three buildings of the hospital. Quantitative polymerase chain reaction was used to quantify the load of several waterborne opportunistic pathogens and related microorganisms, including Legionella spp.,Mycobacterium spp., and M. avium. Illumina sequencing targeting 16 S r RNA genes was performed to profile bacterial communities.Results The occurrence rates of Legionella spp., Mycobacterium spp., and M. avium were 100%, 100%,and 76%, respectively in all samples. Higher occurrence rates of M. avium were observed in the outpatient service building(building 1, 91.7%) and respiration department and wards(building 2, 80%)than in the office building(building 3), where no M. avium was found. M. avium were more abundant in automatic faucets(average 2.21 × 10~4 gene copies/L) than in manual faucets(average 1.03 × 10~4 gene copies/m L)(P 0.01). Proteobacteria, Actinobacteria, Bacteroidetes, Cyanobacteria, Firmicutes, and Acidobacteria were the dominant bacterial phyla. Disinfectant residuals, nitrate, and temperature were found to be the key environmental factors driving microbial community structure shifts in water systems.Conclusion This study revealed a high level of colonization of water faucets by opportunistic pathogens and provided insight into the characteristics of microbial communities in a hospital water system and approaches to reduce risks of microbial contamination.     

Controlled trial of maintenance treatment of intravenous buprenorphine dependence

Background Buprenorphine dependence is a relatively novel addiction. Aims To compare the treatment outcome in three groups over 12-weeks of treatment. Methods Two hundred and four intravenous (IV)-buprenorphine-dependent patients were randomised into three groups. Subjects received 50mg oral methadone tablet, or 5mg sublingual buprenorphine tablet, or 50mg oral naltrexone, and a weekly 30-minute clinical counselling session. Results The majority (80%) had a history of opium or heroin dependency before they were introduced to IV buprenorphine. The main source of buprenorphine for misusers was street sale (91%). The mean duration of buprenorphine dependence was 1.9 years and the mean dose per day was 3.9 ampoules (1 ampoule contains 0.3mg of buprenorphine in 1ml). Overall 59% of the patients completed the 12-week study. Retention in the 50mg methadone group was significantly better than the 5mg dose buprenorphine group (p=0.001) and the 50mg dose naltrexone group (p=0.000). Retention in the 5mg buprenorphine group was significantly better than the 50mg naltrexone dose group (p=0.000). Conclusions These results support the efficacy and safety of oral methadone and sublingual buprenorphine tablets for injection buprenorphine-dependent patients.     

盐酸氨溴索雾化吸入与静脉注射的临床药代动力学和药效学研究

目的 研究盐酸氨溴索雾化吸入与静脉两种给药途径的临床药代动力学研究,评价盐酸氨溴索经雾化吸入给药的有效性。方法 抽取12例存在黏痰不易排出症状的呼吸系统疾病的男性病例(肝肾功能正常)随机分为两组,分别采用初始为盐酸氨溴索雾化和洗脱后静脉注射治疗,以及初始为盐酸氨溴索静脉推注和洗脱后雾化治疗。通过高效液相层析法测定在痰液中及血液中的相应药代动力学参数,如药物浓度-时间曲线下面积AUC(血浆)/AUC(痰液)、达峰浓度、达峰时间,结合临床疗效考察药动学与药效学的相关性。结果 两种给药方式血浆的Tmax、Cmax、AUC基本一致,但是雾化给药方式痰液的Tmax、Cmax、AUC均高于静脉注射方式,雾化吸入治疗的临床好转速率优于静脉注射治疗。结论 盐酸氨溴索经雾化吸入给药较静脉注射给药有更好的临床治疗效果。     

Correlation of Intra Vascular Cannula Insertion Technique and Ward Practices with Local Site Infection

Background

Peripheral intravascular cannulas are indispensable in modern day medical care. These cannulas, if not inserted properly, predispose a patient to various morbidities. The present study was carried out to assess the incidence of intravascular cannula associated infections and correlate it with cannula insertion techniques and ward practices.

Methods

The study was carried out in the wards of a tertiary care hospital. The study was divided into two phases, each phase comprising of 50 patients. In phase 1, cannula insertion was carried out after normal ward cleaning practices. In phase 2, cleaning of the site was done by standard surgical cleaning procedure. The cannula samples after removal were cultured and local signs of thrombophlebitis looked for at the site of insertion. Thrombophlebitis was considered a surrogate marker of local infection in the vessel wall.

Result

The relative risk of acquiring thrombophlebitis increased by 2.18 times (applying univariate analysis) by existing methods as compared to the standard method.

Conclusion

Use of standard cleaning protocol had a significant effect on decreasing the incidence of cannula associated infections and cannula related morbidity.Key Words: Intravascular cannula, Peripheral vein thrombophlebitis, Cannula associated infections     

改良小鼠尾静脉注射器联合微量注射泵在Micro-CT碘海醇增强造影中的应用

目的探讨本研究组改良的穿刺设备及其他类型的穿刺设备在基于碘海醇的小鼠Micro-CT腹部增强造影中的效果。方法 100只昆明小鼠尾部热浴后,使用小动物麻醉机进行麻醉,并监测生命体征。应用5组设备行尾静脉穿刺:1常规1ml注射器及2.5#诺和锐针头;2常规1ml注射器及4.5#针头;3常规输液器7#针头;4常规输液器5#针头;5改良4.5#针头及输液连接装置,评价5组的优缺点并记录穿刺成功率。经Micro-CT扫描,记录图像采集率以及扫描后小鼠死亡率。结果 5组设备穿刺成功率、图像采集成功率以及小鼠死亡率均有差异(P<0.05)。综合比较各组成功率和小鼠死亡率,第5组为最优,能较好的对图像进行采集并且最大程度地减少小鼠的死亡。结论改良的尾静脉穿刺设备联合微量注射泵及小动物麻醉机的综合方式,能显著提高尾静脉穿刺和图像采集成功率以及降低小鼠死亡率,很好地应用于Micro-CT增强造影中,降低了实验动物成本。     

Morbidity,mortality, and emerging drug resistance in Device-associated infections (DAIs) in intensive care patients at a 1000-bedded tertiary care teaching hospital

BackgroundDevice-associated infections (DAIs) such as ventilator associated pneumonia (VAP), central line–associated blood stream infection (CLABSI), and catheter-related urinary tract infection (CAUTI) are principal contributors to health hazard and a major preventable threat to patient safety. Robust surveillance of DAI delineates infections, pathogens, resistograms, and facilitates antimicrobial therapy, infection-control, antimicrobial stewardship, and improvement in quality of care.MethodsThis prospective outcome surveillance study was conducted amongst 2067 ICU patients in a 1000-bedded teaching hospital. Clinical, laboratory, and environmental surveillance, as well as screening of health care professionals (HCPs) were conducted using the modified US Centers for Disease Control and Prevention–National Healthcare Safety Network definitions and methods. Morbidity, mortality, and health-care indices were analyzed and two-tier infection prevention and control was promulgated.ResultsMean occupancy was 95.34% for 2061 patients of 7381 patients/bed/ICU days. One hundred seventeen episodes of DAI occurred in 1258 patients of 12,882 device-days with mean device utilization ratio of 1.79. Mean rate of DAI was 7.40 per 1000 device days. Multiresistant Pseudomonas aeruginosa was most commonly followed by Acinetobacter. Mean all-cause mortality in ICU was 24.85%, whereas all-cause mortality after DAI was 9.79%. Methicillin-resistant Staphylococcus aureus prevalence was 38.46% amongst health-care professionals.ConclusionMean rates of VAP, CLABSI, and CAUTI were 20.69, 2.53, and 2.23 per 1000 device days comparable with Indian and global ICUs. Resolute conviction and sustained momentum in infection prevention and control is an essential step toward patient safety.     

人参及西洋参栽培土壤微生物种群遗传多样性的RAPD分析

目的 研究不同年生人参、西洋参栽培土壤中微生物种群结构差异。方法 采用RAPD技术对采集自吉林省抚松县的18份人参、西洋参根际土和根围土中的微生物种群结构进行遗传多样性分析。结果 栽培年限对根际土及根围土中的微生物种群结构有显著影响;人参和西洋参栽培土壤中的微生物种群结构也存在差异;寄主植物对土壤微生物种群结构的影响表现有根际效应。结论 人参或西洋参根系分泌物对土壤微生物的定向选择压力可能是造成土壤微生物种群遗传多样性变化的主要原因之一,人参或西洋参栽培土壤中微生物种群结构变化是导致土壤生态功能紊乱以及连作障碍形成的关键因子。     

Comparison of contamination between conventional three-way stopcock and needleless injection device: a randomized controlled trial.

BACKGROUND: Intraluminal contamination of catheter hubs has been recognized as the most frequent cause of catheter-related blood stream infections. We have investigated the efficacy of a new hub device, Planecta SC(R) (PNSC), in preventing endoluminal catheter contamination, compared to a conventional three-way stopcock. MATERIAL/METHODS: Adults patients requiring an intravascular catheter placement for at least 48 hours in intensive care units were randomly assigned to receive either the infusion device with the newly designed hub, PNSC (P group, n=89), or with a conventional three-way stopcock (C group, n=73). To evaluate intraluminal contamination, we examined the bacteria isolated in the inline bacterial filters which were attached to downstream of the injection ports. In addition to the clinical study, we conducted a bench study to investigate if use of protection caps or strict disinfection technique prevented intraluminal contamination with this new needleless connector. RESULTS: The incidence of bacterial contamination was not significantly different between the groups (P group 9/89 (10.1%) vs. C group 6/73 (8.2%), P=0.79). There was no correlation between the numbers of injections, duration of the use of the device or the microbial contamination rate. In the bench study, protection caps and disinfection technique significantly decreased microbial transfer from the hub to the fluid space. CONCLUSIONS: We concluded that the use of the new hub device did not reduce endoluminal bacterial contamination rate in comparison with that of a three way stopcock. Intraluminal bacterial contamination may be reduced by either strict disinfection technique or when a protection cap is use.     

灯盏细辛注射液对2型糖尿病并发末梢神经炎血液流变学与血脂改变的影响

[目的]观察分析灯盏细辛注射液治疗2型糖尿病并发末梢神经炎的血液流变学及血脂变化。[方法]治疗组应用灯盏细辛注射液滴注,对照组应用氢溴酸山莨菪硷注射滴注,观察临床症状、血液流变学、血脂、神经传导速度等变化。[结果]治疗组治疗后全血黏度、血球压积、纤维蛋白元明显低于治疗前,有显著性差异,P<0.01;治疗组治疗后甘油三酯(TG)、胆固醇(TC)、低密度脂蛋白(LDL-c)均有降低,有显著性差异P<0.05,高密度脂蛋白(HDL-c)有所增高,但增高不明显P>0.05;治疗组总有效率88.64%,优于对照组,有显著性差异P<0.01;治疗组腓神经运动和感觉传导速度改善明显P<0.05。[结论]灯盏细辛注射液显著改善2型糖尿病并发末梢神经炎患者的血液流变性及脂代谢,治疗2糖尿病并末梢神经炎临床疗效肯定。     

Intravascular catheter colonization and related bloodstream infection in the heart surgery intensive care unit

OBJECTIVE: To study the incidence of catheter tip colonization, catheter-related infections, their risk factors, and to compare these data with other studies. METHODS: Since 2006, we have had a through program for the insertion and care of all catheters used at cardiac surgical intensive care unit SICU, Tabriz University of Medical Sciences, Tabriz, Iran, between May 15, 2006 and September 15, 2007. We studied prospectively 183 catheters in 150 patients in relation to insertion data and catheter characteristics, catheterization time and microbiological cultures. These catheters were in place for >48 hours over a 16 months period. Risk factors were analyzed by multivariate analysis. RESULTS: The analysis included 115 central venous catheter CVCs, 65 arterial catheters ACs, and 3 pulmonary artery catheters PACs inserted in 150 patients. The median time of catheter placement was 4 days. The incidence of positive tip culture was 9.8% and 10 microorganism isolated from 18 colonized catheters. Thirteen Gram-negative bacilli, 4 Gram-positive cocci, and one yeast were isolated. From multivariant analysis, >6 days of catheterization, and insertion site were the variables associated with significantly increased risk of catheter colonization. CONCLUSION: Gram-negative bacilli and Gram-positive cocci are the most common microorganisms colonizing CVC and AC from cardiac SICU patients. Duration of catheterization and catheter insertion site were independent risk factors of catheter related infection.     

应用红花黄色素注射液辅助治疗社区获得性肺炎分析

[目的] 探讨红花黄色素注射液辅助治疗社区获得性肺炎的疗效。[方法] 回顾性分析70例胸部计算机断层扫描（CT）提示实变影且规范治疗有效的患者,根据是否应用红花黄色素注射液分为治疗组与常规组,比较两组患者治疗2周后的实变影完全吸收比率以及发热时间和静脉抗生素使用时间。[结果] 治疗组2周后实变影完全吸收比率为84.2%,常规组为53.1%,两组比较差异有统计学意义（P<0.05）;发热时间及平均静脉应用抗生素时间比较,治疗组均小于常规组（P<0.05）.[结论] 应用红花黄色素注射液辅助治疗胸部CT提示实变影患者可获益,对于胸部CT实变影吸收有促进作用。     

Correlation of intra vascular cannula insertion technique and ward practices with local site infection

Background: Peripheral intravascular cannulas are indispensable in modern day medical care. These cannulas, if not inserted properly, predispose a patient to various morbidities. The present study was carried out to assess the incidence of intravascular cannula associated infections and correlate it with cannula insertion techniques and ward practices.