老年住院患者抗生素治疗继发真菌感染临床分析

随着年龄增长,糖尿病等基础疾病增加,老年患者免疫功能下降,易合并感染,不可避免地应用抗生素治疗,导致继发真菌感染,使患者病情加重,治疗复杂化,住院时间延长,预后差。现对我院干部保健科住院抗生素治疗继发真菌感染的老年患者的临床资料分析如下。     

老年呼吸系统疾病患者医院感染危险因素分析

目的：分析老年呼吸系统疾病患者医院感染危险因素。方法选取2012年2月至2014年2月我院呼吸系统疾病住院治疗的老年患者1017例,对发生医院感染的危险因素进行分析。结果本组老年患者中发生医院感染108例,发生率为10.6％;医院感染部位构成依次为呼吸道、泌尿系统、消化道、皮肤软组织及其他;感染与未感染患者在是否合并糖尿病、长期卧床、住院时间、侵入性操作、年龄方面差别具有统计学差异（P＜0.05）;Logistic回归分析结果显示,年龄、合并糖尿病、长期卧床、住院时间、侵入性操作是老年患者发生医院感染的危险因素。结论年龄、合并糖尿病、长期卧床、住院时间、侵入性操作是老年呼吸系统疾病患者发生医院感染的危险因素,应加强病房管理和基础护理、积极控制血糖、减少侵入性操作等护理措施有助于减少医院感染发生率。     

老年COPD患者合并肺部感染的危险因素与菌群分布分析及护理

目的探讨ICU老年慢性阻塞性肺疾病(COPD)患者合并肺部感染的危险因素和菌群分布,并采取预防性护理措施。方法回顾性分析我院ICU 2016年9月至2018年9月收治的68例COPD患者资料,其中11例患者合并肺部感染,分析发生肺部感染的危险因素及菌群分布。结果年龄、住院时间、合并糖尿病、机械通气、抗生素使用时间、低蛋白血症、长期使用糖皮质激素及呼吸衰竭为老年COPD患者合并肺部感染的相关因素(P 0. 05)。多因素回归分析显示,住院时间、合并糖尿病、长期使用糖皮质激素为ICU老年COPD患者合并肺部感染的独立危险因素(P 0. 05)。菌群分布:G-菌34株,依次为铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌; G~+菌29株,依次为粪肠球菌、金黄色葡萄球菌、表皮葡萄球菌;真菌6株。结论影响ICU老年COPD患者发生肺部感染因素较多,临床应在规范治疗同时遵守无菌原则、积极实施营养支持,提高患者免疫力,控制感染发生率。     

伪膜性肠炎49例临床分析

目的总结伪膜性肠炎（PMC）临床诊疗经验教训,提高诊治水平。方法回顾性分析余干县人民医院2002年1月-2009年6月49例PMC患者的临床资料。结果确诊的49例PMC经停用相关抗生素,应用甲硝唑、万古霉素抗梭状芽胞杆菌（CD）,调整肠道菌群以及积极的对症支持治疗后,痊愈46例,死亡3例,均为年老体弱、误诊时间长的重症患者。结论抗生素不合理应用是引发PMC主要原因,而慢性消耗疾病、恶性肿瘤、手术后、年老体弱等为PMC危险因素,若出现腹泻首先考虑PMC可能。早期诊疗是决定预后的关键,肠镜检查和粪连续涂片查杆/球菌比例,是诊断PMC简便可靠的重要方法。     

激素依赖型哮喘继发真菌性肺炎的诱因分析

目的:探讨长期大量不规则应用激素的支气管哮喘患者继发真菌性肺炎的诱因,总结支气管哮喘患者管理中应注意的问题。方法:分析17例激素依赖型哮喘患者的症状、体征、辅助检查、治疗及转归,并与随机选择同期住院的的17例支气管哮喘患者进行年龄、病程、激素应用时间及用量、夹杂症及合并症、抗生素应用情况的对比。结果:观察组与对照组比较,观察组患者年龄大,病程长,常合并严重并发症或其他疾病,激素应用时间长、量大、不规则,抗生素应用种类多,时间长。结论:支气管哮喘患者本身存在气道炎症,加之反复发作、病程长,常并发严重肺部病变,局部抵抗力低下,加上某些病例合并有糖尿病、肺结核、全身营养不良等,致机体抵抗力低下,在此基础上长期、反复大量应用激素,致机体抵抗力进一步低下,同时较长时间应用广谱抗生素或多种抗生素致体内菌群失调,使对抗生素不敏感的真菌增殖和侵袭机体,发生真菌感染。     

伪膜性肠炎的内镜与临床特征研究

目的：探讨PMC的临床表现及内镜特征。方法：对我院近3年来诊治的10例PMC进行回顾性分析。结果：10例病人中，9例系老年重症患者。全部患者均在使用广谱抗生素过程中出现腹泻、腹痛、血便等症状。8例接受结肠镜检查，提示为PMC，其中4例患者粪便中培养出难辨梭状芽胞杆菌。结论：PMC多系在应用抗生素后发病，老年人、重病患者及外科大手术后等患者为易感人群。结肠镜检查是诊断PMC快速而可靠的方法。对老年人及重症病患者，在使用抗生素过程中出现腹痛、腹泻、发热、白细胞升高等现象，应高度怀疑PMC。及时进行结肠镜、粪便细菌培养等检查，以早期明确诊断。     

住院患者医院感染危险因素分析及护理对策

目的:分析住院患者医院感染的危险因素,总结护理对策。方法:将2013年3月~2016年2月住院并发生医院感染的60例患者的临床资料作为观察组,按1∶1比例选择同期未发生医院感染的60例住院患者临床资料作为对照组,记录患者人口学资料、基础疾病、住院时间、感染诱因、感染时间、感染部位等,总结住院患者发生感染的危险因素,分析护理预防措施。结果:共收治3890例住院患者,发生感染60例,感染率为1.54%;观察组年龄高于对照组,其合并肺部疾病、糖尿病、高血压、低蛋白血症所占比例及留置导尿管、使用呼吸机、气管插管比例均高于对照组,同时其抗菌药物、激素类药物使用比例及手术比例高于对照组,其卧床时间均长于对照组(P0.05);多元回归分析显示,年龄、肺部疾病、合并高血压、留置导尿管、使用呼吸机、气管插管、卧床时间、预防性应用抗生素、手术均与引发住院患者医院感染相关。结论:年龄、侵入性操作、卧床时间、抗生素应用、手术、合并高血压均为住院患者发生医院感染的危险因素。     

长期卧床老年患者肺部感染的原因分析及护理

目的寻找引起长期卧床老年患者并发院内肺部感染的原因,探讨长期卧床老年患者预防肺部感染的护理干预措施。方法对56例长期卧床老年患者并发院内肺部感染的临床资料进行回顾性调查和分析,总结护理干预措施。结果长期卧床老年患者并发肺部感染率高,感染因素与年龄、卧床时间、疾病危重度、吸痰、留置胃管、气管切开、药物的使用、环境卫生等有关。结论除了正确的治疗外,通过各种护理干预措施可提高长期卧床老年患者的生存质量,降低住院患者的死亡率。     

肺结核患者肺部感染相关危险因素分析及临床护理研究

目的 探讨和分析肺结核患者肺部感染的相关危险因素及临床护理方法,以减少肺结核治疗中合并肺部感染的发生概率.方法 选取2014年10月至2015年10月入我院治疗肺结核并发肺部感染的患者128例,通过对患者临床资料进行回顾性分析、随访和主治医生询问等方式分析总结肺结核患者并发肺部感染的相关危险因素,并积极采取相应的护理措施,选取相关危险因素进行分析.结果 本组128例肺结核患者中,发生感染者21例,感染发生率为16.41%,以呼吸道感染最多12例,感染发生率为57.14%,检出革兰阴性菌7例,感染发生率为33.33%,年龄≥65岁,住院时间>15 d的患者感染发生率较高,且肺结核患者合并肺部感染与患者接受治疗前是否戒烟、吸烟指数、是否合并慢性呼吸系统疾病及糖尿病、联合使用抗生素及实施侵入性操作等关系密切.结论 年龄≥65岁,住院时间>15 d的患者感染发生率较高,且肺结核患者合并肺部感染与患者接受治疗前是否戒烟、吸烟指数、是否合并慢性呼吸系统疾病及糖尿病、联合使用抗生素及实施侵入性操作等极易导致肺结核患者发生肺部感染,对相关危险因素采取有效的预防措施,可减少院内感染的发生;对肺结核合并肺部感染的病原菌分布应该足够的重视,临床用药应根据药敏结果合理选择抗生素.     

老年肺炎75例治疗分析

目的：探讨老年肺炎的临床特点和治疗方法。方法：对75例老年肺炎患者的临床表现、胸部X线表现、治疗方法和疗效等情况进行总结分析。结果：本组75例老年肺炎患者合并慢性基础疾病多,并发症多。经治疗后,痊愈44例（58.7%）,显效19例（25.3%）,总有效率为84%。结论：老年肺炎患者临床症状、体征不典型、不明显,容易造成误诊及漏诊。掌握老年肺炎的特点,早期确诊,合理应用抗生素并重视全身综合治疗措施是有效诊治的关键。     

Gastroenteritis and antibiotic-associated diarrhea

Acute gastroenteritis is a common cause of emergency and office visits. This article reviews causes, pathogenesis, diagnosis, prevention, and treatment. The incidence of antibiotic-associated colitis is increasing worldwide as a consequence of widespread use of broad-spectrum antibiotics for various illnesses. The pathogenic organism, Clostridium difficile, produces two enterotoxins, toxin A and toxin B, that cause colonic mucosal inflammation. C. difficile infection presents with a wide range of clinical manifestations, from asymptomatic carriers to life-threatening pseudomembranous colitis.     

How to identify the cause of antibiotic-associated diarrhea

Most cases of antibiotic-associated diarrhea are due to Clostridium difficile or are of enigmatic etiology. The antibiotics most often implicated are clindamycin, ampicillin or amoxicillin, and the cephalosporins. Clinical signs of antibiotic-associated diarrhea may be limited to watery stools; however, evidence of colitis (fever, cramps, leukocytosis, fecal leukocytes) suggests C. difficile infection. The tissue culture assay for C. difficile toxin remains the gold standard for diagnosis, but the enzyme immunoassay is a practical and reasonably accurate alternative. Anatomic changes, such as pseudomembranes, can be confirmed with endoscopy, but such evaluation is not required for diagnosis of C. difficile-associated pseudomembranous colitis.     

抗生素相关性肠炎并肠梗阻一例诊治分析

目的探讨抗生素相关性肠炎(antibiotic-associated coitis,AAC)临床特点,提高诊治水平。方法回顾分析1例AAC并肠梗阻临床资料。结果患者为老年女性,因急性肠炎使用头孢美唑钠、莫西沙星等抗感染治疗20 d后,出现腹泻、腹胀、高热及肛门停止排便排气等症状。影像学检查证实低位性肠梗阻,肠镜检查证实AAC。经胃肠减压、调节肠道菌群等综合治疗痊愈。结论临床医师对于具有老年、禁食、病情危重、抗生素使用多且时间长等危险因素的患者应警惕AAC的发生。对于病情的确需用者,应根据药敏结果选用抗生素。     

Clinical spectrum of antibiotic associated enterocolitis due to methicillin resistant Staphylococcus aureus]

Historically, various types of antibiotic-associated diarrhea have been recognized. In the 1950-1960s, multi-resistant Staphylococcus aureus was implicated to be major cause of antibiotic-associated diarrhea, especially pseudomembranous enterocolitis. In the late 1970s, a new type of antibiotic-associated diarrhea, which is characterized by pseudomembranous colitis and lack of fecal multi-resistant S. aureus, usually following lincosamide administration, was recognized. Many studies have revealed the pathogenic roles of Clostridium difficile in these patients. Recent emergence of methicillin resistant S. aureus (MRSA) provokes another type of antibiotic-associated diarrhea. We have tried to isolate S. aureus and C. difficile from 150 faecal samples of patients with antibiotic-associated diarrhea. S. aureus alone was isolated from 32 (21.3%) samples. C. difficile alone was isolated from 51 (34.0%) samples, and, both were detected in 23 (15.3%) samples. 90.9% of S. aureus were MRSA. Comparing the clinical features of these cases, patients with both C. difficile and MRSA showed more serious clinical features. The patients who had undergone laparotomy were accompanied by shock and meteorism, more often than patients without laparotomy. The management of antibiotic-associated diarrhea due to MRSA is discussed.     

Lincocinamides and the incidence of antibiotic-associated colitis

Reports of antibiotic-associated colitis (AAC) and of pseudomembranous colitis in patients treated with lincocinamides and other antimicrobial agents are reviewed. It is apparent that the incidence of colitis in patients treated with antimicrobials is declining. The greatest risk for AAC is seen in patients treated with ampicillin, followed by the cephalosporins, and then the lincocinamides. Treatment of AAC with vancomycin, metronidazole, or bacitracin is usually effective.     

Analysis of the in vitro interaction between vancomycin and cholestyramine

Vancomycin and cholestyramine have been utilized both alone and in combination for the treatment of antibiotic-associated pseudomembranous colitis. Previous work for the treatment of antibiotic-associated pseudomembranous colitis. Previous work has demonstrated significant binding of vancomycin by the anion-exchange resin. The antibacterial activity of vancomycin was markedly reduced when the suspension was centrifuged and the supernatant was tested for antibacterial activity. This study confirmed these findings but demonstrated that there was no immediate loss of antibacterial activity of bound vancomycin. The degree of inactivation appeared to be dependent upon the duration of incubation of vancomycin and cholestyramine in the testing system.     

Antibiotic-associated colitis.

Patients receiving antibiotics or having just completed a course of antibiotics should be observed for the development of diarrhea. The diagnosis of antibiotic-associated colitis can be made by careful proctoscopic examination. If colitis is found, the antibiotic should be discontinued, vigorous supportive therapy should be instituted, and the patient should be observed carefully. Following these guidelines, the prognosis for antibiotic-associated colitis should be favorable.     

Pseudomembranous colitis in spinal cord injury

Pseudomembranous colitis is a well-known disease associated with antibiotic administration and caused by the Clostridium difficile toxin. Clinical presentation is usually marked by watery diarrhea, crampy abdominal pain, and fever. Since early appropriate therapy can reduce morbidity and mortality, it is important for health care professionals to be aware of this disease. Patients with spinal cord injury have a relatively high incidence of respiratory and urinary tract infections that are treated with antibiotics. Therefore, these patients theoretically have a higher risk of contracting pseudomembranous colitis. This article presents a case report of a spinal cord injured patient with this disease who has several of the common difficulties encountered in the diagnosis and treatment, such as indeterminate assays and relapses. The clinical presentation, diagnosis, and treatment of pseudomembranous colitis are described.     

18例伪膜性肠炎的内镜及临床分析

目的 探讨伪膜性肠炎（PMC）的临床表现、内镜特征及治疗。方法 对该院5年来的18例PMC进行了回顾性分析。结果 全部患者均在使用抗生素过程中出现以腹泻为主要临床表现。内镜检查轻度5例、中度7例、重度6例。所有患者停用抗生素，口服甲硝唑或万古霉素后，全部治愈。结论 在临床抗感染治疗过程中，应警惕PMC的发生。一旦出现腹泻应尽早做内镜检查、早诊断，早治疗。     

Clostridium difficile-associated disease in children with solid tumors

GOALS OF WORK: The goal of this study was to describe the incidence of Clostridium difficile-associated disease (CDAD) in children with solid tumours. PATIENTS AND METHODS: After documentation of a case of C. difficile-associated pseudomembranous colitis in a patient with neuroblastoma, the presence of C. difficile toxins A and B was prospectively tested in all children undergoing antineoplastic chemotherapy for solid tumours or lymphomas at the "G. Gaslini" Children Hospital in Genoa who presented abdominal pain. MAIN RESULTS: From January 2005 to December 2006, nine (6%) out of 141 patients treated for solid tumours had C. difficile toxin A detected in their stools in the presence of abdominal symptoms including vomit, abdominal pain and diarrhoea. The majority of patients had a normal neutrophil count at onset of gastrointestinal disease No patient developed pseudomembranous colitis, and none died. All patients received antibiotics and/or antineoplastic drugs previously associated with CDAD. CONCLUSIONS: CDAD may be a complication of children with solid tumours. Since this disease may be life threatening and cause epidemic clusters, this possibility must be kept in mind for the differential diagnosis of abdominal diseases in children with cancer, especially in absence of neutropenia.