高压氧辅助治疗对儿童急性耐甲氧西林金黄色葡萄球菌性骨髓炎疗效的影响

目的探讨高压氧辅助治疗儿童急性耐甲氧西林金黄色葡萄球菌性骨髓炎的疗效及对炎症指标水平的影响。方法选择2016年1月至2019年12月郑州大学第一附属医院小儿外科收治的符合纳入标准的急性耐甲氧西林金黄色葡萄球菌性骨髓炎患儿56例,按治疗方法分为观察组和对照组,每组28例。对照组采用常规负压封闭引流术联合静脉抗生素治疗,观察组在对照组的基础上辅以高压氧治疗。比较两组治疗后临床疗效及炎症指标[C反应蛋白(CRP)、白细胞计数(WBC)、红细胞沉降率(ESR)]水平的变化。组间比较计数资料采用χ²检验,计量资料采用两独立样本t检验。结果观察组患儿总治愈率高于对照组(89.29%比64.28%,χ²=4.909,P<0.05),差异有统计学意义;观察组治疗1周、治疗2周、治疗3周后的CRP水平低于对照组[(46.55±12.16)mg/L比(54.39±15.62)mg/L,(12.89±5.53)mg/L比(16.17±4.86)mg/L,(3.04±2.12)mg/L比(4.32±2.28)mg/L,t=2.096、2.358、2.176,P值均<0.05],差异有统计学意义;观察组治疗2周、治疗3周后的WBC水平低于对照组[(7.21±3.51)×10⁹/L比(9.93±2.19)×10⁹/L、(6.05±1.67)×10⁹/L比(7.92±1.44)×10⁹/L,(t=3.479、4.487,P值均<0.01),差异有统计学意义;观察组治疗3周的ESR水平低于对照组[(18.32±6.15)mm/h比(21.86±5.78)mm/h,(t=2.219,P<0.05),差异有统计学意义。结论高压氧辅助负压封闭引流术能明显提高急性耐甲氧西林金黄色葡萄球菌性骨髓炎患儿的治愈率,并显著降低炎症指标的水平。     

我院耐甲氧西林金黄色葡萄球菌的耐药性及肠毒素分析

收集了我院1994年10月至1995年4月金黄色葡萄球菌100株,应用药敏试验法筛选 MR-SA,并检测其对12种抗生素的耐药性,计算 MIC_(50)和 MIC_(90)。应用乳胶凝集试验法,测定其肠毒素产生率。结果我院总的 MRSA 阳性率为60%,烧伤科的 MRSA 阳性率为67.4%,内科62.5%,骨科44.5%。MRSA 耐药性低于50%的有万古霉素(3.3%)、去甲万古霉素(5%)、丁胺卡那霉素(21.5%)3种。MR-SA 产肠毒素率为100%,其中产两种以上者占35%,而 MSSA 产肠毒素率仅为20%,其中产两种以上者占5%。     

我院耐甲氧西林金黄色葡萄球菌的耐药性及肠毒素分析

收集了我院１９９４年１０月至１９９５年４月金黄色葡萄球菌１００株，应用药敏试验法筛选ＭＲ－ＳＡ，并检测其对１２种抗生素的耐药性，计算ＭＩＣ５０和ＭＩＣ９０。应用乳胶凝集试验法，测定其肠毒素产生率。结果我院总的ＭＲＳＡ阳性率为６０％，烧伤科的ＭＲＳＡ阳性率为６７．４％，内科６２．５％，骨科４４．５％。ＭＲＳＡ耐药性低于５０％的有万古霉素（３．３％）、去甲万古霉素（５％）、丁胺卡那霉素（２１．５％）３种。ＭＲ－ＳＡ产肠毒素率为１００％，其中产两种以上者占３５％，而ＭＳＳＡ产肠毒素率仅为２０％，其中产两种以上者占５％。     

我院耐甲氧西林金黄色葡萄球菌的耐药性及肠毒素分析

收集了我院１９９４年１０月至１９９５年４月金黄色葡萄球菌１００株，应用药敏试验筛选ＭＲＳＡ，并检测其对１２种抗生素的耐药性，计算ＭＩＣ５０和ＭＩＣ９０，应用乳胶凝集试验法，测定其肠毒素产生率。结果我院总的ＭＲＳＡ阳性率为６０％，烧伤科的ＭＲＳＡ的阳性率为６７．４％，内科６２．５％，骨科４４．５％，ＭＲＳＡ耐药性低于５０％的有万古霉素（３．３％）去甲万古霉素（５％），丁胺卡那霉素（２１．５％）３种，     

烧伤创面耐甲氧西林金黄色葡萄球菌感染的动态观察

临床资料 :收集本科 1995～ 1999年 ,从住院患者创面分泌物培养的金黄色葡萄球菌 (ＭＳＳＡ) 16 8株。选择革兰阳性、葡萄状排列、触酶阳性、氧化酶阴性、还原硝酸盐、发酵葡萄糖产酸、血浆凝固酶阳性者确定为金黄色葡萄球菌。采用琼脂筛选法 ,在ＭＨ琼指中补足ＮａＣＬ到 6 0ｇ/Ｌ ,苯唑西林 0 0 0 4μｇ/Ｌ后倒板 ,将菌液 (浓度为 10 7ＣＦＵ/Ｌ)接种在培养基上 ,30℃孵育 4 8ｈ后观察结果。只要平板上有菌落生长 ,即视为耐甲氧西林金黄色葡萄球菌 (ＭＲＳＡ)。方法 :(1)应用碘纸条法定性 β内酰胺酶 ;(2 )应用Ｋ Ｂ法测定抗生素耐药性 ;…     

糖尿病足患者合并耐甲氧西林金黄色葡萄球菌感染的临床研究

目的探讨糖尿病足患者合并耐甲氧西林金黄色葡萄球菌感染的临床特征。 方法选取2016年9月至2019年9月恩施土家族苗族自治州中心医院收治的128例糖尿病足合并金黄色葡萄球菌感染者为研究对象，对患者溃疡部位细菌进行分离、培养和鉴定，并进行药敏试验，分析病原菌的分布特征及金黄色葡萄球菌耐药情况以及相关影响因素。128例患者所分离株金黄色葡萄球菌对甲氧西林敏感者为敏感菌组（33例），对甲氧西林耐药者为耐药菌组（95例）。 结果共分离出128株菌株，其中革兰阳性菌79株（61.72%）、革兰阴性菌45株（35.16%）和真菌4株（3.12%）；敏感菌组和耐药菌组患者中分别分离病原菌33株和95株；敏感菌组患者分离菌株对利福平、氧氟沙星、左氧氟沙星、苯唑西林、青霉素G、头孢呋辛、阿奇霉素、头孢噻肟、呋喃妥因菌株耐药率高于耐药组，差异均有统计学意义（χ² = 7.856、12.309、19.998、15.682、4.072、30.258、6.089、22.233、5.264，P = 0.004、0.001、< 0.001、< 0.001、0.041、< 0.001、0.007、< 0.001和0.018）；多因素Logistic回归分析显示，低蛋白血症、溃疡面积、溃疡病程、入院前6个月使用抗菌药以及高血压均为糖尿病足患者合并耐甲氧西林金黄色葡萄球菌感染的影响因素，差异均有统计学意义（P = 0.001、0.010、0.023、0.012和0.029）。 结论金黄色葡萄球菌是糖尿病足疾病主要感染病原菌，低蛋白血症、溃疡面积、溃疡病程、入院前6个月使用抗菌药、高血压均为糖尿病足患者合并耐甲氧西林金黄色葡萄球菌感染的危险因素。     

重症医学科耐甲氧西林金黄色葡萄球菌肺部感染老年患者的药物治疗

目的比较3种抗耐甲氧西林金黄色葡萄球菌(MRSA)药物治疗重症医学科(ICU)MRSA肺部感染老年患者的疗效及对细菌清除率和不良反应的影响。 方法选取2015年3月至2017年5月青岛市中心医院ICU收治的114例老年MRSA肺部感染者作为研究对象,根据患者治疗药物不同分为万古霉素组、替考拉宁组和利奈唑胺组,每组各38例患者。比较各组患者的疗效、细菌清除率、治疗前后血清C-反应蛋白(CRP)、降钙素原(PCT)、白细胞计数、中性粒细胞比值变化以及不良反应发生率。 结果利奈唑胺组患者治疗总有效率显著优于万古霉素组和替考拉宁组(χ²= 7.018、P = 0.008,χ²= 4.070、P = 0.044)。利奈唑胺组患者细菌清除率显著高于万古霉素组和替考拉宁组(χ²= 5.182、P = 0.023,χ²= 4.211、P = 0.040)。各组患者治疗后CRP、PCT、白细胞计数、中性粒细胞比值均显著低于治疗前,且利奈唑胺组患者治疗后CRP、PCT、白细胞计数、中性粒细胞比值低于万古霉素组和替考拉宁组(P均< 0.05)。各组患者治疗后均发生恶心、呕吐、肝功能异常、肾毒性、血肌酐水平异常、血小板下降、贫血不良反应,各组不良反应总发生率差异无统计学意义(χ²= 0.647、P = 0.723)。 结论ICU MRSA肺部感染老年患者治疗药物中,利奈唑胺临床疗效、细菌清除率均优于万古霉素和替考拉宁,且临床安全性相当,为治疗MRSA肺部感染较为理想的选择。     

医院耐甲氧西林金黄色葡萄球菌流行的原因分析及对策

近年来医院感染 (下称院感 )问题日益突出 ,特别是耐甲氧西林金黄色葡萄球菌 (MRSA)是引起全球性医院感染的重要致病菌之一。 2 0 0 1年 2～ 6月 ,我院综合性 ICU发生院感 1 1例。对此 ,我们对其原因进行分析 ,提出护理对策。1　临床资料1 1例中 ,男 1 0例、女 1例 ,年龄 (5 2 .1± 6 .3 )岁。中重度颅脑损伤 7例 (其中 5例合并其他部位外伤 ) ,脑出血 2例 ,重度中毒心肺复苏后 1例 ,直肠癌1例。1 1例中痰培养 MRSA阳性 1 0例、口腔伤口分泌物培养阳性 1例。显示 MRSA的流行主要在病人的痰标本中 ,与文献 [1 ]报道相符。1 1例 MRSA…     

MRSA鼻腔筛查可排除MRSA手术部位感染：一项诊断实验meta分析

目的评价耐甲氧西林金黄色葡萄球菌（MRSA）鼻腔筛查对于MRSA手术部位感染的诊断价值。 方法检索PubMed、EMBASE、中国知网和万方数据库中,有关MRSA鼻腔筛查与MRSA手术部位感染的文献。纳入文献时间从数据库建立到2019年3月。使用诊断实验质量评价表（QUADAS-2）进行质量评价。采用STATA软件进行分析,结局指标为灵敏度、特异度、阳性似然比、阴性似然比、阳性预测值和阴性预测值。 结果最终纳入10篇文献,共39 831名患者。MRSA鼻腔筛查对于诊断及预测MRSA手术部位感染的灵敏度为37%（95% CI：27%,48%）、特异度为95%（95% CI：94%,96%）。阳性似然比为7.98（95% CI：6.37,10.0）,阴性似然比为0.66（95% CI：0.57,0.77）,阳性预测值为9.6%,阴性预测值为99.3%,DOR为12.0（95% CI：8.62,16.8）。异质性来源于MRSA筛查时使用的鉴定方法（PCR法/细菌培养法）。Deeks漏斗图显示,纳入研究不存在发表偏倚。 结论MRSA鼻腔筛查对于筛查MRSA手术部位感染具有较高的特异度和阴性预测值,可用于排除MRSA肺炎,患者鼻腔未定植MRSA,则发展为MRSA手术部位感染的可能性较小。所以,MRSA鼻腔筛查可作为规范抗菌药物经验性用药的一种有效管理工具,尤其可用于减少无鼻腔定植者的经验性治疗。     

Surgical management of chronic osteomyelitis: Organisms,recurrence and treatment outcome

PurposeThe study aimed to identify the risk factors of recurrence in chronic osteomyelitis (COM) and to document the microbiological patterns pre- and intra-operatively and at recurrence, if any.MethodsWe performed retrospective review on COM patients treated with surgical debridement and a 6-week course of antibiotics. The patients with symptoms of osteomyelitis for at least 6 weeks, present or past episodes of discharging sinus, documentation of bone sequestration in operative notes or preoperative images were included in the study. Patients with symptoms of osteomyelitis < 6 weeks, lack of history of discharging sinus or lack of evidence of sequestration in preoperative images or intraoperative notes were excluded. Logistic regression models were used to assess the impact of risk factors of recurrence. Cohen-Kappa scores were derived to see the concordance between pre-operative and intra-operative isolates and at recurrence.ResultsTotally, 147 COM patients (115 males and 32 females, mean age (33 ± 19) years) were included in this study. Recurrence was noted in 28 patients (19.0%). Polymicrobial growth and extended spectrum beta-lactamase producing Enterobacteriaceae increased the chance of recurrence. Cierny-Mader stage-1, hematogenous aetiology and negative intraoperative culture reduced the chance of recurrence. Concordance between pre-operative and intra-operative cultures was 59.85% (Kappa score 0.526, p < 0.001) and between index surgery and at recurrence was 23.81% (Kappa score 0.155, p < 0.001). Lack of knowledge of causative organism preoperatively did not affect outcome. At mean follow-up (42 ± 15) months, all patients were apparently infection free for at least 1 year.ConclusionPolymicrobial growth and multi-drug resistant organisms increase the risk of recurrence in COM. Patients’ age, gender, diabetes mellitus, previous failed treatment, duration of symptoms, haemoglobin, white cell count, C-reactive protein and erythrocyte sedimentation rate at presentation did not have any impact on the recurrence of infection. Pre-operative isolation of organism is of questionable value. Recurrences of infections do occur and are more of re-infections than relapses. Diligent isolation of organism must be attempted even in re-debridements. Even patients with recurrences do well with appropriate debridement and antibiotic therapy.     

中西医结合治疗创伤性骨髓炎合并骨缺损

目的 研究应用中西医结合方法治疗创伤性骨髓炎合并骨缺损的疗效。方法 对１３２例创伤性骨髓炎合并骨缺损的患者根据创面细菌培养和药敏试验结果,分别选用有效中药于自控中药湿热熬治疗机上恒温冲洗创面２～４周,配合敏感抗菌素的应用,行病灶彻底清除和复合组织移植Ⅰ期治疗。结果 １３２例中２例手术失败,１２６例获得１～６年随访,１２１例治愈,２例骨髓炎复发,３例骨不愈合,结论 在中西医结合控制感染基础上,应用显     

Implementing a patient education intervention about Methicillin-resistant Staphylococcus aureus prevention and effect on knowledge and behavior in veterans with spinal cord injuries and disorders: A pilot randomized controlled trial

Objectives

To assess the feasibility and effect of a nurse-administered patient educational intervention about Methicillin-resistant Staphylococcus aureus (MRSA) prevention on knowledge and behavior of Veterans with spinal cord injuries and disorders (SCI/D).

Design

Blinded, block-randomized controlled pilot trial.

Setting

Two Department of Veterans Affairs (VA) SCI Centers.

Participants

Veterans were recruited March–September 2010 through referral by a healthcare provider from inpatient, outpatient, and residential care settings.

Intervention

Thirty participants were randomized to the nurse-administered intervention and 31 to the usual care group. The intervention included a brochure and tools to assist nurses in conducting the education.

Outcome measures

Pre- and post-intervention measurement of knowledge and behaviors related to MRSA and prevention strategies and feasibility measures related to implementation.

Results

Participants were primarily male (95.1%), white (63.9%), with tetraplegia (63.9%) and mean age and duration of injury of 64.3 and 20.5 years, respectively. The intervention groups mean knowledge score significantly increased between pre- and post-test (mean change score = 1.70, 95% confidence interval, CI 0.25–3.15) while the usual care groups score did not significantly change (mean change score = 1.45, 95% CI −0.08–2.98). However, the mean knowledge change between intervention and usual care groups was not significantly different (P = 0.81). Overall behavior scores did not significantly differ between treatment groups; however, the intervention group was more likely to report intentions to clean hands (90.0% vs. 64.5%, P = 0.03) and asking providers about MRSA status (46.7% vs. 16.1%, P = 0.01). Nurse educators reported that the quality of the intervention was high and could be implemented in clinical care.

Conclusions

A targeted educational strategy is feasible to implement in SCI/D clinical practices and may improve some participants’ knowledge about MRSA and increase intentions to improve hand hygiene and engagement with providers about their MRSA status.     

Implementing a patient education intervention about Methicillin-resistant Staphylococcus aureus prevention and effect on knowledge and behavior in veterans with spinal cord injuries and disorders: A pilot randomized controlled trial

Abstract

Objectives

To assess the feasibility and effect of a nurse-administered patient educational intervention about Methicillin-resistant Staphylococcus aureus (MRSA) prevention on knowledge and behavior of Veterans with spinal cord injuries and disorders (SCI/D).

Design

Blinded, block-randomized controlled pilot trial.

Setting

Two Department of Veterans Affairs (VA) SCI Centers.

Participants

Veterans were recruited March–September 2010 through referral by a healthcare provider from inpatient, outpatient, and residential care settings.

Intervention

Thirty participants were randomized to the nurse-administered intervention and 31 to the usual care group. The intervention included a brochure and tools to assist nurses in conducting the education.

Outcome measures

Pre- and post-intervention measurement of knowledge and behaviors related to MRSA and prevention strategies and feasibility measures related to implementation.

Results

Participants were primarily male (95.1%), white (63.9%), with tetraplegia (63.9%) and mean age and duration of injury of 64.3 and 20.5 years, respectively. The intervention groups mean knowledge score significantly increased between pre- and post-test (mean change score = 1.70, 95% confidence interval, CI 0.25–3.15) while the usual care groups score did not significantly change (mean change score = 1.45, 95% CI ?0.08–2.98). However, the mean knowledge change between intervention and usual care groups was not significantly different (P = 0.81). Overall behavior scores did not significantly differ between treatment groups; however, the intervention group was more likely to report intentions to clean hands (90.0% vs. 64.5%, P = 0.03) and asking providers about MRSA status (46.7% vs. 16.1%, P = 0.01). Nurse educators reported that the quality of the intervention was high and could be implemented in clinical care.

Conclusions

A targeted educational strategy is feasible to implement in SCI/D clinical practices and may improve some participants’ knowledge about MRSA and increase intentions to improve hand hygiene and engagement with providers about their MRSA status.     

显微外科方法治疗四肢严重毁损伤

目的 探讨显微外科方法治疗四肢严重的毁损伤的临床意义。方法 应用皮瓣、肌皮瓣、游离移植或转位修复、显微外科吻合血管方法以及骨折内外固定等方法一期修复面临截肢四肢毁损伤．结果 １２５例成功１２１例,死亡１例,２例完全截肢,１例部分截肢。随访０．５～９年,肢体功能恢复、效果优良。结论 显微外科方法一期修复四肢严重毁损面临截肢肢体,是保全肢体、恢复功能的有效方法。     

新鲜骨折与血糖的关系

创伤性骨折引起血糖尿糖急骤升高,称创伤性糖尿病或应激性糖尿病.其防治尚未引起临床骨科医师普遍的重视,现将我院近期100例新鲜骨折与血糖的关系,报告如下. 1 对象与方法 1.1 对象来源于我院病案室每日骨科出院病历.随机选择2周内新鲜骨折、X线片证实骨折,具有入院后空腹血糖值患者,作为骨折组.随机选择本地区健康体检表,具有空腹血糖值者,作为对照组.     

慢性骨髓炎治疗的进展

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