大肠埃希氏菌感染的临床护理

大肠埃希氏菌又名大肠杆菌,主要寄生在大肠内,一般不致病,在一定条件下可引起肠道外感染,如腹膜炎、胆囊炎、尿道感染、腹泻等.该细菌属多重耐药菌,能同时对β-内酰胺类和氨基糖甙类药物产生耐药[1].2008年12月至2009年2月我科发生2例大肠埃希氏菌感染病例,通过精心治疗与护理治愈出院.现将报告如下.     

社区获得性泌尿系统感染病原菌分布及耐药性分析

目的 分析社区获得性泌尿系统感染病原菌分布及耐药性,为临床合理使用抗菌药物提供依据, 减少耐药菌株的产生。方法 收集2015年1月~2019年1月绵阳科学城医院门诊疑似泌尿系统感染患者中段尿标本分离培养的病原菌及其体外药敏试验结果,并对结果进行统计分析。结果 共分离187株泌尿系统感染细菌,以大肠埃希菌、肺炎克雷伯菌、肠球菌、葡萄球菌为主,其中革兰阴性杆菌148株,占79.14%,检出产ESBLs大肠埃希菌82株,产ESBLs肺炎克雷伯菌13株;革兰阳性球菌37株,占19.78%。药敏结果分析显示大肠埃希菌、肺炎克雷伯菌对碳青霉烯类和头霉素类抗菌药物高度敏感,其次为哌拉西林+他唑巴坦、呋喃妥因（平均耐药率＜10.00%）;粪肠球菌、葡萄球菌对万古霉素、利奈唑胺、呋喃妥因完全敏感。结论 社区泌尿系统感染病原菌以革兰阴性杆菌为主,大肠埃希菌产酶率高,耐药现象较严重;临床应根据当地病原菌构成特点及药敏试验结果合理使用抗菌药物,避免经验性用药,控制耐药性菌株的播散,提高治疗效果。     

大面积烧伤患者感染分析及护理对策

目的 总结大面积烧伤患者感染的菌种分布及护理对策.方法 统计分析2006年～2008年间烧伤病房患者感染菌种及临床资料,并制定周密有效的护理对策,促进患者早日康复.结果 我院烧伤感染的细菌种类,主要是金黄色葡萄球菌、鲍曼不动杆菌及肺炎克雷伯菌.结论 大面积烧伤的临床护理及治疗应与感染菌结合,针对不同感染菌制定有效护理对策.     

39例产妇分娩后排尿困难的护理体会

产妇分娩后产生尿潴留是产科常见并发症之一.如果处理不及时,常影响子宫收缩导致阴道出血量增多,不利于产妇乳汁的分泌,增加产后泌尿系统感染的机会[1].我科在2007年6月至2008年6月对产后排尿困难的39例产妇根据其发生的原因,制定相应的护理措施.现将护理体会报告如下.     

透析患者深静脉置管感染的预防和护理

目的 探讨透析患者深静脉置管感染的预防和护理对策.方法 我科自2009年10月～2010年11月先后对74例置管透析患者护理的回顾性分析.结果 通过对74例置管透析患者进行有效的预防和护理后,静脉置管的感染明显减少.结论 通过有效的预防和护理可控制血透病人深静脉置管的感染,延长置管时间,从而减少患者的痛苦及治疗费用.     

重型颅脑损伤患者吸痰的护理体会

探讨正确而有效的吸痰护理对减少重型颅脑损伤后长期卧床患者发生肺部感染并发症的意义.通过对我科患者2a时间的观察比较发现,正确掌握吸痰的方法、时机对控制肺部感染和减轻患者的痛苦效果非常显著,从而让患者对医护人员产生了信赖感及提高了护理工作的满意度.     

护理程序预防脑出血患者肺部感染

目的探讨护理程序在预防脑出血患者肺部感染中的作用。方法对我科自2010年12月~20013年12月住院的86例脑出血患者应用护理程序干预肺部感染的发生，对护理程序在预防肺部感染中的作用进行研究。结果应用护理程序干预脑出血患者肺部感染的发生，科学严谨和连贯的护理措施，能显著降低脑出血患者肺部感染的发生，改善预后。结论应用护理程序对脑出血患者进行积极主动的干预能减低肺部感染的发生，提高抢救成功率。     

综合ICU多重耐药菌感染的原因分析与护理干预

目的：分析综合ICU多重耐药菌感染(MDROs)的特点，并探讨综合ICU多重耐药菌感染的护理策略，为综合ICU多重耐药菌感染患者的护理提供一定指导。方法选取20例综合ICU患者作为研究对象，分析其MDROs感染类型及部位等情况，并给予相应的护理干预措施，观察干预效果。结果22例患者中，MDROs感染主要有鲍曼不动杆菌5例，铜绿假单胞菌6例，肺炎克雷伯菌5例，醋酸不动杆菌2例，耐甲氧西林金黄色葡萄球菌4例。感染部位院呼吸道12例，血液4例，泌尿道5例，伤口1例。以上患者均给予相应的护理干预措施，均康愈，未发生MDROs暴发。结论 MDROs是医院感染的主要病原菌，采取有效的护理干预措施可减少医院感染的发生。     

大内科住院患者多种耐药菌感染的病原学分布特点及耐药性分析

目的:分析大内科住院患者多种耐药菌感染的病原学分布特点及耐药性.方法:对 2022 年1 月至 2023 年7月于我院大内科住院期间发生耐药菌感染的 62 例患者进行耐药菌培养及药敏实验,分析耐药菌感染的病原学分布特点及耐药性.结果:大内科住院 62 例患者共检出 124 株耐药菌,其中革兰阴性菌共 101 株占比 81.45%,革兰阳性菌共 23 株,占比 18.55%.痰液标本中共检出 100 株耐药菌,灌洗液标本中共检出 10 株耐药菌;尿液标本中共检出 6 株耐药菌,血液及分泌物标本中共检出 8 株耐药菌.主要革兰阴性菌均对亚胺培南、美罗培南耐药;主要革兰阳性菌对苯唑西林耐药.结论:在对我院大内科住院患者进行治疗时应根据耐药菌的分布特点和耐药性合理用药,保证药物的治疗有效性.     

急性颈髓损伤治疗中平卧位高位气管切开术的应用

1998年9月～2008年12月,为防止肺部感染、窒息及便于吸痰护理,我科采用平卧位高位气管切开术治疗颈椎骨折并高位截瘫患者30例,取得满意效果。     

58例内镜逆行胰胆管造影术患者医院感染特点及护理

目的分析内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）患者医院感染的特点及护理对策。方法随机抽取2011年l至12月ERCP发生医院感染58例患者的病例,对其数据进行统计分析,同时对护理相关问题进行讨论。结果ERCP患者发生医院感染率为12．1％（58／479）,同期住普通病房患者医院感染率为4．4％（36／812）,前者住院感染率明显高于后者（P〈0．05）。无论ERCP患者还是普通病房患者,呼吸道和泌尿道感染均是医院感染最常发生的部位,ERCP医院感染主要发生在呼吸道（67．2％）,其次是泌尿道（29．3％）,其构成比与普通病房接近。ERCP患者医院感染患者58例中死亡5例（8．6％）,高于普通病房的5．6％（2／36,P〈0．05）。结论ERCP患者医院感染率明显高于普通病房,感染部位主要是呼吸道和泌尿道,预防ERCP患者医院感染是防治工作重点,有效的护理措施可以降低ERCP患者医院感染发生率。     

Spectrum of Bacterial Colonization Associated with Urothelial Cells from Patients with Chronic Lower Urinary Tract Symptoms

Chronic lower urinary tract symptoms (LUTS), such as urgency and incontinence, are common, especially among the elderly, but their etiology is often obscure. Recent studies of acute urinary tract infections implicated invasion by Escherichia coli into the cytoplasm of urothelial cells, with persistence of long-term bacterial reservoirs, but the role of infection in chronic LUTS is unknown. We conducted a large prospective study with eligible patients with LUTS and controls over a 3-year period, comparing routine urine cultures of planktonic bacteria with cultures of shed urothelial cells concentrated in centrifuged urinary sediments. This comparison revealed large numbers of bacteria undetected by routine cultures. Next, we typed the bacterial species cultured from patient and control sediments under both aerobic and anaerobic conditions, and we found that the two groups had complex but significantly distinct profiles of bacteria associated with their shed bladder epithelial cells. Strikingly, E. coli, the organism most responsible for acute urinary tract infections, was not the only or even the main offending pathogen in this more-chronic condition. Antibiotic protection assays with shed patient cells and in vitro infection studies using patient-derived strains in cell culture suggested that LUTS-associated bacteria are within or extremely closely associated with shed epithelial cells, which explains how routine cultures might fail to detect them. These data have strong implications for the need to rethink our common diagnoses and treatments of chronic urinary tract symptoms.     

Do clinical microbiology laboratories report complete bacteriology in urine from patients with long-term urinary catheters?

Bacteriuria associated with long-term urinary catheters (those in place for greater than or equal to 30 days) appears to be the most common nosocomial infection in U.S. medical care facilities. This bacteriuria is polymicrobial and dynamic and accompanied by fevers, catheter obstructions, bacteremias, and deaths. We compared the reporting by our research laboratory of bacteria present in urine from long-term-catheterized nursing home patients with that by two commercial laboratories. The commercial laboratories isolated significantly fewer bacterial species at 10(5) CFU/ml of urine specimen. Organisms well recognized as causes of urinary tract infections in noncatheterized patients (Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae) were isolated in comparable frequencies by both the research and commercial laboratories. However, other organisms, including uncommon uropathogens like Providencia stuartii and Morganella morganii, which were actually among the most frequent bacteriuric species in these long-term-catheterized patients, were isolated significantly less frequently by the commercial laboratories. Reasons for the discrepancies are unclear but may involve use of different techniques. More complete reporting may lead to better understanding of the polymicrobial bacteriuria of long-term catheters and its associated complications. This, in turn, may result in improved patient care and infection control in nursing homes.     

外科ICU医院感染临床特点和护理措施

目的分析ICU住院患者医院感染临床特点,为临床护理提供参考。方法将2011年1月至2013年6月我院外科ICU发生的116例医院感染病例作为观察组,外科住院患者发生的72例医院感染病例为对照组,采取回顾性调查方法分析医院感染危险因素,并对护理相关问题进行讨论。结果 ICU患者发生医院感染率为8.44%,同期普通病房患者医院感染率为4.43%,ICU医院感染发生率明显高于普通病房(P0.05)。无论ICU患者还是普通病房患者,呼吸道和泌尿道都是医院感染常发生部位。ICU医院感染病死率9.48%,高于外科普通病房的4.17%,P0.05。ICU和普通病房医院感染与患者年龄、住院时间、接受损伤性操作、抗菌药物或免疫抑制剂使用和意识障碍有明显关系(P0.01)。结论 ICU医院感染率明显高于普通病房,感染部位主要是呼吸道和泌尿道;医院感染与多种因素有关,关键是要建立有效的防治机制和护理措施。     

Molecular epidemiology of catheter-associated bacteriuria in nursing home patients.

Urine samples from 19 nursing home patients with long-term urinary catheters were cultured every 3 months for 18 months. Providencia stuartii, present in 74% of the elderly and in 59% of urine specimens, was the most frequently isolated bacteria. The persistence of P. stuartii was significantly higher among females than among males. In order to study the epidemiology of bacteriuria in this nursing home, bacteria were characterized by biochemical tests, antibiotic susceptibility pattern, and restriction fragment length polymorphism (RFLP) analysis. The antibiotic susceptibility pattern indicated that each patient had two to three different strains of P. stuartii during the 18 months of follow-up. In contrast, the RFLP analysis revealed that a specific strain had persisted in the urinary tract of the patient during the entire follow-up period. According to the biochemical profile, 74% of the patients had the same bacteria in urine cultures, pointing to a common source of transmission. RFLP analysis, however, demonstrated different patterns of RFLP, suggesting concomitant multiple sources of infection.     

针对性护理配合在膀胱全切原位回肠代膀胱术中的应用效果

目的 观察护理配合在经腹腔镜下膀胱全切原位回肠代膀胱术中的应用效果。方法 回顾性分析2018年3月~2019年3月在我院行膀胱全切除原位回肠代膀胱术实施针对性手术配合的48例膀胱癌患者。观察患者手术时间、术中出血量、肠功能恢复时间、新膀胱功能、并发症发生情况及护理满意度。结果 48例患者手术时间5~9 h,平均手术时间（5.98±0.45）h,术中出血量200~1000 ml,平均出血量（398.50±20.64）ml。术后2~3 d胃肠功能恢复,术后3周回肠代膀胱造影、静脉肾盂造影显示,双肾良好,无输尿管反流、梗阻,充盈良好。所有患者术后均未发生尿失禁、排尿困难等并发症。护理满意度调查,满意28例,一般18例,不满意2例,满意度为95.83%。结论 经腹腔镜下膀胱全切除原位代膀胱术患者采用针对性护理配合,可促进术后恢复,预防并发症发生,且术后膀胱功能良好,值得临床推广应用。     

集束化护理对预防全麻苏醒期尿管相关膀胱刺激症的影响

目的 探讨集束化护理对预防全麻苏醒期患者尿管相关膀胱刺激症的影响。方法 选取我院2016年2月~2017年3月男性全麻手术患者共120例,随机分为两组,各60例,对照组予麻醉诱导后常规留置尿管,干预组在此基础上行集束化护理,两组患者术后进入麻醉恢复室评估患者CRBD的程度及血压、心率的变化,术后第1 d随访时评估护理满意度。结果 对照组患者苏醒期发生尿管相关膀胱刺激症的程度明显高于干预组（P＜0.05）,在拔管后患者的血压和心率均得到了很好的控制,术后第1 d随访时评估患者满意度也有所提高。结论 对全麻后留置尿管的患者采取集束化护理可以减少CRBD的发生率,促进术后恢复,同时也提高了患者的满意度。     

留置尿管致尿道狭窄原因分析及护理防范

目的:探讨临床中工作中留置尿管对尿道的影响及防范措施。方法:回顾性分析24例病人由于留置尿管后造成尿道狭窄的原因,根据其发生原因了解相应的防范措施,以减少临床工作中留置尿管的并发症的发生。结果:24例尿道狭窄病人中尿道损伤14例,尿道感染8例,导尿管选择和使用不当2例。结论:留置尿管过程中如操作不当可能会导致尿道狭窄,其中尿道损伤发生率最高,是导致尿道狭窄的主要原因,其次为尿道感染,临床工作中应尽可能减少上述原因的发生,防止尿道狭窄的发生。     

Risk factors and bacterial profiles of urinary tract infections in patients with systemic lupus erythematosus

Bacteremic urinary tract infection (UTI) is known to carry a high mortality rate, especially in immunocompromised patients. Patients with systemic lupus erythematosus (SLE) have an immunocompromised status, and thus an increased risk of infection. To evaluate the risk factors for UTI in SLE patients and to identify factors associated with bacteremic UTI, we reviewed SLE patients hospitalized for UTI over a 20-year study period. Based on our results we conclude that lupus nephritis is a risk factor for UTI in SLE patients. Clinical symptoms do not significantly distinguish bacteremic from non-bacteremic UTI in hospitalized SLE patients. Although Escherichia coli remain the most common bacteria in UTI, Salmonella spp. might need particular attention because of their high likelihood for causing bacteremia.     

Molecular epidemiology of endemic Clostridium difficile infection and the significance of subtypes of the United Kingdom epidemic strain (PCR ribotype 1)

We previously identified two subtypes of the epidemic strain Clostridium difficile PCR ribotype 1, one clindamycin-sensitive strain (arbitrarily primed PCR [AP-PCR] type Ia) and a closely related clindamycin-resistant strain (AP-PCR type Ib) in our institution. We have now carried out prospective epidemiological surveillance for 4 years, immediately following the relocation of two acute medicine wards for elderly patients (wards A and B), to determine the clinical epidemiology of subtypes of the epidemic C. difficile PCR ribotype 1 group. To maximize the chance of strain discrimination, we used three DNA fingerprinting methods, AP-PCR, ribospacer PCR (RS-PCR), and pulsed-field gel electrophoresis (PFGE), to analyze C. difficile isolates recovered from symptomatic patients and from repeated environmental samplings. On ward B the incidence of C. difficile infection correlated significantly with the prevalence of environmental C. difficile both in ward areas closely associated with patients and health care personnel (r = 0.53; P < 0.05) and in high-reach sites (r = 0.85; P < 0.05). No such relationships were found on ward A. Seventeen distinct C. difficile genotypes were identified, 17 by AP-PCR, 12 by PFGE, and 11 by RS-PCR, but only 4 of 17 genotypes caused patient infection. Isolates recovered from the hospital ward environment were much more diverse (14 genotypes). AP-PCR type Ia represented >90% of the C. difficile isolates. In addition to this genotype, only two others were isolated from both patient feces and environmental surfaces. AP-PCR type Ib (clindamycin-resistant PCR ribotype 1 clone) was not associated with any cases of C. difficile infection and was isolated from the environment on only two occasions, after having been implicated in a cluster of six C. difficile infections 5 months before this study. The disappearance of this strain implies that differences in virulence and/or selective pressures may exist for this strain and the closely related, widespread C. difficile AP-PCR type Ia strain. Our findings emphasize the need to understand the epidemiology and virulence of clinically significant strains to determine successful control measures for C. difficile infections.