成人急性腹泻抗菌药物治疗最佳适应证的探索性研究

目的：分析夏秋季急性腹泻患者的临床资料,探索抗菌药物治疗最佳适应证。方法收集2012年4月至10月,本院肠道门诊就诊的3027例患者的临床资料,分析其临床表现与实验室检查结果及治疗效果,探索抗感染治疗的最佳适应证。结果成人急性腹泻患者中,20～30岁人群发病率较高,女性较多,普通留便率较低,感染性因素所致者居多,抗菌药物治疗需要谨慎。结论急性腹泻是夏秋季发病率较高的疾病之一,与饮食习惯、食品卫生等多种因素相关,食品卫生监管部门需加大管理力度,治疗上需要加强抗菌药物使用指征的探索。     

Empiric antibiotic therapy in the treatment of postoperative abdominal abscesses. Clinical and microbiological data

Abdominal abscesses arising postoperatively constitute a serious problem, particularly in the field of oncological surgery. The aim of our study was to interpret clinical and microbiological data relating to a population of oncological patients, undergoing ultrasound-guided drainage for postoperative abdominal abscesses, so as to be able to better plan empiric antibiotic therapy. We therefore retrospectively analysed the data of 24 patients operated on for neoplastic pathologies and treated with ultrasound-guided percutaneous drainage for abdominal abscesses during the postoperative period. Microbiological and clinical data showed that abscesses located in the lower abdominal regions almost always present a polymicrobial growth, though abscesses in the upper regions are more frequent. Moreover, the antibiotic assay results prompted us to consider the use of beta-lactamines, quinolones and glycopeptides more favourably, in view of their greater efficacy against the microbes tested. Thus, the planning of empiric antibiotic therapy should be based above all on the anatomical-topographic location of the abdominal abscess and on the type of operation performed, with thorough assessment of the use of the above-mentioned antibiotics.     

In vitro elution characteristics of commercially and noncommercially prepared antibiotic PMMA beads.

The successful treatment of osteomyelitis with commercially prepared gentamicin-polymethylmethacrylate (PMMA) (Septopal) beads and surgical debridement has led to the use of this technique in the United States. However, commercially prepared gentamicin-PMMA beads are not currently available to orthopedic surgeons in the United States. Therefore, these surgeons commonly manufacture their own antibiotic-containing cement beads in the operating room at the time of surgery. There is little data that compare the antibiotic elution characteristics of such preparations to commercially prepared gentamicin-PMMA beads. This study compares the measured amount of antibiotic elution of either gentamicin or tobramycin from laboratory manufactured Zimmer, Simplex, or Palacos beads to commercially prepared gentamicin-PMMA (Septopal) beads. During a 30-day study period, commercially prepared gentamicin-PMMA beads eluted more total antibiotic and maintain higher concentrations than did antibiotic acrylic composites manufactured in the authors' laboratory.     

Antibiotic management guidelines in trauma and critical care

Many patients with severe illness or conditions like multiple trauma and severe burns are vulnerable to infection due to their depressed immune function. In addition, most patients in the intensive care unit are at increased risk of developing ventilator-associated pneumonia and catheter-related sepsis. A basic concept of antibiotic use in these guidelines is to diagnose infection and identify the pathogenic microorganism as soon as possible. We should not start inadequate empirical antimicrobial therapy in cases of undetermined infection focus or pathogen because it may increase the risk of development of antibiotic-resistant bacteria and opportunistic infections. Antibiotic use should be planned deliberately from the time of admission in patients hospitalized long time. Prophylactic antibiotic use should be restricted to a specific diagnosis or an exceptional condition. The antibiotic choice should be determined based on data on antibiotic-resistant bacteria in the ward of a trauma center.     

Antibiotic prophylaxis in dialysis patients undergoing invasive dental treatment

BACKGROUND AND AIMS: The role of antibiotic prophylaxis for invasive dental procedures in patients on dialysis therapy is unclear. We examined current clinical practice in Australia and New Zealand and compared our findings to a systematic review of the current literature. METHODS: Australian and New Zealand nephrology units were surveyed with regard to their use of antibiotic prophylaxis for dental procedures. A systematic review of the literature was performed by using an online web-based search engine (PubMed) using the key words: renal patients, dental and antibiotic prophylaxis. RESULTS: Forty-one per cent of respondents do not routinely give antibiotic prophylaxis to haemodialysis patients prior to dental surgery, but a majority (53%) would consider antibiotic prophylaxis if the patient had a synthetic arteriovenous fistula. CONCLUSIONS: The majority of clinicians follow the American Heart Association (AHA) guidelines with a single oral preoperative dose of 2 g amoxycillin or 600 mg clindamycin if patients are allergic to penicillin. From the literature and the data obtained by questionnaire, it would appear that renal patients receiving haemodialysis in Australia and New Zealand receive antibiotic prophylaxis prior to invasive dental procedures. The standard single dose of 2 g amoxycillin orally or 600 mg clindamycin orally 1 h preoperatively, as recommended by the AHA, is most frequently used. Peritoneal dialysis patients generally do not receive a prophylactic dose of antibiotics.     

Effect of chronic nitrofurantoin on the rabbit urinary bladder

Interstitial cystitis is a pathological condition whose symptoms mimic urinary tract infection and include urgency, frequency, and moderate to severe pain. Many more women than men are affected, with antibiotic therapy being the usual first treatment approach based on symptomology. Some clinicians believe that chronic antibiotic therapy may play an etiological role in interstitial cystitis; however neither clinical nor experimental data support their opinion. The implied pathogenesis of antibiotic injury is an alteration of the bladder mucosa and its protective mucin coating to allow urine-mediated damage to the bladder wall. The purpose of this study is to evaluate rabbit urinary bladder function and morphology during chronic nitrofurantoin administration. The results demonstrate that up to twelve months of chronic nitrofurantoin administration produce no changes in 1) bacterial adherence to the rabbit bladder mucosa, 2) specific antibacterial adherence activity of the bladder mucin, and 3) ultrastructure of the mucosa, submucosa, and muscularis.     

A case of Fournier's gangrene.

Authors report their case of Fournier's gangrene on the basis of their own observations and relying on data of the literature. Complete healing can be expected of immediate radical surgery and of aggressive intensive and antibiotic treatments.     

Bacteriology of the burn wound at the Bai Jerbai Wadia Hospital for children, Mumbai, India��A 13-year study, Part I-Bacteriological profile

Aim:

To study which organisms were prevalent in our burn unit and their antibiotic sensitivity pattern in brief.

Method:

Microbiological data of 1534 patients admitted to the burns unit of the Bai Jerbai Wadia Hospital for Children, Mumbai over a period of 13 years (1994-2006) was reviewed retrospectively. A total of 9333 swabs were cultured and antibiotic sensitivities to the isolated organisms determined. The age group of patients admitted to our facility ranged from one month to 15 years.

Result:

Klebsiella was the predominant organism in our set-up (33.91%), closely followed by Pseudomonas (31.84%). The antibiotic sensitivities of the isolated organisms are discussed in detail in the text.

Conclusion:

Every treatment facility has microorganisms unique to it and these change with time. It is therefore of paramount importance to have an in-depth knowledge of the resident organisms and their antibiotic sensitivity pattern so that infection-related morbidity and mortality are improved.     

SARECYCLINE AND THE NARROW-SPECTRUM TETRACYCLINE CONCEPT: Currently Available Data and Potential Clinical Relevance in Dermatology

Oral tetracyclines are commonly prescribed in dermatology, especially for acne. The most commonly used oral agents for acne treatment over the past several years are doxycycline and minocycline based on their overall efficacy and safety. Available for over five decades as immediate-release formulations, both of these agents exhibit broad-spectrum antibiotic activity and are primarily FDA-approved for treatment of a variety of cutaneous infections. In 2018, oral sarecycline was FDA-approved for the treatment of acne, which is the only disease state for which it was evaluated based on a narrower antibiotic spectrum of activity. This article reviews the overall antibiotic properties of commonly used oral tetracyclines with a focus on explaining the narrow spectrum of activity exhibited by sarecycline. Specifically, sarecycline has high activity against Cutibacterium acnes, the organism correlated with acne pathogenesis, as well as Staphylococci and Streptococci, with a low potential for emergence of resistant mutant bacteria based on in-vitro testing. The narrow-spectrum antibiotic designation of sarecycline relates to its negligible or low activity against many gram-negative and anaerobic bacteria. This article serves to review available data to date to assist clinicians in determining potential clinical relevance related to oral antibiotic use for acne.     

The current status of material used for depot delivery of drugs

The ideal local antibiotic delivery system has not been created. Antibiotic-laden bone cement has become the gold standard in the treatment of infected orthopaedic implants and there are confirmatory laboratory and clinical data that support the use of these materials. Heat-stable antibiotics elute from antibiotic-laden bone cement and do not have a notable influence on the compressive strengths of bone cement if the antibiotics are used in appropriate amounts. If the proper antibiotic is chosen, placed in the appropriately porous materials in sufficient amounts, and implanted in bone, antibiotic levels in the surrounding bone are many times greater than can be achieved by safe systemic antibiotic doses. Although the materials that have been manufactured commercially have been used for over 30 years in Europe, until recently, they have not been available in the United States. Currently, there are five antibiotic-laden bone cement composites that have been approved by the FDA and that are available for clinical use. Studies are being done to search for biodegradable implants preferable to antibiotic-laden bone cement; however, these studies and the materials are still in early stages and development. Currently, there are no FDA-approved biodegradable materials available for use to treat infected orthopaedic implants. As new materials become available and their elution characteristics are recorded, it is important for surgeons to understand how the data were collected so they can have a clear understanding of the elution characteristics of the material used and how the material acts in different environments. Even with extensive historic, clinical, and research data that prove the effectiveness of antibiotic-laden cement, the ideal drug delivery system is neither agreed on nor available.     

Antimicrobial management of mutilating hand injuries

Antimicrobial drugs are commonly used in the treatment of mutilating hand injuries. Valid arguments for the use of systemic antibiotics can be made despite the lack of data clearly documenting their efficacy in this clinical scenario. There is no information to support the use of topical agents in open hand injuries. When choosing an appropriate systemic antibiotic, the physician should consider unique characteristics of these injuries, the various environments in which they occur, and the potential infecting organisms. The duration of antibiotic use is arbitrary but should be minimized to avoid complications and the development of bacterial resistance.     

Qualitätssicherung in der Intensivmedizin

Intensive care units (ICUs) are high risk areas for emergence and spread of multiresistant bacterial pathogens. In Germany, there are no representative epidemiological data on antibiotic resistance, prophylactic or therapeutic use of antibiotics in ICUs, or on the correlation between antibiotic use and emergence of resistance. Supported by the German Ministry of Science and Education, project SARI (Surveillance on antibiotic use and bacterial resistance in ICUs) started in 02/2000 and now includes data on antibiotic use and resistance rates in 35 medical, surgical and interdisciplinary ICUs. To date (2/2000-12/2002), a total of 939 participant months, 339,461 patient days and 452,282 defined daily doses (DDD) have been covered with a mean antibiotic usage density (AD) of 1,332 DDDs/1,000 patient days and resistance data on 31,189 isolates from ICUs. The design of the project and first results of SARI are presented. The epidemiological data of SARI form a basis for improved antibiotic and infection control management in ICUs (http://www.sari-antibiotika.de).     

泌尿系疾病患者感染标本中大肠杆菌耐药性的检测

目的监测泌尿系疾病患者感染标本中大肠杆菌耐药状况，为临床用药提供参考。方法回顾性分析2003年1—12月泌尿外科住院患者感染标本中分离的32株大肠杆菌对常用抗生紊耐药性的检测结果，其中，菌株来自尿液20株、分泌物4株、脓液4株、引流液2株、血液和精液各1株。结果临床常用的22种抗生素中，耐药率〉50％者10种，占45％。四环素的敏感率为0，氨苄西林、哌拉西林和萘啶酸的敏感率〈10％。敏感率）80％者为阿米卡星、亚胺培南、头孢他啶、呋喃妥因、头孢哌酮、头孢吡肟共6种，未发现亚胺培南耐药菌株。结论泌尿系统感染致病菌中大肠杆菌的耐药性严重，其中以应用历史长、范围广的口服类抗生素的耐药性最为严重。     

Ventilator-associated pneumonia and multiresistant bacteria

Ventilator-associated pneumonia remains the most serious nosocomial infection in critically ill patients. Providing appropriate antibiotic therapy promptly is crucial for successful treatment; whereas the diagnostic approach seems to play a minor role. The empirical antibiotic therapy should be guided by the risk for infections due to multiresistant bacteria. For patients at risk a combination therapy, considering local resistance data and formerly applied antibiotic substances, is recommended. Reevaluation and deescalation of antibiotic therapy based on microbiological culture results and discontinuation of antimicrobial treatment after one week is essential for the control of broadspectrum antibiotic use and antibiotic resistance.     

Providers' beliefs and behaviors regarding antibiotic prescribing and antibiotic resistance in persons with spinal cord injury or disorder

Context

Persons with spinal cord injury or disorder (SCI/D) are at increased risk for antibiotic resistance because of recurrent infections and subsequent use of antibiotics. However, there are no studies focused on providers who care for these patients and their perceptions regarding antibiotic use and resistance.

Objective

To characterize SCI/D provider behavior and attitudes about antibiotic prescribing and resistance.

Design/methods

Anonymous internet-based, cross-sectional survey.

Participants

A total of 314 SCI/D clinicians who prescribe antibiotics (physicians, physician assistants, and nurse practitioners).

Results

A total of 118 providers responded (37.6% response rate) including 80 physicians, 20 nurse practitioners, and 18 physician assistants. The majority of respondents agreed with statements regarding the societal impact of antibiotic resistance; only 17.8% agreed that they prescribed antibiotics more than they should, but 61.0% agreed that patient demand was a major reason for prescribing unnecessary antibiotics. The most frequent problematic organisms reported were: methicillin-resistant Staphylococcus aureus (83.1%), multidrug-resistant Pseudomonas (61.0%), and Clostridium difficile (57.6%). The most frequent antibiotics selected for outpatient treatment of community-acquired pneumonia treatment, based on a clinical scenario were azithromycin (36.4%) and respiratory fluoroquinolones (22.9%).

Conclusion

These data show that the respondents are aware of and concerned with the problem of antibiotic resistance in their practice. Clinician respondents also endorsed the need to improve their own knowledge and that of their colleagues regarding appropriate antibiotic prescribing. These findings suggest that interventions should focus on provider education, particularly regarding appropriate antibiotic prescribing.     

Antibiotic treatment for surgical peritonitis.

The charts of 480 patients with secondary bacterial peritonitis were reviewed. The antibiotics used were compared with the culture and sensitivity data obtained at surgery, and the outcomes of patients were evaluated. Patients treated with a single broad-spectrum antibiotic had a better outcome than patients treated with multiple drug treatment. Inadequate empiric antibiotic treatment was associated with poorer outcome than any other type of treatment. The outcome of this inadequate treatment group could not be improved by any antibiotic response to culture and sensitivity information after operation. Those patients treated with antibiotic coverage for anticipated organisms and having no cultures taken did as well as patients having cultures taken. Surgeons typically ignore culture data after operation, and only 8.8% of patients in this study had an appropriate change in antibiotic treatment after operation. A benefit from obtaining operative cultures could not be identified.     

Prophylactic antibiotic therapy in urology

Prophylactic antibiotic therapy is used increasingly frequently in urology to prevent post-operative septic complications. The use of this method is based on experimental and clinical data which define the optimal time of administration of the antibiotic and the criteria for selection of the most effective drug. Transurethral resection of the prostate is the urological operation most frequently associated with antibiotic prophylaxis. It has been the subject of a large number of randomised studies which have confirmed the efficacy and usefulness of antibiotic prophylaxis. The other urological operations are reviewed and a critical study of the basis for antibiotic prophylaxis for each one is presented.