疖病与低铁血症

复发性葡萄球菌疖病患者痛苦并具高度传染性。本文复发性葡萄球菌疖病的定义是由金黄色葡萄球菌引起的疖肿6个或以上,并持续3个月以上者。作者收集1978～1987年患者分为三组:①组复发性葡萄球菌疖病16例,女性9例,男性7例;年龄11~41岁,平均22岁。②组单一疖肿而无复发性疖病史者8例,男女各     

小儿呼吸系统疾病治疗进展

一、急性呼吸道感染(ARI) 近年来对ARI病原防治的进展主要有: 1.疫苗接种:对腺病毒肺炎,现正生产一种在人类细胞(WI—38细胞)中培育的口服灭活疫苗。对合胞病毒肺炎,目前已研制出只引起初发感染而不产生严重疾病的基因减毒活疫苗。流感疫苗已应用于临床,但由于病毒株有突变性,故尚难阻止流感大流行。肺炎链球菌的多价菌苗和流感杆菌菌苗均处于临床试用阶段。     

金黄色葡萄球菌分离株在住院患者中的临床分布及耐药性分析

目的 探讨某医院住院患者感染金黄色葡萄球菌分离株的临床分布特征及耐药状况,为临床抗感染治疗提供科学依据。方法 选取2021年9月—2023年3月宣城市中心医院收治的金黄色葡萄球菌感染患者作为研究对象,通过聚合酶链反应（polymerase chain reaction,PCR）检测金黄色葡萄球菌的耐药基因mec A和杀白细胞素（Panton-Valentine leukocidin,PVL）基因,采用SPSS 20.0和WHONET 5.6软件分析金黄色葡萄球菌感染的临床分布特征及耐药状况。结果 共有133例金黄色葡萄球菌感染患者纳入分析,单个科室中占比前两位的是呼吸与危重症医学科（21.8%,29/133）和重症医学科（18.8%,25/133）。感染主要类型为皮肤疖痈、褥疮类感染,占47.4%(63/133);上、下呼吸道感染分别占23.3%(31/133)、13.5%(18/133)。药敏结果显示金黄色葡萄球菌对万古霉素、利奈唑胺、替加环素、呋喃妥因及利福平敏感率为100.0%,对青霉素的耐药率最高（88.0%）,其后为红霉素、克林霉素,耐药率分别为34.6%、30.1%。耐甲氧...     

结缔组织病并发肺部感染9例临床分析

目的探讨结缔组织病并发肺部感染的临床特点及治疗。方法对9例住院的结缔组织病合并肺部感染痰培养阳性的患者临床资料进行分析。结果结缔组织病合并肺部感染的临床症状并不明显;并发肺部感染的患者大多有贫血、血清白蛋白降低,肺间质纤维化;痰培养均为革兰阴性杆菌和真菌感染,提示结缔组织病患者并发肺部感染多为革兰阴性杆菌和真菌感染。结论结缔组织病合并肺部感染的临床症状并不明显,只要有咳嗽、咳痰的症状,就是做痰培养的指征。贫血、血清白蛋白降低、肺间质纤维化是结缔组织病患者并发肺部感染的易患因素。结缔组织病患者并发肺部感染多为革兰阴性杆菌和真菌感染,应及时给以相应治疗。     

结核病合并葡萄球菌感染

各种疾病长期以多种抗菌素治疗时,免疫机制障碍是发生葡萄球菌感染的重要因素。使用特效抗菌素和化学药物治疗结核病,效果显著,能够延长患者的生命,但同时也能促进条件致病性微生物,如葡萄球菌的致病性,导致非特异感染的发生。某院768名各种结核病患者中,合并葡萄球菌类感染者184名,占23.9%。从痰、胸腔渗液、脓腔、瘘管等处都检出了大量葡萄球菌,也常常检出链球菌和其他细菌。例1.女,27岁。患者于入院数天前用手挤压脸上一小疖后出现衰弱、低热、右颈部淋巴结及右腋窝淋     

职业性布鲁氏菌病流行病学及临床特征分析

目的探讨职业性布鲁氏菌病流行病学特点,并分析其临床特征,为临床预防及治疗布鲁氏菌病提供科学合理的理论依据。方法采取回顾式分析法,对62例布鲁氏菌病患者,总结其流行病学特点,采用试管凝集法(SAT)以及虎红平板凝集法(RBPT)进行血清学检测,分析其临床表现及治疗情况。结果职业布鲁氏菌病发病人群主要为青壮年,年龄为30~60岁,职业分布主要为农牧区、食品加工厂、养殖厂以及菌苗生产基地从业人员等;患者多明确与牛羊接触或者与相关产品有接触史。发病时间主要集中于3~8月,高发期为4~5月。亚急性、急性布鲁氏菌病患者45例,慢性布鲁氏菌病12例,局限性布鲁氏菌病5例。其中急性与亚急性布鲁氏菌病患者的临床主要表现包括乏力(28例,62.22%)、发热(33例,73.33%)、淋巴结肿大(14例,31.11%)、多汗(15例,33.33%)、骨痛以及关节痛(32例,71.11%);慢性布鲁氏菌病患者上述相应症状分布情况分别为6例(50.00%)、8例(66.67%)、6例(50.00%)、7例(58.33%)、7例(58.33%),与急性及亚急性患者相比,慢性布鲁氏菌病患者肝脾受累、胃肠道症状以及泌尿生殖受累几率有所增加,局限性布鲁氏菌病损伤较为集中,其临床主要表现为胃肠受累(3例,60.00%)、骨关节损害(3例,60.00%)、发热(2例,40.00%)、淋巴结肿大(1例,20.00%)。结论职业布鲁氏菌病临床表现具有复杂性;临床治疗中要加强对疾病的认识,规避误诊风险从而提高治疗效果。     

中药治疗脓疱病156例报告

近年来我们采用中药治疗脓疱病156例,经随访复查,治愈110例,好转26例,症状减轻20例。又用同方治疗湿疹合并感染21例,治愈16例,好转3例,无效2例;对足癣合并感染、疖病、毛囊炎等亦有疗效。用药2～10天即可治愈。     

肺炎球菌菌苗用于老年人慢性阻塞性肺疾病

大量研究证实多价肺炎球菌菌苗能够诱导抗体产生,使机体免于肺炎球菌感染,但对老年患者应用研究甚少。鉴于老年性慢性阻塞性肺病(COPD)患者是应用肺炎球菌菌苗的靶人群(rorge population),本文观察一组老年性COPD患者应用特异性肺炎球菌     

细菌性阴道炎合并妇科感染性疾病的临床特点

目的分析细菌性阴道炎合并妇科感染性疾病的临床特点,指导临床治疗。方法收集148例细菌性阴道炎合并其他妇科感染病患者临床资料,采集宫颈分泌物检测病原体。用甲硝唑联合维生素C药物治疗,并进行统计学分析。结果 148例细菌性阴道炎合并其他妇科感染病患者中,解脲脲支原体、表皮葡萄球菌、棒杆菌属、大肠埃希菌、金黄色葡萄球菌及其他病原体的感染患者数分别为55、34、25、21、10、3例,构成比分别为37.16%、22.97%、16.89%、14.19%、6.76%、2.03%;临床混合性感染细菌+支原体属、细菌+酵母菌属、细菌+滴虫、细菌+衣原体属及其他类型的患者数分别为50、31、25、18、24例,构成比分别为33.78%、20.95%、16.89%、12.16%、16.22%;细菌性阴道炎患者合并盆腔炎、附件炎、子宫内膜炎、慢性盆腔结缔组织炎及其他妇科疾病类型的患者数分别为65、27、16、9、31例,构成比分别为43.92%、18.24%、10.81%、6.08%、20.95%;20岁、20~岁、30~岁、≥40岁患者分别为15、43、61、29例,构成比分别为10.14%、29.05%、41.22%、19.59%;没有性伴侣的患者、1个性伴侣患者、≥2个性伴侣患者例数分别为19例、38例、91例,构成比分别为12.84%、25.68%、61.49%;患者经治疗后,127例痊愈,痊愈率85.81%;21例好转,好转率14.19%。结论细菌性阴道炎患者合并多种妇科感染性疾病发生率高,常见病原体类型为解脲脲支原体。混合感染以细菌+支原体属常见,甲硝唑联合维生素C的药物治疗效果良好。     

金葡菌骨髓炎并败血症继发川崎病合并菊池病1例

目的 探讨川崎病合并菊池病的临床特征、病理特点、诊断及治疗措施 方法: 回顾性分析 1例金葡菌骨髓炎并败血症继发川崎病合并菊池病患者的临床资料并进行讨论 结果: 1例15岁男性患者因间断发热1周入院,入院查血培养及骨髓培养为金黄色葡萄球菌感染,腰椎磁共振报告为骨髓炎,骨髓象结果提示噬血现象,行抗感染治疗效果不佳,入院8天后患者出现右侧颌下淋巴结肿大及躯干四肢红色丘疹,行淋巴结活检提示菊池病,心脏超声表现为川崎病,经丙种球蛋白、阿司匹林、激素等治疗,患者体温恢复正常。 结论 川崎病及菊池病为少见病,当抗感染效果不佳时,需要考虑是否存在少见的川崎病及菊池病。     

Simplified 10-Day Bismuth Triple Therapy for Cure of Helicobacter pylori Infection: Experience From Clinical Practice in a Population With a High Frequency of Metronidazole Resistance

Objective : To evaluate the cure rate of Helicobacter pylori infection, including the impact of in vitro metronidazole resistance (M-R), and the side effects of a simplified 10-day bismuth triple therapy in routine clinical practice. Methods : From September 1995 to March 1996,248 consecutive H. pylori -positive patients received 10 days of bismuth subnitrate 150 mg, oxytetracycline 500 mg, and metronidazole 400 mg, all t.i.d. Before treatment, upper endoscopy, including biopsy specimens for microbiological analysis and IgG serology were performed. M-R was found in 45% of females and 36% of males. At least 2 months after treatment, H. pylori status was assessed by the ¹⁴C urea breath test (  n = 131  ), endoscopy (  n = 37  ), urea breath test and endoscopy (  n = 63  ), or solely by IgG serology (  n = 7  ). Ten patients withdrew. IgG serology was performed again after 1 yr. Results: H. pylori infection was cured in 205 patients: 86% by all-patients-treated analysis and 83% by intention-to-treat analysis. When patients were classified according to pretreatment metronidazole susceptibility, cure of infection was achieved in 76% of females harboring M-R strains versus 96% of those with sensitive strains (   p = 0.002  ) and in 81% versus 88% (   p = 0.34  ) of males with M-R versus sensitive strains, respectively. Twelve patients (5%) had to stop treatment prematurely because of severe side effects, but eight of them were treated successfully. One case of H. pylori infection (0.6%) was detected at 1-yr follow-up. Conclusions : Ten-day bismuth triple therapy t.i.d. was effective in curing H. pylori infection in the context of routine clinical practice. The efficacy was reduced in females harboring M-R strains.     

老年人慢性难愈合创面临床特点分析

目的了解老年人慢性难愈合创面临床特点及细菌学情况，比较不同处理方法的疗效。方法总结1989-2003年住院的老年慢性难愈合创面患者的临床资料170例，对创面细菌培养、药敏试验和各种治疗手段的疗效进行回顾性分析。结果170例中，以压迫性溃疡多见（78例），其次为创伤性溃疡（49例）、放射性溃疡（13例）。治愈率：非手术方法处理创面为25．7％（28／109），皮瓣转移术为88．9％（16／18），植皮手术为91．4％（32／35），截肢（趾）术3例和切除缝合术5例均治愈。细菌培养结果：创面最常见细菌为肠道杆菌（37．8％）、铜绿假单胞菌（31．1％）、金黄色葡萄球菌（13．3％）；肠道杆菌、铜绿假单胞菌对亚胺培南的敏感率均为100．0％，对阿米卡星分别为71．4％和84．6％，头孢哌酮分别为63．6％和70．0％，环丙沙星分别为60．0％和45．5％。结论老年人难愈合创面革兰阴性菌对亚胺培南高度敏感，选择合适的修复方式能提高治愈率。     

成人53株血培养阳性分析

目的分析医院10年来成人败血症者血培养中病原菌的分布、耐药性及临床特点。方法对医院10年来成人50例败血症者的血培养阳性致病菌进行分类鉴定。结果在分离的53株细菌中,革兰氏阳性菌占52．8％,革兰氏阴性菌占45．3％,真菌占1．9％。表皮葡萄球菌等凝固酶阴性葡萄球菌检出率已超过金黄色葡萄球菌。革兰氏阴性菌中大肠埃希氏菌占首位,其次是肺炎克雷伯氏菌。败血症者平均年龄75．88岁,均有发热,多合并有脑血管疾病、冠心病、糖尿病等,有创诊疗多,白细胞、NEU％、CRP大多升高。结论二级医院败血症患者,高龄,合并症多,耐药革兰氏阳性菌是主要病原菌,需早期诊断及治疗,提高治愈率。     

金黄色葡萄球菌的临床分布及耐药性分析

目的 了解金黄色葡萄球菌的临床分布及其耐药情况.方法 对我院2007～2009年分离的金黄色葡萄球菌进行耐药监测.结果 3年共分离出金黄色葡萄球菌106株.在临床标本中,痰液分离率最高,占57.6％;感染分布以呼吸内科为主,占43.4％.MRSA对青霉素类、大环内酯类、氨基糖苷类、喹诺酮类、四环素类、克林霉素的耐药率均很高且明显高于MSSA,并呈现多重耐药;MSSA对青霉素、红霉素、庆大霉素、四环素的耐药率较高在80％左右;MRSA和MSSA对糖肽类、利奎唑胺和奎奴普汀/达福普汀都很敏感.结论 金黄色葡萄球菌耐药严重,特别是对MRSA应引起临床的重视.     

氟康宁胶囊治疗重度氟骨症效果观察

目的探讨治疗重度氟骨症的有效方法。方法采用Ｘ线拍片确诊氟骨症患者,观察以氟康宁胶囊（主要成分马钱子）治疗患者前后症状、体征变化、劳动力恢复情况以及生化改变。结果治疗３３７例,痊愈或临床治愈２３９例,总治愈率７０．９２％,部分瘫痪病例（１６．０２％）能站起来行走,参加生产劳动。结论氟康宁是目前治疗中、重度氟骨症最有效药物之一。     

Pyogenic bacterial pneumonia in the acquired immunodeficiency syndrome

Individuals with human immunodeficiency virus (HIV) infection are more susceptible to bacterial infections because of defects in both cellular and humoral immunity. The most common causes of community-acquired pyogenic bacterial pneumonia in HIV-infected patients are Streptococcus pneumoniae and Haemophilus influenzae. The clinical presentation of HIV-infected patients with pyogenic pneumonia does not seem to differ significantly from that of patients without HIV infection. Response to therapy is generally good, and complications relatively few. Prevention of bacterial pneumonia is very important in the care of HIV-infected persons. The pneumococcal vaccine is currently recommended for all HIV-seropositive individuals, although its efficacy is unknown is this setting. Other forms of prevention require further investigation but may prove to be helpful.     

肺结核合并肺毛霉菌感染的临床分析

目的探讨肺结核合并肺毛霉菌感染的防治。方法对8例肺结核合并肺毛霉菌感染的危险因素、临床表现、诊断及治疗进行总结分析。结果8例肺结核患者经深部痰培养临床确诊为肺毛霉菌感染。用两性霉素B治疗大约4周后，6例有效，1例出现肾功能不全合并高钾血症行透析治疗，1例合并蛛网膜下腔出血死亡。结论肺毛霉菌病因临床表现无特异性，易误诊。早期诊断，规范抗结核治疗，合理应用抗生素、激素，早期应用两性霉素B脂质体是提高肺结核合并肺毛霉菌病治愈率的关键。     

Cure of Helicobacter pylori-positive active duodenal ulcer patients: a double-blind, multicentre, 12-month study comparing a two-week dual vs a one-week triple therapy. GISU (Interdisciplinary Group for Ulcer Study).

AIMS: To compare a two-week dual therapy to a one-week triple therapy for the healing of duodenal ulcer and the eradication of the Helicobacter pylori infection. PATIENTS AND METHODS: A total of 165 patients with active duodenal ulcer were enrolled in the study. At entry, endoscopy, clinical examination and laboratory tests were performed. Histology and the rapid urease test were used to diagnose Helicobacter pylori infection. Patients received either lansoprazole 30 mg plus amoxycillin 1 g bid for two weeks (two-week, dual therapy) or lansoprazole 30 mg plus amoxycillin 1 g plus tinidazole 500 mg bid for one week plus lansoprazole qd for an additional week (one-week, triple therapy). Two and twelve months after cessation of therapy, endoscopy and clinical assessments were repeated. RESULTS: Duodenal ulcer healing and Helicobacter pylori eradication were both significantly greater (p<0.0001) in the triple therapy group (healing: 98.6%; Helicobacter pylori cure rate: 72.6%) than in the dual therapy group (healing: 77.3%; Helicobacter pylori cure rate: 33.3%). Ulcers healed more frequently in Helicobacter pyloricured than in Helicobacter pylori-not cured patients (94.9% vs. 77.2%; p<0.0022). After one year, Helicobacter pylori eradication was re-confirmed in 46/58 patients previously treated with the triple therapy and in 10/40 patients treated with the dual therapy [p<0.0001]. Only three duodenal ulcer relapses were observed throughout follow-up: all were in Helicobacter pylori-not cured patients. CONCLUSIONS: Triple therapy was more effective than dual both in curing Helicobacter pylori infection and healing active duodenal ulcers. The speed of ulcer healing obtained after only 7 days of antibiotics and 14 days of proton pump inhibitors confirmed that longer periods of anti ulcer therapy were not necessary. Helicobacter pylori -not cured patients had more slowly healing ulcers which were more apt to relapse when left untreated.     

中医辨证治疗肺癌患者的顽固性呃逆

目的　探讨中医辩证治疗肺癌患者顽固性呃逆的疗效。方法　设中医辨证治疗组 (33例 )与对照组 (31例 ) ,中医组予具有健脾和胃、降逆止呃作用的基本方辨证论治 ;对照组予利他灵。一周后 ,总结疗效 ,两组中未能治愈病例 ,予交换治疗方法一周后再次总结疗效。结果　中医组总有效率 84 .8% ,对照组 6 1.3% ;两组中未愈病例交换治疗方法后中医治愈 6 4 % ,利他灵治愈 13.3%。差异均有显著性 (P<0 .0 1)。结论　中医辨证治疗肺癌患者的顽固性呃逆治愈率高 ,具有良好的临床应用价值。     

Fatal brain abscess due to community-associated methicillin-resistant Staphylococcus aureus strain USA300.

We report a fatal case of brain abscess caused by infection due to a community-associated methicillin-resistant Staphylococcus aureus strain (USA300) in a 37-year-old incarcerated woman with a history of furunculosis and injection drug use. Community-onset pyogenic brain abscess should be added to the growing list of life-threatening invasive infections caused by epidemic community-acquired methicillin-resistant S. aureus.