先天性单侧唇裂修补术合理使用抗生素的临床疗效观察

目的　先天性单侧唇裂修补术中合理使用抗生素与同类手术中常规使用抗生素的疗效对比观察。方法　选择 5 0例单侧唇裂修补术为实验组 ,术前不使用任何抗生素 ,术中给予静脉推注 30 0mg先锋霉素 ,并采取多种方法减少出血和死腔 ,术后第三天给予多贝氏液含漱。对照组为1997～ 2 0 0 1年在某院治疗的 5 0例先天性单侧唇裂患者 ,按常规术中、术后给予抗生素。结果　实验组无 1例感染 ,对照组有 3例出现术后感染 ,两组患者术后感染率差异无显著性 (P >0 0 5 )。结论　在采用减少出血和死腔的术式前提条件下 ,实验组手术前、后不使用抗生素 ,仅在术中静脉推注先锋霉素 30 0mg ,能达到预期的治疗效果     

食管癌术后早期肠内营养预防肺部感染的临床研究

目的研究食管癌术后早期肠内营养对预防肺部感染所起的作用.方法把食管贲门癌剖胸切除术患者随机分为治疗组(EN)和对照组(PN).EN组(n=50)采用术后第1～5天经鼻肠营养管滴饲能全力500～1 000ml/d,PN组(n=45)术后仅予静脉营养支持;两组病例均在术后第1天和第5天查血淋巴细胞计数、白蛋白、转铁蛋白、前白蛋白,观察这5 d内有否肺部感染.结果EN组术后无肺部感染病例,PN组4例;EN组术后第1天和第5天的白蛋白和淋巴细胞计数前后对比升高明显(P＜0.01),而PN组稍有升高(P＞0.05);两组患者的转铁蛋白和前白蛋白前后对比轻微升高(P＞0.05).结论食管癌术后早期肠内营养有预防肺部感染作用.     

145例唇裂手术患儿医院感染调查分析

唇裂修复术是口腔颌面外科的常见手术 ,患儿年龄偏小 ,医院感染率高。我们对我院口腔科 14 5例唇裂患儿医院感染情况进行调查分析 ,以探讨唇裂患儿医院感染的原因及预防措施。一、对象和方法1.调查对象 :1998年 1月～ 2 0 0 0年 12月在我院住院行唇裂修复术的患儿。2 .诊断标准 :按照中华医院感染管理学会审定的《医院感染诊断标准》。3.调查方法 :采用回顾性调查方法。二、结果1.性别、年龄构成及医院感染率 :14 5名唇裂住院患儿中男性 10 4人 ,女性 4 1人 ;年龄 1个月～ 16岁 ,平均 14 11个月。 14 5名患儿共发生医院感染5 0例 ,感染率为…     

不同季节医院感染临床分析

目的　为各季节预防医院感染的发生提供依据。方法　对 2 2 4 6例医院感染病例进行回顾性分析。结果　 5年医院感染发生率平均为 4 31% ;各季节感染率 :春天 4 2 1%、夏季 4 11%、秋季 4 4 4 %、冬季4 4 5 %。 4个季节医院感染部位以下呼吸道感染最高 (4 6 0 4 % ) ,手术切口感染次之 (16 5 2 % ) ,血液感染最低(1 74 % )。结论　根据 5年医院感染临床资料分析 ,不同季度医院感染率无显著性差异 (P >0 0 5 ) ,但感染部位与不同季节有显著性差异 (P <0 0 5 )。     

剖宫产围手术期用药预防术后感染的临床探讨

:目的 :探讨剖宫产围手术期用药对降低术后感染的效果。方法 :将 2 0 0例选择性剖宫产病人随机分为两组 ,试验组 (围手术期用药组 ) 10 4例 ,选用甲硝唑与头孢噻肟钠 ,于手术开始前 30min内单次静脉冲击给药 ,术中冲洗宫腔及切口 ,腹腔留置抗生素 ;对照组 (传统术后用药组 ) 96例 ,术后头孢噻肟钠 甲硝唑全身用药 5～ 7d。结果 :试验组无一例发生子宫体炎 ,伤口感染率由 15 6 0 %降至 2 88% ,术后致病率由 2 1 88%降至 2 88% ,两组间差异显著 ,P <0 .0 5。结论 :围手术期用药预防感染效果优于术后用药。     

剖胸术后营养状况与切口感染关系的探讨

目的　探讨剖胸术后切口感染与营养状况的相关性。方法　以胸外科剖胸手术病人为研究对象 ,通过病例对照分析方法 ,将病人分为单纯切口感染组 (感染组 )和切口一期愈合组 (对照组 ) ,各 15例 ;分别记录两组术后第 5d血清蛋白定量和累计氮平衡 ;统计数据以t检验处理。结果　感染组血清蛋白各指标均数都低于对照组 ,其中总蛋白比较有统计学意义 (P <0 0 5 ) ,白蛋白比较有极显著差异性 (P <0 0 1) ,前白蛋白比较无统计学意义 (P >0 0 5 ) ,转铁蛋白比较有显著差异性 (P <0 0 5 ) ;感染组和对照组术后 5d累积氮平衡分别为%D -(2 4 5 7± 11 4 3)g和 - (18 4 5± 9 19)g ,两组比较有显著差异性 (P <0 0 5 )。结论　剖胸术后营养状况与切口感染有密切的相关性 ,术后合理的营养支持在预防切口感染中有积极的意义。     

体外循环心内直视手术中抗生素的预防性应用

目的　通过回顾性资料研究体外循环心脏直视手术术中抗生素预防性应用的价值。方法　 198例患者分为两组 ,A组 110例 ,体外循环心内直视手术完成后进入重症监护室 (ICU)时应用抗生素 ,B组 88例 ,患者于体外循环心内直视手术中应用抗生素 ;术后统计患者的感染情况 ,包括呼吸系统感染、泌尿系统感染、切口和纵隔感染及感染性心内膜炎等。结果　 A组术后统计感染 12例 (10 .9% ) ,B组 4例 (4 .5 % ) ,差异有极显著性 P<0 .0 1。结论　体外循环心内直视手术术中应用抗生素是一种有效的预防感染措施     

合并肝硬化门脉高压患者的腹腔镜胆囊切除术

目的　探讨合并肝硬化门脉高压 (CPH)患者腹腔镜胆囊切除 (LC)的可行性与技术特点。方法　对照研究接受LC的 38例CPH组患者和 4 0例正常对照 (NC)组患者的治疗结果。CPH组包括肝功能ChildA级 2 1例 ,B级15例 ,C级 2例。结果　CPH组LC手术完成 36例 ,因术中出血、Calot三角区致密粘连中转各 1例。手术时间(5 2 .6± 15 .2 )min ,术中出血量 (75 .5± 15 .5 )ml。NC组 4 0例均LC手术完成 ,手术时间 (36 .2± 11.6 )min ,术中出血量 (32 .8± 13.4 )ml。术后CPH组 5例 (13.2 % )发生并发症 7例次 ,分别是戳孔感染 1例次 ,呼吸系统感染 1例次 ,泌尿系统感染 1例次 ,上消化道出血 1例次 ,轻度肝性脑病 1例次 ,腹水增多 2例次。均治愈出院 ,术后平均住院 (4.6± 2 .4 )d。NC组术后 1例 (2 .5 % )发生泌尿系统感染 ,术后平均住院 (3.0± 1.5 )d。两组患者在手术时间、术中出血量、中转率及术后并发症发生率、住院时间等方面均有显著性差异。结论　CPH患者的LC属于高难度的手术 ,是可行的、相对安全的 ,掌握手术的技术特点、注重围手术期处理是成功的关键。     

114例剖宫产术后医院感染调查

近几年 ,我院剖宫产率急剧上升 ,1999年为 73 2 9% ,远远高于文献报道的 5 2 84 % [1 ] ,而 2 0 0 1年则高达79 84 %。为探讨剖宫产术后医院感染的特点及预防方法 ,对我院 114例剖宫产术后发生医院感染的病例进行回顾性调查分析 ,现报告如下。对象与方法1　对象　 1999～ 2 0 0 1年剖宫产术后发生医院感染者共 114例 ,年龄 2 2～ 34岁 ,平均 2 6 6± 3 2 4岁。初产妇 96例(84 2 1% ) ,经产妇 18例 (15 79% ) ;孕周在 37周～ 4 2周 ,平均 38 7周 ;择期剖宫 88例 (77 19% ) ,急诊剖宫产 2 6例 (2 2 81% )。 114例中除 2例双胎妊娠外其余…     

综合医院医院感染管理监控指标调查分析

目的分析不同规模医院在不同感染监控指标下的感染情况及相应抗感染药物使用情况。方法该次研究以2019年1—12月间某地66所不同规模的综合医院为研究对象,了解不同规模医院感染管理监控指标,并记录所有医院感染发病率、Ⅰ类切口手术部位感染率、住院患者抗菌药物使用率及Ⅰ类切口手术抗菌药物预防使用率。结果该次研究选取的66所综合医院总计住院患者1742587例,其中感染病例数为31366例,总感染发病率为(1.80%),分析各组感染发生率,医院规模与感染发生率成正比关系,对比第1组与第4组感染发病率情况,前者明显优于后者,数据差异有统计学意义(P<0.05);该次研究选取的66所综合医院Ⅰ类切口手术部位总感染病例数为576例,总感染率为(0.27%),分析第1组与第4组Ⅰ类切口手术部位感染情况,前者明显低于后者,两组数据差异有统计学意义(P<0.05);该次研究选取的66所综合医院住院患者抗菌药物使用率为(52.56%),分析4组医院住院患者抗菌药物使用率,住院患者抗菌药物使用率与医院规模成反比关系;该次研究选取的66所综合医院Ⅰ类切口手术抗菌药物预防使用率为(36.36%),分析4组医院Ⅰ类切口手术抗菌药物预防使用率,Ⅰ类切口手术抗菌药物预防使用率与医院规模成反比关系。结论不同规模综合医院的医院感染监控标准具有一定差异,其中规模较小的医院感染管理还需要进一步完善,抗菌药物预防使用率较高,需要规范这类药物的使用。     

腹股沟疝无张力修补术是否应用抗生素的对比研究

目的探讨腹股沟疝无张力修补术是否需要常规预防性应用抗生素。方法选择204例成年人腹股沟疝患者,根据入院先后顺序按1：3比例随机分为治疗组（51例）和对照组（153例）,治疗组术前使用第一代头孢菌素1次;对照组术前、术后均不使用抗生素,对比两组术后早期切口感染发生情况。结果204例腹股沟疝患者中5例发生术后切口感染,其中治疗组1例,感染率2．0％（1／51）,对照组4例,感染率2．6％（4／153）,两组比较差异无统计学意义（r=0．000,P=1．000）。两组术后第3天白细胞计数、嗜中性粒细胞百分比及住院时间、住院费用比较差异无统计学意义（P〉0．05）。结论无高危因素的成年人腹股沟疝无张力修补术常规应用抗生素预防术后切口感染无实质性必要。     

A prospective, randomized, double-blind studyof single high dose versus multiple standard dose gentamicin both in combination withmetronidazole for colorectal surgicalprophylaxis

Single, high dose regimens of gentamicin plus metronidazole for colorectal surgical prophylaxis have not been adequately studied. Patients received single high dose gentamicin (4.5 mg/kg) plus metroni-dazole (500 mg) preoperatively or multiple standard dose gentamicin (1.5 mg/kg) plus metronidazole (500 mg) preoperatively and every 8h for 24h postoperatively. The deep surgical site infection (SSI) rates were 8.1% (6/74) and 6.9% (5/72) in the single high dose and multiple standard dose groups, respectively (P= 0.94). There was a trend towards fewer superficial SSIs in the single high dose group with infection rates of 18.9% (14/74) vs. 30.6% (22/72) (P= 0.05). Diabetes mellitus (odds ratio = 7.04) and surgery duration of longer than 3h (odds ratio = 5.46) were independent risk factors for the development of SSIs. A subset analysis of prolonged operations found significantly fewer superficial SSIs in the single high dose group than in the multiple standard dose group with rates of 22.2% (6/27) vs. 55% (11/20), respectively (P= 0.021). Single high dose gentamicin plus metronidazole preoperatively was at least as effective as the multiple standard dose regimen and may be more effective for prolonged operations.     

Postoperative infection in cardiac surgery: the influence of a change in prophylactic antibiotic regimen

A total of 448 patients undergoing cardiovascular surgery were followed for the development of postoperative infection. Non-extracorporeal procedures were assigned to group 1 and open-heart procedures to group 2. The incidence of infection was compared in two groups who received prophylactic antibiotics. Patients (n = 253) received ampicillin alone (group 1) or in combination with gentamicin (group 2) for 7 days starting 1 day before the operation (period A). One hundred and ninety-five patients (period B) received cefazolin starting preoperatively 30 min before induction, alone (group 1) or in combination with gentamicin (Group 2) for 3 days. The percentage of patients developing infection in periods A and B for group 1 patients was 4.2% and 3.5% and for group 2 it was 25.8% and 18.7% respectively. The overall infection rate was 13%. The number of infection sites involved were 1.5 per infected patient. Urinary tract infections were the most frequent followed by endocarditis and other deep infections, wound infections and respiratory infection. Gram-negative rods were the predominant pathogens (Klebsiella spp. and Pseudomonas aeruginosa) during both periods (47 out of 70 isolates). Wound infections due to Gram-positive cocci were higher in period A (4/8) as compared to period B (1/5). During period B there were three cases of fungal endocarditis whereas no case occurred during period A. Although the incidence of infection was reduced during the period of cefazolin prophylaxis, the difference was not statistically significant.     

经尿道前列腺电切术前无菌尿的患者行预防性抗菌的合理性评价

目的研究无菌尿的老年患者,经尿道前列腺电切术(TURP)时接受预防性抗菌方案的疗效。方法120例TURP术前无菌尿的良性前列腺增生老年患者随机分为两组,抗生素组(60例)根据临床经验行静脉抗菌方案预防感染(4 d),对照组(60例)则输注5%葡萄糖盐溶液。比较两组TURP术后感染相关性指标。结果抗生素组在术后第4天的菌尿检出率低于对照组(P<0.05),但两组术后第28天的菌尿率及其他感染相关性并发症比较差异无统计学意义。患者TURP术后第4天菌尿与术后长期菌尿、菌血症或尿路感染、前列腺菌群检出率关系不密切。结论抗生素可以预防无菌尿老年患者TURP术后早期出现菌尿,但不能改善感染性并发症的发生率。经验性用药对不同来源分离的病菌不十分敏感。     

Simple peroperative antimicrobial chemoprophylaxis in elective neurosurgical operations

From August 1981 to February 1982 postoperative infections due to different strains of penicillin-resistant Staphylococcus aureus occurred in 20 of 467 patients (4.3%) undergoing elective cranial and spinal operations. These infections were not attributable to defects in procedures or the theatre environment, therefore chemoprophylaxis was instituted. In the following 8 months, when patients were given penicillin G and sulphadiazine for 5 days commencing immediately postoperatively, S. aureus infections occurred in five of 579 patients (0.9%). In a subsequent randomized uncontrolled study, infections occurred in six of 265 patients receiving penicillin (2.3%), three of 270 receiving penicillin and sulphadiazine (1.1%) and one of 45 receiving erythromycin (2.2%) immediately postoperatively for 5 days. In a further study in which 587 patients received penicillin for 5 days commencing immediately preoperatively, infections due to S. aureus occurred in six (1.1%). Infections due to gram-negative organisms were seen in five (0.4%) of 1167 patients in the two uncontrolled studies.     

Comparison of two prevention strategies for neonatal group B streptococcal disease

BACKGROUND: Neonatal group B streptococcal disease is a serious infection, causing more than 2,000 cases of sepsis annually. The Centers for Disease Control and Prevention has recommended two alternative strategies to prevent infection, but few data directly compare the two in terms of intrapartum antibiotic administration, protocol feasibility, newborn laboratory evaluation, and costs. METHODS: We collected data on intrapartum antibiotic administration, protocol compliance, newborn laboratory evaluation, and maternal-newborn length of stay for 347 mother-infant pairs in a family practice residency maternity service. During the first study period, laboring women were managed under the screening strategy, and during the second study period, laboring women were managed under the risk factor strategy. RESULTS: Of those women who qualified for antibiotic prophylaxis, only 28% of women in the screening group and 47% of women in the risk factor group actually received the recommended two or more doses of intrapartum antibiotics. Ninety-one percent of women in the screening group had prenatal cultures done appropriately. Newborns in the screening group had an increased risk of having a complete blood count (OR = 1.35, 95% CI 1.01, 1.80). There was no difference between groups in maternal or newborn length of stay. CONCLUSIONS: A minority of laboring women in either strategy received the recommended doses of intrapartum antibiotics. Feasibility of obtaining prenatal screening cultures is high. Although newborn laboratory testing increased with the screening strategy, overall costs and length of stay were comparable.     

Surgical antibiotic prophylaxis: effect in postoperative infections

Objective: to assess the risk of surgical wound infection and hospital acquired infections among patients with and without adequate antibiotic prophylaxis. Also, to provide models to predict the contributing factors of hospital infection and surgical wound infection. Design: survey study. Prospective cohort study over 14 months, with data collected by a nurse and a epidemiologist through visits to the surgical areas, a review of the medical record and consultation with the medical doctor and nurses attending the patients. Setting: Two hundred and fifty bed, general hospital serving Puertollano (Ciudad Real), population – 50,000. Results: between February 1998 and April 1999, 754 patients underwent surgery, 263 (34.88%) received appropriate peri-operative prophylaxis while 491 (65.12%) received inadequate prophylaxis. For those who received adequate antibiotic prophylaxis, the percentage of nosocomial infection was 10.65% compared with the group who received inadequate prophylaxis in which the percentage of nosocomial infection was 33.40%. The relative risk of nosocomial infection was, therefore, 4.21 times higher in the latter group (confidence intervals 95%: 2.71–6.51). A patient in the inadequate prophylaxis group had a 14.87% chance of wound infection while a patient in the adequate prophylaxis group had a 4.56% chance of wound infection. The relative risk of wound infection was 3.65 times higher in the group that received inadequate prophylaxis (confidence intervals 95%: 1.95–6.86). The final regression logistic model to assess nosocomial infection incorporated seven prognostic factors: age, length of venous periferic route, vesicle catheter, duration of operation, obesity, metabolic or neoplasm diseases and adequate or inadequate prophylaxis. When we incorporated these variables in the multi-factorial analysis we found that the relative risk of developing nosocomial infection was 2.33 times higher in the group which received inadequate prophylaxis. When we applied the second logistic multiple regression model (wound infection), we discovered that the probability of developing surgical wound infection was 2.32 times higher in the group which received inadequate prophylaxis as opposed to the group, which received adequate prophylaxis. The goodness of fit (Hosmer–Lemeshow test) showed a correct significance in all models. Conclusions: a multi-factorial analysis was applied to identify the high-risk patients and the risk factors for postoperative infections. Through the application of these multiple regression logistic models, we conclude that the correct antibiotic prophylaxis is effective and will subsequently reduce postoperative infection rates, especially in high-risk patients. Therefore, the choice of antimicrobial agent should be made on the basis of the criteria of hospital committee.     

Failure of a multi-subunit recombinant leishmanial vaccine (MML) to protect dogs from Leishmania infantum infection and to prevent disease progression in infected animals

We report results of a Phase III trial of the multi-subunit recombinant Leishmania polyprotein MML for the protection of dogs against infection by Leishmania infantum. The antigen, also known as Leish-111f, is the first antileishmanial human vaccine entered Phase I clinical testing. The study was performed in a leishmaniasis endemic area of southern Italy. Three groups of 15 Leishmania-free beagle dogs each, received 3 monthly injections with vaccines A (MML+MPL-SE adjuvant), B (sterile saline = control) and C (MML+Adjuprime adjuvant), respectively, before transmission season 2002. The surviving dogs received a second three-dose vaccine course 1 year later. The dogs were naturally exposed to sandfly bites for 2.5 months in 2002, and for 5 months in 2003. Every 2 months post vaccination, dogs were examined by clinical and immunological evaluation, and by specific serology, microscopy, culture and PCR. A weak lymphoproliferative response to MML was seen in A and C groups throughout the study period. One year after the first vaccine course, the cumulative incidence of leishmanial infections was 40% in group A, 43% in group B and 36% in group C. Two-year post-vaccination (1 year after the second vaccine course) the cumulative incidence was 87% in group A (with three symptomatic cases), 100% in group B (with no symptomatic cases) and 100% in group C (with two symptomatic cases). The efficacy of the MML vaccine as an immunotherapeutic agent for the prevention of disease progression (subpatent infection-->asymptomatic patent infection-->symptomatic patent infection) was evaluated through follow-up of dogs found infected prior to the second vaccination. Among 15 infected animals, progression to a subsequent stage of infection was found in 5/6 dogs of group A, 3/6 of group B and 2/3 of group C. We conclude that vaccination with MML is not effective to prevent leishmaniasis infection and disease progression in dogs under field conditions.     

Combination of recombinant human growth hormone and glutamine-enriched total parenteral nutrition to surgical patients: effects on circulating amino acids

BACKGROUND & AIMS: Both recombinant human growth hormone (rhGH) and glutamine (GLN) may have beneficial anabolic actions on amino acid metabolism. The aim of this study was to evaluate the additive effects of rhGH and GLN on plasma amino acids postoperatively. METHODS: 31 females undergoing laparoscopic cholecystectomy were randomized to three groups: Group I (n=10) received 13 IU/m(2) of rhGH the morning of surgery and the following three postoperative days, together with glutamine-free TPN for the first two postoperative days. Group II (n=11) received rhGH as the first group, together with glutamine-enriched (7 g GLN/m(2)/day) TPN. Group III (n=10) received glutamine-enriched TPN as the second group, but rhGH was replaced by placebo. Daily plasma amino acid concentrations and nitrogen balance were determined. RESULTS: In the GH treated groups, the plasma concentrations of several amino acids were decreased on the third postoperative day, compared to preoperatively. This was not observed in Group III. The changes were more pronounced in Group II. In Group II the negative AV-differences of amino acids tended to be attenuated, while the patients in Group III had increased negative AV-differences. The cumulative nitrogen balance was significantly improved in the GH groups, compared with Group III. CONCLUSION: The combined treatment of growth hormone and glutamine has additive effects on AV-balances of amino acids postoperatively, whereas nitrogen balance is not further improved when adding glutamine to rhGH treatment.