Short antibiotic prophylaxis for bacterial infections in a neonatal intensive care unit: a randomized controlled trial

We compared the effectiveness of a single dose and a three-day course of antibiotic prophylaxis in preventing bacterial infections in high-risk neonates. The study was a prospective, randomized controlled trial conducted in a 20-bed tertiary referral neonatal intensive care unit (NICU). A series of 130 neonates admitted consecutively to the NICU, fulfilling risk factors for infection, were assigned at random to receive intravenous antibiotic prophylaxis with ampicillin and netilmicin either in two daily doses for 72 h (three-day-administration group, 67 infants) or in a single bolus injection on admission (bolus group, 63 infants). Hospital-acquired infection, the main outcome measure, was defined as infection that developed at least 48 h after admission, and vertical infection (maternally transmitted) was considered to be present when clinical symptoms and abnormal laboratory findings became evident within 48 h of birth. Infections were considered as suspected when clinical and laboratory findings of infection were present, without positive cultures, and as confirmed when positive cultures were also present. No significant differences were found between the two groups of neonates studied in mean birth weight, gestational age or postnatal age on admission. The incidence of vertical infection was similar in the two groups (16/67, 23.9% vs. 14/63, 22.2%). Of the 130 newborns studied, 29 (22.3%) acquired at least one nosocomial infection during their NICU stay; total hospital-acquired infections, calculated as the incidence density of infection (the number of infective episodes divided by the number of days in the NICU), were less frequent among newborns who received the three-day course than the bolus (relative risk 0.69). This difference, although not statistically significant, depended on the different incidence density of confirmed nosocomial infections rather than on suspected infections (relative risk 0.59; 95% confidence interval 0.32-1.09; P=0.1). There were no significant differences between the two groups in overall mortality. A single bolus administration on admission is therefore likely to be as effective as a three-day course of antibiotic prophylaxis in preventing bacterial infection in high-risk infants admitted to an NICU.     

腰椎管狭窄症术后感染及危险因素分析

目的分析腰椎管狭窄症术后感染的危险因素,为临床合理使用抗菌药物和控制医院感染提供科学依据。方法采用前瞻性监测和回顾性调查相结合的方法,对2009年1月-2010年12月入住骨科的206例腰椎管狭窄症患者临床资料进行统计分析。结果腰椎管狭窄症术后感染发生率为3.4%,其中上呼吸道感染占42.9%,肺部感染占57.1%,伴有伤口局部感染占42.9%;病原菌以革兰阴性菌为主,占57.1%,其次是革兰阳性菌,占42.9%,且对多种抗菌药物有不同程度的耐药性。结论认真施行无菌操作,严格掌握手术适应证,熟练进行手术操作,尽可能缩短手术时间,加强环境管理和感染监控,合理使用抗菌药物,积极治疗基础疾病,对降低腰椎管狭窄症术后感染具有重要意义。     

预防性应用抗菌药物对腹股沟无张力疝修补术后切口感染效果的荟萃分析

目的评价预防性应用抗菌药物对腹股沟无张力疝修补术后切口感染的作用,明确对于该类手术患者是否需要预防性使用抗菌药物。方法检索2000年1月-2013年11月所有公开发表的关于预防性使用抗菌药物对腹股沟无张力疝修术切口感染的影响,临床随机对照试验,对符合纳入标准的研究使用Revman5.2软件进行统计分析。结果按照筛选标准,共有14项随机对照试验,5 940例患者纳入研究,预防性使用抗菌药物组与未使用抗菌药物组患者一般情况及病例特征分布均衡,预防性应用抗菌药物组术后切口总体感染率2.82%及切口浅部感染率2.25%,较对照组的3.88%及4.36%明显降低(P<0.05),而切口深部感染率两组比较差异无统计学意义。结论行腹股沟疝无张力修补术术前预防性应用抗菌药物能有效降低切口浅部感染的发生率,而对预防切口深部感染无实质性效果。     

Follow-up of antibiotic prophylaxis: impact on compliance with guidelines and financial outcomes

In order to enhance the quality of antibiotic use, a new financial system was introduced in Belgium in 1997, which links reimbursement of antibiotic costs incurred during prophylaxis in surgery and obstetrics to compliance with evidence-based guidelines. At University Hospitals Leuven (UHL), this reimbursement scheme was supplemented with a follow-up programme in 2001 that informs physicians of their compliance with the guidelines and outlines the financial consequences of their use of prophylactic antibiotics. The aim of this paper is to evaluate the impact of the follow-up programme developed and implemented by a clinical pharmacist at UHL. The analysis drew on data on consumption and costs of antibiotics used in standard prophylaxis that were retrieved from patient invoices. Both financial outcomes and results on consumption patterns of antibiotics point to an increasing compliance with guidelines. An average annual loss of 92,353 Euro associated with prophylactic antibiotic use prior to the implementation of the follow-up programme evolved into a profit of 27,269 Euro following its introduction. The share of consumption of prophylactic antibiotics held by cefazolin and metronidazole, the two main antibiotics recommended by the guidelines, increased substantially or remained stable as a result of the follow-up programme, whereas the shares held by other antibiotics generally fell. Moreover, the range of antibiotics consumed during standard prophylaxis narrowed. This follow-up programme thus reduced antibiotic costs, improved profitability and increased physician compliance with guidelines.     

食管癌术后并发肺部感染的高危因素调查分析

目的 调查研究食管癌术后并发肺部感染的高危因素.方法 选取2008年1月-2011年10月进行手术治疗的156例食管癌患者为研究对象,将其术后肺部感染的发生率及其与患者性别、年龄、手术时间、术前是否放疗、合并基础疾病、喉返神经损伤、术后硬膜外自控镇痛情况的相关性进行研究.结果 156例食管癌手术患者,术后发生肺部感染21例,感染率为13.5％,以下因素患者的感染率为:年龄≥60岁为15.2％、手术时间≥4h为25.0％、术前放疗患者为40.0％、合并其他基础疾病为16.3％、喉返神经损伤为80.0％、术后进行硬膜外自控镇痛为25.6％,差异均有统计学意义(均P＜0.05).结论 年龄、手术时间、术前是否放疗、是否合并其他基础疾病、喉返神经损伤、术后镇痛情况均为食管癌术后并发肺部感染的高危因素,在治疗护理的过程中应引起重视.     

Implication of antibiotic referents in complex bone and joint infections

One of the main objectives of antibiotic referents in French hospitals is to promote the nationwide antibiotic stewardship program. National guidelines for complex bone and joint infection management (CBJI) issued in 2009, and expert and associated hospital centres were chosen. Our aim was to determine the role of antibiotic referents in CBJI treatment modalities, in 2012.     

Incidence of surgical site infections and accompanying risk factors in Vietnamese orthopaedic patients

A cohort study of surgical site infections (SSIs) was conducted in 582 orthopaedic surgical patients at Cho Ray Hospital, a reference hospital in Ho Chi Minh City, Vietnam, in order to determine the incidence and analyse risk factors for SSIs in this population. The SSI incidence rate was 12.5% (73 of 582); 3.6% incisional SSIs, 6.8% deep incisional SSIs and 2.1% organ/space SSIs. The incidence increased from 2% in clean wounds to 44.6% in dirty wounds, or 1.3% in patients with a National Nosocomial Infections Surveillance (NNIS) risk index of 0 to 75% in patients with an NNIS risk ratio of 3. In multi-variate analysis, having a dirty wound [odds ratio (OR) 8.7; 95% confidence intervals (CI) 4.6--16.4], American Society of Anesthesiologists' score >2 (OR 3.9; 95%CI 1.8-8.8), procedures with external fixation (OR 2.9; 95%CI 1.4-5.9), emergency surgery with motor-vehicle-related trauma (OR 2.1; 95%CI 1.2-3.9), or duration of procedure >2h (OR 2.1; 95%CI 1.1-4.2) were independent risk factors for SSI. Lack of appropriate prophylaxis was of borderline significance (OR 3.2; 95%CI 0.9-11.1, P=0.06). Among 76 patients with SSIs, 22 patients were discovered during postdischarge follow-up. These late SSIs had age as an additional risk factor (OR 2.8; 95%CI 1.1-7.2). Our data show that SSIs were frequent and differed widely by wound class. The NNIS risk index was predictive of SSI for this population. With a high number of motor vehicle accidents in Vietnam, the majority of orthopaedic operations are trauma related. Emergency surgery for injuries sustained in these accidents, and procedures with external fixation were especially prone to infections.     

Surgical infections surveillance: Results of a sixmonth incidence study in two Italian hospitals

In a six-month incidence study of surgical wound infections (SWI) in two Italian hospitals, 1,019 surgical patients, in three general surgery wards, and 433 surgical patients in one orthopedics ward were studied. For the SWI surveillance, the DANOP-DATA system was used: this microcomputer program was developed by Danish authors and tested in a European multicenter study coordinated by the World Health Organization in 1989. Two Italian hospitals participated in the multicenter study. The overall infection rate was 1.2 per 100 operations in orthopedics and 4.9/100 in general surgery. The risk of infection increased with age (RR = 2.06; 95% CL = 1.20–3.53), wound class (RR = 3.38; 95% CL = 1.97-5.8), length of pre-operative stay (RR = 2.71; 95% CL = 1.54-4.74), and duration of operation (RR = 2.59; 95% CL = 1.48–4.54).The infection rates ranged from 3.7 to 7.3/100 among the three general surgery wards; this variability by ward was only partially explained by differences in the age distribution of in-patients, wound class, duration of operation and length of pre-operative stay. When all these risk factors were simultaneously taken into account using a logistic regression model, the odds ratio, comparing one of the three general surgical wards with the other two, was still 2.29 (95% CL = 1.23–4.26). The observed variability can be attributed to differences, among the participating wards, in the case-mix of patients treated and/or to differences in the quality of infection control programs implemented.Corresponding Author     

Use of probiotics as prophylaxis for postoperative infections

Postoperative bacterial infections are common despite prophylactic administration of antibiotics. The wide-spread use of antibiotics in patients has contributed to the emergence of multiresistant bacteria. A restricted use of antibiotics must be followed in most clinical situations. In surgical patients there are several reasons for an altered microbial flora in the gut in combination with an altered barrier function leading to an enhanced inflammatory response to surgery. Several experimental and clinical studies have shown that probiotics (mainly lactobacilli) may reduce the number of potentially pathogenia bacteria (PPM) and restore a deranged barrier function. It is therefore of interest to test if these abilities of probiotics can be utilized in preoperative prophylaxis. These factors may be corrected by perioperative administration of probiotics in addition to antibiotics. Fourteen randomized clinical trials have been presented in which the effect of such regimens has been tested. It seems that in patients undergoing liver transplantation or elective surgery in the upper gastrointestinal tract prophylactic administration of different probiotic strains in combination with different fibers results in a three-fold reduction in postoperative infections. In parallel there seems to be a reduction in postoperative inflammation, although that has not been studied in a systematic way. The use of similar concepts in colorectal surgery has not been successful in reducing postoperative infections. Reasons for this difference are not obvious. It may be that higher doses of probiotics with longer duration are needed to influence microbiota in the lower gastrointestinal tract or that immune function in colorectal patients may not be as important as in transplantation or surgery in the upper gastrointestinal tract. The favorable results for the use of prophylactic probiotics in some settings warrant further controlled studies to elucidate potential mechanisms, impact on gut microbiota and influence on clinical management. The use of probiotics must be better delineated in relation to type of bacteria, dose and length of administration.     

抗菌药物预防老年植入永久性心脏起搏器术后感染临床研究

目的探讨抗菌药物预防老年植入永久性心脏起搏器术后感染影响性,以期降低感染率,提高临床效果。方法选取2010年4月-2013年2月116例老年植入永久性心脏起搏器患者为研究对象,手术方法相同,将其分为两组均为58例,两组患者术前均应用抗菌药物预防感染,对照组术中予生理盐水冲洗囊袋,观察组予抗菌药物冲洗囊袋,观察治疗后临床效果。结果对照组术后感染8例,感染率13.79%,2周以上感染6例;观察组感染2例,感染率3.44%,2周内感染2例,两组比较差异有统计学意义(P<0.05);且两组在白细胞计数、C-反应蛋白、白细胞介素-1水平比较,差异有统计学意义(P<0.05)。结论应用抗菌药物预防可降低老年植入永久性心脏起搏器术后感染发生率,缩短感染发生时间。     

骨科患者感染的危险因素调查

目的 对骨科患者感染的危险因素进行调查,研究预防感染的控制措施,以降低医院感染率.方法 对医院骨科2009年8月—2011年6月2226例住院患者的病历资料进行回顾性调查分析.结果 2226例骨科住院患者中发生医院感染81例,感染率为3.64％;最主要的感染部位为泌尿系统,占64.20％,其次是手术切口、上呼吸道、皮肤及软组织、下呼吸道;主要的危险因素为抗菌药物使用、侵入性操作、原发疾病;8l例患者中经手术治疗的71例,占87.65％;留置尿管63例,占77.78％,治疗中经验使用抗菌药物72例,占88.89％,使用＞2种抗菌药物46例,占56.79％,是主要的危险因素之一;从培养的菌株显示,以革兰阴性菌为主,共40株,占49.38％,革兰阳性菌32株,占39.51％,真菌9株,占11.11％.结论 骨科患者感染的危险因素是多方面的,对骨科患者的治疗应严格按照岗位标准操作规程进行操作,对各环节治疗均进行严格的质量控制,合理使用抗菌药物,以降低医院感染的发生率.     

影响胰十二指肠切除术后早期并发症的危险因素分析

目的 探讨影响胰十二指肠切除术后早期并发症的危险因素.方法 对2005年3月至2010年10月行胰十二指肠切除术159例患者的临床资料进行回顾性分析;对影响术后早期并发症的相关因素进行分析.结果 49例(30.8％,49/159)患者出现术后早期并发症.单因素分析表明,术前空腹血糖水平、总胆红素水平、白蛋白水平、高密度脂蛋白水平和术中出血量与胰十二指肠切除术后早期并发症发生显著相关(P＜0.05);而性别、年龄、入院前黄疸、糖尿病病史、手术时间及是否门静脉重建与胰十二指肠切除术后早期并发症发生无明显相关性(P＞0.05).多因素分析表明,术前空腹血糖水平(≥6.1 mmol/L)、总胆红素水平(≥171μmol/L)和白蛋白水平(＜35 g/L)是胰十二 指肠切除术后早期并发症发生的独立危险因素.结论 充分认识影响胰十二指肠切除术后早期并发症发生的危险因素,加强这些危险因素的控制,以改善患者的早期预后.     

老年痴呆患者医院感染的危险因素分析

目的 总结分析老年期痴呆患者医院感染的临床特点.方法 将医院收治的老年期痴呆住院患者中发生医院感染的76例患者设为观察组,未发生感染的76例患者设为对照组,对两组患者的一般资料、诊疗资料进行对比研究,分析老年期痴呆患者发生医院感染的危险因素.结果 老年期痴呆患者发生医院感染的高危因素有:合并糖尿病、使用抗菌药物、吞咽障碍、持续导尿以及住院时间＞120 d;观察组患者中合并有肿瘤、低蛋白血症及使用抗精神药物、长期卧床且病房规模＞3张床位的患者比率明显高于对照组(P＜0.05);76例80例次医院感染病例中,共培养出65株病原菌,主要为大肠埃希菌、肺炎克雷伯菌及真菌.结论 对有较高危险性的医院感染致病因素,采取针对性的预防措施,可降低老年期痴呆患者发生医院感染的概率.     

心脏起搏术后感染及其危险因素的研究

对某医院接受医院心脏起搏术治疗的２６６例重症缓慢性心律失常患者，进行起搏术后感染及其危险因素的调查，起搏术后感染６９例，感染率为２５．９４％，其中导管切口感染２５例，感染率９．４０％，皮囊切口感染２２例，感染率８．２７％。对调查的１５个因素进行单因素分析，术前住院天数、本次住院接受手术次数、消毒措施、暴露于ＣＣＵ、机器产地、植入方式、术中切口抗生素冲洗、术后预防用抗生素、易感因素与术后感染的发生有显著的联系。通过逐步回归分析，筛选出了４个与起搏术后感染有显著联系的因素：预防用抗生素、消毒措施、暴露于ＣＣＵ、植入方式。其中预防用抗生素种类多、暴露于ＣＣＵ均增加术后感染的危险性；而消毒措施、植入方式与术后感染呈负相关。     

念珠菌感染的病原学及危险因素研究

目的:探讨住院患者念珠菌感染的病原学特征以及发生的相关危险因素。方法:对2006年4月1日到2008年3月31日间住院的1170例患者进行念珠菌感染的病原学研究;采用病例对照研究,对1170例念珠菌感染者和1220例无念珠菌感染者进行对比分析,应用SPSS13.0统计软件分析念珠菌感染发生的危险因素。结果:(1)从不同部位共分离出念珠菌1258株,以白念珠菌895株(71.14%)为最多、其次为光滑念珠菌(10.73%)、克柔念珠菌(10.26%)、热带念珠菌(3.42%)、近平滑念珠菌(2.78%)、葡萄牙念珠菌(1.67%);(2)单因素统计学分析结果显示住院患者念珠菌感染由多种因素造成;Logistic多因素回归分析结果显示:性别、年龄、病原菌检测时间、基础疾病、白蛋白值、预防性使用抗念珠菌药物、使用免疫抑制剂以及有创的检查和治疗是住院患者念珠菌感染的独立危险因素。结论:白念珠菌仍为住院患者念珠菌感染的主要病原菌;早期诊治基础疾病、合理规范应用检查和治疗手段是预防念珠菌感染的关键。     

食管及贲门癌患者术后感染危险因素研究

目的 探讨食管、贲门癌患者术后感染危险因素,为疾病诊治和术后感染预防提供依据.方法 对医院2009年1月-2012年12月收治的620例食管、贲门癌患者进行回顾性分析,分析其术后感染率、感染部位和病原菌分布;选择性别、年龄、吸烟等16个变量进行单因素回归分析,并应用logistic回归分析分析食管、贲门癌术后感染的危险因素.结果 620例食管、贲门癌患者术后感染率为13.2％,其中切口、肺部、胸腔感染率分别占41.5％、46.3％、3.7％;经单因素logistic回归分析,吸烟、糖尿病、手术方式、术后发热、术后白细胞、肿瘤部位和肺部疾病7个变量与术后感染相关(P＜0.05);经多因素logistic回归分析,吸烟、手术方式、术后发热和肺部疾病4个变量是食管、贲门癌患者术后感染独立危险因素(P＜0.05).结论 食管、贲门癌患者术后感染发病率较高,吸烟、糖尿病、手术方式、术后发热、术后白细胞、肿瘤部位和肺部疾病等与术后感染有关,针对以上因素应积极采取有效措施,降低术后感染发生率.     

2011年医院感染现患率调查结果分析

目的 了解医院感染现状及抗菌药物使用情况,为提高医院感染管理水平提供科学依据.方法 统一培训调查人员,床旁询问病史与查阅病历相结合,填写统一的个案调查表;对调查日处于医院感染状态的病例进行统计分析.结果 应查住院患者656例,实查654例,实查率99.7％,发生医院感染16例,现患率为2.5％,感染1 7例次,例次感染率为2.6％;感染部位前3位依次为上呼吸道、下呼吸道、泌尿系感染,分别占41.2％、23.5％、11.8％;抗菌药物使用率为43.7％.结论 加强重点科室的目标性监测,强化医务人员感染知识培训,减少侵入性操作,合理应用抗菌药物,降低医院感染发生率.