Multidrug resistant Psudomonas aeruginosa infections complicating surgical wounds and the potential challenges in managing post–operative wound infections: University of Calabar Teaching Hospital experience

ObjectiveTo ascertain the antimicrobial susceptibility profile of Pseudomonas aeruginosa (P. aeruginosa) recovered from surgical site infections (SSIs).MethodsThe study was retrospective in nature and was compiled for a period of five years (1st February, 2004–31st January, 2009). Data were generated from the culture of post-operative wound swab specimens by the microbiology laboratory of University of Calabar Teaching Hospital. Relevant information from the patients' records was compiled, such as age, gender, type of surgical procedure, microorganisms recovered and their antibiotic sensitivity patterns. Obtained data was analysed by using Epi Info 6 statistical software.ResultsOf the 4 533 wound swab specimens processed, 673 were culture positive and P. aeruginosa was recovered from 13.1% of the culture positive specimens with its rate of recovery decreasing with age progression (P< 0.05) but with no gender difference (P> 0.05). Most of the P. aeruginosa isolates were from general surgery wards and least from orthopaedic wards. Ofloxacin, ceftriaxone and augmentin were the most active antibiotics while ampicillin, tetracycline and cotrimoxazole were the least active antibiotics, with no antibiotic having a 100% activity against the organism.ConclusionsIn view of the high resistance displayed by P. aeruginosa recovered from SSIs, adequate antiseptic procedures should be entrenched to avoid colonization of surgical wounds by this microorganism as well as others with similar sensitivity profile. Ofloxacin, ceftriaxone and augmentin may be considered for prevention of P.aeruginosa infection.     

无创颅内压监测仪临床应用中N2波的特点

目的:目前无创颅内压监测仪尚未在临床得到广泛和熟练应用,总结无创颅内压监测仪临床应用中的N2波形特点,为今后的工作提供指导意义。方法:①实验对象:选取2006-01/2007-01珠江医院神经外科住院颅脑损伤患者50例,分成3组,其中颅内血肿急诊手术组20例,颅内血肿保守治疗后加重再手术组10例,颅内血肿保守治疗组20例,以及正常对照组20例。均对本实验知情同意。②主要实验仪器:应用MICP-1A型无创颅内压监测仪(重庆名希公司),闪光眼罩,所产生的光源为蓝色氖光,闪光刺激频率1.0Hz,闪光脉冲宽度2ms,闪光次数70次(1次/s),枕部电极和额部电极。③实验评估:前两组分别监测手术前后颅内压闪光视觉诱发电位值,共3次,后两组在相应时间分别测定闪光视觉诱发电位值,每次监测颅内压后即刻腰穿测定颅内压进行对照。闪光视觉诱发电位颅内压监测时,15min内连续3遍测定闪光视觉诱发电位值并记录,取平均值,分析所记录240幅闪光视觉诱发电位的N2波,总结N2波特点,比较同一测试者随着颅内压的改变闪光视觉诱发电位值的变化情况。结果:闪光视觉诱发电位的N2波监测的颅内压结果和腰椎穿刺测定的颅内压结果等效(P>0.05),设定等效界值为0.098kPa(10mmH2O)。颅内血肿组闪光视觉诱发电位值均高于正常对照组(P<0.05)。在同一测试者,多次测量也可得出不同的波形,N2波的变化趋势稳定,N2波波幅与颅内压无关,N2波较宽,其波形的一个主要特点是前后均有较深的P波。颅内压越高N2波潜伏期越长。结论:闪光视觉诱发电位的值和腰穿测定颅内压结果基本接近,可以直接反应出颅内压的改变趋势,尽管N2波形变化较大,但是还是有规律可循,N2波的中点潜伏期可以作为测量颅内压的依据。