Alkaline phosphatase: An old enzyme newly discovered as a medicine

Alkaline phosphatase (AP), a non-toxic natural compound (enzyme) has a great potential to replace or avoid the use of various drugs, in particular anti-inflammatory drugs (e.g. used during surgery and to reduce arthritis) and antibiotics applied to farm animals, which both have serious negative effects on the environment. Promising studies are being performed to demonstrate the possibility to avoid complications after major surgery (thereby eliminating the need to use harmful drugs for many years) and the reduction of antibiotics use in piglets.     

青黛粉联合抗生素治疗糖尿病皮肤感染疗效观察

目的:观察青黛粉联合抗生素治疗糖尿病皮肤感染的临床疗效。方法:选取2009年1月~2012年1月期间在本院皮肤科住院治疗的80例糖尿病皮肤感染患者为研究对象,采用分组对照法,观察组40例采用青黛粉+红霉素敷料换药,对照组40例单纯采用红霉素敷料,回顾性分析两种用药方法的效果。结果:治疗7d后观察组8例(占20%)患者感染创面为重度,对照组为2例(占5%),组间比较μ=3.221,7.609,P<0.05,观察组51个创面,总有效率为90.56%,对照组53个创面,总有效率为84.51%,μ=1.879,P<0.05,提示青黛粉联合抗生素治疗糖尿病皮肤感染疗效显著好于未加青黛粉的对照组,差异显著,有统计学意义。结论:加用青黛粉的观察组疗效显著好于单纯使用抗生素的对照组,有助于缩短疗程,加快皮肤感染组织的修复,促进早期愈合,疗效确切,值得临床推广应用。     

Can we back off using antibiotics in the NICU?

Antibiotics are extensively and inconsistently prescribed in neonatal ICUs, and usage does not correlate with rates of culture positive sepsis. There is mounting data describing the short and long-term adverse effects associated with antibiotic overuse in neonates, including the increased burden of multi-drug resistant organisms. Currently there is considerable variation in antibiotic prescribing practice among neonatologists. Applying the practice of antibiotic stewardship in the NICU is crucial for standardizing antibiotic use and improving outcomes in this population.Several approaches have been proposed to identify neonatal sepsis, with the hope of reducing antibiotic utilization. These strategies all have their limitations, and often include laboratory testing and treatment of well-appearing, non-septic, infants. A conservative “watch and wait” algorithm is suggested as an alternative method for when to initiate antibiotics. This observational approach relies on availability of trained personnel able to examine infants at specified intervals, without delaying antibiotics, should signs of sepsis arise.     

The pattern of infection and antibiotics use in terminal cancer patients

BackgroundAlthough cancer patients are susceptible to infection, there is no evidence-based published guideline on the appropriate use of antimicrobial treatment in this group of patients.MethodsWe retrospectively collected medical records of all terminal cancer patients who died in the oncology department over a 15-month period and were reviewed for the pattern of infection and causes of antimicrobial use during the patients’ last admission of life.ResultsA total of 258 eligible patients were enrolled, there was an equal distribution of males and females (M/F: 129/129), and the mean age was 60.5 years. 221 patients admitted with fever (85%), 22 patients (8.5%) got fever after hospitalization and 15 patients (5.8%) did not suffer from fever. Among patients with fever, 46 patients (18.9%) had two infection episodes and 197 patients (81.1%) had only one infection episode. The culture results revealed positive in 98 patients (40%) with gram-negative organisms were the dominant organisms. The major infection sites were the respiratory tract, urinary tract and wound. 114 patients (47%) received one antibiotic and 129 patients (53%) received more than one. The mean duration of hospitalization was significantly longer for infected patients than for uninfected patients (8.00 vs. 18.15 days, p = 0.0001). Outcome of antibiotic use revealed 42 patients (17.3%) with symptoms improved 71 patients (29.2%) with stationary symptoms and 130 patients (53.5%) revealed symptom deterioration.ConclusionsOur study revealed that antibiotic therapy for terminal cancer patients should be on a clear rationale. We need further study to clarify if there is survival effect with antibiotic use or not.     

2012年医院常见病原菌分布及耐药性分析

目的 分析永州市中心医院临床标本病原菌的构成及耐药性,为医院感染防治及临床合理使用抗菌药物提供依据. 方法 对本院送检至细菌室的标本进行分离培养,其中血培养为美国BD公司BACTEC9120全自动血培养仪及配套血培养瓶,采用法国生物梅里埃VITEK-2 Compact全自动微生物分析系统及配套的鉴定和药敏卡进行测定.结果 分离到4 913株病原菌,其中革兰阴性（G-）杆菌3 046株,占62.00％,革兰阳性（G＋）球菌1 375株,占27.99％,真菌499株,占10.01％.产ESBLs大肠埃希菌和肺炎克雷伯菌总共801株,占这两种菌的55.3％,肠杆菌科细菌对亚胺培南、厄他培南、哌拉西林/他唑巴坦、头孢替坦和阿米卡星敏感,对氨苄西林耐药率最高,铜绿假单胞菌对氨苄西林/舒巴坦最敏感,鲍曼不动杆菌对阿米卡星最敏感.金黄色葡萄球菌中,耐甲氧西林金黄色葡萄球菌（MRSA）检出率为55.00％,敏感的药有替加环素、万古霉素、呋喃妥因、喹努普汀/达福普汀和利奈唑胺. 结论 2012年本院分离的病原菌以G-杆菌为主,常见病原菌耐药严重,需引起临床高度重视,并加强细菌耐药监测,合理用药,减少多重耐药菌的产生,降低医院感染率.     

河南省市售鸡肉和鸡蛋中抗生素残留及膳食暴露风险评估

目的 了解河南省市售鸡肉和鸡蛋中抗生素残留水平及膳食暴露风险。方法 随机采集河南省10个监测区域的222份样品，按照《国家食品污染和有害因素风险监测工作手册》的相关标准程序检测17种抗生素残留，结合食物摄入量，利用点评估方法对人群鸡肉和鸡蛋膳食中抗生素的暴露风险进行评估。结果 222份样品中，抗生素的总体检出率为14.4%，不合格率为6.76%。8份鸡肉样品中检出禁用氧氟沙星，6份鸡蛋样品中检出禁用甲硝唑、氟苯尼考、恩诺沙星。鸡肉中抗生素的IFS均值为0.000155，最大值为0.00350，鸡蛋中抗生素IFS均值为0.000553，最大值为0.00278，均远远低于1。结论 河南省市售鸡肉和鸡蛋中存在一定的抗生素残留，但暴露风险很低，对人体健康危害处于安全可接受水平。     

Environmental and health impact of unrecovered API from pharmaceutical manufacturing wastes: A review of contemporary treatment,recycling and management strategies

Pharmaceutical industries are imminent for the survival of any contemporary society as their products are valuable for the populace's health and wellness. However, the wastes of these industries have become a nuisance with severe implications on human health and ecosystem, especially in many developing countries where they are discharged indiscriminately into the environment, either untreated or poorly treated. Pharmaceutical Manufacturing Waste (PMW) effluents have been reported to possess a high BOD and COD, as well as recoverable APIs of various classes of pharmaceuticals. Moreover, antibiotic residues in these effluents are implicated in the progression and spread of antibiotic resistance in the aquatic and agroecosystem. Globally, the diverse activities of various pharmaceutical industries, owing to their diverse products, have resulted in difficulty in developing universal management and treatment protocols. Consequently, regulatory bodies/institutions find it challenging to monitor waste disposal practices of these industries adequately, primarily owing to their non-disclosure policies of intellectual properties. Hence, to a large extent, the onus for a sustainable society regarding PMWs lies in the decision and policies of these industries. Therefore, this review aims to foster informed policy-making decisions regarding waste management practices of pharmaceutical industries.