Inflammatory bowel disease does not alter the clinical features and the management of acute pancreatitis: A prospective,multicentre, exact-matched cohort analysis

Objective and aimsAcute pancreatitis in inflammatory bowel disease occurs mainly as an extraintestinal manifestation or a side effect of medications. We aimed to investigate the prognostic factors and severity indicators of acute pancreatitis and the treatment of patients with both diseases.DesignWe performed a matched case-control registry analysis of a multicentre, prospective, international acute pancreatitis registry. Patients with both diseases were matched to patients with acute pancreatitis only in a 1:3 ratio by age and gender. Subgroup analyses were also carried out based on disease type, activity, and treatment of inflammatory bowel disease.ResultsNo difference in prognostic factors (laboratory parameters, bedside index of severity in acute pancreatitis, imaging results) and outcomes of acute pancreatitis (length of hospitalization, severity, and local or systemic complications) were detected between groups. Significantly lower analgesic use was observed in the inflammatory bowel disease population. Antibiotic use during acute pancreatitis was significantly more common in the immunosuppressed group than in the non-immunosuppressed group (p = 0.017). However, none of the prognostic parameters or the severity indicators showed a significant difference between any subgroup of patients with inflammatory bowel disease.ConclusionNo significant differences in the prognosis and severity of acute pancreatitis could be detected between patients with both diseases and with pancreatitis only. The need for different acute pancreatitis management is not justified in the coexistence of inflammatory bowel disease, and antibiotic overuse should be avoided.     

社康中心抗菌药用药规范调查及规范用药对策研究

目的调查分析社康中心抗菌药物不合理使用情况,针对原因探讨相应对策,为促进合理用药积累经验。方法随机选取本市27家社康中心为研究对象,在每家社康中心2012年全年开具的抗菌药处方中,采用随机数字法抽取50张进行审核,对审核过程中发现的抗菌药物不合理使用情况进行分类、总结和分析;针对抗菌药物不合理使用原因探讨相应对策,并比较对策实施前后抗菌药物不合理使用情况变化。结果 2012年随机抽取的1350份抗菌药处方中,经过审核发现不合理用药293份,占整个处方量的21.7%,其中药物选择不合理占13.0%,联合用药不合理占20.8%、重复用药占9.2%、溶媒不合理占18.8%、用法用量不合理占38.2%。经过实施规范用药对策,2013年不合理用药发生率显著低于2012年(9.3%vs 21.7%,χ2=78.9,P<0.05)。结论通过对社康中心不合理用药情况的统计分析,制定相应的规范措施,为选择合适的抗菌药物以及采用合适的用药方法等奠定了基础,保证了临床用药的合理性和科学性。     

乌鲁木齐头屯河地区多药耐药菌临床分布及耐药性分析

目的：了解乌鲁木齐头屯河地区多药耐药菌(MDROs)的临床分布及耐药性,为临床合理使用抗菌药物提供参考。方法回顾性分析2014年1月—2015年1月门诊及住院患者分离的MDROs的分布及耐药性,采用合肥恒星科技开发有限公司的HX-21细菌鉴定分析系统软件进行数据分析。结果共分离出215株MDROs,排在前三位的依次是产ESBLs大肠埃希菌、产ESBLs肺炎克雷伯菌、多药耐药鲍氏不动杆菌(MDRAB)。三种MDROs对氨苄西林耐药性均为100%,对头孢唑啉耐药性也均>94%。结论 MDROs对多种常用的抗生素耐药程度高,应加强患者多药耐药的检测,指导临床合理用药。     

抗生素使用策略改进对胎龄<35周早产儿近期临床结局的影响北大核心CSCD

目的分析抗生素使用策略改进对胎龄<35周早产儿近期临床结局的影响。方法收集2014年1月1日至2016年12月31日在中南大学湘雅医院新生儿重症监护室住院的865例胎龄<35周早产儿的临床资料。改进的抗生素使用策略于2015年1月1日开始实施,根据改进抗生素使用策略实施时间将收集的临床资料分为3组:调整前组303例(2014年1月1日至2014年12月31日),调整后Ⅰ组293例(2015年1月1日至2015年12月31日),调整后Ⅱ组269例(2016年1月1日至2016年12月31日),回顾性分析比较3组患儿的临床资料。结果3组早产儿的胎龄、小于胎龄儿比例、性别及出生方式等方面比较差异无统计学意义(P>0.05)。与调整前组相比,调整后Ⅰ组及调整后Ⅱ组在生后早期和住院期间抗生素使用率下降,使用时间明显缩短(P<0.05);生后早期抗生素使用时间≤3 d和4~7 d比例均升高,>7 d比例明显降低(P<0.05)。与调整后Ⅰ组相比,调整后Ⅱ组在生后早期和住院期间抗生素使用时间进一步缩短(P<0.05);生后早期抗生素使用时间≤3 d比例升高,4~7 d和>7 d比例明显降低(P<0.05)。调整后Ⅰ组和调整后Ⅱ组肠外营养使用时间及住院时间较调整前组明显缩短(P<0.05)。≥Ⅲ度脑室内出血及晚发型败血症发生率在抗生素使用策略调整前后呈逐步下降趋势。多因素logistic回归分析提示,调整抗生素使用策略对近期临床不良结局无影响,抗生素使用>7 d明显增加了近期临床不良结局的发生风险(P<0.05)。结论改进抗生素使用策略,减少胎龄<35周早产儿不必要抗生素的使用是可行的,同时明显缩短肠外营养使用时间和住院时间,且≥Ⅲ度脑室内出血及晚发型败血症发生率也呈下降趋势。     

Impact of additional antibiotics on in-hospital mortality in tuberculosis isolated general bacteria: A propensity score analysis

Whether or not additional antibiotics with anti-tuberculosis agents are required to treat bacterial co-infection with pulmonary tuberculosis is unclear. We aimed to assess the impact of additional antibiotics on mortality in pulmonary tuberculosis patients whose sputum cultures were positive for general bacteria as a surrogate definition of bacterial pneumonia. This study was a single-center retrospective cohort using a propensity score analysis. We included patients who were admitted for pulmonary tuberculosis and whose sputum cultures were positive for general bacteria. The mortality of patients who received additional antibiotics was analyzed after adjusting for other variables, including the propensity score predicting treatment with additional antibiotics. We assessed 68 and 55 tuberculosis patients treated with and without general antibiotics, respectively. Additional antibiotics tended to be administered to patients with a high level of C-reactive protein and neutrophil count, poor performance status, hypoxemia and hypoalbuminemia (C-statistics of area under receiver operating characteristic curve to the propensity score; 0.884, p < 0.001). In the multivariate analysis, advanced age and not the use of additional antibiotics was associated with in-hospital mortality. Additional antibiotics with anti-tuberculosis agents may not improve the prognosis of pulmonary tuberculosis patients whose sputum cultures were positive for general bacteria. Isolation of general bacteria does not equate to complication with bacterial pneumonia, so physicians should not administer general antibiotics to TB patients based solely on the results of sputum culture for general bacteria. A prospective study is needed to verify these results using a more accurate definition of pulmonary tuberculosis complicated with bacterial pneumonia.     

Comparison of identification and antimicrobial resistance pattern of Staphylococcus aureus isolated from Amassoma,Bayelsa state,Nigeria

Background

Staphylococcus aureus is often responsible for fatal infections and recent upsurge of resistant strains has resulted in therapeutic failure. The identification of this microorganism is a major challenge to medical microbiologists in developing countries.

Methods

One hundred and eighty five isolates which had been previously isolated from the nares of 185 healthy college students'' volunteers in Amassoma, Bayelsa State, South Nigeria were identified by MALDI TOF mass spectrometry, and PCR amplification of the spa gene. The identified isolates were compared with presumptive identities obtained by growth on MSA, tube coagulation and slide agglutination tests. Antimicrobial susceptibility testing of S. aureus isolates was performed by Kirby Bauer technique while MRSA was screened for by growth on chromlDTM MRSA plate and confirmed by PCR-amplification of mecA/mecC genes.

Results

From the 185 staphylococci that grew with yellow colonies on MSA, 24 were positive in the slide coagulase test, while 17 were positive in the tube coagulase test; MALDI TOF mass spectrometry and PCR amplification of the spa gene showed excellent concordance with the tube test, as all tube coagulase-positive strains were identified as S. aureus, while tube coagulase-test negative isolates in all cases were designated as other staphylococcal species by MALDI-TOF mass spectrometry and were spa PCR test negative. All S. aureus isolates were susceptible to clindamycin, vancomycin, fusidic acid, rifampicin and linezolid, while observed resistance to penicillin and trimethoprim were high. Only one MRSA strain was detected

Conclusion

The study confirms that the tube coagulase test is an accurate diagnostic method for identification of S. aureus, while growths on MSA and slide agglutination tests are inaccurate. We found a low prevalence of MRSA and a high rate of trimethroprim-resistance in the studied population.