Necrotizing soft tissue infections

Necrotizing soft tissue infections (NSTI) represent a spectrum of diseases characterized by extensive rapidly progressive necrosis that may involve the skin, subcutaneous tissues, fascia or muscle. Their progress is extremely fast, leading often to sepsis and septic shock that ends up in multiple organ failure with abrupt and high mortality. A variety of classification systems have been developed based on parameters such as anatomic location of the disease or microbiology. There are a number of factors that predispose to the spread of these soft tissue infections, such as delays in recognition, immune suppression, diabetes mellitus and advanced age. The use of broad‐spectrum antibiotics tends to mask the severity of the underlying infection, modulates the clinical presentation, and even delays hospital admission. The most important factor affecting outcome in NSTI is early diagnosis and aggressive radical surgical treatment. The medical records of 13 patients who had been treated for NSTI from 1996 to 2005 were reviewed, retrospectively. There were eight men (61.5%) and five (38.5%) women. Mean age was 56 years (range 27–73). Seven cases of infection involved the perineal region (54%), two the lower limb, one the upper limb and three the abdominal wall/trunk. The most common associated comorbidity was diabetes mellitus in five patients (38.5%). A single organism was identified in two (15%) and multiple organisms in 11 (85%) patients. Necrotizing aponeurositis Type I was the most common of the polymicrobial necrotizing infections. Overall survival was 85%, and the mean hospital stay for survivors was 35 days (range 17–92).     

自拟消咳贴穴位贴敷治疗小儿反复呼吸道感染的临床研究

[目的 ]探讨自拟消咳贴穴位贴敷治疗小儿反复呼吸道感染 (RRI)的临床效果。 [方法 ]选择 15 0例RRI患儿 ,随机分为观察组和对照组 ,观察组在对因对症治疗基础上应用自拟消咳贴穴位贴敷 ,对照组采用对因对症治疗 ;另选 3 0例正常儿童 ,观察血浆内皮素 (ET -1)、一氧化氮 (NO)变化及临床疗效。 [结果 ]观察组治疗后血浆ET -1、NO含量明显下降 (P <0 .0 1) ,而对照组治疗前后则无统计学意义 ;观察组临床总有效率高于对照组 (P <0 .0 1) ,且每月发病次数及天数也明显降低。 [结论 ]应用自拟消咳贴穴位贴敷能有效地降低RRI患儿血浆ET -1、NO水平 ,从而提高临床疗效     

Brucella phagotypes : Their relation to the spread of infection in Italy

The spread of Brucella infection in man in Italy during the last three years is briefly reviewed with reference to the Brucella strains collected and typed.The strains were tested by H₂S production, dye-inhibition, agglutination by monospecific sera, and sensitivity to a phage set. From 108 tested strains, 91 have been identified by means of the traditional tests as Br. melitensis, sometimes with some irregularities, 10 as Br. abortus, while 7 were not typable.It was possible to recommend some phage sensitivity patterns of Br. melitensis for epidemiological purposes: one phagotype is much more frequent in the north, another in the south of Italy.However, the currently recommended phagotypes must be considered provisional and will be modified in the light of more extensive studies.Corresponding author.     

Systematic review of methods to diagnose infection in foot ulcers in diabetes.

AIM: To undertake a systematic review of the diagnostic performance of clinical examination, sample acquisition and sample analysis in infected foot ulcers in diabetes. METHODS: Nineteen electronic databases plus other sources were searched. To be included, studies had to fulfil the following criteria: (i) compare a method of clinical assessment, sample collection or sample analysis with a reference standard; (ii) recruit diabetic individuals with foot ulcers; (ii) present 2 x 2 diagnostic data. Studies were critically appraised using a 12-item checklist. RESULTS: Three eligible studies were identified, one each on clinical examination, sample collection and sample analysis. For all three, study groups were heterogeneous with respect to wound type and a small proportion of participants had foot ulcers due to diabetes. No studies identified an optimum reference standard. Other methodological problems included non-blind interpretation of tests and the time lag between index and reference tests. Individual signs or symptoms of infection did not prove to be useful tests when assessed against punch biopsy as the reference standard. The wound swab did not perform well when assessed against tissue biopsy. Semiquantitative analysis of wound swab might be a useful alternative to quantitative analysis. The limitations of these findings and their impact on recommendations from relevant clinical guidelines are discussed. CONCLUSION: Given the importance of this topic, it is surprising that only three eligible studies were identified. It was not possible to describe the optimal methods of diagnosing infection in diabetic patients with foot ulceration from the evidence identified in this systematic review.     

老年护理院医院感染病原菌及其耐药特征分析

目的探讨目前老年护理医院院内感染病原菌及其耐药特征。方法对2000年4月-2004年3月徐汇区两家老年护理院出院病人的病史进行统计分析。结果两家老年护理院共计发生医院感染939例次，医院感染率12．86％，检出病原菌284株，阳性率30．28％；病原菌以革兰阴性菌为主，占44．65％，其次为真菌、革兰阳性菌，分别为29．12％、25．92％，位于前3位的病原菌分别为其他真菌（14．36％）、白色念珠菌（12．23％）、铜绿假单胞菌（8．69％）；除嗜麦芽寡养单胞菌外，革兰阴性菌以亚胺培南最敏感，敏感率87％，对氨苄西林、阿莫西林的耐药率〉51％，对头孢哌酮、哌拉西林的耐药率〉33％；MRSA和MRSE的检出率高达86．76％和76．32％；混合感染率34．51％。结论老年护理院医院感染率高．真菌所占的比例高；细菌对抗菌药物的耐药性相当严重。     

干扰素治疗小儿呼吸道感染的研究

目的观察干扰素治疗小儿呼吸道感染的疗效。方法将90例呼吸道感染的小儿随机分成3组,在对症治疗基础上,A组静脉点滴利巴韦林10mg/(kg·d),B组肌注干扰素10μg,1次/d,C组空气压缩泵雾化吸入干扰素10μg,1次/d,观察3组的病情变化。结果C组咳嗽、发热、喘憋及肺部体征好转时间均较A组明显缩短(P<0.01),B组与C组疗效无显著性差异。结论干扰素治疗小儿呼吸道感染疗效确切,值得推广。     

封闭式负压引流治疗软组织感染

目的探讨封闭式负压引流治疗软组织感染的疗效。方法应用封闭式负压引流治疗开放性骨折发生软组织感染18例。结果18例均获随访,时间6个月-1年6个月。软组织感染均愈合,骨折正常愈合12例,延迟愈合6例,无慢性骨感染发生。结论封闭式负压引流治疗软组织感染,可短期控制感染,为进一步治疗创造条件,尤其适用于深部软组织感染患者。手术简单,疗效可靠,适合基层医院应用。     

Effectiveness of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers at hospital admission to prevent hospital-acquired MRSA infections

Screening of potential MRSA-positive patients at hospital admission is recommended in German and international guidelines. This policy has been shown to be effective in reducing the frequency of nosocomial MRSA transmissions in the event of an outbreak, but the influence of screening on reducing hospital-acquired MRSA infections in a hospital setting where MRSA is endemic is not yet well-documented. This study describes the effect of hospital-wide screening of defined risk groups in a 700-bed acute care hospital during a period of 19 months. In a cohort study with a 19-month control period, the frequencies of hospital-acquired MRSA infections were compared with and without screening. In the control period, there were 119 MRSA-positive patients, of whom 48 had a hospital-acquired MRSA infection. On the basis of this frequency, a predicted total of 73.2 hospital-acquired MRSA infections was calculated for the screening period, but only 52% of the expected number (38 hospital-acquired MRSA infections) were observed, i.e., 48% of the predicted number of hospital-acquired MRSA infections were prevented by the screening programme. The screening programme was performed with minimal effort and can therefore be recommended as an effective measure to help prevent hospital-acquired MRSA infections.     

鱼腥草注射液佐治下呼吸道感染的疗效观察

目的观察鱼腥草注射液佐治下呼吸道感染的疗效及安全性.方法将76例急性下呼吸道感染患者随机分为治疗组和对照组,两组均予内科常规治疗,治疗组则另予鱼腥草注射液治疗.结果治疗组的总有效率为94.7%,显著优于对照组的73.7%(x2=6.33,P＜0.05),且未见明显副作用.结论鱼腥草注射液佐治急性下呼吸道感染安全、有效,值得推广.