重症脑出血微创术后下呼吸道感染病原学分析

目的:重症脑出血微创术后气管切开病人痰培养病原菌分布与耐药情况分析,其院内感染发生的原因、探讨防治对策。方法:应用痰培养检出的病原菌及耐药性分析。结果:重症脑出血微创术后气管切开病人下呼吸道感染41例,其中G-杆菌26例占63.4%,G 球菌15例占36.6%,其中金葡菌11例,药敏仍以敏感菌株为主,但耐药菌株有增多趋势。结论:重症脑出血微创术后气管切开病人下呼吸道感染以G-杆菌为主,G 球菌以金葡菌为主,仍以敏感菌珠为主,耐药有增多趋势。万古霉素对G 球菌,氨曲南对G-杆菌敏感性较敏感,故在培养结果未出来之前经验用药是非常重要的。     

门诊抽血室医院感染标本检测结果分析

目的 :了解门诊抽血室医院内感染情况。方法 :通过对空气培养、医护人员的手、物体表面、使用中的消毒液 4项指标 112 0份标本进行监测分析。结果 :112 0份标本检验结果合格 10 30份 ,合格率 92 % ,不合格标本 90份 ,培养出细菌 87份。结论 :通过监测抽血室的医院感染标本 ,了解了院内感染情况 ,有效地减少和防止了医护人员之间、医患之间以及和家属之间的交叉感染 ,提高了医疗护理质量 ,预防了医院交叉感染的发生。     

Posaconazole salvage therapy allows successful allogeneic hematopoietic stem cell transplantation in patients with refractory invasive mold infections

We describe the clinical courses of 3 patients with hematologic malignancies (2 with acute myelogenous leukemia and 1 with multiple myeloma) who developed invasive fungal infections due to uncommon molds (Alternaria spp., Paecilomyces lilacinus, and Zygomycetes). Breakthrough invasive fungal infections of the sinus (n=1), lung (n=3), and pericardium (n=1) developed despite fluconazole prophylaxis and failed to respond to treatment with other licensed antifungal therapies, including amphotericin B (n=3), caspofungin (n=2), and voriconazole (n=3), and surgical intervention (n=2). Salvage therapy with posaconazole oral suspension resulted in successful outcomes in all 3 patients, who subsequently underwent allogeneic hematopoietic stem cell transplantation (HSCT) while on continued posaconazole therapy. The median duration of posaconazole treatment before HSCT was 5 months (range: 1.5-6 months). Posaconazole salvage therapy allowed successful allogeneic HSCT in 3 patients with refractory invasive mold infections.     

加替沙星序贯治疗下呼吸道细菌感染的药物经济学评价

目的对加替沙星序贯治疗下呼吸道细菌感染进行药物经济学评价。方法将69例下呼吸道细菌性感染患者，随机分为A组（34例）、B组（35例），其中A组采用加替沙星注射液400mg静脉滴注，每天1次，连用10天；B组先用加替沙星注射液400mg静脉滴注，每天1次，3—4天后改为口服400mg，每天1次，连用6—7天，然后对两种方案进行成本-效果分析。结果两组在临床疗效、不良反应发生率及细菌清除率方面差异无统计学意义（P〉0．05）；但A组的医疗费用却高于B组（P〈0．01）。结论加替沙星序贯疗法与单纯静脉滴注相比更安全，更经济合理。     

减少护理人员医院感染危险因素的思考

减少护理人员医院感染的发生 ,是现代医院管理的重要内容之一 ,也是护理管理不容忽视的课题。为了提高护理人员对医院感染危险因素的认识和防护能力 ,通过对护理工作中医院感染危险因素的客观分析 ,探讨有效的护理干预和防护措施 ,以保证护理人员的安全     

阴道毛滴虫与沙眼衣原体共生关系的初步探讨

目的 :为了探讨阴道毛滴虫与沙眼衣原体共生、协同致病的关系 ,对南通市公安局收容教育所非淋菌性阴道炎、尿道炎 (后称非淋患者 )患者以及本市某国营纺织厂同龄纺织女工阴道毛滴虫的寄生情况进行了 6个月以上的连续性观察。方法 :对 2 0 0 1年到 2 0 0 3年期间南通市公安局收容教育所非淋患者 1983例女性和随机抽样国营纺织厂纺织女工 2 84人分别采用生理盐水涂片法镜检阴道毛滴虫滋养体。结果 :非淋患者阴道毛滴虫滋养体的平均阳性检出率为 2 0 .6 8% (41/1983) ,明显高于正常对照组 (1.0 6 % ,3/2 84 ) ,差异显著 (X2 =2 5 .2 9,P <0 .0 0 1) .其中沙眼衣原体感染者 ,阴道毛滴虫滋养体的阳性检出率有增高趋势。结论 :非淋患者中沙眼衣原体感染时 ,其阴道毛滴虫阳性检出率高于其他患者。同时选择部分病例采用单纯抗非淋病治疗和抗非淋病与抗滴虫同时治疗进行比较并跟踪追访 6个月 ,缓解和消除症状后者明显优于前者 ,少数不规范治疗或擅自放弃治疗的人 ,延误病情或使病程迁延而转为慢性 ,给根治来一定的难度。建议注意阴道毛滴虫与沙眼衣原体共同感染协同致病的情况 ,要鉴别病原体 ,联合用药 ,提高疗效。     

综合医院医务人员感染SARS情况对比分析

目的：分析在防治SARS工作初期、后期医务人员感染SARS的差异和采取的对策，为减少综合医院内医务人员SARS的感染提供参考。方甚：对本院自2003年3月24日至6月2日SARS诊断治疗任务中发生的医务人员的感染原因和采取的对策进行回顾性分析。结果：防治SARS工作初期，急诊科交叉感染和在SARS隔离病房等与SARS患者密切接触的工作岗位，共有17名医务人员感染，及时隔离治疗，均已痊愈，未造成医护人员的进一步交叉感染：经加强防护培训，改善工作条件，在防治SARS工作后期，仅发生2名护工感染，亦已痊愈，派出非典医疗队实现零感染。结论：综合医院内医务人员感染SARS的问题严峻，加强医院内的全员防护培训，按岗分区管理，改善医务人员的工作条件和病人的隔离观察环境，做好监督检查，积极应对，可以减少医务人员的SARS感染。     

Incidence of hospital-acquired infections associated with caesarean section

A retrospective cohort study was conducted to determine the incidence of post-caesarean infections in a Canadian community teaching hospital using computer algorithms designed for the diagnosis of nosocomial infections. Inferential chart review was done on 1335 women delivered by lower-segment caesarean section (793 primary and 542 secondary) at the Calgary General Hospital between January 1985 and April 1988. The overall infection rates were 42·1 and 46·1% for women delivered by primary and secondary caesarean section, respectively. Incisional surgical wound infection accounted for the largest proportion of post-caesarean infections found. Women delivered by primary caesarean section had significantly higher rates of endometritis, deep surgical wound infection and bacteraemia than those delivered by secondary section. All types of post-caesarean infection, except asymptomatic bacteriuria, caused the duration of the post-partum hospital stay to be significantly increased.     

Nutrition et fonction immunitaireNutrition and immune function

A deficiency of total energy or of one or more essential nutrients, including vitamins A, B₆, B₁₂, C, and E, folic acid, zinc, iron, copper, selenium, essential amino acids and essential fatty acids, will impair immune function and increase susceptibility of the host to infectious pathogens. This is most likely because these nutrients are involved in the molecular and cellular responses to challenge of the immune system. Providing these nutrients to deficient individuals restores immune function and improves resistance to infection. Thus, appropriate nutrition is required in order for the host to maintain adequate immune defences towards bacteria, viruses, fungi, parasites and tumour celîs. Although the intakes of several nutrients which result in greatest enhancement of immune function appear to be greater than recommended intakes, excess intake of certain nutrients also impairs immune responses. Some nutrients (e.g. glutamine, arginine) may become limiting in critical illness and there is mounting evidence that provision of these will aid patient recovery.