How to improve the collection and analysis of hospital antibiotic consumption: preliminary results of the ConsoRes software experimental implementation

Objective

The online software ConsoRes is used to collect and analyze data on antibiotic consumption and evolution of bacterial resistance in healthcare institutions in every hospital ward (HW). We report the first results of ConsoRes implementation in the northeast hospitals of France.

Methodology

ConsoRes was implemented in January 2011, in nine volunteer hospitals after performing an onsite assessment. Five of these hospitals were already monitoring antibiotic consumption with a network such as Raisin ATB or Antibiolor, providing feedback on the various evaluation tools.

Results

The ConsoRes data collection import function meets expectations of pharmacists, bacteriologists, or clinicians since it is user friendly, prevents redundant data input, and allows data transfer to the national databases. Importing the hospital organizational structure prevents mistakes on consumption allocation, which was noted in the previous databases, and makes comparison and benchmark analysis reliable. ConsoRes also provides a rapid consumption data feedback to all registered users within the hospital, whether in charge of a ward (clinician) or having a transversal function (pharmacist, bacteriologist). The availability of an automatic standard report or of an online customized report is another major feature of ConsoRes.

Conclusion

Besides providing surveillance, the concomitant analysis of local antibiotic consumption and bacterial resistance should have an educational impact by allowing each user to implement actions within the framework of antibiotic stewardship.     

Use of creative activities in occupational therapy practice in sweden

The aim of this study was to describe the prevalence of creative activities in occupational therapy in Sweden and how often Swedish occupational therapists use creative activities as a means of intervention. A web‐mail survey was sent to 2975 Swedish occupational therapists working in health care at regional, county council or primary health care level, and those working in vocational rehabilitation. A total of 1867 (63%) answered the questionnaire and showed that 44% did use creative activities as a means of intervention and most often by practitioners working in psychiatric health care. The most commonly used form of creative activity was arts and crafts followed by gardening. This web‐mail survey was based on a limited amount of items regarding creative activities. Further research should focus on in‐depth inquiries about how occupational therapists and their patients perceive the use of creative activities as a means of treatment in occupational therapy. Copyright © 2012 John Wiley & Sons, Ltd.     

女性泌尿生殖道支原体感染情况及耐药性分析

目的 了解某院女性非淋菌性阴道炎患者生殖道支原体感染状况及支原体抗菌药物的敏感性,指导临床合理用药.方法 对984例标本用支原体培养、鉴定药敏试剂盒进行型别鉴定及药敏试验.结果 支原体总阳性感染率为63.7％,解脲脲原体(Uu)、人型支原体(Mh)、Uu+Mh混合感染的阳性率分别为42.6％、1.9％、19.2％,药敏结果显示:支原体对强力霉素、美满霉素、交沙霉素的敏感性较好,对红霉素耐药率最高;支原体多重耐药现象严重.结论 该院女性患者支原体感染检出率很高,尤其是Uu和Uu+Mh的感染;支原体的耐药情况比较严重,进行病原检测及药敏试验对指导临床治疗,控制疾病的传播和蔓延具有重要的意义,强力霉素、美满霉素、交沙霉素可作为该院治疗支原体的经验用药.     

不同标本分离的铜绿假单胞菌对抗生素的耐药性

目的将不同来源标本分离的铜绿假单胞菌(Pseudomonas Aeruginosa,PA)进行抗生素耐药性试验,比较PA菌的院内环境涂抹样、院内患者和院外环境分离株对抗生素的耐药情况。方法收集不同来源PA菌,利用VITEK 2 compact全自动微生物鉴定仪对PA菌进行细菌生化鉴定及药物敏感性试验。结果 16株院内环境涂抹样、28株患者分离株,9株外环境分离株,共53株PA菌。对呋喃妥因与哌拉西林/他唑巴坦耐药率为10%～20%;对庆大霉素、亚胺培南、左旋氧氟沙星、美罗培南、哌拉西林耐药率为20%～30%;对头孢曲松、头孢呋辛酯和环丙沙星耐药率均为98.11%;对阿米卡星、氨苄西林、氨苄西林/舒巴坦、氨曲南、头孢唑啉、头孢吡肟、头孢替坦、头孢他啶、头孢呋辛、妥布坶素、复方新诺明耐药率为100%。PA对7种抗生素耐药率在10.0～30.0%,其中院外环境分离的菌株耐药率为0,院内和患者分离的菌株耐药率分别为18.8%和27.6%。结论不同来源标本分离株对抗生素耐药性存在差异。院外环境与院内环境涂抹样及患者分离株耐药性差异较大。     

团队技能训练在精神障碍患者康复中的效果评价

目的：观察团队生活技能训练模式在精神障碍患者康复中的效果。方法：采用生活技能训练（SST）与放松疗法相结合的精神康复模式,对54例住院精神障碍患者进行为期5周的干预。采用SST评估表、住院精神病患者日常生活能力评定量表（ADLPI）评价患者日常生活能力。结果：训练前、后及随访1年时,各量表分值发生较大变化,差异有统计学意义（P〈0.01）。结论：在常规药物治疗基础上辅以团队生活技能训练,可改善精神障碍患者的日常生活能力,提高患者的生活质量。     

库克沙门菌引起的食物中毒病原学检测

目的:检测从食物中毒事件中分离到的致病菌的生物学特性,确定食物中毒的病原。方法:参照GB4789.4-2010的方法,对检出的菌株进行表型的鉴定;采用WHO推荐的改良K-B纸片法对检出的菌株进行抗生素敏感试验;运用PFGE方法对检出的菌株进行分子分型及流行病学特征分析。结果:从5份粪便样品中检出5株库克沙门菌,从3份剩余食物中检出1株库克沙门菌,共计6株菌。血清抗原式均符合[1,3,19:g,m:-];生物学性状和药敏试验结果一致;PFGE带型完全一致。结论:本次食物中毒是由库克沙门菌污染引起;PFGE技术适用于菌株的同源性分析和传染源的追踪。     

女性泌尿生殖道感染解脲脲支原体的耐药现状

目的 探讨女性泌尿生殖道感染解脲脲支原体(Uu)的耐药现状,为临床医师抗感染治疗提供用药依据.方法 采用珠海迪尔生物工程有限公司生产的支原体培养药敏试剂盒对833例女性泌尿生殖道感染患者进行Uu培养和药敏试验.结果 Uu检测阳性率为52.9％;对Uu敏感率＞70.0％的抗菌药物有四环素、交沙霉素、多西环素、米诺环素、克拉霉素;面对氟喹诺酮类抗菌药物环丙沙星、氧氟沙星敏感率最低,分别为9.3％和15.6％.结论 临床医师应加强对Uu的耐药性监测,按照药敏试验结果合理选用抗菌药物,以提高Uu感染的临床治愈率.     

儿童尿路感染常见病原菌的分布及耐药性

目的 探讨儿童尿路感染常见病原菌的种类分布及耐药性,为临床医师选择抗菌药物提供参考依据.方法 对2009年1月-2010年12月中段尿标本分离的病原菌进行统计分析,细菌培养和菌株鉴定严格按《全国临床检验操作规程》进行;药敏试验采用纸片扩散法,药敏结果按照CLSI 2009-2010年标准进行分析判断.结果 223株儿童尿路感染病原菌以大肠埃希菌为主,占38.1％,其次是肠球菌属,占18.8％,除碳青霉烯类抗菌药物对革兰阴性杆菌、糖肽类抗菌药物对革兰阳性球菌保持了100.0％的抗菌活性以外,尿路感染病原菌对常用抗菌药物均显示了不同程度的耐药性.结论 儿童尿路感染病原菌的耐药性呈上升趋势,其原因与临床大量使用广谱抗菌药物密切相关,应采取有效措施进行干预.     

肺结核患者下呼吸道医院感染病原菌的分布及耐药性分析

目的 探讨肺结核患者下呼吸道医院感染病原菌的分布及耐药现状,为临床选择抗菌药物提供参考依据.方法 病原菌培养与鉴定按照《全国临床检验操作规程》进行;药敏试验采用CLSI推荐的K-B法.结果 223株下呼吸道病原菌中,革兰阴性杆菌占78.5％,革兰阳性球菌占16.1％,真菌占5.4％;分离出的病原菌为多药耐药菌,对常用抗菌药物产生了严重的耐药性;MRSA的检出率为57.7％.结论 应采取有效的干预措施,降低肺结核患者医院感染的发病率.     

ICU医院感染嗜麦芽寡养单胞菌耐药性分析

目的 调查重症监护病房(ICU)医院感染嗜麦芽寡养单胞菌(SMA)的耐药现状,为临床医师诊断疾病与合理用药提供试验依据.方法 细菌培养严格按《全国临床检验操作规程》进行;菌株鉴定采用法国生物梅里埃公司生产的VITEK-32全自动细菌分析系统及鉴定卡;采用K-B法进行药敏试验,依据CLSI最新折点判读结果;数据处理应用WHONET软件分析.结果 179株SMA对亚胺培南耐药率为100.0％;而对CLSI推荐的3种抗菌药物米诺环素、磺胺甲噁唑/甲氧苄啶、左氧氟沙星耐药率分别为7.3％、11.7％、14.0％.结论 SMA具有天然广谱耐药性特征,ICU医护人员应根据其药敏试验检测的结果进行抗感染治疗.