感染性心内膜炎患者病原菌及其耐药率的分析

目的 通过对感染性心内膜炎(IE)患者病原菌及其耐药率的分析,探讨IE病原菌的变迁及抗菌药物的合理应用情况.方法 对1997年1月至2006年12月收治的207例IE患者的病原菌情况进行回顾性分析.按住院时间分为Ⅰ组(2002年1月至2006年12月)及Ⅱ组(1997年1月至2001年12月),其中Ⅰ组77例,Ⅱ组130例.结果 血细菌培养阳性率47.83%,其中Ⅰ、Ⅱ组阳性率分别为38.96%和53.08%.链球菌在致病菌中的比例亦由Ⅱ组的52.17%下降到Ⅰ组的33.33%.而金黄色葡萄球菌的比例则由15.94%上升到23.33%.链球菌对青霉素G耐药率低,但近年来已由19.44%上升到30.00%.结论 血细菌培养阳性率近年来有所下降,链球菌仍然是IE的主要病原菌,对青霉素G耐药率较低,但近年来已有所上升.金黄色葡萄球菌的比例则上升.     

Active vegetations can be differentiated from chronic vegetations by visual inspection of standardized two-dimensional echocardiograms

The ability to differentiate active from chronic valvular vegetations (VEGs) by digital image processing and by visual observation was evaluated in 18 patients with a clinical diagnosis of infective endocarditis (IE). Two-dimensional echocardiographic (2-DE) examinations were performed on all patients at diagnosis and after a mean period of 52 days. Two comparable images (active and chronic) from the same patient and in the same phase of the cardiac cycle were digitized, magnified, and displayed on a high resolution monitor. The mean pixel intensity (MPI) was 72+/-14 in the active stage and 143 +/-23 in the chronic stage (P<0.0001). The VEG size was 0.64+/- 0.15 cm(2) in the active stage and decreased to 0.46+/-0.17 cm(2) in the chronic stage (P<0.001). Two experienced echocardiographers, who were blinded to the age of the VEGs, identified each echocardiographic image as active or chronic based on visual observation of density of the VEGs. The VEGs were correctly identified as active or chronic in 17 out of the 18 patients. In summary, although digital image processing of 2-DE may be useful, the density of VEGs assessed by visual inspection will help differentiate between active and chronic VEGs of IE. The standardization procedure at the time of the initial study and use of identical gain settings in subsequent studies are key factors in making this distinction.     

Anopheles species of the mount Cameroon region: biting habits,feeding behaviour and entomological inoculation rates

There is a lack of data on the Anopheles fauna, its biology and the roles played by different vector species in the transmission of malaria in the mount Cameroon region. The biting habits, feeding behaviour and entomological inoculation rates of different Anopheles species during the dry and rainy season were investigated. A total of 2165 Anopheles was collected, 805 in the rainy season and 1360 in the dry season. Five Anopheles species were identified: Anopheles gambiae s.l., An. funestus, An. hancocki, An. moucheti and An. nili. An. gambiae, An. funestus and An. hancocki, recorded during both seasons, were the main vectors of malaria in the region. An. gambiae s.s. was the only member of the An. gambiae (Giles) complex. These three species had their peak activity between 1 and 2 am. A human blood index (HBI) of 98.29% was recorded for fed Anopheles. The sporozoite rate, for all vectors together, was significantly higher in the rainy season (9.4%) than in the dry season (4.2%) with all the species infected by Plasmodium falciparum. The average inoculation rate was 0.44 infective bites per man per night, which adds up to 161 infective bites per year in this study area. Analyses of relative abundance and infection rate of malaria vectors at different sites situated along a transect of 20 km during the dry season showed high heterogeneity in biting and sporozoite rates. No malaria vector was caught at 1200 m a.s.l. The mount Cameroon region should be considered an area of high malaria transmission intensity.     

抗感染性药物用于非感染性疾病治疗的弊端

目的呼吁严格限制抗微生物药物用于治疗非感染性疾病。方法根据抗微生物药物临床应用的相关报道,分析存在的弊与利、害与益。结果抗微生物药物在治疗非感染性疾病时,其杀菌和抑菌作用即成为治疗中的不良反应,不仅会破坏患者个体体内正常寄生菌群的平衡,引起继发感染;而且其广泛性和长期性的用药特点,将导致耐药性微生物的产生和发展。结论非感染性疾病的治疗有许多其他有效的药物,并非到了不用抗微生物药物不可的地步,因此应该把遏制微生物耐药性、保护现有抗微生物药物资源作为首要任务。     

对艾滋病无症状HIV感染期的认识

对无症状HIV感染期持续时间提出新认识,并从中医学“治未病”和辨证论治等角度来阐述充分重视艾滋病无症状HIV感染期的原因。     

102 175例拟受血者输血感染性疾病血清标志物检出资料分析

目的探讨受血者输血前检测各项血源感染性疾病血清标志物情况及其意义。方法采用酶联免疫吸附试验（ELISA）对102 175例拟受血者于输血前进行乙型肝炎表面抗原、抗体（HBsAg、抗 HBs）及丙型肝炎抗体(抗 HCV)、梅毒螺旋体抗体(抗 TP)、人免疫缺陷病毒抗体（抗 HIV）检测，并进行统计分析。结果102 175例拟受血者中，输血前检出血源感染性疾病血清标志物总阳性率为15.63%，其中HBsAg、抗 HCV、抗 HIV和抗 TP单项阳性率分别为12.95%、1.11%、0.04%和1.53%。2001-2007年期间，HBsAg、抗 HCV和 抗 HBs阳性率呈明显下降趋势（P=0.003或P=0.000），而抗 HIV阳性率呈明显上升趋势（P=0.001）。结论部分受血者在输血前就已有血源性相关病原感染，特别是HBV感染率较高。受血者输血前血源感染性疾病血清标志物的检测不仅可减少和避免医源性感染及医患纠纷，还有利于了解该地区血源感染性疾病的传播情况。     

Concomitant Mitral and Tricuspid Valve Infective Endocarditis: Report of a Case

A rare case of native valve endocarditis affecting both the normal mitral and tricuspid valves is presented. A 25-year-old woman with an acute ischemic stroke was found to have vegetation secondary to infective endocarditis as the embolic source. One month after the onset of embolic cerebrovascular intervention, a valve repair with the implantation of artificial chordae, sliding commissuroplasty, and ring annuloplasty resulted in a complete recovery.     

Extremely rapid formation of mitral valve ring abscess in infective endocarditis

A patient with infective endocarditis (IE) due to methicillin-resistant staphylococcus aureus (MRSA) was found to have conversion of the hypoechoic region of the posterior mitral valve ring apparatus into a clearly delineated echolucent space by repeating transthoracic echocardiography at an interval of 1 week. Color Doppler showed features of blood entry into this space. Abscess formation in IE due to MRSA may be quick and repeated echocardiography may help detect the complications of IE. Semiurgent mitral valve plasty was performed for the associated prolapse of the posterior mitral leaflet using a hand-made, rolled, twisted autologous pericardial ring.     

盐酸左氧氟沙星片与进口左氧氟沙星治疗下呼吸道急性感染的比较

目的：通过随机非盲法试验的方法评价盐酸左氧氟沙星片治疗急性下呼吸道感染的临床疗效、安全性和细菌学。方法：随机对照选用进口左氧氟沙星作对照组,下呼吸道感染病人实验组６０例,对照组４０例,均按２００ｍｇｂｉｄ给药,疗程７ｄ。结果：实验组有效率８６．４％,细菌清除率８６．４％,不良反应发生率１３．３％;对照组分别为８２．５％、８６．８％、１２．５％。以上结果经统计学处理差异无显著性（Ｐ＞０．０５）。结论：国产盐酸左氧氟沙星与进口左氧氟沙星治疗急性下呼吸道感染同样安全有效。