老年人复发性尿路感染长疗程治疗疗效观察

目的 设计一种药物轮换、分期、长疗程的治疗方法,以临床治愈为目标,观察该方法对老年复发性尿路感染患者的疗效.方法 将入选患者分为老年组(年龄≥65岁)30例和非老年组48例,选择数种有效抗生素轮换应用.采用分期治疗方法:(1)治疗期:抗生素按常规剂量应用,直至尿常规正常;(2)巩固期:抗生素减量应用;(3)维持期:抗生素减为每晚1次,维持治疗3个月;(4)观察期:停用抗生素,观察半年.上述各分期如尿常规检查有反复,则转为前一期治疗.结果 78例患者中,治愈69例(88.5%),有效7例(8.9%),无效2例(2.6%).老年组分别为28例、1例、1例;非老年组分别为41例、6例、1例,两组治愈率差异无统计学意义(F=0.469,).老年组与非老年组比较,治愈总疗程[(54.8±16.2)周对(44.5±13.7)周,t=2.8467,P＜0.01]、治疗期[(34.3±15.2)周对(26.2±14.8)局,t=2.2081,P＜0.05]、巩固期[(5.7±2.6)周对(4.1±0.2)周,t=3.9369,P＜0.01]均延长;但两组维持期[(14.8±4.6)周对(14.2±3.1)周]比较,差异无统计学意义(t=0.6480,P＞0.05).治疗前后两组血常规、肝肾功能均无明显变化.结论 对老年复发性尿路感染患者采用药物轮换、分期、长疗程治疗,治愈率高;但老年组所需治疗时间比非老年组长.未见影响血常规、肝肾功能等不良反应.

Abstract：

Objective To observe the therapeutic effects of the drugs alternation multiple stages and long term therapy in elderly patients with recurrent urinary tract infection.Methods The patients were divided into elderly group (age≥65 years,n=30) and non-elderly group (n=48).The multiple effective antibiotics were selected for alternate use.The treatment included four periods as follows:(1)Treatment period:the regular dose of antibiotic was maintained until the urine routine test result became normal;(2)Consolidation period:the dosage of antibiotic was reduced;(3)Maintenance period:the dosage of antibiotic was reduced to once every night and the treatment should be kept for three months;(4)Observation period:the patients were observed for six months after withdrawal of antibiotics.During the treatment,if the urine routine test became abnormal repeatedly,the patient should return to the previous treatment period.During the treatment and consolidation period,each medication should be applied for one week alternatively.Results Among 78 patients,69 cases (88.5%) were cured,7 cases (8.9%) were effective,and two cases (2.56%) were invalid.There were 28 cured cases,1 effective case and 1 invalid case in elderly group.The corresponding data were 41,6 and 1 in non-elderly group,respectively.There was no difference in cure rate between the two groups (F= 0.469).Compared with non-elderly group,the overall treatment time [(54.8± 16.2)weeks vs.(44.5± 13.7) weeks,t= 2.8467,P＜0.01],treatment period [( 34.3± 15.2) weeks vs.(26.2±14.8) weeks,t=2.2081,P＜0.05] and consolidation period [(5.7±2.6) weeks vs.(4.1±0.2) weeks,t=3.9369,P＜0.01] were all prolonged in elderly group.But there was no difference in maintenance period [(14.8±4.6) weeks vs.(14.2±3.1) weeks,t=0.6480,P＞0.05].There were no markedly changes in blood routine,liver and kidney function during the course of treatment.Conclusions For the elderly patients with recurrent urinary tract infection,the drugs alternation,multiple stages and long-term treatment has a high cure rate and no adverse effect on blood routine,liver and renal function.     

超敏C-反应蛋白在白血病粒细胞缺乏期合并感染中的诊断与治疗价值

目的 探讨血清超敏C-反应蛋白(hs-CRP)浓度变化对白血病粒细胞缺乏期合并感染的诊断价值,为临床医师抗感染治疗方案及病情评估提供依据.方法 采用免疫比浊法测定hs-CPR,对87例105例次有明确感染诊断记录的白血病患者血清hs-CRP浓度进行动态检测,并与患者细菌培养结果作比对分析,同时观察hs-CRP浓度变化与白血病患者感染程度以及病情变化的关系.结果 在hs-CRP升高的患者中,以单纯细菌感染为主,检出率为52.4％,真菌培养检出率为9.5％,细菌和真菌混合感染检出率为15.2％;痰及咽拭子细菌培养以革兰阳性球菌为主;血培养主要以革兰阴性杆菌为主;白血病粒细胞缺乏期患者在发生细菌(或)真菌感染时血清hs CRP明显增高,发生败血症的患者血清hs-CRP增高尤为显著,其结果与细菌培养基本一致;抗感染治疗有效后血清hs-CRP浓度明显下降,临床症状明显缓解.结论 hs-CRP浓度的变化与患者感染程度以及病情变化有一定相关;白血病粒细胞缺乏期患者hs-CRP变化是预示机体存在感染和进行抗感染治疗的早期有效指征之一.     

Comparative antibacterial activity of topical antiseptic eardrops against methicillin-resistant Staphylococcus aureus and quinolone-resistant Pseudomonas aeruginosa

ObjectiveAural irrigation using antiseptic solutions can be an effective medical treatment of chronic suppurative otitis media (CSOM) owing to the increasing prevalence of antibiotic-resistant CSOM infections. In the present study, we compared the antimicrobial activities of 100% Burow's solution, 50% Burow's solution, 2% acetic acid, vinegar with water (1:1), and 4% boric acid solution against methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible S. aureus (MSSA), quinolone-resistant Pseudomonas aeruginosa (QRPA), and quinolone-susceptible P. aeruginosa (QSPA) in vitro.MethodsWe examined the antimicrobial activities of five antiseptic solutions against MRSA, MSSA, QRPA, and QSPA. The antimicrobial activities of the solutions were calculated as a percentage of the surviving microorganisms by dividing the viable count in each antiseptic solution with that in control. The time (D₁₀ value) required for each of the five solutions to inactivate 90% of the microorganism population was also investigated.ResultsBurow's solution exhibited the highest antimicrobial activity and the lowest D₁₀ value against MRSA, MSSA, QRPA, and QSPA, followed by 2% acetic acid, vinegar with water (1:1), and 4% boric acid solution.ConclusionOur results indicate that Burow's solution has the most potent activity against bacteria including antibiotic-resistant strains. Twofold dilution of the solution is recommended to avoid ototoxicity.     

111例药品不良反应／事件报告分析

目的：分析药品不良反应／事件（ADPUADE）的发生情况、发生特点及相关因素。方法：收集2012年凤城市中心医院上报的111例ADR／ADE报告,按照国家ADR监测中心制定的标准进行统计、分析。结果：ADR／ADE报告中,抗感染药引起的ADR／ADE最多,其次为循环系统用药;给药途径以静脉滴注为主;临床表现以皮肤及其附件损害最常见。结论：应加强对抗感染药和静脉给药方式的监测,减少ADR／ADE的发生。     

莫西沙星治疗急性胆道感染的多中心随机对照研究

目的 探讨莫西沙星治疗急性胆道感染的有效性及安全性.方法 采用多中心、前瞻性、随机、对照、非盲平行研究,选择中国13家医院普外科2009年3～12月间急性胆道感染患者319例,随机入组后在外科治疗的同时给予莫西沙星400 mg,1次/d静脉点滴为A组;B组采用头孢哌酮/舒巴坦(2.0 g 2次/d静脉点滴)联合甲硝唑(250 ml1次/d静脉点滴)作为阳性对照,比较两组对急性胆道感染治疗的临床有效性和细菌学疗效,同时观察治疗期间的不良事件.统计学分析对主要疗效指标采用Wilcoxon秩和检验比较两组差别,统计学检验均采用双侧检验,安全性分析中对两组不良事件和不良反应的发生率采用x2或Fisher确切概率法,P＜0.05为差异有统计学意义.结果 在A组入选的159例患者中有138例进入疗效评价,B组有160例患者入选,其中144例进入评价,两组基线情况相似.A组疗程(7.6±2.6)d,治疗总有效率为86.2%,B组疗程(8±3)d,治疗有效率为84.7%,差异无统计学意义(P=0.7192).两组从血液或胆汁中分别分离出55株和61株细菌,主要分离菌为大肠埃希菌、肺炎克雷伯杆菌和肠球菌,清除率分别为85.4%和82.0%,两组差异无统计学意义(x2=0.2568,P=0.6123).两组用药期间均无严重不良事件发生,依从性良好.结论 大肠埃希菌、肺炎克雷伯杆菌、肠球菌是胆道感染主要致病菌.莫西沙星单药可安全有效治疗急性胆道感染,疗效不亚于头孢哌酮/舒巴坦+甲硝唑联合治疗.

Abstract：

Objective To compare the efficacy and safety of sequential intravenous moxifloxacin treatment against cefoperazone/sulbactam in patients with acute biliary tract infection. Methods A prospective, randomized, non-blind, multi-centric study was performed to compare the efficacy and safety of moxifloxacin 400 mg Ⅳ once daily to cefoperazone-sulbactam (2 g q12 hours) and metronidazole 250 ml once daily to treat patients, from March- December 2009 in 13 hospitals, with acute biliary tract infection.The primary efficacy variable was clinical cure rate after the end of a 5 - 14 day treatment period,bacteriologic outcomes and adverse reaction effects were also determined. Results A total of 319 subjects were enrolled, 282 of whom were eligible for protocol efficacy analyses ( 138 moxifloxacin, 144 comparator).Demographic and baseline medical characteristics were similar between the 2 groups. Clinical success rates were 86.2％ for moxifloxacin and 84. 7％ for the comparator(P =0. 7192). Pathogens (55 moxifloxacin, 61 comparator) were isolated from bile or blood cultures and the predominant strains were E. coli, Klebsiella species and Enterococcus species. Bacterial eradication rates were 85.4％ ( 37 of 55 ) with moxifloxacin versus 82. 0％ (50 of 61 ) in the comparator group ( x2 = 0. 2568, P = 0. 6123 ). Both treatments were safe and well tolerated. Conclusions E. coli, Klebsiella species and Enterococcus species were the most common bacteria isolated from bile or blood from patients with acute biliary tract infection. Moxifloxacin monotherapy has high clinical and bacteriological efficacies and safety for the treatment of acute biliary tract infection.     

Prevalence and natural history of colonization with fluoroquinolone-resistant gram-negative bacilli in community-dwelling people with spinal cord dysfunction

OBJECTIVES: To estimate the prevalence of colonization with fluoroquinolone-resistant gram-negative bacilli (GNB) and to assess risk factors for and define the natural history of colonization. DESIGN: Cross-sectional study with follow-up of up to 1 year. SETTING: Multiple outpatient sites. PARTICIPANTS: Eighty-four community-dwelling adults with spinal cord dysfunction. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Colonization of perineum with fluoroquinolone-resistant GNB. RESULTS: Overall, 24% of this community-dwelling cohort was colonized with fluoroquinolone-resistant GNB with resistance to both levofloxacin and gatifloxacin. The use of any antibiotic in the last 90 days was most strongly associated with an increased risk of colonization with fluoroquinolone-resistant GNB (relative risk, 2.3; 95% confidence interval, 1.1-4.8; P=.05). Incontinence was significantly more common among those with fluoroquinolone-resistant GNB colonization. Among the participants with incontinence (n=42), the use of intermittent catheterization (vs suprapubic, urethral, or condom catheters or overflow incontinence) was significantly protective. Colonization was not associated with an increase in urinary tract infection and was often transient. CONCLUSIONS: Fluoroquinolone resistance among GNB colonizing community-dwelling people with spinal cord dysfunction is common. Colonization is more common among those receiving antibiotics and less common among those continent of urine. Among those with incontinence, those using intermittent catheterization have less colonization.     

双黄连注射液治疗小儿肺炎有效性的Meta分析

目的:系统评价单独应用双黄连注射液治疗小儿肺炎的有效性和安全性。方法:计算机检索Medline、Embase、Cochrane图书馆临床对照试验资料库和CBMdisc、CNKI及万方数据库,纳入单独应用双黄连注射液治疗小儿肺炎的随机对照试验(RCT),对纳入的研究进行方法学质量评价。结果:共纳入15个RCT,2404例患儿。单独应用双黄连注射液治疗小儿肺炎的疗效优于单独应用抗感染药物,且退热时间、咳嗽缓解时间、肺部音吸收时间、胸片X线炎症吸收时间等指标,2组比较差异有统计学意义(P<0.05);未报道双黄连注射液临床应用相关的严重不良反应。结论:单独应用双黄连注射液治疗小儿肺炎的疗效优于单独应用抗感染药物,且未见明显不良反应。但由于纳入研究质量所限,降低了该系统评价结论的可靠性,尚需开展更多设计合理、执行严格和多中心、大样本的RCT以进一步证实。     

上海地区81家医院2006～2009年抗感染药利用分析

目的:了解上海地区医院抗感染药的应用情况和变化趋势,为临床合理应用抗感染药及科学管理提供参考。方法:调查上海地区81家医院2006～2009年抗感染药的销售金额、主要品种、用药频度(DDDs)及日均费用。结果:该地区抗感染药销售金额呈逐年上升趋势,年复合增长率达21.05%。DDDs和销售金额排序列前2位的均为头孢菌素类和喹诺酮类。头孢呋辛和阿奇霉素分列销售金额和DDDs的首位。注射剂销售金额远高于口服剂型,DDDs和销售金额排序列首位的都是国内生产厂家。结论:该地区医院抗感染药应用情况与国内、外总体用药情况相似,根据药敏结果选择品种是进一步提高抗感染药合理应用的关键。     

中国三地区女性性工作者对杀微生物剂的可接受性及其影响因素研究

目的探索女性性工作者(female sex workers,FSWs)对阴道外用杀微生物剂的可接受性及其影响因素。方法采用横断面调查的方法,于2008年9月至2009年1月在云南德宏、四川乐山和辽宁沈阳3现场共抽取968名FSWs作为研究对象,以面对面访谈方式进行问卷调查。主要评价指标包括杀微生物剂可接受性得分、危险性行为、安全套使用率、性病史、艾滋病/性病感知风险等。结果被调查的FSWs对杀微生物剂的可接受性平均得分为(2.88±0.58)分。可接受性受FSWs的所在地区、性服务场所的档次与性质、年龄、文化程度、是否主动要求使用和被拒绝使用安全套、是否检测过HIV抗体、是否担心感染艾滋病/性病、妊娠史和阴道外用药史等因素影响。结论接受调查的FSWs对使用杀微生物剂的态度普遍较积极,提示杀微生物剂有可能作为安全套的补充措施,满足女性在艾滋病/性病预防中的特殊需要。     

TDM对重症患者个体化抗感染治疗的指导意义

目的:探讨TDM对重症患者个体化抗感染治疗的指导意义.方法:临床药师分析重症患者的药动学变化,结合抗菌药物的药动学特点、血药浓度监测结果、药敏报告,协助医生调整个体化给药剂量.结果 与结论:临床药师参与重症患者的抗感染治疗,能提升抗感染药物的合理使用.