ObjectiveTo systematically evaluate the efficacy and safety of procalcitonin guided algorithms of antibiotic therapy in acute exacerbation chronic obstructive pulmonary disease (AECOPD). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 6, 2016), CBM, CNKI, VIP, and WanFang Data from the date of their establishment to July 2016, to collect randomized controlled trials (RCTs) about procalcitonin guided antibiotics therapy in patients with AECOPD. References of the included literature were also searched manually for additional studies. The literature screening, data extraction and bias risk assessment of the included studies were completed by two reviewers independently. Statistical analysis was conducted using RevMan 5.2 software. ResultsA total of ten RCTs involving 1 071 patients were included. The results of meta-analysis indicated that compared with the standard treatment group, the antibiotic prescription rate (RR=0.70, 95% CI 0.55 to 0.89, P=0.004), the rate of duration of antibiotic >10 days (RR=0.38, 95% CI 0.26 to 0.56, P<0.000 01) and the superinfection rate (RR=0.23, 95% CI 0.09 to 0.58, P=0.002) were significantly lower in the procalcitonin-guided treatment group. There were no statistical differences in clinical effective rate (RR=0.98, 95% CI 0.91 to 1.06, P=0.61), hospital mortality (RR=0.84, 95% CI 0.52 to 1.73, P=0.43), and the rate of need for intensive care (RR=0.77, 95% CI 0.40 to 1.47, P=0.43). ConclusionProcalcitonin guided antibiotics therapy may reduce antibiotic exposure and superinfection rate in patients with AECOPD. In addition, due to the low methodological quality and limited quantity of the included studies, larger sample-size, and high quality RCTs are needed to verify the above conclusion.
【Abstract】ObjectiveTo study the relationship between the bacterial spectrum difference of gallbladder mucosa and choledochus bile and clinical prognosis of gallstone pancreatitis. MethodsA synchronic bacterial culture and drug sensitivity test were carried out on 48 patients with gallstone pancreatitis. ResultsThe cases of positive gallbladder mucosa and choledochus bile were 13 (27.1%) and 31 (64.6%) respectively. The cases of double positivity were 12 (25.0%). The cultural strains of gallbladder mucosa and choledochus bile were significantly different. Some strains were only found in choledochus bile，whereas in gallbladder mucosa L-form bacteria predominated.ConclusionThe most common causative strain of gallstone pancreatitis is Bacterium coli. The drug-resistant strain emerges maybe due to bacterium immigration and delitescence in gallbladder mucosa. L-form bacteria should be considered when using antibiotics, because L-form bacteria have close relationship with the prognosis of gallstone pancreatitis.
A model of infection following trarma was established by introducing B.staphyloecus aureus into the wound.In the exporimental anlmals,the intraoporative high regional concentration of antibiotics was adopted to prevent infection of the distal part of the limb of the rabbits,and those trcated with the conventional method were served as the control.The results showed that in the exporimental animals,not a single limb had developed infection,while in the control group,The tissue culture s...
Objective To explore whether hospitalized elderly patients with severe communityacquired pneumonia ( SCAP) have better outcomes if they are treated with dual-therapy consisting of a β-lactam/macrolide or fluoroquinolone.Methods A prospective study was conducted in patients with SCAP aged 65 years or older between January 2007 and January 2012. These patients were assigned to a combination therapy group or a β-lactam monotherapy group by the attending physicians. Time to clinical stability( TCS) and total mortality were calculated. Prognostic factors for death were analyzed. Results Among the 232 patients, 153 patients were given β-lactam/macrolide or β-lactam/ fluoroquinolone ( macrolide in 67 patients and fluoroquinolone in 86) , while 79 were treated with β-lactam monotherapy. Compared with the monotherapy group, the combination therapy group was associated with significant decreased TCS ( median TCS, 10 days vs. 13 days) , and lower overall in-hospital mortality( 24.2% vs. 43.0%, P lt;0. 01) . Compared with fluoroquinolone, macrolide use was associated with lower ICU mortality ( 14.9% vs. 31.4% , P lt;0. 01) . Simplified acute physiology score Ⅱ, pneumonia severity index, mutilobar infiltration, and β-lactam monotherapy were confirmed as independent predictors of death. Conclusion β-lactam/macrolide or β-lactam/ fluoroquinolone combination therapy, especially with macrolide, has superiority over β-lactam monotherapy in elderly patients with SCAP, and should be recommended.
现有预防非妊娠期妇女膀胱炎复发的临床证据如下:①连续预防性使用抗生素:一系列随机对照试验研究表明,连续预防性使用抗生素(甲氧苄氨嘧啶、复方磺胺甲噁唑、呋喃妥英、头孢克洛或一种喹啉)6～12个月可以减少复发性膀胱炎的发生率,但各种不同用药方案间未发现感染率有差异.一个比较持续性每日使用抗生素与性交后使用抗生素的随机对照试验表明,1年后尿培养阳性率差异无统计学意义.②性交后预防性使用抗生素(复方磺胺甲噁唑、呋喃妥英或一种喹啉):4个随机对照试验研究表明,性交后2 h内使用复方磺胺甲噁唑、呋喃妥英或喹啉较安慰剂能显著降低膀胱炎发生率.一个关于性交后预防性使用抗生素和每日连续使用抗生素的随机对照试验发现,1年后二者的膀胱炎发生率的差异无统计学意义.③一次性使用复方磺胺甲噁唑:一个小样本随机对照试验发现,连续每日预防性使用复方磺胺甲噁唑与在膀胱炎症状出现后一次性使用复方磺胺甲噁唑相比,前者能显著降低膀胱炎发生率.但由于证据太有限,不能得出肯定结论.④酸果蔓汁(cranberry juice)和酸果蔓制品:一个系统评价发现,酸果蔓汁及其制品能预防复发性膀胱炎的证据不足.⑤用马尿酸乌洛托品预防:缺乏研究马尿酸乌洛托品的可靠的随机对照试验.
目的 对546株常见病原菌进行耐药分析，为感染性疾病的临床治疗提供依据。 方法 对2012年4月－9月从临床标本中分离的546株常见病原菌进行耐药分析，菌种鉴定及药物敏感试验结果由法国生物梅里埃公司VITEK 2 COMPACT系统完成。 结果 在546株病原菌中，G−杆菌占82.8%，其前3位分别为大肠埃希菌（占22.2%），鲍曼/溶血不动杆菌（占16.5%），肺炎克雷伯菌（占15.4%）。在G−杆菌中，除嗜麦芽窄食单孢菌外，亚胺培南、厄它培南的耐药率最低，其次为丁胺卡那霉素和哌拉西林/他唑巴坦。鲍曼/溶血不动杆菌、肺炎克雷伯菌、铜绿假单孢对氨苄青霉素的耐药率均超过95%。金黄色葡萄球菌的耐药率较凝固酶阴性葡萄球菌低，耐甲氧西林金黄色葡萄球菌占22.00%；而耐甲氧西林凝固酶阴性葡萄球菌占94.44%。此外，金黄色葡萄球菌和凝固酶阴性葡萄球菌对万古霉素、利奈唑胺、替加环素、奎奴普丁/达福普丁、呋喃妥因的耐药率为0.00%。 结论 在该院新院区临床标本分离的常见病原菌中，仍以G−杆菌占优势。在G−杆菌中，除嗜麦芽窄食单孢菌外，亚胺培南、厄它培南的耐药率最低。金黄色葡萄球菌的耐药率较凝固酶阴性葡萄球菌低，且尚未发现对万古霉素耐药的葡萄球菌。