ObjectiveTo study the clinical distribution and the change of drug resistance of Acinetobacter baumannii from different inpatient specimens sources during 2008 to 2012, and to provide guidance for rational use of antibiotics. MethodsThe identification of Acinetobacter baumannii was conducted by VITEK-2 based on clinical and laboratory standards institute (CLSI) guideline between January 2008 and December 2012. The susceptibility of antibiotics was determined by K-B test, and data analysis was conducted by Excel and SAS. ResultsA total of 3 139 stains of Acinetobacter baumannii were isolated from 2013 patients during this period. The Acinetobacter baumannii was mainly obtained from the Burn ward, Intensive Care Unit ward and Thoracic ward. Sputum was the most specimens of Acinetobacter baumannii, accounting for 48.4%. The drug resistance rates of Acinetobacter baumannii to most of the antimicrobial agents were more than 55%. Compound antibacterial is more effective than the single drug ingredient. Compared with other antimicrobial agents, β-lactams/β-lactamase inhibitor compound and carbapenems antimicrobial agents were more sensitive. ConclusionThe drug resistance of Acinetobacter baumannii is serious and has differences among hospitals. Clinicians should monitor the drug resistance of Acinetobacter baumannii timely and choose proper antibiotics according to the results of drug sensitivity.
ObjectiveTo compare and analyze the differences of bacterial resistance of 3 different strains of bacteria isolated from Mohnarin cerebrospinal fluid (CSF), blood and bile of literature published in China, to provide the basis for clinical rational drug use. MethodsWe searched databases including CNKI and WanFang Data for reports about bacterial resistance from Mohnarin CSF, blood and bile from 2006 to 2014. Two reviewers independently screened literature, extracted data, and analyzed the differences of bacterial resistance from CSF, blood and bile by SPSS 19.0 software. ResultsComposition ratio of the gram positive bacteria from CSF specimens was much higher than those of the blood and the bile (χ2=383.118, P<0.001). The separation of E. coli, K. pneumoniae, E. cloacae, P. aeruginosa, A. baumannii, E. faecium and E. faecalis from CSF exhibited multi-drug resistance, and their resistance rates to commonly used antimicrobial agents were significantly higher than those from blood and bile (P<0.001), especially the A. baumannii, K. pneumoniae, E. cloacae and E. faeciu, and their overall resistance rates to commonly used antimicrobial drugs were 68.1%, 60.5%, 59.8%, and 59.4%, respectively. The top three antibiotics with higher resistance rate were piperacillin, sulfamethoxazole/trimethoprim and cefotaxime in A. baumannii, piperacillin, ceftriaxone and cefotaxime in K. pneumoniae, cefoxitin, Ampicillin/sulbactam and cefuroxime in E. cloacae, penicillin G, ampicillin and erythromycin in E. faecium. The resistant rates of quinolone in E. coli, E. cloacae, A. baumannii and E. faecium from CSF specimens were high, but low in K. pneumoniae, P. aeruginosa and E. faecalis. ConclusionThere are differences for drug resistance of the bacteria from different specimens from Mohnarin, the bacteria from CSF specimens exhibits multi-drug resistance, the resistances are significantly higher than those from blood and bile.
ObjectiveTo analyze the current situation of antimicrobial agents using in day surgery patients to guide the rational use of antimicrobial agents in day surgery.MethodsThe day surgery performed in Day Surgery Center of Xiangya Hospital of Central South University from June 2016 to September 2017 was selected. We retrospectively collected and analyzed patients’ hospitalization data and return visit data, statistically analyzed their use of antimicrobial agents, explored whether there was an unreasonable phenomenon in the use of antimicrobial agents, and analyzed the reasons.ResultsThere were 4 054 surgeries included in this study, and 1 293 patients using antimicrobial agents, the use rate of antimicrobial agents in day surgery patients reached 31.89%. Aseptic, clean-contaminated, contaminated and dirty surgery accounted for 12.22%, 65.20%, 7.27%, and 15.31% separately. Whether the application of antimicrobial agents in aseptic surgery patients had no effect on the outcome of the incision (P=0.073). The most common type of antimicrobial agents used by patients are cephalosporins (57.50%), mainly used as single drugs (97.91%) and mostly oral used in patients’ home. Most of the sources of antimicrobial agents were purchased by patients after they were discharged from the hospital (65.43%). The antimicrobial agents more used by Stemmatological Department (23.98%), Ear/Nose/Throat Department (22.58%) and Obstetrics and Gynecology Department (22.51%). The average used time of antimicrobial agents was (5.37±1.86) days, and 7.42% of patients still had surgical site infections after the use of prophylactic antimicrobial agents, most of them from General Surgery Department.ConclusionsThe unreasonable phenomena in the use of antimicrobial agents in patients with day surgery include: a high proportion of preventive medications for clean-contamination surgery, a high level of initial medication, and most patients take oral medications at home and lack of guidance, and long medication time. There is an urgent need for scientific guidance on the use of antimicrobial agents for patients undergoing day surgery.
ObjectiveTo evaluate the rationality of antibiotics use by analyzing the prescription reviewing results.MethodsThe review data of antibiotic prescriptions in Beijing Hospital was randomly selected from 2016 to 2019, from which unreasonable prescriptions and the antimicrobial agents were analyzed, and the use of antibiotics and unreasonable prescriptions annually were compared.ResultsThe evaluation of rational use of antibiotics involved 79 701 outpatient prescriptions from 2016 to 2019. There were 10 drugs in the top five irrational rates of outpatient antibiotics, primarily cephalosporin and quinolones, accounting for 50% and 30%, respectively. The primarily unreasonable problems were over prescription (common in gastroenterology and dermatology), unsuitable indications (common in otolaryngology), inappropriate usage and dosage (common in urology, dermatology and gastroenterology), and failure to write clinical diagnosis or incomplete clinical diagnosis (common in obstetrics and gynecology and general surgery). During the four years, the proportion of antibiotics prescriptions and the irrational rate decreased annually.ConclusionsThe use of antibiotics in outpatient department of Beijing Hospital has achieved initial results, however, there are still some problems. We should further strengthen the management of antibiotics usage, strengthen training and learning, and increase medical cooperation to promote rational drug use in clinic.
ObjectiveTo examine the characteristics of Rhodococcus equi (R. equi) infection for better awareness of this disease.MethodsThe clinical data of a patient with pulmonary abscess caused by R. equi after renal transplantation were reported. We also reviewed the reports of infections caused by R. equi.ResultsThe clinical manifestations and laboratory examination of the patient were consistent with the characteristics of R. equi infection. The growth of R. equi was found in sputum and blood culture. The follow-up data showed that the treatment was effective. Literature search identified 23 similar patients. In all the 24 patients (containing this one), the time of infection after renal transplantation ranged from 4 months to 11 years. There were 21 patients with cumulative pulmonary infection, and 10 patients had a clear epidemiological history of direct or indirect contact with horses. Eighteen patients improved after regular antibacterial treatment or surgical treatment.ConclusionsOpportunistic infections caused by R. equi mainly affect transplant recipients and other patients with lower immunity. Infections caused by R. equi may affect many organ systems with various manifestations. The optimal therapy is not established due to the rarity of this infection. Clinicians should select antibiotic agents rationally based on antimicrobial susceptibility testing and treatment response of patients.
ObjectiveTo explore the distribution and rule of pathogen strains in the third quarter and fourth quarter of 2012, and to provide the basis for clinical medication. MethodsTo retrospectively analyze the bacterial culture and drug susceptibility test results in the third quarter and the fourth quarter of 2012. ResultsThere were isolated 932 plants in the third quarter, and 915 plants isolated in the fourth quarter. Heavy drug resistance rates of detection of Pseudomonas aeruginosa decrease slightly. There was more multiple drug resistance of A. baumanii, Escherichia coli, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus in the fourth quarter than in the third one. ConclusionThe resistant strain increases in the fourth quarter. We should attach importance to the clinical examination, bacterial drug resistance monitoring, and rational use of antimicrobial agents.
Renal cancer is a common malignant tumor and the deadliest cancer of the urinary and reproductive system. Given the increasing incidence rate of kidney cancer, timely intervention of its controllable risk factors is crucial. Antimicrobial agent is widely used worldwide, and in recent years, some studies have found that long-term use of antimicrobial agent is associated with an increased risk of kidney cancer. The mechanism may involve multiple factors such as nephrotoxicity of antimicrobial agent and intestinal flora imbalance. This article reviews the relationship between long-term use of antimicrobial agent and risk of kidney cancer, and explores possible mechanisms, to understand the impact of long-term use of antimicrobial agent on the risk of kidney cancer, and to provide more references for early prevention of kidney cancer and rational use of antimicrobial agent.
Peptidoglycan is an important component of bacterial cell wall, which plays an important role in maintaining the integrity of bacterial cell structure, stimulating immune response, and anti-infection. Peptidoglycan recycling is an indispensable process for bacterial cell growth and reproduction. In recent years, it has been reported that the peptidoglycan recycling is closely related to the occurrence and development of bacterial resistance, especially with the antibacterial activity of β-lactam antibiotics. In this paper, the relationship between peptidoglycan recycling and resistance is described by combining relevant reports and taking Mycobacterium tuberculosis and Pseudomonas aeruginosa as examples, so as to promote the understanding of bacterial resistance mechanisms and provide potential targets for the development of new antimicrobial drugs.
ObjectiveTo analyze the trend of hospital infection, so as to provide a scientific basis for hospital infection prevention and control. MethodsFrom 2011 to 2013, according to the criteria of diagnosis of nosocomial infections set up by the Ministry of Health, the prevalence rates of nosocomial infections in patients who were hospitalized on the survey day were investigated by the combination of bedside investigation and medical records checking. ResultsThe incidence rates of nosocomial infections from 2011 to 2013 were 2.99%, 2.31% and 1.95%, respectively, presenting a downward trend. The rate of hospital infection was the highest in comprehensive Intensive Care Unit, and the main infection site was the lower respiratory tract. Gram-negative bacteria were the main pathogens causing hospital infections, including Klebliella pnermoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter baumannii and Escherichia coli. The utilization rates of antibacterial agents in these three years were respectively 39.84%, 34.58% and 34.22%. ConclusionTargeted surveillance and management of key departments and sites should be strengthened. It is necessary to strengthen the surveillance and management of antibiotics, raise the submission rate of pathogens, and use antibiotics appropriately.
ObjectiveTo investigate the effects of antimicrobial management program on inpatients outcomes and antimicrobial resistance among clinical isolates in a large-scaled university hospital.MethodsThe antibiotics use density (AUD) and antimicrobial resistance rate of multi-drug resistant bacteria before (from January 2009 to December 2010) and after (from January 2012 to December 2016) the intervention of antimicrobial management program in a large-scaled university hospital (4 300 beds) were calculated and compared, and the correlations of AUD with average length of hospital stay and mortality rate were analyzed.ResultsThe AUD was significantly decreased after intervention (P<0.001). The resistance rate of Staphylococcus aureus to oxacillin decreased (P<0.001). Among Gram-negative bacteria, the resistance rates to carbapenems in Acinetobacter baumannii (P<0.001) and Klebsiella pneumoniae increased (P=0.011). AUD was not correlated with the average length of hospital stay (P=0.644), while positively correlated with the in-hospital mortality rate (r=0.932, P=0.001).ConclusionsThe implementation of antimicrobial management program can significantly reduce the antimicrobial use and do not worsen patient outcomes in the hospital. The impact of the program on resistance varies significantly depending on both the bacterium and the agent, and carbapenem-non-susceptible Gram-negative bacilli emerges as a major threat. It is still necessary to combine other infection control measures.