ObjectiveTo understand the characteristics of and risk factors for nosocomial infection in a newly built branch of a university teaching hospital, in order to investigate the control measures for prevention and control of nosocomial infection. MethodsA total of 598 cases of nosocomial infection from April 2012 to June 2014 were enrolled in this study. We analyzed statistically such indexes as nosocomial infection rate, infection site, pathogen detection, and use of antibiotics. Meantime, infection point-prevalence survey was introduced by means of medical record checking and bedside visiting. ResultsAmong all the 44 085 discharged patients between April 2012 and June 2014, there were 598 cases of nosocomial infection with an infection rate of 1.36%. Departments with a high nosocomial infection rate included Intensive Care Unit (ICU) (9.79%), Department of Orthopedics (2.98%), Department of Geriatrics (2.62%), and Department of Hematology (1.64%). The top four nosocomial infection sites were lower respiratory tract (45.32%), urinary tract (13.21%), operative incision (8.86%), and blood stream (8.86%). The samples of 570 nosocomial infections were delivered for examination with a sample-delivering rate of 95.32%. The most common pathogens were acinetobacter Baumanii (17.02%), Klebsiella pneumoniae (14.21%), Escherichia coli (13.68%), Pseudomonas aeruginosa (11.93%), and Staphylococcus aureus (9.12%). And urinary tract intubation (42.81%), admission of ICU (28.60%), and application of corticosteroid and immunosuppressive agents (26.42%) were the top three independent risk factors for nosocomial infection. ConclusionGeneral and comprehensive monitoring is an effective method for the hospital to detect high-risk departments, factors and patients for nosocomial infection, providing a theoretical basis for prevention and control of nosocomial infection.
ObjectiveTo overview of systematic reviews of the efficacy and safety of antimicrobials in the prevention of postpartum infection after vaginal delivery, and to provide evidence for the rational use of antimicrobials. MethodsThe CNKI, WanFang Data, VIP, PubMed, Embase, and Cochrane Library databases were searched to collect systematic reviews/meta-analyses on antibiotic prophylaxis for transvaginal delivery from inception to June 25, 2023. The data of the included systematic reviews were extracted by 2 investigators independently, and the methodological quality, risk of bias, and report quality were evaluated by AMSTAR 2.0 scale, ROBIS tool, and PRISMA, respectively. And a pool of outcomes for assessing the effectiveness of antimicrobials in prevention of postpartum infection after transvaginal delivery was developed. ResultsA total of 7 systematic reviews were included. And the AMSTAR 2.0 indicated that most studies (5/7) were from very low quality to low quality. The ROBIS tool showed 3 studies with low risk of bias, 3 with high risk of bias, and 1 with unclear risk of bias. The results of the PRISMA statement showed that the included system evaluation reports were relatively complete. The present evidence showed that prophylactic use of antimicrobials may be beneficial and recommended in women with Ⅲ-Ⅳ perineal fissures, with no significant benefit in women with manual placenta removal, but prophylactic use of antimicrobials was recommended considering their invasive nature, but it was controversial whether antimicrobials should be used in the categories of vaginal assisted delivery, perineal lateralization, and spontaneous delivery (without complications). ConclusionAntimicrobial prophylaxis may not be recommended for all the pregnant women undergoing vaginal delivery to prevent the postpartum infection, but considering the low methodological quality of the included systematic review and the inconsistent outcomes in this field, the conclusion should be further verified by future research with high-quality.
Objective To analyze the distribution of pathogens, drug susceptibility and multi-drug resistant bacteria (MDRB) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pneumonia. Methods The clinical data of patients whose discharge diagnosis included AECOPD with pneumonia or pulmonary infection from January 2012 to December 2015 were retrospectively analyzed. Strain identification and drug sensitivity analysis were performed in the pathogenic bacterias isolated from sputum culture. Results A total of 1 978 patients were enrolled in this study, and pathogenic bacterias were isolated from the sputum of 708 patients, including 485 cases of community-acquired pneumonia (CAP) and 223 cases of hospital-acquired pneumonia (HAP); and 786 strains of pathogens were isolated (501 strains from CAP cases, 285 strains from HAP cases), including 448 strains of Gram-negative (G–) bacilli (57.0%), 117 strains of Gram-positive (G+) cocci (14.9%), and 221 strains of fungi (28.1%). Susceptibility testing results showed that G– bacilli were highly resistant to penicillins, third generation cephalosporins, ciprofloxacin, gentamicin, etc., and G+ cocci were highly resistant to penicillin, clindamycin and erythromycin. There were 238 strains of MDRB, mainly including 69 strains of Acinetobacter baumanii [multiple drug resistance rate (MDRR)=67.6%], 27 strains of Escherichia coli (MDRR=52.9%), 25 strains of Klebsiella pneumoniae (MDRR=34.2%), 33 strains of Pseudomonas aeruginosa (MDRR=33.0%) and 24 strains of Stenotrophomonas maltophilia (MDRR=100.0%). MDRR of Enterococcus genus and methicillin-resistant Staphylococcus aureus was 50.0% and 48.0%, respectively. Conclusions The pathogenic bacterias in elderly AECOPD patients complicated with pneumonia are mainly G– bacterias, and the proportion of fungal infection tends to increase. Bacterial drug resistance is serious and the MDRB tends to increase, especially in patients with HAP. Physicians should early find out the characteristics of local pathogenic bacteria and drug sensitivity, rationally select antibiotics, reduce the occurrence of drug-resistant strains and superinfection when treating the elderly patients with AECOPD complicated with pneumonia.
ObjectiveTo systematically review the health economic evaluation studies in which externalities of antibacterial drug uses were identified.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect health economic evaluation studies in which externalities of antibacterial drug uses were identified from inception to December 31st, 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Descriptive analysis was then performed.ResultsA total of 14 studies were included. Negative externalities and their impacts on costs and/or effectiveness were examined in 13 literature, and positive externalities in terms of an improvement in disease control were included in only one study. No study was found in which both negative and positive externalities were included. The methods used to quantify negative externalities included: only costs associated with drug resistance per prescription or per unit were calculated; both costs and health impacts associated with the second/third line treatments followed a treatment failure (due to drug resistance) were calculated using a decision tree. In one study in which positive externalities were measured, both health gain and cost reduction from an improvement in disease control (as a benefit of antibacterial drug uses) were calculated by constructing a dynamic model at the population level.ConclusionsWe propose that both the positive and negative externalities should be included in health economic evaluation. This can be achieved by measuring the relevant costs and health impacts in a broader perspective, using a disease-transmission dynamic model. In addition, to achieve an improved health utility measurement, disability-adjusted-life years rather than quality-adjusted-life years should be encouraged for use. Finally, both costs and effectiveness should be discounted.
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 evaluate the value of serumprocalcitonin( PCT) guided antibiotic strategy in the treatment of acute exacerbation of chronic obstructive pulmonary disease( AECOPD) .Methods From August 2011 to June 2012, a total of 96 patients hospitalized for AECOPD were randomly assigned into a PCT-guided group( n = 48) and an empirical therapy group( n = 48) . The PCT levels of PCT-guided group were measured by immunochemiluminometric assays before and 5,7, 10 days after treatment. The PCT-guided group was treated with antibiotics according to serum PCT levels, ie. antibiotic treatment was applied when PCT level ≥ 0. 25 μg/L and was discouraged when PCT level lt; 0. 25 μg/L. The empirical therapy group received antibiotics according to physician’s decision. The antibiotics usage rate, length of antibiotic exposure, length of hospitalization, clinical efficacy, hospital mortality, rate of invasive mechanical ventilation and costs of hospitalization were recorded. Results The antibiotics usage rate, length of antibiotic exposure, length of hospitalization, and costs of hospitalization in the PCT-guided group were all lower than those of the empirical therapy group( P lt;0.05) while clinical efficacy, hospital mortality and rate of invasive mechanical ventilation were similar in two groups(Pgt;0.05) . Conclusion PCT guided antibiotic strategy can be used in the treatment of AECOPD, which may reduce the dose of antibiotic drugs to avoid bacterial resistance and lower costs of hospitalization.
Objective To explore the interference of recent use of antibiotics in the sensitivities of different methods for the detection of Helicobacter pylori (Hp) in children. Methods From June 2015 to December 2017, children who were highly suspected of Hp infection and required gastroscopy were divided into the antibiotic group and the control group according to the recent use of antibiotics, with 200 cases in each group. The use of antibiotics of children in the antibiotic group was analyzed. The children in the two groups completed five methods of Hp detection, including rapid urease test (RUT), 13C-urea breath test (13C-UBT), pathological Warthin-Starry staining, colloidal gold method for measuring Hp immunoglobulin M (IgM) antibody, and enzyme linked immunosorbent assay method for measuring Hp stool antigen (HpSA). Comparative analyses of data were done. Results The positive rate of RUT was 36.5% in the antibiotic group and 75.0% in the control group (P<0.05). The positive rate and value of13C-UBT were 59.0% and 13.6±4.7 in the antibiotic group, and 78.0% and 41.7±6.6 in the control group (P<0.05). The positive rate of pathological biopsy was 48.0% in the antibiotic group and 68.0% in the control group (P<0.05), and L-forms were found in 80.9% of the Hp-positive specimens in the antibiotic group. The positive rate of IgM antibody was 54.5% in the antibiotic group and 65.5% in the control group (P<0.05). The positive rate of HpSA was 38.0% in the antibiotic group and 69.0% in the control group (P<0.05). In the antibiotic group, only 12.5% of the children used antibiotics for eradication of Hp and 87.5% for non Hp eradication. Conclusions Under the interference of antibiotics use, the sensitivity of 13C-UBT is the highest among the five methods for Hp detection, and the sensitivities of RUT and HpSA are very low. For children who could not cooperate with 13C-UBT, the sensitivity of IgM detection is relatively high. For children who need gastroscopy, prolonged chromogenic time for RUT and multi-point pathological biopsy can reduce misdiagnosis.
Objective To study the distribution and drug resistance of pathogens causing hospital-acquired pneumonia (HAP) and explore the related risk factors, so as to provide valuable clinical reference for prevention and treatment of HAP. Methods A case-control study was conducted in a 3700-bed tertiary hospital. Nosocomial infections reported from January 2014 to December 2014 were investigated. A total of 419 inpatients with HAP were enrolled in as a study group, and 419 inpatients without nosocomial infection in the same period and department, with same gender, underlying diseases, and same age, were chosen as a control group. Risk factors of HAP, distribution and drug resistance of pathogens of HAP were analyzed. Results The incidence rate of HAP was 0.62% and the mortality rate was 19.81%. Multivariate analysis identified chronic lung diseases, admission in ICU, two or more kinds of antibiotics used, hospitalization time≥5 days, cerebrovascular disease, and mechanical ventilation were significant risk factors. Totally 492 strains of pathogens were isolated, including 319 strains of gram-negative bacteria, 61 strains of gram-positive bacteria, 112 strains of fungi.Acinetobacter baumannii,Klebsiella pneumonia,Candida albicans,Pseudomonas aeruginosa,Candida glabrata ranked the top five predominant pathogens. Drug resistance rates ofAcinetobacter baumannii to commonly used antibiotics were higher than 75%. Drug resistance rates ofKlebsiella pneumoniae to piperacillin and third-generation cephalosporin were higher than 50%. Conclusions HAP prevails in patients with hospitalization time≥5 days, admission in ICU, cerebrovascular diseases, two or more antibiotics combined used, chronic lung diseases, and mechanicalventilation. It is associated with increased length of hospital stay, decreased quality of life, and elevated morbidity and mortality. The main pathogens of HAP are Gram-negatives.Acinetobacter baumannii andKlebsiella pneumoniae are resistant to the common antibiotics in different degree.
ObjectiveTo observe the impacts of initial therapy on clinical outcome of patients with community-acquired thoracic infection by retrospective analysis. MethodsClinical data of acute community-acquired thoracic infection patients who met the British Thoracic Society diagnostic criteria were collected. The patients were divided into two groups according to whether adequate initial antibiotic therapy and pleural effusion drainage were performed, namely an adequate group (31 patients) and an inadequate group (17 patients). Clinical manifestations, inflammatory markers, hospital stay and hospital costs were analyzed between the two groups. ResultsFor age, gender, infection sites, and coincident diseases, there were no significant differences between the two groups. Compared with the inadequate group, temperature of the adequate group was significantly decreased, especially on hospital day 5, 6, 7[(37.4±0.1)℃ vs. (38.3±0.2)℃, P < 0.001; (37.4±0.1)℃ vs. (37.9±0.1)℃, P < 0.05; (37.4±0.1)℃ vs. (38.1±0.2)℃, P < 0.01]. The level of serum C-reactive protein (CRP) in first week was also significantly reduced in the adequate group[(123.1±13.8) mg/L vs. (182.7±25.3) mg/L, P < 0.05]. However, there were no differences in white cell counts, percentage of neutrophils, or erythrocyte sedimentation rate between the two groups in six-week follow-up. The adequate group had shorter hospital stay[(25±4) days vs. (34±4) days, P < 0.05] and lower hospital costs[(28 367±3 328) yuan vs. (43 334±7 134) yuan, P < 0.05] compared with the inadequate group. ConclusionsThe initial therapy with appropriate antibiotics and effective thoracic drainage can significantly decrease the temperature and CRP of patients with thoracic infection, as well as the cost of hospitalization and the length of stay. Our study reveals that the temperature which is lower than 37.5℃ on the 5th day of therapy and the CRP in the first follow-up week are sensitive predictors of initial treatment effect, which may be helpful to guide the following therapeutic strategies.
ObjectiveTo systematically review the efficacy of antibiotics on the outcomes of patients with non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors. MethodsPubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect cohort studies on efficacy of antibiotics on the outcomes of patients with NSCLC treated with immune checkpoint inhibitors from inception to August 1st, 2021. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 27 cohort studies involving 7 087 patients were included. The results of meta-analysis showed that antibiotic use was associated with poor overall survival (OS) (HR=2.04, 95%CI 1.68 to 2.49, P<0.000 01) and progression free survival (PFS) (HR=1.63, 95%CI 1.35 to 1.99, P<0.000 01). ConclusionCurrent evidence shows that antibiotic use is associated with poor OS and PFS. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.