目的通过调查重症监护室(ICU)一起疑似泛耐药鲍氏不动杆菌(PDR-AB)感染暴发的情况,研究泛耐药鲍氏不动杆菌医院感染防控的集束化策略,指导医院感染防控措施实施。方法通过分子流行病学分析与环境卫生学监测相结合的方法,对2018年2月-201...目的通过调查重症监护室(ICU)一起疑似泛耐药鲍氏不动杆菌(PDR-AB)感染暴发的情况,研究泛耐药鲍氏不动杆菌医院感染防控的集束化策略,指导医院感染防控措施实施。方法通过分子流行病学分析与环境卫生学监测相结合的方法,对2018年2月-2018年4月ICU住院患者鲍氏不动杆菌分离与感染情况展开调查,对疑似污染的环境与物品进行微生物学采样、鉴定和药敏试验。患者和环境中PDR-AB克隆菌株采用脉冲场凝胶电泳(Pulsed Field Gel Electrophoresis,PFGE)技术进行同源性分析。结果 2018年3月ICU PDR-AB院内定植或感染患者7例,患者新发感染率10.14%;PDR-AB定植或感染患者的头部垫巾,病床床尾板、床栏,护士站台面及医务人员护理服和清洗消毒后的纤支镜中分离出PDR-AB存在;ICU患者与环境分离的27株PDR-AB耐药谱基本一致;PFGE结果显示患者、环境、纤支镜PDR-AB克隆菌株来自于同一亚型。结论 PDR-AB克隆菌株在患者、环境及纤支镜之间具有高度同源性的克隆传播,通过强化医务人员无菌观念,患者隔离,环境及医疗器械的严格清洁消毒,暴发流行情况得到有效控制。展开更多
Objective To assess the efficacy and safety of Chinese medicine injection(CMI)for treating acute lung injury/acute respiratory distress syndrome(ALI/ARDS).Methods Randomized controlled trials(RCTs)were identified by s...Objective To assess the efficacy and safety of Chinese medicine injection(CMI)for treating acute lung injury/acute respiratory distress syndrome(ALI/ARDS).Methods Randomized controlled trials(RCTs)were identified by searching 3 English databases and 4 Chinese databases from their inceptions until February 2019.The Cochrane Handbook was used to evaluate risk of bias in the included studies.Data analysis was conducted using RevMan 5.3.3 software.Results A total of 19 eligible RCTs involving 1,334 participants was included in this systematic review and meta-analysis.The main meta-analysis showed that CMI combined with conventional therapy(CT)was more effective than CT alone in reducing the acute physiology and chronic health evaluation(APACHE)H score[mean difference(MD):−1.74 points,95%confidence interval(CI):−2.77 to−0.71,I^2=0]and increasing the total effective rate[relative risk(RR):1.35,95%CI:1.17 to 1.56,I^2=37%].Compared with CT,CMI combined with CT showed improvements in the arterial partial pressure of oxygen(PaO2,MD:9.25 mm Hg,95%CI:0.87 to 17.63,I^2=98%)and oxygenation index[arterial partial pressure of oxygen(PaO2)/fraction of inspired oxygen(FiO2),MD:50.75 mm Hg,95%CI:35.18 to 66.31,I^2=94%].CMI plus CT was superior to CT in reducing the systemic inflammatory response syndrome(SIRS)score(MD:−0.84 points,95%CI:−1.26 to−0.42,I^2=65%),length of hospital stay(MD:−4.22 days,95%CI:−6.49 to−1.95,I^2=92%),and duration of mechanical ventilation(MD:−2.94 days,95%CI:−4.68 to−1.21,I^2=89%).Only 1 study reported adverse events.Conclusions CMI as an adjuvant therapy showed great potential benefits for the treatment of ALI/ARDS.However,we could not make a definite conclusion due to low quality of included studies and uncertain security.Future studies should focus on improving research design,especially in blindness and placebo.The reporting of adverse events was also needed.展开更多
文摘目的通过调查重症监护室(ICU)一起疑似泛耐药鲍氏不动杆菌(PDR-AB)感染暴发的情况,研究泛耐药鲍氏不动杆菌医院感染防控的集束化策略,指导医院感染防控措施实施。方法通过分子流行病学分析与环境卫生学监测相结合的方法,对2018年2月-2018年4月ICU住院患者鲍氏不动杆菌分离与感染情况展开调查,对疑似污染的环境与物品进行微生物学采样、鉴定和药敏试验。患者和环境中PDR-AB克隆菌株采用脉冲场凝胶电泳(Pulsed Field Gel Electrophoresis,PFGE)技术进行同源性分析。结果 2018年3月ICU PDR-AB院内定植或感染患者7例,患者新发感染率10.14%;PDR-AB定植或感染患者的头部垫巾,病床床尾板、床栏,护士站台面及医务人员护理服和清洗消毒后的纤支镜中分离出PDR-AB存在;ICU患者与环境分离的27株PDR-AB耐药谱基本一致;PFGE结果显示患者、环境、纤支镜PDR-AB克隆菌株来自于同一亚型。结论 PDR-AB克隆菌株在患者、环境及纤支镜之间具有高度同源性的克隆传播,通过强化医务人员无菌观念,患者隔离,环境及医疗器械的严格清洁消毒,暴发流行情况得到有效控制。
基金Supported by the National Natural Science Foundation of China(Nos.81503511 and 81503676)Guangdong Science and Technology Project(Nos.2017A020213007 and 2017B030314176)。
文摘Objective To assess the efficacy and safety of Chinese medicine injection(CMI)for treating acute lung injury/acute respiratory distress syndrome(ALI/ARDS).Methods Randomized controlled trials(RCTs)were identified by searching 3 English databases and 4 Chinese databases from their inceptions until February 2019.The Cochrane Handbook was used to evaluate risk of bias in the included studies.Data analysis was conducted using RevMan 5.3.3 software.Results A total of 19 eligible RCTs involving 1,334 participants was included in this systematic review and meta-analysis.The main meta-analysis showed that CMI combined with conventional therapy(CT)was more effective than CT alone in reducing the acute physiology and chronic health evaluation(APACHE)H score[mean difference(MD):−1.74 points,95%confidence interval(CI):−2.77 to−0.71,I^2=0]and increasing the total effective rate[relative risk(RR):1.35,95%CI:1.17 to 1.56,I^2=37%].Compared with CT,CMI combined with CT showed improvements in the arterial partial pressure of oxygen(PaO2,MD:9.25 mm Hg,95%CI:0.87 to 17.63,I^2=98%)and oxygenation index[arterial partial pressure of oxygen(PaO2)/fraction of inspired oxygen(FiO2),MD:50.75 mm Hg,95%CI:35.18 to 66.31,I^2=94%].CMI plus CT was superior to CT in reducing the systemic inflammatory response syndrome(SIRS)score(MD:−0.84 points,95%CI:−1.26 to−0.42,I^2=65%),length of hospital stay(MD:−4.22 days,95%CI:−6.49 to−1.95,I^2=92%),and duration of mechanical ventilation(MD:−2.94 days,95%CI:−4.68 to−1.21,I^2=89%).Only 1 study reported adverse events.Conclusions CMI as an adjuvant therapy showed great potential benefits for the treatment of ALI/ARDS.However,we could not make a definite conclusion due to low quality of included studies and uncertain security.Future studies should focus on improving research design,especially in blindness and placebo.The reporting of adverse events was also needed.
