感染性角膜炎的易感因素和发病率

Purpose: To examine predisposing factors, treatment costs, and visual outcome of microbial keratitis in an ophthalmic casualty and inpatient population. Design: Retrospective medical records review. Participants: Fifteen-to 64-year-olds with microbial keratitis treated at the Royal Victorian Eye and Ear Hospital between May 2001 and April 2003 (n=291)-. Methods: Risk factors were identified from patient files. Demographic, clinical, and microbiological data; severity; outpatient visits; hospital bed days; and vision loss were examined. Main Outcome Measures: Cost to treat (Australian dollars), vision loss, and factors influencing these outcomes. Results: Ocular trauma (106/291 36.4% ) and contact lens (CL) wear (98/291 33.7% ) were the most commonly identified predisposing factors; 18 (6.1%) had multiple predisposing factors; 17 (5.8%), ocular surface disease; 20 (6.9%), herpetic eye disease; 4 (1.4%), systemic associations; 5 (1.7%), other; and 23 (7.9%), unknown cause. Of trauma cases, 90.6%involved males, compared with 44%to 57%for other groups (P< 0.001). Contact lens wearers were younger than the other groups-mean age 30 years, compared with 40 to 47 years (P< 0.01). Gram-negative organisms were isolated more frequently in CL wearers than trauma cases (18.7%vs. 6.5%, P=0.01). The number of outpatient visits was 4±1 (median±interquartile range), and 19.6%(57/291) were hospitalized for 5±2 days. Hospital resource use and vision loss were similar for predisposing factors but differed by causative microorganism. Eighty-eight percent of cases were scraped: acanthamoeba keratitis was the most expensive to treat, followed by fungal and herpetic keratitis and, lastly, culture-proven bacterial keratitis or culture-negative cases (P<0.0001). After treatment, 21.7%exhibited >2 lines of vision loss, and 1.6%of cases had ≥10 lines of vision loss. Vision loss was associated with clinical severity (P=0.005). Conclusions: Ocular trauma and CL wear are the major predisposing factors for microbial keratitis in this age range. These cases require significant hospital resources during treatment, and the keratitis may result in loss of vision.

在呼吸系统疾病的患儿中诊治点对快速流行性感冒检测的准确度及其影响

Objective:To determine whether a point-of-care rapid influenza test impacts the diagnostic evaluation and treatment of children with acute respiratory illnesses. Design:Randomized controlled trial. Setting:Pediatric emergency department and acute care clinic of a children’s hospital. Participants:Children aged younger than 5 years with fever or acute respiratory symptoms during 2 influenza seasons (2002 through 2004). Interventions:Surveillance days were randomized to performance or no performance of a point-of-care rapid influenza test. All children had a nasal and throat swab obtained for laboratory tests. The rapid testgroup had another nasal swab obtained for the QuickVue Influenza Test(Quidel Corp,San Diego,Calif),which was performed by nurses; results were shared immediately with treating physicians.Main Outcome Measures:Rapid test results were compared with results of the viral culture or 2 polymerase chain reaction assays for influenza. Diagnostic test ordering and antibiotic prescribing were compared for the groups. Results:Of 468 enrolled children,306 were from the emergency department and 162 from the clinic. Overall,88 children(19%) had influenza infection. Of 205 children in the rapid test group,51 (25%) had influenza infection. The rapid influenza test was 82%sensitive and 99%specific. In the emergency department,fewer children in the rapid test group had diagnostic tests ordered than in the no rapid test group(39%vs 51%,P=0.03). There was no difference in test ordering in the clinic or in antibiotic prescribing in either setting.The use of antivirals was low. Conclusions:Point-of-care rapid influenza tests were sensitive and specific and were associated with less diagnostic testing in the emergency department.