Injectable Biological Bulking Agent to Treat Stress Urinary Incontinence in Women: A Feasibility Pilot Study

Background: Urinary incontinence mainly affects women regardless of age and, as it affects their quality of life, influences work, sex life and independence for activities of daily living. The treatment of stress urinary incontinence including urethral volume injection therapy can provide an intermediate option over non-surgical and surgical therapies. One of the mechanisms for stress continence depends on the effective coaptation of the urethra during the increase in intra-abdominal pressure. The bulking agents can be injected transurethral or periurethral retrogradely, using direct vision from a cystoscope. Purpose: To evaluate the feasibility and preliminary outcome performance of the bacterial polysaccharide gel used as biological bulking agent applied in female patients with stress urinary incontinence. Methods: A prospective clinical pilot study was performed, in a single institution, including female patients who were admitted to the urologic outpatient clinic with Stress Urinary Incontinence (SUI) without previous treatments and they were selected and underwent bulking agent procedure. The evaluation was performed at the time of enrollment and 6 months after treatment. The primary outcome was Quality of Life (QOL) using the ICIQ-SF Questionnaire. The amount of urine leakage measured by the 1-HOUR PAD-TEST was the second outcome. Results: Fifteen women (with an average age of 53 years) were submitted to the application of bacterial cellulose gel and she was analyzed. Only two patients presented unchanged incontinence. The study considered as primary outcome the improvement or disappearance of symptoms after six months of intervention. Post-intervention Quality of Life (QOL) questionnaire indicated that all of these patients related a better quality of life (62.5%). Through the PAD-test it was possible to observe a decrease in urinary leak of 85% comparing the results pre and post-intervention (BCA—Bacterial Cellulose Application) with p-value equal to 0.000009. Conclusions: The results of this pilot study suggest that the use of biological bulking agent is a promising approach to treat stress urinary incontinence in female patients. Trial registration: Registration number and date of registration should be instated in this section.

Incidence of Urinary Tract Infections (UTI) amongst Patients Attending Primary Health Centres in Anambra State

Urinary tract infections (UTIs) are one of the most prevalent extra-intestinal bacterial infections. It is a common disease encountered in medical practice affecting people of all ages, from neonate to geriatric age group. These infections are on the increase for outpatients attending Primary Health Centres in Anambra State, Nigeria, therefore the need for this study. The prevalence rate of urinary tract infection, age distribution and influence of sex were determined. Susceptibility pattern of the infectious organisms to antimicrobial agent were examined. Clean-catch midstream urine samples were collected and examined. Out of 3000 urine samples examined, 528 bacterial isolates were recovered and characterized. These include: Escherichia coli (24.2%), Klebsiella spp. (18.2%), Staphylococcus aureus (18.2%), Proteus mirabilis (9.1%), Pseudomonas aeruginosa (9.1%), Enterococcus faecalis (9.1%), Citrobacter intermedius (6.1%) and Staphylococcus saprophyticus (6.1%). More females (52%) were infected than males (48%) and in both sexes, the highest incidence was found amongst the age group, 26 - 38 years. Gram negative rods had the highest incidence in both sexes. Among the towns in Anambra state, Umunya in southern province was observed to have the highest incidence rate of UTI. Susceptibility test of the bacterial isolates to antimicrobial agents showed that Staphylococcus aureus was sensitive to Cephalexin, Penicillin V, Erythromycin and Gentamycin while Pseudomonas aeruginosa was resistant to all the antibiotics. Escherichia coli and Klebsiella spp. were resistant to all the antibiotics except Gentamycin while Citrobacter intermedius was resistant only to Cephalexin and Erythromycin. This study provides the evidence of urinary tract infections amongst outpatients of primary health centres and the drugs for their control.

Injectable treatments for female stress urinary incontinence

The use of injectable agents for the treatment of stress urinary incontinence(SUI)is an option for female patients who are unwilling to undergo surgery,or have concurrent conditions or diseases that render surgical treatment unsuitable.To be effective for SUI,an injectable agent must be nonimmunogenic,hypoallergenic,biocompatible,permanent,nonerosive,nonmigratory and painless.It must also heal with minimal fibrosis,possess a long-term bulking effect,and be easily stored and handled.Glutaraldehyde cross-linked bovine collagen(Contigen),silicone polymers(Macroplastique),Durasphere,calcium hydroxyapatite(Coaptite),polyacrylamide hydrogel(Aquamid,Bulkamid),Permacol,and stem cell therapy have been used as injectable agents.Patients must be informed that treatment with injectable agents is not as effective as surgical treatment,and that such agents might necessitate additional and repeated administrations in order to achieve the desired therapeutic effect.

Effective antimicrobial therapies of urinary tract infections among children in low-and middle-income countries:A systematic review

Importance:Urinary tract infection(UTI)is one of the most common infections encountered in infancy and childhood.Despite the emerging problem of antibiotic resistance in recent years,the use of antibiotics for better management of UTIs is inevitable.Objective:This study aims to explore the efficacy and adverse effects of the available antimicrobial agents that are used in pediatric UTIs in low-and middle-income countries(LMICs).Methods:Five electronic databases were searched to identify relevant articles.Two reviewers independently performed screening,data extraction,and quality assessment of the available literature.Randomized controlled trials providing antimicrobial interventions in both male and female participants within the age range of 3 months to 17 years in LMICs were included.Results:Six randomized controlled trials from 13 LMICs were included in this review(four trials explored the efficacy).Due to high heterogeneity across the studies,a meta-analysis was not performed.Other than attrition and reporting bias,the risk of bias was moderate to high due to poor study designs.The differences in the efficacy and adverse events of different antimicrobials were not found to be statistically significant.Interpretation:This review indicates the necessity for additional clinical trials on children from LMICs with more significant sample numbers,adequate intervention periods,and study design.

某三甲医院尿路感染患者病原菌分布及药敏分析

目的了解自贡市第三人民医院尿路感染患者病原菌分布及药敏耐药性特点,为临床医师合理选用抗菌素及控制院内感染、降低细菌耐药性提供帮助。方法收集2019年1月—2020年12月自贡市第三人民医院尿路感染就诊患者尿液标本3802份,采用MicroScan Walk/Away-40(美国SIEMENS公司)全自动微生物鉴定和药敏系统进行细菌鉴定和药敏试验。结果539株分离菌中革兰阴性菌411株,占比76.25%;革兰阳性菌128株,占比23.75%;其中前5位的菌株416株,依次为大肠埃希菌294株(54.55%)、粪肠球菌46株(8.53%)、肺炎克雷伯菌38株(7.05%)、屎肠球菌23株(4.27%)、奇异变形杆菌15株(2.78%)。前5位3种革兰阴性菌中,大肠埃希菌对复方新诺明、环丙沙星、头孢唑啉及左旋氧氟沙星耐药率均>50.00%,对头孢噻肟、头孢曲松、氨曲南和头孢吡肟耐药率均>40.00%,庆大霉素为35.71%,其余均在30.00%以内;肺炎克雷伯菌对复方新诺明耐药性最高为52.63%,其次是头孢唑林为42.11%、头孢噻肟为36.84%、环丙沙星和头孢曲松均为31.58%,其余均在30.00%以内;奇异变形杆菌,对复方新诺明耐药率最高为60.00%,其次环丙沙星为53.33%、妥布霉素为46.67%,头孢唑啉、庆大霉素和氨曲南均为33.33%,其余均在30.00%以内。前5位2种革兰阳性菌中,粪肠球菌,对四环素耐药性最高为86.96%,其次红霉素为76.09%、利福平为54.35%,环丙沙星为32.61%、左旋氧氟沙星和莫西沙星均为30.43%,其余均在30.00%以内;屎肠球菌,对红霉素、环丙沙星和左旋氧氟沙星耐药率均为100%,其次青霉素G为95.65%、莫西沙星为91.30%、利福平和阿莫西林/克拉维酸均为82.61%、四环素为65.22%,对大多数抗菌药物耐药率均较高,其中对万古霉素耐药率最低为4.35%,其次为利奈唑胺为5.26%、呋喃妥因为8.70%。结论临床医师在诊疗过程中,应加强与实验室合作,重视尿路感染的病原学检查,在选用抗菌药物治疗时应结合实验室病原学报告和药敏试验结果,合理使用抗菌药物,同时遏制细菌耐药性。

Bioactivities,Mechanisms,Production,and Potential Application of Bile Acids in Preventing and Treating Infectious Diseases

Infectious diseases are a global public health problem,with emerging and re-emerging infectious diseases on the rise worldwide.Therefore,their prevention and treatment are still major challenges.Bile acids are common metabolites in both hosts and microorganisms that play a significant role in controlling the metabolism of lipids,glucose,and energy.Bile acids have historically been utilized as first-line,valuable therapeutic agents for related metabolic and hepatobiliary diseases.Notably,bile acids are the major active ingredients of cow bezoar and bear bile,which are commonly used traditional Chinese medicines(TCMs)with the therapeutic effects of clearing heat,detoxification,and relieving wind and spasm.In recent years,the promising performance of bile acids against infectious diseases has attracted attention from the scientific community.This paper reviews for the first time the biological activities,possible mechanisms,production routes,and potential applications of bile acids in the treatment and prevention of infectious diseases.Compared with previous reviews,we comprehensively summarize existing studies on the use of bile acids against infectious diseases caused by pathogenic microorganisms that are leading causes of global morbidity and mortality.In addition,to ensure a stable supply of bile acids at affordable prices,it is necessary to clarify the biosynthesis of bile acids in vivo,which will assist scientists in elucidating the accumulation of bile acids and discovering how to engineer various bile acids by means of chemosynthesis,biosynthesis,and chemoenzymatic synthesis.Finally,we explore the current challenges in the field and recommend a development strategy for bile-acid-based drugs and the sustainable production of bile acids.The presented studies suggest that bile acids are potential novel therapeutic agents for managing infectious diseases and can be artificially synthesized in a sustainable way.

湖南省细菌耐药监测网2012—2021年尿标本分离细菌耐药监测报告

目的了解湖南省临床尿标本细菌分布及耐药情况,为尿路感染患者的抗感染治疗提供科学依据。方法按照全国细菌耐药监测网技术方案要求开展细菌耐药监测工作,参考美国临床实验室标准化协会标准判断药敏试验结果,应用WHONET 5.6软件分析2012—2021年湖南省细菌耐药监测网成员单位上报的尿标本分离细菌的菌株资料及耐药性数据。结果2012—2021年尿标本检出细菌379330株,其中革兰阴性菌占75.3%(72.4%~76.0%),革兰阳性菌占24.7%(24.0%~27.6%)。革兰阴性菌中居前5位的细菌分别为大肠埃希菌(48.3%)、肺炎克雷伯菌(8.4%)、奇异变形杆菌(3.3%)、铜绿假单胞菌(3.0%)、阴沟肠杆菌(1.6%)。革兰阳性菌中居前5位的细菌分别为屎肠球菌(8.1%)、粪肠球菌(6.6%)、表皮葡萄球菌(1.9%)、金黄色葡萄球菌(1.9%)、溶血葡萄球菌(1.4%)。不同性别及不同年龄段患者尿标本检出细菌构成不同,居首位的大肠埃希菌在男性、女性中分别占34.8%、57.2%,在成人和儿童中分别占49.0%、34.4%。大肠埃希菌对碳青霉烯类抗生素、阿米卡星、替加环素、头孢哌酮/舒巴坦、呋喃妥因保持较高的敏感性,耐药率<10%;对头孢唑林、头孢呋辛、头孢曲松、头孢噻肟、喹诺酮类抗菌药物的耐药性较高,耐药率>48%;对头孢他啶、头孢曲松、头孢噻肟、头孢吡肟、氨曲南的耐药率呈下降趋势(均P<0.001)。肺炎克雷伯菌对碳青霉烯类抗生素、阿米卡星、替加环素保持较高的敏感性,耐药率<11%,对喹诺酮类抗菌药物耐药率远低于大肠埃希菌。屎肠球菌、粪肠球菌对万古霉素、替考拉宁、利奈唑胺均保持较高的敏感性,耐药率均<5%;粪肠球菌对氨苄西林、呋喃妥因的耐药率<15%;除利奈唑胺和米诺环素外,屎肠球菌对被检测抗菌药物的耐药率均高于粪肠球菌。未检出对万古霉素、利奈唑胺、替考拉宁耐药的金黄色葡萄球菌。结论湖南省细菌耐药监测网各成员单位尿标本检出细菌以大肠埃希菌为主,在早期经验性治疗的同时,临床应尽快根据细菌鉴定和药敏结果进行目标用药,从而提高治疗效果和减缓耐药产生。

泌尿系结核误诊临床分析

目的探讨泌尿系结核(UTB)误诊原因,提高临床医师对该疾病的认识。方法对2023年2—7月收治的UTB 5例临床资料进行回顾性分析。结果本组中临床表现尿频尿急4例,血尿3例,腰痛3例,发热2例;尿常规异常4例,尿抗酸杆菌涂片阳性1例,24 h尿沉渣GeneXpert MTB/RIF阳性4例,尿分枝杆菌培养阳性4例,血结核感染T细胞斑点试验阳性5例。影像学表现有肾积水、输尿管扩张及尿路钙化4例,膀胱占位1例,肾自截1例。活动性肺结核3例,陈旧性肺结核2例。5例延误诊治时间2~6年。误诊为泌尿系感染合并肾结石2例,泌尿系感染合并膀胱恶性肿瘤1例,肾结石1例,前列腺增生1例;4例确诊后予抗结核治疗,1例未治疗,随访中2例死亡。结论UTB由于临床表现缺乏特异性、早期诊断困难以及临床医师认识不足,容易误诊导致严重后果。对于复杂性尿路感染患者常规抗感染效果不佳,尤其是有胸部影像学异常时,需高度警惕UTB可能。

复杂性尿路感染243例病原菌构成及药敏分析

目的分析复杂性尿路感染的病原菌构成及耐药性,为临床合理使用抗菌药物提供依据。方法收集四川省人民医院2014年1月—2016年12月的复杂性尿路感染243例,对临床资料及实验室检查进行回顾分析。结果 243例复杂性尿路感染共分离出289株病原菌,其中革兰阴性菌211株(73%)、革兰阳性菌55株(19.1%)、真菌23株(7.9%),主要病原菌为大肠埃希菌、肺炎克雷伯菌、屎肠球菌、粪肠球菌、光滑念珠菌及白念珠菌;医院获得复杂性尿路感染分离的肺炎克雷伯菌、肠球菌、光滑念珠菌,较社区获得复杂性尿路感染分离高。主要革兰阴性菌仅对碳青霉烯、哌拉西林/三唑巴坦、阿米卡星的敏感性较好,敏感率在80%以上,其中医院获得复杂性尿路感染分离的大肠埃希菌和肺炎克雷伯菌,除对碳青霉烯类保持高度敏感外,敏感率在92.9%以上,其余常用抗菌药物的敏感性均有不同程度下降,大肠埃希菌和肺炎克雷伯菌中ESBLs检出率分别为59%和44%;肠球菌对利奈唑胺100%敏感,屎肠球菌对万古霉素耐药率达13.8%;8株白念珠菌对常用抗真菌药物均敏感,9株光滑念珠菌中仅2株对氟康唑敏感。结论复杂性尿路感染病原菌以革兰阴性菌为主,ESBLs检出率高,耐药率较高,临床应根据复杂因素及病原菌和药敏结果合理选择抗菌药物。

泌尿系感染病原菌的分布及耐药性分析

目的探讨泌尿系感染病原菌的分布及耐药性,为临床合理选用抗菌药物提供依据。方法对2013年1月-2014年12月送检的尿标本进行病原菌培养、分离及鉴定,用纸片扩散法、E-test法或全自动细菌分析仪测定细菌对不同抗菌药物的敏感性,采用2013年版CLSI标准判读结果。结果共分离出4 027株病原菌,其中革兰阴性菌占66.4%,革兰阳性菌占25.7%,真菌占7.9%。检出率最高的前4位病原菌依次为大肠埃希菌、屎肠球菌、肺炎克雷伯菌和粪肠球菌。大肠埃希菌对亚胺培南和美罗培南最为敏感,对青霉素类耐药性最强。肠球菌属的整体耐药性十分严重,屎肠球菌比粪肠球菌的耐药率高,二者对万古霉素和利奈唑胺较为敏感。结论泌尿系感染病原菌对抗菌药物已产生了一定的耐药性,定期监测尿路感染病原菌的分布及耐药性,对指导临床合理用药具有重要意义。

2016—2018年北京某三甲医院中段尿培养的病原菌构成与耐药性分析

目的分析2016年1月—2018年12月北京积水潭医院住院患者中段尿标本病原菌构成及耐药性,为临床合理使用抗菌药物提供依据。方法采用VITEK 2 compact全自动细菌鉴定药敏仪进行细菌鉴定和药敏分析,应用WHONET 5.6软件进行数据分析。结果 3490株中段尿培养病原菌,其中革兰阴性菌2097株(60.1%),最常见的是大肠埃希菌(32.8%)、肺炎克雷伯菌(5.5%)、铜绿假单胞菌(5.4%)和奇异变形菌(3.4%);革兰阳性菌1323株(37.9%),最常见的是屎肠球菌(12.5%)、粪肠球菌(8.5%)、表皮葡萄球菌株(3.0%)和无乳链球菌(2.0%)。女性患者大肠埃希菌检出率明显高于男性(45.8%对19.9%),但铜绿假单胞菌在男性患者中占比高于女性(7.6%对3.3%)。大肠埃希菌和肺炎克雷伯菌产ESBLs的检出率为56.3%和58.5%;产ESBLs株对头孢菌素、喹诺酮类、四环素、磺胺类抗菌药物敏感率<50.0%;肠杆菌科细菌对碳青霉烯类抗菌药物高度敏感,为88.5%~100.0%。非发酵菌群中铜绿假单胞菌对大部分抗菌药物敏感率>70.0%。革兰阳性菌对万古霉素、替考拉宁和利奈唑胺高度敏感,为89.0%~100.0%。结论大肠埃希菌和肠球菌是尿路感染主要病原菌,临床可依据病原菌分布特点及药物敏感性进行早期用药。

泌尿系感染患者病原菌分布及药物敏感性分析

目的分析泌尿系感染患者病原菌的分布及药物敏感性特征,为临床泌尿系感染的治疗提供依据。方法对2014年1-12月就诊于解放军总医院肾病科门诊的953例泌尿系感染患者的953份尿标本同时进行支原体、细菌培养鉴定和药物敏感性试验。结果953例泌尿系感染患者中,395例支原体培养阳性,阳性检出率41.45%,对美满霉素和强力霉素敏感率>90%;154例细菌培养阳性,阳性检出率16.16%,分离菌株156株,大肠埃希菌71株占首位,其次为草绿色链球菌14株、粪肠球菌12株、肺炎克雷伯菌11株、无乳链球菌11株等,大肠埃希菌和肺炎克雷伯菌超广谱β-内酞胺酶阳性率分别为45.07%和18.18%,未发现对亚胺培南、美罗培南耐药的大肠埃希菌和肺炎克雷伯菌,以及对万古霉素、利奈唑胺耐药的草绿色链球菌、粪肠球菌和无乳链球菌。结论泌尿系感染患者病原菌以解脲支原体和大肠埃希菌为主,及时监测病原菌的种类分布及药物敏感性特征,对泌尿系感染疾病的治疗有重要意义。

老年女性尿路感染病原学及其耐药性

目的探讨老年女性尿路感染的病原菌分布及其耐药特征。方法收集某院2008年1月—2010年10月老年女性尿路感染患者清洁中段尿标本分离的病原菌,进行菌株鉴定及药敏试验。结果共分离病原菌182株,前6位依次为大肠埃希菌(46.70%)、葡萄球菌属(13.74%)、肠球菌属(9.34%)、肺炎克雷伯菌(8.24%)、铜绿假单胞菌(4.95%)、真菌(4.95%)。产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌分别占该2种细菌的22.35%和26.67%;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)占凝固酶阴性葡萄球菌的50.00%,耐甲氧西林金黄色葡萄球菌(MRSA)占金黄色葡萄球菌的44.44%。细菌对各种抗菌药物有不同程度的耐药性,且为多重耐药。结论重视尿路感染病原菌及其耐药性的检测,对控制老年女性尿路感染耐药菌株传播,指导临床合理使用抗菌药物具有重要意义。

东莞地区2010～2012年尿路感染病原菌分布及耐药性分析

目的了解东莞地区近3年尿路感染病原菌分布及其耐药性特点,为临床提供合理应用抗菌药物的依据。方法收集该院2010～2012年1 557株尿路感染患者中段尿标本分离的病原菌,用VITEK32细菌鉴定仪进行鉴定,并采用K-B法进行药敏试验,参照2010年CLSI标准判读结果。结果该院2010～2012年尿液标本共分离出1 557株病原菌,革兰阴性杆菌中以大肠埃希菌、肺炎克雷伯菌为主,分别占42.7%、6.2%。未发现碳氢酶烯类药物耐药株,这两种菌对含酶抑制剂药的耐药率都偏低,对氨苄西林的耐药率较高。革兰阳性球菌以粪肠球菌、屎肠球菌为主,分别占9.2%、3.5%。除四环素以外,屎肠球菌对其他抗菌药物的耐药率均高于粪肠球菌。未发现利奈唑胺和万古霉素的耐药株,这两种菌对红霉素和四环素的耐药率较高。结论临床医生应结合本地区尿路感染病原菌分布特征及药敏试验结果合理应用抗菌药物。

门诊和住院患者尿路感染病原菌的临床分析

目的对2004至2007年门诊和住院患者尿路感染病原菌进行分析,并总结主要病原菌的药敏情况。方法严格按照操作规程进行接种、培养,使用MicroScan半自动细菌鉴定仪进行细菌鉴定和药敏分析。结果4年中中段尿标本共分离致病菌3 139株,其中最常见的是大肠埃希菌和粪肠球菌。分离自住院患者的大肠埃希菌和粪肠球菌药物敏感性普遍低于分离自门诊患者的菌株。大肠埃希菌敏感率较高的分别是亚胺培南(100%)、头孢吡肟、头胞他啶、阿米卡星和头孢噻肟;粪肠球菌敏感率较好的分别是万古霉素(100%)、氨苄西林,环丙沙星和四环素的敏感率不高。结论了解尿路感染病原菌的临床分布和变化趋势。

阿托伐他汀对大脑中动脉栓塞大鼠尿激酶溶栓治疗的影响

目的研究阿托伐他汀联合尿激酶溶栓对大鼠大脑中动脉急性脑梗死的疗效。方法选择SD大鼠48只,采用血栓栓塞法制备大鼠大脑中动脉急性脑梗死模型,随机分为阿托伐他汀组、尿激酶组、联合治疗组和对照组,每组12只。缺血3h给予阿托伐他汀或生理盐水,缺血4h给予尿激酶或生理盐水治疗。治疗前和缺血24h行神经功能缺损评分,缺血24h取脑行2,3,5-氯化三苯基四氮唑染色检测脑梗死体积。结果与对照组比较,阿托伐他汀组缺血24h神经功能显著改善[(6.5±4.3)分vs(12.5±4.3)分],脑梗死体积明显降低[(13.8±7.5)%vs(30.5±23.4)%,P<0.05]。与阿托伐他汀组比较,尿激酶组和联合治疗组神经功能改善程度及脑梗死体积降低程度更显著(P<0.05)。与尿激酶组比较,联合治疗组神经功能改善、脑梗死体积减小,但差异无统计学意义(P>0.05)。结论阿托伐他汀对脑梗死组织有保护作用,阿托伐他汀与尿激酶联合治疗有进一步提高疗效的趋势。

社区老年人尿路感染抗菌药物选择与药敏情况分析

目的探讨社区老年人尿路感染经验性抗菌药物选择与药敏试验的符合率,以指导临床用药。方法回顾性分析我院2011年1—12月74例老年人尿路感染患者中段尿标本培养阳性结果,观察抗菌药物的选择与药敏结果的符合情况。结果抗菌药物使用与药物敏感结果相符合的有25例(占33.8%),不符合的有49例(占66.2%)。相符合病例中有效20例,无效5例,有效率为80.0%;不符合病例中有效25例,无效24例,有效率为51.0%,二者间差异有统计学意义(P<0.05)。结论社区老年人尿路感染病原菌对常用抗菌药物敏感性较差,社区医生选择治疗的药物与药敏试验符合率偏低,应引起重视。

尿培养阳性标本的病原菌分布及耐药性分析

目的分析四川省绵阳市中心医院2011年1～12月尿路感染病原菌的分布及耐药情况,为临床合理选用抗菌药物提供依据。方法采用法国生物梅里埃Vitek Compact 2全自动细菌鉴定系统对细菌进行鉴定,用琼脂稀释法进行药物敏感试验,双纸片表型确证试验检测产超广谱β-内酰胺酶(ESBLs)菌株。结果 354株病原菌中以革兰阴性杆菌为主,占80.79%,其中优势菌株为大肠埃希菌(55.08%);革兰阳性球菌以屎肠球菌为主,占4.24%。大肠埃希菌除对亚胺培南全部敏感外,对其他抗菌药物均表现出不同程度的耐药。195株大肠埃希菌中,产ESBLs 108株,检出率为55.38%。屎肠球菌对高浓度的链霉素和高浓度的庆大霉素敏感率很高,分别为93.3%和100%。结论该院尿路感染的致病菌以大肠埃希菌为代表的革兰阴性杆菌为主,但肠球菌等革兰阳性球菌所占比例比2010年有所增多。细菌对多种抗菌药物耐药,临床应按药敏试验结果合理选择抗菌药物。

Low eradication rate of Helicobacterpyloriwith triple 7-14 days and quadriple therapy in Turkey

AIM:The eradication rate of Helicobacter pylori (H pylori) shows variation among countries and regimens of treatment. We aimed to study the eradication rates of different regimens in our region and some factors affecting the rate of eradication. METHODS:One hundred and sixty-four H pylori positive patients (68 males,96 females;mean age:48±12 years) with duodenal or gastric ulcer without a smoking history were included in the study.The patients were divided into three groups according to the treatment regimens.Omeprazole 20mg,clarithromycin 500mg,amoxicillin 1g were given twice daily for 1 week (Group Ⅰ) and 2 weeks (Group Ⅱ). Patients in Group Ⅲ received bismuth subsitrate 300mg, tetracyline 500mg and metronidazole 500mg four times daily in addition to Omeprazole 20mg twice daily.Two biopsies each before and after treatment were obtained from antrum and corpus,and histopathologically evaluated. Eradication was assumed to be successful if no H pylorus was detected from four biopsy specimens taken after treatment.The effects of factors like age,sex,H pylori density on antrum and corpus before treatment,the total H pylori density,and the inflammation scores on the rate of H pylori eradication were evaluated. RESULTS:The overall eradication rate was 42%.The rates in groups Ⅱ and Ⅲ were statistically higher than that in group Ⅰ (P<0.05).The rates of eradication were 24.5%, 40.7% and 61.5% in groups Ⅰ,Ⅱ and Ⅲ,respectively.The eradication rate was negatively related to either corpus H pylori density or total H pylori density (P<0.05).The median age was older in the group in which the eradication failed in comparison to that with successful eradication (55 yr vs 39 yr,P<0.001).No correlation between sex and H pylori eradication was found. CONCLUSION:Our rates of eradication were significantly lower when compared to those reported in literature.We believe that advanced age and high H pylori density are negative predictive factors for the rate of H pylori eradication.

全国医院感染监测网2012年综合ICU医院感染现患率调查监测报告

目的了解我国医院综合重症监护室(ICU)医院感染发生率、常见侵入性操作使用率及相关感染率、抗菌药物使用及病原体分布情况。方法对2012年3月15日—12月31日期间上报至全国医院感染监测网医院感染横断面调查资料中综合ICU监测数据进行汇总分析。结果 1 313所医院中,621所(47.30%)有综合ICU;共监测患者5 887例,发生医院感染1 634例、1 962例次,医院感染现患率及例次现患率分别为27.76%、33.33%。医院感染部位以下呼吸道(70.39%)居首位,其次为泌尿道(12.79%)、血液(2.86%)。泌尿道插管、动静脉置管及呼吸机使用率分别达53.52%(3 151例)、37.05%(2 181例)、35.62%(2 097例),其相关泌尿道感染、肺炎、血流感染现患率分别为4.67%、20.41%、0.60%,分别占泌尿道、肺炎、血流现患医院感染的58.57%、30.99%、23.21%,三者合计占医院感染现患率29.97%(588/1 962)。检出医院感染病原体1 795株,居前3位的分别是铜绿假单胞菌(20.78%)、鲍曼不动杆菌(17.99%)和肺炎克雷伯菌(11.64%)。抗菌药物使用率为71.58%(4 214例),病原学送检率达75.27%(2 553/3 392)。结论综合ICU住院患者医院感染现患率以及抗菌药物使用率高,各种侵入性操作(泌尿道插管率、动静脉置管率和呼吸机使用率)高,30%的医院感染与侵入性操作相关;非发酵菌感染严重,病原学送检率尚可。