Multidrug-Resistant of Escherichia coli and Salmonella spp. Strains in Chicken Feces Intended for Consumption in Open Spaces of Ouagadougou, Burkina Faso

Resistant bacteria can be transmitted to humans through feces or contaminated meat from local chickens. Bacterial strains were isolated from the intestinal contents of 400 local chicken samples from various sales sites. These strains were then characterized using bacteriological and biochemical methods to identify resistant strains. In a study conducted in Ouagadougou, we systematically collected chicken fecal samples from 20 locations across the city, followed by isolation and identification of Salmonella spp. using specific enrichment and culture methods, as well as Escherichia coli. Bacterial strains were characterized using antibiotic resistance profiles were determined through agar diffusion tests, revealing sensitivity or resistance to a range of antibiotics based on established scientific criteria. The results showed that out of the 400 samples collected, 81.25% and 63.5% were contaminated by Escherichia coli and Salmonella spp., respectively. Among these, 86.15% of identified Escherichia coli and 50.78% of Salmonella spp. displayed resistance to at least one tested antibiotic. Among 280 Escherichia coli isolates identified resistant to at least one antibiotic, 31.07% were resistant to cefotaxime (CTX), 20.35% to ceftazidime (CAZ), 21.07% to ceftriaxone (CTR), 75% to amoxicillin clavulanic acid (AMC), 23.57% aztreoname (ATM) and 27.14% were resistant to imipenem (IMP). In the case of the 129 Salmonella spp. isolates resistant to at least one tested antibiotic, 34.88% were resistant to CTX;41.08% to CAZ;35.65% to CTR, 92% to AMC, 39.53% to ATM and finally 47.28% were resistant to IMP. Our study revealed high prevalence of resistance in bacterial strains isolated from local chickens sold outdoors in Ouagadougou. These findings raise significant public health concerns, due to the possible transmission of these resistant strains to humans through the consumption of contaminated meat, thus complicating the treatment of bacterial infections.

Multidrug dissolvable microneedle patch for the treatment of recurrent oral ulcer

Recurrent oral ulcer is a painful oral mucosal disorder that affects 20%of the world’s population.The lack of a radical cure due to its unknown underlying cause calls for innovative symptomatic treatments.This work reports a hyaluronic acid-based dissolvablemicroneedle patch(ROUMNpatch,short for recurrent oral ulcer microneedle)loaded with dexamethasone acetate,vitamin C and tetracaine hydrochloride for the treatment of recurrent oral ulcers.The ROUMN patch shows enhancement in both the anti-inflammatory effect elicited by dexamethasone and the pro-proliferation effect of vitamin C.In vitro experiments show that ROUMN has a higher efficiency in suppressing lipopolysaccharide(LPS)-induced interleukin-6(IL-6)expression than dexamethasone alone.Cell proliferation and migrationwere also significantly promoted byROUMNcompared to vitamin C alone.The healing-promoting effect of ROUMN was also verified in vivo using an acetic acid-cauterized oral ulcer model in rats.ROUMN as a treatment accelerated the healing process of oral ulcers,shortening the total healing time to 5 days compared with the 7 days required by treatment using watermelon frost,a commonly used over-the-counter(OTC)drug for oral ulcers.The rapid dissolution of the hyaluronic acid-based microneedles and the superior healing-promoting effect of the drug combination could lead to a broad application prospect of the ROUMN patch in the treatment of recurrent oral ulcers.

Genotyping Characteristics of Human Fecal Escherichia coli and Their Association with Multidrug Resistance in Miyun District, Beijing

Objective To explore the genotyping characteristics of human fecal Escherichia coli(E. coli) and the relationships between antibiotic resistance genes(ARGs) and multidrug resistance(MDR) of E. coli in Miyun District, Beijing, an area with high incidence of infectious diarrheal cases but no related data.Methods Over a period of 3 years, 94 E. coli strains were isolated from fecal samples collected from Miyun District Hospital, a surveillance hospital of the National Pathogen Identification Network. The antibiotic susceptibility of the isolates was determined by the broth microdilution method. ARGs,multilocus sequence typing(MLST), and polymorphism trees were analyzed using whole-genome sequencing data(WGS).Results This study revealed that 68.09% of the isolates had MDR, prevalent and distributed in different clades, with a relatively high rate and low pathogenicity. There was no difference in MDR between the diarrheal(49/70) and healthy groups(15/24).Conclusion We developed a random forest(RF) prediction model of TEM.1 + baeR + mphA + mphB +QnrS1 + AAC.3-IId to identify MDR status, highlighting its potential for early resistance identification. The causes of MDR are likely mobile units transmitting the ARGs. In the future, we will continue to strengthen the monitoring of ARGs and MDR, and increase the number of strains to further verify the accuracy of the MDR markers.

Meta‑analysis of influencing factors associating with treatment outcome of multidrug resistant tuberculosis

Objective:To systematically review the influencing factors of the treatment outcome of multidrug-resistant pulmonary tuberculosis and provide reference for the prevention and treatment of multidrug-resistant pulmonary tuberculosis.Method:Case control studies on the factors influencing the treatment outcome of multidrug-resistant pulmonary tuberculosis in Chinese databases(CNKI,VIP,Wanfang,Sinomed)and English databases(Pubmed,Web of science,Medline,Embase,Scopus)were searched and collected by computer.The search period was from the establishment of the database to January 2023.After screening and quality evaluation,RevMan5.4 was used for meta-analysis.Result:Totally 18 articles were ultimately included,with a sample size of 7328 people.The results showed that retreatment,complications,adverse reactions,and gender were related to the treatment outcome of multidrug-resistant pulmonary tuberculosis.The OR values and 95%CI of each factor were 0.22(0.17-0.29),0.38(0.32-0.46),0.27(0.17-0.44),and 0.43(0.33-0.56),respectively.Conclusion:Complications,retreatment,adverse reactions,and male gender are effective risk factors for the treatment outcome of multidrug-resistant pulmonary tuberculosis.In clinical practice,more targeted measures are needed for different types of patients.Due to the limitations of the number of studies,the above conclusions require more research to support them.

Sensorineural Hearing Loss in Multidrug-Resistant Tuberculosis Patients in Kinshasa (Democratic Republic of Congo): Prospective Cohort Study of Therapeutic Regimen with Aminoglycoside versus Bedaquiline

Context: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem in developing countries such as the Democratic Republic of Congo (DRC), which continues to face the emergence of MDR-TB cases. Because of the ototoxic effects of AGs, the World Health Organization (WHO) has recommended the introduction of the bedaquiline regimen. However, very few data are available regarding the susceptibility of bedaquiline to induce hearing loss, hence the present study set out to compare the AG-based regimen and the bedaquiline-based regimen in the occurrence of hearing loss in MDR-TB patients. Methods: This is a prospective multicenter cohort study that included 335 MDR-TB patients, performed in Kinshasa (DRC) during the period from January 2020 to January 2021. Sociodemographic, clinical, biological and audiometric data were analyzed using Stata 17. Repeated-measures analysis of variance was used to compare changes in the degree of hearing loss over time between the two groups of patients on AG and bedaquiline regimens. The double-difference method was estimated using regression with fixed-effects. A p value < 0.05 was considered the threshold for statistical significance. Results: The degree of hearing loss was similar between the two groups at the first month [AGs (28 dB) vs BDQ (30 dB);p = 0.298]. At six months, the mean degree of hearing loss was significantly greater in the aminoglycoside regimen group [AGs (60.5 dB) vs BDQ (44 dB);p < 0.001]. The double difference was significant, with a greater increase in hearing loss in the AGs group (diff-in-diff 18.3;p < 0.001). After adjustment for age and serum albumin, the group receiving the AG-based regimen had a 2-point greater worsening than those with bedaquiline at the sixth month (diff-in-diff 19.8;p Conclusion: Hearing loss is frequent with both treatment regimens, but more marked with the Aminoglycoside-based regimen. Thus, bedaquiline should also benefit for audiometric monitoring in future MDR-TB patients.

多药耐药相关蛋白转运体在药物性肝损伤中的作用研究进展

肝脏是人体新陈代谢最旺盛的器官,也是体内多种药物的解毒器官。当长期或过量使用药物时会增加药物性肝损伤(DILI)的风险。多药耐药相关蛋白(MRPs)是位于细胞膜上的功能蛋白,可转运多种药物,在DILI中发挥重要作用。MRPs功能的抑制、缺失是药物肝毒性产生的重要原因。本文对MRPs的结构、表达部位及功能进行归纳,并对MRPs与DILI的关系及其改善DILI的机制进行总结,期望更好地了解MRPs转运体与DILI的关系,为后续防治DILI提供参考。

肠杆菌科细菌mcr-1流行病学研究

目的探讨临床常见肠杆菌科细菌携带质粒介导多黏菌素耐药基因(mcr-1)的情况,为医院感染防控提供依据。方法收集2018年1月至2022年3月浙江省台州医院临床分离得到的菌株共1980株,包括大肠埃希菌1400株,肺炎克雷伯菌580株。采用PCR检测mcr-1基因;利用微量肉汤稀释法和E-test法检测抗生素对mcr-1阳性菌株的最低抑菌浓度;采用接合试验检测mcr-1基因在可转移质粒上的位置;通过提取细菌DNA基因组进行全基因组测序,并对测序结果进行多位点序列分型、质粒Inc分型和耐药基因识别等分析。结果在1400株大肠埃希菌中,共检测出6株携带mcr-1,阳性率为0.43%;580株肺炎克雷伯菌,仅1株检出mcr-1,阳性率为0.17%。其中5株菌株接合试验成功。6株大肠埃希菌的ST型分别是ST648、ST95、ST359、ST602、ST453、ST156,肺炎克雷伯菌是ST25。质粒Inc分型结果显示不同菌株携带相同类型质粒,提示该类质粒可以在菌株间水平传播。耐药基因分析发现7株细菌均携带大量的耐药基因,其中1株大肠埃希菌和肺炎克雷伯菌同时携带mcr-1和碳青霉烯耐药基因。结论mcr-1在大肠埃希菌和肺炎克雷伯菌中的分离率相对较低,然而考虑到含有mcr-1的质粒在不同细菌之间水平传播的潜力,以及mcr-1与同一质粒内的多个耐药基因整合的能力,在临床环境中要加强对多重耐药菌的管理。

Determinants of the Sensorineural Hearing Loss in Patients with Multidrug-Resistant Tuberculosis in Kinshasa (Democratic Republic of the Congo): A Prospective Cohort Study

Background: The onset of the hearing loss is a major challenge during the treatment of multidrug-resistant tuberculosis (MDR-TB). Aminoglycoside-based regimens, to a lesser extent based on bedaquiline, induce ototoxic sensorineural hearing loss. Research on risk factors is essential to enable high-risk individuals to benefit from preventive measures in settings with limited resources. Objective: This study aimed to assess the determinants of the hearing loss in patients with MDR-TB. Methods: This prospective multicenter cohort study included 337 patients with MDR-TB. It was performed in Kinshasa (Democratic Republic of the Congo) between January 2020 and January 2021. Sociodemographic, clinical, biological, therapeutic, and audiometric data were exported and analyzed using Stata 17 and MedCalc. The fixed-effect linear regression panel model was used to assess the degree of the hearing loss over time according to the following covariates: therapeutic regimen (aminoglycosides, bedaquiline, or alternate), stage of chronic kidney disease (CKD), age at inclusion, body mass index, serum albumin level, HIV status, alcohol intake, hypertension, and hemoglobin level. The Hausman test was used to select between fixed- and random-effect estimators. The threshold for statistical significance was set at p Result: A total of 236 patients (70%) received an aminoglycoside-based regimen, 61 (18%) received a bedaquiline-based regimen, and 40 (12%) received aminoglycosides relayed by bedaquiline. The frequency of the hearing loss increased from 62% to 96.3% within six months for all therapeutic regimens. The Hearing loss worsened, with moderate (72.4%) and profound (16%) deafness being predominant. An Exposure to the treatment for more than one month (β coeff: 27.695, Se: 0.793, p β coeff: 6.102, Se: 1.779, p β coeff: 5.610, Se: 1.682, p = 0.001), and an eGFR β coeff: 6.730, Se: 2.70, p = 0.013) were the independent risk factors associated with the hearing loss in patients with MDR-TB. Conclusions: The Hearing loss was more prevalent and worsened during the treatment of the patients with MDR-TB. An Exposure for more than one month, AG-based regimens, advanced age, hypoalbuminemia, and CKD have emerged as the main determinants of the worsening of the hearing loss.

含贝达喹啉全口服短程化疗治疗耐多药肺结核疗效及安全性观察临床研究

目的:探讨含贝达喹啉全口服短程化疗治疗耐多药肺结核患者的疗效及安全性。方法:选择100例耐多药肺结核患者,以随机数字表法将其分为对照组(WHO长疗程方案)50例和观察组(含贝达喹啉全口服短程方案)50例。比较两组患者痰培养阴转率、治愈率,并行胸部CT检查,观察病灶及空洞变化,并记录不良反应率发生情况。结果:观察组24周阴转率为84.00%(41/50)高于对照组74.00%(27/50),观察组36周时病灶吸收及空洞改善好于对照组(P<0.05)。观察组终点治愈率76.00%(38/50)高于对照组治愈率52.00%(26/50)(P<0.05)。对照组治疗过程中共出现不良反应84例次,观察组共出现不良反应69例次,两组不良反应发生情况比较,差异有统计学意义(P<0.05)。结论:含贝达喹啉全口服短程化疗方案治疗耐多药肺结核疗程短、治愈率高、安全性良好。

Th1/Th2细胞表达对耐多药肺结核患者治疗转归的影响

目的探讨辅助T细胞1(Th1)/辅助T细胞2(Th2)细胞表达对耐多药肺结核(MDR-TB)患者治疗转归的影响。方法回顾性纳入南阳市中心医院2019年1月至2022年9月收治的92例MDR-TB患者临床资料。所有患者均接受左氧氟沙星、贝达喹啉、利奈唑胺、氯法齐明、环丝氨酸联合治疗,强化治疗周期为6个月。根据强化治疗结束后患者治疗转归情况将患者分为转归良好组(74例)和转归不良组(18例)。对比两组一般资料和治疗前所测的Th1、Th2细胞表达情况及其他实验室指标,分析Th1/Th2细胞表达对患者治疗转归的影响。结果转归不良组有既往吸烟史占比、Th2高于转归良好组,Th1、Th1/Th2低于转归良好组(P<0.05)。经点二列相关性分析显示,Th1、Th2、Th1/Th2细胞表达与MDR-TB患者治疗转归情况有关。绘制受试者工作特征(ROC)曲线,结果显示,Th1、Th2、Th1/Th2细胞表达预测MDR-TB患者治疗转归的曲线下面积(AUC)分别为0.827、0.813、0.883,Th1/Th2预测价值最高。结论Th1/Th2细胞表达可对MDR-TB患者治疗转归的产生影响,其值越高,治疗转归不良发生率越高。

耐多药肺结核合并2型糖尿病1例并文献复习

耐多药肺结核的诊治是全球结核病控制的重难点问题,若合并糖尿病将进一步加大治疗难度,影响疾病的转归。本例患者自2015年开始,先后经历2次抗结核治疗失败,经过痰培养及药敏检查确诊耐多药肺结核,调整抗结核治疗方案的同时加强血糖的管理,最终治愈停药。本病例为耐多药肺结核与糖尿病共病患者的诊治提供了参考。

百里香酚对犊牛源生物被膜阳性金黄色葡萄球菌耐药性的消除作用

为了了解内蒙古地区犊牛病料中生物被膜阳性金黄色葡萄球菌的流行情况、耐药情况及百里香酚对生物被膜阳性金黄色葡萄球菌耐药性的消除作用。本试验采用生化鉴定和PCR方法,对采集到的104份犊牛病料进行金黄色葡萄球菌的分离鉴定;采用K-B法检测了金黄色葡萄球菌分离株对18种抗菌药物的敏感性;采用改良结晶紫染色法测定分离株的生物被膜形成能力;选取2株生物被膜强阳性菌株,采用微量肉汤稀释法测定百里香酚对分离株的最小抑菌浓度,并进行百里香酚耐药性消除试验。结果显示,在104份犊牛病料中共分离鉴定获得43株金黄色葡萄球菌。药敏试验结果显示,金黄色葡萄球菌分离株对氨苄西林、头孢西丁、卡那霉素、复方新诺明和红霉素5种抗菌药物的耐药率达到50.0%以上;74.4%(32/43)的分离株为多重耐药株。生物被膜形成能力强、中、弱和无生物被膜形成能力的分离株分别占比23.3%(10/43)、16.3%(7/43)、32.6%(14/43)和27.9%(12/43);生物被膜阳性株中83.9%(26/31)为多重耐药株。百里香酚对2株生物被膜强阳性株的最小抑菌浓度均为256 mg/mL,经百里香酚处理后均恢复了对头孢噻肟的敏感性。结果表明,百里香酚对生物被膜阳性金黄色葡萄球菌具有一定的耐药消除作用。

茵陈水提物对多药耐药蛋白3基因突变致新生儿肠外营养相关性胆汁淤积的保护作用

目的探讨茵陈水提物对多药耐药蛋白3(MDR3)基因突变导致的新生儿肠外营养相关性胆汁淤积(PNAC)的保护作用及可能机制。方法①将人原代培养肝细胞应用体外细胞培养、CRISPR/Cas9慢病毒感染、MDR3突变基因导入等技术处理后,比较1%脂肪乳诱导处理前(0)和处理后16、32、48 h不同时间点肝细胞上清液中肝胆生化指标〔丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)、直接胆红素(DBil)、间接胆红素(IBil)、总胆汁酸(TBA)〕的水平,确定构建MDR3基因突变PNAC肝细胞模型脂肪酸诱导所需的时间。②将人原代培养肝细胞株按随机数字表法分为空白对照组、MDR3基因野生型组、MDR3基因突变组、茵陈水提物干预组。空白对照组只用培养液处理,MDR3基因野生型组应用慢病毒感染融入野生型MDR3基因和培养液培养,MDR3基因突变组应用慢病毒感染慢病毒导入MDR3(c.485T>A、c.2793insA、c.1031G>A、c.3347G>A)突变基因和培养液培养,茵陈水提物干预组应用慢病毒感染导入MDR3突变基因和培养液培养的基础上,加入100 g/L茵陈水提物预处理,然后将4组肝细胞分别加入1%脂肪乳诱导处理,处理时间为构建MDR3基因突变PNAC肝细胞模型脂肪酸诱导所需时间。采用酶联免疫吸附试验(ELISA)测定4组肝细胞上清液中肝胆生化(ALT、AST、TBil、DBil、IBil、TBA)水平,采用实时荧光定量聚合酶链反应(RT-PCR)检测4组肝细胞编码MDR3、胆盐输出泵(BSEP)、多药耐药相关蛋白(MRP)2~4和肿瘤坏死因子-α(TNF-α)的三磷酸腺苷结合盒蛋白(ABCB4、ABCB11、ABCC2、ABCC3、ABCC4)和TNF基因mRNA的表达丰度。结果与空白对照组和MDR3基因野生型组比较,MDR3基因突变组在经1%脂肪乳诱导处理前和处理后16 h肝细胞上清液中肝胆生化指标(ALT、AST、TBil、DBil、IBil、TBA)水平比较差异无统计学意义,经1%脂肪乳诱导处理32 h和48 h MDR3基因突变组肝细胞上清液肝胆生化指标(ALT、AST、TBil、DBil、IBil、TBA)水平均明显升高(均P<0.05),确定构建MDR3基因突变PNAC肝细胞模型脂肪酸诱导所需的时间为32 h。与MDR3基因突变组比较,茵陈水提物干预组肝细胞在脂肪乳处理后32 h肝细胞上清液中肝胆生化指标(ALT、AST、TBil、DBil、TBA)水平均明显降低〔ALT(ng/L):148.3±2.3比164.9±7.0,AST(ng/L):2767.4±78.8比3239.4±107.1,TBi(lμmol/L):7.6±0.2比13.6±0.3,DBi(lμmol/L):1.8±0.1比5.7±0.2,TBA(μmol/L):3.4±0.2比6.7±0.1,均P<0.05〕;空白对照组、MDR3基因野生型组、MDR3基因突变组和茵陈水提物干预组肝细胞编码MDR3、MRP2、MRP3、MRP4的ABCB4、ABCC2、ABCC3、ABCC4基因mRNA表达丰度差异无统计学意义;TNF基因mRNA在MDR3基因突变组呈高表达(2-ΔΔCt:1.258±0.200比1.001±0.052),茵陈水提物干预组呈低表达(2-ΔΔCt:0.387±0.247比1.258±0.200),组间比较差异有统计学意义(P<0.05)。与MDR3基因突变组比较,茵陈水提取物干预组肝细胞编码BSEP的ABCB11基因mRNA的表达丰度明显增高(2-ΔΔCt:2.955±0.479比1.333±0.529,P<0.05)。结论茵陈水提物对MDR3基因突变导致的PNAC有一定保护作用,可能与拮抗炎症反应,降低TNF基因的mRNA表达和改善编码BSEP的ABCB11基因的mRNA表达有关。

初诊肺结核患者肠道菌群改变及其与耐多药的临床关系分析

目的:观察初诊肺结核患者肠道菌群改变,并分析其与耐多药的临床关系。方法:选取2021年6月至2023年5月本院收治的初诊肺结核患者347例,纳入肺结核组。另选取同期于本院体检的健康受试者347例,纳入健康组。比较两组肠道菌群属水平的相对丰度及肠道菌群Observed species指数、Shannon指数;肺结核组患者治疗2个月后,根据结核分枝杆菌(MTB)是否耐多药将肺结核组分为耐多药组、非耐多药组;比较耐多药组、非耐多药组一般资料及肠道菌群属水平的相对丰度;采用Logistic回归模型分析初诊肺结核患者耐多药的影响因素。结果:与健康组比较,肺结核组丁酸单胞菌属、类杆菌属、乳杆菌属、双歧杆菌属、布劳特菌属、梭状芽孢杆菌属的相对丰度及Observed species指数、Shannon指数降低(P<0.05),肠球菌属、粪球菌属、多尔菌属、志贺菌属、小杆菌属、韦荣球菌属、瘤胃球菌属的相对丰度升高(P<0.05);初诊肺结核患者耐多药率23.08%;与非耐多药组比较,耐多药组双歧杆菌属的相对丰度及Observed species指数、Shannon指数降低(P<0.05);Logistic回归模型分析显示,初中及以下文化程度(OR=2.678,95%CI:1.309~5.476)、慢性阻塞性肺疾病(COPD)(OR=3.931,95%CI:1.514~10.212)、结核病接触史(OR=2.494,95%CI:1.364~4.562)、肺结核空洞病灶数量(OR=2.776,95%CI:1.872~4.116)、治疗过程中断(OR=2.450,95%CI:1.306~4.596)、双歧杆菌属相对丰度(OR=0.393,95%CI:0.268~0.576)和Shannon指数(OR=0.463,95%CI:0.302~0.712)是初诊肺结核患者耐多药的影响因素(P<0.05)。结论:初诊肺结核患者肠道菌群平衡失调,初中及以下文化程度、COPD、结核病接触史、肺结核空洞病灶数量、治疗过程中断是其耐多药的危险因素,双歧杆菌属相对丰度、Shannon指数是其保护因素。

诊断相关分组耐药菌院内感染及经济负担分析

目的分析基于DRGs的MDRO医院感染情况与经济负担,为MDRO防控提供依据。方法回顾性分析本院2021年1月-2021年12月MDRO感染情况,将DRGs同组患者分为MDRO医院感染组和非MDRO感染组,分析2组患者住院时间及住院费用。结果2021年住院患者共入组DRGs病例73150例,发生MDRO医院感染188例,感染率为0.26%。MDRO医院感染DRGs组数占全院总DRGs组数的11.64%,下呼吸道感染位居第一位。MDRO医院感染组较非MDRO感染组住院时间延长14.5d,住院总费用增加47188.03元,医疗费、医技费、护理费、药品费、耗材费、抗菌药物费、输血费等MDRO医院感染组均高于非MDRO感染组差异有统计学意义(P<0.001)。结论由DRGs支付的患者医治数据可知易感染MDRO的患者及其所在科室和大幅增加的医治费用,相关部门适时关注DRGs支付情况,及时采取针对性措施,则可降低患者MDRO感染率和经济负担。

规范ICU多重耐药菌感染病人接触隔离的循证护理实践

目的:提高重症监护病房(ICU)医护人员接触隔离管理水平及最佳证据执行能力,降低ICU多重耐药菌医院感染发生率。方法:运用循证护理方法获取最佳证据,制定多重耐药菌感染病人接触隔离管理审查指标并用于临床进行持续质量改进,比较证据应用前后ICU多重耐药菌医院感染发生率、医护人员对多重耐药菌感染病人接触隔离相关知识知晓情况及执行情况。结果:本研究形成21条质量审查指标,应用最佳证据后,ICU医护人员多重耐药菌接触隔离理论知识评分由(73.49±6.50)分提高到(92.88±6.27)分;接触隔离措施依从性大幅提升,13条审查指标执行率提升至88%以上,差异均有统计学意义(P<0.05),ICU多重耐药菌医院感染率从3.2%降低至1.9%。结论:将基于循证的最佳证据应用于临床,有助于推进ICU多重耐药菌感染病人接触隔离管控措施落实,提升医护人员理论知识及实践水平,降低ICU多重耐药菌医院感染发生率。

多重耐药菌感染的中医药治疗干预研究进展

随着多重耐药菌(MDRO)特别是革兰阴性耐药菌的广泛流行,临床抗感染治疗也面临着原有抗菌药物有效性下降的现状,细菌耐药性形势日益严峻,亟需建立多学科协作机制,共同应对MDRO感染。中医学学者也积极对中医药治疗MDRO感染开展研究。MDRO感染可归于现代医学感染性疾病范畴,现代中医学认为,MDRO感染病因病机为正、邪两方面的相互作用,临床治疗应根据中医辨证论治的特点,进行个体化分析。本文旨在从MDRO的中医病因病机、辨证分型及治则治法、中药、方剂及中成药应用等方面对MDRO的中医药治疗干预情况作一综述。

世界卫生组织对BPaLM方案治疗耐多药结核病指南的解读

耐多药结核病仍是人类健康的重大危险因素,近期世界卫生组织推荐贝达喹啉(bedaquiline,Bdq)、普托马尼(pretomanid,Pa)、利奈唑胺(linezolid,Lzd)和莫西沙星(moxifloxacin,Mfx)的6个月方案(BPaLM)治疗耐多药结核病。新指南中短程方案适用人群扩大到耐多药结核病患者,而且适用于病变广泛的肺结核和大多数肺外结核,无疑是耐多药结核病治疗的重要事件。本文就BPaLM方案的研究历程、适用人群和注意事项作一简要介绍。

联合干预对耐多药结核病治疗效果的影响

目的:探讨联合干预对耐多药结核病患者治疗效果的影响。方法:将200例耐多药结核病患者随机分为常规组和干预组各100例。常规组采用一般健康教育及常规护理;干预组采用修订版MoriskY服药依从性量表进行问卷测评并实施团体活动、艾灸干预、营养干预、集中管理等多项式干预。结果:干预组服药依从性总均分8.80±1.41分,高于对照组的8.21±1.63分,差异具有统计学意义(P<0.05);干预组五分类网织检测各项指标值明显高于常规组(P<0.05);干预组患者痰培养检测转阴率明显高于常规组(P<0.05);干预组患者肺CT空洞闭合率明显高于常规组(P<0.05)。结论:联合干预有效提高了患者服药依从性及治疗效果,促进患者康复。

综合护理干预对耐多药结核病患者心理状态及服药依从性的影响

目的:探讨心理干预和团体活动对耐多药结核病患者心理状态及治疗依从性的影响。方法:将200例患者随机分为常规组和干预组各100例,常规组采用常规健康教育及一般常规护理,干预组采用心理干预、团体活动等多形式干预,采用症状自评量表(symptom checklist-90,SCL-90)进行心理状况调查测评,采用服药依从性量表进行服药依从性测评。结果:SCL-90中躯体化、强迫症状、人际关系敏感、抑郁、偏执、精神病性、睡眠及饮食几个维度,干预组得分均低于常规组(P<0.05),干预组SCL-90情况总均分低于常规组(P<0.05);干预组患者治疗依从性总均分高于常规组(t=-2.740,P=0.007);其中“结核病治疗周期长,您是否觉得长期服药有困难?”“您多久会有一次忘记服药?”“在过去的2周内,是否曾经忘记服用结核药?”这3个条目的分值干预组均高于常规组(P<0.05)。结论:心理干预及团体活动可改善耐多药结核病患者的不良心理状态,提高治疗依从性,促进患者康复。