“提高抗菌药物治疗前病原学送检率”专项行动三年改进效果追踪评价

目的追踪评价连续三年推进“提高抗菌药物治疗前病原学送检率”专项行动的改进效果,为今后工作提供循证依据。方法收集2020—2023年某三级综合医院住院患者临床资料,以2020年基线调查结果为改进前组,2021—2023年持续推进专项行动改进目标为改进后组,采取完善信息系统、建立多部门协作机制、全员多层次培训宣教、规范医疗行为和病原学送检流程、强化监管效能等措施,动态追踪指标并及时跟进策略,通过医院感染信息系统开展监测并获取数据。应用R 4.1.3统计软件,比较两组指标的差异和不同年份数据变化趋势以评价改进成效。结果推进专项行动改进目标三年,治疗性抗菌药物使用率有所降低,且随年份变化呈下降趋势(P<0.001)。抗菌药物治疗前病原学送检率由39.38%提高到85.40%,血培养送检率由14.11%提高到49.28%,限制级和特殊级抗菌药物治疗前病原学送检率分别由31.76%、55.97%增至92.11%、99.10%,联合使用重点药物前病原学送检率由83.09%增至97.74%,且均随着年份变化呈逐年增高趋势(均P<0.001)。多重耐药菌检出率下降,耐碳青霉烯类肠杆菌目细菌(CRE)和耐甲氧西林金黄色葡萄球菌(MRSA)检出率呈下降趋势(P<0.001)。医院感染诊断相关病原学送检率保持在90%以上,采集标本与感染部位相符率由73.26%提高到91.67%,且随着年份变化呈逐年增高趋势(P<0.05),其中内科科室相符率最低,重症医学科相符率最高。结论连续三年持续推进专项行动改进目标,保持动态评估,大大提高了临床医务人员对病原学标本送检指征和时机的准确把握,规范了诊疗行为,从而引导临床正确、合理使用抗菌药物,减少医院细菌耐药的发生。

埃博拉病毒病临床治疗的最新进展

埃博拉病毒是目前发现的最凶险、对人类威胁最大的病毒之一，致死率可高达90％。针对面临的巨大挑战，寻找有效的治疗方法和预防性疫苗的研发已成为医学界急需攻克的难题之一。本文综述了埃博拉病毒的病原学特征、发病机制、临床特征以及最新的治疗方法。

The rationale behind the four major anti-COVID-19 principles of Chinese herbal medicine based on systems medicine

As the novel coronavirus disease 2019(COVID-19)and its variants continue to rage into the second year of a global pandemic,many success stories of applying Chinese herbal medicine(CHM)to treat COVID-19 patients continue to emerge from China and other part of the world.Herewith,from a systems medicine perspective,the authors analyze those experiences and categorize them into four major treatment principles:(1)focusing on eliminating toxins in the early stage of the disease,(2)tonifying deficiency of the body throughout the entire disease course,(3)treating the affected lung and intestine simultaneously based on visceral interactions,(4)cooling blood and removing blood stasis at the later stage,as well as interpret the rationale of these principles.This is helpful not only in reducing the complexity of promoting the CHM applications to enhance anti-COVID-19 efficacy,but also in ramping out the process of integrating traditional Chinese medicine with modern medical practices.