BACKGROUNDG roup B Streptococcus agalactiae (GBS) is the main etiologic agent associated withearly-onset neonatal sepsis, and of all newborns of parturients colonized by GBS,approximately 1%-2% develop invasive, early...BACKGROUNDG roup B Streptococcus agalactiae (GBS) is the main etiologic agent associated withearly-onset neonatal sepsis, and of all newborns of parturients colonized by GBS,approximately 1%-2% develop invasive, early-onset disease. The risk of infectionincreases to 15.2% in premature neonates, to 10.7% when the parturient haschorioamnionitis or premature rupture of membranes for more than 24 h and to9.7% if the mother has postpartum bacteremia. In addition to causing perinatal,neonatal and postnatal deaths, neonatal hospital infection is associated with highcosts, as hospitalization is three times longer than in uninfected children. Theidentification of pregnant women colonized by GBS, through universal screening,associated with the adoption of appropriate antibiotics at the time of delivery arethe most successful preventive measures.AIMTo evaluate the sensitivity profile of GBS isolated from pregnant womenattending Vitória da Conquista-BA.METHODS This is a cross-sectional study with a quantitative approach carried out in themunicipality of Vitória da Conquista-Bahia between February 2017 and March2018. The study population was composed of 210 pregnant women, with agestational age of 32 to 40 wk, who were aged 18 years or older living in the urbanarea of the municipality of Vitória da Conquista. After a brief explanation aboutthe research and obtaining a signed an informed consent form, data andvaginorectal swabs were collected from the women for GBS research. Examinationof the samples in order to identify the presence of GBS was by culture on sheep blood agar and chromogenic agar for GBS and then, seeded on plates containingstreptococcal culture medium and incubated for 18 h to 24 h at 35°C. Theantimicrobial sensitivity profile of positive GBS samples was determined by thedisk diffusion technique, according to the Clinical and Laboratory StandardsInstitute manual (2017). The data obtained were stored in a database usingMicrosoft Office Excel spreadsheets and a descriptive analysis was performedwith the aid of the EPI-INFO statistical package (version 3.5.2).RESULTSAmong the 210 pregnant women participating in the study, 38 (18.1%) had apositive GBS culture. All strains isolated from GBS were sensitive to 10 Upenicillin, 10 μg ampicillin, 30 μg cefotaxime and 30 μg vancomycin. Seven strains(18.4%) resistant to clindamycin 2 μg and eight (21.1%) resistant to erythromycin15 μg were found. Of these, six were concomitantly resistant to erythromycin andclindamycin, two resistant only to erythromycin and one resistant only toclindamycin. All nine GBS isolates that showed resistance to erythromycin and/orclindamycin showed negative results on the D-test. Two thirds of the isolatesshowed cMLSB phenotype and resistance only to erythromycin in specimens inthis study (02), refers to strains with phenotype M and resistance to clindamycin(01) only with phenotype L.CONCLUSIONChemoprophylaxis for GBS in pregnant women, especially for those allergic topenicillin, should be guided by an antimicrobial susceptibility test as resistantGBS strains were reported in this study.展开更多
Background： Investigate into the medical expenditures of chronic kidney disease （CKD） patients through path analysis method of three consecutive years within a Grade-A tertiary hospital in Beijing to conduct the ma...Background： Investigate into the medical expenditures of chronic kidney disease （CKD） patients through path analysis method of three consecutive years within a Grade-A tertiary hospital in Beijing to conduct the main influencing factors in diagnosis-related groups （DRGs） grouping of the diagnosis, and reassess the present grouping process to provide information and reference on cost control for hospitals and medical management departments. Methods： Eight hundred and fifty-five inpatient cases whose first diagnosis were defined as CKD in the year 2014-2016 within the hospital were selected as the sample of the study, multiple linear regression and path analysis method were adopted in DRGs grouping process to investigate the main influencing factors of total medical expenditures and DRGs grouping process. Results： The maximum proportion of the medical costs within CKD patients was the costs on treatment, with the highest of 35.3% on the year 2014, the second was the costs on drug, which accounted for 〈30% during consecutive years, and the third was the costs on examination, which accounted for about 20% on average. The main influencing factors of medical expenditures included the type of dialysis, length of hospitalization, the admission of Intensive Care Unit （ICU）, and so on. The coefficients toward the effect for total costs were 0.416, 0.376, and 0.094. respectively. Conclusions： It is suggested that the type of dialysis and the admission of ICU were the major influencing factors of inpatient medical expenditures on CKD patients, and should be taken into consideration into the reassessment of DRGs grouping process to realize the localization and generalization of prospective payment system based on DRGs within the regional area and promote the implementation of medical cost control measures to reduce the economic burdens among patients and the society.展开更多
文摘BACKGROUNDG roup B Streptococcus agalactiae (GBS) is the main etiologic agent associated withearly-onset neonatal sepsis, and of all newborns of parturients colonized by GBS,approximately 1%-2% develop invasive, early-onset disease. The risk of infectionincreases to 15.2% in premature neonates, to 10.7% when the parturient haschorioamnionitis or premature rupture of membranes for more than 24 h and to9.7% if the mother has postpartum bacteremia. In addition to causing perinatal,neonatal and postnatal deaths, neonatal hospital infection is associated with highcosts, as hospitalization is three times longer than in uninfected children. Theidentification of pregnant women colonized by GBS, through universal screening,associated with the adoption of appropriate antibiotics at the time of delivery arethe most successful preventive measures.AIMTo evaluate the sensitivity profile of GBS isolated from pregnant womenattending Vitória da Conquista-BA.METHODS This is a cross-sectional study with a quantitative approach carried out in themunicipality of Vitória da Conquista-Bahia between February 2017 and March2018. The study population was composed of 210 pregnant women, with agestational age of 32 to 40 wk, who were aged 18 years or older living in the urbanarea of the municipality of Vitória da Conquista. After a brief explanation aboutthe research and obtaining a signed an informed consent form, data andvaginorectal swabs were collected from the women for GBS research. Examinationof the samples in order to identify the presence of GBS was by culture on sheep blood agar and chromogenic agar for GBS and then, seeded on plates containingstreptococcal culture medium and incubated for 18 h to 24 h at 35°C. Theantimicrobial sensitivity profile of positive GBS samples was determined by thedisk diffusion technique, according to the Clinical and Laboratory StandardsInstitute manual (2017). The data obtained were stored in a database usingMicrosoft Office Excel spreadsheets and a descriptive analysis was performedwith the aid of the EPI-INFO statistical package (version 3.5.2).RESULTSAmong the 210 pregnant women participating in the study, 38 (18.1%) had apositive GBS culture. All strains isolated from GBS were sensitive to 10 Upenicillin, 10 μg ampicillin, 30 μg cefotaxime and 30 μg vancomycin. Seven strains(18.4%) resistant to clindamycin 2 μg and eight (21.1%) resistant to erythromycin15 μg were found. Of these, six were concomitantly resistant to erythromycin andclindamycin, two resistant only to erythromycin and one resistant only toclindamycin. All nine GBS isolates that showed resistance to erythromycin and/orclindamycin showed negative results on the D-test. Two thirds of the isolatesshowed cMLSB phenotype and resistance only to erythromycin in specimens inthis study (02), refers to strains with phenotype M and resistance to clindamycin(01) only with phenotype L.CONCLUSIONChemoprophylaxis for GBS in pregnant women, especially for those allergic topenicillin, should be guided by an antimicrobial susceptibility test as resistantGBS strains were reported in this study.
文摘Background： Investigate into the medical expenditures of chronic kidney disease （CKD） patients through path analysis method of three consecutive years within a Grade-A tertiary hospital in Beijing to conduct the main influencing factors in diagnosis-related groups （DRGs） grouping of the diagnosis, and reassess the present grouping process to provide information and reference on cost control for hospitals and medical management departments. Methods： Eight hundred and fifty-five inpatient cases whose first diagnosis were defined as CKD in the year 2014-2016 within the hospital were selected as the sample of the study, multiple linear regression and path analysis method were adopted in DRGs grouping process to investigate the main influencing factors of total medical expenditures and DRGs grouping process. Results： The maximum proportion of the medical costs within CKD patients was the costs on treatment, with the highest of 35.3% on the year 2014, the second was the costs on drug, which accounted for 〈30% during consecutive years, and the third was the costs on examination, which accounted for about 20% on average. The main influencing factors of medical expenditures included the type of dialysis, length of hospitalization, the admission of Intensive Care Unit （ICU）, and so on. The coefficients toward the effect for total costs were 0.416, 0.376, and 0.094. respectively. Conclusions： It is suggested that the type of dialysis and the admission of ICU were the major influencing factors of inpatient medical expenditures on CKD patients, and should be taken into consideration into the reassessment of DRGs grouping process to realize the localization and generalization of prospective payment system based on DRGs within the regional area and promote the implementation of medical cost control measures to reduce the economic burdens among patients and the society.
