A Study on Isolation and Antibiotic Sensitivity Testing of Pseudomonas aeruginosa Isolated from Patients with Respiratory Tract Infection with Special Reference to Phenotypic and Genotypic Characterization of Extended Spectrum Beta Lactamases (ESBL)

Backgrounds: Pseudomonas aeruginosa is a classic opportunistic pathogen with innate resistance to many antibiotics and disinfectants. The lung is a main target for colonization and infection by the bacteria either in the context of a chronic, progressively deteriorating infectious and inflammatory pulmonary disease such as cystic fibrosis (CF) or in a more acute setting such as severe pneumonia in immunocompromised patients [1]. Aim and Objectives: To study the prevalence, virulence and the resistance pattern, phenotypic and genotypic characterization of P. aeruginosa from sputum samples. Materials and Methods: The present study was carried out with a total of 500 clinical sputum samples, which were received from patients, admitted to the various departments of Rajah Muthiah Medical College & Hospital, Annamalai University, Chidambaram. Result: Of the 500 samples subjected for isolation and identification of P. aeruginosa, 116 (23.20%) were positive. The isolated strains were tested for antibiotic sensitivity patterns. 93.10% of P. aeruginosa showed a maximum sensitivity to Ofloxacin, Norfloxacin and 86.20% of strains were highly resistant to Cefotaxime. The same isolates were also tested for phenotypic characterization of Extended Spectrum of Beta Lactamases by double disc synergy method against Cefotaxime and Clavulanic acid, according to the criteria of Hi-Media [2]. Of the resistant strains of P. aeruginosa isolated from sputum, 59% were positive for ESBL. The genotype characterization of ESBL P. aeruginosa showed 40% of CTX-M and 46.66% SHV gene. Conclusion: The present study strongly recommends for further checking of the antibiotic resistant strains of P. aeruginosa for phenotypic characterization of ESBL for effective treatment.

心境稳定剂联合喹硫平或奥氮平治疗双相情感障碍躁狂发作疗效分析

目的研究心境稳定剂锂盐、丙戊酸盐联合喹硫平、奥氮平治疗双相情感障碍躁狂发作的疗效差异,为双相情感障碍躁狂发作患者选择合适的治疗方案提供参考。方法采用回顾性分析方法,收集某医院2015年1月—2022年7月收治的120例双相情感障碍躁狂发作患者的病历信息,按治疗方案不同分为4组,碳酸锂联合喹硫平组(21例)、碳酸锂联合奥氮平组(21例)、丙戊酸钠联合喹硫平组(50例)、丙戊酸钠联合奥氮平组(28例)。在治疗前、住院2周后、出院时采用倍克-拉范森躁狂量表评估患者躁狂症状,比较各组临床疗效、不良反应发生率,分析影响2周后躁狂症状缓解率的因素。结果4种联合方案入院时评分与2周后评分、出院时评分差异具有统计学意义(P<0.001);碳酸锂联合喹硫平组2周后缓解率优于碳酸锂联合奥氮平组,差异有统计学意义(P<0.01);多因素Logistic回归分析发现,家族史、药物不良反应、治疗方案、发病年龄与患者治疗2周后躁狂症状缓解率相关。结论4种联合方案均能有效改善双相情感障碍躁狂发作患者的躁狂症状;药物治疗方案推荐依次选用丙戊酸钠联合喹硫平、碳酸锂联合喹硫平、丙戊酸钠联合奥氮平、碳酸锂联合奥氮平;患者治疗2周后的躁狂症状缓解率与家族史、药物不良反应、药物治疗方案、发病年龄相关。

运用失效模式及效应分析改善临床给药流程的探讨

目的对临床给药流程进行改造，以减少用药流程的风险。方法运用失效模式及效应分析的基本步骤，成立流程改进工作小组，列出临床给药的流程，指出子流程下可能导致差错的环节及原因。提出优先解决的问题及流程整改方案，设计新型的临床给药流程。结果新旧给药流程优先风险数值比较差异有显著性（P〈0．01）；改造后用药相关缺陷从4例下降至2例。结论将失效模式及效应分析对临床护理给药流程进行分析，能前瞻性地发现工作流程中潜在的缺陷，使管理者发现流程中应该优先解决的问题，为护理工作流程改造提供科学的方法，确保病人用药安全。