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Investigation and Analysis of Perioperative Prophylactic Use of Antimicrobial in 500 Cases with Incision

摘要:目的：評價圍手術期預防性應用抗菌藥物現狀及合理性。方法：采用回顧性調查的方法，隨機抽查2009年度Ⅰ類切口手術圍手術期病案500份，設計外科圍手術期預防性應用抗生素調查表，對預防用藥的適應證、用藥種類、聯合用藥、給藥時機及持續時間進行統計分析。結果：未使用抗生素5例，預防性使用抗生素495例，其中不合理80例（16.00％）。預防性使用抗生素總品規數為540，其中頭孢菌素類453例（83.89%），青霉素類（包括加酶抑制劑）26例（4.81%），喹諾酮類44例（8.15%）。選用頭孢唑啉鈉178例（32.96%）居第一位，頭孢替唑鈉第二，151例（2796%）。結論：Ⅰ類切口手術患者圍手術期預防性使用抗菌藥物較為合理，但仍存在用藥指征把握不嚴，抗菌藥物的選擇、抗菌藥物使用時間較長等問題，有待進一步規范化管理。Abstract: Objective: To understand the current application of perioperative preventive antibiotics, and their rationality. Methods: Five hundred perioperative records of patients with incision Ⅰ were randomly chosen and surveyed in 2009. A questionnaire for prophylactic use of antimicrobial was designed. The indication of antimicrobial use, the species, combination, timing and drug duration were analyzed. Results: Our of 500, 495 used antimicrobial and 80 were unreasonable; 540 kinds of antimicrobial were used, included cephalosporin 453 cases (83.89%), penicillin class (including plus enzyme inhibitors) in 26 cases (4.81%), quinolone 44 cases (8.15%). Cefazolin sodium (178 patients, 32.96%) ranked first, second was cefazolin sodium (151, 27.96%). Conclusion: Perioperative use of antimicrobial prophylaxis in patients with incision Ⅰ is reasonable, but standardization management should be strengthened in the indication, species, and duration.

Pay Attention to Management of Perioperative Antibiotic’ Application

Effectiveness of inhaled antibiotics combined with intravenous administration for treatment of ventilator-associated pneumonia: a systematic review

Objective To evaluate the effects of inhalation combined intravenous antibiotics for the treatment of ventilator-associated pneumonia. Methods A computerized search was performed through Cochrane library, Joanna Briggs Institute Library, PubMed, MEDLINE, CINAHL, CBM, CNKI and Wangfang medical network about inhalation combined intravenous antibiotics therapy in ventilator-associated pneumonia in the literatures. The data extracting and quality assessment were performed by three researchers. The meta-analysis was performed by RevMan 5.3 software. Results Thirteen studies was included for analysis. The results showed that the cure rate was higher in the experimental group compared with the control group with significant difference (RR=1.16, 95%CI 1.07 to 1.56,P=0.000 5). There were no significant differences in the mortality (RR=1.04, 95%CI 0.82 to 1.32,P=0.74) or the incidence of kidney damage (RR=0.79, 95%CI 0.51 to 1.22,P=0.29). The difference in pathogenic bacteria removal was statistically significant (RR=1.38, 95%CI 1.09 to 1.74,P=0.007). The negative conversion rate of respiratory secretions was higher in the experimental group. Conclusion Inhalation combined intravenous antibiotics can improve the cure rate of patients with ventilator-associated pneumonia, clear pathogenic bacteria effectively, and is worthy of recommendation for clinical use.

AN EXPERIMENTAL STUDY ON PERMEABILITY OF ANTIBIOTICS TO PANCREATIC TISSUE

In order to choose the appropriate antibiotics for treating secondary pancreatic infection, permeability of antibiotics to pancreatic tissue was investigated on experimental dogs with acute hemorrhagic necrotizing pancreatitis. The concentrations of 8 different antibiotics were determined in the blood and the pancreatic tissue using highperformance liquid chromatography. Pancreatic tissue permeability of Cefotaxime, Ofloxacin, Amikacin, Piperacllin, Cefoperazone, Ampicillin, Metronidazole and Ciprofloxacin was 12%, 19%, 20%, 46%, 55%, 63%, 71% and 132% respectively. The study shows that this eight antibiotics have different permeability to the pancreatic tissue. Such observations support the existence of a bloodpancreas barrier, which acts to restrict the permeation of antibiotics into the pancreas. The results suggest that antibiotics with high permeability rate be used to treat the patient with secondary pancreatic infection.

Treatment of antibiotic associated diarrhea by Bifidobacterium tetravaccine in infants in China: a Meta-analysis

Objective To systematically evaluate the clinical effect and safety of Bifidobacterium tetravaccine tablets in the treatment of antibiotic associated diarrhea (ADD) in infants in China. Methods Randomized controlled trials (RCTs) of treatment of AAD by Bifidobacterium tetravaccine in infants were searched by computer from China Knowledge Resource Integrated Database, VIP and Wanfang Data from their inception to November 2016. Meta-analysis of the data was carried out by RevMan 5.3 software. Results Twelve RCTs were chosen, which included 1 761 infant patients. The Meta analysis showed that the effects of treatment of ADD were significantly superior to those of the control group [OR=5.74, 95%CI (4.14, 7.96),P<0.000 01]. Among the 12 RCTs, 8 had no adverse reactions, while the rest4 articles did not mention adverse reactions. Conclusions Based on the present clinical evidences, treatment of ADD by Bifidobacterium tetravaccine in infants is effective and safe. But due to the small number and different quality of RCTs, this conclusion still needs to be confirmed by large sample, multicenter, and high-quality clinical RCTs.

SIMPLE CHOLECYSTECTOMY AND USING ANTIBIOTIC IN PERIOPERATIVE PERIOD(ANALYSIS OF 642 CASES)

目的 了解單純膽囊切除術圍手術期應用預防性抗生素的作用。方法 對我院普外一科1998年1月至1999年12月2年間所施行的642例擇期單純膽囊切除術圍手術期抗生素的使用、細菌培養結果和切口感染情況進行回顧性分析。結果 642例根據其抗生素應用情況分為未用抗生素組(n＝220)、術前30分鐘一次性給藥組(n＝200)和術后3天持續用藥組(n＝222) 3組，3組患者之性別、年齡構成情況、全身狀況及發生術后切口感染情況間的差異均無顯著性意義(Ｐ＞0.05)； 對642例中隨機選擇52例行術中膽囊膽汁培養，結果47例無細菌生長。結論 對單純膽囊切除術患者術前無感染前提下，不用或僅術前30分鐘一次性使用抗生素是安全可行的，這對縮短患者住院日，減少其醫療費用具有積極的意義。

腹膜透析相關性腹膜炎致病菌的耐藥性分析

目的:探討腹膜透析相關性腹膜炎的致病菌及其耐藥性。方法:回顧性分析的93例腹膜透析相關性腹膜炎的致病菌及其耐藥性。結果:34例培養陽性, 透出液培養陽性率為36.6%, 其中革蘭陽性球菌14例, 革蘭陰性桿菌17例, 真菌4例。革蘭陰性桿菌對氨芐西林的耐藥率最高,達83.3%,亞胺培南耐藥性最低,達20.0%。革蘭陽性球菌對青霉素、環丙沙星的耐藥率高,分別為81.8%、71.4%。 結論:提高腹膜透析液細菌培養陽性率有助于腹膜透析相關性腹膜炎的治療;在經驗用藥基礎上,應依據細菌培養、藥敏,選擇治療腹膜透析相關性腹膜炎的敏感、有效抗菌素,真菌性腹膜炎治療效果仍差,應盡早拔管。

Analysis on the Characteristics and Drug Resistance of Ventilator-associated Pneumonia Pathogens

目的　分析呼吸科重癥監護病房（RICU）中呼吸機相關性肺炎（VAP）病原菌的來源、分布特點及耐藥情況, 為在RICU中更好地控制VAP提供科學依據。 方法　回顧性分析2005年1月－2011年12月期間，醫院RICU收治的行機械通氣時間＞48 h，住院時間＞7 d的136例VAP患者病原菌分布情況和耐藥性等臨床資料。 結果　RICU中VAP的發生率為42.8%（136/318），病死率為47.8%（65/136）。共分離出病原菌507株，其中G?菌占74.8%（379/507），銅綠假單胞菌居首位，其次為鮑曼不動桿菌和肺炎克雷伯菌；G+球菌占10.3%（52/507），以金黃色葡萄球菌為主；真菌占14.9%（76/507），以白色念珠菌為主。G?桿菌對常用抗菌藥物表現出較高的耐藥率，其中對青霉素類、頭孢菌素類抗菌藥物高度耐藥，而對碳青霉烯類耐藥率相對較低；耐甲氧西林的金黃色葡萄球菌對多種常見抗菌藥物高度耐藥，但對萬古霉素敏感。 結論　RICU的VAP病原菌以G?菌為主，耐藥情況比較嚴重，銅綠假單胞菌、鮑曼不動桿菌和肺炎克雷伯菌為RICU中的主要致病菌。

Progress in Antimicrobial Prophylaxis for Thoracic and Cardiovascular Surgery

Abstract： Appropriate prophylactic administration of antibiotics for thoracic and cardiovascular surgical procedure can reduce postoperative morbidity and decrease the overall cost due to infections. Prophylactic antibiotics should be given within 30 minutes preceding incision intravascularly. Serum levels of free drug above the minimal inhibitory concentration (MIC) for common contaminating bacteria should be maintained for the entire surgical period. Prophylactic antibiotics after operation are useless for patients without risk factors predisposing to postoperative infection. Heart and(or) lung transplant patients should be given antiviral and antifungal prophylaxis. Selection of antibiotics must be based on the pharmacokinetic, pharcodynamic and pharmacoeconomic properties of antibiotics and features of surgery. The policy of antibiotic prophylaxis must be modified in response to alterations in antibiotic resistance pattern which is constantly changing in hospital.

預防性抗生素應用在日間腹腔鏡膽囊切除術手術部位感染的作用

目的探討常規預防性抗生素應用是否有效預防日間腹腔鏡膽囊切除術后手術部位感染，以及圍手術期不使用抗生素的安全性、可行性。 方法納入2013年1月-12月收治的膽囊疾病患者500例。預防使用抗生素組（A組）228例，無抗生素使用組（B組）272例，均采用全身麻醉，日間手術模式進行收治，觀察兩組外科手術部位感染和預后情況。 結果全部患者均術后第1天出院。A組2例（0.9%）發生手術切口感染，B組3例（1.1%）發生切口感染，差異無統計學意義（P＞0.05）。A組1例劍突下切口紅斑，經口服抗生素治療好轉；另外1例切口感染裂開，經連續換藥5 d切口愈合。B組2例發生切口紅腫，經口服抗生素治愈；另外1例發生切口下積液，經拆除縫線，每天換藥，7 d后切口愈合。所有患者均無肝下積液、肺部感染以及泌尿道感染等。 結論單次劑量抗生素預防性使用并不能降低日間腹腔鏡膽囊切除術后外科手術部位感染發生率。