现有预防非妊娠期妇女膀胱炎复发的临床证据如下:①连续预防性使用抗生素:一系列随机对照试验研究表明,连续预防性使用抗生素(甲氧苄氨嘧啶、复方磺胺甲噁唑、呋喃妥英、头孢克洛或一种喹啉)6～12个月可以减少复发性膀胱炎的发生率,但各种不同用药方案间未发现感染率有差异.一个比较持续性每日使用抗生素与性交后使用抗生素的随机对照试验表明,1年后尿培养阳性率差异无统计学意义.②性交后预防性使用抗生素(复方磺胺甲噁唑、呋喃妥英或一种喹啉):4个随机对照试验研究表明,性交后2 h内使用复方磺胺甲噁唑、呋喃妥英或喹啉较安慰剂能显著降低膀胱炎发生率.一个关于性交后预防性使用抗生素和每日连续使用抗生素的随机对照试验发现,1年后二者的膀胱炎发生率的差异无统计学意义.③一次性使用复方磺胺甲噁唑:一个小样本随机对照试验发现,连续每日预防性使用复方磺胺甲噁唑与在膀胱炎症状出现后一次性使用复方磺胺甲噁唑相比,前者能显著降低膀胱炎发生率.但由于证据太有限,不能得出肯定结论.④酸果蔓汁(cranberry juice)和酸果蔓制品:一个系统评价发现,酸果蔓汁及其制品能预防复发性膀胱炎的证据不足.⑤用马尿酸乌洛托品预防:缺乏研究马尿酸乌洛托品的可靠的随机对照试验.
Based on review and practice of literature search of clinical economic evaluation, We have discussed the source and search strategy of literatures of clinical economic evaluation. A sample on antibiotics in the treatment of community-acquired pneumonia was shown concurrently.
目的 分析下肢慢性创伤性骨髓炎患者创面细菌培养分布情况，为临床用药提供依据。 方法 对2006年1月－2010年12月收治的91例慢性骨髓炎患者创面分泌物细菌培养标本结果进行回顾性调查分析。其中男78例，女13例；年龄5～78岁，平均41.3岁。病程47 d～7个月，平均68.6 d。使用抗生素总疗程均＞7 d。 结果 65例创面细菌培养阳性患者共分离出113株病原菌，其中G?菌72株，占63.71%；G+菌41株，占36.28%。药敏结果显示，G+菌对常规青霉素类基本耐药，碳青霉烯类耐药菌株少见，对万古霉素耐药菌株尚未出现。G?菌对青霉素类及头孢菌素类耐药较高，对头孢哌酮－舒巴坦无耐药。 结论 加强对慢性创伤性骨髓炎患者创面病原菌监测极为必要,对临床抗生素的合理使用具有一定的指导意义。Objective To analyze the distribution of cultured bacteria from chronic osteomyelitis patients, and provide a basis for clinical medicine. Methods We retrospectively analyzed the bacterial culture results of the secretions from 91 patients with chronic osteomyelitis treated in our hospital from January 2006 to December 2010. Among them, there were 78 males and 13 females aged from 5 to 78 years averaging at (41.3 ± 8.35) years. The duration of the disease ranged from 47 days to more than 7 months, averaging (68.6 ± 14.57) days. The total course of antibiotic-taking was longer than 7 days for all the patients. Results A total of 113 pathogen strains were isolated from 65 secretion samples, including 72 Gram-negative bacteria accounting for 63.71% and 41 gram-positive bacteria accounting for 36.28%. Drug susceptibility results showed basic resistance of Gram-positive bacteria to conventional penicillin, rare resistance to carbapenem, and no resistance to vancomycin. Gram-negative bacteria were basically resistant to penicillin and cephalosporins, but not resistant to cefoperazone-sulbactam. Conclusion Enhancing the monitoring of pathogens for patients with chronic osteomyelitis is extremely necessary for the rational clinical use of antibiotics.
目的总结糖尿病并细菌性肝脓肿(DPHA)的临床特点和诊治经验。方法回顾性分析我院2002年3月至2010年12月期间出院的DPHA与无DPHA(NDPHA)患者的临床资料。结果细菌性肝脓肿患者共22例，其中DPHA患者11例。DPHA组人口学特征、临床表现、白细胞计数与NDPHA组比较差异均无统计学意义(Pgt;0.05); DPHA组血白蛋白低于NDPHA(P=0.006)，而ALT高于NDPHA(P=0.006)。DPHA组病灶个数多于NDPHA组(P=0.032)，且病灶直径也大于NDPHA组(P=0.006)。脓培养: 2组大肠杆菌均为3例; DPHA组克雷伯杆菌4例，而NDPHA组无克雷伯杆菌。DPHA组发生切口感染7例、腹腔感染2例，NDPHA组发生切口感染3例。 DPHA组抗生素使用时间、住院时间及住院费用均高于NDPHA组(Plt;0.05)。2组均分别治愈6例、好转5例，2组均无死亡患者。结论DPHA有其特殊的临床特征，并发症多，住院费用高，但预后与NDPHA差别不大。
Objective To discuss the relationship between antibiotic prophylaxis and surgical site infection (SSI) in colorectal cancer. Methods A survey of 880 patients with colorectal cancer from Jan. 1998 to Dec. 2008 were studied. Patients were divided into two groups by antibiotic duration: ≥24 h group (n=401) and lt;24 h group (n=479). To compare the differences of surgical site infection between two groups. Results For SSI patients, operation time obviously prolonged (P=0.04), or with more blood loss (P=0.03) and longer time use of antibiotics (P=0.04). In colon cancer patients with SSI operation time was significantly different from the cases of colon cancer without SSI （P=0.01）, while there was no difference between SSI and operation time, blood loss and duration of antibiotics （Pgt;0.05）. Conclusion Longer operation time, more blood loss and longer bleeding time are the risk factors of surgical site infection. Moreover prolonged antibiotic prophylaxis can not decrease the incidence of SSI.
在外科领域,预防性使用抗生素占有相当重要的地位,这主要是为了预防外科手术部位感染，包括外科手术后的切口感染和手术部位的深部腔隙或器官感染，如胸腔感染、腹腔感染、脓肿形成等。此类感染约占医院全部感染的14%～16%，占外科患者感染的38%［1］，其重要性不容忽视。
手术野感染（surgical site infection, SSI）是外科手术的并发症之一。为预防和减少SSI，采用了不少措施： 提高空气的洁净度，良好的患者皮肤准备和肠道准备，治疗已存在的感染灶，提高术中防护，减少术中污染。预防性抗生素的使用是重要措施之一。多年实践证明，预防性抗生素使用，可以减低SSI发生率。近来预防性抗生素使用已近乎成为常规了，抗生素用量迅速增长。但如何使用预防性抗生素在临床上缺乏统一的认识与规范。
Objective To study endotoxin release induced by differential antibiotics in gram negative bacterial infection. Methods Thirty critical patients accompanied with gram negative bacterial infection were divided into group A (imipenem group, n=15) and group B (ceftazidine group, n=15). Imipenem (0.5 g iv q8h) and ceftazidine (1.0 g iv q8h) were given respectively. White blood cell (WBC), systolic blood pressure (SBP), lipopoly sacchride (LPS), tumor necrosis factor alpha (TNFα) and high density lipoprotein (HDL) were determined in 0, 1, 2, 3, 5 and 7 day. Results There was no difference in the change of WBC between two groups. Group A had a more stable SBP than group B. There was lower endotoxin release in group A than in group B and so were the cytokines release. HDL level was lower in group B than in group A. Conclusion Imipenem has lower endotoxinliberating potential than ceftazidine and mediate lower cytokines release. HDL may protect the patients from LPS damage.