Rational Application Of Antibiotics Research Articles

Effect analysis of multi-department cooperation in improving etiological submission rates before antibiotic treatment.

Increased bacterial drug resistance has become a serious global public health problem. The application of antibiotics involves various clinical departments, and the rational application of antibiotics is the key to improving their efficacy. To provide a basis for further improving the etiological submission rate and standardizing the rational use of antibiotics, this article discusses the intervention effect of multi-department cooperation in improving the etiological submission rate before antibiotic treatment. A total of 87 607 patients were divided into a control group (n = 45 890) and an intervention group (n = 41 717) according to whether multi-department cooperation management was implemented. The intervention group involved the patients hospitalized from August to December 2021, while the control group involved the patients hospitalized from August to December 2020. The submission rates of the two groups; the rates before antibiotic treatment at the unrestricted use level, the restricted use level, and the special use level in departments; and the timing of submission were compared and analysed. The overall differences in the etiological submission rates before antibiotic treatment at the unrestricted use level (20.70% vs 55.98%), the restricted use level (38.23% vs 66.58%), and the special use level (84.92% vs 93.14%) were statistically significant before and after intervention (P < .05). At a more specific level, the etiological submission rates of different departments before antibiotic treatment at the unrestricted use level, the restricted use level, and the special use level were improved, but the special activities of multi-department cooperation management did not improve the submission timing significantly. Multi-department cooperation can effectively improve the etiological submission rates before antimicrobial treatment, but it is necessary to improve measures for specific departments to improve long-term management and incentive and restraint mechanisms.

Distribution of Common Pathogens and Bacterial Resistance in A Tertiary Hospital in China

We aimed to explore the distribution of common pathogens and bacterial resistance in our hospital from 2017 to 2020, and to standardize clinical medication guidance. The pathogens isolated from the submitted specimens were identified, and drug susceptibility results were interpreted according to the Clinical and Laboratory Standards Institute guidelines (2017-2020). A total of 43,588 specimens were collected from patients treatedfrom 2017 to 2020, and 6,285 strains of pathogens were isolated. The most common pathogens were Escherichia coli, Haemophilus influenzae and Klebsiella pneumoniae.Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 32.85%, and methicillin-resistant coagulase-negative Staphylococcus (MRCNS) accounted for 78.79%. The resistance rates of MRSA and MRCNS to ciprofloxacin, levofloxacin, erythromycin, clindamycin and trimethoprim-sulfamethoxazole were significantly higher than those of methicillin-sensitive S. aureus and methicillin-sensitive coagulase-negative Staphylococcus. The resistance rate of Streptococcus pneumoniae to erythromycin, tetracycline and clindamycin was higher than 80%. The detection rates of E. coli and K. pneumoniae producing ESBL strains were 62.2% and 25.6%, respectively. Totally, 769 carbapenem-resistant strains were detected, of which carbapenem-resistant Acinetobacter baumannii (CRAB) accounted for 66.6%, followed by carbapenem-resistant K. pneumoniae (CRKP) and carbapenem-resistant Pseudomonas aeruginosa (CRPA). A total of 202 CRE strains were detected, which were mainly isolated from respiratory tract and urine specimens. CRAB, CRKP and CRPA had higher resistance rates to antibacterial drugs. Gram-negative bacilli are the most common pathogens from 2017 to 2020. Considering that pathogens have high drug resistance, it is recommended to strengthen clinical management and rational application of antibiotics, thus reducing the risk of nosocomial infections.

Urine Culture in Hospitalized Patients during 2014-2018: An Analysis on Pathogen Distribution and Drug Sensitivity.

Objective We sought to analyze the distribution and antibiotic sensitivity of pathogens in hospitalized patients and to provide a scientific reference for the rational application of antibiotics. Methods From January 2014 to December 2018, urine cultures from patients in our hospital were collected and analyzed retrospectively for the presence, distribution, and drug sensitivity of pathogens. Results A total of 42,854 midstream urine cultures were collected from which 11,891 (27.75%) pathogens were isolated, including 8101 (68.13%) strains of gram-negative bacteria, 2580 (21.69%) strains of gram-positive bacteria, and 1210 (10.18%) strains of fungi. Escherichia coli and Enterococci were the most common species of gram-negative and gram-positive bacteria, respectively. Drug sensitivity varied among different pathogens. Clear drug resistance was observed in bacteria, while fungus exhibited relatively lower resistance. Conclusion Pathogens responsible for urinary tract infections in hospitalized patients are diversiform and display resistance to some antibiotics. Drug resistance monitoring should be enhanced to optimize antimicrobial therapy.

Reasonable application of antibiotics in pediatric acute rhinosinusitis

The incidence of upper respiratory tract infection in children is extremely high, and some of them are prone to develop to acute rhinosinusitis. Antibiotics are the first-line medication to alleviate bacterial infections. However, due to the lack of practical and accurate objective indicators for the diagnosis of acute rhinosinusitis, it is difficult to distinguish the acute bacterial rhinosinusitis subgroup, leading to the overuse of antibiotics. In recent years, the form of antibiotic resistance has become more severe, and the application conditions of antibiotics have become more stringent. In addition, the physiological conditions of children are different from adults. Chinese and foreign studies are controversial about the rational application of antibiotics in children with acute rhinosinusitis. The relevant researches of antibiotic treatment in children with acute rhinosinusitis are now reviewed, with a view to providing clinical reference for the rational use of antibiotics in this group of people.

Study on Pharmaceutical Intervention for Rational Application of Antibiotics in Clinic

Study on Pharmaceutical Intervention for Rational Application of Antibiotics in Clinic

Monitoring and Analysis of Drug Resistance of Yersinia in Fresh Meat

Objective To monitor the drug resistance status of yersinia isolates from fresh meat, grasp the drug resistance spectrum and trend of Yersinia isolates in Our province, and provide important reference data for guiding the rational application of antibiotics in human clinical practice and controlling the spread of drug resistant strains. Methods A total of 600 pieces of fresh pork, beef and chicken were collected from several farmers' markets and supermarkets in Changchun every month for 15 months from August 18th to October 19th. 80 strains of Yersinia strains were detected, and MIC concentrations of drug resistance were detected by microbroth dilution with 15 antibiotic sensitive plates. Results 80 strains of Yersinia strains were counted. The total drug resistance rate of Yersinia pestis was 98.8%, and cefazolin (CFZ) had the highest drug resistance rate of 92.5.% (74/80). Erythromycin (ERY) was followed by 58.8% (47/80). Ampicillin (AMP) 57.5% (46/80); Naproxil acid (NAL) and cefoxitin (CFX) were 28.8 (23/80) and were somewhat resistant to other antibiotics. But all strains were sensitive to imipenem (IMP) and gentamicin (GEN). There were 28 strains with multiple drug resistance, accounting for 35.4% (28/79). Conclusion There are multiple antibiotic resistance in Yersinia strains in this monitoring, and the multiple drug resistance is serious and the resistance spectrum is diverse. In order to ensure food safety and human health, great attention should be paid to and enhanced drug resistance monitoring of Yersinia.

The value of serum procalcitonin in the anti-infection therapy of acute stroke patients.

Objectives:To investigate the value of dynamic monitoring of serum procalcitonin (PCT) in anti-infective therapy of patients with acute stroke.Methods:This is a case control retrospective study of acute stroke patients conducted from July 2016 to October 2018, in the Department of Neurology, Affiliated Hospital of Hebei University, who who reached within twenty four hours. They, were selected as the study subjects who were divided into infection group and non-infection group according to the inclusion and exclusion criteria. The serum PCT and CRP levels were compared between the two groups at 24 hours, 48 hours and 72 hours. In order to judge the changes of PCT level and the infection of stroke patients, different kinds of antibiotics were used for corresponding treatment. Retrospective analysis of the cases that did not monitor PCT anti infective treatment before July 2016 were compared with the cases that monitored PCT to guide anti infective treatment after July 2016, and compared the efficacy of antibiotics.Results:The serum PCT level of patients in the infection group was significantly higher than that of patients in the noninfection group (P<0.001). For the patients whose PCT<0.5 ng/ml within 72 hour, anti-infective therapy was not administered. However, for those patients whose PCT<0.5 ng/ml and CRP rose significantly, WBC, body temperature and chest CT were closely monitored. For the patients whose PCT increased slightly (0.5 ng/ml<PCT<2.0 ng/ml), first-generation and second-generation cephalosporin or semisynthetic penicillin, such as mezlocillin, were administered. For the patients whose PCT increased moderately (5 ng/ml>PCT>2 ng/ml), mezlocillin/ sulbactam or ceftriaxone/ tazobactam was administered. For patients whose PCT increased significantly (PCT>5 ng/ml), carbapenem antibiotic or a combination of two antibiotics was administered.Conclusion:Dynamic detection of serum PCT concentration can make accurate judgment on the severity of bacterial infection in patients with acute stroke and guide the rational application of antibiotics.

Selection and application opportunity of antibiotics in children with respiratory tract infections

Respiratory tract infection is the most common disease in children, and it is also the most common disease of irrational use of antibiotics.The rational application of antibiotics is to reduce the rate of bacterial resistance and its adverse events.The emergence of drug-resistant strains is closely related to the wide application of antibiotics.In order to reduce the irrational use of antibiotics in children′s respiratory tract infection, pediatricians need to know the timing of application of antibiotics.The respiratory tract infection can be divided into upper respiratory tract infection and lower respiratory tract infection, including common cold, pharyngitis, sinusitis, otitis media, bronchitis and bronchitis, and pneumonia.This article reviews the application timing of antibiotics in the common respiratory tract infection of these children. Key words: Respiratory tract infection; Child; Antibiotics

Advances in severe community-acquired pneumonia.

Community-acquired pneumonia (CAP) is a common respiratory disease and is considered to be the leading cause of mortality among various infectious diseases.[1,2] A large population-based study showed that among hospitalized patients diagnosed with pneumonia, 21% of them required the intensive care unit (ICU) admission, 6% required invasive mechanical ventilation, and 2% died.[3] Although therapeutic strategies have been significantly improved over recent years, the morbidity and mortality of CAP, especially severe CAP (SCAP), remain high. Mortality of SCAP has been reported to range from 17% to 49% by different multi-center cohort studies.[4] The Infectious Diseases Society of America (IDSA), American Thoracic Society (ATS) and the Infectious Disease Assembly, Chinese Thoracic Society, have published consensus guidelines for CAP (IDSA/ATS 2007, CTS 2016), which clearly defined SCAP criteria.[5] According to IDSA/ATS SCAP criteria, patients with SCAP requiring ICU admission should have at least one major criteria (invasive mechanical ventilation or septic shock with the need for vasopressors) or at least three minor criteria (respiratory rate ≥30 breaths/min, oxygenation index (PaO2/FiO2) ratio ≤250, multi-lobe infiltrates, hypothermia (core temperature <36°C), leukopenia (white blood cell count <4000 cells/mm3), thrombocytopenia (platelet count <100,000 cells/mm3), hypotension requiring aggressive fluid resuscitation, confusion/disorientation, and uremia (blood urea nitrogen (BUN) ≥20 mg/dL).[5] To date, confusion, uremia, respiratory rate, low blood pressure, age 65 years or greater (CURB-65) and pneumonia severity index (PSI), the two primary clinical assessment tools utilized, have been widely used to evaluate the mortality risk of CAP patients in clinical practice.[6,7] Several risk factors associated with high mortality in SCAP have been identified, including anti-microbial resistance, increased age, septic shock, and acute respiratory failure.[8] It is thus greatly beneficial to distinguish high-risk patients with SCAP and formulate personalized treatment strategies. Optimal ICU management and rational application of antibiotics were reported to be two key factors determining outcomes of patients with SCAP.[1] Recently, several advances in SCAP have been made and here we summarized the updated knowledge of diagnostic and therapeutic strategies for SCAP.

Sanjin tablets for acute uncomplicated lower urinary tract infection (syndrome of dampness-heat in the lower jiao): protocol for randomized, double-blind, double-dummy, parallel control of positive drug, multicenter clinical trial

BackgroundAcute uncomplicated lower urinary tract infection (UTI) is one of the most common bacterial infections. Patients usually present with dysuria, urinary urgency, urinary frequency, and suprapubic pain or tenderness. Approximately 150 million people are diagnosed with UTI each year worldwide. The high recurrence rate of lower UTI is a common problem of clinical treatment. The misuse of antibiotics has led to the emergence of a number of resistant bacterial strains. Thus, traditional Chinese medicine is considered as an alternative option for treating acute uncomplicated lower UTI. Thus, this study aims to evaluate the efficacy and safety of Sanjin tablets (SJT) for the treatment of acute uncomplicated lower UTI, explore whether SJT can reduce or substitute the use of antibiotics, and reduce the recurrence rate in the treatment of acute uncomplicated lower UTI.Methods/designIn this study, a randomized, double-blind, double-dummy, parallel control of positive drug, multicenter clinical study will be established. A total of 252 patients with acute uncomplicated lower UTI (syndrome of dampness-heat in the lower jiao) will be randomly allocated in the ratio of 1:1:1 to three groups: experimental group; control group 1; and control group 2. The experimental group receives Sanjin tablets plus levofloxacin tablets (LT) placebo; the control group 1 receives LT plus SJT placebo; and the control group 2 receives SJT plus LT on the first five days, SJT plus LT placebo on the last two days. Each group will be treated for seven days and followed-up 1–2 times. The primary outcome measures of effective rate and recurrence rate are symptoms. Secondary outcome measures of effective rate and recurrence rate are the urine leukocytes, bacteriology examination, and safety assessment. Outcomes will be assessed at baseline and after treatment.DiscussionThis study protocol will provide the research data of efficacy and safety of SJT for the treatment of acute uncomplicated lower UTI. The first aim is to determine whether Sanjin tablets can reduce the use of antibiotics; the second aim is to determine whether Sanjin tablets can substitute the use of antibiotics. The recurrence rate will be assessed after cured to determine whether SJT can reduce the recurrence rate. The results of this study will improve the rational use of drugs, especially the rational application of antibiotics. It will also enable safety evaluation from laboratory indices and adverse events, which will provide reliable evidence for clinical treatment.Trial registrationClinicalTrials.gov, NCT03658291. Registered on 4 September 2018.

POCT in diagnosis of infectious diseases—the state of art and future

The pathogen diagnosis of infectious diseases plays a critical role in the rational application of antibiotics, the monitoring and management of disease epidemiology and the control of drug-resistant bacteria in hospitals and communities. The ideal method for rapid detection of infectious diseases should be sensitive, rapid, specific, stable, low-cost and easy to use. This article reviews the clinical application of POCT in infectious disease antigen detection, antibody detection, nucleic acid detection, etc. and focuses on the advantages and potential of microfluidic technology in pathogen multiplex nucleic acid detection and drug resistance detection. Choosing the right time, the right place, and the right on-site rapid diagnostic technology will provide a new strategy for the diagnosis and treatment of infectious diseases in the graded diagnosis and treatment mode. (Chin J Lab Med, 2018, 41: 641-643) Key words: Infections diseases; Point-of-care testing; Microfluidics; Microchip analytical procedures

Особенности тактики многоэтапного хирургического лечения открытых переломов

Цель. Изучить путем сравнения результаты применения при ОП классической тактики и тактики многоэтапного хирургического лечения, обсудить вопросы выбора метода фиксации ОП и возможности раннего закрытия обширных ран и дефектов мягких тканей.&#x0D; Материалы и методы. Проанализированы результаты лечения 286 пациентов с ОП костей верхних и нижних конечностей в ортопедо-травматологическом центре Киевской областной клинической больницы за период с 2008 по 2016 г. Применяли классические методы и тактику многоэтапного хирургического лечения.&#x0D; Результаты. Оценивали результаты хирургического лечения ОП костей верхних и нижних конечностей с использованием балльной шкалы Neer-Grantham-Shelton. Хорошие результаты получены у 54,84% пациентов 1-й группы и у 80,28% пациентов 2-й группы.&#x0D; Выводы. Успех лечения ОП зависит от ранней госпитализации, ранней радикальной хирургической обработки, стабильной фиксации сломанной кости, применения рациональных доз антибиотиков, коррекции иммунологического статуса. Одними из наиболее спорных и нерешенных остаются проблемы выбора метода фиксации ОП и раннего закрытия раны.

Characterization of carbapenem-resistant Acinetobacter baumannii isolates in a Chinese teaching hospital.

Carbapenem-resistant Acinetobacter baumannii (CRAB) presents a serious therapeutic and infection control challenge. In this study, we investigated the epidemiological and molecular differences of CRAB and the threatening factors for contributing to increased CRAB infections at a hospital in western China. A total of 110 clinical isolates of A. baumannii, collected in a recent 2-year period, were tested for carbapenem antibiotic susceptibility, followed by a molecular analysis of carbapenemase genes. Genetic relatedness of the isolates was characterized by multilocus sequence typing. Sixty-seven of the 110 isolates (60.9%) were resistant to carbapenems, 80.60% (54/67) of which carried the blaOXA-23 gene. Most of these CRAB isolates (77.62%) were classified as clone complex 92 (CC92), and sequence type (ST) 92 was the most prevalent STs, followed by ST195, ST136, ST843, and ST75. One CRAB isolate of ST195 harbored plasmid pAB52 from a Chinese patient without travel history. This plasmid contains toxin–antitoxin elements related to adaptation for growth, which might have emerged as a common vehicle indirectly mediating the spread of OXA-23 in CRAB. Thus, CC92 A. baumannii carrying OXA-23 is a major drug-resistant strain spreading in China. Our findings indicate that rational application of antibiotics is indispensable for minimizing widespread of drug resistance.

PP-005 An analysis on the rational application of antibiotics in the department of gastrointestinal surgery

PP-005 An analysis on the rational application of antibiotics in the department of gastrointestinal surgery

Influence of subinhibitory concentrations of antibiotics on virulence of staphylococci.

The understanding and control of infections caused by staphylococci are still far from complete, and staphylococcal infections continue to be a serious problem. The organisms possess numerous virulence factors that can act independently to induce various symptoms and lesions. Chemotherapy has changed the clinical spectrum of staphylococci but has not eradicated serious staphylococcal infections. An evaluation of the interaction of antibiotics, staphylococci, and host defense will help to identify those factors that determine the success or failure of therapy for staphylococcal infections. The activity of antibiotics is usually expressed in terms of concentrations that either inhibit or kill microorganisms in vitro or in experimental infections. Subinhibitory concentrations of antibiotics may induce changes in bacterial properties both in vitro and in vivo. An understanding of the mechanism of such changes would allow a more rational application of antibiotics that have both specific antistaphylococcal action and positive effects on host defense mechanisms.

Do antibiotics interfere with host/bacterial interaction?

Antibiotics exert a number of effects on bacteria other than simply killing them or inhibiting their growth. Increasing evidence that exposure of bacteria to antibiotics induces profound alterations in the interaction between bacteria and host defense has been noted. The effect of antibiotics on polymorphonuclear leukocytes and the immune specific response of mononuclear cells is reviewed. An understanding of such effects would allow a more rational application of antibiotics, as well as provide direction in the development of new antibiotics that have both specific antibacterial action and positive effects on host defense mechanisms.