Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence

In view of the demographic changes and projected increase of arthroplasty procedures worldwide, the number of prosthetic joint infection cases will naturally grow. Therefore, in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance. In the absence of a "miracle weapon" priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks, the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen. Instead of a "one size fits all" philosophy, it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient-and procedure-related risk factors. A stronger focus on the local application mode via use of high dose dual antibioticloaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre. The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.     

A critical assessment of published guidelines and other decision-support systems for the antibiotic treatment of community-acquired respiratory tract infections

Guidelines are an important means by which professional associations and governments have sought to improve the quality and cost-effectiveness of disease management for infectious diseases. Prescribing of initial antibiotic therapy for community-acquired respiratory tract infections (RTIs) is primarily empiric and physicians may often have a limited appreciation of bacterial resistance. Recent guidelines for managing RTIs have adopted a more evidence-based approach. This process has highlighted important gaps in the existing knowledge base, e.g. concerning the impact of resistance on the effectiveness of oral antibiotics for outpatient community-acquired pneumonia and the level of resistance that should prompt a change in empiric prescribing. In upper RTIs, the challenge is to identify patients in whom antibiotic therapy is warranted. Concentrated, sustained efforts are needed to secure physicians' use of guidelines. The information should be distilled into a simple format available at the point of prescribing and supported by other behavioral change techniques (e.g. educational outreach visits). Advances in information technology offer the promise of more dynamic, computer-assisted forms of guidance. Thus, RTI prescribing guidelines and other prescribing support systems should help control bacterial resistance in the community. However, their effect on resistance patterns is largely unknown and there is an urgent need for collaborative research in this area. Rapid, cost-effective diagnostic techniques are also required and new antibiotics will continue to have a role in disease management.     

Salmonella serovars identified at the centre for enterobacteriaceae of palermo over the 5-year period 1983-87

Salmonellosis is become an increasing public health problem in many countries. Serotyping and assessment of antibiotic resistance are useful tools, which assist in understanding the epidemiology of Salmonella infections. In this respect, the Centre of Enterobacteriaceae of Southern Italy provides helpful information on the changing pattern of Salmonella serovars in this geographic area.This paper reports the distribution of serovars and their antibiotic susceptibility in the years 1983–1987. In particular, because of their peculiar trends during this 5-year period, epidemiological features of Mbandaka, Corvallis, Dublin, Infantis and Wien serovars are described.     

Laryngopyocele: three new clinical cases and review of the literature

Laryngopyocele is a fairly rare disease. It is a complication of laryngocele. Its clinical picture is often alarming; thus it needs fast differential diagnosis. Computed tomography allows early diagnosis. Surgical treatment permits a complete recovery. An association between laryngocele and carcinoma of the larynx has been reported by some authors. Three new cases of laryngopyocele are presented and discussed. Received: 23 November 1999 / Accepted: 29 May 2000     

细菌L型的医院感染及其质粒谱分析研究

目的为了全面防止医院感染,我们对细菌Ｌ型的医院感染进行了研究。方法对医院内环境中８００份标本及医院感染患者９１８份标本分离出的金黄色葡萄球菌Ｌ型、大肠埃希氏菌Ｌ型及铜绿假单胞菌Ｌ型进行了质粒谱分析和药敏试验。结果本院环境及医院感染患者细菌Ｌ型总检出率分别为１９．０％和１６．７％。不同来源的３种细菌Ｌ型的多重耐药性无显著性差异。不同来源３种细菌Ｌ型的同源性比例均较高,分别为９０．３％、７５．０％、８４．２％。结论细菌Ｌ型医院感染患者的病原菌主要来自医院内环境     

The association between radiological spreading pattern and clinical outcomes in necrotizing external otitis

ObjectivesNecrotizing external otitis (NEO) is a rare infectious disease of the skull base. The purpose of this study was to determine whether clinical outcomes of NEO can be correlated to different infectious spread patterns.MethodsRetrospective chart review from 2010 to 2019 with NEO patients, who were divided into two cohorts: single spreading patterns (group A) or complex spreading patterns (group B) as diagnosed by CT. Clinical symptoms, diagnostic and treatment delay, course of disease, complications, and duration of antibiotic exposure were retrospectively collected from patient records.Results41 NEO patients were included, of which 27 patients belonged to group A (66%). The disease-related mortality rate was 12.2% among the entire cohort, no differences were found between group A and B. Higher rates of N.VII (42.9% vs 14.8% P = 0.047) and N. IX palsies were found in group B compared to group A (28.6% vs 3.7%, P = 0.039). The median duration of antibiotic use was significantly different for a complex spreading pattern, clinical recovery and hospitalizations. Complications were associated with higher diagnostic delay and with a complex spread pattern. The median duration of follow-up was 12.0 (IQR 6.0–19.5) months.ConclusionNEO is a severe disease, with significant mortality and morbidity (cranial nerve palsies). The radiological spread pattern may assist in predicting clinical outcome. Furthermore, complex spread patterns are associated with higher rates of clinical nerve palsies (N. VII and N.IX), complications, surgery rates and longer duration of antibiotic use. Diagnostic delay was associated with mortality, complications and facial palsies.Level of evidenceLevel IV.     

规范化Ⅰ、Ⅱ类切口手术预防性抗菌药物使用的实施效果分析

目的 探讨实施院内规范化围手术期预防用药方案的可行性和效果。方法 选择外科Ⅰ、Ⅱ类切口择期手术病例，以2003年10月～2004年3月出院者210例作为实验组，按规范方案用药，以2002年10月～2003年3月出院者212例作为对照组，按习惯方法用药，考察预防手术部位感染的效果及费用指标。结果 实验组与对照组手术部位感染的发生率没有显著性差异，抗菌药物费用、药品费用、住院费用显著降低。结论 在院内制定和实施规范化的围手术期预防用药方案的做法切实可行，可以促进合理用药，降低医疗费用，节约卫生资源，值得推广。     

新型抗生素S632A对单纯疱疹病毒Ⅰ型感染小鼠的治疗作用

目的研究新型抗生素S632A对单纯疱疹病毒Ⅰ型感染小鼠的治疗作用。方法建立小鼠单纯疱疹病毒性脑炎(HSE)模型，观察给药后小鼠存活率和平均存活时间，并检测给药后不同时间小鼠脑组织病毒滴度，以及HE染色观察给药组小鼠脑组织病变程度。结果实验结果显示28mg／kg治疗剂量的S632A能够明显降低小鼠死亡率，延长其平均存活时间，降低脑组织病毒滴度，减轻脑组织病变程度，且与阳性对照药物阿昔洛韦(ACV)治疗效果类似，统计学上无显著差异。结论一定剂量的S632A在小鼠体内具有类似于ACV的治疗作用，值得进一步研究和开发。     

铜陵地区2004年度细菌耐药性监测

目的 了解安徽省铜陵地区临床分离菌株耐药状况。方法2004年1～12月铜陵地区临床分离菌株用Kirby-Bauer法进行药敏试验。结果1071株细菌中革兰阳性菌390株占36．4％，革兰阴性菌681株占63．6％；耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌（CNS）的35．8％和72．0％；金黄色葡萄球菌和CNS对青霉素、氨苄西林及庆大霉素等均高度耐药，对利福平和氯霉素的耐药率均较低；未见耐万古霉素葡萄球菌；粪肠球菌对替考拉宁、万古霉素、青霉素和氨苄西林的耐药率较低；屎肠球菌对万古霉素和替考拉宁无耐药；大肠埃希菌和克雷伯菌属中产超广谱β-内酰胺酶（ESBLs）株分别占41．4％和27．9％，产ESBLs株除对亚胺培南均无耐药外，对其他19种抗菌药物的耐药率均较不产ESBLs株高。结论细菌耐药有一定的地区性，定期对本地区细菌耐药性进行监测，对合理使用抗菌药物、减少耐药菌株的产生和流行有重要临床指导价值。     

幽门螺杆菌治疗中抗生素相关性腹泻的预防

目的 探讨双歧三联活菌胶囊（培菲康）对根除幽门螺杆菌（HP）治疗中所致抗生素相关性腹泻（AAD）的预防作用.方法 将128例HP阳性的胃及十二指肠溃疡患者随机分成A组（阿莫西林、甲硝唑、奥美拉唑、果胶铋四联治疗组）和B组（四联加培菲康治疗组）;两组抗生素疗程均为2周,奥美拉唑及果胶铋疗程为4周;抗生素治疗结束4周后复查13C-尿素呼气试验及尿素酶试验,判断根除HP疗效.结果 A、B组两组根除HP效果相近,根除率分别为92.19%和96.88%（P＞0.05）;AAD发生率B组明显低于A组（P〈0.05）,＞60岁患者AAD发生率明显高于〈60岁患者（P〈0.05）.结论 老年人AAD发生率高,培菲康能有效防治根除HP感染治疗中引起的AAD.