Investing in antibiotics to alleviate future catastrophic outcomes: What is the value of having an effective antibiotic to mitigate pandemic influenza?

Over 95% of post‐mortem samples from the 1918 pandemic, which caused 50 to 100 million deaths, showed bacterial infection complications. The introduction of antibiotics in the 1940s has since reduced the risk of bacterial infections, but growing resistance to antibiotics could increase the toll from future influenza pandemics if secondary bacterial infections are as serious as in 1918, or even if they are less severe. We develop a valuation model of the option to withhold wide use of an antibiotic until significant outbreaks such as pandemic influenza or foodborne diseases are identified. Using real options theory, we derive conditions under which withholding wide use is beneficial, and calculate the option value for influenza pandemic scenarios that lead to secondary infections with a resistant Staphylococcus aureus strain. We find that the value of withholding an effective novel oral antibiotic can be positive and significant unless the pandemic is mild and causes few secondary infections with the resistant strain or if most patients can be treated intravenously. Although the option value is sensitive to parameter uncertainty, our results suggest that further analysis on a case‐by‐case basis could guide investment in novel agents as well as strategies on how to use them.     

抗生素微生物检定法中滴加抗生素溶液方法的研究

目的：探索一种加样方法,用于抗生素微生物检定法中滴加抗生素溶液。方法：根据抗生素微生物检定法实验原理,通过对加样误差来源的分析,比较实验生物统计结果,筛选最佳滴加溶液方法。结果与结论：用微量移液器加样,定量270μL（以下称本方法）,其速度快、间隔时间短、加样量准确、减少实验误差,生物检定统计可靠性测验获得较好的结果,是抗生素微生物检定法实验中较好的加样方法。     

Buruli Ulcer in Traveler from Suriname,South America,to the Netherlands

We report Buruli ulcer in a man in the Netherlands. Phenotyping of samples indicate the Buruli pathogen was acquired in Suriname and activated by trauma on return to the Netherlands. Awareness of this disease by clinicians in non–Buruli ulcer–endemic areas is critical for identification.     

实施综合干预前后脊柱骨科抗菌药物使用强度分析

目的：通过分析脊柱骨科住院患者抗菌药物使用的动态变化规律,以期为医院持续改进抗菌药物合理使用提供技术支持。方法：采用回顾性分析方法,以2009-2012年我院脊柱骨科住院患者抗菌药物使用数据为分析对象,以限定日剂量（DDD）为单位计算抗菌药物使用强度（AUD）,利用Excel 2003进行统计和综合干预前后对比分析。结果：脊柱骨科住院患者2009-2012年的年用药强度分别为69.17、51.24、36.61和22.35 DDDs/100人/天。结论：综合干预措施后,脊柱骨科住院患者抗菌药物的使用强度（AUD）呈下降趋势,抗菌药物的整体用药趋于合理。但仍存在手术抗菌药物使用率较高及疗程不规范等问题,需进一步加强推进干预措施。     

Open clinical trial of rifabutin and clarithromycin therapy in Crohn''s disease

BACKGROUND: Crohn's disease, an inflammatory bowel disease in humans, has a suspected aetiology of Mycobacterium avium subsp. Paratuberculosis. AIMS: To evaluate the role of rifabutin and clarithromycin anti-Mycobacterium avium subsp. Paratuberculosis treatment in Crohn's disease patients using an open clinical trial. METHODS:. A total of 36 patients with acute presentations of Crohn's disease, whose sera tested positive against p35 and p36 antigens (two recombinant proteins of Mycobacterium avium subsp. Paratuberculosis), were selected for treatment with rifabutin and macrolide antibiotic therapy Rifabutin and macrolide antibiotic therapy medications included 250 mg 1 po bid clarithromycin and 150 mg 1 po bid Ri-fabutin accompanied with a probiotic. Crohn's disease patients' response to rifabutin and macrolide antibiotic therapy was monitored over a period ranging from 4 to 17 months. RESULTS: Seven patients (19.4%) withdrew from the study since they were unable to tolerate medications. Of the remaining 29 patients, 21 (58.3%) reached a sustained state of improvement, traditionally defined as a decrease of 70 points between their entrance and exit Crohn's disease activity index scores together with the absence of the need of all other Crohn's medications, such as immunosuppressants and corticosteroids. Three Crohn's disease patients [8. 3%) noticed significant improvements, but required other Crohn's medications, concurrently with rifabutin and macrolide antibiotic therapy, to achieve and sustain improvement. Only 5 Crohn's disease patients (13.8%) were non-responders, noticing no marked improvement while on rifabutin and macrolide antibiotic therapy. CONCLUSION: The data add further evidence to support the role of rifabutin and macrolide antibiotic therapy in the treatment of Crohn's disease specifically in those patients with evidence of Mycobacterium avium subsp. Paratuberculosis infection. A large multi-centre clinical trial is needed to further explore these findings.     

静脉滴注抗生素联合外用双黄液治疗糖尿病足溃疡的临床分析

目的：探讨在综合治疗基础上蚕食清创方法清除坏死组织后,静脉滴注抗生素联合外用双黄液治疗糖尿病足溃疡的临床效果。方法回顾性分析我院收治的120例糖尿病足溃疡患者的临床资料,均采用综合治疗措施,且均根据药敏试验结果静脉滴注抗生素,并采用蚕食清创方法清除坏死组织。对照组( n=60)清创后采用局部外用利凡诺纱条覆盖创面进行治疗;观察组(n=60)采用局部外用双黄液纱条覆盖创面进行治疗,静脉滴注治疗均以14d为1个疗程,相邻两个疗程间间隔5d。治疗2个疗程后观察两组的临床疗效。结果治疗2个疗程后,观察组溃疡面愈合总有效率为83．3%高于对照组的61．7%,差异有统计学意义(P<0．05);观察组溃疡面积、创面渗出、创面浸润带及肉芽生长疗效指数均高于对照组,差异有统计学意义(P<0．05);治疗后两组溃疡面经皮氧分压及pH差异均有统计学意义(P<0．05)。结论在综合治疗基础上,蚕食清创方法清除坏死组织后静脉滴注抗生素联合外用双黄液治疗糖尿病足溃疡临床疗效显著,有利于促进溃疡面的愈合,值得临床推广。     

桂枝茯苓胶囊联合抗生素对慢性盆腔炎患者超敏C反应蛋白、白细胞介素-2及复发率的影响

目的:观察用桂枝茯苓胶囊联合抗生素治疗慢性盆腔炎患者的临床效果,并探讨其对患者超敏C反应蛋白、白细胞介素-2及复发率的影响。方法:选择2012年6月~2014年2月就诊于我院的118例慢性盆腔炎患者为研究对象,随机分为对照组和观察组患者各59例。对照组患者给予静脉滴注甲硝唑及青霉素常规西医抗生素治疗,1次/d;观察组患者则在对照组抗生素治疗的基础上给予桂枝茯苓胶囊内服治疗,3粒/次,3次/d,1w为1个疗程,连续治疗3个疗程。治疗后观察患者下腹部坠胀、疼痛、腰骶部酸痛等症状的缓解情况,统计临床治疗的有效率;治疗前后对患者的痛感采用疼痛视觉模拟评分VAS进行评价,观察痛感的缓解情况;检测2组患者炎性细胞指标C反应蛋白(CRP)、白细胞介素-2(IL-2)、肿瘤坏死因子(TNF-α)的变化情况;治疗后随访半年,统计患者复发率。结果:经治疗后2组患者下腹部坠胀、疼痛、腰骶部酸痛等临床症状均得到缓解,以观察组缓解程度更为明显,观察组的有效率91.5%明显高于对照组的有效率76.3%,差异有统计学意义(P0.05);2组患者经治疗后痛感有所缓解,VAS疼痛评分较治疗前有所降低,以观察组的降低幅度尤为突出,差异有统计学意义(P0.05);两组患者经治疗后炎性细胞指标CRP、IL-2、TNF-α均有所改善,以观察组的变化程度尤为明显,差异有统计学意义(P0.05);随访半年后,对照组患者的复发率23.7%明显高于观察组患者的复发率8.5%,差异性显著(P0.05)。结论:桂枝茯苓胶囊联合抗生素能有效缓解慢性盆腔炎患者的痛感,降低患者的炎性细胞水平,有良好的抗炎作用,疗效确切,是中西医结合论治妇科病的有效方式,值得临床广泛推广运用。     

《社区获得性肺炎诊疗指南》与Fine危险分层在社区获得性肺炎中的应用价值

目的:评价《社区获得性肺炎诊断和治疗指南》(简称《指南》)与Fine危险分层在评价社区获得性肺炎(CAP)中的应用价值.方法:以贵阳地区5所医院呼吸内科病房收治的196名成人CAP患者为研究对象,按照Fine危险分层分为Ⅰ～Ⅴ级,按照《指南》标准分为《指南》1组、2组和3组,比较Fine危险分层重症肺炎发生率和死亡率,分析按照两种方法分组的各组患者的病情程度的相关性,同时观察《指南》各组患者住院及输液时间,治疗费用及危险因素,同时还比较《指南》1组和2组抗菌素使用情况.结果:随Fine危险分层的级别升高,重症肺炎的发生率及病死率升高(P＜0.05),Fine危险分层与《指南》分组具有较强的相关性(r=0.623,P＜0.05);《指南》1组CAP患者的住院及输液时间短于《指南》2组和3组,住院费用及危险因素项目少于《指南》2组和3组,《指南》1组抗生素联合治疗比例低于《指南》2组,静脉用抗生素种类也存在差异(P＜0.05).结论:《指南》与Fine危险分层在评估CAP时具有相似的临床意义.     

老年性白内障超声乳化吸出术使用的刀片及切口处细菌培养结果分析

目的:分析白内障超声乳化吸出术中使用的角膜穿刺刀片及切口处细菌培养及药敏试验结果,为手术前后合理使用抗生素提供依据.方法:选择100例行白内障超声乳化吸出及人工晶体植入术的老年性白内障患者,手术中所使用的角膜穿刺刀片搽拭棉签及角膜切口周边搽拭棉签各50个进行细菌培养,阳性者进一步行药物敏感试验.结果:50个刀片搽拭棉签和50个角膜切口搽拭棉签各有4个培养阳性,阳性率为8.00％,均为表皮葡萄球菌;8个培养阳性菌株对莫西沙星、达托霉素、左氧氟沙星、庆大霉素、四环素敏感率为100.00％(8/8)、1oo.00％(8/8)、87.50％ (7/8)、87.50％(7/8)和62.50％(5/8),所有患者手术后3个月均无感染.结论:白内障超声乳化吸出术中使用的角膜穿刺刀片及切口处可培养出细菌,主要为表皮葡萄球菌,这些细菌对三、四代喹诺酮类抗生素以及脂肽类、氨基糖苷类抗生素等敏感.