综合医院医务人员感染SARS情况对比分析

目的：分析在防治SARS工作初期、后期医务人员感染SARS的差异和采取的对策，为减少综合医院内医务人员SARS的感染提供参考。方甚：对本院自2003年3月24日至6月2日SARS诊断治疗任务中发生的医务人员的感染原因和采取的对策进行回顾性分析。结果：防治SARS工作初期，急诊科交叉感染和在SARS隔离病房等与SARS患者密切接触的工作岗位，共有17名医务人员感染，及时隔离治疗，均已痊愈，未造成医护人员的进一步交叉感染：经加强防护培训，改善工作条件，在防治SARS工作后期，仅发生2名护工感染，亦已痊愈，派出非典医疗队实现零感染。结论：综合医院内医务人员感染SARS的问题严峻，加强医院内的全员防护培训，按岗分区管理，改善医务人员的工作条件和病人的隔离观察环境，做好监督检查，积极应对，可以减少医务人员的SARS感染。     

RAPD技术用于结核病交叉感染的鉴别

目的：调查RAPD技术用于结核菌株DNA指纹鉴定的效果。方法：采用多重PCR方法对一组2例母女同时发病的肺结核患者和一组2例先后发病的兄妹肺结核患者的病原菌进行了菌种鉴定。采用RAPD技术对它们的基因组DNA进行指纹多态性分析。结果：4株病原菌均为结核分支杆菌。经RAPD分型，其中母女组2菌株的DNA指纹图谱完全相同，兄妹组2菌株的DNA指纹图谱有所不同。证明母女组所染病原菌的同源性很好，很可能为同一感染源，母女之间交叉感染的可能性很大；兄妹组病原菌的同源性较差，为非交叉感染。结论：RAPD技术适用于结核分支杆菌流行病学调查，特别是交叉感染的鉴别。     

Incidence of hospital-acquired infections associated with caesarean section

A retrospective cohort study was conducted to determine the incidence of post-caesarean infections in a Canadian community teaching hospital using computer algorithms designed for the diagnosis of nosocomial infections. Inferential chart review was done on 1335 women delivered by lower-segment caesarean section (793 primary and 542 secondary) at the Calgary General Hospital between January 1985 and April 1988. The overall infection rates were 42·1 and 46·1% for women delivered by primary and secondary caesarean section, respectively. Incisional surgical wound infection accounted for the largest proportion of post-caesarean infections found. Women delivered by primary caesarean section had significantly higher rates of endometritis, deep surgical wound infection and bacteraemia than those delivered by secondary section. All types of post-caesarean infection, except asymptomatic bacteriuria, caused the duration of the post-partum hospital stay to be significantly increased.     

Nutrition et fonction immunitaireNutrition and immune function

A deficiency of total energy or of one or more essential nutrients, including vitamins A, B₆, B₁₂, C, and E, folic acid, zinc, iron, copper, selenium, essential amino acids and essential fatty acids, will impair immune function and increase susceptibility of the host to infectious pathogens. This is most likely because these nutrients are involved in the molecular and cellular responses to challenge of the immune system. Providing these nutrients to deficient individuals restores immune function and improves resistance to infection. Thus, appropriate nutrition is required in order for the host to maintain adequate immune defences towards bacteria, viruses, fungi, parasites and tumour celîs. Although the intakes of several nutrients which result in greatest enhancement of immune function appear to be greater than recommended intakes, excess intake of certain nutrients also impairs immune responses. Some nutrients (e.g. glutamine, arginine) may become limiting in critical illness and there is mounting evidence that provision of these will aid patient recovery.     

产后并发症341例分析

报告本院1981年1月至1985年12月,住院分娩4588例中产后并发症341例,发病率为7.43％。其中,产后出血1189例,占4.12％;分娩损伤71例,占1.55％;其它产后病81例,占1.76％。妊娠41—42周并发症发生率为11.14％;超过42周高达15.56％。分娩方式以剖腹产术后并发症最多,占12.48％,提示应对手术中无菌操作与环境,以及分娩后处理应予以足够重视。     

Phaeohyphomycosis caused by Bipolaris spicifera: An informative case

A case of phaeohyphomycosis caused by Bipolaris spicifera involving the brain and sinuses is presented. The patient survived following surgery and ketoconazole therapy, which successfully treated both the sinus and the brain infections.     

Synovial fluid levels of fluconazole in a patient with Candida parapsilosis prosthetic joint infection who had an excellent clinical response

A 73-year-old woman presenting with persistent swelling of the right knee 30 months after total joint arthroplasty was found to have a Candida parapsilosis infection. Treatment with fluconazole resulted in full recovery.     

Brucellosis of the spine with a synchronous Staphylococcus aureus pyogenic elbow infection

Staphylococcus aureus osteomyelitis and pyogenic arthritis has a different pattern in the elderly than in the young. The axial skeleton is the most frequent site of infection and treatment is usually by intravenous antibiotics. We report a case ofStaph. aureus septic arthritis of the elbow with concomitant osteomyelitis of the spine that was thought to be due toStaph. aureus, but culture of debrided material from the lesion grewBrucella in culture. We suggest that in the elderly it is advisable to obtain a tissue culture diagnosis and not to instigate therapy based on positive blood cultures or a concomitant infection.     

Is it possible to prevent bacterial adhesion onto ureteric stents?

The aim of this study was to determine whether the use of bactericidal coatings or immersion in antibiotic solution reduces or prevents bacterial adhesion onto ureteric stents. Precut segments of full silicone, silver-coated and hydrogel-coated ureteric stents were incubated with two uropathogenic bacterial strains with and without previous immersion in antibiotic solution. Tobramycin, ceftriaxone and ciprofloxacin solutions were used, as these antibiotics are commonly administered for the prophylaxis and treatment of urinary tract infection (UTI). Microbiological analysis showed that immersion of ureteric stents in ceftriaxone and ciprofloxacin yielded a significant reduction of bacterial adhesion, whereas immersion in tobramycin did not. The surface material of the stents had no direct influence on bacterial adhesion. In this experimental study, neither the silver nor the hydrogel coat reduced bacterial adhesion onto ureteric stents whereas immersion in a suitable antibiotic solution significantly reduced and even prevented this phenomenon, probably due to the adhesion of the antibiotic onto the stent surface. Prevention of bacterial adhesion onto ureteric stents is essential to reduce the risk of UTI in connection with these devices.     

An observer blind trial of co-amoxiclav versus cefuroxime plus metronidazole in the prevention of postoperative wound infection after general surgery

A consecutive series of 509 patients undergoing abdominal surgery were entered into a randomized, observer and patient blind, controlled, prospective, study to evaluate the efficiency of co-amoxiclav (‘Augmentin’, SmithKline Beecham, UK) compared with cefuroxime (‘Zinacef’ Glaxo, UK) plus metronidazole (Flagyl, M&B, UK) for the prevention of postoperative wound infections. One or three doses of antibiotics were given depending on the type of surgery and operative factors. Co-amoxiclav was given to 230 patients with a total wound infection rate of 5·6% and cefuroxime plus metronidazole were given to 225 patients with a total wound infection rate of 3%. The difference between infection rates was not significant. Both groups were comparable in terms of demographic details, type and duration of surgery, risk factors associated with surgical procedures and postoperative management. Although not statistically significant, a difference in the wound infection rate for those patients undergoing colorectal surgery was seen: for the co-amoxiclav group and for the cefuroxime/ metronidazole group. The estimated cost to our hospital (October 1993) of one dose of co-amoxiclav was less that half the cost of cefuroxime and metronidazole. This study demonstrates that co-amoxiclav is an effective prophylactic antibiotic for abdominal surgery.