ABSTRACT
Fever in patients with severe craniocerebral injury was a frequent occurrence.The rate of fever patients lead to plant man or death high up to 28％-72％.The univariate analysis found that there was significant association between fever and motality.One of the common cause of fever was non-infectious fever,which related with craniocerebral injury,including central fever,dehydration fever,clonus and rebleading fever.The major complication was central high fever after servere craniocerebral injury.The temperature high up to 39 ℃,which aggravated the original basic diseases,lead to respiratory and circulatory failure.Another cause of fever was infection fever which associated with nosocomial infection.Serious disease,long hospiltal stay,high proportion of invasive operation,coma were the high risk factors of patients with craniocerebral injury.The major type of nosocomial infection were pudmonary infection and surgical site infection.By reviewing domestic and foreign literatures and expert consensus,this article was intended to explore the characteristics and mechanism of fever in patients with craniocerebral injury.In order to reduce the secondary brain injury,decrease the disability rate,increase the sutrvival rate,diagnosis and treatment should be taken early.
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Diabetes complicated with urinary tract infection is influenced by many factors, such as low immune function, high blood and urine glucose environment prone for bacterial growth, and nervous lesion.Diabetic urinary tract infections are characterized by insidious onset, high recurrence rate, correlation with high blood glucose and difficulty to control.The related bacterial pathogens are mainly gram-negative bacillus genus ( 58. 59%-76. 19%) , in which the detection rates of extended spectrum β lactamases( ESBLs) Escherichia coli and Klebsiella pneumonia were the highest, followed by Enterobacter cloacae. Gram-positive bacteria only accounted for 23%. Drug-resistant bacteria and fungi would increase under the condition of repeated infection and irrational usage of antibiotics.In recent years, the urine-derived sepsis caused by urinary tract infection had become a popular clinical research topic because of its concealed symptoms, acute onset, rapid development and high mortality. By reviewing domestic and foreign literatures and expert consensus, this article is intended to explore the characteristics and treatment of diabetic urinary tract infections to supply reference for early prevention, correct diagnosis and effective treatments.
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OBJECTIVE To investigate pathogenic bacteria and prognosis of abdominal infection and take measures to prevent and control it.METHODS We analyzed the clinical material and prognosis of 31 patients with abdominal infection retrospectively according to the culture results of puncture and drain liquid from abdominal cavity from Nov 2007 to Nov 2008.RESULTS In 31 patients,5 were complicated with pulmonary infectionwhich the infection rate was 16.13%,and 7(22.58%) died.Totally 48 pathogenic strains were isolated from ascitic fluid culture,20 strains(41.67%) were Escherichia coli,11 strains(22.92%) were Enterococus.Some of coagulase-negative Staphylococcus,Streptococcus,Candida,Klebsiella pneumoniae,and Staphylococcus aureus were also isolated.The resistance rates of E.coli to cephalosporins were above 50.00%,to quinolones were above 65.00%.The susceptibility rates of E.coli to some ?-lactamases inhibitors and carbapenem were very high.The resistance rate of Enterococus to rifampicin was 63.64%,to piperacillin/tazobactam and piperacillin was 81.82%,to erythromycin was 100.00%.The susceptibility rates of Enterococus to teicoplanin,vancomycin,and linezolid were 100.00%.CONCLUSIONS The predominant pathogenic bacteria of abdominal infection are E.coli and Enterococcus.Abdominal infection tends to combine with pulmonary infection.The patients who got into multiple organ dysfunction syndrome have high mortality.
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OBJECTIVE To enhance the healing rate of the wounded victims in earthquake and to do a good job on the nosocomial infection prevention and control according to the feature of the victims. METHODS The advance medical team on the train evaluated thd traumatic condition of the victims and sorted them according to their condition,then the victims with raw surface infection and that with no wound were arranged to the different sections and wards.The cleaning and medical inspection procedure for the victims were formulated.The secretions of their open wound surface with bacterial,fungal and anaerobic culturing at the very beginning were taken when their traumatic condition were examined.The management of wards,attendants and visitors were strengthened,the hand hygiene compliance and the right way to disposal clinical waste the disinfection and sterilization were supervised and directed. RESULTS Most of the 76 victims were with limbs injury,of which 14 victims with open injury,10 got bacterial or fungal infection.The infection rate was 71.43%.Most of them had got combined infection.No Clostridium tetani and C.perfringens were isolated from the secretion of the raw surface.Three victims were complicated with urinary system infection,1 with pulmonary infection and 1 with bed-sore infection after wounded in earthquake.Basing on effective debridement and change dressings,the antibacterial agents were applied according to pathogenic bacteria and the antimicrobial susceptibility test,so the wound surface and general infection were controled effectivelly.Another 35 victims with closed fracture who were operated with internal fixation and reposition after discection in the limited time were not infected. CONCLUSIONS The infection rate of raw surface of victims with open injury is high.Most of the wound surface are infected with some multidrug resistant bacterial and fungi and combined with urinary system infection or pulmonary infection.The nosocomial infections precaution and control should be strengthened to prevent cross infection when treating the victims wounded in earthquake.
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OBJECTIVE To investigate the status of traumatic infection among earthquake in order to provide reasonable evidence for anti-infective therapy. METHODS Samples were collected from 14 patients with compound fracture or osteofascial compartment syndrome for bacterial,fungal and anaerobic culturing,then according to pathogens to choose antimicrobial susceptibility test (AST). RESULTS Among 14 victims,10 had germ growth in wound secretions,the infection rate was 71.43%. Among 17 samples the bacteria,fungi and anaerobic were isolated in 12,4 and (samples,respectively),the isolated rates were 70.59%,23.53% and 5.89%. The main pathogens for the first culture were Enterobacter cloacae,coagulase negative Staphylococcus (CNS) and Acinetobacter. The Clostridium tetani and C. perfringens were all negative. We also isolated 5 strains of fungi from them 1 strain of Candida. CONCLUSIONS Most of the victims from disaster area have got bacterial infection. Most of them are combined infection,some of the infections are nosocomial infections. The key points of the treatment are to find pathogens immediately and choose a reasonable antibacterial agents according to the AST.
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OBJECTIVE To study the prevention strategy of community-acquired pneumonia(CAP) for retired old cadres of PLA.METHODS We adopted the first and second prevention strategy of disease to deduce the frequency for CAP.RESULTS The old cadres were divided into common prevention group and important prevention group by evaluating their body condition.The common prevention group was taken the first prevention strategy:healthy education,inhabit surroundings improvement and proper exercises.The second prevention was carried out to personnel who have chronic disease of respiratory organs which included eliminating the risk factors and making efforts to find, diagnose and treat infection as early as possible.CONCLUSIONS The first and second prevention is an effective working mode which improves the level of CAP prevention.
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OBJECTIVE To improve the level of pathogen detection with the software for drug-resistance message input system. METHODS The software which manufactured by the First Affiliated Clinical hospital of General Hospital of PLA,can detect, analyze,calculate and inquire to samples of inpatients. RESULTS The software may classify the drug-resistance with different partner statistic means.Moreover,it can calculate the sample detection rate and positive rate. CONCLUSIONS The software may provide efficiency and effectiveness for drug-resistance detection.
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OBJECTIVE To investigate the function of department of nosocomial infection management in practice.METHODS It was analyzed the situation that the functional management of department of nosocomial infection in China could not be fully used at present.As far as the main content of nosocomial infection control was concerned,it brought forward the idea of performing the functional management of department of nosocomial infection in practice.RESULTS According to establishing the function of department of nosocomial infection management,strengthening the professional ability,and improving the service,both the effect and quality of nosocomial infection management could be enhanced.CONCLUSIONS The same as medical treatment,scientific research,nursing and logistic management,nosocomial infection management should stick to the legal management,and then its function can be effectively used.
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OBJECTIVE To improve the professional ability of nosocomial infection managers.METHODS By analyzing the status quo and questions among nosocomial infection managers,we explored the essentiality of professionalism construction of the team of nosocomial infection managers and brought forward a way for it.RESULTS It is necessary to set up a professional education and culture system,improve the related guarantee system and keep the team of nosocomial infection managers in stabilization for strengthening the professionalism construction of the team.CONCLUSIONS It is the objective requirement to promote the construction and development of nosocomial infection discipline that impels professionalism construction of the team of nosocomial infection managers.
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OBJECTIVE To use the software for hospital infection control in our hospital to improve monitoring of nosocomial infection in invasive nursing procedure and reduce incidence rate of nosocomial infections.METHODS The software for hospital infection control was used in this prospective investigation to collect common information of invasive nursing procedure,institute intervention measure to invasive nursing procedure,and observe the(occurrence) of nosocomial infection.RESULTS Element administration,process administration,and monitoring(administration) were used to real-time control in invasive nursing procedure,thus fasten information transfer and optimize(performance) flow-sheet of nosocomial infections administration.The software usage could accurately(provide) the(information) of nosocomial infection in-time,and feed-back rapidly.CONCLUSIONS Whole process(control) in invasive nursing procedure can discover and solve problems,thus improve efficiency and effectiveness for preventing and controlling nosocomial infection.
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OBJECTIVE To improve efficiency and quality of antibiotic drug usage in order to assure patients′ security of antibiotic drug usage. METHODS Inducted by strengthening security quality of medical treatment,we are bring antibiotic drug usage into medical quality management by using information technique,training medical workers,putting antibiotic drug into different classifications and surveillancing the usage of antibiotic drug.Moreover,we develop significant basic study for clinic to improve the level of rational use of drug. RESULTS Frequency and number of days for drug usage were reduced by putting measures into effect and inspecting numbers and sorts of drug usage.At the same time,we instituted individualized drug using scheme to critical patients,thereby many critical patients were retrieved. CONCLUSIONS Rational use of drug is a system project which must redeploy all enthusiasm and take comprehensive measures to fight for a safe,effective,economical goal in our work.
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OBJECTIVE To investigate clinical characteristics of spontaneous bacterial peritonitis(SBP) in patients with severe type of viral hepatitis.METHODS A retrospective review of 120 cases of SBP associated with severe type of viral hepatitis was performed.RESULTS Clinical manifestations were as follows:fever 85.0%,abdominal tenderness 51.6%. 63.3% of the total white blood cells count in the ascitic fluid under 0.5×109／L,85.0% of polymorphonuclear cell ratio above 0.50.The positive culture of the ascitic fluid 24.2%,whereas 42.9% of the isolated microorganisms were Escherichia coli.CONCLUSIONS Clinical manifestations in SBP may be non-specific or absent.The total white blood cells count in the ascitic fluid are often under criteria for diagnosis.E.coli was the most common culture isolate.PMN ratio is the reliable parameter for the diagnosis of SBP.