ABSTRACT
Objective To explore the application values of GeneXpert MTB/RIF assay (Xpert assay) for rifampicin resistance and multidrug resistant tuberculosis (MDR-TB).Discordance of Xpert and L-J proportion DST of rifampicin was analyzed.Methods Specimens of 1 300patients from January 2014to June 2016in our hospital were collected for solid culture, Xpert assay and L-J proportion drug susceptibility test (DST).Rifampicin resistance detected by Xpert assay was compared with L-J proportion method as a gold standard.Sequencing of rpoB gene and determination of minimum inhibition concentration were accomplished on the discordant MTB strains between Xpert and L-J proportion DST.Results Compared with the DST, the sensitivity, specificity, positive and negative predictive value of Xpert assay for rifampicin resistance were 99.31％, 97.82％, 92.88％and 99.80％, respectively.Among 1 300culture-positive specimens, mutations were detected from 309specimens by Xpert assay, which included 125initial treatment and 184retreatment patients.Among309specimens with rpoB gene mutations, mutations detected by probes E, D and B were common, and the rates were 65.70％, 14.56％and 10.68％, respectively.Totally 239patients were MDR-TB[77.35％ (239/309) ], of which 94initial treatment patients[75.20％ (94/125) ]and 145retreatment patients[78.80％ (145/184) ]were MDR-TB.Among 22strains which were detected rpoB gene mutations by Xpert, but sensitive by L-J proportion DST, 6strains had no mutation in rpoB gene rifampicin resistance determining region (RRDR);16strains had mutations, which were mainly located in L511Pcodon (8strains) and L533Pcodon (4strains).Among 2strains which had no rpoB gene mutation by Xpert, but were resistant by L-J proportion DST, 1strain had no mutation in rpoB gene RRDR region;1strain had mutation which was located in E546G codon outside RRDR region.Conclusion Xpert assay can be used to rapidly detect rifampicin resistance and to screen MDR-TB.Mutations in codon 511and 533are related to low-level resistance to rifampicin.
ABSTRACT
OBJECTIVE:To provide information for carrying out pharmaceutical care for future emergency relief work. METHODS: Based on our own experiences,the pharmaceutical care-related work involved in the medical relief in "May?12" Wenchuan earthquake was investigated and analyzed summarily. RESULTS: Scientific emergency plan could create order for the busy relief work,and creative work could make up the deficiency of the plan. It is advisable to attach great importance to the role of the clinical pharmacists in the earthquake relief work. Good command and powerful measures contribute to the smooth proceeding of emergency medical rescue. CONCLUSION: The pharmaceutical care plays an important role in the emergency medical rescue.
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OBJECTIVE:To study the bacteria strains and susceptible drugs in open wound in patients with earthquake injury. METHODS:Bacteriological test and the drug susceptibility test were conducted for earthquake injury patients with open wound and the results of bacterial culture and the drug susceptibility test were analyzed using Excel 2003. RESULTS:Of the 1 172 earthquake injury cases,the patients with trauma / wounds represented 93.9%,the wound had obvious infection in 132 cases; of the infected cases,the proportions of patients with open fractures,soft tissue injuries and traumatic brain injury accounted for 63%,28% and 9%,respectively. The positive rate of the bacterial culture was 69%,and gram-negative of bacteria which accounted for 85.6% took the lead,chiefly Acinetobacter baumanii,Enterobacter cloacae and Escherichia coli. The results showed bacterial drug resistance was on the high side. CONCLUSION:The open wounds in patients with earthquake injury are likely to be infected with gram negative organisms. Debridement and correct choice of anti-infective drugs are needed to reduce the risk of wound infection,