ABSTRACT
Objective To investigate the prevalence and drug resistance profile of the strains isolated from cerebrospinal fluid of neurosurgery patients so as to provide guidance for the prevention and treatment of intracranial infection.Methods The prevalence and drug resistance of strains isolated from cerebrospinal fluid of neurosurgery patients admitted from Jan 2011 through Dec 2015.Results A total of 1 060 strains were isolated from 23 259 CSF samples.The positive rate of culture was 4.56％.After 1 060 strains were categorized and some of the same species were eliminated,419 strains of different species were obtained,including 103 (24.6％) strains of gram-positive bacteria,293 (69.9％) strains of gram-negative bacteria and 23 (5.5％) strains of fungus.The three leading strains isolated were Acinetobacter spp.(165 strains,39.4％),Klebsiella pneumoniae (72 strains,17.2％),coagulase negative staphylococcus (54 strains,13.6％).The Acinetobacter baumannii isolates showed high resistance rate to meropenem (82.3％) and to cefoperazone sulbactam (76.4％),while the rates of drug resistance to colistin and amikacin were quite low found to be 3.1％ and 29.8％,respectively.The drug resistance of Klebsiella pneumonia was serious in which the rate of drug resistance to meropenem was 72.6％,and the rate of drug resistance to cefoperazone sulbactam was 79.0％,and rates of drug resistance to colistin and Amikacin were quite low found to be 0％ and 35.2％,respectively.The detection rates of MRSA,MRSE and MRSH were high found to be 76.5％,100％ and 100％ respectively.Non-susceptible to vancomycin and teicoplanin strains in staphylococci species were not found.Conclusions The majority of strains isolated from the cerebrospinal fluid were gram-negative bacteria,and the detection rates of Acinetobacter and Klebsiella pneumoniae were high,and the rates of drug resistance of Acinetobacter baumannii and Klebsiella pneumoniae were high.Doctor should pay more attention to the prevalence of pathogenic strains isolated from cerebrospinal fluid and drug resistance of those strains in order to rational use of antibiotic according to the drug resistance detection.
ABSTRACT
Objective To explore specimen sampling for microbial culture in ICU patients with documented infections in order to offer clinical evidence for improving the rational use of antibiotics.Methods Patients with documented infection on the first day after admission into ICU and discharged from ICU from July to December 2012 and from July to December 2013 were enrolled in the study.Clinical data including presence or absence of infection,initial antimicrobial therapy,microorganism specimen sampling and culture were retrospectively analyzed.Results Of 841 patients discharged from ICU,443 had evidence of infections and received antimicrobial therapy on the admission day,and only 30 (6.8％) of them had microbiological detection results prior to treatment.There were microbial specimens available at infection sites on the admission day in 369 cases,and 360 cases (97.6％) of them were sampled in the first three days after ICU admission,while only 119 cases (33.1％) were sampled before the first dose of antimicrobial therapy.Specimens sampled were sputum (56.4％) in the majority,followed by the blood (17.4％).Further analysis of 269 infected patients receiving initial broad-spectrum antimicrobial therapy also showed that only 33.5％ cases were sampled before the first dose of broad-spectrum antimicrobial administration.The positive isolation rate of multi-drug resistant isolates including A.baumannii,S.maltophilia and B.cepacia from specimens sampled after first dose of initial broad-spectrum antimicrobial therapy were significantly higher than those sampled before antimicrobial therapy,P ＜ 0.05.There was no significant difference in isolation rate of Staph.aureus and Enterobacteriaceae between samples obtained before and after first dose of initial broad-spectrum antimicrobial therapy.Conclusions Few evidence of pathogenic microorganisms was available before initial antimicrobial therapy in ICU patients.Although sampling rate of microbial specimens is high,the most of them are sampled after the first dose of antimicrobial administration,and the patentially contaminated specimens such as sputum in predominance,obviously decrease the reliability of authentic results obtained from microorganism culture.
ABSTRACT
Objective: To retrospectively analyze the clinical efficacy and safety of rivaroxaban in the prevention of deep vein thrombosis ( DVT) after bones of lower extremity surgery. Methods:Totally 94 patients with bones of lower extremity surgery were col-lected in our hospital during June 2010 to June 2013. According to the taken medicine, the patients were divided into groupⅠ(rivarox-aban 10 mg,po,qd) and groupⅡ( low molecular weight heparin injection 4 000 IU, ih,qd) . The bleeding after the surgery, the data of blood routine and coagulation, the occurrence of DVT and the adverse reactions in the two groups were compared. Results:After the medicine treatment, the number of hemoglobin and platelet in the two groups was declined significantly (P<0. 05), while reached the normal value after the medicine withdrawal. No significant difference was found in the blood routine and coagulation routine in the two groups. One case of hemorrhea showed in group I, while three cases showed in groupⅡ. GroupⅠhad no DVT, while groupⅡ had 3 cases of DVT, and the difference was significant (P<0. 05). No severe adverse reactions appeared in the two groups. Conclusion:Rivaroxaban has good effect in the prevention of DVT with better efficacy and safety when compared with low molecular weight heparin.