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Objective To find a more effective alternative therapy for antibiotic therapy and fecal microbiota transplantation in current primary treatment of clostridioides difficile infection (CDI) because of the high recurrence rate. Methods A series of 8-hydroxyquinoline derivatives were designed and synthesized based on 8-hydroxyquinoline scarffold. Results The activity test against C. difficile showed that most of the molecules exhibited good antibacterial activity against C. difficile, and compound 6f showed attractive anti-C. difficile activity. Conclusion A new type of 8-hydroxyquinoline derivatives with anti-clostridium difficile was found, which could be used as good lead compounds for further development.
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Objective:To evaluate the effect of procalcitonin(PCT)guiding anti-infection therapy on the prognosis of elderly patients.Methods:By searching PubMed, EMBASE database, Cochrane library, Cochrane clinical trial center registry and SinoMed database in Chinese, we searched for a randomized controlled clinical(RCT)study on the effect of PCT-guided anti-infection treatment on the prognosis of elderly patients, which was conducted according to the PRISMA statement.The main purpose of the study was to evaluate the time of antibiotic application.Results:After retrieval, 9 RCT clinical studies were finally included, involving 2 702 elderly patients, with an average follow-up of 3.5 months(1-12 months). The average age was(71.3±8.9)years old, with 52.8% of males and baseline levels of white blood cell(WBC)was 12.9×10 9/L, C-reactive protein(CRP)was 18.9 mg/L, PCT was 0.38 μg/L.Compared with conventional anti-infective therapy, PCT-guided anti-infective therapy can reduce the antibiotic application time of elderly patients[standard mean difference( SMD)=-2.39 days, 95% CI(-4.03, -0.75)days, P=0.004]. However, PCT-guided anti-infection treatment had no significant effect on the length of hospital stay[ SMD=-0.46 d, 95% CI(-0.05, 0.14)d, P=0.135], the rate of reinfection[ RR=0.87, 95% CI(0.73, 1.03), P=0.105]and the risk of all-cause death[ RR=1.02, 95% CI(0.80, 1.31), P=0.863]. Conclusions:PCT-guided anti-infection treatment can reduce the time of antibiotic application in elderly patients, but other clinical effects need to be verified by more large-scale studies
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Granulocyte is granular leukocytes in blood, which play an important role in anti-infection treatment and cancer-killing activity. In clinical, allogeneic granulocyte transfusion can be applied for anti-infection treatment when the patients are seriously infected but the antibiotic treatment is ineffective, especially the WBC counts are extremely low. Recently, some progress has been made in the researches about treating cancer with granulocyte infusion. It is possible to use allogeneic granulocyte infusion with high killing activity to treat the certain types of cancers.
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Objective To explore the strategies of drug treatment and pharmaceutical care for children with bacterial meningitis. Methods The anti-infective therapy, therapeutic drug monitoring and dose adjustment of vancomycin in children with bacterial meningitis were analyzed and discussed according to relevant guidelines and literatures. Results Clinical pharmacists analyzed therapeutic regimen. According to the results of etiology and drug sensitivity, meropenem was discontinued and rifampicin was added. Based on drug monitoring of vancomycin, it is suggested to extend the infusion time of vancomycin to reach the target concentration. The child was discharged from hospital. Conclusion Recommendations of the relevant drug treatment guidelines and the latest medical research evidence should be provided by clinical pharmacists in order to promote reasonable and effective clinical uses of medicine.
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Presentamos el caso de un paciente con una tenosinovitis piógena del 5° dedo de la mano, tratado inicialmente con desbridamiento quirúrgico y antibioterapia empírica. La evolución fue desfavorable, pues el dedo presentaba un defecto de cobertura con signos infecciosos en la herida y las curas resultaban muy dolorosas. Al paciente se le ofertaron varias opciones quirúrgicas y, mientras se decidía por alguna, aceptó por escrito iniciar curas con sevoflurano líquido tópico (según protocolo vigente para uso de fármacos fuera de indicación). El efecto analgésico del sevoflurano apareció rápidamente, y la evolución posterior de la herida fue muy favorable, pues los signos infecciosos desaparecieron y el defecto de cobertura se había cerrado tras tres semanas de empleo de sevoflurano tópico, sin necesidad de nuevas cirugías. Este caso ejemplifica que el uso fuera de indicación de sevoflurano tópico para tratar heridas complejas puede evitar actuaciones quirúrgicas, mucho más agresivas para los pacientes.
The clinical case is presented on a patient suffering from pyogenic tenosynovitis affecting the 5th finger of the hand, which was initially treated with surgical debridement and empirical antibiotic treatment. The clinical outcome was unfavourable, since the finger presented with a coverage defect, and the wound seemed to be infected. Wound cleaning and dressings were very painful. The patient was asked to choose between several surgical therapeutic alternatives, but he gave written informed consent to be treated with topical sevoflurane, following an approved protocol for the off-label use of this drug. Pain was accurately controlled after sevoflurane application, and the wound exhibited a very good outcome with disappearance of the clinical signs of infection and complete closure of the defect coverage after three weeks of sevoflurane, with no new surgical procedures. The present clinical case illustrates how the off-label use of topical sevoflurane for the treatment of complicated wounds could be useful to avoid surgical procedures that are more aggressive for patients.
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Humans , Sevoflurane , Tenosynovitis , Wound Infection , Analgesics, Short-Acting , Pain Management , Anti-Infective Agents, LocalABSTRACT
OBJECTIVE：To provide th e ideas a nd for individualized anti-infective treatment of infection after surgery for infants and young children with intussusception and enterobrosis ，and to provide reference for clinical pharmacists participating in the clinical treatment. METHODS ：Clinical pharmacists optimized the anti-infection program for an 11-month-old infant patient infected after surgery with intussusception and enterobrosis in Ordos Central Hospital ；they put forward medication suggestions in respects of the selection of initial anti-infection treatment program ，drug replacement ，the selection of anti-infection treatment program after blood culture showed Enterococcus coli and Enterococcus faecium ，and dosage adjustment. RESULTS ：According to the judgment of the common pathogens and the hospital or community infections in the infant patient with intussusception and enterobrosis，cefoperazone sulbactam 1.0 g，q12 h was adjusted to cefoperazone sulbactam 0.5 g，q8 h combined with Metronidazole chloride sodium injection 20 mL，q8 h；when the blood culture showed E. coli （ESBL-）and E. faecium ，it was recommended to add vancomycin 0.15 g，q12 h. After poor treatment ，it was recommended to adjust the vancomycin dose to 0.2 g，q8 h. All the above suggestions were adopted by doctors. And the child ’s body temperature dropped after treatment ，the blood culture turned negative and laboratory indicators returned to normal. The child was discharged smoothly. CONCLUSIONS ：Infants and young children are special groups. Therefore ，before using antibiotics ，clinical pharmacists should evaluate the age ，body weight ，liver and kidney functions of infants and young children. They should also help doctors select and adjust drugs ，frequency and dosage on the basis of pharmacokinetic characteristics and safety ，so as to avoid adverse drug reactions while ensure curative effect.
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OBJECTIVE：To explore the role of clinical pharm acists in anti-infective therapy in patients with septic shock in the ICU. METHODS ：A total of 180 patients with septic shock were retrospectively collected from ICU of Chongqing Qianjiang Central Hospital during Jan.-Dec. 2018. According to whether clinical pharmacists participated in anti-infective therapy in the whole process，the patients were divided into intervention group （92 cases）and control group （88 cases）. Both groups were given routine treatment according to clinical diagnosis ；on this basis ，clinical pharmacists participated in the whole anti-infective therapy of the intervention group ，including participating in pharmaceutical rounds ，formulating anti-infective programs ，guiding nurses to implement anti-infective plan ，and providing pharmaceutical care for patients. The effectiveness ，safety and antibiotics clinical use indexes（such as proportion ，treatment course and cost of key monitored drugs ）were evaluated in 2 groups. RESULTS ：The cure rate of intervention group （98.91％）was significantly higher than that of control group （93.18％），while the incidence of ADR in the intervention group （8.70％）was significantly lower than control group （23.86％）. The use of antibiotics types was more rational（the proportion of carbapenems used in intervention group and control group were 20.65％，36.36％；those of quinolones were 15.22％，28.41％，respectively）；the duration of antibiotics use in the intervention group [ （15.18±2.25）d] was significantly shorter than control group [ （19.84±3.81）d]. The cost of antibiotics per capita [ （2 846.99±712.48）yuan] was significantly lower than control group [ （3 991.26±577.82）yuan]，with statistical significance of all above （P＜0.05 or P＜0.01）. CONCLUSIONS ： Clinical pharmacists participating in the anti-infective treatment of ICU patients with septic shock and providing pharmaceutical care，can improve the anti-infective effect ，reduce adverse drug reactions and drug-induced diseases ，optimize the use of antibiotics and reduce medical cost.
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OBJECTIVE： To explore the role of clinical pharmacist in individualized treatment for osteosarcoma patients with periprosthetic joint infection （PJI）. METHODS： An osteosarcoma patient was admitted to our hospital and then suffered from PJI after operation. Clinical pharmacist adjusted the initial anti-infection plan and carried out pharmaceutical care according to the results of patients’ etiology and drug sensitivity. According to the PK-PD principle， combined with the therapeutic drug monitoring （TDM）， the dose of antibiotics was adjusted. With the occurrence of ADR， the antibiotic therapeutic regimen was adjusted again. RESULTS： The patient was administrated cefotiam for empiric therapy initially after the diagnosis of PJI. After obtaining the results of etiology and drug sensitivity， the clinical pharmacist suggested that vancomycin sensitive to penicillin-resistant Staphylococcus epidermidis should be used for targeted anti-infection treatment. After adjusting the dosage according to the steady-state valley concentration， the patient had slight liver function damage， accompanied with chest tightness and shortness of breath. After analysis， the clinical pharmacist considered the adverse drug reactions related to vancomycin， and again suggested that the patient should be treated with teicoplanin. After the doctor adopted the treatment plan recommended by the clinical pharmacist， PJI of the patient was effectively controlled， and the adverse reaction symptoms disappeared. The patient was effectively cured for PJI and discharged eventually. During the treatment period， the clinical pharmacist also carried out medication education for the drugs used by the patient. CONCLUSIONS： Clinical pharmacist should master the principle of antibiotic drug PK-PD theory and evaluate the clinical efficacy and safety of anti-infective drugs dynamically based on the guidance of TDM， so as to develop individualized anti-infection therapeutic regimen for osteosarcoma patient with PJI， improve the effect of clinical treatment and guarantee the safety of drug use.
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OBJECTIVE： To explore the methods and ideas for clinical pharmacists to optimize anti-infective treatment programs in obese patients with pulmonary infection. METHODS： The clinical pharmacist optimized the anti-infection regimen of an obese patient with post-stroke pulmonary infection （BMI＝34.602 kg/m2） admitted to our hospital， and adjusted the dose adjustment and drug replacement of piperacillin tazobactam in the obese patient. And the selection of methicillin-resistant Staphylococcus aureus （MRSA） drugs and dose determination were proposed. RESULTS： According to the patient’s body weight and guidelines， the dose of piperacillin tazobactam was adjusted from 4.5 g， q12 h to 4.5 g， q6 h； the antibiotic was changed to moxifloxacin due to pathogenic changes， the dose was 0.4 g， qd， no need to increase When diagnosed as pneumonia caused by MRSA infection， linezolid was used instead of vancomycin for infection treatment in obese patients， and the dose was determined to be 600 mg， q12 h. The physician adopted the above recommendations. After treatment， the patient’s temperature decreased， cough and sputum eased， and the laboratory indicators returned to normal and discharged smoothly. CONCLUSION： Clinical pharmacists can participate in the drug treatment of special obese patients by exerting their own professional advantages： by adjusting the type， dose and frequency of antibacterial drugs， patients can obtain individualized treatment， improve the safety and effectiveness of patients’ medication， and finally obtain satisfactory results.
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Sophora moorcroftiana (S. moorcroftiana) is an endemic leguminous dwarf shrub in Tibet, China. Decoctions of the seeds have been used in Chinese folk medicine for dephlogistication, detoxication, and infectious diseases. The present study aimed to investigate the constituent and biological effects of polysaccharides from S. moorcroftiana seeds in Caenorhabditis elegans (C. elegans). Polysaccharides from S. moorcroftiana seeds (SMpol) were extracted with 60% ethanol and constituent was analyzed by GC-MS. SMpol was composed of glucose, galactose and inositol in the molar ratio of 35.7 : 1.3 : 17.0. Synchronized worms were treated with SMpol and then lifespan, motility, reproduction, stress resistance and antimicrobial activity were examined. Compared with the control group, the lifespan was increased to the average of 27.3 days and the number of laying eggs showed a 1.3-fold increase in nematodes treated with SMpol (4 mg·mL). In SMpol (4 mg·mL) treated worms, there was a 1.1-fold increase in 24-h survival of acute heat stress and a 1.6-fold increase in 2-h survival of oxidative stress The colonization of the bacteria in the SMpol treated nematode was significantly lower than that of the untreated group by 68.3%. In vivo studies showed SMpol significantly extended the life span, improved reproduction, increased stress resistance and antimicrobial capacity of C. elegans. In conclusion, those results indicated that the polysaccharides from S. moorcroftiana seeds were involved in a variety of biological activities leading to its modulatory effects on C. elegans which may be developed as a natural supplement agent.
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Animals , Caenorhabditis elegans , Physiology , Longevity , Plant Extracts , Chemistry , Pharmacology , Polysaccharides , Chemistry , Pharmacology , Reproduction , Seeds , Chemistry , Sophora , Chemistry , Stress, PhysiologicalABSTRACT
Orthopaedic implants in the body brings a high risk of microbial infections. Infection is one of the main reasons for failure of implant in department of orthopaedics, and is more common in open fracture surgery. Fracture nonunion after internal fixations is not rare clinically, and reoperation or even multi-operations are required, which will be a heavy burden for the patients physically, mentally and economically. The aggregation and activation of macrophages can increase the cell count around the implants, which improves the immune function of the implant/tissue interface, thus contributing to prevention or treatment of infection. In addition, surface modification of titanium and its alloys, and loading antibiotics or bioactive substances also play a role in prevention or treatment of infection and nonunion. This review summarizes the current research on anti-infection function and fracture healing promotion in the surface modification of titanium and its alloys, so as to provide references for designing orthopaedic implants with anti-infection and fracture healing promotion functions.
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OBJECTIVE: Discuss the importance of clinical pharmacists and pharmacy care during anti-infective therapy in critically ill patients. METHODS: Clinical pharmacists involved in the treatment process of a case of critically ill patients, who has craniocerebral injury, multiple organ insufficiency, severe infection, electrolyte imbalance, venous thrombosis of both lower extremities, anemia, and gastrointestinal bleeding. Pharmacy care includes adjustment of anti-infective treatment, reduce adverse drug reactions and maintain homeostasis, et al. RESULTS: The patient was cured and in a stable condition after systematic treatment. CONCLUSION: Clinical pharmacists could play an important role in improving the prognosis of critically ill patients.
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Sophora moorcroftiana (S. moorcroftiana) is an endemic leguminous dwarf shrub in Tibet, China. Decoctions of the seeds have been used in Chinese folk medicine for dephlogistication, detoxication, and infectious diseases. The present study aimed to investigate the constituent and biological effects of polysaccharides from S. moorcroftiana seeds in Caenorhabditis elegans (C. elegans). Polysaccharides from S. moorcroftiana seeds (SMpol) were extracted with 60% ethanol and constituent was analyzed by GC-MS. SMpol was composed of glucose, galactose and inositol in the molar ratio of 35.7 : 1.3 : 17.0. Synchronized worms were treated with SMpol and then lifespan, motility, reproduction, stress resistance and antimicrobial activity were examined. Compared with the control group, the lifespan was increased to the average of 27.3 days and the number of laying eggs showed a 1.3-fold increase in nematodes treated with SMpol (4 mg·mL). In SMpol (4 mg·mL) treated worms, there was a 1.1-fold increase in 24-h survival of acute heat stress and a 1.6-fold increase in 2-h survival of oxidative stress The colonization of the bacteria in the SMpol treated nematode was significantly lower than that of the untreated group by 68.3%. In vivo studies showed SMpol significantly extended the life span, improved reproduction, increased stress resistance and antimicrobial capacity of C. elegans. In conclusion, those results indicated that the polysaccharides from S. moorcroftiana seeds were involved in a variety of biological activities leading to its modulatory effects on C. elegans which may be developed as a natural supplement agent.
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Animals , Caenorhabditis elegans , Physiology , Longevity , Plant Extracts , Chemistry , Pharmacology , Polysaccharides , Chemistry , Pharmacology , Reproduction , Seeds , Chemistry , Sophora , Chemistry , Stress, PhysiologicalABSTRACT
Objective To discuss the contribution of clinical pharmacists in anti-infection treatment of a patient with multiple organ dysfunction syndrome ( MODS) undergoing continuous renal replacement therapy ( CRRT). Methods Pharmacists participated in the anti-infection treatment of a MODS patient undergoing CRRT.Pharmacists assisted physicians in optimizing the therapeutic regimen based on treatment guidelines and relative information. Results Physicians accepted the advice of pharmacists after comprehensive evaluation.Ten days later,the patient recovered from shock,as the infection indexes were improved significantly.He then moved back to the general ward. Conclusion Pharmacists should positively participate in clinical treatment with physicians,in order to play a critical role in ensuring the safety and efficacy of the medication.
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Objective To summarize the clinical experience in the treatment of allogeneic lung transplantation with ABO-different donor. Methods Data of three cases of lung transplantation carried out in Tianjin First Central Hospital from August to September 2015 were retrospectively analysed. ABO blood groups were different but compatible in three donors who were with brain death, and their panel reactive antibody (PRA) and lymphocyte poison cross matching test were negative. The surgical approaches were left single-lung transplantation and sequential bilateral single-lung transplantation. After the surgery, measures for pneumonedema control, immuno suppression (mycophenolate mofetil + tacrolimus +glucocorticoids) and anti-infection (imipenem and cilastatin sodium+ micafungin sodium+ganciclovir) were carried out. Results The operation wsa completed successfully in all 3 patients, and the operative time was 5-6 hours. The cold ischemia time was less than 4 hours. The blood loss during the operation was 800-1000 mL. The trachea cannula extubation was pulled out within 24 h, thoracic drainage tube was pulled out within 72 h. All the patients were moved into general ward in 5-8 days. Patients discharged from hospital in 5 weeks after operation. Pneumonia infection occurred in 2 cases on the 6 th day after operation, and antibiotic treatment was upgraded and infection was cured after 3 weeks. All patients were followed up for 21-22 months, and 3 patients survived without serious complications such as graft rejection. Conclusion Comprehensive and effective surgical techniques, reasonable choice of donor lung and preservation method, active anti-infection strategy and triple immunosuppressive program can improve the survival rate after transplantation.
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OBJECTIVE:To investigate the role of clinical pharmacists in the anti-infection treatment for gas gangrene chil-dren. METHODS:Clinical pharmacists participated in the anti-infection treatment of a child with gas gangrene;according to clini-cal symptoms and consultation opinions of different departments,it was suggested to use Piperacillin sodium and tazobactam sodi-um for injection for initial anti-infection treatment. After debridement and drainage of left lower limb,removal of necrotic tissue, clinical pharmacists suggested to stop giving Piperacillin sodium and tazobactam sodium for injection and use Benzylpenicillin sodi-um for injection combined with Imipenem and cilastatin sodium for injection instead for anti-infection treatment according to etiolog-ical characteristic of gas gangrene and related guidelines. According to the results of bacterial culture of wound secretion and drug sensitivity test,clinical pharmacists additionally suggested to use Clindamycin hydrochloride and sodium chloride injection 0.6 g, q8 h,ivgtt to inhibit the generation of Clostridium perfringens.According to the changes of patient's signs and etiological results, it was suggested to stop taking Clindamycin hydrochloride and sodium chloride injection,use Vancomycin hydrochloride for injec-tion successively. RESULTS:The physicians adopted the suggestions of clinical pharmacists.After surgical treatment and anti-infec-tion treatment,the patient's condition was improved,the vital signs were stable,and the patient was transferred to the general ward of orthopedics department for further treatment. CONCLUSIONS:Clinical pharmacists participate in the treatment of gas gan-grene child,and assist physicians to formulate and adjust anti-infection treatment plan according to related guidelines,clinical symp-toms,etiological examination results and consultation opinions,so as to guarantee safe and effective drug use.
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OBJECTIVE: To explore how to carry out pharmaceutical consultation for anti-infection treatment in neutropenic hematological patients with invasive fugal disease and elaborate the value of clinical pharmacists in anti-infection treatment. METHODS: A total of 41 hematologic malignancies patients with invasive fungal disease who were consulted by clinical pharmacist from October 2014 to June 2016 were enrolled into the study. The etiology, bacteria complication, and infection site were summarized. The other 41 agranulocytosis patients complicated with invasive fungal disease without clinical pharmacist consultation randomly sampled by HIS were used as the control. Statistical analysis were carried out to evaluate the effect of anti-infection treatment. The authors also discussed that as a clinical pharmacist how to carry out pharmaceutical consultation through several typical anti-fungal infection cases. RESULTS: Totally 45 strains of fungi were isolated from the secretion specimens obtained from the 41 patients, including Candida albicans, Candida glabrata, Candidakrusei, Candida tropicalis, Aspergillums, and Cryptococcosis, among which Candida albicans accounted for 60.0%, followed by Aspetgillus (13.3%), Candidakrusei (11.1%), Candida glabrata (6.67%), Candida tropicalisi (6.67%), and Cryptococcosis (2.2%). The main infection site was the lung, followed by the digestive tract and blood stream. The positive rate of bacteria culture was 58.5% among the 41 patients, and the major isolated bacteria were Escherichia colis, Pseudomonas aeruginosa, Enterococcus, and Pseudomonas maltophilia. For the antifungal treatment involving the clinical pharmacists, the cure rate was 48.8%, the significant effective rate was 34.2%, the improved effective rate was 7.4%, the total effective rate of treatment was 72.9%, and the failure rate was 9.3%. There was significant difference in the curative effect between the clinical pharmacist consultation group and the control group (P<0.05). CONCLUSION: The incidence of fungal infection in agranulocytosis patients is high, and most of the patients are complicated with bacteria infection. The most frequently infected site is respiratory tract. Clinical pharmacists can play an important role in the treatment of invasive fungal disease in agranulocytosis patients to ensure the treatment safety and efficacy.
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Objective To evaluate the antibacterial effect of mononuclear cells(MCs)in the liver lavage solution. Methods For in vitro experiment, MCs were col ected from the liver lavage solution of SD rats and divided into the supplement of interleukin(IL)-15 and non-supplement groups. The MCs were co-cultured with Pseudomonas aeruginosa (P. aeruginosa)for 4 h and then the supernatant was collected and MCs were lysed. The bacterial load in the lysate was detected after LB plate culture. The levels of interferon(IFN)-γand tumor necrosis factor(TNF)-αin the supernatant were measured by enzyme-linked immune absorbent assay(ELISA). For in vivo experiment, 40 SD rats were administered via tracheal injection of P. aeruginosa solution at a dose of 1×109 CFU/mL and randomly divided into four groups(n=10).In the control group, physiological saline was given via gavage. In the immunosuppression group, tacrolimus(FK506)was delivered via gavage. In the MC group, MCs at a dose of 1.0×108 was given via intravenous injection after use of FK506. In the IL-15 pretreated-MC group, IL-15 pretreated-MCs at a dose of 1.0×108 were administered via intravenous injection after application of FK506. The lavage solution of pulmonary alveolus and the rat lung tissue were col ected. The bacterial load was detected after LB plate culture. The expression of IFN-γand TNF-αin the pulmonary alveolus and lung tissue were measured by ELISA and Western blot. Results Compared with MCs alone, IL-15 pretreated-MCs exhibited significantly higher antibacterial capability in vitro. The CFU was 35%of untreated MCs. The synthesis and release capabilities of IFN-γandTNF-αweresignificantlyenhanced.Comparedwiththecontrolgroup,thequantityofimmunecelsinthelungtissuewas decreased and the bacterial load in the lung tissue and the lavage solution of pulmonary alveolus was significantly increased, whereas the expression levels of IFN-γand TNF-αtended to decline in the immunosuppression group. Administration of IL-15 pretreated-MCs significantly enhanced the quantity of immune cel s in the lung tissue, decreased the bacterial load and increased the secretion of IFN-γand TNF-α. Conclusions MCs in the liver lavage solution exhibit favorable antibacterial activity.Underimmunosuppressioncondition,thedefensecapabilityofthehostagainsttheopportunisticpathogenicbacteria is significantly enhanced.
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Objective To discuss the evaluation method of anti-infective therapy by clinical pharmacist .Methods Anti-infection therapy for an AECOPD patient in department of respiration in our hospital was analyzed to discuss the evaluation method of anti-infective therapy .Results The patient had indication to use antibacterial ,and combination of Amikacin and Piperacillin-sulbactam were selected as initial empirical treatment for common respiratory G --bacilli including drug resistant of Pseudomonas aeruginosa ,which was rationality .But the whole process of using the initial combination linked to the hospital was unreasonable .Conclusion To evaluate the rationality of anti-infection treatment ,the indication to use antibacterial need to be determined firstly ,and combined with the severity of the patient ,prior treatment ,etiology of the site of infection ,and choice of antibiotics to evaluate the rationality of initial empiric regimen secondly .For etiology positive results ,the efficacy of initial empiric therapy ,interpretation of etiology results and the clinical significance ,guidelines recommend should be com-bined ,following-up selection of drug to evaluate the rationality of follow-up treatment .
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Objective To observe the long-term efficacy of anti-infective reconstituted bone xenograft (ARBX) combined with external fixation of posttraumatic long bone infection in lower extremities.Methods This retrospective case series study included 36 patients with posttraumatic long bone infection in lower extremities followed up for more than 18 months after receiving one-stage ARBX bone grafting combined with ring external fixation from January 2004 to December 2013.There were 21 male and 15 female patients,at the age of 19-72 years (mean,35.8 years).Multiple fractures were seen in 24 patients and single fractures in 12 patients.Bone and functional results were evaluated using the association for the study and application of the method of Ilizarov (ASAMI) classification.Results Follow-up ranged from 18 to 72 months (mean,38 months).Bone union was seen in 33 cases in a mean period of 5.2 months,and infection was completely cured.Length of limbs in all patients reached the expected extension length with the bone extension length of 3-10 cm (mean,5.2 cm).All the extended areas showed bone healing.According to the ASAMI classification,bone result was excellent in 20 patients,good in 13 and fair in 3,with the excellent and good rate of 92％,and limb function recovery was excellent in 18 patients,good in 11 and fair in 7,with the excellent and good rate of 81％.Conclusion ARBX adjuvant external fixator treatment of posttraumatic long bone infection in lower extremities improves bone healing rate and limb function recovery rate and shortens bone healing time at one stage.