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BACKGROUND AND AIMS: The microbial spectrum and antimicrobial resistance patterns change over time and vary across regions in patients with spontaneous bacterial peritonitis (SBP). There is an urgent need to clarify the factors associated with in-hospital mortality in these patients. METHODS: In this study, 377 patients with SBP and 794 patients with bacterascites were analyzed for the microbial spectrum, antimicrobial resistance profiles, and laboratory findings. RESULTS: The most common pathogens were Escherichia coli (96, 25.5%), Staphylococcus epidermidis (55, 14.6%), and Enterococcus faecium (42, 11.1%). Multidrug-resistant (MDR) bacteria comprised 49.7% of gram-positive bacteria (GPB) and 48.8% of gram-negative bacteria (GNB). The most sensitive antibiotics were amikacin (91.5%), meropenem (89.8%) and piperacillin/tazobactam (87.6%). Extensively drug-resistant (XDR) (OR=51.457, p < 0.001), neutrophil count (OR=1.088, p < 0.001), and the model for end-stage liver disease (MELD) score (OR=1.124, p < 0.001) were independent predictive factors of in-hospital mortality in patients with SBP. CONCLUSION: MDR represented nearly half of the bacteria isolated from patients with SBP, of which the high prevalence of extended-spectrum ß-lactamase-producing and Carbapenem-resistant bacteria is concerning. The presence of XDR, higher MELD score, and neutrophil count were independent predictive factors associated with higher in-hospital mortality in patients with SBP, indicating that intensive care should be provided to these patients.
Subject(s)
End Stage Liver Disease , Peritonitis , Humans , End Stage Liver Disease/complications , Liver Cirrhosis/complications , Severity of Illness Index , Peritonitis/drug therapy , Anti-Bacterial Agents/therapeutic use , Microbial Sensitivity TestsABSTRACT
Objective:To study whether the "combination of medical care and pension" service model can effectively control the development of chronic disease in the elderly and reduce the direct economic burden caused by the disease.Methods:A total of 180 elderly participants who received the "combination of medical care and pension" service model for chronic disease management in Chongqing, China were investigated and analyzed statistically. Epidata 2.0 was used for data entry, SPSS 20.0 was used for data analysis, and paired sample t test was used for comparison between groups. Results:After 12 months of chronic disease management, hospitalization events and expenses of the elderly were reduced, among which the number of hospitalization was reduced by 0.24 timed on average, the length of hospitalization was reduced by 10.41 days on average, and the hospitalization expenses were reduced by 11 144 yuan on average. The direct economic burden due to chronic diseases was reduced by approximately 8 844.5 yuan, accounting for 33.8% of the average cost of hospitalization for the elderly without the application of the model.Conclusion:The chronic disease of the elderly is well controlled by chronic disease management through the "combination of medical care and pension" service model.
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OBJECTIVE:To explore the effect of comprehensive intervention mode on the rational use of Ribonucleic acid Ⅱ for injection,and to provide reference for the management of adjuvant drugs for cancer therapy.METHODS:The rational use of ribonucleic acid Ⅱ was interfered by establishing evaluation criteria,reviewing medical record,establishing tumor therapy adjuvant management work group,classifying drug prescription right,examining and approving off-label drug use,strengthening the assessment and training,clinical pharmacists intervention.The utilization of ribonucleic acid Ⅱ was analyzed statistically in our hospital during Apr.-Jun.2015 (before intervention),Jul.-Sept.2015 (after the first intervention),Oct.-Dec.2015 (after the second intervention) and Jan.-Mar.2016 (after the third intervention).RESULTS:The reasonable rate of Ribonucleic acid Ⅱ for injection was 77.34％ before intervention,and 83.25％,83.64％,95.12％ after the first,second and third intervention respectively;the difference was statistically significant compared to before intervention (P＜0.05).The irrational types included inappropriate indications,unsuitable treatment course,inappropriate usage and dosage,and unsuitable drug combination,etc.The percentage of these irrational types decreased from 2.96％,4.93％,13.79％ and 0.99％ before intervention to 1.63％,0,3.25％ and 0 after the third intervention,respectively.The utilization rate of Ribonucleic acid Ⅱ for injection was reduced from 8.81％ before intervention to 3.93％ after the third intervention,the differences were statically significant (P＜0.05).CONCLUSIONS:The comprehensive intervention model combined with multiple intervention methods can promote the rational use of Ribonucleic acid Ⅱ for injection.It is suggested to further study and evaluate the intervention effect of this model on other adjuvant drugs for cancer therapy.
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This study was aimed to establish a method of PCR combination with PCR-RFLP for detecting the South-East Asian (SEA) deletion type alpha-thalassemia 1 and non-deletion mutation of Hb Constant Spring (CS), and to investigate the application value of this method. For the members of the families with alpha-thalassemia, SEA deletion mutation was detected by PCR, then the HbCS point mutation was screened by PCR-RFLP. The results indicated that 15 carriers with alpha-thalassemia (--(SEA)/) were found in 19 members from 7 families, and 2 families with genotype of --(SEA)/alpha(CS)alpha were screened out successfully. It is concluded that the PCR combination with PCR-RFLP is a simple, rapid, and reliable method for screening HbH disease with genotype of --(SEA)/alpha(CS)alpha.
