遗忘的药物——呋喃妥因在尿路感染中的应用

随着抗生素的不断发明和应用,目前临床中已经发生很多耐药菌的尿路感染,极大地增加了医疗负担.呋喃妥因虽已使用50多年,但很少耐药菌株,费用低廉,临床仍有广阔的应用前景.本文复习呋喃妥因的相关指南推荐、作用机制、体内代谢、临床抗菌特点和副作用等,希望引起对这个被临床逐渐遗忘的药物重视.     

细菌耐药性对抗策略——中药延缓、逆转细菌耐药性,治疗耐药细菌感染的研究

细菌耐药性和耐药菌感染是医学界面临的一大难题,目前几乎所有的抗菌药物,均出现了耐药菌株.细菌耐药性既是细菌在有害环境中生存的自身防卫体系,更与抗菌药物的医疗与非医疗应用直接相关.中药的抗感染作用历经上千年临床循证,确实有效.近年来的研究表明,中药不仅有抗菌作用,而且还具有延缓、消除细菌耐性的作用.     

铜绿假单胞菌I类整合子及耐药基因分析

铜绿假单胞菌是临床上重要的院内感染菌,对多种抗生素耐药。整合子是能捕获并整合外源耐药基因盒,并使之表达的DNA元件。通过整合子水平转移的方式极大地加速了耐药基因在同种及不同种属之间的传播,造成细菌的耐药以至多重耐药问题日益严重。     

铜绿假单胞菌Ⅰ类整合子及耐药基因分析

铜绿假单胞菌是临床上重要的院内感染菌,对多种抗生素耐药.整合子是能捕获并整合外源耐药基因盒,并使之表达的DNA元件.通过整合子水平转移的方式极大地加速了耐药基因在同种及不同种属之间的传播,造成细菌的耐药以至多重耐药问题日益严重.     

抗菌药物合理应用的宏观和微观问题

抗菌药物不合理应用现象长期得不到纠正,细菌耐药稳步攀升,正引起医学界、社会和政府的高度关注.本文就宏观上的抗菌药物使用政策与微观上的临床用药两方面存在的问题进行探讨.介绍了国际上关于抗菌药物政策的研究以及抗菌药物合理使用的新观点(尽早开始经验性治疗、"降阶梯"治疗策略、运用抗菌药物PK/PD原理指导临床用药、短程治疗).主张调整宏观抗生素策略,去除该政策单纯、片面限制使用和应用药敏实验结果指导临床用药绝对化的做法,吸纳国际上的新成果,强化监管力度,更多采用教育和技术手段.     

抗菌药物合理应用的宏观和微观问题

抗菌药物不合理应用现象长期得不到纠正,细菌耐药稳步攀升,正引起医学界、社会和政府的高度关注。本文就宏观上的抗菌药物使用政策与微观上的临床用药两方面存在的问题进行探讨。介绍了国际上关于抗菌药物政策的研究以及抗菌药物合理使用的新观点（尽早开始经验性治疗、“降阶梯”治疗策略、运用抗菌药物PK／PD原理指导临床用药、短程治疗）。主张调整宏观抗生素策略,去除该政策单纯、片面限制使用和应用药敏实验结果指导临床用药绝对化的做法。吸纳国际上的新成果,强化监管力度,更多采用教育和技术手段。     

解析我国抗生素耐药现状及相应措施

自从20世纪40年代青霉素问世以来,人类对葡萄球菌感染几乎是药到病除,曾挽救了无数感染者的生命。但是,由于抗生素的广泛使用和滥用,使这些不断开发的抗生素失去了应有的威力,抗生素耐药现象日益严重,耐药菌株不断增多,已成为临床医生一个非常棘手的问题。1我国细菌耐药现状根据我国细菌耐药监测研究组1998年~1999年与2000年~2001年监测调查结果,金黄色葡萄球菌对青霉素耐药率两个年度分别为82.7%与89.1%,对红霉素耐药率分别为58.2%与74.4%。表皮葡萄球菌对青霉素的耐药率分别为56.7%与66.2%,对红霉素的耐药率分别为51.5%与76.2%。肺炎链球…     

耐多药肺结核的最优化治疗模式的几点思考

耐多药结核病是结核病治疗中的一个难点,由于耐药成因和耐药种类的多样性决定了治疗应该个体化,对耐多药肺结核的最优化治疗模式的应用和价值进行了思考和总结,这对结核病的治疗有极为重要的意义。     

肺炎支原体肺炎流行病学特点及耐药现状

肺炎支原体(MP)是社区获得性呼吸道感染的重要病原体,引起的呼吸道感染每3年7年出现一次流行,国内外文献报道,监测到多个国家和地区出现MP的爆发流行,流行特点与气候等因素相关,不同地区有所差异,近几年难治性和重症肺炎支原体肺炎增多,对儿童和青少年健康危害严重,目前临床上治疗首选大环内酯类抗生素。自2001年日本首次从临床标本分离到对大环内酯类抗生素耐药的肺炎支原体以来,世界多个国家和地区也相继报道。大环内酯类抗生素耐药的主要机制是23SrRNA基因单个碱基突变,使大环内酯类抗生素与核糖体主要结合部位发生结构改变,亲和性降低,从而产生耐药。合理使用抗生素,在肺炎支原体耐药控制与治疗上至关重要。     

耐多药肺结核的最优化治疗模式的几点思考

耐多药结核病是结核病治疗中的一个难点,由于耐药成因和耐药种类的多样性决定了治疗应该个体化,对耐多药肺结核的最优化治疗模式的应用和价值进行了思考和总结,这对结核病的治疗有极为重要的意义.     

全面认识外科感染 合理使用预防性抗生素

外科感染是一种使用抗菌药物解决不了的而常需外科干预的感染,其主要特点是皮肤和黏膜屏障有了破损、多种内源性致病微生物从破坏部分入侵致病。最常见的外科感染是切口部位感染导管相关血循感染、肺炎和泌尿道感染。外科切口部位感染的发生与外科切口各类密切相关,清洁、清洁—污染、污染和污秽四关的感染发生率分别约为2.1%、3.3%、6.4%和7.1%。预防外科感染可从三方面着手,提高宿主抵抗力;手术操作细致;加强围手术期处理,包括预防性抗生素等。预防性抗生系的适应证为Ⅱ、Ⅲ类切口,一般选择一代头孢菌素用于非厌氧菌污染的手术,二代头孢菌素用于厌氧菌污染的手术。应在手术前8小时内用药,并在术后24小时停药,给药方法是一次静脉滴入。此外还需注意提高外科创口的氧张力、保持体温、控制血糖、合理皮肤准备和掌握延迟性一期缝合的适应证等。     

肺炎支原体感染与婴幼儿哮喘

呼吸道感染是婴幼儿哮喘发病的重要因素,肺炎支原体 （mycoplasma pneumoniae,Mp） 与婴幼儿哮喘的关系是近年研究的热点之一。Mp作为社区获得性常见病原体之一在婴幼儿感染率有增高趋势。Mp感染导致婴幼儿哮喘初次和反复发作可能的机制为：Mp感染可直接损伤呼吸道上皮细胞、影响细胞及体液免疫、粘液分泌和呼吸道上皮内神经调节机制紊乱;反复发作与呼吸道对刺激因子呈现高反应性、呼吸道慢性炎症及婴幼儿特应性体质有关。大环内酯类药物具有抗炎和免疫调节作用,用于治疗Mp相关喘息性疾病时取得了一定疗效。     

Effect of information on reducing inappropriate expectations and requests for antibiotics

People often expect antibiotics when they are clinically inappropriate (e.g., for viral infections). This contributes significantly to physicians’ decisions to prescribe antibiotics when they are clinically inappropriate, causing harm to the individual and to society. In two pre-registered studies employing UK general population samples (n₁ = 402; n₂ = 190), we evaluated the relationship between knowledge and beliefs with antibiotic expectations, and the effects of information provision on such expectations. We conducted a correlational study (study 1), in which we examined the role of antibiotic knowledge and beliefs and an experiment (study 2) in which we assessed the causal effect of information provision on antibiotic expectations. In study 1, we found that both knowledge and beliefs about antibiotics predicted antibiotic expectations. In study 2, a 2 (viral information: present vs. absent) × 2 (antibiotic information: present vs. absent) experimental between-subjects design, information about antibiotic efficacy significantly reduced expectations for antibiotics, but viral aetiology information did not. Providing antibiotic information substantially diminishes inappropriate expectations of antibiotics. Health campaigns might also aim to change social attitudes and normative beliefs, since more complex sociocognitive processes underpin inappropriate expectations for antibiotics.     

Female facial appearance and health

The current study addressed whether rated femininity, attractiveness, and health in female faces are associated with numerous indices of self-reported health history (number of colds/stomach bugs/frequency of antibiotic use) in a sample of 105 females. It was predicted that all three rating variables would correlate negatively with bouts of illness (with the exception of rates of stomach infections), on the assumption that aspects of facial appearance signal mate quality. The results showed partial support for this prediction, in that there was a general trend for both facial femininity and attractiveness to correlate negatively with the reported number of colds in the preceding twelve months and with the frequency of antibiotic use in the last three years and the last twelve months. Rated facial femininity (as documented in September) was also associated with days of flu experienced in the period spanning the November-December months. However, rated health did not correlate with any of the health indices (albeit one marginal result with antibiotic use in the last twelve months). The results lend support to previous findings linking facial femininity to health and suggest that facial femininity may be linked to some aspects of disease resistance but not others.     

Assessment of the Construct Validity of the EQ-5D in Patients with Acute Cough/Lower Respiratory Tract Infections

Although EQ-5D has been used in the context of acute cough/lower respiratory tract infections (acute cough/LRTI), it has not been formally validated in this disease area. The primary aim of this study is to assess the construct validity of EQ-5D as a measure for economic evaluation in the context of acute cough/lower respiratory tract infections. Data were collected alongside an observational study of the management of patients with acute cough/LRTI in thirteen European countries. However, the analysis was limited to 349 patients from the UK. Hypotheses were specified a priori and tested in order to establish the construct validity of EQ-5D. Statistical methods used to test the a priori hypotheses included Wilcoxon signed rank sum test, Kruskal-Wallis test, Chi-square test and regression analysis. Most of the relationships that were tested were in line with the a priori hypotheses. The main results indicate that there was a negative relationship between symptom severity scores and EQ-5D, smoking was associated with worse EQ-5D scores and EQ-5D was able to discriminate between patients with headache, interference with normal activities and disturbed sleep. This study also showed that the EQ-5D is moderately responsive in patients with acute cough/LRTI, and is a suitable measure for use in economic evaluation studies of acute cough/LRTI     

Cerebrospinal fluid cytologic findings in children with borrelia infections (neuroborreliosis)

The infection of the central nervous system by Borrelia burgdorferi induces usually a mononuclear (lympho-mono-plasmocellular) cytogram of the cerebrospinal fluid in humans. The initial granulocytosis of the liquor cerebrospinalis typical for bacterial infections is transistory only. Such cytologic findings may be misleading to a diagnosis as virus infection. In case of clinical signs (Bannwarth syndrome), typical anamnesis or chronic lymphocytic meningitis the estimation of specific IgG/IgM borrelia antibodies is indicated and the antibiotic therapy should be performed.     

The PANDAS subgroup: recognition and treatment

A subgroup of patients with childhood-onset obsessive-compulsive disorder (OCD) has been identified who share a common clinical course characterized by dramatic symptom exacerbations following Group A beta-hemolytic streptococcal (GABHS) infections. The term PANDAS has been applied to the subgroup, to indicate the postulated etiology of their symptoms: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. Five clinical characteristics define the PANDAS subgroup: presence of OCD and/or tic disorder, prepubertal symptom onset, sudden onset or abrupt exacerbations (sawtooth course), association with neurological abnormalities (presence of adventitious movements or motoric hyperactivity during exacerbations), and temporal association between symptom exacerbations and GABHS infections. Post-streptococcal symptom exacerbations are typically quite dramatic, with patients reporting that their symptoms "...came on overnight" or "...appeared all of a sudden a few days after I had a sore throat." The post-streptococcal inflammatory nature of the neuropsychiatric symptoms provides novel opportunities for treatment and prevention, including immunomodulatory therapies such as therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG). A recently completed placebo-controlled trial revealed that both IVIG and TPE were effective in reducing neuropsychiatric symptom severity (40% to 55% reductions, respectively) for a group of severely ill children with OCD and/or tic disorders. Further research is required to determine why the treatments are helpful, as well as to ascertain whether or not antibiotic prophylaxis can help prevent post-streptococcal symptom exacerbations.     

Self-appraised problem-solving skills and the prediction of secondary complications among persons with spinal cord injuries

Secondary complications following spinal cord injury (SCI) include decubitus ulcers and recurrent urinary tract infections. These conditions can significantly impair quality of life and prove life-threatening; it is also believed that these conditions are mediated by behavioral pathways. According to the social problem-solving model, persons who report effective problem-solving skills should be capable of adhering to long-term therapeutic regimens of self-care necessary to prevent these complications. We tested this assumption in the present study. Discriminant function analyses revealed self-appraised skills in approaching and defining problems contributed to the prediction of secondary complications among 53 persons with SCI. Results are discussed in light of the social problem-solving model, and the utility of problem-solving interventions in rehabilitation is explored.     

Positive emotion and health: going beyond the negative.

This study examined the relationships between positive emotions and health. Two positive emotions were considered, hope and curiosity, in conjunction with 3 physician-diagnosed disease outcomes: hypertension, diabetes mellitus, and respiratory tract infections. Medical data were abstracted over a 2-year period from 1,041 patient records from a multispecialty medical practice, and emotions were assessed through a mailed questionnaire. Across 3 disease outcomes, higher levels of hope were associated with a decreased likelihood of having or developing a disease. Higher levels of curiosity were also associated with decreased likelihood of hypertension and diabetes mellitus. Results suggest that positive emotion may play a protective role in the development of disease.     

Academic stress, social support, and secretory immunoglobulin A

We examined the relation of academic stress and social support to salivary concentrations of secretory immunoglobulin A (S-IgA), an antibody class that plays an important role in mucosal defense against acute upper respiratory tract infections. We assayed whole, unstimulated saliva samples collected from 15 healthy undergraduates 5 days before their final exam period, during their exam period, and 14 days after their last final exam for S-IgA concentrations by single radial immunodiffusion. The students rated the university's general psychological climate as being more stressful during the exam period compared with the two other periods. Paralleling this, their salivary concentrations of S-IgA were lower during the exam period. Students who reported more adequate social support at the preexam period had consistently higher S-IgA levels than did their peers reporting less adequate social support. This latter finding is consonant with the social support direct effects hypothesis, which states that social support enhances health outcomes irrespective of whether the individual is exposed to stressful experiences.