Quantitative quality assurance in a community hospital pediatric intensive care unit.

Unbiased, objective evaluations of quality of care are preferred over subjective evaluations. We observed 681 admissions to a pediatric intensive care unit of a community hospital from 1989 through 1990 for outcomes and physiologic profiles of the patients on the admission day using the Pediatric Risk of Mortality score to assess severity of illness. Mortality adjusted for severity of illness was compared with that predicted from a pediatric intensive care unit of a tertiary medical center: 32.6 deaths were predicted based on the physiologic profiles, and 23 occurred. The number of outcomes and their distribution according to mortality risk indicated close agreement between observed and predicted results. Thus, a quality-assurance technique developed in tertiary care centers can be used to indicate a comparable level of care in a community hospital.     

Experience with rotation of basic antibiotics in intensive care unit of cardiosurgical hospital]

Clinical and microbiological efficacies of antibiotic rotation in the intensive care unit of the Hospital were evaluated. The results of the local microbiological monitoring of the profile of the acquired resistance of gramnegative nosocomial pathogens (n = 151) isolated from adult patients with artificial ventilation of the lungs for more than 3 days after the open heart operations (n = 150) were analysed. Three 6-month cycles of cephalosporins rotation in the following order were performed: cefoperazone--ceftazidime--cefepime. The procedure provided a significant decrease in the frequency of infectious complications (7.2 vs. 4.5%, p=0.015). The rotation did not require any increase of the use of reserve antibiotics such as vancomycin and carbapenems. The use of the drugs active against Pseudomonas aeruginosa promoted its eradication in the structure of the nosocomial pathogens in the intensive care unit.     

Psychiatric aspects of a pediatric intensive care unit

Although there is a growing body of literature about the medical problems which arise in a pediatric intensive care unit (PICU), rather little has been written about psychiatric issues characteristic of the critical care setting for children. This article will describe the PICU as a community made up of several sub-groups, the various psychosocial stresses, the reactions to stresses, and the interventions appropriate for the PICU and each of its sub-groups.     

Nosocomial infections in the pediatric intensive care unit

Nosocomial (hospital-acquired) infections are a major complication of serious illnesses. Severely ill patients have a greater risk of acquiring nosocomial infections, so this problem is greatest in intensive care units. Studies have demonstrated that nosocomial infections are largely preventable. Adherence to recommended techniques for patient care will have the greatest benefit in the intensive care unit. In this paper the background epidemiology of nosocomial infections is reviewed and related to pediatrics and intensive care units. Types of diseases, assistance equipment, and monitoring devices which are associated with a high risk of nosocomial infections are emphasized and specific steps for lowering this risk are listed.     

Comparative study on factors influencing the codon and amino acid usage in Lactobacillus sakei 23K and 13 other lactobacilli

In this study, major factors shaping codon and amino acid usage variation Lactobacillus sakei 23K were investigated. It included 13 other Lactobacillus species for a comparative analysis. The correspondence analysis (COA) showed that in 13 species the major trend of synonymous codon usage was highly correlated with gene expression level as assessed by the “Codon Adaptation Index” (CAI) values. In addition, Nc (effective number of codons) plot, SCUO (synonymous codon usage order) plot and correlation analyses showed that the base composition and mutational bias have dominant role in the codon usage variation. However, the translational selection for genes at higher expression level, where more frequent synonymous codons correspond to more abundant cognate transfer RNAs (tRNAs), was not found to be similar in all species. The study also showed that the amino acid usage in these species was significantly (P < 0.01) influenced by hydrophobicity and aromaticity of proteins. Furthermore, 24 codons that were found to be optimally used by L. sakei and its comparative study with 13 Lactobacillus species might provide some useful information in their further study of molecular evolution and genetic engineering.     

Radiologic assessment in the pediatric intensive care unit.

The severely ill infant or child who requires admission to a pediatric intensive care unit (PICU) often presents with a complex set of problems necessitating multiple and frequent management decisions. Diagnostic imaging plays an important role, not only in the initial assessment of the patient''s condition and establishing a diagnosis, but also in monitoring the patient''s progress and the effects of interventional therapeutic measures. Bedside studies obtained using portable equipment are often limited but can provide much useful information when a careful and detailed approach is utilized in producing the radiograph and interpreting the examination. This article reviews some of the basic principles of radiographic interpretation and details some of the diagnostic points which, when promptly recognized, can lead to a better understanding of the patient''s condition and thus to improved patient care and management. While chest radiography is stressed, studies of other regions including the upper airway, abdomen, skull, and extremities are discussed. A brief consideration of the expanding role of new modality imaging (i.e., ultrasound, CT) is also included. Multiple illustrative examples of common and uncommon problems are shown.     

Evaluation of bacteremia in a pediatric intensive care unit: epidemiology, microbiology, sources sites and risk factors

Bacteremia is a common cause of morbidity and mortality in children treated in pediatric intensive care unit (PICU). We have investigated the causative agents of bacteremia in our PICU over a one-year period, to determine mortality associated with such infection and identify the dependent predictors for morbidity and mortality. From 1 January till 31 December 2006, 479 patients were admitted in the PICU and 379 blood culture samples were taken. Samples were incubated in the BACTEC 9050 System, and isolates identified by routine microbiological methods. A pair of samples taken for aerobic and anaerobic culture were statistically regarded as one sample. Data collected from the medical records of each patient were recorded onto standardized collections sheets and included demographic information, predisposing conditions, source(s) of infection, important clinical and laboratory parameters at the time of infection, and microbiological data. Based on these data, positive blood cultures were classified as either contaminants or true bacteremias. During a year period, 117 episodes of bacteremia were documented in 72 patients. The most frequent isolates were the coagulase-negative staphylococci 32.2% (39), followed by Candida spp. 30.5% (36). The mean white blood cell count (WBC) on the day of bacteremia was 15.2 x 10(9)/L (range 0.1-48.0 x 10(9)/L), and 3.3% of episodes occurred in neutropenic (WBC count < 1 x 10(9)/L) children. The mean temperature on the day of infection was 38.2 +/- 1.1 degrees C (range, 34-41 degrees C). Some newborns 23% (n = 5) had a significantly lower mean temperature (p < 0.02) and lower mean WBC count (p < 0.05) than older children. Hemodynamic instability was noted in 11% of bacteremic episodes. Among all bacteremias, intravascular catheters were implicated in 22.6%, pneumonia in 20.4%, genitourinary tract in 14.2%, surgical wounds in 11.7% and, gastrointestinal tract in 9.8%. Seven patients died because of sepsis. Early diagnosis, prompt blood culture reports, followed by appropriate antibiotic treatment is essential in reducing mortality in such patients. Short hospital stay and restricted use of invasive devices should be the aims to reduce the risk of bacteremia during the stay in the PICU.     

Environmental and other factors influencing fertility in Sri Lanka

The study utilizes the complete tabulations from the 1971 census and data from the Registrar General's and Meteorological departments for the same year. It applies a multiple regression analysis of the total fertility rate for each district for 1971 on a series of environmental variables. These include the proportion of the rural population by district to the all-island rural population; the district mean annual rainfall and the proportion of the district population employed in the major rural occupations to the total employed. To these 3 environmental variables were added 2 socioeconomic variables: the proportion of the population aged 10+ years and who are literate, and infant mortality. Results indicate that the 5 independent variables are clearly intercorrelated. The multiple regression analysis shows that the 5 variables together account for 76.4% of the total variation in district total fertility rate. It is argued that this and other studies undertaken previously provide useful pointers to the type of variable to be considered in any policy aimed at population control and indicate where major efforts should be directed.     

The comparative activity of cefepime and other current antibiotics against microorganisms isolated from patients in pediatric intensive therapy units]

Comparative activity of cefepime, ceftazidime, ceftriaxone, ciprofloxacin, imipenem and piperacillin/tazobactam against isolates from patients of pediatric intensive care units within October-December 1998 was studied. The isolates were identified with the Walkaway-40 System. The antibiotic susceptibility was evaluated by the E-test on the Mueller-Hinton II agar. The data were interpreted in accordance with the NCCLS. The number of the isolates totaled 100. Among them not more than 10 to 12 strains belonged to the same species. 92 per cent of the isolates was susceptible to cefepime and 70 to 75 per cent of the isolates were susceptible to the third generation cephalosporins. Piperacillin/tazobactam proved to be highly susceptible, the number of the isolates resistant and moderately resistant to it being 6 and 1 per cent respectively. The results showed that cefepime was intermediate between the third generation cephalosporins and carbapenems.     

Utilisation of dental services in a university hospital palliative and long-term care unit in Geneva

Objectives: Dental care plays an important role in the multidisciplinary approach, which is used in palliative and long‐term care to address the complex needs of terminally ill patients. The aim of this study was to assess the utilisation of dental services in a University Hospital Palliative and Long‐term Care Unit. Material and method: Over an observation period of 13 months, structured questionnaires were filled in after each dental appointment. The survey covered three main topics: the initiation and incentive from the dental consultation, particular difficulties because of the patient’s health or the hospital’s organisation as well as the accomplished treatment. Results: Two hundred and seventy‐five questionnaires from a total of 102 patients were available for analysis. The patients’ median age was 83 years (SD 10.3, range 49–101 years), 63 were female, 39 male. A majority of first appointments were initiated by a physician (n = 49 of 102), mainly because of pain (n = 62 of 275). 10.5% of the appointments were cancelled on the same day. Only one‐fifth of the patients were able to reach the practice on foot. Six used a walking stick and 54 relied on a wheelchair. Eighteen patients needed to be seen in their bed. The most frequently performed procedures were extractions and removal of denture sore spots (n = 67 of 275) followed by the manufacturing of new dentures (n = 38 of 275). In more than 17% of the appointments, no particular treatment was performed. Conclusion: The utilisation of dental services in terminally ill and severely compromised elderly patients shown justifies a dental service in a palliative care or geriatric hospital setting. The particular dental work profile requires a practitioner with empathy and professional experience.     

Respiratory viruses in the pediatric intensive care unit: prevalence and clinical aspects

A survey was conducted in two pediatric intensive care units in hospitals in Porto Alegre, Brazil, in order to monitor the main respiratory viruses present in bronchiolitis and/or pneumonia and their involvement in the severity of viral respiratory infections. Viral respiratory infection prevalence was 38.7%. In bronchiolitis, respiratory syncytial virus (RSV) was detected in 36% of the cases. In pneumonia, the prevalence rates were similar for adenovirus (10.3%) and RSV (7.7%). There was a difference among the viruses detected in terms of frequency of clinical findings indicating greater severity. Frequency of crackles in patients with RSV (47.3%) showed a borderline significance (p = 0.055, Fisher's exact test) as compared to those with adenovirus (87.5%). The overall case fatality rate in this study was 2.7%, and adenovirus showed a significantly higher case fatality rate (25%) than RSV (2.8%) (p = 0.005). Injected antibiotics were used in 49% of the children with RSV and 60% of those with adenovirus. Adenovirus was not detected in any of the 33 children submitted to oxygen therapy.     

上海市某医院艾滋病合并梅毒病例特征分析及影响因素探讨

为了解近年来上海市艾滋病合并梅毒患者的特征及变化趋势,探讨艾滋病患者合并梅毒的影响因素,本研究收集了2013—2019年上海市(复旦大学附属)公共卫生临床中心(简称临床中心)诊断为艾滋病合并梅毒的病例作为研究对象。经详细查询研究对象的住院登记资料和病史,本文整理出用于研究的资料,并将研究对象分为艾滋病合并梅毒组和艾滋病不合并梅毒组。结果显示,临床中心艾滋病患者中有10.55%合并梅毒;2013—2019年临床中心艾滋病合并梅毒感染率总体呈上升趋势(χ2＝17.640,P<0.05),每年7—8月份为收治高峰期。患者主要来源于本地居民(占55.49%),男女性别比为14∶1,平均年龄为38±12岁。通过Logistic回归分析发现,影响艾滋病合并梅毒的因素有性别、年龄、病例来源和CD4^＋T细胞计数,其中本地来源、年龄在21～40岁、男性和CD4^＋T细胞计数≤500 /μL是艾滋病患者合并梅毒感染的高危因素。研究提示,上海市艾滋病合并梅毒感染病例数呈上升趋势,重点防控人群是上海市青壮年男性居民,应提高对此类人群的主动监测能力,加大筛查力度,做好健康教育;重点防控时间是每年7、8月份,应精准防控以期取得明显效果。本研究为上海市此类疾病防控提供了一定的科学依据。     

ICU患者艰难梭菌分离培养与流行病学特征研究

目的 了解ICU患者艰难梭菌的定植和感染情况,为预防艰难梭菌的流行提供参考。方法 收集2016年9月至2017年6月福建医科大学附属第一医院ICU中139例住院时间＞7 d的患者的粪便样本,对其进行选择性厌氧培养和质谱鉴定。对艰难梭菌培养阳性标本进行毒素基因（tcdA、tcdB、cdtA、cdtB）的PCR检测以及毒素A、B表型检测。收集所有患者的临床资料,并对艰难梭菌培养阳性患者的临床特征和实验室检查结果进行单因素分析和多因素回归分析。结果 艰难梭菌检出率为17.27%（24/139）。其中,14株艰难梭菌的tcdA和tcdB基因检测阳性,占58.3%（14/24）;10株为tcdA和tcdB基因检测阴性,占41.7%（10/24）。所有菌株二元毒素基因（ctdA/ctdB）均未检出。单因素分析提示,高龄、长时间住院、高淋巴细胞数、使用β-内酰胺类抗生素是艰难梭菌定植的高危因素;多因素回归分析提示,使用β-内酰胺类抗生素是艰难梭菌定植的独立危险因素（OR=3.881,P=0.039）。结论 我院ICU可能存在艰难梭菌感染和传播的风险,对具有高龄、长期住院以及使用抗生素等高危因素的患者应进行艰难梭菌的监测,以防艰难梭菌的传播、感染和艰难梭菌相关性腹泻的发生。     

革兰阴性菌在儿科重症监护病房的分布及耐药性分析

目的分析儿科重症监护病房(PICU)常见革兰阴性(G~-)菌的分布特点及其对常用抗菌药物的耐药性情况,为合理使用抗生素提供参考。方法回顾性分析重庆医科大学附属儿童医院重症医学科2013年1月至2015年2月临床分离的213株G~-菌进行耐药性分析。结果经培养共分离出的213株G~-菌,以呼吸道来源为主,占64.8%。常见G~-菌为铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌、阴沟肠杆菌、嗜麦芽黄单胞菌。药敏结果显示细菌耐药性明显增强,阴沟肠杆菌、大肠埃希菌、肺炎克雷伯菌肺炎亚种对美洛培南、亚胺培南敏感率为100.0%,对环丙沙星、左旋氧氟沙星、阿米卡星敏感性在70.3%以上;超广谱β-内酰胺酶(ESBLs)菌株检出率在76.7%以上。铜绿假单胞菌仅对环丙沙星、左旋氧氟沙星、庆大霉素、阿米卡星、多粘菌素敏高度感度,敏感度在87.0%以上。鲍曼不动杆菌对美洛培南、亚胺培南、环丙沙星、左旋氧氟沙星、庆大霉素、阿米卡星、头孢吡肟、头孢他啶相对敏感,敏感度在53.3%~73.3%;ESBLs检出率为76.7%。嗜麦芽黄单胞菌仅对左旋氧氟沙星、环丙沙星、复方新诺明相对敏感,敏感度在53.3%~73.3%,对美洛培南、亚胺培南100.0%耐药。结论 G~-菌耐药日趋严重,多为多重耐药。为避免耐药率上升,临床应合理使用抗生素。     

自然曝气生物滤床对二级污水处理厂尾水中抗生素的去除效果及影响因素研究

采用自然曝气生物滤床工艺处理污水处理厂尾水中抗生素,对生物滤床中抗生素的去除特点和影响因素进行研究。研究结果发现,自然曝气生物滤床能够有效地去除四环素类抗生素(58±2)%、喹诺酮类抗生素(48±20)%和大环内酯类抗生素(18±11)%。微生物降解和物理吸附是生物滤床去除抗生素的主要途径,而这两种途径的协同作用则延长了生物滤床的运行周期。结果还表明,水力负荷对抗生素的去除效率影响较大,当水力负荷为4.8～6.4m/d时,生物滤床对抗生素有较好的处理效果。此外,水质参数(水温、pH、COD浓度和硝化作用等)在一定程度上也可以影响生物滤床对抗生素的处理效果。