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中华肾脏病杂志 1990年第1期6卷 42-43页

作者：洪丰颖福建厦门杏林医院内科

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Antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease: a cost effectiveness analysis

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ANNALS OF THE RHEUMATIC DISEASES 2001年第4期60卷 359-366页

作者： Krijnen, P Kaandorp, CJE Steyerberg, EW van Schaardenburg, D Moens, HJB Habbema, JDF Erasmus Univ Dept Publ Hlth Ctr Clin Decis Sci NL-3000 DR Rotterdam Netherlands Jan van Breemen Inst Rheumatol & Rehabil Amsterdam Netherlands Med Spectrum Twente Enschede Netherlands

Objective-To assess the cost effectiveness of antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease. Methods-In a decision analysis, data from a prospective study on bacterial arthritis in 4907 patients with joint disease were combined with literature data to assess risks and benefits of antibiotic prophylaxis. Effectiveness and cost effectiveness calculations were performed on antibiotic prophylaxis for various patient groups. Grouping was based on (a) type of event leading to transient bacteraemia-that is, infections (dermal, respiratory/urinary tract) and invasive medical procedures-and (b) the patient's susceptibility to bacterial arthritis which was increased in the presence of rheumatoid arthritis, large joint prostheses, comorbidity, and old age. Results-Of the patients with joint disease, 59% had no characteristics that increased susceptibility to bacterial arthritis, and 31% had one. For dermal infections, the effectiveness of antibiotic prophylaxis was maximally 35 quality adjusted life days (QALDs) and the cost effectiveness maximally $52 000 per quality adjusted life year (QALY). For other infections, the effectiveness of prophylaxis was lower and the cost effectiveness higher. Prophylaxis for invasive medical procedures seemed to be acceptable only in patients with high susceptibility: 1 QALD at a cost of $1300/QALY;however, the results were influenced substantially when the level of efficacy of the prophylaxis or cost of prophylactic antibiotics was changed. Conclusion-Prophylaxis seems to be indicated only for dermal infections, and for infections of the urinary and respiratory tract in patients with increased susceptibility to bacterial arthritis. Prophylaxis for invasive medical procedures, such as dental treatment, may only be indicated for patients with joint disease who ape highly susceptible.

关键词：年龄因素阿莫西林棒酸钾合剂/经济学阿莫西林棒酸钾合剂/治疗应用抗生素预防/经济学关节炎感染性/药物疗法关节炎感染性/经济学关节炎感染性/病因学关节炎类风湿/并发症置信区间费用效益分析决策支持技术药物疗法联合/经济学药物疗法联合/治疗应用 Logistic模型假体和植入物质量校正寿命 ROC曲线呼吸道感染/药物疗法危险因素皮肤疾病细菌性/药物疗法外科手术泌尿道感染/药物疗法成年人老年人女(雌)性人类男(雄)性中年人

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RIFAMPICIN PLUS NALIDIXIC-ACID - RATIONAL COMBINATION FOR TREATMENT OF URINARY-INFECTION

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 1978年第6期4卷 533-538页

作者： GREENWOOD, D ANDREW, J Department of Microbiology and Public Health Laboratory University Hospital Queen's Medical Centre Nottingham NG7 2UH England

The combination of rifampicin and nalidixic acid was tested in vitro against a variety of gram-negative bacilli. Exposure of bacterial cultures to either of these agents alone readily evoked the emergence of resistant bacteria, but when they were used in combination such resistance was mutually suppressed. When tested in conditions simulating those of the exposure of bacteria to drug in the treatment of bacterial cystitis [in humans], low concentrations of the combination (10 .mu.g rifampicin plus 2 .mu.g nalidixic acid per ml) suppressed bacterial growth for the whole of the 40 h period of observation, whereas growth occurred within 24 h of first exposure to much higher concentrations (50 .mu.g/ml) of the individual components of the mixture.

关键词：抗药性微生物药物协同作用药物疗法联合大肠杆菌/药物作用肺炎克雷伯菌/药物作用萘啶酸/投药和剂量萘啶酸/药理学萘啶酸/治疗应用散射测浊法和比浊法奇异变形杆菌/药物作用铜绿假单胞菌/药物作用利福平/投药和剂量利福平/药理学利福平/治疗应用膀胱/微生物学泌尿道感染/药物疗法

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A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 1999年第Sup1期43卷 67-75页

作者： Iravani, A Klimberg, I Briefer, C Munera, C Kowalsky, SF Echols, RM Cent Florida Med Res Ctr Orlando FL USA Urol Ctr Florida Ocala FL USA Univ Michigan Hlth Serv Ann Arbor MI 48109 USA Synergex Inc Greenwich CT USA Bayer Corp Div Pharmaceut West Haven CT USA

The study was undertaken to compare the safety and efficacy of twice-daily ciprofloxacin for 3 days with standard 7 day therapy with either co-trimoxazole or nitrofurantoin in the treatment of women with acute, uncomplicated urinary tract infections (UTI). This multicentre, prospective, randomized, double-blind trial compared oral ciprofloxacin (100 mg bd) for 3 days with co-trimoxazole (160/800 mg bd) or nitrofurantoin (100 mg bd) for 7 days. Bacteriological and clinical evaluations were performed at study entry, during therapy and 4-10 days and 4-6 weeks after the completion of therapy. The primary efficacy parameter was eradication of the causative organism 4-10 days following treatment. Of 713 women enrolled and evaluable for safety, 521 were evaluable for efficacy (168 ciprofloxacin, 174 co-trimoxazole, 179 nitrofurantoin). Escherichia coli (83%) was the most frequently isolated pathogen in all treatment groups. Bacteriological eradication was reported in 88% of ciprofloxacin patients, 93% of co-trimoxazole patients and 86% of nitrofurantoin patients. At the 4-6 week follow-up, ciprofloxacin had statistically significantly higher eradication rates (91%) than co-trimoxazole (79%;95% confidence limit (CL) = -20.6%, 3.9%) and nitrofurantoin (82%;95% CL = -17.1%, -0.9%). Clinical resolution 4-10 days after therapy and at the 4-6 week follow-up was similar among the three treatment groups. The overall incidence of treatment-emergent adverse events was not significantly different (P = 0.093) among the three drug regimens, although co-trimoxazole was associated with a greater number of adverse events than ciprofloxacin (P less than or equal to 0.05). Ciprofloxacin also caused fewer episodes of nausea than either of the other agents (P less than or equal to 0.01).

关键词：急性病抗感染药/治疗应用抗感染药泌尿系/治疗应用环丙沙星/治疗应用膀胱炎/药物疗法膀胱炎/微生物学剂量效应关系药物双盲法大肠杆菌感染/药物疗法呋喃妥因/治疗应用前瞻性研究葡萄球菌感染/药物疗法链球菌感染/药物疗法甲氧苄啶磺胺甲异恶唑合剂/治疗应用泌尿道感染/药物疗法泌尿道感染/微生物学青少年成年人老年人老年人 80以上女(雌)性人类中年人

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Comparison of test characteristics of urine dipstick and urinalysis at various test cutoff points

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ANNALS OF EMERGENCY MEDICINE 2001年第5期38卷 505-512页

作者： Lammers, RL Gibson, S Kovacs, D Sears, W Strachan, G Michigan State Univ Kalamazoo Ctr Med Studies Dept Emergency Med Kalamazoo MI 49008 USA

Study objective: We compare the test characteristics of urine dipstick and urinalysis at various test Cutoff points in women presenting to emergency departments and an intermediate care center with symptoms of urinary tract infection. Methods: This was a prospective, observational study of adult women presenting to 1 of 2 community hospital EDs or an intermediate care center with dysuria, urgency, or urinary frequency on history, or suprapubic or costovertebral angle tenderness on examination. Patients who had taken antibiotics in the past 72 hours, had indwelling Foley catheters, symptomatic vaginal discharge, diabetes mellitus, immunodeficiency disorders, or were unable to provide a reliable history were excluded. The patient's clean-catch or catheterized urine specimen was tested immediately by a nurse using a Multistix 9 SG reagent strip. A second aliquot was sent within 1 hour of collection to the hospital laboratory, where a semiautomated microscopic urinalysis and a urine culture were performed. A positive urine culture was defined as more than 100,000 colonies of 1 or 2 uropathogenic bacteria per mL of urine at 48 hours. Dipstick and urinalysis data were compared with urine culture results. Sensitivity, specificity, and predictive values were calculated at various definitions of a positive test, or "test cutoff points," for combinations of leukocyte esterase nitrite and blood on dipstick and,, for RBCs and WBCs on urinalyses. The probability of an erroneous decision to withhold treatment on the basis of a negative test result was defined as "undertreatment," or 1 minus the negative predictive value. "Overtreatment" was defined as 1 minus the positive predictive value. Results: Three hundred forty-three patients were enrolled in this study. Twelve patients were withdrawn because of missing laboratory results. Forty-six percent (152/331) of patients had positive urine cultures. If urine dipstick results are defined as positive when leukocyte esterase or nitrit

关键词：抗感染药泌尿系/治疗应用羧酸酯水解酶类/尿红细胞计数血尿/诊断血尿/尿白细胞计数亚硝酸盐类/尿前瞻性研究敏感性与特异性尿分析/方法泌尿道感染/诊断泌尿道感染/药物疗法泌尿道感染/尿尿/化学青少年成年人老年人老年人 80以上女(雌)性人类中年人

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A comparative trial of imipenem versus ceftazidime in the release of endotoxin and cytokine generation in patients with Gram-negative urosepsis

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JOURNAL OF ENDOTOXIN RESEARCH 2000年第1期6卷 25-31页

作者： Luchi, M Morrison, DC Opal, S Yoneda, K Slotman, G Chambers, H Wiesenfeld, H Lemke, J Ryan, JL Horn, D Univ Kansas Med Ctr Dept Med 6080F Div Infect Dis Kansas City KS 66160 USA St Lukes Hosp Off Res Adm Kansas City MO 64111 USA Brown Univ Mem Hosp Sch Med Pawtucket RI 02860 USA Calif State Univ Sacramento Davis Med Ctr Sacramento CA 95819 USA Rutgers State Univ Med Ctr Cooper Hosp Dept Surg Camden NJ 08102 USA San Francisco Gen Hosp San Francisco CA 94110 USA Magee Womens Hosp Dept OB GYN RS Pittsburgh PA USA Univ Iowa Coll Med Dept Prevent Med & Environm Hlth Iowa City IA 52242 USA Genet Inst Inc Cambridge MA 02140 USA Bristol Myers Squibb Co Plainsboro NJ USA

Evidence from in vitro experiments and animal and human studies indicate that antibiotic therapy may induce the release of endotoxin from the outer membrane of Gram-negative bacteria. Antibiotics that bind preferentially to penicillin-binding protein-2 (PBP-2) -such as imipenem - are associated with little release of endotoxin, while antibiotics that preferentially bind to PBP-3 - such as ceftazidime - are associated with far greater release of endotoxin. We conducted a randomized, multicenter, double-blind study comparing imipenem to ceftazidime in patients with urinary tract infections caused by Gram-negative bacilli associated with signs and symptoms of systemic inflammation. A total of 33 patients were randomized to receive either imipenem (n = 14) or ceftazidime (n = 19) for initial treatment for urosepsis. No differences in plasma endotoxin, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) or urine endotoxin, IL-6 or IL-8 levels were found between the two treatment groups within the first 8 h after antibiotic administration. We conclude that, if differences exist with respect to endotoxin release by these two antimicrobial agents, these differences an not readily demonstrable in this clinical study with carefully defined patients with Gram-negative urinary tract infections.

关键词：抗菌药/治疗应用头孢他啶/治疗应用细胞因子类/代谢双盲法内毒素类/代谢革兰氏阴性菌感染/药物疗法亚胺培南/治疗应用脓毒症/药物疗法脓毒症/微生物学泌尿道感染/药物疗法泌尿道感染/微生物学成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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PHARMACOKINETICS AND CLINICAL USE OF CEPHALOSPORIN ANTIBIOTICS

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JOURNAL OF PHARMACEUTICAL SCIENCES 1975年第12期64卷 1899-1927页

作者： NIGHTINGALE, CH GREENE, DS QUINTILIANI, R UNIV CONNECTICUT SCH PHARM STORRS CT 06268 USA HARTFORD HOSP DEPT MED HARTFORD CT USA

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Urinary tract infections during pregnancy and mental retardation and developmental delay

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OBSTETRICS AND GYNECOLOGY 2000年第1期96卷 113-119页

作者： McDermott, S Callaghan, W Szwejbka, L Mann, H Daguise, V Univ S Carolina Sch Med Family Practice Ctr Dept Family & Prevent Med Columbia SC 29203 USA S Carolina Budget & Control Board Off Res & Stat Columbia SC USA

Objective: To investigate the association between urinary tract infections during pregnancy and mental retardation or developmental delay in infants. Methods: An inception cohort design was used to analyze Medicaid maternal and infant-linked records and vital records for 41,090 pregnancies from 1995-1998. Results: The relative risk (RR) for mental retardation or developmental delay among infants of mothers with diagnosed urinary tract infections but no antibiotic claims was 1.31 with a 95% confidence interval (CI) of 1.12, 1.54 compared with the group without urinary tract infections. The RR for infants of mothers with urinary tract infections without antibiotic claims was 1.22 (95% CI 1.02, 1.46) compared with infants of mothers with urinary tract infections and antibiotic claims. The RR was significant in the first trimester (1.46, 95% CI 1.07, 1.99) and third trimester (1.41, 95% CI 1.11, 1.79) after controlling for race and gestational age at birth. Conclusion: There was a statistically significant association between maternal urinary tract infections without evidence of antibiotics and mental retardation or developmental delay in infants. The relationship persisted when we assumed that over 30% of women who had antibiotic claims filled but did not take the medicine, and 40% of the women who did not have antibiotic claims did take the medication. (Obstet Gynecol 2000;96:113-9. (C) 2000 by The American College of Obstetricians and Gynecologists.).

关键词：抗菌药/治疗应用发育障碍智力障碍妊娠并发症感染性/药物疗法回顾性研究南卡罗来纳患者拒绝治疗泌尿道感染/药物疗法青少年成年人女(雌)性人类妊娠

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Epidemiology of bacteriuria caused by vancomycin-resistant enterococci - a retrospective study

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第4期28卷 277-281页

作者： Wong, AHM Wenzel, RP Edmond, MB Virginia Commonwealth Univ Dept Internal Med Div Qual Hlth Care Richmond VA USA

Background: The epidemiology of vancomycin-resistant enterococcal (VRE) bacteriuria has not been previously described. Our objectives are to describe the frequency of VRE bacteriuria, to use strict definitions to distinguish symptomatic urinary tract infection (UTI) versus urine colonization without pyuria versus asymptomatic bacteriuria with pyuria, and to describe the outcomes of each group. Methods: We used a retrospective analysis of patients with VRE bacteriuria in an academic medical center. Results: During the 18-month study period, 98 of the 107 patients (92%) with urine cultures positive for VRE (23/10,000 admissions), had charts that were available for review. In 94 of 98 patients, the organism was Enterococcus faecium, and in only 4 was Enterococcus faecalis recovered. Thirty-seven patients were colonized with VRE;21 patients had asymptomatic bacteriuria, and the status of 27 patients was not ascertainable. Thirteen patients had VRE UTIs with two associated bacteremias and one death. Patients with UTI versus patients without UTI were more likely to have an underlying malignancy (39% vs 9%, P = .014). Conclusion: The majority of urine cultures yielding VRE do not represent true infection, rather colonization or asymptomatic bacteriuria.

关键词：抗感染药泌尿系/治疗应用菌血症/微生物学细菌尿/并发症细菌尿/诊断细菌尿/药物疗法细菌尿/流行病学细菌尿/微生物学诊断鉴别肠球菌属/药物作用肠球菌属/分离和提纯肠球菌粪/分离和提纯肠球菌屎/分离和提纯医院教学回顾性研究治疗结果泌尿道感染/并发症泌尿道感染/诊断泌尿道感染/药物疗法泌尿道感染/流行病学泌尿道感染/微生物学万古霉素抗药性弗吉尼亚/流行病学青少年成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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GENITOURINARY CANDIDIASIS - DIAGNOSIS AND TREATMENT

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JOURNAL OF UROLOGY 1976年第6期116卷 778-780页

作者： WISE, GJ GOLDBERG, P KOZINN, PJ MAIMONIDES MED CTR DIV UROL BROOKLYN NY 11219 USA

Candida in the urine or surgical wound is a potentially lethal pathogen. Management of 82 patients provided a rationale for the treatment of these infections. Urine colony counts, serologic findings and clinical observations determine therapy. Amphotericin B irrigants are effective for local infections. Disseminated infections require flucytosine and/or i.v. amphotericin B.

关键词：两性霉素B/治疗应用念珠菌属/分离和提纯念珠菌病/诊断念珠菌病/药物疗法念珠菌病/免疫学氟胞嘧啶/治疗应用制霉菌素/治疗应用输尿管/放射摄影术输尿管梗阻/放射摄影术泌尿道感染/诊断泌尿道感染/药物疗法泌尿道感染/放射摄影术尿/微生物学人类

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