Objective:To evaluate the effectiveness of antimicrobial stewardship based on self-developed antibiotic clinical decision support system (aCDSS) in the inpatients at a tertiary hospital for consecutive 6 years, and to provide reference for rational use and antimicrobial stewardship.Methods:aCDSS was self-designed based on information technology and applied in clinical use in our hospital from 2015. Data of inpatient information and antibacterial use from January 2015 to December 2020 were collected from HIS and aCDSS. A retrospective study was conducted in all inpatients on the utilization rate and antibiotic use density.Results:Since 2015, with the comprehensive implementation of antimicrobial stewardship based on the aCDSS,there was a significant decline on the annual rate of antibiotic usage from 44.18% in 2015 to 38.70% in 2020, as well as on the usage rate of extended-spectrum antimicrobial agents including carbapenems, broad-spectrum β-lactam/β-lactamase inhibitors, tigecycline, broad-spectrum cephalosporins, fluoroquinolones, as well as glycopeptide and antifungal drugs. Compared with 2015, the usage of carbapenems, tigecycline and broad-spectrum β-lactam/β-lactamase inhibitors was declined nearly 50% in 2020, and the density of carbapenems and tigecycline were decreased by 29.6% and 7.1%, respectively in 2020. On the other side, the utilization rate and use density of narrow-spectrum cephalosporins continued to increase by year, the use density of narrow-spectrum cephalosporins accounting for 28.2% of all antibiotics in 2020.Conclusions:With the comprehensive implementation of aCDSS, the utilization rate and density of broad-spectrum and high-priced antibacterial drugs in our hospital have decreased continuously to decline in the past 6 years, while the proportion of narrow-spectrum antimicrobials has increased year by year, indicating that the structure of antimicrobial use has been continuously optimized and that antimicrobial stewardship based on the information technology have achieved remarkable results.

Objective:To evaluate the effectiveness of the information management system on the clinical application of special-grade antimicrobial.Methods:Using the established knowledge database, a computer program was designed and developed, which was embedded in the electronic medical record to intervene the clinical use of the special-grade antimicrobial since 2015. The basic information of all discharged patients from the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2013 to December 2020 were extracted from the HIS system, including the medical orders for antibiotics and the drug storehouse dispensing data.The trend analysis was carried out on the changes of the use rates and antibiotic use density (AUD) of the special-grade antimicrobials in the whole hospital and intensive care units (ICU). The data were processed and analyzed using SPSS 24.0.Results:From 2013 to 2015, except for meropenem and amphotericin B, the usage rate of all special-grade antimicrobials in the whole hospital showed an upward trend ( P<0.05). The proportion of special-grade antimicrobials used in the hospital increased year by year ( χ2=7 804.081, P<0.01). The total usage rate of special-grade antimicrobials in ICU showed an upward trend year by year ( χ2=67.028, P<0.01). Since the implementation of the special-grade antimicrobial information management system in 2015, the total use rate of special-grade antimicrobials in the hospital, the use rate of various antibiotics except linezolid, amphotericin B and posaconazole, and the proportion of special-grade antimicrobials used in the hospital have all shown a downward trend year by year ( P<0.01). The total usage rate and total AUD of special-grade antimicrobials in ICU showed a decreasing trend year by year ( χ2=343.514, P<0.01, β=-0.963, P=0.002). Conclusion:The information management system for special-grade antimicrobial can effectively reduce the utilization rate and AUD of most special-grade antibiotics in hospitalized patients including ICU, and has a good clinical application value in antimicrobial stewardship.

Objective:To explore the changes and clinical significance of inflammatory indices of urogenic sepsis with different severity.Methods:A retrospective case-control study was used to analyze the clinical data of 71 patients with urogenic sepsis admitted to 940th Hospital of PLA Joint Logistics Support Force from January 2010 to April 2018, including 34 males and 37 females, aged 39-96 years [(63.1±18.3)years]. The patients were divided into three groups according to the clinical diagnostic criteria for septic shock and sepsis according to the 2014 edition of the Chinese Urology Surgical Guidelines for Diagnosis and Treatment: 21 cases in sepsis group [sequential organ failure assessment (SOFA) score of 3.0 (2.0, 3.0)points], 21 cases in severe sepsis group [SOFA score of 9.0 (6.0, 11.0)points], and 29 cases in septic shock group [SOFA score of 15.0 (14.0, 16.0)points]. Spearman correlation analysis was used to analyze the correlation of inflammatory indicators with SOFA, including white blood cell count, percentage of neutrophils, C-reactive protein, interleukin-6, procalcitonin, fibrinogen, D-dimer, and platelet. Multiple linear regression analysis and stepwise regression weighted analysis were performed to analyze the relation between inflammatory indicators and sepsis severity. Levels of each inflammatory indicator was detected and compared among the groups.Results:① Spearman correlation analysis: percentage of neutrophils, D-dimer, interleukin-6, procalcitonin and SOFA scores were significantly positively correlated, with the r s value of 0.738, 0.712, 0.31, 0.795, respectively ( P<0.01); platelet and SOFA scores were significantly negatively correlated, with the r s value of -0.661 ( P<0.01). ② Multiple linear regression analysis: percentage of neutrophils, platelet, D-dimer, procalcitonin and SOFA score were significantly correlated ( P<0.01); Stepwise regression weighted analysis suggested that the model linear relationship and fit was good. ③ Inflammatory index comparison: percentage of neutrophils in sepsis group, severe sepsis group and septic shock group was 82.30 (76.25, 88.45), 90.50 (86.55, 93.85), 95.10 (92.05, 97.95), respectively; level of platelet was 183.01 (144.50, 246.50)×10 9/L, 149.11 (81.04, 207.00)×10 9/L, 81.26 (50.01, 93.50)×10 9/L, respectively; level of D-dimer was 0.98 (0.71, 1.74)mg/L, 3.45 (1.79, 5.56)mg/L, 7.19 (4.26, 11.63)mg/L, respectively; level of procalcitonin was 0.55 (0.21, 1.09)ng/ml, 5.45 (3.74, 11.80)ng/ml, 17.68 (13.97, 26.75)ng/ml, respectively. There were significant differences in above indicators among the groups ( P<0.05). Conclusions:The serum levels of procalcitonin, percentage of neutrophils, D-dimer and platelet are positively correlated with the severity of urogenic sepsis. While combined detection of those indicators can better predict the severity of the sepsis.

Enterovirus 71 (EV71) is a major pathogen causing severe hand, foot and mouth disease (HFMD) in infants under five years old. It can cause central nervous system damageand even death in severe cases. Considering the high mortality and disability rate of HFMD, this review focused on the most recent developments in vaccines and treatments against EV71 infection.

OBJECTIVE: To analyze the association of the clinical inflammatory indices with the severity of urinary sepsis. METHODS: We reviewed the clinical data of 70 patients with urinary sepsis treated in our hospital between January, 2013 and April, 2018. All the patients were diagnosed in line with the Guidelines for Diagnosis and Treatment of Urological Diseases in China (2014 edition), including 22 patients with sepsis, 12 with hypotension and severe sepsis, 17 with septic shock, and 19 with critical septic shock. White blood cell count (WBC), neutrophil percentage (N%), platelets (PLT), fibrinogen (FIB), Ddimer, interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) were examined in all the cases and compared among the 4 groups. The correlations of these inflammatory markers with the severity of sepsis were analyzed using logistic regression analysis. RESULTS: The 4 groups of patients showed significant differences in N%, PLT, D-dimer, and PCT ( < 0.05) but not in CRP (>0.05). Kruskal-Wallis Pairwise comparisons showed that the N% and PCT in patients with sepsis differed significantly from those in the other 3 groups; platelets in patients with sepsis differed significantly from those in patients with septic shock and critical septic shock; D-dimer differed significantly between patients with sepsis and those with septic shock. Among the 4 groups, the median levels of PLT decreased and PCT and N% increased with the worsening of sepsis. Logistic regression analysis indicated that PCT (=0.186, =0.000), N% (=0.047, =0.035) and PLT (=-0.012, =0.003) were significantly correlated with the severity of sepsis in these patients. CONCLUSIONS PCT, PLT and N% are all significantly correlated with the severity of sepsis, and their combined detection can be informative for assessing the severity of sepsis to facilitate clinical decisions on treatment.
Biomarkers ; blood ; C-Reactive Protein ; analysis ; China ; Fibrin Fibrinogen Degradation Products ; analysis ; Fibrinogen ; analysis ; Humans ; Interleukin-6 ; blood ; Leukocyte Count ; Platelet Count ; Procalcitonin ; blood ; Sepsis ; blood ; diagnosis ; Severity of Illness Index ; Shock, Septic ; blood ; diagnosis ; Statistics, Nonparametric ; Urinary Tract Infections ; diagnosis

Objective To evaluate the kidney safety of tenofovir (TDF) as a first-line antiretroviral drug in patients with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) and to analyze the risk factors for TDF nephrotoxicity.Methods Clinical data of treatment-naive adult HIV/AIDS patients were retrospectively collected from Longtan Hospital,Guangxi from September 2010 to June 2013.The estimated glomerular filtration rates (eGFR) between adults HIV/AIDS patients who maintained antiretroviral therapy (TDF/Lamivudine[3TC]/Efavirenz[EFV] and AZT/3TC/EFV groups) for one year or more were compared.The incidences of chronic kidney disease (CKD) and renal insufficiency were compared between the two groups.The categorical variables were described with the percentage (％) and compared with the chi-square test.Normal distribution data were described with mean±standard deviation and compared with Student t test.Non-normal distribution data were described with M (P25,P75) and compared with nonparametric test.The Cox hazard model was used to determine the risk factors for CKD in uni-and multivariate analyses.Results Among 441 patients enrolled in this study,232 were in TDF group,while 209 in AZT group.At baseline,the median age was 42 (32,51) years;the median weight was 55 (50,60) kg;the mean time of follow-up was (18.5±5.0)months.Eighty-three patients (18.8％) suffered from mild renal dysfunction.During the course of 24-month treatment,eGFR level in TDF group was lower than that in AZT group,with statistical significant difference (all P＜0.05).The cumulative incidences of renal hypofunction in the TDF group and AZT group were 18.8％ and 5.8％,respectively.The difference between the two groups was statistically significant (x2 =8.017,P=0.001).The cumulative incidences of CKD in the TDF and AZT groups were 3.4％ and 0.0％,respectively,with statistically significant difference (x2 =4.544,P =0.022).Age (HR=1.148,P＜0.01),the baseline eGFR (HR=4.193,P=0.002) were independent risk factors for renal toxicity.The subgroup analysis of TDF group of age ＜40,40-49,50-59,≥60 years old showed that the cumulative incidences of CKD in the four subgroups were 0,1.9％,5.4％ and 11.1％,respectively.The difference among groups was statistically significant (x2 =10.627,P =0.014).Conclusions As the first-line antiretroviral therapy,TDF can cause renal insufficiency in patients with HIV/AIDS,but the incidence of CKD is low.Age and the baseline eGFR are the independent risk factors for TDF-induced renal toxicity.The CKD incidence is significantly elevated among patients over 50 years old who exposed to TDF,especially in patients over 60 years old.

Objective To explore the effect of information-motivation-behavioral (IMB) skills model on self-management behavior and self perceived burden of elderly patients with permanent bladder fistula. Methods A total of 92 elderly patients with permanent urinary bladder fistula were randomly divided into experiment group and control group in our hospital from November 2015 to November 2016, 46 cases in each group. In the control group, taking classes, face-to-face education were done for a total of 6 months once a month, 60 minutes each time. In the experiment group, the IMB model was used for the nursing intervention for a total of 6 months once a month, 60 minutes each time. The two groups of patients were assessed by self management behavior scale and self perceived burden scale. Results After the intervention, the score on self-management ability of the experiment group was (76.32 ± 4.73), higher than (67.22 ± 3.14) of the control group (P<0.05). The score on the self perceived burden of the experiment group was significantly lower than that of the control group (10.32 ± 4.48 vs. 19.98± 6.63, P<0.05). Conclusion The implementation of IMB model can improve the self-management behavior of elderly male patients with bladder fistula, and reduce the burden of self perception.

Objective To evaluate the incidence and risk factors of urinary tract infection(UTI)following uret-eroscopy.Methods Patients undergoing ureteroscopy examination or ureteroscopic lithotripsy in a hospital between 2002 and 2011 were analyzed retrospectively,clinical data of patients were collected and analyzed,including age, sex,history,complication ,urine routine test,urine culture,blood routine test,urethral catheterization,ureteral stent placing and antimicrobial use.Results Incidence of UTI following ureteroscopy was 3.77% (20/531),UTI fol-lowing ureteroscopy examination was higher than ureteroscopic lithotripsy (5.84% [9/154]vs 2.92% [11/377]). Pyelonephritis was the main infection type(n= 15 ),the main pathogen was Escherichia coli (n= 6 ),there was no statistical difference in UTI among patients receiving different types of antimicrobial prophylaxis (P= 0.185 ). Patients with bacteriuria,hydronephrosis,urethral catheterization,without ureteral stent placing,and without re-ceiving antimicrobial prophylaxis had higher incidence of URI(all P<0.05).Conclusion Bacteriuria,hydronephro-sis,urethral catheterization,without postoperative ureteral stent placing,ureteroscopy examination,and without receiving antimicrobial prophylaxis are risk factors of UTI following ureteroscopy.

Objective To investigate the mechanism of CD34+ progenitor cell differentiation in rat by observing the change relations between the eosinophils (EOS) and the content of Eotaxin and IL-5 in blood and the CD34+/CCR3+,CD34+/IL-5Rα+ in bone marrow after occupational asthma (OA) model rats are simulated,and to observe the effect of WTKYD Trraitioual Chinese Medicine intervention.Methods A total of 40 healthy male SD model rats (200 ～ 250 g weight) were randomly divided into model contrast Group,prednisone acetate intervention Group,WTKYD+1/2 prednisone acetate intervention Group and WTKYD intervention Group,10 in each group,and set a Group for blank contrast.Give them saline (20 ml/kg),prednisone acetate (8.22 mg/kg),WTKYD (20g/kg) +1/2 prednisone acetate (4.11 mg/kg) and WTKYD (20 g/kg) intervention respectively.By means of cell count,immunohistochemical,ELISA,flow cytometry technique,situ hybridization and so on,to observe EOS anti the expression of Eotaxin in lung tissue,the EOS in peripheral blood,the content of Eotaxin and IL-5 in blood as well as the expression of CD34+/CCR3 + and CD34+/IL-5Ra+ in bone marrow respectively.Results The number of EOS,the content of Eotaxin and IL-5,the expression of CD34+/CCR3+ and CD34+/IL-5Ra+ in Model Contrast Group were higher in Blank Contrast Group,the difference was statistically significant (P＜0.01),while they were lower in mnedical intervention Groups when comparing to Model Contrast Group,the difference was statistically significant (P＜0.01 or P＜0.05),and the above items in WTKYD +1/2 Prednisone Acetate Intervention Group were even lower thau in Prednisone Acetate Intervention Group and WTKYD Intervention Group,the difference was statistically significant (P＜0.05).EOS in lung tissue is highly positive related to the content of Eotaxin and IL-5 in peripheral blood as well as the expression of CD34+/CCR3 and CD34+/IL-5Rα in bone marrow (0.9666,0.9829,0.9142,0.8874).Conclusion The increase of internnd EOS in lung tissue is related to the up-regulated expression of CD34+/CCR3+ and CD34+/IL-5Ra+ in bone marrow after antigens in Occupational Asthma model rats are stimulated.Through down-regulating it's expression to restrain the differentiation of CD34 + progenitor cells towards EOS,meanwhile,the collaboration of WTKYD and prednisone acetate possess a certain synergistic action.

Objective To investigate the mechanism of CD34+ progenitor cell differentiation in rat by observing the change relations between the eosinophils (EOS) and the content of Eotaxin and IL-5 in blood and the CD34+/CCR3+,CD34+/IL-5Rα+ in bone marrow after occupational asthma (OA) model rats are simulated,and to observe the effect of WTKYD Trraitioual Chinese Medicine intervention.Methods A total of 40 healthy male SD model rats (200 ～ 250 g weight) were randomly divided into model contrast Group,prednisone acetate intervention Group,WTKYD+1/2 prednisone acetate intervention Group and WTKYD intervention Group,10 in each group,and set a Group for blank contrast.Give them saline (20 ml/kg),prednisone acetate (8.22 mg/kg),WTKYD (20g/kg) +1/2 prednisone acetate (4.11 mg/kg) and WTKYD (20 g/kg) intervention respectively.By means of cell count,immunohistochemical,ELISA,flow cytometry technique,situ hybridization and so on,to observe EOS anti the expression of Eotaxin in lung tissue,the EOS in peripheral blood,the content of Eotaxin and IL-5 in blood as well as the expression of CD34+/CCR3 + and CD34+/IL-5Ra+ in bone marrow respectively.Results The number of EOS,the content of Eotaxin and IL-5,the expression of CD34+/CCR3+ and CD34+/IL-5Ra+ in Model Contrast Group were higher in Blank Contrast Group,the difference was statistically significant (P＜0.01),while they were lower in mnedical intervention Groups when comparing to Model Contrast Group,the difference was statistically significant (P＜0.01 or P＜0.05),and the above items in WTKYD +1/2 Prednisone Acetate Intervention Group were even lower thau in Prednisone Acetate Intervention Group and WTKYD Intervention Group,the difference was statistically significant (P＜0.05).EOS in lung tissue is highly positive related to the content of Eotaxin and IL-5 in peripheral blood as well as the expression of CD34+/CCR3 and CD34+/IL-5Rα in bone marrow (0.9666,0.9829,0.9142,0.8874).Conclusion The increase of internnd EOS in lung tissue is related to the up-regulated expression of CD34+/CCR3+ and CD34+/IL-5Ra+ in bone marrow after antigens in Occupational Asthma model rats are stimulated.Through down-regulating it's expression to restrain the differentiation of CD34 + progenitor cells towards EOS,meanwhile,the collaboration of WTKYD and prednisone acetate possess a certain synergistic action.