[Outpatient parenteral anti-infective therapy (OPAT)]. / Ambulante parenterale antiinfektive Therapie (APAT).

Outpatient parenteral anti-infective therapy (OPAT) involves the administration of intravenous anti-infectives outside a hospital setting. This shortens the inpatient stay and leads to a reduction in treatment costs, fewer instances of nosocomial infections and enhanced quality of life for the patient.

Bacterial pathogens in pediatric appendicitis: a comprehensive retrospective study.

Background: Appendicitis is a frequent condition, with peak incidences in the second decade of life. Its pathogenesis is under debate, but bacterial infections are crucial, and antibiotic treatment remains essential. Rare bacteria are accused of causing complications, and various calculated antibiotics are propagated, yet there is no comprehensive microbiological analysis of pediatric appendicitis. Here we review different pre-analytic pathways, identify rare and common bacterial pathogens and their antibiotic resistances, correlate clinical courses, and evaluate standard calculated antibiotics in a large pediatric cohort. Method: We reviewed 579 patient records and microbiological results of intraoperative swabs in standard Amies agar media or fluid samples after appendectomies for appendicitis between May 2011 and April 2019. Bacteria were cultured and identified via VITEK 2 or MALDI-TOF MS. Minimal inhibitory concentrations were reevaluated according to EUCAST 2022. Results were correlated to clinical courses. Results: Of 579 analyzed patients, in 372 patients we got 1330 bacterial growths with resistograms. 1259 times, bacteria could be identified to species level. 102 different bacteria could be cultivated. 49% of catarrhal and 52% of phlegmonous appendices resulted in bacterial growth. In gangrenous appendicitis, only 38% remained sterile, while this number reduced to 4% after perforation. Many fluid samples remained sterile even when unsterile swabs had been taken simultaneously. 40 common enteral genera were responsible for 76.5% of bacterial identifications in 96.8% of patients. However, 69 rare bacteria were found in 187 patients without specifically elevated risk for complications. Conclusion: Amies agar gel swabs performed superior to fluid samples and should be a standard in appendectomies. Even catarrhal appendices were only sterile in 51%, which is interesting in view of a possible viral cause. According to our resistograms, the best in vitro antibiotic was imipenem with 88.4% susceptible strains, followed by piperacillin-tazobactam, cefuroxime with metronidazole, and ampicillin-sulbactam to which only 21.6% of bacteria were susceptible. Bacterial growths and higher resistances correlate to an elevated risk of complications. Rare bacteria are found in many patients, but there is no specific consequence regarding antibiotic susceptibility, clinical course, or complications. Prospective, comprehensive studies are needed to further elicit pediatric appendicitis microbiology and antibiotic treatment.

Single-atom nanozymes: From bench to bedside.

Single-atom nanozymes (SANs) are the new emerging catalytic nanomaterials with enzyme-mimetic activities, which have many extraordinary merits, such as low-cost preparation, maximum atom utilization, ideal catalytic activity, and optimized selectivity. With these advantages, SANs have received extensive research attention in the fields of chemistry, energy conversion, and environmental purification. Recently, a growing number of studies have shown the great promise of SANs in biological applications. In this article, we present the most recent developments of SANs in anti-infective treatment, cancer diagnosis and therapy, biosensing, and antioxidative therapy. This text is expected to better guide the readers to understand the current state and future clinical possibilities of SANs in medical applications.

Application of metagenomic next-generation sequencing in the diagnosis and treatment of recurrent urinary tract infection in kidney transplant recipients.

Background: Rapid and accurate pathogen diagnosis is an urgent unmet clinical need for recurrent urinary tract infection (RUTI) in kidney transplant recipients (KTRs). Metagenomic next-generation sequencing (mNGS) may offer another strategy for diagnosing uropathogens but remains to be studied. Methods: Nineteen KTRs with RUTI were collected in this study. The uropathogens were detected and compared by mNGS and urine culture, respectively. Modifications of the anti-infection strategy were also assessed. Results: Rich and diverse pathogens were revealed by mNGS. mNGS was significantly higher than culture in total positive rate (100.0% vs. 31.6%; p < 0.01) and in identification rates for bacteria (89.5% vs. 31.6%; p < 0.01), for viruses (57.9% vs. 0; p < 0.01), and for fungi (42.1% vs. 0; p < 0.01), respectively. mNGS identified a significantly higher proportion of mixed infections than culture (89.5% vs. 10.5%; p < 0.01). The anti-infection therapies were adjusted in two (33.3%) and 12 (76.9%) cases guided by culture and mNGS, respectively. Conclusion: mNGS has more remarkable etiological diagnostic performance compared with urine culture for KTRs with RUTI to guide anti-infection strategies and, in turn, protect the graft.

Hemodialysis catheter-related infection caused by Pannonibacter phragmitetus: a rare case report in China.

Pannonibacter phragmitetus (P. phragmitetus) is rarely related with human disease. We reported a case of catheter-related infection caused by P. phragmitetus in a 68-year-old woman on hemodialysis. The patient developed recurrent fever during hemodialysis and blood cultures were positive for P. phragmitetus. The patient's body temperature returned to normal after intravenous cefoperazone/sulbactam treatment, and the hemodialysis catheter was locked with gentamicin and urokinase. The potential anti-infective treatment against P. phragmitetus was discussed.

[Optimization of microbial diagnostics by introduction of a blood culture standard operating procedure in the emergency department]. / Optimierung der mikrobiellen Diagnostik durch Einführung einer Standard Operating Procedure "Blutkulturen" in der zentralen Notaufnahme.

INTRODUCTION: The emergency department (ED) is the main port of entry for patients with infectious diseases, the place where a number of diagnostic procedures are performed and treatment is often initiated. The aim of this retrospective study was to estimate the influence of the establishment and introduction of a blood culture standard operating procedure (BC-SOP) and of the subsequent training of microbial diagnostics in an ED. METHODS: In a before and after study over a study period of 3 months each (November 2017-January 2018 and November 2018-January 2019), the number of blood cultures taken, the rate of blood cultures per 1000 patients, the number of positive blood cultures and the frequency of typical skin pathogens were evaluated. In the interim time between the two study periods, a BC-SOP was developed in collaboration with the hospital's antibiotic stewardship team and subsequently introduced with staff training in the ED. The study was approved by the local ethics committee of the medical faculty of the Heinrich Heine University (2019-392-RetroDEuA). RESULTS: In total 92% of the nursing personnel and 93% of the medical personnel received training. The total number of blood cultures increased from 1757 to 2872 (64% increase) and the rate of blood cultures per 1000 patients from 287 to 481 (68% increase). The number of positive blood cultures decreased from 18.6% to 13.7% (p < 0.05). Typical skin pathogens were found in 34.4% and 26.4% of the cases, respectively (p < 0.05). CONCLUSION: The development, introduction and training of a BC-SOP in the ED can make a relevant contribution to the microbial diagnostics and increase the quantity as well as the quality.

Primer on etiology and treatment of progressive/severe periodontitis: A systemic health perspective.

Periodontology is an infectious disease-based discipline. The etiopathology of progressive/severe periodontitis includes active herpesviruses, specific bacterial pathogens, and proinflammatory cytokines. Herpesviruses and periodontopathic bacteria may interact synergistically to produce periodontal breakdown, and periodontal herpesviruses may contribute to systemic diseases. The infectious agents of severe periodontitis reside in deep pockets, furcation lesions, and inflamed gingiva, sites inaccessible by conventional (purely mechanical) surgical or nonsurgical therapy but accessible by systemic antibiotic treatment. This brief overview presents an effective anti-infective treatment of severe periodontitis, which includes systemic chemotherapy/antibiotics against herpesviruses (valacyclovir [acyclovir]) and bacterial pathogens (amoxicillin + metronidazole or ciprofloxacin + metronidazole) plus common antiseptics (povidone-iodine and sodium hypochlorite) and select ultrasonic scaling. The proposed treatment can cause a marked reduction or elimination of major periodontal pathogens, is acceptably safe, and can be carried out in minimal time with minimal cost.

[Implant-associated joint infections]. / Implantatassoziierte Gelenkinfektionen.

Due to the increasing number of endoprosthetic joint replacement operations in older patients as well as in patients with severe primary diseases and comorbidities, the number of revision operations is continuously increasing due to infections. The infection of an endoprosthesis represents a complex clinical picture. This article provides a detailed overview of the treatment of periprosthetic infections with a focus on the diagnostic approach and treatment decision-making. A differentiation is made in periprosthetic infections between infections with a mature or immature biofilm on the surface of the implant. Depending on this, different treatment concepts are available. Highly acute infections represent an orthopedic/surgical emergency in artificial as well as in native joints. Low-grade infections play a role particularly in the area of exchange endoprosthetics. The greatest possible success is achieved only by the interplay of a timely diagnosis, sufficient surgical approach and individualized anti-infective treatment.

Analysis of Drug Use of Anti-infective Treatment for a 400 g Super-premature Infant by Clinical Pharmacists / 中国药房

OBJECTIVE：To optimize the ant i-infective treatment plan for the super-premature infants and provide reference for the clinical treatment of the super-premature infants and the whole pharmaceutical care. METHODS ：A super-premature infant with gestational age of 25+5 weeks and weight of 400 g was delivered in the second department of neonatology in Hunan Maternal and Child Health Hospital. This child suffered from complex complications. Clinical pharmacists ，relevant medical staff and hospital infection department personnel formed a multidisciplinary treatment team. According to Neonatal Sepsis Treatment Scheme ， Antimicrobial Treatment Guide ，Premature Medicine ，combining with the analysis of infection indicators ，biochemical indicators ， vital signs and other indicators ，a individualized anti-infective diagnosis and treatment plan was developed for the child. After entering the NICU ，this child was given Piperacillin sodium and sulbactam sodium for injection （100 mg/kg，ivgtt，q12 h）for anti-infective treatment ；considering the possibility of sepsis ，clinical pharmacists suggested that Piperacillin sodium and sulbactam sodium for injection should be stopped and Meropenem for injection （40 mg/kg，ivgtt，q12 h）should be used instead. After 7 day of meropenem treatment ，clinical pharmacists suggested adding antifungal Fluconazole injection （5.0 mg/kg，ivgtt，qod）. After 11 days of meropenem treatment ，in order to avoid the aggravation of infection ，according to the drug sensitivity results （sensitive to Ticarcillin sodium and clavulanate potassium for injection ），clinical pharmacists suggested adding Ticarcillin sodium and clavulanate potassium for injection （75 mg/kg，ivgtt，q8 h）for combined anti-infective treatment ，and hospital infection treatment was carried out at the same time. After the infection index was stable ，all antibiotics were stopped. When E. coli infection occurred later，clinical pharmacists suggested that Piperacillin tazobactam sodium for injection （75 mg/kg，ivgtt，q8 h）should be used. After the infection aggravated ，Piperacillin tazobactam sodium for injection was stopped and Imipenem cilastatin sodium forinjection（20 mg/kg，ivgtt，q8 h）was used instead. The child received ladder treatment after the decline of infection index ，and Ceftazidime for injection （50 mg/kg，ivgtt，q12 h）was used. RESULTS ：The doctors adopted the above suggestions. After treatment ，the prognosis of the child was good ，the vital signs were stable ，and the body weight reached 3 000 g at discharge. CONCLUSIONS ：For preterm infants as special group ，before using antibiotics ，clinical pharmacists should focus on the vital signs ，infection indicators and laboratory test results of the child ，so as to help doctors improve the treatment plan and ensure the effectiveness and safety of their medication.

[Controlling glucocorticoid treatment in critically ill patients with rheumatism exemplified by systemic lupus erythematosus]. / Zur Steuerung einer Glukokortikoidtherapie beim kritisch kranken Rheumapatienten am Beispiel des systemischen Lupus erythematodes.

BACKGROUND: Infections are one of the most common clinical problems in patients with rheumatic diseases who need to be treated with glucocorticoids in an intensive care unit. To date, there are no recommendations for the standardized control of glucocorticoid treatment in such situations. OBJECTIVE: Based on a literature search this paper provides an overview of evidence-based and eminence-based recommendations for the control of glucocorticoid treatment under intensive care conditions using the example of systemic lupus erythematosus. METHODS: A systematic literature search was carried out using a MeSH term search in the PubMed database. RESULTS: Infections are one of the most common causes for the treatment of patients with rheumatic diseases in intensive care units. In the case of systemic lupus erythematosus it is particularly challenging to distinguish the infection from increased disease activity or to treat the parallel occurrence. Patients in an intensive care unit are exposed to an increased level of physical stress due to the severity of the disease, which is why special attention should be paid to symptoms of adrenocortical insufficiency. Evidence-based recommendations for prophylaxis of an adrenal crisis only exist in relation to perioperative procedures and not for the situation of severe infections. CONCLUSION: The use of glucocorticoids in systemic lupus erythematosus is often chronic and there is an increased risk of infections. In the case of infections (or simultaneous disease flare) adequate anti-infective treatment should be administered, the treatment with glucocorticoids should be adjusted accordingly and symptoms of adrenocortical insufficiency should simultaneously be looked for.

Pharmaceutical Care for One Case of Mycobacterium Marinum Infection / 中国药师

Taking full advantage of professional knowledge,clinical pharmacist involved in the whole treatment process of one case of mycobacterium infection by assisting doctors in determining and optimizing the anti-infective treatment plan, and performing pharmaceutical care. After the active, rational and effective anti-infective treatment, the patient's infection was controlled effectively. The active participation of clinical pharmacist gains clinical experience for the treatment of rare bacterial infections.

Case Analysis of Participation of Clinical Pharmacists in Anti-infective Treatment for a Case of Septic Shock Induced by Intrauterine Infection / 中国药房

OBJECTIVE: To explore the role of clinical pharmacists in anti-infective treatment for the patient with septic shock induced by intrauterine infection. METHODS: Clinical pharmacists participated in anti-infective treatment for a patient with septic shock induced by intrauterine infection, and assisted physicians to formulate empirical anti-infective treatment, determine that Escherichia coli was pathogenic bacteria and analyze the causes of fluctuations in body temperature. According to the patient's disease condition and results of assistant examination, clinical pharmacists suggested using Imipenem and cilastatin sodium for injection 1. 0 g, ivgtt, q6 h, stopping Teicoplanin for injection, de-escalation using Cefoxitin sodium for injection 2. 0 g, ivgtt, q8 h for anti-infective treatment, with oral sequential therapy. RESULTS: Physicians adopted most advice of pharmacists. After 30 d anti-infective and symptomatic treatment, the patients symptoms were better than before, and discharged from the hospital. CONCLUSIONS: Clinical pharmacists participate in formulating individual anti-infective treatment regimen, so as to promote the rational use of antibiotics and improve the response rate and success rate of treatment.

Treatment Practice of Clinical Pharmacists for One Case of Complexity Urinary Tract Infection with Septic Shock Induced by Cellulitis / 中国药师

Objective:To investigate the role of clinical pharmacists in the anti-infective treatment of one patient with complexity urinary tract infection with septic shock induced by cellulitis. Methods:Clinical pharmacists participated in one case of complexity uri-nary tract infection with septic shock induced by cellulitis, and according to the clinical curative effect and the patient' s condition change, clinical pharmacists adjusted the medication nine times and provided individualized pharmaceutical care and service in the whole process. Results:Physician accepted the suggestions of clinical pharmacists, the infection was controlled after the 38-day treat-ment, and then the patient was discharged from the hospital. Conclusion:Clinical pharmacists should participate in the clinical treat-ment, provide whole process of pharmaceutical care for severe patients and assist physician in drug treatment decisions to promote safe, effective and economical drug use.

Retrospective Analysis of Anti-infective Treatment for CAP Patients in Our Hospital / 中国药房

OBJECTIVE:To provide reference for rational use of antibiotics in community-acquired pneumonia (CAP) pa-tients. METHODS:Medical records of 342 CAP inpatients in our hospital during Jan.-Dec. in 2014 were analyzed retrospectively by DDDs and SPSS 19.0 statistical software. According to the age,the patients were divided into youth group,the young group, middle age group and elderly group,and clinical information and the use of antibiotics were analyzed statistically. RESULTS:Mi-crobiological examination of 320 of 342 CAP inpatients were performed with detection rate of 93.57%;sputum culture,blood cul-ture and PCT were conducted in 67 case to find out pathogenic bacteria with negative rate of 20.18%. 338 patients had used antibi-otics (98.83%),and other 4 patients refused anti-infective treatment. Selected empirical antibiotics of our hospital were mainlyβ-lactam (50.07%),quinolones (35.70%) and macrolides (9.80%). CAP inpatients were mainly given two-drug therapy,of which cephalosporin combined with quinolone were most common,including 178 cases in total (53.61%). During treatment,17 patients suffered from ADR,with incidence of 5.03%. CONCLUSIONS:The detection rate from patients with CAP in our hospital is high in microbiological examination,but culture results should be analyzed dialectically according to clinical signs. Empirical an-ti-infective therapy mainly include β-lactams,quinolones and macrolides antibiotics alone or in combination with,basically meet the guideline for CAP Diagnosis and Therapy Guideline.

Pharmaceutical Care for Anti-infective Treatment of A Case of Septic Shock / 中国药房

OBJECTIVE:To investigate the role of clinical pharmacists in anti-infective treatment for the patient with septic shock. METHODS:Clinical pharmacists participated in anti-infective treatment for a patient with septic shock,assisted physicians to formulate individual regimen based on empirical anti-infective treatment,ESBLs producing Escherichia coli and anti-fungal treat-ment. Clinical pharmacists suggested using Itraconazole injection 200 mg,ivgtt,qd,for anti-fungal treatment;Itraconazole cap-sules 200 mg,po,bid,instead of fusidinic for anti-fungal treatment;meropenem 0.5 g,ivgtt,q6 h,for anti-infective treatment. RESULTS:Physicians adopted the suggestion of clinical pharmacists;the infection had been controlled after 16 d treatment and then the patient discharged from the hospital. CONCLUSIONS:Clinical pharmacists participate in clinical treatment,and assist phy-sicians to make a decision and formulate individual regimen,so as to promote rational drug use.

Pharmaceutical Care in Anti-infective Therapy for a Patient with Severe Pneumonia Complicated with Re-nal Insufficiency / 中国药师

Objective: To discuss the importance of pharmaceutical care in anti-infective treatment for one patient with severe pneumonia and renal insufficiency performed by clinical pharmacists. Methods: Clinical pharmacist participated in evaluating and changing the anti-infective treatment regimen, adjusted the drug dosage according to the renal function reasonably to avoid adverse drug reactions and completed the medication education and health education for the patient. Results:The infection was controlled effective-ly, gasp was controlled effectively and blood pressure was steady. Conclusion:Clinical pharmacists should monitor the whole treatment process,evaluate the drug regimen comprehensively and reduce adverse drug reaction to the maximum limit during the pharmaceutical care.