Objective:Patients with cerebrospinal fluid(CSF)pleocytosis are routinely admitted to the hospital and treated with parenteral antibiotics,although few have bacterial meningitis(BM).The aim of this study was to evalua...Objective:Patients with cerebrospinal fluid(CSF)pleocytosis are routinely admitted to the hospital and treated with parenteral antibiotics,although few have bacterial meningitis(BM).The aim of this study was to evaluate predictors to differentiate BM from aseptic meningitis(ASM).Methods:The study was conducted in Razi hospital,a training center affiliated to Ahvaz Joundishapoor University of Medical Sciences in Iran.and all patients were 18 years old or above and were treated in the hospital between 2003 and 2007.Data of those who had meningitis,tested as CSF pleocytosis but had not received antibiotic treatment before lumbar puncture were retrospectively analyzed.Results:Among 312 patients with CSF pleocytosis,two hundred fifteen(68.9%)had BM and ninety seven(31.1%)had ASM.The mean age for patients with BM was(34.7±17.7)years(P=0.22,NS).Sixty percent of the BM cases and 61.2% of the ASM cases occurred in men(P=0.70,NS).We identified the following predictors of BM:CSF-WBC count>100 per micro liter,CSF-glucose level<40 mg/dL,CSF-protein level>80 mg/dL.Sensitivity,specificity,PPV,NPV of these predictors,and LR for BM are 86.5%,52.6%,80.2%,63.7% and 104.1 for CSF-WBC count and 72.1%,83.5%,90.6%,57.4% and 164.2% for CSF glucose,and 49.7%,91.8%,93.4%,45.2% and 104.5% for CSF protein.Conclusion:The CSF WBC count should not be used alone to rule out bacterial meningitis.When it is combined with other factors such as CSF glucose and protein improved decision making in patients with suspected BM may occur.展开更多
目的采用荟萃分析方法对国内外已发表的文献进行综合分析,评价雾化吸入阿米卡星对呼吸机相关性肺炎治疗的有效性及安全性。方法全面检索PubMed、Embase、Cochrane Central Register of Controlled Trials、Web of Science数据库、中国...目的采用荟萃分析方法对国内外已发表的文献进行综合分析,评价雾化吸入阿米卡星对呼吸机相关性肺炎治疗的有效性及安全性。方法全面检索PubMed、Embase、Cochrane Central Register of Controlled Trials、Web of Science数据库、中国知网、维普及万方数据库,获取数据检索时间限定为从建库至2018年11月,对比雾化吸入阿米卡星联合静脉抗生素治疗与单用静脉抗生素治疗的随机对照研究(RCTs),依照系统评价和荟萃分析优先报告的条目进行文献筛选、数据提取以及质量评价,采用Revman 5.3软件进行荟萃分析。结果共有8篇RCTs纳入研究。荟萃分析结果显示:与单用静脉抗生素治疗相比,雾化吸入阿米卡星联合静脉抗生素治疗显著提高临床治愈率(OR=2.59,95%CI:1.87~3.59,P<0.00001),增加细菌清除率(OR=2.87,95%CI:1.93~4.27,P<0.00001),雾化联合治疗组撤机率(OR=1.88,95%CI:1.16~3.04,P=0.01)。但雾化吸入阿米卡星联合静脉抗生素和单纯抗生素治疗2组的病死率差异无统计学意义(OR=1.39,95%CI:0.86~2.24,P=0.18),支气管痉挛发生率(OR=2.30,95%CI:1.00~5.30,P=0.05)、肾功能损伤率(OR=0.61,95%CI:0.34~1.11,P=0.10)差异无统计学意义。结论呼吸机相关性肺炎患者予以雾化吸入阿米卡星联合静脉抗生素较单用静脉抗生素能改善患者临床治愈率、细菌清除率及呼吸机撤机率,但不会降低患者病死率及增加支气管痉挛发生率和肾功能损伤率。展开更多
文摘Objective:Patients with cerebrospinal fluid(CSF)pleocytosis are routinely admitted to the hospital and treated with parenteral antibiotics,although few have bacterial meningitis(BM).The aim of this study was to evaluate predictors to differentiate BM from aseptic meningitis(ASM).Methods:The study was conducted in Razi hospital,a training center affiliated to Ahvaz Joundishapoor University of Medical Sciences in Iran.and all patients were 18 years old or above and were treated in the hospital between 2003 and 2007.Data of those who had meningitis,tested as CSF pleocytosis but had not received antibiotic treatment before lumbar puncture were retrospectively analyzed.Results:Among 312 patients with CSF pleocytosis,two hundred fifteen(68.9%)had BM and ninety seven(31.1%)had ASM.The mean age for patients with BM was(34.7±17.7)years(P=0.22,NS).Sixty percent of the BM cases and 61.2% of the ASM cases occurred in men(P=0.70,NS).We identified the following predictors of BM:CSF-WBC count>100 per micro liter,CSF-glucose level<40 mg/dL,CSF-protein level>80 mg/dL.Sensitivity,specificity,PPV,NPV of these predictors,and LR for BM are 86.5%,52.6%,80.2%,63.7% and 104.1 for CSF-WBC count and 72.1%,83.5%,90.6%,57.4% and 164.2% for CSF glucose,and 49.7%,91.8%,93.4%,45.2% and 104.5% for CSF protein.Conclusion:The CSF WBC count should not be used alone to rule out bacterial meningitis.When it is combined with other factors such as CSF glucose and protein improved decision making in patients with suspected BM may occur.
文摘目的采用荟萃分析方法对国内外已发表的文献进行综合分析,评价雾化吸入阿米卡星对呼吸机相关性肺炎治疗的有效性及安全性。方法全面检索PubMed、Embase、Cochrane Central Register of Controlled Trials、Web of Science数据库、中国知网、维普及万方数据库,获取数据检索时间限定为从建库至2018年11月,对比雾化吸入阿米卡星联合静脉抗生素治疗与单用静脉抗生素治疗的随机对照研究(RCTs),依照系统评价和荟萃分析优先报告的条目进行文献筛选、数据提取以及质量评价,采用Revman 5.3软件进行荟萃分析。结果共有8篇RCTs纳入研究。荟萃分析结果显示:与单用静脉抗生素治疗相比,雾化吸入阿米卡星联合静脉抗生素治疗显著提高临床治愈率(OR=2.59,95%CI:1.87~3.59,P<0.00001),增加细菌清除率(OR=2.87,95%CI:1.93~4.27,P<0.00001),雾化联合治疗组撤机率(OR=1.88,95%CI:1.16~3.04,P=0.01)。但雾化吸入阿米卡星联合静脉抗生素和单纯抗生素治疗2组的病死率差异无统计学意义(OR=1.39,95%CI:0.86~2.24,P=0.18),支气管痉挛发生率(OR=2.30,95%CI:1.00~5.30,P=0.05)、肾功能损伤率(OR=0.61,95%CI:0.34~1.11,P=0.10)差异无统计学意义。结论呼吸机相关性肺炎患者予以雾化吸入阿米卡星联合静脉抗生素较单用静脉抗生素能改善患者临床治愈率、细菌清除率及呼吸机撤机率,但不会降低患者病死率及增加支气管痉挛发生率和肾功能损伤率。
