BACKGROUND & AIMS: BACKGROUND:Elective hysterectomy is commonly performed for benign gynaecological conditions. Hysterectomy can be performed abdominally, laparoscopically, or vaginally, with or without laparoscopic assistance. Antibiotic prophylaxis consists of administration of antibiotics to reduce the rate of postoperative infection, which otherwise affects 40%-50% of women after vaginal hysterectomy, and more than 20% after abdominal hysterectomy. No Cochrane review has systematically assessed evidence on this topic. OBJECTIVES:To determine the effectiveness and safety of antibiotic prophylaxis in women undergoing elective hysterectomy. SEARCH METHODS:We searched electronic databases to November 2016 (including the Cochrane Gynaecology and Fertility Group Specialised Register, the Cochrane Central Register of Studies (CRSO), MEDLINE, Embase, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), as well as clinical trials registers, conference abstracts, and reference lists of relevant articles. SELECTION CRITERIA:All randomised controlled trials (RCTs) comparing use of antibiotics versus placebo or other antibiotics as prophylaxis in women undergoing elective hysterectomy. DATA COLLECTION AND ANALYSIS:We used Cochrane standard methodological procedures. MAIN RESULTS:We included in this review 37 RCTs, which performed 20 comparisons of various antibiotics versus placebo and versus one another (6079 women). The quality of the evidence ranged from very low to moderate. The main limitations of study findings were risk of bias due to poor reporting of methods, imprecision due to small samples and low event rates, and inadequate reporting of adverse effects. Any antibiotic versus placebo Vaginal hysterectomyModerate-quality evidence shows that women who received antibiotic prophylaxis had fewer total postoperative infections (risk ratio (RR) 0.28, 95% confidence interval (CI) 0.19 to 0.40; five RCTs, N = 610; I2 = 85%), less urinary tract infection (UTI) (RR 0.58, 95% CI 0.43 to 0.77; eight RCTs, N = 1790; I2 = 44%), fewer pelvic infections (RR 0.28, 95% CI 0.20 to 0.39; 11 RCTs, N = 2010; I2 = 57%), and fewer postoperative fevers (RR 0.43, 95% CI 0.34 to 0.54; nine RCTs, N = 1879; I2 = 48%) than women who did not receive such prophylaxis. This suggests that antibiotic prophylaxis reduces the average risk of postoperative infection from about 34% to 7% to 14%. Whether this treatment has led to differences in rates of other serious infection remains unclear (RR 0.20, 95% CI 0.01 to 4.10; one RCT, N = 146; very low-quality evidence).Data were insufficient for comparison of adverse effects. Abdominal hysterectomyWomen who received antibiotic prophylaxis of any class had fewer total postoperative infections (RR 0.16, 95% CI 0.06 to 0.38; one RCT, N = 345; low-quality evidence), abdominal wound infections (RR 0.64, 95% CI 0.45 to 0.92; 11 RCTs, N = 2434; I2 = 0%; moderate-quality evidence), UTIs (RR 0.39, 95% CI 0.29 to 0.51; 11 RCTs, N = 2547; I2 = 26%; moderate-quality evidence), pelvic infections (RR 0.50, 95% CI 0.35 to 0.71; 11 RCTs, N = 1883; I2 = 11%; moderate-quality evidence), and postoperative fevers (RR 0.60, 95% CI 0.51 to 0.70; 11 RCTs, N = 2581; I2 = 51%; moderate-quality evidence) than women who did not receive prophylaxis, suggesting that antibiotic prophylaxis reduces the average risk of postoperative infection from about 16% to 1% to 6%. Whether this treatment has led to differences in rates of other serious infection remains unclear (RR 0.44, 95% CI 0.12 to 1.69; two RCTs, N = 476; I2 = 29%; very low-quality evidence).It is unclear whether rates of adverse effects differed between groups (RR 1.80, 95% CI 0.62 to 5.18; two RCTs, N = 430; I2 = 0%; very low-quality evidence). Head-to-head comparisons between antibiotics Vaginal hysterectomyWe identified four comparisons: cephalosporin versus penicillin (two RCTs, N = 470), cephalosporin versus tetracycline (one RCT, N = 51), antiprotozoal versus lincosamide (one RCT, N = 80), and cephalosporin versus antiprotozoal (one RCT, N = 78). Data show no evidence of differences between groups for any of the primary outcomes, except that fewer cases of total postoperative infection and postoperative fever were reported in women who received cephalosporin than in those who received antiprotozoal.Only one comparison (cephalosporin vs penicillin; two RCTs, N = 451) yielded data on adverse effects and showed no differences between groups. Abdominal hysterectomyWe identified only one comparison: cephalosporin versus penicillin (N = 220). Data show no evidence of differences between groups for any of the primary outcomes. Adverse effects were not reported. Combined antibiotics versus single antibiotics Vaginal hysterectomyWe identified three comparisons: cephalosporin plus antiprotozoal versus cephalosporin (one RCT, N = 78), cephalosporin plus antiprotozoal versus antiprotozoal (one RCT, N = 78), and penicillin plus antiprotozoal versus penicillin (one RCT, N = 230). Data were unavailable for most outcomes, including adverse effects. We found no evidence of differences between groups, except that fewer women receiving cephalosporin with antiprotozoal received a diagnosis of total postoperative infection, UTI, or postoperative fever compared with women receiving antiprotozoal. Abdominal hysterectomyWe identified one comparison (penicillin plus antiprotozoal vs penicillin only; one RCT, N = 230). Whether differences between groups occurred was unclear. Adverse effects were not reported. Comparison of cephalosporins in different regimensSingle small trials addressed dose comparisons and provided no data for most outcomes, including adverse effects. Whether differences between groups occurred was unclear. No trials compared route of administration.The quality of evidence for all head-to-head and dose comparisons was very low owing to very serious imprecision and serious risk of bias related to poor reporting of methods. AUTHORS' CONCLUSIONS:Antibiotic prophylaxis appears to be effective in preventing postoperative infection in women undergoing elective vaginal or abdominal hysterectomy, regardless of the dose regimen. However, evidence is insufficient to show whether use of prophylactic antibiotics influences rates of adverse effects. Similarly, evidence is insufficient to show which (if any) individual antibiotic, dose regimen, or route of administration is safest and most effective. The most recent studies included in this review were 14 years old at the time of our search. Thus findings from included studies may not reflect current practice in perioperative and postoperative care and may not show locoregional antimicrobial resistance patterns.

背景与目标：

BACKGROUND & AIMS: :Venous thromboembolism (VTE) is a potentially serious complication occurring in 1%-2% of hospitalized medical patients. Despite this low absolute risk, as many as 82% of medical patients are considered to be at increased risk of developing VTE and are eligible for medical thromboprophylaxis. In this commentary, The author will discuss the main findings of a recent paper published in Clinical Epidemiology that questions the large proportion of individuals who are eligible for medical thromboprophylaxis, and also discuss the potential implications for the prevention of VTE. The recent paper demonstrated that when a population is divided into high- and low-risk groups, the maximum absolute risk depends on the inverse of the proportion of patients that is considered to be high risk. Consequently, even an effective treatment will only result in a small reduction in the absolute risk when the high-risk group comprises the largest proportion of this population. For medical thromboprophylaxis, this implies that even patients considered to be at high-risk for developing VTE have a maximum absolute VTE risk of 2% when the overall risk is 1.6%. Therefore, even an effective preventive initiative will only result in a small risk reduction. This small potential benefit should be weighed against potential harms associated with prophylaxis, mainly bleeding events. Still, there may be a reasonable overall balance between prevention of pulmonary embolism and major bleeding, mainly because major bleeding events are rare. Nonetheless, this discussion underscores that future risk prediction models should aim to predict the benefits and harms in individual patients in order to provide optimal care for the right patients.

背景与目标： : 静脉血栓栓塞 (VTE) 是一种潜在的严重并发症，发生在住院患者的1% 2% 中。尽管绝对风险较低，但仍有多达82% 的医疗患者被认为患有VTE的风险增加，并且有资格进行医疗血栓预防。在这篇评论中，作者将讨论最近发表在《临床流行病学》上的一篇论文的主要发现，该论文质疑了有资格进行医疗血栓预防的大部分个体，并讨论了预防VTE的潜在影响。最近的论文表明，当人群分为高风险组和低风险组时，最大绝对风险取决于被认为是高风险的患者比例的倒数。因此，当高危人群占该人群的最大比例时，即使是有效的治疗也只能导致绝对风险的小幅降低。对于医疗血栓预防，这意味着即使被认为处于发生VTE的高风险的患者，当总体风险1.6% 时，也具有2% 的最大绝对VTE风险。因此，即使是有效的预防举措，也只会导致很小的风险降低。应权衡这种小的潜在益处与预防相关的潜在危害，主要是出血事件。尽管如此，预防肺栓塞和大出血之间可能存在合理的总体平衡，主要是因为大出血事件很少。尽管如此，该讨论强调了未来的风险预测模型应旨在预测单个患者的收益和危害，以便为合适的患者提供最佳护理。

BACKGROUND & AIMS: Stress ulcer prophylaxis protects against clinically important gastrointestinal bleeding and has gained widespread use. This study compares the efficacy of omeprazole to ranitidine for this indication. This was a prospective, randomized clinical trial. Sixty-seven high-risk patients were randomized to receive either ranitidine 150 mg (N = 35) intravenously daily or omeprazole 40 mg (N = 32) daily orally or by nasogastric route. Patients were monitored for clinically important bleeding. There was no statistically significant difference between treatment groups in the number of patients enrolled, gender, race, or age. The study groups were comparable in regard to the severity of illness based on their similar APACHE II score, duration of ICU stay, duration of ventilator dependence, and mortality rate. A significant difference was found only in regard to the number of risk factors per patient. The ranitidine-treated group had 2.7 risk factors per patient while the omeprazole-treated group had 1.9 (P < 0.05). Eleven patients (31%) given ranitidine and two patients (6%) given omeprazole developed clinically important bleeding (P < 0.05). Nosocomial pneumonia developed in five patients (14%) receiving ranitidine and one patient (3%) receiving omeprazole (P > 0.05). We conclude that oral omeprazole is safe, effective, and clinically feasible for stress ulcer prophylaxis.

背景与目标： 预防应激性溃疡可预防临床上重要的胃肠道出血，并已获得广泛应用。本研究比较了奥美拉唑与雷尼替丁对该适应症的疗效。这是一项前瞻性随机临床试验。67名高危患者被随机分配，每天静脉注射雷尼替丁150 mg (N = 35) 或每天口服奥美拉唑40 mg (N = 32) 或通过鼻饲途径。监测患者的临床重要出血情况。治疗组在入组患者人数，性别，种族或年龄方面没有统计学上的显着差异。基于相似的APACHE II评分，ICU停留时间，呼吸机依赖持续时间和死亡率，研究组在疾病严重程度方面具有可比性。仅在每位患者的危险因素数量方面发现显着差异。雷尼替丁治疗组每个患者有2.7危险因素，而奥美拉唑治疗组有1.9 (P <0.05)。11名患者 (31%) 接受雷尼替丁治疗，2名患者 (6%) 接受奥美拉唑治疗，出现临床上重要的出血 (P <0.05)。5例接受雷尼替丁治疗的患者 (14% 例) 和1例接受奥美拉唑治疗的患者 (3% 例) 发生院内肺炎 (P> 0.05)。我们得出的结论是，口服奥美拉唑对预防应激性溃疡是安全，有效且临床上可行的。

BACKGROUND & AIMS: :Pain prophylaxis is an everyday experience in clinical anaesthesia. There is now considerable experimental evidence that short-term nociceptive stimuli evoke a long-lasting excitatory state of the central nervous system. This excitatory state can be largely prevented by relatively small doses of anaesthetics (local anaesthetics, opioids) given prelesionally. Suchpre-emptive analgesia is the theoretical basis of the clinical experience cited above. This experimental knowledge has clinical applications in the field of postoperative analgesia-which, as is well known, is the Cinderella of anaesthesia. Al-thoughs sound knowledge of the methods is available, postoperative pain relief is very often inadequate. because of organizational difficulties. Pre-emptive analgesia reduces the frequency and intensity of postoperative pain. Infiltration of the surgical incision with local anaesthetics, regional blockades, and spinal and epidural analgesia, all performed preoperatively, and also the administration of analgesies with the premedication, produce postoperative analgesia lasting longer than the known duration of any of these alone. The efficiency of these methods has been scientifically proved during recent years. Pre-emptive analgesia is advantageous in out-patient surgery as well as for routine clinical anaesthesia, and has proved effective in the prevention of phantom limb pain. Many questions on the nature and clinial application of pre-emptive analgesia are still unanswered. However, its ease of performance and the clear clinical advantages of pain prophylaxis mean that it should have a place in the everyday practice of anaesthesia.

背景与目标： : 疼痛预防是临床麻醉的日常经验。现在有相当多的实验证据表明，短期伤害性刺激会唤起中枢神经系统的持久兴奋状态。这种兴奋状态可以通过相对小剂量的麻醉剂 (局部麻醉剂，阿片类药物) 在很大程度上预防。这种先发制人的镇痛是上述临床经验的理论基础。这些实验知识在术后镇痛领域具有临床应用，众所周知，这是麻醉的灰姑娘。尽管对该方法有充分的了解，但术后疼痛缓解往往不足。因为组织困难。先发制人镇痛可降低术后疼痛的频率和强度。术前均进行了局部麻醉剂，区域封锁以及脊柱和硬膜外镇痛的手术切口浸润，以及术前使用镇痛药的给药，可产生的术后镇痛持续时间长于已知的任何一种。近年来，这些方法的有效性已得到科学证明。先发制人镇痛在门诊手术以及常规临床麻醉中都是有利的，并且已被证明可有效预防幻肢疼痛。关于先发制人镇痛的性质和临床应用的许多问题仍未得到解答。但是，它的易用性和预防疼痛的明显临床优势意味着它应该在日常麻醉实践中占有一席之地。

BACKGROUND & AIMS: BACKGROUND:Catheter-related infections cause morbidity and mortality in patients undergoing hemodialysis. PURPOSE:To examine whether topical or intraluminal antibiotics reduce catheter-related bloodstream infection compared with no antibiotic therapy in adults undergoing hemodialysis. DATA SOURCES:Electronic databases, trial registries, bibliographies, and conference proceedings up to October 2007, with no language restrictions. STUDY SELECTION:Two reviewers independently selected randomized, controlled trials using topical or intraluminal antibiotics for prophylaxis of infection in adults with catheters who are undergoing hemodialysis. DATA EXTRACTION:Two independent reviewers assessed studies for inclusion, quality, and extracted data. DATA SYNTHESIS:Fixed-effects models were used to estimate pooled rate ratios for outcomes. Topical antibiotics reduced the rate of bacteremia (rate ratio, 0.22 [95% CI, 0.12 to 0.40]; 0.10 vs. 0.45 case of bacteremia per 100 catheter-days), exit-site infection (rate ratio, 0.17 [CI, 0.08 to 0.38]; 0.06 vs. 0.41 case of infection per 100 catheter-days), need for catheter removal, and hospitalization for infection. Intraluminal antibiotics reduced the rate of bacteremia (rate ratio, 0.32 [CI, 0.22 to 0.47]; 0.12 vs. 0.32 case of bacteremia per 100 catheter-days) and need for catheter removal. Intraluminal antibiotics did not significantly reduce the rate of exit-site infection, and no hospitalization data were available for these agents. LIMITATIONS:The evidence base included only 16 trials, and most had less than 6 months of follow-up. Only one third of studies were blinded. Publication bias was evident. CONCLUSION:Both topical and intraluminal antibiotics reduced the rate of bacteremia as well as the need for catheter removal secondary to complications. Whether these strategies will lead to antimicrobial resistance and loss of efficacy over longer periods remains unclear.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:There is paucity of information on what happens to the migraine attack after withdrawal of prophylactic drugs. In this study we report the outcome of migraine patients after withdrawal of prophylactic medication and also predictors of long-term remission. METHODS:Migraine patients on prophylactic treatment followed for 1 year were included. Their detailed demographic and clinical information were noted. The patients were followed up at 3, 6, 9, and 12 months. At 6 months, if patients had more than four migraine attacks per month in the last 2 months, they were gradually withdrawn from the treatment. The recurrence of headache during or after withdrawal was noted including its severity, frequency, and the number of analgesic used. The baseline characteristics of the patients with remission and relapse were compared. The predictors of long-term remission were also evaluated. RESULTS:One hundred and twenty-seven patients whose median age was 32 years were included. At 6 months withdrawal of prophylactic drug was attempted in 68 patients but was successful in 48 patients only, because 20 relapsed. At 1 year, 70 (63·6%) patients needed prophylactic treatment and drug could be stopped in 40 patients only. The remission was achieved after withdrawal of drug in 48 (43·6%) patients at 6 months, 43 (39·1%) at 9 months, and 40 (36·4%) at 1 year. The most important predictors of persistent remission were improvement at 3 months (P = 0·02) and precipitating factors of migraine (P = 0·005). CONCLUSION:The majority of migraine patients need long-term prophylactic treatment. The patients who respond by 3 months of treatment are more likely to have long-term remission.

背景与目标：

BACKGROUND & AIMS: :Essentials Prophylaxis is the standard of care for congenital factor XIII-A (FXIII-A) deficiency. Six children with FXIII-A deficiency received once-monthly prophylaxis with recombinant FXIII-A. Prophylaxis was well tolerated and no anti-FXIII antibodies were detected. Prophylaxis was effective with an annualized bleeding rate of zero. SUMMARY:Background Factor XIII deficiency is a rare, severe congenital bleeding disorder. Monthly prophylaxis with recombinant FXIII A-Subunit (rFXIII) has demonstrated favorable safety and efficacy in patients aged ≥ 6 years, and may similarly benefit younger children. Objective To evaluate the long-term safety and efficacy of rFXIII in children aged < 6 years with congenital FXIII A-subunit deficiency. Patients/methods Six children, who had previously completed a single-dose pharmacokinetic trial of rFXIII, received 35 IU kg-1 rFXIII every 28 days (± 2 days) for a minimum of 52 weeks, and were evaluated for bleeding and adverse events. The Berichrom FXIII activity assay was used to monitor FXIII activity. Results The children, three girls and three boys, had an average age of 3.0 years (range: 1-4 years) at enrollment. The total treatment duration was 1.8-3.5 years, giving a total of 16.6 patient-years. No antibody development, thromboembolic events or allergic reactions occurred. There were 93 mild and seven moderate adverse events. Two adverse events (lymphopenia and gastroenteritis) were reported as probably or possibly related to rFXIII in two children. Two serious adverse events, unrelated to rFXIII, were reported in a single child, each related to head injury, and neither resulting in intracranial hemorrhage. The geometric mean FXIII activity trough was 0.19 IU mL-1 . No bleeding episodes requiring treatment with an FXIII-containing hemostatic agent occurred during the trial; thus, the annualized bleeding rate was 0. Conclusions Consistent with data from older age groups, prophylaxis with rFXIII appears to be safe and effective in young children with congenital FXIII A-subunit deficiency.

背景与目标：

BACKGROUND & AIMS: :The prevention of venous thromboembolism is a major concern in cancer patients undergoing pelvic surgery. Radical retropubic prostatectomy is a common treatment for localized prostate cancer and has been identified as a high risk procedure for postoperative venous thromboembolism. However, most patients diagnosed with prostate cancer in the current era have clinically localized, low volume disease and the risk of venous thromboembolism is very low. Multiple guidelines exist for the prevention of venous thromboembolism in patients undergoing radical retropubic prostatectomy and pharmacological venous thromboembolism prophylaxis is recommended. Most urological surgeons in the USA however, do not routinely utilize pharmacological prophylaxis. A major concern arises when radical retropubic prostatectomy is performed with a concomitant pelvic lymphadenectomy. Pharmacological prophylaxis is known to increase the rate of lymph drainage and the rate of lymphocele formation. Evidence suggests that lymphocele may be an independent risk factor for venous thromboembolism in the postoperative period. These factors raise concern over current guidelines calling for routine use of pharmacological venous thromboembolism prophylaxis in radical retropubic prostatectomy especially when lymphadenectomy is performed simultaneously.

背景与目标： : 预防静脉血栓栓塞是接受骨盆手术的癌症患者的主要关注点。耻骨后前列腺根治术是局部前列腺癌的常见治疗方法，已被确定为术后静脉血栓栓塞的高风险手术。但是，当今时代诊断为前列腺癌的大多数患者都具有临床局限性，低体积的疾病，并且发生静脉血栓栓塞的风险非常低。在接受根治性耻骨后前列腺切除术的患者中，有多种预防静脉血栓栓塞的指南，建议使用药物预防静脉血栓栓塞。然而，美国大多数泌尿外科医生并不常规使用药物预防。当进行根治性耻骨后前列腺切除术并同时进行盆腔淋巴结清扫术时，会引起主要关注。已知药物预防会增加淋巴引流率和淋巴囊肿形成率。有证据表明，淋巴囊肿可能是术后静脉血栓栓塞的独立危险因素。这些因素引起了人们对当前指南的关注，该指南要求在根治性耻骨后前列腺切除术中常规使用药理学静脉血栓栓塞预防，尤其是同时进行淋巴结清扫术时。

BACKGROUND & AIMS: BACKGROUND:Optimal prophylaxis against cytomegalovirus (CMV) disease for organ transplant patients at risk for primary infection (donor seropositive, recipient seronegative, D+R-) remains to be determined. We hypothesized that prolonged oral ganciclovir therapy following intravenous therapy would provide increased protection. METHODS:A total of 155 evaluable D+R- organ transplant recipients from 13 transplant centers were entered into the study: all received intravenous ganciclovir (5 mg/kg/day) for 5-10 days and then either oral acyclovir (400 mg tid) or oral ganciclovir (1 g tid) for an additional 12 weeks. Patients were assigned to their treatment groups at a central randomization site, with a separate randomization scheme for each of the organs transplanted (kidney, heart, or liver). In the case of kidney transplants, the patients were stratified according to source of the kidney (living related vs. cadaveric donor). The primary endpoint was the incidence of CMV disease in the first six months post-transplant. RESULTS:Treatment with oral ganciclovir was associated with a significant decrease in the incidence of symptomatic disease or viremia when compared with the oral acyclovir group (32% vs. 50%, P<0.05). This difference was most marked in terms of tissue invasive disease: only 3 of 15 symptomatic patients in the ganciclovir group vs. 10 of 21 in the acyclovir group developed tissue-invasive infection (P<0.05). There was a significant difference in the time to CMV disease or viremia in the two groups: mean time 212+/-17 days post-transplant for the acyclovir group vs. 291+/-13 days for the ganciclovir group (P<0.001). The incidence of allograft rejection was 34% in the ganciclovir group and 46% in the acyclovir group (P=NS). Leukopenia was more common in the ganciclovir group (P<0.05), but in no case did it require drug discontinuation. Ganciclovir resistance did not develop in this study. CONCLUSION:Prophylaxis with oral ganciclovir following a brief course of intravenous ganciclovir provides useful protection against primary CMV disease.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The authors conducted an in vivo study to determine if low-speed handpiece motors can become contaminated with oral flora when used with prophylaxis angles. METHODS:This crossover study involved 20 subjects, two types of handpieces and three prophylaxis angles. The authors used each handpiece/prophylaxis angle system to polish teeth. They then collected samples, spiral-plated the specimens and incubated them at 37 degrees C anaerobically and aerobically (with 5 percent carbon dioxide). After incubation, the authors examined the plates for the presence of bacterial colonies. RESULTS:At least 75 percent of the handpiece/prophylaxis angle systems used on the 20 subjects had bacterial contamination for at least one cultured area. Of the 420 specimens, 258 (61.4 percent) produced bacterial growth. Contamination varied from zero to 6,300 colony-forming units per milliliter. CONCLUSIONS:These data suggest that the internal surfaces of low-speed handpieces can become microbially contaminated during use with prophylaxis angles. CLINICAL IMPLICATIONS:Unless low-speed handpieces are sterilized properly after each use, they pose a risk for crossinfection.

背景与目标：

BACKGROUND & AIMS: :One of the most common reasons for failure of primary total knee arthroplasty and need for revision surgery is periprosthetic infection. Antibiotics are one of the mainstays of treatment to address prosthetic joint infections, but the route of administration and timing of delivery to optimize patient outcomes are debated. This article reviews the use and attributes of commonly used oral antibiotics, especially extended or long-term utilization, as prophylaxis and treatment for prosthetic joint infections in a primary or revision total knee arthroplasty, which include debridement, antibiotics, and implant retention, one-stage and two-stage exchange arthroplasty.

背景与目标： : 初次全膝关节置换术失败和需要翻修手术的最常见原因之一是假体周围感染。抗生素是治疗假体关节感染的主要手段之一，但给药途径和给药时机以优化患者预后仍存在争议。本文回顾了常用的口服抗生素的用途和属性，尤其是长期或长期使用，作为预防和治疗原发性或翻修全膝关节置换术中的假体关节感染，包括清创术，抗生素和植入物保留，一阶段和两阶段交换关节置换术。

BACKGROUND & AIMS: :Our aim was to investigate the correlation among antibiotic prophylaxis, difficulty of extraction, and postoperative complications in the removal of lower 3rd molars. A total of 1222 such extractions in 890 patients between January 2010 and January 2012 were analysed retrospectively. The difficulty of extraction measured by Pederson's index, antibiotic prophylaxis with cefditoren, and postoperative complications were recorded. The difficulty of extraction was significantly associated with postoperative complications (p=0.03). There were no significant associations between antibiotic prophylaxis and postoperative complications in groups of equal difficulty ("easy" group (class I) p=1.00; "moderate" group (class II) p=1.00; and "difficult" group (class III) p=0.65). There was a small but insignificant increase in the number of dry sockets and infections in class III cases. In conclusion, this study provides further evidence that antibiotic prophylaxis for the prevention of postoperative inflammatory complications is unnecessary for extraction of 3rd molars.

背景与目标： : 我们的目的是研究抗生素预防，拔除困难和术后并发症之间的相关性。回顾性分析了2010年1月和2012年1月之间的890例患者中的1222例此类提取物。记录peterson指数测量的提取难度，头孢托仑预防抗生素和术后并发症。拔除困难与术后并发症显著相关 (p = 0.03)。在同等困难的组 (“轻松” 组 (I类) p = 1.00; “中度” 组 (II类) p = 1.00; 和 “困难” 组 (III类) p = 0.65) 中，抗生素预防与术后并发症之间没有显着关联。在III类病例中，干插座和感染的数量略有增加，但微不足道。总之，这项研究提供了进一步的证据，表明抗生素预防预防术后炎症并发症对于拔除第三磨牙是不必要的。

BACKGROUND & AIMS: :The emergence of fluoroquinolone-resistant gram-negative organisms has been demonstrated in patients given fluoroquinolone prophylaxis. To prevent increases in resistant bacteria, we restricted prophylactic use of fluoroquinolones. The spectrum and susceptibility patterns of isolates causing bloodstream infection (BSI) were assessed in patients receiving chemotherapy during periods of routine prophylaxis (period A: October 2001 to May 2003) and restricted prophylaxis (period B: June 2003 to January 2005). The total number of patients receiving chemotherapy was 442 during period A and 365 during period B. No significant differences were seen between periods with respect to patient characteristics. BSI was identified in 42 patients (44 episodes) during period A and 69 patients (74 episodes) during period B. Incidence of BSI increased significantly from 10.0% (44/442) during period A to 20.3% (74/365) during period B (P < 0.0001). Rate of Enterobacteriaceae BSI increased significantly, from 2.0% (9/442) during period A to 8.2% (30/365) during period B (P < 0.0001). For all BSI episodes, the proportion of BSI with gram-positive cocci decreased from 63.6% (28/44) during period A to 44.6% (33/74) during period B (P = 0.045), while the proportion of BSI with Enterobacteriaceae increased from 20.5% (9/44) to 40.5% (30/74) (P < 0.0001). The proportion of fluoroquinolone-resistant Enterobacteriaceae BSI for all Enterobacteriaceae BSI decreased from 75% (9/12) during period A to 17% (5/30) during period B (P = 0.0078). Restriction of fluoroquinolone prophylaxis affects the etiology of BSI and reduces the proportion of drug-resistant organisms.

背景与目标： : 在给予氟喹诺酮预防的患者中，已经证实出现了对氟喹诺酮类耐药的革兰氏阴性生物。为了防止耐药细菌增加，我们限制了氟喹诺酮类药物的预防性使用。在常规预防 (A期: 2003年5月2001年10月) 和限制性预防 (B期: 2005年1月2003年6月) 期间接受化疗的患者中，评估了引起血流感染 (BSI) 的分离株的谱和易感性模式。接受化疗的患者总数在A期442，在B期365。就患者特征而言，不同时期之间没有显著差异。在A期42例患者 (44次发作) 和B期69例患者 (74次发作) 中鉴定出BSI。BSI的发生率从A期的10.0% (44/442) 显着增加到B期的20.3% (74/365) (P <0.0001)。肠杆菌科BSI的比率显着增加，从A期的2.0% (9/442) 增加到B期的8.2% (30/365) (P <0.0001)。对于所有BSI发作，具有革兰氏阳性球菌的BSI比例从A期的63.6% (28/44) 降至B期的44.6% (33/74) (P = 0.045)，而BSI与肠杆菌科的比例从20.5% (9/44) 增加到40.5% (30/74) (P <0.0001)。所有肠杆菌科BSI中耐氟喹诺酮的肠杆菌科BSI的比例从A期的75% (9/12) 降至B期的17% (5/30) (P = 0.0078)。氟喹诺酮预防的限制会影响BSI的病因并降低耐药生物的比例。

BACKGROUND & AIMS: :Intrauterine fetal death and maternal shock occurred as a result of a type-1 hypersensitivity reaction following antibiotic prophylaxis in a cesarean section. Amniotic fluid embolism may mimic the condition. The ability to diagnose and treat such an event as early as possible is necessary in all maternity centers. The selection of antibiotic regimen and the type of anesthesia should be individualized depending upon the existing facilities and the patient's profile, especially in a resource-scarce developing country.

背景与目标： : 剖宫产术后使用抗生素预防后，由于1型超敏反应而导致宫内胎儿死亡和产妇休克。羊水栓塞可能模仿这种情况。所有产科中心都必须具备尽早诊断和治疗此类事件的能力。抗生素方案的选择和麻醉类型应根据现有设施和患者的情况进行个性化选择，尤其是在资源稀缺的发展中国家。

BACKGROUND & AIMS: :Although acyclovir prophylaxis against varicella zoster virus (VZV) infection for ≥1 year is recommended after allogeneic hematopoietic cell transplantation (HCT), the emergence of acyclovir-resistant viruses and adverse drug effects cannot be ignored. We investigated the cumulative incidence of VZV infection after allogeneic HCT in children receiving a shorter duration of acyclovir prophylaxis than recommended and evaluated the appropriateness of the short duration of acyclovir prophylaxis.Medical records of 217 children who received allogeneic HCT were retrospectively reviewed until a median of 25 months (range = 1-59 months) after HCT. Acyclovir prophylaxis was given for a median of 9 weeks (range = 3-24 weeks) after HCT.VZV infection was diagnosed in 33 (15.2%) children at a median time of 5 months (range = 2-41 months) after HCT. The 1-year and 2-year cumulative incidences of VZV infection after allogeneic HCT were 11.2% and 15.5%, respectively. These incidences were between the previously reported 1-year incidence of 25% to 30% in patients not receiving prophylaxis and 1-year incidence of 4% to 5% in patients receiving ≥1 year duration of prophylaxis. Male sex and older age were significantly associated with VZV infection after allogeneic HCT. Only 1 chickenpox patient experienced severe complications because of VZV infection, and there were no deaths attributable to VZV infection.In conclusion, a shorter duration of acyclovir prophylaxis may be appropriate for children receiving allogeneic HCT, based on the rare occurrence of severe complications because of VZV infection and the expected discomfort because of daily oral medication for a long time.

背景与目标： : 尽管异基因造血细胞移植 (HCT) 后建议使用阿昔洛韦预防水痘带状疱疹病毒 (VZV) 感染 ≥ 1年，但阿昔洛韦耐药病毒的出现和药物不良反应不容忽视。我们调查了接受阿昔洛韦预防时间比推荐时间短的儿童在异基因HCT后VZV感染的累积发生率，并评估了阿昔洛韦预防时间短的适当性。回顾性回顾了接受异基因HCT的217名儿童的病历，直到中位数为25个月 (范围   = 1-59个月)) 在HCT之后。在HCT后的中位时间为9周 (范围   =   3-24周) 给予阿昔洛韦预防治疗。在HCT后的中位时间为5个月 (范围   =   2-41个月) 的33 (15.2%) 名儿童中诊断出VZV感染。异基因HCT后VZV感染的1年和2年累积发生率分别为11.2% 和15.5%。这些发生率介于先前报道的未接受预防的患者1年25% 至30% 的发生率和接受 ≥ 1年预防持续时间的患者1年4% 至5% 的发生率之间。同种异体HCT后，男性和年龄较大与VZV感染显着相关。只有1名水痘患者因VZV感染而出现严重并发症，并且没有因VZV感染而导致的死亡。总之，较短的阿昔洛韦预防时间可能适合接受同种异体HCT的儿童。基于因VZV感染而罕见的严重并发症的发生，以及因长期每日口服药物而预期的不适。