BACKGROUND & AIMS: Mice which have recovered from Babesia microti infection lose their parasitaemia as soon as three weeks after recovery and become solidly immune. This sterile immunity is not affected by splenectomy and may last for the life of the mouse. Mice which have recovered from B. hylomysci infection continue to harbour parasites at a subpatent level and spontaneous relapses were common after recovery. Hence the type of immunity which developed against this parasite is premunition and may last for life. Such immunity was not absolute and considerable parasitaemias developed after challenge. Cross-protection occurred between the two species of parasite.

背景与目标： 从巴氏杆菌微量感染中恢复过来的小鼠在恢复后三周之内就失去了寄生虫血症，并具有牢固的免疫力。这种无菌免疫不受脾切除术的影响，并且可以持续小鼠的一生。从hypoyysci感染中恢复的小鼠继续在亚专利水平上携带寄生虫，并且恢复后自发复发很常见。因此，针对这种寄生虫而产生的免疫力类型是弹药，可能会持续一生。这种免疫力不是绝对的，在攻击后会产生大量的寄生虫病。两种寄生虫之间发生交叉保护。

BACKGROUND & AIMS: :Community-acquired Clostridium difficile infection (CA-CDI) is a growing concern. CA-CDI differs from hospital-acquired C. difficile infection (HA-CDI) in its epidemiology, risk factors, severity, and outcomes. In this study, we investigated C. difficile infections in a tertiary care hospital in Seoul, Korea, and compared the CA-CDI and HA-CDI cases diagnosed in the same period. Total 593 cases were confirmed as CDI in 2014, of which CA-CDI accounted for 68 (11.5%) of the total CDI cases. Compared with HA-CDI, the mean age of CA-CDI cases was lower than that of HA-CDI (42.7 vs 60.4). In CA-CDI, antibiotic and proton pump inhibitor (PPI) use in the 12 preceding weeks and concurrent chemotherapy and tube feeding were less frequent compared with HA-CDI. In most cases (63/68, 92.6%), patients with CA-CDI recovered without any complications or recurrence. The most prevalent C. difficile type in CA-CDI cases was PCR-ribotype 012, accounting for 18.3% of the total, followed by PCR-ribotype 018 (16.7%).

背景与目标： ：社区获得性艰难梭菌感染（CA-CDI）引起了越来越多的关注。 CA-CDI的流行病学，危险因素，严重性和结局与医院获得性艰难梭菌感染（HA-CDI）不同。在这项研究中，我们调查了韩国首尔一家三级医院的艰难梭菌感染情况，并比较了同期诊断出的CA-CDI和HA-CDI病例。 2014年，共有593例确诊为CDI病例，其中CA-CDI占CDI总数的68（11.5％）。与HA-CDI相比，CA-CDI病例的平均年龄低于HA-CDI（42.7对60.4）。在CA-CDI中，与HA-CDI相比，前12周使用抗生素和质子泵抑制剂（PPI）的频率较低，同时进行化学疗法和试管喂养的频率较低。在大多数情况下（63 / 68，92.6％），CA-CDI患者康复后没有任何并发​​症或复发。在CA-CDI病例中，最常见的艰难梭菌类型是PCR核型012，占总数的18.3％，其次是PCR核型018（16.7％）。

BACKGROUND & AIMS: OBJECTIVE:Urinary tract infections (UTIs) are the most common type of hospital-acquired infection, and most are associated with indwelling urinary catheters, that is, catheter-associated UTIs (CAUTIs). Our goal was to reduce the CAUTI rate. DESIGN: SETTING: INTERVENTIONS:We retrospectively examined the feasibility and cost-effectiveness of a bundle of four evidence-based interventions upon the incidence rate (IR) of CAUTIs in a community hospital. The first intervention was the exclusive use of silver alloy catheters in the hospital's acute care areas. The second intervention was a securing device to limit the movement of the catheter after insertion. The third intervention was repositioning of the catheter tubing if it was found to be touching the floor. The fourth intervention was removal of the indwelling urinary catheter on postoperative Day 1 or 2, for most surgical patients. MAIN OUTCOME MEASURE:Rates of CAUTI per 1000 catheter days were estimated and compared using the generalized estimating equations Poisson regression analysis. RESULTS:During the study period, 33 of the 2228 patients were diagnosed with a CAUTI. The CAUTI IR for the pre-intervention period was 5.2/1000. For the 7 months following the implementation of the fourth intervention, the IR was 1.5/1000 catheter days, a significant reduction relative to the pre-intervention period (P = 0.03). The annualized projection for the cost of implementing this bundle of four interventions is $23 924. CONCLUSION:A bundle of four evidence-based interventions reduced the incidence of CAUTIs in a community hospital. It is relatively simple, appears to be cost-effective and might be sustainable and adaptable by other hospitals.

背景与目标： 目的：尿路感染（UTIs）是医院获得性感染的最常见类型，且多数与留置导尿管（即导管相关的UTIs（CAUTIs））相关。我们的目标是降低CAUTI率。
设计：
环境：
干预措施：我们回顾了社区医院中CAUTI发生率（IR）的四种循证干预措施的可行性和成本效益。最初的干预措施是在医院的急诊区域独家使用银合金导管。第二种干预措施是固定装置，以限制插入后导管的运动。第三次干预是重新定位导管管道，如果发现导管管道接触地面。对于大多数外科手术患者，第四项干预措施是在术后第1天或第2天取下留置导尿管。
主要观察指标：采用广义估计方程泊松回归分析法估算并比较每1000导管日的CAUTI率。
结果：在研究期间，2228例患者中有33例被诊断出患有CAUTI。干预前的CAUTI IR为5.2 / 1000。在实施第四次干预后的7个月中，IR为1.5 / 1000导管天，相对于干预前期显着减少（P = 0.03）。实施这四项干预措施的年度成本预测为23 924美元。
结论：四种基于证据的干预措施减少了社区医院中CAUTI的发生。它相对简单，似乎具有成本效益，并且可能是可持续的并且可以被其他医院适应。

BACKGROUND & AIMS: :Urinary tract infections are a real public health problem. They are a frequent reason for consultation as they entail a significant and sometimes inappropriate prescription of antibiotics. This is a retrospective study which involved 1,334 patients between October 2007 and February 2011. Enterobacteriaceae accounted for 85% of isolated bacteria, predominantly Escherichia coli (60%). Gram-positive bacteria account for only 11%. The highest rate of acquired resistance of Escherichia coli was observed with ampicillin (70%). This study give an idea on the rates of antibiotic resistance of the main bacteria involved in urinary tract infections and illustrate the importance of the proper use of antibiotics coupled to surveillance in order to control the spread of these resistances.

背景与目标： ：尿路感染是一个真正的公共卫生问题。它们是进行咨询的常见原因，因为它们需要使用大量有效的抗生素处方，有时甚至是不合适的处方。这是一项回顾性研究，涉及2007年10月至2011年2月之间的1,334例患者。肠杆菌科细菌占分离细菌的85％，主要是大肠杆菌（60％）。革兰氏阳性细菌仅占11％。氨苄青霉素（70％）观察到最高的获得性大肠埃希菌耐药率。这项研究给出了尿路感染中涉及的主要细菌对抗生素耐药率的观点，并说明了正确使用抗生素与监测相结合以控制这些耐药性传播的重要性。

BACKGROUND & AIMS: PURPOSE:To evaluate the outcomes of the patients who were infected with colistin-only-susceptible (COS) Acinetobacter baumannii and treated with either colistin monotherapy or colistin combined therapy. MATERIALS AND METHODS:This retrospective case-control study was conducted in the training and research hospital with an 800 beds between August 2008 and December 2011. The patients, who were infected with COS A. baumannii and received either colistin monotherapy or colistin combined therapy, were included into the study. RESULTS:In total, 51 patients fulfilling study criteria were evaluated. Colistin monotherapy was found effective as much as colistin combined therapy in terms of clinical and microbiological responses in patients with ventilator associated pneumonia (VAP) and also in patients with blood stream infections. CONCLUSION:Although there is no randomised controlled study yet, colistin monotherapy and colistin combined therapy are likely to achieve similar treatment responses rates. Heteroresistant strains can emerge in patients who receive colistin monotherapy.

背景与目标： 目的：评估感染仅大肠埃希菌敏感（COS）鲍曼不动杆菌并接受大肠素单药治疗或大肠素单药联合治疗的患者的预后。
材料与方法：该回顾性病例对照研究于2008年8月至2011年12月在训练与研究医院拥有800张床位的医院进行。被纳入研究。
结果：总共评估了51名符合研究标准的患者。就呼吸机相关性肺炎（VAP）患者以及血流感染患者而言，在临床和微生物反应方面，发现共利斯汀​​单药疗法与大肠菌素联合疗法一样有效。
结论：尽管尚无随机对照研究，但粘菌素单药疗法和粘菌素联合疗法可能达到相似的治疗反应率。接受粘菌素单药治疗的患者会出现异种耐药株。

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： 背景：与导管相关的感染会导致血液透析患者的发病和死亡。
目的：探讨在接受血液透析的成年人中，与不使用抗生素治疗相比，局部或腔内抗生素是否可减少与导管相关的血液感染。
数据来源：截止到2007年10月的电子数据库，审判登记簿，参考书目和会议记录，没有语言限制。
研究选择：两名评价者独立选择了局部或腔内抗生素治疗患有血液透析的成人导管感染的随机对照试验。
数据提取：两名独立的审阅者对研究的纳入，质量和提取的数据进行了评估。
数据综合：固定效应模型用于估计结果的合并比率。外用抗生素降低了菌血症的发生率（比率，0.22 [95％CI，0.12至0.40]； 0.10对0.45例细菌血症，每100个导管日），出部位感染（比率，0.17 [CI，0.08至[0.38]；每100个导管日感染0.06例vs.0.41例），需要拔除导管并进行感染住院。腔内抗生素降低了菌血症发生率（比率比率，每100个导管日为0.32 [CI，0.22至0.47]； 0.12比0.32例菌血症），并且需要移除导管。腔内抗生素并没有显着降低出口部位感染的发生率，也没有这些药物的住院数据。
局限性：证据仅包括16个试验，并且大多数随访时间少于6个月。只有三分之一的研究是盲目的。出版偏见显而易见。
结论：局部和腔内抗生素均可降低菌血症发生率，并减少因并发症而需要拔除导管的情况。这些策略是否会在较长时期内导致抗药性和药效下降尚不清楚。

BACKGROUND & AIMS: :Biomaterial-related infection of joint replacements is the second most common cause of implant failure, with serious consequences. Chronically infected replacements cannot be treated without removal of the implant, as the biofilm mode of growth protects the bacteria against antibiotics. This review discusses biofilm formation on joint replacements and the important clinical phenomenon of small-colony variants (SCVs). These slow-growing phenotypic variants often remain undetected or are misdiagnosed using hospital microbiological analyses due to their unusual morphological appearance and biochemical reactions. In addition, SCVs make the infection difficult to eradicate. They often lead to recurrence since they respond poorly to standard antibiotic treatment and can sometimes survive intracellularly.

背景与目标： ：关节置换的生物材料相关感染是植入失败的第二大最常见原因，其后果很严重。如果不移除植入物，就不能治疗长期感染的替代品，因为生物膜的生长方式可以保护细菌免受抗生素的侵害。这篇综述讨论了关节置换上生物膜的形成以及小菌落变异体（SCV）的重要临床现象。这些缓慢生长的表型变异体由于其异常的形态学外观和生化反应，经常被医院的微生物学分析所发现或误诊。此外，SCV使感染难以根除。它们通常导致复发，因为它们对标准抗生素治疗反应差，有时可以在细胞内存活。

BACKGROUND & AIMS: OBJECTIVES:To assess the clinical effectiveness and cost-effectiveness of central venous catheters (CVCs) treated with anti-infective agents in preventing catheter-related bloodstream infection (CRBSI). DATA SOURCES:Major electronic databases were searched from 1985 to August 2005. REVIEW METHODS:The systematic clinical and economic reviews were conducted according to accepted procedures. Only full economic evaluations (synthesis of costs and benefits) comparing the use of anti-infective central venous catheters (AI-CVCs) with untreated CVCs or other treated catheters were selected for inclusion in the economic review. RESULTS:A total of 32 trials met the clinical inclusion criteria. Seven different types of AI-CVC were identified, with the most frequently tested being chlorhexidine and silver sulfadiazine (CHSS) (externally treated), CHSS (externally and internally treated) and minocycline rifampicin (internally and externally treated). In general, the trials were of a poor quality in terms of reported methodology, microbiological relevance and control of confounding variables. The pooled result suggests a statistically significant advantage for AI-CVCs in comparison to standard catheters in reducing CRBSI [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.34 to 0.60, 24 studies, I-squared = 0%, fixed effects]. Analysis by subgroups of catheters demonstrates that antibiotic-treated catheters and catheters treated internally and externally decrease CRBSI rates significantly (OR 0.26, 95% CI 0.15 to 0.46, six studies, I-squared = 0%, fixed effects, and OR 0.43, 95% CI 0.26 to 0.70, nine studies, I-squared = 0%, fixed effects, respectively). Catheters treated only externally demonstrate a wider CI and non-significant effect (OR 0.67, 95% CI 0.43 to 1.06, nine studies, I-squared = 0%, fixed effects). A treatment effect was also found for trials with an average duration of between 5 and 12 days, and for the one study with a mean duration of over 20 days. There was a statistically significant treatment effect for both femoral and jugular insertion sites and for those studies reporting a mix of insertion sites. The treatment effect was not observed in trials using exclusively subclavian insertion sites. Of the four trials that compared treated catheters, one reported a benefit of antibiotic-treated catheters over catheters treated externally with CHSS. All three sensitivity analyses testing for study design differences reported a statistically significant treatment effect. The review was limited owing to the quality of the trials included, marked differences in the definitions and methods of diagnosis of CRBSI, and inconsistent reporting of risk factors and patient population factors. Furthermore, two-thirds of trials were commercially funded. The economic performance (cost-effectiveness and potential cost-savings) of using AI-CVCs to reduce the number of CRBSIs in patients requiring a CVC was also reviewed. Results show that the use of AI-CVCs instead of standard CVCs can lead to a reduction in CRBSIs and decreased medical costs. To complement the reviews, a basic decision-analytic model was constructed to explore a range of possible scenarios for the NHS in England and Wales. Results show that for every patient who receives an AI-CVC there is an estimated cost-saving of 138.20 pounds. The multivariate sensitivity analyses estimate potentially large cost-savings, depending on the size of the population, under a wide range of cost and clinical assumptions. However, those considering the purchase of AI-CVCs should ensure that their patient populations and the important characteristics of local clinical practice are indeed similar to those described in this economic evaluation. CONCLUSIONS:Overall, AI-CVCs are clinically effective and relatively inexpensive and therefore their integration into clinical practice can be justified. However, the use of these anti-infective catheters without the appropriate use of other practical care initiatives will have only a limited success on the prevention of CRBSIs. Comparative trials are required to determine which, if any, of the treated catheters is the most effective. Pragmatic research related to the effectiveness of bundles of care that may reduce rates of CRBSI is also warranted.

背景与目标： 目的：评估用抗感染药治疗的中心静脉导管（CVC）在预防导管相关的血流感染（CRBSI）方面的临床效果和成本效益。
数据来源：从1985年到2005年8月，检索了主要的电子数据库。
审查方法：根据公认的程序进行系统的临床和经济审查。只有将将抗感染中心静脉导管（AI-CVC）与未经治疗的CVC或其他经过治疗的导管进行比较的全面经济评估（成本和收益的综合）才被选入经济评估。
结果：总共32项试验符合临床纳入标准。鉴定出七种不同类型的AI-CVC，最常测试的是洗必太和磺胺嘧啶银（CHSS）（外部治疗），CHSS（外部和内部治疗）和米诺环素利福平（内部和外部治疗）。总体而言，就报告的方法学，微生物学相关性和混杂变量的控制而言，这些试验的质量较差。汇总结果表明，与标准导管相比，AI-CVC在降低CRBSI方面具有统计学上的显着优势[比值比（OR）0.45，95％置信区间（CI）0.34至0.60，24个研究，I平方= 0％，固定效果]。导管亚组的分析表明，抗生素治疗过的导管和内外治疗过的导管显着降低了CRBSI率（OR 0.26，95％CI 0.15至0.46，六项研究，I平方= 0％，固定效应，OR 0.43，95 ％CI 0.26至0.70，九项研究，I平方= 0％，分别为固定效应）。仅经外部治疗的导管显示出较宽的置信区间，且无显着影响（OR为0.67，95％置信区间为0.43至1.06，九项研究，I平方= 0％，固定效应）。对于平均持续时间为5至12天的试验以及平均持续时间超过20天的一项研究，也发现了治疗效果。股骨和颈静脉插入部位以及报告混合插入部位的研究在统计学上均具有显着的治疗效果。在仅使用锁骨下插入位点的试验中未观察到治疗效果。在比较经治疗的导管的四项试验中，有一项报告指出，与经CHSS外部治疗的导管相比，经抗生素治疗的导管有益处。针对研究设计差异的所有三个敏感性分析测试均报告了统计学上显着的治疗效果。由于包括的试验质量，CRBSI的诊断定义和诊断方法存在明显差异以及危险因素和患者人群因素的报告不一致，因此该审查受到了限制。此外，三分之二的试验是由商业资助的。还回顾了使用AI-CVC减少需要CVC的患者的CRBSI数量的经济表现（成本效益和潜在的成本节省）。结果表明，使用AI-CVC代替标准CVC可以减少CRBSI并降低医疗成本。为了补充评论，构建了基本的决策分析模型，以探索英格兰和威尔士的NHS的各种可能方案。结果表明，每位接受AI-CVC的患者估计可节省138.20磅。多元敏感性分析估计，在广泛的成本和临床假设下，取决于人群的规模，可能会节省大量成本。但是，考虑购买AI-CVC的人员应确保其患者人数和当地临床实践的重要特征确实与本经济评估中所述的相似。
结论：总体而言，AI-CVC具有临床效果且相对便宜，因此可以证明将其整合到临床实践中是合理的。但是，在没有适当使用其他实践护理措施的情况下使用这些抗感染导管在预防CRBSI方面仅会取得有限的成功。需要进行比较试验，以确定哪一种治疗过的导管最有效。还必须进行与可能降低CRBSI发生率的护理捆绑的有效性相关的务实研究。

BACKGROUND & AIMS: :Pathogenic bacteria have evolved multiple mechanisms aimed to evade host defenses. This review summarizes selected examples of how bacteria utilize proteolytic enzymes to efficiently establish and spread infection systemically. First, the role of proteases in intracellular survival and persistence - the primary means used by bacteria to endure phagocytosis and/or avoid the vigilance of the immune system - is discussed. Second, it is demonstrated how some bacteria escape entanglement in fibrin(ogen) meshes, by inducing their proteolytic dissolution while other species modify the proteolytic cascade of mesh formation to divert this important innate immune defense for their own benefit. Third, bacterial proteolytic toxins are introduced, which allow microorganisms to exert and take advantage of systemic effects already during primary, localized infection. Finally, it is discussed how viruses utilize bacterial proteases by taking advantage of concurrent infection, and how pathogens may even mutually benefit from the joint presence of other pathogens. The reviewed adaptations are often essential for pathogen survival in the hostile environment of a host organism. As such, the potential benefits of pharmacological interference in relevant pathways for the struggle against bacterial pathogens are also discussed.

背景与目标： ：致病细菌已经进化出多种旨在逃避宿主防御的机制。这篇综述总结了细菌如何利用蛋白水解酶有效地系统建立和传播感染的选定例子。首先，讨论了蛋白酶在细胞内存活和持久性中的作用-细菌用来抵抗吞噬作用和/或避免免疫系统保持警惕的主要手段-。其次，证明了某些细菌如何通过诱导其蛋白水解溶解而逃脱纤维蛋白原网格中的纠缠，而其他物种则通过自身的作用修改了网状结构的蛋白水解级联，从而转移了这种重要的先天免疫防御能力。第三，引入细菌蛋白水解毒素，该毒素使微生物能够在原发性局部感染期间发挥作用并利用全身作用。最后，讨论了病毒如何通过并发感染利用细菌蛋白酶，以及病原体如何甚至可以从其他病原体的共同存在中互惠互利。对于病原体在宿主生物的不利环境中的生存，经过审查的适应性常常是必不可少的。这样，还讨论了药理干预在与细菌病原体作斗争的相关途径中的潜在益处。