Antibiotic

抗生素
  • 文章类型: Journal Article
    在波兰的鸡群中,家禽腺病毒(FAdV)感染的爆发威胁着鸟类的健康和生命,并且频率正在上升。通过对肉鸡的病毒检测以及病例与禽类免疫强度的相关性,分析了在具有发展的临床症状的免疫功能低下的家禽群中这些感染的风险。
    分析了来自西里西亚同一孵化场的四个肉鸡养殖场的样品,波兰的喂养制度不同。向对照农场的鸟类提供正常饮食;正常饮食和益生菌,益生元,维生素和微量元素补充剂在另一个农场提供;正常饮食和抗生素在第三个农场;和正常饮食和两种形式的补充在第四个农场。用六邻体基因L1环高变区1-4引物在PCR中扩增病毒DNA,确定了从尸检组织样品中获得的腺病毒株分离株的分子特征。分析扩增子序列,确定了成对距离,产生了站点速率的伽马参数的最大似然估计,进行Tajima的D中性测试,并计算相对同义密码子使用和转换/颠换偏倚。
    在对照农场的三周龄肉鸡小鸡中分离出两种种类和两种血清型的家禽腺病毒-MW353018-FAdV-1/A-L-肝和MW353019-FAdV-5/B-I-肠。
    用益生菌补充肉鸡群,益生元,维生素和微量元素可能对免疫有显著的有益作用,并可以预防病毒感染。这些研究为从免疫水平低的雏鸡中分离出的腺病毒株的分子特征提供了新的信息。
    UNASSIGNED: Outbreaks of fowl adenovirus (FAdV) infection in chicken flocks in Poland threaten birds\' health and lives and are rising in frequency. The risk of these infections in immunocompromised poultry flocks with developed clinical symptoms was analysed through virus detection in broiler chicks and correlation of cases with the birds\' immune strength.
    UNASSIGNED: Samples were analysed from four broiler farms with chicks from the same hatchery in Silesia, Poland where feeding regimes were different. A normal diet was provided to birds on the control farm; a normal diet and probiotic, prebiotic, vitamin and microelement supplementation was supplied on another farm; a normal diet and antibiotics on the third; and a normal diet and both forms of supplementation were given on the fourth farm. Amplification of the virus DNA in a PCR with hexon gene L1 loop hypervariable region 1-4 primers determined the molecular characteristics of isolates of adenovirus strains obtained from necropsy tissue samples. The amplicon sequences were analysed, the pair-wise distances were determined, the maximum likelihood estimate for the gamma parameter for site rates was produced, Tajima\'s D neutrality test was run and the relative synonymous codon usage and transition/transversion bias were calculated.
    UNASSIGNED: Two species and two serotypes of fowl adenovirus - MW353018-FAdV-1/A-L-liver and MW353019-FAdV-5/B-I-intestine - were isolated in three-week-old broiler chicks on the control farm.
    UNASSIGNED: Supplementation of broiler chicken flocks with probiotics, prebiotics, vitamins and microelements may have a significant beneficial effect on immunity and can prevent virus infection. The studies provided new information on the molecular characteristics of adenovirus strains isolated from chicks with a low level of immunity.
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  • 文章类型: Journal Article
    本研究旨在探讨乳酸乳球菌亚种的抗氧化和抗炎特性。乳酸HFY14(LLSLHFY14),并研究其对肠道屏障的影响,颅神经,和用抗生素治疗的小鼠的运动功能。
    给小鼠服用抗生素混合物(新霉素5mg/mL,万古霉素25mg/mL,两性霉素B0.1mg/mL,氨苄青霉素10mg/mL,甲硝唑文件5毫克/毫升,和脂多糖1.5μg/mL)腹膜内,血清和脑组织中的氧化应激和炎症标志物,测量肝脏指数。进行H&E染色以检测脑组织中的病理改变。使用聚合酶链反应(PCR)检测大脑中肠屏障相关基因和炎症途径相关基因的表达。
    LLSLHFY14给药延长了小鼠的负重游泳和跑步时间,并降低了肝脏指数。此外,丙二醛(MDA)的水平,白细胞介素-6(IL-6),血清和脑组织中肿瘤坏死因子α(TNF-α)均降低,而超氧化物歧化酶(SOD),谷胱甘肽(GSH),白细胞介素-10(IL-10)升高。蛋白激酶B(AKT)/cAMP反应元件结合蛋白(CREB)/脑源性神经营养因子(BDNF)/细胞外信号调节激酶1(ERK1)途径的脑表达升高,IL-6基因的大脑表达减少,盲肠小带1(ZO-1)的表达升高,注意到occludin-1和claudin-1基因。LLSLHFY14补充显着增加了拟杆菌的表达,但降低了Firmicutes的表达,从而增加拟杆菌/厚壁菌的比例。
    总的来说,LLSLHFY14补充剂改善了抗生素诱导的小鼠中枢神经系统的氧化应激和炎症,肠屏障功能障碍,增加了运动功能,从而证实了其作为益生菌的潜在应用。
    UNASSIGNED: This study aimed to explore the anti-oxidative and anti-inflammatory properties of Lactococcus lactis subsp. lactis HFY14 (LLSLHFY14) and investigate its effects on the intestinal barrier, cranial nerve, and motor function in mice treated with antibiotics.
    UNASSIGNED: Mice were administered an antibiotic mixture (neomycin 5 mg/mL, vancomycin 25 mg/mL, amphotericin B 0.1 mg/mL, ampicillin 10 mg/mL, metronidazole file 5 mg/mL, and lipopolysaccharide 1.5 μg/mL) intraperitoneally, and oxidative stress and inflammatory markers in the serum and brain tissues, and liver index were measured. H&E staining was performed to detect pathological alterations in brain tissues. The expression of intestinal-barrier-related genes and that of genes involved in inflammatory pathways in the brain were detected using polymerase chain reaction (PCR).
    UNASSIGNED: LLSLHFY14 administration extended the weight-loaded swimming and running times of mice and decreased the liver index. Moreover, the levels of malondialdehyde (MDA), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) in the serum and brain tissue were reduced, whereas those of superoxide dismutase (SOD), glutathione (GSH), and interleukin-10 (IL-10) were elevated. Elevated brain expression of the protein kinase B (AKT)/cAMP-response element binding protein (CREB)/brain-derived neurotrophic factor (BDNF)/extracellular signal-regulated kinase 1 (ERK1) pathway, decreased brain expression of the IL-6 gene, and elevated cecum expression of zonula occludens-1 (ZO-1), occludin-1, and claudin-1 genes were noted. LLSLHFY14 supplementation significantly increased Bacteroidetes expression but decreased Firmicutes expression, thus increasing the Bacteroidetes/Firmicutes ratio.
    UNASSIGNED: Overall, LLSLHFY14 supplementation ameliorated antibiotic-induced oxidative stress and inflammation in the mouse central nervous system, intestinal barrier dysfunction, and increased motor function, thus confirming its potential application as probiotics.
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  • 文章类型: Journal Article
    重金属离子和抗生素污染已成为世界范围内的主要环境问题。在水溶液中超低浓度的这些污染物的有效识别策略的开发以及内在传感机制的阐明是具有挑战性的任务。在这项工作中,通过合理的配体设计组装了独特的发光Ln-MOF材料(NIIC-3-Ln)。其中,NIIC-3-Tb在小于7s的亚纳摩尔浓度下表现出对Hg2和磺胺嘧啶(SDI)的高度选择性发光猝灭响应。此外,在单晶X射线衍射分析和Hg2+吸附研究的基础上,提出了一种通过螯合的Hg2+传感机理。使用新开发的方法揭示了NIIC-3-Tb与SDI的相互作用机理,该方法涉及基于(TD-)DFT的MOF分析物超分子复合物模型在基态和激发态下的电荷转移定量。通过气体吸附实验揭示了超声处理对MOF传感性能重要的表面形态的影响。结果表明,NIIC-3-Ln不仅是在超低浓度下有效检测Hg2和SDI的先进传感材料,同时也为在超低浓度下研究分子水平的传感机理开辟了新的途径。
    Heavy metal ions and antibiotic contamination have become a major environmental concern worldwide. The development of efficient recognition strategies of these pollutants at ultra-low concentrations in aqueous solutions as well as the elucidation of the intrinsic sensing mechanism are challenging tasks. In this work, unique luminescent Ln-MOF materials (NIIC-3-Ln) were assembled by rational ligand design. Among them, NIIC-3-Tb demonstrated highly selective luminescence quenching response toward Hg2+ and sulfadiazine (SDI) at subnanomolar concentrations in less than 7 s. In addition, a Hg2+ sensing mechanism through chelation was proposed on the basis of single-crystal X-ray diffraction analysis and Hg2+ adsorption study. The interaction mechanism of NIIC-3-Tb with SDI was revealed using a newly developed approach involving a (TD-)DFT based quantification of the charge transfer of a MOF-analyte supramolecular complex model in the ground and excited states. Effect of ultrasonic treatment on the surface morphology important for MOF sensing performance was revealed by gas adsorption experiments. The presented results indicate that NIIC-3-Ln is not only an advanced sensing material for the efficient detection of Hg2+ and SDI at ultra-low concentrations, but also opens up a new approach to study the sensing mechanism at the molecular level at ultra-low concentrations.
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  • 文章类型: Journal Article
    背景:住院新生儿易受感染,抗生素使用率高。
    方法:十四个南非新生儿病房(七个公共,七个私营部门)组建了涉及新生儿学家的多学科小组,微生物学家,药剂师,和护士实施前瞻性审核和反馈新生儿抗菌药物管理(NeoAMS)干预措施。这些团队参加了七个在线培训课程。药剂师在新生儿重症监护病房和/或新生儿病房进行了平日的抗生素处方审查,向临床团队提供反馈。出于描述性目的和统计分析的目的,对匿名的人口统计学和NeoAMS干预数据进行了汇总。
    结果:在2022年进行的为期20周的NeoAMS干预期间,纳入了565名新生儿。药剂师评估了700次抗生素处方发作;排除败血症(180;26%)和培养阴性败血症(138;20%)是抗生素处方的最常见适应症。对于已确定病原体的感染事件,只有51%(116/229)的经验性治疗提供了足够的抗菌药物覆盖率.药剂师推荐437个NeoAMS干预措施(每个抗生素处方发作0·6),抗生素停药(42%),治疗药物监测(17%),和给药(15%)建议最频繁。新生儿临床医生对AMS建议的接受率很高(338;77%)。从9·1到6·9天,平均抗生素治疗时间减少了24%(每个干预周减少0·1天;p=0·001),培养阴性脓毒症的治疗时间缩短最大(8·2天(95CI5·7-11·7)至5·9天(95%CI4·6-7·5);p=0·032)。
    结论:这项新生儿AMS计划在异质和资源有限的环境中成功实施。药剂师推荐的AMS干预措施对临床医生的接受率很高。NeoAMS干预显着减少了新生儿抗生素的使用,特别是培养阴性脓毒症。
    背景:默克公司的一项资助提供了部分支持。
    BACKGROUND: Hospitalised neonates are vulnerable to infection and have high rates of antibiotic utilisation.
    METHODS: Fourteen South African neonatal units (seven public, seven private sector) assembled multidisciplinary teams involving neonatologists, microbiologists, pharmacists, and nurses to implement prospective audit and feedback neonatal antimicrobial stewardship (NeoAMS) interventions. The teams attended seven online training sessions. Pharmacists conducted weekday antibiotic prescription reviews in the neonatal intensive care unit and/or neonatal wards providing feedback to the clinical teams. Anonymised demographic and NeoAMS interventions data were aggregated for descriptive purposes and statistical analysis.
    RESULTS: During the 20-week NeoAMS intervention in 2022, 565 neonates were enrolled. Pharmacists evaluated seven hundred antibiotic prescription episodes; rule-out sepsis (180; 26%) and culture-negative sepsis (138; 20%) were the most frequent indications for antibiotic prescription. For infection episodes with an identified pathogen, only 51% (116/229) of empiric treatments provided adequate antimicrobial coverage. Pharmacists recommended 437 NeoAMS interventions (0·6 per antibiotic prescription episode), with antibiotic discontinuation (42%), therapeutic drug monitoring (17%), and dosing (15%) recommendations most frequent. Neonatal clinicians\' acceptance rates for AMS recommendations were high (338; 77%). Mean antibiotic length of therapy decreased by 24% from 9·1 to 6·9 days (0·1 day decrease per intervention week; p=0·001), with the greatest decline in length of therapy for culture-negative sepsis (8·2 days (95%CI 5·7-11·7) to 5·9 days (95% CI 4·6-7·5); p=0·032).
    CONCLUSIONS: This neonatal AMS programme was successfully implemented in heterogenous and resource-limited settings. Pharmacist-recommended AMS interventions had high rates of clinician acceptance. The NeoAMS intervention significantly reduced neonatal antibiotic use, particularly for culture-negative sepsis.
    BACKGROUND: A grant from Merck provided partial support.
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  • 文章类型: Journal Article
    抗生素耐药性(AMR)是由环境中的抗生素残留引发的不断升级的公共卫生危机。特别是在土壤中,作为抗微生物药物抗性基因(ARGs)的储库。仅量化抗微生物剂的总可提取浓度,而不是生物可利用的部分,可能大大低估了它们传播ARGs的最小选择浓度。为了阐明生物有效性在土壤中ARG丰度中的作用,建立了系统的生物利用度评估方法,以准确地定量中国代表性土壤中多类抗微生物剂的分配。微观世界研究表明,在生物可利用部分中持续存在的抗菌剂可能会延长其选择压力持续时间以触发AMR。值得注意的是,农药或类固醇激素的共同出现影响了ARG亚型的发展趋势,与氟喹诺酮抗性基因(RGs)特别敏感。偏最小二乘路径模型(PLS-PM)分析揭示了抗菌药物的潜在不同诱导机制:可观察到的结果表明,可提取的残留浓度可能对ARGs的发展施加直接选择压力,而生物可利用浓度可能在影响可移动遗传元素的丰度和启动ARG传播方面发挥逐步作用。对土壤中生物可利用的抗微生物剂与ARG丰度之间相互作用的这种前所未有的审查为制定土壤修复的监管政策或指南提供了宝贵的见解。
    Antimicrobial resistance (AMR) stands as an escalating public health crisis fueled by antimicrobial residues in the environment, particularly in soil, which acts as a reservoir for antimicrobial resistance genes (ARGs). Merely quantifying the total extractable concentration of antimicrobials, instead of bioavailable fractions, may substantially underestimate their minimal selection concentration for propagating ARGs. To shed light on the role of bioavailability in ARG abundance within soil, a systematic bioavailability assessment method was established for accurately quantifying the partitioning of multi-class antimicrobials in representative Chinese soils. Microcosm studies unveiled that antimicrobials persisting in the bioavailable fraction could potentially prolong their selection pressure duration to trigger AMR. Notably, the co-occurrence of pesticide or steroid hormone influenced the development trends of ARG subtypes, with fluoroquinolone resistance genes (RGs) being particularly susceptible. Partial least squares path model (PLS-PM) analysis uncovered potentially distinct induction mechanisms of antimicrobials: observable results suggested that extractable residual concentration may exert a direct selection pressure on the development of ARGs, while bioavailable concentration could potentially play a stepwise role in affecting the abundance of mobile genetic elements and initiating ARG dissemination. Such unprecedented scrutinization of the interplay between bioavailable antimicrobials in soils and ARG abundance provides valuable insights into strategizing regulatory policy or guidelines for soil remediation.
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  • 文章类型: Journal Article
    在科学文献中,抗生素在培养基中的长期稳定性仍未得到充分研究。这项研究评估了八种不同的抗生素储备溶液-阿莫西林的稳定性,头孢噻肟,新霉素,土霉素,氟苯尼考,恩诺沙星,粘菌素,并在37°C的胰蛋白tone大豆肉汤(TSB)中增强了磺酰胺及其10倍稀释系列,超过12天。在制备后立即和在第1、2、5、7、9和12天收集样品,使用超高效液相色谱(UHPLC)结合质谱测定活性物质浓度。结果表明,在超纯水原液中,新霉素,氟苯尼考,和强化磺酰胺保持稳定性(>95%)。在培养基中,氟苯尼考在整个研究中表现出一致的稳定性(100%),强化磺酰胺经历轻微降解(>85%),和新霉素经历了显著降解。阿莫西林,土霉素,粘菌素在两种溶液中都显示出相当大的降解,但在超纯水溶液中更稳定。比较时,头孢噻肟和恩诺沙星在超纯水溶液和培养基中的稳定性非常相似;然而,前者的3.6%和后者的88.7%在第12天仍可检测到。这些发现对于最低抑制浓度(MIC)评估至关重要,特别是在最低杀菌浓度(MBC)研究中,以及关于长期进化和共同选择的实验。这项研究强调了在培养基中进行稳定性评估以验证未来实验结果的必要性。
    The long-term stability of antibiotics in culture media remains underexplored in scientific literature. This study evaluated the stability of eight distinct antibiotic stock solutions-amoxicillin, cefotaxime, neomycin, oxytetracycline, florfenicol, enrofloxacin, colistin, and potentiated sulfonamide-and their 10-fold dilution series in tryptone soy broth (TSB) at 37 °C, over 12 days. Samples were collected immediately after preparation and on days 1, 2, 5, 7, 9, and 12, with active substance concentrations measured using ultra-high-performance liquid chromatography (UHPLC) coupled with mass spectrometry. The results indicated that among the ultrapure water stock solutions, neomycin, florfenicol, and potentiated sulfonamide maintained stability (>95%). Within the culture medium, florfenicol showed consistent stability (100%) throughout the study, potentiated sulfonamide experienced minor degradation (>85%), and neomycin underwent significant degradation. Amoxicillin, oxytetracycline, and colistin displayed considerable degradation in both solution types but were more stable in ultrapure water solutions. The stability of cefotaxime and enrofloxacin in ultrapure water solutions and in the medium was very similar when compared; however, 3.6% of the former and 88.7% of the latter remained detectable by day 12. These findings are crucial for minimum inhibitory concentration (MIC) assessments, especially in minimum bactericidal concentration (MBC) studies, and in experiments concerning long-term evolution and co-selection. This study underscores the necessity of stability assessments in culture media to validate future experimental outcomes.
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  • 文章类型: Journal Article
    由产生KPC的肺炎克雷伯菌引起的感染由于其对新的抗微生物剂的新出现的抗性而继续构成重大的临床挑战。我们调查了两种药物之间的关联,这两种药物的作用已针对耐多药细菌重新利用:磷霉素和替莫西林。替莫西林对KPC酶表现出异常的稳定性,而磷霉素则是一种有效的“增效剂”。我们使用磷霉素和替莫西林的组合对100种产KPC的肺炎克雷伯菌的临床分离株进行了体外抗菌活性研究。结果表明在91%的分离物中具有协同活性。随后,我们使用五种基因不同的KPC-Kp分离株评估了对海绵状菌幼虫的影响。向替莫西林中添加磷霉素可将幼虫的存活率从73%提高到97%(Δ32%;分离株1),从93到100%(+Δ7%;隔离2),从63%到86%(+Δ36%;隔离3),从63%到90%(+Δ42%;隔离4),从93到97%(+Δ4%;分离株10)。在产生耐替莫西林KPC的肺炎克雷伯菌分离株(24株)中,在除一个分离株之外的所有分离株中,磷霉素的添加将替莫西林的MIC值降至耐药断点以下。替莫西林与磷霉素联合使用,是对抗产生KPC的肺炎克雷伯菌的有希望的组合,需要进一步的临床评估。
    Infections caused by KPC-producing K. pneumoniae continue to pose a significant clinical challenge due to their emerging resistance to new antimicrobials. We investigated the association between two drugs whose roles have been repurposed against multidrug-resistant bacteria: fosfomycin and temocillin. Temocillin exhibits unusual stability against KPC enzymes, while fosfomycin acts as a potent \"synergizer\". We conducted in vitro antimicrobial activity studies on 100 clinical isolates of KPC-producing K. pneumoniae using a combination of fosfomycin and temocillin. The results demonstrated synergistic activity in 91% of the isolates. Subsequently, we assessed the effect on Galleria mellonella larvae using five genetically different KPC-Kp isolates. The addition of fosfomycin to temocillin increased larvae survival from 73 to 97% (+Δ 32%; isolate 1), from 93 to 100% (+Δ 7%; isolate 2), from 63 to 86% (+Δ 36%; isolate 3), from 63 to 90% (+Δ 42%; isolate 4), and from 93 to 97% (+Δ 4%; isolate 10). Among the temocillin-resistant KPC-producing K. pneumoniae isolates (24 isolates), the addition of fosfomycin reduced temocillin MIC values below the resistance breakpoint in all isolates except one. Temocillin combined with fosfomycin emerges as a promising combination against KPC-producing K. pneumoniae, warranting further clinical evaluation.
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  • 文章类型: Journal Article
    药物之间的相互作用是重症监护病房患者的常见问题,因为他们主要有一个关键的条件,往往需要同时服用多种药物。抗生素是最常用的药物之一,因为在ICU患者中经常观察到感染性疾病。在这次审查中,最重要的抗生素-药物相互作用,基于药代动力学和药效学机制,他们聚集在一起描述。特别是,在同时服用口服抗凝剂的患者中观察到一些与主要抗菌药物的最重要的相互作用,NSAIDs,loop利尿剂,和丙戊酸。因此,药物的活性可以增加或减少,因为剂量修改可能是必要的。应该指出的是,这些关键的相互作用可以帮助预测和避免负面后果,导致更好的患者康复。此外,因为还有其他因素,如液体疗法或白蛋白,这也可能改变抗菌治疗的有效性,麻醉师意识到它们是很重要的。
    Interactions between drugs are a common problem in Intensive Care Unit patients, as they mainly have a critical condition that often demands the administration of multiple drugs simultaneously. Antibiotics are among the most frequently used medications, as infectious diseases are often observed in ICU patients. In this review, the most important antibiotic-drug interactions, based on the pharmacokinetic and pharmacodynamic mechanisms, were gathered together and described. In particular, some of the most important interactions with main groups of antibacterial drugs were observed in patients simultaneously prescribed oral anticoagulants, NSAIDs, loop diuretics, and valproic acid. As a result, the activity of drugs can be increased or decreased, as dosage modification might be necessary. It should be noted that these crucial interactions can help predict and avoid negative consequences, leading to better patient recovery. Moreover, since there are other factors, such as fluid therapy or albumins, which may also modify the effectiveness of antibacterial therapy, it is important for anaesthesiologists to be aware of them.
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  • 文章类型: Journal Article
    尽管抗生素如氯霉素(CAP)的有益作用,它们对人类健康产生一些破坏性影响。我们设计了一种基于还原氧化石墨烯(rGO)/Au/Co2CuS4纳米杂化物的电化学传感器,用于食品和生物样品中CAP的测定。Co2CuS4是由双核金属-有机骨架(CoCu-BDC)通过两步法合成的。通过X射线光电子能谱和透射电子显微镜对纳米杂化物进行了表征。rGO/Au/Co2CuS4提供更多的活性位点和良好的导电性以降低电荷转移电阻并提高用于测定CAP的电催化活性。制备的传感器具有7至141nM的宽线性范围,检测极限为2.5nM,定量极限为21.92nM。它还提供了高选择性和可重复性,相对标准偏差为2.6%。稳定性研究表明,电极在33天后具有可接受的性能,效率为95%。
    Despite the beneficial effects of antibiotics such as chloramphenicol (CAP), they exert some destructive impacts on human health. We designed an electrochemical sensor based on reduced graphene oxide (rGO)/Au/Co2CuS4 nanohybrid for determination of CAP in food and biological samples. The Co2CuS4 was synthesized from binuclear metal-organic framework (CoCu-BDC) through a two-step process. Nanohybrid was characterized by X-ray photoelectron spectroscopy and transmission electron microscopy. The rGO/Au/Co2CuS4 provides more active sites and good electrical conductivity to reduce charge transfer resistance and improve the electrocatalytic activity for determination of CAP. The prepared sensor has a wide linear range from 7 to 141 nM with a limit of detection of 2.5 nM and a limit of quantification of 21.92 nM. It also provided high selectivity and repeatability with a relative standard deviation of 2.6%. Stability studies showed that the electrode has acceptable performance with efficiency of 95% after 33 days.
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  • 文章类型: Journal Article
    背景:\“直接对消费者(DTC)远程医疗\”正在全球范围内增加,并改变了初级卫生保健(PHC)的地图。虚拟医疗在过去十年中有所增加,随着COVID-19大流行的持续,患者对在线护理的使用进一步增加。在瑞典,在线咨询是今天政府支持的医疗保健的一部分,瑞典市场上有几家数字护理提供商,这样就可以在几分钟内与医生取得联系。这个市场的快速扩张引发了人们对仅在没有任何身体预约的在线环境中提供的初级保健质量的质疑。抗生素处方是PHC的常见治疗方法。
    目的:本研究旨在比较数字PHC提供者(互联网PHC)和传统物理PHC提供者(物理PHC)之间的抗生素处方,并确定特定诊断的处方在互联网PHC和物理PHC预约之间是否有所不同,根据任命时年龄的影响进行了调整,性别,和时间相对于COVID-19大流行。
    方法:从2020年1月至2021年3月,从地区行政办公室获得了Sörmland地区居民基于解剖治疗化学(ATC)代码的抗生素处方数据。总的来说,包括68,332名Sörmland居民的160,238个任命(124,398个物理PHC和35,840个互联网PHC任命)。考虑了由互联网PHC或物理PHC医生发布的处方。关于预约日期的信息,为病人服务的人员类别,ICD-10(国际疾病统计分类,第十次修订)诊断代码,处方药的ATC代码,并使用患者的年龄和性别。
    结果:总共登记了160,238次医疗保健预约,其中18433导致感染诊断。在物理PHC和互联网PHC约会中,性别和达到的年龄分布存在很大差异。物理-PHC预约在60-80岁的患者中达到顶峰,而互联网-PHC预约在20-30岁的患者中达到顶峰。在9.3%(11,609/124,398)的物理PHC预约中使用了ATC代码为J01A-J01X的抗生素,而在互联网PHC预约中使用了6.1%(2201/35,840)。此外,61.3%(6412/10454)的物理-PHC感染预约导致抗生素处方,相比之下,只有25.8%(2057/7979)的互联网PHC预约。对处方抗生素的分析表明,互联网PHC对所有诊断均遵循区域建议。Physical-PHC也遵循了建议,但使用了更广泛的抗生素。接受抗生素处方的赔率比(在预约时调整年龄后,患者性别,与物理PHC预约相比,在互联网PHC预约期间处方是否在COVID-19大流行之前或期间)为0.23-0.39。
    结论:互联网-PHC预约导致抗生素处方数量明显低于物理-PHC预约,调整了咨询互联网PHC和物理PHC的患者特征的巨大差异。互联网PHC处方者根据指南显示适当的处方。
    BACKGROUND:  \"Direct-to-consumer (DTC) telemedicine\" is increasing worldwide and changing the map of primary health care (PHC). Virtual care has increased in the last decade and with the ongoing COVID-19 pandemic, patients\' use of online care has increased even further. In Sweden, online consultations are a part of government-supported health care today, and there are several digital care providers on the Swedish market, which makes it possible to get in touch with a doctor within a few minutes. The fast expansion of this market has raised questions about the quality of primary care provided only in an online setting without any physical appointments. Antibiotic prescribing is a common treatment in PHC.
    OBJECTIVE:  This study aimed to compare antibiotic prescribing between digital PHC providers (internet-PHC) and traditional physical PHC providers (physical-PHC) and to determine whether prescriptions for specific diagnoses differed between internet-PHC and physical-PHC appointments, adjusted for the effects of attained age at the time of appointment, gender, and time relative to the COVID-19 pandemic.
    METHODS:  Antibiotic prescribing data based on Anatomical Therapeutic Chemical (ATC) codes were obtained for Region Sörmland residents from January 2020 until March 2021 from the Regional Administrative Office. In total, 160,238 appointments for 68,332 Sörmland residents were included (124,398 physical-PHC and 35,840 internet-PHC appointments). Prescriptions issued by internet-PHC or physical-PHC physicians were considered. Information on the appointment date, staff category serving the patient, ICD-10 (International Statistical Classification of Diseases, Tenth Revision) diagnosis codes, ATC codes of prescribed medicines, and patient-attained age and gender were used.
    RESULTS:  A total of 160,238 health care appointments were registered, of which 18,433 led to an infection diagnosis. There were large differences in gender and attained age distributions among physical-PHC and internet-PHC appointments. Physical-PHC appointments peaked among patients aged 60-80 years while internet-PHC appointments peaked at 20-30 years of age for both genders. Antibiotics with the ATC codes J01A-J01X were prescribed in 9.3% (11,609/124,398) of physical-PHC appointments as compared with 6.1% (2201/35,840) of internet-PHC appointments. In addition, 61.3% (6412/10,454) of physical-PHC infection appointments resulted in antibiotic prescriptions, as compared with only 25.8% (2057/7979) of internet-PHC appointments. Analyses of the prescribed antibiotics showed that internet-PHC followed regional recommendations for all diagnoses. Physical-PHC also followed the recommendations but used a wider spectrum of antibiotics. The odds ratio of receiving an antibiotic prescription (after adjustments for attained age at the time of appointment, patient gender, and whether the prescription was issued before or during the COVID-19 pandemic) during an internet-PHC appointment was 0.23-0.39 as compared with a physical-PHC appointment.
    CONCLUSIONS:  Internet-PHC appointments resulted in a significantly lower number of antibiotics prescriptions than physical-PHC appointments, adjusted for the large differences in the characteristics of patients who consult internet-PHC and physical-PHC. Internet-PHC prescribers showed appropriate prescribing according to guidelines.
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