Infectious Diseases Training Summary

Dear leaders, colleagues, everyone!

Today, I will report to you on xxxxx at the Xxxx Hospital Infectious Disease Control Center.

Huaxi Hospital is the largest general hospital in Southwest China. There are 20 national key laboratories, 20 provincial key laboratories and research centers, 2 key disciplines of the Ministry of Education, 2 key projects of the “211 Project”, 16 provincial key disciplines, and the Infectious Disease Control Center. One of the national drug research bases. Divided into two parts of the infection department, infectious disease clinic and a laboratory.

First of all, I am studying in the Infectious Diseases Department. This department is equivalent to Puneco. It mainly treats all kinds of patients who are fever-seeking and infected, and learns the diagnosis ideas of patients who are waiting for fever through learning. The first consideration is whether the infection is a factor or not. Infected factors, then consider the site of infection, followed by pathogenic bacteria, the initial diagnosis is positive bacteria, negative bacteria, or fungal infections, select sensitive antibiotics, select specimens, culture and drug sensitivity, and obtain laboratory evidence. Here I saw acute infection of chronic obstructive pulmonary disease, lymphoma, adult still disease, severe tetanus, AIDS complicated with pulmonary infection, infection after renal transplantation, cryptococcal meningitis, infective endocarditis, sepsis Lung cancer metastasis, extensive infection of the abdominal wall, and other diseases such as incision and drainage. The use of antibiotics has also been further improved through learning. The basic principle of antibacterial drug application: According to the type of infectious pathogens and bacterial drug susceptibility results, antibacterial drugs are selected. The selection of antibacterial drugs caused by different kinds of pathogenic bacteria varies, and the sensitivity of different strains of similar pathogens to antibacterial drugs can be very different. Therefore, when the clinical diagnosis is a bacterial infection, the corresponding specimen should be taken as soon as possible to send a bacteriological examination to identify the pathogen, and the drug can be selected according to the bacterial susceptibility result. According to the pharmacological action characteristics of antibacterial drugs. The antibacterial effects and in vivo processes of different kinds of antibacterial drugs are different. Taking cephalosporins as an example, the first generation cephalosporins have high antibacterial activity against Gram-positive cocci, such as Staphylococcus, while the third-generation cephalosporins are Gram-negative bacilli such as Enterobacteriaceae have a strong antibacterial effect, so it is necessary to be sensitive to antibiotics according to their characteristics. According to the patient's pathological and physiological state characteristics, the elderly, newborn, pregnant women, and lactating women have different physiological characteristics. According to liver dysfunction, renal insufficiency, heart failure and other basic diseases, patients with different pathologies have different pathologies. basis. All of the above can directly affect the in vivo processes of antibacterial drugs, such as absorption, secretion, distribution, excretion and metabolism of drugs. For example, in elderly patients, the effective nephron is significantly reduced, renal function is reduced, and the enzymes that are mainly excreted by the kidney are applied. The cephalosporin drugs need to be reduced, and the nephrotoxic antibiotics should be avoided. The application of antibacterial drugs in the following cases should be strictly controlled and avoided as much as possible. 1. The prevention and treatment of antibacterial drugs should have clear guidelines. For example, it can be effective for 1-2 specific bacterial infections. However, if it is expected to prevent infection by various bacteria or even all bacteria, the results are often counterproductive, not only failing. Prevention of infection will increase the chance of infection of highly resistant bacteria; 2. Local application of antibiotics should be avoided as much as possible to avoid the development of bacterial resistance and cause allergic reactions; 3. Viral infection and fever of unknown origin In addition to concurrent bacterial infections, it is not appropriate to apply antibacterial drugs; 4. Antibiotics should be combined with the use of antibiotics, in general, no need to use drugs. Antibiotics are divided into three categories: time-dependent, concentration-dependent, and some. Time-dependent drugs represent drugs: b-indoleamine, cinnamicin, first, second and third generation cephalosporins and aztreonam. It is recommended that the drug administration method be a dressing change, and the blood concentration should be prolonged as much as possible. The tolerance is represented by aminoglycosides and quinolones. It is recommended to increase the plasma concentration and prolong the interval between dressings. Between the two are represented by carbapenems, fourth-generation cephalosporins, macrolides, lincosin, and genomic enzymes. Antibacterial drugs and their mechanism of action: b-indoleamines, inhibiting the synthesis of bacterial cell wall into a fungicide during the late stage; Phosphatins inhibit the early synthesis of bacterial cell walls, and are fungicides during breeding; aminoglycosides, macrolides , tetracyclines, forest enzymes inhibit bacterial protein synthesis, amino sugars are static bactericides, macrolides, tetracyclines are rapid bacteriostatic agents; forest enzymes are bacteriostatic agents; rifampins Inhibition of bacterial rna synthesis, is a stationary phase fungicide; quinolones inhibit bacterial DNA synthesis, a banned fungicide; sulfonamides inhibit bacterial folate synthesis. Antifungal drugs include fluconazole, itraconazole, and amphotericin b.

In the second half of the year, I was studying in the Department of Infectious Diseases. Here, I mainly treat patients with various liver diseases. Among them, patients with severe chronic hepatitis B, chronic severe hepatitis, post-hepatitis cirrhosis, and decompensated patients are common. Through the study, the diagnosis of severe hepatitis was strengthened. The jaundice was rapidly deepened and severely diagnosed as severe hepatitis with the following two or more: 1. Extreme fatigue, anorexia, severe abdominal distension and high jejunum. 2. Ascites or rapidly increasing ascites in the short term. 3. Liver and kidney syndrome. 4. Significant bleeding tendency. 5. Symptoms of hepatic encephalopathy. 6. The liver function appears to be separated from the enzyme. 7. pta ≦ 40%, three points of diagnosis: 1. Symptoms are heavy; fatigue, gastrointestinal symptoms, 2. liver damage: tb rises, enzyme bile separation. 3.pta≦40%, staging of severe hepatitis: early pta30%-40%, hepatic encephalopathy with more than twice ascites, advanced: pta≦20%, multiple complications, critical pta<15%, 100% death. Learn more about the indications and contraindications of antiviral drugs. Anti-disease drugs mainly include interferon and nucleosides, hbeag+, hbv-dna>10e5 copies; hbeag-, hbv-dna>10e4 copies; antiviral therapy is needed. Interferon can not be used with jaundice, nucleoside drug act is about 2-10 times normal value, and jaundice value is considered to be less than 2 times. The advantage of interferon is that the course of treatment is affirmative. The disadvantage is that the side reaction is large. There are two kinds of common interferon and pegylated interferon. The usual interferon treatment is one year, the next day, mainly causing the c area or the former c area. Variability, the advantage of 18% nucleoside drugs in 1 year is that it is easy to take and has a quick onset. The disadvantage is that the course of treatment is not certain. There are four kinds of lamivudine, adefovir, entecavir and telbivudine. Each day, the treatment is at least two years, and patients with cirrhosis take life for the rest of their lives. The resistance rate of lamivudine is 14%-32% in the first year and 38%, 49%, 66% in the 2.3.4.5 years. 75%,

Adefovir dipivoxil is 10% for 3 years, 29.5% for 5 years, 0% for entecavir within 1 year, less than 2% for four years, 4.5% for telbivudine and 20% for 3 years. The use of telbivudine for the drug resistance is not the same, because the two drug resistance sites are the same, and lamivudine-resistant patients should be added with entecavir. After drug resistance occurs, according to the results of sequencing of drug-resistant virus genes, patients who choose not to be resistant are treated for remedial treatment. For example, lamivudine resistance, add or use adefovir dipivoxil, second, use entecavir, three, add tenofovir; for adefovir dipivoxil resistance, one plus In the case of bifidine, telbivudine was added, lamivudine was added or entecavir was used, and entecavir was used in the third step; entecavir resistance could be selected with adefovir dipivoxil. Second, adefovir dipivoxil was used, and ten plus tenofovir. If the above-mentioned nucleoside antiviral drug resistance occurs, it can also be treated with interferon, especially polyglycol interferon.

It is my study summary. I am grateful to the leaders and directors of the institute for their cultivation and trust. I have given me a chance to study the skills of medical technology and a strong comprehensive study of modern clinical medical schools.

Source: blog.sina.com.cn/woshihongzhihu