国产加替沙星等多种抗菌药物对常见病原菌的体外抗菌活性

目的 研究国产加替沙星与对照药物对常见病原菌的抗菌活性。方法 收集2003年9月-2003年12月自我院分离的307株细菌。采用NCCLS2003年规定的琼脂稀释法测定国产加替沙星和其他8种抗菌药物对这307株菌的MIC并判断结果。结果 氟喹诺酮类对于肺炎链球菌有良好抗菌活性，敏感率为93．5％～100％，其中莫西沙星的抗菌活性是加替沙星的2～4倍，加替沙星的抗菌活性是左氧氟沙星的4倍；莫西沙星、加替沙星的抗菌活性不受青霉素、大环内酯类耐药性的影响。所有β-溶血性链球菌对青霉素、头孢呋辛、头孢曲松均呈敏感。4种氟喹喏酮类对该菌的抗菌活性依次为：加替沙星=莫西沙星〉左氧氟沙星=环丙沙星。MSSA对头孢呋辛和头孢曲松、加替沙星、莫西沙星100％敏感，仅50％的MSSA菌株对阿奇霉素敏感。4种氟喹喏酮类对肠球菌属的活性均较低。流感嗜血杆菌和卡他莫拉菌产β内酰胺酶率分别为12．9％和72．7％。头孢呋辛、头孢曲松、阿奇霉素、4种氟喹喏酮类对这2种细菌的抗菌活性均很高。头孢呋辛、头孢曲松对产ESBLs的大肠埃希菌、肺炎克雷伯菌无抗菌活性。大肠埃希菌、肺炎克雷伯菌对4种氟喹喏酮类的敏感率为30％～50％。加替沙星、左氧氟沙星对铜绿假单胞菌的抗菌活性是环丙沙星活性的1／4。结论 国产加替沙星对常见社区获得性呼吸道病原菌有良好的抗菌活性，对一些医院内病原菌也有一定抗菌活性。     

头孢地尼等五种抗菌药物对呼吸道感染致病菌体外抗菌活性的研究

目的比较头孢地尼与其他4种抗菌药物对临床常见呼吸道致病菌的体外抗菌活性。方法采用琼脂稀释法测定对239株临床分离菌株的最低抑菌浓度。结果金黄色葡萄球菌(MSSA)对头孢地尼的敏感性最高，敏感率为100％，肺炎链球菌(包括PSSP、PISP)对头孢地尼的敏感性较高，敏感率为63．6％～100．0％。流感嗜血杆菌、卡他莫拉菌对3种头孢菌素类抗菌药物比较敏感。肺炎克雷伯菌中产ESBL菌株对3种头孢菌素类抗菌药物耐药率为100％；非产ESBLs菌株对3种头孢菌素类抗菌药物的敏感率为73．1％～88．5％。结论头孢地尼与其他4种抗菌药物比较，对呼吸道常见致病菌有较强的抗菌活性。     

2004-2005年中国社区获得呼吸道感染常见病原菌耐药性研究

目的调查中国6所教学医院2004--2005年分离的社区获得呼吸道感染常见病原菌的耐药性。方法收集2004年7月-2005年3月全国6个地区6所医院社区获得呼吸道感染患者中分离的510株肺炎链球菌、流感嗜血杆菌、卡他莫拉菌、p溶血链球菌及MSSA、非产ESBLs的肺炎克雷伯菌和大肠埃希菌，以琼脂稀释法测定头孢泊肟等9种抗菌药物的MIC。结果肺炎链球菌中，青霉素敏感肺炎链球菌（PSSP）、青霉素中介肺炎链球菌（PISP）、青霉素耐药肺炎链球菌（PRSP）对头孢泊肟的敏感率分别为98．9％、42．2％、6．4％。肺炎链球菌对莫西沙星的敏感率为100％；对米诺环素的敏感率为94．6％；对阿奇霉素的敏感率仅为10．7％；流感嗜血杆菌、MSSA、非产ESBL的肺炎克雷伯菌和大肠埃希菌对头孢泊肟、头孢丙烯、头孢克洛、莫西沙星和米诺环素的敏感率在51．3％～100％。结论呼吸道病原菌特别是肺炎链球菌、流感嗜血杆菌的耐药率与往年监测结果相比较呈增加趋势；头孢泊肟对呼吸道病原菌的抗菌活性优于头孢丙烯和头孢克洛。     

医院产超广谱β-内酰胺酶情况及耐药性监测

超广谱β-内酰胺酶（ESBLs）主要由肠杆菌科细菌产生，尤以肺炎克雷伯菌和大肠埃希菌为代表。产ESBLs菌株无论体外药敏试验敏感与否，均应报告该菌株对所有青霉素类、头孢菌素类包括第四代头孢菌素以及氨曲南耐药。但对头霉素类抗菌药如头孢西汀、氨基糖苷类、氟喹诺酮类、磺胺类以及碳青霉烯类等抗菌药应按药敏结果如实报告。     

临床常见病原菌对喹诺酮类抗菌药物的耐药性分析

目的 探讨该院临床常见病原菌的菌群分布及对喹诺酮类抗菌药物的耐药性,指导临床合理使用抗菌药物.方法 对2015-2019年该院住院及门诊患者临床感染标本进行病原菌培养,采用VIT EK 2 Com-pact系统进行细菌菌种鉴定、药敏试验,采用WHONET5.6软件进行数据统计分析.结果 5年内共分离到27663株非重复致病菌株,其中革兰阴性菌20931株(75.66％),革兰阳性菌6732株(24.34％).菌株主要来源于痰、创口分泌物/组织、血液和尿液等临床标本.药敏试验结果显示,喹诺酮类抗菌药物耐药率最高的前3位细菌分别为屎肠球菌、鲍曼不动杆菌和大肠埃希菌;产碳青霉烯酶和产超广谱β-内酰胺酶的大肠埃希菌、肺炎克雷伯菌对2种喹诺酮类抗菌药物(环丙沙星和左氧氟沙星)的耐药率均高于不产酶菌株(P<0.01);耐甲氧西林的葡萄球菌对3种喹诺酮类抗菌药物(环丙沙星、左氧氟沙星和莫西沙星)的耐药率明显高于甲氧西林敏感菌株(P<0.01).结论 临床分离的常见病原菌对喹诺酮类抗菌药物的耐药性差异较大,应加强细菌耐药性及产酶菌株的监测,加强抗菌药物管理,减少耐药菌株的产生和传播.     

产ESBL菌流行趋势及耐药趋势分析

目的：分析产超广谱β-内酰胺酶（ESBL）肺炎克雷伯氏菌及大肠埃希氏菌的流行趋势和耐药趋势，为临床合理选择抗生素提供依据。方法：对本院2003年1月～2004年12月临床标本中分离的肺炎克雷伯氏菌和大肠埃希氏菌，采用Vitek-32全自动细菌鉴定和药敏分析仪进行ESBL检测，药敏实验，及其变化趋势分析。结果：2003年有33．3％的肺炎克雷伯氏菌和35．3％大肠埃希氏菌产ESBL，2004年则为29．3％和32．2％；两年相比产ESBL菌分离率差异无显著性意义（P〉0．05）；两年中产ESBL菌对青霉素类、头孢菌素类和单环类抗生素耐药率在90％以上，产ESBL和不产ESBL菌株对亚胺培能均未发现耐药。产ESBL菌株三代头孢菌素、单环类、氨基糖苷类、喹诺酮类的耐药率两年间对比差异无显著性意义（P〉0．05）。结论：2003、2004年ESBL细菌的分离率及耐药性无明显差异，趋势监测对临床用药具有指导意义。     

上海地区肺炎链球菌对氟喹诺酮类的敏感性及其喹诺酮耐药决定区突变研究

目的了解上海地区临床分离肺炎链球菌对氟喹诺酮类等抗菌药物的敏感性，并对氟喹诺酮类敏感菌株的喹诺酮耐药决定区（QRDR）突变进行初步研究。方法收集上海地区部分医院2004-2005年共176株肺炎链球菌临床分离株，用琼脂稀释法测定环丙沙星、左氧氟沙星、加替沙星和莫西沙星等15种抗菌药物的抗菌活性，并选取部分左氧氟沙星敏感肺炎链球菌菌株进行QRDRPCR扩增、测序。结果176株受试菌株中．PSSP、PISP和PRSP各占48．9％、47．1％和4．0％，受试菌株对环丙沙星、左氧氟沙星、加替沙星和莫西沙星敏感率均为100％。QRDR的扩增测序结果发现，20株左氧氟沙星MIC1～2mg／L的敏感菌株中，19株的parC、parE基因上已存在不同程度的氨基酸突变．包括ParC：Phe 105→Leu／Asp136→Tyr，Pare：Asp435→AsnjIle460→ValjAsn477→Lys．而在gyrA、gyrB基因上仅发现点突变，未导致相关氨基酸突变。结论上海地区未发现氟喹诺酮类耐药肺炎链球菌临床分离株，但左氧氟沙星MIC1～2mg／L的敏感株中已发现QRDR一级突变现象，突变的基因位点均见于parC、pare基因。     

用琼脂稀释法检测产超广谱β内酰胺酶的大肠埃希菌和肺炎克雷伯菌的体外抗菌活性

目的用琼脂稀释法检测大肠埃希菌和肺炎克雷伯菌产超广谱β内酰胺酶(ESBLs)菌株与不产ESBLs菌株对13种抗生素的耐药情况.方法以双纸片协同试验对临床分离的29株大肠埃希菌和30株肺炎克雷伯菌检测ESBLs的产生,并以琼脂稀释法对亚胺培南等临床常用的13种抗生素作了最低抑菌浓度(MIC)检测及分析.结果双纸片协同试验对两种菌产ESBLs总得检出率为37.3%.其中大肠埃希菌为46.7%,肺炎克雷伯菌为33.3%.不产ESBLs菌株对各处抗生素的耐药率低于18%,MIC50为0.125至8,MIC90为0.5至64不等(氨曲南、环丙沙星、替卡西林/棒酸除外,耐药率分别为20%至40%不等).产ESBLs菌株对亚胺培南,头孢美他醇全部敏感,亚胺培南的MIC50为0.25,MIC90为0.5.对头孢派酮/舒巴坦的耐药率低,为18.2%,MIC50为32.对喹诺酮类,氨基糖苷类及其他β-内酰胺类抗生素的耐药率大于50%,MIC50为64至256.对三代头孢菌素,氨曲南的耐药率大于80%,三代头孢菌素MIC50为256,MIC90为256至512.对环丙沙星、替卡西林/棒酸、氨曲南、庆大霉素呈交耐药,产ESBLs菌株,.大肠埃希菌耐药率高达58.3～100%,肺炎克雷伯菌耐药率高达40～60%.结论治疗ESBLs菌引起的感染,应用亚胺培南,头孢美他醇为好.可根据药敏结果合理选用高浓度的含酶抑制剂的复方β-内酰胺类抗生素及头孢吡肟.     

用琼脂稀释法检测产超广谱β内酰胺酶的大肠埃希菌和肺炎克雷伯菌的体外抗菌活性

目的用琼脂稀释法检测大肠埃希菌和肺炎克雷伯菌产超广谱β内酰胺酶(ESBLs)菌株与不产ESBLs菌株对13种抗生素的耐药情况。方法以双纸片协同试验对临床分离的29株大肠埃希菌和30株肺炎克雷伯菌检测ESBLs的产生,并以琼脂稀释法对亚胺培南等临床常用的13种抗生素作了最低抑菌浓度(MIC)检测及分析。结果双纸片协同试验对两种菌产ESBLs总得检出率为37.3%。其中大肠埃希菌为46.7%,肺炎克雷伯菌为33.3%。不产ESBLs菌株对各处抗生素的耐药率低于18%,MIC50为0.125至8,MIC90为0.5至64不等(氨曲南、环丙沙星、替卡西林/棒酸除外,耐药率分别为20%至40%不等)。产ESBLs菌株对亚胺培南,头孢美他醇全部敏感,亚胺培南的MIC50为0.25,MIC90为0.5。对头孢派酮/舒巴坦的耐药率低,为18.2%,MIC50为32。对喹诺酮类,氨基糖苷类及其他β-内酰胺类抗生素的耐药率大于50%,MIC50为64至256。对三代头孢菌素,氨曲南的耐药率大于80%,三代头孢菌素MIC50为256,MIC90为256至512。对环丙沙星、替卡西林/棒酸、氨曲南、庆大霉素呈交耐药,产ESBLs菌株,。大肠埃希菌耐药率高达58.3～100%,肺炎克雷伯菌耐药率高达40～60%。结论治疗ESBLs菌引起的感染,应用亚胺培南,头孢美他醇为好。可根据药敏结果合理选用高浓度的含酶抑制剂的复方β-内酰胺类抗     

氟喹诺酮类抗菌药物对2554株细菌的抗菌活性分析

目的:监测我国不同地区13所医院34个研究病房患者中分离的细菌对氟喹诺酮抗菌药物的耐药状况。方法:于2000年7月1目至2001年6月30日收集13所医院分离的2 554株病原菌,采用国际标准的二倍稀释法进行体外敏感试验,并按美国国家临床实验标准委员会(NCLLS)2001版标准,判断菌株对抗菌药物的敏感度,并计算出所测细菌对抗菌药物的耐药率(R％)、中介率(I％)和敏感率(S％)。结果:共收集到2 554株致病菌,包括革兰阳性菌958株(37.5％)和革兰阴性菌1596株(62.5％);氟喹诺酮抗菌药物中的新品种——莫西沙星和加替沙星对大多数革兰阳性球菌的作用明显强于环丙沙星和氧氟沙星(P<0.05),对革兰阴性肠杆菌科细菌的作用也较强;而非发酵革兰阴性菌中的铜绿假单胞菌和不动杆菌属对左氧氟沙星的耐药率最低。结论:新一代氟喹诺酮抗菌药物莫西沙星和加替沙星对革兰阳性球菌的作用增强,对革兰阴性肠杆科细菌的作用无减弱;杜绝不合理滥用,是防止细菌对氟喹诺酮药物耐药的最有效方法。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.