头孢吡肟致神经毒性文献分析

目的：对头孢吡肟引起神经毒性的国内外文献进行统计分析,提示临床应用注意本药可导致神经毒性,避免引起严重后果。方法：利用中国期刊网数据库和Pubmed检索1999—2009年报道静滴头孢吡肟引起神经毒性不良反应的文献,分析其引起神经毒性的规律和特点。结果：共检索到头孢吡肟引起神经毒性的文献71篇,中文文献53篇,英文文献18篇。其中个例报道36例。头孢吡肟引起神经毒性发病年龄平均为64．5岁,1例高龄患者死亡,死亡率为2．8％。结论：头孢吡肟引起神经毒性与患者年龄和肾功能密切相关,与患者性别、给药剂量无明显相关性。     

Species interactions drive the spread of ampicillin resistance in human-associated gut microbiota

Background and objectivesSlowing the spread of antimicrobial resistance is urgent if we are to continue treating infectious diseases successfully. There is increasing evidence microbial interactions between and within species are significant drivers of resistance. On one hand, cross-protection by resistant genotypes can shelter susceptible microbes from the adverse effects of antibiotics, reducing the advantage of resistance. On the other hand, antibiotic-mediated killing of susceptible genotypes can alleviate competition and allow resistant strains to thrive (competitive release). Here, by observing interactions both within and between species in microbial communities sampled from humans, we investigate the potential role for cross-protection and competitive release in driving the spread of ampicillin resistance in the ubiquitous gut commensal and opportunistic pathogen Escherichia coli.MethodologyUsing anaerobic gut microcosms comprising E.coli embedded within gut microbiota sampled from humans, we tested for cross-protection and competitive release both within and between species in response to the clinically important beta-lactam antibiotic ampicillin.ResultsWhile cross-protection gave an advantage to antibiotic-susceptible E.coli in standard laboratory conditions (well-mixed LB medium), competitive release instead drove the spread of antibiotic-resistant E.coli in gut microcosms (ampicillin boosted growth of resistant bacteria in the presence of susceptible strains).Conclusions and implicationsCompetition between resistant strains and other members of the gut microbiota can restrict the spread of ampicillin resistance. If antibiotic therapy alleviates competition with resident microbes by killing susceptible strains, as here, microbiota-based interventions that restore competition could be a key for slowing the spread of resistance.Lay SummarySlowing the spread of global antibiotic resistance is an urgent task. In this paper, we ask how interactions between microbial species drive the spread of resistance. We show that antibiotic killing of susceptible microbes can free up resources for resistant microbes and allow them to thrive. Therefore, we should consider microbes in light of their social interactions to understand the spread of resistance.     

Factors associated with emergence of pristinamycin‐resistant Staphylococcus aureus in a dermatology department: a case–control study

Background Pristinamycin is used for the treatment of Staphylococcus aureus skin infection. Staphylococcus aureus pristinamycin resistance is usually low. The frequency of pristinamycin‐resistant S. aureus (PRSA) increased in the Caen University Hospital dermatology department from 1% in 1998 to >11% in 1999–2002. Objectives This study aimed to identify the factors associated with PRSA acquisition. Methods Incidences of PRSA and pristinamycin consumption were calculated for the dermatology department and for the rest of the hospital from 1997 to 2007. Individual factors of PRSA acquisition in the dermatology department from 2000 to 2001 were analysed in a retrospective case–control study including 23 cases of PRSA skin colonization or infection and 46 controls with pristinamycin‐susceptible S. aureus. Clonal relatedness of isolates was analysed by pulsed‐field gel electrophoresis and pristinamycin resistance genes were detected by polymerase chain reaction. Conditional logistic regression was performed to analyse the relationship between pristinamycin resistance and epidemiological and microbiological data. Results PRSA frequency and pristinamycin consumption were significantly higher in the dermatology department than in other hospital departments. Two epidemic clones of two and six isolates were found for periods of 1 and 2 months, respectively. Thirteen of the 23 PRSA isolates (57%), including all isolates of the two epidemic clones, were found 48 h after the hospitalization or later. PRSA was associated with pristinamycin use during the previous year [odds ratio (OR) 5·60, 95% confidence interval (CI) 1·41–22·22], cumulative use of antibiotics exceeding 1 week during the previous year (OR 4·63, 95% CI 1·47–14·54) and methicillin resistance (OR 6·35, 95% CI 1·38–29·15). Conclusions Results suggest that antimicrobial selective pressure and microbial cross‐transmission are involved in PRSA acquisition.     

剖宫产围手术期使用抗生素的临床观察

目的探讨择期剖宫产围手术期预防性应用抗生素不同用药方法预防术后感染的效果。方法采用前瞻性随机实验方法,比较剖宫产围手术期组及常规用药组的临床疗效及经济学差异。结果2组在最高体温、平均体温、产褥病例、伤口感染、白细胞总数和中性粒细胞比例之间无显著性差异（P〉0．05）。观察组的平均住院日和术后住院日明显短于对照组（P〈0．05）。观察组中抗生素的费用明显低于对照组（P〈0．05）。结论剖宫产围手术期使用抗生素能够有效预防感染、降低抗生素费用、加快病床周转率。     

中药奇蒿提取物体外抗菌活性的实验研究

目的研究中药奇蒿80%乙醇粗提取物及其石油醚、氯仿、乙酸乙酯、正丁醇提取物对临床常见菌种的抗菌活性。方法对中药奇蒿进行系统性分离提取,以80%乙醇粗提取物和石油醚、氯仿、乙酸乙酯、正丁醇提取物进行体外药敏实验,序贯使用纸片扩散法和常量肉汤稀释法,选用临床常见的致病菌株,包括金黄色葡萄球菌（标准型ATCC25923）、大肠埃希氏菌（标准型ATCC25922）、铜绿假单胞菌（标准型ATCC27853）、无乳链球菌（临床型）、粪肠球菌（临床型）、福氏志贺菌（临床型）和痢疾志贺菌（临床型）。结果奇蒿80%乙醇粗提取物对痢疾志贺菌的最小杀菌浓度（MBC）为25 mg/ml;奇蒿氯仿提取物对大肠埃希氏菌的MBC为6.25 mg/ml,对金黄色葡萄球菌的MBC为12.5 mg/ml;奇蒿乙酸乙酯提取物对福氏志贺菌、痢疾志贺菌、无乳链球菌的MBC均为6.25 mg/ml,对金黄色葡萄球菌的MBC为12.5 mg/ml;奇蒿正丁醇提取物对无乳链球菌的MBC为12.5 mg/ml,对痢疾志贺菌的MBC为25 mg/ml;石油醚提取物未对测试的细菌表现出明显的抗菌活性。结论奇蒿不同提取物对临床多种致病菌表现出了良好的杀菌作用,在抗感染治疗领域具有较好的开发和应用前景,其有效单体及杀菌机制有待进一步研究发现。     

β-内酰胺类抗生素与其酶抑制剂复方制剂分析方法概述

β-内酰胺类抗生素是临床广泛应用的抗生素品种．为了抵抗细菌的耐药性,临床常与β-内酰胺类酶抑制剂联用,其中常用的有克拉维酸的联合制剂,舒巴坦的联合制剂和他唑巴坦的联合制剂。本文就上述三大类复方制剂的分析方法做一概述。     

临床肺部感染评分干预对老年重症肺炎患者的疗效观察

目的探讨临床肺部感染评分对老年重症肺炎患者抗生素选择策略进行干预后对预后的影响。方法采用随机、对照、开放、临床研究。连续入选符合诊断标准的老年重症肺炎患者78例,随机分为两组：A组（评分干预组,39例）入院时临床肺部感染评分大于6分者抗生素选择策略采用降阶梯治疗方案,小于6分者采用常规升级治疗方案。B组（常规组,39例）按常规自然决定抗生素的选择和疗程。比较两组患者抗生素使用疗程、病死率及真菌定植发生率等。结果A组抗生素使用疗程、病死率显著低于B组,B组真菌定植发生率高于A组。结论临床肺部感染评分干预抗生素选择策略对改善老年重症肺炎的疗效、预后具有良好效果。     

Serum hydrogen sulfide as a novel marker predicting bacterial involvement in patients with community-acquired lower respiratory tract infections

Background and objective: Endogenous hydrogen sulfide (H₂S) may be involved in the pathogenesis of systemic inflammation. It was investigated whether serum H₂S levels differed among patients with community‐acquired pneumonia, those with exacerbations of COPD or control subjects, and whether H₂S may be used as a surrogate marker of the need for antibiotic treatment. Methods: Serum H₂S levels were measured in 129 patients with pneumonia or COPD exacerbations and in 72 healthy control subjects. Results: The mean serum H₂S concentration was 36% lower in patients with pneumonia (22.7 ± 14.6 µmol/L) than in control subjects (35.4 ± 5.3 µmol/L) (P < 0.01). Serum H₂S concentration did not differ between patients with acute exacerbations of COPD (33.8 ± 18.6 µmol/L) and control subjects. Within the COPD group, patients with Anthonisen type 1 exacerbations had a lower serum H₂S concentration (22.5 ± 11.6 µmol/L) than control subjects, and those with type 3 exacerbations had a higher serum H₂S concentration (54.2 ± 21.3 µmol/L) than control subjects. There was no difference between patients with type 2 exacerbations (41.7 ± 8.4 µmol/L) and control subjects. In patients requiring antibiotics, serum H₂S concentration was 41% lower than in those not requiring antibiotics. The area under the receiver operating characteristic curve for H₂S as a surrogate marker of the need for antibiotics was 0.862 (95% confidence interval: 0.805–0.919, P < 0.01). Serum H₂S levels were inversely correlated with serum CRP levels (r = ?0.337, P < 0.01). Conclusions: Serum H₂S levels may be used as a marker in lower respiratory tract infections. Further studies are required to validate the role of serum H₂S levels in guiding antibiotic selection.     

上海闸北区性病门诊生殖道支原体检出率及药敏分析

目的了解上海闸北地区性病门诊患者人型支原体（Mycoplasma hominis,Mh）与解脲脲原体（Ureaplasma urealyticum,Uu）感染及药敏情况,为临床生殖道支原体感染的诊治提供依据。方法采用支原体诊断试剂盒,对性病门诊患者进行支原体培养、鉴定和药敏试验。结果248例性病门诊患者支原体培养结果阳性（39．12％）,其中男性145例,女性103例。单纯Mh感染男性38例（9．09％）,女性12例（5．56％）;单纯Uu感染男性61例（14．59％）,女性69例（31．94％）;混合感染男性46例（11．00％）,女性22例（10．19％）。男性与女性单纯Mh感染和Mh＋Uu混合感染的检出率差异无统计学意义（P〉0．05）;女性单纯Uu感染检出率高于男性,差别有统计学意义（P〈0．001）。药敏试验结果显示,13种抗生素治疗Mh／Uu感染时,各类抗生素之间总体耐药性有差别（P〈0．001）。支原体对美满霉素、强力霉素、交沙霉素、左氧氟沙星和氧氟沙星有较高的敏感性。结论本地区治疗支原体感染时应尽量避免使用大环内酯类抗生素（交沙霉素除外）,（左）氧氟沙星可作为耐红霉素类和四环素类支原体感染的备选治疗药物。     

常见革兰阴性菌耐药性变迁临床分析

目的了解临床常见革兰阴性菌的耐药谱变化趋势,为临床预防和治疗提供依据。方法调查本院2007年1月1日-2009年12月31日住院患者临床送检的痰、尿、血、创面分泌物等标本,对分离得到的细菌采用自动细菌鉴定仪及其配套的鉴定卡和药敏卡．根据微量稀释法所测MIC值以判定其对抗菌药物的耐药情况．结果按NCCLS2003标准判断。结果亚胺培南和阿米卡星是本院治疗革兰氏阴性菌较有效的药物：大肠埃希菌和肺炎克雷伯杆菌对舒普深、头孢西丁、哌拉西林,他唑巴坦较敏感;铜绿假单胞菌对头孢吡肟、头孢他啶和妥布霉素较敏感;鲍曼不动杆菌最近两年对各种抗生素耐药性上升明显,ICU出现较多多重耐药菌株。结论临床医生要及时掌握临床上细菌耐药谱的变化,合理使用抗生素,防止院内交叉感染的发生。