2012—2014年临床分离鲍曼不动杆菌分布情况及耐药性分析

目的:了解徐州医学院附属医院2012—2014年鲍曼不动杆菌的标本来源?科室分布情况及3年间的耐药性变迁?方法:采用美国BD公司Phoenix 100全自动微生物分析系统进行菌株鉴定,采用纸片扩散(K-B)法测定菌株对抗菌药物的敏感性,以WHONET5.6软件分析数据?结果:2012—2014年分别分离鲍曼不动杆菌1 213?1 492?1 712株,各占非发酵革兰阴性杆菌的53.5%?44.4%和39.9%;其中标本来源以痰液为主,达89.2%;急诊ICU的感染率最高,达37.5%?除了左氧氟沙星?阿米卡星?多粘菌素和复方新诺明4种抗菌药物外,3年中鲍曼不动杆菌对头孢类?碳青霉烯类?喹诺酮类?氨基糖苷类等临床常用药耐药率均达80.0%以上?其中亚胺培南的耐药率从2012年的83.1%上升至2013年的87.1%,2014年下降至82.8%;与之类似,鲍曼不动杆菌对美洛培南的耐药率在2012?2013?2014年分别为84.9%?87.7%?85.1%;对多粘菌素的耐药率最低,为1.5%~2.9%?结论:与2012年相比,2013年鲍曼不动杆菌的耐药率明显升高,2014年有所下降,但仍非常严重,需高度警惕,加强鲍曼不动杆菌耐药监测和规范临床合理用药?     

丙戊酸和碳青霉烯类抗菌药的相互作用研究进展

为评估丙戊酸和碳青霉烯类抗菌药之间相互作用的机制,本文通过在Pubmed上检索关于丙戊酸与碳青霉烯类抗菌药相互作用的文献,并进行归纳分析,发现两药相互作用的机制在丙戊酸的吸收、分布、代谢和排泄方面均有作用。丙戊酸和碳青霉烯类抗菌药合用会导致丙戊酸的血药浓度下降,引起癫痫的再发作,因此临床上应该避免丙戊酸和碳青霉烯类抗菌药的联合使用,以保障临床用药安全。     

mCIM 与eCIM 筛选肠杆菌科细菌碳青霉烯酶的效果评价

目的评价改良碳青霉烯类失活法(modified carbapenem inactivation method,m CIM)和EDTA碳青霉烯类失活法(EDTAcarbapenem inactivation method,e CIM)对肠杆菌科细菌碳青霉烯酶表型的筛选能力。方法分别收集碳青霉烯类耐药和敏感肠杆菌科细菌102株和53株,采用m CIM和e CIM进行碳青霉烯酶表型筛选试验,PCR法检测blaKPC-2、blaNDM-1、blaIMP-4、blaVIM-1和blaOXA-48耐药基因,并对表型筛选试验结果与基因检测结果的一致性进行统计分析。结果 102株碳青霉烯类耐药肠杆菌科细菌中97株检出耐药基因,包括51株blaKPC-2基因、38株blaNDM-1基因、5株blaIMP-4基因以及3株同时携带blaKPC-2和blaNDM-1基因;m CIM检出阳性98株,阴性4株。98株m CIM阳性菌中,e CIM阳性46株,阴性52株。53株碳青霉烯类敏感肠杆菌科细菌耐药基因检测及m CIM试验均为阴性。m CIM试验筛选碳青霉烯类耐药肠杆菌科细菌碳青霉烯酶产生的敏感性为99.0%,特异性为96.6%,与PCR结果一致性Kappa值为0.959;e CIM筛选金属酶敏感性为93.5%,特异性为94.6%,Kappa值为0.881;e CIM筛选丝氨酸碳青霉烯酶敏感性为92.6%,特异性为95.8%,Kappa值为0.882。结论 m CIM试验与e CIM试验联合检测,不仅可以有效筛选碳青霉烯酶产酶株,而且可同时区分碳青霉烯酶类型,对流行病学调查研究及疾病治疗有重要意义。     

Physical Compatibility of Meropenem and Vaborbactam With Select Intravenous Drugs During Simulated Y-site Administration

Purpose

Meropenem/vaborbactam is a novel intravenous antibiotic combining the carbapenem, meropenem, with a novel β-lactamase inhibitor, vaborbactam. Meropenem/vaborbactam is administered as a 3-hour infusion given every 8 hours, thereby potentially restricting an intravenous line for 9 h/d. Intravenous medications may be given concurrently via Y-site when compatibility data are available. Herein, physical compatibility was determined for the identification which medications can be coadministered with meropenem/vaborbactam via Y-site.

儿童耐碳青霉烯类肠杆菌目细菌感染治疗药物研究进展

近年来,随着碳青霉烯类抗生素的广泛使用,儿童中耐碳青霉烯类肠杆菌目细菌(CRE)感染的病例越来越常见,且往往临床结局不良.由于儿童特殊的药代动力学/药效动力学(PK/PD)特征,多数抗CRE药物缺乏在这一群体中的临床应用经验,儿科医生在治疗CRE时面临巨大挑战.本文收集对儿童CRE感染的现有认识,就其流行病学、耐药机制...     

Combination carbapenem-sulbactam therapy for critically ill patients with multidrug-resistant Acinetobacter baumannii bacteremia: four case reports and an in vitro combination synergy study

Infections caused by multidrug-resistant Acinetobacter baumannii have become a therapeutic challenge for clinicians worldwide. Although colistin and tigecycline have been successful in treating patients with these infections, these agents are not available on a worldwide basis. We describe four critically ill patients in Taiwan who were diagnosed with multidrug-resistant Acinetobacter baumannii bacteremia. All bacterial isolates from these patients were resistant to commonly available antibiotics, including carbapenems and sulbactam; however, combination therapy with a carbapenem and sulbactam led to favorable clinical outcomes in all four patients. We also conducted an in vitro study using isolates from these patients that showed that this drug combination had a synergistic effect with enhanced antibacterial activity against the isolates. Thus, a carbapenem-sulbactam combination may be a therapeutic alternative for multidrug-resistant Acinetobacter baumannii bacteremia in countries where colistin and tigecycline are not available for clinical use.     

8例NSICU耐碳青霉烯-肺炎克雷伯菌感染的治疗分析

目的:探讨临床药师参与神经外科重症监护病房耐碳青霉烯肺炎克雷伯菌感染治疗的效果。方法:对2016年1-12月临床药师参与会诊的8例会诊记录进行统计分析,以病死率为主要结局指标,以临床疗效、细菌学疗效、不良事件发生率为次要结局指标探讨会诊效果。结果:8例会诊病历,临床有效率为75%,细菌清除率为50%,病死率为25%,未发生药品不良反应。结论:临床药师参与CRKP感染的会诊,可以通过优化药物治疗方案,提高疗效,保障医疗质量安全。     

Predictors of mortality in multidrug-resistant Klebsiella pneumoniae bloodstream infections

The dramatic increase of antibiotic resistance in Klebsiella pneumoniae has been associated with fatal outcomes. First, bloodstream infections (BSIs) caused by extended-spectrum β-lactamases (ESBL) Enterobacteriaceae have been associated with treatment failure, more recently BSIs caused by carbapenem-resistant K. pneumoniae (CR-KP) have been reported to be fatal in approximately 50% of cases. Severity of underlying disease, intensive care unit stay at infection onset, infection with ESBL or CR-KP strain and delay in administration of appropriate therapy are among the most common risk factors for mortality in patients with K. pneumoniae BSI, while infection source control and early appropriate antimicrobial treatment have been associated with survival. Thus, risk assessment for ESBL and/or CR-KP is mandatory in patients with suspicion of K. pneumoniae BSI. Here, we examine current evidence regarding risk factors for mortality in patients with K. pneumoniae BSI and address the issue of a risk prediction model for CR-KP BSI.     

鲍曼不动杆菌对碳青霉烯类耐药性及耐药基因型分析

目的:了解南京地区鲍曼不动杆菌耐药特点及分析碳青霉烯酶、金属β-内酰胺酶基因型。方法:K-B法测定临床分离的73株鲍曼不动杆菌对亚胺培南、美洛培南的耐药性;PCR检测碳青霉烯酶(OXA)、金属β-内酰胺酶(IMP和VIM)耐药基因,并对OXA基因进行测序。结果:73株鲍曼不动杆菌对亚胺培南、美洛培南耐药率均为10.9%;8株耐药菌中3株是IMP型,2株是VIM型,4株是OXA型,其中有1株菌含有OXA及IMP两种基因型。4例OXA型标本经测序,在Genbank中进行同源性比对,均为OXA-23亚型。结论:目前南京地区鲍曼不动杆菌的耐药性与其携带OXA-23、IMP和VIM基因相关。