2012—2015年1380株肝移植术后感染病原菌的分布及耐药性分析

目的了解江苏省人民医院肝移植术后感染病原菌的分布及耐药性,为临床合理用药提供参考。方法对2012年1月—2015年1月江苏省人民医院肝移植术后感染病原菌的分布及耐药性进行统计分析。结果共分离出病原菌1 380株,主要来源于痰液标本。病原菌分布以革兰阴性菌为主,占69.57%,革兰阳性菌和真菌分别占20.07%、10.36%;其中革兰阴性菌以鲍曼不动杆菌、肺炎克雷伯菌为主,革兰阳性菌以溶血葡萄球菌为主;革兰阴性菌对美罗培南、阿米卡星、亚胺培南较为敏感,耐药率均低于30%,对头孢曲松、氨曲南等的耐药率均较高;革兰阳性菌对万古霉素、利奈唑胺、替考拉宁较为敏感,耐药率均低于20%,对氨苄西林、诺氟沙星等耐药率均较高。结论肝移植术后感染病原菌的构成主要是鲍曼不动杆菌、肺炎克雷伯菌和溶血葡萄球菌,临床选择抗菌药物时建议选用病原菌表现较低耐药性的美罗培南、阿米卡星、万古霉素、利奈唑胺等药物。     

Trimethoprim-Sulfamethoxazole plus Amikacin as First-Line Therapy and Imipenem/Cilastatin as Second Empirical Therapy in Febrile Neutropenic Patients with Hematological Disorders

One hundred and thirty-nine consecutive episodes of fever were evaluated in 55 patients with hematological disorders during persistent neutropenia. In 121 instances, patients were given trimethoprim-sulfamethoxazole + amikacin (TMP/SMZ + AMI) as an initial antibiotic regimen with clinical success in 51% (i.e. antibiotic treatment was not changed within the first 7 days).

Imipenem/cilastatin (I/C) therapy was instituted in: (a) 22 episodes with clinical failure and fever of unknown origin during TMP/SMZ + AMI therapy and (b) 18 episodes with a second fever episode during initially successful TMP/SMZ + AMI therapy. The response rate for all 40 I/C treated episodes was 80%. One neutropenic patient in the whole series died from infectious complications within four weeks from institution of therapy.

TMP/SMZ + AMI seems to be a safe and inexpensive «standard» antibiotic regimen in neutropenic patients. I/C appears to have good efficacy when used as secondary therapy after failure with TMP/SMZ + AMI.     

Monte Carlo法用于新生儿阿米卡星的群体药动学分析和认证(英文)

目的:用Monte Carlo算法编制群体药动学分析程序并认证该方法估计药动学参数和预测血药浓度的能力.方法:用阿米卡星作为模型药物,对来自42名新生儿共142对血药浓度时间数据进行分析;根据Sheiner等提出的群体药动学思想,我们编制了估计群体参数和个体参数的程序,目标函数最小值以Monte Carlo算法求得,方法的认证采用经典药动学 程序3p87作为对照,预测能力通过计算预测血药浓度的均方根误差(RMSD)和偏性(BIAS)来考察.结果:我们自编的程序运行稳定;本法提取的群体参数与3p87得到的一致,学习样本与认证样本的预测浓度与实测浓度显著相关(相关系数分别为0.995和0.990),预测误差大多数小于1 mg/L,认证样本RMSD和BIAS分别为0.58和-0.07 mg/L.结论:本法估计参数准确,预测血药浓度能力令人满意.     

电荷转移络合分光光度法测定硫酸丁胺卡那霉素注射液的含量

本文根据四氯苯醌和氨基糖甙类抗生素在pH9.0硼酸盐缓冲液中形成电荷转移络合物的原理,试用紫外分光光度法进行含量测定,经与药典法比较,方法简便快速,结果可靠。     

Treatment of chronic bacterial prostatitis with amikacin through anal submucosal injection

Aim: To assess the efficacy and safety of anal submucosal injection (ASI) of amikacin in chronic bacterial prostatitis (CBP). Methods: Fifty male outpatients with CBP were randomly divided into two groups. Thirty cases of ASI group were given amikacin 400 mg daily by ASI for ten times and the other twenty cases of intramuscular injection (IM) group were given the same drug dally by IM. All patients were evaluated with NIH-Chronic prostatitis symptom index (NIH-CPSI), the bacteria culture of the expressed prostate secretion (EPS), proctoscopic examination, rectal biopsy and the clinical manifestation were checked at pretreatment and on day 7 and 90 after cessation of therapy. Results: The cure rate, apparent effective rate and effective rate of ASI group and IM group were 33.3% vs 5% (P<0.05), 43.3% vs 10% (P<0.05) and 16.7% vs 20% (P>0.05), respectively. The score of NIH-CPSI in both of ASI group and IM group decreased significantly 7 days after cessation of therapy, both ASI and IM of amikacin could re     

In vitro susceptibility of Mycobacterium marinum to dihydromycoplanecin A and ten other antimicrobial agents

The in vitro susceptibilities of 16 Mycobacterium marinum strains to 11 antimicrobial agents were determined by the Dubos Tween albumin liquid dilution technique. The results (MICs) were: 0.19-0.39 microgram/ml for dihydromycoplanecin A; 0.78-1.56 micrograms/ml for amikacin; 1.56-3.13 micrograms/ml for ofloxacin, norfloxacin and enoxacin; 1.56-6.25 micrograms/ml for minocycline; 1.56-25 micrograms/ml for sulfamethoxazole and sulfamethoxazole-trimethoprim; 3.13-12.5 micrograms/ml for oxytetracycline; 25-200 micrograms/ml for trimethoprim; and 50-200 micrograms/ml for pipemidic acid. The most active drugs were dihydromycoplanecine A and amikacin. Also active were minocycline, oxytetracycline, sulfamethoxazole and sulfamethoxazole-trimethoprim. Ofloxacin, norfloxacin and enoxacin demonstrated activity only at concentrations at or greater than those usually attained in serum. Pipemidic acid and trimethoprim were inactive.     

A meta-analysis of the target trough concentration of gentamicin and amikacin for reducing the risk of nephrotoxicity

IntroductionAntimicrobial resistance is one of the biggest threats to public health systems worldwide, and aminoglycosides are key drugs for treating drug-resistant infections. Because of the nephrotoxicity of aminoglycosides, therapeutic drug monitoring is recommended, but few studies of the target trough concentration (Cmin) have been reported. To address the problem, we performed a meta-analysis to confirm the target Cmin of aminoglycosides for minimizing the risk of nephrotoxicity.MethodsWe conducted a literature search using MEDLINE, the Cochrane Library, and Ichushi-Web. In the meta-analysis, nephrotoxicity was compared between the Cmin ≥2 mg/L and Cmin <2 mg/L groups for gentamicin and between the Cmin ≥10 mg/L and Cmin <10 mg/L groups for amikacin.ResultsNo randomized controlled trials were reported for any of the drugs. Five observational studies involving 615 patients were reported for gentamicin, and two observational studies involving 159 patients were identified for amikacin. For gentamicin, Cmin <2 mg/L was linked to a significantly lower rate of nephrotoxicity than Cmin ≥2 mg/L (odds ratio [OR] = 0.22, 95% confidence interval [CI] = 0.12–0.40). For amikacin, Cmin <10 mg/L was associated with a significantly lower rate of nephrotoxicity than Cmin ≥10 mg/L (OR = 0.05, 95% CI = 0.01–0.21).ConclusionsAlthough further well-controlled studies with a low risk of bias are needed, the current meta-analysis demonstrated that Cmin <2 mg/L and Cmin <10 mg/L may reduce the risk of nephrotoxicity linked to gentamicin and amikacin, respectively.     

硫酸阿米卡星对EDTA依赖性假性血小板减少症血小板聚集的解离作用

目的：探讨硫酸阿米卡星对乙二胺四乙酸(EDTA)依赖性假性血小板减少症（EDTA-PTCP）患者血标本中血小板聚集的解离作用,为这类标本血小板的准确计数提供有效方法。方法：在1例少见的EDTA-PTCP患者EDTA-K2抗凝管中预先加入或不加硫酸阿米卡星后采集静脉血,分别于采血后不同时间用全自动血细胞分析仪检测血小板数和其他血细胞参数;留取EDTA-K2抗凝血后不同时间加入阿米卡星,观察其对血小板聚集的解离作用,并检查血涂片中血小板形态改变。结果：未加阿米卡星的EDTA-PTCP标本,随采血后标本放置时间（0.5~4.0 h）的延长,血小板数从117×109 L-1逐渐降至41×10⁹ L^-1。在EDTA-K2抗凝管中预先加入阿米卡星的血标本,血小板计数在正常参考值范围内,且标本室温放置4.0 h内血小板计数值相对稳定。采集的血标本放置30 min以内加入阿米卡星,血小板计数（186×109 -1~191×10⁹ L^-1）在正常参考值范围内,血涂片镜检可见聚集的血小板明显解离,而超过30 min后加入硫酸阿米卡星,随标本放置时间（40 min~4 h）的延长,血小板计数从放置40 min时的168×109 L^-1逐渐降至放置4 h时的42×109 L^-1,镜检血涂片中血小板逐渐明显聚集。结论：留取血标本前或留取标本后30 min内加入一定量硫酸阿米卡星,全自动血细胞分析仪检测EDTA-PTCP患者血小板计数是准确的,且其他血细胞参数的测定未受影响。