抗菌药物的非抗菌作用

抗菌药物的主要作用是各从不同的角度抑制细菌繁殖或杀灭细菌 ,在临床上主要用于感染性疾病的治疗。然而 ,许多抗菌药物 ,除抗菌作用外 ,还有许多有益的非抗菌作用 ,如抗肿瘤作用、免疫调节作用、抗病毒作用等等。全面了解抗菌药物的作用及其机制 ,对合理应用抗菌药物有重要意义     

住院患者抗菌药相关性腹泻44例调查分析

目的:调查我院抗菌药相关性腹泻发生情况。方法:对2005年16月44例住院患者的抗菌药相关性腹泻进行回顾性调查和分析。结果:抗菌药相关性腹泻占同期感染性腹泻的41.5%。以老年患者、肝肾功能异常患者为主。常见致病药物有:左氧氟沙星、头孢哌酮/舒巴坦、克林霉素等,均为静脉滴注给药。抗菌药相关性腹泻最快出现在用药第2天,经抗真菌药物、微生态制剂治疗7d后患者症状消失。结论:静注抗菌药物可引致腹泻,因此,医师临床应用抗菌药物时应加以注意,特别是对老年及肝肾功能不全患者,以避免药源性腹泻的发生。     

抗菌药与哮喘用药的合用

哮喘的发作与感染有一定的关系，需针对致病原选择抗微生物药物。茶碱类、肾上腺皮质激素、抗组胺药等哮喘患者用药与多种抗菌药具有相互作用，临床应予注意。     

我院临床常见病原菌的药物敏感性分析

目的对医院常见病原菌的耐药性情况进行分析。方法对分离到的912株病原菌的细菌耐药情况进行回顾性分析。结果革兰阴性菌占优势，为82．35％；从菌种分布来看，大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌居前5位，为医院临床常见致病菌。结论细菌耐药形势严峻，做好临床细菌耐药监测、合理应用抗菌药物已是当务之急。     

Wild-growing lignicolous mushroom species as sources of novel agents with antioxidative and antibacterial potentials

Crude extracts of two edible and two medicinal lignicolous mushroom species: Meripilus giganteus, Agrocybe aegerita, Fomes fomentarius and Xylaria polymorpha, growing wild in Serbia, were analyzed for their antioxidative and antibacterial potentials. Free radical scavenging capacity (RSC) on DPPH^? and ^?OH was evaluated both by spectrophotometer and by Electron Spin Resonance (ESR) spectroscopy against DPPH^?. The highest antioxidant and antibacterial bioactivity was obtained with F. fomentarius extracts (IC₅₀?≈?10.7?µg/ml in DPPH^? assay; 136.6?mg ascorbic acid equivalents (AAE)/g dry weight (d.w.) for ferric reducing antioxidant power FRAP). It also showed the highest total phenol (TP) (82.54?mg gallic acid equivalents (GAE)/g dry weight (d.w.)) and total flavonoid (TF) content (76.8?µg rutin equivalents (RE)/g dry weight (d.w.)). A. aegerita showed the best antioxidant activity (IC₅₀?=?0.87?mg/ml) against DPPH^? in ESR analysis. Total redox potential of extracts was in direct positive correlation with TP content (r^2?=?0.98) and TF content (r^2?=?0.58). GC/MS analysis detected major constituents of extracts, confirming the presence of the following organic and phenolic acids: fumaric, succinic, mallic, 4-hydroxy benzoic, gentisic, protocatechuic, vanillic, gallic and p-coumaric acid.     

阴沟肠杆菌临床分布及耐药性监测分析

目的对阴沟肠杆菌的临床分布及耐药情况进行探讨,为抗菌药物的合理使用及医院感染的防控提供参考。方法收集2015年—2018年某综合医院临床标本分离的阴沟肠杆菌,对其临床分布特征及耐药情况进行统计分析。结果共分离出阴沟肠杆菌195株,主要来自于住院患者(98.5%),以儿科检出率最多(36.9%),其次是神经外科(13.3%)及ICU(12.3%)。标本类型以痰液和分泌物为主,分别占69.2%、15.4%。阴沟肠杆菌对头孢唑啉、头孢替坦耐药率>90.0%,对阿米卡星的耐药率最低(1.5%);对头孢吡肟、环丙沙星、哌拉西林/三唑巴坦、左氧氟沙星、亚胺培南和厄他培南的耐药率<10.0%。不同病区和不同标本类型分离阴沟肠杆菌对抗菌药物的耐药情况不同,ICU病区耐药情况最为严重,神经外科病区次之,儿科病区耐药性普遍较低;除头孢唑啉和头孢替坦外,分离自尿液标本菌株对其他抗菌药物的耐药率高于痰液和分泌物标本来源菌株。结论该综合医院阴沟肠杆菌的分离率趋于稳定,阴沟肠杆菌对多种抗菌药物耐药性呈现下降趋势,不同病区、不同标本类型分离阴沟肠杆菌的耐药性具有较大差异,临床应及时进行细菌培养,根据病区耐药性的特点,合理选用抗菌药物。儿科、ICU及神经外科病区是预防控制的重点科室,应予以高度关注。     

Pharmacokinetics of ciprofloxacin tablets in renal failure; influence of haemodialysis

Summary The pharmacokinetics of ciprofloxacin has been studied after a single oral dose of 500 mg given to 5 normal subjects (N) and to 15 patients grouped according to their residual renal creatinine clearance: Group I, 8–30 ml·min^–1, Group II, <8 ml·min^–1, and Group III, haemodialysed patients studied twice — during an interdialysis period (IIIa) and in a 4 h haemodialysis session (IIIb). Ciprofloxacin was assayed by reverse phase HPLC using a spectrofluorimetric detection. The peak plasma concentration (2–5 mg·l^–1) was reached within 2 h after drug administration. Apparent volume of distribution, 6.6 (N), 5.0 (I), 2.7 (II) and 4.2 (IIIa) l·kg^–1 and total plasma clearance, 770 (N), 440 (I), 378 (II) and 314 (IIIa) ml·min^–1 were decreased in relation to the degree of renal impairment. Mean plasma half-lives for patients in the 4 groups were 7.3 (N), 10.4 (I), 7.2 (II) and 9.3 (IIIa) h. In groups N, I and II, 40, 16 and 8% of the administered dose was eliminated through the kidney, with mean renal clearances of 305±63,61±21 and 21±3 ml·min^–1. A linear relationship was found between the renal clearance of ciprofloxacin and the glomerular filtration rate (r=0.75,n=15). Ciprofloxacin was partly removed by haemodialysis (IIIb): the dialyser extraction ratio was 23% and the dialysis clearance was 40 ml·min^–1.     

Antimicrobial discovery from natural and unusual sources

Objectives

Whether vertebrates/invertebrates living in polluted environments are an additional source of antimicrobials.

Key findings

Majority of antimicrobials have been discovered from prokaryotes and those which are of eukaryotic origin are derived mainly from fungal and plant sources. With this in mind, it is important to note that pests, such as cockroaches come across pathogenic bacteria routinely, yet thrive in polluted environments. Other animals, such as snakes thrive from feeding on germ‐infested rodents. Logically, such species must have developed an approach to protect themselves from these pathogens, yet they have largely been ignored as a potential source of antimicrobials despite their remarkable capability to fight disease‐causing organisms.

Summary

Animals living in polluted environments are an underutilized source for potential antimicrobials, hence it is believed that several novel bioactive molecule(s) will be identified from these sources to counter increasingly resistant bacterial infections. Further research will be necessary in the development of novel antimicrobial(s) from these unusual sources which will have huge clinical impact worldwide.

     

抗菌药物临床应用管理及干预成效评价

目的：对上海市杨浦区中心医院2010-2012年的抗菌药物临床应用管理及干预成效进行评价,为持续改进抗菌药物临床应用管理提供依据。方法：对2010-2012年抗菌药物的用药频度（DDDs）、用药金额构成比和用药强度等进行统计和分析。结果：2012年本院抗菌药物的DDDs比2010年下降10％,其中注射剂的DDDs下降9.26％。抗菌药物的用药结构发生了变化,大环内酯类、第一代和第二代头孢菌素的DDDs构成比有所增加,而喹诺酮类、第三代和第四代头孢菌素的DDDs构成比显著下降。整改以后,清洁手术抗菌药物预防性使用率下降,用药指征、品种选择、用法用量和用药疗程合格率均有显著改善。治疗性应用抗菌药物的微生物标本送检率和检出阳性率也逐步提高。结论：本院的抗菌药物临床应用整治措施成效显著,使得用药合理性明显改善,但某些指标还未达标,需继续加强管理。