结核性胸膜炎使用喹诺酮类抗生素探讨

目的　观察结核性胸膜炎患者使用喹诺酮类抗生素的疗效。方法　观察结核性胸膜炎患者分别给予抗结核 +胸腔穿刺抽液或者在此基础上使用喹诺酮类抗生素的两种方法后胸腔积液的平均消退时间和胸膜粘连的动态改变。结果　观察组和对照组的胸腔积液消退时间分别为 (2 1 2± 5 4 )d和 (2 8 7± 7 1)d ,两组对比P <0 0 5 ;两组患者胸膜粘连对比无显著性差异 (P >0 0 5 )。结论　喹诺酮类抗生素对结核杆菌引起的胸腔积液治疗有效 ,但对结核性胸膜炎后期胸膜粘连无效。     

Prevalence and characteristics of aac(6′)-Ib-cr in AmpC-producing Enterobacter cloacae, Citrobacter freundii, and Serratia marcescens: a multicenter study from Korea

We investigated the prevalence of aac(6′)-Ib-cr and its association with other resistance genes in AmpC-producing Enterobacteriaceae without any selection criteria. A total of 479 clinical isolates of Enterobacter cloacae (179), Citrobacter freundii (134), and Serratia marcescens (166) from 12 laboratories between March and July 2005 were examined. We performed polymerase chain reaction for aac(6′)-Ib, bla_OXA-1, ISEcp1, and class 1 integron. The aac(6′)-Ib-cr was further identified by digestion with BstF5I and sequencing. The aac(6′)-Ib was detected in 110 (23%) of 479 isolates, and 15 isolates (3.1%) were cr variants (8 E. cloacae, 5 C. freundii, and 2 S. marcescens). The aac(6′)-Ib-cr was significantly associated with various resistance genes (bla_OXA-1, qnrS, qnrA, bla_CTX-M-3, and bla_CTX-M-14), mobile elements (ISEcp1, ISCR1, and class 1 integron), and quinolone resistance. Eleven of 15 aac(6′)-Ib-cr producers coharbored qnr genes. Although aac(6′)-Ib-cr was uncommon in Korean AmpC producers, its association with various resistance genes and mobile elements would facilitate the dissemination of this variant.     

司帕沙星治疗耐多药肺结核疗效观察

评价司帕沙星对耐多药肺结核（ＭＤＲ－ＰＴＢ）的疗效与安全性,将１０４例ＭＤＲ－ＰＴＢ患者随机分为两组,以氧氟沙星作为对照。治疗组５２例均采用３ＳＨＲＺＥ＋ＳＰＬＸ／９ＨＲＥ＋ＯＦＬＸ方案治疗,疗程均为１２个月。疗程结束时,治疗组痰转阴率９２．３１％。明显高于对照组６９．２３％（０．０１〈Ｐ〈０．０５）;治疗２个月时治疗组痰菌转阴率非常显著（Ｐ〈０．０１）,表明司帕沙星是目前氟喹诺酮类中治疗ＭＤＲ－     

氟喹诺酮类抗菌药物的交叉耐药性分析

目的调查氟喹诺酮类抗菌药物的交叉耐药性,以指导氟喹诺酮类抗菌药物的合理更换与应用。方法采用微量肉汤稀释法进行药敏试验并进行统计、分析。结果革兰阴性杆菌对氟喹诺酮类抗菌药物存在交叉耐药性,氟喹诺酮类抗菌药物对耐甲氧西林金黄色葡萄球菌无抗菌作用,第四代的加替沙星和第三代的左氧氟沙星对甲氧西林敏感金黄色葡萄球菌敏感性无显著差别。结论氟喹诺酮类抗菌药物存在交叉耐药性。不需要应用加替沙星替代左氧氟沙星用于抗甲氧西林敏感金黄色葡萄球菌感染的治疗。     

铜绿假单胞菌对喹诺酮类药物的耐药机制研究

目的研究临床分离的铜绿假单胞菌对喹诺酮类药物的耐药机制。方法用琼脂稀释法测定临床分离的铜绿假单胞菌对环丙沙星和左氧氟沙星的最小抑菌浓度（MIC）以及加入羰基氰氯苯腙（CCCP）后的MIC;用PCR扩增gyrA及parC基因的喹诺酮耐药决定区,并对扩增产物进行测序分析;用肠杆菌基因间重复序列PCR（ERIC—PCR）对铜绿假单胞菌进行基因分型。结果20株临床分离株中,16株对喹诺酮类药物耐药,4株敏感;CCCP未能显著降低耐药株对环丙沙星和左氧氟沙星的MIC;16株耐菌株在gyrA均有Thr-83→Ile的改变,在parC均有Ser-87→Leu的改变;ERIC—PCR显示这16株耐药株电泳图谱一致,属于同一基因型,与敏感株有明显区别。结论gyrA合并parC基因突变是临床分离的铜绿假单胞菌对喹诺酮类药物耐药的主要机制。     

肺移植患者泛耐药铜绿假单胞菌耐喹诺酮gyrA基因突变的研究

由于广谱抗菌药物的广泛应用和不合理使用,世界范围内铜绿假单胞菌的耐药率逐年上升,已呈多药耐药趋势,甚至出现泛耐药菌株,使医生无药可用。氟喹诺酮类对铜绿假单胞菌有较强的杀菌活性,是对铜绿假单胞菌惟一有效的口服药物。它通过抑制DNA促旋酶或拓扑异构酶Ⅳ而抑制DNA的合成,从而发挥抑菌和杀菌的作用。因此,DNA促旋酶的基因突变被认为是铜绿假单胞菌对氟喹诺酮类产生耐药的主要机制。本文对1株从肺移植患者痰液样本中分离到的泛耐药铜绿假单胞菌DNA促旋酶A亚单位（gyrA）基因的序列进行了分析。     

Self-reported Antibiotic Allergy Incidence and Prevalence: Age and Sex Effects

Background

Data on the prevalence and incidence of adverse reactions to antibiotics in outpatient populations are rare. These events are commonly called “allergy” when noted in the medical record.

Objectives

Determine the prevalence and incidence of allergy, as recorded in the medical record, to the most commonly used antibiotic classes in a large outpatient population using health care in the United States during 2007.

Methods

Data for drug allergy and antibiotic use were extracted from the electronic health records of 411,543 patients cared for by Kaiser Permanente in San Diego County who had at least one outpatient visit during 2007. Outpatient antibiotic utilization data was obtained for each year between 1995 and 2007. Penicillins, sulfas, cephalosporins, tetracyclines, macrolides, and quinolones were the classes of antibiotics evaluated.

Results

Antibiotics account for a majority of drug allergy entries. Antibiotic classes with higher historical use have higher allergy prevalence. Female patients use more antibiotics than males, and have higher allergy prevalence rates for all classes of antibiotics. There is a steady increase in antibiotic allergy prevalence with aging for both sexes. Females have higher allergy incidence rates for all classes of antibiotics. Antibiotic allergy incidence in female patients is highest for sulfas, 3.4%, compared with 1%-1.5% for all other classes of antibiotics. Antibiotic allergy incidence in males also is highest for sulfas, 2.2%, compared with 1.1% for penicillins and 0.5%-0.6% for all other classes of antibiotics.

Conclusions

Female sex, use, and increasing age are the primary factors that account for higher antibiotic allergy prevalence. Antibiotic allergy incidence is highest with sulfa class antibiotics.     

喹诺酮类药物及细菌对其耐药性机制研究进展

本文从喹诺酮类抗菌药物的结构、进入细菌体内的方式及喹诺酮类药物的作用机理进行简明阐述.针对喹诺酮类药物的广泛使用而导致的细菌对喹诺酮类药物的耐药性逐渐增加的原因入手,阐述了细菌对喹诺酮类药物耐药性--从染色体突变到质粒介导的喹诺酮类耐药性的几种分子机制及研究进展,为研究新型喹诺酮类抗菌药物提供依据.     

不同孔径输液器对喹诺酮类抗生素所致疼痛和静脉炎的影响

目的探讨使用不同孔径的输液器输液对喹诺酮类抗生素所致疼痛和静脉炎的影响。方法将210例患者以分层随机的方法分为试验组1(70例)、试验组2(67例)和对照组(73例),均以40滴/min的滴速静脉输注喹诺酮类抗生素,试验组1、试验组2分别采用5.0μm、3.0μm孔径的精密输液器,对照组采用15.0μm孔径的普通输液器。观察3组输液时疼痛及静脉炎的发生率。结果 3组输液滴速均达标,采用5.0μm孔径的精密输液器输液时疼痛和静脉炎的发生率低于采用普通输液器输液,采用3.0μm孔径的精密输液器输液时疼痛和静脉炎的发生率低于采用5.0μm孔径的精密输液器输液。结论采用5.0μm和3.0μm孔径的精密输液器均可有效地减少疼痛和静脉炎的发生,但3.0μm孔径的精密输液器效果更显著。