头孢美唑和头孢西丁对产与不产超广谱β-内酰胺酶菌株体外抗菌活性比较

目的：测定头孢羡唑和头孢西丁对产与不产超广谱β-内酰胺酶（ESBLs）菌株的体外抗菌活性。方法：收集2004年1月到2004年12月从华西医院各临床科室分离出的大肠埃希菌和肺炎克雷伯菌520株,采用Kirby-Bauer琼脂扩散法进行体外药敏试验并用表型确证试验检测ESBLs。结果：筛选出产ESBLs菌226株,ESBLs阳性检出率为43．5％,其中大肠埃希菌的ESBLs检出率为45．8％．肺炎克雷伯菌的ESBLs检出率为39．6％。头孢美唑对我院ESBLs阳性菌株体外抗菌活性优于头孢西丁。结论：头霉素类抗生素可作为治疗ESBLs菌株引起的重症感染的可选药物,且对我院分离的产ESBLS犬肠杆菌和肺炎克雷伯菌,头孢美唑体外活性略优于头孢西丁。     

Extended-spectrum β-lactamases fromKlebsiella pneumoniae strains isolated at an Italian hospital

Eighteen strains ofKlebsiella pneumoniae recently isolated from hospitalized patients were resistant or moderately resistant to oxyimino-cephalosporins (ceftazidime and/or cefotaxime), aztreonam, cefoxitin and all but one were susceptible to imipenem. Analysis of enzymes produced by these clinical isolates revealed a wide pattern of extended-spectrum -lactamases. All isolates produced one or more -lactamases that were characterized preliminarily by their isoelectric point. Strains isolated early were from patients in the Intensive Care Unit and produced an ES-lactamase with an apparent pI of 7.6, whereas the later isolates were from surgical and medical wards of the same hospital and produced ES-lactamases with apparent pI of 8.2 and 8.4, repectively. This suggests the emergence of SHV-5 and MIR-1 -lactamases in our hospital. Agarose gel electrophoresis of plasmid DNA revealed the presence of a similar plasmid of approximate size 60 Kb in all isolates.     

亚抑菌浓度头孢西丁体外诱导大肠埃希菌耐药转移

目的:探讨亚浓度头孢西丁对产ESBL大肠埃希菌耐药质粒接合转移率的影响。方法:分析不同亚抑菌浓度的头孢西丁(0、1、0.5、0.25、0.125μg/ml)分别在不同时间(0、2、4、6、8、10h)对产ESBL大肠埃希菌诱导后,再与受体菌接合4h后观察耐药质粒的接合转移率。结果:产ESBL大肠埃希菌耐药质粒在0.25μg/ml头孢西丁诱导4h后的接合转移率最高,1μg/ml可降低接合转移率,经药物诱导后的各接合子MIC值均有所增高。结论:临床应该合理足量的使用抗生素,以防止耐药性的增强和耐药质粒的播散。     

头孢西丁钠在不同溶液中的稳定性考察

目的：考察注射用头孢西丁钠与4种输液配伍的稳定性,为临床合理用药提供科学依据。方法：在25℃将头孢西丁钠分别与0．9％氯化钠注射液、5％葡萄糖注射液、葡萄糖氯化钠注射液、木糖醇注射液配伍,在12h内用高效液相色谱法测定头孢西丁钠的含量。结果：头孢西丁钠在50-800L／检测浓度范围内呈良好线性关系（r=0．9998）,平均回收率为（99．7±1．1）％;日内差RSD≤1．4％（n=5）,日间差RSD≤1．9％（n=5）。头孢西丁钠与4种输液配伍12h内含量〉93％。结论：头孢西丁钠与4种输液在25℃、12h内配伍稳定。     

Sulbactam/ampicillin compared with cefoxitin for chemoprophylaxis in elective colorectal surgery

In a prospective, randomized, comparative study, patients undergoing elective major colorectal surgery received four six-hour doses of either sulbactam (a β-lactamase inhibitor) with ampicillin (1 gm with 1 gm), or cefoxitin (2 gm) commencing at induction of anesthesia. The groups were well matched for age, sex, diagnosis, and surgical procedures. Three patients in the sulbactam group (N=44), and four in the cefoxitin group (N=48) developed significant would sepsis. Minor wound sepsis occurred in an additional four sulbactam patients, and in five cefoxitin patients. There was no difference between the groups in deep sepsis or anastomotic leak rates (sulbactam, four patients; cefoxitin, seven patients). No serious side effects were recorded in either group. These results suggest that sulbactam combined with ampicillin provides a safe, effective alternative to cefoxitin for prophylaxis in colorectal surgery.     

Activity of fosfomycin alone or combined with cefoxitin in vitro and in vivo in a murine model of urinary tract infection due to Escherichia coli harbouring CTX-M-15-type extended-spectrum β-lactamase

The efficacy of fosfomycin alone or combined with cefoxitin was investigated in vitro and in a murine model of urinary tract infection due to susceptible Escherichia coli CFT073-RR and its transconjugant CFT073-RR Tc (pbla_CTX-M-15) harbouring a plasmid carrying the bla_CTX-M-15 gene. In vitro, the combination of cefoxitin and fosfomycin was synergistic and bactericidal and prevented the emergence of fosfomycin-resistant mutants of CFT073-RR and CFT073-RR Tc (pbla_CTX-M-15) that were selected with fosfomycin alone. In vivo, the combination conferred an advantage in terms of kidney sterilisation of mice infected with either strain compared with fosfomycin monotherapy.     

双纸片抑制增效试验在 AmpC 酶检测中应用分析

目的：探讨分析双纸片抑制增效试验在肺炎克雷伯菌产 AmpC 酶的检测应用,评价该方法在临床实验室的应用价值。方法采用头孢西丁纸片法,头孢西丁三维试验,双纸片抑制增效试验,以及耐药基因多重 PCR 技术对临床分离菌株进行检测。结果137株临床分离肺炎克雷伯菌中,对头孢西丁不敏感的菌株共有22株,头孢西丁三维试验阳性有11株;双纸片抑制增效试验 FOX/FOX＋PBA 双纸片组中阳性有18株,CTT/CTT＋PBA 双纸片组中阳性有11株;多重 PCR 技术检测阳性有19株。头孢西丁三维试验阳性结果与 PCR 结果符合率为47．4％（9/19）,双纸片抑制增效试验中,CTT/CTT＋PBA 双纸片组阳性结果与 PCR 结果符合率为57．9％（11/19）;FOX/FOX＋PBA 双纸片组阳性结果与 PCR 结果符合率为94．7％（18/19）。结论双纸片抑制增效试验,其方法简便,结果准确性高,其中 FOX/FOX＋PBA 双纸片组可应用于临床分离肺炎克雷伯菌产 AmpC 酶的检测。     

清开灵注射液联合头孢西丁治疗急性上呼吸道感染的临床研究

目的 探讨清开灵注射液联合注射用头孢西丁钠治疗急性上呼吸道感染的临床疗效。方法 选取2020年2月—2022年1月秦皇岛市中医医院收治的76例急性上呼吸道感染患者,全部患者按照随机数字表法分为对照组和治疗组,每组各38例。对照组患者静脉滴注注射用头孢西丁钠,2g加入100mL生理盐水中,2次/d。治疗组患者在对照组治疗的基础上静脉滴注清开灵注射液,20mL加入100mL葡萄糖液中,1次/d。两组患者连续治疗7d。观察两组的临床疗效,比较两组的主要症状的消失时间、血清白细胞介素-18（IL-18）、C反应蛋白（CRP）、白细胞（WBC）水平。结果 治疗后,治疗组的总有效率为97.37%,高于对照组的总有效率81.58%,差异有统计学意义（P＜0.05）。治疗后,治疗组患者的体温复常时间、咳嗽消失时间、咽部红肿消失时间均短于对照组,差异有统计学意义（P＜0.05）。治疗后,两组患者的血清IL-18、CRP、WBC水平显著降低（P＜0.05）;治疗组的血清IL-18、CRP、WBC水平低于对照组,差异有统计学意义（P＜0.05）。结论 清开灵注射液联合注射用头孢西丁钠治疗急性上呼吸道感染具有较好的临床疗效,能缓解临床症状,减轻炎症反应,药物安全性良好。     

注射用头孢西丁钠与注射用氯诺昔康配伍稳定性考察

目的:考察注射用头孢西丁钠与注射用氯诺昔康在0.9%氯化钠注射液中的配伍稳定性。方法:在(25±1)℃下,采用高效液相色谱法(HPLC)测定配伍液8 h内头孢西丁钠与氯诺昔康的含量变化,并观察和检测配伍液的外观、pH及不溶性微粒变化。结果:8 h内配伍液外观、pH、不溶性微粒及氯诺昔康的含量无明显变化,头孢西丁钠含量不断下降,8 h含量为95.5%。结论:室温条件下,注射用头孢西丁钠与注射用氯诺昔康在0.9%氯化钠注射液中8 h内保持稳定。     

不同孵育温度对耐甲氧西林葡萄球菌药敏结果的影响

目的探讨不同孵育温度对耐甲氧西林葡萄球菌（MRS）药敏结果的影响,为临床提供更为可靠的用药依据。方法收集,分离,鉴定耐甲氧西林葡萄球菌。用K—B纸片扩散法于34℃和36℃进行药敏试验。结果32株耐甲氧西林葡萄球菌对头孢西丁的药敏试验34℃和36℃判读结果存在明显差别。结论在测定耐甲氧西林葡萄球菌的药敏时,适当控制孵育温度（34℃±1℃）能更好地反映药敏结果的真实情况,为临床提供更为可靠的用药依据。