头孢唑林钠水合物新晶体及其理化特性的研究

头孢唑林钠(cefazolin sodium)是目前临床中最常用的半合成头孢菌素,其与水分子等作用可形成α型(含5分子结晶水)、β型(含3/2分子结晶水)和γ型(含1分子结晶乙醇)等晶体[1],但目前仅有少量文献对其晶体结构进行探讨[2～4].     

高效毛细管电泳法测定头孢唑啉钠的含量

目的：测定头孢唑啉钠的含量。方法：采用毛细管电泳法,选用硼砂缓冲液（pH7.89）;运行电压14kV,检测波长214nm。选择枸橼酸昔多芬为内标。结果：头孢唑啉钠在33．9－678μg.ml^-1范围内线性关系良好,r=0.9996(n=5),平均回收率99．57％,RSD为2．37％（n=5)。结论：该法分离效率高,快速,简便,低耗。     

用高效液相色谱法测定头孢唑啉钠与利多卡因及葡萄糖配伍的稳定性

采用Shim-packCLC-ODS柱,以0.01mol/L醋酸铵-甲醇（85：15）为流动相,比较样品溶液与标准溶液的峰面积,测定头孢唑啉钠的含量,以考察其在利多卡因溶液与葡萄糖溶液中的稳定性。结果表明：头孢唑啉钠利多卡因溶液的稳定性高于葡萄糖溶液,因此,临床上以利多卡因注射液为溶剂,溶解头孢唑啉钠进行肌肉注射以缓解注射时的疼痛是可行的。     

The Efficacy of Prophylactic Antibiotics Administration prior to Insertion of Tunneled Catheter in Hemodialysis Patients

Aim and background: Central venous catheter (CVC)-related blood stream infection is a major cause of morbidity and mortality in patients with end-stage renal diseases. However, CVCs are quite frequently required for vascular access in hemodialysis (HD) patients. Tunneled catheters (TCs) are widely used when a catheter is needed for a long period. However, long-term catheter survival is limited by TC-related infections. The purpose of this prospective study was to assess clinical outcomes of prophylactic antibiotics administration prior to insertion of TCs in HD patients. Material and methods: Sixty uremic patients who required TC insertion due to vascular access failure were included in our study between April 2009 and April 2010. Patients were randomized into two groups: group I and group II. Group I received 1 g of cefazolin sodium intravenously 1 h prior to catheter insertion. Group II received equal amount of saline intravenously 1 h prior to catheter insertion. The primary end points of the study were catheter loss, hospitalization, or mortality due to catheter-related infections (CRIs). The secondary end points included exit-site infection (not requiring hospitalization), tunnel infections (not requiring catheter removal), and bacteremia. Results: During the follow-up period, one patient in group I and three patients in group II reached primary end point (p < 0.05). Catheter loss due to infection was higher in group II than in group I as 6 versus 3, respectively (p < 0.05). Catheter exit-site infections, which does not require hospitalization, have been considered as secondary end points and have been detected in four patients for 7 times in group I and in six patients for 10 times in group II (p < 0.05). Tunnel infection, which does not require removal of the catheter, has been detected in two patients for 3 times in group I and in five patients for 6 times in group II (p < 0.05). Conclusion: The prophylactic antibiotic use prior to TC insertion significantly reduced CRIs, bacteremia, and catheter loss.     

Are all beta-lactams similarly effective in the treatment of methicillin-sensitive Staphylococcus aureus bacteraemia?

Methicillin-sensitive Staphylococcus aureus (MSSA) is susceptible to many beta-lactams. We compared cloxacillin and cefazolin, the first-line recommended antibiotics, and other beta-lactams in the treatment of MSSA bacteraemia. This was a retrospective cohort study. Included were adult patients with clinically-significant MSSA bacteraemia treated with a beta-lactam that was started within 48 h after blood cultures were taken. We separated between empirical treatment administered to the patient before receipt of final blood culture results and definitive treatment administered thereafter. Univariate and multivariable analyses for 30-day (empirical treatment) and 90-day (definitive treatment) mortality were conducted, including the type of beta-lactam administered to the patient. Five-hundred and forty-one patients were included for the analysis of empirical treatment and 498 patients alive at 7 days were evaluable for definitive treatment. Empirical treatment with cloxacillin or cefazolin (n = 131) was associated with lower 30-day mortality as compared with cefuroxime (n = 98, p 0.058), ceftriaxone or cefotaxime (n = 194, p 0.008) and beta-lactam-beta-lactamase combinations (n = 61, p 0.013), with adjusted odds ratios (OR) for death ranging from 1.98 to 2.68. Definitive treatment with cefazolin (n = 72) was not significantly different from cloxacillin (n = 281); adjusted OR for 90-day mortality 0.91 (95% confidence interval 0.47–1.77). Treatment with cefazolin both in the empirical and definitive periods was not significantly different from cloxacillin; adjusted OR 0.81 (95% confidence interval 0.18–3.62). Treatment of MSSA bacteraemia with cefazolin is not significantly different from treatment with cloxacillin, while treatment with other beta-lactams, including second and third generation cephalosporins, might be associated with higher mortality.     

Adverse reaction to metal debris after ReCap-M2A-Magnum large-diameter-head metal-on-metal total hip arthroplasty

Background and purpose The clinical findings of adverse reaction to metal debris (ARMD) following large-diameter-head metal-on-metal total hip arthroplasty (LDH MoM THA) may include periarticular fluid collections, soft tissue masses, and gluteal muscle necrosis. The ReCap-M2a-Magnum LDH MoM THA was the most commonly used hip device at our institution from 2005 to 2012. We assessed the prevalence of and risk factors for ARMD with this device.

Methods 74 patients (80 hips) had a ReCap-M2a-Magnum LDH MoM THA during the period August 2005 to December 2006. These patients were studied with hip MRI, serum chromium and cobalt ion measurements, the Oxford hip score questionnaire, and by clinical examination. The prevalence of ARMD was recorded and risk factors for ARMD were assessed using logistic regression models. The mean follow-up time was 6.0 (5.5–6.7) years.

Results A revision operation due to ARMD was needed by 3 of 74 patients (3 of 80 hips). 8 additional patients (8 hips) had definite ARMD, but revision was not performed. 29 patients (32 hips) were considered to have a probable or possible ARMD. Altogether, 43 of 80 hips had a definite, probable, or possible ARMD and 34 patients (37 hips) were considered not to have ARMD. In 46 of 78 hips, MRI revealed a soft tissue mass or a collection of fluid (of any size). The symptoms clicking in the hip, local hip swelling, and a feeling of subluxation were associated with ARMD.

Interpretation ARMD is common after ReCap-M2a-Magnum total hip arthroplasty, and we discourage the use of this device. Asymptomatic patients with a small fluid collection on MRI may not need instant revision surgery but must be followed up closely.     

薄膜包衣用于中药浸膏粉胶囊剂防潮的试验研究

本实验对替硝唑葡萄糖注射液与头孢唑啉钠于5、25、37℃条件下配伍进行了考察。两药配伍后6h内外观检查溶液澄明，无沉淀产生和颜色变化，pH值无明显变化，两组分含量降低不明显。     

Retinal toxicity of antibiotics: Evaluation by electroretinogram

Toxicity of an intravitreal injection of gentamicin sulfate, disodium sulbenicillin and cefazolin sodium on the retina was investigated by electroretinogram in albino and pigmented rabbits. Recordings were made before injection and 2 hours and 3, 7, 14, and 21 days after injection.Significant differences were found in the susceptibility of the electroretinogram components to various antibiotics as follows. Gentamicin 0.24mg/0.1ml irreversibly abolished all the components examined. Sulbenicillin 4.0, 8.0, or 12mg/0.1ml transiently suppressed the fawave and the oscillatory potentials incrementally with increasing dose. Cefazolin 0.5, 2.0, or 5.0mg/0.1 ml selectively reduced the oscillatory potentials, leaving the a- and b-waves almost unattenuated. The cefazolin-suppressed oscillatory potentials recovered within 14 days after injection.Judging from the most susceptible electroretinogram components to each antibiotic, we recommend intravitreal doses of these antibiotics for clinical use as follows: gentamicin 0.1 mg/0.1 ml, sulbenicillin 2mg/0.1 ml, and cefazolin 0.25mg/0.1 ml.     

Cefazolin tissue concentrations with a prophylactic dose administered before sleeve gastrectomy in obese patients: a single centre study in 116 patients

Background

In obese patients undergoing sleeve gastrectomy, the blood and fatty-tissue concentrations of cefazolin required for adequate antibiotic prophylaxis are uncertain.

3种头孢菌素类药物皮肤过敏试验必要性的临床观察

[目的 ]观察头孢唑啉、头孢拉定、头孢哌酮皮肤过敏试验的临床意义。 [方法 ]将注射使用 3种头孢菌素类药物的住院病人 42 0 5例 ,分为皮试组和非皮试组 ,观察用药后不良反应发生情况。 [结果 ] 3种药物皮试阳性率无显著差异 ,平均为 2 .42 % ;有青霉素过敏史、其他物质过敏史和无过敏史人群皮试阳性率分别为 19.85 %、12 .12 %和0 .65 % ;皮试阴性后用药组过敏反应和总不良反应发生率显著低于非皮试组 ,尤其有过敏史的病人 ,不良反应的减少更为显著。 [结论 ]过敏史是影响 3种头孢菌素类药物皮试阳性率和不良反应发生的最重要因素 ,建议在用药前对有过敏史者要以拟用药作皮试。