巴洛沙星的合成

目的合成巴洛沙星(Balofloxacin),并进行工艺优化。方法以1-环丙基-6,7-二氟-8-甲氧基-4-氧代-1,4二氢喹啉-3-羧酸乙酯为起始原料,经保护、缩合、水解等反应制得抗菌药巴洛沙星。结果合成目标化合物,总收率为54.9%。结论本工艺反应条件平和,成本较低,收率较高。     

住院患者抗菌药物使用调查分析

目的:了解住院患者抗菌药物使用的基本情况为用药管理提供依据.方法:根据设计的表格项目调查2004年4月所有16个临床科室的1 569份出院患者的病历.结果:1 569份病历中1 293份使用抗菌药物,使用率82.40%:内外科系统使用率分别为62.50%、90.56%.使用的抗菌药物可分为10大类69种.内科用药前三位为喹诺酮类42.11%,青霉素类36.14%,头孢类32.98%;外科围手术期用药前三位为第三代头孢27.53%,青霉素类20.22%,加酶抑制剂的复合药19.66%.结论:抗菌药物滥用现象严重,必须进一步加强抗菌药物使用的管理.     

安徽省医院感染监控网医院感染病原菌分布及耐药性分析

目的了解医院感染病原菌的分布及细菌的耐药情况. 方法对全省医院感染监控网40所医院感染病原菌来源及细菌耐药进行统计分析. 结果在8 490例医院感染病例中分离出病原菌3 808株(45.30%);病原菌以革兰阴性菌为主,占42.33%,主要来源于下呼吸道,占38.81%;大肠埃希菌对庆大霉素耐药率67.93%,与阿米卡星相比,对两者耐药性差异有显著性(P<0.01),耐甲氧西林葡萄球菌为66.89%,分离出的病原菌对氨苄西林的耐药率均>60%,大多数病原菌对常用抗菌药物均有较高的耐药率. 结论医院感染细菌的耐药性日趋严重,应引起高度重视.     

肝移植病区感染的病原菌分布及耐药性分析

目的探讨肝移植病区感染的病原菌分布及其耐药性.方法对我院2001～2002年肝移植病区各类标本首次分离的1035株病原菌的分布及耐药性进行回顾性分析.结果肝移植病区感染的病原菌以革兰阴性杆菌为主,占56.3%;其次为革兰氏阳性球菌(25.0%)和真菌(18.7%).最常见的5个菌种依次是表皮葡萄球菌、嗜麦芽窄食单胞菌、铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌.病原菌分离部位以痰、血液、胆汁为主,占86.4%.细菌的耐药现象严重,常见菌种基本上都呈多重耐药,但革兰阴性杆菌对泰能耐药率相对较低.没有发现耐万古霉素的葡萄球菌.结论加强肝移植病区的细菌分离及耐药性监测,对于合理使用抗生素预防和治疗感染十分重要.     

重庆地区2015～2017年幽门螺杆菌耐药性分析

【摘要】 目的 分析重庆地区幽门螺杆菌（Hp）耐药情况。方法 收集2015年1月～2017年12月在重庆市大坪医院行胃镜检查患者的胃黏膜标本14882例,进行Hp分离培养,并采用琼脂稀释法对Hp进行药敏试验,对药敏结果进行统计学分析。结果 分离培养Hp阳性菌株3841株,培养阳性率2581%,男性培养阳性率高于女性（P＜005）。Hp对甲硝唑、克拉霉素、左氧氟沙星、阿莫西林总的耐药率分别为9409%、2630%、3398%、026%,未发现对四环素及呋喃唑酮耐药。重庆地区2015～2017年Hp对甲硝唑、克拉霉素、左氧氟沙星的耐药率上升（P＜005）;女性对克拉霉素、左氧氟沙星耐药率均高于男性（P＜005）;随着年龄的增长,人群对甲硝唑和左氧氟沙星耐药率呈上升趋势,不同年龄段人群对克拉霉素耐药率比较差异无统计学意义(P＞005)。结论 重庆地区Hp对甲硝唑、克拉霉素、左氧氟沙星的耐药率均较高,临床工作者应根据药敏结果选择个体化治疗方案,或者采用含阿莫西林、四环素、呋喃唑酮或甲硝唑的铋剂四联疗法行经验性治疗。     

重症监护病房肺炎克雷伯菌临床特点及耐药分析

目的 分析重症监护病房（ICU）肺炎克雷伯菌感染的临床特点及耐药情况,为临床合理使用抗菌药物提供依据。方法 回顾性分析重庆医科大学附属第一医院2014年1月～2016年12月ICU肺炎克雷伯菌感染病例483例,药敏试验采用纸片扩散法,双纸片协同试验进行超广谱β内酰胺酶检测,WHONET5.6及SPSS 21.0软件统计分析数据。结果 ICU肺炎克雷伯菌感染常见于伴多种易患因素的老年患者,下呼吸道为主要感染部位;CREKp感染死亡率高,多合并感染性休克或多器官功能障碍。3年来ICU检出肺炎克雷伯菌对常用抗菌药物耐药率不同程度上升,特别是CREKp菌株分离逐渐增加且呈泛耐药特点,仅对替加环素、米诺环素敏感。结论 ICU肺炎克雷伯菌感染发病率高且病情重,CREKp感染死亡风险高,应充分认识其严重性。治疗上依据药敏试验结果指导临床选择适当抗菌药物尤为重要。     

Treatment of Urinary Tract Infections and Antibiotic Stewardship

Urinary tract infections affect >30% of people around the world. Empirical treatments are currently used for several infections, but appropriate criteria for the rational use of antibiotics should be focused to prevent bacterial resistance phenomena and the increased risk of difficult to-treat infections. Relevant information concerning risk factors and different levels of severity as well as appropriate microbiological interpretation of pathogens have been included and discussed. Moreover, the optimal clinical approach to asymptomatic bacteriuria and recurrent infection episodes has been evaluated, with appropriate suggestions for antibiotic treatment. The prevalence of antibiotic resistance is worsening, probably because of the increasing number of multidrug-resistant bacterial strains and the indiscriminate use of broad-spectrum antibiotics and empirical treatments, inducing increased treatment costs and hospitalizations. Antibiotic stewardship should be introduced in clinical practice to avoid the risk of infection episodes in which the urologist cannot risk systemic inflammatory response syndrome or sepsis. For these reasons, adequate indications for the rational use of antibiotic treatment have been described and discussed, including when and how empirical treatments should be used in current clinical practice.Patient summaryThe prevalence of antibiotic resistance is worsening likely because of the increasing number of multidrug-resistant bacterial strains and the indiscriminate use of broad-spectrum antibiotics. Antibiotic stewardship should be introduced in clinical practice to avoid the risk of infection episodes in which the urologist cannot risk systemic inflammatory response syndrome or sepsis.     

Increased infection risk after hip hemiarthroplasty in institutionalized patients with proximal femur fracture

In patients undergoing hip hemiarthroplasty (HHA) secondary to proximal femur fracture, acute periprosthetic joint infection (PJI) is one of the most important complications. We have detected an increased risk of PJI in chronic institutionalized patients (CIPs), and a higher number of early postoperative infections are caused by Gram-negative bacteria (GNB), not covered by the current prophylaxis (cefazolin in noninstitutionalized patients (NIPs) and cotrimoxazole in CIPs). We sought to compare infection characteristics between NIPs and CIPs, analyzing predisposing factors, causative pathogens, and antibiotic prophylaxis-related microbiological characteristics. We performed a retrospective review of our prospective institutional database to identify all patients consecutively admitted for HHA to treat proximal femur fracture at our centre between 2011 and 2013. PJI was diagnosed in 21 of 381 (5.51%) patients, with 10 of 105 (9.52%) in the CIP group and 11 of 276 (3.99%) in the NIP group, and statistical significance was achieved. GNB accounted for PJI in 14 (66.67%) patients. We detected a single case of methicillin-resistant Staphylococcus aureus (MRSA) infection in the NIP group.We confirm a higher risk of acute PJI among institutionalized patients, commonly caused by Gram-negative microorganisms, which are not covered by the current prophylaxis. New prophylactic strategies should be investigated in order to reduce this problem.     

Whole genome sequence to decipher the resistome of Shewanella algae,a multidrug-resistant bacterium responsible for pneumonia,Marseille, France

We characterize and decipher the resistome and the virulence factors of Shewanella algae MARS 14, a multidrug-resistant clinical strain using the whole genome sequencing (WGS) strategy. The bacteria were isolated from the bronchoalveolar lavage of a hospitalized patient in the Timone Hospital in Marseille, France who developed pneumonia after plunging into the Mediterranean Sea. Results: The genome size of S. algae MARS 14 was 5,005,710 bp with 52.8% guanine cytosine content. The resistome includes members of class C and D beta-lactamases and numerous multidrug-efflux pumps. We also found the presence of several hemolysins genes, a complete flagellum system gene cluster and genes responsible for biofilm formation. Moreover, we reported for the first time in a clinical strain of Shewanella spp. the presence of a bacteriocin (marinocin). Conclusion: The WGS analysis of this pathogen provides insight into its virulence factors and resistance to antibiotics.     

病原菌明确的细菌性脑膜炎146例临床及病原学分析

目的 分析细菌性脑膜炎患儿临床表现和病原特点，为临床诊治提供帮助。方法 收集复旦大学附属儿科医院2001年1月至2012年12月病原菌诊断明确的细菌性脑膜炎住院患儿，采集临床表现、辅助检查、并发症、病原菌种类和耐药情况等资料，分为0~28 d（新生儿组），~1岁、~3岁和>3岁组进行描述分析。结果 146例细菌性脑膜炎患儿进入分析，新生儿组58例，~1岁组36例，~3岁组20例，>3岁组32例。①新生儿组发热、呕吐和脑膜刺激征的发生率较低，>3岁组伴有颅面、脊柱解剖畸形50%（16/32）。②革兰阳性菌占54.8%（80株），以凝固酶阴性葡萄球菌（33株）、肠球菌（19株）和肺炎链球菌（12株）为主；革兰阴性菌占45.2%（66株），以大肠埃希菌（30株）和鲍氏不动杆菌（10株）为主。③革兰阳性菌对万古霉素和利奈唑胺均敏感，革兰阴性菌除3/10株鲍氏不动杆菌和1/3株铜绿假单胞菌对美罗培南耐药外，余均敏感；大肠埃希菌、克雷伯菌和阴沟肠杆菌产超广谱β内酰胺酶阳性率分别达到66.7%、60.0%和100%。④63例（43.2%）出现急性期并发症，以硬膜下积液（26例）、脑积水（20例）和局部神经损害（13例）最常见；出现并发症主要病原菌为大肠埃希菌(15/30)、凝固酶阴性葡萄球菌（14/33）、肺炎链球菌（6/12）和鲍氏不动杆菌(6/10)。⑤出院结局：死亡或放弃治疗31例（21.2%），其中肺炎链球菌性脑膜炎为5/12例（41.7%）。结论 细菌性脑膜炎新生儿临床表现多不典型，>3岁患儿应关注神经系统相关解剖结构缺陷的可能。可根据病原菌分布特点和药敏结果选用敏感抗生素。肺炎链球菌性脑膜炎患儿预后可能不良。