4238份血培养标本的病原菌分布情况及耐药性研究

目的对该院2012年6月至2016年6月血培养标本中病原菌分布情况及耐药性的研究。方法选用BD Bactec FX-200血培养分析仪对2012年6月至2016年6月共4 238份标本进行检测并对鉴定结果进行回顾性分析。结果 4 238份血培养标本中检测出阳性标本455株,阳性率为10.74%,革兰阳性菌占38.02%,革兰阴性菌占60.00%,真菌占1.98%;主要分布在新生儿和中老年患者中,分别为6.78%和76.17%。其中肠杆菌科占54.10%,以大肠埃希菌和肺炎克雷伯菌为主,非发酵菌占2.90%。革兰阳性球菌以葡萄球菌属为主,占25.87%。肠杆菌科对美罗培南、亚胺培南等较为敏感,非发酵菌对哌拉西林/他唑巴坦较为敏感,葡萄球菌和链球菌对万古霉素较为敏感。结论结合患者病原菌分布及耐药情况,临床医生应合理用药增强菌血症和真菌血症的治愈率。     

Antibiotics and Bone Cements: Experimental and Clinical Long-Term Observations

Comparing several antibiotics and different bone cements, the mixture of Palacos® R (polymethylmethacrylate, PMMA) with gentamicin proved to be the most suitable one as far as a high and sustained release of the antibiotic from the artificial resin is concerned. A continuous leaching of gentamicin was observed for more than 5 years. Gentamicin proved to be stable in Palacos R for the whole period of time.

The release of 12 antibiotics from Palaes R was evaluated in vitro. Four other bone cements were included in this ttudy as well, in order to evaluate the leaching of gentamicin from these materials. the combination Gentamicin-Palacos R (GP) showed a 2–3 fold higher and much more prolonged release than did the other mixtures. From this investigation, which also included studies of commercially available antibiotic bone cement mixtures, it is quite obvious that there exist distinct differences in the various bone cements as well as in the various antibiotics as regards their qualification for use in alloarthroplasty.

Pharmacokinetic studies in patients after implantation of GP showed low gentamicin concentrations in serum (on average 1.8μg/ml) and urine. However, in wound exudate, derived directly from the vicinity of the implanted cement, gentamicin concentrations up to 150μg/ml were observed. Also in tissue samples from the vicinity of the implant, high concentrations were measurable for a long period of time (up to 5 1/2 years).     

我院抗菌药物应用现状及措施分析

目的探究我院抗菌药物应用现状及措施.方法 将我院2012年4~9月抗菌药物临床应用情况作为研究对象,进行专题调查.结果 我院抗菌药物品种共计61个,住院病患使用抗菌药物的概率平均为75.26%,使用的强度则平均为108.4,Ⅰ类切口手术与介入治疗抗菌药物预防使用率达到了100.00%,门诊抗菌药物处方比例平均为16.27%.结论 在临床使用抗菌药物方面,相关医生尚不规范,因此必须加强医务人员在该方面的培训,以此保障抗菌药物使用的有效与安全,实现经济合理,减少耐药.     

Duodenal Ulcer and Eradication of Helicobacter pylori in a Developing Country An 18-Month Follow-up Study

Forty-eight patients with endoscopically proven duodenal ulcer (DU) and Helicobacter pylori infection detected by ¹⁴C-urea breath test (BT) were assigned to 5 days of treatment with furazolidone, metronidazole, and amoxicillin in addition to eventual classical anti-ulcer agents if necessary. Clinical evaluation and BT were repeated at 2, 6, and 18 months after therapy to determine H. pylori eradication or reinfection. Endoscopy was also repeated at 6 and 18 months after treatment to detect DU relapse. In 29 (60%) patients H. pylori had been eradicated at 2 months after therapy, and in 19 (40%) infection persisted. After successful eradication, 6 of 29 (20.7%) were reinfected. All 24 patients who were negative at the 18-month evaluation were asymptomatic, free of anti-ulcer drugs, and with healed ulcers, whereas among the 19 positive patients followed up, 11 (57%) continued to be symptomatic and still using anti-ulcer agents (p < 0.010), and 10 (53%) showed active ulcers at endoscopy (p < 0.010). H. pylori eradication is clearly followed by long-term remission of DU. Reinfection may be an additional problem in treating DU patients in developing countries.     

Clinical relevance of the ESKAPE pathogens

In recent years, the Infectious Diseases Society of America has highlighted a faction of antibiotic-resistant bacteria (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp.) – acronymically dubbed ‘the ESKAPE pathogens’ – capable of ‘escaping’ the biocidal action of antibiotics and mutually representing new paradigms in pathogenesis, transmission and resistance. This review aims to consolidate clinically relevant background information on the ESKAPE pathogens and provide a contemporary summary of bacterial resistance, alongside pertinent microbiological considerations necessary to face the mounting threat of antimicrobial resistance.