伪膜性肠炎26例临床诊治分析

目的：分析伪膜性肠炎（pseudomenbraneouscolitis PME）的临床特点、内镜下表现、病理特点及诊治要点,以提高对该病的认识。方法：回顾性分析冠县人民医院消化内科2005年2月-2010年7月收治的26例PME患者的临床资料,对病史、临床表现、实验室结果、内镜结果及治疗情况汇总分析。结果：26例患者大多数在使用广谱抗生素尤其是头孢菌素的过程中出现腹泻、腹痛及发热等表现,少部分发生在外科手术、恶性肿瘤的患者。结论：PME多在应用广谱抗生素或有基础疾病的患者中发病,体质衰弱、外科重大手术、恶性肿瘤患者等为易感人群。根据抗生素应用史、易患人群、典型临床表现、内镜下典型表现及必要的实验室检查多可明确诊断。停用原来应用的抗生素,给予甲硝唑、万古霉素以及对症支持治疗多可获得满意效果。     

万古霉素血药浓度与儿科临床疗效关系研究

目的:分析儿童万古霉素血药浓度与疗效的关系,指导万古霉素在儿童中合理使用。方法:采用回顾性分析使用万古霉素儿童的临床诊断、血药浓度、疗效、不良反应等资料,并进行统计分析。结果:万古霉素常规用量对儿童感染控制有效,但血药浓度偏低,且血药浓度与疗效成正相关;不良反应以转氨酶升高为主,肾毒性较轻。结论:对万古霉素血药浓度监测指导临床个体化用药,提高万古霉素血药浓度以增强疗效,减少药物不良反应。     

777株临床分离肠球菌的分布及耐药性分析

目的了解本院临床肠球菌的菌群分布及耐药情况。方法采用回顾性调查分析方法对我院分离自各类临床标本的777株肠球菌进行统计,并对抗菌药敏试验结果进行分析。结果肠球菌菌株来源以尿液(30.5%)、胆汁(25.5%)、分泌物(17.8%)为主;2007～2010年分离的肠球菌对抗生素的耐药率有逐年增高趋势(P<0.05);屎肠球菌对多种抗生素的耐药率明显高于粪肠球菌,且在分离的肠球菌构成比有增高趋势。结论屎肠球菌在临床分离的肠球菌中越来越常见,肠球菌的多重耐药严重。     

利奈唑胺与万古霉素对金黄色葡萄球菌耐药突变选择的比较

目的在体外测定利奈唑胺与万古霉素对金黄色葡萄球菌ATCC29213的最低抑菌浓度(MIC)、防细菌耐药突变体选择浓度(MPC)和突变选择指数(SI),比较其防耐药突变能力。方法 采用肉汤法富集1×1010?CFU/mL金黄色葡萄球菌ATCC29213,采用平板稀释法测两种药物对金黄色葡萄菌的MIC、MPC以及SI,同时测定万古霉素联合利福平与左氧氟沙星后的MPC、SI。结果利奈唑胺与万古霉素对金黄色葡萄球菌ATCC29213的MIC、MPC以及SI分别为1.0、1.0?g/L;6.4、 51.2?g/L;6.4、51.2;万古霉素分别联合利福霉素与左氧氟沙星后的MPC及SI分别为12.8?g/L、25.6;8.0?g/L、16.0。结论利奈唑胺对金黄色葡萄球菌防耐药突变能力强于万古霉素,万古霉素与利福霉素及左氧氟沙星联合后均能降低万古霉素的MPC、SI,提高万古霉素的防耐药突变能力。     

Vancomycin assay performance in patients with acute renal failure

Objective: Fluorescence polarization immunoassays (FPIA) have been reported to overestimate vancomycin serum concentrations compared to high-performance liquid chromatography (HPLC) or enzyme multiplied immunoassay technique (EMIT) in patients with chronic renal disease. The assay manufacturer has modified the FPIA to remedy this overestimation. The purpose of this study was to compare the assay performance of two FPIAs to EMIT in acute renal failure patients receiving vancomycin and continuous venovenous hemofiltration.¶Design: Open-label trial.¶Setting: Intensive care unit in a university affiliated hospital.¶Patients and participants: 15 serum and ultrafiltrate samples were obtained from 14 critically ill patients (mean ± SD; 57 ± 12 years; 8 males/6 females).¶Measurements and results: Vancomycin concentrations were determined by a polyclonal FPIA (pFPIA) performed on the TDx system, a monoclonal FPIA (mFPIA) performed on the AxSYM system and EMIT. The coefficient of variation for all assays was < 5 %. The mean difference ± SD_d between mFPIA vs EMIT and pFPIA vs EMIT assays in serum were: –0.08 ± 1.55 and 1.24 ± 2.11 mg/l, respectively. The limits of agreement between the mFPIA vs EMIT and pFPIA vs EMIT assays in serum were: –3.18 to 3.03 and –2.99 to 5.46 mg/l, respectively.¶Conclusions: Our data demonstrate that the manufacturer's changes to the pFPIA have reduced overestimation. The mFPIA appears to be an acceptable assay for measuring vancomycin serum concentrations in acute renal failure patients and does not significantly overestimate these concentrations.     

高效液相色谱法测定人脑脊液中万古霉素浓度及临床应用

目的：采用HPLC-DAD快速有效地测定人脑脊液中万古霉素浓度,为颅内感染患者鞘内注射调整剂量提供依据。方法：前处理采用乙腈: 6%高氯酸（1∶1,v/v）沉淀萃取,采用Eclipse XDB C18柱（250 mm × 4.6 mm,5 μm）;流动相：A-pH3.2磷酸二氢钾缓冲液,B-乙腈,梯度洗脱;流速：1 mL·min-1;检测波长：236 nm;柱温：30 ℃;进样量：20 μL;二极管阵列检测。内标法定量,去甲万古霉素为内标。结果：万古霉素低、中、高3个浓度（3.125、25、50 mg·L-1）方法的绝对回收率分别为95.4%、97.5%、100.7%,日内精密度RSD小于2.76%,日间精密度RSD小于5.24%,基质效应小于1.08%。结论：本方法准确简便,符合万古霉素药物浓度监测的要求。     

重症肺部感染患者肺泡上皮衬液万古霉素渗透性研究

目的对万古霉素在重症肺炎患者的肺组织渗透性进行探索,了解万古霉素在肺组织内分布情况,为研究万古霉素组织浓度与疗效相关性,制订更精准药物治疗方案提供参考。方法选取2016年5月—2017年1月间入住老年重症监护病房(ICU)、因肺部感染使用万古霉素,呼吸衰竭进行机械通气且治疗期间需进行支气管肺泡灌洗治疗患者。万古霉素0.5 g,q8h,持续静脉输注1 h。分别于用药3 d后,于给药间隔内进行一次支气管肺泡灌洗,收集灌洗液和同时期的血液样本,利用液相色谱-串联质谱(LC-MS/MS)法测定万古霉素浓度。同时使用尿素试剂盒对二者中尿素浓度进行测定,以获得灌洗液中药物浓度的稀释倍数,利用Renard公式计算药物在肺组织的渗透性,以渗透率表示。结果纳入符合条件的患者16例,其中男12例,女4例。平均年龄60.94岁,平均急性生理及慢性健康(APACHEⅡ)评分30.31分,主要诊断均为肺部感染,住院期间死亡2例,主要死亡原因为多器官功能衰竭。用药后感染性指标中白细胞(WBC)计数和降钙素原(PCT)差异有统计学意义(P<0.05)。肺泡灌洗操作平均分布在给药间隔内5个采血点,灌洗液回收率为38.83%,尿素在灌洗液中稀释倍数平均为37.34倍(17.8~79倍),肺泡上皮衬液中药物浓度为1.48~10.15μg·mL^-1,万古霉素血清药物浓度为8.71~61.96μg·mL^-1,万古霉素在肺组织渗透率为23.12%。结论万古霉素对重症患者肺部渗透性较低,在血药浓度达标的情况下,感染部位抗菌药物的实际浓度可能并不能达到最佳靶值,可能导致治疗失败。     

Molecular Epidemiology of Oxacillin-resistant Staphylococcus aureus and in vitro Activity of Glycopeptides against Staphylococcus species

Oxacillin resistant Staphylococcus aureus and coagulase negative Staphylococcus species (MRSA and MRSCoN)have become major pathogens in nosocomial infections.The first MRSA isolate in the world was identified in En gland in 1961 [1]. Since that tim…     

Detection of vancomycin resistance genes combined with typing of Enterococci by means of multiplex PCR amplification and multiple primer DNA sequencing

A multiplex PCR assay for the detection of vancomycin resistance (van) genes in enterococci was established. Primers targeting the 16S rRNA gene were included in the reaction mixture. Multiple-primer DNA sequencing of the PCR products provided species identification through partial nucleotide sequences of 16S rRNA genes, as well as confirmation of the correct identification of vanA, vanB, vanC-1, and vanC-2/3 genotypes. Thirty-nine enterococcal clinical isolates and type strains were examined for the presence of vancomycin resistance determinants. Twelve other isolates from a clinical reference collection (some of them having vanA, vanB, vanC-1, or vanC-2/3 genotypes) were used as controls. Hybridization and partial DNA sequence analysis of multiplex PCR products revealed that none of the clinical isolates had a vanA genotype and only one had a vanB genotype. vanC-1 was found in three clinical isolates, and vanC-2/3 in one. Results obtained with the reference and type strains were in agreement with earlier results.     

Vancomycin-associated spontaneous cutaneous adverse drug reactions

Purpose

With the increase in vancomycin use, adverse drug reactions (ADRs) associated with vancomycin have been reported increasingly more often. However, the characteristics of cutaneous ADRs with and without systemic reactions (SRs) have not been described. This study investigated the characteristics of spontaneously reported and assessed ADRs associated with vancomycin by a pharmacovigilance center.

Methods

ADRs (n=121) associated with vancomycin in 96 patients were collected from 2008 to 2009. Records from physician- and nurse-reported suspected cases of vancomycin ADRs, ADR type, latent period, and laboratory results were compared between cutaneous ADRs with and without SRs.

Results

The main vancomycin-related ADRs were skin rashes (47.9%), hematologic abnormalities (17.36%), fever (12.4%), and elevated serum creatinine (12.4%). Significant differences were observed in latent period (days) and the mean change in eosinophils (%) between cutaneous (9.21±9.71 and 1.4±3.4, respectively) and other ADRs (14.03±11.71 and -0.5±3.5, respectively). Twelve cases of cutaneous ADRs with SRs had been initially reported as cutaneous ADRs only. Mean changes in the eosinophil count were significantly higher for cutaneous ADRs with SRs compared to those without SRs.

Conclusions

Skin rashes accompanied by peripheral eosinophilia, representing suspected immune-mediated delayed hypersensitivity reactions, are a common vancomycin ADR. For the early and exact detection of ADRs associated with vancomycin administration, close monitoring of laboratory tests, including complete blood counts with differential analysis, is recommended.