2012—2015年1380株肝移植术后感染病原菌的分布及耐药性分析

目的了解江苏省人民医院肝移植术后感染病原菌的分布及耐药性,为临床合理用药提供参考。方法对2012年1月—2015年1月江苏省人民医院肝移植术后感染病原菌的分布及耐药性进行统计分析。结果共分离出病原菌1 380株,主要来源于痰液标本。病原菌分布以革兰阴性菌为主,占69.57%,革兰阳性菌和真菌分别占20.07%、10.36%;其中革兰阴性菌以鲍曼不动杆菌、肺炎克雷伯菌为主,革兰阳性菌以溶血葡萄球菌为主;革兰阴性菌对美罗培南、阿米卡星、亚胺培南较为敏感,耐药率均低于30%,对头孢曲松、氨曲南等的耐药率均较高;革兰阳性菌对万古霉素、利奈唑胺、替考拉宁较为敏感,耐药率均低于20%,对氨苄西林、诺氟沙星等耐药率均较高。结论肝移植术后感染病原菌的构成主要是鲍曼不动杆菌、肺炎克雷伯菌和溶血葡萄球菌,临床选择抗菌药物时建议选用病原菌表现较低耐药性的美罗培南、阿米卡星、万古霉素、利奈唑胺等药物。     

Trimethoprim-Sulfamethoxazole plus Amikacin as First-Line Therapy and Imipenem/Cilastatin as Second Empirical Therapy in Febrile Neutropenic Patients with Hematological Disorders

One hundred and thirty-nine consecutive episodes of fever were evaluated in 55 patients with hematological disorders during persistent neutropenia. In 121 instances, patients were given trimethoprim-sulfamethoxazole + amikacin (TMP/SMZ + AMI) as an initial antibiotic regimen with clinical success in 51% (i.e. antibiotic treatment was not changed within the first 7 days).

Imipenem/cilastatin (I/C) therapy was instituted in: (a) 22 episodes with clinical failure and fever of unknown origin during TMP/SMZ + AMI therapy and (b) 18 episodes with a second fever episode during initially successful TMP/SMZ + AMI therapy. The response rate for all 40 I/C treated episodes was 80%. One neutropenic patient in the whole series died from infectious complications within four weeks from institution of therapy.

TMP/SMZ + AMI seems to be a safe and inexpensive «standard» antibiotic regimen in neutropenic patients. I/C appears to have good efficacy when used as secondary therapy after failure with TMP/SMZ + AMI.     

A Comparative Study on Aztreonam,Ceftazidime and Amikacin in the Treatment of Complicated Urinary Tract Infections

Summary

In a prospective, randomized trial, aztreonam (1 g intravenously or intramuscularly, twice daily) was compared with ceftazidime (1 g intravenously or intramuscularly, twice daily) and amikacin (500 mg intravenously or intramuscularly, twice daily) in 76 patients aged 24 to 84 years (mean, 59.7 years) with complicated urinary tract infections. Initial pathogens included Escherichia coli (47.5%), Pseudomonas aeruginosa (22.5%), Klebsiella spp. (9%), Proteus spp. (7.5%) and Enterobacter spp (6%). In four patients initial urine cultures yielded more than one organism. All pathogens were sensitive to the three study drugs. Including performance of 4- to 6-week follow-up cultures, eradication of the pathogens occurred in 72% of patients treated with aztreonam, in 74% of those treated with ceftazidime and in 71% treated with amikacin (p>0.05). Clinical success was observed in 84% of patients treated with aztreonam, in 82% of those treated with ceftazidime and in 85% treated with amikacin (p>0.05). All drugs were well tolerated. It is concluded that aztreonam, ceftazidime and amikacin are equally effective and safe for the treatment of complicated urinary tract infections due to susceptible organisms.     

哌拉西林/他唑巴坦联合阿米卡星治疗绿脓杆菌肺炎疗效分析

目的:观察哌拉西林/他唑巴坦联合阿米卡星治疗绿脓杆菌肺炎的疗效.方法:对我科收治的绿脓杆菌肺炎100例病人采用哌拉西林/他唑巴坦联合阿米卡星治疗,静脉滴注剂量为哌拉西林/他唑巴坦4.5 g,q 8 h,阿米卡星400 mg,qd,疗程7-10 d.结果:总有效率为81%,细菌清除率为72%,不良反应率低.结论:哌拉西林/他唑巴坦联合阿米卡星是治疗绿脓杆菌肺炎的有效选择.     

载缓释阿米卡星导尿管的研制及体外释放试验的研究

目的 研制用于防治导尿管相关性尿路感染(CAUTI)的发生与发展的载缓释阿米卡星硅胶导尿管.方法 采用复方壳聚糖为载体,制作载缓释阿米卡星的硅胶导尿管.采用分光光度法测定1～15天内浸提液中阿米卡星的浓度,并用能谱分析技术(EDAX)对膜层的实际组分进行检测,证实阿米卡星在导尿管上的成功负载;直接抑菌实验证实所负载的阿...     

滂胺天蓝与阿米卡星相互作用的共振瑞利散射光谱及其应用

目的:采用共振瑞利散射法(Resonance Rayleigh scattering,RRS)测定不同制剂中阿米卡星(Amikacin,AMK)的含量.方法:考察RRS增强的机理、反应条件对RRS强度的影响以及AMK浓度与RRS强度的关系.结果:在pH3.0的Britton-Robinson缓冲液中,滂胺天蓝(Pontamine sky blue,PSB)与AMK在静电引力及疏水性作用结合成组成比为2∶1的离子缔合物.AMK的浓度在0.01～1.7mg/L范围内与RRS强度成正比,检出限(3σ)为3.0μg/L.结论:该法简便快速、结果准确可靠,可用于不同制剂中AMK的含量测定.     

噬菌体生物扩增法检测结核分枝杆菌阿米卡星耐药性方法的建立及应用评价

目的 建立结核分枝杆菌阿米卡星(Am)耐药性的噬菌体生物扩增法(PhaB)快速检测技术,并探讨其临床应用价值。 方法 通过不同菌量及药物浓度的筛选,建立PhaB测定结核分枝杆菌阿米卡星药敏检测方法;用该方法对108株结核分枝杆菌临床分离株进行了阿米卡星药敏检测,同步进行Bactec MGIT 960的Am药敏检测,对2种方法的检测结果进行比较分析。结果不符合的菌株测定其Am的最低抑茵浓度(MIC)。 结果 以细菌接种量10^-3 mg／ml、药物浓度2 μg／ml、37℃作用48-h为药敏最佳检测条件,噬菌体检测108株结核分枝杆菌临床分离株阿米卡星敏感82株、耐药26株,Bactec MGIT 960检测敏感80株、耐药28株;2法测定均为敏感79株、均为耐药25株。以Bactec MGIT 960测定结果为判断标准,则PhaB的敏感性、特异性、阳性和阴性预测值及符合率分别为89.3%、98.8%、96.2%、96.3%、96.3%。 结论 PhaB检测结核分枝杆菌的Am耐药性有较高的敏感性、特异性和准确性,整个检测只需3 d,且操作简单、不需特殊仪器设备,可作为 M .TB临床分离株Am药敏快速检测备选方法之一。     

Meta-analysis: combination of meropenem vs ceftazidime and amikacin for empirical treatment of cancer patients with febrile neutropenia

Background:Meropenem monotherapy vs ceftazidime plus amikacin have been approved for use against febrile neutropenia. To assess the effectiveness and safety of them for empirical treatment of cancer patients with febrile neutropenia, we conducted a meta-analysis of randomized controlled trial.Methods:Randomized controlled trials on ceftazidime plus amikacin, or/and monotherapy with meropenem for the treatment of cancer patients with febrile neutropenia were identified by searching Cochrane Library, PubMed, Science Direct, Wiley Online, Science Citation Index, Google (scholar), National Center for Biotechnology Information, and China National Knowledge Infrastructure. Data on interventions, participants’ characteristics and the outcomes of therapy, were extracted for statistical analysis. Seven trials fulfilled the inclusion criteria.Result:The treatment with ceftazidime plus amikacin was more effective than meropenem (OR = 1.17; 95% CI 0.93–1.46; 1270 participants). However, the treatment effects of the 2 therapy methods were almost parallel in adults (OR = 1.15; 95% CI 0.91–1.46; 1130 participants older than 16). Drug-related adverse effects afflicted more patients treated with ceftazidime plus amikacin (OR = 0.78; 95% CI 0.52–1.15; 1445 participants). The common responses were nausea, diarrhea, rash, and increased in serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase and bilirubin.Conclusion:Ceftazidime plus amikacin should be the first choice for empirical treatment of cancer patients with febrile neutropenia, and meropenem may be chosen as a last defense against pathogenic bacteria.