用微机对青霉素皮试作辅助判断的临床应用的探讨

目的探讨微机对青霉素皮试结果作辅助判断的准确性。方法我们根据青霉素皮试常规观察指标设计了青霉素皮试观察记录单,分三个时段观察青霉素皮试的结果。计算机程序判断青霉素皮试的结果是对观察记录经过综合分析得出的。结果应用计算机对376例青霉素皮试的结果进行辅助判定,其结果表明计算机程序对青霉素皮试结果的判断正确性不低于人工判定,经χ2检验P>0.05,说明两者判断结果无显著性。     

CASE REPORT: Antibiotic-associated haemorrhagic colitis

Antibiotic-associated haemorrhagic colitis is an uncommon cause of bloody diarrhoea in patients taking penicillin or penicillin-related antibiotics. Symptoms of abdominal pain and bloody diarrhoea occur within 1 week of antibiotic use and resolve without specific therapy within days of discontinuing the offending antibiotic. There is an apparent increased incidence of the disease in patients of Oriental ethnicity. The pathogenesis is unknown. We present two cases of haemorrhagic colitis in patients taking penicillin-related antibiotics who presented within 4 months of each other. One of the patients was being treated for Helicobacter pylori infection. The published literature is reviewed with particular emphasis on the histology and pathogenesis of the condition.     

* Immediate allergic reactions to amoxicillin

A large group of patients with suspected allergic reactions to (β-lactam antibiotics was evaluated. A detailed clinical history, together with skin tests, RAST (radioallergosorbent test), and controlled challenge tests, was used to establish whether patients allergic to β-lactam antibiotics had selective immediate allergic responses to amoxicillin (AX) or were cross-reacting with other penicillin derivatives. Skin tests were performed with benzylpenicilloyl-poly-L-lysine (BPO-PLL), benzylpenicilloate, benzylpenicillin (PG), ampicillin (AMP), and AX. RAST for BPO-PLL and AX-PLL was done. When both skin test and RAST for BPO were negative, single-blind, placebo-controlled challenge tests were done to ensure tolerance of PG or sensitivity to AX. A total of 177 patients were diagnosed as allergic to β-lactam antibiotics. We selected the 54 (30.5%) cases of immediate AX allergy with good tolerance of PG. Anaphylaxis was seen in 37 patients (69%), the other 17 (31%) having urticaria and/or angioedema. All the patients were skin test negative to BPO; 49 of 51 (96%) were also negative to MDM, and 44 of 46 (96%) to PG. Skin tests with AX were positive in 34 (63%) patients. RAST was positive for AX in 22 patients (41%) and to BPO in just 5 (9%). None of the sera with negative RAST for AX were positive to BPO. Challenge tests with AX were performed in 23 subjects (43%) to establish the diagnosis of immediate allergic reaction to AX, and in 15 cases (28%) both skin test and RAST for AX were negative. PG was well tolerated by all 54 patients. We describe the largest group of AX-allergic patients who have tolerated PG reported so far. Diagnosis of these patients can be achieved only if specific AX-related reagents are employed. Further studies are necessary to determine the exact extent of this problem and to improve the efficacy of diagnostic methods.     

Molecular epidemiology of penicillin-resistant Streptococcus pneumoniae in a university hospital, Ankara, Turkey

Penicillin-resistant Streptococcus pneumoniae isolates (n = 76) from clinical samples of patients admitted to Hacettepe University Hospital between January 1997 and December 2001 were included in the study. MICs of penicillin G, erythromycin A, clindamycin, cefaclor, cefotaxime, vancomycin, chloramphenicol, tetracycline, ciprofloxacin and rifampicin were determined by agar dilution. The isolates were serogrouped on the basis of the Neufeld Quellung reaction and were typed by BOX-PCR. Genetic polymorphism of the penicillin resistance genes pbp2b and pbp2x was investigated by restriction fragment length polymorphism (RFLP) analysis. Of the 76 isolates tested, 64 (84.2%) showed intermediate resistance to penicillin, while 12 (15.8%) were resistant to higher levels of penicillin (MIC > or = 2 mg/L). The resistance patterns of the isolates revealed six different resistance profiles. There were 22 different serotypes, with c. 55% of the isolates belonging to serotypes 23B, 19A, 19F, 14, 6 A and 9V. Five distinct patterns for pbp2b and 12 distinct patterns for pbp2x were obtained by RFLP analysis of penicillin-binding protein genes. The combination of these patterns allowed isolates to be classified into 22 fingerprint subgroups. BOX-PCR analysis showed that the isolates fell into 14 distinct BOX genotypes, with 33 subtypes. Serotype 9V isolates with pbp genotype 2-6 and BOX-PCR type 4, 4.1 or 4.2 were related to the pandemic clone Spain(9V)-3. No relatedness to other international clones was detected among the other study strains, but genetic relatedness was observed among some of the serotype 19A and 23B isolates. Overall, the results demonstrated that most of the penicillin-resistant pneumococcal isolates in Turkey, other than those belonging to serotypes 9V, 19A and 23B, were derived from several independent clones, possibly resulting from multiple importation of strains originating from outside the country. Differences in pbp patterns, serotypes and resistance profiles among isolates that showed similar BOX-PCR patterns supported the hypothesis that horizontal transfer of capsular genes, pbp genes and other genetic determinants between S. pneumoniae and viridans group streptococci may have occurred.     

How long is too long? Determining the early management ofmeningococcal disease in Birmingham

Objective:

To determine the length of time cases of meningococcal disease wait before receiving parenteral antibiotic therapy in hospital.

Method:

The hospital case notes of residents of Birmingham who were admitted to local hospitals in 1993 anddischarged with a diagnosis of meningitis or meningococcal disease were reviewed. This information was combined with that held by the West Midlands Ambulance Service.

Results:

Forty out of the 82 patients (49%) who met the case definition had meningococcal infection. Twentyone patients (26%) were admitted by ambulance, 11 of whom had meningococcal infection. The mean time from a request for an ambulance to the patient reaching hospital was 52 min for those with meningococcal infection compared to 55 min for those without. Nineteen patients (47.5%) with meningococcal infection waited more than one hour after admission for antibiotic treatment. Seven had an initial diagnosis of meningitis or meningococcal infection. Ten out of 27 patients with a meningococcal rash (37%), 13 out of 22 patients aged under five years (59%) and 13 out of 24 patients with microbiologically confirmed meningococcal infection (54%) waited more than one hour for treatment. Seven patients with meningococcal infection received benzyl penicillin before admission. Six received hospital antibiotic treatment within the hour.

Conclusion:

The assumption that patients suspected of having meningitis or meningococcal disease are treated promptly once in hospital is not always correct. The results of this study reinforce the need for all doctors to give benzyl penicillin promptly to patients they suspect have meningococcal disease.     

肺炎链球菌对抗菌药物的耐药性分析

目的 :调查肺炎链球菌对青霉素等抗菌药物的耐药性 ,并进行初步分析。方法 :采用肉汤微量稀释法测定肺炎链球菌对常用抗菌药物的耐药性。结果 :统计分析 5年中痰标本分离的 16 0株肺炎链球菌对常用的 8种抗菌药物的耐药性 ,结果显示对头孢噻肟耐药率最低 ,对红霉素耐药率最高。结论 :肺炎链球菌的耐药性有逐年增加的趋势 ,其中耐青霉素肺炎链球菌 (PRP)的耐药性同时也有逐年增加的趋势。     

青霉素用于唇裂修复术预防感染的研究

目的　对 114例唇裂修复术病例使用青霉素预防感染的效果进行对比研究。方法　将病例随机分为 2组 ,第 1组 5 4例 ,手术前后共使用青霉素 4～ 6d ;第 2组 6 0例 ,分别于手术前后各使用青霉素 1次。结果　手术后第 1组感染 2例 (3.70 % ) ,第 2组感染 1例 (1.6 7% ) ,经统计学处理 ,差异无显著性 (P >0 .0 5 )。结论　对比研究显示 ,短疗程青霉素可作为唇裂修复术的预防用药模式。     

掌叶半夏超临界CO_2乙醇萃取物的抗惊厥作用(英文)

目的研究掌叶半夏超临界CO2乙醇萃取物(SEE-CO2 PP)对青霉素诱发惊厥的对抗作用。方法采用大鼠皮质局部定位注射青霉素诱发惊厥模型,研究SEE-CO2 PP对惊厥发作的潜伏期以及惊厥行为变化的影响,并用RM6240C型多道生理信号采集处理仪记录皮质和海马痫性放电的潜伏期、频率和痫波最高发放波幅,同时应用高效液相色谱法测定海马谷氨酸(Glu)、天冬氨酸(Asp)、甘氨酸(Gly)和γ-氨基丁酸(GABA)递质的含量。结果 SEE-CO2 PP 15和30 g·kg-1(ig)可延长青霉素诱发惊厥的潜伏期,并减弱发作强度。SEE-CO2PP能够延长痫性放电的潜伏期,减少痫性放电的频率,减小皮质和海马发放痫波的最高波幅,同时,SEE-CO2PP可以增加海马GABA的水平,对Gly,Asp和Glu水平无明显影响。结论 SEE-CO2PP可对抗青霉素诱发的惊厥行为和痫样放电,具有抗惊厥作用。     

普鲁卡因青霉素的溶液微粒结晶 Ⅰ.溶解度和超溶解度的测定

采用激光测量装置研究了普鲁卡因青霉素在不同温度、不同浓度、不同ｐＨ值的氯化钠水溶液中的溶解与超溶解特性,为系统研究普鲁卡因青霉素溶液微粒结晶过程提供了一定的热力学基础。