美罗培南和亚胺培南/西司他丁治疗呼吸道细菌感染的临床研究

 目的评价美罗培南的有效性和安全性。方法 采用随机对照试验,选用亚胺培南／西司他丁为对照药,共治疗呼吸道细菌感染患者60例,其中美罗培南组和亚胺培南／西司他丁组各30例。结果 美罗培南组临床痊愈率为80.0%,有效率为93.3%,细菌清除率为92.3%。亚胺培南／西司他丁组相应为76.7% ,90.0% ,91.3%。统计学处理两组无显著性差别。两组不良反应发生率均为3.3%。结论美罗培南在临床的有效性和安全性与亚胺培南／西司他丁相似,是一种高效、安全的新型抗茵药。     

2012年新乡市第一人民医院抗菌药物使用与细菌耐药率分析

目的分析新乡市第一人民医院抗菌药物的临床使用情况和细菌耐药率,为临床合理应用抗生素提供依据。方法对2012年抗菌药物用药频度、用药金额、院内检出病原菌耐药率进行统计、分析。结果抗菌药物中头孢菌素、青霉素、喹诺酮类、其他β内酰胺类、大环内酯类金额排列占前五名。单品种金额排序特殊级别使用药物美罗培南、氨曲南排序靠前。用药频度前15名药物注射剂占绝大多数。金黄色葡萄球菌对阿奇霉素、青霉素、红霉素耐药率都己在90％以上。凝固酶阴性葡萄球菌对阿奇霉素、青霉素、红霉素耐药率都已在75％以上,铜绿假单胞菌对左氧氟沙星、环丙沙星、哌拉西林的耐药率都已超过50％。左氧氟沙星对克雷伯菌和其他非发酵菌保持敏感,对其他细菌耐药率均超过50％。美罗培南、亚胺培南对大部分细菌还保持高度敏感,但院内监测耐药率也在逐年增高。结论临床抗菌药物应用与院内检出致病菌耐药性基本相符,但药物注射剂使用量大、档次偏高,仍需加强抗菌药的规范应用。     

卒中相关性肺炎的病原菌分布及抗菌药物敏感性分析

目的探讨卒中相关性肺炎的病原菌分布及抗菌药物的敏感性,旨在为今后临床上研究肺炎的病原菌方面提供参考和依据。方法选取卒中相关性肺炎患者150例,根据痰培养结果分析病原菌分布及其耐药性,并对革兰阴性菌进行ESBLs检测。结果所有患者下呼吸道分泌物培养出病原菌282株,革兰阴性杆菌占63.9%,革兰阳性球菌占21.8%,真菌感染14.3%,各类病原菌混合感染者占88.1%;革兰阴性菌中以鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌和肺炎克雷伯杆菌为主,鲍曼不动杆菌仅对亚胺培南、美罗培南敏感,铜绿假单胞菌对头孢哌酮舒巴坦、亚胺培南、美罗培南及阿米卡星敏感性较好,大肠埃希菌和肺炎克雷伯杆菌对阿米卡星、妥布霉素、亚胺培南、美罗培南、哌拉西林舒巴坦、头孢哌酮舒巴坦敏感性较好,其中对亚胺培南、美罗培南2种药物耐药率为0;革兰阳性菌中以金黄色葡萄球菌、肺炎链球菌和表皮葡萄球菌为主,金黄色葡萄球菌、肺炎链球菌和表皮葡萄球菌对万古霉素及替考拉宁敏感。结论卒中相关性肺炎的主要病原菌为革兰阴性杆菌且存在较严重的耐药现象,在临床上应加强细菌耐药性监测,指导临床合理使用抗菌药物,有效地预防和控制感染。     

抗菌药物使用与院内感染G~-菌敏感性的关系

目的评价抗菌药物的使用与抗菌药物对院内感染常见G-菌敏感性之间的关系。方法 2009年1月—2013年6月监测每个季度广谱头孢菌素、氟喹诺酮、β-内酰胺类/β-内酰胺酶抑制剂、碳青霉烯消耗量(DDD/1000Patient-days)和抗菌药物对院内感染常见G-菌(铜绿假单胞菌、不动杆菌、大肠埃希菌)敏感率。结果院内感染G-菌主要是铜绿假单胞菌、肺炎克雷伯菌、不动杆菌、大肠埃希菌。出院占用总床日呈增加趋势(r=0.858,P=0.021)。四大类抗菌药物总消耗量未随时间显著增加。院内感染的大肠埃希菌对哌拉西林/他唑巴坦、头孢吡肟敏感率下降;不动杆菌对美洛培南和亚胺培南敏感率下降(P均<0.05);铜绿假单孢菌对头孢吡肟、头孢他啶、阿米卡星、亚胺培南的敏感率上升(P均<0.05)。结论抗菌药物使用与院内感染G-菌对抗菌药物敏感性相关;以药敏实验结果为参考,根据实际情况制定并执行抗菌药物干预措施,指导临床合理用药非常有必要,有助于优化抗菌药物使用,控制院内感染G-菌耐药率。     

美罗培南治疗血液系统恶性肿瘤并发感染的疗效观察

 目的：比较美罗培南与亚胺培南/西司他汀对血液系统恶性肿瘤并发感染的疗效。方法：美罗培南组21例（男11例、女10例），美罗培南1.0 g加入5%葡萄糖注射液250 ml静脉滴注，每天2次，组21例 （男15例、女例）亚胺培南/西司他汀1.0 g加入5%葡萄糖注射液250 ml静脉滴注，每天2次。结果：美罗培南与亚胺培南/西司他汀的临床有效率分别为76.2%和72%(P>0.05)，两组病例除少数病例出现恶心、呕吐、腹泻外，未见严重不良反应。结论：美罗培南与亚胺培南/西司他汀对血液系统并发感染均能取得良好疗效。     

临床合理用药中微生物以及细菌耐药性检验的应用与结果分析

目的:探讨临床合理用药中微生物以及细菌耐药性检验的应用价值。方法:选择2018年1月至2019年12月本院收治行中微生物以及细菌耐药性检验患者60例作为资料,采用全自动细菌鉴定分析仪检测,分析细菌分布情况及对常见抗菌药物的耐药性。结果:60例患者共培养出52株致病菌,铜绿假单胞菌23.08%,大肠埃希菌17.31%,金黄色葡萄球菌15.38%,肺炎克雷伯菌11.54%;革兰阴性菌中铜绿假单胞菌对米诺环素、哌拉西林耐药性较高,阿米卡星耐药性低;大肠埃希菌对哌拉西林、氨曲南、头孢曲松耐药性较高,亚胺培南、美罗培南耐药性低;肺炎克雷伯菌对哌拉西林耐药性较高,美罗培南耐药性低;金黄色葡萄球菌对头孢西丁、苯唑西林、四环素耐药率较高,对呋喃妥因、利奈唑胺、万古霉素耐药率低。结论:加强微生物以及细菌耐药性检验是保证临床合理用药的可靠依据,细菌分布以大肠埃希菌、铜绿假单胞菌多见,均对常见抗菌药物耐药性高,应加强合理用药管理,分析耐药趋势,保证用药有效性及安全性,研究价值较高。     

美罗培南治疗多重耐药菌感染的临床研究

目的:分析总结美罗培南治疗多重耐药菌感染的疗效。方法:我院重症监护室2010年7月~2012年5月收治多重耐药菌感染患者48例,随机分为两组,两组分别采用美罗培南和西司他丁治疗。结果:美罗培南组24例患者有效22例(有效率91.67%),治愈18例(治愈率75.00%),细菌清除率75.00%;西司他丁组24例患者有效21例(有效率87.50%),治愈14例(治愈率70.83%),细菌清除率70.83%。两组患者疗效和细菌清除率方面比较差异无统计学意义(P0.05),美罗培南治疗多重耐药菌感染副作用轻。结论:美罗培南对多重耐药菌感染疗效肯定,值得临床推广。     

大肠埃希菌与肺炎克雷伯菌分布及耐药分析

目的：分析分离大肠埃希菌与肺炎克雷伯菌的分布及耐药性,为临床合理使用抗菌药物提供参考和帮助。方法：采集标本进行分离培养,进行菌株鉴定、药敏试验。结果：分离出大肠埃希菌83株,肺炎克雷伯菌59株,其中产ESBLs阳性率分别为54.2%、11.9%;大肠埃希菌对亚胺培南、美罗培南、呋喃妥因100%敏感,而肺炎克雷伯菌对亚胺培南、美罗培南、头孢哌酮/舒巴坦100%敏感。结论：根据检验结果,应根据细菌培养及药敏结果合理选用抗菌药物,以减少耐药菌的产生。     

焦作市妇幼保健院 2018–2021 年难治性肺炎 患者病原菌分布特点及药敏分析

〔摘 要〕 目的：分析焦作市妇幼保健院 2018–2021 年难治性肺炎患者病原菌分布特点及药敏试验结果,为指导临 床合理用药,改善患者预后提供依据。 方法：选取 2018 年 1 月至 2021 年 12 月期间于焦作市妇幼保健院接受诊疗的 76 例难治性肺炎患者为研究对象,采集所有患者的支气管肺泡灌洗液标本并进行病原菌分离、培养。之后观察病原 菌种类、分布特点,并检测病原菌对常用抗菌药物耐药情况。 结果：76 例难治性肺炎患者肺泡灌洗液标本中,总共 分离出病原菌 84 株。常见革兰阴性菌中,肺炎克雷伯菌对头孢哌酮钠舒巴坦钠、头孢唑林、头孢曲松、头孢吡肟耐 药性较高,对美罗培南耐药性较低;铜绿假单胞菌对头孢曲松耐药性较高,对亚胺培南、美罗培南耐药性较低;大肠 埃希菌对左氧氟沙星、氨苄西林舒巴坦耐药性较高,对美罗培南、阿米卡星耐药性较低。常见革兰阳性菌中,金黄色 葡萄球菌对青霉素、红霉素、利奈唑胺耐药性较高,对替考拉宁、万古霉素耐药性较低;表皮葡萄球菌对利奈唑胺、 青霉素耐药性较高,对阿奇霉素、替考拉宁、万古霉素耐药性较低。 结论：肺炎克雷伯菌、铜绿假单胞菌、大肠埃希 菌、金黄色葡萄球菌和表皮葡萄球菌是难治性肺炎患者主要致病菌,上述致病菌对多种抗菌药物的敏感性偏低,临床 应积极进行病原菌鉴定、药敏试验,以促进合理选择抗菌药物。     

鲍曼不动杆菌体外药敏试验方法评价及敏感性分析

目的：评价纸片扩散法和仪器法检测鲍曼不动杆菌药敏试验可靠性,分析鲍曼不动杆茵对常用抗菌药物敏感性。方法：VITEK2-compact和纸片扩散法检测鲍曼不动杆菌对12种抗菌药物敏感性。结果：纸片与VITEK2－compact检测鲍曼不动杆菌对阿米卡星药敏结果差异有显著性,其他抗茵药物药敏结果没有显著性差异;鲍曼不动杆菌对亚胺培南,美罗培南敏感率最高,高于50％,对其他所测抗茵药物敏感率均小于35％。结论：VITEK2－compact于鲍曼不动杆菌药物敏感性检测存在缺陷;治疗鲍曼不动杆菌引起感染可选亚胺培南,美罗培南。     

7种抗菌药物对临床常见致病菌抗菌活性的比较

 采取琼脂平析稀释法测定了泰宁（ｉｍｉｐｅｎｅｍ／ｃｉｌａｓｔａｉｎ）等７种抗菌药物对２１５株临床常见致病菌的最低抑菌浓度（ＭＩＣ），并统计了敏感率。结果表明７种抗菌药物对大多数受试菌均显示了较高的抗菌活性，其中泰宁的抗菌活性最强，金黄色葡萄球菌、变形杆菌属、大肠埃希菌、肺炎克雷白菌对泰宁的敏感率达９７．６％～１００．０％；而１７．０２％的绿脓假单胞菌对泰宁耐药；有２～６株绿脓假单胞菌和１株肺炎克雷白菌对泰宁和其它抗菌药物呈现部分交叉耐药性。而环丙沙星与其它抗菌药物对不同受试菌呈现２．３８％～１９．０５％的交叉耐药率。该结果提示对其它β－内酰胺类抗菌药物耐药的致病菌引起的严重感染，可考虑选用泰宁。     

Antimicrobial activity of antibiotics in combination with natural flavonoids against clinical extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae

Extended-spectrum beta-lactamases (ESBLs) are plasmid-mediated class A enzymes commonly found in the family Enterobacteriaceae, mainly in Klebsiella pneumoniae. Flavonoids have also been reported to possess antimicrobial activity. In this study, the in vitro activities of 18 antibiotics and 12 flavonoids against 20 ESBL-producing K. pneumoniae isolates were evaluated. All of these isolates were susceptible to imipenem and cefmetazole, but were resistant to ampicillin, ampicillin/sulbactam, aztreonam, cefazolin, cefoperazone, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, piperacillin and ticarcillin. Susceptibilities to amikacin, amoxicillin/clavulanate, cefoxitin, ciprofloxacin and gentamicin were variable. Myricetin, a flavonol, inhibited ESBL-producing K. pneumoniae isolates at a high minimum inhibitory concentration (MIC) (MIC(90) value 256 mg/mL), but exhibited significant synergic activity against ESBL-producing K. pneumoniae in separate combination with amoxicillin/clavulanate, ampicillin/sulbactam and cefoxitin. Because of the low-toxic nature of flavonoids, the combination of antibiotics and flavonoids is a potential new strategy for developing therapies for infections caused by ESBL-producing bacteria in the future.     

中国西南7种石斛植物活性内生真菌及其遗传关系

目的:对中国西南地区7种石斛植物的内生真菌进行抗菌活性筛选,考察活性菌株之间的遗传关系。方法:采用组织块法分离真菌,琼脂扩散法进行抑菌活性筛选,通过rDNA的ITS序列为基础鉴定活性真菌,用邻接法(NJ)和最大简约法(MP)进行遗传关系考察。结果:从7种石斛属植物分离到98株真菌,它们对Escherichia coli,Bacillus subtilis,Staphylococcus aureus,Candida albicans,Cryptococcus neoformans和Aspergillus fumigatus的抑制率分别是1.02%,102%,184%,1.02%,1.02%,10.2%,其中DL-3,DL-18,DL-21,DM-2,DG-10和DN-1显示出了对B.subtilis,S.aureus和A.fumigatus较强的生长抑制性。24株活性真菌隶属于7个目,11个属,14个种,NJ和MP系统树阐明活性菌之间的亲缘关系。结论:本研究对于考察珍惜濒危石斛属植物的内生真菌的生物活性以及它们之间的遗传关系具有重要的生态价值,为石斛根茎部活性真菌的研究提供参考。     

Comparative in vitro antimicrobial activity of Chinese medicinal herbs

Eighteen herbs used in the treatment of infectious diseases in traditional Chinese medicine were evaluated for in vitro activity against ten microbial pathogens. Lyophilized teas were tested by the agar dilution technique at 100-1600 micrograms/ml. Eleven of the preparations were active against at least one microorganism and six of these were active against at least three of the test isolates. Huangqin (Scutellaria sp.) and Huanglian (Coptis sp.) were each active against five of the isolates. Huangqin inhibited Klebsiella pneumoniae and Proteus vulgaris at 200 micrograms/ml. Huangqin alone showed strong activity against Mycobacterium smegmatis (less than or equal to 100 micrograms/ml) and Candida albicans (200 micrograms/ml). The antimicrobial activity of various teas, prepared with equal weights of herbs, could be compared against a particular pathogen by considering both the percentage of water-soluble material in the herbs and the minimum inhibitory concentrations of the filtered, lyophilized decoctions.     

Antienterobacterial activity of Hemidesmus indicus R. Br. root extract

The antienterobacterial activity of the chloroform and methanol extracts of Hemidesmus indicus root was demonstrated using a variety of methods and different enterobacterial strains. Although the constituents were similar in the chloroform extract (CHI) and the fatty substance separated (ME1) from the methanol extract (MHI), ME1 was found to be more effective than CHI as evident from the disc diffusion method. ME1 was found to be more active than MHI, followed by CHI. This may be due to the inefficient diffusion of CHI into the medium. In a modified agar well diffusion and swab method the activity of the extract against different strains was observed in a single plate. The extracts inhibited growth in a dose dependent manner; both MHI and CHI were most effective against S. flexneri, least effective against S. dysenterie and moderately effective against the other strains. The presence of antimicrobial trace elements such as copper and zinc, along with other active constituents may contribute to the antienterobacterial activity of Hemidesmus indicus root.     

国产罗红霉素体外抗菌作用的研究

 目的:研究国产罗红霉素体外杭菌作用，并同大环内醋类其它杭生素进行比较。方法:未用二倍平皿稀释法测定最低抑菌浓度(MIC)和影响因素的作用，采用试管二倍稀释法测定最低杀菌浓度(MBC)，未用平皿菌落计数法绘制杀菌曲线。结果:国产罗红霉素与红霉素具有交叉耐药性，红霉素的MIC多等于国产罗红霉素MIC的1/2或1/4。国产罗红霉素对于所采用实验菌株的MBC要大于MIC的4 --16倍。10⁶ CFU · ml ^-1以下的细菌接种量几乎不影响国产罗红霉素的MIC。随着pH的增高，细菌对国产罗红霉素的敏感性增大。人血清可使国产罗红霉素MIC升高。结论:国产罗红霉素的杭菌谱与红霉素相同，体外杭菌活性略弱于红霉素或相近，但优于交沙霉素、麦迪霉素和柱晶白霉素，为一抑菌药。     

Antimicrobial activities of naphthazarins from Arnebia euchroma

Bioassay-directed fractionation of extract of Arnebia euchroma led to the isolation of alkannin (1), shikonin (2), and their derivatives (3-8) as the active principles against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The stereochemistry of alpha-methylbutyryl alkannin (8) is revealed for the first time, and the antimicrobial activity of 8 was compared with its corresponding diastereomer (9). The derivatives 3-9 showed stronger anti-MRSA activity [minimum inhibitory concentrations (MICs) ranged from 1.56 to 3.13 microg/mL] than alkannin or shikonin (MIC = 6.25 microg/mL). Anti-MRSA activity of derivatives was bactericidal with minimum bactericidal concentration (MBC)/MIC < or = 2. In a time-kill assay, the bactericidal activity against MRSA was achieved as rapidly as 2 h. The derivatives 3-9 were also active against vancomycin-resistant Enterococcus faecium (F935) and vancomycin-resistant Enterococcus faecalis (CKU-17) with MICs similar to those with MRSA. Aromatic ester derivatives were also synthesized for antimicrobial activity comparison. None of these compounds were active against Gram-negative bacteria tested. Their cytotoxicity was also evaluated on selected cancer cell lines, and they expressed their activity in the range 0.6-5.4 microg/mL (CD(50)). Our results indicate that the ester derivatives of alkannin are potential candidates of anti-MRSA and anti-VRE agents with antitumor activity.     

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??OBJECTIVE To develop a sensitive and specific ultra performance liquid chromatography-tandem mass spectrometry(UPLC-MS/MS)method for simultaneous determination of imipenem and meropenem in human plasma to monitor therapeutic drug concentration. METHODS The plasma samples were extracted with dichloromethane after precipitated protein by acetonitrile. And then, the analytes were gradient eluted on a UPLC^® BEH-C₁₈ (2.1 mm×50 mm,1.7 μm) by UPLC-MS/MS with positive ionization.Ions monitored in the multiple reaction monitoring (MRM)mode were m/z 300.0→171.0 for imipenem,384.0→141.0 for meropenem and 390.1→147.0 for meropenem-d6(internal standard), respectively. RESULTS Calibration plots were established over the concentration range of 0.39-50 μg·mL^-1 of imipenem and meropenem, with the lowest detection limit of 0.39 μg·mL^-1 using 2 μL sample volumn. Determination of control samples of imipenem and meropenem in plasma validated the LC-MS/MS method. Accuracy, extraction recovery, matrix effect, intra-assay and inter-assay precision all met the requirements. CONCLUSION This novel method of imipenem and meropenem determination by LC-MS/MS is proven to be a robust protocol that is consistent and reproducible.     

五倍子有效部位抗病原微生物活性

目的:探讨五倍子抗细菌和抗白假丝酵母真菌的有效活性部位。方法:采用琼脂平板二倍稀释法测定了五倍子醇提物的石油醚、三氯甲烷、乙酸乙酯、正丁醇、乙醇和水6个有效部位对金黄色葡萄球菌、链球菌、大肠埃希菌等5个种属细菌和白假丝酵母真菌的最低抑菌浓度(MIC)。用单因素方差分析法、独立样本t检验比较分析不同活性部位对受试菌株抑菌活性的强弱。结果:五倍子石油醚、三氯甲烷和乙醇有效部位均无抗细菌和真菌活性,水部位仅对金黄色葡萄球菌有一定抗菌活性,MIC为733.69 g·L-1,正丁醇部位仅对5种细菌有较强的抗菌活性,MIC为2.06~32.96 g·L-1,而乙酸乙酯部位对受试细菌和白假丝酵母真菌均有强的抗菌活性,MIC分别为2.88~23.07 g·L-1和0.36~27.28 g·L-1。统计分析表明,乙酸乙酯和正丁醇部位对革兰阳性菌的抑菌活性强于对革兰阴性菌的抑菌活性(P<0.01,P<0.05),两者对同种属细菌的抑菌活性强弱相当,对耐药株和敏感株具有相似的抗菌活性。虽五倍子乙酸乙酯部位对白假丝酵母真菌临床分离株的MIC(95.15±96.34)mg·L-1明显高于克霉唑(8.00±8.92)mg·L-1(P<0.01),但克霉唑对临床分离株的耐药率为14.29%(2/14),而乙酸乙酯部位对所有临床分离株均有相似的抗菌活性(MIC为0.36~0.72 g·L-1)。结论:五倍子抗细菌和真菌的活性部位为乙酸乙酯部位。     

中药单体与抗菌药物联合应用对抗泛耐药鲍曼不动杆菌的作用研究

目的:研究中药单体槲皮素二水物、盐酸小檗碱、黄芩苷3种中药单体对泛耐药鲍曼不动杆菌(XDRAB)生物被膜形成能力及粘附作用的影响,并探讨以上3种中药单体分别与4种特殊使用级抗菌药物(亚胺培南、美罗培南、替加环素、多粘菌素)联合应用对抗XDRAB的协同效应。方法:应用微量肉汤稀释法检测槲皮素二水物、盐酸小檗碱、黄芩苷3种中药单体和15种抗菌药物对9株XDRAB的最低抑菌浓度(MIC),结晶紫染色法和平板菌落计数法检测3种中药单体对XDRAB生物被膜形成能力和粘附能力的影响,微量棋盘稀释法检测中药单体槲皮素二水物、盐酸小檗碱、黄芩苷分别与亚胺培南、美罗培南、替加环素、多粘菌素B联合应用的协同抗菌效应。结果:槲皮素二水物、盐酸小檗碱、黄芩苷对XDRAB的MIC分别为512μg/ml、256μg/ml、1024μg/ml,除多粘菌素B和替加环素以外,9株XDRAB对13种抗菌药物均耐药;槲皮素二水物、盐酸小檗碱、黄芩苷分别在64μg/ml、32μg/ml、128μg/ml的浓度下抑制XDRAB生物被膜的形成以及对导尿管的粘附。与模型对照组相比,3种中药单体分别与亚胺培南、美罗培南、替加环素联用...