粒细胞缺乏合并医院感染的抗生素经验治疗

目的 探讨血液系统肿瘤化疗后粒细胞缺乏合并中、重度感染患者的抗生素经验性治疗。方法对粒细胞缺乏合并中、重度感染的４０例患者给予头孢他啶或亚胺培南联合万古霉素治疗,对照组３２例给予单一头孢他啶或亚胺培南治疗。结果 治疗组有效率为９７．５％,对照组有效率为８４％,联合用药组疗效明显高于单一用药组（Ｐ〈０．０１）。结论 对粒细胞缺乏合并中、衙度感染的血液肿瘤患者,应早期经验性选择足够的广谱抗生素治疗。     

产诱导酶和超广谱酶细菌药敏结果分析

目的 了为解产诱导酶及产超广谱酶细菌的耐药特点，给临床提供可靠的药敏试验数据。方法 药敏试验按K－B法进行，诱导酶及产超广谱酶测定采用双纸片法。结果 产诱导酶细菌对一代和二代头孢类抗生素的耐药率＞90％，三代头孢菌素的耐药率在33％－58％，敏感率较高的抗生素有喹诺酮类、氨基糖苷类及碳青酶烯类抗生素；产ESBLs细菌除对亚胺培南和头孢哌酮／舒巴坦表现为100％的敏感外，对氨苄西林和复方新诺明的耐药率达100％，对三代头孢菌素的耐药率在50％－69％，对氨基糖苷类和喹诺酮类药物也存在着严重的交叉耐药性，结论 诱导酶和ESBLs测定可以弥补体外常规药敏试验之不足，对临床用药有重要的指导作用。     

鲍曼不动杆菌肺部感染药物治疗和耐药特点分析

目的 回顾性分析某院2008～2010年鲍曼不动杆菌肺部感染患者55例的治疗方法和耐药性特点.方法 从临床症状和外周血白细胞和中性粒细胞比值来评价碳青酶烯类,舒巴坦,多黏菌素,四环素类和5种抗生素治疗鲍曼不动杆菌肺部感染的临床效果.从分离和鉴定的鲍曼不动杆菌菌落中随机抽取110例,用于抗生素耐药性分析,分析该院鲍曼不动杆菌的耐药特点.结果 从外周血白细胞计数和中性粒细胞比值,CD3细胞和CD8细胞数量,和CD4/CD8细胞比值得出,与舒巴坦和多黏菌素的治疗效果相比,碳青酶烯类,四环素类治疗鲍曼不动杆菌肺部感染效果显著(P均＜0.05).该院鲍曼不动杆菌对氨苄西林,头孢噻肟,头孢哌酮,哌拉西林/他唑巴坦,头孢哌酮/舒巴坦,头孢西丁,孢他啶等高度耐受.结论 碳青酶烯类,四环素类和可用于鲍曼不动杆菌的治疗,且要合理使用抗生素用于鲍曼不动杆菌.     

中性粒细胞缺乏伴发热的肿瘤患者经验性二线治疗

目的 评价在粒细胞缺乏伴发热的肿瘤患者中，联合应用左氧氟沙星和去甲万古霉素在二线经验性治疗中的价值。方法 从1999年1月～2002年12月，67例肿瘤患者总计114次在化疗后出现粒细胞缺乏伴发热，并首选亚胺培南／西司他丁治疗，如果发热持续72h，改用去甲万古霉素或去甲万古霉素加左氧氟沙星，第5天开始加用氟康唑。结果亚胺培南／西司他丁治疗的有效率是72．8％，有23例患者31次发热经初始治疗无效；在可评价的26次发热中，15次使用去甲万古霉素治疗，11次使用左氧氟沙星和去甲万古霉素，有效率分别是53．3％和72．7％；有18次培养出耐亚胺培南／西司他丁的细菌，革兰阳性细菌占72．2％；呼吸道是常见感染病灶。结论 联合应用左氧氟沙星、去甲万古霉素和氟康唑，适用于粒细胞缺乏伴发热的肿瘤患者的二线经验性治疗。     

医院感染人苍白杆菌的临床特征与耐药性研究

目的探讨医院感染人苍白杆菌的临床特征与耐药性,为临床抗感染治疗提供依据。方法对2008年1月-2017年9月从各临床科室送检的各类标本中分离到的69株人苍白杆菌相关资料进行统计分析。结果 69例人苍白杆菌感染者临床表现无特异,细菌感染性指标显著升高,侵入性诊疗和机体免疫力下降是主要的危险因素;主要集中在感染科和ICU,分别占30.5%和24.6%;标本分布上主要来自血液和导管,分别占62.3%和21.7%;人苍白杆菌对单环β-内酰胺类、含酶抑制剂复合制剂、一代~三代头孢类、青霉素类抗菌药物均保持较高的耐药性,耐药率均高于90.0%,对喹诺酮类、四代头孢类、氨基糖苷类、四环素类和碳青酶烯类抗菌药物敏感性较好,耐药率均低于10.0%。结论侵入性操作诊疗是引起医院感染人苍白杆菌的主要危险因素,该菌主要引起血流感染,人苍白杆菌对β-内酰胺类抗菌药物高度耐药,治疗首选四代头孢类和碳青酶烯类抗菌药物。     

去甲万古霉素治疗粒细胞缺乏并发危重感染21例疗效分析

目的 观察去甲万古霉素治疗粒细胞缺乏并发危重感染患者的疗效.方法 选择经大剂量化疗导致骨髓抑制,引起粒细胞缺乏合并危重感染的42例恶性血液病患者最为研究对象,随机分为两组,治疗组采用去甲万古霉素加1～2种其他抗菌药物,疗程5～10 d;对照组采用单一亚胺培南/西司他丁或三代头孢联合喹诺酮类5～14 d作为对照.结果 两组的临床有效率分别为71.4%、52.3%,统计学分析表明,两组间疗效差异有统计学意义,治疗组去甲万古霉素不良反应较小.结论 去甲万古霉素加1～2种其他抗菌药物在治疗化疗后粒细胞缺乏并发危重感染时有良好的疗效,且安全性较高.     

心脏直视手术切口皮肤病原菌分布及耐药性分析

目的:分析心脏直视手术切口致病菌的种类及耐药性,为进一步控制术后感染提供帮助.方法:分析56例心脏直视手术患者的资料.结果:24例患者(42.9％)培养出细菌,共计32株,其中革兰阳性球菌占87.50％,革兰阴性杆菌占9.375％,真菌占3.125％.革兰阳性球菌对于青霉素类、头孢类、红霉素、克林霉素耐药率均>50％,对于利奈唑胺、万古霉素耐药率为0.革兰阴性杆菌对于三代头孢类耐药率>50％,对于碳青霉烯类、喹诺酮类耐药率较低.真菌普遍耐药率不高.结论:当前心脏直视手术常规预防使用的头孢类抗生素耐药率不佳,预防术后切口感染需考虑多方面影响因素.     

胆道感染病原菌种类及药物敏感性分析

目的:了解胆道感染病原菌的种类和对常用抗生素的敏感性情况。方法:取605例胆道感染病人胆汁标本进行培养,对分离出的病原菌进行鉴定和药物敏感试验。结果:424例病人胆汁培养阳性(70.1%),共分离细菌580株。4种主要革兰阴性杆菌对青霉素类、头孢菌素类和喹诺酮类抗生素的耐药率均超过30%,对哌拉西林/他唑巴坦、亚胺培南和阿米卡星的耐药率低于20%。肠球菌属对青霉素、氨苄西林、红霉素、四环素的耐药率超过25%,对氨基糖苷类、喹诺酮类和万古霉素相对敏感。结论:针对中、重度胆道感染的经验性治疗推荐哌拉西林/他唑巴坦、亚胺培南或阿米卡星加喹诺酮类或万古霉素加甲硝唑的联合用药。     

头孢类抗菌药物联合阿米卡星治疗白血病感染患者的疗效

目的探讨头孢类抗菌药物联合阿米卡星在治疗白血病患者化疗后粒细胞缺乏合并感染中的疗效,以提高临床诊治水平。方法选取2013年3月-2014年3月于医院接受治疗的白血病化疗后粒细胞缺乏合并感染患者92例,随机分为观察组与对照组,各46例,其中对照组给予头孢他啶联合阿米卡星治疗,观察组给予头孢吡肟联合阿米卡星治疗,对比分析两组的临床疗效。结果头孢他啶联合阿米卡星治疗后临床有效率80.43%,头孢吡肟联合阿米卡星治疗后临床有效率82.61%,两组比较差异无统计学意义;患者发生上呼吸道及肺部感染较为常见,两组感染部位比较差异无统计学意义;患者年龄(≥60岁或<60岁)、白血病治疗后缓解指标(完全缓解/部分缓解或无效)、粒细胞缺乏持续时间(≥10d或<10d)与疾病预后存在相关性(P<0.05)。结论头孢他啶联合阿米卡星与头孢吡肟联合阿米卡星治疗白血病化疗后粒细胞缺乏合并感染的临床有效率相当,且安全可靠,值得临床推广应用。     

美罗培南、亚胺培南治疗成人急性粒细胞缺乏症的疗效观察

目的评价两种碳青酶烯类抗生素美罗培南、亚胺培南治疗成人急性粒细胞缺乏症的疗效及安全性. 方法回顾分析31例使用美罗培南、30例使用亚胺培南治疗的成人急性粒细胞缺乏症患者的临床表现、细菌学培养结果以及不良反应,临床分离菌分别进行美罗培南、亚胺培南的体外药敏试验. 结果美罗培南、亚胺培南疗效均较好,临床治疗总有效率分别是93.5%和86.7%,P>0.05;本组患者咽拭子、血、尿培养共获90株病原菌,经治疗后,美罗培南组病原菌清除率为77.6%,亚胺培南组为63.4%,P<0.01;另外,这两种药物使用中不良反应发生较少而轻. 结论碳青酶烯类抗生素用于治疗成人急性粒细胞缺乏症疗效确切安全,是理想的选择.     

Treatment with fluorated quinolones of febrile neutropenia in patients with hematologic malignancies

The use of fluoroquinolones in the treatment of cytotoxic therapy-induced febrile neutropenia is controversial. AIM: The aim of the study was to compare the therapeutic effect of fluoroquinolones with that of standard antibiotic regimens in patients with hematologic malignacies and febrile neutropenia following antineoplastic chemotherapy. PATIENTS AND METHODS: This is a prospective randomized study including 129 patients with 141 neutropenic episodes divided into two groups. Fluoroquinolones are used in the trial group and broad-spectrum beta-lactam antibiotics in the control group. The data are analyzed using alternative analysis, non-parametrical chi-square test and Student-Fisher t-test. RESULTS: The febrile neutropenic episodes were classified as fever of unknown origin (50.4%) and documented infection (49.6%). In the category "fever of unknown origin" no statistically significant difference was found in the clinical effect, patient survival, general and infectious lethality between the trial and control group. In the category "documented infection" the trial group showed significantly lower therapeutic effect and lower infection-free survival of the patients. The clinical effect and infection-free survival after treatment with fluoroquinolones were significantly lower in the category "documented infection" than in the category "fever of unknown origin". CONCLUSION: Fluoroquinolones can be alternative drugs to the standard antibiotic regimens in the treatment of febrile neutropenia in cases of fever of unknown origin. Fluoroquinolone monotherapy is not recommended in cases of febrile neutropenia with documented infection.     

抗菌药物联用治疗发热性中性粒细胞减少症血液肿瘤患儿的临床研究

目的比较头孢他啶单用与联用万古霉素对治疗发热性中性粒细胞减少症血液肿瘤患儿的疗效。方法62例中性粒细胞减少伴发热的血液肿瘤患儿随机分为两组,A组32例联合应用头孢他啶和万古霉素,B组30例单独应用头孢他啶。结果A组总有效率为84.4%,高于B组的60.0%(P<0.05),A组退热时间亦较B组有降低的趋势,而两组不良反应发生率的差异无统计学意义(P>0.05)。结论头孢他啶和万古霉素联合应用的抗菌谱广,疗效优于单用头孢他啶,可作为治疗血液肿瘤患儿中性粒细胞减少伴发热的经验性用药之一。     

Prophylactic antibiotic treatment of neutropenic patients

There is no special signs of neutropenia therefore it is usually diagnosed due to an acute infection or laboratory control. Infections acquired during chemotherapy induced myelosuppression may further deteriorate the neutropenia in cancer patients. There are many possible cause of fever in cancer patients but in case of neutropenia infection is the most likely reason. If febrile neutropenia occurs immediately broad spectrum intravenous antibiotic treatment should be initiated. Recently introduced aggressive chemotherapy protocols further increased the number of neutropenic patients. Therefore it would be important to prevent febrile neutropenia. Unfortunately the available data still insufficient to make any conclusions regarding the efficacy of short or long term prophylactic treatment. While there are generally accepted recommendations of empiric antibiotic therapy no such options are available regarding prophylactic treatments. The decision regarding prophylactic treatment (similarly to empiric therapy) should be based on the resistance of the dominant pathogens in a therapeutic unit. Several study had been conducted regarding prophylactic administration of antibiotics the results however contradictory. Considering the advantages and disadvantages, the prophylactic antibiotic treatment of neutropenic patients could be suggested only in certain cases.     

血液肿瘤化疗后粒缺伴发热患者一线经验性抗感染治疗的临床疗效及治疗费用

 目的 评价血液肿瘤化疗后中性粒细胞缺乏（粒缺）伴发热患者两种一线经验性抗感染治疗策略的优劣。方法 回顾性分析2017年8月—2018年12月某院血液肿瘤化疗后粒缺伴发热病例的感染部位及病原菌分布情况,按一线抗感染治疗方案分为以碳青霉烯类药物为主治疗组（碳青霉烯类组）和以含酶β-内酰胺类抗生素为主治疗组（含酶β-内酰胺类组）,对两组病例治疗疗效、住院总费用以及住院日数进行比较。结果 共收集粒缺伴发热的病例103例,其中碳青霉烯类组为71例,含酶β-内酰胺类组32例。最常见的感染部位是呼吸道,其次为血液、胃肠道。检出病原菌47株,革兰阴性菌、革兰阳性菌、真菌分别占68.1%、12.8%、19.1%,以肺炎克雷伯菌占比最高为（25.5%）,其次为大肠埃希菌（21.3%）和铜绿假单胞菌（8.5%）。碳青霉烯类组、含酶β-内酰胺类组患者治疗有效率分别为90.1%、71.9%,住院总费用分别为（59 529.7±39 771.3）、（49 546.9±31 641.1）元,住院日数分别为（28.7±7.9）、（26.2±6.3）d,两组治疗有效率比较,差异有统计学意义（P=0.038）,两组患者住院总费用、住院日数比较,差异均无统计学意义（均P>0.05）。结论 对血液肿瘤化疗后粒缺伴发热的患者,一线经验性应用碳青霉烯类为主的药物抗感染治疗的疗效优于应用含酶β-内酰胺类为主的药物,两组住院总费用以及住院日数差异不明显。     

Treatment of febrile neutropenia episodes in children, with a piperacillin-tazobactam and netilmicin combination

OBJECTIVES: The authors had for aim to assess the effectiveness and toxicity of a piperacillin-tazobactam-netilmicin combination, and the possibility of avoiding using glycopeptide, in children with febrile neutropenic episodes induced by chemotherapy. METHODS: A retrospective study was made, including children treated for a febrile neutropenic episode (absolute neutrophile count < 0.5 x 10(9)/l) by a piperacillin-tazobactam-netilmicin combination. If fever persisted 48 hours after the beginning of antibiotic therapy, a glycopeptide could be added. The responses to the treatment were defined as follows: 1) total success (no fever or documented infection) at 48 hours and at 72 hours following the beginning of treatment; 2) partial success (apyrexia beyond 72 hours without any therapeutic change); 3) failure (persistent infectious signs 48 hours after the introduction of glycopeptide). RESULTS: Sixty-nine episodes were assessable, corresponding to 41 patients, treated for a solid tumour (29), an acute leukaemia in remission (11), or a metabolic disease (1). The febrile episodes were divided into fever of unknown origin (71%), microbiologically documented fever (12%), and clinically documented fever (17%). No death occurred, no toxicity was reported. With this antibiotic therapy, total success at 72 hours was observed in 72% in case of fever of unknown origin and 45% in case of documented infections. The success rate reached 84% when a glycopeptide was added (30% of the cases). CONCLUSION: The piperacillin-tazobactam-netilmicin combination is very effective and well tolerated in probabilistic treatment of febrile neutropenia induced by chemotherapy, but does not allow to decreasing the frequency of glycopeptide administration.     

Bacterial meningitis--ten years experience.

Between January 1968 and December 1977, 635 cases of acute bacterial meningitis were admitted to hospitals in the Birmingham Area Health Authority. The epidemiology of these cases was analysed and compared with the 270 cases which were admitted to the regional infectious diseases unit at East Birmingham Hospital (E.B.H.). In children and young adults the meningococcus was the commonest causative organism while over the age of 25 pneumococcal meningitis predominated. Although Haemophilus influenzae was the second commonest infecting organism it was a rare cause of meningitis in school children and adults, only four cases presenting in these age groups in the Birmingham Area. A detailed analysis was made of the symptoms, signs, laboratory investigations and clinical course of the 270 cases treated at E.B.H. The mortality in the patients with pneumococcal meningitis was 30%. In the meningococcal group it was 3.5% and in the haemophilus groups 7.7%. An analysis of the various treatment regimes employed in the 270 E.B.H. patients supports the view that a single antibiotic is sufficient for the therapy of most forms of bacterial meningitis. Intrathecal antibiotic administration is unnecessary in pyogenic meningitis caused by meningococci, pneumococci or H. influenzae.     

Management of Febrile Episodes in Neutropenic Patients

Neutropenic patients with cancer are at risk of serious infection, particularly if neutropenia is severe or prolonged. Because patients with neutropenia have a diminished inflammatory response, fever is sometimes the first, and only, sign of infection.Prompt empirical antibacterial therapy is imperative in neutropenic patients with fever, as minor localised infections can progress rapidly to bacteraemia. An antipseudomonal β-lactam agent plus an aminoglycoside, 2 β-lactam agents or monotherapy with an appropriate cephalosporin or carbapenem are all currently recommended as first-line empirical treatment in this patient group by the Infectious Diseases Society of America. Addition of a glycopeptide should be considered only in patients at high risk of Gram-positive infection. The empirical regimen may be modified as appropriate after 72 to 96 hours. It may be possible to discharge selected patients at low risk of complications on oral or parenteral outpatient therapy.Meropenem, a parenteral carbapenem, has excellent activity against all Gram-negative and Gram-positive anaerobic pathogens, and slightly more variable activity against Gram-positive aerobic organisms. In 8 clinical trials, meropenem 3 g/day consistently demonstrated similar efficacy to other regimens (imipenem/ cilastatin, ceftazidime with or without amikacin) commonly used in the empirical treatment of neutropenic patients with febrile episodes. Response rates with meropenem at treatment end ranged from 37 to 59% compared with 36 to 62% for comparator regimens (modification of the empirical regimen was considered a treatment failure). Meropenem is generally well tolerated; diarrhoea, nausea and vomiting, rash and pruritus are the most commonly reported adverse events. Seizures occur infrequently (0.24% overall incidence) and have not, to date, been reported in trials of patients with febrile neutropenia.Meropenem can be used effectively as monotherapy in the first-line empirical treatment of febrile episodes in neutropenic patients. It offers better activity against many Gram-negative pathogens and stability against a broader spectrum of β-lactamases than the third generation and extended spectrum cephalosporins, with possibly fewer gastrointestinal and CNS tolerability problems than imipenem/cilastatin. Therefore, meropenem is likely to be an important first-line agent particularly at institutions where resistant Gram-negative pathogens are problematic. It may also be useful as a second-line agent in infections unresponsive to other regimens. Although meropenem is administered 3 times daily, it can be given as a bolus without the need for monitoring of plasma concentrations and so may have a potential place in the outpatient management of febrile neutropenia.     

Meropenem therapy in children with febrile neutropenia

OBJECTIVES: Infectious complications are the major causes of morbidity and mortality in children receiving chemotherapy for malignant diseases. Granulocytopenia carries the risk of bacterial infection, and also, if prolonged, of fungal infection. The aim of this study was to evaluate the clinical effectiveness of meropenem in immunocompromised children in association with isolated bacteria from blood cultures and clinical background. METHODS: Retrospective study of all febrile episodes when meropenem was used in neutropenic children between January 1998 and December 2002 in the haemato-oncological units of the authors hospital. During the study period meropenem was used in 87 febrile events diagnosed in 55 patients (mean age 10 years 5 months), and 328 bacterial cultures were performed. Blood samples were taken from each patient with granulocytopenia (< 0.5 G/l) and fever (> or = 38 degrees C), prior to the start of any antibiotic therapy. For the microbiological process Bactec 9050 (Becton Dickinson) blood culture systems were used. RESULTS: Microorganisms were detected and identified in 64 (19.5%) from the 328 hemocultures. There was a predominance of Gram-positive strains, 67% (43/64)--the most common bacteria being coagulase negative Staphylococcus (cnS). From the 87 periods in 43 cases (49.4%) the infection was documented microbiologically. In 16 additional cases the infection was proven clinically (based on the clinical course, laboratory and radiologic results) and 32.2% (28/87) of the febrile neutropenic episodes were considered to be fever of unknown origin. Meropenem was used in a mean dose of 60.8 (30-120) mg/kg/die, for 9.3 (2-24) days. The success rate of the meropenem therapy -excluding the proven fungal (n = 13) or cnS (n = 15) infections-was 72.9%. No severe side effects occurred in any regimens. CONCLUSION: The results demonstrate that meropenem is effective and well-tolerated when used for the treatment of feverish neutropenic cancer children.     

胆道感染细菌学检验与耐药性分析

目的 了解胆道感染病原菌的种类及其对抗菌药物的耐药性,以指导临床用药.方法 调查医院2009年9月-2011年9月收治的170例胆道感染患者,所有患者均通过抽取病变胆囊内胆汁4～6 ml进行细菌培养以及药敏试验.结果 170例患者共培养出病原菌120株,检出率为70.6％;其中革兰阳性菌42株占35.0％;革兰阴性菌78株占65.0％;革兰阳性菌对青霉素类和喹喏酮类敏感率均＞80.0％,对万古霉素敏感率为100.0％;革兰阴性菌对亚胺培南的敏感率为100.0％.结论 胆道感染病原菌以革兰阴性菌为主,普通感染可选用喹喏酮类或氨基糖苷类抗菌药物,中、重度感染可选用头孢哌酮/舒巴坦或哌拉西林/他唑巴坦,严重感染可选用亚胺培南.