9、3″-双-氧-乙酰麦迪霉素联合β-内酰胺抗生素治疗绿脓杆菌感染

体内及体外试验均已证明,经β-内酰胺类抗生素治疗后诱导出的 L-型菌或成球形菌变成对β-内酰胺抗生素不敏感而对原来不敏感的大环内酯类抗生素显著敏感,两种抗生素联合治疗有效。作者试图进一步通过临床试验确定,联合应用β-内酰胺抗生素和一种大环内酯类抗生素9、3″-双-氧-乙酰麦迪霉素(9、3″-di-O-Acetylmidecamycin,MOM)治疗绿脓杆菌感染患者是否有效。临床标本取自10例绿脓杆菌感染患者,     

医院感染绿脓杆菌下呼吸道感染耐药性分析

目的：分析医院内感染绿脓杆菌型下呼吸道感染耐药性特点,为临床上选择合理的抗菌药物治疗提供指导。方法选择2011年1月-2013年12月该院呼吸内科住院治疗的下呼吸道感染患者1208例,培养患者的痰液,分离绿脓杆菌358株,358株绿脓杆菌进行抗生素耐药实验。结果在1208例样本2387株病原菌中,分离出绿脓杆菌358株,总分离率为15.00%。头孢曲松对绿脓杆菌的耐药率最高（91.34%）,阿米卡星对绿脓杆菌的耐药率最低（4.19%）。结论该院院内感染绿脓杆菌引起的下呼吸道感染耐药形势依旧很严峻,临床医师应慎重选择使用抗生素,院内感染科需切实做好监督管理工作,加大消毒力度,保证患者早日恢复健康。     

外伤矫形患者绿脓杆菌感染的化学疗法

绿脓杆菌对许多化学制剂具有很高的抗药性,其感染的治疗十分困难。择优选用有效药品是治疗成功的重要环节。本文旨在探索治疗外伤矫形患者绿脓杆菌感染的最佳方法。绿脓杆菌对十二种抗生素的敏感性利用两次连续培养的320株绿脓杆菌菌株对链霉素等12种抗生素进行了敏感性测定。其结果以敏感性大小为序排列如下:绿脓杆菌对     

难治性烧伤感染创面的临床治疗体会

耐药性绿脓杆菌和耐药性金葡菌感染的烧伤创面的修复一直是烧伤治疗的重点。如何提高植皮成活率,促进创面愈合,是一个较为棘手问题。我科从1998年以来,应用薄层中厚皮片游离移植及持续湿敷包扎治疗耐药性绿脓杆菌和耐药性金葡菌单一或混合感染的烧伤创面,取得良好效果,现报道如下。1　临床资料1 1　一般资料　本组15例,男10例,女5例,年龄3～4 9岁,面积3%～2 0 %。其中耐药性绿脓杆菌感染7例,耐药性金葡菌感染5例,二者混合感染4例。经薄中厚皮片游离移植及持续湿敷包扎治疗后,皮片成活良好,均在3周左右愈合。1 2　典型病例　患者男,4 9岁,全…     

Aztreonam与氯林可霉素磷酸酯配伍的稳定性

Aztreonam(Azt)是一种新型单环β—内酰胺抗生素。尤其对需氧革兰氏阴性菌如绿脓杆菌有较高的抗菌作用。然而Aztreonam必须与其它抗生素联合来治疗那些革兰氏阴性和阳性菌复合感染的病例。本品口服无效。     

耐Imipenem的绿脓杆菌

Imipenem 是第一个碳青霉烯抗生素,具有包括大部分绿脓杆菌在内的异常广谱活性。不幸之处在于本品对绿脓杆菌感染的临床应用,因分离出的耐药绿脓杆菌接近20%而复杂化。此耐药性导致约半数绿脓杆菌感染的治疗失败。此耐药性最重要的微生物学特点是对其它β-内酰胺类没有交叉耐药性。这与面对用头孢菌素类或青霉素类治疗,产生耐药性时所发现的广谱耐药性适成对照。我们研究了绿脓杆菌临床分离菌的 Imipenem 选择耐药性,并特别提到耐药分离菌特有的47kD外膜蛋白(OMP)的缺失。这些资料不只为其它研究者进一步证实。接着研究了我们所做的碳青霉烯类经由一种独有而特殊的孔蛋白,透过绿脓杆菌外膜的假说。本文描述通过通透性试验,和控     

四肢骨骨折感染治疗探讨

目的探讨四肢骨骨折感染的治疗,减少或避免因骨折感染带来的严重后果,提高治愈率,提高患者生活质量。方法对近十年来收治25例四肢骨骨折感染治疗的临床资料回顾性分析。结果25例病例中20例治愈,治愈率80%,显效3例,有效2例,总有效率100%。结论四肢骨骨折感染,运用多种方法、综合治疗,才能取得满意疗效。早期手术彻底的清创是治疗四肢骨骨折感染的关健,局部抗生素液持续冲洗,配合有效的抗生素全身用药是治疗四肢骨骨折感染的重要手段。     

骨折钢板内固定术后感染的治疗探讨

目的：探讨治疗骨折钢板内固定术后发生感染的有效治疗方法。方法：对本组39病例均进行清创或内固定物取出,术后所有患者进行伤口局部持续冲洗或负压吸引治疗,所有患者均根据细菌培养药敏使用抗生素。结果：39例钢板内固定术后感染病例,23例取出内固定物,余16例保留内固定物,经手术为主的综合治疗骨折和伤口顺利愈合。结论：以手术为主的综合治疗骨折钢板内固定术后感染有肯定的疗效。     

假单胞菌抗菌剂的评价

前言由绿脓杆菌引起严重的或威胁生命的感染,其标准治疗是以一种氨基糖苷抗生素如妥布拉霉素与一种扩谱青霉素如替卡西林联用。近几年,我们已经目睹具有抗绿脓杆菌活性的三种新的扩谱青霉素,一种新近销售的氨基糖苷抗生素和许多扩大了抗菌谱的头孢菌素抗生素的有效性。此外,喹诺酮类化     

自体骨髓和外周血干细胞移植骨髓抑制期感染的泰能治疗

18例自体骨髓（ABMT）和9例自体外周血干细胞移植（APBSCT）骨髓抑制期感染的发生率100％（肛周、口腔等内源性感染占70％），危重感染发生率48％，革兰氏阴性菌感染发生率74％。利用泰能治疗12例。治愈率83．33％，经调整添加抗厌氧菌药或氨基甙类或抗真菌药后治愈率达100％。与非泰能的抗生素组比较，有着广谱的抗菌效力和独到的抗绿脓杆菌作用，需添加其它类抗生素少且毒副作用小，应为骨髓抑制并发重感染的首选药之一。     

Cefsulodin and ceftazidime, two antipseudomonal cephalosporins

The microbiologic, pharmacokinetic, and clinical profiles of cefsulodin and ceftazidime are reviewed. Ceftazidime is a broad-spectrum beta-lactamase stable cephalosporin with excellent activity against gram-negative bacilli, including Pseudomonas aeruginosa. Cefsulodin is a narrow-spectrum cephalosporin with activity against Staphylococcus aureus and Ps. aeruginosa. Both antibiotics, which are expected to be marketed in the United States, are superior to currently available cephalosporins against Ps. aeruginosa. Cefsulodin and ceftazidime are administered by the i.m. or i.v. route, are widely distributed in body fluids and tissues, and exhibit relatively low binding to serum proteins. They are eliminated primarily through the urine, and they generally can be administered every 8 to 12 hours, depending upon the type of infection. Cefsulodin has been used successfully in the treatment of various Ps. aeruginosa infections in noncomparative studies. Ceftazidime has been successfully used as a single agent in comparative studies for Ps. aeruginosa infections. Because of its broad spectrum and its activity against penicillin-resistant and aminoglycoside-resistant Pseudomonas, ceftazidime can be used empirically as a single agent in place of combination therapy in patients with cystic fibrosis. Ceftazidime has also been useful as a single agent used empirically for treating febrile episodes in neutropenic patients and for treating hospital-acquired infections in nonneutropenic patients when Pseudomonas cannot be ruled out. Ceftazidime is a useful broad-spectrum antibiotic, particularly in the empiric therapy of nosocomial infections and in patients whose underlying conditions predispose them to Ps. aeruginosa infections. Cefsulodin may prove useful as single-agent therapy of certain infections known to be caused by Ps. aeruginosa, but its empiric use is not encouraged.     

多耐药铜绿假单孢菌医院内下呼吸道感染耐药性的分析和治疗对策

目的：探讨我院下呼吸道铜绿假单孢茵感染现状及其耐药情况。方法：对2003年1月～2006年12月住院病人下呼吸道痰标本分离出的铜绿假单孢菌的药物敏感进行分析。结果：下呼吸道铜绿假单胞茵感染菌株逐渐增加，对哌拉西林／他唑巴坦、亚胺培南／西司地丁、头孢拉定及环丙沙星耐药率逐渐上升。结论：铜绿假单胞菌在下呼吸道感染中有重要地位，临床治疗需重视病原学检查及药敏检测，根据药敏合理用药.     

450株铜绿假单胞菌的临床分布及药敏分析

目的研究本地区铜绿假单胞菌感染的临床分布及药敏情况,指导临床抗生素的使用。方法对细菌进行常规分离培养鉴定,并进行药敏实验。结果 450株铜绿假单胞菌临床主要分布情况:痰68.1%、伤口脓液13.1%、尿液6.0%,以呼吸道感染为主;抗生素耐药情况:头孢哌酮/舒巴坦、阿米卡星、亚胺培南的耐药率分别达到21.8%、28.3%、29.9%,头孢吡肟、头胞他啶、哌拉西林/他唑巴坦、环丙沙星的耐药率分别33.7%、34.4%、36.9%、38.6%,其余的抗生素耐药性更高,且呈现多重耐药性。结论临床用药应根据药敏分析,合理使用抗生素。     

In vitro activity of cefepime and cefpirome compared to other third-generation cephem antibiotics against gram-negative nosocomial pathogens

The in vitro activities of new expanded spectrum of fourth-generation cephalosporins, cefepime and cefpirome, were compared with those of three third-generation cephalosporins, cefoperazone, ceftazidime, and ceftriaxone, that are commonly used in the treatment of serious infections caused by aerobic gram-negative bacteria. The agar dilution method described by the US National Committee for Clinical Laboratory Standards was used to determine the minimum inhibitory concentrations of antibiotics tested. 302 clinical isolates, representing a cross-section of Klebsiella and Enterobacter species and Pseudomonas aeruginosa were tested. Cefepime was considerably more active than other antibiotics tested, against Klebsiella species and Enterobacter species, and demonstrated activity similar to ceftazidime against Pseudomonas aeruginosa. Ceftazidime was active against Pseudomonas aeruginosa but was less potent against Enterobacter species. Cefoperazone and ceftriaxone were less active than ceftazidime against Pseudomonas aeruginosa. Cefepime had slightly greater activity than cefpirome against the gram-negative bacteria tested. However, cefepime and cefpirome were found to be highly active against many resistant organisms that traditionally have been difficult to treat.     

下呼吸道感染铜绿假单胞菌的耐药性研究

目的：探讨医院下呼吸道感染患者对铜绿假单胞菌的耐药情况变化,以指导临床合理使用抗生素。方法：选取本院呼吸内科2007年8月～2009年10月收治的600例下呼吸道感染患者为研究对象,取患者的痰液进行标本培养,对分离出的63例铜绿假单胞菌进行药敏试验,并对结果进行统计学分析。结果：在600例下呼吸道感染患者中分离出铜绿假单胞菌63株,总分离率为10.5%,在6种抗生素中,亚胺培南的耐药性最低,耐药率为15.87%,其次为阿米卡星,耐药率为30.16%。铜绿假单胞菌对两药耐药率比较,差异有统计学意义（P〈0.05）。结论：铜绿假单胞菌目前仍是医院病原菌感染的主要致病菌之一,临床中要加强耐药性监测,合理使用抗生素。     

对亚胺培南耐药的铜绿假单胞菌药敏情况分析

目的了解对亚胺培南耐药的铜绿假单胞菌的药敏情况。方法细菌的鉴定及药敏试验均采用法国梅里埃公司的VITEK-2微生物鉴定与药敏系统,选择经VITEK-2测定对亚胺培南耐药的铜绿假单胞菌(耐药株)136株及对亚胺培南敏感的铜绿假单胞菌(敏感株)134株,统计分析两者对丁胺卡那、庆大霉素、头孢他啶、头孢他啶/阿奇霉素、哌拉西林、哌拉西林/他唑巴坦等几种临床上常用抗生素的药敏情况。结果耐药株对以上6种抗生素的敏感率分别为:丁胺卡那20.6%、庆大霉素19.1%、头孢他啶/阿奇霉素70.6%、头孢他啶27.9%、哌拉西林63.2%、哌拉西林/他唑巴坦72.1%;而敏感株对此6种抗生素的敏感率则分别为32.8%、68.7%、92.5%、65.7%、88.1%和89.6%,明显高于耐药株。经x2检验,除丁胺卡那两者比较差异无统计学意义(P>0.05)外,对其余5种抗生素的敏感率两者比较差异有统计学意义(P均<0.05)。结论对亚胺培南耐药的铜绿假单胞菌引起的感染,头孢他啶/阿奇霉素、哌拉西林/他唑巴坦、哌拉西林是较好的选择,而丁胺卡那、庆大霉素及单独使用头孢他啶则不推荐。     

重症监护病房耐美罗培南铜绿假单胞菌感染的危险因素分析及干预对策

目的 探讨重症监护病房耐美罗培南铜绿假单胞菌感染的危险因素并制定相应干预对策.方法 选择四川省达州市中心医院重症监护病房2013年1月—2016年10月感染耐美罗培南铜绿假单胞菌的40例作为研究组,并选择同期未感染耐美罗培南铜绿假单胞菌的40例作为对照组.记录2组年龄、机械通气时间、合并基础性疾病、入住重症监护病房时间、免疫抑制剂应用时间及经验性使用碳青霉烯类抗菌药物情况等并进行危险因素分析.结果 机械通气时间≥1周、入住重症监护病房时间≥1周、有经验性应用碳青霉烯类抗菌药物是重症监护病房感染耐美罗培南铜绿假单胞菌的独立危险因素(P<0.05).结论 在重症监护病房对于需要给予抗生素治疗的患者,应当早期行细菌学检查确定致病菌,降低经验性应用碳青霉烯类抗菌药物的频率,缩短患者机械通气治疗时间,可降低耐美罗培南铜绿假单胞菌的感染率.     

Bacterial combination effect between carumonam and eight other antibiotics

In vitro interactions between carumonam (CRMN) and 8 other antibiotics were studied using the agar dilution checkerboard technique against 88 clinical isolates of Escherichia coli, Proteus vulgaris, Serratia marcescens and Pseudomonas aeruginosa. Combinations of CRMN with 8 other antibiotics were generally additive or indifferent. Synergism was found against S. marcescens or P. aeruginosa with CRMN plus fosfomycin, gentamicin (GM) or dibekacin. Antagonism was not observed with CRMN plus any of the 8 other antibiotics tested. In a phase-contrast microscopic study, the synergism of CRMN in combination with GM were confirmed against P. aeruginosa 15846. CRMN in combination with GM demonstrated a in vivo synergy against experimental urinary tract infection caused by P. aeruginosa 15846 in mice. We think that combinations of several antibiotics with CRMN should be appropriate for initial therapy of infections because no antagonism appeared to occur with other antibiotic agents.     

Characteristics of Pseudomonas aeruginosa isolated from skin infections

From January 1995 to June 2000, 19 Pseudomonas aeruginosa were detected in 19 cases of infectious skin diseases. Coagulase-negative staphylococci coexisted with P. aeruginosa in 10 cases and P. aeruginosa was also often associated with Enterococcus sp., Staphylococcus aureus, Streptococcus sp. or other species. Twelve cases carried P. aeruginosa more predominantly than the other species. Some coagulase-negative staphylococci, Enterococcus sp., S. aureus and Streptococcus sp. were also predominant. The frequency of predominant P. aeruginosa was significantly higher in secondary infections due to ulcers and decubitus than in secondary infections due to other skin diseases. P. aeruginosa was also often detected in the legs and feet, but not in the trunk. This organism showed high sensitivities to antibiotics, except minocycline. No significant differences in sensitivity or resistance to antibiotics were found between P. aeruginosa when detected as the predominant or single strain and this microorganism when detected as the non-predominant strain. Thus, the detection of P. aeruginosa important in choosing the appropriate antibiotics to be used and this is sometimes influenced by the patient's condition.     

三种常见革兰阴性菌医院感染的耐药性分析

目的　了解大肠埃希菌、铜绿假单胞菌及克雷伯菌属医院感染的耐药情况。方法　对来源于全省医院感染监控网医院710株细菌的耐药性进行统计分析。结果　 3种细菌对氨苄西林的耐药率均 >90 %。大肠埃希菌和铜绿假单菌对阿米卡星较敏感 ,与庆大霉素的耐药性相比差异有显著性 (P <0 0 5 ) ,铜绿假单胞菌对亚胺培南的耐药率为 32 2 6 % ,对头孢噻肟为89 19%。结论　 3种常见革兰阴性菌对多数抗生素都有较高的耐药率 ,应加强细菌耐药性监测工作 ,指导临床合理用药