替加环素对碳青霉烯类敏感或耐药克雷伯菌属和肠杆菌属的体外抗菌活性

替加环素是新一代四环素类抗菌药，对除变形杆菌外的绝大部分肠杆菌科细菌都有良好的活性。本次研究共入选869株2004年6月-2006年7月间英国细菌耐药监测网的临床分离株，测定细菌对替加环素敏感性。     

头孢洛林-avibactam对含多种β内酰胺酶的革兰阴性菌和金葡菌的抗菌活性

头孢洛林是对革兰阳性菌和革兰阴性菌均有抗菌活性的新的广谱头孢菌素。本文报道头孢洛林联合β内酰胺酶抑制剂avibactam对含一种或多种β内酰胺酶的革兰阴性菌和甲氧西林敏感和耐药金葡菌的体外抗菌活性。431株1999—2008年临床分离菌,其中肠杆菌科细菌272株,包括99株携带多种β内酰胺酶,110株金葡菌中MSSA10株,     

医院感染革兰阴性菌发展趋势研究

摘要 目的 了解医院感染革兰阴性菌发展趋势,为医院感染防控提供依据。方法通过回顾性调查方式,对某医院临床革兰阴性菌感染病例进行分析。结果该医院在2010-2014年期间从感染患者标本中共检出病原菌2 225株,其中革兰阴性杆菌1 267株,占病原菌总数的56.94%。检出革兰阴性杆菌居前4位的依次是鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌。多重耐药菌409株,占革兰阴性菌总数的32.28%。分离的革兰阴性杆菌主要分离自痰液标本,其次是血液和尿液;感染部位以下呼吸道为主,其次是血液和泌尿道。结论该医院临床分离的病原菌以革兰阴性杆菌为主,多重耐药菌株占较大比例,主要感染下呼吸道、血液和泌尿道。     

北京石景山医院2008年革兰阴性菌的抗菌药物敏感性分析

目的监测本院2008年临床分离的革兰阴性菌株对抗菌药的敏感性，旨在为临床合理应用抗菌药物提供参考。方法按《全国临床检验操作规程》进行操作，以CLSI2007推荐的纸片扩散法测定其抗菌药物敏感性，用WHONET5．4软件分析其结果。结果分离出革兰阴性菌737株，其中铜绿假单胞菌（281株）、大肠埃希菌（161株）、肺炎克雷伯菌（63株）、嗜麦芽窄食单胞菌（45株）。铜绿假单胞菌对丁胺卡那霉素、庆大霉素、亚胺培南较敏感（84％、61％、61％），对其它药物敏感率均低于50％。大肠埃希菌、肺炎克雷伯菌对碳青霉烯类最敏感（100％），其敏感率在70％以上的药物为丁胺卡那霉素、头孢替坦、呋喃妥因、奈替米星。肠杆菌属、柠檬酸杆菌属、沙雷菌属对碳青霉烯类、丁胺卡那霉素、环丙沙星和左旋氧氟沙星的敏感率分别为100％、93％-100％和75％～100％，对头孢曲松、头孢替坦的敏感率也均在70％以上。鲍曼不动杆菌对亚胺培南敏感率为55％。结论碳青霉烯类对大肠埃希菌、肺炎克雷伯菌、肠杆菌属、柠檬酸杆菌属、沙雷菌属有很高的敏感性，铜绿假单胞菌对其耐药率升高。     

替加环素对临床多重耐药菌的体外药敏结果的分析

目的分析替加环素及另外11种抗菌药物对临床上常见的多重耐药菌的体外药敏试验结果。方法采用微量肉汤稀释法检测替加环素对临床上分离出的200株多重耐药菌,包括常见的耐甲氧西林金黄色葡萄球菌(MRSA)、鲍曼不动杆菌、肠球菌属、产超广谱β-内酰胺酶(ESBLs)的大肠杆菌、产ESBLs的肺炎克雷伯菌及肠杆菌属等细菌的最小抑菌浓度(MIC),并和另外10种抗菌药物进行分析比较,得出的数据采用WHONET5.4软件进行分析研究。结果 MRSA对替加环素、利奈唑胺的敏感率均为100.0%、对美罗培南的敏感率为98%;重度耐药的粪肠球菌和屎肠球菌对利奈唑胺和替加环素敏感率均为100.0%。大肠杆菌对替加环素和美罗培南也为100.0%的敏感率;肺炎克雷伯菌对替加环素和美罗培南的敏感率分别是96.0%和100.0%;阴沟肠杆菌和产气杆菌对替加环素的敏感率均为87.5%。结论替加环素对多重耐药的常见革兰阳性球菌和革兰阴性杆菌均有较佳的体外抑菌活性。     

临床多重耐药肠杆菌科细菌对替加环素的体外敏感性分析

为评估多重耐药肠杆菌科细菌（MDRE）对替加环素的体外敏感性,收集比利时91所医院2010年14月临床分离的MDRE菌株。     

肝移植受者中多重耐药革兰阴性菌的检测和同源性分析

目的了解肝移植受者中分离的多重耐药革兰阴性菌及各菌种的同源性。方法对上海交通大学附属第一人民医院2007年1月—2010年4月肝移植受者的各种标本中分离菌进行微量稀释法药敏试验,ESBLs和金属β内酰胺酶(MBL)检测并应用重复序列PCR(REP-PCR)技术测定菌株的同源性。结果从250例肝移植受者中,分离出124株革兰阴性菌,其中多重耐药革兰阴性菌67株(54.0%),包括鲍曼不动杆菌20株(29.9%)、大肠埃希菌16株(23.9%)、肺炎克雷伯菌13株(19.4%)、嗜麦芽窄食单胞菌8株(11.9%)、铜绿假单胞菌6株(9.0%)和阴沟肠杆菌4株(6.0%)。产ESBLs菌株主要为肺炎克雷伯菌(61.5%,8/13)和大肠埃希菌(81.3%,13/16);产金属酶的细菌为嗜麦芽窄食单胞菌(8/8)、铜绿假单胞菌(5/6)和鲍曼不动杆菌(95.0%,19/20);REP-PCR检测鲍曼不动杆菌4个基因型,其中C型17株,均在同一段时间内发现;大肠埃希菌分12个基因型,B型5株;肺炎克雷伯菌7个基因型,E型6株;铜绿假单胞菌5个基因型,C型2株;嗜麦芽窄食单胞菌7个基因型,F型2株;阴沟肠杆菌4个基因型,A型、B型、C型和D型各1株。结论肝移植术后多重耐药革兰阴性菌感染发生率较高;病原菌中鲍曼不动杆菌呈泛耐药,并且可能在肝移植病房暴发流行。     

米诺环素、替加环素对多重耐药菌的体外抗菌活性比较

目的评价米诺环素、替加环素对多重耐药的耐甲氧西林金葡菌(MRSA)、肠球菌和鲍曼不动杆菌的体外抗菌活性。方法采用微量肉汤稀释法测定临床分离的多重耐药细菌对米诺环素、替加环素的敏感性。结果多重耐药的1 55株鲍曼不动杆菌,99株(63.9%)对米诺环素敏感,39株(25.2%)对米诺环素耐药,17株(11.0%)对米诺环素中介。75株多重耐药MRSA,50株(66.7%)对米诺环素敏感,20株(26.7%)对米诺环素中介,5株(6.7%)为耐药株。93株多重耐药屎肠球菌中36株(38.7%)对米诺环素敏感,57株(61.3%)对米诺环素耐药。39株粪肠球菌中25株(64.1%)对米诺环素敏感。75株MRSA对替加环素100%敏感,132株肠球菌100%敏感。5株耐万古霉素屎肠球菌和4株产新德里金属β内酰胺酶不动杆菌全部对替加环素敏感,MRSA和肠球菌对替加环素敏感性为100%。结论替加环素对米诺环素耐药的肠球菌和MRSA有很好的体外抗菌活性,替加环素对米诺环素耐药的鲍曼不动杆菌的抗菌活性也不理想。     

替加环素对碳青霉烯类耐药鲍曼醋酸钙复合不动杆菌的体外抗菌活性

目的 测定替加环素对碳青霉烯类耐药鲍曼醋酸钙复合不动杆菌的体外抗菌活性。方法 收集2013年12月至2014年2月本院分离的碳青霉烯类耐药鲍曼醋酸钙复合不动杆菌,采用MTS法检测替加环素MIC值,折点采用美国食品药物管理局(FDA)公布的判定标准。结果 61株碳青霉烯类耐药鲍曼醋酸钙复合不动杆菌对临床常用抗菌药物具有极高的耐药率,替加环素的灵敏度为80.3%,中介率为19.7%,无耐药菌株。MIC90为3μg/mL,而MIC50为2μg/mL。结论 替加环素对于本院分离的碳青霉烯类耐药鲍曼醋酸钙复合不动杆菌有较好的体外抗菌活性。     

外科患者多重耐药革兰阴性菌严重感染的治疗体会

目的总结外科患者多重耐药（MDR）革兰阴性菌感染的特点与治疗经验。方法回顾分析2006年1月至2008年12月本院外科ICU收治的61例MDR革兰阴性菌严重感染患者的细菌学特点、抗菌药物选择及疗效。结果 61例患者共出现肺部感染34例、腹腔感染31例、尿路感染2例和继发性血流感染11例,其中12例同时存在2个或2个以上部位感染。共检出MDR鲍曼不动杆菌33株、铜绿假单胞菌19株、大肠埃希菌8株、肺炎克雷伯菌6株和阴沟肠杆菌2株。接受头孢哌酮-舒巴坦和碳青霉烯类抗生素治疗的患者分别为31例和28例,临床有效率分别为54.8%和60.7%,细菌清除率分别为38.7%和53.6%。其中15例治疗无效患者接受了注射用硫酸多黏菌素E治疗,临床有效率73.3%,细菌清除率53.3%。总病死率24.6%。结论外科ICU患者MDR革兰阴性菌感染以鲍曼不动杆菌和铜绿假单胞菌为主,其中泛耐药（PDR）菌株占50.0%左右。头孢哌酮-舒巴坦对MDR尤其是耐碳青霉烯类抗生素的鲍曼不动杆菌与铜绿假单胞菌感染有一定疗效,碳青霉烯类抗生素对其敏感的革兰阴性菌感染疗效较好,国产硫酸多黏菌素E亦有较好疗效,不良反应较少。     

Current concepts in antibiotic-resistant Gram-negative bacteria

Gram-negative bacteria are the dominant killers among bacterial pathogens in the intensive care unit. Antibiotic resistance has become a threat in hospital settings and efforts are being made to understand the underlying mechanisms. This review describes current data on the most important mechanisms of resistance in prevalent Gram-negative pathogens as well as newer therapeutic options.     

口服化疗增敏剂鲨烯胺对耐药革兰阴性杆菌的作用

耐多药(MDR)病原菌在全球广泛播散,严重影响抗菌药物的疗效。革兰阴性菌比革兰阳性菌多了一层细胞外膜,增加了抗菌药物渗入细菌体内的屏障作用,使许多抗菌药物对革兰阴性菌的作用远较其对革兰阳性菌的作用为差。鲨烯胺可增加革兰阴性菌的细胞膜渗透性,使抗菌药物容易进     

医院感染常见革兰阴性杆菌的耐药性分析

目的了解我院2003—2004年间临床分离的常见革兰阴性杆菌的耐药状况，为临床抗感染治疗和合理选择抗菌药物提供依据。方法VITEA-32全自动细菌鉴定仪对临床分离菌株进行鉴定，kirby—Bauer法对临床分离菌株进行药物敏感试验。结果两年间共分离革兰阴性杆菌3262株，占临床细菌总分离率的68．6％。常见的革兰阴性杆菌依次为大肠埃希菌（1021株）、铜绿假单胞菌（609株）、不动杆菌属（575株）、肺炎克雷伯菌（423株）、肠杆菌属（382株）。在大肠埃希菌中，检出产超广谱β-内酰胺酶（ESBLs）349株，产酶率为34．2％；在肺炎克雷伯菌中，检出产ESBLs菌株149株，产酶率为35．2％。药敏结果显示，革兰阴性杆菌对亚胺培南和哌拉西林／他唑巴坦的耐药率较低，对氨苄西林、头孢唑啉、庆大霉素等抗生素具有较高的耐药率，并且多重耐药现象比较严重。结论革兰阴性杆菌的分离率较高，耐药现象严重。临床医生在抗感染治疗中应根据药敏实验结果，合理选择抗菌药物，以提高抗感染的治疗效果。     

Current concepts in antibiotic-resistant gram-negative bacteria

Gram-negative bacteria are the dominant killers among bacterial pathogens in the intensive care unit. Antibiotic resistance has become a threat in hospital settings and efforts are being made to understand the underlying mechanisms. This review describes current data on the most important mechanisms of resistance in prevalent gram-negative pathogens as well as newer therapeutic options.     

In vitro activity of para-guanidinoethylcalix[4]arene against susceptible and antibiotic-resistant Gram-negative and Gram-positive bacteria

OBJECTIVES: Emergence of multidrug-resistant bacteria has encouraged vigorous efforts to develop antimicrobial agents with new mechanisms of action. In this study, the in vitro antibacterial activity of para-guanidinoethylcalix[4]arene was evaluated and compared with that of its constitutive monomer, para-guanidinoethylphenol. Hexamidine, a widely used antiseptic, and synthalin A, an old antidiabetic and anti-trypanosomal compound, were chosen as references. METHODS: MIC and MBC were determined for five reference strains (Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923 and ATCC 29213, Enterococcus faecalis ATCC 29212 and Pseudomonas aeruginosa ATCC 27853), as well as five antibiotic-resistant clinical isolates. Toxicity on MRC-5 and HaCaT eukaryotic cell lines was also evaluated by MTT and Neutral Red assays. RESULTS: No antibacterial activity was observed for para-guanidinoethylphenol (MIC >or= 512 mg/L) and synthalin A (MIC >or= 64 mg/L). Conversely, para-guanidinoethylcalix[4]arene and hexamidine: (i) showed a broad antibacterial spectrum, both on Gram-positive and on Gram-negative bacteria (MIC = 4 mg/L against E. coli and 8 mg/L against S. aureus for para-guanidinoethylcalix[4]arene), to a lesser degree against E. faecalis and P. aeruginosa (MIC = 32 mg/L); (ii) were bacteriostatic (MBC >or= 256 mg/L); and (iii) MICs and MBCs obtained for clinical isolates were similar to those obtained with reference strains. Both compounds, the monomer and the calixarene, showed no apparent cytotoxicity, whereas hexamidine and synthalin A had significant toxic effects that increased with time and concentration and in a range of 100-1000 times that for calixarene. CONCLUSIONS: In conclusion, results confirm para-guanidinoethylcalix[4]arene as a broad-spectrum new agent or an auxiliary in antimicrobial chemotherapy.     

Impact of antibiotic-resistant Gram-negative bacilli infections on outcome in hospitalized patients

OBJECTIVE: The impact of resistant (vs. nonresistant) Gram-negative infections on mortality remains unclear. We sought to define risk factors for and excess mortality from these infections. DESIGN: Prospective cohort study. SETTING: Inpatient surgical wards at a university hospital. PATIENTS: All patients in the general, transplant, and trauma surgery services diagnosed with Gram-negative rod (GNR) infection. MEASUREMENTS AND MAIN RESULTS: All culture-proven GNR infections (n = 924) from December 1996 to September 2000 were studied. Characteristics and outcomes were compared between GNR infections with and without antibiotic resistance. Univariate and logistic regression analysis identified factors associated with antibiotic-resistant GNR (rGNR) infection and mortality. rGNR infection (n = 203) was associated with increased Acute Physiology and Chronic Health Evaluation (APACHE) II scores (17.8 +/- 0.5), multiple comorbidities, pneumonia and catheter infection, coexistent infection with antibiotic-resistant Gram-positive cocci and fungi, and high mortality (27.1%). Only seven isolates were resistant in vitro to all available antibiotics. Logistic regression demonstrated that rGNR infection was an independent predictor of mortality (odds ratio, 2.23; 95% confidence interval, 1.35-3.67; p =.002). Analysis of rGNR infection with controls matched by organism, age, APACHE II score, and site of infection, however, revealed that antibiotic resistance was not associated with increased mortality (23.6% vs. 29.2%, p =.35). Furthermore, analysis of all Pseudomonas aeruginosa infections demonstrated no significant difference in mortality between resistant and sensitive strains (18.9% vs. 20.0%, p =.85). CONCLUSION: rGNRs are associated with prolonged hospital stay and increased mortality. Infection with rGNRs independently predicts mortality; however, this may be more closely related to selection of certain bacterial species with a high frequency of resistance rather than actual resistance to antibiotic therapy. Therefore, altering infection-control practices to limit the dissemination of certain bacterial species may be more effective than attempts to control only antibiotic-resistant isolates.