替考拉宁与万古霉素治疗耐甲氧西林金黄色葡萄球菌肺炎的疗效比较

目的：比较替考拉宁与万古霉素治疗耐甲氧西林金黄色葡萄球菌（ MRSA）肺炎的安全和有效性。方法选取68例MRSA肺炎患者按照随机数字分组法分为两组：观察组34例,采用替考拉宁治疗;对照组34例,采用万古霉素治疗。观察和比较两组的临床疗效、细菌学疗效及不良反应。结果观察组和对照组的临床总有效率分别为82．35％、76．47％,细菌总清除率分别为91．18％、85．29％,两组差异均无统计学意义（均P＞0．05）;观察组出现红斑、皮疹、腹泻各1例,对照组出现肾毒性4例及耳毒性、静脉炎、腹泻各1例,观察组的总不良反应发生率略低于对照组,但差异无统计学意义（P＞0．05）。结论替考拉宁治疗MRSA肺炎的疗效良好、肾损伤较轻,与万古霉素的治疗效果基本相当,值得临床推广和应用。     

利奈唑胺与替考拉宁治疗耐甲氧西林金黄色葡萄球菌感染的效果比较

目的:探究利奈唑胺与替考拉宁治疗耐甲氧西林金黄色葡萄球菌(MRSA)感染的疗效和安全性.方法:选取2015年1月～2016年12月我院收治的MRSA感染患者126例作为研究对象,按照治疗方式不同分为利奈唑胺组(n=63)和替考拉宁组(n=63),利奈唑胺组每日静脉滴注利奈唑胺,替考拉宁组每日静脉滴注替考拉宁,比较两组临床疗效、细菌清除率和不良反应发生率.结果:利奈唑胺组总有效率(85.71％)显著高于替考拉宁组(69.84％),差异具有统计学意义(X2=4.5913,P=0.0321);利奈唑胺组细菌清除率(82.54％)显著高于替考拉宁组(65.08％),差异具有统计学意义(X2=4.9677,P=0.0258);利奈唑胺组不良反应发生率(3.17％)显著低于替考拉宁组(12.70％),差异具有统计学意义(X2=3.9103,P=0.0480).结论:利奈唑胺治疗MRSA感染的疗效和安全性均显著优于替考拉宁,值得推广.     

大剂量替考拉宁治疗耐甲氧西林金黄色葡萄球菌感染呼吸机相关性肺炎的疗效观察

目的研究大剂量替考拉宁治疗耐甲氧西林金黄色葡萄球菌感染呼吸机相关性肺炎的疗效。方法选取2011年4月至2013年8月接受治疗的86例耐甲氧西林金黄色葡萄球菌感染呼吸机相关性肺炎患者,随机分成大剂量组(n=43例)和小剂量组(n=43例),其中大剂量组患者采用大剂量替考拉宁静脉滴注治疗,小剂量组患者采用小剂量考拉宁静脉滴注治疗,跟踪随访,观察2组患者的疗效、症状改善、细菌清除率、不良反应情况,并记录住院时间。结果大剂量组患者的痊愈率及总有效率明显高于小剂量组(P<0.05);大剂量组患者症状改善用时及住院时长均明显低于小剂量组(P<0.05);大剂量组患者的细菌总清除率明显高于小剂量组患者(P<0.05)。结论大剂量替考拉宁治疗耐甲氧西林金黄色葡萄球菌感染呼吸机相关性肺炎的疗效显著,能明显缩短病程,提供细菌清除率,且不良反应率低,因此具有较高的临床应用价值。     

国产替考拉宁对耐甲氧西林表皮葡萄球菌的体外抗菌活性观察

评价国产替考拉宁对耐甲氧西林表皮葡萄球菌（MRSE）和甲氧西林敏感表皮葡萄球菌（MSSE）的体外抗菌活性，用琼脂二倍稀释法测定了84株MRSE和28株MSSE临床菌株的最低抑菌浓度，并与万古霉素进行了比较，结果表明国产替考拉宁对48株MRSE和28株MSSE抑菌效果较好，其敏感率分别为97．62％和100％。     

利奈唑胺联合替考拉宁治疗耐甲氧西林金黄色葡萄球菌重症肺炎的临床疗效及其安全性

目的 探讨利奈唑胺联合替考拉宁治疗耐甲氧西林金黄色葡萄球菌(MRSA)重症肺炎的临床疗效及其安全性.方法 选取吉安市中心人民医院2017—2019年收治的MRSA重症肺炎患者65例,按随机数字表法分为对照组32例,观察组33例.对照组予以替考拉宁治疗,观察组采用利奈唑胺联合替考拉宁治疗.比较2组病菌清除率,治疗前后炎性...     

县级医院耐甲氧西林金黄色葡萄球菌的检测及药敏分析

目的分析该地区金黄色葡萄球菌的药物敏感性,为临床治疗提供依据。方法对我院2008年3月至2011年9月患者各种临床合格标本进行分离培养,将鉴定出的金黄色葡萄球菌进行耐甲氧西林金黄色葡萄球菌(MRSA)的耐药性检测,并把MRSA药敏进行统计分析。结果 156株金黄色葡萄球菌中,检出113株MRSA,占72.4%,另43株为MSSA,MRSA呈多药耐药性。结论本地区患者标本耐甲氧西林金黄色葡萄球菌分离率显著增高,加强对MRSA菌株的监测非常重要。     

耐甲氧西林金黄色葡萄球菌耐药分析

目的了解全院临床科室耐甲氧西林金黄色葡萄球菌(MRSA)耐药情况,为呼吸科临床治疗提供抗菌药选用依据。方法对临床分离的28株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)的药物敏感报告单进行耐药分析。结果 28株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)的检出率为53.57%,MRSA对18种抗菌药物中种耐药率>63.24%,对青霉素类、头孢菌素类以及红霉素100.0%耐药,MRSA对替考拉宁、利奈唑胺100.0%敏感,检测到1株耐万古霉素金黄色葡萄球菌。结论本研究中我院呼吸科MRSA发生率低于国内平均水平,复方新诺明和氯霉素对其仍较敏感,万古霉素出现耐药菌株,替考拉宁、利奈唑胺仍为首选。     

不同维持剂量替考拉宁对耐甲氧西林金黄色葡萄球菌肺部感染患者的疗效及安全性比较

目的:比较不同维持剂量的替考拉宁对耐甲氧西林金黄色葡萄球菌(MRSA)肺部感染患者的疗效及安全性及其对细菌清除的影响。方法:选取2018年3月—2019年6月间收治的MRSA肺部感染患者83例资料,按给药剂量的不同将其随机分为观察组(43例)和对照组(40例);对照组患者给予替考拉宁400 mg,q12h给药,给药3次后,每日给药维持剂量400 mg(治疗14 d);观察组患者给予替考拉宁400 mg,q12h给药,给药3次后每日给药600 mg(治疗14 d);比较两组患者用药后的总有效率、MRSA清除率、替考拉宁血药谷浓度测得值(Cmin)、临床症状(咳嗽咳痰、体温)复常时间,以及治疗期间不良反应发生率的差异。结果:观察组患者用药后临床症状(咳嗽咳痰、体温)复常时间早于对照组(P<0.05),替考拉宁血药谷浓度显著高于对照组(P<0.05),治疗后的总有效率显著高于对照组(P<0.05),MRSA清除率显著高于对照组(P<0.05);两组患者用药期间不良反应发生率经组间比较其差异无统计学意义(P>0.05)。结论:采用600 mg维持剂量的替考拉宁可有效提高患者血药谷浓度,有助于患者临床症状的改善,提高了临床疗效,不良反应轻微且安全性较高。     

基于指南评估我院治疗耐甲氧西林金黄色葡萄球菌感染的抗菌药物应用

目的:调查我院治疗耐甲氧西林金黄色葡萄球菌(MRSA)感染的抗菌药物使用情况,分析导致抗感染失败的原因。方法:收集2011年在我院进行抗MRSA感染治疗的患者资料,在美国感染性疾病学会2011年发布的《耐甲氧西林金黄色葡萄球菌感染的循证治疗指南》以及我国《耐甲氧西林金黄色葡萄球菌感染防治专家共识》的基础上,从患者的基本情况、感染部位、药敏数据与选用的抗感染药物的品种、剂量、疗程等方面对治疗效果进行评价。结果:我院MRSA感染的治疗方案与指南的推荐基本相符,但仍存在选药不当与用药剂量过小的问题。结论:应充分发挥临床药师的作用,为抗MRSA感染提供服务,提高MRSA感染的治愈率。     

Investigation of methicillin-resistant Staphylococcus aureus showing reduced vancomycin susceptibility isolated from a patient with infective endocarditis

A patient with infective endocarditis (IE) caused by methicillin-resistant Staphylococcus aureus (MRSA) was treated with vancomycin (VAN). VAN was ineffective, although therapeutic drug monitoring (TDM) indicated that the recommended trough level was maintained. Five MRSA isolates obtained at various times were analyzed to determine the minimum inhibitory concentration (MIC) and were subjected to population analysis, simulation analysis pulsed-field gel electrophoresis (PFGE). MRSA susceptible to VAN was isolated before and during the early stage of treatment, while an MRSA strain showing reduced VAN MIC was isolated during treatment. Simulation analysis indicated that the viable bacterial count only decreased to 10⁻³ to 10⁻⁴ cells after 72 h of incubation. The five MRSA strains isolated at various times were identical by PFGE.     

抗菌药物联用对耐甲氧西林金黄色葡萄球菌体外抗菌活性研究

目的了解万古霉素与头孢哌酮/舒巴坦、亚胺培南、左氧氟沙星联用对MRSA的体外抗菌活性,指导临床合理用药。方法常规方法培养分离细菌,用VITEK微生物自动分析仪或API系统鉴定到种。MRSA鉴定应用乳胶凝集试剂盒,药敏试验采用肉汤倍比稀释法和琼脂平板稀释法。结果万古霉素对40株MRSA的MIC90为4mg/L,而与头孢哌酮/舒巴坦、亚胺培南、左氧氟沙星联用MIC90降为0.25～1mg/L。结论万古霉素与上述三种药物联用以协同作用为主,抗菌活性提高4倍以上。临床上治疗由MRSA引起的重症感染应根据药敏试验结果采用万古霉素与亚胺培南或头孢哌酮/舒巴坦或其它抗菌药物联合应用。     

Population pharmacokinetics of teicoplanin in patients with endocarditis

Teicoplanin is a new glycopeptide antibiotic, active against aerobic and anaerobic gram-positive bacteria. The drug is intended for the treatment of systemic infections including endocarditis. In two U.S. clinical safety and efficacy trials, loading doses of 6 to 30 mg/kg doses of teicoplanin were administered initially to 197 patients, followed by once-a-day treatment of approximately the same doses over several weeks. Blood samples were collected sporadically during the study to monitor serum teicoplanin concentrations either by FPIA or microbiological assay. Nonlinear mixed-effects modeling was performed on these data to characterize the population pharmacokinetics of teicoplanin that were best described by a two-compartment model. Patient body weight, concomitant gram-positive drug treatment, and serum creatinine had significant influences on systemic clearance(CL) of the glycopeptide. In addition, body weight affected the volume of distribution of the central compartment(Vc). Other demographic factors such as age, gender, etc., had no effects. The FPIA assay method was more precise than the microbiological assay.     

手术治疗感染性心内膜炎35例临床分析

目的探讨感染性心内膜炎的临床特点、手术指征及手术要点。方法回顾性分析该院接受手术治疗的35例感染性心内膜炎患者的临床资料。结果围术期死亡1例(2.86%)。术后随访6个月至5.5年均无心内膜炎复发,33例心功能Ⅰ～Ⅱ级,1例心功能Ⅲ级。结论及时把握手术时机,对感染性心内膜炎患者进行外科手术治疗,能明显改善患者生活质量,降低死亡率及围术期并发症的发生,效果满意。     

Treatment and prevention of infective endocarditis

The paper presents the most recent recommendations for the treatment and prevention of infective endocarditis (IE). The treatment of IE is complex and requires close collaboration among specialists in infectious diseases, cardiology, cardiac surgery and microbiology. The mainstay of medical treatment is antibiotic therapy. Theoretical considerations regarding vegetations and antibiotics have practical consequences on the route and modalities of administration of antibiotics and on the techniques used to monitor treatment. The choice of antibiotics depends on the microorganism (streptococci, enterococci, staphylococci, HACEK group [Haemophilus sp., Actinobacillus sp., Cardiobacterium sp., Eikenella sp. and Kingella sp.], Coxiella, Brucella, Legionella, Bartonella, fungi) and on whether IE occurs on native or prosthetic valves. Treatment of IE with negative blood cultures is particularly difficult. Cardiac surgery is often needed during the bacteriologically active period (in ~ 50% of patients). The decision to intervene and the optimal timing of the intervention requires careful consideration of multiple potential risks: the haemodynamic risk, the infectious risk, the risk due to cardiac lesions, the risk due to extracardiac complications and the risk due to the location of infective endocarditis. Even though the efficacy of antibiotic prophylaxis of IE is not completely proven, it is recommended for selected patients who undergo an at-risk procedure. Lists of cardiac conditions and of medical procedures at risk are presented; specific antibiotic prophylactic regimens for dental and upper respiratory tract procedures in out-patients, procedures under general anaesthesia and urological and GI procedures are outlined.     

感染性心内膜炎的抗菌药应用分析

目的：通过对感染性心内膜炎（ＩＥ）使用抗药物的分析，探讨ＩＥ抗菌药物的合理用。方法：对广东省人民医院近５年１８７例ＩＥ患者的抗菌药应用情况进行回顾性分析。结果：青霉素类，头孢菌素类、氨基糖苷类和喹诺酮类的使用频率位于前４位。在各种抗菌药中，青霉素、丁胺卡那霉素的ＤＤＤｓ，居前２位，远高于其他药物，除苯唑青霉素外，其他抗生素的药物利用指数（ＤＵＩ）均≤１。青霉素类与氨基粮苷类的联合是最常用的治疗方案     

Antibacterial activity of hydroxychalcone against methicillin-resistant Staphylococcus aureus

Anti-candidal hydroxychalcone, 2,4,2′-trihydroxy-5′-methylchalcone (THMC), was investigated for its antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA). THMC showed the minimum inhibitory concentrations of 25.0–50.0 μg/ml against tested 20 strains, at which the effect was based on a bacteriostatic action. THMC of 25.0 μg/ml completely inhibited the incorporation of radio-labelled thymidine and uridine into MRSA cells. In combination with antibiotics, the fractional inhibitory concentration indices were 0.47 for gentamicin and 0.79 for vancomycin, indicating that THMC acts synergistically with these agents. THMC would be a potent therapeutic agent for MRSA infections.     

Efficacy and safety of outpatient parenteral antibiotic therapy in patients with infective endocarditis: a meta-analysis

BackgroundTo investigate the clinical outcome of patients with infective endocarditis (IE) during and after outpatient parenteral antimicrobial treatment (OPAT), and to further clarify the safety and efficacy of OPAT for IE patients.MethodsThrough December 20, 2021, a total of 331 articles were preliminarily searched in Pubmed, Web of Science, Cochrane Library and Embase, and 9 articles were eventually included in this study.ResultsA total of 9 articles comprising 1,116 patients were included in this study. The overall mortality rate of patients treated with OPAT was 0.04 (95% CI, 0.02-0.07), that means 4 deaths per 100 patients treated with OPAT. Separately, mortality was low during the follow-up period after OPAT treatment, with an effect size (ES) of 0.03 (95%CI, 0.02-0.07) and the mortality of patients during OPAT treatment was 0.04 (95% CI, 0.01-0.12). In addition, the readmission rate was found to be 0.14 (95% CI, 0.09-0.22) during the follow-up and 0.18 (95% CI, 0.08-0.39) during treatment, and 0.16 (95% CI, 0.10-0.24) for patients treated with OPAT in general. Regarding the relapse of IE in patients, our results showed a low overall relapse rate, with an ES of 0.03 (95% CI, 0.01-0.05). In addition, we found that the incidence of adverse events was low, with an ES of 0.26 (95% CI, 0.19-0.33).ConclusionIn general, the incidence of adverse events and mortality, readmission, and relapse rates in IE patients treated with OPAT are low both during treatment and follow-up period after discharge, indicating that OPAT is safe and effective for IE patients. However, our study did not compare routine hospitalization as a control group, so conclusions should be drawn with caution. In order to obtain more scientific and rigorous conclusions and reduce clinical risks, it is still necessary to conduct more research in this field and improve the patient selection criteria for OPAT treatment, especially for IE patients. Finally, clinical monitoring and follow-up of OPAT-treated patients should be strengthened.     

337株金黄色葡萄球菌对替考拉宁等的体外抗菌活性研究

目的检测替考拉宁等8种抗菌药物对金葡菌的体外抗菌活性,为临床合理用药提供依据。方法应用琼脂平板稀释法检测了337株金葡菌对8种抗菌药物的耐药性。结果在8种药物中,替考拉宁、去甲万古霉素、万古霉素对MRSA的抗菌活性相似,MIC90分别为1、2、2mg/L;利福平、克林霉素对MRSA的抗菌活性较差,MIC90分别为256、>512mg/L。未发现对替考拉宁、去甲万古霉素、万古霉素耐药的菌株,但发现有3株MRSA分别对对替考拉宁、去甲万古霉素中敏。结论替考拉宁、去甲万古霉素、万古霉素是临床治疗MRSA感染患者的重要药物,合理使用糖肽类抗生素非常重要。