呼吸机相关性肺炎病原菌检测及临床探讨

目的分析呼吸机相关性肺炎（VAP）病原菌特点、危险因素布及耐药性,便于控制VAP。方法对2007年7月—2009年6月确诊的VAP患者分离到的病原菌进行鉴定并用纸片扩散法进行药物敏感试验。结果 187例机械通气的患者发生VAP 83例（44.38%）;共分离出165株病原菌。其中,革兰阴性菌占71.51%,革兰阳性菌占20.6%,真菌占7.88%。位于前5位的病原菌依次位鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、嗜麦芽假单胞菌、表皮葡萄球菌。亚胺培南对主要革兰阴性菌有较好的敏感性。结论革兰阴性菌是VAP的主要病原菌,且存在严重的耐药现象。临床医师应根据药敏试验结果合理使用抗生素,及时治疗VAP。     

大学生下呼吸道感染病原菌的临床检验分析

目的掌握我校大学生病原菌种类与药敏性,给临床合理使用抗菌药物提供实验室依据,提高疾病治愈率。方法对收治的下呼吸道感染患者805例的痰培养标本进行检验,检测病原菌分布与药敏试验。结果共分离1438株病原菌,革兰阳性球菌284株,占19.75%;革兰阴性杆菌987株,占68.64%;真菌167株,占11.61%。革兰阳性球菌中比例前3位:金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌;革兰阴性杆菌中比例前3位:铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌。结论我校大学生下呼吸道感染的主要病原菌为革兰阴性杆菌,所占比例最多的是铜绿假单胞菌。临床中应重视病原菌检测,从而选择合理的抗菌药物进行治疗。     

呼吸机相关肺炎的临床分析

目的观察呼吸机相关肺炎(ventilator associated pneumonia,VAP)的病原菌、药物敏感试验及其耐药性的情况,为临床抗感染药物的正确应用提供参考。方法对呼吸科监护病房使用呼吸机的24例患者的临床资料、病原菌组成及药物敏感试验、细菌对抗生素耐药性结果进行回顾性分析。结果24例VAP患者共培养出致病菌46株,其中革兰阴性菌30株(65.21%),革兰阳性菌11株(23.91%),真菌5株(10.8%)。单纯革兰阴性菌感染3例,单纯革兰阳性菌感染2例,两种或两种以上混合感染19例,其中合并真菌感染5例。占前5位的病原菌分别是:铜绿假单胞菌、肺炎克雷伯杆菌、金黄色葡萄球菌、鲍曼不动杆菌和大肠埃希氏菌,药敏结果显示这些菌株耐药严重。结论VAP以革兰阴性菌感染为主,念珠菌属仍为真菌感染的主要致病菌,细菌的耐药率普遍较高,临床上应注重病原菌培养及药敏试验,加强抗生素的合理使用。     

86例老年患者医院获得性肺炎感染病原菌及耐药性分析

目的了解老年人医院获得性肺炎的病原菌构成及耐药情况。方法对86例老年患者的痰标本进行细菌培养及药敏试验。结果 86例标本检出致病菌103株,其中革兰阴性杆菌70株占68%,以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌占前3位;革兰阳性球菌10株占9.7%,以金黄色葡萄球菌、表皮葡萄球菌为主;真菌14株占13.6%。格兰阴性杆菌对头孢哌酮/舒巴坦、亚胺培南、哌拉西林/他唑巴坦敏感性较高,而格兰阳性球菌对万古霉素、哌拉西林/他唑巴坦高度敏感。结论引起老年患者医院获得性肺炎病原菌以格兰阴性杆菌为主,且呈多重耐药,真菌感染呈上升趋势。故临床选药应结合本地区的微生物学资料。     

老年患者呼吸机相关性肺炎病原菌分布及耐药性研究

目的:探讨医院呼吸机相关性肺炎(VAP)老年患者感染病原菌分布及耐药情况,使临床用药更具合理性与针对性。方法:收集2009年1月~2014年1月我院收治的586例进行机械通气老年患者临床资料进行回顾性调查,从资料中筛选出VAP老年患者并对其下呼吸道分泌物培养及病原菌耐药结果进行统计分析。结果:586例进行机械通气患者中总共有198例患者并发有VAP(发生率为33.8%),下呼吸道分泌物共分离出224株病原菌,其中革兰阴性杆菌构成比最高(72.8%),其次为革兰阳性球菌(17.4%),真菌(9.8%);革兰阴性杆菌中前3位病原菌依次为鲍曼不动杆菌(23.2%)、铜绿假单胞菌(16.1%)、大肠埃希菌(8.9%);鲍曼不动杆菌和铜绿假单胞菌泛耐药菌株的检出比例分别为97.69%和22.2%,产ESBLs细菌检出比例为55.0%。革兰阳性球菌中,以金黄色葡萄球菌和表皮葡萄球菌为主,耐甲氧西林金黄色葡萄球菌(MRAS)和耐甲氧西林表皮葡萄球菌(MRSE)检出比例分别为68.2%和66.7%。结论:VAP的病原菌以革兰阴性杆菌为主,相关菌株耐药性较高,及时监测相关病原菌耐药性对指导临床合理用药至关重要。     

儿科呼吸机相关性肺炎的病原菌及药物敏感性分析

目的了解小儿机械通气(MV)相关性肺炎(VAP)的主要病原菌及药物敏感情况,指导临床合理使用抗生素。方法回顾分析2005～2007年我院呼吸机治疗的154例危重小儿的临床资料。所有病例上机后常规采集下呼吸道分泌物作细菌培养及药敏试验,对确诊为VAP的病例,分析其病原菌分布及药物敏感性情况。结果VAP发生率为38.3%;病原菌主要是耐药性条件致病菌,以革兰阴性杆菌为主(74.2%),革兰阳性球菌次之(23.7%)。结论在治疗VAP时,经验用药除了要考虑肺炎克雷伯菌、大肠埃希菌及铜绿假单胞菌感染外,还必须注意耐药葡萄球菌感染。     

呼吸机相关性肺炎的病原菌分布特点和耐药性分析

目的:分析呼吸机相关性肺炎(VAP)感染病原菌的分布特点和耐药性。方法:采集46例VAP患者下呼吸道分泌物,采用全自动细菌鉴定仪及药敏试验仪进行病原菌培养和药敏试验。结果:46例VAP患者共收集98株VAP病原菌,其中革兰阴性菌68株(69.4%);革兰阳性菌17株(17.3%);真菌感染13株(13.3%)。铜绿假单胞菌、鲍曼不动杆菌、大肠埃希氏菌、肺炎克雷伯杆菌、不动杆菌、金黄色葡萄球菌、白色念珠菌是主要VAP病原菌,对头孢他啶和氨苄青霉素均表现为较高的耐药性;除不动杆菌外,其他7种VAP病原菌对哌拉西林和头孢唑林耐药性低;8种VAP病原菌对亚胺培南耐药性低。结论:VAP的主要病原菌为革兰阴性杆菌,并存在较严重的耐药现象,进行病原菌培养和药敏试验对合理选用抗菌药物治疗VAP患者具有重要意义。     

重症监护病房67例呼吸机相关肺炎临床分析

目的探讨重症监护病房呼吸机相关肺炎(VAP)病原菌分布及耐药性,为防治呼吸机相关肺炎提供科学依据。方法对2010年3月至2011年10月重症医学科确诊的VAP 67例患者下呼吸道分泌物进行细菌培养和药敏试验。结果分离出病原菌163株,其中以革兰阴性杆菌126株(77.3%),以鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯杆菌、大肠埃希菌为主,革兰阳性球菌次之,分离出26株(16.0%),以金黄色葡萄球菌为主,真菌感染也较常见,分离出11株(6.7%),主要为白色念珠菌。大多数革兰阴性杆菌对抗菌药物表现出较高的耐药性,但是β-内酰胺类抗生素及亚胺培南对革兰阴性杆菌有较好作用,革兰阳性球菌对万古霉素敏感。结论 VAP病原菌多为革兰阴性杆菌,并具有多重耐药性,治疗时注意下呼吸道病原体检测,缩短机械通气时间及根据细菌培养及药敏实验结果正确合理应用抗生素,是预防呼吸机相关肺炎的主要措施。     

医院重症监护室呼吸机相关性肺炎的病原学及其耐药性分析

目的探讨医院重症监护室(ICU)患者呼吸机相关性肺炎(VAP)的病原学特点及其耐药性,指导临床合理用药。方法回顾性分析医院ICU收治的采用机械通气超过48 h的患者253例,确诊为VAP的患者共53例,对所有患者进行呼吸道分泌物细菌培养及抗菌药物敏感性分析。结果VAP患者病原学检查共培养出107株病原菌,其中革兰阴性杆菌占71.03%,前3位分别为铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌;革兰阳性球菌占24.30%,前3位分别为金黄色葡萄球菌、肠球菌、表皮葡萄球菌;真菌占4.67%,以白色念珠菌为主。最主要的3种革兰阴性杆菌对亚胺培南、氨曲南、左氧氟沙星耐药性较低,最主要的3种革兰阳性球菌对万古霉素、替考拉宁耐药性最低。结论医院ICU中VAP病原菌以革兰阴性杆菌为主,呈多重耐药性,临床需动态监测VAP病原菌及其耐药性,促进临床合理用药。     

ICU呼吸机相关性肺炎病原学及耐药性分析

目的:探讨呼吸机相关肺炎(VAP)病原学分布特点及耐药性,便于指导临床用药。方法:回顾分析83例VAP患者的临床资料。结果:83例VAP患者共分离病原菌127株,革兰阴性杆菌占63.07%,革兰阳性菌占19.89%,真菌占17.04%。病原菌以铜绿假单胞菌、肺炎克雷伯杆菌、大肠埃希菌、金黄色葡萄球菌和白色念珠菌为主。分离的细菌除对泰能较敏感外,对其它抗生素均有不同程度耐药。结论:VAP常为多种病原菌的混合性感染,普遍存在耐药性;选择敏感抗生素可提高VAP治愈率。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.