肠球菌β-内酰胺酶的测定及耐药性分析

目的 研究肠球菌β—内酰胺酶与耐药性的关系。方法 采用纸片扩散法(K—B法)检测32株肠球菌对8种抗生素的耐药性，采用nitrocefin法测定β—内酰胺酶。结果 药敏测定结果显示肠球菌对链霉素、红霉素、庆大霉素的耐药率分别达到96．9％、93．8％、84．4％，对万古霉素、替考拉宁的耐药率都为0。对青霉素类抗生素的耐药性，屎肠球菌对氨苄西林、青霉素G、氨节西林／舒巴坦耐药率分别为71．4％、85．7％、57．1％，粪肠球菌则分别为8．7％、13．0％、0；屎肠球菌产β—内酰胺酶阳性率为71．4％，粪肠球菌为31．1％。结论 肠球菌对氨基糖苷类抗生素、红霉素具有高度耐药性，对万古霉素、替考拉宁全部敏感，屎肠球菌对青霉素类抗生素的耐药性与产β—内酰胺酶率明显高于粪肠球菌，且屎肠球菌、粪肠球菌对青霉素类抗生素的耐药性与β—内酰胺酶的产生呈正相关系。     

VanC型肠球菌与屎肠球菌对常用抗菌药的耐药状况研究

目的：比较VanC型肠球菌及屎肠球菌对常用抗菌药物的敏感性。方法针对56株VanC型肠球菌及299株屎肠球菌,用琼脂二倍稀释法进行药物敏感性分析;检测高水平耐万古霉素屎肠球菌的万古霉素耐药基因型。结果VanC型肠球菌万古霉素最低抑菌浓度（ MIC）众数为4 mg? L－1,未发现对氨苄西林、万古霉素、替考拉宁及利奈唑胺耐药的VanC型肠球菌。屎肠球菌对氨苄西林、左氧氟沙星、红霉素及利福平的耐药率均达85％以上;对万古霉素和替考拉宁的耐药率分别为1．7％和0．7％;未发现对利奈唑胺和替加环素耐药的屎肠球菌。屎肠球菌万古霉素MIC众数为0．5 mg? L－1。5株万古霉素屎肠球菌万古霉素耐药基因均为vanA型。结论屎肠球菌对万古霉素尚保持较高敏感性,万古霉素对VanC型肠球菌最低抑菌浓度较屎肠球菌高。     

223株常见肠球菌的临床分布和耐药性分析

目的分析常见肠球菌在临床标本中的分布及对常用抗菌药物的耐药性,为临床治疗提供参考。方法采用法国梅里埃生物API鉴定系统进行菌种鉴定,并采用K—B纸片扩散法进行体外耐药监测及统计耐药率。结果肠球菌的临床分离率为8．78％,分类以粪肠球菌为主,其次为屎肠球菌,肠球菌属对利福平、四环素、红霉素、达福普汀、氯霉素耐药率较高。而对万古霉素、替考拉宁和呋喃妥因仍然保持良好的敏感性。粪肠球菌对青霉素、氨苄西林、左旋氧氟沙星的耐药率分别为2．4％、2．4％、5．9％,均低于屎肠球菌的90．7％、88．9％、13．0％,屎肠球菌对四环素、氯霉素的耐药率分别为51．9％和48．1％,均低于粪肠球菌的95．3％和78．1％。结论临床标本中,肠球菌在泌尿生殖道标本中的分布最高,粪肠球菌和屎肠球菌的耐药谱明显不同,在重症感染时可选用万古霉素、替考拉宁和呋喃妥因进行治疗。     

莫西沙星对224株肠球菌的体外抗菌活性研究

目的观察莫西沙星对224株肠球菌的体外抗菌活性。方法采用二倍琼脂稀释法对224株肠球菌进行体外抗菌实验．并与意大利Aventis公司生产的替考拉宁和Lilly公司生产的万古霉素进行抗菌效果对比。结果莫西沙星的抗菌效果较好，对169株粪肠球菌和51株屎肠球菌的MIC90均为4mg／L，替考拉宁和万古霉素对169株粪肠球菌的MIC90分别为1、2mg／L；对51株屎肠球菌的MIC90分别为0．5和2mg／L。结论莫西沙星对224株肠球菌的抗菌效果较好，肠球菌对莫西沙星的敏感率均为76．34％。莫西沙星的抗菌效果低于替考拉宁和万古霉素。     

天津市八家医院肠球菌临床分离株的耐药分析

目的：研究天津地区临床分离的肠球菌对常用抗生素的耐药情况，为临床合理选用抗生素提供科学依据。方法：收集天津市8家三级甲等医院于2001年2月-2002年2月分离的149株肠球菌，采用纸片扩散法(K-B法)进行药敏试验。结果：149株肠球菌感染中粪肠球菌73．8％，屎肠球菌16．1％。110株粪肠球菌耐药率较低的药物为万古霉素1．0％，氨苄西林38．6％，青霉素41．3％等。24株屎肠球菌耐药率较低的药物为万古霉素4．3％，氯霉素38．5％。结论：肠球菌耐药情况较为严重，应根据药敏试验合理使用抗菌药物。     

头孢硫脒等6种抗菌药物对革兰氏阳性球菌体外抗菌活性研究

目的 对比研究头孢硫脒(CTM)、头孢唑林(CEZ)、头孢映辛(CXM)、头孢曲松(CRO)、苯唑西林(MPIPC)、万古霉素(VCM)对99株临床分离革兰氏阳性球菌的抗菌活性。方法采用琼脂平板稀释法测定最低抑菌浓度(MIC)。结果 CTM对32株金黄色葡萄球菌的MIC50、MIC90均为0．5mg/L，低于CRO，CTM对29株表皮葡萄球菌的MIC50、MIC90分别为0．125和8mg/L，是CRO的l／16，对9株甲氧西林耐药的葡萄球菌(MRS)的范围与CXM相近；CTM对粪肠球菌的抗菌活性与万古霉家相仿，强于CEZ、CXM、CRO、LGIPC。结论头孢硫腺对葡萄球菌和粪肠球菌具有很强的体外抗菌活性。     

头孢硫脒等抗菌药物对革兰氏阳性球菌体外抗菌活性研究

目的 评价头孢硫脒及其他12种抗菌药对革兰氏阳性球菌的体外抗菌活性。方法 从本院2001年9月～12月临床病人血液、痰、分泌物、尿标本中分离出57株致病菌，经VITEK—AMS分析仪鉴定，共有金葡球菌24株，凝固酶阴性葡萄菌21株，粪肠球菌12株。质控金葡球菌ATCC25923，粪肠球菌ATCC29212。判断标准按2000年NCCLS标准。结果 头孢硫脒等10种抗菌药对金葡球菌体外抗菌活性，头孢硫脒敏感率87．5％，有2株耐药菌(8．33％)，敏感率与万古霉素、利福平比较无统计意义(P＞0．05)。头孢硫脒等10种抗菌药对凝固酶阴性葡萄球菌体外抗菌活性，头孢硫脒敏感率85．7％，有3株耐药菌株(14．29％)，敏感率略低于万古霉素、利福平(P＞0．05)，显著高于庆大霉素、氧氛沙星等(P＜0．05)。对粪肠球菌，头孢硫脒敏感率83．33％，有2株耐药菌株(16．67％)，其敏感率与庆大霉素、四环素、链霉素差异显著(P＜0．005，P＜0．01)。结论头孢硫脒是临床治疗金葡球菌、凝固酶阴性葡萄球菌、粪肠球菌感染的有效药物。     

HLAR粪肠球菌和屎肠球菌医院感染分布特征及耐药性分析

目的了解氨基糖甙类高水平耐药（HLAR）粪肠球菌和屎肠球菌在医院感染中分布特征及耐药现状。方法常规方法对本院2004年1月至2007年12月住院患者的各种临床标本进行培养分离，采用全自动微生物鉴定仪VITEK2对细菌进行鉴定及药敏检测。结果265株中引起医院感染的HLAR主要分布在ICU占26．8％（71／265），其次肾内科17．0％（45／265）及神经内科8．3％（22／265），感染以泌尿系统感染为主占30．2％（80／265），其中粪肠球菌占54．3％（144／265），屎肠球菌占45．7％（121／265），屎肠球菌对B-内酰胺类抗生素的耐药率明显高于粪肠球菌，但粪肠球菌对喹奴普汀／达福普汀的耐药率明显高于屎肠球菌（P〈0．05），粪肠球菌及屎肠球菌对万古霉素、替考拉宁均敏感，对力奈唑烷耐药率为0及4．1％。结论HLAR粪肠球菌及屎肠菌对临床常用的抗生素耐药性有较大的差异，临床治疗时要合理选择抗生素，万古霉素、替考拉宁对其均有较好的体外抗菌活性。     

利奈唑胺对万古霉素敏感及耐药屎肠球菌的抗菌活性

目的 评价利奈唑胺对临床分离万古霉素敏感及耐药屎肠球菌的体外抗菌活性.方法 多重PCR法鉴定屎肠球菌万古霉素耐药基因类型,平皿二倍稀释法测定利奈唑胺等11种抗菌药物MIC值.结果 75株临床分离万古霉素耐药屎肠球菌均携带vanA基因.万古霉素敏感及耐药屎肠球菌对利奈唑胺均敏感,MIC范围1～2mg/L.与红霉素、氨苄西林、左氧氟沙星和利福平相比,万古霉素敏感及耐药屎肠球菌的耐药率均在80%以上.万古霉素敏感屎肠球菌对高浓度庆大霉素、高浓度链霉素、四环素和氯霉素的耐药率分别为80.2%、13.9%、38.6%和37.6%;万古霉素耐药屎肠球菌对上述4种药物的耐药率分别为64.5%、8.0%、18.5%和5.3%.结论 利奈唑胺对我国临床分离万古霉素敏感和耐药屎肠球菌均具有很好的体外抗菌活性.     

夫西地酸对革兰阳性球菌的体外敏感性分析

摘要：目的检测夫西地酸对临床常见革兰阳性球菌的体外抗菌活性。方法用纸片扩散法检测夫西地酸对葡萄球菌和肠球菌的抑菌活性，并与其他常用抗生素比较。同时用琼脂稀释法检测部分菌株的夫西地酸最低抑菌浓度（MIC）。结果在121株菌株中MRSA34株，MRCNS41株，粪肠球菌15株，屎肠球菌10株。对夫西地酸的耐药率分别为2．9％、4．8％、100．0％和100．0％，略高于万古霉素，明显低于其他常用的抗生素（如红霉索、头孢唑林，环丙沙星等）。夫西地酸对MRSA、MRCNS的抗菌活性明显高于肠球菌。结论夫西地酸对MRS有较高的体外抗菌活性。夫西地酸对肠球菌并无杀菌作用。     

1332株葡萄球菌的标本分布及耐药性分析

目的了解我院葡萄球菌的临床分布及对常用药物的耐药性,为临床控制感染及经验用药提供有力依据。方法收集2011-2013年我院分离的葡萄球菌,采用西门子Micro Scan Walk Away40SI全自动细菌鉴定药敏分析系统进行鉴定和药敏试验,结果按CLSI M100-S23进行判断,采用WHONET 5.6软件进行统计分析。结果 3年中共检出葡萄球菌1 332株,MRSA和MRCo NS的发生率分别为51.7%(372/720)和80.4%(492/612),未发现对万古霉素、利奈唑胺和达托霉素耐药的葡萄球菌。结论我院相关结果与全国耐药监测数据比较,有地区性差异,只有不断提高监测水平,合理选用抗菌药物,才能减少耐药菌的发生。     

安徽省淮南地区鲍曼不动杆菌耐药性检测

目的 了解淮南地区临床分离鲍曼不动杆菌对临床常用抗生素的耐药性,指导临床合理使用抗生素.方法 选择淮南地区3家医院2010年10月至2012年6月临床分离鲍曼不动杆菌160株,应用生物梅里埃公司的VITEK32全自动微生物分析系统进行细菌鉴定和药物敏感试验,头孢哌酮/舒巴坦药敏试验使用纸片扩散法检测.结果 鲍曼不动杆菌对10种抗菌药物耐药率高于50.0％,其中对氨曲南的耐药率达到90.1％;仅对4种抗菌药物耐药率低于50.0％,其中对头孢哌酮/舒巴坦耐药率最低,为23.4％,其次为亚胺培南和美罗培南,耐药率分别为26.0％和31.2％.结论 淮南地区临床分离的鲍曼不动杆菌耐药和多重耐药现象严重,头孢哌酮/舒巴坦和亚胺培南可做为临床鲍曼不动杆菌感染治疗的首选药物.     

家蝇抗菌肽抗菌活性及抗菌机制的初步研究

目的　研究家蝇抗菌肽的抗菌活性及抗菌机制。方法　用损伤感染的方法诱导家蝇幼虫表达抗菌肽 ,通过 Sephadex过滤层析和 HL PC技术纯化提取 ,用平板法和稀释法作抗菌活性试验 ,并用电子扫描技术研究抗菌肽的抗菌机制。结果　家蝇抗菌肽对铜绿假单胞菌、大肠埃希氏菌、耐甲氧西林金黄色葡萄球菌( MRSA)均有明显的抗菌活性。大肠埃希氏菌与 5 0 μg/ml的纯化抗菌肽溶液一起 37℃孵育 6 0 min后 ,大肠埃希氏菌不能存活。经电镜扫描观察发现 ,细菌的细胞膜出现破损和穿孔现象。结论　家蝇抗菌肽具有明显的广谱抗菌活性 ,对阴性杆菌和阳性球菌均有杀伤作用。抗菌肽的抗菌机制是通过破坏细菌的细胞膜而杀伤细菌的     

Innovation in infectious disease therapies from immunology

Antimicrobial therapies developed from immunology, specifically the primary function of the immune system in host defence against microbial pathogens, could offer some of the step-change strategies in drug design and development urgently required to generate much needed, truly novel interventions in infectious disease. The immune system is an as yet underexploited resource of novel molecules and the blueprints for new approaches to combating infection with non-antibiotic, directly antimicrobial strategies.     

Antimicrobial activity and durability of a novel antimicrobial-impregnated bladder catheter

The main objective of this study was to examine the antimicrobial activity and durability of a novel indwelling bladder catheter impregnated with minocycline and rifampin. Thirty antimicrobial-impregnated bladder catheters were inserted transurethrally in spinal cord-injured patients and removed, in six groups of five catheters each, at 3, 7, 10, 14, 17 or 21 days. Removed catheters had detectable zones of inhibition against two different clinical isolates of each of the 10 tested uropathogens (Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter cloacae, Citrobacter diversus, Enterococcus faecalis, Enterococcus faecium, Staphylococcus saprophyticus and Candida albicans) for greater than 14 days after catheter insertion. The residual zones of inhibition and levels of antimicrobial agents in removed catheters were both inversely related to the duration of catheter placement. Minocycline and rifampin were undetectable in serum and urine. These results support the ongoing efforts for examining the clinical efficacy of these experimental bladder catheters.     

Cathelicidins抗菌肽家族的研究进展

Cathelicidins是一族在哺乳动物中发现的含有保守的cathelin区域的抗菌肽，是宿主防御系统的重要组成部分，具有广谱且强大的抗菌活性。文章综述了cathelicidins抗菌肽家族的基因组成、结构、抗菌活性、作用机制及构效关系等。     

Implementation and outcomes of a hospital-wide computerised antimicrobial stewardship programme in a large medical centre in Taiwan

Antibiotic stewardship is important to address the problem of antimicrobial resistance, but a practical and sustainable strategy to provide stewardship in a large hospital setting is lacking. We developed a hospital-wide computerised antimicrobial approval system (HCAAS) to guide the use of antimicrobial agents in late 2004 in a 3500-bed medical centre in Taiwan. The objective of this study was to evaluate the impacts of HCAAS on the hospital from 2003 to 2009. Following HCAAS deployment, the gradients of consumption over time during the study period of third- and fourth-generation cephalosporins, fluoroquinolones and glycopeptides fell significantly, whilst that of carbapenems increased. The amount and expenditure of antimicrobial use did not increase with the overall healthcare-associated infection rate, and inpatient mortality rate remained stable with a slight decreasing trend. The rate of meticillin-resistant Staphylococcus aureus started to decline in 2002 and continued after HCAAS deployment. There was an increasing isolation of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae, presumably leading to the increased use of carbapenems. The isolation rate of Clostridium difficile from patients who developed diarrhoea after antimicrobial therapy did not change over the years, with a mean annual rate of 10.0% after the implementation of HCAAS. HCAAS along with strict infection control measures is necessary to reduce the spread of resistant organisms within the hospital. HCAAS is a sustainable system for providing antibiotic stewardship and exerts a positive impact on the hospital by reducing antimicrobial consumption and expenditure whilst not compromising healthcare quality.     

Studies on the kinetics of killing and the proposed mechanism of action of microemulsions against fungi

Microemulsions are physically stable oil/water clear dispersions, spontaneously formed and thermodynamically stable. They are composed in most cases of water, oil, surfactant and cosurfactant. Microemulsions are stable, self-preserving antimicrobial agents in their own right. The observed levels of antimicrobial activity associated with microemulsions may be due to the direct effect of the microemulsions themselves on the bacterial cytoplasmic membrane. The aim of this work is to study the growth behaviour of different microbes in presence of certain prepared physically stable microemulsion formulae over extended periods of time. An experiment was designed to study the kinetics of killing of a microemulsion preparation (17.3% Tween-80, 8.5% n-pentanol, 5% isopropyl myristate and 69.2% sterile distilled water) against selected test microorganisms (Candida albicans, Aspergillus niger, Schizosaccharomyces pombe and Rhodotorula spp.). Secondly, an experiment was designed to study the effects of the microemulsion preparation on the cytoplasmic membrane structure and function of selected fungal species by observation of 260 nm component leakage. Finally, the effects of the microemulsion on the fungal membrane structure and function using S. pombe were studied using transmission electron microscopy. The results showed that the prepared microemulsions are stable, effective antimicrobial systems with effective killing rates against C. albicans, A. niger, S. pombe and Rhodotorula spp. The results indicate a proposed mechanism of action of significant anti-membrane activity, resulting in the gross disturbance and dysfunction of the cytoplasmic membrane structure which is followed by cell wall modifications, cytoplasmic coagulation, disruption of intracellular metabolism and cell death.     

国外抗菌药物管理项目实施经验及启示

抗菌药物管理项目（antimicrobial stewardship programs,ASP）是在医疗机构实施的综合性管理项目,用来提高抗菌药物的使用合理性,并预防和控制耐药性的产生.自20世纪90年代,欧美许多国家就已开展了ASP,并取得了成效.本文总结了国外ASP实施的一些成功经验,提出对我国抗菌药物管理的启示和建议.