Susceptibility of Canadian isolates of Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae to oral antimicrobial agents

We measured the susceptibility of Canadian isolates of three respiratory tract pathogens (Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae) to several currently approved antimicrobial agents by two different methods. We also measured the susceptibility of isolates to seven fluoroquinolones. Beta-lactamase was produced by 123/566 (21.7%) of H. influenzae isolates compared with 178/200 (89%) of M. catarrhalis isolates. For S. pneumoniae 83/374 (22.2%) isolates were penicillin resistant and of these 2.1% (8/374) showed high level resistance (MIC≥2 mg/l). Regardless of methodology, all fluoroquinolones were highly active against H. influenzae (MIC₉₀ ≤0.031 mg/l) and M. catarrhalis (MIC₉₀ ≤0.064 mg/l) isolates. Susceptibility of H. influenzae to cefuroxime and amoxycillin/clavulanic acid was 99–100% whereas 84–85.5% were susceptible to cefaclor and cefprozil. Azithromycin susceptibility ranged from 82.6 to 99.2% depending on the method. M. catarrhalis isolates were uniformly susceptible to all agents tested except amoxycillin. Cross-resistance in S. pneumoniae to all non-quinolone agents was concurrent with increasing penicillin resistance as shown by increasing MIC₉₀ values. For the fluoroquinolones tested, the rank order of potency based on MIC₉₀ values was as follows: gemifloxacin (0.031–0.063 mg/l), trovafloxacin (0.125 mg/l), moxifloxacin (0.125–0.25 mg/l), grepafloxacin (0.125–0.25 mg/l), gatifloxacin (0.5 mg/l), levofloxacin (1 mg/l) and ciprofloxacin (2 mg/l). Our study confirms either a high or increasing prevalence of antimicrobial resistant respiratory pathogens in Canada and also compares the new and old fluoroquinolones and their potential role as therapy for community-acquired infections. The prevalence of β-lactamase positive H. influenzae may have decreased from levels reported in previous studies.     

5种抗菌剂对淋病奈瑟氏球菌的抑菌效果研究

采用脂稀释法测定了５种抗菌剂对２０１株淋病奈瑟氏菌的最低抑菌浓度。结果检出４株为产β－内酰胺酶菌株，对青霉素和四环素的耐药率分别为５７．２％和８２．６％，其ＭＩＣ９０均已超过药界限。     

常用抗菌药物对101株铜绿假单胞菌的体外抗菌活性研究

目的调查医院临床分离的铜绿假单胞菌对常用抗菌药物的体外抗菌活性,了解其耐药趋势,指导临床合理应用抗菌药物。方法收集2005—2006年临床分离的铜绿假单胞菌,药敏实验采用K-B纸片扩散法和琼脂平板稀释法,按NCCLS/CLSI规定的标准进行。结果铜绿假单胞菌在呼吸道的分离率为89.11%,头孢吡肟、哌拉西林/他唑巴坦和头孢哌酮/舒巴坦的最低抑菌浓度(MIC)90已达到256μg/ml,头孢他啶为128μg/ml,亚胺培南为64μg/ml,美罗培南和帕珠沙星为32μg/ml。除美罗培南和哌拉西林/他唑巴坦的抑菌率分别为70.30%和68.31%,其余均在50%以下,其中头孢哌酮/舒巴坦的抑菌率仅为19.80%。结论铜绿假单胞菌的感染主要为呼吸道标本,临床应加强对呼吸系统感染的护理和监控,铜绿假单胞菌的多重耐药现象越来越高,临床治疗其感染应根据药敏实验和患者的个体情况合理联合应用抗菌药物。     

Susceptibility of Canadian isolates of Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae to oral antimicrobial agents

We measured the susceptibility of Canadian isolates of three respiratory tract pathogens (Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pneumoniae) to several currently approved antimicrobial agents by two different methods. We also measured the susceptibility of isolates to seven fluoroquinolones. Beta-lactamase was produced by 123/566 (21.7%) of H. influenzae isolates compared with 178/200 (89%) of M. catarrhalis isolates. For S. pneumoniae 83/374 (22.2%) isolates were penicillin resistant and of these 2.1% (8/374) showed high level resistance (MIC≥2 mg/l). Regardless of methodology, all fluoroquinolones were highly active against H. influenzae (MIC₉₀ ≤0.031 mg/l) and M. catarrhalis (MIC₉₀ ≤0.064 mg/l) isolates. Susceptibility of H. influenzae to cefuroxime and amoxycillin/clavulanic acid was 99–100% whereas 84–85.5% were susceptible to cefaclor and cefprozil. Azithromycin susceptibility ranged from 82.6 to 99.2% depending on the method. M. catarrhalis isolates were uniformly susceptible to all agents tested except amoxycillin. Cross-resistance in S. pneumoniae to all non-quinolone agents was concurrent with increasing penicillin resistance as shown by increasing MIC₉₀ values. For the fluoroquinolones tested, the rank order of potency based on MIC₉₀ values was as follows: gemifloxacin (0.031–0.063 mg/l), trovafloxacin (0.125 mg/l), moxifloxacin (0.125–0.25 mg/l), grepafloxacin (0.125–0.25 mg/l), gatifloxacin (0.5 mg/l), levofloxacin (1 mg/l) and ciprofloxacin (2 mg/l). Our study confirms either a high or increasing prevalence of antimicrobial resistant respiratory pathogens in Canada and also compares the new and old fluoroquinolones and their potential role as therapy for community-acquired infections. The prevalence of β-lactamase positive H. influenzae may have decreased from levels reported in previous studies.     

解脲支原体对7种抗生素的体外敏感性测定

目的：了解非淋菌性尿道炎（NGU）患解脲支原体（UU）对7种抗生素的敏感性。方法：采用微量肉汤稀释法测定体外药物敏感性，对培养阳性的150例患进行了分析。结果：UU对7种抗生素的敏感性的顺序由高到低依次为：交沙霉素（96．67％）、强力霉素（90．67％）、美满霉素（88．67％）、司巴沙星（58．67％）、罗红霉素（39．33％）、氧氟沙星（18．00％）和阿奇霉素（8．00％）。UU耐药率最高的为氧氟沙星（31．33％），其次为司巴沙星（18．67％）和罗红霉素（18．00％）。结论：UU存在多重耐药，对UU进行药敏监测对指导临床合理用药及防止耐药株的发生有重要意义。     

腹外疝围术期抗菌药物应用情况分析

目的 对我院外科腹外疝围术期抗菌药物应用情况进行分析,为抗菌药物的使用管理提供参考依据.方法 抽取2011年1月至2012年8月100例腹外疝手术病例,根据《抗菌药物临床应用指导原则》、卫办医政发[2009]38号文件和《2011年抗菌药物临床应用专项整治活动督导检查表》的要求,对围术期抗菌药物的适应症、药物选择、使用率、用药时间、给药时机、药物利用指数(DUI)和人均限定疗程进行回顾分析评价.结果 我院100例腹外疝手术患者围术期全部使用了抗菌药物,使用率为100％;抗菌药物选择合理52例;术前0.5～2h给药55例;术后预防用药疗程＜ 48 h 56例,合理率为56％,术后平均用药疗程3.53 d,大部分抗菌药物利用指数(DUI)=1或接近1,人均限定疗程＞3d.结论 我院腹外疝围术期抗菌药物的使用存在不合理现象,应加强医务人员的抗菌药物应用水平,加强抗菌药物使用监管,保证用药的安全、有效.     

250株鲍曼不动杆菌对14种抗菌药物的药敏测定

目的对2005年1月至2007年3月,本院分离的鲍曼不动杆菌耐药状况进行分析。方法收集临床分离的鲍曼不动杆菌,培养鉴定。采用纸片扩散法(K-B法),根据美国临床实验室标准化委员会(NCCLS)相关文件判断结果。结果期间分离出250株鲍曼不动杆菌,对14种抗菌药物体外敏感试验结果显示,对氨曲南耐药率为88%、头孢哌酮72%、复方磺胺甲口恶唑56.4%、替卡西林/克拉维酸55.6%、哌拉西林53.2%、庆大霉素51.2%、头孢吡肟50.4%、左氧氟沙星48.8%、头孢他啶48.4%、哌拉西林/他唑巴坦46.8%、妥布霉素44.8%、阿米卡星42%、头孢哌铜/舒巴坦14%、亚胺培南13.6%。结论鲍曼不动杆菌对14种抗菌药物均有不同程度的耐药。     

抗菌药物分级管理干预效果分析

目的：探究抗菌药物分级管理干预效果。方法：对我院抗菌药物分级管理进行效果分析,对出院患者使用的抗菌药物进行干预前后的信息采集分析抗菌药物的使用情况,再通过使用前后对比分析方法进行研究。结果：对前后信息进行回顾性分析显示,干预前抗菌药物的使用率、人均费用和使用频次和干预后相比有明显降低,差异具有统计学意义,P<0.05,由于各个区域情况不同,用量最大的抗菌药物是第三代头孢类抗生素。结论：对抗菌药物的使用需要进行严格分级管理,因为抗生素药物有很好的疗效,但是长期服用使用者会产生很大的抗药性,所以,需要采取对药物的分级进行合理管理,加强管理措施。     

Etest测定295株临床分离菌对抗菌药物的耐药性

目的　监测 2 95株临床分离菌对常用抗菌药物的耐药性 ,为临床合理选用抗菌药物提供实验研究依据。方法　通过E试验方法测定四川大学华西医院、第二医院 6个月内部分临床分离菌 12种 2 95株对临床常用 β 内酰胺类、氟喹诺酮类及大环内酯类的耐药性。结果　 32 .8%的金葡球菌耐苯唑西林 ,且为多重耐药株 ;37%～ 41%化脓性链球菌耐大环内酯类 ;肠球菌属 10 0 %耐头孢菌素 ;肺炎链球菌 8%耐酶抑制剂复合制剂 ;流感嗜血杆菌 85 %～ 94%耐克拉霉素、罗红霉素 ,仅 5 %耐阿奇霉素 ;肺炎克雷伯氏菌与大肠埃希氏菌产超广谱 β 内酰胺酶分别为 45 %与 35 % ;变形杆菌属对 β 内酰胺类耐药率为 30 %～ 5 0 % ,对氟喹诺酮类敏感 ;肠杆菌属细菌 2 5 %耐氟喹诺酮类、5 0 %耐 β 内酰胺类 ,但对头孢哌酮 /舒巴坦敏感 ;不动杆菌属细菌对氟喹诺酮类耐药率为 40 % ,对第二、三代头孢菌素类为 6 0 %～ 75 %、对 β 内酰胺酶抑制剂复合制剂的耐药率在35 %～ 5 5 % ;铜绿假单胞菌 10 0 %耐所试广谱青霉素、头孢呋辛 ,75 %耐头孢曲松、2 5 %耐头孢哌酮 /舒巴坦 ,5 %耐氟喹诺酮类 ;4株粘膜炎莫拉氏菌完全耐大环内酯类 ,耐环丙沙星与头孢克洛各 1株。结论　临床分离致病菌对常用抗菌药物均有不同程度的耐药性 ,密切监测细菌的耐     

医院抗菌药物不合理用药情况分析

目的分析并探讨抗菌药物的不合理用药现状,为制定相应对策提供参考。方法对所抽查的全部处方以及相关资料进行分类整理,主要对抗菌药物处方的选用、给药方案、用法用量、联合用药、药理拮抗等情况进行分类统计。结果本组研究共抽查覆盖各个科室的处方6290张,其中有2140张处方为抗菌药物处方,占总抽查数的34.02%。对2140张抗菌药物处方进行检查发现不合理用药处方共有584张,占27.29%,并且一部分抗菌药物不合理处方中有多项不合理用药情况。对不合理用药情况进行分析表明不合理用药类别主要为:选择不合理、给药方案不合理、重复给药、无指征滥用、理化禁忌、毒性相加以及药理拮抗等。结论医院药剂科必须对门诊处方以及住院处方进行严格检查与监督,并制定有效的管理制度及措施,定期组织开展抗菌药物用药知识的相关培训,及时纠正抗菌药物的不合理用药现象,提高抗菌药物的合理用药水平及医疗质量。     

呼吸内科应用抗菌药物的干预对照研究

目的探讨呼吸内科应用抗菌药物干预的临床效果。方法选取本院2013年1～3月的179例患者作为干预组,2013年1月前出院的179作为对照组。采用本院制定的干预方式进行合理干预,比较干预组与对照组两组患者抗菌药使用率,抗菌药物费用占总费用的比例,不合理给药情况,患者的住院时间。结果与对照组相比,患者抗菌药物的使用率从85.03%下降至70.57%（P〈0.05）;患者平均每人的抗菌药物费用支出比例从干预前60.13%降至干预后的44.79%（P〈0.05）,干预效果明显。平均住院天数有一定程度的下降,从干预前的（19.03±5.34）d降至干预后的（10.11±3.43）d,明显缩短患者的住院天数（P〈0.05）。不合理用药情况亦得到明显改善,从干预前20.21%下降到7.01%。结论对本院呼吸内科应用抗菌药物实行合理的干预能够明显的改善疗效,减轻患者经济负担,节约医疗资源,值得临床应用推广。     

某基层社区医院抗菌药物应用情况调查分析及对策

目的:调查基层社区医院抗菌药物应用现状,探讨并制定抗菌药物合理应用的对策,提高临床医师合理应用抗菌药物的水平,达到卫生部对抗菌药物专项整治所预期的目的.方法:从我院信息管理中心整体抽取2010年7月至2011年6月门诊处方201140张、住院病历1614份,对其进行统计分析.结果:门诊抗菌药物使用率高达55.36％,住院抗菌药物使用率达81.47％,Ⅰ类切口手术抗菌药物使用率达98,28％.头孢菌素类、青霉素类药物从销售金额中还是DDDs文字说明排序中分析均居前2位.结论:在抗菌药物品种的选择、给药方法、联合用药方面基本合理,但对抗菌药物应用指征掌握不够,存在滥用现象,需加强管理,专项整治.     

Evidence of a conjugal erythromycin resistance element in the Lyme disease spirochete Borrelia burgdorferi

We report the identification of isolates of Borrelia burgdorferi strain B31 that exhibit an unusual macrolide–lincosamide (ML) or macrolide–lincosamide–streptogramin A (MLS_A) antibiotic resistance pattern. Low-passage isolates were resistant to high levels (>100 μg/mL) of erythromycin, spiramycin and the lincosamides but were sensitive to dalfopristin, an analogue of streptogramin B. Interestingly, the high-passage erythromycin-resistant strain B31 was resistant to quinupristin, an analogue of streptogramin A (25 μg/mL). Biochemical analysis revealed that resistance was not due to antibiotic inactivation or energy-dependent efflux but was instead due to modification of ribosomes in these isolates. Interestingly, we were able to demonstrate high-frequency transfer of the resistance phenotype via conjugation from B. burgdorferi to Bacillus subtilis (10⁻²–10⁻⁴) or Enterococcus faecalis (10⁻⁵). An intergeneric conjugal system in B. burgdorferi suggests that horizontal gene transfer may play a role in its evolution and is a potential tool for developing new genetic systems to study the pathogenesis of Lyme disease.     

Association between the consumption of antimicrobial agents in animal husbandry and the occurrence of resistant bacteria among food animals

Antimicrobial agents are used in food animals for therapy and prophylaxis of bacterial infections and in feed to promote growth. The use of antimicrobial agents for food animals may cause problems in the therapy of infections by selecting for resistance among bacteria pathogenic for animals or humans. The emergence of resistant bacteria and resistance genes following the use of antimicrobial agents is relatively well documented and it seems evident that all antimicrobial agents will select for resistance. However, current knowledge regarding the occurrence of antimicrobial resistance in food animals, the quantitative impact of the use of different antimicrobial agents on selection for resistance and the most appropriate treatment regimens to limit the development of resistance is incomplete. Surveillance programmes monitoring the occurrence and development of resistance and consumption of antimicrobial agents are urgently needed, as is research into the most appropriate ways to use antimicrobial agents in veterinary medicine to limit the emergence and spread of antimicrobial resistance.     

我院清洁手术围术期预防性应用抗菌药物分析

目的通过探讨本院清洁手术围术期预防性使用抗菌药物情况,评价清洁手术抗菌药物使用的合理性,促进本院抗菌药物合理规范使用。方法采用回顾性调查方法,对本院2012年6～12月1850例清洁手术患者围术期预防性使用抗菌药物的情况进行统计分析。结果 1850例清洁手术患者中,预防性使用抗菌药物765例,使用率为41.35%;抗菌药物涉及6类17种药物,其中使用最多的是头孢菌素类（359例,占46.93%）;合理使用608例（占79.48%）,不合理使用157例（占20.52%）;不合理使用中以预防用药时间过长为主,占39.49%,其次为无指征用药,占22.29%。结论本院清洁手术围术期预防使用抗菌药物仍存在不合理现象,有待进一步加强管理。     

Use of antimicrobial agents in veterinary medicine and food animal production

Antimicrobial resistance is a growing area of concern in both human and veterinary medicine. This review presents an overview of the use of antimicrobial agents in animals for therapeutic, metaphylactic, prophylactic and growth promotion purposes. In addition, factors favouring resistance development and transfer of resistance genes between different bacteria, as well as transfer of resistant bacteria between different hosts, are described with particular reference to the role of animals as a reservoir of resistance genes or resistant bacterial pathogens which may cause diseases in humans.     

Artificial intelligence for the discovery of novel antimicrobial agents for emerging infectious diseases

The search for effective drugs to treat new and existing diseases is a laborious one requiring a large investment of capital, resources, and time. The coronavirus 2019 (COVID-19) pandemic has been a painful reminder of the lack of development of new antimicrobial agents to treat emerging infectious diseases. Artificial intelligence (AI) and other in silico techniques can drive a more efficient, cost-friendly approach to drug discovery by helping move potential candidates with better clinical tolerance forward in the pipeline. Several research teams have developed successful AI platforms for hit identification, lead generation, and lead optimization. In this review, we investigate the technologies at the forefront of spearheading an AI revolution in drug discovery and pharmaceutical sciences.     

Results of an interlaboratory test on antimicrobial susceptibility testing of bacteria from animals by broth microdilution

A standard operating procedure for the determination of minimum inhibitory concentrations (MICs) of antimicrobial agents by the broth microdilution method was developed and evaluated for its fitness for use in an interlaboratory ring trial involving 46 routine diagnostic laboratories. All laboratories tested five strains (one reference strain and four field strains) against a total of 22 different antimicrobial agents. Gram-negative strains were tested against 16 different antimicrobial agents and Gram-positive strains against 14 different antimicrobial agents. Tests were performed once a week for three consecutive weeks. At least 80% of the results determined by 35 of the 46 participating laboratories were within the expected range (mode MIC ± 1 dilution step), with the 18 participating laboratories experienced in MIC determination showing a slightly higher mean percentage of accurate results (89.3% reproducible results) than the 28 non-experienced laboratories (86.7% reproducible results). The most accurate results were obtained for the Escherichia coli field strain, whilst the results for the Streptococcus uberis field strain showed the highest error rate. Among the 22 antimicrobial agents tested, the highest variabilities in the results (mean value for all antimicrobial agents 12.3%) were recorded for ceftiofur (27.8%), penicillin G (20.8%) and cefoperazone (20.6%).     

物理抗微生物膜与常用抗菌药物对糖尿病足耐药菌株药敏情况的比较研究

目的 研究创新物理抗微生物膜对临床糖尿病足耐药菌株的药敏情况.方法 对168例糖尿病足感染患者行病原菌分离培养,以最低抑菌浓度（MIC）稀释法进行药敏试验,比较常用抗菌药物及物理抗微生物膜的耐药情况.结果 分离出的63株菌株按构成比例由多到少依次为：金黄色葡萄球菌、铜绿假单胞菌、产气肠杆菌、阴沟肠杆菌、不动杆菌、表皮葡萄球菌.金黄色葡萄球菌对青霉素、左氧氟沙星、氨苄西林、苯唑西林、哌拉西林、庆大霉素、头孢唑林、头孢他啶等8种抗菌药物耐药率为23.5％～100％;铜绿假单胞菌为23.5％～97.8％;产气肠杆菌为7.5％～75.3％;阴沟肠杆菌为30.5％ ～ 94.6％;不动杆菌为21.6％ ～ 94.6％;表皮葡萄球菌为5.6％～83.8％.以上6种分离菌对物理抗微生物膜耐药率为0.结论 物理抗微生物膜具有广谱抗菌,对各种细菌敏感率高的特点,为临床治疗糖尿病足提供了有效,而且可避免耐药的物理学抗感染新方法.