成人住院患者尿路感染及经验用药调查

目的：调查某院成人住院患者尿路感染及经验用药情况。方法：调取柳州市人民医院2015年1月-2016年12月住院尿培养阳性的成人尿路感染患者,分析不同年龄、性别及危险因素对尿路感染的影响及细菌耐药及经验用药情况。结果：505例住院尿路感染患者,女性（71.49%）、61~90岁（70.30%）所占比例高,其中77例为反复发作性尿路感染患者。糖尿病、尿路梗阻和留置导尿管患者分别占40.59%、35.05%和30.10%。致病菌以大肠埃希氏菌为主（57.28%）,ESBL （extended-spectrum β-lactamases,超广谱β-内酰胺酶）阳性率达42.57%,环丙沙星耐药率达56.77%;反复发作性尿路感染检出细菌耐药率更高;84例真菌感染,尿路梗阻和留置导尿管都占67.86%。经验用药中以喹诺酮类（51.68%）、β-内酰胺类/β-内酰胺酶抑制剂（28.12%）和头孢类（14.85%）为主;反复发作患者以喹诺酮类（44.16%）、β-内酰胺类/β-内酰胺酶抑制剂（42.86%）为主。结论：我院住院患者尿路感染以G^-菌为主,耐药率高;控制血糖、尽早拔除导尿管以减低尿路感染的危险因素;经验用药基本符合指南要求,但对反复发作的尿路感染患者,经验用药可减少喹诺酮类的使用。     

壳聚糖-β-环糊精药物载体的制备与表征

目的：制备壳聚糖-β-环糊精药物载体,以期开发β-环糊精在疏水性药物缓释制剂方面的潜在应用价值。方法：采用共价键使壳聚糖与β-环糊精偶联,利用红外光谱（IR）、核磁共振氢谱（¹H-NMR）以及X-射线衍射（X-RD）对偶合物进行表征,运用元素分析法对偶合物中的β-环糊精进行定量。结果：壳聚糖与β-环糊精成功偶联,β-环糊精取代度为13%。结论：通过亲核取代反应,可以成功将β-环糊精嫁接到壳聚糖分子上。     

β-内酰胺类抗菌药物临床交叉过敏反应的发生机制及美国相关处理流程介绍

目的:了解β-内酰胺类抗菌药物在临床使用中发生交叉过敏反应的机制,为临床合理用药提供参考。方法:结合笔者在美国伊利诺伊大学芝加哥分校(UIC)附属医院进修期间的学习心得,同时根据美国拉什大学医学中心对β-内酰胺类抗菌药物过敏史者的安全用药管理经验,总结β-内酰胺类抗菌药物发生交叉过敏反应的机制,并介绍美国UIC附属医院对β-内酰胺类抗菌药物过敏患者的处理流程。结果:β-内酰胺类抗菌药物发生交叉过敏反应的主要原因是由于药物之间存在相同或相似的侧链,人体内免疫球蛋白E通过识别这些侧链而产生交叉过敏反应。美国UIC附属医院对β-内酰胺类抗菌药物过敏患者的处理流程,包括对患者是否有β-内酰胺类抗菌药物使用指征进行评估,根据评估结果进行规范的青霉素皮试,并采用谨慎渐进式流程用药和快速诱导药物耐受流程进行抗感染治疗。结论:美国UIC附属医院对β-内酰胺类抗菌药物交叉过敏反应患者的处理方法,可为国内临床药师处理可疑β-内酰胺类抗菌药物过敏史者,尤其是针对孕妇、儿童等特殊人群提供新的思路。     

37例艾滋病患者药物热临床分析

目的：探究艾滋病患者发生药物热的临床特征,以期为其药物热的诊疗提供参考。方法：回顾性收集发生药物热的艾滋病患者基本情况、诊疗经过、药物热发热特点、致热药物等,将感染性发热与药物热比较,总结药物热临床特征。结果：（1）共收集发生药物热的艾滋病患者37例,其入院时均因合并其他感染性疾病有不同程度发热,体温（39.2±0.87）℃,抗感染治疗后体温均恢复正常,感染性发热病程（17.72±12.98）d。（2）β-内酰胺类抗生素、美罗培南、异烟肼及利福霉素类抗结核药物、复方磺胺甲基异唑均可导致药物热,以β-内酰胺类最常见（51%）,其次是利福霉素类（30%）。（3）与感染性发热比较,药物热高热者更多（70.3%）,以弛张热、稽留热为主,而感染性发热高热者43.2%,以不规则热更常见（均P<0.05）;药物热时血白细胞数及中性粒细胞比例均明显低于感染性发热,而嗜酸性粒细胞比例明显高于感染性发热患者（均P<0.05）。结论：药物热是艾滋病患者发热原因中并不少见的原因,β-内酰胺类抗生素及利福霉素类抗结核药物最常见。发热的热型、热度、用药情况及实验室检查结果可作为药物热鉴别诊断要点。     

湖北省内医疗机构β-内酰胺类抗菌药物皮肤试验现状调查分析

目的： 通过问卷调查分析湖北省内各家医院β-内酰胺类抗菌药物皮肤试验的实际情况。方法： 通过湖北省临床药学质量控制中心向湖北省内各市、州部省属医疗机构临床药学部门发出调查问卷,调查各医疗机构使用β-内酰胺类抗菌药物前的皮肤试验方法。结果： 收到反馈信息完整的问卷有849份（反馈率为91.09%）,其中二级及以上医院303家,基层卫生院及社区医院546家。调查显示各医疗机构在β-内酰胺类抗菌药物皮试品种、皮试方法、存在过敏史时药物的选择以及口服青霉素制剂是否进行皮试等方面均存在明显差异。结论： 本研究反映了湖北省内医疗机构在β-内酰胺类抗菌药物皮肤试验方面缺乏统一标准,卫生部门亟需尽快制定相关临床指南或操作实施规范,以保证临床使用β-内酰胺类抗菌药物的安全性与规范性。     

2016至2020年上海市某三级医院肺炎克雷伯菌耐药率与抗菌药物使用强度相关性分析

目的：分析某三级综合性医院肺炎克雷伯菌耐药率与抗菌药物使用强度之间的关系,为临床合理用药提供参考依据。方法：回顾性分析2016年1月至2020年12月住院患者肺炎克雷伯菌耐药率及同期抗菌药物使用强度,使用SPSS 25.0软件进行统计分析,以Pearson进行相关性检验。结果：临床共分离肺炎克雷伯菌3017株,分离率为26.05%(3017/11580)。2016至2018年肺炎克雷伯菌对大部分抗菌药物耐药率始终保持较高水平。从2019年开始,亚胺培南和美罗培南等抗菌药物耐药率呈现下降趋势。在抗菌药物使用强度上,一代、三代头孢菌素,β-内酰胺类抗生素/β-内酰胺酶抑制剂和喹诺酮类抗菌药物使用强度呈逐年上升趋势,碳青霉烯类抗菌药物使用强度呈缓慢下降趋势。肺炎克雷伯菌对头孢唑啉的耐药率与二代头孢AUD呈正相关(P＜0.05);对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和氨苄西林/舒巴坦的耐药率与三代头孢和β-内酰胺类抗生素/β-内酰胺酶抑制剂AUD呈正相关(P＜0.05);对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和氨苄西林/舒巴坦的耐药率与碳青霉烯类AUD呈负相关(P＜0.05);头孢哌酮/舒巴坦的耐药率与喹诺酮类药物AUD呈正相关(P＜0.05)。结论：通过多个部门对抗菌药物的合理使用进行联合管控,抗菌药物耐药率在2016至2018年波动平稳,在2019年后呈下降趋势,院内管理抗菌药物合理使用初见成效,但部分抗菌药物大量使用导致耐药率仍维持较高水平,临床应继续加强抗菌药物的合理使用,做好院内管控。     

丹参素对血管平滑肌细胞钙化和凋亡的抑制作用

目的：探讨丹参素对血管平滑肌细胞（VSMCs）凋亡和钙化的影响。方法：β-磷酸甘油诱导培养的VSMCs发生钙化;通过细胞钙含量和碱性磷酸酶（ALP）活性测定,判断钙化程度;用Western blot方法检测细胞中骨形成蛋白BMP-2、凋亡相关蛋白Bax、Bcl-2和cleaved caspase 3的蛋白水平。结果：与正常组相比,β-磷酸甘油引起VSMCs中钙含量和ALP活性明显增加。丹参素显著抑制β-磷酸甘油引起的钙化VSMCs中的钙含量和ALP活性。Western blot结果显示β-磷酸甘油可引起VSMCs中BMP-2,bax和cleaved caspase 3的蛋白水平显著增高,Bcl-2蛋白水平明显降低;丹参素可明显改善钙化的VSMCs中上述蛋白的变化。结论：丹参素可以抑制VSMCs发生钙化和凋亡,此效应可能与抑制BMP-2、bax和cleaved caspase 3的蛋白水平,上调Bcl-2蛋白水平有关。     

2008—2012年解放军第281医院注射用β-内酰胺类抗菌药物应用分析

目的：了解我院β-内酰胺类抗菌药物的使用情况,为临床合理用药提供参考。方法：统计2008—2012年我院β-内酰胺类抗菌药物的用药情况,并对其销售金额、用药频度（DDDs）等进行排序。结果：头孢菌素类和非典型β-内酰胺类销售金额呈逐年上升趋势,是目前我院主要应用的抗菌药物,使用频率高、用量较大;而青霉素类和β-内酰胺类＋β-内酰胺酶抑制剂复方制剂销售金额呈逐年下降趋势。结论：通过5年的用药分析,我院β-内酰胺类抗菌药物的使用基本合理,但仍然存在用药起点偏高的问题,需加强监督、管理,避免滥用。     

2006—2007年我院铜绿假单胞菌的耐药性调查

目的分析铜绿假单胞菌的耐药原因及趋势，促进临床合理使用抗菌药物。方法利用SPSS软件统计出各季度铜绿假单胞菌对各类抗菌药物的耐药性及各类抗菌药物的使用量。结果铜绿假单胞菌对β-内酰胺类抗菌药物的耐药率呈上升趋势，对氨基苷类抗菌药物和喹诺酮类抗菌药物的耐药率除2006年第4季度异常外，其他季度均低于40％；各类抗菌药物的使用量在2006年和2007年一直呈上升趋势，β-内酰胺类抗菌药物使用量最高。结论铜绿假单胞菌对各类抗菌药物的耐药情况不一样，与β-内酰胺类抗菌药物的使用量有一定相关性，而与氨基苷类和喹诺酮类抗菌药物使用量的相关性无统计学意义。     

联用药物对β-内酰胺类抗菌药物所致迟发型过敏反应患者的影响

目的:了解β-内酰胺类抗菌药物所致迟发型过敏反应患者的联用药物使用情况,以及联用药物与迟发型过敏反应的关系。方法:回顾性分析β-内酰胺类抗菌药物所致迟发型过敏反应的住院患者64例,并随机选择未发生迟发型过敏反应的同期住院患者300例和皮试阳性患者150例作为平行对照组,对迟发型过敏反应发生率、联用药物使用情况进行统计分析。结果:β-内酰胺类抗菌药物所致迟发型过敏反应的发生率为0.26%;使用易导致皮试假阴性药物在迟发型过敏反应患者中占比75.00%,在未出现迟发型过敏反应的患者中占比19. 67%,在皮试阳性的患者中占比8.67%。结论:联用易导致皮试假阴性的药品可能与β-内酰胺类抗菌药物所致迟发型过敏反应的发生相关,临床使用β-内酰胺类抗菌药物时应予以重点关注。     

Antimicrobial selection in the penicillin-allergic patient

Patients frequently state that they have a penicillin allergy that often presents a therapeutic problem in treating a variety of infectious disorders. Penicillin and beta-lactam allergic reactions should be determined by a careful history. Many patients who say they have a penicillin allergy, in fact do not. If it is determined that the patient has a penicillin allergy, then the clinician should determine whether it is of an anaphylactic or nonanaphylactic variety. Most reactions to beta-lactams are of the nonanaphylactic variety and are usually manifested clinically as a mild maculopapular rash or drug fever. Uncommonly, penicillin allergies are clinically manifested as anaphylactic reactions, e.g., bronchospasm, laryngospasm, hypotension or hives. Patients' hypersensitivity reactions tend to be stereotyped on rechallenge, which make the reactions predictable. Patients who have a questionable penicillin allergy, or have had only fever or rash, may be safely given beta-lactam antibiotics without fear of anaphylaxis. Patients with a documented history of anaphylactic reactions should receive non-beta-lactam antibiotics. Although monobactams and carbapenems are structurally related to beta-lactams, they are unrelated in terms of allergic potential. There is no cross-reactivity between mono-bactams or carbapenems with beta-lactams, and these drugs may be used safely in patients with anaphylactic reactions to beta-lactams. Because so many antibiotics are available that are allergically unrelated to beta-lactams, beta-lactam desensitization procedures are rarely necessary. (c) 2001 Prous Science. All rights reserved.     

行湿颗粒联合玉龙散对腰椎间盘突出症的疗效及血清炎症因子的影响

目的：考察行湿颗粒联合玉龙散对腰椎间盘突出症临床疗效及对血清炎症因子的调节作用。方法：将符合纳入标准的320例寒湿证腰椎间盘突出症患者随机分为对照组、玉龙散组、行湿颗粒组、联合用药组,每组80例。各组患者用药治疗2个疗程后,通过对治疗前后临床疗效、JOA腰椎功能评分、VAS疼痛评分、外周血清炎症因子[肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、白细胞介素-1β（interleukin-1β,IL-1β）、白细胞介素-6（interleukin-6,IL-6）]的表达水平及用药期间药物不良反应发生情况进行对比分析。结果：联合用药组临床总有效率达92.50%,与对照组相比差异具有显著性（P<0.05）。联合用药组VAS、JOA评分均显著低于其他各组,组间比较差异具有显著性（P<0.05）。联合用药组患者外周血清TNF-α、IL-1β、IL-6的下调作用明显强于对照组,组间比较差异具有显著性（P<0.05）。各组患者用药期间未发生明显不良反应。结论：行湿颗粒联合玉龙散配合常规理疗的治疗方案对LIDH患者能明显减轻患者的疼痛感,还能最大程度地改善腰椎活动状态,其发挥该作用趋势的主要原因可能与玉龙散和行湿颗粒下调血清炎症因子TNF-α、IL-1β、IL-6的表达有关。     

FAK抑制剂对人肝星状细胞Akt/GSK-3β/β-catenin信号通路的影响

目的：探讨FAK抑制剂（PF562，271）对人肝星状细胞（LX-2）Akt/GSK-3β/β-catenin信号通路的影响，为抗肝纤维化寻找新的作用靶点。方法：CCK-8法检测不同浓度范围（0~7 μmol·L^-1）FAK抑制剂（PF562，271）在12、24、48 h和72 h时对LX-2细胞增殖的影响，Real-time PCR分析PF562，271对LX-2细胞中α-SMA、Collagen Ⅰ mRNA表达水平的影响，Western-blot检测不同浓度PF562，271对LX-2细胞中Akt、p-Akt、GSK-3β、p-GSK-3β、β-catenin蛋白表达的影响，评价PF562，271对LX-2细胞中Akt/GSK-3β/β-catenin信号通路的影响。结果：PF562，271能够抑制LX-2细胞增殖，且该作用呈剂量和时间相关性；qRT-PCR检测到PF562，271能够抑制LX-2细胞中α-SMA、collagen ⅠmRNA表达，与对照组相比，表达量显著降低（P<0.05）；Western-blot结果显示PF562，271对Akt/GSK-3β的磷酸化表达水平显著降低（P<0.05）。结论：FAK抑制剂能够抑制LX-2细胞增殖，促进其凋亡，其作用机制可能是通过抑制Akt/GSK-3β/β-catenin信号通路从而缓解肝纤维化进程。     

桑蒺颗粒中陈皮、枳壳挥发油的提取及β-环糊精包合工艺

目的：优选桑蒺颗粒中陈皮、枳壳挥发油的最佳提取及包合工艺。方法：采用正交试验法,以挥发油提取量为评价指标,优化加水量、浸泡时间和提取时间3个因素,优选挥发油提取工艺;以挥发油包合率和包合物收率为评价指标,优化挥发油︰β-环糊精（β-CD）、包合温度和包合时间,优选挥发油包合工艺;采用显微镜、薄层色谱及加速试验对所得包合物进行表征。结果：桑蒺颗粒中陈皮、枳壳挥发油的最佳提取工艺为加8倍量水,浸泡0.5 h,提取6 h;最佳包合工艺为挥发油与β-CD比例1：10,在40℃下包合0.5 h;3项表征试验均证实挥发油已包合于β-CD内。结论：优选的桑蒺颗粒中陈皮、枳壳挥发油的最佳提取及包合工艺稳定可行。     

β-内酰胺类抗菌药物皮肤过敏试验探讨

目的:为β-内酰胺类抗菌药物使用前是否需作皮肤过敏试验(下简称皮试)提供参考。方法:根据近年国内有关文献报道、药学资料记载及多年的用药经验,从过敏反应发生机制方面对β-内酰胺类抗菌药物是否需作皮试进行分析讨论。结果与结论:β-内酰胺类抗菌药物中的头孢菌素类(下简称头孢类)的β-内酰胺环较青霉素类稳定,所以头孢类过敏反应发生率较低;头孢类各药物间缺乏共同的抗原决定簇,所以头孢类极少发生交叉过敏反应。此外相对于青霉素类,头孢类的皮试符合率太低,因此β-内酰胺类抗菌药物使用前是否作皮试应严格按照规范药品说明书要求执行,青霉素类抗菌药物只需作青霉素皮试,不应盲目扩大β-内酰胺类抗菌药物皮试的品种范围,造成患者不必要的负担。     

Prevalence of latex allergy in spina bifida: genetic and environmental risk factors

AIM OF STUDY: To evaluate the prevalence of latex allergy in a population of children with spina bifida (SB) and to assess the role of early exposure to latex products and others risk factors. INTRODUCTION: SB is related with an higher incidence of latex allergic reactions. These patients received repeated surgical procedures, implant of latex-containing materials and catheterization. MATERIALS AND METHODS: Eighty consecutive subjects affected with SB besides answering a questionnaire, underwent a skin-prick test (SPT) to latex and the determination of the specific serum IgE (RAST CAP) to latex. 40% (32/80) of the patients showed a latex sensitization with specific IgE > 0.7 kU/I but only twelve of the 32 sensitized patients (40%) suffered from clinical reactions to latex (urticaria, conjunctivitis, angioedema, rhinitis, bronchial asthma). Number of surgical procedures, but particularly early exposure to latex and familiarity for allergy are correlated with latex allergy (p < 0.01). CONCLUSION: Latex allergy in SB children is multifactorial situation related with a disease-associated propensity for latex sensitization, early exposure and number of surgical procedures. Prophylactic measures to avoid the exposure, not only in the sanitary environment, through the institution of latex-safe routes and every day, prevent potentially serious allergic reactions.     

Adverse reactions to β-lactam antimicrobials

Introduction: Beta-lactam antibiotics are among the most clinically useful antimicrobials used in medicine. Unfortunately, adverse events related to their use remain poorly understood by many clinicians and, in particular, the misdiagnosis of β-lactam allergy and misunderstanding of crossreactivity among members of the β-lactam antibiotics may effectively eliminate a whole class of antimicrobials from use and require the use of broader spectrum agents with less well-established safety profiles.

Areas covered: This review describes the range, diagnosis and management of adverse events associated with β-lactam antimicrobials, particularly focusing on recognition, diagnosis and management of true allergy and risk of cross-sensitivity between β-lactam antibiotics. A literature review was undertaken using PubMed, focusing primarily on literature published in the past 10 years relating to β-lactam adverse events and allergy.

Expert opinion: Beta-lactams are generally safe drugs and serious adverse events are rare and allergy is overdiagnosed. Accurate diagnosis can usually be achieved through careful history and in some instances skin or in vitro testing is required. Even among individuals with true immediate-type allergy to penicillin, most cephalosporins are readily tolerated and desensitization is usually an option in cases where no alternate antimicrobials are available. Other allergic reactions (Type II, III and IV) are rare and avoidance of the culprit agent is generally recommended. Nonallergic or morbilliform rashes are generally not allergic in nature and should not prompt drug or class avoidance. Other adverse events are frequently dose-related and can be avoided by appropriate dosing and consideration of renal function.     

Adverse reactions to β-lactam antimicrobials

INTRODUCTION: Beta-lactam antibiotics are among the most clinically useful antimicrobials used in medicine. Unfortunately, adverse events related to their use remain poorly understood by many clinicians and, in particular, the misdiagnosis of β-lactam allergy and misunderstanding of crossreactivity among members of the β-lactam antibiotics may effectively eliminate a whole class of antimicrobials from use and require the use of broader spectrum agents with less well-established safety profiles. AREAS COVERED: This review describes the range, diagnosis and management of adverse events associated with β-lactam antimicrobials, particularly focusing on recognition, diagnosis and management of true allergy and risk of cross-sensitivity between β-lactam antibiotics. A literature review was undertaken using PubMed, focusing primarily on literature published in the past 10 years relating to β-lactam adverse events and allergy. EXPERT OPINION: Beta-lactams are generally safe drugs and serious adverse events are rare and allergy is overdiagnosed. Accurate diagnosis can usually be achieved through careful history and in some instances skin or in vitro testing is required. Even among individuals with true immediate-type allergy to penicillin, most cephalosporins are readily tolerated and desensitization is usually an option in cases where no alternate antimicrobials are available. Other allergic reactions (Type II, III and IV) are rare and avoidance of the culprit agent is generally recommended. Nonallergic or morbilliform rashes are generally not allergic in nature and should not prompt drug or class avoidance. Other adverse events are frequently dose-related and can be avoided by appropriate dosing and consideration of renal function.