Effect of vaccination on the use of antimicrobial agents: a systematic literature review

Abstract

Background

Antimicrobial resistance is a growing global health threat. To preserve the effectiveness of antimicrobials, it is important to reduce demand for antimicrobials.     

2013年北京协和医院细菌耐药性监测

  目的  了解北京协和医院2013年临床分离细菌对抗菌药物的耐药性。  方法  收集2013年1月1日至12月31日北京协和医院临床分离的7236株非重复细菌, 采用纸片扩散法或自动化仪器法进行药敏试验, 按美国临床实验室标准化协会2013年版标准判读药敏结果, 采用WHONET 5.6软件进行数据分析。  结果  7236株非重复的细菌中, 革兰阴性菌占71.1%(5147株), 革兰阳性菌占28.9%(2089株)。耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphalococcus aureus, MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(methicillin-resistant coagulase-negative Staphylococcus, MRCNS)的检出率分别为34.9%(244/700)和67.2%(123/183)。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。发现少数万古霉素和替考拉宁耐药的屎肠球菌, 未发现对利奈唑胺耐药的肠球菌。产超广谱β-内酰胺酶(extended spectrum β-lactamases, ESBLs)的大肠埃希菌、克雷伯菌属细菌(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌的检出率分别为49.5%(698/1410)、25.4%(235/925)和22.6%(30/133)。肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感, 总耐药率1.5%~2.3%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为19.4%和15.6%。鲍曼不动杆菌对上述两种抗菌药物的耐药率分别为70.9%和72.0%。泛耐药鲍曼不动杆菌的检出率为42.9%(306/714)。  结论  细菌耐药性仍是临床重要问题, 特别是泛耐药鲍曼不动杆菌, 应采取有效的医院感染控制措施和合理使用抗菌药物。     

524株解脲脲原体及人型支原体药物敏感性分析

目的了解女性患者解脲脲原体（Ureaplasma urealyticum,Uu）和人型支原体（Mycoplasma hominis,Mh）对目前常用具有抗支原体活性抗菌药物的耐药情况。方法采用支原体鉴定药敏试剂盒,对1238例女性疑似泌尿生殖道感染标本进行培养及药敏试验。结果1238份标本中Uu阳性492份（39．7％）,Uu＋Mh阳性31份（2．5％）,Mh阳性1份（0．4％）,总检出率42．3％（524份）。药敏试验结果显示,Uu和Mh对交沙霉素、多西环素、米诺环素敏感率高,对红霉素、阿奇霉素、氧氟沙星耐药率较高。结论Uu和Mh对常用抗支原体药物耐药率增高,经验治疗应首选交沙霉素、多西环素或米诺环素。     

呼吸道感染中革兰阴性杆菌分布及耐药性变迁

目的了解徐州医学院附属医院近5年住院患者呼吸道感染分离菌中革兰阴性杆菌的分布及耐药性的变化。方法收集该院2008至2012年住院呼吸道感染患者分离菌株,进行药敏试验并分析结果。结果呼吸道标本主要来源于ICU、神经科和呼吸科;5年内大肠埃希菌所占比率呈显著下降趋势,克雷伯菌属、不动杆菌属细菌逐年升高,铜绿假单胞菌略有降低。近3年嗜麦芽窄食单胞菌增多。革兰阴性杆菌对多黏菌素B敏感率保持在90．0％以上;大肠埃希菌对碳青霉烯类抗生素敏感率保持90．0％以上;碳青霉烯类抗生素对不动杆菌属和克雷伯菌属细菌的抗菌活性逐年下降;细菌对头孢菌素类的敏感性普遍降低,大肠埃希菌和克雷伯菌属细菌对头孢菌素类抗生素敏感率〈20．0％,对氨曲南的敏感率更低;而对阿米卡星的敏感性有所恢复。结论革兰阴性杆菌是呼吸道感染的重要病原菌,对临床常用抗菌药物敏感率下降值得重视,应加强对呼吸道病原菌耐药性监测和防控。     

SD抗菌布的抗菌效果

研制出含有洗必泰的SD抗菌布,经整理后,有良好与持久的扰菌作用。用该布制作的床单与白大衣在烧伤病房试用,抑菌率达50％以上,洗涤15次仍有显著效果。     

2010年中国CHINET铜绿假单胞菌耐药性监测

目的了解2010年我国不同地区铜绿假单胞菌临床分离株的耐药性和耐药特征,指导临床合理使用抗菌药物。方法对全国14所医院临床分离的5 080株铜绿假单胞菌按照统一的方案,采用统一的材料、方法(K-B法)和判断标准(CLSI 2010年版),进行铜绿假单胞菌的耐药性监测,并用WHONET5.4软件进行数据分析。结果 2010年14所医院共收集5 080株临床分离的铜绿假单胞菌,其中91.2%分离自住院患者;69.9%分离自呼吸道标本。铜绿假单胞菌对阿米卡星的耐药率最低,平均为15.3%,对其他抗菌药物的耐药率均高于18%。昆明一医院的分离株对各种抗菌药物的耐药率均高于28%,对其中13种抗菌药物的耐药率是14所医院中最高者;北京一医院分离的菌株对大多数抗菌药物的耐药率在40%左右,甘肃省一医院的分离株对抗菌药物(除头孢哌酮和氨曲南外)耐药率均低于20%;上海一儿童医院的分离株对各抗菌药物的耐药率均低于5%。从ICU分离菌对各种抗菌药物的耐药率均高于门诊、内科、外科和整体分离菌的耐药率(P=0.001)。各医院泛耐药铜绿假单胞菌的检出率平均为1.7%。结论我国临床分离的铜绿假单胞菌对常用抗菌药物的耐药性仍处于较高水平,但本次有轻微下降趋势。不同地区、不同医院的分离株对抗菌药物的耐药性相差较大,ICU仍应是监控重点。医疗机构应加强细菌耐药监测,指导临床合理使用抗菌药物。同时要加强感染控制措施,预防和控制耐药菌株的医院内流行。     

Tackling antibiotic resistance in India

Infectious diseases are major causes of mortality in India. This is aggravated by the increasing prevalence of antimicrobial resistance (AMR) both in the community and in hospitals. Due to the emergence of resistance to all effective antibiotics in nosocomial pathogens, the situation calls for emergency measures to tackle AMR in India. India has huge challenges in tackling AMR, ranging from lack of surveillance mechanisms for monitoring AMR and use; effective hospital control policies; sanitation and non-human use of antimicrobial. The Ministry of Health and Family Welfare of Govt. of India has taken initiatives to tackle AMR. Extensive guidelines have been drafted and a model worksheet has been developed as a roadmap to tackle AMR.     

2015年北京协和医院细菌耐药性监测

目的了解2015年北京协和医院临床分离细菌对抗菌药物的耐药性。方法收集2015年1月1日至12月31日北京协和医院临床分离的5746株非重复细菌,采用纸片扩散法或自动化仪器法进行药敏试验,按美国临床实验室标准化协会2015年版标准判读药敏结果,采用WHONET 5.6软件进行数据分析。结果 5746株非重复细菌中,10种最常见细菌分别为:大肠埃希菌(19.4%)、铜绿假单胞菌(11.3%)、肺炎克雷伯菌(10.9%)、金黄色葡萄球菌(9.8%)、鲍曼不动杆菌(9.6%)、粪肠球菌(6.5%)、B群链球菌(5.1%)、屎肠球菌(4.6%)、凝固酶阴性葡萄球菌(2.7%)、阴沟肠杆菌(2.5%)。其中革兰阴性菌占67.5%,革兰阳性菌占32.5%。耐甲氧西林金黄色葡萄球菌(methicillin-resistant Staphylococcus aureus,MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(methicillin-resistant coagulase-negative Staphylococcus,MRCNS)的检出率分别为22.9%和77.6%。MRSA和MRCNS菌株对β内酰胺类和其他抗菌药物的耐药率明显高于甲氧西林敏感金黄色葡萄球菌(methicillin-susceptible Staphylococcus aureus,MSSA)和甲氧西林敏感凝固酶阴性葡萄球菌(methicillin-susceptible coagulase-negative Staphylococcus,MSCNS)菌株。仍有88.8%的MRSA对磺胺甲噁唑-甲氧苄啶敏感。MRCNS中有81.7%的菌株对利福平敏感。未发现对万古霉素、替考拉宁和利奈唑胺耐药的葡萄球菌。粪肠球菌对大多数抗菌药物(除氯霉素外)的耐药率要明显低于屎肠球菌。两者中均有少数万古霉素耐药株,未发现对利奈唑胺耐药的肠球菌。β溶血链球菌对青霉素的敏感率为90.8%。产超广谱β-内酰胺酶的大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形杆菌的检出率分别为52.3%(582/1112)、28.9%(200/692)和26.2%(27/103)。肠杆菌科细菌对碳青霉烯类仍高度敏感,总耐药率≤4.3%。泛耐药肺炎克雷伯菌的检出率为3.0%(19/630)。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别为76.5%和74.8%,对头孢哌酮-舒巴坦和米诺环素的耐药率最低,分别为49.8%和21.8%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为16.6%和11.9%,对阿米卡星的耐药率最低(5.2%)。泛耐药鲍曼不动杆菌和铜绿假单胞菌的检出率分别是20.8%(115/553)和1.8%(12/650)。结论细菌耐药性仍对临床构成严重威胁,临床需合理规范应用抗菌药物,避免耐药菌株的广泛传播。     

Inappropriate antimicrobial use and potential solutions: a Middle Eastern perspective

Addressing the many challenges posed by escalating antimicrobial resistance requires a strategy at institutional, community, national, regional and international levels. Partners in the development of such a strategy should include representatives from clinical and veterinary medicine, public health, microbiology, animal husbandry, the pharmaceutical and agriculture industries as well as behavioral sciences. In the Middle East, antimicrobial resistance is a crisis at the present time. It stems from a wide range of problems; however, there are few studies from this region about factors associated with proliferating resistance. In this article, we explore inappropriate antimicrobial use in this part of the world and suggest possible solutions to mitigate the problem.     

2010年中国CHINET鲍曼不动杆菌耐药性监测

目的了解2010年中国不同地区14所教学医院临床分离鲍曼不动杆菌的耐药性。方法收集14所教学医院临床分离的非重复不动杆菌属共5 523株,其中鲍曼不动杆菌4 949株,按照统一方案,在各监测点采用纸片扩散法进行药敏试验,试验结果按照CLSI 2010年版标准判读,采用WHONET 5.4软件进行数据分析。结果鲍曼不动杆菌对头孢哌酮-舒巴坦和米诺环素耐药率最低,分别为33.6%和35.4%。对碳青霉烯类抗生素亚胺培南和美罗培南的耐药率分别为62.1%和63.6%,对其他监测的抗菌药物的耐药率均达56.2%以上。不同医院分离菌对抗菌药物的耐药率不同,其中以ICU分离菌耐药率最高,急诊次之,内科最低。门诊与住院患者分离菌对亚胺培南和美罗培南的耐药率分别为48.3%/50.8%和62.3%/63.8%,且住院患者分离菌对抗菌药物的耐药率高于门诊患者(米诺环素除外)。全国14所教学医院药敏试验结果显示多重耐药(MDR)及泛耐药(PDR)鲍曼不动杆菌分别达55.0%(2 720/4 949)和21.4%(1 058/4 949)。2010年鲍曼不动杆菌耐药率与往年相比,呈上升趋势,尤以对头孢哌酮-舒巴坦、碳青霉烯类抗生素耐药率升高显著。结论鲍曼不动杆菌对各抗菌药物的耐药性仍呈上升趋势。头孢哌酮-舒巴坦和米诺环素对鲍曼不动杆菌仍具有较好的体外抗菌活性。不同医院、不同科室鲍曼不动杆菌对抗菌药物的耐药率存在显著差异。     

2011～2015年某院肺炎克雷伯菌的分布特点及耐药性分析

目的：探讨2011～2015年海军总医院肺炎克雷伯菌的临床分布情况及耐药性变迁,为临床用药提供参考依据。方法选取海军总医院2011～2015年临床分离出的肺炎克雷伯菌,分析其检出率、科室分布情况、标本来源、抗菌药物耐药性及对碳青霉烯类抗菌药物耐药性的变化趋势。结果2011～2015年肺炎克雷伯菌的检出株数和分离率呈逐年上升趋势,标本主要来源于重症监护室、高压氧科、呼吸内科、放射肿瘤科、肾脏病科等10个科室,其中高压氧科检出率最高,其次是呼吸内科、重症监护室;送检标本以痰液和尿液为主,分别占送检标本的59．7％和21．4％;2011～2015年肺炎克雷伯菌耐药性呈逐年上升趋势。该菌对哌拉西林、氨苄西林、氨苄西林／舒巴坦和头孢呋辛酯耐药率较高,对阿米卡星、亚胺培南、美罗培南和妥布霉素的耐药率较低;对碳青霉烯类抗菌药物亚胺培南和美罗培南的耐药率逐年不断上升,泛耐药肺炎克雷伯菌呈快速上升趋势。结论肺炎克雷伯菌耐药现象严重,尤其耐碳青霉烯类抗菌药物的肺炎克雷伯菌近年来明显增加,应加强对其耐药性监测,指导临床合理用药。     

感染性心内膜炎194例的临床和病原学特点

目的 分析血培养阳性的感染性心内膜炎(infective endocantitis,IE)患者的临床及病原学特点,为合理使用抗菌药物提供依据.方法 回顾性分析武汉亚洲心脏病医院2014年1月-2018年12月收治的194例血培养阳性的IE患者病历资料,包括年龄、性别、临床表现及病原学检查结果 等.结果 194例血培养阳...     

2008年某院临床分离的常见细菌耐药性监测

目的调查包头医学院第一附属医院2008年临床分离常见细菌对常用抗菌药物的耐药情况。方法收集2008年1～12月临床分离的常见细菌,采用纸片扩散法进行抗菌药物敏感性试验,数据用WHONET5.4进行统计分析。结果 720株临床分离细菌中,其中革兰阳性球菌165株(22.9%),革兰阴性杆菌555株(77.1%)。革兰阳性球菌中前3位分别是肠球菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌。革兰阴性杆菌前3位分别是大肠埃希菌、铜绿假单胞菌、克雷伯菌属。耐甲氧西林金黄色葡萄球菌检出率为45.5%,耐甲氧西林凝固酶阴性葡萄球菌检出率为52.6%。未检出耐糖肽类抗菌药物的革兰阳性球菌。大肠埃希菌和克雷伯菌属中产超广谱β-内酰胺酶(ESBLs)菌株检出率分别为59.1%、53.9%;产ESBLs菌株耐药率均高于非产ESBLs菌株。其他肠杆菌对多数抗菌药物耐药率较高。非发酵糖革兰阴性杆菌的耐药率均较高。结论临床常见病原菌以革兰阴性杆菌为主,革兰阳性球菌对糖肽类抗菌药物耐药率最低;肠杆菌科细菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐药率较低。     

泌尿生殖道支原体属感染特点及耐药性分析

目的探讨泌尿生殖道支原体属感染状况及对抗菌药物的耐药情况,指导临床合理用药。方法采用支原体培养药敏试验试剂盒,对临床收集的1852例泌尿生殖道感染患者标本进行支原体属培养及10种抗菌药物的体外药敏试验。结果在1852例受检患者标本中检出支原体阳性782例,总阳性率为42．2％。其中解脲脲原体（Uu）单一感染617例,占78．9％;人型支原体（Mh）单一感染28例,占3．6％;Uu和Mh混合感染137例,占17．5％。21～30岁年龄段患者支原体培养阳性率为42．9％,明显高于其他年龄段。药敏试验结果显示,Uu阳性者对交沙霉素、多西环素、米诺环素、克拉霉素较敏感,敏感率分别为95．7％、92．9％、92．8％和91．6％,而耐药率在70．0％以上的有大观霉素、阿奇霉素、环丙沙星、罗红霉素。结论治疗泌尿生殖道支原体属感染应首选交沙霉素和多西环素等敏感性高的药物,避免使用大观霉素、阿奇霉素等耐药性高的药物。临床上对疑似泌尿生殖道感染的患者进行支原体属的培养和药敏试验,对支原体属感染的抗菌治疗有重要的临床意义。     

Multidrug-resistant Klebsiella pneumoniae: challenges for treatment,prevention and infection control

ABSTRACT

Introduction: Management of antimicrobial resistance in multi-drug-resistant-Klebsiella pneumoniae (MDR-KP) is a major challenge for clinicians. The optimal treatment option for MDR-KP infections is still not well established. Combination therapies including high-dose meropenem, colistin, fosfomycin, tigecycline, and aminoglycosides are widely used, with suboptimal results. New antimicrobials targeting MDR-KP have been developed during the last decades and are now at various stages of clinical research.

Areas covered: The PubMed database was searched to review the most significant literature on the topic, with a special consideration for articles coming from endemic countries.

Expert commentary: We reviewed the currently available treatment options, discussing the characteristics of new antibiotics with activity against MDR Gram-negative bacteria and the strategies for preventing the spread of MDR-KP. While we wait for real-world data from novel compounds, coordinated strategies and common efforts in infection control and stewardship programs remain the cornerstone for limiting, or potentially reversing, conditions that favor the spread of MDR-KP.     

Global antimicrobial resistance: from surveillance to stewardship. Part 2: stewardship initiatives

22nd European Congress of Clinical Microbiology and Infectious Diseases

London, UK, 31 March–3 April 2012

Twelve months after the WHO launched its World Health Day 2011 campaign to combat antimicrobial resistance, antibiotic stewardship initiatives were a major focus at the annual meeting of the European Society of Clinical Microbiology and Infectious Diseases, in London, UK. In the second part of their report from the Congress, the authors review the impact of some of these initiatives in achieving their goals of reducing overall antibiotic usage, ensuring timely, appropriate prescribing and avoiding sub-optimal dosing and unnecessarily prolonged treatment. The authors also report new data on antibiotic prescribing in primary care and latest research in the development of novel antibiotics for the future.     

Pharmacokinetics of norfloxacin in the elderly

9 elderly and 9 younger adult patients, with proven post-operative lower urinary tract infection were treated with 400 mg of norfloxacin twice daily for 5 days. Pharmacokinetics of norfloxacin were measured on days 1 and 5. Compared to the younger adult patients, the elderly showed a decreased creatinine clearance and, following the last dose on day 5, an increased maximum plasma concentration of norfloxacin, an increased area under the concentration-time curve and a decreased total body clearance of norfloxacin. These results confirm that in elderly, as in younger adult patients, the pharmacokinetics of norfloxacin can be described by a linear model and accumulation of the drug during repetitive multiple doses is predictable. The differences between the two groups cannot be considered as clinically significant so that no dose change would be required in elderly patients within the range of creatinine clearance studied.