法罗培南治疗细菌性呼吸道感染的临床研究

目的评价国产法罗培南治疗细菌性呼吸道感染的疗效和安全性。方法将64例细菌性呼吸道感染患者随机分为试验组和对照组各32例。试验组予以法罗培南钠口服治疗,对照组予以头孢呋辛酯口服治疗,疗程均为6～14d。比较2组临床疗效、细菌学疗效及不良反应发生率。结果试验组和对照组痊愈率分别为78.1%和81.3%,总有效率分别为96.9%和93.7%;细菌清除率分别为92.8%和88.9%;不良反应发生率分别为6.3%和6.3%,差异均无统计学意义(P>0.05)。结论国产法罗培南治疗细菌性呼吸道感染安全、有效,与头孢呋辛酯相仿。     

小儿下呼吸道感染肺炎链球菌耐药性分析

目的了解我院住院患儿感染肺炎链球菌的耐药性状况。方法收集儿科2010年1月至2012年1月患儿连续3次痰培养肺炎链球菌进行耐药分析。采用纸片扩散法（K—B法）,药敏试验结果按NCCL200版判断标准,对照质控菌株判断敏感、中介、耐药。结果所有菌株对万古霉素敏感,耐药率为0,左氧氟沙星敏感率率较高,耐药率为3．3％,菌株对红霉素的耐药率最高,其次为克林霉素。红霉素、克林霉素耐药率为90．2％和89．3％,对复方新诺明、青霉素的敏感率有下降趋势。青霉素G耐药率为82．7％,阿莫西林克拉维酸钾、美洛西林舒巴坦的耐药率13．1％和16．4％,头孢呋辛和头孢噻肟的耐药率分别为18．9％和19．7％。结论儿科冬季下呼吸道感染。肺炎链球菌多见,以婴幼儿多见,早期用药效果欠佳,易出现并发症,并发脓胸、肺脓肿、肺炎、心肌炎,甚至并发感染性休克,应动态监测肺炎链球菌的耐药情况。指导临床合理选择抗生素,提高治愈,减少并发症。     

法罗培南钠片治疗细菌性呼吸道感染疗效及体外抗菌活性研究

目的评价法罗培南钠片治疗细菌性呼吸道感染疗效及体外抗菌活性。方法轻、中度细菌性呼吸道感染患者50例,随机分为2组：A组（治疗组）25例用法罗培南钠片治疗,B组（对照组）25例用头孢克洛治疗,2组均每次口服1片,tid,疗程5-10 d,观察临床疗效;患者痰或咽拭子中分离,培养细菌,测定抗生素最低抑菌浓度（M IC）。结果A治疗组有效率为92%,B对照组有效率为84%,2组比较差异无显著性（P〉0.05）;法罗培南钠片对呼吸道常见细菌有良好抗菌活性;2组均无病例发生严重不良反应。结论法罗培南钠片是一种安全有效的治疗细菌性呼吸道感染的口服抗生素。     

Pharmacodynamics of ceftriaxone and cefixime against community-acquired respiratory tract pathogens

Over the last decade or so there has been a growing interest in routes of antimicrobial administration other than by the conventional intravenous route for institutionalized patients and for some outpatients. Both oral (PO) and intramuscular (IM) routes of administration are less costly than giving antimicrobial agents by vein (IV). In addition, fewer complications such as catheter-related sepsis and phlebitis are associated with non-IV routes of administration. Furthermore, a reduced-dosage, reduced-volume IM administration of ceftriaxone may provide a tolerable route of administration and equivalent bactericidal activities compared with higher dose IV ceftriaxone. The purpose of this study was to determine the time that the drug concentration remained in excess of the minimum inhibitory concentration (MIC) (T>MIC) and the duration of bactericidal activities of ceftriaxone one gram administered IV, ceftriaxone 250 mg given IM and cefixime 400 mg given orally against clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in adult volunteers. Single doses of each agent were administered and serum concentrations were collected over the standard dosing period of 24 h for all study regimens. Ceftriaxone, regardless of route of administration and dose, resulted in bactericidal activities and T>MIC for 100% of the dosing period for S. pneumoniae, H. influenzae, and M. catarrhalis. Cefixime maintained at least 50% T>MIC and bactericidal activity against both isolates each of H. influenzae and M. catarrhalis. Against both isolates of S. pneumoniae, cefixime achieved T>MIC for at least 50% of the dosing period, but did not maintain bactericidal activity. Reduced dose ceftriaxone given IM seems to be a viable alternative to ceftriaxone IV if the pathogen, susceptibility and infection site are known. Based on T>MIC exceeding 50% of the dosing interval, cefixime would be considered an effective alternative to IV therapy against common respiratory tract pathogens. Clinical studies need to be conducted to confirm these findings.     

Epidemiological aspects of antibiotic resistance in respiratory pathogens

Respiratory infections are the most frequent reason for primary health care consultation. The main causes of respiratory tract infections in children are viruses and the most common types are upper respiratory tract infections: common cold, pharyngitis, otitis media and sinusitis. Pneumonia is much more serious. As well as viruses, bacteria are often involved in respiratory tract infections. Three bacterial species are most commonly isolated: Streptococcus pneumoniae, non-encapsulated Haemophilus influenzae and Moraxella (Branhamella) catarrhalis. The most common bacterial cause of pharyngitis is Streptococcus pyogenes. Bacteria isolated from community-acquired infection usually are sensitive to the majority of suitable drugs, but during the past two decades, significant antibiotic resistance has emerged. Resistance to penicillins has spread among H. influenzae and S. pneumoniae. The mechanism of penicillin resistance in H. influenzae is mainly by production of β-lactamases TEM-1 and ROB-1, whereas in S. pneumoniae resistance is an effect of the changes in penicillin binding proteins. Among respiratory pathogens, resistance to tetracyclines, macrolides, trimethoprim–sulphamethoxazole and fluoroquinolones has also appeared. Several mechanisms depending on changes in target, active efflux and modifying enzymes are involved.     

社区呼吸道感染中肺炎链球菌对常用抗菌药物敏感性

目的了解社区获得性呼吸道感染中肺炎链球菌对常用抗菌药物的体外抗菌活性。方法先用做肺炎链球菌鉴定粗筛,后用全自动细菌分析系统的革兰阳性菌鉴定卡和单克隆乳胶试剂做肺炎链球菌的最终鉴定,药物敏感性试验用微量稀释方法测定其最低抑菌浓度。结果在1997-11~1998-04,1999-11~2000-04和2001-11~2002-04 3个阶段共收集肺炎链球菌271株。在这3个阶段,肺炎链球菌分别为83,101,87株;对青霉素不敏感率分别为9.6%,8.9%和16%,对青霉素耐药率分别为1.2%,2%和8%;对大环类脂类抗生素的敏感性分别为28.9%,39.6%和18.4%。肺炎链球菌对克拉霉素显示高水平耐药。阿其霉素和克拉霉素的交叉耐药率可达98.4%。对左氧氟沙星的耐药率分别为1.2%,6.9%和1.2%; 对复方新诺明的耐药率分别为30.1%,62.4%和66.7%;多重耐药的肺炎链球菌分别为2.4%,3.0%和6.9%。在多重耐药的肺炎链球菌中,以阿齐霉素、复方新诺明和青霉素模式为主,占72.7%(8/11),同时有80%(8/10)对青霉素耐药的肺炎链球菌发生多重耐药;肺炎链球菌对万古霉素未见有耐药株。结论对青霉素耐药的肺炎链球菌有逐年上升的趋势,定期进行细菌耐药性的监测,有助于合理应用抗菌药物。     

重症监护病房下呼吸道感染病原菌分布及耐药性分析

目的分析医院重症监护病房（ICU）下呼吸道感染病原菌的分布及耐药情况,为临床合理使用抗菌药物提供参考依据。方法取2007年1月至2009年7月ICU下呼吸道感染患者深部痰做病原菌培养,按美国临床实验室标准化委员会（CLSI）标准分离鉴定病原菌并进行药敏试验,统计检出阳性率、病原菌分布比例及敏感率。结果从310份痰液标本中分离出病原菌株382株,其中G-杆菌233株（61.0%）,G＋球菌106株（27.7%）,真菌43株（11.3%）。排名前4位的G-杆菌分别为铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯杆菌、大肠埃希菌。超广谱β-内酰胺酶（ESBLs）检出率分别为70.7%、77.3%,耐甲氧西林金黄色葡萄球菌（MRSA）检出率为92%。结论 ICU下呼吸道感染病原菌以G-杆菌为主,病原菌耐药性较强,应加强细菌药敏实验监测,为重症监护病房合理选用抗菌药物提供依据。     

莫西沙星与其他12种抗菌药物对呼吸道常见感染致病菌体外抗菌活性研究

目的比较研究莫西沙星与其他12种抗菌药物对临床常见致病菌的体外抗菌活性.方法采用琼脂平板二倍稀释法测定对411株临床分离菌株的最低抑菌浓度.结果金黄色葡萄球菌(包括MRSA)和肺炎链球菌(包括PISP和PRSP)对万古霉素的敏感性最高,敏感率为95.8%～100%,对莫西沙星、加替沙星的敏感性较高,对大环内酯类药物则比较耐药.流感嗜血杆菌、卡他莫拉菌对莫西沙星、加替沙星等4种氟喹诺酮类和5种头孢菌素类及阿齐霉素比较敏感.肺炎克雷伯菌(包括产ESBLs菌株)对莫西沙星等4种氟喹诺酮类和头孢美唑很敏感;非产ESBLs菌株对8种抗菌药物均敏感,但产ES-BLs菌株对第二、三代头孢菌素则显示了较高的耐药率.大肠埃希菌(包括产ESBLs菌株)对氟喹诺酮类敏感率在40%左右,非产ESBLs菌株对5种头孢菌素均较敏感,但产ESBLs菌株除对头孢美唑敏感外,对其他头孢菌素类耐药率较高;结论莫西沙星与其他12种抗菌药物比较,对革兰阳性菌(包括MRSA和PRSP)作用增强,对肺炎克雷伯菌(包括产ESBLs菌株)抗菌活性较强,大肠埃希菌对莫西沙星与其他氟喹诺酮类有一定的交叉耐药性.     

Resistance patterns of lower respiratory tract pathogens in Europe

Resistance to antimicrobial drugs in the major respiratory tract pathogens is known to vary profoundly depending on geographic location. In Europe high rates (>44%) of penicillin-resistance in pneumococci have been recorded in France and Spain, while countries like The Netherlands, the Czech Republic, Austria and Italy are only marginally affected. Similarly, the incidence of macrolide resistance differs widely among European nations with figures ranging from 45.9% (France) to 1.5% (The Netherlands). Significant percentages (>20%) of co-trimoxazole and doxycycline resistance have been found in France, Spain, Italy, Hungary, Poland and Belgium. The prevailing mechanism of resistance in Haemophilus influenzae is represented by beta-lactamase synthesis for which considerable variations (from 0 to 38.5%) have been evidenced. Ampicillin resistant beta-lactamase negative H. influenzae are very uncommon. Over 90% of Moraxella catarrhalis isolates are beta-lactamase producers without big differences among European countries.     

呼吸机相关下呼吸道感染的病原菌调查

目的分析机械通气引发下呼吸道感染病原菌的构成及其耐药情况,指导早期经验性抗生素治疗. 方法对2001年1月～2004年9月间我院ICU收住的113例机械通气引发下呼吸道感染患者的病原菌及耐药情况进行回顾性调查分析. 结果检出病原菌138株,其中革兰阴性(G-)细菌87株(63.0%),革兰阳性细菌(G 菌)33株(23.9%),真菌18株(13.1%).大多数菌株多重耐药.结论机械通气引发下呼吸道感染院内感染病原菌以G-菌为主,其药敏实验呈多重耐药,临床早期经验性抗生素治疗应选择敏感广谱抗生素.     

儿童心脏术后下呼吸道分离菌的分布及耐药性分析

目的 回顾性分析心血管病医院儿童心脏术后下呼吸道分离菌的分布及其耐药特点,为临床治疗提供用药参考。方法 对2014年1月1日-2016年12月31日术后送检的痰标本进行培养,对分离出的致病菌做鉴定及药敏实验。结果 共分离出762株致病菌,革兰阴性菌占69.29%,革兰阳性菌占21.65%,真菌占7.87%,排名前5位的细菌为铜绿假单胞菌(138株)、大肠埃希菌(95株)、肺炎克雷伯菌(95株)、金黄色葡萄球菌(66株)和肺炎链球菌(64株)。药敏结果显示非发酵菌对氨基糖苷类的耐药率为0.72%~8.57%但对碳青霉烯类≥40%;肺炎克雷伯菌对碳青霉烯类的耐药率为16.13%~24.21%,远高于大肠埃希菌和阴沟肠杆菌的0~2.44%;阴沟肠杆菌的整体耐药率低于大肠埃希菌和肺炎克雷伯菌;金黄色葡萄球菌中MRSA占29.23%,其对青霉素的耐药率为98.41%,对万古霉素、利奈唑胺、替加环素的耐药率为0;肺炎链球菌对青霉素的耐药率为14.06%,对万古霉素、利奈唑胺的耐药率为0。结论 儿童心脏术后下呼吸道分离菌以革兰阴性菌为主;碳青霉烯类抗生素对非发酵菌的高耐药率值得高度重视;肺炎克雷伯菌对碳青霉烯类抗生素的耐药率有上升趋势。     

合肥地区儿童呼吸道感染病原体情况分析

目的 了解合肥地区儿科就诊病人呼吸道感染病原体分布特征以及流行特点.方法 收集2018年9—12月安徽省立医院儿科就诊疑似呼吸道感染病人的呼吸道标本共257例,包括250份咽拭子和7份肺泡灌洗液.利用13种呼吸道病原体多重聚合酶链式反应(PCR)检测试剂盒对所有标本进行检测.结合临床诊疗资料,对多重PCR检测结果进行统计学分析.结果 257份标本总阳性率为66.1％(170/257),其中病毒阳性率为60.7％(156/257),以呼吸道合胞病毒(RSV)、鼻病毒(HRV)和腺病毒(ADV)为主,阳性率分别为31.5％(81/257)、17.5％(45/257)、5.1％(13/257);非典型病原体阳性率为8.2％,以肺炎支原体(MP)为主,阳性率为7.8％(20/257).23例标本检出2种及以上病原体,以呼吸道合胞病毒和鼻病毒同时感染较为常见.男性呼吸道感染病原体阳性率为67.81％(99/146),女性呼吸道感染病原体阳性率为63.96％(71/111),呼吸道病原体感染性别间阳性率差异无统计学意义(χ2=0.416,P=0.519).呼吸道合胞病毒感染多发生在1～2岁组儿童(χ2=16.562,P=0.001),各年龄组间阳性率依次为37.8％(34/90)、40.9％(36/88)、13.7％(7/51)、14.3％(4/28),其阳性率随着年龄的增长而降低.肺炎支原体感染多发生在6～15岁组儿童(χ2=34.346,P<0.001),各年龄组间阳性率依次为0.0％(0/90)、3.4％(3/88)、13.7％(7/51)、35.7％(10/28),其阳性率随年龄的增长而上升.结论 呼吸道合胞病毒、腺病毒、鼻病毒、肺炎支原体在儿童呼吸道感染病原体中较为常见,病原体感染在性别间不存在差异,呼吸道合胞病毒和肺炎支原体感染在年龄组间存在差异.     

呼吸内科患者下呼吸道感染病原菌及药敏分析

目的 了解下呼吸道感染病原菌分布、药敏情况.方法 回顾分析下呼吸道感染住院的细菌培养为阳性并做药敏试验的病历,统计病原菌分布、药敏情况.结果 本组71例患者共培养出病原菌118株,其中金黄色葡萄球菌16株,占13.56%;流感嗜血杆菌13株,占11.01%;鲍曼不动杆菌9株,占7.63%;肺炎克雷伯菌9株,占7.63%;大肠埃希菌7株,占5.93%;肺炎链球菌7株,占5.93%;铜绿假单胞菌6株,占5.08%;副流感嗜血杆菌6株,占5.08%.结论 对于下呼吸道感染患者在治疗中对抗生素的选择应根据当地病原体的特点制定当地经验治疗方案.     

阿莫西林与红霉素对肺炎链球菌的体外抗菌效果

目的研究阿莫西林(β内酰胺类抗生素)和红霉素(大环内酯类抗生素)联合应用体外对肺炎链球菌的相互作用,并验证红霉素对肺炎链球菌的杀菌作用。方法用琼脂平板二倍稀释法测定阿莫西林和红霉素对肺炎链球菌的最低抑菌浓度(MIC),用影印培养法测定最低杀菌浓度(MBC)。用棋盘微量稀释法和时间-杀菌曲线分析测定两药对肺炎链球菌的联合作用效果。结果阿莫西林对44株菌株的MIC为≤0.004～2mg·L-1,MBC≤0.004～4mg·L-1;红霉素对其的MIC值为0.008～≥256mg·L-1,MBC为0.016～≥256mg·L-1。阿莫西林的MBC/MIC为1～2;红霉素的MBC/MIC的为1～4。对阿莫西林和红霉素均敏感的肺炎链球菌株联合用药时,大部分菌株较单用时相同或略下降,其FICI在1～2。结论红霉素在体外对肺炎链球菌有杀菌作用;与阿莫西林体外联合应用时,阿莫西林杀菌效果不会被减弱。     

反复下呼吸道感染患儿罹患细菌性下呼吸道感染的病原菌分布及耐药性分析

目的:探讨儿童反复呼吸道感染(recurrent respiratory tract infection,RRTI)罹患细菌性下呼吸道感染的病原菌分布及耐药率特点.方法:回顾收集同期收治的RRTI和非RRTI罹患细菌性下呼吸道感染者为RRTI组和非RRTI组(每组各150例),对比2组患者的病原菌分布及耐药性差异.结果...     

Population antibiotic susceptibility for Streptococcus pneumoniae and treatment outcomes in common respiratory tract infections

PURPOSE: Antibiotic-resistant Streptococcus pneumoniae potentially threatens the successful treatment of common respiratory tract infections (RTIs); however, the relationship between antibiotic resistance and treatment outcomes remains unclear. We aimed to test the hypothesis that higher in vitro penicillin and erythromycin nonsusceptibility levels among clinical isolates of S. pneumoniae are associated with higher risk of treatment failure in suppurative acute otitis media (AOM), acute sinusitis, and acute exacerbation of chronic bronchitis (AECB). METHODS: We conducted a population-level analysis using treatment outcomes data from a national, managed-care claims database, and antibiotic susceptibility data from a national repository of antimicrobial susceptibility results between 1997 and 2000. Treatment outcomes in patients with suppurative AOM, acute sinusitis, or AECB receiving selected macrolides or beta-lactams were assessed. Associations between RTI-specific treatment outcomes and antibiotic nonsusceptibility were determined using Spearman correlation coefficients with condition-specific paired outcome and susceptibility data for each region and each year. RESULTS: There were 649 552 available RTI outcomes and 7252 susceptibility tests performed on S. pneumoniae isolates. There were no statistically significant trends across time for resolution proportions following treatment by either beta-lactams or macrolides among any of the RTIs. Correlation analyses found no statistically significant association between S. pneumoniae susceptibility and RTI treatment outcomes apart from a significant positive association between of erythromycin nonsusceptibility in ear isolates and macrolide treatment resolution for suppurative AOM. CONCLUSION: On the population level, in vitro S. pneumoniae nonsusceptibility to macrolide or beta-lactam antibiotics was not associated with treatment failure in conditions of probable S. pneumoniae etiology.     

法罗培南钠片治疗细菌性感染的随机双盲对照临床研究

目的评价国产法罗培南钠片治疗细菌性感染的临床疗效与安全性。方法采用多中心、双盲、随机对照试验设计，以头孢克洛为对照药，两组均口服，每次2片，tid，疗程5～10d。结果本研究共纳入60例，法罗培南组和头孢克洛组各30例，其中法罗培南组及头孢克洛组纳入ITT分析均为30例，PP分析分别为28和30例。疗程结束时，呼吸系统PP人群中，法罗培南组与头孢克洛组治疗后总痊愈率和有效率分别为71．43％与47．67％和92．86％与93．33％，泌尿道PP人群中，法罗培南组与头孢克洛组总痊愈率和有效率分别为85．71％与73．33％和100％与93．33％。疗程结束时两组细菌清除率均分别为83．33％和79．17％，法罗培南组和头孢克洛组的不良反应发生率分别为10．71％和20％，主要表现为恶心、呕吐、头晕、皮疹、腹泻等。以上结果两组比较无统计学差异（P〉0．05）。结论国产法罗培南钠片治疗呼吸道感染和泌尿道感染疗效确切，安全性较好。     

下呼吸道感染病原菌分布及耐药性分析

目的:了解我院呼吸科住院病人下呼吸道感染的病原菌分布情况及其耐药特点.方法:应用ATB细菌鉴定及药敏分析仪,对2007～2008年度呼吸科临床送检标本中分离的菌株进行鉴定和药敏感性检测.结果:共分离出253株致病菌,其中革兰阴性菌111株(43.87%),真菌99株(39.13%),革兰阳性菌43株(17%).耐药分析显示主要革兰阴性菌对碳青酶烯类抗生素敏感性最高;主要真菌对两性霉素B(100.00%)、伏力康唑(99.42%)、5-氟胞嘧啶(96.85%)以及氟康唑(63.52%)均较敏感.结论:下呼吸道感染病原菌中真菌所占比例越来越大,临床应合理应用抗生素,为减少医源性二重感染以及细菌耐药性的发生.     

Telithromycin: a new ketolide antimicrobial for treatment of respiratory tract infections

Telithromycin is a new ketolide antimicrobial, specifically developed for the treatment of community-acquired respiratory tract infections. It has a wide spectrum of antibacterial activity against common respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes. It also has activity against atypical pathogens, such as Chlamydia pneumoniae, Legionella pneumophila and Mycoplasma pneumoniae. Telithromycin maintains activity against β-lactam and macrolide-resistant respiratory tract pathogens and does not appear to induce cross-resistance to other members of the macrolide-lincosamide-streptogramin (MLS) group of antimicrobials. It demonstrates bactericidal activity against S. pneumoniae and H. influenzae and has a prolonged concentration-dependent post-antibiotic effect (PAE) in vitro. The drug has favourable pharmacokinetics following oral administration. It is well absorbed, achieves good plasma levels and is highly concentrated in pulmonary tissues and white blood cells. In clinical trials, telithromycin given orally at a dose of 800 mg once daily for 5 - 10 days was as effective as comparator antimicrobials for the treatment of adults with community-acquired pneumonia, acute exacerbations of chronic bronchitis, acute maxillary sinusitis and group A-β-haemolytic streptococcal pharyngitis or tonsillitis. The adverse events and safety profile were similar to comparator antimicrobials. The most common adverse events were diarrhoea, nausea, headache and dizziness. Telithromycin should provide an effective, convenient and well-tolerated once-daily oral therapy for treatment of respiratory infections.     

儿童急性下呼吸道感染病毒病原学分析

目的 分析儿童急性下呼吸道感染(Acute low er respiratory infection,ALRTI)病毒病原学特点.方法 我院自2009年1月至2012年1月收治的ALRTI患儿共1045例.采用逆转录(RT)-PCR 方法检测呼吸道合胞病毒(RSV)、鼻病毒(RV)、甲型流感病毒(IFA)、乙型流感病毒(IFB)、副流感病毒(PIV)1～4型、偏肺病毒(hMPV)、腺病毒(AdV)、冠状病毒(HCoV)、肠道病毒(EV)、博卡病毒(HBoV).分析各病毒检出情况,病毒感染与年龄的关系,以及病毒感染与季节的关系.结果 ①儿童下呼吸道感染病毒检出以RSV(29.38%),RV(18.56%),PIV(8.32%),IFB(8.04%),HBoV(8.04%),AdV(7.08%),EV(4.59%),HCoV(1.15%),hMPV(0.77%),IFA(0.48%).②病毒感染阳性率6月至1岁(95.05%),1-3岁(84.14%),＞5岁(76.71%),3-5岁(74.75%),0-6月(70.26%).病毒感染与年龄的关系具有统计学上的显著性意义(P<0.005).③冬季97.19%,春季(88.78%),夏季(84.4%),秋季(66.67%).季节病毒阳性感染率具有统计学上的显著性意义(P<0.001).结论 病毒病原检测在儿童急性下呼吸道感染中占有重要位置,RSV,RV为主要病毒病原,在6月至1岁年龄发检出率最高,冬季检出率最高.