大肠埃希菌耐药机制研究及进展

大肠埃希菌的耐药机制主要是产生灭活酶、细胞壁的改变、主动外排以及作用靶位结构的改变。随着广谱抗生素、第3代头孢菌素及β-内酰胺类药物的应用使耐药菌不断产生。对大肠埃希菌耐药机制的研究进展作简要综述。     

153例泌尿系大肠埃希菌感染分析

大肠埃希菌是条件致病菌 ,广泛分布于自然界 ,是引起人类泌尿系感染的常见病原菌。随着抗生素应用的升级 ,以大肠埃希菌为代表的细菌耐药性不断增加 ,给临床治疗带来了极大的困难。为此我们对泌尿系感染的大肠埃希菌进行分析 ,了解其耐药现状并指导临床合理用药。1　一般资料15 3例大肠埃希菌均分离自我院门诊和住院病人 ,经诊断为泌尿系感染的 2 76例尿标本中 ,取清晨中段洁净尿标本于无菌杯内 ,及时送检。2 76例泌尿系感染尿标本中共分离出 15 3株大肠埃希菌 (包含 2种细菌感染 ,未见 2种以上 ) ,占泌尿系总感染率的 5 5 4 %。 15 3株大…     

县级医院产广谱β-内酰胺酶大肠埃希菌的耐药分析

目的了解临床上我院分离的大肠埃希菌产广谱β-内酰胺酶的情况,并对其耐药性进行分析,从而为临床上抗菌药物的合理使用提供科学的使用依据。方法使用珠海黑马半自动微生物鉴定敏分析仪对细菌进行鉴定,而药敏试验使用K-B纸片扩散法。结果在2013年6月至2014年6月,我院共送检600份临床标本,在其中共分离出大肠埃希菌150株,而其中共有40株能够产广谱β-内酰胺酶。总检出率为26.67%(40/150)。产广谱β-内酰胺酶大肠埃希菌极度耐药的抗生素为头孢类抗生素包括头孢唑啉、头孢他啶,其耐药率分别为100%和93.23%;对于复方新诺明、庆大霉素的耐药性也较强,其耐药率分别为86.11%和72.87%;对于阿米卡星、氨苄西林以及哌拉西林的耐药性较弱,其耐药率分别为51.23%、48.56%和34.21%;对于亚胺培南、头孢哌酮/舒巴坦及左氧氟沙星和的耐药性最弱,其耐药率分别为0%、10.8%与21.2%。结论目前,我院产广谱β-内酰胺酶的大肠埃希菌的阳性率比较高,已经成为患者发生感染的主要病原菌,因此应该以细菌耐药性的监测数据资料为根据,严格管理并加强临床上抗菌药物的合理使用,积极预防耐药菌株的产生和医院感染的暴发流行。     

大肠埃希氏菌产超广谱β-内酰胺酶研究进展

大肠埃希氏菌产 β -内酰胺酶是其对 β -内酰胺类抗生素耐药的主要机制 ,所产 β -内酰胺酶种类繁多、特性各异。并在 β -内酰胺类抗生素广泛应用的选择压力下 ,不断有新的 β -内酰胺酶产生。本文对大肠埃希氏菌产 β -内酰胺酶 (ESBL ,IRTs ,AmpC)的耐药机制的研究进展作简要综述。     

205株大肠埃希菌的耐药分析

目的：了解大肠埃希菌的耐药特点,探讨耐药性产生的原因。方法：常规细菌培养分离,采用ＶＩＴＥＫ－ＡＭＳ进行鉴定和药敏试验。结果：２０５株大肠埃希菌从尿中分离出９２株（４４．８％）。对头孢类的耐药率为５．６￣７６．３２％对合成青霉素类为６０￣８７．２３％;在１２种抗生素中,对５种以上耐药的菌株有１４０株;耐环丙沙星８３株,并且至少４种药物。结论：大肠埃希菌为泌尿系统感染的首位细菌临床应重视它的多重耐药     

医院内感染大肠埃希氏菌超广谱β-内酰胺酶的监测与耐药分型的研究

目的 对大肠埃希氏菌医院分离株进行ESBL分子流行病学和耐药分型研究。方法 应用WALKAWAY-40全自动细菌鉴定仪确定大肠埃希氏菌907菌株。对其进行ESBL的产生再行13种抗菌素的耐药分型研究。结果 用3种测定907例大肠埃希氏菌产ESBL阳性率为9.6％和12.5％,经PFGE图谱证实神经外科流行A型菌株,呼吸和肾内科流行B型菌株,其他各型呈散在分布。结论 严格遵守无菌操作规程和屏障护理,对控制医院感染的流行十分重要。     

超广谱β-内酰胺酶大肠埃希菌的耐药监测

目的 了解超广谱β-（ESBLs）大肠埃希菌的耐药特点。方法采用复合纸片表型确证法检测80株产ESBLs大肠埃希菌的体外抗生素耐药性作初步研究。结果产ESBLs的大肠埃希菌的检出率为14．8％，产ESBLs菌对13种常用抗菌药物的耐药率明显高于非产酶菌株。结论提高产ESBLs菌株的阳性检出率，治疗ESBLs菌引起的感染，首选亚胺培南及其药敏试验显示敏感的药物。     

大肠埃希菌耐药机制研究进展

大肠埃希菌对常用抗菌药物的耐药机制相当复杂,主要包括产生灭活抗生素的酶、改变药物作用靶位、细胞外膜通透性的改变及细菌药物外排泵。近年来对其耐药机制研究较多,尤其是在质粒介导耐药性的研究上取得了一些进展。     

大肠埃希菌ESBLs、AmpC酶的检测及耐药特性

目的 分析大肠埃希菌产超广谱β-内酰胺酶（ESBLs）、头孢菌素（AmpC）酶的情况及耐药特性,指导临床合理用药.方法 收集2011年1月至2012年6月我院临床分离的大肠埃希菌287株.用双纸片确诊法检测ESBLs,三维试验检测AmpC酶,KB法进行药敏试验.结果 287株大肠埃希菌中,产ESBLs 119株（41.5％）,产AmpC酶47株（16.4％）,同时检出产ESBLs和AmpC酶16株（5.6％）.单一产ESBLs或AmpC酶的菌株有较高的耐药性,同时检出ESBLs和AmpC酶的菌株对多种抗菌药耐药,所有菌株对亚胺培南均敏感.结论 大肠埃希菌ESBLs和AmpC酶的分离率及耐药率都较高,同时检出ESBLs和AmpC酶的菌株具多重耐药性;亚胺培南具有良好的抗菌活性.临床应加强ESBLs和AmpC酶的检测及耐药监测,采取有效措施防止耐药菌株产生.     

临床分离大肠埃希菌ESBLs的检出率与耐药性分析

目的 了解临床分离大肠埃希菌超广谱β-内酰胺酶的检出率和耐药情况,为临床合理选用抗生素提供依据.方法 根据NCCLS推荐的琼脂稀释法进行药敏试验;用双纸片协同试验检测产ESBLs菌.结果 108株临床分离大肠埃希菌检出产ESBLs菌62株,检出率为57.4%.ESBLs菌株对15种常用抗菌药物耐药率,对亚胺培南的耐药率低于2%,对哌拉西林/他唑巴坦耐药率为35.5%,对头孢哌酮/舒巴坦的耐药率为45.2%,对头孢他啶的耐药率为46.8%,对其他药物的耐药率均较高.结论 应加强对临床分离大肠埃希菌耐药性监测,指导临床合理使用抗生素,减少新的ESBLs的产生.     

Extreme thrombocytosis under the treatment by amoxicillin/clavulanate

Amoxicillin/Clavulanate related extreme thrombocytosis during the treatment of pneumonia has never been reported. We present a 54-year-old patient who was admitted due to pneumonia, and was treated with amoxicillin/clavulanate IV and 3-day course of 500 mg azithromycin. Despite clinical and radiological evidence showing that pneumonia improved, thrombocytes increased rapidly. After stopping the antibiotic, the thrombocytes returned gradually to normal. Considering the clinical course, we propose that this extreme thrombocytosis was caused by the administration of amoxicillin/clavulanate. We describe this rare and unique patient and review the literature.     

阿莫西林/克拉维酸钾治疗呼吸道感染疗效比较

目的：观察阿莫西林,克拉维酸钾治疗呼吸道感染的疗效。方法：采用随机对照单盲设计,比较阿莫西林,克拉维酸钾与头孢哌酮,舒巴坦治疗呼吸道感染的临床疗效。结果：试验组和对照组的临床总有效率分别为89．58％和89．13％,细菌清除率分别为95.00％和89.74％,不良反应发生率分别为8.3％和6．52％。结论：阿莫西林,克拉维酸钾是一种治疗呼吸道感染安全有效的药物。     

左氧氟沙星联合阿莫西林克拉维酸钾治疗耐多药肺结核的临床疗效

目的：探讨左氧氟沙星联合阿莫西林克拉维酸钾治疗耐多药肺结核的临床疗效。方法将212例耐多药肺结核患者随机分为观察组和对照组各106例。所有患者均严格给予抗结核化疗,支持治疗和密切护理,观察组给予左氧氟沙星联合阿莫西林克拉维酸钾治疗,对照组仅给予左氧氟沙星治疗。治疗后观察2组临床疗效、病灶吸收程度、空洞闭合情况。结果观察组总有效率为95．28％高于对照组的83．02％,差异均有统计学意义（P＜0．05）。观察组病灶吸收率、空洞闭合率均高于对照组,差异均有统计学意义（P＜0．05）。结论左氧氟沙星联合阿莫西林克拉维酸钾治疗耐多药肺结核具有良好的治疗效果,且不增加不良反应事件发生率,值得临床推广应用。     

Once daily clarithromycin extended-release vs twice-daily amoxicillin/clavulanate in patients with acute bacterial sinusitis: a randomized,investigator-blinded study

ABSTRACT

Objective: To compare the efficacy and tolerability of clarithromycin extended-release (ER) to amoxicillin/clavulanate in patients diagnosed with acute bacterial sinusitis.

Research design and methods: In a controlled, multicenter, investigator-blinded study, 437 ambulatory patients at least 12?years old with signs/symptoms and radiographic findings of acute sinusitis were randomized to receive clarithromycin ER 1000?mg once daily or amoxicillin/clavulanate 875?mg/125?mg twice daily for 14?days.

Main outcome measures: Clinical and bacteriological response rates were determined at a test-of-cure visit, which was conducted up to 10?days following the completion of treatment. Radiological response was assessed at a follow-up visit.

Results: The clinical cure rate in clinically evaluable patients was 98% (184/188) in the clarithromycin ER group and 97% (179/185) in the amoxicillin/clavulanate group (95% CI for the difference in rates [–2.4%, 4.7%]). Clinical cure was sustained at the follow-up visit (96% for each treatment group). The pathogen eradication rates were 94% (61/65) in the clarithromycin ER group and 98% (61/62) in the amoxicillin/clavulanate group (95% CI for difference in rates [–12.0%, 2.9%]). The radiological success rate was 94% (172/183) in both the clarithromycin ER and amoxicillin/clavulanate groups (95% CI for difference in rates [–4.9%, 4.9%]). Symptomatic improvement or relief was observed as early as 2?days–5?days after the initiation of study drug, with a statistically significantly higher resolution rate of sinus pressure (?p = 0.027) and improvement/resolution rate of nasal congestion (?p = 0.035) during treatment with clarithromycin ER. The resolution/improvement rate at the test-of-cure visit for each treatment group was ≥ 94% for the primary acute sinusitis signs/symptoms, with a statistically significantly higher resolution/improvement rate of purulent nasal discharge with clarithromycin ER (?p = 0.010). Both study drugs had a positive and rapid impact on quality of life. Patients reported a high level of satisfaction and probability of using either study antibiotic again, and health care resource use was low, with slightly fewer sinusitis-related physician and outpatient visits required by patients in the clarithromycin ER group (?p = 0.055). The treatment groups were comparable with respect to incidence of drug-related adverse events.

Conclusion: In this multinational population of patients with acute bacterial sinusitis, clarithromycin ER was comparable, and for selected measures superior, to amoxicillin/clavulanate based on clinical, bacteriological, and radiological responses as well as quality of life measures, satisfaction with antibiotic therapy, and health care resource utilization.     

Efficacy,tolerability, and parent reported outcomes for cefdinir vs. high-dose amoxicillin/clavulanate oral suspension for acute otitis media in young children*

ABSTRACT

Objectives: To compare efficacy, tolerability, and parental satisfaction of cefdinir and high-dose amoxicillin/clavulanate oral suspensions given to young children with non-refractory acute otitis media (AOM) based on clinical endpoints and outcomes measures.

Research design and methods: This was an investigator-blinded, multicenter study in which 318 children 6 months through 6 years of age with a clinical diagnosis of AOM were randomized to receive 10 days of either cefdinir (14?mg/kg divided BID) or high-dose amoxicillin/clavulanate (90/6.4?mg/kg divided BID).

Main outcome measures: Investigators evaluated clinical response at an end-of-therapy (EOT) office visit conducted on day 12–15. Outcomes of satisfaction, tolerability, and adherence were also assessed at that visit using an Otitis Parent Questionnaire.

Results: The treatment groups were similar at baseline with respect to patient demographics. At the EOT visit, for cefdinir and amoxicillin/clavulanate, respectively, intent-to-treat (ITT) clinical cure rates were 82% (129/158) and 85% (134/158) (?p = 0.547; 95% confidence interval [CI] –11.7 to 5.4) and per-protocol cure rates were 82% (123/150) and 90% (129/143) (?p = 0.045; 95% CI –16.4 to 0.0). This difference was driven primarily by reduced cefdinir response in patients with recurrent AOM (p = 0.010) and those younger than 24 months (p = 0.039). Comparing cefdinir with amoxicillin/clavulanate, parents more often reported significantly better ease of use (89% vs. 57%; p < 0.0001), better taste (85% vs. 39%; p < 0.0001), and better adherence (at least 95% of doses) (82% vs. 61%; p < 0.0001). Diarrhea/loose stools were more common in the amoxicillin/clavulanate group than in the cefdinir group (28% vs. 18%, respectively; p = 0.0341). One patient in the cefdinir group and eight patients in the amoxicillin/clavulanate group withdrew from the study prematurely due to at least one adverse event (?p = 0.0364). Study limitations included assessment of clinical recurrence by telephone call rather than office visit, exclusion of children with refractory AOM, and no assessment of middle ear microbiology.

Conclusions: Among young children with non-refractory AOM, cefdinir was as efficacious as high-dose amoxicillin/clavulanate in the ITT group, but somewhat less effective in per-protocol analysis. From the parental perspective, cefdinir was easier to administer, had a better taste, caused less diarrhea, and resulted in higher treatment adherence than high-dose amoxicillin clavulanate.     

阿莫西林克拉维酸钾序贯疗法治疗肺炎患儿的效果分析

目的 分析阿莫西林克拉维酸钾序贯疗法治疗肺炎患儿的临床疗效。方法 100例肺炎患儿,采用随机数字表法分为对照组和观察组,每组50例。对照组患儿给予阿莫西林克拉维酸钾静脉滴注治疗,观察组患儿采取阿莫西林克拉维酸钾序贯治疗。比较两组患儿症状改善时间、治疗前后肺功能指标、临床疗效及不良反应发生情况。结果 观察组体温恢复正常时间(2.21±0.34)d、肺鸣音消失时间(6.24±0.28)d、咳嗽消失时间(6.56±0.14)d均短于对照组的(3.82±1.46)、(7.54±1.41)、(7.45±1.18)d,差异有统计学意义(P<0.05)。治疗后,观察组第1秒用力呼气容积(FEV1)(2.44±0.31)L、用力肺活量(FVC)(2.84±0.41)L均高于对照组的(1.92±0.24)、(2.25±0.43)L,差异有统计学意义(P<0.05)。观察组治疗总有效率96.00%高于对照组的80.00%,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论 阿莫西林克拉维酸钾序贯治疗肺炎患儿的临床效果确切,可快速...     

阿莫西林与阿莫西林-克拉维酸钾不良反应的对比研究

目的：对比研究阿莫西林和阿莫西林-克拉维酸钾的不良反应,为临床安全用药提供参考。方法：收集解放军药品不良反应监测中心数据库2000年3月至2010年3月阿莫西林和阿莫西林-克拉维酸钾的不良反应报告,并进行回顾性分析。报告的病例分为阿莫西林组和阿莫西林-克拉维酸钾组,比较2组药物的不良反应在临床表现、转归、严重性、对原患疾病影响及发生时间等方面的差异。结果：共收集到576份阿莫西林和阿莫西林-克拉维酸钾不良反应报告。其中438份阿莫西林不良反应报告涉及814例次不良反应1,38份阿莫西林-克拉维酸钾不良反应报告涉及233例次不良反应。阿莫西林组男性220例,女性218例,平均年龄（36.4±19.0）岁;阿莫西林-克拉维酸钾组男性62例,女性76例,平均年龄（40.4±20.9）岁。阿莫西林组和阿莫西林-克拉维酸钾组患者出现皮肤及附件、胃肠、循环和中枢神经系统损害的构成比分别为77.4%（n=630）和55.8%（130）、5.3%（43）和19.7%（46）1、.3%（11）和4.3%（10）、1.3%（11）和4.3%（10）;2组非严重和严重ADR病例的构成比分别为92.5%（405例）和97.8%（135例）7、.5%（33例）和2.2%（3例）;对原患疾病影响明显和不明显患者的构成比分别为9.1%（40例）和1.4%（2例）9、0.9%（398例）和98.6%（136例）;2组之间上述各项指标比较差异均有统计学意义（均P〈0.05）。2组患者不良反应中位发生时间分别为3和1 d。结论：临床应用阿莫西林-克拉维酸钾治疗感染性疾病与阿莫西林相比似较为安全。     

阿莫西林克拉维酸钾口服干混悬剂含量测定方法研究

目的：对阿莫西林克拉维酸钾口服干混悬剂含量测定方法研究。方法：采用高效液相色谱法，在３×３ＣＲＣ１８柱（４ｍｍ×３．５ｃｍ）上，以ｐＨ４．４磷酸二氢钠溶液－甲醇（９５∶５）为流动相，流速１．０ｍｌ·ｍｉｎ－１，检测波长为２２０ｎｍ。结果：阿莫西林和克拉维酸浓度分别在２５～５００μｇ·ｍｌ－１及１０～２００μｇ·ｍｌ－１范围内有良好的线性关系，平均方法回收率分别为９９．４％±１．９％和９９．５％±２．０％，日内精密度分别在１．１％～２．３％和１．７％～２．６％之间，日间精密度分别＜３．１％和＜２．５％。结论：本法实用简便，结果可靠。     

阿莫西林/克拉维酸钾治疗下呼吸道感染临床观察

目的观察阿莫西林/克拉维酸钾治疗下呼吸道感染的临床疗效。方法70例下呼吸道感染患者随机分为治疗组和对照组各35例,分别滴注阿莫西林/克拉维酸钾(实验组)1.8 g或头孢噻肟钠4 g(对照组),每日2次,共7~14 d。结果:治疗组痊愈27例,显效3例,进步2例,总有效率91.4%;对照组痊愈28例,显效1例,进步3例,总有效率91.4%。两组有效率比较无显著性差异(2χ=0.2647,P>0.05)。不良反应发生率分别为8.5%和5.7%。结论阿莫西林/克拉维酸钾治疗下呼吸道感染安全、有效的。     

注射用阿莫西林钠克拉维酸钾的质量评价

摘要：目的 评价国产注射用阿莫西林钠克拉维酸钾的质量现状,并提出改进建议。方法 法定标准检验结合探索性研 究,对产品的杂质谱、克拉维酸聚合物及其他荧光杂质、复溶行为、成盐率、包材密封性等进行比较研究。结果 212批次样 品法定标准检验均符合规定;采用建立的杂质分析方法,对主要杂质的结构与来源进行确证;证明水分和温度易促进主成分 的降解;此外,应严格控制原料成盐过程中的工艺参数,控制成盐剂的残留量;并关注包材密封完整性对产品全生命周期的影 响。结论 注射用阿莫西林钠克拉维酸钾总体质量较好,现行质量标准有待提高。