碳青霉烯类抗生素耐药菌的治疗选择

多重耐药菌在全球范围内的快速增长和流行日益严重,给临床治疗带来严峻挑战,直接影响患者预后,造成严重的社会和经济负担。最严重的泛耐药菌铜绿假单胞菌、产碳青霉烯酶肺炎克雷伯菌和鲍曼不动杆菌使抗生素的治疗选择濒临绝望的境地。为应对多重耐药菌,在加强耐药监测指导临床治疗的同时,也在不断探讨新的治疗措施。本文对目前国内外碳青霉烯类抗生素耐药菌的流行状况和治疗新进展进行阐述。     

铜绿假单胞菌对碳青霉烯耐药机制的研究

铜绿假单胞菌（Pseudomonas aeruginosa,PA）是一种常见的院内获得性感染的条件致病菌,其所致感染可供选择的有效抗菌药物甚少。碳青霉烯类抗生素常被作为治疗对其它β-内酰胺抗生素耐药的革兰阴性菌的最后一道防线,但是近年来PA对其耐药率在逐年上升。PA对碳青霉烯的耐药机制是复杂的,通常是多种机制综合作用产生的,目前认为主要是由于：产生β-内酰胺酶（碳青霉烯酶、AmpC酶）、外膜通透性改变和主动外排泵系统的存在。     

烧伤病房老年患者感染铜绿假单胞菌耐碳青霉烯类药物现况

<正>铜绿假单胞菌是医院获得性感染最常见的条件致病菌之一。碳青霉烯类抗菌药物在临床抗铜绿假单胞菌感染治疗中发挥了十分重要的作用,然而,铜绿假单胞菌耐碳青霉烯类抗菌药物临床分离株逐渐增多,并在不同地区、国家播散,对临床控制医院感染造成了严重的危害。铜绿假单胞菌耐药机制复杂,包括抗生素灭活酶或修饰酶的生成、外膜低渗透性、外膜孔蛋白缺失、生物膜形成和主动外排等〔1〕。产金属β-内酰胺酶(MBL)又称金属酶,能水解β-内酰胺类抗菌药物,包括碳青霉     

铜绿假单胞菌耐药性及产碳青霉烯酶研究

目的了解医院2010年分离的铜绿假单胞菌的耐药性及耐亚胺培南菌株产碳青酶烯酶情况。方法 K-B纸片扩散法进行药敏试验;碳青霉烯酶检测采用改良Hodge试验。结果 2010年分离铜绿假单胞菌145株,主要来自呼吸道标本、脓汁及分泌物。药敏结果显示铜绿假单胞菌氨苄西林耐药率最高,达88.97%。对阿莫西林/克拉维酸、头孢噻肟、环丙沙星和头孢他啶的耐药率均超过50%。对洛美沙星和头孢哌酮/舒巴坦较敏感;耐亚胺培南铜绿假单胞菌31株,耐药率21.38%,改良Hodge试验阳性10株,阳性率为32.26%。结论分离的铜绿假单胞菌耐药性和产碳青霉烯酶率均较高,铜绿假单胞菌耐药严重     

碳青霉烯类耐药的铜绿假单胞菌感染对血液病患者病死率的影响

目的 评估碳青霉烯类耐药铜绿假单胞菌(CRPA)对血液病患者病死率的影响,寻找引起感染的预测因素和分析预后的风险因素,为预防和治疗CRPA提供依据。方法 本项研究为回顾性队列研究。纳入上海市第一人民医院2010年1月至2016年12月血液系统疾病治疗期间住院的铜绿假单胞菌感染的成人患者。比较CRPA和碳青霉烯类敏感铜绿假单胞菌(CSPA)感染患者的临床特征、预后因素和病死率。主要观察终点是30 d全因病死率。结果 共81例患者纳入研究,CSPA组58例,CRPA组23例,主要为急性白血病和淋巴瘤患者,占79.0%(64/81),发生感染时中位中性粒细胞绝对计数为0.24×109/L。CRPA的独立风险因素是感染前平均住院时间长(P=0.013,OR=1.045)和30 d内曾经使用碳青霉烯类药物(P=0.005,OR=8.132)。81例患者30 d全因病死率为29.6%(24/81);归因病死率为13.6%(11/81);肺部感染是主要死亡原因,占41.7%(10/24)。CRPA组30 d全因病死率显著高于CSPA组[60.9%(14/23)比17.2%(10/58),P<0...     

细菌对碳青霉烯类抗生素耐药的机制及对策

碳青霉烯类抗生素(亚胺培南、美罗培南等)1987年开始应用于临床，它是全新的β-内酰胺类抗生素，对革兰氏阴性菌和阳性菌、需氧菌和厌氧菌等均有超广谱、强效抗菌作用。二十世纪90年代以来广泛用于治疗未知病原体引起的重症感染，但随之出现了日益严重的细菌耐药性问题。铜绿假单胞菌、不动杆菌、肠杆菌科等细菌耐药报道有所增加，这些细菌导致的感染往往暴发流行，使治疗陷入无药可用的境地，     

耐碳青霉烯肺炎克雷伯菌感染的危险因素及耐药机制的研究

目的 探讨耐碳青霉烯肺炎克雷伯菌感染的危险因素及耐药机制.方法 对我院2018年6月1日-2019年5月31日57例耐碳青霉烯肺炎克雷伯菌(CRKP)感染患者和70例碳青霉烯敏感肺炎克雷伯菌(CSKP)感染患者进行回顾性分析.结果 CRKP感染患者主要分布在呼吸科31.6％(18/57)、神经内科21.1％(12/57...     

碳青霉烯类耐药肠杆菌科细菌的研究进展

碳青霉烯类抗菌药物通常被认为是治疗常见革兰阴性杆菌严重感染最有效的抗菌药物,包括由耐药菌株引起的感染。然而,随着碳青霉烯类抗菌药物在临床的广泛应用,产碳青霉烯酶的细菌也不断出现。肠杆菌科细菌是临床最常见的革兰阴性杆菌,尤其是碳青霉烯类耐药肠杆菌科细菌(carbapenem-resistant Enterobacteriaceae,CRE)的分离率在逐年增加。CRE传播速度快、范围广、致死率高,并且已在许多国家发生流行,对全球公共卫生构成重大威胁,应当引起高度重视与关注。本文就CRE流行情况、耐药机制、检测方法、治疗方案以及防控策略等作简要综述。     

耐碳青霉烯类大肠埃希菌产碳青霉烯酶基因型和同源性检测及分析

目的 检测并分析耐碳青霉烯类大肠埃希菌(CRECO)产碳青霉烯酶基因型及其同源性.方法 对2020年湖北省十堰市3家三甲医院临床分离的31株CRECO采用MALDI-TOF质谱仪进行菌种再鉴定,K-B纸片扩散法和E test条复核药敏结果,得到23株CRECO.采用碳青霉烯类药物的协同试验初筛产碳青霉烯酶基因型,PCR...     

Natriuretic peptides in heart failure: where we are, where we are going

Tremendous advances have been made in understanding the pathophysiology and treatment of congestive heart failure (CHF). However, diagnosis still remains difficult, even with a comprehensive physical examination. Symptoms such as dyspnea are non-specific and poorly sensitive indicators for early CHF that can be largely undetected. The discovery of natriuretic peptides (BNP) as diagnostic biomarkers has been one of the most critical advances for heart failure diagnosis. Therefore, both B-type and N-terminal pro-B-type have potential role in the diagnosis of heart failure, as well as in prognostic risk assessment. A single determination of BNP at any time during the progression of chronic HF provides a clinically useful tool for risk stratification. The hypothesis that repeated measurements might carry prognostic information beyond a single measure was confirmed in different settings. One of the main interests is given to the values of repeated determinations for monitoring progression of disease, and for the evaluation of the clinical effects of medical therapy. Nevertheless, despite thousands of papers describing their potential utility, current guidelines have not endorsed the highest level of recommendation for their use, in part, because the application in clinical practice is often limited for the absence of well codified cut off. Recently, European guidelines emphasized the role of natriuretic peptides as potential laboratory markers. In the near future, algorithm building will take into consideration clinical and echocardiographic parameters as well as NP measurements, and this may lead to a correct diagnosis and identification of patients at high risk. The purpose of this review is to discuss the clinical approaches and future applications of natriuretic peptides in heart failure and coronary disease.     

Management of indolent lymphoma: Where are we now and where are we going

Indolent lymphoma comprises a unique and challenging subset of non-Hodgkin lymphoma (NHL). While definitions of indolence will vary, the most common indolent NHL subtypes include follicular lymphoma, marginal zone lymphoma, and small lymphocytic lymphoma. Patients with indolent NHL (iNHL) excluding those with rare localized presentations are often met with an incurable but highly treatable NHL. In the rituximab era, response rates are approaching 90% with rituximab plus chemotherapy and time to next treatment are beginning to be measured in years. As a result of a prolonged natural history, we are encountering a gridlock of novel regimens and agents that appropriately fill peer-reviewed journals. In this review, we tackle a spectrum of topics in the management of indolent lymphoma including the initial approach to the newly diagnosed patient, approaches to first cytotoxic chemotherapy, maintenance and consolidation techniques, as well as highlight promising treatments on the horizon in iNHL. Clinicians continue to face tough choices in the management of iNHL. Through well-thought out clinical trials and peer-reviewed vetting of data we will continue to determine how to best manage the clinical continuum that is iNHL.