应对细菌耐药——研发新药与合理使用抗生素

抗生素的滥用不仅浪费医药资源,增加患者的医疗费用,更会导致细菌耐药。从开始利用抗生素治疗疾病到第五代头孢菌素的成功研发,人类一直在应对细菌耐药这一问题。当前,研究者致力于研究新型杀菌药物,监管部门加强医疗机构对抗菌药物使用的管理,努力寻找遏制细菌耐药的措施。     

分析细菌耐药机制指导在促进抗生素合理用药中的效果

目的:探究抗生素合理用药管理中细菌耐药机制指导的管理作用.方法:我院抗生素药物管理自2019年1月起实施细菌耐药机制指导,分别自管理前后各抽取100例患者的治疗参与本次研究,对比管理前后医院感染质量、对抗生素相关知识的掌握程度.结果:管理后医院感染、联合用药、多重耐药菌检出、高耐药性药物使用以及抗生素不合理用药的管理效...     

医院细菌耐药分析及对策

目的对医院常见病原菌进行耐药性分析,为临床提供合理使用抗菌药物、制订合理用药方案的依据。方法从送检标本中分离出病原菌,用全自动细菌鉴定,进行耐药性监测。结果常见的革兰阳性菌对青霉素、氨基苷类、大环内酯类、β-内酰胺类等耐药率较高,常见的革兰阴性菌对亚胺培南、美罗培南敏感性较高,含酶抑制剂的耐药率低于不含酶抑制剂者。结论对进行病原菌耐药性监测,掌握常见病原菌耐药特点,更重要的是合理使用抗菌药物。     

规范抗生素使用原则,降低细菌耐药性

目前 ,抗生素不断推陈出新 ,但细菌的耐药问题也日趋严重。除了细菌本身的微生物学特征可能促进耐药性形成之外 ,另一原因就是抗生素的大量滥用。特别是近几年 ,许多医务人员使用抗生素广泛存在无序、不规范的情况 ,为细菌耐药菌株的产生创造了条件。1　抗生素滥用的原因1 1　药品促销及医生道德。受我国制药及医药经营企业的发展水平、规模、历史原因等因素的影响 ,我国的医药市场一直竞争激烈 ,各种药品促销手段层出不穷 ,严重干扰了药品从审核引进到使用的各个环节。个别医德薄弱的医生 ,在利益驱使下 ,大量使用有丰厚促销费的抗生素。…     

2011年我院细菌监测与耐药情况分析

目的了解该院2011年临床分离最多的几种细菌及其对常用抗菌药物的耐药性,分析细菌耐药与抗菌药物使用的关联性。方法对2011年我院微生物室对临床标本(血、脓、粪及尿)培养,共检出细菌4865份,按照《全国临床检验操作规程》(第3版)及药敏试验对其进行分析;对比2011年我院抗菌药物使用情况。结果前6位的细菌为:大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌和凝固酶阴性葡萄球菌。结论该院培养出部分细菌耐药性较高,临床使用抗菌药物时应该根据药敏结果合理使用,减少耐药菌株的产生。     

细菌耐药机制指导在抗生素合理应用中的临床价值分析

目的在抗生素合理应用中进行细菌耐药机制指导,分析细菌耐药机制指导的临床应用价值。方法选择医院住院部患者,共计100例(研究组),2016年6月至2016年11月是此次研究时间段落,在此期间对患者进行细菌耐药机制指导;与此同时,选择2016年1月至2016年5月的100例医院住院部患者作为对照组(没有进行细菌耐药机制指导),分析组间患者的抗生素处方不合理用药率、高耐药可能性药物使用率、联合用药率。结果在此次观察项目对比中,存在统计学意义的数据指标有:组间患者的抗生素处方不合理用药率、高耐药可能性药物使用率、联合用药率,且均以研究组的数据指标更具有优势性,即研究组患者的抗生素处方不合理用药率、高耐药可能性药物使用率、联合用药率数据均更低,P均<0.05。结论在抗生素合理应用中加以细菌耐药机制指导,能够提高医院耐药菌感染防控水平,有实施价值。     

对医院抗生素的使用与细菌耐药性监测的分析

目的 监测抗生素的使用与临床主要分离菌的耐药率.方法 通过电脑程序调取住院药房抗生素的消耗数量,并按用药频度(DDDs)进行排序;临床分离菌用Kirby Bauer法进行药敏试验.结果 头孢菌素类、喹诺酮类、大环内酯类临床用药最为广泛;在抗生素DDDs的排序中前10位包括2种喹诺酮类和6种头孢菌素类,尤其头孢唑啉的使用频率最高.在临床分离菌中最常见的菌种为大肠埃希菌、凝固酶阴性葡萄球菌、铜绿假单胞菌、金黄色葡萄球菌等.结论 抗生素管理与临床应用需进一步规范,细菌耐药监测应高度重视.     

2012年~2013年某院细菌耐药的监测情况

目的分析2012年~2013年包头医学院第一附属医院分离的主要病原菌及耐药情况,为感染性疾病治疗和抗菌药合理应用提供依据。方法对2012年~2013年从临床标本分离的2631株细菌统计及对常见细菌耐药率分析。结果 2年共分离细菌2631株,革兰阴性菌1750株,革兰阳性球菌881株。2年来革兰阴性菌前三位均是:大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌。产超广谱β-内酰胺酶(ESBL)大肠埃希菌检出率分别为47.2%和52.2%;革兰阳性球菌前三位2012年为凝固酶阴性葡萄球菌、金黄色葡萄球菌、屎肠球菌;2013年为金黄色葡萄球菌、凝固酶阴性葡萄球菌、表皮葡萄球菌,其中MRSA检出率分别为23.3%(2012年)和20.2%(2013年),未检出耐糖肽类药物的金葡菌。结论医院的细菌耐药比较严重,细菌监测对临床合理应用抗生素及预防细菌耐药有重要的参考价值。     

我院抗菌药物应用与细菌耐药性分析

目的：分析本院抗菌药物应用情况和细菌耐药性相关性,研究抗菌药物用药频度（DDDs）和细菌耐药性之间的关系,为临床应用抗菌药物提出合理化建议。方法对2010~2013年12种抗菌药物年用量和医院常见病原菌对这些药物的耐药性进行统计学分析,分析DDDs与细菌耐药性之间的相关性。结果2010~2013年12种抗菌药物的DDDs呈波动状况,细菌耐药率逐年上升;DDDs排名前列的药物,细菌耐药性较高。结论抗菌药物不合理应用会加速细菌耐药性的发生,合理规范地应用和管理抗菌药物可以延缓耐药菌的产生,对临床治疗有重要意义。     

Monitoring bacterial resistance to restricted antibiotics.

Data on patterns of resistance of eight strains of bacteria toward various restricted antibiotics were collected from 18 public health laboratories in Czechoslovakia. Development of bacterial resistance to gentamicin and colistin did not appear to follow the resistance patterns of bacteria toward more commonly used antibiotics, but there did appear to be a tendency of mutual coresistance to those two drugs in E. coli and Pseudomonas strains. Similarly, oxacillin coresistance was found in lincomycin-resistant staphylococcal strains. Computer-assisted analysis of resistant bacterial strains revealed otherwise-hidden tendencies and mutual relationships among drugs newly marketed in Czechoslovakia.     

Economic implications of resistance to antimalarial drugs

The widespread evolution of drug resistance in malarial parasites has seriously hampered efforts to control this debilitating disease. Chloroquine, the mainstay of malaria treatment for many decades, is now proving largely ineffective in many parts of the world, particularly against the most severe form of malaria--falciparum. Alternative drugs have been developed, but they are frequently less safe and are all between 50 and 700% more expensive than chloroquine. Choice of drug clearly has important budgetary implications and national malaria control programmes need to weigh up the costs and benefits in deciding whether to change to more effective but more expensive drugs. The growth in drug resistance also has implications for the choice of diagnostic tool. Clinical diagnosis of malaria is relatively cheap, but less specific than some technological approaches. As more expensive drugs are employed, the cost of wasted treatment on suspected cases who do not in fact have malaria rises and the more worthwhile it becomes to invest in more specific diagnostic techniques. This paper presents an economic framework for analysing the various malaria drug and diagnostic tool options available. It discusses the nature of the key factors that need to be considered when making choices of malaria treatment (including treatment costs, drug resistance, the costs of treatment failure and compliance) and diagnosis (including diagnosis cost and accuracy, and the often overlooked costs associated with delayed treatment), and uses some simple equations to illustrate the impact of these on the relative cost effectiveness of the alternatives being considered. On the basis of some simplifying assumptions and illustrative calculations, it appears that in many countries more effective drugs and more specific and rapid diagnostic approaches will be worth adopting even although they imply additional expense.     

Antiretroviral therapy and resistance to antiretroviral drugs

Slightly more than a decade after the discovery of HIV as the causative agent of AIDS, effective therapies against this virus have become available. Because of a large degree of cross-resistance among antiretroviral agents in the same class (nRTIs, NNRTIs, or PIs), once a therapy has failed virologically, future therapeutic options with currently available drugs are limited, however. Poor tolerability and toxicity may also compromise the long-term prospects of antiretroviral therapy. Nevertheless, benefits of antiretroviral therapy far outweigh the downsides and efforts to scale up responsible use of antiretroviral agents in developing countries are a priority in the fight against HIV/AIDS. This paper presents an overview of antiretroviral therapy and resistance to antiretroviral drugs.     

Transporters involved in resistance to antimalarial drugs

The ability to treat and control Plasmodium falciparum infection through chemotherapy has been compromised by the advent and spread of resistance to antimalarial drugs. Research in this area has identified the P. falciparum chloroquine resistance transporter (PfCRT) and the multidrug resistance-1 (PfMDR1) transporter as key determinants of decreased in vitro susceptibility to several principal antimalarial drugs. Transfection-based in vitro studies are consistent with clinical findings of an association between mutations in the pfcrt gene and failure of chloroquine treatment, and between amplification of the pfmdr1 gene and failure of mefloquine treatment. Many countries are now switching to artemisinin-based combination therapies. These incorporate partner drugs of which some have an in vitro efficacy that can be modulated by changes in pfcrt or pfmdr1. Here, we summarize investigations of these and other recently identified P. falciparum transporters in the context of antimalarial mode of action and mechanisms of resistance.     

Antibiotic drugs targeting bacterial RNAs

RNAs have diverse structures that include bulges and internal loops able to form tertiary contacts or serve as ligand binding sites. The recent increase in structural and functional information related to RNAs has put them in the limelight as a drug target for small molecule therapy. In addition, the recognition of the marked difference between prokaryotic and eukaryotic rRNA has led to the development of antibiotics that specifically target bacterial rRNA, reduce protein translation and thereby inhibit bacterial growth. To facilitate the development of new antibiotics targeting RNA, we here review the literature concerning such antibiotics, mRNA, riboswitch and tRNA and the key methodologies used for their screening.KEY WORDS: RNA, Antibiotics, Drug targeting, Bacteria     

PTEN基因与肿瘤耐药

肿瘤对抗肿瘤药物产生耐受性是肿瘤内科治疗失败的主要原因.PTEN是一种具有双特异性磷酸酶活性的抑瘤基因,其失活与多种肿瘤的发生发展密切相关.近年来的研究表明,PTEN在肿瘤耐药中发挥着重要作用.PTEN失活可介导肿瘤对表皮生长因子受体(EGFR)酪氨酸激酶抑制剂、抗Her-2/ErbB2人源化单克隆抗体曲妥珠单抗(trastuzumab)、抗EGFR人/鼠嵌合型单克隆抗体西妥昔单抗(cetuximab)、NOTCH1抑制剂、顺铂、阿霉素和紫杉醇等的耐受性,其机制与PTEN对PI3K-AKT信号途径的抑制有关.现综述PTEN基因的生物学特性及其在近年研究较多的几种肿瘤靶向药物耐药中的作用特征.