典型抗生素对羊角月牙藻的生长抑制及其联合毒性

目的 研究两种使用量较大的头孢类抗生素(头孢氨苄、头孢拉定)及其主要降解产物7-氨基头孢霉烷酸(7-ACA)和四环素类药物(四环素和金霉素)对羊角月牙藻(Selenastrum capricornutum)生长的作用及其联合毒性.方法 将5种物质分别暴露于羊角月牙藻,设置5个浓度梯度(四环素和金霉素均为0.25～4 μg,/ml,头孢氨苄、头孢拉定均为0.1～1 000 μg/ml,7-ACA为60～960 μg/ml)及空白对照;同时,依据毒性单位法设计四环素+金霉素及四环素+7-ACA的联合毒性实验,5个浓度梯度的混合物总毒性单位(TU)为0.2、0.4、0.8、1.6和3.2 TU,培养72 h后测定藻液密度并计算相应抑制率和半数抑制浓度(IC50值).结果 羊角月牙藻的72 h-IC50分别为:四环素0.50 μg/ml、金霉素0.47 μg/ml、7-ACA 775.6μg/ml.头孢拉定在测试浓度范围(0.1～1 000 μg/ml)的抑制率均为负值;头孢氨苄在低浓度(0.1、1和10μg/ml)时的抑制率为负值,但在高浓度(100和1 000 μg/ml)下产生抑制作用;且当头孢氨苄浓度为1 000 μg/ml时,抑制率小于50％.因而头孢拉定和头孢氨苄在所测试范围内不能计算出72 h-IC50值.四环素+金霉素组的IC50值为0.99 TU;而四环素+7-ACA组的IC50值为1.5 TU.结论 四环素类药物对羊角月牙藻的生长产生抑制作用;但头孢拉定在测试浓度却刺激羊角月牙藻的生长;头孢氨苄和7-ACA对羊角月牙藻的作用存在明显hormesis现象,且7-ACA的毒性明显高于其母体.四环素和金霉素的联合毒性表现为相加作用,而四环素+7-ACA的联合毒性则为拮抗作用.     

Antibiotic related acute kidney injury in patients treated for open fractures

ObjectiveAntibiotic administration during the treatment of open fractures has been shown to reduce infection rates and is considered a critical step in the management of these injuries. The purpose of this study was to determine if aminoglycoside administration during the treatment of open fractures leads to acute kidney injury.MethodsPatient records at a level I trauma centre were reviewed for adult patients who presented in 2014 with open fractures were screened for inclusion. Patients were excluded with fractures of the phalanges, metatarsals, and metacarpals, with isolated traumatic arthrotomies, or pre-existing renal dysfunction. Charts were reviewed for patient age, gender, race, past medical history, medication history, injury severity score, intravenous dye studies and fracture type. Patients were divided into those given cefazolin (Group A) and cefazolin with gentamicin (Group B). Laboratory values were used to determine which patients developed kidney dysfunction as measured using the RIFLE criteria. Wilcoxon–Mann–Whitney test and Chi-square were used to compare interval and categorical variables, respectively. Significance was set at P < 0.05.ResultsOne-hundred and fifty-nine patients met inclusion criteria. Forty-one (25%) patients were given cefazolin alone and 113 (68%) patients were given cefazolin with gentamicin. Ten (18%) patients with Gustilo-Anderson type III fractures were given cefazolin alone and 67 (67%) patients with types I or II fractures were given a cefazolin with gentamicin. Baseline characteristics and risk factors for renal dysfunction did not vary between groups. Two (4.8%) patients in Group A and 5 (4%) patients in Group B developed acute kidney injury (P = 0.599).ConclusionsGentamicin use during the treatment of open fractures does not lead to increased rates of renal dysfunction when used in patients with normal baseline renal function.     

紫外线与亚硝酸复合诱变在顶头孢霉菌选育中的应用

为了提高头孢菌素C的产量,通过对头孢菌素C产生菌顶头孢霉菌B42-V2进行紫外线和亚硝酸的复合诱变处理,得到变株B42-V2N,单位提高10．04％,且遗传性状非常稳定。实验表明：紫外线和亚硝酸复合诱变,操作简便、安全高效,所选育菌种遗传性状稳定。     

Salmonella meningitis: clinical experience of third-generation cephalosporins

Fifteen paediatric patients with Salmonella meningitis were retrospectively reviewed. Presenting symptoms and signs included fever, vomiting, seizures, poor activity, diarrhoea and bulging anterior fontanelle in most patients. Seven out of eight patients with prolonged fever for > 10 days had neurologic sequelae; therefore, prolonged fever is a significant prognostic factor of a poor outcome ( p < 0. 005). All 15 patients had a brain ultrasound or computed tomography in the acute stage and 11 patients had abnormal findings. The 14 surviving patients were treated with a third-generation cephalosporin for at least 3 weeks. Seven patients (47%) made complete recoveries; two of them were treated solely with a third-generation cephalosporin. Only one mortality (6%) occurred and there were no relapses. In conclusion, high frequencies of prolonged fever, neuroimaging abnormalities and neurologic sequelae were seen in patients with Salmonella meningitis treated with third-generation cephalosporins.     

New concepts in the field of cephalosporins: C-3'quaternary ammonium cephems (Group IV)

The C-3' quaternary ammonium cephems belong to group IV of the microbiological classification of cephalosporins. This group is divided into two subgroups according to the position of the quaternary ammonium moiety (C-3 or C-7). These compounds are structurally related to the third-generation cephalosporins (or group III of the microbiological classification), but in addition are featured with two or more of the following properties: broad-spectrum activity including Pseudomonas aeruginosa; activity against Enterobacteriaceae producing type 1 β-lactamase; the presence of a quaternary moiety. The zwitterionic properties of the C-3' quaternary cephalosporins allow rapid penetration through the outer membrane of Gram-negative bacteria, stability to and low affinity for type 1 β-lactamases in the periplasmic space and high affinity for the penicillin binding proteins (PBPs). Among the currently available analogues cefpirome and cefozopran exhibit a well-balanced antibacterial spectrum against Gram-negative bacilli and Gram-positive cocci. Cefepime is less active against Staphylococcus aureus.     

头孢他美（Cefetamet）的合成

２－甲肟基－２－（２－氨基－４－噻唑）乙酸经Ｖｉｌｓｍｅｉｅｒ试剂活化后，与带有保护基的７－ＡＤＣＡ缩合得到头孢他美。     

痰热清注射液联合西药治疗青壮年肺部感染随机平行对照研究

[目的]观察痰热清注射液联合西药治疗青壮年肺部感染疗效。[方法]使用随机平行对照方法,将98例住院患者按抽签法简单随机分为两组。对照组49例止咳、去热、吸氧以及化痰等;根据细菌药敏试验结果,头孢哌酮钠舒巴坦钠1.5g+100mL生理盐水,1次/d,静滴;头孢西汀钠2g+100mL5%葡萄糖,2次/d,静滴。治疗组49例痰热清注射液20mL+200mL5%葡萄糖,1次/d,静滴;西药治疗同对照组。连续治疗7d为1疗程。观测临床症状、白细胞、痰菌、不良反应。连续治疗2疗程,判定疗效。[结果]治疗组痊愈36例,显效7例,有效4例,无效2例,总有效率95.92%。对照组痊愈23例,显效12例,有效9例,无效5例,总有效率89.80%。治疗组疗效优于对照组(P0.05)。[结论]痰热清注射液联合西药治疗青壮年肺部感染效果显著,值得推广。     

我院住院患者头孢菌素类药物利用分析

目的：了解医院头孢菌素类药物的使用情况及其合理性,促进临床合理用药。方法：根据医院计算机药品信息管理系统的原始数据资料,采用世界卫生组织（WHO）推荐的限定日剂量法,以限定日剂量（DDD）、用药频度（DDDs）、药物利用指数（DUI）为指标对2007年我院住院患者头孢菌素类药物使用情况进行统计分析。结果：2007年我院住院患者应用头孢菌素类药物有25个品种,占总抗菌药金额的59．39％,其中,第三代头孢菌素类药物及其复方制剂和氧头孢烯类药物销售金额占75．14％,成为临床治疗的主导药物。结论：2007年我院住院患者应用头孢菌素类药物基本合理,应严格控制第三代头孢菌素类药物及其复方制剂的应用,掌握用药指征,以提高疗效,延缓细菌耐药。     

我院头孢菌素类抗生素使用分析

目的:了解头孢菌素类抗生素的临床应用情况,为医院头孢菌素类抗生素应用管理提供依据。方法:对2005年~2007年我院头孢菌素的品种、用药金额、用药频度(DDDs)等进行统计、分析。结果:3年中,我院头孢菌素类抗生素的用药金额年平均增长率为39.57%;第三代头孢菌素类抗生素用量最大,用药金额占当年头孢菌素类抗生素75%以上;2007年的第一代、第三代口服头孢菌素类抗生素的DDDs明显高于2005年。结论:第三代头孢菌素类抗生素的使用明显增加,为减少细菌耐药性的发生,应采取措施防止滥用该类药物。     

Clostridium difficile bacteremia and meningitis as a complication of prolonged cephalosporin therapy in a case of staphylococcal pyogenic arthritis

With increasing incidence of Clostridium difficile (C. difficile) associated diarrhea and pseudomembranous colitis, several extra-intestinal manifestations of the organism have been unmasked which include-bacteremia, brain abscess, pericarditis etc. We report a rare and interesting case of C. difficile bacteremia and subsequent meningitis in a 10 year old child. The child was immune competent, which further raises the question about the virulent possibilities of the organism and its implications in the near future. The condition resulted from a prolonged treatment with intravenous (I.V.) cefotaxime for staphylococcal pyogenic arthritis. The child recovered from the septic arthritis but on the 7th day post-admission developed features of bacteremia. The child was later treated with intravenous metronidazole and vancomycin and he was discharged on the 21st day post-admission. No recurrence of symptoms was noted.