NICU新生儿败血症首选抗生素现状和预后调查分析

调查分析我院新生儿NICU新生儿败血症患儿首选抗生素的现状及其对预后的影响。方法:对73例新生儿败血症患儿首选抗生素情况及其临床疗效和预后进行回顾性调查分析。调查内容:首选抗生素及其5日内换药率和有效率。查阅文献,结合药理学知识,对所用抗生素进行药效学分析。结果:我院NICU 6种首选抗生素及其5日内换药率、有效率分别如下:头孢三嗪/舒巴坦5日内换药率为74%、有效率为68%,头孢三嗪为50%和50%、头孢噻肟为69%和69%、头孢他啶为60%和60%、头孢地嗪为11%和100%、哌拉西林/他巴唑为50%和25%。结论:新生儿败血症的预后和首选抗生素的更换率成反比,和其药效成正比。6种抗生素中头孢地嗪的疗效最好,因其有独特的广谱强力抗菌活性和免疫增强活性,且副作用少,可作为新生儿败血症的首选抗生素。头孢地嗪对新生儿细菌感染的抗感染和免疫调节作用需进一步研究。     

84株肺炎克雷伯杆菌耐药性分析

目的:探讨肺炎克雷伯杆菌对抗菌药物的耐药性。方法:采用M icro Scan auto SCAN4微生物分析仪测定84株肺炎克雷伯杆菌的耐药性。结果:肺炎克雷伯杆菌对氨苄青霉素的耐药率超过94.0%,氧哌嗪青霉素耐药率83.3%,亚胺硫霉素耐药率15.5%,其余药物耐药率为25.0%~76.2%。结论:亚胺硫霉素对肺炎克雷伯杆菌的耐药率最低,应作为治疗重症肺炎克雷伯杆菌感染的首选用药。     

The epidemiology of preterm labour—why have advances not equated to reduced incidence?

The major burden of preterm birth is in the developing world, where most of the increasing death and morbidity is secondary to infectious diseases such as malaria, HIV, tuberculosis, bacterial vaginosis and intestinal parasites. In some developing countries, the growth of medical care has outstripped the growth of preventive public health, with an associated increase in iatrogenic preterm births. In developed countries, more than one-third of preterm births are medically indicated because of conditions such as fulminating pre-eclampsia or severe intrauterine growth restriction. Neither of these conditions is currently preventable. One in five preterm births is associated with multiple pregnancy, and these have been greatly increased by assisted reproduction techniques. The use of tocolytics has proved disappointing perhaps because inflammation rather than spontaneous uterine activity is increasingly recognised as the final common pathway. Inappropriate antibiotics used late in pregnancy are ineffective and may have adverse effects. Currently, the most promising interventions are public health related and include reducing the transmission of communicable diseases, improvements in the management of diabetes and reduction in harmful behaviours such as smoking and drug abuse.     

Aetiology of preterm labour: bacterial vaginosis

Bacterial vaginosis (BV) is a common condition characterised by a polymicrobial disorder, with an overgrowth of several anaerobic or facultative bacteria and with a reduction or absence of lactobacillus colonisation. The prevalence of BV ranges from 4 to 64%, depending on the racial, geographic and clinical characteristics of the study population. In asymptomatic women, the prevalence varies from 12 to 25%, and similar percentages are observed in pregnant women. Although BV is associated with several adverse outcomes, such as upper genital tract infections, pelvic inflammatory disease, endometritis, preterm birth and low birthweight, many basic questions regarding the pathogenesis of BV remain unanswered. Mucosal immune system activation may represent a critical determinant of adverse consequences associated with BV. An unequal risk for BV acquisition and\or recurrence could derive from different mucosal immune host abilities and\or capability of invading microbes to produce factors that inactivate the local immune response. BV is associated with a two-fold increased risk of preterm birth, with the greatest risk when BV is present before 16 weeks of gestation (odds ratio = 7.55). This may indicate a critical period during early gestation when BV-related organisms can gain access to the upper genital tract and set the stage for spontaneous preterm labour later in gestation. The results of treatment trials for pregnant women with BV have been heterogeneous, with anywhere from an 80% reduction to a two-fold increase in preterm birth among women who received treatment. For this reason, in current clinical practice significant controversy surrounds determining not only who and when to screen but also who and how to treat. Recent evidence shows that individual genetic backgrounds can affect chemokine production. This is an interesting area for future research and could lead to trials of treatment only for women genetically predisposed to preterm birth.     

大肠埃希菌氨基糖苷酰基转移酶基因型研究

目的：了解大肠埃希菌的耐药谱、氨基糖苷酰基转移酶基因（aac）的分布规律及其与氨基糖苷类抗生素耐药的相关性。方法：琼脂稀释法测定无菌体液分离的44株大肠埃希菌对阿米卡星等12种抗生素的耐药性，聚合酶联反应（PCR）法测定酰基转移酶基因型aac（3）-Ⅰ、Ⅱ和aac（6’）-Ⅰ。结果：大肠埃希菌超广谱β-内酰胺酶（ESBLs）的发生率为45．45％（20／44），对亚胺培南（IPM）、关罗培南（MEM）的耐药率为0，对哌拉西林／他唑巴坦、头孢他啶的耐药率较低（〈20％），对左氟沙星、环丙沙星的耐药率较高（〉60％），对氨基糖苷类阿米卡星、庆大霉素、妥布霉素的耐药率分别为18．18％、56．82％、61．36％。氨基糖苷类耐药模式TG（妥布霉素、庆大霉素）〉TGA（妥布霉素、庆大霉素、阿米卡星）〉T（妥布霉素）〉G（庆大霉素），分别占36．36％、18．189／5、6．82％、2．27％。氨基糖苷酰基转移酶基因检出以aac（3）-Ⅱ最高，占52．27％（23／44），aac（6＇）-Ⅰ次之，占29．55％（13／44），aac（3）-Ⅱ和aac（6’）-Ⅰ同时检出者占15．91％（7／44），未检出aac（3）-Ⅰ。ESBLs阳性株的aac（3）-Ⅱ、aac（6’）-Ⅰ检出率分别为60％、50％，高于ESBLs阴性株的45．81％、12．51％。TG模式与其耐药基因aac（3）-Ⅱ符合率较高为93．75％（15／16）。结论：本地分离大肠埃希菌氨基糖苷类耐药模式以TG为主，酰基转移酶基因以aac（3）-Ⅱ为主，aac（6’）-Ⅰ次之，aac（3）-Ⅰ罕见。     

抗菌药物的不合理应用情况

目的对广东省职业病防治院抗菌药物临床应用的不合理现象进行分析,促进临床合理用药。方法随机抽取该院2003年度门诊、急诊处方,根据临床药理学知识及文献资料对抗菌药物不合理应用情况进行分析。结果共抽查处方9 600张,其中使用抗菌药物处方2 023张,占21．07%；不合理处方197张,占9．74%。主要表现在联用不合理、配伍不当、给药方法不当、剂量不合理和选药不合理等方面。结论严格控制抗菌药物的临床应用,处方审核将有助于促进抗菌药物的合理使用。     

尿路感染病原菌的分布及耐药性分析

目的了解尿路感染病原菌的分布及耐药性,为临床提供可靠的诊断和治疗依据. 方法对1999年1月～2003年1月间,我院住院及门诊患者尿培养分离出的107株细菌进行鉴定和耐药分析. 结果尿路感染菌株以大肠埃希菌为主,占57.9%;其次为肠球菌属、变形菌属、肺炎克雷伯菌、铜绿假单胞菌、葡萄球菌属及真菌;肠杆菌科细菌除对亚胺培南保持100%敏感外,对其他抗生素耐药率均呈上升趋势;革兰阳性球菌耐药率也相当严重,仅万古霉素对革兰阳性球菌敏感率为100%. 结论尿路感染主要病原菌为肠杆菌科细菌,由于病原菌耐药性呈上升趋势,临床医师应根据尿培养结果合理使用抗菌药物.     

174例手术患者抗菌药物应用的调查分析

目的了解手术科室抗菌药物的应用,进一步规范手术科室正确使用抗菌药物. 方法随机抽查进行手术的外科病例174份,调查其抗菌药物应用的情况. 结果所有被调查的病例均使用了抗菌药物,其中预防用药占84.48%,术前1 h内给药者占预防用药的36.73%,治疗用药占15.52%;抗菌药物的疗程为1～27 d,多数病例为4～12 d,术后预防用药最长22 d,Ⅰ类切口多为4～7 d,Ⅱ类切口4～12 d;多数病例为单用或二联;共用品种多为1～2种,最多达8种;用药频数从高到低前7位依次为头孢呋辛、左氧氟沙星、阿米卡星、青霉素G、甲硝唑、阿莫西林,头孢唑林;预防用药排位:头孢呋辛、左氧氟沙星、青霉素G、阿米卡星、美洛西林、甲硝唑;部分病例应用三代头孢预防手术部位的感染. 结论手术科室普遍采用抗菌药物预防手术部位的感染,但严格按围手术期预防用药原则应用者少、手术后预防用药的时间长、选用的品种起点高、存在不必要的联用等,必须加强围手术期抗菌药物应用的管理.     

Improved in vitro evaluation of novel antimicrobials: potential synergy between human plasma and antibacterial peptidomimetics,AMPs and antibiotics against human pathogenic bacteria

Stable peptidomimetics mimicking natural antimicrobial peptides (AMPs) have emerged as a promising class of potential novel antibiotics. In the present study, we aimed at determining whether the antibacterial activity of two α-peptide/β-peptoid peptidomimetics against a range of bacterial pathogens was affected by conditions mimicking in vivo settings. Their activity was enhanced to an unexpected degree in the presence of human blood plasma for thirteen pathogenic Gram-positive and Gram-negative bacteria. MIC values typically decreased 2- to 16-fold in the presence of a human plasma concentration that alone did not damage the cell membrane. Hence, MIC and MBC data collected in these settings appear to represent a more appropriate basis for in vivo experiments preceding clinical trials. In fact, concentrations of peptidomimetics and peptide antibiotics (e.g. polymyxin B) required for in vivo treatments might be lower than traditionally deduced from MICs determined in laboratory media. Thus, antibiotics previously considered too toxic could be developed into usable last-resort drugs, due to ensuing lowered risk of side effects. In contrast, the activity of the compounds was significantly decreased in heat-inactivated plasma. We hypothesize that synergistic interactions with complement proteins and/or clotting factors most likely are involved.     

霉菌性食管炎26例临床分析

目的探讨霉菌性食管炎患者的发病诱因以及发病特点。方法对2006年1月到2011年6月在我院进行内镜检查确认的霉菌性食管炎患者共26例的临床资料进行回顾性分析。结果确认轻度感染6例,中度感染13例,重度感染7例。患者同时伴有其他肠胃疾病为:胃炎8例,消化性溃疡4例,胃炎伴胃溃疡4例,反流性食管炎3例,食管静脉曲张2例,胃癌3例。患者服用氟康唑或制霉菌素1～2周后,23名患者痊愈,另有3名患者因其他原因转到省级医院治疗,判定治愈率为88.5%。结论霉菌性食管炎近年来检出率较高,医务工作人员在患者患有其他疾病时应尽量减少抗生素或者强抑酸剂的使用,同时患者本身患有肠胃疾病时要尽早治疗,以避免霉菌的感染。