头孢抗生素对干化学法检测尿红细胞的影响

目的观察尿中各类头孢抗生素对干化学法检测尿红细胞定性实验的干扰作用。方法将尿液、红细胞、各类头孢抗生素按一定比例配制,用尿液干化学分析仪进行测定。结果尿中各类头孢抗生素浓度达到10mg／ml时,可使尿测定为“＋”的红细胞降低为“±”。当尿中头孢浓度达20mg/ml,可致假阴性;＂-3尿中浓度头孢抗生素达10mg／ml时,可使原测定“＋＋”的红细胞降低为“＋”,当尿中头孢浓度达20mg／ml或超过20mg／ml,可使结果降低为“±”,甚至出现假阴性;当尿中头孢浓度达20mg/ml,可使原测定为“＋＋＋”的红细胞结果降低。结论尿液中的头孢抗生素浓度严重影响干化学法检测红细胞的定性结果,并随着尿液中头孢类药物浓度的增加,干扰度随之增加,甚至可致尿红细胞检测呈假阴性。     

气相色谱法测定3-氯-7-氨基去乙酰氧基头孢烷酸中残留溶剂

目的:建立3-氯-7-氨基去乙酰氧基头孢烷酸(7-ACCA)中丙酮、甲醇、二氯甲烷、乙酸乙酯、异丁醇、吡啶、甲苯残留量的测定方法。方法:采用气相色谱法,载气为氮气,FID检测器,色谱柱为Agilent INNOWAX毛细管柱,柱温为程序升温:起始温度70℃,保持6 min,以10℃/min升温至160℃,保持1 min;进样量1.0μl,分流进样,分流比10∶1,外标法检测7-ACCA中丙酮、甲醇、二氯甲烷、乙酸乙酯、异丁醇、吡啶、甲苯的含量。结果:在本研究建立的色谱条件下,丙酮、甲醇、二氯甲烷、乙酸乙酯、异丁醇、吡啶、甲苯的最低检出质量浓度分别为2.5μg/ml、1.5μg/ml、15μg/ml、2.5μg/ml、2.5μg/ml、2.5μg/ml、11μg/ml。样品中仅检测到丙酮,且其残留量远在药典规定的限量以下。结论:建立的方法能有效控制7-ACCA中丙酮、甲醇、二氯甲烷、乙酸乙酯、异丁醇、吡啶、甲苯的残留量。     

Nonconvulsive status epilepticus due to drug induced neurotoxicity in chronically ill children

Nonconvulsive status epilepticus (NCSE) is a specific form of status epilepticus and is defined as epileptic activity on an EEG without seizures and as an alteration in mental status lasting more than 30 min. NCSE may be caused by drugs, cerebrovascular events, metabolic disorders or toxins. Herein, we present four cases of patients with drug-induced NCSE who were chronically ill due to renal failure or childhood leukemia. NCSE should be suspected in patients with an altered mental status without clinical seizures who are being treated with multiple drugs.     

Pharmacokinetics of cephalosporins in the neonate: a review

The aim of this work was to review the published data on the pharmacokinetics of cephalosporins in neonates to provide a critical analysis of the literature as a useful tool for physicians. The bibliographic search was performed for articles published up to December 3, 2010, using PubMed. In addition, the book Neofax: A Manual of Drugs Used in Neonatal Care by Young and Mangum was consulted. The cephalosporins are mainly eliminated by the kidneys, and their elimination rates are reduced at birth. As a consequence, clearance is reduced and t1/2 is more prolonged in the neonate than in more mature infants. The neonate's substantial body water content creates a large volume of distribution (Vd) of cephalosporins, as these drugs are fairly water soluble. Postnatal development is an important factor in the maturation of the neonate, and as postnatal age proceeds, the clearance of cephalosporins increases. The maturation of the kidney governs the pharmacokinetics of cephalosporins in the infant. Clearance and t1/2 are influenced by development, and this must be taken into consideration when planning a cephalosporin dosage regimen for the neonate.     

Faecal carriage of extended-spectrum β-lactamase-producing and AmpC β-lactamase-producing bacteria among Danish army recruits

During May and June 2008, 84 Danish army recruits were tested for faecal carriage of extended-spectrum β-lactamase (ESBL)-producing and AmpC β-lactamase-producing bacteria. Three ESBL-producing (CTX-M-14a) Escherichia coli isolates, two AmpC-producing (CMY-2) E. coli isolates and one AmpC-producing (CMY-34) Citrobacter freundii isolate were detected. Two of the CTX-M-14a E. coli isolates had similar pulsed-field gel electrophoresis and multilocus sequence typing profiles, indicating the same origin or transmission between the two army recruits. The bla_CTX-M-14a genes were transferable to an E. coli recipient. These commensal bacteria therefore constitute a reservoir of resistance genes that can be transferred to other pathogenic bacteria in the intestine.     

Another look at differences in the susceptibility of Escherichia coli and Klebsiella pneumoniae to cephalothin and cefazolin

The significance of in vitro susceptibility tests on Enterobacteriaceae to cephalothin and cefazolin has not been exactly defined in the guidelines of the National Committee for Clinical Laboratory Standards. In the hope of clarifying this confusion, we provide additional information from an ancillary study of the Taiwan Surveillance of Antimicrobial Resistance 1998 (TSAR I). There were 505 Escherichia coli and 227 Klebsiella pneumoniae isolates susceptible to cephalothin, reported by 42 participating hospitals. The susceptibility of these isolates were re-tested at the Microbial Infections Reference Laboratory using cefazolin, with the result that 72% of the 252 cephalothin-resistant E. coli isolates and 24% of the 41 cephalothin-resistant K. pneumoniae isolates were found to be susceptible to cefazolin. We further surveyed the availability of cephalothin and cefazolin in Pharmacy Departments; all of the TSAR I hospitals had cefazolin available in their pharmacies. The resistance rate of E. coli was significantly lower for 12 hospitals that had cefazolin in both pharmacy and laboratory compared with 11 hospitals that had cefazolin available in pharmacy but cephalothin in laboratory. In addition, for all the hospitals that had cephalothin available for clinical use, the resistance rate was twice as low in two hospitals reporting cefazolin susceptibility as in the seven hospitals reporting cephalothin susceptibility. Our findings suggest that inappropriate selection of cephalothin and cefazolin for susceptibility testing contribute to inaccurate indications of in vivo activity for first generation cephalosporins in the treatment of E. coli infections.     

头孢地嗪钠的合成研究

研究第三代头孢菌素头孢地嗪钠的适合工业化生产的制备工艺，即7-氨基头孢烷酸(7-ACA)与2-(2-氨基噻唑-4-基)-(顺式)-2-甲氧亚胺乙酰硫代苯并噻唑活性酯(5)在二氯甲烷于5℃反应4h生成头孢噻肟酸(3)。收率90％，3在水-丙酮溶液中碳酸钠存在下与2-巯基-4-甲基．5-噻唑乙酸(4)在55～60℃反应4h生成头孢地嗪酸(2)，收率66．3％，最后2与异辛酸钠丙酮溶液在低温反应成盐得到头孢地嗪钠(1)，收率89．7％。三步反应总收率53．5％。所得产品含量99．5％(HPLC)。     

反相高效液相色谱溶剂系统优化的正交设计法

在高效液相色谱(HPLC)中,通过改变流动相组成来调节色谱系统的选择性,以适应各种分析要求,但如何改变流动相组成以适应分析要求往往是一项费时而又复杂的工作。目前,国内外已报道了许多HPLC分析条件优化的方法,尤其是溶剂系统优化方法。本文     

2007—2010年头孢菌素类抗菌药物应用情况分析

目的:了解头孢菌素类抗菌药物的临床应用情况,为临床合理应用提供参考。方法:对2007—2010年我院头孢菌素的品种、销售金额、用药频度(DDDs)、日均费用(DDC)等进行统计分析。结果:4年来,医院头孢菌素类药销售金额呈逐年上升趋势;头孢菌素的销售金额占全部药品总金额的20%以上,其中第3代头孢菌素及其复方制剂销售金额占头孢菌素的40%以上,第4代头孢菌素销售金额呈下降趋势。结论:我院头孢菌素应用基本合理,为延缓细菌耐药的产生,应进一步规范管理头孢菌素类药的使用。     

2006—2009年住院部头孢菌素类药物应用分析

目的：了解南京医科大学第二附属医院住院部头孢菌素类抗菌药物的应用情况和趋势。方法：对我院住院部2006—2009年头孢菌素的销售金额、用药频度（DDDs）、日均费用（DDC）等进行回顾性统计、分析。结果：头孢菌素销售金额占药品总销售金额的12.71%～15.14%,其中第3代头孢菌素及其复方制剂销售金额最大,占头孢菌素销售金额的50%以上,第4代头孢菌素销售金额呈逐年上升趋势。大多数第2、3代头孢菌素的销售金额、DDDs和DDC均比第1代高,但第4代头孢菌素头孢吡肟的销售金额、DDDs逐年增加,至2008年和2009年均排序第1位。DDC波动范围较大,最高者达1068元/日。结论：我院住院部头孢菌素应用基本合理,但存在用药起点过高现象,应进一步规范管理头孢菌素类药物的应用。