Comparison of efficacy of cefoperazone/sulbactam and imipenem/cilastatin for treatment of Acinetobacter bacteremia

Multiple antibiotic resistance threatens successful treatment of Acinetobacter baumannii infections worldwide. Increasing interest in the well-known activity of sulbactam against the genus Acinetobacter has been aroused. The purpose of this study was to compare the outcomes for patients with Acinetobacter bacteremia treated with cefoperazone/sulbactam versus imipenem/cilastatin. Forty-seven patients with Acinetobacter baumannii bacteremia were analyzed through a retrospective review of their medical records for antibiotic therapy and clinical outcome. Thirty-five patients were treated with cefoperazone/sulbactam, and twelve patients with imipenem/cilastatin. The percentage of favorable response after 72 hours was not statistically different between cefoperazone/sulbactam group and imipenem/cilastatin group. The mortality rate was not statistically different, too. Cefoperazone/sulbactam was found to be as useful as imipenem/cilastatin for treating patients with Acinetobacter bacteremia.     

Early treatment of severe pancreatitis with imipenem: A prospective randomized clinical trial

Objective. The main causes of death in severe pancreatitis are multiorgan failure and septic complications. Prophylactic treatment with effective antibiotics is therefore a tempting therapeutic option. However, there could be side effects such as selection of resistant microbes and fungi. The aim of the present study was to compare the rate of infectious complications, interventions, days in the intensive care unit (ICU), morbidity and mortality in patients with severe pancreatitis randomized to prophylactic therapy with imipenem compared with those receiving no treatment at all. Material and methods. Seventy-three patients with severe pancreatitis were included in a prospective, randomized, clinical study in seven Norwegian hospitals. The number of patients was limited to 73 because of slow patient accrual. Severe pancreatitis was defined as a C-reactive protein (CRP) level of >120 mg/l after 24 h or CRP >200 48 h after the start of symptoms. The patients were randomized to either early antibiotic treatment (imipenem 0.5 g×3 for 5–7 days) (imipenem group) (n=36) or no antibiotics (control group) (n=37). Results. The groups were similar in age, cause of pancreatitis, duration of symptoms and APACHE II score. Patients in the imipenem group experienced lower rates of complications (12 versus 22 patients) (p=0.035) and infections (5 versus16 patients) (p=0.009) than those in the control group. There was no difference in length of hospital stay (18 versus 22 days), need of intensive care (8 versus 7 patients), need of acute interventions (10 versus 13), nor for surgery (3 versus 3) or 30-day mortality rates (3 versus 4). Conclusions. The study, although underpowered, supports the use of early prophylactic treatment with imipenem in order to reduce the rate of septic complications in patients with severe pancreatitis.     

痰标本铜绿假单胞菌224株5年耐药变迁

目的分析解放军第一一八医院2006～2010年痰标本铜绿假单胞菌检出情况及耐药谱变化,为指导临床控制肺部铜绿假单胞菌感染及合理使用抗菌药物提供参考。方法用自编Excel软件从LIS数据库中采集2006年1月至2010年12月该院住院患者送检痰标本中分离的铜绿假单胞菌共224株。菌株鉴定和药敏试验采用法国生物梅里埃公司的ATB Expression细菌鉴定系统和药敏板条,并用Excel透视图表进行铜绿假单胞菌检出率及耐药分析,率的差异性比较用u检验。结果 5年来该院住院患者送检痰标本778份,共分离检出致病菌571株,其中铜绿假单胞菌224株,占总检出菌的39.2%。亚胺培南耐药株166例,占铜绿假单胞菌的74.1%。按亚胺培南敏感程度分组后,其对常用抗菌药物的耐药率差异有统计学意义(P<0.01)。结论痰标本分离的铜绿假单胞菌对碳青霉烯类抗菌药物耐药率高,耐亚胺培南铜绿假单胞菌对常用抗菌药物的耐药率亦明显高于非耐药株。     

国产亚胺培南/西司他丁钠治疗重症吸入性肺炎疗效观察

目的 评价国产亚胺培南/西司他丁钠(速能)治疗重症吸入性肺炎的疗效和安全性.方法 采用随机开放、平行对照试验设计,将68例重症吸入性肺炎患者按照随机数宁表分配法分为试验组(36例)和对照组(32例),试验组静脉滴注(静滴)国产亚胺培南/西司他丁钠1.0 g,6～8h1次,用药7～14 d;对照组静滴进口亚胺培南/西司他丁钠(泰能)1.0 g,6～8h1次,用药7～14d.观察记录两组患者的每日最高体温(T)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度( SpO2)、动脉血氧分压(PaO2)、吸入氧浓度(FiO2)、氧合指数(PaO2/FiO2)、气道峰压(Paw)、分钟通气量(MV)及治疗前和治疗1、3、7d白细胞计数(WBC)、降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)等指标,定期检查肝肾功能、X线胸片,以及痰培养+药敏试验;并按疗效及安全性标准判定治疗效果.结果 两组治疗后各指标均有明显改善,T、HR、RR、Paw、MV、WBC、PCT、CRP均逐渐下降,PaO2/ FiO2均逐渐升高,试验组和对照组治疗3d即与治疗前比较差异有统计学意义[T(℃):37.35±0.91比38.43±1.06,37.28 ±0.88比38.35±1.11;HR(次/min):90.25±10.60比118.94±15.46,89.31±11.17比124.34±17.87;RR(次/min):25.14±3.17比32.28±4.49,24.81±2.43比33.13±4.17;Paw(cm H2O,1 cm H2O=0.098 kPa):23.03±3.04比33.22±4.59,22.75±3.22比33.63 ±4.79; MV(L/min):8.67±1.26比11.80±2.01,8.88±1.45比13.21±2.90; WBC(×109/L):11.26±1.96比14.57±3.10,12.28±3.38比15.25±4.93; PCT(μg/L):6.90±5.46比16.97±7.93,6.17±6.13比21.26±11.54; hs-CRP (mg/L):85.50±37.91比120.17±45.47,94.31±38.51比142.34±53.57; PaO2/FiO2 (mm Hg,1 mm Hg=0.133 kPa):182.06±40.88比98.67±20.62,184.09±43.78比96.22±22.59,均P＜0.05];而两组治疗前后SpO2无明显改变.试验组与对照组临床总有效率分别为83.4％和81.2％,不良反应发生率分别为13.9％和9.4％,细菌清除率为90.3％和87.0％,两组比较差异均无统计学意义(均P＞0.05).结论 国产亚胺培南/西司他丁钠可有效控制重症吸入性肺炎,是安全有效的广谱抗菌药物.     

耐亚胺培南/西司他丁鲍曼不动杆菌的分离及耐药性

目的了解耐亚胺培南/西司他丁（IPM）鲍曼不动杆菌(Ab)在某院的分离及其耐药性。方法收集该院2006年1月-2010年12月临床各类标本,除血培养采用美国BD公司BACTEC9120进行检测,其余标本按常规方法培养分离细菌;在Phoenix 100全自动分析系统和配套试剂中,对菌株进行鉴定及药敏试验。采用2 巯基丙酸抑制试验测定金属酶。结果检出154株耐IPM的Ab,主要分离自痰及咽拭子标本,占74.03%;科室分布：主要分布于重症监护室（98株,63.64%）、神经科（25株,16.23%）、烧伤科（13株,8.44%）、呼吸内科（8株,5.19%）、老年内科（4株,2.60%）、普通外科和血液科（各3株,1.95%）。耐IPM的Ab对头孢哌酮/舒巴坦耐药率最低,为42.21%;对其他抗菌药物的耐药率均＞65%。耐IPM的Ab产金属酶率为14.94%（23/154）。结论耐IPM的Ab主要来源于呼吸道感染标本,对抗菌药物敏感率较低。加强监控和优化抗菌药物的使用,对控制耐IPM的Ab在医院内流行有重要意义。     

Pharmacokinetic/pharmacodynamic profiling of imipenem in patients admitted to an intensive care unit in India: A nonrandomized,cross-sectional,analytical, open-labeled study

Results:The difference in the plasma imipenem concentration between the gastrointestinal and the nongastrointestinal groups was significant at 2 h (P = 0.015) following drug dosing; while the difference was significant between the skin/cellulitis and nonskin/cellulitus groups at 2 h (P = 0.008), after drug dosing. The imipenem levels were above the MIC and 5 times the MIC for the isolated organism in 96.67% and 50% of the patients, respectively.Conclusions:The pharmacokinetic profile of imipenem does not vary according to the locus of an infection in critically ill patients. Imipenem, 3 g/day intermittent dosing, maintains a plasma concentration which is adequate to treat most infections encountered in patients admitted to an ICU. However, a change in the dosing regimen is suggested for patients infected with organisms having MIC values above 4 mg/L.     

First report of the blaVIM gene in environmental isolates of Buttiauxella sp.

Several works have demonstrated the presence of metallo‐β‐lactamases (MBLs) in clinical bacteria. However, in environmental isolates, few works have reported on these enzymes. In this study, we report for the first time two environmental isolates of Buttiauxella sp. recovered from chrysanthemum plantations in Brazil containing bla_VIM gene and producing MBLs.     

亚抑菌浓度亚胺培南对MRSA体外增殖及毒力相关基因mRNA表达水平的影响

目的：探讨亚抑菌浓度亚胺培南对耐甲氧西林金黄色葡萄球菌（MRSA）生物学活性的影响,阐明碳青霉烯类抗生素对MRSA活性的抑制作用及其机制,为临床应用碳青霉烯类抗生素治疗MRSA感染提供依据。方法：选取5株ST239型MRSA临床分离株,采用1/10和1/2最小抑菌浓度（MIC）亚胺培南与其体外共培养1.5、6.0和12.0h,分为对照组（培养液中不加亚胺培南）、1/10MIC组（培养液中添加1/10MIC浓度亚胺培南）和1/2MIC组（培养液中添加1/2MIC浓度亚胺培南）。采用荧光定量PCR方法检测各组MRSA株毒力相关基因纤维黏连蛋白A（fnbA）、葡萄球菌蛋白A（spa）、α溶血素（hla）、白细胞毒素D（lek-D）和E（lek-E）、肠毒素A（sea）mRNA相对表达水平,分光光度法检测各组MRSA株体外增殖活性。结果：与对照组比较,体外共培养6.0和12.0h时,1/2MIC组MRSA株增殖活性明显降低（P<0.01）;培养1.5和6.0h时,6个MRSA毒力相关基因mRNA相对表达水平均明显低于对照组（P<0.01）;培养12h时,1/10MIC和1/2MIC浓度组MRSA株各毒力相关基因mRNA表达未能检测到。结论：亚抑菌浓度亚胺培南对ST239型MRSA多种毒力相关基因mRNA表达具有明显抑制效应,高浓度亚胺培南可抑制MRSA的体外增殖,提示亚胺培南对于重症MRSA感染患者具有潜在的应用价值。     

亚胺培南治疗72例卒中相关性肺炎的临床疗效分析

目的 评价亚胺培南对卒中相关性肺炎(SAP)的临床疗效.方法 选择2014年1月至2016年1月在西南医科大学附属医院神经内科重症监护室(NICU)住院的SAP患者72例.在给予患者卒中相关治疗及对症支持治疗的基础上给予亚胺培南1.0 g+0.9％生理盐水100mL,每8小时注射1次,观察治疗过程中患者病情变化,比较治疗2周前后实验室检查结果、胸部CT变化,并进行危险因素相关性分析.结果 治疗期间死亡病例12例,存活60例.给予亚胺培南治疗后2周体温逐渐降至正常,治疗后美国国立卫生研究院卒中量表(NIHSS)评分、白细胞计数(WBC)、中性粒细胞数、C反应蛋白均较治疗前降低,血气分析显示氧分压氧合指数均较治疗前升高,胸部CT显示炎性渗出病灶及渗出胸水较治疗前吸收好转,72例患者痊愈55例,显效5例,无效12例,总效率83.33％.危险因素相关性分析提示吞咽功能障碍、意识障碍、慢性阻塞性肺疾病急性发作病史均与疗效呈负关联.结论 亚胺培南治疗SAP效果满意.