美罗培南联合鱼油脂肪乳剂治疗重症医院获得性肺炎的疗效观察

目的观察美罗培南联合鱼油脂肪乳剂治疗重症医院获得性肺炎的疗效。方法对48例重症医院获得性肺炎进行治疗,将患者随机分为两组,两组患者均按照重症肺炎常规治疗方法,予以美罗培南抗感染及对症治疗,治疗组加用ω-3鱼油脂肪乳剂注射液,对照组患者只予常规治疗,观察治疗前后两组临床疗效、不良反应发生率及免疫功能。结果治疗组临床症状较对照组明显改善（P〈0．05）。结论美罗培南联合鱼油脂肪乳剂对重症医院获得性肺炎疗效好,安全性高,值得广泛推广。     

Meropenem–vaborbactam for adults with complicated urinary tract and other invasive infections

ABSTRACT

Introduction: Complicated urinary tract infections are increasingly caused by multidrug-resistant organisms. Carbapenem-resistant Enterobacteriaceae (CRE) constitute a rising threat among uropathogens with significant morbidity and mortality. Meropenem–vaborbactam is a novel carbapenem and cyclic boronic acid-based beta-lactamase inhibitor combination with potent activity against subtypes of CRE.

Areas covered: This article reviews mechanisms of carbapenem resistance, existing treatment options for CRE, and the current evidence to support the use of meropenem–vaborbactam for the treatment of infections caused by subtypes of CRE including complicated urinary tract infections.

Expert commentary: Meropenem–vaborbactam is a superior treatment option for infections secondary to Klebsiella pneumoniae carbapenemase (KPC)-producing CRE. It is associated with higher rates of treatment success and lower rates of toxicity than traditional agents and demonstrates a potentially higher barrier to acquired antimicrobial resistance than ceftazidime–avibactam. At present, meropenem–vaborbactam should be regarded as a preferred treatment option for invasive infections secondary to KPC-producing CRE.     

An updated approach to healthcare-associated meningitis

Among hospital-associated infections, healthcare-associated central nervous system infections are quite important because of high morbidity and mortality rates. The causative agents of healthcare-associated meningitis differ according to the status of immune systems and underlying diseases. The most frequent agents are Gram-negative bacilli (Pseudomonas spp., Acinetobacter spp., Escherichia coli and Klebsiella pneumoniae) and Gram-positive cocci (Staphylococcus aureus and coagulase-negative staphylococci). There are currently several problems in the treatment strategies of healthcare-associated meningitis due to a globally increasing resistance problem. Strategies targeting multidrug-resistant pathogens are especially limited. This review focuses on healthcare-associated meningitis and the current treatment strategies with a particular focus on methicillin-resistant Staphylococcus aureus (MRSA) meningitis.     

美罗培南致血小板计数异常的文献分析

目的 分析美罗培南致血小板计数异常（增多或减少）的发生特点,为临床合理用药提供参考。方法 检索PubMed、Embase、MedLine、Research Gate、中国知网、万方数据库和维普数据库,时间截止至2022年5月,纳入美罗培南致血小板计数异常的中英文病例报道,对文献进行筛选、数据归纳及统计。结果 最终纳入22例患者,其中男性13例,女性9例;年龄0.5～96岁,平均（59.98±25.34）岁;14例患者患有基础疾病,15例患者为联合用药。引起血小板计数增多症患者9例（40.91%）,血小板计数减少症患者13例（59.09%）,所有患者血小板计数异常均发生在用药期间。停用美罗培南并给予对症处理后,21例（95.45%）患者血小板计数恢复正常或好转。结论 美罗培南致血小板计数异常以血小板减少症相对多见。临床在使用美罗培南期间应加强对血小板计数的监测,一旦发现异常变化应及时停药和对症处理,减少血栓或出血事件的发生。     

基于PK/PD效应相关的目标获得概率论述美罗培南延长输注给药的适宜性

目的： 探讨美罗培南延长输注给药的适宜性。方法： 以美罗培南0.5 g q 8 h、1 g q 8 h和2 g q 8 h为模型方案，以40%、60%和80%fT>MIC为PK/PD靶标，以目标获得概率（PTA）为PK/PD效应指标，通过蒙特卡洛模拟计算各方案对MIC分别为0.125，0.25，0.5，1，2，4，8，16，32，64 mg·L^-1分别通过0.5，1，2，4，6 h输注给药达到各靶标的PTA。同一方案对同一MIC在2种不同的输注时间下可得到2个PTA值，结果组成一个对子，对所有MIC可组成10个对子。对所有对子进行配对资料检验，考察输注时间对PTA的影响。结果： 无论PK/PD靶标和给药方案如何，均存在这样一个MIC临界值，使得对于那些小于该值的MIC，即使美罗培南0.5 h输注，PTA也远远大于90%；而对于那些大于该值的MIC，即使美罗培南6 h输注，PTA也远远小于90%；对于这些非临界值上的MIC，延长输注给药并不能有效增加PTA。但对于部分处在临界值上的MIC，美罗培南延长输注可大大增加PTA。但任何2个不同时间的输液组的PTA进行比较，统计学分析结果显示差异均无统计学意义（P>0.05）。结论： 美罗培南延长输注给药获得的PK/PD增效对分离菌株或MIC具有一定的选择性，并非所有菌株均适宜采用延长输注给药。对处于MIC临界值上的分离菌株，更适合延长输注给药；对处于非MIC临界值上的分离菌株，无需采用延长输注给药。     

Efficacy of Gemifloxacin in Acute Exacerbations of Chronic Bronchitis: a Randomised,Double-Blind Comparison with Trovafloxacin

Abstract

This randomised, double-blind, double-dummy, multinational study compared the efficacy and safety of gemifloxacin with trovafloxacin in the treatment of acute exacerbations of chronic bronchitis. There were 617 patients randomised: 303 to gemifloxacin and 314 to trovafloxacin. Clinical success rates at follow-up (clinical per-protocol population) were 91.5% for gemifloxacin and 87.6% for trovafloxacin. For the intent-to-treat population, the clinical efficacy of gemifloxacin was statistically significantly superior to that of trovafloxacin. In general, the in vitro activity of gemifloxacin against the major respiratory bacterial pathogens was superior to that of other antibiotics tested. Per-patient bacteriological success rates at follow-up (bacteriology per-protocol population) were 86.8% for gemifloxacin and 82.4% for trovafloxacin. Both agents were well tolerated. The clinical and bacteriological efficacy of a once-daily 5-day course of gemifloxacin is at least as good as that of a similar regimen of trovafloxacin in the treatment of acute exacerbations of chronic bronchitis.     

肾脏替代治疗严重脓毒症患者美罗培南血清药物浓度监测的临床研究

目的:探讨肾脏替代治疗(CRRT)严重脓毒症患者美罗培南血清谷浓度能否达到目标浓度,为个体化用药提供参考。方法:对给予美罗培南静脉滴注的20例接受CRRT治疗的严重脓毒症伴急性肾损伤患者进行回顾性分析,以患者急性生理功能和慢性健康状况评分Ⅱ(APACHE Ⅱ)评分的高低进行分组,APACHE Ⅱ≤25为轻度组,APACHE Ⅱ>25为重度组。美罗培南第4剂给药前收集血液样本,采用高效液相色谱法(HPLC)测定其血药浓度,计算不同最低抑菌浓度(MIC)值时100%T_>MIC与100%T_>4×MIC的达标率。对APACHEⅡ评分、白蛋白、肌酐清除率、临床结果与美罗培南血清谷浓度的相关性进行关联性分析。结果:MIC值分别为0.5,1,2,4,8 μg·mL^-1,以100%T_>MIC为PK/PD靶目标时轻度组的达标率分别为100%,100%,100%,100%,81.8%,重度组的达标率分别为100%,100%,100%,100%,66.7%。以100%T_>4×MIC为PK/PD靶目标时轻度组的达标率分别为100%,100%,81.8%,18.2%,0%,重度组的达标率分别为100%,100%,66.7%,22.2%,0%;APACHE评分、临床结果与美罗培南血清谷浓度存在明显相关性(P<0.05)。轻、重度组临床结果阳性率分别为40%,25%,1例患者出现恶心呕吐症状。结论:当MIC>2.0 μg·mL^-1时,CRRT严重脓毒症患者美罗培南血清谷浓度临床达标率低,因此临床有监测的必要,美罗培南血清谷浓度与APACHE Ⅱ评分及临床结果密切相关。     

Imipenem but not meropenem induces convulsions in DBA/2 mice, unrelated to cerebrospinal fluid concentrations

Imipenem and meropenem CSF diffusion was comparable in DBA/2 mice but only imipenem induced convulsions, not related to CSF concentration.     

改良美罗培南输注方案治疗ICU获得性鲍氏不动杆菌肺炎临床分析

目的使用改良美罗培南输注方案治疗ICU获得性鲍氏不动杆菌肺炎并评价其疗效。方法选取2006年3月10日-7月10日,ICU获得性多药耐药鲍氏不动杆菌肺炎患者30例,随机分为传统治疗组和改良滴注组,传统治疗组的治疗方案为1 g,静脉滴注,1次/8 h,每次静脉滴注在1 h内完成;美罗培南改良滴注组滴注方案为500 mg,静脉滴注,1次/6 h,使用输液泵每次持续滴注3 h;比较两组患者在第3、5、7天的治疗成功率、复发率以及患者抗菌药物经济支出。结果两组患者的治疗成功率、复发率以及疗程差异均无统计学意义(P>0.05);且两组均未筛选出泛耐药菌和出现MIC升高等;改良滴注组的抗菌药物经济支出明显低于传统治疗组(P<0.01)。结论使用美罗培南改良滴注方案,治疗ICU鲍氏不动杆菌肺炎疗效同传统治疗方案疗效相当,但更为经济。