美罗培南与头孢哌酮钠/舒巴坦钠治疗急性白血病合并重症肺部感染的疗效观察

目的：评价美罗培南及头孢哌酮钠/舒巴坦钠治疗急性白血病患者合并重症肺部感染的临床疗效及安全性。方法： 随机选择60例重度细菌性肺炎患者分成两组,每组各30例,一组使用美罗培南治疗,另一组使用头孢哌酮钠/舒巴坦钠治疗,观察患者的临床疗效及药物不良反应发生率。结果： 30例美罗培南治疗组里面,显效3例,治愈25例,总有效率为 93.33％,其中有1例出现不良反应,发生率为 3.33％;临床上主要表现为轻度皮疹;30例细菌培养阳性13例,阳性率为 43.33％,细菌清除11例,清除率为 84.62％;30例头孢哌酮钠/舒巴坦钠治疗组里面显效2例,治愈15例,总有效率为 43.33％,其中有6例出现不良反应,发生率为20％;临床上主要有肝功能损害、轻度皮疹、凝血功能障碍等表现;30例细菌培养中,阳性12例,阳性率为40％,细菌清除5例,清除率为 41.67％;两组临床疗效及清除率比较,差异均有统计学意义（P〈0.05）。所有入选病例均完成治疗,未因药物不良反应而中止治疗。结论：美罗培南在治疗急性白血病患者合并肺部细菌感染时疗效显著、安全性高,均优于头孢哌酮钠/舒巴坦钠。     

咸阳市第一人民医院475例碳青霉烯类抗菌药物使用合理性评价及经济学分析

目的 分析咸阳市第一人民医院近3年出院患者碳青霉烯类抗菌药物应用情况,为该类抗菌药物的管理及临床合理应用提供参考。方法 回顾性分析咸阳市第一人民医院2017年1月1日—2019年12月31日出院的475例应用碳青霉烯类抗菌药物患者的病案资料,对患者的基本信息、用药科室、患者感染部位、用法用量、送检情况以及适应症等运用WPS 2020进行统计分析。结果 用药数量：美罗培南 > 亚胺培南-西司他丁 > 比阿培南。用药科室分布：呼吸与危重症医学科第一、中心ICU第二,其余科室相对较少。药物用法：静脉滴注473例,超声透药2例。药物用量：91例剂量不足,47例剂量过高。联合用药情况：与抗菌药物联用195例,与丙戊酸钠联用6例。病原学送检率88.84%。适应症：48例为无适应症用药。结论 咸阳市第一人民医院碳青霉烯类抗菌药物临床应用合理性有待提高,合理应用抗菌药物可节约部分医疗花费。     

供肾灌洗液培养出耐碳青霉烯类肺炎克雷伯菌的防治策略

 目的 探讨肾移植患者中供肾灌洗液培养出耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae, CRKP)的防治策略。方法 总结2020-05至2021-01行肾移植手术、供肾灌洗液培养为CRKP的12例肾移植患者的治疗经过。结果 12例均在获知灌洗液培养结果后及时予以治疗,其中4例使用大剂量美罗培南延长输注联合磷霉素,7例使用头孢他啶阿维巴坦联合氨曲南或磷霉素,1例联用多黏菌素、大剂量美罗培南延长输注与磷霉素。除1例受者出现一过性体温升高外,其余均无明显不适,但白细胞、中性粒细胞、降钙素原等有不同程度的升高。12例中,4例引流液培养为CRKP,1例引流液培养为屎肠球菌后加用利奈唑胺,其余均为仅灌洗液培养阳性。所有患者经治疗后未发生肾动脉破裂、移植肾切除或死亡,出院时血肌酐水平在79.8～202.5 μmol/L。结论 供肾灌洗液培养为CRKP的阳性结果应尽早防治,根据药敏结果、药品可获得性等制定给药方案。     

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。     

Relative Potency of Different Generic Brands of Meropenem,Colistin and Fosfomycin: Implications for Antimicrobial Therapy and Antimicrobial Formulary

There is a need of a relatively simple and inexpensive method for the determination of relative potency of various generic brands of antibiotics in comparison to original products. The current study describes an agar diffusion method which can be performed in any microbiology laboratory, is cheap (costs $2 per test) and its results can be available after overnight incubation. The results show that neither all generics are reliable nor are all generic antibiotics of poor quality.