注射用盐酸头孢吡肟与3种输液配伍的高分子杂质研究

目的采用高效液相色谱法研究注射用盐酸头孢吡肟与3种常用输液配伍后高分子杂质的稳定性。方法建立注射用盐酸头孢吡肟在3种输液的配伍稳定性中的高分子杂质测定方法,分析混合液6 h内高分子杂质的稳定性。用葡聚糖凝胶G-10为填料,以p H=7.0的0.1 mol/L磷酸盐缓冲液为流动相A,以水为流动相B,流速为每分钟0.6 m L,检测波长为254 nm。结果在室温30℃条件下,注射用盐酸头孢吡肟在3种配伍液中2 h内基本稳定,且与0.9%氯化钠注射液配伍时高分子杂质在6 h内基本稳定。结论注射用盐酸头孢吡肟最好与0.9%氯化钠注射液配伍使用。     

Chemical and Physical Stability of an Admixture Containing Cefepime and Vancomycin in Lactated Ringer Solution

Purpose: To evaluate the chemical and physical stability of an admixture containing cefepime and vancomycin in a single volume of lactated Ringer solution at refrigerated temperatures. Methods: Cefepime 2000 mg and vancomycin 1000 mg were, respectively, reconstituted with 10 and 20 mL of sterile water for injection (SWFI) per manufacturer instructions. This resulted in cefepime and vancomycin concentrations of 200 and 50 mg/mL, respectively. The resulting cefepime and vancomycin solutions at 10 and 20 mL, respectively, were drawn up and injected into 1000 mL lactated Ringer solution. Aliquot samples were obtained on days 0 to 9, visually inspected for gross incompatibility, and then stored at −80°C. Samples were thawed on the day of the analysis and run through ultraperformance liquid chromatography. Area under the concentration-time curve (AUC) on each day was compared with baseline AUC values. Chemical stability was defined as an AUC more than 93% of the baseline value. Results: No evidence of gross physical incompatibility was observed by visual inspection. Cefepime and vancomycin replicants were more than 94.5% and 98% of baseline AUC values. Therefore, all sample replicants were found to be more than 93% of their baseline AUC value. Conclusion: An admixture containing cefepime 2000 mg and vancomycin 1000 mg in 1000 mL lactated Ringer solution appears to be chemically and physically stable at refrigerated temperatures for up to 9 days.     

3例疑似用盐酸头孢吡肟致精神症状的护理

盐酸头孢吡肟可用于治疗成人及儿童敏感细菌引起的中重度感染,包括下呼吸道感染,单纯性下尿道感染和复杂性的尿路感染(包括肾盂肾炎)等。因头孢吡肟是革兰氏阳性和革兰氏阴性菌的广谱杀菌剂,临床应用较多。不良反应有腹泻、发热、过敏、头痛,肾功能不全患者而未相应调整其剂量时,可引起脑病,癫痫。2011年4月～5月份我科3例使用头孢吡肟出现精神症状,现将护理报告如下。     

Prevalence of antimicrobial resistant genes in Bacteroides spp. isolated in Oita Prefecture,Japan

IntroductionBacteroides spp. are the most common anaerobic bacteria isolated from the human gastrointestinal tract. Several resistant genes are present in Bacteroides spp. However, most studies have focused on the prevalence of the c?A gene in Bacteroides fragilis alone. We assessed the susceptibility to antimicrobial agents and the prevalence of cepA, cfiA, cfxA, ermF, nim, and tetQ genes in Bacteroides strains isolated from clinical specimens in our hospital.MethodsWe isolated 86 B. fragilis and 58 non-fragilis Bacteroides strains from human clinical specimens collected from January 2011 to November 2021. Resistance against piperacillin (PIPC), cefotaxime (CTX), cefepime (CFPM), meropenem (MEPM), clindamycin, and minocycline was determined.ResultsThe resistant rates of penicillins and cephalosporins in non-fragilis isolates were significantly higher than those in B. fragilis isolates. In B. fragilis isolates, the resistant rates of PIPC, CTX, and CFPM in cfxA-positive isolates were significantly higher than those in cfxA-negative isolates (71% vs. 16%, 77% vs. 19%, and 77% vs. 30%, respectively). Thirteen B. fragilis isolates harbored the cfiA gene, two of which were resistant to MEPM. Six of the 13 cfiA-positive B. fragilis isolates were heterogeneously resistant to MEPM.ConclusionIt is important to evaluate the use of MEPM as empirical therapy for Bacteroides spp. infections, considering the emergence of carbapenem resistance during treatment, existence of MEPM-resistant strains, and heterogeneous resistance.     

Pulmonary abscess caused by Cladosporium cladosporioides after receiving outpatient chemotherapy

Cladosporium cladosporioides is one of the most ubiquitous dematiaceous fungi that seldomly occur human infection. Here, we demonstrate a rare case of pulmonary phaeohyphomycosis with a distinctive pulmonary lesion during the nadir period of outpatient chemotherapy against endometrial cancer. In addition to severe neutropenia, excessive exposure to C. cladosporioides at patient's residence was considered as dominant causative factor. More caution is considered necessary for pulmonary phaeohyphomycosis in patients who receive outpatient chemotherapy and are homebound during neutropenic status.