我院2007-2010年糖肽类抗菌药的使用与革兰阳性球菌的耐药性分析

目的:了解我院糖肽类抗菌药的应用现状和革兰阳性球菌分离率及耐药情况,为临床合理应用抗菌药提供依据。方法:对我院2007-2010年住院患者糖肽类抗菌药的用药频度(DDDs)、销售金额等数据进行统计、分析,并将各科室送检标本检出的革兰阳性球菌分布及药敏试验结果进行汇总。结果:4年来我院住院患者糖肽类抗菌药的DDDs持续增加。4年中分离率在前6位的革兰阳性球菌分别为金黄色葡萄球菌、凝固酶阴性葡萄球菌、肺炎链球菌、粪肠球菌、屎肠球菌、β溶血链球菌;其中金黄色葡萄球菌分离率始终保持在第1位,占所有分离菌的11.0%～14.4%,未发现对万古霉素、利奈唑胺不敏感的葡萄球菌;屎肠球菌的耐药性高于粪肠球菌;耐万古霉素肠球菌(VRE)分离率呈上升趋势。结论:应加强对糖肽类抗菌药合理应用管理,以延缓耐万古霉素葡萄球菌的产生。     

婴儿胆汁淤积性肝病的病因学研究进展

目的：分析芜湖市第一人民医院儿童药品不良反应（ADR）发生的特点和规律,为儿童临床合理用药提供参考。方法：对2012-2018年我院收集的144例儿童ADR进行回顾性分析。结果：144例ADR患儿中,男81例（56.25%）,女63例（43.75%）;学龄前期发生的ADR最多（29.86%）;抗感染药引发的ADR居首位,涉及17个药物品种,共64例（44.44%）,其中以头孢菌素类为主,共26例（40.63%）;ADR主要累及皮肤及其附件,共74例（48.37%）,主要临床表现为皮疹、瘙痒。结论：儿童ADR的发生与药物类型、品种等多种因素相关,临床应加强重视,减少ADR的发生。     

哮喘治疗研究进展

哮喘是儿童期最常见的慢性呼吸道疾病,经过规范化的治疗,绝大多数患者的哮喘症状可以得到良好控制.但是哮喘是一种异质性的疾病,部分患者对常规哮喘治疗反应欠佳.随着对哮喘发病机制的深入了解,新的哮喘治疗理念和方法不断成熟,文章主要介绍近年来逐渐应用于临床的新的哮喘治疗方法.     

Efficacy and Safety of a Strategy for Reviewing Intravenous Antibiotics for Hospitalized Japanese Patients with Uncomplicated Diverticulitis: A Single-center Observational Study

Objective Treatment for uncomplicated diverticulitis (UD) is not well established. We evaluated the strategy of reviewing intravenous antibiotics for hospitalized Japanese patients with UD. Methods Treatment was based on the physician''s choice until August 2018; the indications for hospitalization and treatment have been standardized since September 2018. In this study, we monitored the use of intravenous antibiotics administered to patients hospitalized for UD and then reviewed the need for them on hospital day 3. We compared patients'' length of antibiotic use, hospital stay, health care cost, and complications via the review strategy from September 2018 to December 2020 and via the previous physicians'' choice strategy from January 2016 to August 2018. Results Two hundred and forty-seven patients were admitted to our hospital because of acute colonic diverticulitis from January 2016 to December 2020. After excluding complicated cases, 106 individuals were enrolled during the period of physician''s choice; 87 were enrolled when treatment review was employed. There were no significant differences in age, sex, inflammation site, or severity during the first hospital visit. The median duration of antibiotic use was significantly reduced from 5 to 4 days (p=0.0075), with no marked increase in rates of transfer to surgery, mortality, or readmission due to recurrence. A more significant proportion of patients completed 3-day antibiotic treatment with the review strategy than with the physician''s choice strategy (6.6% vs. 25.3%, p=0.0004). However, the length of hospital stay and total medical costs did not decrease. Conclusion The strategy of reviewing treatment on day 3 after hospitalization for UD safety reduced the duration of antibiotic use, but the hospital stay and health care costs did not decrease.     

载抗生素骨科内植入物的研究进展

临床上骨科内固定手术后,由于感染或者感染后形成的高抗药性生物膜,在全身应用大剂量抗生素的情况下,病灶局部组织仍难达到有效的抗生素浓度,使感染久治难愈,导致内固定失败,为了减少术后感染的发生,可以使用载抗生素内植入物来进行治疗,或者在感染后经过清创后再次使用载抗生素内植入物进行治疗.本文对载抗生素内植入物的研究进展作一综述.     

Metronidazole-induced hepatotoxicity in a patient with xeroderma pigmentosum: A case report

Rationale:Whereas metronidazole-induced hepatotoxicity is quite rare in the general population, in individuals carrying a nucleotide excision repair disorder, namely Cockayne syndrome, there is a high risk of developing this complication.Patient concerns:We report the case of a 44-year-old man, affected by xeroderma pigmentosum, who was admitted to the hospital presenting aspiration pneumoniae caused by worsening dysphagia and with severe hepatotoxicity during the hospitalization.Diagnoses:Acute hepatitis, which was leading to acute liver failure, occurred during antibiotic treatment with metronidazole and ceftazidime with an elevation of liver enzymes consistent with hepatocellular damage pattern.Interventions:Hydration with glucose 5% solution, pantoprazole and vitamin K were administered, meanwhile other causes of hepatitis were ruled out and the ongoing antibiotic treatment was stopped suspecting a drug-induced liver injury.Outcomes:Liver function nearly completely recovered 1 month later with a first rapid improvement, within few days, of aminotransferases and coagulation studies, and slower of cholestatic enzymes.Lessons:We describe the first case available in the literature of hepatotoxicity associated with metronidazole treatment in a xeroderma pigmentosum patient. Clinicians therefore, based on this report and according to the possible underlying mechanism shared by other genetic diseases characterized by alterations in the pathway of DNA-repair, should consider such adverse event also in patients affected by this rare disease.     

抗凝/抗血小板治疗患者拔牙术后出血的研究进展

对接受抗凝/抗血小板治疗的患者进行拔牙手术,常因术后出血风险较高被许多口腔颌面外科门诊医生视为禁忌.多种因素与其发生术后出血相关,但目前还未达成共识.本文以近年文献为基础,对接受抗凝/抗血小板治疗患者发生拔牙术后出血的相关因素进行综述.文献复习结果表明,服用抗血小板药物的患者术后出血风险较服用抗凝药物的患者低;抗凝药物...     

2011~2013年医院感染菌群分布及耐药状况分析

目的统计医院患者细菌感染菌群的变化以及耐药情况,为医院内感染管理和临床合理用药提供参考依据。方法常规培养分离临床标本,采用梅里埃公司的VITEK2全自动微生物分析仪,对标本进行细菌鉴定和药敏分析。药敏确证实验,采用美国临床检验室标准化委员会(Clinical and Laboratory Standards Institute,CLSI)推荐的纸片扩散法,进行确证实验。结果2011~2013年医院感染的细菌标本来源以痰液、分泌物和中段尿为主;且感染的主要细菌呈上升趋势,排在前五位的细菌分别是:大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和金黄色葡萄球菌;常见的多重耐药菌,排前三位的是鲍曼不动杆菌、铜绿假单胞菌和大肠埃希菌,其在3年中的构成比有小幅度的增加;3年中革兰阴性杆菌(G-)耐药率大于70%的抗菌药物有:氨苄西林、头孢呋辛钠和头孢呋辛酯;革兰阳性球菌(G+)耐药率大于70%的抗菌药物有:青霉素G和红霉素。除4例粪肠球菌外,没发现其他耐万古霉素的菌株。结论细菌感染的标本来源以痰液为主。革兰阴性杆菌是医院感染的主要致病菌,呈每年递增的趋势,多重耐药菌株也不断上升,青霉素类药物已不适用于临床细菌感染的治疗;亚胺培南对大肠埃希菌和肺炎克雷伯有很高的敏感性。医院应高度重视感染的管理,加强抗菌药物应用的监管,减少细菌感染的爆发和流行,减少耐药菌株的增加。     

ICU痰革兰阴性杆菌菌群变迁及抗生素敏感性分析

目的：了解我院重症监护病房（ICU）呼吸道感染革兰阴性杆菌的菌种和抗生素敏感性变迁,指导临床合理选用抗生素。方法：2004年1月至2006年12月从我院ICU患者痰标本中分离到801株细菌,其中革兰阴性杆菌681株,占85%。细菌鉴定及药敏试验采用ATB Express ion全自动微生物分析仪。结果：3年间革兰阴性杆菌呼吸道感染前5位的分别是不动杆菌属、肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌和阴沟肠杆菌。对这五种病原菌敏感性最高的是亚胺培南（81%~97%）;对三代头孢菌素及单环β-内酰胺类抗生素耐药率较高,但对β-内酰胺类加酶抑制剂敏感率明显增加,特别是哌拉西林/三唑巴坦对肺炎克雷伯菌（81%）和大肠埃希菌（83%）敏感率高;阿米卡星对肺炎克雷伯菌（87%）和大肠埃希菌（89%）敏感率较高;铜绿假单胞菌对复方替卡西林（69%）、哌拉西林/三唑巴坦（67%）和环丙沙星（57%）等抗生素敏感率较低;不动杆菌属和阴沟肠杆菌耐药率较高,但对亚胺培南敏感,敏感率分别为95%和88%。结论：亚胺培南、阿米卡星、复方替卡西林和哌拉西林/三唑巴坦等抗生素对革兰阴性杆菌保持较高的敏感性。建议临床用药应参考药敏结果合理使用抗生素。     

Re-establishing the utility of tetracycline-class antibiotics for current challenges with antibiotic resistance

The progressive increase in antibiotic resistance in recent decades calls for urgent development of new antibiotics and antibiotic stewardship programs to help select appropriate treatments with the goal of minimising further emergence of resistance and to optimise clinical outcomes. Three new tetracycline-class antibiotics, eravacycline, omadacycline, and tigecycline, have been approved within the past 15 years, and represent a new era in the use of tetracyclines. These drugs overcome the two main mechanisms of acquired tetracycline-class resistance and exhibit a broad spectrum of in vitro activity against gram-positive, gram-negative, anaerobic, and atypical pathogens, including many drug-resistant strains. We provide an overview of the three generations of tetracycline-class drugs, focussing on the efficacy, safety, and clinical utility of these three new third-generation tetracycline-class drugs. We also consider various scenarios of unmet clinical needs where patients might benefit from re-engagement with tetracycline-class antibiotics including outpatient treatment options, patients with known β-lactam antibiotic allergy, reducing the risk of Clostridioides difficile infection, and their potential as monotherapy in polymicrobial infections while minimising the risk of any potential drug-drug interaction.

KEY MESSAGES

• The long-standing safety profile and broad spectrum of activity of tetracycline-class antibiotics made them a popular choice for treatment of various bacterial infections; unfortunately, antimicrobial resistance has limited the utility of the early-generation tetracycline agents.
• The latest generation of tetracycline-class antibiotics, including eravacycline, tigecycline, and omadacycline, overcomes the most common acquired tetracycline resistance mechanisms.
• Based on in vitro characteristics and clinical data, these newer tetracycline agents provide an effective antibiotic option in the treatment of approved indications in patients with unmet clinical needs – including patients with severe penicillin allergy, with renal or hepatic insufficiency, recent Clostridioides difficile infection, or polymicrobial infections, and those at risk of drug–drug interactions.