临床常见的革兰阴性杆菌耐药情况及其aac(6’)-Ib-cr基因检测结果分析

目的了解我院临床常见的革兰阴性杆菌的耐药状况及其质粒介导的能使喹诺酮类和氨基糖甙类药物同时耐药的基因aac(6’)-Ib-cr的流行分布状况和比较分析。方法用微量肉汤稀释法测定2010年从临床分离的299株临床常见的革兰阴性杆菌(53株鲍曼不动杆菌、66株铜绿假单胞菌、83株大肠埃希菌和97株肺炎克雷伯菌)的MIC值。采用PCR检测所有菌株的aac(6’)-Ib基因;并以内切酶BtsCI酶切消化aac(6’)-Ib的PCR阳性产物以确定aac(6’)-Ib-cr。结果氨苄西林耐药率最高,达75.3%,其次是头孢唑林,耐药率为58.5%;环丙沙星和左氧氟沙星的耐药率分别为25.1%和16.7%;哌拉西林/他唑巴坦、阿米卡星和亚胺培南的敏感率均在90%以上。共检出aac(6’)-Ib基因29株,其中有21株变异为aac(6’)-Ib-cr,变异率为72.4%(21/29);aac(6’)-Ib-cr的总阳性率为7.0%(21/299),其中大肠埃希菌有9株及肺炎克雷伯菌有22株,其阳性率为11.67%(21/180),而在鲍曼不动杆菌和铜绿假单胞菌中未检出aac(6’)-Ib-cr(0.0%,0/119);经χ2检验,两者间的差异具有统计学意义(χ2=14.932,P<0.01)。结论目前哌拉西林/他唑巴坦、阿米卡星和亚胺培南为抗感染治疗的首选药;环丙沙星的耐药率较高,要慎选,而左氧氟沙星耐药率相对低一些,可优先于环丙沙星选用。aac(6’)-Ib-cr基因在肠杆菌科细菌与非发酵细菌中的分布差异具有统计学意义。     

Treatment strategies for Legionella infection

Given the nonspecific clinical manifestations of Legionnaires' disease and the high mortality of untreated Legionnaires' disease, we recommend routine use of Legionella testing, especially the Legionella urinary antigen test, for all patients with community-acquired pneumonia. This includes patients with ambulatory pneumonia and hospitalized children. Legionella cultures should be more widely available, especially in hospitals where the drinking water is colonized with Legionella. Azithromycin or levofloxacin can be considered as first-line therapy. Other antibiotics including tetracyclines, tigecycline, other fluoroquinolones and other macrolides (especially clarithromycin) are also effective. The clinical response of quinolones may be somewhat more favorable compared to macrolides, but the outcome is similar. If the Legionnaires' disease is hospital-acquired, culturing of the hospital drinking water for Legionella is indicated.     

Moxifloxacin: a respiratory fluoroquinolone

Background: Respiratory quinolones are a class of antimicrobials with a high activity against most respiratory pathogens. Moxifloxacin is a fourth-generation fluoroquinolone that has been shown to be effective against Gram-positive, Gram-negative, and atypical strains, as well as multi-drug resistant Streptococcus pneumoniae. Objective: To review and update the clinical efficacy of moxifloxacin in the treatment of respiratory infections. Method: To perform a systematic review of publications on the clinical efficacy of moxifloxacin in respiratory infections. Results: The clinical efficacy of moxifloxacin has been shown in controlled studies of community-acquired pneumonia, exacerbations of chronic bronchitis and acute bacterial rhinosinusitis. Moxifloxacin has demonstrated a faster resolution of symptoms in community-acquired pneumonia and exacerbations of chronic bronchitis patients compared with first-line therapy together with excellent eradication rates. Conclusions: The use of moxifloxacin as first-line therapy for moderate to severe respiratory infections in the community and the hospital has been recognized in international guidelines.     

3种喹诺酮类药物治疗呼吸道感染的成本-效果比较

目的比较氧氟沙星、左氧氟沙星及洛美沙星治疗呼吸道感染的成本-效果,促进临床合理用药。方法回顾性分析医院2011年6月至12月收治的134例呼吸道感染患者的临床资料,根据不同治疗方法分为氧氟沙星组、左氧氟沙星组和洛美沙星组,采用药物经济学方法进行分析。结果氧氟沙星、左氧氟沙星及洛美沙星的有效率分别为80.43%,88.64%,77.27%,成本-效果比值分别为6.27,6.16,6.88。结论左氧氟沙星注射液是治疗呼吸道感染最安全有效、经济合理的药物。     

In Vitro Activity of Lomefloxacin (SC-47111) Against Enterobacteriaceae,Enterococci and Staphylococci

Summary

The activity of lomefloxacin, a new difluorinated quinolone, was tested against 190 Enterobacteriaceae strains (belonging to 23 different species), 70 enterococci and 70 staphylococci. As regards Enterobacteriaceae, the activity of lomefloxacin was the same as that of norfloxacin in 9 out of the 23 species tested, and only slightly lower in further 8 species. Minimum inhibitory concentrations (MIC) values for 90% of strains were 0.5 μg/ml in 2 species, 0.25 μg/ml in 6, 0.125 μg/ml in 4, and lower than 0.125 μg/ml in 8. Slightly higher values were obtained for Serratia marcescens (2 μg/ml), whilst, as already reported for the other new quinolones, the susceptibility of the Providencia genus was very poor, with MIC values up to 128 μg/ml for the vast majority of strains. Lomefloxacin proved bactericidal at the MIC in all the Enterobacteriaceae strains tested but 20. In the latter strains, however, bactericidal activity could be appreciated at values slightly exceeding MIC. As regards enterococci, the MIC for 90% of strains was 32 μg/ml. Minimum bactericidal concentration (MBC) was the same as the MIC for 78% of the strains tested and was only twofold higher in all the others. The new drug was also active against staphylococci having an MIC50 and MIC₉₀ of 0.5 and 2 μg/ml, respectively. It was bactericidal at the MIC for 62% of the strains and at twofold the MIC for all the others.     

AcrAB外排泵ramA对肺炎克雷伯菌耐喹诺酮类药物的影响

目的 探讨AcrAB外排泵调控基因ramA对肺炎克雷伯菌耐喹诺酮类药物的影响。方法 用喹诺酮类药敏纸片扩散法、MIC及其逆转实验和有机溶剂耐受实验测定细菌耐药表型,用PCR扩增外排泵结构基因acrA、acrB、tolC及调控基因acrR,ramA,marA,用半定量PCR 检测调控基因的转录水平。结果 泵的结构基因和调控基因均存在43株KP菌中。仅喹诺酮类耐药株与敏感株ramA转录水平存在统计学差异(P<0.05)。和对照组相比,高表达ramA的 AC-1株,其泵结构基因的转录水平增高,耐药表型也有明显改变,用泵抑制剂后,其喹诺酮类的MIC恢复对照水平。结论 ramA是KP菌耐喹诺酮类抗生素的一个重要因素。抑制ramA的表达,有助于治疗多重耐药肺炎克雷伯菌的感染。     

布伦登卢普沙门菌耐药性与毒力基因分析

目的 研究临床分离的非伤寒沙门菌布伦登卢普血清型（布伦登卢普沙门菌）对抗菌药物的耐药性及其 携带的毒力基因特征。方法 收集 2012—2014 年每年 4—10 月天津市两家教学医院肠道门诊急性腹泻患者的临 床资料, 将急性腹泻患者粪便标本进行沙门菌分离培养、 生化及 PCR 鉴定、 血清学分型, 对得到的布伦登卢普沙门菌 进行抗菌药物敏感性检测、 PCR 扩增沙门菌毒力岛 （SPI） 1~5 的代表性基因和 SPI 的调节基因。结果 3 年共检测到 非重复非伤寒沙门菌 153 株, 其中 8 株 （5.23%） 为布伦登卢普沙门菌。8 株 invA-PCR 鉴定均呈阳性, 对萘啶酸耐药 率 100%, 对环丙沙星和左氧氟沙星中介耐药率 100%, 对其余检测的抗菌药物敏感; 8 株均检测到了 SPI 1~5 代表性 基因和 SPI 调节基因 （sitC、 hilA、 sseL、 sifA、 mgtC、 siiE、 sopB 和 phoP）。结论 天津地区布伦登卢普沙门菌临床株对氟 喹诺酮耐药并携带 SPI 1~5 毒力基因与调节基因, 对公众健康构成潜在威胁, 应持续开展相关监测与研究。     

新喹诺酮类药物在治疗结核病中的应用

经参考大量文献,对新喹诺酮类药物(本研究将第三、四代统称为新喹诺酮类药物)在治疗结核病中的应用情况进行探讨。新喹诺酮类药物具有良好抗结核作用,是一种使用安全、副反应小的新一代的抗结核药物。但存在一系列不良反应,应注意选择适应病例,通过皮试、控制用药剂量、给药速度、药物配伍等进行防范。     

2016—2021年咸阳市中心医院抗感染药物不良反应报告分析

目的 分析抗感染药物不良反应（ADR）发生的特点,为临床安全用药提供依据。方法 对咸阳市中心医院2016年1月—2021年12月上报的317例抗感染药物不良反应进行回顾性分析。结果 老年患者（36.28%）最易发生ADR;静脉滴注（89.27%）ADR发生率最高;ADR主要发生在用药31～60 min;引起ADR最多的药物为头孢类,其次是喹诺酮类;ADR的临床表现以皮肤及附件系统损害最多见。结论 医院重视抗感染药物的管理,提高用药合理性,加强用药监测,有效降低不良反应的发生率。