Analysis of species distribution and antibiotic susceptibility trends of 1 172 bacterial uropathogens isolated in urine cultures on an outpatient basis

Objective To assess the bacterial profiles and antimicrobial susceptibility patterns in uropathogens, and help to inform the empiric treatment decisions for urinary tract infection in outpatient settings. Methods A single institutional retrospective analysis was performed on positive urine cultures from outpatient settings between January 1998 and December 2018. To analyze changes over time, trends analysis were undertaken on bacterial profiles, antimicrobial susceptibility and resistance. Results A total of 1.172 pathogenic bacteria were isolated after exclusion of duplicate strains originated from the same patient, including 991(84.6%) Gram-negative bacterial strains and 181(15.4%) Gram-positive strains. The most common Gram-negative uropathogens were Escherichia coli (60.8%) and Klebsiella pneumonia (8.1%). Enterococcus faecalis (4.6%) was the predominant Gram-positive strain. The detection rate of Escherichia coli increased significantly, from 50.8% to 63.2% (χ2=7.978, P=0.046), and no significant difference was observed in the distribution of major uropathogenic bacteria over the 20 years (all P＞0.05). The proportion of extended-spectrum β-lactamase (ESBLs) producing strains increased significantly across the 20 years (P＜0.05). The resistance rates of Escherichia coli to amoxicillin and clavulanate potassium, aztreonam, ceftazidime, ciprofloxacin and sulbactam+cefoperazone increased significantly (all P＜0.05). All the isolates sustained high susceptibility to tazobactam+piperacillin, amikacin, imipenem and nitrofurantoin (95.0%, 95.7%, 97.9% and 91.1%). Similar to those of Escherichia coli, Klebsiella pneumoniae remained a high and stable sensitivity to tazobactam+piperacillin, amikacin and imipenem during the 20 years (79.1%, 88.0% and 80.3%). However, the proportion of ESBLs producing strains increased significantly (P＜0.05). Among Gram-positive bacteria isolates, the sensitivity rates of Enterococcus faecalis to ampicillin, nitrofurantoin and penicillin G were 100.0%. No vancomycin resistant strain was detected in Gram-positive bacteria. Conclusions From 1998 to 2018, Escherichia coli and Klebsiella pneumoniae are the most common Gram-negative bacteria uropathogens obtained in outpatient settings. Significant increases of resistance to some antimicrobial agents such as second- and third-generation cephalosporins and fluoroquinolones are observed during the 20 years and high susceptibilities to tazobactam+piperacillin, amikacin, imipenem and nitrofurantoin sustain over time. Local treatment strategies of urinary tract infections on outpatient basis should be made according to epidemiology of drug resistance and individual characteristics to control the spread and curb the prevalence of drug resistant.     

Unveiling the Amphotericin B Degradation Pathway and Its Kinetics in Lipid-Based Solutions

The purpose of this work was to determine the degradation pathway of Amphotericin B (AmB) and its kinetics in lipid-based solutions. Mixtures of AmB in lipophilic solvent media were stored under different conditions, such as surface area, temperature, light exposure, presence of antioxidants and other co-solutes. AmB was quantified by HPLC and UV–Vis spectrometry. Empirical models were proposed, and degradation rate constants were estimated by nonlinear regression. The HPLC method was precise and accurate with linearity from 4.45 to 52.0 nM. Surface area studies revealed that adsorption to glass did not affect AmB loss. Unsaturated oils and methanol better preserved AmB compared to medium chain-triglyceride. Temperature increased AmB loss in a nonlinear behavior and the presence of antioxidants reduced its degradation. Under dark conditions, autoxidation was the predominant degradation pathway of AmB in oil, which undergoes a complex degradation. Under light exposure, photo-oxidation accounted for AmB loss, which appeared to be of pseudo-first order. AmB oily samples should be preferably stored in glass vials protected from light with the addition of antioxidants. Furthermore, this work encourages further investigation in other media for future complex modeling and estimation of AmB degradation and kinetics in lipid-based formulations.     

临床药师参与治疗一例病态肥胖患者丹毒感染的病例分析

目的 探讨临床药师在1例病态肥胖丹毒患者抗感染治疗中发挥的作用。方法 临床药师参与1例病态肥胖丹毒患者抗感染治疗方案的调整,根据该病态肥胖患者体内药代动力学变化,结合国内外相关文献,建议该患者抗感染药物的剂量分别为：青霉素480万IU ivd q6h、头孢曲松4g ivd qd、左氧氟沙星750mg ivd qd,以此给予医师以参考。结果 临床药师后续的建议被医师所采纳,临床药师协助医师制订个体化给药方案,患者丹毒感染得到了有效控制。结论     

Factors associated with treatment failure after advice from infectious disease specialists

ObjectiveRisk factors associated with treatment failure after the infectious disease specialist's (IDS) advice remain unknown. We aimed to identify these risk factors.MethodsWe included patients hospitalized in our tertiary care center who consulted an infectious disease specialist between January 2013 and April 2015. Treatment failure was defined by a composite criterion: signs of sepsis beyond Day 3, ICU admission, or death. Treatment success was defined by the patient's sustained clinical improvement.ResultsA total of 240 IDS recommendations were made. Diagnosis was changed for 64 patients (26.7%) and 50 patients experienced treatment failure after the IDS advice. In multivariate analysis, compliance with the IDS advice was associated with a higher rate of success (OR = 0.09, 95%CI [0.01–0.67]). Variables associated with treatment failure in the multivariate analysis were Charlson comorbidity score at admission (OR = 1.24, 95%CI [1.03–1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR = 8.27, 95%CI [1.37–49.80]), and deterioration of the patient's status three days after the IDS advice (OR = 12.50, 95%CI [3.16–49.46]).ConclusionReassessing IDS recommendations could be interesting for specific patients to further adapt and improve them.     

666例药品不良反应报告分析

目的：了解我院药品不良反应（ADR）发生的特点及规律,为临床合理用药提供参考依据.方法：对我院2011年12月至2013年11月上报的666例ADR报告进行统计、分析.结果：666例ADR报告中,大于70岁老年患者发生率最高（96例,占14.41％）;引发ADR的给药途径以静脉给药为主（589例,占88.44％）;引起ADR的药品种类以抗感染药最多（173例,占25.98％）,中药制剂次之（135例,占20.27％）;皮肤及其附件的损害最常见（252例,占37.84％）.结论：应正确认识和重视ADR监测工作,合理用药,避免或减少ADR的发生,保障患者用药安全、有效.     

我院442例抗感染药不良反应回顾性分析

目的:了解我院抗感染药致不良反应(ADR)的发生情况,探讨引起ADR发生的因素.方法:对2008～2009年我院上报的442例抗感染药致ADR病例报告按性别、年龄、药物类别、给药途径、ADR的临床表现等进行统计分析.结果:涉及ADR的药品65种,头孢菌素类居首位,其次为喹诺酮类;用药途径以静脉给药为主;主要ADR类型为...     

血液内科住院老年肿瘤患者感染病原菌分布和耐药性分析研究

目的 探究血液内科住院老年肿瘤患者并发感染时分离获得的致病菌分布特点及其对抗感染药物的耐药性.方法 在2010年1月至2012年6月期间,采用常规方法对血液内科住院老年肿瘤患者并发感染时获得的标本进行病原菌分离和培养,采用微量稀释法进行药敏试验.结果 所有送检标本中分离出致病菌共302株,其中革兰阴性菌194株,革兰阳性菌91株,真菌17株.分离出的真菌大多对抗真菌药物敏感,革兰阴性菌对碳青霉烯类抗生素最敏感,革兰阳性菌对万古霉素和替考拉宁敏感.结论 血液内科住院老年肿瘤患者感染以革兰阴性菌为主,在细菌培养结果出来前,建议使用以抗革兰阴性菌为主、同时兼顾抗革兰阳性菌的广谱抗生素.     

Synergistic antibacterial effect of honey and Herba Ocimi Basilici against some bacterial pathogens

Objective

To evaluate the antibacterial activity of the combination of different honey brands and methanolic fraction of Herba Ocimi Basilici using agar well diffusion assay.

Methods

The antibacterial activity was determined against thirteen pathogenic bacterial clinical isolates including six gram negative (Klebsiella pneumonia, Pseudomonas aeroginosa, Escherichia coli, Salmonella typhi, Salmonella typhimirium, Xanthomonas campestris) and six gram positive strains (Enterococcus faecalis faecalis, Bacillus subtilis, Staphylococcus aureus, Clostridium perfringens type C, Clostridium perfringens type D, Clostridium chauvoei). Agar well diffusion method was used while zones of inhibition were measured with vernier scale.

Results

At higher concentration, all the honey brands showed good to significant activity. The highest activity was observed for Hamdard brand honey (27.60±0.40) against Enterococcus faecalis.

Conclusion

These results revealed that combinations of plant extracts of Herba Ocimi Basilici with honey can be used for the development of potent and novel antibacterial agents.     

抗感染药不合理应用实例分析

目的:分析抗感染药临床不合理应用情况,为临床合理用药提供参考。方法:通过对典型病例进行详细的用药分析,找出用药中存在的问题,提出解决办法。结果与结论:抗感染药不合理应用主要有无适应证用药或药物选择不当、用法与用量不正确、药物配伍不当等,临床应加强对抗感染药的合理使用,保证患者用药安全有效。     

我院333例药品不良反应/事件报告分析

目的:分析药品不良反应/事件(ADR/ADE)的发生情况、发生特点及相关因素.方法:收集我院2010年7 - 12月上报的333例ADR/ADE报告,按照国家ADR监测中心制定的标准进行分析,总结ADR/ADE的发生状况.结果:ADR/ADE报告中,抗感染药引起的ADR/ADE最多,其次为抗肿瘤药、中成药、循环系统用药;给药途径以静脉滴注为主;临床表现以皮肤及其附件损害最常见.结论:应加强对抗感染药和静脉给药方式的监测,减少ADR/ADE的发生.