可赛舒治疗成年肝硬化并自发性腹膜炎体会

目的：探讨可赛舒治疗自发性腹膜炎的疗效。方法：对12例成年肝硬化并自发性腹膜炎试用可赛舒进行短程、不同剂量治疗。结果：12例患者症状缓解，腹水消失，痊愈出院。结论：可赛舒作为一种广谱抗生素治疗自发性腹膜炎值得推广。     

3种 头孢菌素对肾功能及环孢素血浓度的影响

５１例肾移植术后患者中随机分组，考查３种新头孢菌素分别与环孢素合并使用时对肾功能及环孢素全血药浓浓度的影响，在合并用头孢菌素前，合并用药７ｄ，停药后７ｄ测定患者的血清肌酐、尿素氮和环孢素全血药物浓度。     

A new anti-microbial combination prolongs the latency period,reduces acute histologic chorioamnionitis as well as funisitis,and improves neonatal outcomes in preterm PROM

Objective: Antibiotic administration is a standard practice in preterm premature rupture of membranes (PROM). Specific anti-microbial agents often include ampicillin and/or erythromycin. Anaerobes and genital mycoplasmas are frequently involved in preterm PROM, but are not adequately covered by antibiotics routinely used in clinical practice. Our objective was to compare outcomes of PROM treated with standard antibiotic administration versus a new combination more effective against these bacteria.

Study design: A retrospective study compared perinatal outcomes in 314 patients with PROM <34 weeks receiving anti-microbial regimen 1 (ampicillin and/or cephalosporins; n?=?195, 1993–2003) versus regimen 2 (ceftriaxone, clarithromycin and metronidazole; n?=?119, 2003–2012). Intra-amniotic infection/inflammation was assessed by positive amniotic fluid culture and/or an elevated amniotic fluid MMP-8 concentration (>23?ng/mL).

Results: (1) Patients treated with regimen 2 had a longer median antibiotic-to-delivery interval than those with regimen 1 [median (interquartile range) 23?d (10–51?d) versus 12?d (5–52?d), p?<?0.01]; (2) patients who received regimen 2 had lower rates of acute histologic chorioamnionitis (50.5% versus 66.7%, p?<?0.05) and funisitis (13.9% versus 42.9%, p?<?0.001) than those who had received regimen 1; (3) the rates of intra-ventricular hemorrhage (IVH) and cerebral palsy (CP) were significantly lower in patients allocated to regimen 2 than regimen 1 (IVH: 2.1% versus 19.0%, p?<?0.001 and CP: 0% versus 5.7%, p?<?0.05); and (4) subgroup analysis showed that regimen 2 improved perinatal outcomes in pregnancies with intra-amniotic infection/inflammation, but not in those without intra-amniotic infection/inflammation (after adjusting for gestational age and antenatal corticosteroid administration).

Conclusion: A new antibiotic combination consisting of ceftriaxone, clarithromycin, and metronidazole prolonged the latency period, reduced acute histologic chorioamnionitis/funisitis, and improved neonatal outcomes in patients with preterm PROM. These findings suggest that the combination of anti-microbial agents (ceftriaxone, clarithromycin, and metronidazole) may improve perinatal outcome in preterm PROM.     

Are third-generation cephalosporins associated with a better prognosis than amoxicillin–clavulanate in patients hospitalized in the medical ward for community-onset pneumonia?

ObjectivesWe aimed to assess whether treatment with ceftriaxone/cefotaxime is associated with lower in-hospital mortality than amoxicillin–clavulanate in pati0ents hospitalized in medical wards for community-onset pneumonia.MethodsWe conducted a retrospective and multicentre study of patients hospitalized in French medical wards for community-onset pneumonia between 2002 and 2015. Treatments with ceftriaxone/cefotaxime or amoxicillin–clavulanate were defined by their start in the emergency department for a duration of 5 days or more with no other β-lactam. A logistic regression analysis was performed on the overall population, and a propensity score analysis was restricted to patients treated with either ceftriaxone/cefotaxime or amoxicillin–clavulanate.Results1698 patients (median age, 80 y) were included, of which 716 and 198 were treated with amoxicillin–clavulanate and ceftriaxone/cefotaxime, respectively. In-hospital mortality was 10% (9–12%). In multivariate analysis, factors associated with in-hospital mortality were treatment with ceftriaxone/cefotaxime (aOR 2.9; (1.4–5.7)), pneumonia severity index class 4 or 5 (aOR 7.8 (4.3–15.7)), do-not-resuscitate order (aOR 8.7 (5.2–14.6)) and fluid therapy (aOR 6.3 (2.5–15.1)). The propensity score analysis was performed on 178 patients treated with ceftriaxone/cefotaxime matched with 178 patients treated with amoxicillin–clavulanate; no significant association between treatment with ceftriaxone/cefotaxime and in-hospital mortality was found (OR 1.5 (0.7–3.0)).ConclusionIn the largest study aiming to compare amoxicillin–clavulanate and ceftriaxone/cefotaxime in community-onset pneumonia, ceftriaxone/cefotaxime was not associated with lower in-hospital mortality than amoxicillin–clavulanate. Our results suggest that ceftriaxone/cefotaxime should not be preferred over amoxicillin–clavulanate for patients hospitalized in medical wards with community-onset pneumonia.     

淋球菌对头孢曲松的敏感性及淋球菌多抗原测序分型研究

目的了解中国广东地区2010—2016年淋球菌对头孢曲松的敏感性以及相应菌株的淋球菌多抗原测序分型(NGMAST)基因型别。方法 2010—2016年在广东省疾病预防控制中心收集的285株淋球菌,经分离纯化及鉴定后,采用美国临床实验室标准化委员会(CLSI)推荐的琼脂稀释法测定其对头孢曲松的最小抑菌浓度(minimal inhibitory concentration,MIC);菌株培养后利用试剂盒提取DNA,并进行淋球菌多抗原测序分型(NG-MAST)。结果本次测试的285株淋球菌除1株MIC>0.25μg/mL外,其他都属于敏感菌株(CLSI敏感标准为≤0.25μg/mL),MIC≥0.06μg/mL的菌株比例为63.2%,其中2016年度MIC≥0.06μg/mL菌株比例为44.4%,2010年MIC≥0.06μg/mL菌株比例为70.6%。NG-MAST分型研究显示,285株淋球菌共有166个型别,菌株多样性较高,其中73种为已知型别,93种为新型别。测定的所有菌株中主要包括ST568(n=13),ST270(n=9),ST421(n=7),ST2288(n=5),ST1731(n=4),ST1766(n=4),ST1866(n=4),ST1870(n=4),ST1053(n=4),ST2318(n=4),ST5990(n=4),ST1614(n=4),ST1866(n=3)等。相同NG-MAST型别的菌株具有相同或相近的MIC值。结论广东地区淋球菌对头孢曲松MIC≥0.06μg/mL菌株比例较高,需要对此进行长期监测。7年间菌株的优势型别有较大变化,显示该地区性网络可能发生较大波动。NG-MAST分型可以作为分子生物学标记用于淋球菌耐药监测。     

Bactericidal activity of cefepime and ceftriaxone tested against Streptococcus pneumoniae

The bactericidal activities of cefepime and ceftriaxone were assessed by testing a contemporary collection of 50 Streptococcus pneumoniae strains. Minimum inhibitory and bactericidal concentrations (MIC and MBC, respectively) of cefepime and ceftriaxone were determined, and time-kill studies were performed on 14 selected strains (10 penicillin-resistant, 2-intermediate, and 2-susceptible). Cefepime and ceftriaxone showed essentially identical potency (MIC50, 1 microg/mL and MIC90, 2 microg/mL, for both compounds) and MBC values (MBC50, 1 microg/mL for both). MBC/MIC ratios were < or = 4 for cefepime and < or = 8 for ceftriaxone on 48 (96.0%) strains, and 2 strains (4.0%) displayed MBC/MIC ratios > or = 32 (tolerance) to the 2 cephalosporins. Time-kill curves corroborated the MBC/MIC studies. Cefepime and ceftriaxone bactericidal activity (> or = 3 log10 CFU/mL reduction in inoculum) was demonstrable after 24 h of exposure to 8x MIC for 13 (92.9%) of 14 strains, whereas 1 strain showed approximately 2 log10 CFU/mL reduction. In conclusion, our results indicate that cefepime and ceftriaxone exhibit comparable potency and bactericidal activities when tested against contemporary pneumococcal strains with varying penicillin susceptibility patterns. Both parenteral cephems offer alternative therapeutic choices for the treatment of invasive pneumococcal infections.     

Subcutaneous and intravenous ceftriaxone administration in patients more than 75 years of age

Objective

We wanted to compare the first line intravenous administration of ceftriaxone to a subcutaneous administration in patients more than 75 years of age.

Method

We performed a retrospective monocentric study on all patients more than 75 years of age admitted to the Ales hospital between January 1 and December 31, 2011, having received at least two doses of ceftriaxone intravenously (IV) or subcutaneously (SC).

Results

One hundred and forty-eight patients (70 females/78 males patients) were included, 110 received ceftriaxone IV and 38 SC. They were a mean age of 84.7 years, older in the SC group (86.9 years) than in the IV group (83.9 years) (P = 0.0052). The SC group patients presented more frequently with dementia (57% vs. 25% P = 0.001), were more often bedridden (22% vs. 7% P = 0.023), had a higher mean World Health Organization status (3.13 vs. 2.76, P = 0.0181), and higher ADL score (7.79 vs. 5.76, P = 0.0056). There was no statistical difference for isolated bacteria, site of infection, death rate, and patients cured.

Conclusion

Subcutaneous ceftriaxone administration seems to be preferred for fragile elderly patients independently of disease severity. This administration is not associated to an impaired effectiveness or to an increased death rate.     

Assessment of ceftaroline fosamil in the treatment of community-acquired bacterial pneumonia due to Streptococcus pneumoniae: insights from two randomized trials

Ceftaroline fosamil resulted in higher cure rates than ceftriaxone in patients with community-acquired bacterial pneumonia in 2 randomized trials (FOCUS 1 and FOCUS 2). The present analysis examines the subgroup of patients with Streptococcus pneumoniae infection to determine whether the apparent difference in cure rates persists after adjusting for potential covariates. We retrospectively pooled subjects with S. pneumoniae isolated at baseline in the original studies and employed logistic regression to evaluate the independent relationship between clinical cure and treatment with ceftaroline. Covariates evaluated included demographics, severity of illness, bacteremia, and pathogen characteristics. The final cohort included 139 subjects (69 ceftaroline, 70 ceftriaxone). Unadjusted cure rates were 85.5% and 68.6% (P = 0.009) in the ceftaroline and ceftriaxone groups, respectively. After logistic regression, ceftaroline remained associated with higher cure rates. Our findings indicate that ceftaroline may result in improved outcomes of S. pneumoniae pneumonia. Formal clinical trials are warranted to confirm this hypothesis.     

头孢曲松钠联合胸腺五肽治疗早期宫颈癌合并梅毒的临床疗效分析

目的:观察头孢曲松钠联合胸腺五肽治疗早期宫颈癌合并梅毒的临床疗效。方法:随机选取94例早期宫颈癌合并梅毒患者,随机分为对照组和实验组各47例。对照组予青霉素钠+苄星青霉素治疗,实验组予头孢曲松钠+胸腺五肽治疗,两组经治疗后行相同外科宫颈癌手术治疗。观察两组患者治疗后12周、24周、48周时复查快速血浆反应素环状卡片实验(RPR)转阴例数及梅毒复发例数,以及患者1年、3年、5年生存率。结果:两组经治疗后在12周、24周、48周RPR转阴例数均呈上升趋势,但实验组RPR转阴例数在12周、24周、48周时均高于对照组(P<0.05)。对照组总梅毒总复发例数17例(占17.0%),实验组2例(占4.2%),两组差异有统计学意义(P<0.05)。两组生存率呈下降趋势,其中两组1年生存率、3年生存率差异不明显(P>0.05);但实验组5年生存率高于对照组(P<0.05)。结论:头孢曲松钠联合胸腺五肽治疗早期宫颈癌合并梅毒,疗效好,复发率低,能提高宫颈癌患者5年生存率。