A man who wanted to commit suicide by hanging himself: an adverse effect of ciprofloxacin

In this case report, we describe a man who developed recurrent depression and suicidal ideation with a serious plan to commit suicide as definite adverse effect of ciprofloxacin, which had been prescribed for recurrent prostatitis.     

深圳市综合医院二线抗结核药物相关抗生素使用情况

目的了解深圳市综合医院二线抗结核病药物相关的抗生素使用情况。方法调查2008年深圳市三家综合医院住院部呼吸内科、消化内科和泌尿内科三个科室245例病例,均按不同科室内住院号顺序依次抽取;门诊部调查4990例病例,按门诊号先后顺序依次抽取。住院病人查阅病案资料,门诊病例查阅门诊处方,分别记录使用的StD相关的抗生素种类和时间段。结果综合医院住院病人有15．9％的病例有抗生素药物敏感试验,59．6％的病例使用过SLD相关的抗生素,其中以氟喹诺酮类居多,占49．8％,其次是大环内酯类,占9％;氟喹诺酮类的使用大多集中于左氧氟沙星和莫西沙星,而大环内酯类多集中于阿齐霉素和克拉霉素;不同科室中呼吸内科应用较多,占75．1％。8．06％的门诊病例使用了与二线抗结核药物相关的抗生素,其中4413％的病例使用氟喹诺酮类,55．7％使用大环内酯类;呼吸内科病例使用较多,占42．5％,其次为消化内科占22．5％;178例使用氟喹诺酮类抗生素的病人中,以左氧氟沙星为多,占总数的66．3％,大环内酯内使用以阿奇霉素为主,有79例,占使用大环内酯类病例总数的35．3％,其次是罗红霉素和克拉霉素,各占27．2％和24．6％;使用大环内酯类的科室以呼吸内科为主,病例数占各科室病例总数的46．9％。结论深圳市综合医院住院部和门诊部抗生素以经验用药为主,并都存在氟喹诺酮类和大环内酯类抗生素过度应用的现象。     

体外获得性人型支原体氟喹诺酮耐药株GyrA基因研究

目的探讨GyrA基因突变与体外诱导人型支原体（Mh）氟喹诺酮耐药的相关关系。方法将Mh标准株PG21在分别含有4种次抑菌浓度氟喹诺酮类药物的液体培养基中传代培养3代和12代后,筛选诱导株并分别检测其对4种药物的最低抑菌浓度（MIC）值;对所有诱导株GyrA基因PCR扩增后进行DNA测序分析。结果经体外诱导后,共筛选出8株诱导株。其中4株短期诱导株呈现低度的耐药和交叉耐药,仅SPX诱导株G3发生GvrA基因Ser83→Leu变异,4株长期诱导株呈现高度的耐药和交叉耐药。除CFX诱导株C12外,均发生GyrA基因Ser83→Leu变异。SPX诱导株G12同时还出现GyrA基因Ser84→Trp变异。结论体外长时间、次抑茵浓度的氟喹诺酮类药物刺激将诱导Mh产生耐药和交叉耐药。GyrA基因83住上丝氨酸（Ser）→亮氨酸（Leu）的变异可能是Mh体外获得性氟喹诺酮耐药的重要分子机制。     

Activity of JNJ-Q2, a novel fluoroquinolone,tested against Neisseria gonorrhoeae, including ciprofloxacin-resistant strains

JNJ-Q2 is a broad-spectrum fluoroquinolone with activity against Gram-positive and -negative pathogens. The in vitro activity of JNJ-Q2 was evaluated when tested against Neisseria gonorrhoeae isolates, including 31 ciprofloxacin-resistant strains with documented mutations in the quinolone resistance determining region. MIC values were determined using reference agar dilution methods using ciprofloxacin, penicillin, ceftriaxone, tetracycline, and azithromycin as comparators. All isolates were inhibited by ≤ 0.25 μg/mL of JNJ-Q2 (range, 0.004–0.25 μg/mL; MIC_50/90, 0.03/0.25 μg/mL) which was 8-fold (MIC₅₀) and 32-fold more potent (MIC₉₀) compared to ciprofloxacin. Few strains were susceptible to penicillin (3.0%) and tetracycline (6.1%), and with the use of the European Committee on Antimicrobial Susceptibility Testing interpretive criteria, 13.6% were resistant to azithromycin. All strains were susceptible to ceftriaxone, the most potent agent (MIC₉₀, 0.06 μg/mL) followed by JNJ-Q2 (MIC₉₀, 0.25 μg/mL). JNJ-Q2 appears to be a potent fluoroquinolone when tested against contemporary multidrug-resistant N. gonorrhoeae.     

Activity of JNJ-Q2 against Staphylococcus aureus isolated from patients with acute bacterial skin and skin-structure infection obtained during a Phase 2 clinical trial

JNJ-Q2, a fluorinated 4-quinolone, was very active against both methicillin-susceptible Staphylococcus aureus (n = 42; MIC(50/90), 0.008/0.12 μg/mL) and methicillin-resistant S. aureus (n = 69; MIC(50/90), 0.12/0.12 μg/mL) obtained from patients with acute bacterial skin and skin-structure infection (ABSSSI). Overall moxifloxacin and levofloxacin resistance rates were 31.5% and 46.9%, respectively. These favorable results support the continued clinical development of JNJ-Q2 to treat ABSSSI.     

耐氟喹诺酮类肺炎克雷伯菌GyrA变异的研究

目的：研究肺炎克雷伯菌DNA旋转酶A亚单位(GyrA)变异与其耐氟喹诺酮类(FQNL)的关系。方法：采用琼脂平板双倍稀释法测定环丙沙星、左氧氟沙星、依诺沙星和诺氟沙星对临床分离筛选的31株肺炎克雷伯菌和肺炎克雷伯菌的标准菌株ATCC10031的最低抑菌浓度(MIC)，并对此32株肺炎克雷伯菌的GyrA的基因(gyrA)进行聚合酶链反应(PCR)扩增和DNA序列的分析比较。结果：发现在所有19株耐FQNL肺炎克雷伯菌中都存在着GyrA的变异，同FQNL耐药性相关的变异有Ser83(TCC)→Phe(TTC)、Ⅱe(ATC)、Tyr(TAC)和Lys(TGC)；Asp87(GAC)→Ala(GCC)。其中Set83→Ⅱe(ATC)、Lys(TGC)的变异是本研究的新发现。结论：在耐FQNL肺炎克雷伯菌中普遍存在着GyrA的变异，其中以Ser83(TCC)的变异尤为多见。     

Surveillance of the prevalence of macrolide and/or fluoroquinolone resistance-associated mutations in Mycoplasma genitalium in Japan

To clarify the status of macrolide and fluoroquinolone resistance of clinical strains of Mycoplasma genitalium in Japan, we amplified portions of the gyrA, parC, and 23S rRNA genes from DNAs in 627 first-voided urine specimens collected from men with M. genitalium-positive urethritis who visited clinics mainly in Sendai, Tokyo, and Osaka, Japan, from 2013 to 2017, by PCR and sequenced. The incidence of single amino acid changes at Met95 or Asp99 in GyrA increased chronologically and was approximately 10% from 2015 onward. The incidence of amino acid changes at Ser83 or Asp87 in ParC was approximately 50% in 2013 but increased to 60–70% from 2014 to 2017. The incidence of mutations at A2071 or A2072 in the 23S rRNA gene increased chronologically and reached over 70% in 2017. The prevalence of M. genitalium harboring alterations in ParC and mutations in the 23S rRNA gene increased and was approximately 50% in 2016 and 2017. The prevalence of M. genitalium with alterations in both GyrA and ParC and mutations in the 23S rRNA gene, which could be associated with treatment failures with the sitafloxacin and azithromycin regimens, were approximately 15% and 10% in 2016 and 2017, respectively. The prevalence of M. genitalium with genetic alterations associated with resistance to fluoroquinolones and/or macrolides is increasing rapidly in Japan. We must prevent the further selection of multi-drug-resistant M. genitalium so that M. genitalium infections will not become untreatable.     

156例氟喹诺酮类抗菌药不良反应报告调查

目的：了解氟喹诺酮类抗菌药不良反发生的特点,为临床合理用药提供参考。方法：回顾性调查2008-2012年我院临床上报的156例喹诺酮类抗菌药所致的不良反应（ADR）报告,建立Excel表格,分别统计患者的一般情况、用药情况、ADR临床表现、ADR处置等项目并作分析。结果：发生ADR患者中女性89例,男性67例,平均年龄（56.7±1.75）岁。ADR共涉及3种药物,左氧氟沙星88例（56.4%）,其中严重ADR12例,莫西沙星58例（37.2%）,其中严重ADR12例,环丙沙星10例（6.4%）,无严重ADR。临床ADR主要累及消化系统、免疫系统、神经系统等。引起ADR主要给药途径为静脉滴注。结论：氟喹诺酮类抗菌药临床不良反应表现多样,应加强该类抗菌药的不良反应监测,确保临床用药安全。     

Species-level assessment of the molecular basis of fluoroquinolone resistance among viridans group streptococci causing bacteraemia in cancer patients

Viridans group streptococci (VGS) are a major cause of bacteraemia in neutropenic cancer patients, particularly those receiving fluoroquinolone prophylaxis. In this study, we sought to understand the molecular basis for fluoroquinolone resistance in VGS causing bacteraemia in cancer patients by assigning 115 VGS bloodstream isolates to specific species using multilocus sequence analysis (MLSA), by sequencing the quinolone resistance-determining regions (QRDRs) of gyrA, gyrB, parC and parE, and by testing strain susceptibility to various fluoroquinolones. Non-susceptibility to one or more fluoroquinolones was observed for 78% of isolates, however only 68.7% of patients were receiving fluoroquinolone prophylaxis. All but one of the determinative QRDR polymorphisms occurred in GyrA or ParC, yet the pattern of determinative QRDR polymorphisms was significantly associated with the fluoroquinolone prophylaxis received. By combining MLSA and QRDR data, multiple patients infected with genetically indistinguishable fluoroquinolone-resistant Streptococcus mitis or Streptococcus oralis strains were discovered. Together these data delineate the molecular mechanisms of fluoroquinolone resistance in VGS isolates causing bacteraemia and suggest possible transmission of fluoroquinolone-resistant S. mitis and S. oralis isolates among cancer patients.