我院2013～2015年住院患者抗菌药物应用分析

目的分析并评价我院住院患者抗菌药物的应用情况,为合理使用抗菌药物提供参考依据。方法利用信息系统收集2013~2015年我院抗菌药物的使用数据,对抗菌药物的费用比例、用药频度(DDDs)及日均费用(DDC)等进行回顾性分析。结果我院住院患者使用抗菌药物DDDs排名前10位的药品基本来自头孢菌素类、其他β-内酰胺类、喹诺酮类、硝基咪唑类及青霉素类复方制剂,住院患者抗菌药物占总销售金额的比例逐年上升,头孢菌素类使用频度较高,部分药物DDC较高。结论我院还存在部分药物DDDs偏高的情况,应严格限制头孢菌素类(尤其是三代头孢菌素)、其他β-内酰胺类、喹诺酮类(尤其是左氧氟沙星)及青霉素类复方制剂的临床应用,避免DDDs的过快增长,加强监督和管理。     

Trowels and Tribulations: Review of Antimicrobial‐Impregnated Bone Cements in Prosthetic Joint Surgery

Antimicrobial‐impregnated bone cement (AIBC) is a staple of contemporary orthopedic surgery and has been used to either treat or prevent prosthetic joint infection. Applied intraoperatively during primary arthroplasty or prosthetic joint exchange, this drug‐delivery vehicle has become a popular means of maximizing drug concentrations within a joint space while minimizing systemic exposure. Antimicrobial characteristics conducive to cement loading include availability of a crystalline powder formulation, molecular characteristics, minimal impact on cement integrity, and other variables promoting drug elution. Antimicrobials most commonly incorporated into cements are vancomycin and aminoglycosides, usually in combination due to synergistic antibacterial activity and enhanced cement elution. Other classes include the β‐lactams, lipopeptides, oxazolidinones, and antifungals. With the exception of several commercially available AIBCs, most products are compounded extemporaneously without a formal safety or efficacy assessment. Few randomized controlled trials have been conducted to assess the benefit or optimal use of these cement preparations, and variable methodology renders cross‐study comparison challenging. Given the lack of standardization and multidisciplinary oversight often seen with practical AIBC use, additional data are needed. This review presents information intended to guide AIBC preparation, selection, dosing, and safe use. In addition, opportunities for best practice development, antimicrobial stewardship, and future research are discussed.     

Hypothesis-driven weight-of-evidence analysis of endocrine disruption potential: a case study with triclosan

Triclosan is an antimicrobial agent used in a range of consumer products, such as deodorants, oral care, clothing, and household items. As with many consumer products, triclosan can be rinsed down the drain and transported to wastewater treatment plants. While most is eliminated during activated sludge sewage treatment by biodegradation and adsorption, some triclosan enters the aquatic environment and may expose wildlife. Given the potential for exposure to both humans and wildlife, resolving whether triclosan is endocrine active is important due to growing concerns about potential adverse public health and environmental effects of endocrine-disrupting substances. A weight of evidence (WoE) analysis focusing on specific hypotheses related to interaction with estrogen, androgen, and thyroid hormone pathways, and steroidogenesis was applied to triclosan. This WoE procedure involved systematic consideration of each endpoint, focused on screening level studies in the US Endocrine Disruptor Screening Program, as well as those in levels 1 through 5 of the OECD Conceptual Framework. This was followed by a semiquantitative relevance weighting of each endpoint to a given hypothesis to reach scientifically justified conclusions. Use of all relevant and reliable information and consistent observations in multiple studies strengthen support for or against each mode of action hypothesis. Using data from multiple animal species and in vitro systems, this systematic and transparent WoE assessment indicated that triclosan is not acting as an agonist or antagonist within the estrogen, androgen, thyroid, or steroidogenic pathways and is not impacting endocrine pathways as a lead or primary mode of toxicity.     

A patent review of the therapeutic potential of isoflavones (2012-2016)

Introduction: Isoflavones are well-studied natural products isolated from natural sources with interesting chemodiversity and possess a wide variety of biological effects. Moreover, chemical modifications based on the isoflavone scaffold, has generated synthetic chemodiversity to enhance the bioactivities of isoflavones.

Areas covered: The current review summarizes the discovery of new chemotherapeutic agents possessing the isoflavone skeleton. This review incorporates patents filed between 2012 and 2016 mostly related to anticancer, antidiabetic, antimicrobial, anti-HIV, anti-gastric ulcer, anti-gastritis, antiparasitic and some other biological effects demonstrated by isoflavone analogs.

Expert opinion: The number of interesting patents published during the five year period (2012–2016) on the therapeutic potential of isoflavones indicated the importance of this molecule. Natural isoflavones possess potent anticancer, anti-HIV and antidiabetic activities and chemical analogs of natural isoflavones increase the abovementioned biological effects. Additionally isoflavones have only been tested for a limited number of biological activities and thus future research should focus on additional biological activities viz., anti-inflammatory, antimalarial, and anti-leishmanial effects. However, the absence of SAR studies and in vivo data restricted the rational design of more potent isoflavone analogs and we believe that in order to get lead compounds, there needs to be a greater focus on SAR and in vivo studies.     

Medical management of chronic rhinosinusitis – a review of traditional and novel medical therapies

Introduction: Chronic rhinosinusitis (CRS) is a commonly seen persistent inflammatory disease process affecting the paranasal sinuses with extensively reported economic implications. Despite an elusive pathophysiologic mechanism underlying this disease process, treatment outcomes are encouraging with the employment of an array of medical and surgical therapies.

Areas covered: The goal of this paper is to provide a comprehensive, up to date analysis of the literature concerning the medical management of CRS by summarizing the evidence in support of traditional medical therapies for the management of CRS in addition to highlighting novel medical therapies currently under investigation.

Expert opinion: The current staples of medical therapy for CRS based on the strength of available evidence include topical and oral corticosteroids, oral antibiotics and topical saline. The introduction of immunomodulatory therapies (‘Biologics’) for the treatment of CRS shows promise but have yet to be employed in a widespread fashion due to the need for additional research to better elucidate their role.     

颌面部感染的病原菌及耐药性

目的了解颌面部感染患者病原菌分布及其药物敏感性,为临床合理使用抗菌药物提供依据。方法收集2012年1月—2016年12月某医院口腔颌面部感染患者标本进行病原菌培养,对病原菌进行鉴定和药敏检测,分析病原菌分布及耐药性。结果882例颌面部感染患者中男性占32.20%,女性占67.80%;年龄为~40岁、~60岁组的患者较多,分别占35.38%和32.65%;共分离病原菌145株,革兰阴性菌88株,占60.69%,以肺炎克雷伯菌和铜绿假单胞菌为主;革兰阳性菌56株,占38.62%,以金黄色葡萄球菌为主。肺炎克雷伯菌对检测的16种药物的耐药率均50%,对亚胺培南和美罗培南的耐药率最低,均为3.45%,11株为产超广谱β-内酰胺酶(ESBLs)阳性菌株;铜绿假单胞菌对检测的10种药物耐药率均40%。金黄色葡萄球菌对替加环素、利奈唑胺、万古霉素均敏感,对青霉素的耐药率最高(66.67%),对苯唑西林的耐药率为20.83%。结论口腔颌面部感染病原菌以革兰阴性菌为主,不同病原菌耐药性差别较大,在临床治疗时,应根据药敏结果合理使用抗菌药物。     

91株恶臭假单胞菌流行病学特征及耐药性

目的分析临床分离恶臭假单胞菌的流行病学与耐药特点,为临床合理防治其感染提供依据。方法收集2010年1月—2015年12月临床分离的恶臭假单胞菌及其感染者临床资料,以美国临床实验室标准化协会中的K-B纸片扩散法、药敏判断标准进行药物敏感性试验及其结果判断,以WHONET5.5软件对分离菌株药敏结果进行统计分析。结果临床标本共分离出91株恶臭假单胞菌,以60岁以上老年患者为主(占70.33%);基础疾病以社区获得性肺炎检出最多(占23.08%),其次慢性肺原性心脏病(占15.38%);标本主要来源于深部痰(占57.14%),其次为中段尿(占27.47%);主要分布于呼吸内科(占28.57%),其次为心血管内科(占13.19%)。除对氨曲南耐药率(52.75%)较高外,对庆大霉素、亚胺培南、左氧氟沙星、头孢他啶、美罗培南、环丙沙星等耐药率较低,分别为7.78%、9.89%、2.20%、9.89%、7.69%、2.22%,对阿米卡星和多粘菌素的耐药率均为0。结论恶臭假单胞菌感染主要发生于伴有基础疾病的老年患者,以呼吸道感染为主,对多数抗菌药物的耐药率10%。     

中国东海及东太平洋海山区来源抗菌活性海洋微生物的筛选研究

摘要：目的 研究中国东海及东太平洋区域来源微生物的抗菌活性,意在筛选具有良好抗菌活性的海洋微生物,并初步研究活性菌株代谢产物的结构,为探求新型抗生素提供基础。方法 以金黄色葡萄球菌、大肠杆菌和白色念珠菌为指示菌株,采用牛津杯法进行抗菌活性微生物初筛和复筛。通过HPLC-DAD结合TLC对活性突出的4株真菌及1株细菌进行活性提取物指纹图谱分析。对广谱抗菌活性菌株WBX-38进行菌种鉴定及活性代谢产物分离纯化,利用核磁共振和质谱等手段对活性化合物进行结构鉴定。采用微量稀释法测定活性化合物的最小抑菌浓度（MIC）。结果与结论 从中国东海及东太平洋来源样品中共筛选90株海洋来源菌株,获得抗菌活性菌株16株,4株为海洋细菌,12株为海洋真菌。通过HPLC-DAD结合TLC分析,发现5株活性菌株均具有独特的色谱行为。海洋真菌WBX-38通过菌种鉴定,确认为海洋来源曲霉（Aspergillus sp.）。从其发酵液提取物中分离获得1个活性化合物5-hydroxymethylfuran-3-carboxylic acid,该化合物对3种指示菌均具有一定生长抑制活性。     

98株洋葱伯克霍尔德菌临床分布及耐药性

目的分析临床分离的洋葱伯克霍尔德菌的耐药情况,为临床合理用药提供依据。方法回顾性分析2013年1月—2014年12月某院临床各科室送检标本中分离的洋葱伯克霍尔德菌,对其药敏结果进行统计分析。结果 2013年1月—2014年12月共检出洋葱伯克霍尔德菌98株,标本类型分布主要为痰(86株,占87.76%),科室分布以重症监护病房(ICU)检出最多(46株,占46.94%),洋葱伯克霍尔德菌对替卡西林/克拉维酸的耐药率最高,为73.47%,对哌拉西林/他唑巴坦和头孢哌酮/舒巴坦的耐药率均为16.33%,对米诺环素的耐药率最低,为5.10%。结论洋葱伯克霍尔德菌引起的感染耐药性高,应加强医院感染的预防与控制,及早进行病原学检查,治疗上应结合药敏结果合理用药。     

肠杆菌科细菌耐药性及其耐碳青霉烯类菌株分布特点

目的了解2015年度西京医院肠杆菌科细菌耐药性,以及耐碳青霉烯类肠杆菌科细菌的分布特点,为临床合理应用抗菌药物提供依据。方法对2015年1—12月西京医院住院及门诊患者临床感染标本进行病原菌培养、分离和鉴定,采用K-B纸片扩散法进行药敏试验,采用改良Hodge方法进行碳青霉烯酶确证试验,统计肠杆菌科细菌耐药情况。结果 2015年共检出病原菌4 166株,肠杆菌科细菌1 554株,分离率为37.30%,其中大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、奇异变形杆菌及产气肠杆菌位列肠杆菌科细菌的前5位。787株大肠埃希菌中产ESBLs菌株581株,产酶率为73.82%;367株肺炎克雷伯菌中产ESBLs菌株182株,产酶率为49.59%。大肠埃希菌、肺炎克雷伯菌对头孢唑林耐药率最高,分别为93.14%、78.48%。共检出耐碳青霉烯类抗生素肠杆菌科细菌81株,分离率为5.21%,其中肺炎克雷伯菌41株,阴沟肠杆菌27株,大肠埃希菌13株;主要来自神经外科(42株),消化内科(9株),神经内科(8株)。1.02%(8/787)的大肠埃希菌、3.27%(12/367)的肺炎克雷伯菌具有多重耐药性。结论医院感染病原菌中肠杆菌科细菌所占比例较高,肠杆菌科细菌产ESBLs菌株的检出率较高,耐碳青霉烯类抗生素肠杆菌科细菌分离率较去年有所上升,尤以肺炎克雷伯菌显著。