耐药质粒在肠道杆菌间的接合传递研究

选用１３ 种抗菌药物对１８ 株肠道杆菌进行药敏试验、质粒检测并用传统及改良两种接合转移试验方法,以５ 株伤寒杆菌的不相容性 Ｃ群（ Ｉｎｃ Ｃ） Ｒ 质粒、６ 株大肠杆菌及２ 株鼠伤寒杆菌的 Ｒ 质粒作供体,研究其在肠道杆菌间的传递。结果显示, Ｒ 质粒能在４ 种肠道杆菌间互相传递,其中伤寒杆菌 Ｉｎｃ Ｃ 群 Ｒ 质粒能在这４ 种菌中稳定复制并表达耐药性。质粒的可传递性给阻断耐药性的传播和疾病的防治带来很大困难,单纯消除某个菌中的耐药质粒已难以奏效,正常菌群中庞大的耐药基因库是致病性耐药菌株流行的潜在危险;合理选择、控制抗生素的使用,降低“选择性压力”显得尤为重要。     

179株β-内酰胺酶阳性细菌的体外药敏试验

目的：探讨β－ 内酰胺酶阳性菌的抗药性。方法：从２１７ 株临床革兰阴性杆菌和革兰阳性葡萄球菌中测得β－ 内酰胺酶阳性者１７９ 株。采用 Ｋ－ Ｂ 法测定舒普深、优力新和安美汀对这１７９ 株细菌的体外药敏试验,并与头孢哌酮、氨苄青霉素、羟氨苄青霉素及其他一些抗生素进行比较。结果说明：３ 种复方制剂对产酶细菌的抗菌作用较相应单药均有不同程度的增效。此外,对产酶革兰阴性杆菌舒普深效果较好,对产酶葡萄球菌优力新效果较好。     

Protective effects induced by alcoholic Phlomis fruticosa and Phlomis herba‐venti extracts in isolated rat colon: Focus on antioxidant,anti‐inflammatory,and antimicrobial activities in vitro

Phlomis fruticosa L. and P. herba‐venti are species belonging to the Lamiaceae family, which have been traditionally used to prepare tonic and digestive drinks. Multiple studies also demonstrated the inhibitory effects of P. fruticosa extracts and essential oil against oxidative/proinflammatory pathways and bacterial strains deeply involved in ulcerative colitis. Considering these findings, the present study evaluated the effects of alcoholic P. fruticosa and P. herba‐venti leaf extracts in isolated rat colon challenged with Escherichia coli lipopolysaccharide (LPS), an ex vivo experimental paradigm of ulcerative colitis. In this context, we assayed colon levels of pro‐oxidant and proinflammatory biomarkers, including nitrites, malondialdehyde (MDA), lactate dehydrogenase (LDH), and serotonin (5‐HT). Additionally, the extracts have been tested in order to evaluate possible inhibitory effects on specific bacterial and fungal strains involved in ulcerative colitis. Alcoholic P. fruticosa and P. herba‐venti extracts were able to blunt LPS‐induced nitrite, MDA, 5‐HT, and LDH levels in isolated rat colon. The same extracts also inhibited the growth of Pseudomonas aeruginosa, E. coli, Staphylococcus aureus, Candida albicans and Candida tropicalis. In conclusion, our findings show a potential role exerted by alcoholic P. fruticosa and P. herba‐venti in managing the clinical symptoms related to ulcerative colitis.     

Prevention of infectious complications after prostate biopsy procedure

Although febrile complications are rarely encountered after a prostate biopsy procedure, in recent years the number of cases of fatal infection after that have increased along with increases in resistant bacteria. The available biopsy approaches are transrectal and transperineal, with the transrectal approach primarily used. As the invasion path of the puncture needle differs between these approaches, pretreatment and the method of administration of preventive antimicrobial drugs should be separately considered for infection prevention. Recently, the Japanese guidelines for perioperative infection prevention in the field of urology were revised after receiving approval from the Japanese Urological Association. With use of the transrectal approach, attempts have been made to selectively administer prophylactic antibiotics by confirming the presence or absence of resistant bacteria in rectal swab culture results before carrying out a prostate biopsy procedure because of potential problems associated with resistant bacteria in rectal flora. For preventive antibiotics, a single dose of oral quinolone is recommended for patients with low risk, whereas daily administrations of piperacillin/tazobactam are recommended for those considered to be high risk. In contrast, for the transperineal procedure, a single dose of oral quinolone is recommended as a preventive antibiotic. With both approaches, it is important to empirically administer broad‐spectrum antimicrobials when occurrence of a febrile infection after a prostate biopsy procedure is confirmed.     

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。