Haematogenous Osteomyelitis of the Patella: Report of Three Cases

Three cases of osteomyelitis of the patella are reported. One presented as an acute septic arthritis and another developed a sterile arthritis despite antibiotics. The clinical signs, diagnosis and treatment are discussed. Treatment with rest and antibiotics failed to cure the disease. in all three cases a sequestrectomy was carried out resulting in healing of the affected patella and recovery of knee mobility.     

72例疝修补术患者预防用抗菌药物分析

目的:分析常熟市第一人民医院腹外疝患者围手术期预防性使用抗菌药物的情况,为合理用药提供参考。方法:采取回顾性分析方法,抽查该医院2011年7—8月间腹股沟疝手术患者出院病历72份,填写患者基本情况和用药情况调查表并进行统计分析。结果:72例患者中,42例使用了抗菌药物且都为静脉给药,抗菌药物预防用药率为58.33%(42/72),有指证用药占85.71%(36/42),给药时机合理率64.29%(27/42),术后48h内停药28例(66.67%),平均用药时间(2.13±1.38)d,抗菌药物品种以β-内酰胺类使用频率最高,无使用喹诺酮类抗菌药物现象。结论:腹外疝手术围手术期预防用抗菌药物在用药指证、品种选择、用药时机等方面较合理,但仍需改进。     

Effects of Synthetic Retinoids on the Growth of Bacteria and Their Susceptibility to Antibiotics

Summary

In patients treated with oral retinoids the recovery of Propionibacterium acnes and other anaerobic bacteria in the skin is markedly reduced, whereas an increased colonization of the skin and a significant rise in the incidence of cutaneous staphylococcal infections are observed. Since very little is known about the effects of retinoids on bacteria, in the present study we investigated the influence of 4 retinoids (isotretinoin, etretinate, arotinoid ethyl ester, arotinoid sultane) in 15 different concentrations on the growth of 10 Gram-positive and Gram-negative bacteria in vitro and on their susceptibility to 10 antibiotics.

It was found that all retinoids were not capable of affecting either the growth of bacteria or their susceptibility to antibiotics. It seems reasonable, therefore, to assume that the retinoid-induced changes in cutaneous bacterial flora in vivo are due to mechanisms other than to the direct action of these compounds on bacteria.     

23S rRNA base pair 2057-2611 determines ketolide susceptibility and fitness cost of the macrolide resistance mutation 2058A-->G

The 23S rRNA A2058G alteration mediates macrolide, lincosamide, and streptogramin B resistance in the bacterial domain and determines the selectivity of macrolide antibiotics for eubacterial ribosomes, as opposed to eukaryotic ribosomes. However, this mutation is associated with a disparate resistance phenotype: It confers high-level resistance to ketolides in mycobacteria but only marginally affects ketolide susceptibility in streptococci. We used site-directed mutagenesis of nucleotides within domain V of 23S rRNA to study the molecular basis for this disparity. We show that mutational alteration of the polymorphic 2057-2611 base pair from A-U to G-C in isogenic mutants of Mycobacterium smegmatis significantly affects susceptibility to ketolides but does not influence susceptibility to other macrolide antibiotics. In addition, we provide evidence that the 2057-2611 polymorphism determines the fitness cost of the 23S rRNA A2058G resistance mutation. Supported by structural analysis, our results indicate that polymorphic nucleotides mediate the disparate phenotype of genotypically identical resistance mutations and provide an explanation for the large species differences in the epidemiology of defined drug resistance mutations.     

糖尿病患者腹股沟疝无张力修补术围手术期抗生素的临床应用

目的探讨糖尿病患者腹股沟疝无张力修补术是否需要常规预防性应用抗生素。方法回顾性分析近年收治合并糖尿病的腹股沟疝手术患者96例,其中预防性使用抗生素患者36例(A组);未使用抗生素患者60例(B组)。比较和评价两组患者术后体温、血液检查、切口的愈合情况。结果两组患者切口均愈合良好,手术前后外周血象白细胞计数,中性粒细胞比例及体温的变化差异均无统计学意义(P>0.05);结论糖尿病患者行腹股沟疝无张力修补术,只要在围手术期控制好血糖水平,勿需常规性使用抗生素。     

抗菌药物使用的多变量监控

目的 建立基于多变量数据分析(multivariate data analysis,MVA)的抗菌药物监控模型,为规范临床抗菌药物的合理使用提供依据。方法 提取浙江省立同德医院住院患者2011—2013年共12个季度81种抗菌药物的用药频度(defined daily doses,DDDs)数据,建立主成分分析(principal component analysis,PCA)模型。通过构建得分图和X区块模型距离(distance to model X block,DModX)控制图,结合变量贡献图,对不同季度的抗菌药物进行监控,评价季度一致性,分析导致异常的原因。结果 2011年第4季度和2012年、2013年4个季度抗菌药物DDDs的一致性较好。2011年第1~3季度的DModX统计值超出了控制限,主要原因为3种特殊使用级抗菌药物(头孢噻利、夫西地酸、去甲万古霉素)、8种限制使用级抗菌药物(头孢米诺、哌拉西林/舒巴坦、阿莫西林/舒巴坦、呋苄西林、头孢丙烯、头孢唑肟、异帕米星、奥硝唑)和4种非限制使用级抗菌药物(氯唑西林、头孢氨苄、头孢羟氨苄、头孢噻肟)的DDDs偏高。结论 本研究证明了MVA在抗菌药物监控中的有效性,为临床抗菌药物监控提供新的方法。     

Plazomicin: an investigational therapy for the treatment of urinary tract infections

Introduction: Living in the ever-expanding era of multidrug-resistant (MDR), extensively drug-resistant (XDR), and even pandrug-resistant Gram-negative microorganisms, the medical community is facing the approaching fear of the “End of Antibiotics.” Plazomicin is a next-generation aminoglycoside designed to evade all clinically relevant aminoglycoside-modifying enzymes, the main mechanism of aminoglycoside resistance. A newer aminoglycoside active against several MDR-XDR microorganisms is herein presented and discussed.

Areas covered: Herein, the authors present the currently available information on plazomicin. This includes the current knowledge concerning plazomicin’s: mechanisms of action, in vitro activity and interactions, its pharmacokinetics, its clinical efficacy in complicated urinary tract infections (cUTIs) and acute pyelonephritis, and its toxicity issues.

Expert opinion: Plazomicin was developed to evade all clinically relevant aminoglycoside-modifying enzymes. Unfortunately, ribosomal enzymatic modification by ribosomal 16S-rRNA methyltransferases confers broad-spectrum high-level aminoglycoside resistance. Still, plazomicin demonstrates high activity against the Enterobacteriaceae including extended spectrum beta lactamase and most carbapenemase producers, as well as several of the non-fermenters. When compared to levofloxacin, the in vivo activity of plazomicin in complicated urinary tract infections (cUTIs) and in acute pyelonephritis in humans was very promising. Furthermore, regarding safety, no clinically significant effects on renal, vestibular, or cochlear function have been observed both at Phase I and II studies in humans, with mild to moderate adverse events being dose related. However, the authors believe that the real position of plazomicin in the MDR-XDR world will be revealed once pending Phase III studies are completed.