甲型副伤寒31例临床分析

目的总结近年来甲型副伤寒的临床特点、实验室检查及治疗与转归,以指导诊断与治疗。方法采用回顾性调查分析方法,对31例甲型副伤寒的临床表现、实验室检查及治疗效果进行总结分析。结果该组病例临床表现及并发症多样,氟喹诺酮类及第三代头孢菌素类抗生素对其疗效佳,所有病例经其治疗后全部痊愈。结论甲型副伤寒的临床表现缺乏特异性,确诊依靠血和骨髓细菌培养。氟喹诺酮类及第三代头孢菌素类抗生素为治疗甲型副伤寒的临床主要用药。     

4种氟喹诺酮类药物对金黄色葡萄球菌的防耐药变异浓度

目的 建立防耐药变异浓度(MPC)体外测定方法,并测定氟喹诺酮类(FQ)药物对金黄色葡萄球菌的MPC。方法 肉汤法富集10^10CFU／ml金黄色葡萄球菌ATCC25923和20株对环丙沙星敏感的金黄色葡萄球菌临床分离菌,采用平板稀释法测定莫西沙星、加替沙星、帕珠沙星和环丙沙星对金黄色葡萄球菌的最低抑菌浓度(MIC)、MIC。初测MPC(MPCpr)及MPC。结果 莫西沙星、加替沙星、帕珠沙星和环丙沙星对金黄色葡萄球菌ATCC25923的MPC分别为0．18、0．3、0．75l和1．8μg／ml,选择指数(MPC／MIC99)分别为9．0、7．5、8．0和10．6。而以上药物对20株临床分离菌的MPCpr90值分别为1、1、4和8μg／ml,MPCpr90／MIC90分别为8、8、16和16。结论 莫西沙星和加替沙星限制金黄色葡萄球菌耐药突变株选择的能力优于帕珠沙星和环丙沙星。结合药代动力学参数,莫西沙星和加替沙星对环丙沙星敏感的金黄色葡萄球菌临床分离菌能有效限制耐药突变株的选择,而环丙沙星则容易选择出耐药突变株。     

Surgical Antibiotic Prophylaxis in a Turkish University Hospital

Abstract

A prospective study was performed to assess the practice of antibiotic prophylaxis for surgical procedures in Pamukkale University Hospital, Denizli, Turkey. All surgical procedures performed between April 1 and July 31, 2001, were included. During the study period 897 operations were reviewed. 96% of all procedures were elective, 4% emergencies. Approximately 70.7% were clean surgery, 25.3% clean-contaminated, 2.8% contaminated, and 1.2% dirty. 98% of patients (879) received antibiotic prophylaxis. Although timing of prophylaxis was appropriate in all procedures, the duration of prophylaxis was optimal in only 47.7% of all cases. Sulbactam/ampicillin (SAM), cefazolin and cefepime were the most commonly used antibiotics during the study period. The results of our study suggest that the choice of prophylactic antimicrobial agent was inappropriate in most cases. In conclusion, we think that compliance regarding the optimal choice, frequency, and duration of perioperative antibiotic prophylaxis is not adequate in our hospital, and that more education on the subject is necessary.     

Further increases in carbapenem-, amikacin-, and fluoroquinolone-resistant isolates of Acinetobacter spp. and P. aeruginosa in Korea: KONSAR study 2009

Purpose

The increasing prevalence of antimicrobial resistant bacteria has become a serious worldwide problem. The aim of this study was to analyze antimicrobial resistance data generated in 2009 by hospitals and commercial laboratories participating in the Korean Nationwide Surveillance of Antimicrobial Resistance program.

Materials and Methods

Susceptibility data were collected from 24 hospitals and two commercial laboratories. In the analysis, resistance did not include intermediate susceptibility. Duplicate isolates were excluded from the analysis of hospital isolates, but not from the commercial laboratory isolates.

Results

Among the hospital isolates, methicillin-resistant Staphylococcus aureus, penicillin G-non-susceptible Streptococcus pneumoniae based on meningitis breakpoint, and ampicillin-resistant Enterococcus faecium remained highly prevalent. The proportion of vancomycin-resistant E. faecium gradually increased to 29%. Ceftazidime-resistant Escherichia coli and Klebsiella pneumoniae increased to 17% and 33%, respectively, and fluoroquinolone-resistant K. pneumoniae, Acinetobacter spp. and Pseudomonas aeruginosa increased to 33%, 67% and 39%, respectively. Amikacin-resistant Acinetobacter spp. increased to 48%. Imipenem-resistant Acinetobacter spp. and P. aeruginosa increased to 51% and 26%, respectively. Higher resistance rates were observed in intensive care unit (ICU) isolates than in non-ICU isolates among the isolates from hospitals. Resistance rates were higher in hospital isolates than in clinic isolates among the isolates from commercial laboratories.

Conclusion

Among the hospital isolates, ceftazidime-resistant K. pneumoniae and fluoroquinolone-resistant K. pneumoniae, Acinetobacter spp., and P. aeruginosa further increased. The increase in imipenem resistance was slight in P. aeruginosa, but drastic in Acinetobacter spp. The problematic antimicrobial-organism combinations were much more prevalent among ICU isolates.     

Clinical Manifestations and Outcomes of Fluoroquinolone-Related Acute Interstitial Nephritis

Objective

To describe the clinical presentation, diagnosis, and outcomes of patients with biopsy-proven acute interstitial nephritis (AIN) related to fluoroquinolone (FQ) therapy.

氟罗沙星的合成

以２,３,４－三氟硝基苯为原料,经还原、与ＥＭＭＥ缩合、环合、氟乙基化、与Ｎ－甲基哌嗪缩玫水解６步反应制得氟罗沙星,合成工艺有所改进,总收率为５５．５％。     

肠球菌GyrA基因突变和多重耐药泵与氟喹诺酮耐药性关系研究

目的探究肠球菌GyrA基因突变和多重耐药泵与氟喹诺酮类药物耐药性的关系。方法全部试验菌株使用VITEK 2-Compact仪器和GPI卡进行鉴定。通过PCR和单链构象多态性(SSCP)法检测对左氧氟沙星(Levo)与环丙沙星(Cip)耐药的30株粪肠球菌和10株屎肠球菌GyrA基因有无碱基发生突变,并通过基因测序确定其突变类型。检测了30株粪肠球菌在M-H琼脂中加入终浓度为20μg/mL利血平后Cip MIC值的改变。结果 PCR-SSCP分析结果表明40株对Levo和Cip同时耐药肠球菌均扩增出GyrA基因,其中有24株粪肠球菌和4株屎肠球菌的单链泳动带与粪肠球菌ATCC 29212和敏感菌株的单链泳动带相比较出现异常。其中粪肠球菌在第87位上有密码子改变:GAA变为GGA;屎肠球菌在第83位有密码子改变:AGT变为TAT,这些突变均可引起氨基酸的改变。在M-H琼脂中加入利血平可以提高部分粪肠球菌对环丙沙星的敏感性。结论用PCR-SSCP法检测40株肠球菌的GyrA基因并通过测序分析,显示有70%(28株)肠球菌碱基发生了突变,说明GyrA基因喹诺酮类药物耐药决定区(QRDR)突变是肠球菌对氟喹诺酮类药物耐药的重要原因,此外还有药物泵出等耐药机制的存在。     

212例氟喹诺酮不良反应/事件分析

目的分析氟喹诺酮药物不良反应发生的一般规律及其特点,为临床合理使用提供依据。方法采用回顾性研究方法 ,对2004至2009年中日友好医院上报的212例氟喹诺酮药品不良反应/事件报告进行统计分析。结果不良反应/事件以静脉剂型为主（85.38%）、女性患者比例高（72.64%）,首次用药后出现症状的比例高（90.09%）,主要表现为神经系统、皮肤及其附件的临床症状,多数患者在停药后1天内康复或明显好转。结论应重视氟喹诺酮药物首次用药后的监护,以及新的、罕见不良反应的正确诊断和治疗。     

Antimicrobial activity of a new fluoroquinolone, DU-6859a, against quinolone-resistant clinical isolates ofPseudomonas aeruginosa with genetic alterations in the GyrA subunit of DNA gyrase and the ParC subunit of topoisomerase IV

The in vitro antimicrobial activity of DU-6859a, a new fluoroquinolone, was tested against 22 clinical isolates ofPseudomonas aeruginosa, including strains with fluoroquinolone resistance-associated alterations in the GyrA subunit of DNA gyrase and the ParC subunit of topoisomerase IV. The MICs of DU-6859a for 10 isolates with both altered GyrA and ParC and for 7 isolates with altered GyrA alone ranged from 1.56 to 25 μg/mL and from 0.78 to 6.25 μg/mL, respectively. The MIC of DU-6859a at which 90% of the strains were inhibited (MIC₉₀) of these 17 isolates was 12.5 μg/mL. However, there was no significant difference between DU-6859a and the other quinolones tested against 5 strains which did not have any alterations of either GyrA or ParC. Based on the MIC₉₀s, DU-6859a exhibited 8- to 32-fold greater activity than the currently available fluoroquinolones against strains having alterations in DNA gyrase and topoisomerase IV.