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Sample records for cilastatin

  1. Protective Effects of Cilastatin against Vancomycin-Induced Nephrotoxicity

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    Blanca Humanes

    2015-01-01

    Full Text Available Vancomycin is a very effective antibiotic for treatment of severe infections. However, its use in clinical practice is limited by nephrotoxicity. Cilastatin is a dehydropeptidase I inhibitor that acts on the brush border membrane of the proximal tubule to prevent accumulation of imipenem and toxicity. The aim of this study was to investigate the potential protective effect of cilastatin on vancomycin-induced apoptosis and toxicity in cultured renal proximal tubular epithelial cells (RPTECs. Porcine RPTECs were cultured in the presence of vancomycin with and without cilastatin. Vancomycin induced dose-dependent apoptosis in cultured RPTECs, with DNA fragmentation, cell detachment, and a significant decrease in mitochondrial activity. Cilastatin prevented apoptotic events and diminished the antiproliferative effect and severe morphological changes induced by vancomycin. Cilastatin also improved the long-term recovery and survival of RPTECs exposed to vancomycin and partially attenuated vancomycin uptake by RPTECs. On the other hand, cilastatin had no effects on vancomycin-induced necrosis or the bactericidal effect of the antibiotic. This study indicates that cilastatin protects against vancomycin-induced proximal tubule apoptosis and increases cell viability, without compromising the antimicrobial effect of vancomycin. The beneficial effect could be attributed, at least in part, to decreased accumulation of vancomycin in RPTECs.

  2. Evaluation of the appropriateness of imipenem/cilastatin prescription and dosing in a tertiary care hospital

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    Kabbara WK

    2015-03-01

    Full Text Available Wissam K Kabbara, George T Nawas, Wijdan H RamadanDepartment of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon Background: Imipenem/cilastatin is an antibacterial agent of the carbapenem class of β-lactams that is known to have an extremely wide spectrum of activity against Gram-positive, Gram-negative, aerobic, anaerobic, and even multidrug-resistant strains. The objective of this study was to evaluate the appropriate use of imipenem/cilastatin in a local tertiary care hospital. The study assessed the indication both empirically and after the culture results were available, the dose and dose adjustment in renal failure, as well as the incidence of seizure in hospitalized patients receiving imipenem/cilastatin. Methods: This observational study was conducted in a tertiary care hospital over a 3-month period. The treatment of 100 patients with imipenem/cilastatin was evaluated both empirically and after culture results were available. Analysis of the appropriateness of imipenem/cilastatin indication, dose, and monitoring of seizure frequency was based on the package insert, updated published guidelines, and clinical judgment. Results: Patients from internal medicine and intensive care units comprised approximately 50% of the population in the study. The patients received imipenem/cilastatin mainly for urinary tract infections (27% or for sepsis of an unknown focus (22%. The use of imipenem/cilastatin empirically was appropriate in 97.2% (n=69/71 of the cases, and its use postculture in 86% of the cases. There were 29% of the patients who were not started on imipenem/cilastatin empirically. Four patients out of the 29 patients (13.8% who were not started on imipenem/cilastatin empirically inappropriately received imipenem/cilastatin post-culture results. Thirty-three patients (33% were not dosed appropriately, 30 of whom had renal impairment and creatinine clearance fluctuations. Only one patient developed a

  3. Evaluation of the appropriateness of imipenem/cilastatin prescription and dosing in a tertiary care hospital

    Science.gov (United States)

    Kabbara, Wissam K; Nawas, George T; Ramadan, Wijdan H

    2015-01-01

    Background Imipenem/cilastatin is an antibacterial agent of the carbapenem class of β-lactams that is known to have an extremely wide spectrum of activity against Gram-positive, Gram-negative, aerobic, anaerobic, and even multidrug-resistant strains. The objective of this study was to evaluate the appropriate use of imipenem/cilastatin in a local tertiary care hospital. The study assessed the indication both empirically and after the culture results were available, the dose and dose adjustment in renal failure, as well as the incidence of seizure in hospitalized patients receiving imipenem/cilastatin. Methods This observational study was conducted in a tertiary care hospital over a 3-month period. The treatment of 100 patients with imipenem/cilastatin was evaluated both empirically and after culture results were available. Analysis of the appropriateness of imipenem/cilastatin indication, dose, and monitoring of seizure frequency was based on the package insert, updated published guidelines, and clinical judgment. Results Patients from internal medicine and intensive care units comprised approximately 50% of the population in the study. The patients received imipenem/cilastatin mainly for urinary tract infections (27%) or for sepsis of an unknown focus (22%). The use of imipenem/cilastatin empirically was appropriate in 97.2% (n=69/71) of the cases, and its use postculture in 86% of the cases. There were 29% of the patients who were not started on imipenem/cilastatin empirically. Four patients out of the 29 patients (13.8%) who were not started on imipenem/cilastatin empirically inappropriately received imipenem/cilastatin post-culture results. Thirty-three patients (33%) were not dosed appropriately, 30 of whom had renal impairment and creatinine clearance fluctuations. Only one patient developed a seizure while on imipenem/cilastatin. Conclusion The prescription of imipenem/cilastatin at our setting was mostly appropriate to what is recommended in the guidelines

  4. Imipenem-cilastatin sodium, a broad-spectrum carbapenem antibiotic combination.

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    Pastel, D A

    1986-09-01

    The chemistry, antimicrobial spectrum, mechanism of action, pharmacology and pharmacokinetics, clinical use, adverse effects, dosage and administration, place in therapy, cost-effectiveness, and formulary considerations of imipenem-cilastatin sodium are reviewed. Imipenem is the first carbapenem antibiotic of the thienamycin class to be used clinically. Imipenem has the widest spectrum of antimicrobial activity of currently available beta-lactam agents and, in contrast to other beta-lactam antibiotics, lacks cross resistance with recently introduced extended-spectrum penicillins and third-generation cephalosporins. Against gram-positive and gram-negative aerobic and anaerobic organisms, imipenem demonstrates excellent activity. Pseudomonas maltophilia, some strains of Pseudomonas cepacia, and Streptococcus faecium are resistant. Strains of methicillin-resistant staphylococci should also be considered resistant to imipenem. For clinical use imipenem is coadministered in equal parts with cilastatin. Cilastatin is a renal dehydropeptidase inhibitor that inhibits the metabolism of imipenem by renal brush-border enzymes, thus increasing imipenem concentrations in urine. Imipenem-cilastatin is administered by the intravenous route only. The adverse reaction profile of imipenem-cilastatin is similar to t that of other beta-lactam antibiotics. Recommended dosage reductions appropriate for renal impairment should be guided by periodic assessments of renal function, with close adherence to recommended dosage schedules, particularly among patients who are predisposed to seizures or receiving anticonvulsant medication. Imipenem-cilastatin performed well in both comparative and noncomparative trials of clinical efficacy and safety. For infections with multiple organisms (e.g., pelvic, intra-abdominal, or soft-tissue infections), imipenem-cilastatin may be a cost-effective and less toxic single-agent alternative to "standard" combination (e.g., aminoglycoside-penicillin plus an

  5. [A case of Mycobacterium abscessus pulmonary infection; effectiveness of clarithromycin, amikacin and imipenem/cilastatin].

    Science.gov (United States)

    Shikama, Yusuke; Kamio, Yoshito; Kuriu, Kazuyuki; Shibuya, Yasuhiro; Kimura, Satoshi; Nakajima, Hiroaki

    2006-11-01

    A 42-year-old woman presented with persistent cough, bloody sputum and fever. Her chest X-ray film showed an infiltrative shadow with cavitation in the upper lobe of the left lung. Acid-fast-bacilli were shown by sputum smear staining. The anti-tuberculosis drugs isoniazid, refampicin, ethambutol and pyrazinamide were prescribed, but her symptoms and chest X-ray findings did not improve. Findings of MTD and MAC-PCR were negative but Mycobacterium abscessus was confirmed by sputum culture with the DNA hybridization method. Combination therapy with clarithromycin, amikacin and imipenem/cilastatin for one month improved her symptoms and chest X-ray shadow, and clarithromycin monotherapy was carried out for another ten months. Drug susceptibility tests revealed this mycobacterium was sensitive to clarithromycin and amikacin. To determine the environmental factors related to this infection, several samples were examined. Acid-fast-bacilli were present in a smear from the bath room drain. However, to confirm the infectious routes, longer observation is needed. Moreover, serum amyloid protein A and ESR were useful markers to estimate the clinical course. PMID:17144576

  6. A Prospective Randomized Trial of Imipenem-Cilastatin Versus Clindamycin/Tobramycin in the Treatmentof Intra-Abdominal and Pelvic Infections

    Directory of Open Access Journals (Sweden)

    Lionel A Mandell

    1993-01-01

    Full Text Available Objective: A Canadian multicentre clinical trial in the treatment of intra-abdominal and pelvic infections to compare the efficacy and safety of monotherapy using imipenem-cilastatin (imipenem (500 mg intravenously every 6 h versus combination therapy with clindamycin/tobramycin (clindamycin 600 mg intravenously every 6 h and tobramycin 1.7 mg/kg intravenously every 8 h.

  7. Spectrophotometric and chemometric methods for determination of imipenem, ciprofloxacin hydrochloride, dexamethasone sodium phosphate, paracetamol and cilastatin sodium in human urine

    Science.gov (United States)

    El-Kosasy, A. M.; Abdel-Aziz, Omar; Magdy, N.; El Zahar, N. M.

    2016-03-01

    New accurate, sensitive and selective spectrophotometric and chemometric methods were developed and subsequently validated for determination of Imipenem (IMP), ciprofloxacin hydrochloride (CIPRO), dexamethasone sodium phosphate (DEX), paracetamol (PAR) and cilastatin sodium (CIL) in human urine. These methods include a new derivative ratio method, namely extended derivative ratio (EDR), principal component regression (PCR) and partial least-squares (PLS) methods. A novel EDR method was developed for the determination of these drugs, where each component in the mixture was determined by using a mixture of the other four components as divisor. Peak amplitudes were recorded at 293.0 nm, 284.0 nm, 276.0 nm, 257.0 nm and 221.0 nm within linear concentration ranges 3.00-45.00, 1.00-15.00, 4.00-40.00, 1.50-25.00 and 4.00-50.00 μg mL- 1 for IMP, CIPRO, DEX, PAR and CIL, respectively. PCR and PLS-2 models were established for simultaneous determination of the studied drugs in the range of 3.00-15.00, 1.00-13.00, 4.00-12.00, 1.50-9.50, and 4.00-12.00 μg mL- 1 for IMP, CIPRO, DEX, PAR and CIL, respectively, by using eighteen mixtures as calibration set and seven mixtures as validation set. The suggested methods were validated according to the International Conference of Harmonization (ICH) guidelines and the results revealed that they were accurate, precise and reproducible. The obtained results were statistically compared with those of the published methods and there was no significant difference.

  8. Cefepime versus Imipenem-Cilastatin for Treatment of Nosocomial Pneumonia in Intensive Care Unit Patients: a Multicenter, Evaluator-Blind, Prospective, Randomized Study

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    Zanetti, G.; Bally, F.; Greub, G.; Garbino, J.; Kinge, T.; Lew, D.; Romand, J.-A.; Bille, J.; Aymon, D.; Stratchounski, L.; Krawczyk, L.; Rubinstein, E.; Schaller, M.-D.; Chiolero, R.; Glauser, M.-P.; Cometta, A.

    2003-01-01

    In a randomized, evaluator-blind, multicenter trial, we compared cefepime (2 g three times a day) with imipenem-cilastatin (500 mg four times a day) for the treatment of nosocomial pneumonia in 281 intensive care unit patients from 13 centers in six European countries. Of 209 patients eligible for per-protocol analysis of efficacy, favorable clinical responses were achieved in 76 of 108 (70%) patients treated with cefepime and 75 of 101 (74%) patients treated with imipenem-cilastatin. The 95% confidence interval (CI) for the difference between these response rates (−16 to 8%) failed to exclude the predefined lower limit for noninferiority of −15%. In addition, therapy of pneumonia caused by an organism producing an extended-spectrum β-lactamase (ESBL) failed in 4 of 13 patients in the cefepime group but in none of 10 patients in the imipenem group. However, the clinical efficacies of both treatments appeared to be similar in a secondary intent-to-treat analysis (95% CI for difference, −9 to 14%) and a multivariate analysis (95% CI for odds ratio, 0.47 to 1.75). Furthermore, the all-cause 30-day mortality rates were 28 of 108 (26%) patients in the cefepime group and 19 of 101 (19%) patients in the imipenem group (P = 0.25). Rates of documented or presumed microbiological eradication of the causative organism were similar with cefepime (61%) and imipenem-cilastatin (54%) (95% CI, −23 to 8%). Primary or secondary resistance of Pseudomonas aeruginosa was detected in 19% of the patients treated with cefepime and 44% of the patients treated with imipenem-cilastatin (P = 0.05). Adverse events were reported in 71 of 138 (51%) and 62 of 141 (44%) patients eligible for safety analysis in the cefepime and imipenem groups, respectively (P = 0.23). Although the primary end point for this study does not exclude the possibility that cefepime was inferior to imipenem, some secondary analyses showed that the two regimens had comparable clinical and microbiological

  9. Imipenem and Cilastatin Injection

    Science.gov (United States)

    ... heart lining and valves) and respiratory tract (including pneumonia), urinary tract, abdominal (stomach area), gynecological, blood, skin, ... effects. Call your doctor if you have any unusual problems while taking this medication.If you experience ...

  10. 亚胺培南西司他丁钠致中毒性表皮坏死松解型药疹1例%One case of toxic epidermal necrolysis induced by imipenem and cilastatin sodium

    Institute of Scientific and Technical Information of China (English)

    徐锦龙; 王雄雄; 陈武; 胡东军; 叶忠亮; 马卫成

    2014-01-01

    One 48-year-old male patient with head trauma surgery was hospitalized because of unconsciousness for 1 month. The patient had no drug and food allergic history. After the evacuation of hematoma by craniotomy in emergency, the patient was fever, and the cefoxitin was used according to the susceptibility test. After 5 days, cefoxitin was discontinued, and the antibacterial agent was adjusted to imipenem and cilastatin sodium. Three days later, red rash appeared mainly in the patient's back and chest, and gradually spread to the whole body with peeling. Patient was diagnosed with toxic epidermal necrolysis. Then imipenem and cilastatin sodium was stopped, cefoperazone and sulbactam sodium and fosfomycin sodium were used for anti-infection, and methylprednisolone sodium succinate and other antiallergic treatments were given. Since then, no new rash appeared, skin wound gradually dried, and lesion area gradually diminished.%1例48岁男性患者,因头颅外伤术后伴意识不清1个月入院。既往无药物、食物过敏史。急诊行开颅血肿清除术,术后患者出现发热,根据药敏试验结果给予头孢西丁。5d后停用头孢西丁,改为亚胺培南西司他丁钠,3d后患者出现红色皮疹,以胸背部为主,并逐步蔓延至全身,部分伴脱皮,皮肤科会诊后诊断为中毒性表皮坏死松解型药疹。遂停用亚胺培南西司他丁钠,改为头孢哌酮舒巴坦钠与磷霉素钠,并给予甲泼尼龙琥珀酸钠等抗过敏治疗,之后患者再无新发皮疹,皮损创面逐步干燥,面积也逐渐缩小。

  11. Therapeutic drug monitoring for peripartum use of imipenem/cilastatin%围生期孕产妇应用亚胺培南/西司他丁钠的治疗药物监测

    Institute of Scientific and Technical Information of China (English)

    刘维; 朱立勤; 张现化; 魏瑗; 熊歆; 刘洋; 杨丽

    2015-01-01

    目的:探讨治疗药物监测手段支持围生期孕妇应用亚胺培南/西司他丁钠治疗的作用。方法1名孕29周患者因宫内感染使用亚胺培南/西司他丁钠进行抗感染治疗,为明确药物使用的安全性,临床药师通过治疗药物监测手段,协助临床科室进行围生期抗感染治疗。结果与结论对母体静脉血及胎儿脐带血进行血药浓度监测发现,母体及胎儿的血药浓度均在安全范围,通过随访,母婴均恢复良好出院。临床药师为临床特殊患者进行治疗药物监测,为围生期使用美国食品药品监管理局妊娠分级C级的抗菌药物积累了应用经验和药学监护方法。%Objective To report a case of peripartum use of imipenem/cilastatin supported by therapeutic drug monitoring ( TDM ) technique. Methods A 29-week pregnant woman was prescribed imipenem/cilas-tatin because of intrauterine infection , to ensure the safety of this Food and Drug Administration ( FDA ) Class C drug , pharmacists carried out TDM for this patient.Results and Conclusion By establishing a rapid analyzing method , the parent venous blood and fetus umbilical cord blood was measured.The concentration of imipenem/cilastatin were within nor-mal range in both the mother and the baby .Through follow-up, no ad-verse event were developed and both were discharged later .By providing TDM and pharmaceutical care , the pharmacists supported the clinical us-age of peripartum anti -infectious therapy , and more experience and con-fidence would be gained and shared .

  12. Isolation and antimicrobial resistance of imipenem/cilastatin-resistant Acinetobacter baumannii%耐亚胺培南/西司他丁鲍曼不动杆菌的分离及耐药性

    Institute of Scientific and Technical Information of China (English)

    欧阳育琪; 史文元; 黄红卫; 林应标; 黄强; 熊劲芝

    2011-01-01

    Objective To study the isolation and antimicrobial resistance of imipenem/cilastatin (IPM)-resistant Acinetobacter baumannii (A. Baumannii) in a hospital. Methods Clinical specimens were collected from January 2006 to December 2010, except the blood culture was performed with United States BD BACTEC9120 system, the other specimens were cultured and isolated bacteria with routine method ; strains were identified and performed drug sensitive test with Phoenix 100 automatic analysis system and reagents. The metallo-j3-lactamases were detected with 2-mercaptopropanoic acid inhibited assays. Results One hundred and fifty-four (74. 03%) IPM-resistant A. Baumannii strains were mainly isolated from sputum and throat swabs, strains mainly distributed in the following departments: intensive care unit (98 isolates,63. 64%),. Department of neurology (25,16. 23%), burn unit (13, 8.44%), respiratory department(8, 5. 19%), geriatrics department (4, 2. 60%), department of general surgery (3,1. 95%), and hematological department(3,1. 95%) . IPM-resistant A. Baumannii had the lowest resistant rate to cefoperazone/sulbactam (42. 21%), and the resistant rates to the other antimicrobial agents were all >65 %. The rate of metallo-fMactamase-producing strains was 14. 94%(23/154). Conclusion The IPM-resistant A. Baumannii are chiefly from specimens in respiratory tract infection, and the susceptibility to antimicrobial agents is low. The strengthening of the monitor and optimization use of antimicrobial agents is important for controlling the prevalence of IPM-resistant A. Baumannii in hospitals.%目的 了解耐亚胺培南/西司他丁(IPM)鲍曼不动杆菌(Ab)在某院的分离及其耐药性.方法 收集该院2006年1月-2010年12月临床各类标本,除血培养采用美国BD公司BACTEC9120进行检测,其余标本按常规方法培养分离细菌;在Phoenix 100全自动分析系统和配套试剂中,对菌株进行鉴定及药敏试验.采用2-巯基丙酸抑

  13. 两种亚胺培南/西司他丁钠制剂治疗中性粒细胞缺乏伴发热的对照研究及成本-效果分析%The Clinical Efficacy and Cost-Effectiveness of Two Kinds of Imipenem/Cilastatin Sodium Formulations for Febrile Neutropenia: A Controlled Clinical Trial

    Institute of Scientific and Technical Information of China (English)

    卢双龙; 周宁; 乔晓红; 邵越霞; 谢晓恬

    2013-01-01

    Objective: To evaluate the clinical efficacy and cost-effectiveness of two kinds of imipenem/cilastatin sodium formulations: Bacqure and Tienam for febrile neulropenia. Methods: Fifty one cases of palients wilh febrile neutropenia were randomly divided into two groups. Bacqure was used in one group (29 cases) and the other group (22 cases) was treated with Tienam. Evaluate the efficacy of the two groups and use the pharmacological economic principle to analyze the cost-effectiveness of the two groups. Results: The effective rates of Bacqure group and Tienam group in the treatment of febrile neutropenia were 86. 20 % and 86. 36 % (P>0. 05) respectively; the cost-effectiveness ralio ( C/E) were 28.54 and 42. 15. The cost for every one unit increment of effectiveness in Tienam group was 7,375 RMB. which was higher than thai in Bacqure group. Conclusions: There was no significant difference between Bacqure group and Tienam group in the clinical efficacy for febrile neutropenia. The cost-effectiveness ratio of Bacqure is superior to that of Tienam and Bacqure is likely to have pharmacoeconomical advantage over Tienam in the treatment of febrile neutropenia.%目的:比较分析两种亚胺培南/西司他丁钠制剂齐佩能(Bacqure)与泰能(Tienam)治疗中性粒细胞缺乏伴发热的疗效及成本.方法:将51例次中性拉细胞缺乏伴发热患儿随机分为齐佩能组29例和泰能组22例,分别选用齐佩能和泰能进行治疗,比较两组临床疗效,并运用药物经济学原理对两种治疗方案进行成本-效果分析.结果:齐佩能与泰能治疗中性粒细胞缺乏伴发热的有效率分别为86.20%和86.36% (P>0.05),成本-效果比(C/E)分别为28.54和42.15;与齐佩能相比,泰能每增加一个单位效果需多花费7 375元结论:齐佩能与泰能治疗中性粒细胞缺乏伴发热临床疗效比较差异无统计学意义,但齐佩能的成本-效果比低于泰能,有一定的经济学优势.

  14. Local treatment of generalised peritonitis in rats; Effects on bacteria, endotoxin and mortality

    NARCIS (Netherlands)

    Rosman, C; Westerveld, GJ; Kooi, K; Bleichrodt, RP

    1999-01-01

    Objective. To assess the effect of debridement, intraoperative lavage with saline, and additional instillation of taurolidine or imipenem/cilastatin in rats with faecal peritonitis. Design: Laboratory study. Setting: University hospital, The Netherlands. Material: 60 male Wister rats. Interventions:

  15. Efficacies of Imipenem, Meropenem, Cefepime, and Ceftazidime in Rats with Experimental Pneumonia Due to a Carbapenem-Hydrolyzing β-Lactamase-Producing Strain of Enterobacter cloacae

    OpenAIRE

    Mimoz, Olivier; Leotard, Sophie; Jacolot, Anne; Padoin, Christophe; Louchahi, Kamel; Petitjean, Olivier; Nordmann, Patrice

    2000-01-01

    The antibacterial activities of imipenem-cilastatin, meropenem-cilastatin, cefepime and ceftazidime against Enterobacter cloacae NOR-1, which produces the carbapenem-hydrolyzing β-lactamase NmcA and a cephalosporinase, and against one of its in vitro-obtained ceftazidime-resistant mutant were compared by using an experimental model of pneumonia with immunocompetent rats. The MICs of the β-lactams with an inoculum of 5 log10 CFU/ml were as follows for E. cloacae NOR-1 and its ceftazidime-resis...

  16. Pharmacodynamics of Imipenem in Combination with beta-Lactamase Inhibitor MK7655 in a Murine Thigh Model

    NARCIS (Netherlands)

    Mavridou, E.; Melchers, M.J.B.; Mil, A.C. van; Mangin, E.; Motyl, M.R.; Mouton, J.W.

    2015-01-01

    MK7655 is a newly developed beta-lactamase inhibitor of class A and class C carbapenemases. Pharmacokinetics (PK) of imipenem-cilastatin (IMP/C) and MK7655 were determined for intraperitoneal doses of 4 mg/kg to 128 mg/kg of body weight. MIC and pharmacodynamics (PD) studies of MK7655 were performed

  17. Ertapenem Resistance of Escherichia coli

    OpenAIRE

    Lartigue, Marie-Frédérique; Poirel, Laurent; Poyart, Claire; Réglier-Poupet, Hélène; Nordmann, Patrice

    2007-01-01

    An ertapenem-resistant Escherichia coli isolate was recovered from peritoneal fluid in a patient who had been treated with imipenem/cilastatin for 10 days. Ertapenem resistance may be explained by a defect in the outer membrane protein and production of extended-spectrum β-lactamase CTX-M-2.

  18. Increased GVHD-related mortality with broad-spectrum antibiotic use after allogeneic hematopoietic stem cell transplantation in human patients and mice.

    Science.gov (United States)

    Shono, Yusuke; Docampo, Melissa D; Peled, Jonathan U; Perobelli, Suelen M; Velardi, Enrico; Tsai, Jennifer J; Slingerland, Ann E; Smith, Odette M; Young, Lauren F; Gupta, Jyotsna; Lieberman, Sophia R; Jay, Hillary V; Ahr, Katya F; Porosnicu Rodriguez, Kori A; Xu, Ke; Calarfiore, Marco; Poeck, Hendrik; Caballero, Silvia; Devlin, Sean M; Rapaport, Franck; Dudakov, Jarrod A; Hanash, Alan M; Gyurkocza, Boglarka; Murphy, George F; Gomes, Camilla; Liu, Chen; Moss, Eli L; Falconer, Shannon B; Bhatt, Ami S; Taur, Ying; Pamer, Eric G; van den Brink, Marcel R M; Jenq, Robert R

    2016-05-18

    Intestinal bacteria may modulate the risk of infection and graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Allo-HSCT recipients often develop neutropenic fever, which is treated with antibiotics that may target anaerobic bacteria in the gut. We retrospectively examined 857 allo-HSCT recipients and found that treatment of neutropenic fever with imipenem-cilastatin and piperacillin-tazobactam antibiotics was associated with increased GVHD-related mortality at 5 years (21.5% for imipenem-cilastatin-treated patients versus 13.1% for untreated patients, P = 0.025; 19.8% for piperacillin-tazobactam-treated patients versus 11.9% for untreated patients, P = 0.007). However, two other antibiotics also used to treat neutropenic fever, aztreonam and cefepime, were not associated with GVHD-related mortality (P = 0.78 and P = 0.98, respectively). Analysis of stool specimens from allo-HSCT recipients showed that piperacillin-tazobactam administration was associated with perturbation of gut microbial composition. Studies in mice demonstrated aggravated GVHD mortality with imipenem-cilastatin or piperacillin-tazobactam compared to aztreonam (P short-chain fatty acids or numbers of regulatory T cells. Notably, imipenem-cilastatin treatment of mice with GVHD led to loss of the protective mucus lining of the colon (P intestinal barrier function (P < 0.05). Sequencing of mouse stool specimens showed an increase in Akkermansia muciniphila (P < 0.001), a commensal bacterium with mucus-degrading capabilities, raising the possibility that mucus degradation may contribute to murine GVHD. We demonstrate an underappreciated risk for the treatment of allo-HSCT recipients with antibiotics that may exacerbate GVHD in the colon. PMID:27194729

  19. Pharmacodynamics of Imipenem in Combination with β-Lactamase Inhibitor MK7655 in a Murine Thigh Model

    OpenAIRE

    Mavridou, Eleftheria; Melchers, Ria J. B.; van Mil, Anita C. H. A. M.; Mangin, E.; Motyl, Mary R.; Mouton, Johan W.

    2014-01-01

    MK7655 is a newly developed beta-lactamase inhibitor of class A and class C carbapenemases. Pharmacokinetics (PK) of imipenem-cilastatin (IMP/C) and MK7655 were determined for intraperitoneal doses of 4 mg/kg to 128 mg/kg of body weight. MIC and pharmacodynamics (PD) studies of MK7655 were performed against several beta-lactamase producing Pseudomonas aeruginosa and Klebsiella pneumoniae strains to determine its effect in vitro and in vivo. Neutropenic mice were infected in each thigh 2 h bef...

  20. Imipenem-induced clostridium difficile diarrhea in a patient with chronic renal failure

    Directory of Open Access Journals (Sweden)

    R Enríquez

    2011-01-01

    Full Text Available An 80-year-old man was diagnosed to have pneumonia and advanced chronic kidney disease. He presented with anuria and hemodialysis, by temporary femoral catheter, was initiated. He was empirically treated with imipenem/cilastatin 500 mg/24 h after hemodialysis. After 10 days of antibiotic intake, he developed severe diarrhea. Diagnosis of Clostridium difficile (CD-associated diarrhea was confirmed by detection of the toxins A and B in his stool. Imipenem therapy was discontinued; Vancomycin 500 mg orally every 6 h and 1000 mg per rectum every day was added. After two weeks of this treatment, the patient reported complete resolution of the diarrhea and stool samples were negative for Clostridium toxin. In this case, the most possible cause of CD colitis was considered to be imipenem because of the temporal relationship between exposure to the drug and onset of symptoms.

  1. Noma in an immunocompromised patient.

    Science.gov (United States)

    Silva, Igor Henrique Morais; Faria, Andreza Barkokebas S de; Fonseca, Deborah Daniela Diniz; Aguiar, Carlos Menezes; Carvalho, Alessandra Tavares; Gueiros, Luiz Alcino; Leao, Jair Carneiro

    2013-01-01

    Noma (also known as cancrum oris) is classified by the World Health Organization as a necrotizing ulcerative stomatitis, an invasive acute infection which affects the orofacial tissues. Patients who are subject to such risk factors as severe malnutrition or alteration of the immune system are predominantly affected. This article presents a case of noma in a 62-year-old immunocompromised patient with pain and tooth mobility in the mandibular region, ulceration, bleeding, gingival inflammatory secretion, and oral malodor. The signs and symptoms were controlled only after the intravenous administration of 500 mg tid of imipenem/cilastatin sodium and 2 g qd of vancomycin. After infection control was maintained, the patient was directed to surgery for removal of bone sequestration and curettage of the maxillary sinus. The patient was prescribed 1 g qd of oral clindamycin for 3 months postsurgery.

  2. Pulmonary nocardiosis in patients with connective tissue disease: A report of two cases.

    Science.gov (United States)

    Hagiwara, Shinya; Tsuboi, Hiroto; Hagiya, Chihiro; Yokosawa, Masahiro; Hirota, Tomoya; Ebe, Hiroshi; Takahashi, Hiroyuki; Ogishima, Hiroshi; Asashima, Hiromitsu; Kondo, Yuya; Umeda, Naoto; Suzuki, Takeshi; Hitomi, Shigemi; Matsumoto, Isao; Sumida, Takayuki

    2014-02-01

    Reported here are 2 patients with connective tissue disease who developed pulmonary nocardiosis. Case 1 involved a 73-year-old man with malignant rheumatoid arthritis treated with prednisolone 25 mg/day. Chest X-rays revealed a pulmonary cavity and bronchoscopy detected Nocardia species. The patient was successfully treated with trimethoprim/sulfamethoxazole. Case 2 involved a 41-year-old woman with systemic lupus erythematosus. The patient received remission induction therapy with 50 mg/day of prednisolone and tacrolimus. Six weeks later, a chest CT scan revealed a pulmonary cavity; bronchoscopy resulted in a diagnosis of pulmonary nocardiosis. The patient had difficulty tolerating trimethoprim/sulfamethoxazole, so she was switched to and successfully treated with imipenem/cilastatin and amikacin.

  3. [Legionella pneumophila serogroup 3 isolated from a patient of pneumonia developed after drowning in bathtub of a hot spring spa].

    Science.gov (United States)

    Shiota, R; Takeshita, K; Yamamoto, K; Imada, K; Yabuuchi, E; Wang, L

    1995-12-01

    A 71-year-old Japanese female, was found unconscious by drawing, in a hot spring spa, at around noon of 20 October 1994. She recovered by emergency cardiopulmonary resuscitation, and admitted to the Takinomiya General Hospital, with adult respiratory distress syndrome (ARDS). Although she recovered from ARDS within 4 days after her admission, she developed severe pneumonia accompanied with the second attack of ARDS. Ordinary bacteriological culture of her respiratory specimens failed to yield any significant pathogen for her pneumonia, and neither cefazolin nor imipenem/cilastatin was effective. Thus minocyclin was given on the 7th hospital-day and this was effective for blood gas and C-reactive protein (CRP) levels. Intratracheal exsudate inoculated on BCYE alpha agar plate yielded grayish white colonies. Cells of the colonies were clearly agglutinated by anti-Legionella pneumophila serogroup (SG) 3 serum. Antibody titers of patient's paired sera against the strain L. pneumophila SG3 Bloomington-2 and the patient's strain (Y-1) were determined by microplate agglutination test, and a significant rise from 1:20 to 1:320 was demonstrated. Patient recovered by erythromycin treatment and was discharged on the 59th hospital day. L. pneumophila SG3 organisms were again isolated from the spa water where the patient drawn. From these findings described above, we diagnosed the patient as pneumonia due to L. pneumophila SG3, and the spa water was the most probable source of infection.

  4. Cost - minimization Analysis of 2 Therapeutic Schemes in the Empirical Treatment for Patients with Neutropenia and Fever%2种用药方案经验性治疗中性粒细胞缺乏伴发热的最小成本分析

    Institute of Scientific and Technical Information of China (English)

    田元春; 伍小燕; 卢锡京

    2009-01-01

    目的:比较2种用药方案经验性治疗中性粒细胞缺乏伴发热的经济学效果.方法:采用已发表的经验性治疗中性粒细胞缺乏伴发热患者的资料,按其给药方案分为A组(头孢哌酮/舒巴坦联合阿米卡星)与B组(亚胺培南/西司他丁),采用药物经济学最小成本法进行比较.结果:A、B组临床有效率分别为69.05%、74.44%(P>0.05),细菌学有效率分别为62.50%、40.43%(P0.05); the bacteriological ef-fection rates were 62.50% vs. 40.43%(P<0.05); the total cost was 2 313.6 yuan vs. 5 709.2 yuan (P<0.05), and the drug cost was 2 258.9 yuan vs. 5 709.2 yuan(P<0.05) . CONCLUSION: Cefoperazone/sulbactam combined with amikacin is superior to imipenem/cilastatin in pharmacoeconomic efficacy in the empirical treatment of patients with neutropenia and fever.

  5. Molecular detection and antimicrobial resistance of Klebsiella pneumoniae from house flies (Musca domestica) in kitchens, farms, hospitals and slaughterhouses.

    Science.gov (United States)

    Ranjbar, Reza; Izadi, Morteza; Hafshejani, Taghi T; Khamesipour, Faham

    2016-01-01

    Identifying disease vectors and pathogens is one of the key steps in controlling vector-borne diseases. This study investigated the possible role of house flies (Musca domestica) as vectors in the transmission of Klebsiella pneumoniae in Chaharmahal VA Bakhtiari and Isfahan provinces of Iran. House flies were captured from household kitchens, cattle farms, chicken farms, animal hospitals, human hospitals and slaughterhouses. Isolation of K. pneumoniae from external surfaces and guts of the flies was performed using MacConkey agar (MA) and thioglycollate broth (TGB). Identification of the isolates was performed with phenotypic techniques and polymerase chain reaction (PCR). A total of 600 house flies were sampled during the study period from different locations in four different seasons. Overall, 11.3% of the captured house flies were positive for K. pneumoniae. In Chaharmahal VA Bakhtiari province, the prevalence was 12.7%, while in Isfahan province, 10.0% of the sampled house flies were infected with K. pneumoniae. Season-wise, the highest prevalence of infections among the house flies was in summer. The organisms were highly resistant to ampicillin, amoxicillin, cefotaxime and piperacillin. A lowest level of resistance was observed for imipenem/cilastatin. The findings of this study demonstrated that house flies are potential vectors of antibiotic-resistant K. pneumoniae in Isfahan and Chaharmahal provinces, Iran. Control efforts for infections caused by this particular bacterium should take M. domestica into account.

  6. Clinical efficacy of ciprofloxacin in lower respiratory tract infections.

    Science.gov (United States)

    Pedersen, S S

    1989-01-01

    The sputum pharmacokinetics and clinical efficacy of ciprofloxacin in lower respiratory tract infections is reviewed. Following intravenous administration, ciprofloxacin penetrates rapidly into bronchial tissue; the elimination half life is between 3 and 4 h and a dose dependency is seen. Following oral intake, the time to reach maximal concentrations is approximately two hours and after a dose of 750 mg the concentration may reach 1.7 mg/l in patients without cystic fibrosis and range from 0.5 to 3.4 mg/l in cystic fibrosis patients. Coadministration of ciprofloxacin increases serum levels and decreases total body clearance of theophylline. In controlled comparative clinical trials, ciprofloxacin has been found to have similar clinical efficacy as amoxycillin, ampicillin, cefalexin, doxycycline, co-trimoxazole, imipenem-cilastatin and ceftazidime for the treatment of a range of lower respiratory tract infections. Ciprofloxacin has been found to be superior in clinical efficacy to cefaclor. Experimental animal models suggest a role for ciprofloxacin in infections caused by Legionella pneumophila and Mycoplasma pneumoniae. The clinical and bacteriological efficacy of ciprofloxacin is less pronounced in lung infections caused by Pseudomonas aeruginosa, but is comparable to the combination of beta-lactams and aminoglycosides. Development of resistance is frequently observed during ciprofloxacin treatment of Ps. aeruginosa. Because of the availability of other oral and effective agents, ciprofloxacin is not recommended for empirical treatment of community acquired lower respiratory infections, but should be reserved for infections caused by multiply resistant organisms. PMID:2667111

  7. Tigecycline: a critical update.

    Science.gov (United States)

    Shakil, S; Akram, M; Khan, A U

    2008-08-01

    Tigecycline is the first Food and Drug Administration (FDA) approved glycylcycline antibiotic. It has shown remarkable in vitro activity against a wide variety of gram-positive, gram-negative and anaerobic bacteria including many multidrug resistant (MDR) strains. However, it has minimal activity against Pseudomonas aeruginosa and Proteus spp. To date, little resistance to tigecycline has been reported. Clinical trials studying complicated skin and skin-structure infections (cSSSIs) demonstrated that tigecycline has equivalent efficacy and safety compared with the combination of vancomycin and aztreonam. For complicated intra-abdominal infections (cIAIs), tigecycline was found to be as effective as imipenem/cilastatin. Adverse events related to tigecycline therapy, i.e. nausea and vomiting, were tolerable. Currently available data suggest that tigecycline may play an important role in the future as a monotherapy alternative to older broad-spectrum antibiotics, such as advanced generation cephalosporins, carbapenems, fluoroquinolones, piperacillin/tazobactam, and gram-positive directed agents (e.g. daptomycin, linezolid and quinupristin/dalfopristin) for which resistance is being increasingly reported from all parts of the world. PMID:18676218

  8. Multi-drug resistant Pseudomonas aeruginosa keratitis and its effective treatment with topical colistimethate

    Directory of Open Access Journals (Sweden)

    Samrat Chatterjee

    2016-01-01

    Full Text Available The purpose was to evaluate the clinical outcome in multi-drug resistant Pseudomonas aeruginosa (MDR-PA bacterial keratitis and report the successful use of an alternative antibiotic, topical colistimethate in some of them. The medical records of 12 culture-proven MDR-PA keratitis patients, all exhibiting in vitro resistance by Kirby–Bauer disc diffusion method to ≥ three classes of routinely used topical antibiotics were reviewed. Eight patients were treated with 0.3% ciprofloxacin or ofloxacin, 1 patient with 5% imipenem/cilastatin and 3 patients with 1.6% colistimethate. The outcomes in 8 eyes treated with only fluoroquinolones were evisceration in 4 eyes, therapeutic corneal graft in 1 eye, phthisis bulbi in 1 eye, and no improvement in 2 eyes. The eye treated with imipenem/cilastin required a therapeutic corneal graft. All the three eyes treated with 1.6% colistimethate healed. Colistimethate may prove to be an effective alternative antibiotic in the treatment of MDR-PA keratitis.

  9. Rational design of a carboxylic esterase RhEst1 based on computational analysis of substrate binding.

    Science.gov (United States)

    Chen, Qi; Luan, Zheng-Jiao; Yu, Hui-Lei; Cheng, Xiaolin; Xu, Jian-He

    2015-11-01

    A new carboxylic esterase RhEst1 which catalyzes the hydrolysis of (S)-(+)-2,2-dimethylcyclopropanecarboxylate (S-DmCpCe), the key chiral building block of cilastatin, was identified and subsequently crystallized in our previous work. Mutant RhEst1A147I/V148F/G254A was found to show a 5-fold increase in the catalytic activity. In this work, molecular dynamic simulations were performed to elucidate the molecular determinant of the enzyme activity. Our simulations show that the substrate binds much more strongly in the A147I/V148F/G254A mutant than in wild type, with more hydrogen bonds formed between the substrate and the catalytic triad and the oxyanion hole. The OH group of the catalytic residue Ser101 in the mutant is better positioned to initiate the nucleophilic attack on S-DmCpCe. Interestingly, the "170-179" loop which is involved in shaping the catalytic sites and facilitating the product release shows remarkable dynamic differences in the two systems. Based on the simulation results, six residues were identified as potential "hot-spots" for further experimental testing. Consequently, the G126S and R133L mutants show higher catalytic efficiency as compared with the wild type. This work provides molecular-level insights into the substrate binding mechanism of carboxylic esterase RhEst1, facilitating future experimental efforts toward developing more efficient RhEst1 variants for industrial applications.

  10. Experimental models of epilepsy

    Directory of Open Access Journals (Sweden)

    Stanojlović Olivera P.

    2004-01-01

    Full Text Available Introduction An epileptic seizure is a clinical event and epilepsy is rather a group of symptoms than a disease. The main features all epilepsies have in common include: spontaneous occurrence, repetitiveness, and ictal correlation within the EEG. Epilepsies are manifested with distinct EEG changes, requiring exact clinical definition and consequential treatment. Current data show that 1% of the world's population (approximately 50 million people suffers from epilepsy, with 25% of patients being refractory to therapy and requiring search for new substances in order to decrease EEG and behavioral manifestations of epilepsies. Material and methods In regard to discovery and testing of anticonvulsant substances the best results were achieved by implementation of experi- mental models. Animal models of epilepsy are useful in acquiring basic knowledge regarding pathogenesis, neurotransmitters (glutamate, receptors (NMDA/AMPA/kainate, propagation of epileptic seizures and preclinical assessment of antiepileptics (competitive and non-competitive NMDA antagonists. Results and conclusions In our lab, we have developed a pharmacologic model of a (metaphit, NMDA and remacemide-cilastatin generalized, reflex, and audiogenic epilepsy. The model is suitable for testing various anticonvulsant substances (e.g. APH, APV, CPP, Mk-801 and potential antiepileptics (e.g. DSIP, its tetra- and octaanalogues.

  11. Evaluation of the in vitro ocular toxicity of the fortified antibiotic eye drops prepared at the Hospital Pharmacy Departments.

    Science.gov (United States)

    Fernández-Ferreiro, Anxo; González-Barcia, Miguel; Gil-Martínez, María; Santiago Varela, María; Pardo, María; Blanco-Méndez, José; Piñeiro-Ces, Antonio; Lamas Díaz, María Jesús; Otero-Espinar, Francisco J

    2016-01-01

    The use of parenteral antibiotic eye drop formulations with non-marketed compositions or concentrations, commonly called fortified antibiotic eye drops, is a common practice in Ophthalmology in the hospital setting. The aim of this study was to evaluate the in vitro ocular toxicity of the main fortified antibiotic eye drops prepared in the Hospital Pharmacy Departments. We have conducted an in vitro experimental study in order to test the toxicity of gentamicin, amikacin, cefazolin, ceftazidime, vancomycin, colistimethate sodium and imipenem-cilastatin eye drops; their cytotoxicity and acute tissue irritation have been evaluated. Cell-based assays were performed on human stromal keratocytes, using a cell-based impedance biosensor system [xCELLigence Real-Time System Cell Analyzer (RTCA)], and the Hen's Egg Test for the ocular irritation tests. All the eye drops, except for vancomycin and imipenem, have shown a cytotoxic effect dependent on concentration and time; higher concentrations and longer exposure times will cause a steeper decline in the population of stromal keratocytes. Vancomycin showed a major initial cytotoxic effect, which was reverted over time; and imipenem appeared as a non-toxic compound for stromal cells. The eye drops with the highest irritating effect on the ocular surface were gentamicin and vancomycin. Those antibiotic eye drops prepared at the Hospital Pharmacy Departments included in this study were considered as compounds potentially cytotoxic for the ocular surface; this toxicity was dependent on the concentration used. PMID:27570987

  12. In vitro antibacterial activity of fosfomycin combined with nine antimicrobial agents against acinetobacter%磷霉素与9种抗菌药物分别联用对不动杆菌的体外抗菌活性研究

    Institute of Scientific and Technical Information of China (English)

    杨莹莹; 王镇山; 薛欣; 聂大平; 李玉中

    2011-01-01

    [ Objective] To study the antibacterial activity of fosfomycin combined with other 9 antimicrobial agents against 47 strains of Acinetobacter in vitro, in order to provide laboratory data for clinical combination application. [ Methods] The 47 strains of acinetobacter isolated from sputum samples were treated by 10 antimicrobial agents alone and by fosfomycin combined with other 9 antimicrobial agents. Through the minimal inhibitory concentration (MIC) and fractional inhibitory concentration (FIC) index, using a two -fold agar dilution method, we could evaluate the antibacterial activity of fosfomycin combined with other 9 antimicrobial agents in vitro. [ Results] All the 47 strains of acinetobacter were resistant to fosfomycin, levofloxacin, ciprofloxacin, cefuroxime, ceftazidime, cefepime, cefoperazone/sulbactam, amikacin, and were intermedium to meropenem and imipenem/cilastatin. The ratio of antimicrobial agents was 1: 1. The MICs of fosfomycin combined with other 9 antimicrobial agents were lower than those of 10 antimicrobial agents alone and FIC index≤2. The primary action was synergistic/additional effect. There was no antagonistic effect observed. [ Conclusion] Synergistic/additional effect was observed in fosfomycin combined with levofloxacin, ciprofioxacin, cefuroxime, ceftazidime, cefepime, cefoperazone/sulbactam, amikacin, meropenem and imipenem/cilastatin against acinetobacter in vitro. The antimicrobial activities of combination were increased.%[目的]研究磷霉素与其它9种临床常用抗菌药物分别联合应用对47株不动杆菌的体外抗菌活性.[方法]收集痰标本中分离出的不动杆菌47株,将磷霉素与其它9种抗菌药物在体外单独以及联合应用,采用琼脂二倍稀释法,测定最低抑菌浓度(MIC)、计算部分抑菌浓度(FIC)指数,评价磷霉素与其它9种抗菌药物分别联合应用的体外抗菌活性.[结果]磷霉素、左氧氟沙星、环丙沙星、头孢呋辛、头孢他啶、头孢

  13. Clinical efficacy research of cefoperazone and sulbactam in the treatment of severe infections%头孢哌酮/舒巴坦治疗急诊重症感染临床疗效研究

    Institute of Scientific and Technical Information of China (English)

    刘宝龙; 张云霞

    2014-01-01

    目的:探讨头孢哌酮/舒巴坦治疗急诊重症感染患者的临床疗效。方法根据患者入院前30 d是否服用抗生素药物分为观察组和对照组。两组均给予头孢哌酮/舒巴坦治疗,每日2次,每次4.0 g。比较两组疗效及细菌清除率。同时对分离菌株进行药敏试验,并记录不良反应。结果观察组和对照组治疗有效率分别为84.62%和82.05%,细菌清除率分别为88.2%(30/34)、81.1%(30/37),两组在疗效和细菌清除率方面比较差异无统计学意义( P >0.05)。头孢哌酮/舒巴坦治疗重症感染的总有效率为83.33%,细菌清除率为84.5%(60/71)。患者分离菌对亚胺培南/西司他丁钠、头孢哌酮/舒巴坦、头孢哌酮钠的敏感率分别为86.67%(39/45)、93.33%(42/45)、64.44%(29/45)。头孢哌酮/舒巴坦的敏感率与亚胺培南/西司他丁钠比较差异无统计学意义( P >0.05),与头孢哌酮钠的敏感率比较差异有统计学意义( P 0. 05). Cefoperazone / sulbactam in the treatment of severe infections, the total effective rate was 83. 33 % ,the bacterial clearance rate was 84. 5%(60 / 71). The sensi-tivity rate of isolates to imipenem / cilastatin sodium,cefoperazone / sulbactam and cefoperazone sodi-um was 86. 67%(39 / 45),93. 33%(42 / 45),64. 44%(29 / 45). The sensitivity rate had no significant difference between the cefoperazone / sulbactam and imipenem / cilastatin sodium( P >0. 05),but had significant difference between the cefoperazone / sulbactam and cefoperazone sodium ( P < 0. 05). The patients had no serious adverse reactions. Conclusions There is good clinical ef-ficacy of cefoperazone / sulbactam on patients with severe infections,and it is worth to be popularized in clinical medicine as experience.

  14. Assessing the pharmacodynamic profile of intravenous antibiotics against prevalent Gram-negative organisms collected in Colombia

    Directory of Open Access Journals (Sweden)

    Maria Virginia Villegas

    2011-10-01

    Full Text Available OBJECTIVES: This study was designed to simulate standard and optimized dosing regimens for intravenous antibiotics against contemporary populations of Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa using MIC distribution data to determine which of the tested carbapenem regimens provided the greatest opportunity for obtaining maximal pharmacodynamic (PD activity. METHODS: The isolates studied were obtained from the COMPACT-COLOMBIA surveillance program conducted between February and November 2009. Antimicrobial susceptibility testing was conducted by broth microdilution method according to the CLSI guidelines. Doripenem, imipenem-cilastatin, and meropenem, were the modeled antibiotics. A 5,000 patient Monte Carlo simulation was performed for each regimen and PD targets were defined as free drug concentrations above the MIC for at least 40% of the dosing interval. RESULTS: All carbapenem regimens obtained optimal exposures against E. coli, unlike the other Enterobacteriaceae tested. Against P. aeruginosa, only a prolonged infusion of doripenem exceeded the 90% cumulative fraction of response (CFR threshold. Worrisomely, no regimens for any of the drugs tested obtained optimal CFR against A. baumannii. For P. aeruginosa intensive care unit (ICU isolates, CFR was approximately 20% lower for isolates collected in the respiratory tract compared with bloodstream or intra-abdominal for imipenem and meropenem. Noteworthy, all doripenem and meropenem regimens achieved greater than 90% CFR against bloodstream and respiratory isolates of K. pneumoniae. CONCLUSIONS: Our data suggests that higher dosing and prolonged infusion of doripenem or meropenem may be suitable for empirically treating ICU P. aeruginosa, while none of the carbapenems achieved optimal cumulative fraction of response against A. baumannii. Standard dosing regimens of all the carbapenems tested achieved optimal CFR against E. coli isolates, but

  15. Comparison of the Carba NP, Modified Carba NP, and Updated Rosco Neo-Rapid Carb Kit Tests for Carbapenemase Detection.

    Science.gov (United States)

    AbdelGhani, Sameh; Thomson, Gina K; Snyder, James W; Thomson, Kenneth S

    2015-11-01

    The accurate detection of carbapenemase-producing organisms is a major challenge for clinical laboratories. The Carba NP test is highly accurate but inconvenient, as it requires frequent preparation of fresh imipenem solution. The current study was designed to compare the Carba NP test to two alternative tests for accuracy and convenience. These were a modified Carba NP test that utilized intravenous (i.v.) imipenem-cilastatin, which is less expensive than reference standard imipenem powder, and an updated version of the Rosco Neo-Rapid Carb kit, which does not require the preparation of imipenem solution and has a shelf life of 2 years. The comparison included 87 isolates that produced class A carbapenemases (including KPC-2, -3, -4, -5, -6, and -8, NMC-A, and SME type), 40 isolates that produced metallo-β-lactamases (including NDM-1, GIM-1, SPM-1, IMP-1, -2, -7, -8, -18, and -27, and VIM-1, -2, and -7), 11 isolates that produced OXA-48, and one isolate that produced OXA-181. Negative controls consisted of 50 isolates that produced extended-spectrum β-lactamases (ESBLs), AmpCs (including hyperproducers), K1, other limited-spectrum β-lactamases, and porin and efflux mutants. Each test exhibited 100% specificity and high sensitivity (Carba NP, 100%; Rosco, 99% using modified interpretation guidelines; and modified Carba NP, 96%). A modified approach to interpretation of the Rosco test was necessary to achieve the sensitivity of 99%. If the accuracy of the modified interpretation is confirmed, the Rosco test is an accurate and more convenient alternative to the Carba NP test. PMID:26311862

  16. Hematoma and abscess formation caused by Mycoplasma hominis following cesarean section

    Directory of Open Access Journals (Sweden)

    Hisato Koshiba, Akemi Koshiba

    2011-01-01

    Full Text Available Hisato Koshiba1,2, Akemi Koshiba1,2, Yasushi Daimon3, Toshifumi Noguchi1,2, Kazuhiro Iwasaku2, Jo Kitawaki21Department of Obstetrics and Gynecology, Kyoto Prefectural Yosanoumi Hospital, Kyoto, Japan; 2Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan; 3Department of Clinical Laboratory, Kyoto Prefectural Yosanoumi Hospital, Kyoto, JapanAbstract: Mycoplasma species cannot be identified by routine bacteriological culture methods and are resistant to common antimicrobial agents. Mycoplasma hominis usually colonizes the lower urogenital tract and causes pyelonephritis, pelvic inflammatory disease, chorioamnionitis, rupture of fetal membranes, preterm labor, postpartum fever, postabortal fever, and neonatal infection. This organism is highly prevalent in cervicovaginal cultures of sexually active women. M. hominis, M. genitalis, Ureaplasma urealyticum, and U. parvum may invade and infect placental and fetal tissues, leading to adverse pregnancy outcomes. M. hominis occasionally causes nongenitourinary infection of the blood, wounds, central nervous system, joints, or respiratory tract. We present a case of a 27-year-old woman who developed abdominal wound hematoma and abscess after cesarean section. The wound was drained, but her high fever persisted, in spite of antibiotic treatment using flomoxef sodium and imipenem•cilastatin sodium. Because the exudate exhibited M. hominis growth in an anaerobic environment, we administered the quinolone ciprofloxacin. This therapy resolved her fever, and her white blood cell count and C-reactive protein level diminished to the normal ranges. To our knowledge, there are four published articles regarding the isolation of M. hominis from postcesarean incisions. Based on the current study and the literature, infection by this pathogen may cause hematoma formation with or without abscess after cesarean section or in immunosuppressed

  17. Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

    International Nuclear Information System (INIS)

    PurposeOsteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis.MethodsTranscatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 μm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores.ResultsAbnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4–19 months).ConclusionTranscatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function

  18. Pharmaceutical care on the patient with serious infection after ovarian cancer surgery%卵巢癌术后切口感染患者的药学监护

    Institute of Scientific and Technical Information of China (English)

    王清理; 王永玲

    2011-01-01

    1例62岁女性患者,接受卵巢癌手术后,因使用化疗药物,手术切口不愈合,进行二次手术后又出现手术部位感染.临床药师对其进行了积极地药学监护,主要内容包括:亚胺培南西司他丁钠的用药剂量调整及其不良反应监测;纠正低蛋白、高血糖、贫血等易感因素;监护两性霉素B的安全使用;对患者进行用药教育、应用微生物制剂减轻抗茵药物的不良反应等,保障患者用药安全有效.%The operative incision of one 62-year-old female patient with ovarian cancer didn't heal up because of using chemotherapy drugs. The surgical site infection occurred after the second operation. The positive pharmaceutical cares by clinical pharmacist were carried out. Monitoring points included adjusting the doses of imipenem/cilastatin sodium and monitoring its adverse reactions, correcting the low-protein, high blood sugar situation and anemia, etc. Monitoring the safe use of amphotericin B, providing medication education for the patient, reducing the adverse effects of microbial agents were accomplished. Clinical pharmacist played an important role in the safety and effectiveness of drug use.

  19. Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

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    Okuno, Yuji, E-mail: how-lowlow@yahoo.co.jp [Edogawa Hospital, Department of Orthopedic Surgery (Japan); Korchi, Amine Mohamed, E-mail: amine.korchi@gmail.com [Geneva University Hospitals, Department of Diagnostic and Interventional Radiology (Switzerland); Shinjo, Takuma, E-mail: shin.takuma@a7.keio.jp [Keio University, Institute for Integrated Sports Medicine, School of Medicine (Japan); Kato, Shojiro, E-mail: shojiro7@yahoo.co.jp [Edogawa Hospital, Department of Orthopedic Surgery (Japan)

    2015-04-15

    PurposeOsteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis.MethodsTranscatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 μm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores.ResultsAbnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4–19 months).ConclusionTranscatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function.

  20. Tigecycline: an evidence-based review of its antibacterial activity and effectiveness in complicated skin and soft tissue and intraabdominal infections

    Directory of Open Access Journals (Sweden)

    Christopher J. Dunn

    2006-03-01

    Full Text Available Christopher J. DunnCatalyst Communications Ltd, Auckland, New ZealandIntroduction: There is an urgent need for novel agents to manage serious bacterial infections, particularly those contracted in healthcare facilities. Tigecycline is a novel broad-spectrum glycylcycline with good activity against Gram-positive, many Gram-negative, anaerobic, and some atypical pathogens that has been developed to address this need.Aims: To review the evidence for the use of tigecycline in serious and complicated skin and soft tissue and intraabdominal infections.Evidence review: There is substantial evidence that tigecycline is as effective as vancomycin plus aztreonam in complicated skin and skin structure infections (SSSIs and as effective as imipenem plus cilastatin in intraabdominal infections. Limited evidence shows effectiveness in patients with resistant Acinetobacter infection in an intensive care unit, and the possibility that the use of tigecycline may reduce length of hospital stay. The drug is well tolerated, with nausea and vomiting as the major adverse effects.Outcomes summary: The introduction of tigecycline should be beneficial at a time of increasing problems with bacterial resistance, and evidence to date has been sufficient for regulatory approval for complicated SSSIs and intraabdominal infections. Research into tigecycline’s efficacy in other infectious diseases (notably pneumonia and bacteremia is ongoing. Further good quality studies and ongoing surveillance for any emerging bacterial resistance will be needed to determine outcomes with tigecycline relative to other novel antibacterial agents, and to explore the economic implications of its adoption.Key words: antibiotic resistance, bacterial infections, glycylcycline, nosocomial infections, review, tigecycline

  1. Clinical Pharmacists’Involvement in Pharmacy Consultation for One Case of Multidrug-resistant Pseudomo-nas aeruginosa Infection%临床药师参与1例耐多药铜绿假单胞菌感染患者会诊的药学实践

    Institute of Scientific and Technical Information of China (English)

    龙一文; 杨秀泽

    2014-01-01

    目的:为耐多药铜绿假单胞菌感染患者的抗菌药物合理应用提供参考。方法:分析1例耐多药铜绿假单胞菌感染患者的抗感染方案,结合痰培养、药敏试验结果及抗菌药物的药理学特性,临床药师建议用药方案为亚胺培南/西司他丁钠(1 g、ivgtt、q6h)+盐酸莫西沙星氯化钠注射液(0.4 g、ivgtt、qd)二联抗感染治疗。结果:患者的感染症状得到有效控制。结论:临床药师参与耐多药铜绿假单胞菌感染患者的临床会诊,可帮助临床医师解决药物治疗难题,提高治疗水平,保证药物治疗的有效、安全、经济和合理。%OBJECTIVE:To provide reference for rational use of antibiotics in patients with multidrug-resistant Pseudomonas aeruginosa infection. METHODS:By analyzing the anti-infective program for one case of multidrug-resistant Pseudomonas aerugino-sa infection and based on sputum culture,antimicrobial susceptibility test results and the pharmacological properties of antibiotics, clinical pharmacist recommended using imipenem/cilastatin sodium (1 g,ivgtt,q6h) plus Moxifloxacin hydrochloride and sodium chloride injection(0.4 g,ivgtt,qd)as anti-infection therapy. RESULTS:Patients’infection was under effective control. CONCLU-SIONS:The clinical pharmacists’involvement in clinical consultation for patient with multi-drug resistant Pseudomonas aeruginosa infection can help clinicians solve the medication problem,improve the treatment level and ensure effective,safe,economic and reasonable medication.

  2. 1例挤压综合征术后感染患者的药学监护%Pharmaceutical care on one patient with postoperative infection after crush syndrome

    Institute of Scientific and Technical Information of China (English)

    史文慧; 郭蓉; 罗朝利

    2011-01-01

    One 26-year-old male patient with crush injuries to both lower extremities after being involved in carbon monoxide poisoning was admitted to hospital. After the operation for treatment of crush syndrome, he developed postoperative infection,sustained muscle necrosis and fascial infections. The patient used some antimicrobial agents, while the efficacy of infection control was poor, and Shigella was found from secretions. After consultation with clinical pharmacists, the individualized dosing regimen was made. In the first treatment course (10 days), imipenem-cilastatin and clindamycin were combined. During the second course(14 days ), clindamycin and piperacillin-tazobactam were given in combination. In the third course, cefuroxime was given for 5 days.Three days later, the body temperature was normal, the number of white blood cells and granulocytes decreased, 21 days later no continuing muscle necrosis occurred, 23 days later the body temperature and blood routine were normal, infection was controlled.%1例26岁男性患者,因一氧化碳中毒后导致双下肢挤压伤入院.入院后行挤压综合征减张术后发生感染,肌肉持续坏死、筋膜感染,曾使用多种抗菌药物,感染控制不佳,多次分泌物培养为志贺氏菌属.临床药师会诊后,制订了个体化给药方案,第一疗程10 d:亚胺培南西司他丁联合克林霉素;第二疗程14 d:克林霉素联合哌拉西林他唑巴坦;第三疗程5 d:头孢呋辛.3 d后,体温正常,白细胞和粒细胞降低,21 d后无肌肉持续坏死现象,23 d后,体温、血常规均正常,感染得到控制.

  3. 临床合理用药基本原则(下)

    Institute of Scientific and Technical Information of China (English)

    赵香兰; 潘启超

    2000-01-01

    @@ 5 合理配伍用药 5.1 联合用药目的明确 5.1.1 增强疗效:例如(1)抗菌药磺胺加TMP:在细菌叶酸代谢过程中呈双重阻断,抗菌力增加,抗菌谱扩大;(2)青霉素类加氨基甙类抗生素:青霉素类妨碍细菌胞壁合成,增加氨基甙类进入细菌胞内,增强杀菌作用;(3)棒酸加羟氨苄青霉素:棒酸抑制β_内酰胺酶,使羟氨苄青霉素对耐药株仍有效;(4)亚胺硫霉素加脱氢肽酶抑制西拉斯他丁(Cilastatin),而保持亚胺硫霉素在泌尿道强大的抗菌力;(5)氟尿嘧啶(5Fu)加醛氢叶酸可增加药物与TMPS酶的结合,而增强抗癌效果;(6)在高血压治疗中,降血压药的联合应用也常可增强疗效,如①血管紧张素转换酶抑制剂加β_受体阻断剂;②长期应用胍乙啶、长压定(Minoxidil)二氮嗪(Diazoxide)或肼苯达嗪等降压药可产生水钠潴留,降压作用减弱,此时,伍用利尿药可增强降压药的治疗效果;(7)急性哮喘时,β2_受体激动药如沙丁胺醇(Salbutamol)与茶碱类合用可收到相加的疗效;(8)抗癌药物只有在联合应用时才能获得较好效果.

  4. 急诊重症监护病房机械通气相关性肺炎患者病原菌耐药性及死亡因素分析%Analysis of pathogenic bacteria resistance and risk factors of death on ventilator-associated pneumonia pa-tients in emergency intensive care unit

    Institute of Scientific and Technical Information of China (English)

    龚黎; 郁念明; 刘海峰

    2014-01-01

    Objective To analyze the clinical characteristics of ventilator-associated pneumonia ( VAP) in patients admitted to the emergency intensive care unit ( EICU) , pathogen distribution and drug resistance char-acteristics;to explore the risk factors for death in VAP patients .Methods The clinical data of 190 cases of VAP patients from June 2012 to May 2013 in the Second Hospital of Jiaxing city , were retrospectively analyzed .Clinical characteristics , distribution and drug resistance of pathogenic bacteria and death risk factors of death were ana -lyzed.Results Two hundred and forty-two strains of pathogens were isolated from 190 patients, with 184 strains of Gram-negative bacteria.74 Pseudomonas aeruginosa (40.2%) and 70 Escherichia coli (38.0%) were most com-mon pathogenic bacteria in Gram-negative bacilli.Antibiotic sensitive rate of Pseudomonas aeruginosa was 77.0%(57/74) and 73.0%(54/70) to amikacin and imipenem/cilastatin sodium.Antibiotic sensitivity rate of Esche-richia coli was 71.4%to ceftazidime and imipenem/cilastatin sodium.Age≥60 years [odds ratio (OR)=6.675, 95%confidence interval (CI):2.620-9.731], the cumulative organ ≥3[OR=3.225, 95%CI:1.337-7.806] and lack of nutrition therapy [OR=1.912, 95% CI: 1.043-8.522] were death risk factors for VAP patients . Conclusions Gram-negative bacteria are the main pathogenic bacteria of VAP patients in EICU .Comprehensive treatment should be applied to treat complicated multiple organ dysfunction and malnutrition to reduce VAP mortality.%目的:分析急诊重症监护病房(EICU)中机械通气相关性肺炎(VAP)患者临床特点、病原菌分布及耐药性特点,探讨导致VAP患者死亡的危险因素。方法对浙江省嘉兴市第二医院2010年6月至2013年5月收治的190例VAP患者的临床资料作回顾性分析,分析患者的临床特点、病原菌的分布及耐药性以及死亡危险因素。结果190例VAP患者分离革兰阴性菌184株(76.0

  5. 临床药师在厄罗替尼致间质性肺炎患者药物治疗中的作用%Role of Clinical Pharmacists in Therapy for Patient with Interstitial Lung Disease Induced by Erlotinib

    Institute of Scientific and Technical Information of China (English)

    李义秀; 娄艳; 章新晶; 熊爱珍

    2016-01-01

    OBJECTIVE:To explore the role of clinical pharmacists in therapy for patient with interstitial lung disease (ILD) induced by erlotinib. METHODS:Clinical pharmacists participated in the therapy for ILD in a patient receiving erlotinib target treat-ment after thoracic vertebra and lumbar radiation,analyzed the cause of ILD and suggested to stop taking imipenem and cilastatin sodium,fluconazol and erlotinib according to lab indexes and patient’s symptom;took prednisone 30 mg,po,qd,for anti-inflam-mation instead of methylprednisolone;adjusted the dose of prednisone to 40 mg/d,and additionally took Carbocisteine oral solution 10 ml,tid,for improving respiratory symptom;panipenem betamipron 1 g,ivgtt,bid,instead of piperacillin sodium and sulbactam sodium. RESULTS:Physicians adopted the suggestions of clinical pharmacists,and the symptom of anhelation and double pneumo-nia recovered;discharged medication plan was erlotinib 150 mg,po,qd. CONCLUSIONS:The patient with radiation history easily suffers from ILD when using erlotinib,and should use erlotinib carefully in the clinic. Clinical pharmacists participated in drug ther-apy and promote safe and rational use of drugs in the clinic.%目的:探讨临床药师在厄罗替尼致间质性肺炎(ILD)患者药物治疗中的作用。方法:临床药师参与1例肺癌患者胸、腰椎放疗后续厄罗替尼靶向治疗中出现ILD的药物治疗,分析ILD的发生原因,并根据患者实验室检查指标和症状先后建议停用亚胺培南西司他丁钠、氟康唑、厄罗替尼;停用甲基强的松龙,改予泼尼松30 mg,po,qd抗炎;调整泼尼松剂量至40 mg/d,加用羧甲司坦口服液10 ml,tid改善呼吸道症状;将哌拉西林钠舒巴坦钠改为帕尼培南倍他米隆1 g,ivgtt,bid。结果:医师采纳临床药师建议,患者气促、双肺炎症好转,出院带药方案为厄罗替尼150 mg,po,qd。结论:有既往放疗史的患者使用厄罗替尼易

  6. 呼吸道161株鲍曼不动杆菌的临床分布及耐药性分析%Clinical distribution and drug resistance analysis of 161 strain Acinetobacter baumannii in respiratory tract

    Institute of Scientific and Technical Information of China (English)

    温燕; 陆华; 唐双意; 杨天燕; 蒋霞

    2013-01-01

    目的 了解痰液标本分离的鲍曼不动杆菌的临床分布及对各种常用抗菌药物的耐药情况,为临床合理治疗提供依据.方法 从2011年1月至12月广西医科大学第一附属医院患者的痰液标本中分离出161株鲍曼不动杆菌,采用WHONET 5.4软件对数据进行统计分析.结果 在161株鲍曼不动杆菌标本中,其临床分布以重症监护病房为主(47.83%),其次为内科(24.23%)和外科(13.04%);鲍曼不动杆菌对常用抗菌药物的耐药率以头孢哌酮/舒巴坦最低(6.21%),其次为亚胺培南/西司他丁及美罗培南(分别为46.58%、47.83%);哌拉西林、哌拉西林/他唑巴坦、头孢他啶、安曲南、庆大霉素、阿米卡星、环丙沙星、左氧氟沙星、复方磺胺甲噁唑及头孢吡肟等的耐药率均在50%以上.结论 鲍曼不动杆菌主要分布于各重症监护病房,对多种常见抗生素耐药率有升高趋势,提示临床应加强抗生素的合理应用,防止耐药率进一步增长.%Objective To investigate the clinical distribution and the drug resistance to various antibacterials of Acinetobacter baumannii from sputum specimen,and provide reference for the clinical rational therapy.Methods The 161 strain Acinetobacter baumaniis were separated from sputum specimen of patients in the First Affiliated Hospital of Guangxi Medical University from January to December in 2011,and the data were analyzed by WHONET 5.4 software.Results Among the 161 specimens of Acinetobacter baumannii,the dominant clinical distribution was intensive care unit(47.83%)followed by medical department(24.23%)and surgery department(13.04%).The drug resistance rate of Acinetobacter baumanii to cefoperazone/sulbactam was the lowest (6.21%),then was the i mipenem/cilastatin (46.58 %)and meropenem (47.83 %).The drug resistance rates of Acinetobacter baumanii to piperacilli,piperacilli

  7. Distribution and Resistance Analysis of Pathogenic Bacteria Causing Catheter Associated Urinary Tract Infection in ICU%ICU导尿管相关性尿路感染的病原菌分布及耐药性分析

    Institute of Scientific and Technical Information of China (English)

    邵俊; 郑瑞强; 林华; 卢年芳; 於江泉

    2013-01-01

    Objective :To explore the distribution and resistance of pathogenic bacteria causing catheter associated uri-nary tract infection in ICU so as to guide the clinical rational use of antibiotics .Methods :Urine culture and its drug sus-ceptibility results of patients who were diagnosed catheter associated urinary tract infection were analyzed retrospective-ly from July 2009 to June 2013 in ICU of Subei People’s Hospital of Jiangsu Province .Results:226 strains of pathogenic bacteria was detected from 4558 urine specimens ,of which 138 strains of gram-negative bacteria (61 .06% ) ,57 strains of gram-positive bacteria(25 .22% ) ,31 fungi strains(13 .72% ) .Top five of pathogenic bacteria was followed by acine-tobacter baumannii ,pneumonia klebsiella ,Escherichia coli ,Enterococcus faecalis ,candida albicans .Resistance of acine-tobacter baumannii in most drug was >50% .Under 50% of the resistance was just cefoperazone/sulbactam ,meropen-em ,imipenem/Cilastatin ,SMZ/TMP .Conclusion:Gram-negative bacteria is still the main pathogenic bacteria of catheter associated urinary tract infections in ICU .Acinetobacter baumannii has risen to the first pathogenic bacteria ,and drug resistance is very severe .Rational use of antibiotics and good hand hygiene is very important according to the results of drug susceptibility .%目的:探讨IC U导尿管相关性尿路感染的病原学分布及耐药性,为临床合理使用抗菌药物提供依据。方法:回顾性对2009年7月-2013年6月入住我院IC U确诊导尿管相关性尿路感染的患者送检的尿液标本培养及药敏结果进行统计分析。结果:4558份尿标本共检出226株致病菌,其中革兰氏阴性菌138株,占61.06%,革兰氏阳性菌株57株,占25.22%,真菌株31株,占13.72%。排名前五位的病原菌依次是鲍曼不动杆菌、肺炎克雷伯氏菌、大肠埃希菌、粪肠球菌、白色念珠菌。鲍曼不动杆菌对大部分药物耐药性均>50

  8. 2型糖尿病反复合并类鼻疽伯克霍尔德杆菌脾脓肿一例报告%One case report of repeated splenic abscess caused by burkholderia pseudomallei in type 2 diabetes mellitus

    Institute of Scientific and Technical Information of China (English)

    王斐; 全会标; 陈道雄; 陈开宁; 高勇义

    2015-01-01

    [Summary] A fisherman with type 2 diabetes has admitted to hospital twice due to fever. During the first hospitalization ,blood culture and imaging examination showed the presence of burkholderia pseudomallei septicemia and multiple abscesses in liver and spleen. The patient was treated with intensive insulin therapy for glycemic control and imipenem cilastatin in combination with compound sulfamethoxazole(SMZ) for anti-infection. His body temperature returned to normal after one week. The anti-infection regimen was adjusted to SMZ monotherapy after 24 days ;antibiotics and hypoglycemic agent were stopped after 74 days. However ,the patient hospitalized due to fever again after 8 months. During the second hospitalization ,the blood culture was negative and CT showed abscess in spleen. The patient was given insulin for intensive glycemic control and ceftazidime in combination with SMZ for anti-infection. 17 days later ,only SMZ was continued for anti-infection ,insulin was also continued for glycemic control. All drugs were discontinued after 6 months. The patient was re-examined with splenic abscess reduced. Good glycemic control and active infection control were the keys for treatment. The bacteria in spleen can recrudesce when the patient is in poor glycemic control and low immunity status.%报告1例T2DM渔民因发热先后2次入院,第1次入院血培养和影像学检查提示,类鼻疽伯克霍尔德杆菌败血症和肝脾内多发脓肿,予胰岛素强化控制血糖,予亚胺培南西司他丁联合复方磺胺甲恶唑(SMZ)抗感染1周后体温正常,24 d后改为SMZ单药治疗,74 d后停抗生素和降糖药物;8个月后再次发热,血培养阴性,CT 示脾内脓肿。在胰岛素强化控制血糖同时,予头孢他啶联合SMZ抗感染,17 d后改为SMZ单药抗感染,继续胰岛素控制血糖,6个月后停药,复查脾内脓肿体积缩小。血糖的良好控制和感染的积极控制是治疗的关键,在

  9. 腹膜透析相关性腹膜炎的菌谱及其药敏分析%Bacterial spectrum and antimicrobial sensitivity in CAPD-related peritonitis

    Institute of Scientific and Technical Information of China (English)

    朱伟平; 崔彤霞; 徐庆东; 李中和; 张桦

    2011-01-01

    Objective To find out the antimicrobial sensitivity characteristics of bacteria from CAPD-related peritonitis patients in an attempt to optimize the clinical therapy. Methods We collected 79 episodes of peritonitis from 50 patients between January 2006 and August 2010. We then analyzed the changes of bacterial spectrum and the differences of bacterial resistance to antibiotics. SPSS 13.0 software was used for the analyses. Results In the 79 peritonitis episodes, gram-positive organism infection was found in 34 episodes (44.3%), gram-negative organism infection in 17 episodes (21.5%), fungus infection in one episode (1.3%), mycobacterium tuberculosis infection in one episode (1.3%), and bacterial culture was negative in 25 episodes (31.6%), with the positive culture rate of 68.4%. In staphylococcus strains, the percentage of resistance to Penicillin and Ampicillin was >90%, that of resistance to Cefazolin was 30.0%, and that of resistance to Cephradine was 0. Methicillin-resistant staphylococcus aureus (MRSA) was not found in this study. In streptococcus strains, the percentage of resistance to Streptomycin, Levofloxacin and Vancomycin was low. In gram-negative organisms, most of them were sensitive to Amikacin and Imipenem/Cilastatin, but the percentage of resistance to Ceftazidime was 17.6%. Conclusion In addition to the traditional antibiotics of Cefazolin and Ceftazidime, Cephradine combined with Amikacin are preferable for the treatment of CAPD-related peritonitis.%目的 通过分析腹膜透析相关性腹膜炎患者的资料,总结感染病菌的菌谱和药敏特点,以指导临床治疗.方法 收集中山大学附属第五医院腹膜透析中心50例持续性不卧床腹膜透析患者共79例次腹膜炎资料,分析菌谱并采用统计软件比较各种抗生素的耐药率之间是否存在差异.结果 在79例次腹膜炎中,G+菌感染共35例(44.3%),G -菌感染17例(21.5%),真菌及结核菌各1例(各1.3%),

  10. 胆道感染患者的病原菌分布及耐药性分析%Distribution and drug resistance of Pathogenic bacteria in patients with biliary tract infection

    Institute of Scientific and Technical Information of China (English)

    杨培; 马春华; 罗华

    2012-01-01

    OBJECTIVE To study the microbiologed distribution of biliary tract infection in patients with resistant strains so as to guide rational drug use. METHODS There were 275 cases with submission sample. The isolation and culture of bacteria and drug susceptibility test were executed according to'National Clinical Laboratory Operating Procedures' (third edition) standards using automated microbial (VITEK-32, France) analyzer. KB method was used for drug susceptibility testing and the results were judged by Clinical Laboratory Standards (CLSI) standards. RESULTS A total of 183 strains were detected from 275 samples, with the detection rate of 66. 55%. They included 95 strains of gram-negative bacteria accounting for 51. 91%, 63 strains of gram-positive bacteria accounting for 34. 43% and 12 strains of fungi accounting for 6. 56%. The resistance rates of the major bacteria Escherichia coli and Klebsiella pneumoniae to imipenem/cilastatin was 0, and the resistance rate of Enterococcus faecalis, Enterococci feces, Staphylococcus aureus to quinolones was low. CONCLUSION The biliary system is widely distributed with microbial infections, and some strains may cause multidrug resistance. We suggest clinicians emphasize the monitoring of the dynamic distribution of pathogenic bacteria and changes in drug susceptibility to guide rational antibiotics use.%目的 了解胆道感染患者的病原菌分布及耐药性特点,指导合理用药.方法 送检标本275例,菌种分离培养和药物敏感试验执行《全国临床检验操作规程》(第3版)标准;分析仪器采用全自动微生物(VITEK-32法国)分析仪鉴定,用K-B法进行药物敏感试验,操作规程执行《全国临床检验操作规程》,结果判断执行美国临床实验室标准化研究所(CLSI)标准.结果 送检标本275份,检出病原菌183株,检出率为66.55%;其中革兰阴性菌95株,占51.91%,革兰阳性菌63株,占34.43%,真菌12株,占6.56%;大肠埃希菌、肺炎克

  11. Analysis for bloodstream infections caused by extended-spectrum β-lactamase-producing Escherichia coli in patients with liver cirrhosis%肝硬化患者产超广谱β-内酰胺酶大肠埃希菌血液感染的分析

    Institute of Scientific and Technical Information of China (English)

    张思泉; 叶卫江; 朱明利; 王飞; 刘华锋

    2009-01-01

    目的 分析肝硬化患者产超广谱β-内酰胺酶(ESBLs)大肠埃希菌(大肠杆菌)血液感染的危险因素及其对常用抗菌药物的耐药性,为临床治疗提供参考.方法 对2001年9月-2008年12月我院30例产ESBLs的大肠埃希菌血液感染肝硬化患者(A组)与60例非产ESBLs的大肠埃希菌血液感染肝硬化患者(B组)进行病例-对照研究.结果 A组重型肝炎及继发性败血症发生率明显高于B组(P<0.05),既往三代头孢菌素、β-内酰胺酶抑制剂复合制剂或氟喹诺酮类抗菌药物使用率均高于对照组(P<0.05).产ESBLs大肠埃希菌除亚胺培南/西司他丁、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦外,对各类抗菌药物呈现了较为普遍的耐药性.结论 严重肝功能损伤、使用过三代头孢菌素、β-内酰胺酶抑制剂复合制剂或氟喹诺酮类抗菌药物是产ESBLs大肠埃希菌血液感染的危险因素.对有产ESBLs大肠埃希菌败血症的肝硬化高危患者,应首选亚胺培南/西司他丁、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦作为经验性治疗.%Objective To investigate the risk factors for bloodstream infections caused by extended-spectrum β-lactamases(ESBLs)-producing Escherichia coli in patients with liver cirrhosis,and provide reference for clinical therapy.Methods An exploratory case control study was used,in which 30 cases of liver cirrhosis with bacteraemia caused by ESBLs-producing E.coli(Group A)were compared with 60 cases of liver cirrhosis with bacteraemia caused by non-ESBLs-producing E.co1i(Group B).Results Previous use ratio of third generation cephalosporins,combinations of β-lactams and β-lactamase inhibitors or fluoroquinolones and the incidence of chronic severe hepatitis and secondary septicamia were higher in group A than in group B(P<0.05).In addition to imipenem-cilastatin,cefoperazone-sulbactam,piperacillin-tazobactam,ESBLs-producing E.coli was usually resistant to most antimicrobial

  12. Study on Acinetobacter baumannii plasmid with 3 types of beta-lactamase genes in a burn ward%关于携带3种β内酰胺酶基因的鲍氏不动杆菌质粒的研究

    Institute of Scientific and Technical Information of China (English)

    李蓉; 李文林; 石小玉; 曾元临; 徐小文; 赵林

    2008-01-01

    Objective To study the transferrable character of Aciuetobacter baumanni i(AB)plasraids with 3 types of beta-lactamase gene. Methods The plasmid of multi-drug resistant AB(donor)isolated from burn wound were transferred to E.coil ATCC25922 (receptor) through conjugation,and drug sensitivity was also observed.Drug-resistant gene and Stability of filial generation and zygote were analyzed by PCR. Results The dug-resistance of donor plasmids to Sulfamethoxazole, Ampicillin, Cefalotin, Cetpodoxime,Cefuroxime,Imipenem/Cilastatin and Ampicillin/SuIbactam,and three types of beta-lactamase gene were transferred to the receptor,and were also stably transmitted for passages. The minimum inhibitor concentration ot receptor to Sulfamethoxazole was>2 mg/L after conjugation with donor,and inhibitory character could be transferred to next generation. Conclusion blaTEM-1,blaPER-1 and blaOXA-23 genes carried in the ptasmid of AB can be transferred through conjugation and stably transmitted for passages,and it is one of the molecular mechanisms for AB with multi-drug resistance after burn infections.%目的 了解携带3种β内酰胺酶基因的鲍氏不动杆菌质粒的町传递性.方法 选取从烧伤创面分离出的多重耐药鲍氏不动杆菌(供体菌),将之与大肠埃希菌ATCC 25922(受体菌)进行耐药质粒接合、药物敏感试验,并采用PCR分析接合子及其子代的耐药基因型、传代稳定性. 结果鲍氏不动杆菌通过接合将其携带对磺胺甲恶唑、氨苄西林、头孢噻吩、头孢博肟、头孢呋辛、亚胺培南/两司他丁和氨苄西林/舒巴坦的耐药性质粒及3种耐药基因传递给受体菌(例如经接合,使受体菌对磺胺甲恶唑的最低抑菌浓度>2 mg/L),且可稳定传代. 结论鲍氏不动杆菌质粒上携带可接合传递并稳定传代的β内酰胺酶基冈(blaTEM-1、blaPER-1、blaOXAS-23),是烧伤感染后其具有多重耐药性的分子生物学机制之一.

  13. [Comparison of the modified Hodge test and the Carba NP test for detection of carbapenemases in Enterobacteriaceae isolates].

    Science.gov (United States)

    Bayramoğlu, Gülçin; Uluçam, Gülşen; Gençoğlu Özgür, Çiğdem; Kılıç, Ali Osman; Aydın, Faruk

    2016-01-01

    A rapid, practical, and accurate identification of carbapenemase-producing Enterobacteriaceae isolates is crucial for the implementation of appropriate infection control measures and proper treatment of the infections. For this purpose, a large number of phenotypic test methods have been developed, although none has 100% sensitivity and specificity. Variations in sensitivity and specificity of these tests based on the type of beta-lactamase enzymes carried by that isolates might result in differences between regions and countries. The aim of this study was to compare the performances of widely used modified Hodge test (MHT) and Carbapenemase Nordmann-Poirel (Carba NP) test in the detection of carbapenemases in Enterobacteriaceae family members. A total of 65 Enterobacteriaceae isolates (43 bla(OXA-48), 10 bla(VIM), 9 bla(IMP), 1 bla(NDM-1), 1 bla(KPC-2) and 1 bla(OXA-48)+bla(VIM) carrying strains) that showed decreased sensitivity to at least one carbapenem (ertapenem, imipenem or meropenem), and carriage of carbapenemase gene confirmed by polymerase chain reaction (PCR), were included in the study. Seventy-eight isolates showing decreased susceptibility to carbapenems but lacking carbapenemase genes were used as controls. All isolates were identified by using conventional methods as well as automated BD Phoenix System (Becton Dickinson, USA). The antimicrobial susceptibility testing was performed using the same automated system, and was confirmed by disk diffusion method. Results were evaluated according to the CLSI criteria. MHT was performed in accordance with the CLSI guideline, and Carba NP test was carried out by a modified protocol. Instead of imipenem monohydrate, which was used in the original protocol, 6 mg/ml imipenem/cilastatin was used in the modified protocol. In the study, MHT identified 90.8% (59/65) of carbapenemase-producing isolates, while 93.9% (61/65) of the isolates were identified by Carba NP test. With MHT, four Klebsiella pneumoniae

  14. Change of drug resistance of Proteus mirabilis causing nosocomial infections and clinical strategies%奇异变形菌医院感染的耐药性变迁及临床对策

    Institute of Scientific and Technical Information of China (English)

    王晓慧; 王银存

    2012-01-01

    OBJECTIVE To analyze the change in antibiotic resistance of clinical isolates of Proteus mirabilis 30 as to provide basis for clinical reasonable use of antibiotics. METHODS A total of 385 P. mirabilis strains isolated from various clinical specimens from Jan 2008 to Dec 2010 were collected. Drug susceptibility testing was performed for 17 antimicrobial agents; the changes of the drug resistance during the 3 years were compared. RESULTS Of the P. mirabilis isolated, the susceptibility rate to imipenem/cilastatin was the highest (100. 0%) , the drug susceptibility rates to meropenem, piperacillin / methimazole, aztreonam, ceftriaxone, cephaiosporin, ceftazidime, and tobramycin were above 90. 0% ; the drug resistance rates to nitrofurantoin and sulfamethoxazole / trimethoprim were above 50. 0%, and the resistance rate to cefoperazone /sulbactam was 0. 2% , the resistance rates to ampicillin/sulhactam, eiprofloxacin, and levofloxacin kept an increasing upward tendency. CONCLUSION The isolation rate of P. mirabilis is high, the susceptibility is high ta many antimicrobial agents, but the drug resistance rates to some antibacterial agents are on the rise ;it is necessary to strengthen the monitoring and reasonably use of antibiotics on the basis of drug susceptibility testing.%目的 分析临床分离的奇异变形菌的耐药性及其变迁,为临床合理用药提供依据.方法 对医院2008年1月-2010年12月住院患者各种标本中分离到的奇异变形菌385株,采用17种抗菌药物进行药敏试验;并比较3年的变迁情况.结果 分离到的奇异变形菌对亚胺培南/西司他丁的敏感率最高为100.0%,对美罗培南、哌拉西林/他巴唑、氨曲南、头孢曲松、头孢匹美、头孢他啶、妥布霉素的敏感率均>90.0%;对呋喃妥因、磺胺甲噁唑/甲氧苄啶的耐药率均>50.0%,头孢哌酮/舒巴坦为0.3%,对氨苄西林/舒巴坦、环丙沙星、左氧氟沙星耐药率呈升高趋势.结论 医

  15. 产超广谱β-内酰胺酶细菌的检测及耐药性分析%Examination and Resistance Analysis of Producing Extended-spectrum β-lactamase Strains

    Institute of Scientific and Technical Information of China (English)

    陈幼华; 陶健萍

    2011-01-01

    Objective: To understand the resistance of ESBL strains of our hospital in recent three years and then guide the rational use of antibacterial drugs clinically. Method: Adopted the method of prospective monitoring to study 1120 strains of escherichia coli of producing extended-spectrum β-lactamase clinically separated from 2008 to 2011 in our hospital, and analyzed results of drug sensitivity. Result; The detection rate of escherichia coli of producing extended-spectrum β-lactamase in recent years was 51.1% , 52.1% and 55.6% respectively. According to the drug sensitivity test, there were high resistance of ESBLs to the 3rd generation of cephalosporins of cefuroxime and ceftriaxone and monocyclic β-lactams, as well as amin-oglycosides, flouroquinolones and sulfonamides, while sensitive to imipenem - cilastatin ( namely Taineng, because the single usage of imipenem is instable). Conclusion; Results indicate that the detection rate of escherichia coli of producing extended-spectrum β-lactamase increases year by year and there are multi-drug resistance. Clinicians should pay a high attention to it and guide the clinical rational usage of antibacterial drugs and thus control the further transmission and prevalence of ESBL strains.%目的:了解本院近三年产ESBLs大肠埃希菌的耐药性,指导临床合理使用抗菌药物.方法:采取前瞻性监测的方法对我院2008年至2011年临床分离出的1120株产ESBLs的大肠埃希菌进行监测,对药敏结果进行分析.结果:发现近三年来产ESBLs的大肠埃希菌的检出率分别是51.7%、52.7%和55.6%;药敏试验发现,ESBLs对头孢呋辛、头孢曲松等第3代头孢菌素及单环3-酰胺类抗菌药物有较高的耐药性,而对氨基糖苷类、氟喹诺酮类、磺胺类抗菌药物也有较高耐药性,但是对亚胺培南+西司他丁(也就是泰能,因为亚胺培南单用是不稳定的,临床一般不单独用)敏感.结论:研究发现,近年来产

  16. Severe delayed diarrhea and myelosuppression due to irinotecan%伊立替康致重度迟发性腹泻与骨髓抑制

    Institute of Scientific and Technical Information of China (English)

    赵霞; 李妍; 徐巍; 韩毅

    2014-01-01

    A 63-year-old woman with colon cancer was treated with a chemotherapy consisting of irinotecan and oxaliplatin. She was given irinotecan 200 mg plus oxaliplatin 200 mg by subclavian vein intubation on the first day,and irinotecan 160 mg on the 8th day. On day 7,the patient developed yellow stools. The chemotherapy discontinued. Drugs for protection of intestinal mucosa and antidiarrheal agent were given. On day 8 night,she had a fever. The temperature was 38. 0 ℃. Laboratory tests showed the following values:WBC count 0. 27 × 109/L,platelet count 117 × 109/L. Anti-infection therapy was given. On day 14,the severe watery stool appeared again,laboratory tests showed following values:serum potassium 2. 26 mmol/L, sodium 126 mmol/L. She received the therapies for infection control and correcting electrolyte imbalance. On day 16, the patient presented persistent fever, severe abdominal distension with intestinal paralysis. Laboratory tests showed following values:WBC count 0. 25 × 109/L, platelet count 25 × 109/L. She was given imipenem and cilastatin sodium and octreotide. On day 18,her blood pressure decreased to 70/40 mmHg,blood oxygen saturation was not monitored. She was in a coma. On day 19,the patient died despite all rescue measures.%1例63岁女性结肠癌患者术后采用伊立替康﹢奥沙利铂化疗方案:首日给予伊立替康200 mg﹢奥沙利铂200 mg,第8天给予伊立替康160 mg。化疗第7天患者出现黄色稀便,遂停止化疗,给予保护肠黏膜和止泻药。第8天夜间患者发热(体温38.0℃),外周血白细胞计数0.27×109/L,血小板计数117×109/L,给予抗感染和升白细胞治疗。第14天再次出现严重水样便,当日血钾2.3 mmol/L、钠126 mmol/L,给予抗感染和纠正电解质紊乱治疗。第16天患者出现持续发热、严重腹胀合并肠麻痹,外周血白细胞计数0.25×109/L,血小板计数25×109/L,给予亚胺培南/西司他丁钠与奥曲肽。第18

  17. Distribution and drug resistance of pathogens causing early wound infections in burn patients%烧伤患者早期创面感染病原菌分布与耐药性分析

    Institute of Scientific and Technical Information of China (English)

    王进勇; 邹飞扬; 李莉莉; 徐向荣; 张承德; 朱志英; 龚海南

    2014-01-01

    OBJECTIVE To analyze the distribution and drug resistance of pathogens causing early wound infections in the burn patients so as to provide guidance for prevention and treatment of burn wound infections .METHODS A total of 2 981 burn patients who were treated in the hospital from Jan 2007 to Dec 2012 were enrolled in the study , among whom 310 patients with burn wound infections were chosen as the study objects ,then the pathogens isola-ted from the early wounds were detected ,and the drug resistance of the major species of pathogens was analyzed . RESULTS Of the 2 981 patients ,the wound infections occurred in 355 cases with the infection rate of 11 .9% , among whom 45 cases were complicated with other sites of infections .Totally 329 strains of pathogens have been isolated ,including 175 (53 .2% ) strains of gram-negative bacteria , 147 (44 .7% ) strains of gram-positive bacteria ,and the fungi (2 .1% );the Pseudomonas aeruginosa and Acinetobacter were the predominant species of gram-negative bacteria ;the Staphylococcus aureus was dominant among the gram-positive bacteria .The main gram-negative bacteria showed low drug resistance to imipenem but were highly resistant to ampicillin ,ceftriax-one ,and cefotaxime;the drug resistance rates of the S .aureus to penicillin ,ampicillin ,and clindamycin were high ,and the drug resistance rate to vancomycin was low ;the drug resistance rates of the fungi to penicillin and clindamycin were high , and the drug resistance rates to vancomycin and imipenem-cilastatin were low . CONCLUSION The incidence of early wound infections is high among the burn patients ,and the drug resistance rates of most of the pathogens are increased year by year ;it is necessary to prevent the infections according to the indications for use of antibiotics and perform corresponding supportive therapy so as to avoid cross drug resistance or mutations of the pathogens and ensure the curative effect as well as prevention of infections .%目的:分

  18. 2005-2007年山西省儿童医院儿童细菌性肺炎病原菌分布及耐药性变迁分析%Pathogen distribution and antibiotic resistance diversification of children bacterial pneumonia in Shanxi Province Children Hospital from 2005 to 2007

    Institute of Scientific and Technical Information of China (English)

    刘克战; 张俊艳

    2008-01-01

    were gram-positive bacterium;362 strains were gram-negative bacterium.Streptococcus viridans,Streptococcus pneumoniae,Streptococcus C group,enterococcus group and methicillin resistant staphylococcus epidermidis were gram-positive bacterium's primary pathogens by turns;for gram-negative bacterium,they were ESBLs E.coil,Ps.aeruginosa,Stenotrophomonas maltophilia,E,coli and A.baumanii by turns.The increase of detection rates are statistically significant for Streptococcus viridans,Streptococcus C group and Ps.aeruginosa(P < 0.001) ;the increase of detection rate of ESBLs strain is also significant (P < 0.001).In gram-positive bacterium,The better antibiotics for Streptococcus viridans and Streptococcus pneumoniae were piperacillin and ceftriaxone;vancocin was sensitive to all gram-positive bacterium.In gram-negative bacterium,imipenem/cilastatin was the best sensitive to all ESBLs E.coli and ESBLs (-) E.coli,the next was cefoperazone/ sulbactam;nevertheless cefoperazone/ sulbactam was best for Ps.aernginosa.Conclusion The popular strains and their drug sensitivity of children bacterial pneumonia were maybe different in various regions.We must notice these situations and take more effective measures against them.

  19. 地震伤患儿感染创面病原菌分布与耐药性分析%Distribution and drug resistance of pathogenic bacteria isolated from infected wounds of children after Wenchuan earthquake

    Institute of Scientific and Technical Information of China (English)

    冉迎春; 敖晓晓; 刘岚; 符宜龙; 庹慧; 许峰

    2009-01-01

    infections (the infection rate was 67.7%). Ninety-nine pathogens were isolated, gram positive bacteria accounted for 16.16% (16 strains), Gram negative bacteria accounted for 81.82% (81 strains), and fungus 2.02% (2 strains). Staphylococcus aureus (5 strains, 5.05%), Enterococcus faecalis (3 strains, 3.03%) and Enterococcus faecium (2 strains, 2.02%)were the primary Gram-positive bacteria identified and Gram-negative infections typically included Acinetobacter baumanii (27 strains, 27.27%), Enterobacter cloacae (18 strains, 18.18%)and Pseudomonas aeruginosa(13 strains, 13.13%). Acinetobacter baumanii was the most common organism isolated from wounds. Duration of being sieged and complications had a significant association with wound infection with Acinetobacter baumanii. Drug sensitivity tests displayed that the isolated bacteria were highly resistant to common antibiotics. One strain of Acinetobacter baumanii-calcoaceticus complex and six strains of Acinetobacter baumanii were resistant to all common antibiotics including imipenem/cilastatin. Vancomycin-resistant Gram-positive bacteria were not identified. Conclusion Following the Wenchuan earthquake disaster, wound infection profiles of pediatric patients were significantly different, Acinetobacter baumanii was the main common organism isolated from wounds in contrast to the previous low isolation rate. The isolated bacteria were highly and multiple drug resistant and it was difficult to treat. Knowing the distribution and the drug resistance pattern of pathogen is of paramount importance in guiding the clinical treatment.

  20. Death from hypersensitivity syndrome and acute exacerbation of renal insufficiency due to allopurinol overdose%别嘌醇过量致超敏综合征合并肾功能不全急性加重死亡

    Institute of Scientific and Technical Information of China (English)

    江宇泳; 刘洋; 侯艺鑫

    2014-01-01

    liver injury and acute exacerbation of chronic renal insufficiency were diagnosed. Allopurinol was discontinued and he was given IV infusions of compound glycyrrhizin,glutathione,vitamin C,vitamin B6 ,imipenem and cilastatin sodium, and human albumin. On day 5 after administration,the patient developed fever,cough and gastrointestinal hemorrhage. Then he was transferred into intensive care unit and received methylprednisolone pulse therapy. The patient developed pulmonary infection,typeⅠrespiratory failure,reduced urine and kidney failure successively in the following two weeks. On day 31 of admission,the patient died from liver and renal failure and septic shock.

  1. Ward Remodeling and Supplementary to Other Measures in Prevention of Drug Resistant Bacillus Infection%病房装修辅助其它措施预防烧伤耐药杆菌感染

    Institute of Scientific and Technical Information of China (English)

    孟进松; 肖荣; 林国安; 杨晓东; 李文军; 袁仕安

    2015-01-01

    Objective Clinically study the effects of ward remodeling on reducing the species of drug resistant pathogenic germs, improving drug sensitivity, and preventing the infection of drug resistant bacteria in burns. Methods Since February 19, 2012, the remodeled wards have been put into use with comprehensive management of routine disinfec⁃tion and isolation, control of the use of antibacterial drugs, emptying the wards in turn, assigning certain wards to the pa⁃tients transferred from other hopitals at admission, etc. The 2484 samples of 421 patients admitted between March 1, 2012 and April 30, 2013 were compared to the 2564 samples of 458 patients admitted between January 1, 2010 to October 29, 2011. Chi⁃square tests were used for comparative study on the bacteria detected and the sensitivity to antibacterial drugs in the two groups. Results The germiculture results showed that, before ward remodeling, the bacteria positive rate was 87�21% in the 2564 samples, little drug has sensitivity rate over 60%, and the bacteria are resistant to all the conventional antibacterial drug for multi⁃drug resistant pseudomonas aeruginosa. While after remodeling, the bacteria positive rate was 69�10% in the 2484 samples ( P<0�01 ) and 5 drugs have a sensitivity rate over 60�00%, among which the sensitivity rate of Imipenem and Cilastatin were 78�31% and the sensitivity rate of Sulperazone ( Cefoperazone sodium/Sulbactam sodi⁃um) was 66�30%. The multi⁃drug resistant Acinetobacter Bauman was only sensitive to one kind of antibiotic, Sulpera⁃ zone, with an improvement of the sensitivity rate from 60�00% remodeling to 88�74% after the remodeling ( P<0�01 ) . And only Vancomycin had over 60% sensitivity rate to methicillin⁃resistant staphylococcus aureus and the sensitivity rate was 100%. Conclusion Comprehensive management of routine disinfection and isolation, control of the use of antibacteri⁃al drugs, emptying the wards in turn, assigning certain

  2. Distribution and drug resistance of pathogens causing pulmonary infections in patients with chronic heart failure%慢性心力衰竭患者肺部感染的病原菌分布及耐药性分析

    Institute of Scientific and Technical Information of China (English)

    陈贵艳; 张秀义; 勾建强; 周江

    2015-01-01

    OBJECTIVE To explore the distribution and drug resistance of pathogens causing pulmonary infections in patients with chronic heart failure so as to provide guidance for reasonable clinical use of antibiotics .METHODS The sputum specimens were collected from 132 chronic heart failure patients complicated with pulmonary infec‐tions who were treated from Dec 2011 to Dec 2012 ,then the bacterial culture and identification were conducted on the basis of National guidelines for clinical laboratory procedures ,the drug susceptibility testing was performed ac‐cording to the criteria of CLSI 2009 ,and the distribution and drug resistance of the pathogens were observed . RESULTS A total of 146 strains of pathogens have been isolated from the sputum specimens obtained from the 132 patients ,including 104 (71 .23% ) strains of gram‐negative bacteria ,36 (24 .66% ) strains of gram‐positive bacte‐ria ,and 6 (4 .11% ) strains of fungi;the Acinetobacter baumannii ,Pseudomonas aeruginosa ,and Escherichiacoli were the predominant species of gram‐negative bacteria ,accounting for 23 .28% ,16 .44% ,and 12 .33% ,respec‐tively ;the Staphylococcus aureus and Staphylococcus epidermidis were dominant among the gram‐positive bacte‐ria ,accounting for 16 .44% and 5 .48% ,respectively .The gram‐negative bacteria were susceptible to cefopera‐zone‐sulbactam and imipenem‐cilastatin ,and the gram‐positive bacteria were highly susceptible to vancomycin and teicoplanin ,with the drug susceptibility rate of 100 .00% .CONCLUSION The gram‐negative bacteria are dominant among the pathogens causing pulmonary infections in the patients with chronic heart failure ,and the reasonable use of antibiotics may contribute to the reduction of drug resistance rate of the pathogens .%目的:探讨慢性心力衰竭并发肺部感染患者的病原菌分布及耐药性,为临床合理用药提供参考。方法采集2011年12月-2012年12月132例慢性心力衰竭并发肺部