Sample records for cilastatin

  1. Imipenem and Cilastatin Injection (United States)

    ... Imipenem is in a class of medications called carbapenem antibiotics. It works by killing bacteria. Cilastatin is ... you are allergic to imipenem or cilastatin; other carbapenem antibiotics such as doripenem (Doribax), ertapenem (Invanz), or ...

  2. Protective Effects of Cilastatin against Vancomycin-Induced Nephrotoxicity

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    Blanca Humanes


    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.

  3. Protective Effects of Cilastatin against Vancomycin-Induced Nephrotoxicity. (United States)

    Humanes, Blanca; Jado, Juan Carlos; Camaño, Sonia; López-Parra, Virginia; Torres, Ana María; Álvarez-Sala, Luís Antonio; Cercenado, Emilia; Tejedor, Alberto; Lázaro, Alberto


    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.

  4. Imipenem-cilastatin sodium, a broad-spectrum carbapenem antibiotic combination. (United States)

    Pastel, D A


    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. [Fundamental and clinical studies of imipenem/cilastatin sodium in the field of obstetrics and gynecology]. (United States)

    Nakanishi, A; Hino, K; Shimamoto, I; Ichijo, M


    Imipenem (MK-0787), a new carbapenem antibiotic, combined with cilastatin sodium (MK-0791), was studied clinically and microbiologically. The following results were obtained: Concentrations of MK-0787 in the plasma and internal genital tissues were measured at 1 hour after an intravenous drip infusion of MK-0787/MK-0791 (500 mg/500 mg) for 30 minutes. Mean plasma levels higher than 11.8 micrograms/ml and mean tissue levels higher than 2.3 micrograms/g were observed. When its MIC values are considered, MK-0787/MK-0791 appeared to be bactericidal against many Gram-positive and Gram-negative bacteria except some Pseudomonas sp. and Enterococcus faecium. Clinical effects of the therapy with MK-0787/MK-0791 (500 mg/500 mg) using a drip infusion twice daily were evaluated in 3 patients with pyometra and 3 patients with Bartholin's gland abscess. Clinical responses were good in 5 of the 6 patients. One patient with pyometra due to E. coli didn't respond to the therapy. No side effects or abnormal laboratory findings due to the drug were noted.

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

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    Lionel A Mandell


    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. [Clinical and pharmacokinetic evaluation of imipenem/cilastatin sodium in children]. (United States)

    Fujita, K; Kakehashi, H; Murono, K; Sakata, H; Ohmi, H; Yoshioka, H; Maruyama, S; Sanae, N; Inyaku, F


    Nineteen episodes of infection in 17 children (one had 3 episodes) were treated with imipenem/cilastatin sodium (MK-0787/MK-0791), and the clinical efficacy and side effects were evaluated. The ages of patients ranged from 1 month to 8 years 1 month and their body weights ranged from 3.9 to 25.2 kg. The MK-0787/MK-0791 was administered intravenously by a 30-60 minutes infusion, in doses ranging from 8-42 mg/8-42 mg/kg every 6 to 12 hours for 3 to 40.5 days. Among 18 episodes in 16 patients (one patient proved to have rubella meningoencephalitis and was excluded from evaluation of the clinical efficacy) with bacterial infections including sepsis, pneumonia, acute suppurative thyroiditis and urinary tract infections, the results were excellent in 10, good in 5, fair in 2, and poor in 1 episode. Some side effects were noted; among all 19 episodes in the 17 patients diarrhea was noted in 3, rash in 1, slightly elevated serum transaminases in 1 and thrombocytosis in 1 episode. Pharmacokinetic studies were done in 7 patients whose ages ranged from 3 years 2 months to 13 years 1 month. Plasma concentrations of MK-0787 in 2 children were 19.6 and 20.0 micrograms/ml at 15 minutes and 5.6 and 2.1 micrograms/ml at 2 hours after a 10 mg/10 mg/kg intravenous 30-minute drip infusion of MK-0787/MK-0791. Plasma half-lives of MK-0787 were 1.52 and 0.74 hour, and total urinary recoveries were 54.6 and 71.4% during 0-6 hours. After a 20 mg/20 mg/kg intravenous 30-minute drip infusion into 2 other children, plasma concentrations of MK-0787 were 46.8 and 44.0 micrograms/ml at 15 minutes and 7.8 and 7.4 micrograms/ml at 2 hours. Plasma half-lives were 0.82 and 0.83 hour, and total urinary recoveries were 110.2 and 80.5% during 0-6 hours. Plasma concentrations of MK-0787 were less than 0.2, 0.2 and 1.2 micrograms/ml just before the next doses in 3 patients given 11-20 mg/11-20 mg/kg of MK-0787/MK-0791 every 6-8 hours. The time course of the plasma levels and urinary excretion in these

  8. Spectrophotometric and chemometric methods for determination of imipenem, ciprofloxacin hydrochloride, dexamethasone sodium phosphate, paracetamol and cilastatin sodium in human urine (United States)

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


    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.

  9. 头孢噻肟与亚胺培南西司他丁钠治疗新生儿败血症的效果比较研究%Comparative Research on Effect of Cefotaxime and Imipenem and Cilastatin Sodium in Treatment of Neonatal Septicemia

    Institute of Scientific and Technical Information of China (English)



    Objective To analyze the effect of cefotaxime and imipenem and cilastatin sodium in treatment of neonatal sep-ticemia and provide reference for the clinical treatment. Methods 120 cases of children with septicemia diagnosed and treated in our hospital from February 2011 to February 2015 were analyzed, and the treatment effects of cefotaxime and imipenem and cilastatin sodium were compared. Results There was no statistical difference in the type of pathogen isolated from blood between the cefotaxime treatment group and the imipenem and cilastatin sodium group, P>0.05, the effective rate of cefotaxime was obviously lower than that of imipenem and cilastatin sodium, (86.7%vs 96.7%), P0.05. Conclusion Cefotaxime and imipenem and cilastatin sodium in treatment of neonatal septicemia has a certain curative effect, but the effect of the latter is better.%目的:对头孢噻肟与亚胺培南西司他丁钠治疗新生儿败血症的效果进行分析,为临床治疗提供参考。方法方便选取该院2011年2月—2015年2月期间诊治的120例新生儿败血症患儿进行分析,比较头孢噻肟与亚胺培南西司他丁钠的治疗效果。结果头孢噻肟治疗组和亚胺培南西司他丁钠治疗组患者血培养病原菌的种类无统计学差异性(P>0.05);头孢噻肟的有效率(86.7%)明显低于亚胺培南西司他丁钠的有效率(96.7%)(P0.05)。结论头孢噻肟与亚胺培南西司他丁钠均对新生儿败血症有一定疗效,但后者效果更佳。

  10. 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


    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

  11. Process optimization catalyzed by recombinant Pichia patoris derived lipase B for the synthesis of cilastatin%利用产脂肪酶B的毕赤酵母工程菌生物拆分制备西司他丁关键手性中间体的体系优化

    Institute of Scientific and Technical Information of China (English)

    郑磊; 何军邀; 黄金; 王普


    S (+)2,2二甲基环丙烷甲酸( S (+) DMCPA)是合成西司他丁的关键手性中间体。构建的毕赤酵母工程菌生产的脂肪酶可高选择性催化外消旋2,2二甲基环丙烷甲酸乙酯( DMCPE)不对称水解制备 S (+) DMCPA。对该工程菌产胞外脂肪酶的产酶条件及生物拆分反应条件进行优化,以提高其催化效率。优化获得重组毕赤酵母最佳产酶条件:采用BMMY培养基,培养基初始pH 8�0,500 mL摇瓶装50 mL培养基,每隔4 h向培养基中补加终体积分数为1%的甲醇。培养192 h后,发酵液中脂肪酶比酶活为4�41 U/L,较优化前提高了90�9%。利用含脂肪酶的发酵上清液进行DMCPE的生物拆分反应,底物浓度为15 mmol/L,30℃反应36 h,S (+) DMCPA的产率可达43�8%,e�e.值为99�8%。%S⁃(+)⁃2, 2⁃dimethylcyclopropane carboxylic acid ( S⁃(+)⁃DMCPA ) is a key chiral intermediate for the synthesis of cilastatin. A recombinant Pichia patoris can convert racemic ethyl⁃2,2⁃dimethylcyclopropane carboxylate ( DMCPE) to S⁃(+)⁃DMCPA with high enantioselectivity. In order to enhance its catalytic efficiency,the lipase⁃producing conditions and catalytic conditions were optimized. The optimal conditions for lipase production were as follows:the optimal loaded volume was 50 mL/500 mL, initial pH of fermentation medium was 8�0. Methanol was added into the medium to a final concentration of 1% ( V/V) at every 4 h intervals. Under the optimal conditions,the lipase activity of the recombinant reached 4�41 U/L within 192 h,with an increase of 90�9% compared to the control. The supernatant containing lipase was then used for biocatalytic resolution of DMCPE to S⁃(+)⁃DMCPA at 15 mmol/L substrate concentration at 30 ℃ for 36 h. Under above conditions,the best yield of 43�8% was obtained with enantiomeric excess (e�e.) value of 99�8%.

  12. 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


    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.

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

    NARCIS (Netherlands)

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


    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:

  14. Doripenem Injection (United States)

    ... injection is in a class of medications called carbapenem antibiotics. It works by killing bacteria.Antibiotics such ... if you are allergic to doripenem injection; other carbapenem antibiotics such as imipenem/cilastatin (Primaxin) or meropenem ( ...

  15. Ertapenem Injection (United States)

    ... Ertapenem is in a class of medications called carbapenem antibiotics. It works by killing bacteria.Antibiotics such ... pharmacist if you are allergic to ertapenem; other carbapenem antibiotics such as imipenem/cilastatin (Primaxin), doripenem (Doribax), ...

  16. Infectious Complications of Open Type III Tibial Fractures among Combat Casualties (United States)


    13) 10 20 (M, IIIb) ESBL Klebsiella pneumoniae (3) Ampicillin, gentamicin, imipenem-cilastatin (2)d MSSA (16) Union (25) 11 27 (M, IIIb) Acb (15...CoNS, coagulase-negative staphylococci; ESBL , extended-spectrum b-lactamase–producing; M, male; MRSA, methicillin resistant Staph- ylococcus aureus

  17. First case of Nocardia amamiensis pulmonary infection in Mexico

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    A. Martinez-Gamboa


    Full Text Available We report a case of Nocardia amamiensis pulmonary infection in a 43-year-old immunocompromised woman. The patient was treated with imipenem/cilastatin and trimethoprim/sulfamethoxazole and had a favourable outcome. It is important that laboratories perform species identification to understand the epidemiology and susceptibility patterns of the different Nocardia spp.

  18. 血液系统疾病并发院内感染的治疗%Antimicrobial Therapy of Nosocomial Infectious Complications in Patients with Hematological Diseases

    Institute of Scientific and Technical Information of China (English)

    黄洪晖; 陈芳源; 方智雯; 韩洁英; 朱学宏; 邵念贤


    Objective To evaluate the clinical efficacy of imipenem/cilastatin in the treatment of nosocomial infectious complications in patients with hematological diseases. Methods 52 patients were treated with imipenem/cilastatin alone or in combination with other antibiotics. It was administered intravenously at a dosage of 1.5~2g per day. Results 1. The overall response rate of imipenem/cilastatin was 59.6%. 2. For Grme - positive and Grme - negative aerobes infections the clinical response rates were 44.4% and 60.0%, respectively. 3. The response rate of imipenem/cilastatin in patients who failed to respond to the third generation cephalosporins was 56.4%. 4. The response rate in febrile agranulocytosis patients was 51.9%. Conclusion Imipenem/cilastatin is a highly effective and broad-spectrum antibacterial agent for the treatment of nosocomial infectious complications in patients with hematologic diseases.%目的观察亚胺培南/西司他丁对血液系统疾病并发院内感染的治疗效果。方法 52例患者,单一使用亚胺培南/西司他丁或亚胺培南/西司他丁与其他抗菌素合用。亚胺培南/西司他丁每日剂量15~2g,静脉滴注。结果 1.亚胺培南/西司他丁治疗的总有效率为59.6%;2.对G+需氧菌及G需氧菌感染的临床有效率分别为44.4%,60.0%;3.应用第三代头孢菌素无效的患者用亚胺培南/西司他丁治疗,总有效率达56.4%;4.粒细胞缺乏合并感染患者中的有效率为51.9%。结论亚胺培南/西司他丁具有高效、广谱的抗菌作用,是治疗血液系统疾病院内感染的有效药物。

  19. Measurement and Correlation for Solubility of (S)-(+)-2,2-Dimethyl-cyclopropane Carbox Amide in Different Solvents%(S)-(+)-2,2-二甲基环丙烷甲酰胺在不同溶剂中溶解度的测定与关联

    Institute of Scientific and Technical Information of China (English)

    石晓华; 周彩荣; 高玉国; 陈新志


    (S)-(+)-2,2-dimethylcyclopropane carbox amide is a key intermediate of Cilastatin, an inhibitor of dehydropeptidase-I. Its corresponding solid-liquid equilibrium data will provide essential support for industrial design and further theoretical studies. The solubilities of (S)-(+)-2,2-dimethylcyclopropane carbox amide in toluene, dichloromethane, trichloromethane, ethyl acetate, ethanol and pure water at different temperature were measured using the synthetic method by a laser monitoring observation technique. The solubility data were correlated with the modified Apelblat equation. The calculated values were good in agreement with the experimental values.

  20. Mycobacterium abscessus complex bacteremia due to prostatitis after prostate biopsy. (United States)

    Chen, Chung-Hua; Lin, Jesun; Lin, Jen-Shiou; Chen, Yu-Min


    We present the case of a 49-year-old man, who developed Mycobacterium abscessus complex (M. abscessus complex) bacteremia and prostatitis after prostate biopsy. The patient was successfully treated with amikacin with imipenem-cilastatin with clarithromycin. Infections caused by M. abscessus complex have been increasingly described as a complication associated with many invasive procedures. Invasive procedures might have contributed to the occurrence of the M. abscessus complex. Although M. abscessus complex infection is difficult to diagnose and treat, we should pay more attention to this kind of infection, and the correct treatment strategy will be achieved by physicians.

  1. Absence of cross-reactivity to carbapenems in patients with delayed hypersensitivity to penicillins. (United States)

    Romano, A; Gaeta, F; Valluzzi, R L; Alonzi, C; Maggioletti, M; Zaffiro, A; Caruso, C; Quaratino, D


    Studies performed on subjects with IgE-mediated hypersensitivity to penicillins have demonstrated a 1% rate of cross-reactivity between penicillins and both imipenem and meropenem, while a single study found a 5.5% rate of cross-reactivity with imipenem/cilastatin in subjects with T-cell-mediated hypersensitivity to β-lactams, mostly penicillins. We studied 204 consecutive subjects with a well-demonstrated T-cell-mediated hypersensitivity to assess the cross-reactivity with carbapenems and the tolerability of such alternative β-lactams. All 204 subjects underwent skin tests with imipenem/cilastatin and meropenem; 130 of them were skin-tested also with ertapenem. Subjects with negative test results were challenged with these carbapenems. All subjects displayed negative skin tests to carbapenems and tolerated challenges. These data demonstrate the absence of clinically significant T-cell-mediated cross-reactivity between penicillins and carbapenems. Negative delayed-reading skin testing with carbapenems in individuals with documented T-cell-mediated hypersensitivity to penicillins correlates well with subsequent clinical tolerance of therapeutic doses of carbapenems.

  2. In vivo activity of ceftobiprole in murine skin infections due to Staphylococcus aureus and Pseudomonas aeruginosa. (United States)

    Fernandez, Jeffrey; Hilliard, Jamese J; Abbanat, Darren; Zhang, Wenyan; Melton, John L; Santoro, Colleen M; Flamm, Robert K; Bush, Karen


    Ceftobiprole, a broad-spectrum cephalosporin with activity against methicillin-resistant Staphylococcus aureus (MRSA) (P. Hebeisen et al., Antimicrob. Agents Chemother. 45:825-836, 2001), was evaluated in a subcutaneous skin infection model with Staphylococcus aureus Smith OC 4172 (methicillin-susceptible S. aureus [MSSA]), S. aureus OC 8525 (MRSA), Pseudomonas aeruginosa OC 4351 (having an inducible AmpC beta-lactamase), and P. aeruginosa OC 4354 (overproducing AmpC beta-lactamase). In the MSSA and MRSA infection models, ceftobiprole, administered as the prodrug ceftobiprole medocaril, was more effective in reducing CFU/g skin (P ceftobiprole were 19 to 29% lower than those for cefazolin-, vancomycin-, or linezolid-treated animals (P ceftobiprole-treated mice was 34% less than that with cefazolin or linezolid treatment (P ceftobiprole at similar doses was as effective as meropenem-cilastatin in reductions of CFU/g skin, despite 8- and 32-fold-lower MICs for meropenem; both treatments were more effective than was cefepime (P Ceftobiprole was similar to meropenem-cilastatin and 47 to 54% more effective than cefepime (P ceftobiprole is effective in reducing both bacterial load and lesion volume associated with infections due to MSSA, MRSA, and P. aeruginosa in this murine model of skin and soft tissue infection.

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

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    R Enríquez


    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.

  4. A case of pneumonia caused by Legionella pneumophila serogroup 12 and treated successfully with imipenem. (United States)

    Nishizuka, Midori; Suzuki, Hiroki; Ara, Tomoka; Watanabe, Mari; Morita, Mami; Sato, Chisa; Tsuchida, Fumihiro; Seto, Junji; Amemura-Maekawa, Junko; Kura, Fumiaki; Takeda, Hiroaki


    The patient was an 83-year-old man hospitalized for Haemophilus influenzae pneumonia, who developed recurrent pneumonia after improvement of the initial episode. Legionella pneumophila serogroup 12 was isolated from the sputum, accompanied by increased serum antibody titers to L. pneumophila serogroup 12. Therefore, the patient was diagnosed as having Legionella pneumonia caused by L. pneumophila serogroup 12. Case reports of pneumonia caused by L. pneumophila serogroup 12 are rare, and the case described herein is the first report of clinical isolation of this organism in Japan. When the genotype was determined by the protocol of The European Working Group for Legionella Infections (Sequence-Based Typing [SBT] for epidemiological typing of L. pneumophila, Version 3.1), the sequence type was ST68. Imipenem/cilastatin therapy was found to be effective for the treatment of Legionella pneumonia in this patient.

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


    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.

  6. Noma in an immunocompromised patient. (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


    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.

  7. [Treatment in the event of antibiotic prophylaxis failure in gynecologic surgery. A retrospective study of 20 cases]. (United States)

    Paparella, P; Zullo, M A; Astorri, A L; Bondì, M; Maglione, A; Oliva, C; Mancuso Bondì, S


    A retrospective study was performed of the type of treatment used in 20 patients undergoing gynecological surgery in whom antibiotic prophylaxis with Mezlocillin (2 g i.v.) had failed. Patients were subdivided into three groups: A) Initial therapy with Mezlocillin (8 patients, 2 g/die i.m.) or Cefotetan (2 patients, 2 g/die i.m.) and subsequent addition of Gentamicin (8 patients, 240 mg/die i.m.) or Tobramycin (2 patients, 200 mg/die i.m.) and subsequently Metronidazole (7 patients, 1.5 g/die per os). B) Therapy with Imipenem/Cilastatin (6 patients, 1.5 g/die i.m.). C) Therapy with Imipenem/Cilastatin (4 patients, 1.5 g/die i.m.) after a variety of antibiotics: Cotrimoxazole (Trimethoprim 160 mg/die and sulphamethoxazole 800 mg/die per os), Pefloxacin (800 mg/die per os), Cefotetan (2 g/die i.m.) and Mezlocillin (2 g/die i.m.). Time taken to lower temperature was shorter in Group B (3.5 days) compared to Group A (6.8 days) and Group C (10 days). Postoperative hospital stay was also shorter in Group B (9 days) compared to Group C (16.5 days) and Group A (11.1 days). The immediate administration of an antibiotic active against Gram+ and Gram- germs, aerobes and anaerobes is therefore useful in the event of failure of antibiotic prophylaxis, rather than the use in succession of associations of antibiotics with a limited spectrum.

  8. A study of compatible stability between 54 antibiotics for injection and invert sugar infusion after mixing%54种常用抗菌药物与转化糖注射液的配伍稳定性研究

    Institute of Scientific and Technical Information of China (English)

    王建平; 段广民


    目的 观察54种临床常用抗菌药物在转化糖输液中的配伍稳定性.方法 测量54种常用抗菌药物在室温下与转化糖注射液配伍后8 h内不同时间的溶液外观性状及pH值变化.结果 除外亚胺培南/西司他丁外,其余53种临床常用抗菌药物产品与转化糖输液配伍后外观无明显变化,溶液pH值变化范围≤0.3.结论除外亚胺培南/西司他丁外,其余53种临床常用抗菌药物在常温下与转化糖输液配伍稳定,宜于8 h内使用.%OBJECTIVE To study the compatible stablity between 54 antibiotics for injection and invert sugar infusion.METHODS The appearance of the solution mixed with 54 antibiotics for injection and invert sugar infusion were observed, and the PH assay of the solution were determined.RESULTS Except imipenem and cilastatin sodium,no marked changes were noted in appearance of the other 53 antibiotics production mixed with invert sugar infusion,and the changing ranges≤0.3 in PH assay.CONCLUSION Except imipenem and cilastatin sodium, the other 53 antibiotics can be used within 8h after mixing with invert sugar infusion at room temperature.

  9. 我院住院病房2008-2010年碳青霉烯类抗生素应用分析%Analysis of the Utilization of Carbapenem Antibiotics in the Wards of Our Hospital from 2008 to 2010

    Institute of Scientific and Technical Information of China (English)



    目的:评价我院住院病房碳青霉烯类抗生素的应用情况.方法:从医院信息系统中调取我院2008-2010年38个科室应用碳青霉烯类抗生素的医嘱信息,结合公布的细菌分离和亚胺培南/西司他丁耐药率情况,判断碳青霉烯类抗生素合理应用情况.结果:碳青霉烯类抗生素3年内用量基本稳定,以重症监护室和老年患者集中的干部科室为主.至2010年,美罗培南替代亚胺培南/西司他丁成为碳青霉烯类抗生素的首选.结论:我院碳青霉烯类抗生素使用基本合理.%OBJECTIVE: To analyze the utilization of carbapenems antibiotics in the wards of our hospital from 2008 to 2010.METHODS: The information of medical orders of carbapenem use in 38 departments of our hospital was collected from hospital information system (HIS) of our hospital from 2008 to 2010. Bacteria isolation and drug resistant rate of imipenem/cilastatin were abstracted from Hospital Infection Control Information pressed by our hospital to analyze the rational use of imipenem antibiotics. RESULTS: The utilization of carbapenem antibiotics is stable during the past three years, mainly in ICU and cadre department in which old patients concentrate. More clinicians are preferred to using meropenem rather than imipenem or cilastatin by 2010. CONCLUSION: The utilization of carbapenems antibiotics in our hospital is reasonable basically.

  10. [Pharmaco-economic evaluation of antibiotic therapy in a ward for infections diseases (United States)

    Sabbatani, S.; Cannella, B.; Fulgaro, C.; Pipitone, E.; Cesari, R.


    For all hospitalized patients admitted in the first six months of 1999, we recorded the data relative to antibiotic therapy (TA) administered, establishing the period of treatment in days and the dosage, including any variations during the period in question. We calculated the prescribed daily dose (PDD) and were thus able to establish the expense incurred in antibiotic therapy, comparing the real overall cost per product used. For all patients, the discharge diagnosis was reported, and the whole case-study was aggregated into homogeneous groups. PDD was compared with DDD (defined daily doses). The Pareto curve was used to highlight the antibiotics with higher overall cost. Besides cotrimoxazole, ceftriaxone and ciprofloxacin were the antibiotics most frequently prescribed, while ceftriaxone, imipenem-cilastatine and vancomycin were the antibiotics incurring the greatest expense. With reference to the average duration of the treatment cycle, ceftriaxone (9.75 dd) and ciprofloxacin tbl (6.75 dd) were the only antibiotics (in monotherapy) used for less than 10 treatment days. Special attention was paid to analysing the TA costs in treating pneumonia, which accounted for the highest percentage of cases (50 cases). Ceftriaxone, especially pulmonary infections, was the most commonly used drug. In hospitalized subjects treated who show good therapeutic response, we recommend early discharge and continuation of the therapy at home (switch therapy). This strategy will allow the patient to return to his/her family in good time, also thereby reducing hospital management costs.

  11. Nocardiose pulmonar em portador de doença pulmonar obstrutiva crônica e bronquiectasias Pulmonary nocardiosis in a patient with chronic obstructive pulmonary disease and bronchiectasis

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    Miguel Abidon Aidê


    Full Text Available Relatamos o caso de um paciente com doença pulmonar obstrutiva crônica e bronquiectasias, em uso crônico de corticosteróides, que desenvolveu nocardiose pulmonar, sob a forma de múltiplos nódulos pulmonares escavados. Os sintomas principais foram a tosse produtiva com escarro purulento, febre e dispnéia A radiografia simples e a tomografia computadorizada do tórax mostravam nódulos em ambos os pulmões, alguns escavados. O exame direto de escarro e a cultura mostraram a presença de Nocardia spp. A paciente foi tratada com imipenem e cilastatina, com excelente resposta clínica.We report the case of a patient with chronic obstructive pulmonary disease and bronchiectasis, chronically using corticosteroids, who acquired pulmonary nocardiosis, which presented as multiple cavitated nodules. The principal symptoms were fever, dyspnea and productive cough with purulent sputum. Chest X-ray and computed tomography of the chest revealed nodules, some of which were cavitated, in both lungs. Sputum smear microscopy and culture revealed the presence of Nocardia spp. The patient was treated with imipenem and cilastatin, which produced an excellent clinical response.

  12. Rational design of a carboxylic esterase RhEst1 based on computational analysis of substrate binding. (United States)

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


    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.

  13. Experimental models of epilepsy

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    Stanojlović Olivera P.


    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.

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


    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.

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

    Directory of Open Access Journals (Sweden)

    Anxo Fernández-Ferreiro


    Full Text Available 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

  16. Associated factors and outcomes for OXA-232 Carbapenem-resistant Enterobacteriaceae infections in a tertiary care centre in Mexico City: A case-control-control study. (United States)

    Torres-González, Pedro; Ortiz-Brizuela, Edgar; Cervera-Hernandez, Miguel Enrique; Bobadilla-Del Valle, Miriam; Martínez-Gamboa, Areli; Sifuentes-Osornio, José; Ponce-de-Leon, Alfredo


    We describe the outcomes and factors associated with OXA-232 producing carbapenem-resistant Enterobacteriaceae infections. A case-control-control study was performed; each case of infection by a carbapenem-resistant/OXA-232 (OXA-232-cases, n=27) was matched by isolation site, species, and date, with 2 cases of infection by carbapenem-susceptible/third-generation cephalosporin-susceptible (TGCS-controls, n=54) and 2 cases by carbapenem-susceptible/ESBL producing Enterobacteriaceae (ESBL-controls, n=54); 66% were urinary tract and 18.5% intra-abdominal infections. In the multivariable analysis with ESBL-controls, previous use β-lactam/β-lactamase antibiotics (OR 6.2; 95% CI 1.6-23.8) and, third-generation cephalosporins (OR 0.2; 95% CI 0.05-0.8) were associated with OXA-232 infection; with TGSC-controls previous use of β-lactam/β-lactamase antibiotics (OR 3.7; 95% 1.1-12.0) was associated. Among the OXA-232-cases, 29% received imipenem/cilastatin or meropenem, 11.1% ceftriaxone, 22.2% a carbapenem-based combination and 33.3% other antimicrobials as treatment. Previous β-lactam/β-lactamase antibiotics are associated with OXA-232 infections, and some may be treated with other active carbapenems or, in the absence of ESBL, third-generation cephalosporins.

  17. [Activity of doripenem against Pseudomonas spp. and Acinetobacter spp. rods]. (United States)

    Bogiel, Tomasz; Deptuła, Aleksander; Gospodarek, Eugenia


    Doripenem, the newest carbapenem was approved in 2008 by the European Medicines Agency for the treatment of complicated intra-abdominal infections and complicated urinary tract infections. Its spectrum of activity is similar to that of meropenem and imipenem/cilastatin. The aim of this study was to compare in vitro activity of doripenem against nonfermentative Gram-negative rods. A total of 235 strains of Pseudomonas spp. (74.9%) and Acinetobacter spp. (25.1%) were included into the study. Strains were isolated in The Department of Clinical Microbiology of the University Hospital No 1 in Bydgoszcz and identified using ID GN tests (bioMérieux). To determine susceptibility to doripenem and other carbapenems disc-diffusion method was applied. Percentage of doripenem resistant strains reached 28.4% and 39.0% for Pseudomonas spp. and Acinetobacter spp, respectively. All doripenem sensitive or intermediate Acinetobacter spp. strains were simultaneously sensitive to imipenem and meropenem. Activity of imipenem and meropenem among doripenem resistant Acinetobacter spp. were represented by 60.9% and 56.5% strains, respectively. Activity of imipenem and meropenem among doripenem resistant Pseudomonas spp. strains were represented by 12.0% and 18.0%, respectively. Occurence of one doripenem sensitive Pseudomonas spp. strain simultaneously resistant to imipenem and meropenem was observed.

  18. Nocardia elegans infection: a case report and literature review

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    Itaru Nakamura


    Full Text Available A case of disseminated nocardiosis caused by Nocardia elegans in a 72-year-old man with rheumatoid arthritis, treated with tacrolimus and prednisolone, is reported herein. The patient had impaired vision and was diagnosed with endophthalmitis and an abdominal skin abscess. He was started on trimethoprim–sulfamethoxazole treatment, followed by cefepime. The patient was then switched to a combination of imipenem–cilastatin and minocycline. Although the patient survived as a result of surgery and prolonged antibiotic treatment, he eventually lost vision after the infection became resistant to antibiotic treatment. Molecular analysis of samples from the abscess and vitreous fluid confirmed the extremely rare pathogen N. elegans, which accounts for only 0.3–0.6% of infections caused by Nocardia species. This organism is almost always associated with pulmonary infection, and disseminated infections are rare. As with previously reported norcardial infections, the current case was treated successfully with trimethoprim–sulfamethoxazole, carbapenems, and aminoglycosides. However, the clinical characteristics of this organism remain unclear. Further studies are therefore required to develop more effective treatment protocols for disseminated nocardiosis caused by this problematic pathogen.

  19. Carbapenems: past, present, and future. (United States)

    Papp-Wallace, Krisztina M; Endimiani, Andrea; Taracila, Magdalena A; Bonomo, Robert A


    In this review, we summarize the current "state of the art" of carbapenem antibiotics and their role in our antimicrobial armamentarium. Among the β-lactams currently available, carbapenems are unique because they are relatively resistant to hydrolysis by most β-lactamases, in some cases act as "slow substrates" or inhibitors of β-lactamases, and still target penicillin binding proteins. This "value-added feature" of inhibiting β-lactamases serves as a major rationale for expansion of this class of β-lactams. We describe the initial discovery and development of the carbapenem family of β-lactams. Of the early carbapenems evaluated, thienamycin demonstrated the greatest antimicrobial activity and became the parent compound for all subsequent carbapenems. To date, more than 80 compounds with mostly improved antimicrobial properties, compared to those of thienamycin, are described in the literature. We also highlight important features of the carbapenems that are presently in clinical use: imipenem-cilastatin, meropenem, ertapenem, doripenem, panipenem-betamipron, and biapenem. In closing, we emphasize some major challenges and urge the medicinal chemist to continue development of these versatile and potent compounds, as they have served us well for more than 3 decades.

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

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


    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.

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

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


    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.

  2. Analysis of drug resistance in 1,861 strains of Acinetobacter baumannii (United States)



    Acinetobacter baumannii is an emerging human pathogen that causes hospital-acquired infections. The trend in increased antimicrobial resistance limits the choice of effective antimicrobial agents. The present study reports the resistance to Acinetobacter baumannii and analyzes the associations between antibiotic use and resistance rates at a general hospital between 2010 and 2014. A total of 1,861 isolates were obtained from clinical cultures, accounting for 10.33% of all detected bacteria (1,861/18,016). The strains were mainly from respiratory samples (1,628 isolates, 87.5%) and the intensive care unit (696 isolates, 37.4%). The resistance rates of Acinetobacter baumannii to the majority of antibiotics were >50%, particularly the resistance rate to cefoperazone/sulbactam increased from 47.37 in 2011 to 89.25% in 2014. However, the rates of imipenem and cilastatin sodium decreased from 81.03 to 69.44% due to the antibiotic policy. There were Pearson significant associations between the use of three antibiotics and resistance in Acinetobacter baumannii to this drug, piperacillin/tazobactam (r=0.976, P<0.01), gentamicin (r=0.870, P<0.01) and cefoxitin (r=0.741, P<0.05). Therefore, a combination of drugs should be adopted to treat Acinetobacter baumannii infections. Microbiology laboratory support and surveillance policies are essential to control the emergence of multidrug-resistance Acinetobacter baumannii. PMID:27073633

  3. 角膜炎的的病原菌分布和耐药性分析%Pathogenic Bacteria Distribution and Resistance Research Analysis in patients with infectious keratitis

    Institute of Scientific and Technical Information of China (English)



      目的探讨感染性角膜炎患者角膜溃疡物培养结果病原菌分布和耐药性情况.方法采集2010年4月~2012年4月在我院眼科住院治疗的217例感染性角膜炎患者角膜溃疡物,将其送病原菌分离培养、鉴定和药物敏感试验,总结感染性角膜炎患者角膜溃疡物培养结果及药物敏感试验结果.结果在217份送检角膜溃疡物标本中,有116份检出病原菌,总阳性率为53.46%,以真菌感染为主,占81.90%,细菌对四环素和青霉素均耐药,耐药率为100.00%,对万古霉素及亚胺培南西司他丁钠敏感,耐药率为0.00%,而检出95株真菌对氟胞嘧啶、酮康唑、伊曲康唑和两性霉素耐药率分别为38.10%、52.38%、57.14%和71.43%.结论感染性角膜炎以真菌性角膜炎为主,细菌对四环素和青霉素均耐药,而对万古霉素及亚胺培南西司他丁钠敏感等耐药率低.%  Objective To probe into pathogen distribution and drug sensitivity test results of corneal ulcer things in patients with infectious keratitis.Methods Corneal ulcer things in patients with infectious keratitis who were treated in the department of ophthalmology in our hospital from April 2010 to April 2012 were colected,then them were sent to pathogen separation,identification of cultivation and the drug sensitivity test,and in the end we summarized pathogen distribution and drug sensitivity test results of corneal ulcer things in patients with infectious keratitis.Results One hundred and sixteen strains of bacteria were isolated from two hundred and seventeen corneal ulcer things in patients with infectious keratitis,total positive rate was 53.46%,and most of patients with infectious keratitis infected with fungus(81.90%),bacteria to tetracycline and penicilin are the resistance,the resistant rate was 100.00%,but bacteria to vancomycin and imipenem and cilastatin sodium were sensitive,ninety-five strains of fungus,to fluorocytosine

  4. 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


    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.

  5. Sulbactam-based therapy for Acinetobacter baumannii infection: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Haiqing Chu


    Full Text Available BACKGROUND: A number of studies have reported on the effectiveness of sulbactam-based therapies for Acinetobacter baumannii infection; however, there is little evidence that sulbactam-based therapies are more or less effective than alternative therapies. Unfortunately, there is a distinct lack of high quality data (i.e., from randomized controlled trials available on this issue. Therefore, we conducted a systematic review and meta-analysis comparing the efficacy of sulbactam-based and non-sulbactam-based regimens in the treatment of A. baumannii infection. METHODS: We searched PubMed, MEDLINE, Biomedical Central, Google Scholar, the China National Knowledge Infrastructure, the Cochrane library, and the Directory of Open Access using the terms "sulbactam and baumannii" or "maxtam and baumannii". Randomized controlled trials, controlled clinical studies, and cohort studies were considered for inclusion. The primary outcome was the clinical response rate for sulbactam-based therapy vs comparator therapies. RESULTS: Four studies (1 prospective, 3 retrospective were included in the metaanalysis. Sulbactam was given in combination with ampicillin, carbapenem, or cefoperazone (n = 112 participants. Comparator drugs included colistin, cephalosporins, anti-pseudomonas penicillins, fluoroquinolones, minocycline/doxycycline, aminoglycosides, tigecycline, polymyxin, imipenem/cilastatin, and combination therapy (n = 107 participants. The combined clinical response rate odds ratio did not significantly favor sulbactam-based therapy over comparator therapy (odds ratio = 1.054, 95% confidence interval = 0.550-2.019, p = 0.874, nor did any of the individual study odds ratios. CONCLUSIONS: The available evidence suggests that sulbactam-based therapy may be similarly efficacious to alternative antimicrobial therapies for the treatment of A. baumannii infection. Further research on this issue is warranted given the limited availability of data from high quality

  6. 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


    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.

  7. Infectious anastomotic pseudoaneurysm complicating renal allograft: case report and review of literature

    Directory of Open Access Journals (Sweden)

    Chung MMT


    Full Text Available Marvin MT Chung, Yiu Che Chan, Yuk Law, Stephen WK Cheng Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong Abstract: Infectious anastomotic pseudoaneurysm complicating renal transplant is rare, but probably under-reported with <30 cases worldwide. We report a 45-year-old man with hypertension, diabetes mellitus and end stage renal failure, who had a renal transplant anastomosed to the right external iliac artery and vein. Postoperatively, he made a slow recovery with malaise and persistent vague right iliac fossa discomfort. Ultrasound scan 1 month postoperatively showed perinephric collection, and fluid culture grew Enterococcus faecium and Pseudomonas aeruginosa. He was started on vancomycin, daptomycin and colistin. MAG-3 scan also showed suboptimal function in the renal allograft. His symptoms persisted with fever, and blood culture yielded P. aeruginosa. Repeated ultrasound scan, and subsequent computed tomography scan a few weeks later, showed perinephric collection and a large, 3.8×3.5 cm pseudoaneurysm posteromedial to the graft kidney. He underwent emergency graft excision, together with resection of the pseudoaneurysm with in situ reversed great saphenous vein interposition graft, and made a good recovery on hemodialysis. The aneurysm wall grew P. aeruginosa, and he was put on imipenem and cilastatin (tienam, colistin, ciprofloxacin and daptomycin. To our knowledge, this is one of very few cases in the world’s literature in which a P. aeruginosa infectious anastomotic pseudoaneurysm developed after a renal allograft. Keywords: infectious anastomotic pseudoaneurysm, renal allograft artery, renal transplant, multidrug-resistant Pseudomonas aeruginosa, in situ interposition bypass graft

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

    Energy Technology Data Exchange (ETDEWEB)

    Okuno, Yuji, E-mail: [Edogawa Hospital, Department of Orthopedic Surgery (Japan); Korchi, Amine Mohamed, E-mail: [Geneva University Hospitals, Department of Diagnostic and Interventional Radiology (Switzerland); Shinjo, Takuma, E-mail: [Keio University, Institute for Integrated Sports Medicine, School of Medicine (Japan); Kato, Shojiro, E-mail: [Edogawa Hospital, Department of Orthopedic Surgery (Japan)


    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.

  9. Dynamic changes in thrombin generation in abdominal sepsis in mice. (United States)

    Wang, Yongzhi; Braun, Oscar O; Zhang, Su; Luo, Lingtao; Norström, Eva; Thorlacius, Henrik


    Systemic inflammatory response syndrome and severe infections are associated with major derangements in the coagulation system. The purpose of this study was to examine the dynamic alterations in thrombin generation in abdominal sepsis. Abdominal sepsis was induced by cecal ligation and puncture (CLP) in C57/Bl6 mice. Cecal ligation and puncture caused a systemic inflammatory response, with neutrophil recruitment and tissue damage in the lung as well as thrombocytopenia and leukocytopenia. Thrombin generation, coagulation factors, lung histology, and myeloperoxidase activity was determined 1, 3, 6, and 24 h after induction of CLP. It was found that thrombin generation was increased 1 h after CLP and that thrombin generation started to decrease at 3 h and was markedly reduced 6 and 24 h after CLP induction. Platelet-poor plasma from healthy mice could completely reverse the inhibitory effect of CLP on thrombin generation, suggesting that sepsis caused a decrease in the levels of plasma factors regulating thrombin generation in septic animals. Indeed, it was found that CLP markedly decreased plasma levels of prothrombin, factor V, and factor X at 6 and 24 h. Moreover, we observed that CLP increased plasma levels of activated protein C at 6 h, which returned to baseline levels 24 h after CLP induction. Finally, pretreatment with imipenem/cilastatin attenuated the CLP-evoked decrease in thrombin generation and consumption of prothrombin 24 h after CLP induction. Our novel findings suggest that thrombin generation is initially increased and later decreased in abdominal sepsis. Sepsis-induced reduction in thrombin generation is correlated to changes in the plasma levels of coagulation factors and activated protein C. These findings help explain the dynamic changes in global hemostasis in abdominal sepsis.

  10. Endothelial Cell Toxicity of Vancomycin Infusion Combined with Other Antibiotics. (United States)

    Drouet, Maryline; Chai, Feng; Barthélémy, Christine; Lebuffe, Gilles; Debaene, Bertrand; Décaudin, Bertrand; Odou, Pascal


    French guidelines recommend central intravenous (i.v.) infusion for high concentrations of vancomycin, but peripheral intravenous (p.i.v.) infusion is often preferred in intensive care units. Vancomycin infusion has been implicated in cases of phlebitis, with endothelial toxicity depending on the drug concentration and the duration of the infusion. Vancomycin is frequently infused in combination with other i.v. antibiotics through the same administrative Y site, but the local toxicity of such combinations has been poorly evaluated. Such an assessment could improve vancomycin infusion procedures in hospitals. Human umbilical vein endothelial cells (HUVEC) were challenged with clinical doses of vancomycin over 24 h with or without other i.v. antibiotics. Cell death was measured with the alamarBlue test. We observed an excess cellular death rate without any synergistic effect but dependent on the numbers of combined infusions when vancomycin and erythromycin or gentamicin were infused through the same Y site. Incompatibility between vancomycin and piperacillin-tazobactam was not observed in our study, and rinsing the cells between the two antibiotic infusions did not reduce endothelial toxicity. No endothelial toxicity of imipenem-cilastatin was observed when combined with vancomycin. p.i.v. vancomycin infusion in combination with other medications requires new recommendations to prevent phlebitis, including limiting coinfusion on the same line, reducing the infusion rate, and choosing an intermittent infusion method. Further studies need to be carried out to explore other drug combinations in long-term vancomycin p.i.v. therapy so as to gain insight into the mechanisms of drug incompatibility under multidrug infusion conditions.

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

    Directory of Open Access Journals (Sweden)

    Maria Virginia Villegas


    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

  12. 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


    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

  13. [Analysis on the sensitivity to beta-lactam antibiotics of respiratory-infectious isolates on the second survey on the sensitivity of isolates conducted by the Japanese Society of Chemotherapy in 2007--concerning the aspect of PK/PD break points]. (United States)

    Niki, Yoshihito; Kohno, Shigeru; Watanabe, Akira; Aoki, Nobuki


    Sensitivity to beta-lactam antibiotics of isolates clinically obtained from respiratory infection sites in adults on the second survey on sensitivity of isolates conducted by the Japanese Society of Chemotherapy in 2007 was investigated according to the classification of the "Guideline for treatment for adult nosocomial pneumonia in 2008". Among the primary antibacterial drugs for mild (A) and moderate (B) nosocomial pneumonia in adults, beta-lactam antibiotics; ceftriaxone (CTRX), sulbactam/ampicillin (SBT/ABPC), panipenem/betamipron (PAPM/BP), tazobactam/piperacillin (TAZ/PIPC), imipenem/cilastatin (IPM/CS), meropenem (MEPM), doripenem (DRPM), biapenem (BIPM) were studied to evaluate their clinical efficacy. The covering rate was analyzed using the minimal inhibitory concentration (MIC) and break point of pharmacokinetics/pharmacodynamics (PK/PD). Consequently, the results with methicillin-susceptible Staphylococcus aureus (MSSA), Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Klebsiella pneumoniae revealed the MIC90 of all antibacterial drugs to be at low levels, while almost 100% of isolates were within the range of PK/PD break points except BIPM and SBT/ABPC to H. influenzae, and SBT/ABPC to K. pneumoniae. However, the analysis of P. aeruginosa didn't reach 100% for the covering rates of isolates, indicating that these drugs did not have a complete inhibitory action to restrict bacterial proliferation. The analysis of all 5 carbapenem drugs showed superiority to TAZ/PIPC in MIC90 while covering rates of isolates at PK/PD break points showed inferiority to TAZ/PIPC. This tendency was found to be more significant in covering the rates of isolates on the regular dose with maximal bactericidal action and on the maximum dose. This is because the maximum dose approved in Japan is as low as half that in IPM/CS and 1/3 that in MEPM in Western countries.

  14. 鲍氏不动杆菌121株临床分布和耐药分析%Clinical distribution and antimicrobial resistance of acinetobacter baumannii infection

    Institute of Scientific and Technical Information of China (English)

    谭薇; 郭桂芳; 王乐强; 于振刚


    目的 了解鲍氏不动杆菌感染的临床分布及其耐药特点.方法 收集2006年1月至2007年12月从临床感染标本分离的121株鲍氏不动杆菌,了解其临床分布并做药物敏感试验,比较其耐药率.结果 121株鲍氏不动杆菌临床分布以呼吸科和ICU最多(63株,占52.07%),且多见于老年患者(67株,占55.37%);对第三代头孢菌素及环丙沙星的耐药率均>50.0%;对帕尼培南/倍他米隆、亚胺培南/西司他丁、头孢哌酮/舒巴坦的耐药性较低,分别为3.31%、6.61%、9.92%.结论 碳青霉烯类及头孢哌酮/舒巴坦对鲍氏不动杆菌感染仍有较强的活性;要减少多重耐药菌株的产生,应注意合理使用抗菌药物.%Objective To observe the clinical distribution and antimicrobial resistance of Acinetobacter baumannii(A. banmannii) infection. Methods One hundred and twenty-one strains of A. banmannii from January 2006 to December 2007 were collected and drug sensitivity tests were performed. Results Sixty-three strains (52.07%) of A. baumannii were from respiratory unit and intensive care unit. Sixty-seven strains(55.37%) were from old patients. The resistant rates to the third generation cephalosperin and ciprofloxacin were beth more than 50.0% ; Drug resistance rate of A. baumannii to panipenem/betamipron, imipenem/cilastatin and cefoperazone-sul-bactam was 3.31%, 8.26%, and 13.23% respectively. Conclusion Carbapenem and cofoperazone/sulhactam still have a strong antimierobial activity against A. banmannii. Antimicrobial agents should be used rationally to decrease multiple antibiotic resistant strains.

  15. 临床药师参与重症肺炎患者抗感染治疗的药学实践%Pharmaceutical Practice for the Severe Pneumonia Patient with Anti-infection Treatment by Clinical Pharmacists

    Institute of Scientific and Technical Information of China (English)

    梁秀群; 许明睿; 陆翠林; 唐云峡


    To probe into the role of clinical pharmacists in the treatment of patient with severe pneumonia. METHODS:The clinical pharmacists participated in to the ward round and consultation of one patient with severe pneumonia;combined with patient's clinical symptoms and drug susceptibility test result, the clinical pharmacists presented concrete suggestions about the formulation and adjustment of anti-infection treatment scheme:imipenem and cilastatin sodium combined with linezolid, and piperacillin sodium and tazobactam sodium combined with voriconazole. Meanwhile, the clinical pharmacists emphatically monitored the blood routine, liver and kidney function, and pulmonary lesions absorption of the patient.RESULTS: The therapeutic scheme provided by clinical pharmacists obtained a good therapeutic effect.The patient's pulmonary infected symptoms ( cough, expectoration, shortness of breath and hypoxemia, etc.) were controlled.The fungal infection was also gradually improved and discharged. CONCLUSIONS: The clinical pharmacists based on clinical, focus on the patient, assist clinicians to optimize therapeutic scheme and implement pharmaceutical care for patient, which can make the patient get the best therapeutic services.%目的:探讨临床药师在重症肺炎患者救治过程中的作用。方法:临床药师参与1例重症肺炎患者的查房、会诊,结合患者的临床症状和药物敏感性试验结果,对抗感染方案的制订和调整提出具体意见,先后使用亚安培南西司他丁钠联合利奈唑胺、哌拉西林钠他唑巴坦钠联合伏立康唑抗感染治疗,同时重点监测患者的血常规、肝肾功能、肺部病灶吸收情况。结果:临床药师提供的用药方案取得了良好的治疗效果,患者咳嗽、咳痰、气促、低氧血症等肺部感染症状得到了控制,相继出现的真菌感染也逐步好转。结论:临床药师立足临床,以患者为中心,协助医师优化治疗方案,

  16. 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


    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.

  17. 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


    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

  18. 2010-2012年我院2种非发酵菌耐药变迁及抗菌素应用相关性分析%Antimicrobial resistance of two non-fermenting bacteria and correlation with antibiotic consumption from 2010 to 2012 in our hospital

    Institute of Scientific and Technical Information of China (English)

    董凌云; 吴巧珍; 吴文英; 张利芳


    rise.Cefoperazone sulbactam had the lowest resistance rate.The resistance rates of levofloxacin,cefepime,piperacillin-tazobactam and imipenem/cilastatin had decreased in the past two years.Correlation analysis showed that the AUD of aztreonam,levofloxacin and imipenem/cilastatin was positively correlated with the resistance rate of Pseudomonas aeruginosa (r =1.000,0.998,0.998,respectively,all P <0.05).The AUD of ceftazidime and piperacillin-tazobactam was positively correlated with the resistance rate of Acinetobacter banmannii (r =0.997,0.999,respectively,all P < 0.05).Conclusions The change of antimicrobial resistance rate of two non-fermenting bacteria has a correlation with AUD.Strengthening the clinical antibiotics application management,monitoring the drug resistance of bacteria,and giving interventions,would contribute to decrease the resistance rate of bacteria.

  19. 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


    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

  20. 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


    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

  1. EICU呼吸机相关性肺炎病原菌分布及耐药性分析%Distribution and drug resistance of pathogens causing ventilator-associated pneumonia in EICU

    Institute of Scientific and Technical Information of China (English)

    陈先汉; 钟惠萍; 陈旭侠; 宗建平


    OBJECTIVE To understand the distribution of pathogens causing ventilator-associated pneumonia (VAP) in emergency intensive care unit (EICU) and the condition of drug resistance so as to provide reference for the clinical prevention. METHODS The species of pathogenic bacteria and antimicrobial resistance of the 60 VAP patients were reviewed retrospectively during 2007- 2011 in EICU. RESULTS A total of 103 strains of pathogens were isolated, including 84 (81. 6%) strains of gram-negative bacilli, 11 (10. 7%) strains of gram-positive bacteria, and 8 (7. 7%) strains of fungi. The top 3 gram-negative bacilli were Pseudomonas aeruginosa, Acinetobacter baumannii ,and Klebsiella pneumonia. Staphylococcus aureus was the main species of gram-positive bacteria, and Candida albicans was the only species of fungi. The gram-negative bacteria were highly resistant to various common antibiotics, P. eruginosa and A. baumannii were sensitive to cefoperazone/sulbactam relatively, K. pneumonia and Escherichia coli were sensitive to imipenem/cilastatin relatively; the gram-postive cocci were highly sensitive to vancomycin; the fungi were highly sensitive to amphotericin. All the isolated pathogens were multidrug-resistant. CONCLUSION The gram-negative bacteria are the main pathogens causing VAP in EICU and are multidrug-resistant. It is necessary to put emphasis on the reasonable use of antibiotics and the prevention of the risk factors.%目的 了解急诊重症监护病房(EICU)呼吸机相关性肺炎(VAP)病原菌分布特征及耐药性,为临床防治提供参考.方法 回顾性调查医院2007-2011年EICU60例VAP患者感染病原菌的种类及耐药性.结果 共检出103株病原菌,其中革兰阴性菌84株占81.6%,居前3位的依次为铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌;革兰阳性菌11株占10.7%,以金黄色葡萄球菌为主;真菌8株占7.7%,均为白色假丝酵母菌;革兰阴性菌对各种常用抗菌药物耐药严重,铜

  2. 400例应用特殊使用抗菌药物的住院患者常见细菌分布及耐药性分析%Distribution and drug resistance of the common pathogenic bacteria in 400 cases of inpatients with special use of antibiotics

    Institute of Scientific and Technical Information of China (English)

    赵泉; 张向萍; 温清; 李泮海; 栾瑞玲; 霍雪臣


    OBJECTIVE To acquaint the distribution of pathogenic bacteria and drug-resistance in patients with special use of antibiotics in our hospital; to provide an effective guidance for reasonable use of antibiotics and strengthening the clinical management of the special use of antibiotics. METHODS 400 cases of inpatients with special use of antibiotics in our hospital from Jul. 2011 to Dec. 2011 were collected randomly, and the results of bacterial culture and antibiotic sensitivity tests were analyzed retrospectively. RESULTS The aetiology detection rate was 93% , positive rate was 35. 7% ; the top 5 pathogenic bacteria were Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter Baumannii, Pseudomonas aeruginosa and Escherichia coli. A- mong them, methicillin-resistant Staphylococcus aureus (MRSA) accounted for 84. 6% , Klebsiella pneumoniae and Eschenchia coli producing superspectrumβ accounted for 56. 7% and 66. 7%, respectively. The antibiotic resistance rate of Acin-etobacter baumannii to carbapenems was over 50%, and the sensitive rate of Pseudomonas aeruginosa to imipenem cilastatin and meropenem were both 68. 4%. CONCLUSION Bacterial strains detected from inpatients with special use of antibiotics in our hospital were the common pathogens of nosocomial infection with serious antibiotic resistance, which should be paid more attention.%目的:了解我院应用特殊使用抗菌药物的住院患者细菌分布特点及耐药情况,指导临床合理选用特殊使用抗菌药物,加强对该类药物临床应用的管理.方法:随机抽取我院2011年7月~12月应用特殊使用抗菌药物的400例住院患者,对其细菌培养+药敏结果进行回顾性调查并加以分析.结果:治疗用药病原学送检率达93%,阳性率为35.7%;排名前5位分别为金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希氏和铜绿假单胞菌.其中耐甲氧西林金黄色葡萄球菌(MRSA)占84.6%,肺炎克雷伯

  3. Analysis of Bacterial Resistance in 200 Inpatients Treated with Antibiotics for Special Use%200例应用特殊使用类抗菌药物的住院患者的细菌耐药情况分析

    Institute of Scientific and Technical Information of China (English)

    赵泉; 王颖琳; 刘信宇; 张华芸; 张向萍


    OBJECTIVE: To investigate pathogens distribution and the present status of drug-resistance in the inpatients with antibiotics for special use from our hospital. METHODS: 200 inpatients with antibiotics for special use were collected from our hospital randomly during Jul.—Dec. in 2011. Bacterial culture and the antibiotic sensitivity tests were analyzed by a retrospective investigation. RESULTS: The aetiology detection rate was 95.0%, and the positive rate was 52.6% ; Staphyhcoccus aureus, Klebsiella peumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Escherichia coli were the top 5 causes. Among them, methicil-lin-resistant Staphyhcoccus aureus (MRSA) accounted for 80.6% ; K. peumoniae and Escherichia coli producing extended-spectrum (ESBLs) accounted for 54.5% and 60.0% , respectively; the resistance rate of A. baumannii to carbapenems was beyond 50% , and the sensitive rates of P. aeruginosa to imipenem/cilastatin and meropenem were 66.7%. CONCLUSION: Bacterial strains of inpatients with antibiotics for special use in our hospital are the common pathogens of nosocomial infection. The severe situation of drug resistance should be paid enough attention.%目的:了解我院应用特殊使用类抗菌药物的住院患者的细菌分布特点及耐药情况.方法:抽取我院2011年7-12月应用特殊使用类抗菌药物的200例住院患者,对其细菌培养及药敏试验结果进行回顾性分析.结果:治疗用药病原学送检率达95.0%,阳性率为52.6%;检出菌株数排名前5位的分别为金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌.其中耐甲氧西林金黄色葡萄球菌(MRSA)占80.6%,肺炎克雷伯菌及大肠埃希菌产超广谱β-内酰胺酶(ESBLs)率分别为54.5%和60.0%,鲍曼不动杆菌对碳青霉烯类抗菌药物的耐药率>50%,铜绿假单胞菌对亚胺培南/西司他丁和美罗培南的敏感率均为66.7%.结论:我院应用特殊使用类

  4. [Comparison of the modified Hodge test and the Carba NP test for detection of carbapenemases in Enterobacteriaceae isolates]. (United States)

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


    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

  5. 产ESBL大肠埃希菌和肺炎克雷伯菌的临床分布及耐药性特点%Clinical distribution of ESBL-producing E.coli and K.pneumoniae and analysis of drug resistance

    Institute of Scientific and Technical Information of China (English)

    张永恩; 陈茜; 牛肖梅; 彭丽娥


    Objective To investigate the drag resistance of extended-spectrum β-lactamase-producing E. coli (ESBL-EC) and ESBL-producing K. pneumoniae (ESBL-KP) in hospital. Methods The data of the resistance of ESBL-EC and ESBL-KP to commonly used antibiotics from clinical microbiology laboratory in the hospital from 2010 to 2011were analyzed. Results ESBL-EC and ESBL-KP were all totally sensitive to imipenem and cilastatin sodium, and highly sensitive to cefoxitin and amikacin (>80%). ESBL-EC and ESBL-KP showed descending drug resistance to ceftazidime and cefepime, but they were totally resistant to most/Mactam antibiotics (ampicillin, piperacil-lin, ticarcillin, cefazolin, ceftriaxone, cefotaxime, cefoperazone). ESBL-EC were highly sensitive to β-lactamase inhibitors (>92%), but ESBL-KP were less sensitive to /J-lactamase inhibitors (50%~89% to cefoperazone/sulbactam and 67%~92% to piperacillin/tazobactam). The drug resistance rates of ESBL-EC to levofloxacin were 57%~81% and that of ESBL-KP to levofloxacin were 16%~41%. Conclusion Choosing antibiotics according to the susceptibility test is one of the principles to increase the success rate of anti-infection treatment and reduce drug resistance. Carbapenems are the premium choice for ESBL-EC and ESBL-KP. β-lactamase inhibitors, cefoxitin and amikacin are also good choices.%目的 了解某综合医院产ESBL大肠埃希菌(ESBL-EC)和肺炎克雷伯菌(ESBL-KP)耐药性的变迁.方法 分析该医院2010-2011年临床微生物室上报医院感染控制科ESBL-EC及ESBL-KP对常用抗菌药物的耐药性变迁数据.结果 碳青霉烯类亚胺培南-西司他丁对ESBL-EC及ESBL-KP保持完全敏感,头孢西丁及阿米卡星对ESBL-EC及ESBL-KP均有良好的敏感性(>80%),头孢他啶及头孢吡肟耐药率逐年下降,但ESBL-EC及ESBL-KP对大多数β-内酰胺类药(氨苄西林,哌拉西林,替卡西林,头孢唑林,头孢曲松,头孢噻肟,头孢哌酮)完全耐药.含酶抑制剂对ESBL-EC

  6. 血培养常见病原菌分布及药敏分析%Distribution of common pathogens isolated from blood culture and drug susceptibility

    Institute of Scientific and Technical Information of China (English)

    谭云昌; 曾正莲


    OBJECTIVE To understand the distribution and drug resistance of common pathogens of positive blood culture from outpatients and inpatients? To provide clinical reference rational use of antimicrobial drugs. METHODS The French company bioMerieux BacT/Alert240 automated blood culture system was used for culture tests. The species were identified by the French Merieux API identification system, and susceptibility testing was performed by using KB method. RESULTS Of 2423 cases of censorship specimens, 260 strains of pathogens were detected, blood culture positive rate was 10. 73%, Gram-positive cocci accounted for 53.46%, Gram-negative bacilli accounted for 42. 69%, fungi accounted for 3. 85%, the highest detection rate of bacteria was coagulase-negative staphylococcus, Escherichia coli and Klebsiella pneumoniae ; Gram-positive bacteria were highly sensitive to vancomycin, teicoplanin lalin, and amikacin. Escherichia coli and Klebsiella pneumoniae were 100. 00 sensitive to imipenem/cilastatin and meropenem. CONCLUSION The drug resistance rates of the pathogens isolated from blood culture are high, to keep abreast of the results of clinical blood culture targeted antimicrobial therapy is of great significance to improve the cure rate.%目的 了解医院门诊与住院患者血培养阳性标本检出的病原菌分布及耐药性,为临床合理应用抗菌药物提供参考.方法 采用法国生物梅里埃公司的BacT/Alert240全自动血培养仪进行培养检测,阳性标本转种后用法国生物梅里埃公司API鉴定系统进行鉴定,然后用K-B法进行药敏测试.结果 送检的2423份标本中,血培养阳性率10.73%,检出病原菌260株,其中革兰阳性球菌占53.46%,革兰阴性杆菌占42.69%,真菌占3.85%,检出率最高的病原菌为凝固酶阴性葡萄球菌、大肠埃希菌和肺炎克雷伯菌;主要革兰阳性菌对万古霉素、替考拉林,阿米卡星呈高度敏感,大肠埃希菌和肺炎克雷伯菌对亚胺培

  7. 某院碳青霉烯类抗菌药物的临床应用调查与用药合理性评估%Clinical Utilization Investigation and Rationality Analysis of Carbapenems in A Hospital

    Institute of Scientific and Technical Information of China (English)

    张楠; 陆红柳; 杨慧鹃; 李桃园; 夏文斌


    OBJECTIVE:To explore the clinical utilization of carbapenems in a hospital,analyze and evaluate its medication rationality. METHODS:All the 508 medical records of inpatients treated with carbapenems from Jul. 2012 to Jun. 2015 were retro-spectively investigated,the utilization and pathogenic examination of carbapenems were evaluated;by setting the carbapenems eval-uating standard,the medication rationality of carbapenems was evaluated and inappropriate cases were classified and analyzed statis-tically. RESULTS:The drug utilization indexed (DUI) of Imipenem and cilastatin sodium for injection and Meropenem for injec-tion were 0.80 and 1.32,respectively;the total rate of microbial inspection was 95.9%;according to the drug sensitive test result, the rate of drug selection was 62.8%;there were 54 cases(10.6%)of irrational use records,in which,irrational dosage(42.6%) and improper drug selection (31.4%) were the major problems. CONCLUSIONS:There are some inappropriate medication prob-lems in carbapenems utilization in the hospital. Developing the carbapenems utilization evaluation is helpful to discover typical medi-cation problems,which can provide reference for intervention and continuous improvement of rational drug use.%目的:了解某院碳青霉烯类抗菌药物的临床应用情况,分析和评价其用药合理性。方法:回顾性调查该院2012年7月-2015年6月期间使用碳青霉烯类抗菌药物的全部住院患者508例,对药品使用及病原学检查情况进行分析评价,并根据制定的碳青霉烯类抗菌药物临床应用合理性评估标准进行用药合理性评估,对不适宜问题进行分类整理。结果:该院注射用亚胺培南西司他丁钠及注射用美罗培南的药物利用指数分别为0.80和1.32;总的微生物送检率为95.9%;按药敏试验结果选择用药率为62.8%;用药不适宜病历共54份,占全部抽取病历的10.6%,其中用法用量不适宜(42.6

  8. Pyopneumothorax caused by Salmonella choleraesuis: a case report and review of the literature%猪霍乱沙门菌致脓气胸一例并文献复习

    Institute of Scientific and Technical Information of China (English)

    江立斌; 朱奕豪; 姚宇锋; 徐峻; 王真


    choleraesuis. Methods One case of pyopneumothorax caused by Salnonella choleraesuis diagnosed and treated in our hospital in 2010 was reported and the related literatures were reviewed.As of May 2011,the literature review was carried out with "Salmonella choleraesuis" and "thoracic empyema" as the search terms in Wanfang Med Online and Pubmed Database. Results A 43 year-old Chinese woman presenting with fever and chest pain for 4 days was admitted to our hospital.ACT scan of the chest revealed a massive shadow with mixed density in the right hemithorax,from the top of thorax to diaphragmatic surface,and there was air inside or surrounding the mass irregularly but without an air-fluid level.Blood culture and bronchial secretion culture by bronchoscope both showed some serotypes of Salmonella strains. At first intravenous antibiotic therapy (piperacillin-tazobactam,ceftazidime,and then imipenem-cilastatin) was ineffective.Open chest surgery was performed,and chest tube placed.Salmonella choleraesuis was isolated from the drained pleural fluid.Chest tube drainage remained in place for more than 6 weeks,and with prolonged antibiotic therapy,which contributed to a good outcome. Literature review found no related reports in Wanfang Med Online,while 3 literatures were found in Pubmed,including 2 of case report and 1 of retrospective study. Among 973 patients with empyema thoracis in the retrospective study,12 of these patients,including 9 men and 3 women,were infected with Salmonella species. The median age was 49 years,and 10 patients were immunocompromised,including malignancy,liver cirrhosis,and diabetes mellitus. Seven patients were infected with Salmonella choleraesuis,and 4 (57%) of them died.Conclusions Pyopneumothorax or thoracic empyema is a rare complication of Salmonella choleraesuis infection. Higher rates of death were noted in this disease. Salmonella choleraesuis infection is even more serious in adult patients with underlying diseases. Early diagnosis

  9. 鲍曼不动杆菌临床分布及耐药表型检测分析%Clinical distribution of Acinetobacter baumannii and detection of enzyme-producting resistant phenotype

    Institute of Scientific and Technical Information of China (English)

    李文波; 贾晓冬; 张文杰; 钱兴玲; 王沛; 陈丹


    -,second-and third-generation cephalosporin as well as aztreonam (resistance rate 71.O%-100%).Its resistance rate was 12.6%to amikacin,25.4%to cefepime,40.8% to cefoperazone/sulbactam,43.6% to ciprofloxacin;its resistance rate was very low to imipenem/cilastatin,polymycin B and rifapin.Totally 38 strains were enzyme-producting ones,33 strains were enzyme non-producting ones,and enzyme-producting rate was 53.5%.In enzyme-producting strains,9 strains produced single ESBL(23.7%),26 strains produced AMPC enzyme(68.4%),11strains produced SSBL enzyme (28.9%),and 3 strains produced MBL enzyme(7.89%).Conclusion Acinetobacter baumannii shows multi-resistance,and enzyme-producing strains mainly produce AMPC enzyme and ESgLs.

  10. 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


    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

  11. Acute renal injury and tubular acidosis caused by intravenous voriconazole%静脉应用伏立康唑致急性肾损伤及肾小管性酸中毒

    Institute of Scientific and Technical Information of China (English)

    周晓明; 陈愉; 冯学威; 赵立


    1例80岁男性患者因术后感染给予亚胺培南西司他汀钠、万古霉素、卡泊芬净、米卡芬净及美罗培南,效果不佳,后治疗改为联用美罗培南1.0 g,1次/8 h静脉滴注及伏立康唑200 mg(首日剂量400 mg,1次/12 h),1次/12 h静脉滴注.第5~9天,实验室检查示血清肌酐(SCr)154~208 μmol/L,尿素氮(BUN)24.3~35.9 mmol/L,血清胱抑素C 4.54~5.44 mg/L;血pH值7.18~7.34,氯离子122~130 mmol/L,钾离子3.4~4.1 mmol/L,标准碳酸氢盐波动于12~15 mmol/L,实际碳酸氢盐 13~14 mmol/L,阴离子间隙13~14 mmol/L.尿分析示红细胞3.8~4.8个/HP,蛋白±,pH值保持在5.5.诊断为肾小管性酸中毒、急性肾损伤.第9天,伏立康唑用法改为每晨静脉滴注200 mg,每晚鼻饲给药200 mg.调整用法后第3天患者出现高氯性酸中毒、低钾血症,第11天停用伏立康唑,美罗培南继续应用.停药2 d后,患者血清SCr及BUN水平升至最高,分别达282 μmol/L及49.4 mmol/L,随后逐渐降低,分别于停药后第25天和停药后34天降至正常,血气分析各项指标于停药后第25天基本恢复正常.%An 80-year-old male; patient was given imipenem/cilastatin, vancomycin, caspofungin, micafungin, and meropenem for post-operative infections, but these had no effect. The treatment was then switched to an IV infusion of meropenem 1. 0 g every 8 hours combined with an IV infusion of voriconazole 400 mg every 12 hours on the first day followed by 200 mg every 12 hours. On days 5-9 of treatment, the laboratory tests showed the following levels; serum creatine ( SCr ) 154-208 (xmol/L, blood urea nitrogen ( BUN ) 24.3-35.9 mmol/L, serum cystatin C 4. 54-5.44 mg/L, blood pH 7. 18-7. 34, Cl" 122-130 mmol/L, K*3.4-4. 1 mmol/L, standard bicarbonate 12-15 mmol/L, actual bicarbonate 13-14 mmol/L,anion gap 13-14 mmol/L. Urinalysis revealed the following levels; RBC connt 3. 8-4. 8 cells/HP, protein ?, and pH 5. 5. Acute renal tubular acidosis and acute renal injury were

  12. 噬菌体治疗泛耐药鲍氏不动杆菌所致脓毒症小鼠的效果%Therapeutic effect of phages on extensively drug-resistant Acinetobacter baumannii-induced sepsis in mice

    Institute of Scientific and Technical Information of China (English)

    邓柳洋; 杨子晨; 龚雅利; 黄广涛; 殷素鹏; 姜北; 彭毅志


    Objective To study the therapeutic effect of phages on extensively drug-resistant Acinetobacter baumannii-induced sepsis in mice.Methods (1) Sixty BALB/c mice were divided into blank control group,sepsis control group,antibiotics treatment group,phage treatment group,and phage control group according to the random number table,with 12 mice in each group.Mice in blank control group were intraperitoneally (the same injection position below) injected with 1 mL normal saline.Mice in sepsis control group,antibiotics treatment group,and phage treatment group were injected with 1 mL extensively drug-resistant Acinetobacter baumannii (the strain was isolated from the blood of a severely burned patient hospitalized in our unit) in the concentration of 5 × 107 colony-forming unit/mL to reproduce sepsis model.Two hours later,mice in sepsis control group,antibiotics treatment group,and phage treatment group were injected with 1 mL saline,1 mg/mL imipenem/cilastatin,and 1 × 108 plaque-forming unit (PFU)/mL phages screened based on above-mentioned Acinetobacter baumannii (the same phages below) respectively.Mice in phage control group were injected with 1 mL phages in the titer of 1 × 108 PFU/mL.The injection was performed continuously for 7 days in each living mouse,and the survival situation of mice was observed each day to calculate the survival ratio in one week.(2) Another 60 BALB/c mice were grouped and treated as in experiment (1),and the injection was performed continuously for 5 days in each living mouse.On experiment day 2,4,and 6,3 mice from each group were selected (if the number of survived mouse in any group was less than 3 at sample collecting,all the survived mice were selected),and blood was drawn to determine white blood cell count (WBC,with 3 samples at each time point in each group).On experiment day 2,blood was drawn from the mice that had their blood taken earlier for bacterial culture,and lung,liver,kidney,and spleen tissue was collected from the same