摘要:目的:了解细菌药物敏感性以指导临床合理选用抗生素。方法:采用VITEK32及GNS120药敏卡、GPS107药敏卡完成细菌的鉴定及药敏实验。结果:葡萄球菌占72.5%。青霉素对葡萄球菌敏感性几乎为0,葡萄球菌的产酶率均在95%以上。结论:临床应了解细菌对抗生素的耐药特点,掌握好适应症,科学合理选用抗生素
目的 探讨鲍曼不动杆菌感染的临床分布及药敏情况。 方法 对2009年1月－2011年12月的微生物送检标本进行统计分析，鲍曼不动杆菌2009年培养出19株，2010年29株（多重耐药菌株1株），2011年35株（多重耐药菌株2株），并对其分布的标本类型、科室及耐药情况进行分析。 结果 鲍曼不动杆菌在痰中检出率最高；科室分布依次为重症监护室（ICU）、神经外科、呼吸科；该菌对亚胺培南敏感性最高，对青霉素和头孢类抗生素耐药率均在55%以上。 结论 鲍曼不动杆菌感染患者的经验性抗生素治疗应根据其地区、医院最新的院内感染病原体分布及耐药性，合理选择抗生素；病情、高龄、免疫抑制剂、机械通气、多种侵入性操作及抗生素的使用为鲍曼不动杆菌医院感染危险因素；ICU存在多重耐药鲍曼不动杆菌的感染，应加以控制。
【Abstract】ObjectiveTo establish adriamycin (ADM) resistant pancreatic cancer cell line SW1990/ADM and to investigate its drug resistance mechanism.MethodsADM-resistant pancreatic cancer cell line SW1990/ADM was obtained by culture of pancreatic cancer cell line SW1990 in vitro with intermittently increasing the concentration of ADM in the culture medium for ten months. After two months of drug free culture, its biological characteristics, drug sensitivity as well as the expression and function of multidrug resistant gene 1 (mdr1) were detected, respectively. ResultsCompared with the parental cell line, SW1990/ADM showed great changes in biological characteristics and developed a cross resistance to various chemotherapy drugs. The drug resistance indexes of cell line SW1990/ADM to ADM, mitomycin, fluorouracil and gemcitabine were 49.60, 7.25, 3.80 and 1.25, respectively. The level of mdr1 mRNA expression in cell line SW1990/ADM was much higher than that of the parental cell line（P＜0.01). ConclusionWe have established adriamycin resistant pancreatic cancer cell line SW1990/ADM with multidrug resistance phenotype, its multidrug resistance is positively relevant to the expression of mdr1.
目的 了解2011年1月－2012年12月临床分离病原菌的分布和耐药情况，为指导临床合理用药和医院感染的控制提供依据。 方法 采用法国梅里埃API半自动微生物鉴定分析系统进行细菌鉴定和药物敏感试验，对所得数据用WHONET 5.4软件完成统计分析。 结果 送检的3 073份临床标本中共分离出病原菌696株，阳性率22.1%。其中，G+菌占31.3%，G?菌占64.1%，主要为金黄色葡萄球菌（25.6%）、大肠埃希菌（17.8%）、肺炎克雷伯菌（16.4%）、铜绿假单胞菌（11.5%）。在葡萄球菌中，青霉素、红霉素的耐药率最高，分别是95.6%、78.5%；尚无耐万古霉素菌株。肠道杆菌中，阿莫西林的耐药率最高，为95.0%；替卡西林的耐药率为91.0%；头孢噻吩的耐药率为72.0%；尚无耐亚胺培南菌株。多重耐药的大肠埃希菌、肺炎克雷伯菌对亚胺培南具有良好的敏感性。 结论 该院临床分离的致病菌耐药情况不严重，对病原菌的分布和耐药情况的研究较好地指导了临床合理用药和控制了医院感染。
In recent years, with the wide application of carbapenems, the resistance of Enterobacterium to carbapenems has become increasingly high, leading to a large number of carbapenem-resistant Klebsiella pneumoniae (CRKP). These bacteria are often resistant to many different types of antibacterial drugs, including carbapenems, which leads to clinical treatment failure and seriously threatens the life safety of patients. Currently, these bacteria have become an independent risk factor for patients’ death. This article reviews the drug resistance, infection status and influencing factors, and medication therapy of CRKP, in order to facilitate the clinical diagnosis, treatment, and disease process control of CRKP infection, and provide reference for curbing bacterial drug resistance.
Objective To investigate the characteristics of the pathogens causing bloodstream infection after general surgery in infant and young children patients, and to provide the references for disease treatment and nosocomial infection control. Methods The clinical and laboratory examination data after general surgery in infant and young children patients, who were admitted to our hospital from January 2012 to March 2017, were retrospectively collected. The pathogens and drug resistance were analyzed by SPSS 18.0 software. Results In this study, 109 cases were included, and 117 strains of the pathogens were isolated, including 53 isolates (45.3%) of gram negative bacteria, 41 isolates (35.0%) of gram positive bacteria, and 23 isolates (19.7%) of fungi. Escherichia coli (16/117, 13.7%), Enterococcus faecium (13/117, 11.1%), Candida parapsilosis (12/117, 10.3%), Klebsiella pneumoniae (9/117, 7.7%) and Enterococcus faecalis (8/117, 6.8%) were the top 5 species. Strains producing extended-spectrum beta-lactamase accounted for 87.5% of E. coli (14/16) and 44.4% (4/9) of K. pneumoniae isolates. Both E. faecium and E. faecalis were susceptible to vancomycin. C. parapsilosis showed the susceptibility to the antifungal agents. Conclusion Gram negative bacteria are predominant pathogens causing bloodstream infection after general surgery in infant and young children patients, and infection caused by resistant isolates should be prevented and controlled.
Objective To investigate the clinical characteristics and drug sensitivity of patients with Gram-negative bacilli infection, and evaluate the risk factors related to infection, so as to provide a theoretical basis for clinical prevention and treatment of hospital-acquired infection. Methods The complete medical records of 181 patients with Gram-negative bacilli infection in the Department of Respiratory and Critical Care Medicine of Beijing Anzhen Hospital from January 2018 to September 2021 were retrospectively collected. They were divided into a Carbapenem-resistant Gram-negative bacillus (CR-GNB) group and a Carbapenem-sensitive Gram-negative bacillus (CS-GNB) group according to their different sensitivities to carbapenems. Results A total of 238 strains of Gram-negative bacilli were detected, including 108 strains of CR-GNB and 130 strains of CS-GNB. Acinetobacter baumannii was the most common, followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli and Serratia marcescens. Univariate analysis showed that the risk factors of CR-GNB infection were heart disease and cerebrovascular disease, receiving invasive mechanical ventilation, deep venous catheterization and indwelling catheter, hypoproteinemia, renal insufficiency, pre-infection exposure to tigecycline, carbapenems, vancomycin, polymyxin, and combined use of antibiotics. Hypoproteinemia and deep venous catheterization were independent risk factors for CR-GNB infection. The resistance rates of CR-GNB to cefepime, ceftazidime, levofloxacin and ciprofloxacin were 88.0%, 88.0%, 86.1% and 75.0%, respectively. The resistance rate to cefuroxime, amika, ceftriaxone, gentamicin and cotrimoxazole was low, and the resistance rate to ceftazidime avibactam was the lowest (3.7%). Except tetracycline, tigecycline, cefuroxime, polymyxin, cefazolin and ampicillin, the drug resistance rates of CR-GNB group to other antibacterial drugs were higher than those of CS-GNB group, and the differences were statistically significant (P<0.05). The all-cause mortality in CR-GNB group (42.4%) was significantly higher than that in CS-GNB group (6.3%), and the difference was statistically significant (P<0.05). Conclusions The disease burden caused by CR-GNB infection is becoming heavier and heavier, which has a serious impact on the prognosis of hospitalized patients. The increase of antibiotic resistance leads to poor efficacy of antimicrobial therapy. Therefore, early identification of high-risk groups of infection and reasonable and prudent application of antimicrobial therapy can achieve the purpose of reducing the mortality of infection and improving the prognosis of hospitalized patients.
【摘要】 目的 分析成都市近年一线抗结核药的耐药状况，为耐药结核病预防控制提供依据。 方法 对成都市2007年1月-2009年12月就诊的结核患者，临床分离株培养鉴定为结核分枝杆菌的菌株采用绝对浓度法进行一线抗结核药:链霉素（SM）、异烟肼（INH）、利福平（RF）、乙胺丁醇（EMB）耐药性检测，分析结核分枝杆菌的耐药情况。 结果 1 235例结核患者中，总耐药率和总耐多药率分别为28.83%、14.01%，初始耐药率和获得性耐药率分别为12.82%、61.27%。近3年耐多药率有下降趋势，但获得性耐药率呈逐年上升趋势。 结论 成都市结核耐药状况仍然比较严重，进一步加强耐药结核的监测和控制非常重要。【Abstract】 Objective To analyze the drug resistant treating mycobacterium tuberculosis (MTB) in Chengdu in recent three years, and to provide the evidence for tuberculosis controlling. Methods The patients with MTB diagnosed from January 2007 to December 2009 in Chengdu were enrolled. Absolute concentration method was used to test the drug-resistance of streptomycin (SM), isoniazide (INH), rifampicin (RFP), and ethambutol (EMB). Results The total rate of drug resistance and multi-drug resistance were 28.83% and 14.01% respectively. The rates of initial drug resistance and the acquired drug resistance were 12.88% and 61.27% respectively. Multi-drug resistance rate showed a downward trend, but the rate of acquired drug resistance increased gradually. Conclusion The situation of drug resistance of tuberculosis in Chengdu is still serious, and it′s very important to further monitor and control the drug resistance treating tuberculosis.
ObjectiveTo systematically review the health economic evaluation studies in which externalities of antibacterial drug uses were identified.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect health economic evaluation studies in which externalities of antibacterial drug uses were identified from inception to December 31st, 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Descriptive analysis was then performed.ResultsA total of 14 studies were included. Negative externalities and their impacts on costs and/or effectiveness were examined in 13 literature, and positive externalities in terms of an improvement in disease control were included in only one study. No study was found in which both negative and positive externalities were included. The methods used to quantify negative externalities included: only costs associated with drug resistance per prescription or per unit were calculated; both costs and health impacts associated with the second/third line treatments followed a treatment failure (due to drug resistance) were calculated using a decision tree. In one study in which positive externalities were measured, both health gain and cost reduction from an improvement in disease control (as a benefit of antibacterial drug uses) were calculated by constructing a dynamic model at the population level.ConclusionsWe propose that both the positive and negative externalities should be included in health economic evaluation. This can be achieved by measuring the relevant costs and health impacts in a broader perspective, using a disease-transmission dynamic model. In addition, to achieve an improved health utility measurement, disability-adjusted-life years rather than quality-adjusted-life years should be encouraged for use. Finally, both costs and effectiveness should be discounted.