某三甲医院抗菌药物临床规范化应用的现状分析

??????? 目的 分析和调查抗菌药物临床应用的情况,研究规范化应用抗菌药物在临床使用的效果。方法 根据计算机管理系统提供的抗菌药物用药信息,对某三甲综合医院抗菌药物临床应用专项整治前、后医院门诊患者抗菌药物处方比例及住院患者抗菌药物使用率、使用强度、I类手术预防用药率等指标进行调查及分析。结果 门诊患者抗菌药物处方比例降低至6.2﹪;住院患者抗菌药物使用率降低至49.7﹪;抗菌药物使用强度降低至42.48;I类手术预防用药率降低至32.1﹪。结论 抗菌药物临床规范化应用,促进医院抗菌药物临床合理使用的效果显著。     

我国抗菌药物临床应用专项整治情况调查与分析

目的 了解抗菌药物临床应用专项整治以来,我国医院的抗菌药物使用情况。方法 2011年和2012年分别选取了241所医院进行调查。运用系统随机抽样方法抽取5—9月期间医院的门诊处方和住院病历进行分析。抗菌药物使用强度（每百人天DDDs值）、门诊患者抗菌药物处方比例、综合I类切口手术预防使用抗菌药物比例等为主要分析指标。结果 从2011年至2012年,被调查医院的平均抗菌药物使用强度和综合I类切口手术预防使用抗菌药物比例下降有统计学意义;门诊患者抗菌药物处方使用率整体变化不显著,联合用药情况仍普遍存在。且医院的规模与抗菌药物使用存在显著关联性。结论 仍需通过进一步加强抗生素耐药性监测以及对医务工作者和公众抗菌药物使用培训等管理措施,从本质上改善抗菌药物使用情况。     

多部门联动推行抗菌药物合理应用的精细化管控

探讨抗菌药物临床合理应用中存在的问题,列举了多部门联动实行抗菌药物精细化管控的具体做法和取得的成效,进而提出多部门联动精细化管控是实现抗菌药物临床合理应用的有效策略。     

医院抗菌药物临床应用专项整治持续效果分析

?????? 目的 分析抗菌药物临床应用专项整治对医院住院患者抗菌药物临床用药的持续效果。方法 采用回顾性调查方法,以开展抗菌药物临床应用专项整治前后的2010—2012为研究时间,对医院住院患者抗菌药物使用率、使用强度、用药金额及清洁手术预防用药率、清洁手术术后24小时停药率进行调查及分析。结果 2010—2012年,抗菌药物使用率分别为70.0%、64.4%和49.3%,抗菌药物使用强度分别为73.3、58.2和37.9,抗菌药物用药金额占药费总额比例分别为21.9%、16.2%和11.1%;清洁手术预防用抗菌药物比率分别为95.5%、91.0%和50.3%,清洁手术术后24小时停药率分别为11.0%、27.2%和42.0%。结论 抗菌药物临床应用专项整治对抗菌药物的合理使用起到了积极的促进作用。     

创伤弧菌抗菌药物药敏实验及结果分析

目的:本研究通过药敏实验对创伤弧菌进行抗菌药物敏感性分析,探讨在创伤弧菌感染中如何选择抗菌药物,提高临床治疗的效果.方法:利用ATCC标准的创伤弧菌菌株,进行了临床常用抗生素单个药敏实验和不同类型抗生素间的2种药物联合药敏实验.结果:创伤弧菌对抗革兰氏阴性菌的抗菌药物比较敏感,这些抗菌药物归属为(1)四环素类;(2)第三代头孢类;(3)第三、四代氟喹诺酮类;(4)新一代氧基糖甙类.四环素和头孢噻肟之间、氨苄西林和左旋氧氟沙星之间、复方新诺明和四环素之间等存在明显的协同关系,左旋氧氟沙星与头孢噻肟及四环素,头孢噻肟与庆大霉素及红霉素均不存在协同作用.结论:临床上主要应用抗菌药物对创伤弧菌感染进行对症治疗,本研究为临床中抗菌药物治疗创伤弧菌感染提供了实验依据,可作为临床用药和提高临床治疗效果的重要参考.     

对围手术期抗菌药物应用进展及干预管理的探讨

抗菌药物合理应用是医院感染管理的一个重要方面。为减少医院感染的发生,降低药品不合理支出费用及住院天数,减少耐药菌株的产生和不良反应,必须加强对抗菌药物合理应用的管理。从手术部位感染的病原体种类、来源、围手术期预防使用抗菌药物的适应症、给药的时机、使用的疗程、选择的种类、预防手术部位感染的预防措施及围术期抗菌药物的干预管理等几方面的进展作一概述。     

我院2009-2011年门诊用抗菌药物分析

目的:分析我院门诊处方中抗菌药物的应用情况,为临床合理使用抗菌药物提供依据。方法:利用我院HIS系统,得到2009年1月-2011年12月门诊药物的消耗报表。采用用药频度分析(DDDs)及消耗金额排序比较的方法做统计分析。结果:2009年、2010年和2011年消耗的抗菌药物分别占门诊用药金额为17.95%、13.94%和7.99%;用药频度和消耗金额较大的有头孢菌素类、大环内酯类、青霉素类和喹诺酮类,而且排序每年有所变化。从抗菌药物DDDs排序来看,排序在前面的都是口服药,医生按照抗菌药物使用原则给轻症感染的患者首选口服药,而对于重症感染则采取序贯疗法。结论:我院门诊抗菌药物使用结构基本合理。     

行政干预对Ⅰ类切口围术期预防性使用抗菌药物的影响

目的:探讨行政干预对I类切口围术期预防性使用抗菌药物的影响。方法:2011年4月～6月对全院手术科室进行行政干预,具体做法:卫生行政部门与医院一把手、医院与手术科室主任、科室主任与科室执业医生分别签订目标责任状;医院配合全国抗菌药物临床应用专项整治活动方案进行全员培训,并对医师进行抗菌药物临床应用培训并考核合格后,授予其相应级别的抗菌药物处方权,明确各级医师使用抗菌药物的处方权限;由医务科牵头与院感染科、药剂科、质控科联合对I类切口手术患者预防使用抗菌药物情况进行检查,定期实施目标奖罚,责任到科室主任和临床医生。然后抽取我院2010年7月～12月(行政干预前)和2011年7月～12月(行政干预后)I类切口手术病历各210份,参考《抗菌药物临床应用指导原则》、卫办医政发[2009]38号通知对420例I类切口手术患者预防使用抗菌药物情况进行回顾性分析。结果:行政干预前(2010年7月～12月)I类切口围手术期预防性抗菌药物的使用率达83.81%(176/210),术后抗菌药物使用时间在2～7天者占69.52%,大于7天者占6.67%;行政干预后(2011年7月～12月)210例患者预防使用抗菌药物使用率为30%(63/210),显著低于未使用行政干预的Ⅰ类切口术患者(P<0.05),围术期术后抗菌药物使用时间在2～7天者占16.67%,没有1例患者用药超过7天,抗菌药物的使用时间较未使用行政干预的Ⅰ类切口术患者显著缩短(P<0.05)。结论:有效的行政干预可以强化临床医生合理应用抗菌药物的意识,提高合理用药的水平,明显降低I类切口预防性抗菌药物的使用率,缩短抗菌药物的使用疗程。     

浅谈抗菌药物的合理使用

在目前的形势下,抗菌药物的应用最为广泛。随着医药科学和制药工业的迅猛发展,新的抗菌药物的种类、品种、剂型已不断用于临床,抗菌谱也越来越广,使得细菌性疾病可以比较容易得到控制,但是,医生在使用和选用抗菌药时遇到的问题随之增多,抗菌药物的长期大量应用,特别是不注意合理应用、误用、滥用、等现象,不仅造成大量的浪费,以及达不到良好的治疗效果,更重要的是导致细菌耐药的产生及不良反应,而细菌耐药性又直接导致了用药剂量的增大,甚至更新换代。因此必须合理使用抗菌药物,防止滥用抗菌药物,或用昂贵的抗菌药,以杜绝、减少药源性疾病,做到有的放矢合理用药。     

医院计算机网络在抗菌药物使用管理中的应用

利用医院计算机网络管理抗菌药物使用,提高抗菌药物使用的合理性。经统计学检验,说明计算机网络在抗菌药物管理中的应用是有效的。它能准确、高效、有效地协助管理部门做好抗菌药物合理使用的管理工作,协助临床医生规范、合理地使用抗菌药物。     

Quantitative assessment of peptide-lipid interactions.: Ubiquitous fluorescence methodologies

Peptide-membrane interactions have been gaining increased relevance, mainly in biomedical investigation, as the potential of the natural, nature-based and synthetic peptides as new drugs or drug candidates also expands. These peptides must face the cell membrane when they interfere with or participate in intracellular processes. Additionally, several peptide drugs and drug leads actions occur at the membrane level (e.g., antimicrobial peptides, cell-penetrating peptides and enveloped viruses membrane fusion inhibitors). Here we explore fluorescence spectroscopy methods that can be used to monitor such interactions. Two main approaches are considered, centered either on the peptide or on the membrane. On the first, we consider mainly the methodologies based on the intrinsic fluorescence of the aminoacid residues tryptophan and tyrosine. Regarding membrane-centric approaches, we review methods based on lipophilic probes sensitive to membrane potentials. The use of fluorescence constitutes a simple and sensitive method to measure these events. Unraveling the molecular mechanisms that govern these interactions can unlock the key to understand specific biological processes involving natural peptides or to optimize the action of a peptide drug.     

Antimicrobial peptides effectively kill a broad spectrum of <Emphasis Type="Italic">Listeria monocytogenes</Emphasis> and <Emphasis Type="Italic">Staphylococcus aureus</Emphasis> strains independently of origin,sub-type,or virulence factor expression

Background  

Host defense peptides (HDPs), or antimicrobial peptides (AMPs), are important components of the innate immune system that bacterial pathogens must overcome to establish an infection and HDPs have been suggested as novel antimicrobial therapeutics in treatment of infectious diseases. Hence it is important to determine the natural variation in susceptibility to HDPs to ensure a successful use in clinical treatment regimes.     

The antimicrobial potential of a new derivative of cathelicidin from <Emphasis Type="Italic">Bungarus fasciatus</Emphasis> against methicillin-resistant <Emphasis Type="Italic">Staphylococcus aureus</Emphasis>

Cathelicidins are a family of antimicrobial peptides which exhibit broad antimicrobial activities against antibiotic-resistant bacteria. Considering the progressive antibiotic resistance, cathelicidin is a candidate for use as an alternative approach to treat and overcome the challenge of antimicrobial resistance. Cathelicidin-BF (Cath-BF) is a short antimicrobial peptide, which was originally extracted from the venom of Bungarus fasciatus. Recent studies have reported that Cath-BF and some related derivatives exert strong antimicrobial and weak hemolytic properties. This study investigates the bactericidal and cytotoxic effects of Cath-BF and its analogs (Cath-A and Cath-B). Cath-A and Cath-B were designed to increase their net positive charge, to have more activity against methicillin resistant S. aureus (MRSA). The results of this study show that Cath-A, with a +17-net charge, has the most noteworthy antimicrobial activity against MRSA strains, with minimum inhibitory concentration (MIC) ranging between 32–128 μg/ml. The bacterial kinetic analysis by 1 × MIC concentration of each peptide shows that Cath-A neutralizes the clinical MRSA isolate for 60 min. The present data support the notion that increasing the positive net charge of antimicrobial peptides can increase their potential antimicrobial activity. Cath-A also displayed the weakest cytotoxicity effect against human umbilical vein endothelial and H9c2 rat cardiomyoblast cell lines. Analysis of the hemolytic activity reveals that all three peptides exhibit minor hemolytic activity against human erythrocytes at concentrations up to 250 μg/ml. Altogether, these results suggest that Cath-A and Cath-B are competent candidates as novel antimicrobial compounds against MRSA and possibly other multidrug resistant bacteria.     

细菌耐药专刊序言

抗生素是人类对抗病原微生物感染的重要"武器"。然而,抗生素的大规模使用导致细菌耐药性不断增强并广泛传播。细菌耐药不仅是医学问题,同时也是社会和经济问题,涉及公共卫生、环境污染、食品安全等诸多领域。本专刊从临床耐药与流行病学、动物及环境耐药、细菌耐药机制、抗菌药物研发和耐药防控策略等角度对细菌耐药性问题进行了较系统的综述和探讨,为全面认识细菌耐药现状、深入开展耐药机制研究并制定综合防控策略等提供参考。     

The structure of Escherichia coli cytosine deaminase

Cytosine deaminase (CD) catalyzes the deamination of cytosine, producing uracil. This enzyme is present in prokaryotes and fungi (but not multicellular eukaryotes) and is an important member of the pyrimidine salvage pathway in those organisms. The same enzyme also catalyzes the conversion of 5-fluorocytosine to 5-fluorouracil; this activity allows the formation of a cytotoxic chemotherapeutic agent from a non-cytotoxic precursor. The enzyme is of widespread interest both for antimicrobial drug design and for gene therapy applications against tumors. The structure of Escherichia coli CD has been determined in the presence and absence of a bound mechanism-based inhibitor. The enzyme forms an (αβ)₈ barrel structure with structural similarity to adenosine deaminase, a relationship that is undetectable at the sequence level, and no similarity to bacterial cytidine deaminase. The enzyme is packed into a hexameric assembly stabilized by a unique domain-swapping interaction between enzyme subunits. The active site is located in the mouth of the enzyme barrel and contains a bound iron ion that coordinates a hydroxyl nucleophile. Substrate binding involves a significant conformational change that sequesters the reaction complex from solvent.     

西藏拉萨地区常见致病菌及其耐药性分析

目的研究2009年至2011年西藏拉萨地区主要医院的常见致病菌及其耐药性情况。方法采集拉萨市临床医院细菌感染性疾病临床标本1 200份进行致病菌的分离。采用法国梅里埃-ATB菌种鉴定仪对分离的菌株鉴定到种,参照2010年CLSI推荐方法进行耐药性分析。结果对拉萨地区主要临床医院的感染者标本分离鉴定出332株临床致病菌,其中细菌304株(91.57%),真菌28株(8.43%)。病原细菌分布主要为革兰阳性球菌97株,占29.22%;革兰阴性杆菌200株,占60.24%;其他菌7株,占2.11%。凝固酶阴性葡萄球菌对苯唑西林﹑头孢曲松和环丙沙星的耐药率分别为72%﹑40%和44%。大肠埃希菌对氨苄西林﹑哌拉西林和头孢唑林耐药率分别为83%﹑53%和43%。克雷伯菌属对氨苄西林﹑头孢唑林耐药率分别为86%和58%。铜绿假单胞菌和不动杆菌对亚胺培南的耐药率分别高达20%和19%。结论拉萨地区的细菌感染及其耐药菌株分布较为广泛,该地区应加强常规临床致病菌的耐药性监测以指导临床医师合理使用抗菌药物。     

Investigation of integrons/cassettes in antimicrobial-resistant <Emphasis Type="Italic">Escherichia coli</Emphasis> isolated from food animals in China

In this study,326 Escherichia coli isolates from food animals collected during the last four decades in China were characterized using antimicrobial susceptibility testing and screening for integrons/cassettes.Minimum inhibitory concentration(MIC) testing indicated that the antimicrobial resistance of E.coli has increased since the 1970s.The findings of this study present a warning to veterinary practitioners about the excessive use of antimicrobials,and suggest the necessity for surveillance and control of...     

临床病原菌种类及耐药性监测

目的 探讨病原菌种类及其对抗菌药物的耐的耐药状况。方法 收集１９９８年１月－１９９９年１２月临床感染标本分离的病原菌并分析其种类,药敏试验采用Ｋｉｒｂｙ－Ｂａｕｅｒ纸片扩散法。结果 １１８２株病原菌,革兰氏阳性球菌６０４株（５１．１％）,革兰氏阴性杆菌５７８株（４８．９％）。病原菌以金黄一萄球菌、大肠埃希菌、表皮葡萄球菌、铜绿假单胞菌最多见。去甲万古霉素、阿米卡星、新霉素对革兰氏阳性球菌抗菌作用较     

Antimicrobial factor from <Emphasis Type="Italic">Bacillus amyloliquefaciens</Emphasis> inhibits <Emphasis Type="Italic">Paenibacillus larvae</Emphasis>, the causative agent of American foulbrood

Bacillus amyloliquefaciens LBM 5006 produces an antimicrobial factor active against Paenibacillus larvae, a major honeybee pathogen. The antagonistic effect and the mode of action of the antimicrobial factor were investigated. The antibacterial activity was produced starting at mid-logarithmic growth phase, reaching its maximum during the stationary phase. Exposure of cell suspensions of P. larvae to this antimicrobial resulted in loss of cell viability and reduction in optical density associated with cell lysis. Scanning electron microscopy showed damaged cell envelope and loss of protoplasmic material. The antimicrobial factor was stable for up to 80°C, but it was sensitive to proteinase K and trypsin. Mass spectrometry analysis indicates that the antimicrobial activity is associated with iturin-like peptides. The antimicrobial factor from B. amyloliquefaciens LBM 5006 showed a bactericidal effect against P. larvae cells and spores. This is the first report on iturin activity against P. larvae. This antimicrobial presents potential for use in the control of American foulbrood disease.