2006年南京医大一附院下呼吸道感染病原分布和耐药性分析

目的了解我院2006年痰培养阳性标本病原菌分布和耐药性规律。方法采用API鉴定系统鉴定细菌及真菌；纸片扩散法测定细菌药物敏感性，Rosco纸片法测定真菌药物敏感性；wHONET5．4软件进行统计分析。结果2006年我院痰培养阳性率为18．8％；阳性标本主要分布在老年医学科、重症监护病房、呼吸内科及急诊病房等；检出率最高的病原菌是铜绿假单胞菌，占阳性标本的26％，其次是不动杆菌（12．8％）和肺炎克雷伯菌（11．6％）；耐药性分析结果显示，葡萄球菌属未发现万古霉紊耐药株，但对其它多种抗菌药物耐药；肠杆菌科细菌对美洛培南、亚胺培南、头孢哌酮／舒巴坦和哌拉西林／三唑巴坦较敏感；非发酵菌中，铜绿假单胞菌和嗜麦芽寡养假单胞菌对大部分抗菌药物耐药，不动杆菌对美洛培南、亚胺培南和头孢哌酮／舒巴坦较敏感。结论下呼吸道感染病原菌对多种抗菌药物耐药率较高，应引起重视，合理选择抗菌药物。     

2009年呼吸内科下呼吸道感染患者病原菌分布及耐药性分析

目的了解2009年呼吸内科下呼吸道感染患者的病原菌种类分布及其耐药性。方法对呼吸内科病房下呼吸道感染住院患者痰菌培养阳性标本进行回顾性分析。结果革兰阴性杆菌占76.5%,依次为铜绿假单胞菌、不动杆菌属、大肠埃希菌、肺炎克雷伯菌,对亚胺培南、头孢哌酮/舒巴坦、阿米卡星耐药率为0.0%～40%;革兰阳性球菌占17.4%,仅对万古霉素耐药率为0;真菌占6.1%。结论呼吸内科下呼吸道感染病原菌,主要为革兰阴性杆菌,病原菌耐药现象严重,加强耐药性监测,合理应用抗菌药物十分重要。     

临床分离铜绿假单胞菌的标本、科室分布及耐药性分析

目的 分析铜绿假单胞菌的临床感染特点及其耐药性,为临床防止感染及合理用药提供依据.方法 对2009年10月至2011年6月我院门诊和住院患者的各类送检标本进行病原菌培养与鉴定,药敏试验采用K-B纸片扩散法;并对铜绿假单胞菌临床分离株标本分布及耐药性进行分析.结果 从送检标本中分离到的铜绿假单胞菌182株,痰及咽拭子标本占120株(65.9%);主要分布在重症监护病房(76株,占41.8%)、呼吸科(26株,14.3%).头孢哌酮/舒巴坦、亚胺培南的耐药率较低,其中头孢哌酮/舒巴坦耐药率最低(15.9%).结论 铜绿假单胞菌多重耐药情况严重,临床应根据近期监测结果及药敏结果合理选用抗菌药物.     

596株铜绿假单胞菌临床分布特点及耐药性分析

目的分析我院596株铜绿假单胞菌对抗菌药物的耐药情况。方法细菌鉴定采用VITEK32全自动细菌培养鉴定仪,药敏试验采用K-B纸片法。结果铜绿假单胞菌主要从痰液标本中分离,占77.7%(463/596);最多的分布病区为呼吸内科(164株)、其次为干部病房(91株)和普通外科(48株)。对阿米卡星的耐药性为84.9%、其次为碳青霉烯类(亚胺培南),耐药性79.8%、加酶抑制剂的复合药物(哌拉西林/他唑巴坦)耐药性为78.5%,对头孢哌酮/舒巴坦的耐药性位72.8%,敏感性尚可。结论院内感染的主要病原菌之一为铜绿假单胞菌,其耐药机制复杂多样,对于大多数抗菌药物耐药,所以要及时进行检测,这样才能采取措施控制感染。     

重症监护病房感染病原菌分布和耐药分析

目的分析重症监护病房(ICU)感染患者的病原菌分布及耐药性。方法收集ICU2010年1-12月各类感染标本,分离出病原菌528株,以法国生物梅里埃公司vitekII全自动细菌鉴定仪鉴定菌种,采用K-B法进行药物敏感实验,使用WHONET 5.6软件进行耐药分析。结果 528株病原菌中,革兰阴性菌80.3%,革兰阳性菌12.7%,真菌7.0%;铜绿假单胞菌位居第一(26.1%),其次是鲍曼不动杆菌24.2%,大肠埃希菌5.5%,肺炎克雷伯菌5.3%,金黄色葡萄球菌4.7%。铜绿假单孢菌和鲍曼不动杆菌的耐药率分别高于70.0%和78.0%(除头孢哌酮/舒巴坦和米诺环素),肠杆菌科细菌对头孢类的耐药率高于55.0%,对碳青霉烯类的亚胺培南和美洛培南耐药率分别为11.2%和10.1%。结论 ICU感染病原菌以革兰阴性菌为主,对多种抗菌药物耐药率高,应重视合理应用抗菌药,有效控制院内感染。     

老年慢性阻塞性肺疾病的病原菌构成及耐药性分析

目的:分析老年慢性阻塞性肺疾病(COPD)的病原菌构成及耐药性,为临床合理选用抗菌药物提供参考。方法:对156例COPD患者的痰培养和药敏试验结果进行回顾性分析。结果:革兰阴性(G-)菌125株,以铜绿假单胞菌为首;革兰阳性(G+)菌48株,以金黄色葡萄球菌为首;真菌18株。铜绿假单胞菌对氨苄西林/舒巴坦、头孢哌酮/他唑巴坦、亚胺培南和头孢他啶的耐药率均<35%;肺炎克雷伯菌和大肠埃希菌对氨苄西林/舒巴坦、头孢哌酮/他唑巴坦和亚胺培南耐药率均<35%;鲍曼不动杆菌除了对亚胺培南和头孢哌酮/他唑巴坦敏感外,对其他药物的耐药率均>60%。G+菌耐药性严重,但对万古霉素和替考拉宁敏感率均为100.0%。结论:老年COPD患者的主要病原菌为G-菌,呈现出多重耐药性,耐药率也不断增加。     

2009—2013年贺州市人民医院铜绿假单胞菌的分布及耐药性分析

目的分析贺州市人民医院铜绿假单胞菌的分布及耐药性变迁,为指导临床合理使用抗菌药物提供可靠依据。方法回顾性分析2009—2013年贺州市人民医院临床各科室送检标本分离的铜绿假单胞菌,采用纸片扩散法测定抗菌药物的敏感性。结果 5年间送检标本共分离出1 544株铜绿假单胞菌,检出率为16.9%。铜绿假单胞菌的标本来源以痰液为主,占78.2%,主要来自呼吸内科、ICU、神经内科,分别占29.7%、21.2%、17.5%。药敏结果显示,铜绿假单胞菌对喹诺酮类、亚胺培南、头孢哌酮/舒巴坦耐药率相对较低,但对环丙沙星、氨苄西林、氨苄西林/舒巴坦高度耐药,且呈逐年上升趋势。结论贺州市人民医院临床分离的铜绿假单胞菌对常用抗菌药物耐药性日益严重,因此临床上应重视监测病原菌的分布及耐药趋势,根据药敏结果合理选择抗生素,减少耐药菌株的产生。     

佛山市中医院重症医学科痰液病原菌分布及耐药性分析

目的了解佛山市中医院重症医学科(ICU)近3年痰液标本的病原菌分布情况及对抗菌药物的耐药性,为指导临床合理用药提供参考依据。方法选取2017年1月1日至2019年10月17日佛山市中医院ICU合格痰液标本分离的病原菌与药敏进行回顾性调查分析。结果共分离出748株病原菌,其中革兰阴性菌579株,占77.41%,主要以鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌为主;革兰阳性菌113株,占15.11%,主要为金黄色葡萄球菌、肺炎链球菌;酵母样真菌56株,占7.48%,主要以白假丝酵母菌为主。鲍曼不动杆菌对大多数抗菌药物的耐药率大于70.00%,其中对美罗培南、亚胺培南耐药率高达91.26%、93.20%;铜绿假单胞菌对多粘菌素B高度敏感,对美罗培南、亚胺培南的耐药率分别为36.41%、39.81%;肺炎克雷伯菌对亚胺培南耐药率为9.33%,对多粘菌素B高度敏感;大肠埃希菌对美罗培南、亚胺培南的耐药率均为0.00%;金黄色葡萄球菌对苯唑西林耐药率为35.48%,未发现耐万古霉素及利奈唑胺的金黄色葡萄球菌;白假丝酵母菌对酮康唑、5-氟胞嘧啶的耐药率均为3.23%,对其他监测抗菌药物均高度敏感。结论佛山市中医院ICU痰液标本感染病原菌以革兰阴性菌为主,不同细菌的耐药率有所不同,特别是鲍曼不动杆菌、铜绿假单胞菌对碳青霉烯类抗菌药物呈现高耐药性,临床必须合理使用抗菌药物。     

1322例重症监护病房患者感染致病菌谱的构成及其对抗菌药物的耐药性分析

目的:了解和分析医院重症监护病房(ICU)患者感染致病菌谱的构成及其对抗菌药物的耐药特性。方法:抽取2018年1月—12月间ICU重症患者1 322例临床资料,统计其病原菌的培养、分离、鉴定和药敏试验结果,分析其感染致病菌谱的构成及其对抗菌药物的耐药特性。结果:1 322例患者中,送检标本中分离出341株致病菌,其阳性率为25.79%,其中革兰阳性球菌81株占23.75%,革兰阴性杆菌260株占76.25%,病原菌主要来自痰液标本;排名前5位的致病菌依次为铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌和金黄色葡萄球菌;甲氧西林耐药金葡菌和凝固酶阴性葡萄球菌(MRSA和MRCNS)分别占各自菌株的60.00%和80.00%,未检出万古霉素、替考拉宁耐药的葡萄球菌;金葡菌对复方新诺明的耐药率较低,而大肠埃希菌对头孢哌酮-舒巴坦、美洛培南、阿米卡星的耐药率较低(<10%);肺炎克雷伯菌对常用抗菌药物的耐药率均大于40%,而其对亚胺培南和美洛培南的耐药率分别为46.94%和44.68%,鲍曼不动杆菌除对头孢哌酮-舒巴坦耐药率为31.71%外,其对其他抗菌药物的耐药率均大于60.00%,而铜绿假单胞菌对10种受试抗菌药物的耐药率均<30.00%。结论:铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌等革兰阴性杆菌是ICU患者的主要致病菌,尤其是鲍曼不动杆菌的耐药性极为严重,应采取有效的院感防控措施,加强抗菌药物的合理使用,以确保患者用药的合理性和有效性。     

2008年本院细菌耐药性监测

目的:了解某院临床送检标本分离株的抗菌耐药性。方法:采用K-B法,参照2008年CLSI判定标准判断结果,并用WHONET5.4软件进行数据处理。结果:1075株非重复菌株中,革兰阳性球菌246株(22.9%),革兰阴性杆菌829株(77.1%)。前5位病原菌为大肠埃希菌、铜绿假单胞菌、克雷伯菌属、不动杆菌属、凝固酶阴性葡萄球菌。MRSA、MRCNS的检出率为52.7%、79.3%。未有万古霉素不敏感菌株。产ESBLs大肠埃希菌、克雷伯菌属的检出率62.4%、28.9%,变形杆菌属对大多数抗菌药物的耐药率低于30%,肠杆菌属对大多数抗菌药物的耐药率大于40%。碳青霉烯类(亚胺培南)对肠杆菌科细菌抗菌活性较好。除头孢哌酮/舒巴坦外,不动杆菌属对其他抗菌药物的耐药率均高于铜绿假单胞菌。结论:某院临床常见病原菌革兰阴性杆菌占绝大多数,碳青霉烯类(亚胺培南)对肠杆菌科细菌抗菌活性最好,临床常见细菌对常用抗菌药物耐药性严重。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。