血流和尿路感染耐碳青霉烯类肺炎克雷伯菌患者死亡的相关危险因素分析

目的 分析血流和尿路感染耐碳青霉烯类肺炎克雷伯菌(CRKP)患者死亡的相关危险因素.方法 选取内蒙古自治区人民医院2017年1月至2019年6月血液和尿液标本培养出CRKP的住院患者32例和97例.采用单因素和多因素Logistic回归方法分析血流和尿路感染CRKP患者死亡的相关危险因素.结果 单因素Logistic回...     

碳青霉烯类抗菌药物使用强度与耐药革兰阴性杆菌检出率的相关性

目的 分析合肥市第三人民医院住院患者碳青霉烯类抗菌药物使用强度(AUD)与耐碳青霉烯类革兰阴性杆菌(CRO)检出率之间的相关性,为临床合理用药和控制细菌耐药提供参考依据.方法 统计该院2014年1月至2019年12月碳青霉烯类AUD及CRO检出率,采用SPSS 20.0统计软件对其进行Spearman相关性分析.结果 ...     

耐碳青霉烯类肺炎克雷伯菌感染临床特征及危险因素分析

目的 分析耐碳青霉烯类肺炎克雷伯菌(carbapene-resistant Klebsiella pneumoniae, CRKP)感染临床特征及危险因素,为临床有效防控CRKP感染提供科学依据。方法 选取兰州大学第一医院2020年1月—2021年12月检出肺炎克雷伯菌的住院患者作为研究对象,采用回顾性病例-对照研究方法,选取该时段检出CRKP的住院患者113例作为CRKP组,同期检出碳青霉烯类敏感肺炎克雷伯菌(carbapenem-susceptible Klebsiella pneumoniae, CSKP)的住院患者113例作为CSKP组,收集两组患者临床资料,采用单因素分析和二元Logistic回归分析方法,分析CRKP感染的危险因素。结果 CRKP菌株的耐药率均高于CSKP菌株的耐药率;113株CRKP对甲氧苄啶/磺胺甲恶唑和阿米卡星耐药率相对稍低(70.80%和75.22%);对氨曲南、庆大霉素、左氧氟沙星和四环素的耐药率分别为99.12%、84.96%、87.61%和87.61%,对其余抗菌药物的耐药率均高达100%;二元Logistic回归分析显示,神经系统疾病、低白蛋...     

泌尿外科患者尿路感染产ESBLs大肠埃希菌的 危险因素及其耐药性分析*

目的：探讨本院泌尿外科患者尿培养中检出产ESBLs大肠埃希菌的危险因素及其耐药性情况,为减少该菌的感染及临床合理使用抗菌药物提供依据。方法：调查2016～2018年尿培养检出大肠埃希菌321例,应用单因素分析(t检验和χ2检验)及多因素Logistic回归分析产ESBLs大肠埃希菌感染的危险因素,并分析该菌的药敏情况。结果：多因素Logistic回归分析提示,院内感染（OR=5.902,95%CI=1.282～27.178）、反复尿路感染（OR=2.800,95%CI=1.235～6.349）、尿培养前15天内使用三代头孢类（OR=6.720,95%CI=1.924～23.480）、尿培养前15天至3月内使用二代头孢类（OR=4.088,95%CI=1.469～11.376）是感染产ESBLs大肠埃希菌的独立危险因素（P＜0.05）;在321例中,产ESBLs大肠埃希菌的检出率为53.0%,该菌对碳青霉烯类、阿米卡星、头霉素类、哌拉西林他唑巴坦、呋喃妥因仍保持较高的敏感性（>90%）,耐药率超过75%的药物仅有氨苄西林。结论：规范医院对感染患者的管理,合理使用抗菌药物,对减少该菌感染具有重要意义。     

泌尿外科患者尿路感染产ESBLs大肠埃希菌的 危险因素及其耐药性分析*

目的：探讨本院泌尿外科患者尿培养中检出产ESBLs大肠埃希菌的危险因素及其耐药性情况,为减少该菌的感染及临床合理使用抗菌药物提供依据。方法：调查2016～2018年尿培养检出大肠埃希菌321例,应用单因素分析(t检验和χ2检验)及多因素Logistic回归分析产ESBLs大肠埃希菌感染的危险因素,并分析该菌的药敏情况。结果：多因素Logistic回归分析提示,院内感染（OR=5.902,95%CI=1.282～27.178）、反复尿路感染（OR=2.800,95%CI=1.235～6.349）、尿培养前15天内使用三代头孢类（OR=6.720,95%CI=1.924～23.480）、尿培养前15天至3月内使用二代头孢类（OR=4.088,95%CI=1.469～11.376）是感染产ESBLs大肠埃希菌的独立危险因素（P＜0.05）;在321例中,产ESBLs大肠埃希菌的检出率为53.0%,该菌对碳青霉烯类、阿米卡星、头霉素类、哌拉西林他唑巴坦、呋喃妥因仍保持较高的敏感性（>90%）,耐药率超过75%的药物仅有氨苄西林。结论：规范医院对感染患者的管理,合理使用抗菌药物,对减少该菌感染具有重要意义。     

急诊科耐碳青霉烯类肠杆菌科细菌的耐药现状与感染危险因素分析

目的 分析急诊科耐碳青霉烯类肠杆菌科细菌(CRE)的临床分布、耐药情况及感染危险因素.方法 回顾性调查北京大学首钢医院急诊科2018年1月至2020年12月期间急诊科住院患者,选取耐碳青霉烯类肠杆菌科细菌感染患者63例作为观察组,同期入院的碳青霉烯类药物敏感肠杆菌科细菌感染患者285例作为对照组,分析观察组患者标本的临...     

绿脓杆菌对碳青霉烯类的耐药机制

碳青霉烯类为β-内酰胺类抗生素,对绝大多数致病菌具较强抗菌活性,尤其对引起院内感染的常见致病菌包括绿脓杆菌的多重耐药菌株亦具较强抗菌活性。该类药物对β-内酰胺酶稳定,因此临床上常用于绿脓杆菌及其它产β-内酰胺酶细菌感染的治疗。近年来,国外临床分离出一些对该类药物耐药的细菌,包括绿脓杆菌、粘质沙雷菌等。绿脓杆菌对碳青霉烯类药物耐药的主要原因为外膜通透性改变尤其是D_2蛋白的缺失,其次为某些β-内酰胺酶的水解作用。本文对绿脓杆菌     

32例氟喹诺酮类抗菌药物对耐药大肠埃希菌致尿路感染患者的临床疗效与耐药性分析

目的:分析氟喹诺酮类抗菌药物对耐药大肠埃希菌致尿路感染患者的临床疗效与耐药性。方法:抽取2018年3月—2019年6月间收治的氟喹诺酮类抗菌药物耐大肠埃希菌致尿路感染患者32例资料,分析其患者氟喹诺酮类抗菌药物耐大肠埃希菌对不同抗菌药物的耐药性,以及治疗方案的合理性。结果:32例耐大肠埃希菌致尿路感染患者对亚胺培南均敏感,但对哌拉西林-他唑巴坦耐药率为6.25%,而其对头孢哌酮-舒巴坦的耐药率为9.38%,对头孢西丁的耐药率为12.50%,对复方新诺明的耐药率为96.88%,而产ESBLs对其耐药率为84.38%。结论:临床对氟喹诺酮类抗菌药物耐大肠埃希菌而导致的尿路感染患者,应根据患者药敏试验结果合理选用抗菌药物治疗,以提高耐大肠埃希菌致尿路感染患者的临床疗效。     

肺炎克雷伯菌对碳青霉烯类的耐药机制与危险因素#br#

肺炎克雷伯菌是一种重要的院内以及社区感染的病原菌。近年来,随着碳青霉烯类抗生素的广泛应用,碳青霉烯类耐药的肺炎克雷伯菌株(carbapenem-resistant Klebsiella pneumoniae, CRKP)显著增加,尤其是产KPC型碳青霉烯酶的ST258型肺炎克雷伯菌已经在全球范围内传播,严重威胁人类健康,给临床治疗带来巨大困难与挑战。CRKP有多种耐药机制,包括碳青霉烯酶的产生、细菌孔蛋白丢失或者数量减少、主动外排系统活跃等。因此,研究CRKP对碳青霉烯类药物的耐药机制与危险因素是解决其耐药问题并指导临床用药的重要途径。本篇文章对CRKP的耐药机制、KPC型碳青霉烯酶的基因传播、定植的危险因素进行综述,旨在加强临床对CRKP的了解及为临床合理用药提供依据。     

碳青霉烯类耐药大肠埃希菌耐药基因型检测及同源性分析

目的检测临床分离碳青霉烯类耐药大肠埃希菌的耐药基因型,并对其同源性进行分析,研究其流行情况。方法收集铜陵市人民医院 2012年 9月至 2016年 10月临床分离碳青霉烯类耐药大肠埃希菌,采用 VITEK?2 Compact全自动微生物鉴定仪进行鉴定,改良 Hodge试验检测碳青霉烯酶表型, EDTA双纸片协同试验进行金属酶初筛,聚合酶链反应( PCR)检测碳青霉烯酶基因( blaKPC、blaIMP、blaVIM、blaNDM和 blaOXA?48)并对阳性扩增产物进行基因测序;同源性分析采用肠杆菌科基因间重复一致序列聚合酶链反应技术( ERIC?PCR)。结果共收,集碳青霉烯类耐药大肠埃希菌 25株, 8株改良 Hodge试验阳性, 13株金属酶初筛试验阳性,其中 4株携带 blaNDM?1基因, 1株携带 blaIMP?4基因, 1株携带 blaKPC?2基因; ERIC?PCR检测分为 10种型别。结论碳青霉烯类耐药大肠埃希菌的耐药机制主要是产金属酶,携带 NDM?1型碳青霉烯酶大肠埃希菌需重点监测;碳青霉烯类耐药大肠埃希菌未在医院引起克隆流行。     

老年患者泌尿系统感染大肠埃希菌耐药性分析

目的:分析老年患者泌尿系统感染大肠埃希菌的特点及其耐药性,为临床合理用药提供依据.方法:采用全自动微生物鉴定系统对老年泌尿系统感染患者分离出的大肠埃希菌进行鉴定和药敏分析.结果:大肠埃希菌非产ESBLs株对青霉素类抗菌药物、第一、二代头孢菌素类药品高度耐药;对第三代头孢菌素耐药率大于40%;对碳青霉烯类药物美罗培南无耐...     

Risk factors for aquiring multidrug-resistant organisms in urinary tract infections: A systematic literature review

Background

This is the first review to analyze literature identifying risk factors for a multidrug-resistant urinary tract infection (MDR UTI). Risk factors for other infections involving multidrug-resistant organisms have been evaluated in other reviews, but they do not assess urinary tract infections. The purpose of this study is to collect currently published data to determine the most commonly and consistently identified risk factors for UTIs.

糖尿病患者合并尿路感染的危险因素及防治措施

目的探讨糖尿病患者尿路感染的危险因素,寻找降低尿路感染发生率的有效方法。方法回顾分析糖尿病合并尿路感染患者的临床资料。结果糖尿病合并尿路感染患者中61.1%为无症状尿路感染,其发病率与年龄、病程、血糖情况、并发症情况呈正相关。结论控制危险因素,积极治疗并发症,合理应用抗生素,是防治糖尿病合并尿路感染的主要措施。     

老年患者大肠埃希菌尿路感染现状及耐药性分析

目的了解老年患者大肠埃希菌尿路感染的感染现状及耐药性特征,为临床治疗及合理使用抗菌药物提供理论依据。方法收集我院2013年1月至2015年12月65岁及以上住院患者送检的中段清洁尿标本,从中培养出444株大肠埃希菌,采用回顾性分析方法进行感染现状及耐药性分析。结果美罗培南及厄他培南耐药率最低,亚胺培南其次,耐药率高于70%的抗生素分别为哌拉西林、氨苄西林、加替米星、头孢唑林、头孢唑喃钠、头孢噻吩、环丙沙星、罗米沙星、左氧氟沙星、左旋氧氟沙星、氨苄西林/舒巴坦。结论老年患者大肠埃希菌尿路感染现状较为严峻,从尿液标本中分离出的大肠埃希菌耐药率较高,应根据药敏试验结果合理使用抗菌药物。     

Finafloxacin for the treatment of urinary tract infections

Introduction: In the past decade, the indiscriminate use of fluoroquinolones in the prophylaxis and treatment of urinary tract infections (UTIs) has led to an increase of antibiotic resistance patterns. Finafloxacin is a new generation fluoroquinolone with interesting preclinical characteristics and pH-related efficacy.

Areas covered: This review summarizes finafloxacin’s safety profile and prospectively evaluates its specific use in the treatment of UTIs. This article was based on a Medline English literature search.

Expert opinion: In vitro and in vivo studies have shown that finafloxacin expresses its full antibacterial activity in acidic environments and is able to exert significant bactericidal effects in difficult-to-treat infections. Finafloxacin has a broad antibacterial spectrum and efficient pharmacokinetic absorption. Moreover, it undergoes extensive tissue distribution, resulting in good antibacterial activity for daily dosages from 400 to 800 mg. This novel compound has also been successfully tested on biofilm-related Escherichia coli. Finafloxacin has demonstrated a good safety and tolerability profile in humans when administered orally or intravenously and is thus an interesting compound for the treatment of UTIs. However, further prospective randomized clinical trials will be necessary to confirm these preliminary results before definitive conclusions can be made.     

泌尿道产ESBLs大肠埃希菌医院感染危险因素病例对照及干预措施研究

目的探究泌尿道产ESBLs大肠埃希菌医院感染的危险因素及控制效果。方法将46例泌尿道产ESBLs大肠埃希菌医院感染患者设为观察组,按照1：1比例选同病种同病区非产ESBLs大肠埃希菌医院感染患者为对照组,通过病例对照研究,以条件Logistic法筛选出泌尿道产ESBLs大肠埃希菌医院感染危险因素,并针对这些因素采取相应的控制措施,前瞻性观察感染控制效果。结果住院时间长、泌尿道留置引流管、先期使用第3代头孢菌素及使用多种抗菌药物（≥3种）经单因素和多因素分析有统计学意义;采取相应控制措施后,在泌尿道大肠埃希菌医院感染病例中,产ESBLs菌株检出率从2011年的57％降至2012年的31％。结论住院时间长、泌尿道留置引流管、先期使用第3代头孢菌素及使用多种抗菌药物（≥3种）是泌尿道产ESBLs大肠埃希菌医院感染的独立危险因素。加强对产ESBLs菌株的认识、切断传播途经、严格控制广谱抗生素的使用、 正确留置尿路引流管、缩短患者住院时间是控制泌尿道产ESBLs大肠埃希菌医院感染的有效措施。     

Catheter-associated urinary tract infections: new aspects of novel urinary catheters

Nosocomial urinary tract infection is the most common infection acquired both in hospitals and nursing homes and is usually associated with catheterisation. These catheter-associated urinary tract infections (CAUTIs) have been reported to increase mortality and have a considerable economic impact. To date, the sole effective preventative strategy is the use of a closed drainage system and removal of the catheter as soon as possible. The underlying cause of CAUTI is the formation of a pathogenic biofilm on the surface of the indwelling urinary catheter. Currently, researchers seek to alter the catheter surface in order to inhibit biofilm formation. Many substances are being studied for their potential as biofilm-disrupting catheter coatings. Among these substances, recently developed antibiotic-coated catheters may provide promise for the control of CAUTI. More basic research at the level of pathogenesis and catheter substance is needed to design novel strategies.     

异帕米星治疗尿路感染

目的：评价异帕米星对尿路感染的疗效。方法：尿液细菌培养证实有感染者２６例（男性４例，女性２２例，年龄５３±ｓ１４ａ）。用异帕米星４００ｍｇ，ｉｍ（６例静脉滴注）ｑｄ，疗程８±３ｄ，根据症状、体征、临床检验及细菌学检查４项判断疗效分痊愈、显效、进步和无效。测定异帕米星药物用ＭＨ培养基及ＫＢ法。结果：总有效率８８％，细菌清除率８０％。１例用药后腹胀，局部注射部位疼痛；２例用药后尿素氮轻度升高。结论：异帕米星治疗尿路感染有效，不良反应轻。     

When to do culture in urinary tract infections

A brief review of the value of quantitative bacteriology of the urine in patients with symptoms of urinary tract infections is presented. Changes in our approach to the diagnosis of urinary tract infections are briefly discussed. The economic value of empiric treatment without urine cultures in young women with dysuria and frequency is presented along with our approach to patients with asymptomatic bacteriuria in the presence of an indwelling bladder catheter. In addition, specific groups of patients with symptomatic urinary tract infections who require urine cultures in order to receive optimal antimicrobial therapy is reviewed. Although these suggestions may not be appropriate for all patients in each category, their use in some patients is likely to result in economic benefits without reducing the quality of their health care.     

An update on new antibiotic prophylaxis and treatment for urinary tract infections in children

Introduction: This review focuses on the treatment of urinary tract infections (UTI) in children and in particular its recent changes.

Areas covered: Acute pyelonephritis, acute cystitis and asymptomatic bacteriuria or asymptomatic infections have to be clearly distinguished. Prompt treatment is required in pyelonephritis and cystitis, but not in asymptomatic bacteriuria or infection, in order to avoid selection of more virulent strains. This concept should be considered even in immunocompromised or bedridden children. In case of pyelonephritis, there should be no delay in beginning the antibiotic treatment in order to decrease the risk of long term complication, such as renal scars. Predisposing conditions for UTI, such as voiding anomalies and urinary tract malformation should be carefully evaluated.

Expert opinion: One major concern is the increasing resistance to 3^rd generation cephalosporins. Therefore overconsumption in low-risk settings should be absolutely avoided. The prevalence of infections with E. coli producing extended spectrum ß-lactamase (ESBL) is increasing and pediatricians should be aware about the specific treatment options. Any recommendation about (initial) antibiotic treatment should be regularly updated and adapted to local resistance profiles and to economic factors in different health systems.