单药及联合用药对金黄色葡萄球菌突变选择窗的影响

随着细菌耐药现象越来越严重，人们对细菌耐药机制的研究越深入，但主要集中在如何延缓获得性耐药的传播。Dong等1999年提出的防突变浓度（mutant prevention concentration，MPC）和突变选择窗（mutant selection window）的概念，则是用于体外判定药物是否可能导致病原菌产生自发耐药，为研究耐药机制开辟了新的领域。我们通过测定氟喹诺酮类药物单用及与头孢唑林联用对金黄色葡萄球菌ATCC29213株的最低抑菌浓度（MIC）MIC99和MPC，探讨联合用药对细菌突变选择窗的影响，寻找减少耐药突变菌株产生的新途径。     

单耐氧氟沙星的结核分枝杆菌耐药机制研究

目的探讨单耐氧氟沙星的结核分枝杆菌中耐药相关基因突变及外排泵基因风坦两种不同耐药机制的作用。方法从国家结核病参比实验室2007年全国耐药基线调查菌株库中挑选单耐氧氟沙星的菌株17株。采用直接测序法检测利福平耐药相关基因删似和gyrB突变情况。提取gyrA和gyrB无突变菌株的RNA后反转录并采用Real—timePCR方法检测20个药物外排泵基因的表达量，对比菌株最低抑菌浓度（MIC）试验结果，筛选可能与氧氟沙星药物外排泵的相关基因，并选用大肠埃希菌为模式生物构建表达载体，检测过表达目的外排泵蛋白的大肠埃希菌对氧氟沙星的耐药程度加以验证。结果在17株单耐氧氟沙星的菌株中，有4株（4／17）检测到gyrA突变，其中包括90位点突变1株及94位点突变3株，上述突变均表现为高浓度耐药，其MIC均不低于4μg/ml。在gyrA和gyrB未突变菌株中，通过real-timePCR检测发现在高浓度耐药的2株菌株中，Rv0933和Rv2938的转录水平显著高于其他低浓度耐药菌株，较对照株H37Rv转录水平高16倍和5倍。在对照组和转入pEASY-E1-Rv2938的大肠埃希菌中MIC均小于0．125μg／ml，而转入pEASY-E1-Rv0933的大肠埃希菌的MIC为2μg／ml。结论本研究结果显示，gyrA耐药决定区基因突变与氧氟沙星高浓度耐药相关，PstB可能是氧氟沙星特异性的药物外排泵基因，其高水平表达与氧氟沙星高浓度耐药相关。     

基于表面增强拉曼光谱法快速检测细菌抗生素敏感性的研究

目的基于核酸适配体表面增强拉曼光谱技术(SERS),建立一种快速检测细菌抗生素敏感性试验方法,评价不同抗生素对细菌拉曼光谱强度的影响。方法将大肠埃希菌O157:H7和金黄色葡萄球菌分别与不同抗生素作用,再将大肠埃希菌O157:H7和金黄色葡萄球分别与其特异性适配体共孵育,通过表面增强银纳米粒子的方法在金黄色葡萄球菌-适配体和大肠埃希菌-适配体表面还原银纳米粒子,通过SERS技术检测目标细菌。结果分别用大肠埃希菌O157:H7和金黄色葡萄球菌进行SERS试验,用不同浓度萘啶酸、硫酸粘菌素、土霉素、利福平作用于大肠埃希菌。结果表明在抗生素作用1h发现萘啶酸浓度达到1μg/ml、硫酸粘菌素浓度达到1μg/ml、土霉素浓度达到1μg/ml、利福平浓度为2μg/ml时,细菌拉曼光谱显著降低,并可快速确定此时抗生素浓度为大肠埃希菌最低抑制浓度(MIC)值;用不同浓度环丙沙星、氯霉素、红霉素、万古霉素作用于金黄色葡萄球菌,结果在抗生素作用1h发现环丙沙星浓度为1μg/ml、氯霉素浓度达到1μg/ml、红霉素浓度达到1μg/ml、万古霉素浓度达到1μg/ml,细菌拉曼光谱显著降低,并可快速确定此时抗生素浓度为金黄色葡萄球菌最低抑制浓度(MIC)值;当反应时间达到2h,可发现抗生素低于MIC时,细菌的拉曼强度与对照组相似,而MIC未发生变化,证明试验结果正确。结论基于核酸适配体SERS方法可快速评价抗生素对细菌的影响,并在短时间内确定MIC值,因此可用于检测细菌对抗生素敏感性的快速检测。     

387例急性脑梗死合并肺部感染患者病原菌分布及耐药性分析

目的检测和分析急性脑梗死合并肺部感染患者的病原菌分布以及耐药性,为合理使用抗菌药物提供依据。方法收集2012年1月至2018年6月在本院进行诊治并符合急性脑梗死患者合并肺部感染诊断标准的患者387例,对其痰标本进行细菌培养,并检测分析其耐药性。结果 387例急性脑梗死合并肺部感染患者临床标本共培养出431株病原菌,其中革兰阴性菌(G-)304株,占70.53%;革兰阳性菌(G+)98株,占22.74%;真菌29株,占6.73%。G-菌中检出率较高的次为肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌。其中肺炎克雷伯菌对哌拉西林他唑巴坦、头孢哌酮舒巴坦、亚胺培南具有较高的敏感性,对氨苄西林、左氧氟沙星具有较高的耐药性;铜绿假单胞菌对哌拉西林他唑巴坦、头孢哌酮舒巴坦、头孢吡肟、亚胺培南、氨曲南较敏感,对氨苄西林、头孢唑林、左氧氟沙星耐药率为79.41%-86.76%;大肠埃希菌对哌拉西林他唑巴坦、头孢哌酮、头孢哌酮舒巴坦、亚胺培南较敏感,对头孢唑林、左氧氟沙星耐药率为85.71%-96.43%。G+菌中检出率较高的是金黄色葡萄球菌和表皮葡萄球菌,两细菌对利奈唑胺、替考拉宁、呋喃妥因、万古霉素较敏感,对青霉素、氨苄西林耐药率为81.48%-100.00%;真菌中检出率较高的是白色假丝酵母菌和热带假丝酵母菌,两真菌对酮康唑、制霉菌素、氟胞嘧啶较敏感,对氟康唑、伊曲康唑和两性霉素B耐药率为26.67%-40.00%。结论急性脑梗死合并肺部感染患者感染病原菌普遍存在一定的耐药性,应及时做病原菌培养和耐药性试验,以利于控制患者病情。     

大肠埃希菌药敏分析及qnr基因分布情况研究

目的了解衡水地区大肠埃希菌的药敏情况以及qnr基因的存在情况。方法采用肉汤稀释法测15种抗菌药物最低抑菌浓度（MIC）并计算其MIC50和MIC90;采用聚合酶链反应（PCR）检测qnr基因。结果15种抗菌药物中仅亚胺培南、哌拉西林／他唑巴坦和头孢哌酮／舒巴坦对大肠埃希菌敏感,245例大肠埃希菌中检出5株存在qnrB基因,占2．O％,1株存在qnrS基因,占0．4％。结论我院检出的大肠埃希菌存在多重耐药。少数菌株中,存在qnrB和qnrS基因,临床应加强监测。     

老年下呼吸道感染患者肺炎克雷伯菌和大肠埃希菌耐药性分析

目的：监测老年下呼吸道感染患者肺炎克雷伯菌和大肠埃希菌的耐药性。为临床合理应用抗生素提供依据。方法：对我院下呼吸道感染患者中分离出的肺炎克雷伯菌和大肠埃希菌240株，以Kirby-Bauer(K-B)琼脂扩散法作药敏试验；以美国临床实验室标准委员会（NCCLS）1999年推荐的表型确认试验检测超广谱β－内酰胺酶（ESBLs）。结果：老年组和非老年组肺炎克雷伯菌和大肠埃希菌对14例抗生素的耐药率分别为阿莫西林93．2％和87．3％，哌拉西林57．1％和42．9％、头孢呋新51．4％和33．3％、头孢噻肟40．1％和17．5％、头孢他啶13．6％和3．2％、头孢曲松39．0％和17．5％、头孢哌酮37．3％和15．9％，头孢吡肟10．2％和3．2％、阿米卡星47．5％和34．9％，环丙沙星54．2％和38．1％、亚胺培南15．9％、头孢吡肟10．2％和3．2％、阿米卡星47．5％和34．9％、环丙沙星54．2％和38．1％，亚胺培南0和0、头孢哌酮／舒巴坦0和0、哌拉西林／三唑巴坦1．1％和0、头孢美唑9．6％和4．8％。78株肺炎克雷伯菌和大肠埃希菌被证实为产ESBLs菌，ESBLs检测出率为32．5％（78／240），其中老年组ESBLs检出率为38．4％（68／177），非老年组ESBLs检出率为15．9％（10／63）。亚胺培南，头孢哌酮／舒巴坦，哌拉西林／三唑巴坦和头孢美唑对产ESBLs菌的耐药率最低，分别为0、0、2．6％和12．8％。结论：老年下呼吸道感染患者肺炎克雷伯菌和大肠埃希菌的耐药率和ESBLs检出率均显著高于非老年患者；亚胺培南，头孢哌酮／舒巴坦、哌拉西林／三唑巴坦和头孢美唑是治疗由产ESBLs菌引起感染的有效抗生素。     

2006～2009年武汉同济医院血液科病房主要病原菌耐药性变迁

目的了解武汉同济医院血液科病房2006～2009年主要病原菌耐药性变迁。方法将分离的病原菌采用K-B法进行药敏试验,应用WHONET5．4软件进行数据分析。结果前3位病原菌为凝固酶阴性葡萄球菌、大肠埃希菌和铜绿假单胞菌。凝固酶阴性葡萄球菌和大肠埃希菌耐药严重。耐甲氧西林的凝固酶阴性葡萄球菌和超广谱13内酰胺酶（ESBLs）阳性大肠埃希菌检出率在2006～2008年间呈逐年上升趋势,2009年稍有下降,铜绿假单胞菌2007年后对头孢哌酮／舒巴坦、美罗培南、哌拉西林／他唑巴坦及左旋氧氟沙星的耐药率呈下降趋势。结论凝固酶阴性葡萄球菌、大肠埃希菌和铜绿假单胞菌是血液科病房主要致病菌;耐甲氧西林的凝固酶阴性葡萄球菌和ESBLs（＋）大肠埃希菌耐药2006—2008年间呈逐年上升趋势,2009年稍有下降;铜绿假单胞菌2007年后对常用抗生素耐药率呈下降趋势。     

天津市某三甲医院2011～2013年常见致病菌的耐药率及其变化趋势

目的：了解天津市某三甲医院2011～2013年临床常见致病菌的耐药率及其变化趋势。方法分析天津市某三甲医院2011年1月～2013年12月6种常见病原菌对常用抗生素的耐药资料,并对耐药率变化进行统计学分析。结果金黄色葡萄球菌和表皮葡萄球菌对利奈唑胺均敏感,没有发现对万古霉素耐药的金黄色葡萄球菌,肺炎克雷白菌和大肠埃希菌对哌拉西林他唑巴坦和头孢哌酮舒巴坦的耐药率均较低（＜15％）,没有发现对碳青霉烯类抗生素耐药菌株,鲍曼不动杆菌和铜绿假单胞菌对头孢哌酮舒巴坦的耐药率均较低（＜10％）,但鲍曼不动杆菌对其耐药率上升（P＜0．01）,表皮葡萄球菌和铜绿假单胞菌对部分抗生素的耐药率上升（P均＜0．05）,肺炎克雷白菌、大肠埃希菌、鲍曼不动杆菌对头孢吡肟、头孢曲松、头孢他啶的耐药率均有所下降（P均＜0．05）。结论常见致病菌对部分抗生素耐药率有下降趋势,耐药结果可对临床抗感染经验用药提供参考。     

济宁市某医院呼吸道感染患者病原菌分布及耐药性分析

目的了解济宁市第一人民医院呼吸道感染的病原菌菌群分布及耐药性,为临床治疗提供依据。方法采取生物梅里埃APISystem鉴定和VitekAmSystena微生物自动分析仪进行细菌鉴定,抗生素耐药性分析采用K—B纸片法,20eAUX酵母菌法测定真菌。MIC评价其耐药性。结果从148例呼吸道感染患者留取的痰标本中共分离出菌株120株,病原菌以革兰阴性菌为主,占66．7％,前5位分别为铜绿假单胞、肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌及阴沟肠杆菌和嗜麦芽寡养单胞菌;革兰阳性菌占23．3％,主要为金黄色葡萄球菌、肺炎链球菌及粪肠球菌和肺炎链球菌;真菌占10．0％,以白念珠菌为主。大多数革兰阴性菌对头孢哌酮／舒巴坦、左氧氟沙星、亚胺培南的耐药率较低,耐药率为5．8％～33．3％;头孢唑林、头孢曲松、氨苄西林的耐药率较高,耐药率均在50％以上。革兰阳性致病菌对万古霉素较敏感,对其他抗菌药物耐药程度均较低。结论济宁市第一人民医院呼吸道感染的病原菌以革兰阴性杆菌为主,且耐药菌株所占比例较高,应合理地应用抗菌药物。     

不同类型尿路感染大肠埃希菌的分布和耐药性分析

目的:了解2014年～2016年本地区尿路感染患者大肠埃希菌的分布和耐药性特点。方法:回顾分析复旦大学附属华东医院肾内科3年间1 034例住院患者的菌尿记录和药敏试验结果,分为非复杂感染组和复杂尿路感染两组,计算两组大肠埃希菌的构成比及药物敏感率,了解两组病例大肠埃希菌的分布和耐药性特点。结果:非复杂感染组和复杂感染组在平均年龄及性别方面未见差异。非复杂感染组3年大肠埃希菌的构成比无差异(48. 4%、38. 1%、42. 7%),抗生素敏感率无差异。复杂感染组3年大肠埃希菌的构成比无差异(32. 0%、25. 8%、35. 2%),对头孢哌酮/舒巴坦的敏感率呈逐年降低趋势(87. 5%vs 63. 4%vs 42. 6%,P0. 05)。与非复杂感染组相比,复杂感染组大肠埃希菌的构成比较低(31. 2%vs 42. 3%,P0. 05),对阿米卡星、左氧氟沙星、头孢唑啉、头孢呋辛、头孢吡肟、头孢他啶、头孢哌酮/舒巴坦的敏感率均较低,尤其对头孢哌酮/舒巴坦的敏感率明显降低(58. 9%vs 91. 5%,P=0. 000)。结论:本地区3年的复杂尿路感染患者大肠埃希菌的构成比较低,且耐药谱增宽、耐药程度加剧,临床应根据药敏试验结果合理使用抗生素以减少耐药菌株的产生和扩散。     

Lactoferricin of bovine origin is more active than lactoferricins of human, murine and caprine origin

The antimicrobial peptide lactoferricin is generated by gastric pepsin cleavage of lactoferrin. We have examined the antimicrobial activity of lactoferricins derived from lactoferrin of human, murine, caprine and bovine origin with minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) against E. coli ATCC 25922 and S. aureus ATCC 25923. We found that lactoferricin of bovine origin (Lf-cin B) was the most efficacious of the lactoferricins tested. By comparing the linear and cyclic Lf-cin B we found the cyclic peptide to be the most active. Lactoferricin B was moderately active against E. coli ATCC 25922 and S. aureus ATCC 25923, but had no activity against P. mirabilis or Y. enterocolitica. Lf-cin B showed good activity against C. albicans, C. tropicalis and C. neoformans.     

Interference of the antimicrobial peptide lactoferricin B with the action of various antibiotics against Escherichia coli and Staphylococcus aureus.

The antimicrobial peptide, lactoferricin, can be generated upon gastric pepsin cleavage of lactoferrin. We have examined the interaction of lactoferricin of bovine origin, Lf-cin B, with the antibiotics penicillin G, vancomycin, gentamicin, colistin, D-cycloserine and erythromycin against E. coli ATCC 25922 and Staphylococcus aureus ATCC 25923. We demonstrated synergism between Lf-cin B and erythromycin against E. coli, and partial synergism between Lf-cin B and penicillin G, vancomycin and gentamicin against E. coli. Only penicillin G acted in partial synergism with Lf-cin B against S. aureus. Lf-cin B antagonized vancomycin and gentamicin against S. aureus in low concentration. We conclude that Lf-cin B may facilitate the uptake of antibiotics across the cell envelope.     

Restricting the selection of antibiotic-resistant mutant bacteria: measurement and potential use of the mutant selection window

The selection of antibiotic-resistant mutant bacteria is proposed to occur in a drug concentration range (the mutant selection window) that extends from the minimum inhibitory concentration (MIC) of susceptible cells to the MIC of the least susceptible, single-step bacterial mutants (the mutant prevention concentration [MPC]). MPCs were estimated for tobramycin, chloramphenicol, rifampicin, penicillin, vancomycin, and several fluoroquinolones by use of Escherichia coli and Staphylococcus aureus. Comparisons among reported serum drug levels indicate that new fluoroquinolones are the least likely to enrich populations of resistant mutant bacteria during monotherapy. These data partly explain the selective enrichment of populations of resistant mutant bacteria in medical practice. The mutant selection window range (MPC:MIC) was narrowed for fluoroquinolones by structure modification, pointing to a new direction in antibiotic refinement. The mutant selection window and the MPC were determined for combinations of rifampicin and tobramycin, using S. aureus, as a guide for combination therapy with compounds that alone cannot block enrichment of mutant bacterial populations.     

社区及医院感染中常见细菌的耐药性分析

目的探讨社区和医院感染中细菌耐药谱的特点。方法药敏试验用KirbyBauer法,根据2003年美国临床实验室标准化委员会(NCCLS)标准判定结果,应用WHONET-5软件对临床分离细菌的药敏结果进行数据分析。结果医院感染480株,常见细菌依次为:铜绿假单胞菌(19.37%),肺炎克雷伯菌(15.83%),大肠埃希菌(11.87%)。社区感染726株,常见细菌为:金黄色葡萄球菌(14.05%),大肠埃希菌(12.67%),凝固酶阴性葡萄球菌(11.43%)。医院感染的金黄色葡萄球菌,凝固酶阴性葡萄球菌,铜绿假单胞菌,大肠埃希菌耐药率明显高于社区感染,差异有统计学意义(P<0.01)。而肺炎克雷伯菌和不动杆菌属差异无统计学意义。结论重视细菌耐药性监测,合理使用抗生素。     

Reduced mucosal antimicrobial activity in Crohn's disease of the colon

OBJECTIVES: In order to maintain the mucosal barrier against luminal microorganisms the intestinal epithelial cells synthesise various broad-spectrum antimicrobial peptides including defensins and cathelicidins. Recent studies indicate that both may be deficient in Crohn's disease. To elucidate the possible functional consequences of this deficiency antimicrobial activity in colonic mucosa from patients with inflammatory bowel disease and healthy controls was investigated. METHODS: A flow cytometric assay was established to quantitate bacterial killing and test the antibacterial activity of cationic peptide extracts from colonic biopsies taken from patients with active or inactive ileocolonic or colonic Crohn's disease (n = 22), ulcerative colitis (n = 29) and controls (n = 13) against clinical isolates of Bacteroides vulgatus and Enterococcus faecalis or the reference strains Escherichia coli American Type Culture Collection (ATCC) 25922 and Staphylococcus aureus ATCC 25923. RESULTS: Compared with controls and ulcerative colitis there was a reduced antimicrobial effect in Crohn's disease extracts that was most evident against B. vulgatus. The antimicrobial effect against E. coli and E. faecalis was significantly lower in Crohn's disease compared with ulcerative colitis. Activity against S. aureus disclosed a similar pattern, but was less pronounced. The differences were independent of the inflammation status or concurrent steroid treatment. Bacteria incubated with biopsy extracts from ulcerative colitis patients frequently showed a characteristic change in cell size and granularity, compatible with more extensive membrane disintegration, compared with bacteria incubated with extracts from controls or Crohn's disease. CONCLUSION: Crohn's disease of the colon is characterized by a diminished functional antimicrobial activity that is consistent with the reported low antibacterial peptide expression.     

In vitro antibacterial effect of aqueous and ethanolic Moringa leaf extracts

ObjectiveTo evaluate the antibacterial effect of aqueous and ethanolic moringa leaf extracts (Moringa oleifera) on the growth of gram-positive and negative bacteria.MethodsPaper disks were soaked with 100, 200, 300 and 400 μL of extract at 20 g/180 mL and 10 g/190 mL. All extracts were tested against Escherichia coli (ATCC25922), Staphylococcus aureus (ATCC25923), Vibrio parahaemolyticus, Enterococcus faecalis (ATCC29212), Pseudomonas aeruginosa (ATCC27853), Salmonella enteritidis (IH) and Aeromonas caviae. The susceptibility tests were performed using the modified disk diffusion method.ResultsThe strains E. coli, P. aeruginosa and S. enteritidis (IH) were resistant to all treatments. In general, disks with 400 μL extract were the most efficient against S. aureus, V. parahaemolyticus, E. faecalis and A. caviae.ConclusionsThe study indicates a promising potential for aqueous and ethanolic Moringa leaf extracts as alternative treatment of infections caused by the tested strains.     

Derepressed beta-lactamase production as a mediator of high-level beta-lactam resistance in pseudomonas cepacia

A mechanism of high-level resistance to readily and poorly hydrolyzable betalactam substrates in Pseudomonas cepacia was identified using a hypersusceptible, betalactamase-inducible, non-CF clinical isolate, 75–26, and a drug-resistant mutant derived from this strain. Inoculation of 75–26 onto agar containing 16 μg/ml of ceftazidime produced a stable, beta-lactam-resistant mutant at a frequency of 1.7 × 10^?5. Baseline beta-lactamase production by a representative mutant isolate (75–26z) was almost 40-fold greater than the parent. Both strains produced major beta-lactamase bands with isoelectric points of 6.9, 7.8, 8.1, 8.5, and 9.2 by isoelectric focusing. Compared with the parental strain, multiple satellite bands associated with the major beta-lactamase bands were present in the mutant. Growth of an indicator strain, E. coli ATCC 25922, was inhibited by ceftazidime and piperacillin but was not inhibited after the compounds were preincubated with the beta-lactamase preparation from 75–26z. Preincubation of ceftazidime with beta-lactamase, followed by the addition of a beta-lactamase inhibitor, inhibited the growth of the indicator strain; piperacillin failed to inhibit growth of the indicator strain in a similar experiment. One mechanism of high-level resistance to both poorly and readily hydrolyzable beta-lactam substrates in P. cepacia is derepressed chromosomal beta-lactamase production. Pediatr Pulmonol 1988; 4:72–77.     

上海市华山医院血流感染患者的病原学和临床研究

目的了解近年来血流感染（BSI）病原菌变迁及其对常用抗菌药物的敏感状况.方法根据美国疾病控制中心（CDC）1996年医院感染标准诊断BSI,琼脂扩散法测定病原菌对抗菌药物的敏感性,并对BSI患者的临床特点、病原菌分布及耐药状况进行统计分析.结果1998年1月1日至2003年3月31日上海市华山医院276例确诊BSI者中属社区获得性BSI 71例（25.7%）,医院获得性BSI 205例（74.3%）.276例患者共获病原菌287株.革兰阳性菌、革兰阴性菌、真菌、复数菌感染分别占38%、44.2%、13.8%、4.0%.医院获得性BSI的病原菌以凝固酶阴性葡萄球菌（CoNS）、大肠埃希菌、念珠菌属最为常见.社区获得性BSI的病原菌以草绿色链球菌最常见,其次为大肠埃希菌等.药敏结果显示,48株金葡菌中甲氧西林耐药金葡菌（MRSA）占56%,100株CoNS中甲氧西林耐药CoNS（MRCoNS）占88%.革兰阴性杆菌如肠杆菌科细菌对第3代头孢菌素的耐药率较20世纪80年代、90年代初明显增高.碳青霉烯类对肠杆菌科细菌抗菌活性最强.引起葡萄球菌BSI最常见的诱发因素为静脉留置导管,手术和肾上腺皮质激素的使用.结论CoNS,肺炎克雷伯菌,真菌BSI较上个世纪七、八十年代明显上升,肠杆菌属、不动杆菌属及真菌在医院获得性BSI中明显高于社区获得性BSI,引起BSI病原菌对抗感染药物耐药性较其他部位分离病原菌高.     

慢性肾脏病并发脓毒血症40例的临床分析

目的:分析慢性肾脏病(CKD)并发脓毒血症的临床特征,为临床诊治提供依据.方法:回顾性分析慢性肾脏病并发脓毒血症40例的临床病历资料.结果:在40例CKD的患者中,肾衰竭30例(75％),深静脉置管22例(55％),使用免疫抑制剂和糖皮质激素12例(30％),18例患者合并泌尿系统和呼吸系统感染.分离的病原菌中,大肠埃希菌13例,金黄色葡萄球菌(金葡菌)11例(60％),其它16例；有4例(10％)合并了真菌感染.金葡菌对青霉素G均耐药,对环丙沙星和克林霉素耐药＞50％.死亡8例,32例经有效抗生素治疗3～4周康复.结论:CKD患者易罹患脓毒血症,除与贫血、低蛋白血症和其它的感染因素有关外,与肾功能的下降、深静脉留置导管和免疫抑制剂的应用相关.     

左氧氟沙星与加替沙星对肺炎克雷伯菌防耐药突变的比较

目的观察左氧氟沙星与加替沙星对肺炎克雷伯菌的防耐药突变作用。方法肉汤法富集受试菌菌液,接种含不同浓度左氧氟沙星及加替沙星琼脂平皿,测定左氧氟沙星、加替沙星对临床分离的肺炎克雷伯菌、ATCC700603及其耐药突变体的防耐药突变浓度;菌落计数法描绘菌落恢复生长曲线;测定ATCC700603及突变体的耐药突变窗及选择指数;结合药代动力学和药效动力学参数确定临床治疗方案。结果左氧氟沙星较加替沙星的防耐药突变浓度与细菌耐药选择指数大;菌落恢复生长曲线显示加替沙星的平台期窄于左氧氟沙星;加替沙星较左氧氟沙星的突变体耐药突变窗增宽幅度小。结论加替沙星防止肺炎克雷伯菌发生耐药突变作用强于左氧氟沙星。