Imipenem-Resistant Pseudomonas aeruginosa: Risk Factors for Nosocomial Infections

The aim of this study was to determine the risk factors for nosocomial infections of imipenem-resistant Pseudomonas aeruginosa (IRPA). A prospective case-control study was performed at a tertiary care hospital in Ankara from January to December 2004. The patients with nosocomial P. aeruginosa infection were included in the study. The features of the patients with IRPA infections were compared to those with imipenem-sensitive P. aeruginosa (ISPA) infections. Only the first isolation of P. aeruginosa was considered. Nosocomial infections were defined according to Center for Disease Control (CDC) criteria. IRPA was isolated from 75 (44.1%) patients, and ISPA was isolated from 95 (55.9%) patients during the study period. IRPA were most frequently isolated from endotracheal aspirate (19%) cultures (p=0.048), whereas ISPA were most frequently isolated from urine (28%) cultures (p=0.023). In multivariate analysis, a longer duration of hospital stay until P. aeruginosa isolation (odds ratio [OR], 1.027; 95% confidence interval [CI], 1.002-1.054, p=0.034), arterial catheter administration (OR, 2.508; 95% CI, 1.062-5.920, p=0.036), vancomycin (OR, 2.882; 95% CI, 1.130-7.349, p=0.027), piperacillin-tazobactam (OR, 6.425; 95% CI, 2.187-18.875, p=0.001), and imipenem (OR, 3.580; 95% CI, 1.252-10.245, p=0.017) treatment within the 14 days before isolation of IRPA were independently associated with imipenem resistance. It was concluded that treatment with imipenem, vancomycin and piperacillin-tazobactam were major risk factors for IRPA infections in hospitalized patients. The nosocomial occurrence of IRPA was also strongly related to the duration of hospital stay, arterial catheter administration.     

亚胺培南/西司他丁治疗血液肿瘤合并感染的疗效与分析

目的分析亚胺培南/西司他丁(泰能)治疗血液肿瘤合并感染的疗效. 方法对289例经临床确诊为血液疾患合并有明确感染的住院患者,使用亚胺培南/西司他丁治疗,治疗效果根据卫生部新药临床研究指导原则标准进行评定. 结果 289例患者中痊愈191例(66.1%);显效41例(14.6%);总有效患者为232例(80.7%). 结论应用亚胺培南/西司他丁治疗血液肿瘤合并感染的患者,具有疗效快、作用显著之特点.     

亚抑菌浓度亚胺培南体外诱导铜绿假单胞菌耐药

目的探讨铜绿假单胞菌对碳青酶烯类抗生素的耐药机制. 方法分析亚抑菌浓度亚胺培南诱导耐药的铜绿假单胞菌株体外抗菌活性、OprD2相对含量、β-内酰胺酶活性的改变. 结果与对照组相比,诱导组亚胺培南体外抗菌活性下降,OprD2的相对含量减少,β-内酰胺酶活性明显增加. 结论铜绿假单胞菌诱导耐药可能是OprD2的缺失和β-内酰胺酶高诱导表达共同作用的结果.     

耐亚胺培南铜绿假单胞菌的分布及耐药性分析

目的了解耐亚胺培南铜绿假单胞菌的分布及对抗菌药物的敏感性. 方法利用K-B法、琼脂扩散法、微量稀释法测定临床铜绿假单胞菌与耐亚胺培南铜绿假单胞菌对抗菌药物的敏感性. 结果耐亚胺培南铜绿假单胞菌尤其是多重耐药铜绿假单胞菌在ICU和老年病房比普通病房更加严重,对照组对抗菌药物的耐药率明显低于耐亚胺培南铜绿假单胞菌. 结论铜绿假单胞菌对阿米卡星、环丙沙星、头孢哌酮/舒巴坦的效果都不错,耐亚胺培南铜绿假单胞菌选择抗菌药物的范围很窄,只有阿米卡星的活性较好.     

亚安培南对产超广谱β-内酰胺酶肺炎克雷伯菌抗菌活性的研究

目的探讨亚安培南对产超广谱β-内酰胺酶（ESBLs）肺炎克雷伯菌的杀菌机制，指导临床用药。方法利用标准肉汤稀释法检测各主要抗生素对肺炎克雷伯菌的最低抑菌浓度（MIC）。结果亚安培南的最低抑菌浓度明显低于其他主要抗生素。结论在治疗产ESBLs肺炎克雷伯菌严重感染时，建议应用碳青霉烯类抗生素亚安培南。     

美罗培南治疗急性细菌性感染临床观察

目的：评价美罗培南治疗细菌性感染的安全性及有效性。方法：采用随机对照试验方法。试验组美罗培南500mg-1g,静脉点滴,每12h1次,对照组亚胺培南－西司他丁500mg/500mg-1g/1g,每12h1次,静脉点滴。疗效均为7－14d。结果：美罗培南组及亚胺培南－西司他丁组分别有42例及41例可评价疗效。两组有效率分别为88．1％（37／42）及85．4％（35／41）。对各种致病菌感染有效率分别为85．3％（29／34）和82．4％（28／34）。两组治疗前分离株分别为37株及38株。治疗后细菌清除率分别为81．1％（30／37）和84．2％（32／38）。两组安全性评价分别为44例及41例,不良反应发生率分别为13．6％（6／44）与12．2％（5／41）。两组经统计学处理差异无显著性（P＞0．05）。结论：美罗培南治疗急性细菌性感染疗效好,较安全。     

Metallo-β-lactamase–producing imipenem-resistant Pseudomonas aeruginosa clinical isolates in a university teaching hospital in Malaysia: detection of IMP-7 and first identification of IMP-4, VIM-2, and VIM-11

Ninety (n = 90) imipenem-resistant Pseudomonas aeruginosa (IRPA) clinical isolates collected randomly during 2005 to 2008 from University Malaya Medical Center were assessed for the presence of different variants of metallo-β-lactamase (MBL) genes. Polymerase chain reaction (PCR) assay detected 32 (n = 32) MBL gene PCR-positive isolates with the presence of bla_IMP gene in 14 (n = 14) and bla_VIM in 18 (n = 18) isolates. Four allelic variants, bla_IMP-7 (12 isolates), bla_IMP-4 (2 isolates), bla_VIM-2 (17 isolates), and bla_VIM-11 (1 isolate), of MBL genes were identified. This study is the first report of detection of bla_IMP-4, bla_VIM-2, and bla_VIM-11 MBL genes from IRPA clinical isolates in Malaysia.     

52例老年吸入性肺炎治疗效果评价

目的 评价氨苄西林/舒巴坦钠和亚胺培南/西司他丁钠治疗老年人吸入性肺炎的效果,为临床合理用药提供参考.方法 26例给予氨卞西林/舒巴坦钠2.25～3.00 g加入0.9%氯化钠溶液250 ml静脉滴注,每日2次.26例给予亚胺培南/西司他丁钠0.5 g加入5%葡萄糖溶液100 ml间隔6～8小时静脉滴注.通过评估体温、胸部影像分级、WBC和CRP分析2组治疗效果、副作用的发生情况以及治疗时间和细菌的清除情况等.结果 氨苄西林/舒巴坦钠组有效率为84.6%(22/26),亚胺培南/西司他丁钠组为92.3%(24/26),组间差异无统计学意义(χ2=0.188,P=0.664).治疗时间:氨苄西林/舒巴坦钠组(8.2±2.8)d,亚胺培南/西司他丁钠组(7.5±1.6)d,组间差异无统计学意义(t=1.107,P=0.274).氨苄西林/舒巴坦钠治疗组出现胃肠道反应1例,亚胺培南/西司他丁钠治疗组1例出现轻微的肝功能异常.2组的副作用在抗生素使用后很快完全消失.结论 氨苄西林/舒巴坦钠和亚胺培南/西司他丁钠均是有效的治疗老年人吸入性肺炎的抗菌药.     

帕尼培南-倍他米隆的临床评价

目的 评价碳青霉烯类新药帕尼培南－倍他米隆的疗效与安全性。方法 以亚胺培南－西司他丁为对照药,对两种药物治疗重症下呼吸道、尿咱和腹腔细菌性感染共２４６例的疗效和窀生进行随机对照观察。另以帕尼培南－倍他米隆开放治疗其他感染１０例。结果 帕尼培南－倍他米隆组和亚胺培南－西司他丁组的有效率分别为８９．０％和８９．９％,细菌清除率分别为７８．４％和８０．０％;治疗组和对照组的不良反应发生率各为５．８％和９     

亚胺培南耐药鲍曼不动杆菌小鼠肺部感染模型建立

目的 建立亚胺培南耐药鲍曼不动杆菌小鼠肺部模型,为泛耐药鲍曼不动杆菌抗感染研究提供实验动物模型.方法 随机选取120只约4周大雄性BALB/C小鼠,平均分成3组:微量气管注射法组、超声雾化法组和滴鼻法组.每组小鼠用甲氨蝶呤化疗降低BALB/C小鼠的免疫力,然后将亚胺培南耐药鲍曼不动杆菌分别用微量气管注射法、超声雾化法、滴鼻法感染免疫力低下和正常的BALB/C小鼠,检测微量气管注射法、超声雾化法、滴鼻法感染的小鼠感染率、死亡率、细菌清除率、肺部病理变化.结果 微量气管注射法、超声雾化法感染免疫力低下的BALB/C小鼠的肺部感染率均为100%(30/30),死亡率分别为100%(10/10),33%(3/10),2组小鼠肺部细菌感染12～24 h后支气管周及肺泡间质内见中性粒细胞、淋巴细胞、巨噬细胞为主的炎症细胞浸润,微量气管注射法感染的小鼠部分肺泡组织结构崩解,肺泡腔内可见脓肿形成及较多细菌集落,超声雾化法感染的小鼠24 h见肺部部分区域存在细胞变性,但支气管及肺泡组织结构基本正常,肺泡壁血管轻度扩张伴淤血,24～48 h后可见支气管和支气管周围变性,部分肺组织血管高度扩张,伴有水肿,48 h后炎症逐渐恢复.滴鼻法感染免疫力低下的BALB/C小鼠的肺部感染不明显,未见小鼠死亡(0/10),肺部无明显病理变化.结论 免疫力低下BALB/C小鼠可以通过微量气管注射法和超声雾化法建立亚胺培南耐药鲍曼不动杆菌肺部感染模型,超声雾化法可以大批量同时操作,简单经济快速,实用性强.亚胺培南耐药鲍曼不动杆菌难以感染免疫力正常小鼠.