Sequential intraventricular injection of tigecycline and polymyxin B in the treatment of intracranial Acinetobacter baumannii infection after trauma: a case report and review of the literature

Background:Intracranial infection after craniotomy is one of the most serious postoperative complications,especially multidrug-resistant(MDR)or extensively drug-resistant(XDR)bacterial meningitis,and strongly affects the prognosis of patients.Current treatment experience regarding these infections is scarce.Case presentation:We report a case of severe intracranial infection of XDR Acinetobacter baumannii(A.baumannii)that was treated by intravenous(IV)injection,sequential intraventricular(IVT)injection of tigecycline and polymyxin B,and other anti-infective drugs.Good results were obtained,and the patient was eventually discharged from the hospital.This case is characterized by intracranial infection.Conclusions:The polymyxin B IV+IVT pathway is an ideal treatment strategy for XDR A.baumannii.The tigecycline IVT pathway is also a safe treatment option.

Porphyromonas gingivalis Resistance to Polymyxin B Is Determined by the Lipid A 4’-Phosphatase, PGN_0524

Aim To elucidate the genetic basis for the pronounced resistance that the oral pathogen, Porphyromonas gingivalis （P. gingivalis）, exhibits towards the cationic antimicrobial peptide, polymyxin B. Methodology A genetic screen of P. gingivalis clones generated by a Tn4400-based random insertion mutagenesis strategy was performed to identify bacteria harboring novel genetic mutations that render P. gingivalis susceptible to killing by the cationic antimicrobial peptide, polymyxin B （PMB, 50μg·mL^-1）. Results P. gingivalis （ATCC 33277） is unusually resistant to the cationic antimicrobial peptide, PMB at relatively high concentrations （200μg·mL^-1）. Approximately 2,700 independent Tn4400 ＇-derived mutants ofP. gingivalis were examined for increased sensitivity to PMB killing at a relatively low dose （50 μg·mL^-1）. A single PMB-sensitive mutant was obtained in this phenotypic screen. We determined that the Tn4400＇ transposon was integrated into the gene encoding the lipid A 4＇-phosphatase, PGN 0524, demonstrating that this insertion event was responsible for its increased susceptibility of this clone to PMB-dependent killing. The resulting mutant strain, designated 0524-Tn4400＇, was highly sensitive to PMB killing relative to wild-type P. gingivalis, and exhibited the same sensitivity as the previously characterized strain, 0524KO, which bears a genetically engineered deletion in the PGN_0524 locus. Positive ion mass spectrometric structural （MALDI-TOF MS） analyses revealed that lipid A isolates from 0524-Tn4400＂ and 0524KO strains displayed strikingly similar MALDI-TOF MS spectra that were substantially different from the wildtype P gingivalis lipid A spectrum. Finally, intact 0524- Tn4400＇ and 0524KO mutant bacteria, as well as their corresponding LPS isolates, were significantly more potent in stimulating Toll-like receptor 4 （TLR4）-dependent E-selectin expression in human endothelial cells relative to intact wild-type P.. gingivalis or its corresponding LPS isolate. Conclusion The combined molecular evidence provided in this report suggests that PGN 0524, a lipid A 4＇-phosphatase, is the sole genetic element conferring the ability of the periodontopathogen, P. gingivalis, to evade the killing activity of cationic antimicrobial peptides, such as PMB. These data strongly implicate PGN_0524 as a critical virulence factor for the ability of P.. gingivalis to evade front-line host innate defenses that are dependent upon cationic antimicrobial peptide activity and TLR 4 sensing.

Preliminary study on the safety and efficacy of a new polymyxin B-immoblized resin column in treatment of LPS-induced sepsis beagles

Background:This study aims to assess the safety and efficacy of direct hemoperfu-sion using a new polymyxin B-immobilized resin column(disposable endotoxin ad-sorber,KCEA)in an endotoxin/lipopolysaccharide(LPS)-induced sepsis model.Methods:Eighteen beagles were randomized into 1 intervention group(KCEA group,n=6)and 2 control groups(sham group and model group,n=6 each).Sepsis was in-duced by continuous intravenous application of 0.5 mg/kg body weight of endotoxin for 60 min.An extracorporeal hemoperfusion device made with KCEA for endotoxin adsorption was used.Model group beagles received standard treatment with fluids and vasoactive drugs,KCEA group beagles received standard treatment and direct hemoperfusion of KCEA for 2 h,and sham group beagles were treated with standard treatment and direct hemoperfusion of a sham column for 2 h.Results:Good blood compatibility of KCEA was confirmed by assessing clinical pa-rameters.Blood endotoxin peak levels in the KCEA group were significantly lower,resulting in a significant suppression of IL-6,TNF-αand procalcitonin,which improved mean arterial pressure and significantly lowered vasopressor demand,thereby pro-tecting organ function and improving survival time and rate.In the KCEA group,MAP was significantly higher over 6 h than those recorded both in the sham group and model group.The 7-day survival rates of the KCEA,sham and model groups were 50%,0%and 0%,respectively.Conclusion:KCEA hemoadsorption was effective at detoxifying circulatory endotoxin and inflammatory mediators and contributed to the decreased mortality rate in the sepsis beagles.

Nystatin-Neomycin-Polymyxin B Combination:Efficacy and Tolerance as 1st-Line Local Treatment of Infectious Vaginitis

Objective: To evaluate the efficacy and tolerance of a local treatment combining two antibacterials and one antifungal in patients with a clinical presentation suggesting infectious vaginitis. Patients and methods: 169 patients presenting with clinical criteria for vaginitis were included in an open, multicenter trial. Vaginal samples were taken for microbiological analyses and a triple-combination product of nystatin, neomycin and polymyxin B was then started as local treatment, without waiting for the test results. The treatment was continued with the usual dosage (1 vaginal capsule at bedtime for 12 days) for vaginal infections in the scope of the combination product with approved labeling. A second vaginal sample was performed at the end of the treatment. The main efficacy criterion was the clinical success rate (cure or improvement of the clinical signs and symptoms) according to the investigator.Results: 93 patients were included in the efficacy population. Non-exclusively fungal vaginitis (strictly bacterial or bacterial + fungal) represented 31.2% of the cases. The clinical success rate was 97.8% according to the investigator and 95.7% according to the patients. The microbiological success rate was 81.3%, with no differences between etiologies (Candida spp., bacteria or both). The combination product was well-tolerated, despite the local inflammation before treatment. Discussion and conclusion: Given the etiological diversity of vaginitis, this trial supports the efficacy of a triple-combination product (nystatin, neomycin, polymyxin B) as a first-line local treatment of Candida, bacterial or mixed vaginitis.

Hemoperfusion with polymyxin B-immobilized fiber column improves liver function after ischemia-reperfusion injury

AIM:To investigate the usefulness of direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX therapy)for warm hepatic ischemia-reperfusion(I/R)injury after total hepatic vascular exclusion (THVE)using a porcine model. METHODS:Eleven Mexican hairless pigs weighing 22-38 kg were subjected to THVE for 120 min and then observed for 360 min.The animals were divided into two groups randomly:the DHP-PMX group(n=5)underwent DHP-PMX at a flow rate of 80 mL/min for 120 min(beginning 10 min before reperfusion),while the control group did not(n=6).The rate pressure product (RPP):heart rate×end-systolic arterial blood pressure, hepatic tissue blood flow(HTBF),portal vein blood flow (PVBF),and serum aspartate aminotransferase(AST) levels were compared between the two groups. RESULTS:RPP and HTBF were significantly(P< 0.05)higher in the DHP-PMX group than in the control group 240 and 360 min after reperfusion.PVBF in the DHP-PMX group was maintained at about 70%of the flow before ischemia and differed significantly(P <0.05)compared to the control group 360 min after reperfusion.The serum AST increased gradually afterreperfusion in both groups,but the AST was significantly(P<0.05)lower in the DHP-PMX group 360 min after reperfusion. CONCLUSION:DHP-PMX therapy reduced the hepatic warm I/R injury caused by THVE in a porcine model.

Direct hemoperfusion with a polymyxin B-immobilized cartridge in intestinal warm ischemia reperfusion

AIM: To investigate the effectiveness of direct hemo- perfusion with polymyxin B-immobilized fibers (DHP- PMX therapy) on warm ischemia-reperfusion (I/R) injury of the small intestine. METHODS: The proximal jejunum and distal ileum of mongrel dogs were resected. Warm ischemia was performed by clamping the superior mesenteric artery (SMA) and vein (SMV) for 2 h. Blood flow to the proximal small intestine was restored 1 h after reperfusion, and the distal small intestine was used as a stoma. The experiment was discontinued 6 h after reperfusion. The dogs were divided into two groups: the DHP-PMX group (n = 6, DHP-PMX was performed for 180 min; from 10 min prior to reperfusion to 170 min after reperfusion) and the control group (n = 5). The rate pressure product (RPP), SMA blood flow, mucosal tissue blood flow, and intramucosal pH (pHi) were compared between the two groups. The serum interleukin (IL)-10 levels measured 170 min after reperfusion were also compared. RESULTS: The RPP at 6 h after reperfusion was significantly higher in the PMX group than in the control group (12 174 ± 1832 mmHg/min vs 8929 ± 1797 mmHg/min, P < 0.05). The recovery rates ofthe SMA blood flow at 1 and 6 h after reperfusion were significantly better in the PMX group than in the control group (61% ± 7% vs 44% ± 4%, P < 0.05, and 59% ± 5% vs 35% ± 5%, P < 0.05, respectively). The recovery rate of the mucosal tissue blood flow and the pHi levels at 6 h after reperfusion were significantly higher in the PMX group (61% ± 8% vs 31% ± 3%, P < 0.05 and 7.91 ± 0.06 vs 7.69 ± 0.08, P < 0.05, respectively). In addition, the serum IL-10 levels just before DHP-PMX removal were significantly higher in the PMX group than in the control group (1 569 ± 253 pg/mL vs 211 ± 40 pg/mL, P < 0.05). CONCLUSION: DHP-PMX therapy reduced warm I/R injury of the small intestine. IL-10 may play a role in inhibiting I/R injury during DHP-PMX therapy.

Polymyxin B hemoperfusion as a feasible therapy after source control in abdominal septic shock

BACKGROUND Polymyxin B hemoperfusion(PMX-HP)has been used as a treatment for intraabdominal septic shock by absorbing and removing endotoxins of gram-negative bacilli.AIM To investigate the clinical efficacy of PMX-HP in patients with gram-negative septic shock who underwent abdominal surgery.METHODS From January 2012 to December 2018,patients who had septic shock secondary to peritonitis were enrolled.They were classified into PMX-HP treated and control groups based on postopreative intervention using PMX-HP.The clinical outcomes were compared using 1:1 propensity score matching methods to balance the overall distribution between the two groups.RESULTS After propensity score matching,40 patients were analyzed(20 patients in the PMX group and 20 patients in the control group).The scores of total Sequential Organ Failure Assessment(SOFA)score,renal SOFA and coagulation SOFA were significantly improved in the PMX group but not in the control group.(from 11.2±5.8 to 4.7±3.5 in PMX group vs 10.0±4.0 to 8.7±7.3 in control group,P=0.047 from 2.6±1.0 to 0.7±1.0 in PMX group vs 2.6±1.5 to 2.8±1.6 in control group,P=0.000,from 1.6±1.5 to 1.3±1.3 in PMX group vs 1.2±1.2 to 2.8±1.8 in control group,P=0.014,respectively).Further,the length of intensive care unit(ICU)stay was significantly shorter in PMX group.However,no statistically significant difference was found in ICU mortality(50%in PMX group vs 50%in control group).CONCLUSION PMX-HP is a feasible adjunct treatment for peritonitis in ICU patients with peritonitis for improved organ impairment and to stabilize hemodynamics.It would be helpful to enhance clinical outcomes especially in patients with complete elimination of the source of gram-negative bacilli infection by surgical procedure accompanied with conventional treatment of sepsis.

Polymyxin B-immobilized fiber columns:A column to breathe new life into the treatment of interstitial lung disease?

Acute exacerbations of idiopathic pulmonary fibrosis(IPF) is a severe respiratory condition with high mortality rate. Direct hemoperfusion with polymyxin B-immobilized fiber columns(PMX-DHP) was originally introduced for the treatment of septic shock. Application of PMX-DHP to the treatment of acute exacerbations of IPF may improve oxygenation and survival of the patients with the disease. In addition to acute exacerbations of IPF, PMXDHP has been applied to acute respiratory failure fromvarious causes; an amyopathic dermatomyositis patient who developed rapidly progressive interstitial lung disease(ILD) with elevated anti-CADM-140/MDA5 autoantibody and a patient with severe amiodarone pulmonary toxicity. It is also demonstrated that PMX-DHP performed on the first day of steroid pulse therapy may improve the prognosis of patients with rapidly progressive ILDs in a case-control setting. PMX treatment decreases not only various circulating molecules but also inflammatory cells, in particular activated monocytes, producing such mediators. Although the incidence of acute exacerbations of IPF is too low for proper randomization, in order to test the effects of PMX-DHP on the disease, a cohort or casecontrol analytic study needs to be conducted, preferably from more than one center or research group.

Differential Role of Two-Component Regulatory Systems (<i>phoPQ</i>and <i>pmrAB</i>) in Polymyxin B Susceptibility of <i>Pseudomonas aeruginosa</i>

Polymyxins are often considered as a last resort to treat multidrug resistant P. aeruginosa but polymyxin resistance has been increasingly reported worldwide in clinical isolates. Polymyxin resistance in P. aeruginosa is known to be associated with alterations in either PhoQ or PmrB. In this study, mutant strains of P. aeruginosa carrying amino acid substitution, a single and/or dual inactivation of PhoQ and PmrB were constructed to further understand the roles of PhoQ and PmrB in polymyxin susceptibility. Polymyxin B resistance was caused by both inactivation and/or amino acid substitutions in PhoQ but by only amino acid substitutions of PmrB. Alterations of both PhoQ and PmrB resulted in higher levels of polymyxin B resistance than alteration of either PhoQ or PmrB alone. These results were confirmed by time-killing assays suggesting that high-level polymyxin resistance in P. aeruginosa is caused by alterations of both PhoQ and PmrB.

Polymyxin B Alleviates Angiotensin II-Induced Stress Fiber Formation and Cellular Hypertrophy

Polymyxin B is widely used antibiotic in the clinic for resistant Gram-negative infections. In addition, polymyxin B-immobilized hemoperfusion cartridge has been used for endotoxin removal therapy in patients with septic shock. The aim of this study was to investigate the anti-fibrotic and anti-cellular hypertrophic effects of polymyxin B, and further to explore its possible mechanism. Polymyxin B (3, 10 μM) significantly inhibited stress fiber formation induced by angiotensin II (Ang II) in rat heart-derived H9c2 cells. Furthermore, polymyxin B (1 - 10 μM) showed a potent inhibitory effect on Ang II-induced cellular hypertrophy in H9c2 cells. Under the mechanism study, the inhibitory activities of polymyxin B against kinases involved in cellular hypertrophy such as AKT1, CAMK, GRK5, GSK3β, MLCK, PKC, PKD2, AMPK, ROCK2, p70S6K, SGK1were evaluated. Polymyxin B possesses a potent G protein related kinase 5 (GKR5) inhibitory activity with IC50 value of 1.1 μM, and has an ATP non-competitive inhibitory mode. Taken together, these results indicate that polymyxin B alleviates Ang II-induced stress fiber formation and cellular hypertrophy, and propose that one mechanism underlying these effects involves inhibition of the GRK5 pathway.

Chinese consensus guidelines for therapeutic drug monitoring of polymyxin B,endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society

Polymyxin B,which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections,became available in China in Dec.2017.As dose adjustments are based solely on clinical experience of risk toxicity,treatment failure,and emergence of resistance,there is an urgent clinical need to perform therapeutic drug monitoring(TDM)to optimize the use of polymyxin B.It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use.We report a consensus on TDM guidelines for polymyxin B,as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society.The consensus panel was composed of clinicians,pharmacists,and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations,sample collection,reporting,and explanation of TDM results.The guidelines provide the first-ever consensus on conducting TDM of polymyxin B,and are intended to guide optimal clinical use.

多黏菌素B治疗危重症儿童多重耐药革兰阴性菌感染的疗效观察

目的:评估多黏菌素B治疗危重症儿童多重耐药革兰阴性菌感染的疗效,并探讨其影响多黏菌素B疗效的可能因素。方法:选取某院重症监护室2020年2月~2022年6月诊治的26例危重症多重耐药革兰阴性菌感染患儿,根据患者的疗效分为临床有效组(n=14)和临床无效组(n=12)。比较两组患者的性别、年龄、小儿危重病例评分、合并疾病、病原菌、治疗时间、机械通气情况以及与其他抗菌药物联用情况。对其中有意义的变量进行多因素Logistic回归分析,探讨影响多黏菌素B疗效的可能因素。结果:临床有效组与无效组的性别、年龄、小儿危重病例评分、合并疾病、病原菌以及与其他抗菌药物联用情况比较均无统计学差异(P>0.05)。临床有效组的多黏菌素B使用时间较无效组更长(P=0.000),临床无效组有更多的患儿应用机械通气(P=0.034)。Logistic回归分析果结提示治疗时间(OR:2.606,95%CI:1.346~5.046,P=0.004)是影响多黏菌素B治疗危重症儿童多重耐药革兰阴性菌感染临床疗效的可能因素。结论:多黏菌素B治疗危重症儿童多重耐药革兰阴性菌感染具有较好的治疗效果,治疗时间是影响多黏菌素临床疗效的可能因素。

硫酸多黏菌素B在两种溶媒中的含量稳定性

目的考察硫酸多黏菌素B在成品输液及高浓度储备液中的含量稳定性,为临床给药提供依据。方法建立测定硫酸多黏菌素B含量的高效液相色谱方法,将硫酸多黏菌素B分别溶于0.9%氯化钠注射液及5%葡萄糖注射液,配成0.5、1 mg·mL-1成品输液及5 mg·mL-1储备液,并在4和25℃储存条件下于0、2、4、6、8、12、16、20及24 h测定多黏菌素B含量。结果4和25℃储存条件下,0.5、1 mg·mL-1硫酸多黏菌素B成品输液和5 mg·mL-1硫酸多黏菌素B储备液均稳定,多黏菌素B1和多黏菌素B2含量和0 h(以100%计)比较,分别在97.23%~102.63%和97.30%~102.63%范围内。结论硫酸多黏菌素B溶于0.9%氯化钠注射液及5%葡萄糖注射液,0.5、1和5 mg·mL-1溶液在4和25℃储存,24 h内稳定性良好。

替加环素和多黏菌素B治疗重症患者耐碳青霉烯类肠杆菌科细菌肺炎的疗效和安全性分析

目的:比较替加环素和多黏菌素B治疗重症患者耐碳青霉烯类肠杆菌科细菌(CRE)肺炎的疗效和安全性。方法:回顾性分析2018年1月1日至2023年6月30日于我院重症医学科(ICU)接受替加环素或多黏菌素B治疗的CRE肺炎患者的临床资料。主要结局包括28 d全因病死率和28 d临床治愈率。次要结局包括ICU病死率、住院病死率、住院时间、ICU住院时间、微生物清除率、机械通气时间。采用Cox回归分析检验影响28 d临床治愈率的独立预测因素。结果:倾向性评分匹配后纳入83名患者,其中替加环素组54例,多黏菌素B组29例。替加环素组28 d全因病死率为31.5%(17/54),多黏菌素B组为37.9%(11/29),差异无统计学意义(P=0.554);替加环素组28 d临床治愈率为63%(34/54),显著高于多黏菌素B组的34.5%(10/29)(P=0.013)。两组的次要结局指标均无统计学差异。多因素回归分析发现,使用替加环素是28 d临床治疗有效的独立预测因素(HR:2.083,95%CI 1.018-4.263,P=0.045)。但替加环素组用药后活化部分凝血活酶时间、凝血酶原时间较多黏菌素B组显著延长(P=0.047;P=0.027),纤维蛋白原显著下降(P<0.001)。结论:替加环素组和多黏菌素组28 d全因病死率无显著差异;与多黏菌素B相比,替加环素可能与更高的28 d临床治愈率相关。同时需注意,替加环素可能增加凝血功能异常的风险。

TAO联合rh-bFGF凝胶对深Ⅱ度烧伤患者症状消失时间及炎症因子的影响

目的探讨复方多粘菌素B软膏(TAO)联合重组牛碱性成纤维细胞生长因子(rh-bFGF)凝胶治疗深Ⅱ度烧伤患者的疗效。方法选取2022年1-11月该院收治的深Ⅱ度烧伤患者60例,采用随机数字表法分观察组和对照组,每组30例。对照组给予TAO治疗,观察组加用rh-bFGF凝胶治疗。对比2组患者临床疗效、症状消失时间、创面愈合时间、换药疼痛、炎症因子、并发症发生率及生活质量。结果观察组患者总有效率明显高于对照组的,并发症发生率明显低于对照组,中、重度疼痛程度明显低于对照组,肿胀消失时间、红斑消失时间、渗液消失时间、水疱消失时间、疼痛消失时间、创面愈合时间均明显短于对照组,差异均有统计学意义(P<0.05)。2组治疗前炎症因子、生活质量比较,差异均无统计学意义(P>0.05);观察组患者治疗后降钙素原、C反应蛋白水平均明显低于对照组,精简烧伤健康量表中的基本生活能力维度、手功能维度、情感维度、人际关系维度、性生活维度、体热维度、热敏感维度、配合治疗维度、工作维度评分均明显高于对照组,差异均有统计学意义(P<0.05)。结论TAO联合rh-bFGF凝胶治疗深Ⅱ度烧伤患者中疗效显著,能加快症状消失及创面愈合,减轻换药疼痛与炎症反应,降低并发症发生率,提高患者生活质量。

芬戈莫德增效多粘菌素B抗铜绿假单胞菌活性的发现

耐碳青霉烯类铜绿假单胞菌(Carbapenem resistant Pseudomonas aeruginosa,CRPA)已被世界卫生组织列为迫切需要开发新抗生素的最优先级关键性病原体之一[1]。多粘菌素B(PolymyxinB,PB)对包括CRPA在内的耐药革兰阴性菌具有良好的抗菌效果,被认为是治疗其感染的“最后一道防线”[1]。然而,PB的毒性及临床上出现的多粘菌素耐药是阻碍其临床应用的两个重要因素[2]。开发新的替代PB的抗生素是解决上述问题最有效的方式,但周期较长且成功率极低,而开发其增效剂则是一种很好的替代方案[3]。本研究通过对已知靶点化合物库的筛选发现芬戈莫德可增强PB的抗PA活性,具有与PB形成联合用药方案的潜能。芬戈莫德(Fingolimod)的中文化学名称:2-氨基-2-[2-(4-辛烷基苯基)乙基]-1,3-丙二醇,分子式为C19H33NO2,分子量为307.5[4]。

银离子敷料联合复方多粘菌素B软膏治疗深Ⅱ度烧伤感染性创面的疗效观察

目的:探讨银离子敷料联合复方多粘菌素B软膏治疗深Ⅱ度烧伤感染性创面的疗效。方法:选取149例深Ⅱ度烧伤感染性创面患者,依照乱数表法分为观察组(n=75例)和对照组(n=74例),对照组给予复方多粘菌素B软膏治疗,观察组在对照组基础上加用银离子敷料治疗。统计比较两组创面恢复相关指标、创面疼痛程度、血清炎性因子和疼痛介质水平、临床疗效及瘢痕情况。结果:治疗后,观察组感染控制时间、住院时间、创面愈合时间均短于对照组(P<0.05),治疗21 d后的创面愈合率高于对照组(P<0.05)。观察组治疗后各时间点疼痛评分均低于对照组(P<0.05);治疗21 d后,观察组血清C反应蛋白、白介素-6、神经肽Y、前列腺素E2水平均低于对照组(P<0.05),创面愈合总有效率高于对照组(P<0.05);创面愈合后6个月,观察组温哥华瘢痕量表各评分及总分均低于对照组(P<0.05)。结论:银离子敷料联合复方多粘菌素B软膏治疗深Ⅱ度烧伤感染性创面能促进创面愈合,减轻创面疼痛程度,并能有效抑制血清炎性因子、疼痛介质水平,减轻创面瘢痕程度,提升创面美学效果。

多黏菌素B和米诺环素对鲍曼不动杆菌的体外抗菌活性检验研究

目的 探究多黏菌素B和米诺环素对鲍曼不动杆菌的体外抗菌活性。方法 择取2021年1月至2023年1月本院80例鲍曼不动杆菌感染患者深入分析,均采用多黏菌素B、米诺环素检验鲍曼不动杆菌,分析体外抗菌活性。结果 鲍曼不动杆菌产酶类型有产金属β内酰胺酶(MBLs)、质粒型AmpC酶、诱导型AmpC酶。鲍曼不动杆菌产MBLs阳性例数为75例,阳性率为93.75%;产质粒型AmpC酶阳性例数为35例,阳性率为43.75%;产诱导型AmpC酶阳性例数为30例,阳性率为37.50%。多黏菌素B产MBLs型、产质粒型AmpC型、产诱导型AmpC酶鲍曼不动杆菌最低抑菌浓度(MIC)范围、MIC50、MIC90低于米诺环素,抑菌率较米诺环素高(P<0.05)。结论 在对鲍曼不动杆菌检测时,多黏菌素B与米诺环素相比,米诺环素活性更强。

复方多黏菌素B软膏联合点阵激光治疗痤疮瘢痕的效果

目的分析复方多黏菌素B软膏联合点阵激光治疗痤疮瘢痕的效果及安全性。方法以随机数字表法将晋江市医院晋南分院2022年1—12月收治的70例痤疮瘢痕患者分为2组,各35例。对照组采用点阵激光治疗,研究组采用复方多黏菌素B软膏联合点阵激光治疗。治疗3个月后,对比2组疗效、痤疮瘢痕权重评分(echelle d'evaluation clinique des cicatrices d'acne,ECCA)、皮肤状态变化、炎症因子、蠕形螨虫阳性率、不良反应及痤疮复发率。结果研究组总有效率为97.14%,高于对照组的80.00%(P<0.05);研究组ECCA评分低于对照组,痂皮脱落时间、红肿及疼痛消失时间均短于对照组,蠕形螨虫阳性率、痤疮复发率低于对照组(P<0.05);研究组干扰素γ(interferon-γ,IFN-γ)高于对照组,白介素-4(interleukin-4,IL-4)、可溶性白介素-2受体(soluble interleukin-2 receptor,SIL-2R)低于对照组(P<0.05);2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论点阵激光联合复方多黏菌素B软膏治疗痤疮瘢痕效果确切,能减轻炎症损伤,加快痂皮脱落,缓解红肿及疼痛,降低螨虫阳性率及痤疮复发率。

多黏菌素B负荷剂量对肾功能影响的临床回顾性研究

目的探讨多黏菌素B负荷剂量对肾功能影响。方法回顾性分析2019年1月1日至2021年4月17日,南昌大学一附院使用注射用硫酸多黏菌素B治疗的患者共469例,根据使用剂量的不同分为未使用负荷剂量组133例(A组),使用负荷剂量组336例(B组)。比较两组患者用药前后肾功能变化、合用肾毒性药物、联用其他抗菌药物以及急性肾损伤的发生情况,分析其相关性。结果B组的肌酐异常率为24.78%,A组的为19.35%(P>0.05),B组的尿素氮异常率为30.21%,A组的为19.57%(P>0.05),两组比较差异均无统计学意义。而联用肾毒性药物(P=0.043,OR=0.317)为发生急性肾损伤的独立危险因素。结论本研究中多黏菌素B负荷剂量的使用对肾功能并无影响,且即使超负荷剂量也不会提高急性肾损伤的发生率,所以进一步证明无需根据不同程度肾功能进行剂量调整,但当与肾毒性药物联用时需警惕急性肾损伤的发生。