BACKGROUND Resistance to clarithromycin(CLA)and levofloxacin(LFX)of Helicobacter pylori(H.pylori)is increasing in severity,and successful eradication is essential.Presently,the eradication success rate has greatly dec...BACKGROUND Resistance to clarithromycin(CLA)and levofloxacin(LFX)of Helicobacter pylori(H.pylori)is increasing in severity,and successful eradication is essential.Presently,the eradication success rate has greatly declined,leaving a large number of patients with previous treatment histories.AIM To investigate secondary resistance rates,explore risk factors for antibiotic resistance,and assess the efficacy of susceptibility-guided therapy.METHODS We recruited 154 subjects positive for Urea Breath Test who attended The First Affiliated Hospital of China Medical University between July 2022 and April 2023.Participants underwent a string test after an overnight fast.The gastric juice was obtained and transferred to vials containing storage solution.Subsequently,DNA extraction and the specific DNA amplification were performed using quantitative polymerase chain reaction(qPCR).Demographic information was also analyzed as part of the study.Based on these results,the participants were administered susceptibility-guided treatment.Efficacy was compared with that of the empiric treatment group.RESULTS A total of 132 individuals tested positive for the H.pylori ureA gene by qPCR technique.CLA resistance rate reached a high level of 82.6%(n=109),LFX resistance rate was 69.7%(n=92)and dual resistance was 62.1%(n=82).Gastric symptoms[odds ratio(OR)=2.782;95%confidence interval(95%CI):1.076-7.194;P=0.035]and rural residence(OR=5.152;95%CI:1.407-18.861;P=0.013)were independent risk factors for secondary resistance to CLA and LFX,respectively.A total of 102 and 100 individuals received susceptibility-guided therapies and empiric treatment,respectively.The antibiotic susceptibility-guided treatment and empiric treatment groups achieved successful eradication rates of 75.5%(77/102)and 59.0%(59/411)by the intention-to-treat(ITT)analysis and 90.6%(77/85)and 70.2%(59/84)by the per-protocol(PP)analysis,respectively.The eradication rates of these two treatment strategies were significantly different in both ITT(P=0.001)and PP(P=0.012)analyses.CONCLUSION H.pylori presented high secondary resistance rates to CLA and LFX.For patients with previous treatment failures,treatments should be guided by antibiotic susceptibility tests or regional antibiotic resistance profile.展开更多
Corrugated surface microparticles comprising levofloxacin(LEV),chitosan and organic acid were prepared using the 3-combo spray drying method.The amount and the boiling point of the organic acid affected the degree of ...Corrugated surface microparticles comprising levofloxacin(LEV),chitosan and organic acid were prepared using the 3-combo spray drying method.The amount and the boiling point of the organic acid affected the degree of roughness.In this study,we tried to improve the aerodynamic performance and increase aerosolization by corrugated surface microparticle for lung drug delivery efficiency as dry powder inhaler.HMP175 L20 prepared with 175 mmol propionic acid solution was corrugated more than HMF175 L20 prepared with 175 mmol formic acid solution.The ACI and PIV results showed a significant increase in aerodynamic performance of corrugated microparticles.The FPF value of HMP175 L20 was 41.3%±3.9%compared with 25.6%±7.7%of HMF175 L20.Corrugated microparticles also showed better aerosolization,decreased x-axial velocity,and variable angle.Rapid dissolution of drug formulationswas observed in vivo.Lowdoses administered to the lungs achieved higher LEV concentrations in the lung fluid than high doses administered orally.Surface modification in the polymer-based formulation was achieved by controlling the evaporation rate and improving the inhalation efficiency of DPIs.展开更多
目的:探讨重组人粒细胞集落刺激因子(G-CSF)联合左氧氟沙星或仅用G-CSF支持疗法在预防自体造血干细胞移植感染中的作用,分析移植患者住院时间、住院费用及移植后生存情况。方法:回顾性分析2012年1月至2022年7月于本院就诊的接受自体造...目的:探讨重组人粒细胞集落刺激因子(G-CSF)联合左氧氟沙星或仅用G-CSF支持疗法在预防自体造血干细胞移植感染中的作用,分析移植患者住院时间、住院费用及移植后生存情况。方法:回顾性分析2012年1月至2022年7月于本院就诊的接受自体造血干细胞移植的恶性血液病患者,观察自体造血干细胞移植期间左氧氟沙星+G-CSF预防感染组和G-CSF支持组中性粒细胞缺乏伴发热、细菌感染发生率及静脉抗菌药物使用情况,并比较两组住院时间、住院期间总费用及移植90天后存活情况。结果:102例患者纳入研究,其中多发性骨髓瘤54例,急性白血病36例,淋巴瘤7例,骨髓增生异常综合征3例,轻链型淀粉样变性1例,POEMS综合征1例。47例接受G-CSF+左氧氟沙星预防感染,55例接受G-CSF支持治疗。左氧氟沙星+G-CSF组中40例(85.11%)发生中性粒细胞缺乏伴发热,13例(27.66%)明确为细菌感染。G-CSF组中44例(80.00%)发生中性粒细胞缺乏伴发热,16例(29.09%)细菌感染。两组中性粒细胞缺乏伴发热和细菌感染发生率均无统计学差异(χ^(2)=0.46,P=0.50;χ^(2)=0.03,P=0.87)。左氧氟沙星+G-CSF组静脉抗菌药物使用率为85.11%(40/47),与G-CSF组的85.45%(47/55)比较无统计学差异(χ^(2)=0.04,P=0.84)。左氧氟沙星+G-CSF组与G-CSF组左氧氟沙星耐药菌的检出率分别为8.57%(3/35)和21.43%(6/28),无统计学差异(χ^(2)=0.65,P>0.05)。左氧氟沙星+G-CSF与G-CSF组患者住院中位时间为25 d vs 22 d,住院中位费用为78216.24元vs 80724.38元,差异均无统计学意义(t=3.00,P=0.09;t=0.94,P=0.09)。移植后90天内,左氧氟沙星+G-CSF组有2例(4.26%)死亡,G-CSF组有1例(1.82%)死亡,两组比较无统计学差异(χ^(2)=0.53,P=0.47)。结论:较G-CSF支持相比,患者在自体造血干细胞移植期间应用G-CSF+左氧氟沙星预防感染无明显获益。展开更多
基金The study was reviewed and approved by the the Human Ethics Review Committee of the First Affiliated Hospital of China Medical University(Approval No.2021325).
文摘BACKGROUND Resistance to clarithromycin(CLA)and levofloxacin(LFX)of Helicobacter pylori(H.pylori)is increasing in severity,and successful eradication is essential.Presently,the eradication success rate has greatly declined,leaving a large number of patients with previous treatment histories.AIM To investigate secondary resistance rates,explore risk factors for antibiotic resistance,and assess the efficacy of susceptibility-guided therapy.METHODS We recruited 154 subjects positive for Urea Breath Test who attended The First Affiliated Hospital of China Medical University between July 2022 and April 2023.Participants underwent a string test after an overnight fast.The gastric juice was obtained and transferred to vials containing storage solution.Subsequently,DNA extraction and the specific DNA amplification were performed using quantitative polymerase chain reaction(qPCR).Demographic information was also analyzed as part of the study.Based on these results,the participants were administered susceptibility-guided treatment.Efficacy was compared with that of the empiric treatment group.RESULTS A total of 132 individuals tested positive for the H.pylori ureA gene by qPCR technique.CLA resistance rate reached a high level of 82.6%(n=109),LFX resistance rate was 69.7%(n=92)and dual resistance was 62.1%(n=82).Gastric symptoms[odds ratio(OR)=2.782;95%confidence interval(95%CI):1.076-7.194;P=0.035]and rural residence(OR=5.152;95%CI:1.407-18.861;P=0.013)were independent risk factors for secondary resistance to CLA and LFX,respectively.A total of 102 and 100 individuals received susceptibility-guided therapies and empiric treatment,respectively.The antibiotic susceptibility-guided treatment and empiric treatment groups achieved successful eradication rates of 75.5%(77/102)and 59.0%(59/411)by the intention-to-treat(ITT)analysis and 90.6%(77/85)and 70.2%(59/84)by the per-protocol(PP)analysis,respectively.The eradication rates of these two treatment strategies were significantly different in both ITT(P=0.001)and PP(P=0.012)analyses.CONCLUSION H.pylori presented high secondary resistance rates to CLA and LFX.For patients with previous treatment failures,treatments should be guided by antibiotic susceptibility tests or regional antibiotic resistance profile.
基金supported by a National Research Foundation of Korea grant provided by the Korean government(NRF-2021R1A2C4002746 and 2017R1A5A2015541)This research was supported by"Regional Innovation Strategy(RIS)"through the National Research Foundation of Korea(NRF)funded by the Ministry of Education(MOE)(2021RIS-001)Finally,this work was supported by a funding for the academic research program of Chungbuk National University in 2022.
文摘Corrugated surface microparticles comprising levofloxacin(LEV),chitosan and organic acid were prepared using the 3-combo spray drying method.The amount and the boiling point of the organic acid affected the degree of roughness.In this study,we tried to improve the aerodynamic performance and increase aerosolization by corrugated surface microparticle for lung drug delivery efficiency as dry powder inhaler.HMP175 L20 prepared with 175 mmol propionic acid solution was corrugated more than HMF175 L20 prepared with 175 mmol formic acid solution.The ACI and PIV results showed a significant increase in aerodynamic performance of corrugated microparticles.The FPF value of HMP175 L20 was 41.3%±3.9%compared with 25.6%±7.7%of HMF175 L20.Corrugated microparticles also showed better aerosolization,decreased x-axial velocity,and variable angle.Rapid dissolution of drug formulationswas observed in vivo.Lowdoses administered to the lungs achieved higher LEV concentrations in the lung fluid than high doses administered orally.Surface modification in the polymer-based formulation was achieved by controlling the evaporation rate and improving the inhalation efficiency of DPIs.
文摘目的:探讨重组人粒细胞集落刺激因子(G-CSF)联合左氧氟沙星或仅用G-CSF支持疗法在预防自体造血干细胞移植感染中的作用,分析移植患者住院时间、住院费用及移植后生存情况。方法:回顾性分析2012年1月至2022年7月于本院就诊的接受自体造血干细胞移植的恶性血液病患者,观察自体造血干细胞移植期间左氧氟沙星+G-CSF预防感染组和G-CSF支持组中性粒细胞缺乏伴发热、细菌感染发生率及静脉抗菌药物使用情况,并比较两组住院时间、住院期间总费用及移植90天后存活情况。结果:102例患者纳入研究,其中多发性骨髓瘤54例,急性白血病36例,淋巴瘤7例,骨髓增生异常综合征3例,轻链型淀粉样变性1例,POEMS综合征1例。47例接受G-CSF+左氧氟沙星预防感染,55例接受G-CSF支持治疗。左氧氟沙星+G-CSF组中40例(85.11%)发生中性粒细胞缺乏伴发热,13例(27.66%)明确为细菌感染。G-CSF组中44例(80.00%)发生中性粒细胞缺乏伴发热,16例(29.09%)细菌感染。两组中性粒细胞缺乏伴发热和细菌感染发生率均无统计学差异(χ^(2)=0.46,P=0.50;χ^(2)=0.03,P=0.87)。左氧氟沙星+G-CSF组静脉抗菌药物使用率为85.11%(40/47),与G-CSF组的85.45%(47/55)比较无统计学差异(χ^(2)=0.04,P=0.84)。左氧氟沙星+G-CSF组与G-CSF组左氧氟沙星耐药菌的检出率分别为8.57%(3/35)和21.43%(6/28),无统计学差异(χ^(2)=0.65,P>0.05)。左氧氟沙星+G-CSF与G-CSF组患者住院中位时间为25 d vs 22 d,住院中位费用为78216.24元vs 80724.38元,差异均无统计学意义(t=3.00,P=0.09;t=0.94,P=0.09)。移植后90天内,左氧氟沙星+G-CSF组有2例(4.26%)死亡,G-CSF组有1例(1.82%)死亡,两组比较无统计学差异(χ^(2)=0.53,P=0.47)。结论:较G-CSF支持相比,患者在自体造血干细胞移植期间应用G-CSF+左氧氟沙星预防感染无明显获益。
