Treatment of methicillin-resistant Staphylococcus aureus infections:Importance of high vancomycin minumum inhibitory concentrations

Staphylococcus aureus(SA) infections remain a major cause of morbidity and mortality despite the availability of numerous effective anti-staphylococcal antibiotics.This organism is responsible for both nosocomial and community-acquired infections ranging from relatively minor skin and soft tissue infections to life-threateningsystemic infections.The increasing incidence of methicillin-resistant strains has granted an increasing use of vancomycin causing a covert progressive increase of its minimum inhibitory concentration(MIC)(dubbed the MIC "creep").In this way,the emergence of vancomycinintermediate SA(VISA) strains and heteroresistantVISA has raised concern for the scarcity of alternative treatment options.Equally alarming,though fortunately less frequent,is the emergence of vancomycin-resistant SA.These strains show different mechanisms of resistance but have similar problems in terms of therapeutic approach.Ultimately,various debate issues have arisen regarding the emergence of SA strains with a minimum inhibitory concentration sitting on the superior limit of the sensitivity range(i.e.,MIC = 2 μg/mL).These strains have shown certain resilience to vancomycin and a different clinical behaviour regardless of vancomycin use,both in methicillin-resistant SA and in methicillin-sensitive SA.The aim of this text is to revise the clinical impact and consequences of the emergence of reduced vancomycin susceptibility SA strains,and the different optimal treatment options known.

Emergence of vancomycin-intermediate resistant Staphylococcus aureus in north of Palestine

Objective:This study was conducted to update the prevalence of methicillin-resistant Staphylococcus aureus(MRSA) isolates among human clinical S.aureus isolates recovered from Northern Palestine,to evaluate the possible presence of vancomycin-Resistant S.aureus(VRSA) and vancomycin- intermediate resistant S.aureus strains(VISA) and to determine the antimicrobial susceptibilities of these clinical isolates.Methods:The in vitro activities of 11 antibiotics against 204 non-duplicate S.aureus isolates from clinical samples in North of Palestine were determined by the diskdiffusion method.These samples were isolated between June 2006 and December 2007.The minimum inhibitory concentration (MIC) of vancomycin for 115 methicillin resistant Staphylococcus aureus(MRSA) strains was carried out using the agar dilution method.Results:One hundred and fifteen(56.4%) of these isolates were MRSA and according to their antibiotic profile these are multidrug resistant(resistant to three or more non-p-lactam antibiotics). Ninety nine(43.6%) isolates were methicillin sensitive S.aureus(MSSA),forty four of MSSA isolates(44.4%) were multidrug resistant,while forty five(45.6%) were non multidrug resistant.Our results showed that the most common resistance(95.6%) was to penicillin.Two strains of MRSA have shown to be vancomycin- intermediate resistant,had MIC of 4μg/rnL and 8μg/mL and these vancomycin- intermediate resistant S.aureus strains(VISA) are resistant to all antibiotics tested.Conclusion:According to our information this is the first study report about VISA in Palestine.

Co-Habitation of <i>Staphylococcus lugdunensis</i>with <i>Staphylococcus aureus</i>Resistant to Methicillin and Vancomycin in the Nasal Snares of Laboratory Rats

The public health problem created by multidrug resistant bacteria in the 21st century continues to receive attention by researchers all over the world. As the production of new antibiotics is not commeasurable with the rate of evolvement of MDR bacteria, the news of a proposed new antibiotic “Lugdunin” is much awaited and a welcomed development. Lugdunin is produced by Staphylococcus lugdunensis and has the ability to kill S. aureus. Both bacteria are nasal colonizers. The present investigation looks into the antibiotic susceptibility pattern of co-habitation of S. lugdunensis with methicillin and vancomycin resistant Staphylococcus aureus in laboratory bred Wister rats. Nasal swabs of anaesthetized rats were collected using a sterile cotton swab moistened in 0.9% saline solution. All swabs were inoculated into nutrient broth, cultured at 37°C for 24 hrs. Overnight bacterial growth plated on blood agar and incubated at 37°C for 24 hrs. Organism identification and antibiotic susceptibility test were by using BioMerieux VITEK 2 compact automated system (BioMerieux, Marcy I’Etoile France), according to the manufacturers guidelines. Results obtained showed co-habitation of S. aureus with co-agulase negative bacteria, inclusive of S. lugdunensis. All the isolates were resistant to methicillin with a 33.3% resistance to vancomycin. The difference between the number of antibiotic resistant or sensitive varied statistically among the Staphylococcal isolates. For S. aureus 1, the difference was significant with p-value 0.034 but not significant for isolates 2, 3 and 4 with p-values of 0.158, 0.477 and 0.158 respectively. A statistically significant difference was seen with S. lugdunensis. The result from the study therefore, showed that the colonization of the nasal snares of the laboratory bred rats with S. aureus and other co-agulase negative Staphylococci was not affected by the presence of S. lugdunensis.

Methicillin-Resistant Staphylococcus aureus May Also Be Resistant to Clindamycin and Vancomycin

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a global superbug widely distributed in hospitals, communities and livestock settings. This study investigated the presence and molecular characterization of MRSA co-resistance to clindamycin and vancomycin in the southeastern region of Nigeria. The susceptibility of these organisms to other selected antibiotics was also investigated. Method: Biological samples were obtained from consenting patients from three establishments in Enugu, Nigeria and cultured for isolation and purification. The pure isolates were subjected to antimicrobial susceptibility profiling using conventional antibiotics. The genomic DNAs of the pure isolates were isolated using the Promega genomic DNA purification kit while the antibiotic resistance genes (mecA) genes were identified using a multiplex polymerase chain reaction. Also, the minimum inhibitory concentration of the clindamycin and vancomycin antibiotics was determined as well as their combined activity on the MRSA isolates. Results: A large proportion (71%) of the MRSA isolates was from urine samples and then from the High Vaginal Swab (19%). All the isolates were resistant to cloxacillin while 95% were resistant to ciprofloxacin. MRSA isolates demonstrated resistance to clindamycin (with MIC of 23.44 - 250 μg/ml) and to vancomycin (with MIC of 62.5 - 250 μg/ml). The isolated MRSA also demonstrated multidrug-resistant traits. The combined effects of vancomycin and clindamycin against different species of MRSA exhibited additive, antagonistic and indifferent effects and none had a synergistic effect. Multiplex Polymerase Chain Reaction revealed that the majority of the strains were positive for the 162-bp internal fragment of the mecA gene of MRSA and basically displayed SCCmec type III, indicating that they were multidrug-resistant and hospital-acquired. Conclusion: Clindamycin and vancomycin-resistant MRSA infections are also within the Eastern region of Nigeria as found in other countries of the world. This superbug, therefore, may require drastic and urgent measures to curtail its spread and attendant healthcare challenges like outbreaks of infections. In addition, strict adherence to antibiotic policy and continuous surveillance is highly advocated.

Linezolid versus Vancomycin for the Treatment of Methicillin-Resistant <i>Staphylococcus aureus</i>in Hospital-Acquired, Ventilator-Associated, and Healthcare-Associated Pneumonia at Tertiary Care Hospital

Aim: To evaluate morbidity and mortality rate, clinical cure rate and cost of linezolid versus vancomycin in patients who have hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP) or Healthcare-associated pneumonia (HCAP) caused by methicillin-resistant Staphylococcus aureus (MRSA). Methods: Retrospective analysis data. Data were collected for adult patients admitted to King Faisal Specialist Hospital and Research Centre-Jeddah (KFSH & RC-J) from January 2010 to May 2015. Method: A total of 88 patients with HAP, VAP and HCAP caused by MRSA treated with vancomycin (IV) or linezolid (IV or PO) either as empirically or directed therapy ≥ 7 days. They are retrospectively evaluated and analyzed. The primary end points are morbidity and mortality rate as well as clinical cure rate. The secondary end point is the cost analysis for each medication. Results: A total of 40 patients (ICU, n = 13 (32.5% and non ICU, n = 27 (67.5%)) were included in the study. Among vancomycin, n = 21 (52.5%);age (54.95 ± 18.255) and linezolid, n = 19 (74.5%);age (48.684 ± 25.593), there was no statistical differences in mortality and morbidity rate (P = 0.375). Clinical cure rate (fever improvement, 12 (57.1%) vs 12 (63.2%);P = 0.698, leukocytosis improvement, 15 (71.4%) vs 14 (73.7%);P = 0.873, purulent sputum improvement, 6 (28.6%) vs 4 (21.1%);P = 0.429, dyspnea improvement, 8 (38.1%) vs 3 (15.8%);P = 0.115,cough improvement 4 (19.0%) vs 4 (21.1%);P = 0.592, microbiological eradication of MRSA from sputum culture, 2 (9.5%) vs 6 (31.6%);P = 0.089 and improvement of radiographic finding (pulmonary infiltration), 17 (81.0%) vs 16 (84.2%);P = 0.559) of vancomycin vs linezolid, respectively. The cost analysis in the treatment of MRSA pneumonia with linezolid is statistical significantly higher than vancomycin. The mean cost of vancomycin = 185.9143 SR and of linezolid = 4547.3684 SR (P Conclusion: There are no statistical differences in mortality and morbidity rate and clinical cure rate between linezolid and vancomycin in the treatment of MRSA in HAP, VAP, and HCAP. However, the cost of linezlid is significantly higher than vancomycin during the treatment period of one patient.

Effect of Photoactivated Hypericin on Growth and Antibiotic Susceptibility of Hospital-Related Staphylococcus aureus and Enterococcus sp. Clinical Strains

Resistance against commonly used antibiotics is a serious clinical problem in recent medical practice. There exist several bacterial strains in which the possibilities of their inhibition are very limited due to multidrug resistance. Antimicrobial photodynamic therapy (aPDT) represents an option how to effectively suppress the growth of resistant pathogens. In this work we have studied interactions of potent photosensitizer hypericin (Hyp) with hospital-related gram positive (Gram+) and gram negative (Gram-) bacterial strains and the effects of photodynamic activated Hyp on bacterial susceptibility and/or resistance of these strains to antibiotics. We demonstrated a significant influence of photoactivated Hyp on growth of Staphylococcus aureus and Enterococcus sp. We have also shown that it is extremely important to use the effective concentrations of Hyp for aPDT, which completely inhibit the growth of microorganisms. Otherwise, there appears an increase in resistance, probably due to the activation of efflux mechanisms, which are involved in the efflux of Hyp and antibiotics as well.

MRSA血流感染患者万古霉素相关肾毒性预测模型构建

目的构建耐甲氧西林金黄色葡萄球菌(MRSA)血流感染患者万古霉素相关肾毒性预测模型。方法回顾性分析2019年1月至2023年1月天津医科大学总医院收治的128例接受万古霉素治疗的MRSA血流感染患者临床资料。其中男66例,女62例;年龄(61.47±10.25)岁。根据患者是否发生万古霉素相关急性肾损伤(AKI)分为AKI组(32例)和非AKI组(96例),比较两组患者性别、年龄、体质量指数(BMI)、休克、白细胞计数(WBC)、降钙素原、超敏C反应蛋白(hs-CRP)、序贯器官功能衰竭评估(SOFA)评分、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、合并基础病(糖尿病、高血压、冠心病)、血肌酐、使用非甾体抗炎药、使用氨基糖苷类药物、使用血管活性药物、使用肾毒性药物数量、肾小球率滤过率(GFR)、治疗剂量、给药间隔、治疗时间、累积剂量、万古霉素曲线下面积(AUC)等资料。采用logistic回归方程分析MRSA血流感染患者万古霉素相关肾毒性的危险因素。基于危险因素构建万古霉素相关肾毒性的风险列线图模型,并对构建的模型进行验证及预测效能评估。采用独立样本t检验、Mann-Whitney U检验、χ^(2)检验、Hosmer-Lemeshow检验。结果AKI组年龄、血肌酐水平、万古霉素AUC及使用肾毒性药物数量≥2个、GFR≤60 ml/min占比均高于非AKI组(均P<0.05)。logistic回归分析结果显示,年龄≥60岁、血肌酐≥95.42µmol/L、使用肾毒性药物数量≥2个、GFR≤60 ml/min、万古霉素AUC≥30 g/L均是影响接受万古霉素治疗的MRSA血流感染患者发生AKI的独立危险因素(均P<0.05)。Hosmer-Lemeshow拟合优度检验结果显示,列线图模型预测接受万古霉素治疗的MRSA血流感染患者发生AKI风险的一致性良好(χ^(2)=3.571,P=0.672)。Bootstrap法内部验证结果显示,列线图预测模型C指数为0.785(95%CI 0.678~0.889),表明该模型具有较好的区分度。受试者操作特征曲线(ROC)结果显示,列线图风险模型预测接受万古霉素治疗的MRSA血流感染患者发生AKI的AUC(95%CI)、灵敏度、特异度分别为0.859(0.618~0.979)、94.50%、78.30%(均P<0.001)。结论年龄≥60岁、血肌酐≥95.42µmol/L、使用肾毒性药物数量≥2个、GFR≤60 ml/min、万古霉素AUC≥30 g/L均是影响接受万古霉素治疗的MRSA血流感染患者发生AKI的独立危险因素。基于上述危险因素构建的风险列线图模型对接受万古霉素治疗的MRSA血流感染患者发生AKI具有较高的预测价值。

氯己定擦浴预防ICU病人多重耐药菌感染效果的Meta分析

目的:系统评价氯己定全身擦浴对重症监护室(ICU)病人多重耐药菌感染的预防效果。方法:检索the Cochrane Library、PubMed、Web of Science、EMbase、中国知网、万方数据库、维普数据库、中国生物医学文献数据库中关于氯己定全身擦浴预防ICU病人多重耐药菌感染效果的中英文文献。由2名研究者根据纳入与排除标准独立筛选文献、质量评价及提取资料,采用Stata 16.0软件进行Meta分析。结果:最终纳入11项研究共23090例病人。Meta分析结果显示,与常规温水或肥皂水擦浴比较,氯己定能降低ICU病人多重耐药菌感染(OR=0.770,P<0.001)。其中氯己定全身擦浴能降低耐万古霉素肠球菌(VRE)(OR=0.664,P=0.004)及耐碳青霉烯类铜绿假单胞菌(CRPA)(OR=0.442,P=0.034)的感染发生风险,但不能降低耐甲氧西林金黄色葡萄球菌(MRSA)(OR=0.852,P=0.193)及耐碳青霉烯类鲍曼不动杆菌(CRAB)的感染发生风险(OR=0.888,P=0.537)。结论:现有证据显示,氯己定全身擦浴能降低ICU病人多重耐药菌感染,但仅对部分耐药菌有效。

万古霉素联合骨搬移术治疗MRSA感染胫骨创伤性骨髓炎的效果及对血清TLR4、TNF-α和PCT水平的影响

目的:探讨万古霉素联合骨搬移术治疗耐甲氧西林金黄色葡萄球菌(MRSA)感染胫骨创伤性骨髓炎的效果及对血清Toll样受体4(TLR4)、肿瘤坏死因子α(TNF-α)和降钙素原(PCT)水平的影响。方法:选取2020年4月至2022年4月中南大学湘雅医学院附属海口市人民医院收治的MRSA感染胫骨创伤性骨髓炎患者120例,利用计算机生成的随机数列分为对照组、观察一组和观察二组,每组40例。对照组患者采用常规手术治疗,观察一组患者采用骨搬移术治疗,观察二组患者采用万古霉素联合骨搬移术治疗。比较三组患者血清TLR4、TNF-α和PCT水平,观察两组患者的临床疗效、MRSA清除率、炎症指标[白细胞计数(WBC)、血清C反应蛋白(CRP)和白细胞介素6(IL-6)]及血液流变学指标(血浆黏度、全血黏度、纤维蛋白原、红细胞压积、红细胞沉降率和红细胞聚集指数)水平。结果:治疗2周后,观察二组患者TLR4、TNF-α和PCT水平低于对照组、观察一组,差异均有统计学意义(P<0.05)。治疗2周后,观察二组患者的总有效率、MRSA清除率分别为92.50%(37/40)、90.00%(36/40),高于对照组[80.00%(32/40)、75.00%(30/40)]和观察一组[85.00%(34/40)、80.00%(32/40)],差异均有统计学意义(P<0.05)。治疗2周后,观察二组患者WBC、CRP和IL-6水平,血浆黏度、全血黏度、纤维蛋白原、红细胞压积和红细胞沉降率低于对照组和观察一组,红细胞聚集指数高于对照组和观察一组,差异均有统计学意义(P<0.05)。结论:万古霉素联合骨搬移术治疗MRSA感染胫骨创伤性骨髓炎的疗效较好,能有效抑制患者血清TLR4、TNF-α和PCT水平的升高。

Incidence and risk factors for potentially suboptimal serum concentrations of vancomycin during cardiac surgery

AIM To investigate the incidence and risk factors for vancomycin concentrations less than 10 mg/L during cardiac surgery.METHODS In this prospective study, patients undergoing cardiac surgery received a single dose of 1000 mg of vancomycin. Multiple arterial samples were drawn during surgery. Exclusion criteria were hepatic dysfunction; renal dysfunction; ongoing infectious diseases; solid or hematologic tumors; severe insulin-dependent diabetes; body mass index of < 17 or > 40 kg/m^2; pregnancy or lactation; antibiotic, corticosteroid, or other immunosuppressive therapy; vancomycin or nonsteroidal anti-inflammatory drug therapy in the previous 2 wk; chemotherapy or radiation therapy in the previous 6 mo; allergy to vancomycin or cefazolin; drug abuse; cardiac surgery in the previous 6 mo; previous or scheduled organ transplantation; preoperative stay in the intensive care unit for more than 24 h; emergency procedure or lack of adequate preparation for surgery; and participation in another trial.RESULTS Over a 1-year period, 236 patients were enrolled, and a total of 1682 serum vancomycin concentrations(median 7/patient) were measured. No vancomycin levels under 10 mg/L were recorded in 122 out of 236 patients(52%), and 114 out of 236 patients(48%) were found to have at least 1 serum sample with a vancomycin level < 10 mg/L; 54 out of 236 patients(22.9%) had at least 5 serum samples with a vancomycin level lower than 10 mg/L. Vancomycin infusion was administered for 60 min in 97 out of 236 patients(41%). In 47 patients(20%), the duration of infusion was longer than 60 min, and in 92 patients(39%) the duration of infusion was shorter than 60 min. The maximum concentration and area under the concentration-time curve were significantly higher in patients with no vancomycin levels less than 10 mg/L(P < 0.001). The multivariate analysis identified female gender, body mass index(BMI) > 25 kg/m^2, and creatinine clearance above 70 mL/min as risk factors for vancomycin levels less than 10 mg/L.CONCLUSION Results of this study identified female gender, BMI > 25 kg/m^2, and creatinine clearance above 70 mL/min as risk factors for suboptimal vancomycin serum concentration during cardiac surgery; no relationship was found between infusion duration and vancomycin levels less than 10 mg/L. These findings call attention to the risk of facilitating the emergence of vancomycin-resistant methicillin-resistant Staphylococcus aureus strains.

人参皂苷Rh2联合万古霉素对万古霉素耐药型耐甲氧西林金黄色葡萄球菌生物膜和抑菌效果的影响

目的 研究人参皂苷Rh2联合万古霉素对万古霉素耐药型耐甲氧西林金黄色葡萄球菌生物膜和抑菌效果的影响。方法 诱导万古霉素耐药型耐甲氧西林金黄色葡萄球菌(VRSA),分别用10μg/m L、30μg/mL、90μg/m L人参皂苷Rh2处理VRSA作为不同浓度人参皂苷Rh2处理组;VRSA分别用1μg/mL、4μg/mL、16μg/mL万古霉素处理,作为不同浓度万古霉素处理组;10μg/mL人参皂苷Rh2和1μg/mL万古霉素共同作用VRSA记为10μg/mL人参皂苷Rh2+1μg/mL万古霉素组;不作处理的VRSA作为空白对照组。原始分离的对万古霉素敏感型的耐甲氧西林金黄色葡萄球菌作为VSSA组。结晶紫法检测生物膜形成能力;实时荧光定量PCR (RT-qPCR)检测fnbA、atlA表达水平;分光光度计检测菌活性。结果 与VSSA组比较,VRSA组生物膜的光密度值及fnbA、atlA的表达水平均明显升高,差异有统计学意义(P<0.05);与空白对照组比较,16μg/mL万古霉素及10μg/mL人参皂苷Rh2+1μg/mL万古霉素处理的VRSA增殖活性明显降低,而10μg/mL人参皂苷Rh2+1μg/mL万古霉素处理的VRSA增殖活性明显低于不同浓度人参皂苷Rh2处理组,且明显高于4μg/mL万古霉素处理者,差异均有统计学意义(P<0.05);与空白对照组比较,不同浓度人参皂苷Rh2处理的VRSA生物膜的光密度值明显降低,fnbA、atlA的表达水平明显降低,差异均有统计学意义(P<0.05);与空白对照组比较,不同浓度万古霉素处理的VRSA中fnbA、atlA表达水平显著升高,4μg/mL和16μg/mL万古霉素处理的VRSA生物膜的光密度值也明显升高,差异均有统计学意义(P<0.05);与空白对照组比较,10μg/mL人参皂苷Rh2组及10μg/mL人参皂苷Rh2+1μg/mL万古霉素组VRSA生物膜的光密度值及fnbA、atlA的表达水平明显降低,fnbA、atlA的表达水平明显升高,且10μg/mL人参皂苷Rh2+1μg/mL万古霉素组VRSA生物膜的光密度值及fnbA、atlA的表达水平均显著高于10μg/mL人参皂苷Rh2组,但明显低于1μg/mL万古霉素组,差异均有统计学意义(P<0.05)。结论 人参皂苷Rh2可抑制VRSA生物膜形成,但不抑菌;万古霉素可抑菌但不能抑制生物膜形成,两者联用能抑制生物膜形成且增强万古霉素的抑菌作用。

替考拉宁对MRSA肺部感染患者细菌清除情况、肺功能指标及氧化应激指标的影响

目的探讨替考拉宁治疗耐甲氧西林金黄色葡萄球菌(MRSA)肺部感染患者的临床效果,以为临床治疗药物的合理选择提供参考。方法选取2018年1月至2021年1月本院收治的90例MRSA肺部感染患者作为研究对象,按照随机数字表法将其分为对照组与观察组,各45例。对照组给予万古霉素治疗,观察组给予替考拉宁治疗。比较两组的细菌清除情况、肺功能指标及氧化应激指标。结果观察组的细菌总清除率高于对照组,差异具有统计学意义(P<0.05)。治疗后,两组的每分钟最大通气量(MVV)、呼气峰流速(PEF)、功能残气量(FRC)、最大呼气中期流速(MMEF)均升高,且观察组高于对照组,差异具有统计学意义(P<0.05)。治疗后,两组的超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)水平均升高,脂质过氧化物(LPO)、髓过氧化物酶(MPO)水平均降低,且观察组优于对照组,差异具有统计学意义(P<0.05)。结论替考拉宁用于MRSA肺部感染患者中的效果较好,其可有效清除细菌,改善患者的肺功能指标及氧化应激指标,值得临床推广和应用。

What’s old is new again:Insights into diabetic foot microbiome

Diabetes is a chronic disease that is considered one of the most stubborn global health problems that continues to defy the efforts of scientists and physicians.The prevalence of diabetes in the global population continues to grow to alarming levels year after year,causing an increase in the incidence of diabetes complications and health care costs all over the world.One major complication of diabetes is the high susceptibility to infections especially in the lower limbs due to the immunocompromised state of diabetic patients,which is considered a definitive factor in all cases.Diabetic foot infections continue to be one of the most common infections in diabetic patients that are associated with a high risk of serious complications such as bone infection,limb amputations,and life-threatening systemic infections.In this review,we discussed the circumstances associated with the high risk of infection in diabetic patients as well as some of the most commonly isolated pathogens from diabetic foot infections and the related virulence behavior.In addition,we shed light on the different treatment strategies that aim at eradicating the infection.

1例耐甲氧西林金黄色葡萄球菌引起皮肤软组织感染患儿抗感染治疗分析

目的:分析应用万古霉素和利奈唑胺治疗耐甲氧西林金黄色葡萄球菌引起的皮肤软组织感染的效果,以及临床药师对患者用药的干预。方法:根据病原学检查结果、初始抗感染治疗方案等,分析1例耐甲氧西林金黄色葡萄球菌引起的皮肤软组织感染患儿抗菌药物使用情况。结果:在治疗患儿皮肤软组织感染过程中,组织分布是影响药物临床疗效的一个因素,万古霉素和利奈唑胺组织分布情况略有差异。相比于万古霉素,利奈唑胺属于亲脂性抗菌药物,主要分布在脂肪组织,更加适用于皮肤软组织感染。临床药师通过对该患儿实施药学监护,在治疗中给予医生、患儿家属相应的建议,通过开展药学监护保证患儿用药安全。结论:临床药师通过查房、会诊等方式参与患儿全程药学监护,为抗菌治疗提供方案及建议,也为临床药师参与复杂感染的抗菌治疗提供参考。

2010年中国CHINET细菌耐药性监测

目的了解国内主要地区临床分离菌对常用抗菌药物的耐药性。方法国内主要地区14所教学医院(12所综合性医院、2所儿童医院)临床分离菌采用K-B法按统一方案进行细菌药敏试验。按CLSI 2010年版判断结果。结果 2010年1—12月收集各医院临床分离菌共47 850株,其中革兰阳性菌13 568株,占28.4%,革兰阴性菌34 282株,占71.6%。金葡菌和凝固酶阴性葡萄球菌(CNS)中甲氧西林耐药株平均为51.7%和71.6%。葡萄球菌属中甲氧西林耐药株对β内酰胺类抗生素和其他测试药的耐药率显著高于甲氧西林敏感株,MRSA中分别有73.9%、63.2%的菌株对磺胺甲噁唑-甲氧苄啶、磷霉素呈现敏感;MRCNS中分别有87.8%、68.7%的菌株对利福平、磷霉素敏感。未发现万古霉素、替考拉宁和利奈唑胺耐药株,但首次出现少数凝固酶阴性葡萄球菌对利奈唑胺中介株,主要为溶血葡萄球菌。肠球菌属中粪肠球菌对呋喃妥因、磷霉素、氨苄西林的耐药率低于屎肠球菌,两者中均有少数万古霉素耐药株,根据表型推测多数为VanA型耐药。肺炎链球菌非脑膜炎株成人组中PSSP较2009年略有降低,PRSP的检出率有所上升。部分大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)中产ESBLs株分别平均为56.2%和43.6%。肠杆菌科细菌中产ESBLs株对所测试抗菌药物的耐药率均比非产ESBLs株高。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,总耐药率<6%。不动杆菌属(鲍曼不动杆菌占86.8%)对亚胺培南和美罗培南的耐药率分别为57.1%和58.3%。与2009年相比肺炎克雷伯菌和鲍曼不动杆菌中的泛耐药株数显著增多。结论细菌耐药性仍呈增长趋势,对临床构成严重威胁。加强感染控制措施是当务之急。

万古霉素治疗重症G^+球菌感染的有效性和安全性

目的 :探讨万古霉素治疗重症G+ 菌感染的有效性和安全性。方法 :对 32例耐甲氧西林金葡球菌(MRSA)、耐甲氧西林凝固酶阴性葡萄球菌 (MRCON)和肠球菌所致的重症感染患者 ,给予万古霉素 5 0 0mg ,q8h或q6h ,疗程至少 1周 ,观察其治疗效果和不良反应发生率。 结果 :万古霉素治疗重症G+ 菌感染的总临床有效率为84.38% (2 7/ 32 ) ,细菌清除率 79.10 % (34 / 43) ,不良反应总发生率 9.38% (3/ 32 ) ,其中肾毒性 2例 ,药物热 1例 ,均未经特殊处理 ,停药后恢复正常。结论 :万古霉素是治疗MRSA/MRCON和肠球菌所致重症感染包括败血症、肺部感染。

2009年中国CHINET细菌耐药性监测

目的了解国内不同地区14所医院临床分离菌对常用抗菌药物的耐药性。方法国内不同地区14所教学医院(12所综合性医院、2所儿童医院)临床分离菌采用K-B法按统一方案进行细菌药物敏感试验。按CLSI 2009版判断结果。结果 2009年1月—12月收集各医院临床分离菌共43670株,其中革兰阳性菌占29%,革兰阴性菌占71%。金葡菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)平均为52.7%和71.7%。葡萄球菌属中甲氧西林耐药株对β内酰胺类抗生素和其他测试药的耐药率显著高于甲氧西林敏感株,但仍有72%和65% MRSA对磷霉素敏感;89.0%、66.0%和66.7%的MRCNS对利福平、磷霉素和氨苄西林-舒巴坦敏感,未发现万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中粪肠球菌对多数测试药物的耐药率低于屎肠球菌,两者中均有少数万古霉素耐药株,根据表型推测多数为VanA型耐药。本次监测首次出现少数耐利奈唑胺的粪肠球菌和屎肠球菌。非脑膜炎肺炎链球菌(SP)儿童株中PSSP较2008年减少,PISP和PRSP有所增多,在儿童株中首次出现少数喹诺酮类耐药株。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)中产ESBLs株分别平均为56.5%和41.4%。肠杆菌科细菌中产ESBLs株对药物的耐药率均比非产ESBLs株高。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,总耐药率<2%。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为30.5%和25.2%,不动杆菌属(鲍曼不动杆菌占86.8%)对两者的耐药率分别为50.0%和52.4%。与2008年相比肺炎克雷伯菌和鲍曼不动杆菌中的泛耐药株数量显著增多。新出现了5株泛耐药大肠埃希菌和6株泛耐药肠杆菌属细菌。结论细菌耐药性仍呈增长趋势,尤其泛耐药革兰阴性杆菌增多,对临床构成严重威胁。合理选用抗菌药,及早检测泛耐药菌,加强感染控制措施是当务之急。

万古霉素单用及联合利福平或磷霉素对耐甲氧西林金黄色葡萄球菌防耐药突变浓度的研究

目的在体外探讨万古霉素单用及其分别与利福平、磷霉素联合使用对耐甲氧西林金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA)防耐药突变浓度的影响,为防止细菌耐药的产生提供理论依据。方法应用肉汤法富集浓度为1010 CFU.ml-1细菌,琼脂平板倍比稀释法测定上述抗菌药物单用及联合使用对10株MRSA临床分离株的防耐药突变浓度,并计算相应的选择指数和耐药频率。结果万古霉素单用对上述10株MRSA的选择指数为16～64;分别与利福平、磷霉素联合使用选择指数下降为2～16和1～8,联合用药较单独用药选择指数下降2～32倍,其耐药频率也大幅下降。结论万古霉素分别与利福平、磷霉素联合使用均可降低其单用对MRSA的防耐药突变浓度,缩小耐药突变选择窗,防止耐药突变菌的产生。

进口万古霉素与国产去甲万古霉素治疗耐甲氧西林金葡球菌下呼吸道感染的对比研究

目的 探讨万古霉素和去甲万古霉素对耐甲氧西林金黄色葡萄球菌 (MRSA)下呼吸道感染的敏感性、临床疗效和不良反应。方法 对本院呼吸疾病重症监护病房 (RICU)住院的 115例MRSA所致下呼吸道感染患者采用随机配对法分为去甲万古霉素治疗组 (A组 ,68例 )和万古霉素治疗组 (B组 ,47例 ) ,比较两组病人的临床疗效和不良反应发生率。并对MRSA进行药敏分析。结果 两组病人 115株MRSA均对万古霉素和去甲万古霉素敏感 (敏感率 10 0 % ) ,A、B两组临床有效率分别为 80 9%和 78 7% (P >0 0 5 ) ,MRSA清除率分别为 80 9%和 82 9% (P >0 0 5 )。A组有 5例和B组有 3例出现肾功能损害 ,A、B组各有 2例出现皮疹。结论 国产去甲万古霉素对MRSA敏感 ,临床疗效良好 ,与进口万古霉素一致 ,而且不良反应较轻 ,适用于治疗MRSA感染。

万古霉素治疗耐甲氧西林金黄色葡萄球菌肺炎老年患者的疗效分析

目的：探讨万古霉素治疗耐甲氧西林金黄色葡萄球菌（M RS A ）肺炎老年患者的疗效和安全性。方法回顾性分析M RS A肺炎老年患者40例，根据治疗方案，将患者分为2组：万古霉素组25例，给予万古霉素每次0．5 g ，每8小时1次，静脉滴注，治疗时间10～14 d；利奈唑胺组15例，给予利奈唑胺每次0．6 g ，每12小时1次，静脉滴注，治疗时间10～14 d。比较两组患者的疗效和不良反应。结果万古霉素组临床有效率为72．0％，利奈唑胺组为86．7％，两组比较差异无统计学意义（P＞0．05）；经治疗后，万古霉素组MRSA清除率为76．0％，利奈唑胺组为80．0％，两组比较差异无统计学意义（P＞0．05）；利奈唑胺组有3例发生血小板减少＞25％，占20．0％，万古霉素组未见血小板减少，万古霉素组有4例发生急性肾功能不全，占16．0％，利奈唑胺组未见肾功能损害。结论万古霉素治疗老年M RS A肺炎有较好的临床疗效，血小板减少的发生率低，应警惕急性肾功能不全的风险。