我院专项治理前后抗菌药物使用情况分析

目的:通过分析抗菌药物临床应用专项治理前后住院患者抗菌药的使用情况,以促进合理用药。方法:随机抽取我院2010年1至2011年12月病例1680份,抽取甲状腺/乳腺/疝气/闭合性骨折I类切口手术病历100份,分析治理前后抗菌药物使用率、使用强度、病原送检率、DDDs、DUI及I类切口抗菌药物应用情况。结果:治理前住院患者抗菌药物使用率、使用强度分别为68.50%、49.8DDD;治理后分别为56.2%、37.8DDD,显著降低(P<0.05)。治理前有四种抗菌药物DUI>1,依次为头孢哌酮/舒巴坦钠>头孢噻吩钠=头孢唑啉>头孢呋辛;治理后有两种抗菌药物DUI>1,依次为磺苄西林>头孢哌酮/舒巴坦钠;治理后I类切口手术患者预防使用抗菌药物比例略为下降,疗程符合率、用药合理率明显上升(P<0.05)。结论:我院住院患者抗菌药使用情况基本达到《抗菌药物临床应用专项工作方案》要求。但在某些方面,如I类切口使用率、疗程、用药选择上需要持续改进,应加强对I类切口的监管力度,以确保用药的经济、有效、合理。     

某三甲医院抗菌药物临床规范化应用的现状分析

??????? 目的 分析和调查抗菌药物临床应用的情况,研究规范化应用抗菌药物在临床使用的效果。方法 根据计算机管理系统提供的抗菌药物用药信息,对某三甲综合医院抗菌药物临床应用专项整治前、后医院门诊患者抗菌药物处方比例及住院患者抗菌药物使用率、使用强度、I类手术预防用药率等指标进行调查及分析。结果 门诊患者抗菌药物处方比例降低至6.2﹪;住院患者抗菌药物使用率降低至49.7﹪;抗菌药物使用强度降低至42.48;I类手术预防用药率降低至32.1﹪。结论 抗菌药物临床规范化应用,促进医院抗菌药物临床合理使用的效果显著。     

医院抗菌药物临床应用专项整治持续效果分析

?????? 目的 分析抗菌药物临床应用专项整治对医院住院患者抗菌药物临床用药的持续效果。方法 采用回顾性调查方法,以开展抗菌药物临床应用专项整治前后的2010—2012为研究时间,对医院住院患者抗菌药物使用率、使用强度、用药金额及清洁手术预防用药率、清洁手术术后24小时停药率进行调查及分析。结果 2010—2012年,抗菌药物使用率分别为70.0%、64.4%和49.3%,抗菌药物使用强度分别为73.3、58.2和37.9,抗菌药物用药金额占药费总额比例分别为21.9%、16.2%和11.1%;清洁手术预防用抗菌药物比率分别为95.5%、91.0%和50.3%,清洁手术术后24小时停药率分别为11.0%、27.2%和42.0%。结论 抗菌药物临床应用专项整治对抗菌药物的合理使用起到了积极的促进作用。     

心内科患者医院感染鲍氏不动杆菌的耐药性分析

目的了解心内科住院患者医院感染鲍氏不动杆菌的耐药性,为指导临床合理用药提供依据。方法从2010—2012年心内科住院患者送检标本中分离鲍氏不动杆菌,采用PHOENIX-100全自动细菌鉴定药敏系统进行细菌鉴定及药敏试验,并对结果进行统计分析。结果2010-2012年心内科住院患者共分离出166株鲍氏不动杆菌,其中泛耐药菌株34株,检出率为20．5％。药敏结果显示鲍氏不动杆菌对常用抗菌药物的耐药率呈逐年上升趋势,并显示出多重耐药性,对多粘菌素B、头孢哌酮／舒巴坦、亚胺培南和美罗培南等耐药率相对较低。结论鲍氏不动杆菌已成为医院感染重要病原菌,对多种抗菌药物耐药,临床应加强耐药性监测,根据药敏结果合理选用抗菌药物,以控制医院感染的暴发流行。     

医院感染主要病原菌分布及耐药性分析

目的:分析我院一年来主要病原菌分布及耐药性结果,为临床经验性治疗提供依据。方法:选取2013年9月—2014年9月我院住院患者送检的标本6983份,标本采集主要有痰液、尿液、咽拭子、分泌物、血液、粪便等,采用全自动分析仪鉴定菌种,药敏采用纸片扩散法或自动化仪器法。结果:6983份标本中以痰液标本为主,占52.6%;送检标本中共分离病原菌1065株,其中排在前五位的病原菌为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、阴沟肠杆菌。革兰氏阴性杆菌主要以肠杆科细菌为主,对碳青霉烯类抗生素耐药率很低,其他抗菌药物呈现不同程度的耐药,但肺炎克雷伯菌对大多数抗生素都敏感;铜绿假单胞菌耐药率也较低,金黄色葡萄球菌对万古霉素、替考拉宁、利奈唑胺的耐药率均为0,而对其他抗菌药物呈现不同程度的耐药。结论:我院感染病原菌以肠杆科细菌为主,其次为铜绿假单胞菌、金黄色葡萄球菌、除肺炎克雷伯菌对大多数抗生素都敏感,其他病原菌对多数抗菌药物呈现不同程度的耐药,因此了解不同细菌对不同抗菌药物的耐药性合理应用抗生素,以减少耐药菌的产生。     

我院抗菌药物实行分级管理后使用情况分析

目的:分析抗菌药物分级管理干预措施的实施及效果。方法:选择2011年5月至2013年5月间我院全院出院患者6622例的病案资料。其中实施分级管理制度之前的患者3238例,实施分级管理制度之后的患者3384例,分析分级管理前后医院抗菌药物使用情况。结果:实施分级管理制度后抗菌药物使用率,人均使用频次及人均抗菌药物费用均明显降低,与实施分级管理制度前比较差异具有统计学意义(P0.05)。实施分级管理制度后一线抗菌药物使用率显著提高,二线、三线抗菌药物使用率降低,与实施分级管理制度前比较差异具有统计学意义(P0.05)。实施分级管理后三联用药比例显著降低(P0.05),送检标本及检出阳性率较实施分级管理前无统计学意义(P0.05)。结论:实施抗菌药物分级管理可以有效的限制抗菌药物滥用情况,对于临床抗菌药物合理应用有积极意义。     

不同标本中检出细菌的耐药性分析

目的探讨不同标本中检出的同一种细菌对抗菌药物的敏感性有无差异,指导临床不同感染部位标本的送检及合理使用抗菌药物.方法 2000年1月至2002年12月对新泰市人民医院各科室送检的痰液、分泌物、尿液、血液和脓汁中检出的铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌和表皮葡萄球菌,用13种抗菌药物进行药敏试验,药敏试验用K-B纸片法进行.结果不同标本中检出的同一种细菌,对同一种抗菌药物的耐药率不同,差异有显著性或高度显著性.结论不同标本中检出的同一细菌对同一种抗菌药物存在不同的耐药性.     

老年女性糖尿病合并尿路感染的细菌分布及耐药性分析

目的了解老年女性糖尿病患者尿路感染病原菌分布及其对抗菌药物的耐药情况。方法对大连大学附属新华医院2005年1月至2006年12月169例住院及门诊患者送检的尿标本进行培养,并对145例阳性标本中的细菌进行鉴定及药敏试验。结果尿路感染率为85.8%,感染的病原菌中革兰阴性杆菌占首位,占75.2%,对亚胺培南的耐药性最低,革兰阳性球菌占19.3%,均对万古霉素敏感。结论老年女性糖尿病合并尿路感染的细菌种类发生变化,应定期监测细菌的耐药趋势,以指导临床用药。     

老年慢性支气管炎急性加重期105例痰需氧菌培养及药敏结果分析

目的分析慢性支气管炎急性加重期病原菌的类型、分布以及药物敏感性试验的情况。方法收集2004年1月至2007年12月我所住院的慢性支气管炎急性加重期患者共送检168例次痰标本进行培养和药物敏感试验。结果从痰液中共检出156株需氧菌,其中革兰阴性菌93株（59．62％）,革兰阳性菌41株（26．28％）,真菌22株（14．1％）;在革兰阴性菌中,以克雷伯菌属为主,占总分离率的21．15％（33／156）,其次是铜绿假单胞菌,分离出24株（15．38％）;革兰阳性菌则以金黄色葡萄球菌及肺炎链球菌居多。感染以革兰阴性杆菌为主,对11种临床常用的抗生素敏感率较高的是亚胺培南,其次是氨基糖苷类。结论本试验可提高对慢性支气管炎的临床诊断,根据其病原学特点合理使用抗菌药物。     

恶性肿瘤患者放化疗后并发真菌感染及耐药分析

目的以三甲医院为样本来源,调查恶性肿瘤患者放化疗后合并真菌感染的现状,分析诱发真菌感染的危险因素和常用抗菌药物的耐药性,促进临床合理使用抗真菌药。方法对医院2012年1月至2014年10月420例恶性肿瘤患者放化疗后送检标本进行真菌培养鉴定及药敏试验。结果 420例标本中检出真菌105例,感染率为25%。感染部位以呼吸道为主,占81.90%。感染的真菌以白假丝酵母菌为主,占73.33%,真菌对唑类药物耐药率较高。结论恶性肿瘤患者放化疗后易并发院内真菌感染,而感染主要与患者年龄、原发肿瘤部位、住院时间等有关。根据药敏结果合理选用抗真菌药物,可有效降低真菌感染率。     

2002-2004年鲍曼不动杆菌临床感染分布和耐药性分析

目的了解白求恩国际和平医院临床分离的鲍曼不动杆菌临床感染分布和耐药现状。方法收集2002年1月至2004年12月白求恩国际和平医院鲍曼不动杆菌临床分离株,采用Kirby-Bauer法对19种抗菌药物进行药敏试验;用WHONET5分析试验结果;分析感染患者基础疾病特征。结果3年间共分离鲍曼不动杆菌267株．96．25％分离自住院患者。3．75％分离自门诊患者。该菌对亚胺培南高度敏感,对其他药物呈多重耐药。多重耐药菌株在逐年上升。它主要引起住院老年人和严重外伤患者的下呼吸道感染。结论鲍曼不动杆菌耐药性有逐年上升趋势。     

2007-2010年大兴区人民医院细菌耐药情况调查分析

目的调查分析北京大兴地区细菌耐药情况。方法选取我院2007-2010年度门诊及病房患者的尿液910例和痰液5471例，样本手工接种后，选取优势菌或高致病性菌使用细菌鉴定和药敏全自动分析仪进行全自动分析。结果细菌检出率排在前三位依次为铜绿假单胞菌（15．73％）、大肠埃希菌（14．18％）、肺炎克雷伯菌（10．11％）；金黄色葡萄球菌的耐药性最为突出。结论根据细菌耐药情况，选取合适的抗菌药物进行科学治疗，提高患者治愈率。     

嗜麦芽窄食单胞菌感染的临床特征、高危因素及预后分析

目的了解嗜麦芽窄食单胞菌感染的临床特点、危险因素、预后及耐药现状,为有效预防和治疗该病原菌感染提供依据。方法收集2013年11月至2014年4月浙江大学医学院附属第一医院收治的129例细菌培养为嗜麦芽窄食单胞菌患者的临床资料进行回顾性统计分析。结果 129例细菌培养确诊嗜麦芽窄食单胞菌感染患者平均年龄（65.1±17.0）岁,包括下呼吸道感染和非呼吸道感染患者分别为100例和29例,下呼吸道感染患者存在原发肺部疾病的患病率、ICU入住率、气管切开比例、广谱抗生素的使用率、患病年龄等均高于非呼吸道感染患者（P〈0.05）。而非呼吸道感染患者的外科手术、无菌腔内置管比例及免疫抑制剂使用率高于下呼吸道感染患者（P〈0.05）。嗜麦芽窄食单胞菌感染后选择敏感抗生素治疗的患者的死亡率明显低于未选择敏感抗生素的患者（15.0%/30.4%,P〈0.05）。结论原发肺部疾病、入住ICU、气管切开、广谱抗生素使用、年龄大是下呼吸道感染嗜麦芽窄食单胞菌的高危因素,外科手术、无菌腔内置管、免疫抑制剂使用是非呼吸道感染嗜麦芽窄食单胞菌的高危因素。使用敏感抗生素可以降低嗜麦芽窄食单胞菌感染患者的死亡率。     

Bactericidal effects of hematoporphyrin monomethyl ether-mediated photosensitization against pathogenic communities from supragingival plaque

Photodynamic antimicrobial chemotherapy (PACT) is proposed as a potential candidate to inactivate pathogens in localized infections due to the rapid evolution of bacterial resistance. The treatment modality utilizes nontoxic agents called photosensitizers and harmless visible light to generate reactive oxygen species which result in microbial cells’ killing. Hematoporphyrin monomethyl ether (HMME) as a novel and affordable photosensitizer has been used in treating various clinical diseases for years, but few applications in infection. In this report, we studied the bactericidal effects of the HMME-mediated photodynamic reaction on the pathogenic microbes in supragingival plaque which can lead to many oral infectious diseases such as caries, gingivitis, and so on. Our findings demonstrated that HMME promoted an effective action in bacterial reduction with the application of laser energy. Moreover, the antimicrobial activities were dramatically enhanced as the HMME concentration and exposure time were increased, but reached a plateau when matched the appropriate agent concentration and illumination. It was found that the survival fraction of microorganisms is exponentially dependent on the product of HMME concentration and irradiation time. These promising results suggest the HMME may be an excellently cost-effective photosensitizing agent for mediating PACT in the treatment of supragingival plaque-related diseases. An optimized HMME concentration and irradiation time has been found to achieve the best results under our experimental conditions. The high HMME concentration matching short curative time, or vice versa, can achieve the similar therapeutic effect, which may provide more flexible treatment plans according to specific conditions.     

Characterization of induced Staphylococcus aureus bacteriophage SAP-26 and its anti-biofilm activity with rifampicin

Lytic bacteriophages (phages) have been investigated as treatments for bacterial infectious diseases. An induced phage, SAP-26, was isolated from a clinical isolate of Staphylococcus aureus. It belongs to the family Siphoviridae and its genome consists of double-stranded 41,207 bp DNA coding for 63 open reading frames. The phage SAP-26 showed a wide spectrum of lytic activity against both methicillin-resistant S. aureus and methicillin-susceptible S.aureus. Furthermore, combined treatment with a phage and antimicrobial agents showed a strong biofilm removal effect which induced structural changes in the biofilm matrix and a substantial decrease in the number of bacteria. Such a broad host range in S. aureus and biofilm removal activity of the phage SAP-26 suggests the possibility of its use as a therapeutic phage in combination with appropriate antimicrobial agent(s). Among the three antimicrobial agents combined with phage, the combination of rifampicin showed the best biofilm removal effect. To the authors' knowledge, this study showed for the first time that S. aureus biofilm could be efficiently eradicated with the mixture of phage and an antimicrobial agent, especially rifampicin.     

下呼吸道感染不动杆菌属流行和药敏变迁分析

目的：分析近年来南京医科大学第一附属医院不动杆菌属的流行情况及耐药现状,为临床合理应用抗菌药物提供指导依据。方法：收集2004年-2008年南京医科大学第一附属医院下呼吸道感染住院病人痰培养结果为不动杆菌的数据,用WHONET5.3软件统计分析。结果：2004年-2008年该院下呼吸道感染住院病人痰培养为不动杆菌属占所有病原体比例为7．0％．9．2％,占革兰阴性菌比例为13．9％-17．5％。革兰阴性菌中,不动杆菌始终排在前三位。不动杆菌对亚胺培南、美罗培南和头孢哌酮／舒巴坦较敏感。结论：下呼吸道感染病原体中不动杆菌占据越来越大的比例,减少医源性感染、合理选择的抗菌药物对于降低死亡率、提高医疗资源利用率至关重要。     

Bacterial community and decomposition rate in long term fed-batch composting using woodchip and Polyethylene terephthalate (PET) as bulking agents

Long term fed-batch composting experiments were conducted for 200 days using two types of bulking agents; woodchip and PET flake, with periodic compost withdrawal through a washing process. The bacterial communities of composting materials in the two different bulking agents were also investigated by 16S rRNA gene clone analysis. The decomposition rate in both composting reactors was 86.1% and 88.2% of the total organic load, respectively. The control experiment of dead-end operation without compost withdrawal by washing process could not be maintained for more than 102 days because of its low performance. The reactor with compost withdrawal, however, improved the decomposition rate in the composting process, and could be applied in the long run. There was a significant difference in the bacterial community between the FBC reactor with woodchip and another with PET flake as the bulking agent though the decomposition rates were similar. The reactor with woodchip as the bulking agent consisted of 95% Bacillales while the PET flake reactor contained 54% of total bacteria count. In addition, Lactobacillales was dominant at 38% in the PET flake reactor and the bacterial community in general significantly differed from the woodchip reactor. Furthermore, there was a difference in the species composition in the Bacillales and the bacterial community showed a significant difference at the species level between the two reactors. Although bacterial community differed, the decomposition rates between the two reactors were similar and PET flake showed greater viability than woodchip as a bulking agent due to its high abrasion resistance and non-biodegradability.     

A novel approach to pharmacodynamic assessment of antimicrobial agents: new insights to dosing regimen design

Pharmacodynamic modeling has been increasingly used as a decision support tool to guide dosing regimen selection, both in the drug development and clinical settings. Killing by antimicrobial agents has been traditionally classified categorically as concentration-dependent (which would favor less fractionating regimens) or time-dependent (for which more frequent dosing is preferred). While intuitive and useful to explain empiric data, a more informative approach is necessary to provide a robust assessment of pharmacodynamic profiles in situations other than the extremes of the spectrum (e.g., agents which exhibit partial concentration-dependent killing). A quantitative approach to describe the interaction of an antimicrobial agent and a pathogen is proposed to fill this unmet need. A hypothetic antimicrobial agent with linear pharmacokinetics is used for illustrative purposes. A non-linear functional form (sigmoid Emax) of killing consisted of 3 parameters is used. Using different parameter values in conjunction with the relative growth rate of the pathogen and antimicrobial agent concentration ranges, various conventional pharmacodynamic surrogate indices (e.g., AUC/MIC, Cmax/MIC, %T>MIC) could be satisfactorily linked to outcomes. In addition, the dosing intensity represented by the average kill rate of a dosing regimen can be derived, which could be used for quantitative comparison. The relevance of our approach is further supported by experimental data from our previous investigations using a variety of gram-negative bacteria and antimicrobial agents (moxifloxacin, levofloxacin, gentamicin, amikacin and meropenem). The pharmacodynamic profiles of a wide range of antimicrobial agents can be assessed by a more flexible computational tool to support dosing selection.     

The ability of an antimicrobial agent to penetrate a biofilm is not correlated with its killing or removal efficiency

The penetration ability of 12 antimicrobial agents, including antibiotics and biocides, was determined against biofilms of B. cereus and P. fluorescens using a colony biofilm assay. The surfactants benzalkonium chloride (BAC) and cetyltrimethyl ammonium bromide (CTAB), and the antibiotics ciprofloxacin and streptomycin were of interest due to their distinct activities. Erythromycin and CTAB were retarded by the presence of biofilms, whereas ciprofloxacin and BAC were not. The removal and killing efficacies of these four agents was additionally evaluated against biofilms formed in microtiter plates. The most efficient biocide was CTAB for both bacterial biofilms. Ciprofloxacin was the best antibiotic although none of the selected antimicrobial agents led to total biofilm removal and/or killing. Comparative analysis of the results obtained with colony biofilms and microtiter plate biofilms show that although extracellular polymeric substances and the biofilm structure are considered a determining factor in biofilm resistance, the ability of an antimicrobial agent to penetrate a biofilm is not correlated with its killing or removal efficiency. Also, the results reinforce the role of an appropriate antimicrobial selection as a key step in the design of disinfection processes for biofilm control.     

The livestock reservoir for antimicrobial resistance: a personal view on changing patterns of risks,effects of interventions and the way forward

The purpose of this review was to provide an updated overview on the use of antimicrobial agents in livestock, the associated problems for humans and current knowledge on the effects of reducing resistance in the livestock reservoir on both human health and animal production. There is still limiting data on both use of antimicrobial agents, occurrence and spread of resistance as well as impact on human health. However, in recent years, emerging issues related to methicillin-resistant Staphylococcus aureus, Clostridium difficile, Escherichia coli and horizontally transferred genes indicates that the livestock reservoir has a more significant impact on human health than was estimated 10 years ago, where the focus was mainly on resistance in Campylobacter and Salmonella. Studies have indicated that there might only be a marginal if any benefit from the regular use of antibiotics and have shown that it is possible to substantially reduce the use of antimicrobial agents in livestock production without compromising animal welfare or health or production. In some cases, this should be done in combination with other measures such as biosecurity and use of vaccines. To enable better studies on both the global burden and the effect of interventions, there is a need for global harmonized integrated and continuous surveillance of antimicrobial usage and antimicrobial resistance, preferably associated with data on production and animal diseases to determine the positive and negative impact of reducing antimicrobial use in livestock.