2%利拉萘酯乳膏治疗足癣和体股癣疗效和安全性评价

目的评价2%利拉萘酯乳膏治疗足癣和体股癣的疗效及安全性,并与1%联苯苄唑霜对照。方法采用多中心随机双盲对照试验。试验组及对照组分别外用2%利拉萘酯乳膏和1%联苯苄唑霜,1次/d,疗程足癣4周,体股癣2周。结果足癣试验组71例,对照组70例;体股癣试验组70例,对照组69例进行评价。足癣患者在4周时临床有效率试验组97.2%,对照组92.9%,在6周时分别为100%和98.6%;在4周时真菌学清除率试验组93.0%,对照组94.3%,在6周时分别为94.4%和92.9%;在4周时总有效率试验组90.1%,对照组88.6%;在6周时分别为94.4%和92.9%。体、股癣患者在2周时临床有效率试验组97.1%,对照组95.7%,在4周时分别为97.1%和94.2%;在2周时真菌学清除率试验组94.3%,对照组95.7%;在4周时分别为97.1%和97.1%;在2周时总有效率试验组92.9%,对照组91.3%,在4周时分别为95.7%和94.2%。与药物相关的不良事件发生率对照组1.4%,表现为局部刺激。结果显示2%利拉萘酯乳膏治疗足癣和体股癣的疗效及安全性与1%联苯苄唑霜相似（P〉0.05）。结论2%利拉萘酯乳膏治疗足癣和体、股癣有效、安全。     

口服特比萘芬联合外用自制双唑霜治疗足癣临床疗效观察

目的观察口服特比萘芬联合外用自制双唑霜治疗足癣的临床疗效。方法57例足癣患者口服特比萘芬0.25g/d,并外用自制双唑霜(主要成分咪康唑与联苯苄唑)2次/d,疗程1周。于停药时、停药4周后分别记录患者皮损情况,不良反应,同时作真菌镜检。结果停药时临床治愈率43.86%,有效率73.68%,真菌清除率78.95%。停药4周后,临床治愈率75.44%,有效率91.23%,真菌清除率96.49%。结论口服特比萘芬联合外用自制双唑霜治疗足癣方便、安全、起效快、患者依从性好,值得临床应用。     

1％联苯苄唑霜治疗足癣长期疗效观察

联苯苄唑（Bifonazole）属于咪唑类广谱抗真菌药物。对皮肤癣菌、酵母菌、非皮肤癣菌性霉菌具有较高的抗菌活性;对革兰阳性球菌和棒状杆菌亦有效;还有明显的抗炎作用,其抗炎作用相当于1％氢化可的松霜。本研究采用多中心、随机开放、平行对照研究评价由拜耳医药保健有限公司生产的1％联苯苄唑霜（美克）治疗足癣的长期疗效,并与2％硝酸咪康唑霜（达克宁）和1％特比萘芬霜（丁克）进行对照。     

1%盐酸布替萘芬溶液治疗趾间型足癣的疗效和安全性

本研究评价以1％盐酸布替萘芬（butenafine hydrochloride）溶液治疗趾间型足癣的疗效和安全性,并与市售1％联苯苄唑溶液的作用进行比较。     

医院血流感染病原菌分布及耐药性分析

目的了解医院血流感染病原菌的分布及其耐药性,为临床治疗提供参考。方法收集2013年1月至12月浙江中医药大学附属第一医院患者血培养标本,采用WHONET 5.6软件对所分离的病原菌及药敏结果进行统计分析。结果 2 017份血培养标本共检出病原菌370株,阳性率为18.34%,其中革兰阳性菌142株占38.38%,革兰阴性菌213株占57.57%,真菌15株,占4.05%。排名前5位病原菌依次是凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、肠球菌属和金黄色葡萄球菌,分别占19.73%、17.03%、13.51%、6.22%和4.59%。除哌拉西林/他唑巴坦对大肠埃希菌和铜绿假单胞菌仍保持较高的抗菌活性外,革兰阴性菌尤其是肺炎克雷伯菌对多种药物均产生了严重耐药性,其中产ESBLs大肠埃希菌和肺炎克雷伯菌分别占46.80%和20.00%。革兰阳性菌对利奈唑胺100%敏感,检出耐甲氧西林金黄色葡萄球菌(MRSA)4株,占25.00%,耐甲氧西林凝固酶阴性葡萄球菌(MRCNs)占92.00%,耐万古霉素的表皮葡萄球菌1株和耐万古霉素的粪肠球菌3株。结论血流感染病原菌分布复杂,以革兰阴性菌为主,耐药率高,且已出现耐万古霉素的表皮葡萄球菌和粪肠球菌,因此,进行早期监测和耐药性分析非常必要,对控制感染、指导合理使用抗菌药物,减缓耐药菌株的出现具有重要的临床意义。     

老年脑梗死并发尿道感染患者病原菌分布及耐药性分析

目的:分析老年脑梗死并发尿道感染的病原菌分布及其耐药性。方法:选取2014年9月-2016年9月于我院治疗的240例老年脑梗死并发尿道感染患者为研究对象,收集患者中段尿标本进行细菌分离培养鉴定,分析病原菌分布情况并测定其耐药性。结果:共检出160株病原菌,其中革兰阴性菌108株,占67.50%,革兰阳性菌43株,占26.88%,真菌9株,占5.63%,前五位病原菌分别为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、溶血性葡萄球菌及粪肠球菌。在主要革兰阴性菌中,大肠埃希菌对头孢曲松耐药率最高(69.81%),对亚胺培南最敏感(3.77%);铜绿假单胞菌对环氧沙星耐药率最高(88.24%),对头孢曲松、头孢唑啉、头孢他啶、阿米卡星、哌拉西林、亚胺培南最敏感,耐药率均为0.00%;肺炎克雷伯菌对头孢唑林耐药率最高(75.00%),对呋喃妥因最敏感(6.25%)。在主要革兰阳性菌中,金黄色葡萄球菌对红霉素耐药率最高(85.71%);肠球菌属(粪肠球菌及屎肠球菌)对氨苄西林耐药率最高(70.00%);凝固酶阴性葡萄球菌(溶血性葡萄球菌及表皮葡萄球菌)对头孢曲松耐药率最高(93.75%);主要革兰阳性菌对万古霉素、利奈唑胺最敏感,耐药率均为0.00%。结论:老年脑梗死并发尿道感染病原菌种类多,应根据耐药性结果合理选用抗生素。     

食管癌根治术后肺部感染的病原菌与耐药性分析

目的:探讨食管癌根治术后肺部感染的病原菌及耐药性,为临床合理应用抗菌药物提供依据。方法:选择2009年1月-2017年12月在我院行食管癌根治术的764例患者作为研究对象,记录患者临床基本资料,采集肺部感染患者深部痰液标本进行细菌培养,并对病原菌进行药物敏感性试验,分析其病原菌分布和耐药性。结果:764例食管癌根治术后患者肺部感染146例,感染率为19.11%;肺部感染患者痰液标本培养获得病原菌185株,其中革兰阴性菌116株,占62.70%,以铜绿假单胞菌和肺炎链球菌最多,分别占18.38%和14.05%;革兰阳性菌40株,占21.62%,以金黄色葡萄球菌最多,占8.65%;真菌29株,占15.68%,以白假丝酵母菌最多,占9.19%。铜绿假单胞菌、肺炎链球菌、鲍氏不动杆菌、大肠埃希菌对美洛西林的耐药率最高,分别占70.59%、73.08%、86.96%、62.50%,对亚胺培南耐药率最低,分别占5.88%、3.85%、26.09%、12.50%。金黄色葡萄球菌、表皮葡萄球菌对头孢唑林的耐药率最高,分别占81.25%、63.64%,溶血葡萄球菌对头孢唑林、阿奇霉素、环丙沙星的耐药率最高,均占71.43%,肠球菌对头孢唑林、环丙沙星耐药率最高,均占100.00%;黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌、肠球菌对万古霉素耐药率最低,均为0.00%。结论:食管癌根治术后肺部感染以革兰阴性菌为主,病原菌主要对美洛西林、头孢唑林、阿奇霉素、环丙沙星产生耐药性,对亚胺培南、万古霉素耐药性较低,临床应合理选用抗菌药物进行治疗。     

氟曲马唑对足癣分离病原菌的体外抗菌活性研究

目的评价氟曲马唑对足癣分离病原菌的体外抗菌活性,并与联苯苄唑相比。方法采用CLSI推荐的M-38 A2(皮肤癣菌)和M27-A3(酵母菌)微量液基稀释法对病原菌进行体外药物敏感性测定。结果氟曲马唑对红色毛癣菌最小抑菌浓度(MIC)范围为0.031~2μg/m L,MIC50为0.5μg/m L,MIC90为1μg/m L,GM值为0.637μg/m L;联苯苄唑分别为0.031~16μg/m L,0.25μg/m L,2μg/m L,0.634μg/m L;两药对红色毛癣菌MIC GM值比较差异无统计学意义(P=0.974)。氟曲马唑对趾(指)间毛癣菌MIC范围为0.031~1μg/m L,MIC50为0.031μg/m L,MIC90为0.5μg/m L,GM值为0.17μg/m L;联苯苄唑分别为0.125~16μg/m L,1μg/m L,2μg/m L,1.886μg/m L;两药对趾(指)间毛癣菌MIC GM值比较差异具有统计学意义(P=0.001)。尽管酵母菌菌株数偏少,但研究结果显示两药对念珠菌属和毛孢子菌属MIC GM值比较差异具有统计学意义(P=0.000和P=0.031)。结论氟曲马唑对红色毛癣菌的抗菌活性与联苯苄唑相似,但对趾(指)间毛癣菌、念珠菌属和毛孢子菌属的抗菌活性明显优于联苯苄唑。     

1%氟曲马唑乳膏治疗足癣疗效和安全性评价

目的评价1%氟曲马唑乳膏治疗足癣的疗效及安全性。方法采用多中心、随机、双盲、非劣效临床试验,每天1次外用,疗程4周。结果主要疗效4周时的总有效率氟曲马唑组为71.43%,联苯苄唑组为64.81%(P=0.190)。在6周时(停药后2周),总有效率分别为82.61%和71.60%(P=0.018);真菌清除率分别为86.16%和77.50%(P=0.045);临床有效率分别为93.43%和91.58%(P=0.504)。与研究药物相关的不良反应发生率氟曲马唑组2.44%,联苯苄唑组2.46%(P=1.000),主要表现为用药局部皮肤刺激。结论 1%氟曲马唑乳膏治疗足癣有效安全,4周时总疗效非劣效于1%联苯苄唑乳膏,但在6周时总疗效优于1%联苯苄唑乳膏,主要体现在真菌学疗效方面。     

复方联苯苄唑乳膏治疗足癣疗效和安全性评价

复方联苯苄唑乳膏（compound bifonazole cream）是以1％联苯苄唑为主要成分,以5％克罗米通、2％利多卡因、0．5％甘草次酸、2％L-薄荷醇等为次要成分组方而成的新型乳膏制剂。根据国家药品监督管理局第HL20020003号文件要求,对拜耳（中国）有限公司提供的复方联苯苄唑乳膏治疗足癣和体股癣进行疗效及安全性评价,并以1％联苯苄唑霜作对照。黄怀球等已就其治疗体、股癣的疗效和安全性进行了报道,本文仅就其治疗足癣的疗效和安全性进行总结。     

口服特比萘芬联合外用联苯苄唑乳膏治疗足癣长期临床研究

目的 为足癣治疗提供较理想的方案.方法 盐酸特比萘芬250 mg,口服1次/d;1%联苯苄唑乳膏,外用1次/d.250例足癣患者随机入组.A组口服1周加外用1周,B组口服1周加外用2周,C组口服2周加外用1周,D组口服2周加外用2周,E组单独外用4周.在治疗结束时、治疗结束后4周、24周、40周、56周、72周时对各组的疗效、复发率进行评价.结果 在停药后第24周时,A、B、C、D组与E组疗效比较差异有统计学意义.在停药后第40周、56周、72周时,D组与A、B组疗效比较差异也出现统计学意义.在停药后24周、40周时,A、B、C、D组真菌学疗效与E组比较差异有统计学意义.在停药56周、72周时,D组与A、B组真菌学疗效比较差异也出现统计学意义.在停药40周时,A、B、C、D组与E组复发率比较差异有统计学意义.在停药56周、72周时,D组与A、B组复发率比较差异也出现统计学意义.结论 口服特比萘芬2周联合外用1%联苯苄唑乳膏2周治疗足癣的有效率和真菌学疗效最高,复发率最低.     

Bacterial competition for human nasal cavity colonization: role of Staphylococcal agr alleles

We examined the bacterial aerobic nasal flora of 216 healthy volunteers to identify potential competitive interactions among different species, with special emphasis on the influence of staphylococcal agr alleles. The Staphylococcus aureus colonization rate correlated negatively with the rate of colonization by Corynebacterium spp. and non-aureus staphylococci, especially S. epidermidis, suggesting that both Corynebacterium spp. and S. epidermidis antagonize S. aureus colonization. Most of the S. aureus and S. epidermidis isolates were agr typed by a PCR method. Only one S. aureus agr (agr(Sa)) allele was detected in each carrier. Multiple logistic regression of the two most prevalent agr(Sa) alleles (agr-1(Sa) and agr-2(Sa)) and the three S. epidermidis agr (agr(Se)) alleles showed a specific influence of the agr system. The results of this model did not support conclusions drawn from previous in vitro agr-specific cross-inhibition experiments. Our findings suggest that the agr alleles, which are strongly linked to the bacterial genetic background, may simply be associated with common biological properties--including mediators of bacterial interference--in the strains that bear them.     

Detection of pathogenic bacteria in skin lesions of patients with chiclero's ulcer. Reluctant response to antimonial treatment

We investigated the bacterial flora present in skin lesions of patients with chiclero's ulcer from the Yucatan peninsula of Mexico using conventional culture methods (11 patients), and an immunocolorimetric detection of pathogenic Streptococcus pyogenes (15 patients). Prevalence of bacteria isolated by culture methods was 90.9% (10/11). We cultured, from chiclero's ulcers (60%), pathogenic bacterial such as Staphylococcus aureus (20%), S. pyogenes (1.6%), Pseudomonas aeruginosa (1.6%), Morganella morganii (1.6%), and opportunist pathogenic bacteria such as Klebsiella spp. (20.0%), Enterobacter spp. (20%), and Enterococcus spp. (20%). We also cultured coagulase-negative staphylococci in 40% (4/10) of the remaining patients. Micrococcus spp. and coagulase-negative staphylococci constituted the bacterial genuses more frequently isolated in the normal skin of patients with chiclero's ulcer and healthy individuals used as controls. We also undertook another study to find out the presence of S. pyogenes by an immunocolorimetric assay. This study indicated that 60% (9/15) of the ulcerated lesions, but not normal controls, were contaminated with S. pyogenes. Importantly, individuals with purulent secretion and holding concomitant infections with S. pyogenes, S. aureus, P. aeruginosa, M. morganii, and E. durans took longer to heal Leishmania (L.) mexicana infections treated with antimonial drugs. Our results suggest the need to eliminate bacterial purulent infections, by antibiotic treatment, before starting antimonial administration to patients with chiclero's ulcer.     

Fungal infection of the feet in soccer players and non-athlete individuals

This study was conducted to evaluate the occurrence of mycoses affecting the feet of soccer players and to compare this results with those in non-athlete individuals of the same age and sex. Initial evaluation consisted of a dermatological examination of the foot in 22 Chinese athletes, 83 Brazilian athletes and 24 Brazilian non-athletes. Scales of plantar skin, interdigital and subungual areas of the foot were collected for mycological examination (direct and culture). Nail clippings were obtained for histopathologic analysis. Tinea pedis was diagnosed more frequently among the non-athlete individuals. None of the Chinese athletes had tinea pedis alone. However, in this group onychomycosis was frequently higher when compared to the other groups. The fungal microbiota comprised Trichophyton rubrum (40%), Trichophyton mentagrophytes (36.4%) and Candida spp (20%). Candida spp was isolated only from Brazilian athletes. Results obtained with KOH wet mounts agreed with the results obtained in culture and with histopathologic examinations (50.5% vs 40.9%). The frequency of tinea pedis among soccer players was lower than the other groups in this study, possibly due to health education and professional feet care.     

Comparison of terbinafine and clotrimazole in treating tinea pedis.

OBJECTIVE--To compare the efficacy and safety of terbinafine 1% cream and clotrimazole 1% cream in the treatment of tinea pedis. DESIGN--Multicentre, double blind parallel group study. SETTING--32 general practices and one hospital. PATIENTS--256 patients with mycologically confirmed tinea pedis. Of the 211 patients evaluable, 107 were randomised to terbinafine (75 male, 32 female; mean (range) age 40 (12-81) years) and 104 to clotrimazole (79 male, 25 female; mean (range) age 36 (12-71) years). INTERVENTIONS--Terbinafine 1% cream applied twice daily for one week and inert cream applied twice daily for the next three weeks. Clotrimazole 1% cream applied twice daily for four weeks. MAIN OUTCOME MEASURES--Mycological cure (negative results on microscopy and culture) and effective treatment (mycological cure plus no or minimal signs and symptoms) measured at weeks 1, 2, 3, 4, and 6. RESULTS--At week four rates of mycological cure were 93.5% for terbinafine and 73.1% for clotrimazole (p = 0.0001); and at week six 97.2% for terbinafine and 83.7% for clotrimazole (p = 0.001). Rates of effective treatment at week 4 were 89.7% for terbinafine and 58.7% for clotrimazole (p = 0.0001); and 89.7% for terbinafine and 73.1% for clotrimazole (p = 0.002) at week 6. CONCLUSION--These results indicate that a one week course of terbinafine 1% cream is more effective in the treatment of tinea pedis than a four week course of clotrimazole 1% cream, both in terms of mycological cure and effective treatment.     

Slime-producing Staphylococcus epidermidis and S. aureus in acute bacterial conjunctivitis in soft contact lens wearers

In recent years, an increase in ocular pathologies related to soft contact lens has been observed. The most common infectious agents were Staphylococcus spp. Some strains produce an extracellular polysaccharidic slime that can cause severe infections. Polysaccharide synthesis is under genetic control and involves a specific intercellular adhesion (ica) locus, in particular, icaA and icaD genes. Conjunctival swabs from 97 patients with presumably bacterial bilateral conjunctivitis, wearers of soft contact lenses were examined. We determined the ability of staphylococci to produce slime, relating it to the presence of icaA and icaD genes. We also investigated the antibiotic susceptibility and Pulsed Field Gel Electrophoresis (PFGE) patterns of the clinical isolates. We found that 74.1% of the S. epidermidis strains and 61.1% of the S. aureus strains isolated were slime producers and showed icaA and icaD genes. Both S. epidermidis and S. aureus slime-producing strains exhibited more surface hydrophobicity than non-producing slime strains. The PFGE patterns overlapped in S. epidermidis strains with high hydrophobicity. The similar PFGE patterns were not related to biofilm production. We found scarce matching among the Staphylococcus spp. studied, slime production, surface hydrophobicity and antibiotic susceptibility.     

Tolnaftate (Tinactin), a New Topical Antifungal Agent

Using the double-blind technique, patients with tinea pedis, tinea cruris and tinea corporis were treated with either (a) 1% tolnaftate in a cream base or (b) the cream base.Twenty-four of 29 patients (82.7%) using 1% tolnaftate cream demonstrated clearing or great improvement of their lesions after three weeks of therapy, whereas only two of nine (22.2%) had similar results using the placebo.     

2%硝酸舍他康唑乳膏治疗体股癣和足癣疗效和安全性评价

目的 评价2％硝酸舍他康唑乳膏治疗足癣和体、股癣的疗效及安全性,并与2％硝酸咪康唑乳膏对照。方法 采用多中心随机双盲对照试验。试验组及对照组分别外用2％硝酸舍他康唑乳膏和2％硝酸咪康唑乳膏,每天2次,疗程4周。在治疗开始及治疗2周、4周、6周时进行观察。结果 足癣试验组61例,对照组58例;体、股癣试验组56例,对照组55例完成了观察。足癣在4周时,临床有效率试验组98．36％,对照组93．10％,在6周时分别为100％和98．28％;在4周和6周时真菌学清除率试验组均为95．1％,对照组均为100％;在4周时总有效率试验组98．36％,对照组93．10％,在6周时分别为100％和98．28％。体、股癣在4周时,临床有效率试验组98．21％,对照组92．73％,在6周时分别为100％和98．18％;在4周和6周时真菌学清除率试验组和对照组均为100％;在4周时总有效率试验组98．21％,对照组92．73％,在6周时分别为100％和98．18％。药物不良反应发生率试验组1．7％,对照组0．9％,表现为局部刺激。结果 显示2％硝酸舍他康唑乳膏治疗足癣和体、股癣的疗效及安全性与2％硝酸咪康唑乳膏相似（P〉0．05）。结论 2％硝酸舍他康唑乳膏治疗足癣和体、股癣有效、安全。     

Influence of substances produced by lipophilic Corynebacterium CDC G1 ZMF 3P13 on the microorganisms inhabiting human skin

Lipophilic species of Corynebacterium inhabiting skin as residents produces substances that can regulate the composition of natural flora. Research that was carried out concerned an influence of the substances produced by Corynebacterium CDC G1 ZMF 3P13 on the set of 22 bacterial strains (Staphylococcus spp., Corynebacterium spp., Propionibacterium spp.) mutually existing on the skin and the set of 6 Candida spp. isolated from patients. It was found out that the strain gives off into environment a mixture of substances with opposite effects. In the course of research an inhibiting substance (BLIS) was isolated with its evident effect on S. aureus, S. epidermidis, C. diphtheriae i Propionibacterium spp.     

萘替芬酮康唑乳膏每日1次治疗足癣疗效观察

目的观察萘替芬酮康唑乳膏1次/d治疗足癣的效果与安全性。方法将参与试验的足癣患者随机分组,试验组每晚1次外用萘替芬酮康唑乳膏,对照组早晚各1次外用萘替芬酮康唑乳膏。连续用药4周,于治疗前,用药2周、4周及停药2周后分别进行症状和体征评分。结果治疗结束和停药2周时,两组的临床疗效无显著差异(P>0.05)。治疗2周时试验组和对照组的真菌清除率分别为78.6%和90.3%,有显著差异(P<0.05);治疗结束和停药2周时试验组的真菌清除率分别为92.9%和97.6%,对照组分别为94.4%和98.6%,均无显著差异(P>0.05)。结论萘替芬酮康唑乳膏1次/d治疗足癣疗效好,简便易行,安全性高。