磷霉素、米诺环素等抗生素对bla_(KPC-2)肺炎克雷伯杆菌的体外药敏研究

目的研究筛选治疗产KPC-2型碳青霉烯酶的肺炎克雷伯杆菌的敏感性抗生素。方法用氯霉素、多西环素、磷霉素、米诺环素和替加环素对已知blaKPC-2菌株进行体外药敏试验。结果氯霉素、多西环素米诺环素、磷霉素和替加环素耐药率分别为20%、17%、15%、6%和5%。结论本研究所选用抗生素的耐药率明显低于常规抗生素,为治疗产blaKPC-2菌株提供新参考方案     

替加环素不敏感鲍曼不动杆菌的分子流行病学及耐药机制

为探讨替加环素不敏感鲍曼不动杆菌Acinetobacter baumannii的耐药机制,为院内感染控制及临床合理用药提供理论依据,采用琼脂稀释法和微量肉汤稀释法检测全国多中心12个城市20家医院临床分离的94株非重复的替加环素不敏感鲍曼不动杆菌的最低抑菌浓度(Minimum inhibitory concentration,MIC),应用多位点序列分型(Multilocus sequence typing,MLST)技术进行分子流行病学研究,应用eBURST软件对MLST结果进行分析;用PCR和测序技术分析常见耐药基因(bla_(OXA-40-like)、bla_(OXA-58-like)、bla_(OXA-23-like)、bla_(OXA-51-like)、bla_(NDM-1)),与替加环素耐药相关的外排泵调控基因adeR和adeS的突变位点、trm的突变位点。经检测94株鲍曼不动杆菌除对多粘菌素B 100%敏感、对米诺环素敏感率25.5%外,其他抗菌药物的敏感率均低于3.5%,亚胺培南和美罗培南敏感率均只有1.1%。MLST分型得到12种ST分型,以ST195(45株,47.9%)、ST208(19株,20.2%)和ST457(10株,10.6%)为主,eBURST分析发现其中8个ST型均属于克隆复合体92(Clonal Complex 92,CC92);99%菌株bla_(OXA-23-like)型碳青霉烯酶基因阳性;均未扩增出bla_(NDM-1)基因;外排泵调控基因adeR和adeS的检出率分别是73.4%和91.5%,Asp26Asn和Ala97Glu分别为adeR和adeS的高频突变位点;在12株鲍曼不动杆菌中检测到了adeS基因的ISAba1,以北部地区为主;trm基因均在第240位核苷酸发生缺失突变。综上所述,替加环素不敏感鲍曼不动杆菌对除多粘菌素B外的大多数抗菌药物具有很高的耐药性,AdeABC外排泵上游的双组分调控系统adeR和adeS的缺失和突变,trm缺失突变是导致鲍曼不动杆菌对替加环素敏感性降低的主要原因。     

云南土壤宏基因组文库中替加环素耐药基因的筛选与分析

【背景】随着抗生素的广泛应用以及滥用,出现了多重耐药的"超级细菌",并且在临床上已出现对治疗"超级细菌"感染的最后一线抗生素——替加环素耐药的细菌。【目的】对土壤环境中存在的替加环素耐药基因进行筛选调查,探讨替加环素耐药机制,为临床抗生素治疗提供借鉴。【方法】利用功能宏基因组学技术对土壤宏基因组文库进行替加环素耐药阳性克隆的筛选和耐药亚克隆的构建,对构建成功的亚克隆进行测序和生物信息学分析探知其功能,同时进行最低抑菌浓度(Minimum Inhibitory Concentration,MIC)的测定。【结果】筛选得到一个四环素抗性Major Facilitator Superfamily(MFS)外排泵基因,携带该基因的菌株对四环素类抗生素均耐药,对替加环素和四环素的MIC值分别为16μg/mL和32μg/mL。当MFS外排泵抑制剂羰基氰化物间氯苯腙(CarbonylCyanide3-Chlorophenylhydrazone,CCCP)浓度为4μg/mL时可以抑制其对四环素类抗生素的外排作用。生物信息学结果表明该基因编码483个氨基酸,编码的蛋白质属于疏水稳定蛋白;其含有的14个跨膜区构成MFS外排泵蛋白典型的14次跨膜螺旋保守结构域;系统进化树分析表明其与其他替加环素耐药基因编码的蛋白质位于不同的分支上,相似性较低。【结论】利用功能宏基因组学技术筛选得到一个有替加环素抗性的MFS外排泵基因,编码的蛋白质属于14次跨膜螺旋MFS外排泵家族,为今后研究替加环素耐药机制提供参考。     

米诺环素对临床几种常见假丝酵母菌体外药敏的初步探究

探究米诺环素在体外对常见酵母菌的药敏特点。采用Rosco纸片扩散法对168株常见的几种假丝酵母菌进行米诺环素的药敏试验。米诺环素有抑菌环的比率:白假丝酵母菌41%,光滑假丝酵母菌1.2%,热带假丝酵母菌和克柔假丝酵母菌没有抑菌环。在常见几种酵母菌中,米诺环素几乎只对白假丝酵母菌在体外有抗菌活性。     

替加环素与5种抗生素对多重耐药鲍曼不动杆菌体外联合药敏实验的研究

分析亚胺培南、头孢哌酮-舒巴坦、头孢曲松、左氧氟沙星、庆大霉素5种临床常用鲍曼不动杆菌治疗的抗生素单用和分别与替加环素联用的体外敏感性实验的研究,以期发现较好的联合用药方案,为临床合理使用抗生素提供用药参考。采用微量肉汤稀释法测定5种抗生素对鲍曼不动杆菌的MIC值,再采用棋盘法测定5种抗生素分别与替加环素联用MIC值,并计算FIC指数。结果显示,替加环素与亚胺培南、头孢哌酮舒巴坦、左氧氟沙星、头孢曲松具有协同和相加作用,替加环素与庆大霉素具有拮抗作用。临床在选择抗生素治疗鲍曼不动杆菌所引起的重症感染时,可根据该药敏实验结果与亚胺培南或头孢哌酮舒巴坦或左氧氟沙星或头孢曲松与替加环素联合使用,但应避免与庆大霉素联合使用。     

替加环素治疗多重耐药菌感染的药物监测

随着抗菌药物在临床中的广泛应用,多重耐药(multidrug-resistant, MDR)菌株日益增多且缺乏有效的治疗药物,已成为公共卫生领域的严重问题。替加环素作为新一代甘氨酰四环素类抗生素,对耐碳青霉烯类鲍曼不动杆菌、耐碳青霉烯类肠杆菌科细菌、耐甲氧西林金黄色葡萄球菌(methicilinresistant Staphylococcus aureus, MRSA)等多重耐药菌具有较高的抗菌活性,其临床应用备受关注。一方面,在治疗多重耐药菌感染时,替加环素在临床中的治疗方案及使用剂量缺乏统一的定论,仍是目前研究的热点;另一方面,替加环素的药代动力学参数受到不同疾病及同种疾病病程发展不同阶段的病理生理变化的影响。所以,开展替加环素的药代动力学/药效学(pharmacokinetic/pharmacodynamic, PK/PD)研究及对多重耐药菌感染患者进行治疗药物监测(therapeutic drug monitoring, TDM)并探索最佳PK/PD参数实属必要。本文将对当前使用替加环素治疗多重耐药菌感染的疗效及其TDM指标作一综述。     

米诺环素对泛耐药鲍曼不动杆菌的体外药敏分析

初步探讨米诺环素对泛耐药的鲍曼不动杆菌体外药敏。将各种标本分离获得的鲍曼不动杆菌,进行米诺环素药敏试验,并将检测结果进行统计和分析。2009年1月至2011年9月共检出鲍曼不动杆菌471株,其中米诺环素敏感的鲍曼不动杆菌2009年5株、2010年12株、2011年23株;亚胺培南、美洛培南敏感其他耐药的0株,亚胺培南、美洛培南、米诺环素敏感其他耐药的0株;米诺环素和头孢哌酮/舒巴坦同时敏感的236株,占总数的50.1%。米诺环素对泛耐药的鲍曼不动杆菌在体外有很好的抗菌活性,特别是联合头孢哌酮/舒巴坦治疗泛耐株鲍曼不动杆菌的感染是一个不错的选择。     

加倍剂量替加环素治疗呼吸机相关性肺炎的临床效果

目的 探讨加倍剂量替加环素治疗呼吸机相关性肺炎的临床效果. 方法 选择2020年2月～2021年8月我院治疗的呼吸机相关性肺炎患者100例,按照随机数字表法分为对照组和观察组各50例.对照组严格按照说明书使用替加环素(首剂量为100 mg,然后每间隔12 h静脉滴注50 mg)治疗,观察组则使用加倍剂量替加环素(首剂量...     

三种方法测定多重耐药菌对替加环素敏感性的评价

目的评价三种方法测定替加环素对多重耐药菌药物敏感的准确性。方法分别采用K-B法、Vitek 2法及MTS法检测临床分离的82株多重耐药细菌(MRSA、VRE、耐碳青霉烯类大肠埃希菌、耐碳青霉烯类肺炎克雷伯杆菌、耐碳青霉烯类鲍曼不动杆菌),比较其结果的差异性。结果 MTS法检测13株MRSA、10株VRE测得的替加环素MIC50和MIC90分别为0.25、0.064 mg/L,0.50、0.125 mg/L;Vitek 2法测MRSA、VRE的MIC50和MIC90分别为0.5、0.25 mg/L,1、0.5 mg/L;MTS法检测15株耐碳青霉烯类大肠埃希菌、19株耐碳青霉烯类肺炎克雷伯杆菌、28株耐碳青霉烯类鲍曼不动杆菌测得的替加环素MIC50和MIC90分别为0.25、0.5、1 mg/L,0.25、1、2 mg/L;Vitek 2法测耐碳青霉烯类大肠埃希菌、耐碳青霉烯类肺炎克雷伯杆菌、耐碳青霉烯类鲍曼不动杆菌分别为0.25、1、2 mg/L,1、1、4 mg/L;K-B法的替加环素对五种多重耐药菌依序的敏感率分别为100.0%、100.0%、66.7%、79.0%、78.0%。与MTS比较,其他两种方法测定MRSA、VRE的分类一致性(categorical agreement,CA)均为100.0%,其他三种CA分别为86.7%/73.3%、89.5%/84.2%、78.6%/89.3%;重大误差(major error,ME)分别为6.7%/6.7%、5.3%/5.3%、0.0%/3.6%;小误差(minor error,Me)分别为13.3%/13.3%、10.5%/10.5%、17.9%/21.4%。结论替加环素对各种多重耐药菌的每种测定方法敏感率存在差异,对耐碳青霉烯类鲍曼不动杆菌,使用K-B法来作为首选,而对耐碳青霉烯类大肠埃希菌、耐碳青霉烯类肺炎克雷伯杆菌及MRSA、VRE来说,Vitek 2法仍作为其敏感性的常规操作。需制定较方便合适的方法来指导临床用药。     

苦楝素联合BIT对白色念珠菌的协同抑菌效果研究

探讨苦楝素与BIT分别单独及二者联合使用对白色念珠菌的浮游菌生长及其生物膜形成的影响。以预加菌液倾注平板打孔抑菌实验法测定苦楝素、BIT及二者联合使用对白色念珠菌菌体生长的抑制效果,96孔板微量稀释法培养该菌浮游菌及其生物膜,分别测定浮游菌及其生物膜的吸光度并进行比较分析,判断最小抑菌浓度(MIC),计算二者联合时的抑菌指数(FIC)。平板打孔抑菌实验结果显示,其抑菌效果依次为:二者联合BIT苦楝素;96孔微量稀释法结果显示:二者联合的FIC系数为0.75;二者联合抑制该浮游菌生长比单用时药效增加了20%～50%,抑制其生物膜的形成比单用时药效增加了33%～50%。苦楝素与BIT联合使用具有对白色念珠菌生长的复配增效抑制作用,不但有效抑制该菌浮游菌生长,也能抑制其生物膜的形成。     

Enhanced clearing of Helicobacter pylori after omeprazole plus roxithromycin treatment

The in vitro antibacterial activity of omeprazole against eight strains of Helicobacter pylori was evaluated. Minimum inhibitory concentration (MIC) values were 32 micrograms/ml and 64 micrograms/ml (MIC50 and MIC90 respectively). We performed a randomized single blind study comparing the efficacy of omeprazole alone (for 4 weeks) or combined with roxithromycin (for 2 weeks) in the treatment of duodenal ulcer and chronic active gastritis associated with H. pylori infection, H. pylori was eradicated in 75% of patients treated with omeprazole alone whereas the patients treated with the combination of these drugs were completely free from H. pylori at the end of the therapy.     

Antimicrobial activity of mupirocin, daptomycin, linezolid, quinupristin/dalfopristin and tigecycline against vancomycin-resistant enterococci (VRE) from clinical isolates in Korea (1998 and 2005)

It is a hot clinical issue whether newly approved antimicrobial agents such as daptomycin, linezolid, quinupristin/dalfopristin (synercid) and tigecycline are active enough to be used for infections caused by vancomycin resistant bacteria. We performed susceptibility tests for mupirocin, which is in widespread clinical use in Korea, and four new antimicrobials, daptomycin, linezolid, quinupristin/dalfopristin and tigecycline, against vancomycin-resistant Enterococcus faecalis and Enterococcus faecium isolated from Korean patients in 1998 and 2005 to evaluate and compare the in vitro activity of these antimicrobials. Among these agents, quinupristin/dalfopristin, which is rarely used in hospitals in Korea, showed relatively high resistance to several vancomycin-resistant enterococci (VRE) isolated in 2005. Likewise, daptomycin, linezolid and tigecycline have not yet been in clinical use in Korea. However, our results showed that most of the 2005 VRE isolates were already resistant to linezolid and daptomycin (highest minimum inhibitory concentration (MIC) value >100 microg/ml). Compared with the other four antimicrobial agents tested in this study, tigecycline generally showed the greatest activity against VRE. However, four strains of 2005 isolates exhibited resistance against tigecycline (MIC >12.5 microg/ml). Almost all VRE were resistant to mupirocin, whereas all E. faecium isolated in 1998 were inhibited at concentrations between 0.8 to approximately 1.6 microg/ml. In conclusion, resistances to these new antimicrobial agents were exhibited in most of VRE strains even though these new antibiotics have been rarely used in Korean hospitals.     

Inhibition of Klebsiella pneumoniae ATCC 13883 cells by hexane extract of Halimeda discoidea (Decaisne) and the identification of its potential bioactive compounds

The inhibitory effect of the Klebsiella pneumoniae ATCC 13883 strain caused by the hexane extract of Halimeda discoidea (Nor Afifah et al., 2010) was further evaluated by means of the microscopy view and its growth curves. The morphological changes of the K. pneumoniae ATCC 13883 cells were observed under the scanning electron microscope (SEM) and transmission electron microscope (TEM) after they were treated at minimum inhibitory concentration (MIC; 0.50 mg/ml) (Nor Afifah et al., 2010) for 12, 24, and 36 h. The results showed the severity of the morphological deteriorations experienced by the treated cells. The killing curve assay was performed for 48 h at three different extract concentrations (1/2 MIC, MIC, and 2 MIC). An increase in the extract concentration of up to 2 MIC value did significantly reduce the number of cells by approximately 1.9 log10, as compared with the control. Identification of the potential compounds of the extract responsible for the antibacterial activity was carried out through the gas chromatography-mass spectrum (GCMS) analysis of the active subfraction, and the compound E-15-heptadecenal was identified and suggested as the most potential antibacterial compound of this extract. The subsequent cellular degenerations showed by the data might well explain the inhibitory mechanisms of the suggested antibacterial compound. All of these inhibitory effects have further proven the presence of an antibacterial compound within H. discoidea that can inhibit the growth of K. pneumoniae ATCC 13883.     

Ellipticines and 9-acridinylamines as inhibitors of D-alanine:D-alanine ligase

D-Alanine:D-alanine ligase (Ddl), an intracellular bacterial enzyme essential for cell wall biosynthesis, is an attractive target for development of novel antimicrobial drugs. This study focused on an extensive evaluation of two families of Ddl inhibitors encountered in our previous research. New members of both families were obtained through similarity search and synthesis. Ellipticines and 9-acridinylamines were both found to possess inhibitory activity against Ddl from Escherichia coli and antimicrobial activity against E. coli and Staphylococcus aureus. Ellipticines with a quaternary methylpyridinium moiety were the most potent among all studied compounds, with MIC values as low as 2 mg/L in strains with intact efflux mechanisms. Antimicrobial activity of the studied compounds was connected to membrane damage, making their development as antibacterial drug candidates unlikely unless analogues devoid of this nonspecific effect can be discovered.     

Improvement of cyclic decapeptides against plant pathogenic bacteria using a combinatorial chemistry approach

Cyclic decapeptides were developed based on the previously reported peptide c(LysLeuLysLeuLysPheLysLeuLysGln). These compounds were active against the economically important plant pathogenic bacteria Erwinia amylovora, Pseudomonas syringae and Xanthomonas vesicatoria. A library of 56 cyclic decapeptides was prepared and screened for antibacterial activity and eukaryotic cytotoxicity, and led to the identification of peptides with improved minimum inhibitory concentration (MIC) against P. syringae (3.1-6.2 microM) and X. vesicatoria (1.6-3.1 microM). Notably, peptides active against E. amylovora (MIC of 12.5-25 microM) were found, constituting the first report of cyclic peptides with activity towards this bacteria. A second library based on the structure c(X(1)X(2)X(3)X(4)LysPheLysLysLeuGln) with X being Lys or Leu yielded peptides with optimized activity profiles. The activity against E. amylovora was further improved (MIC of 6.2-12.5 microM) and the best peptides displayed a low eukaryotic cytotoxicity at concentrations 30-120 times higher than the MIC values. A design of experiments permitted to define rules for high antibacterial activity and low cytotoxicity, being the main rule X(2) not equal X(3), and the secondary rule X(4)=Lys. The best analogs can be considered as good candidates for the development of effective antibacterial agents for use in plant protection.     

Clinical pharmacology and efficacy of fluoroquinolones in fish

The fluoroquinolones are a relatively new group of man-made antibacterial compounds that are highly effective against a wide variety of gram-negative and gram-positive organisms. They have been evaluated for several years for human and veterinary medical applications and more recently they have been evaluated for use in fish. Studies in fish have included minimum inhibitory concentration (MIC) evaluations of the drugs against bacteria found to be pathogenic to fish, pharmacokinetic studies, laboratory efficacy studies, and field trials. The data collected to date encourage further evaluations of fluoroquinolones in fish.     

Anti-anaerobic activity of serum from patients treated with tigecycline for skin/soft tissue infections

To gain additional data concerning the anti-anaerobic activity of tigecycline in serum, we analyzed blood samples from six patients with a complicated skin/soft tissue infection who were receiving IV tigecycline 50 mg every 12 h. Venous blood samples were obtained after multiple doses of tigecycline at 1, 6 and 12 h after the initiation of a 1 h IV infusion. Sera from these samples were tested to determine serum inhibitory and bactericidal activity over time against 4 anaerobic bacteria (Bacteroides fragilis, Peptoniphilus asaccharolyticus, Prevotella bivia and Finegoldia magna). An analysis of serum titers found that tigecycline exhibited early (1 h) and prolonged (12 h) inhibitory activity against each study isolate. Moreover, it provided bactericidal activity for 12 h against these strains with the exception of F. magna. Tigecycline was found to exhibit antibacterial activity at serum concentrations below the MICs of the anaerobic bacteria tested. This finding further supports that the antimicrobial activity of tigecycline can be greater than that suggested by the free fraction of drug and that serum appears to enhance this antibacterial activity.     

Combined Activity of Azithromycin and Lansoprazole Against Helicobacter pylori

Background. Due to its unique pharmacokinetic properties, azithromycin may be an attractive combination partner for H. pylori eradication regimens. However, up to 15% of clinical isolates are primarily resistant to azithromycin as well as to other macrolide antibiotics. Combination therapy with lansoprazole, a proton pump inhibitor known to have intrinsic antibacterial activity against H. pylori , may be useful to counteract such resistance. We therefore evaluated the combined effects of azithromycin and lansoprazole in vitro.
Materials and Methods. Minimal inhibitory concentrations (MICs) of azithromycin and lansoprazole alone and in combination were determined for 106 clinical H. pylori isolates by means of an agar dilution technique. Killing kinetics of seven isolates were also studied in fluid medium.
Results. MIC values for 50 and 90% of the isolates (MIC₅₀, MIC₉₀) were 0.19 and 0.5 mg/l for azithromycin, and 44.5 and 104 mg/l for lansoprazole. Nine strains (8.5%) had an MIC of azithromycin ≥ 16 mg/l and were regarded as resistant. An additive interaction between the two drugs was found in 72 (68%), and indifferent effects in 24 strains (23%). Three of 9 azithromycin-resistant strains regained sensitivity in the presence of lansoprazole. In fluid culture, synergism between the two drugs occurred in 6 out of 7 strains tested.
Conclusion. In the majority of strains, lansoprazole and azithromycin interacted in an additive or synergistic manner depending on the test method employed. Addition of lansoprazole restored in vitro sensitivity to azithromycin in 3 out of 9 azithromycin-resistant strains. Such effects may enhance the elimination of H. pylori during clinical eradication therapy.     

Inhibition of Helicobacter pylori by garlic extract (Allium sativum)

Abstract The antibacterial effect of aqueous garlic extract (AGE) was investigated against Helicobacter pylori . Sixteen clinical isolates and three reference strains of H. pylori were studied. Two different varieties of garlic were used. The concentration of AGE required to inhibit the bacterial growth was between 2–5 mg ml⁻¹. The concentration, for both AGE types, to inhibit 90% (MIC₉₀) of isolates was 5 mg ml⁻¹. The minimum bactericidal concentration (MBC) was usually equal to, or two-fold higher than, minimum inhibitory concentration (MIC). Heat treatment of extracts reduced the inhibitory or bactericidal activity against H. pylori ; the boiled garlic extract showed a loss of efficacy from two-to four-fold the values of MIC and the MBC obtained with fresh AGR. The antibacterial activity of garlic was also studied after combination with a proton pump-inhibitor (omeprazole) in a ratio of 250:1. A synergistic effect was found in 47% of strains studied; an antagonistic effect was not observed.