2014年大连市结核病耐药监测结果分析

摘要：目的 全面了解大连市耐药结核病流行现状和特点,为有效控制耐药结核病提供依据。方法 收集2014年度初治、复治涂阳病例,对成功分离的448例结核分枝杆菌菌株,采用比例法对利福平、异烟肼、链霉素、乙胺丁醇、左氧氟沙星、阿米卡星、对氨基水杨酸、丙硫异烟胺、卷曲霉素9种药物进行药物敏感试验,采用SPSS 12.0进行统计学分析,对耐药率的比较采用卡方检验,P<0.05为差异有统计学意义。结果 分离的448株菌株总体耐药率为26.8%,初治耐药率22.2%,获得性耐药率37.2%,耐多药率为6.9%,初始耐多药率5.5%,获得性耐多药率10.2%。结论 大连市结核病耐药发生率较高,但呈下降趋势。     

Drug-resistant malaria

In the past 21 years, a modest increase in the range of antimalarial drugs approved for clinical use has been complemented by a more impressive expansion in the analysis and understanding of the molecular mechanisms underlying resistance to these agents. Such resistance is a major factor in the increasing difficulty in controlling malaria, and important developments during this period are recounted here.     

Drug-resistant bacteria in Continental Shelf sediments.

Fecal indicator bacteria were isolated from water and sediment samples obtained from a sewage sludge disposal site in the Middle Atlantic. Some were found to be resistant to several antimicrobial agents. Isolation of these microbes 30 months after cessation of sludge dumping indicates their survivability in the environment.     

Drug-resistant malaria - an insight

Despite intensive research extending back to the 1930s, when the first synthetic antimalarial drugs made their appearance, the repertoire of clinically licensed formulations remains very limited. Moreover, widespread and increasing resistance to these drugs contributes enormously to the difficulties in controlling malaria, posing considerable intellectual, technical and humanitarian challenges. A detailed understanding of the molecular mechanisms underlying resistance to these agents is emerging that should permit new drugs to be rationally developed and older ones to be engineered to regain their efficacy. This review summarizes recent progress in analysing the causes of resistance to the major antimalarial drugs and its spread.     

Drug-resistant bacteria in Continental Shelf sediments

Fecal indicator bacteria were isolated from water and sediment samples obtained from a sewage sludge disposal site in the Middle Atlantic. Some were found to be resistant to several antimicrobial agents. Isolation of these microbes 30 months after cessation of sludge dumping indicates their survivability in the environment.     

耐药菌非抗生素疗法研究进展*

抗生素耐药性是21世纪人类面临的主要公共卫生威胁之一。抗生素滥用导致越来越多的细菌产生了耐药性,使得传统抗生素治疗面临着巨大挑战。非抗生素治疗策略,如噬菌体疗法、抗菌肽疗法、抗毒力因子疗法等,在应对耐药性细菌方面具有独特的优势与临床潜力,并且能够有效避免细菌耐药性的产生与传播。综述耐药菌非抗生素疗法的研究进展,探讨其在抗感染领域的新型治疗方案。未来,耐药菌非抗生素疗法有望协同乃至替代抗生素疗法,从而应对“抗生素危机”。     

纤维支气管镜局部注药治疗耐药支气管内膜结核

目的:探讨和评价经纤维支气管镜局部注药对耐药肺结核合并支气管内膜结核患者的可行性和疗效.方法:对120例确诊为耐药肺结核合并支气管内膜结核患者,在进行全身抗结核治疗的同时依据患者志愿,随机分为两组,一组即单纯化疗者,另一组化疗+支气管镜注药组.比较两组病人在临床症状、痰菌阴转、影像学及纤维支气管镜下的疗效差异.结果:耐药肺结核合并支气管内膜结核经全身抗结核治疗辅以支气管镜局部给药,疗效显著优于单纯全身抗结核治疗.结论:使用支气管镜治疗耐药支气管内膜结核,可明显提高疗效、缩短病程,值得在临床上广泛应用.     

金黄色葡萄球菌耐消毒剂基因及抗生素耐药相关基因检测

目的 了解温州地区临床分离的金黄色葡萄球菌(SA)的耐药特点,探讨SA中耐β-内酰胺类、氨基糖苷类、四环素类药物耐药基因及耐消毒剂基因(qacA)的存在情况.方法 采用聚合酶链式反应(PCR)法对SA进行β-内酰胺酶基因、氨基糖苷类修饰酶基因、四环素类基因和耐消毒剂基因检测.结果 PCR结果显示94株SA中耐药相关基因检出率mecA 53.2％、aac(6’)/aph(2")68.1％、aph(3’)-Ⅲ 37.2％、tetM 53.2％和qacA 7.4％,其中59株MRSA的耐药相关基因检出率分别为mecA 83.1％、aac(6’)/aph(2")86.4％、aph(3 ′)-Ⅲ 42.4％、tetM 76.4％和qacA 8.5％.结论 多数SA菌株存在耐β-内酰胺类、氨基糖苷类、四环素类等多种抗生素耐药基因,具有多重耐药特征,但尚未出现明显耐消毒剂状况.     

Drug-resistant bacteria: responding to the infectious disease crisis

The 1990s have been a period of growing anxiety about the emergence of antibiotic-resistant bacteria. Public health, society and the research community must respond quickly to safeguard existing drugs and develop new ones to prevent resistance overwhelming healthcare systems worldwide.