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[A case report of pulmonary aspergillosis in lung transplant recipient successfully treated with inhalation administration of liposomal amphotericin B]. [吸入两性霉素B脂质体治疗肺移植受者肺曲霉病1例报告]。
Pub Date : 2013-02-01
Masaki Fujita, Jun Yanagisawa, Masafumi Hiratsuka, Takeshi Shiraishi, Ryosuke Hirano, Takemasa Matsumoto, Motokimi Shiraishi, Akinori Iwasaki, Kentaro Watanabe

We report a case of pulmonary aspergillosis in lung transplant recipient who was successfully treated with inhalation administration of anti-fungal agent. The case was 33-year-old female. Two years ago, she had received lung transplant because of lymphangioleiomyomatosis. One year ago, she had diagnosed of pulmonary aspergillosis and successfully treated with micafungin and itraconazole. Then she had been continuous administered with itraconazole. In June 20xx, she had nausea and vomiting and was diagnosed of viral enteritis. Although abdominal symptoms were relieved, ground glass opacity was discovered in her right lung. Bronchoscopic examination revealed ulceration of bronchus with white necrotic substance. Laboratory culture test demonstrated Aspergillus spp. Finally she was diagnosed of recurrent pulmonary aspergillosis. First, she was treated with intravascular administration of micafungin. Then, inhalation administration of liposomal amphotericin B was changed. Ground glass opacity and bronchial region of pulmonary aspergillosis was improved. Thereafter, inhalation of amphotericin B was continued and no recurrence of pulmonary aspergillosis has been found. Inhalation of anti-fungal agent could be an option for pulmonary aspergillosis.

我们报告一例肺移植受者肺曲霉病成功治疗吸入抗真菌剂。该病例为33岁女性。两年前,她因为淋巴管平滑肌瘤病接受了肺移植手术。一年前,她被诊断为肺曲霉病,并成功地用米卡芬净和伊曲康唑治疗。此后持续给予伊曲康唑治疗。xx年6月出现恶心、呕吐,诊断为病毒性肠炎。虽然腹部症状减轻,但右肺发现磨玻璃样混浊。支气管镜检查显示支气管溃疡伴白色坏死物质。实验室培养结果显示为曲霉属,最后诊断为复发性肺曲霉病。首先,她接受血管内给药米卡芬宁治疗。然后改变两性霉素B脂质体吸入给药方式。肺曲菌病的磨玻璃影及支气管区改善。此后继续吸入两性霉素B,未发现肺曲霉病复发。吸入抗真菌剂可能是肺曲霉病的一种选择。
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引用次数: 0
Rapid bactericidal activity of sitafloxacin against Streptococcus pneumoniae. 西他沙星对肺炎链球菌的快速杀菌活性研究。
Pub Date : 2013-02-01
Hiroko Kanda, Kazue Inoue, Ryo Okumura, Kazuki Hoshino

The initial bactericidal activity of quinolones against Streptococcus pneumoniae at the concentration equivalent to their respective peak serum concentration (C(max)) and free drug fraction of C(max) (fC(max)) were investigated. The bactericidal activity of sitafloxacin (STFX), levofloxacin (LVFX), moxifloxacin (MFLX), and garenoxacin (GRNX) were compared by determining the actual killing of bacteria at C(max) and fC(max) for 1 and 2 hours based on the Japanese maximum dose per administration (100, 500, 400, and 400 mg, respectively). Against 4 quinolone-susceptible clinical isolates (wild-type), STFX with C(max) and fC(max) exhibited the most rapid bactericidal activity resulting in an average reduction of > or = 3.0 log10 colony forming units (CFU)/ mL in 1 hour. STFX with C(max) and fC(max) also showed the most rapid and potent bactericidal activity against 9 clinical isolates with single par (C/E) mutation, resulting in > or = 3.0 log10 CFU/mL average reduction in viable cells in 1 hour. STFX showed a statistically significant advantage in initial bactericidal activity over other quinolones for single mutants (P < 0.001). The propensity that the difference in the initial bactericidal activity between STFX and other quinolones was higher in single mutants than wild-type strains, was confirmed using S. pneumoniae ATCC49619 (wild-type) and its laboratory single parC mutant. As a result, STFX showed a similar rapid and potent initial bactericidal activity against both strains, while initial bactericidal activity for other quinolones was significantly reduced in the single mutant (P < 0.05). In conclusion, STFX has the most rapid and potent initial bactericidal activity against wild-type and single mutants of S. pneumoniae and its bactericidal activity is not affected by the presence of a single par mutation compared to LVFX, MFLX, and GRNX.

研究了喹诺酮类药物在其各自的血清峰值浓度(C(max))和游离药物分数(C(max))相等的浓度下对肺炎链球菌的初始杀菌活性。以日本最大给药剂量(分别为100、500、400和400 mg)为基准,测定了西他沙星(STFX)、左氧氟沙星(LVFX)、莫西沙星(MFLX)和加诺沙星(GRNX)在C(max)和fC(max)作用1和2小时的实际杀灭菌量,比较了它们的杀菌活性。对4株喹诺酮类药物敏感临床分离株(野生型),具有C(max)和fC(max)的STFX表现出最快的杀菌活性,在1小时内平均减少>或= 3.0 log10菌落形成单位(CFU)/ mL。具有C(max)和fC(max)的STFX对9株具有单par (C/E)突变的临床分离株也表现出最快速和最有效的杀菌活性,导致活细胞在1小时内平均降低>或= 3.0 log10 CFU/mL。STFX在单突变体的初始杀菌活性上比其他喹诺酮类药物有统计学上的显著优势(P < 0.001)。利用肺炎链球菌ATCC49619(野生型)及其实验室单个parC突变体证实了STFX与其他喹诺酮类药物在单突变株中的初始杀菌活性差异高于野生型菌株的趋势。结果表明,STFX对两种菌株均表现出相似的快速有效的初始杀菌活性,而对其他喹诺酮类药物的初始杀菌活性在单突变体中显著降低(P < 0.05)。综上所述,与LVFX、MFLX和GRNX相比,STFX对肺炎链球菌野生型和单突变体具有最快速、最有效的初始杀菌活性,且其杀菌活性不受单突变体存在的影响。
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引用次数: 0
[Bactericidal effect of levofloxacin injection in combination with meropenem against Pseudomonas aeruginosa using an in vitro simulation model with a hollow fiber system]. [利用中空纤维系统体外模拟模型研究左氧氟沙星注射液联合美罗培南对铜绿假单胞菌的杀菌效果]
Pub Date : 2012-12-01
Saori Uoyama, Hiroko Kanda, Kumi Yoshida, Kazuki Hoshino

An in vitro human plasma concentration simulation model with a hollow fiber system was established and used to evaluate the bactericidal effect of levofloxacin (LVFX) 500mg q.d. in combination with meropenem (MEPM) 1000mg t.i.d. against Pseudomonas aeruginosa. Six clinical isolates of P. aeruginosa which had MEPM MICs of 2 - 16 microg/mL, LVFX MICs of 2 microg/mL, and fractional inhibitory concentration (FIC) indices by the in vitro checkerboard method of 0.625-1 were used. In the treatment with MEPM alone, initial viable counts (10(6)-10(7) CFU/ mL) decreased, but did not reach below the detection limit (100 CFU/mL) and the regrowth of bacteria was observed. In the treatment with LVFX alone, viable counts decreased once below the detection limit, although increased after treatment for 24 hours. On the other hand, in the treatment with LVFX-MEPM combination, more potent bactericidal effects were observed compared to LVFX or MEPM alone in all strains. Especially, in the strains with MEPM MICs of 2 and 4 microg/mL, viable counts rapidly decreased below the detection limit and no regrowth was observed until 24 hours. These results suggested that LVFX-MEPM has a potential to be an effective combination against P. aeruginosa by synergistic rapid bactericidal action in clinical settings, even in the strain against which no significant synergy is confirmed by the traditional in vitro checkerboard method.

采用中空纤维系统建立体外人血药浓度模拟模型,评价左氧氟沙星(LVFX) 500mg q.d联合美罗培南(MEPM) 1000mg t.d对铜绿假单胞菌的杀菌效果。选用MEPM mic为2 ~ 16 μ g/mL、LVFX mic为2 μ g/mL、体外棋盘法分数抑制浓度(FIC)指数为0.625-1的6株铜绿假单胞菌临床分离株。MEPM单独处理时,初始活菌计数(10(6)~ 10(7)CFU/mL)下降,但未低于检出限(100 CFU/mL),并观察到细菌的再生。在单独使用LVFX治疗时,活菌计数下降一次,低于检测限,尽管在治疗24小时后增加。另一方面,在LVFX-MEPM联合治疗中,所有菌株的杀菌效果都比单独使用LVFX或MEPM更强。特别是在MEPM mic为2和4 μ g/mL的菌株中,活菌数迅速下降到检测限以下,直到24小时才出现再生。这些结果表明,LVFX-MEPM在临床环境中具有协同快速杀菌作用的潜力,即使在传统体外棋盘法未证实对P. aeruginosa有显著协同作用的菌株中也是如此。
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引用次数: 0
[Efficacy and safety of levofloxacin to non-gonorrheal urethritis]. 左氧氟沙星治疗非淋病性尿道炎的疗效和安全性。
Pub Date : 2012-12-01
Shoichi Onodera, Yasuhiko Onoe, Takahide Hosobe, Tetsuro Kato, Masaki Yoshida

We investigated the efficacy and safety of levofloxacin (LVFX) 500mg once a day in patients with non-gonorrheal urethritis. Men, aged 20 years or older, with urethritis symptoms, and detection of Chlamydia trachomatis (C. trachomatis) or Mycoplasma genitalium (M. genitalium) by a microbiological examination were eligible for this study. Patients were administered LVFX 500mg, orally, once a day and the dosage period was seven days. We assumed 22 patients for a safety and efficacy analysis. In 22 patients, 17 patients had urethritis with C. trachomatis, 4 patients urethritis with M. genitalium, and one patient mixed infection of C. trachomatis and M. genitalium. In the clinial study, the primary endpoint was set as the bacteriological eradication rate at two to four weeks after completion of treatment. The bacterial eradication rate in the urethritis was 86.4% (19/22). The bacterial eradication rate in the urethritis with C. trachomatis, M. genitalium, and mixed infection of C. trachomatis and M. genitalium were 94.1% (16/17), 50.0% (2/4), 100% (1/1), respectively. A significant difference was not recognized among the three groups. The clinical efficacy at two to four weeks after completion of treatment was 90.9% (20/22). The clinical efficacy rates in the urethritis with C. trachomatis, M. genitalium, and mixed infection of C. trachomatis and M. genitalium were 100% (17/17), 50.0% (2/4), 100% (1/1), respectively. The efficacy rate of urethritis with M. genitalium was significantly low. No adverse drug reactions were observed. These results suggest that once-a-day levofloxacin (500mg) is effective and safe treatment for non-gonorrheal urethritis.

我们研究了左氧氟沙星(LVFX) 500mg / d治疗非淋病性尿道炎的疗效和安全性。年龄在20岁或以上,有尿道炎症状,并通过微生物检查检测出沙眼衣原体(C.沙眼)或生殖道支原体(M.生殖道支原体)的男性符合本研究的条件。患者给予LVFX 500mg,口服,每日1次,给药期为7天。我们假设22例患者进行安全性和有效性分析。22例患者中,合并沙眼衣原体尿道炎17例,合并生殖道支原体尿道炎4例,合并生殖道支原体混合感染1例。在临床研究中,主要终点设定为治疗完成后2 - 4周的细菌根除率。尿道炎的细菌根除率为86.4%(19/22)。沙眼衣原体、生殖道支原体及沙眼衣原体与生殖道支原体混合感染尿道炎的细菌根除率分别为94.1%(16/17)、50.0%(2/4)、100%(1/1)。在三组之间没有发现显著的差异。治疗结束后2 ~ 4周的临床疗效为90.9%(20/22)。沙眼衣原体、生殖道支原体混合感染尿道炎的临床有效率分别为100%(17/17)、50.0%(2/4)、100%(1/1)。生殖道支原体尿道炎的有效率较低。未见药物不良反应。这些结果表明,每天一次左氧氟沙星(500mg)是治疗非淋病性尿道炎的有效和安全的方法。
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引用次数: 0
[In vitro activity of doripenem against strains from pediatric diseases and strains causing purulent meningitis]. [多利培南对小儿疾病菌株和引起化脓性脑膜炎菌株的体外活性研究]。
Pub Date : 2012-12-01
Merime Ohta, Shinsuke Toba, Akinobu Ito, Rio Nakamura, Masakatsu Tsuji

This study evaluated the in vitro activity of doripenem (DRPM) against 200 Streptococcus pneumoniae and 197 Haemophilus influenzae from children and adults in 2007, 50 H. influenzae type b in 2006, 20 Listeria monocytogenes in 1990-2005, 23 Neisseria meningitidis in 2007-2009 and 83 Bordetella pertussis in 1989-2003. All strains were isolated from Japanese clinical facilities. We also investigated in vitro activity of other carbapenems (meropenem, imipenem, panipenem, biapenem), cephems (ceftriaxone, cefotaxime), ampicillin and clarithromycin. The all MICs were determined by a broth micro dilution method or an agar dilution method according to CLSI. The MIC90(s) of DRPM against S. pneumoniae and H. influenzae from children were 0.25 microg/mL, 1 microg/mL, respectively, which were similar to strains from adults. These results suggested that antibacterial activity of DRPM is not variable by patient's age. DRPM also showed excellent activities against H. influenzae type b, L. monocytogenes and N. meningitidis, which cause purulent meningitis, and B. pertussis causing whooping cough more than the other carbapenems. DRPM showed superior activities against serious strains of pediatric infection diseases.

本研究评估了多利培南(DRPM)在2007年对200种肺炎链球菌和197种流感嗜血杆菌的体外活性,2006年对50种b型流感嗜血杆菌的体外活性,1990-2005年对20种单核细胞增生李斯特菌的体外活性,2007-2009年对23种脑膜炎奈瑟菌的体外活性和1989-2003年对83种百日咳博德特菌的体外活性。所有菌株均从日本临床机构分离。我们还研究了其他碳青霉烯类(美罗培南、亚胺培南、帕尼培南、比阿培南)、头孢类(头孢曲松、头孢噻肟)、氨苄西林和克拉霉素的体外活性。所有mic采用肉汤微量稀释法或琼脂稀释法,按CLSI测定。DRPM对儿童肺炎链球菌和流感嗜血杆菌的MIC90(s)分别为0.25 μ g/mL、1 μ g/mL,与成人菌株相似。这些结果表明,DRPM的抗菌活性不随患者年龄的变化而变化。与其他碳青霉烯类相比,DRPM对b型流感嗜血杆菌、单核细胞增生乳杆菌和脑膜炎奈希菌(引起化脓性脑膜炎)和百日咳嗜血杆菌(引起百日咳)也表现出较好的活性。DRPM对严重的儿童传染病具有较强的防治作用。
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引用次数: 0
[Efficacy and safety of sitafloxacin in patients with urinary tract infections]. 西他沙星治疗尿路感染的疗效和安全性。
Pub Date : 2012-12-01
Takuyuki Matsumoto, Hiroki Yamaguchi, Kazuhiro Uchino, Megumi Takahashi, Hiroko Kodama, Satoko Hamajima, Rie Yonemochi, Sachiko Fujita, Atsushi Takita, Naoki Yamanouchi, Tomoo Shiozawa, Yukihiro Okutani

Sitafloxacin (STFX, Gracevit 50mg, fine granules 10%), a new quinolone antibacterial agent, was approved in January 2008, and the use-results survey was carried out over the 2 years between December 2008 and November 2010. We studied the efficacy and safety of STFX in 1,452 patients with urinary tract infections (cystitis, pyelonephritis, urethritis). The total efficacy rate for urinary tract infections was 91.4% (1,235/1,351 patients). Efficacy rates, classified by the type of infection, were: uncomplicated cystitis 95.9% (466/486 patients), complicated cystitis 87.2% (511/586 patients), uncomplicated pyelonephritis 96.1% (49/51 patients), complicated pyelonephritis 93.5% (145/155 patients), and urethritis 87.7% (64/73 patients). Efficacy rates were 86.0% (49/57 patients) for non-responders to cephems and 77.4% (48/62 patients) for non-responders to quinolones. The eradication rate of indicated strains was 90.5% (545/602 strains). The eradication rates of major causative bacteria were; Escherichia coli 92.7% (294/317 isolates), Enterococcus faecalis 86.0% (43/50 isolates), Pseudomonas aeruginosa 66.7% (16/24 isolates), Klebsiella pneumoniae 95.2% (20/21 isolates), and Chlamydia trachomatis 88.9% (8/9 isolates). The incidence of adverse drug reactions (ADRs) was 2.71% (37/1,365 cases). Major ADRs were diarrhoea (0.88%, 12 cases) and hepatic function disorders (0.51%, 7 cases). A serious ADR (hepatic function abnormality) was observed in 1 case, and the hepatic function in this patient returned to normal after treatment with STFX was discontinued. In conclusion, these results suggest that STFX is a useful antibacterial agent with an efficacy rate of 91.4% against urinary tract infections, with a minimum efficacy rate of 87.2% (against complicated cystitis), and has no serious problems in its safety profile.

西他沙星(STFX, Gracevit 50mg,细粒10%)是一种新型喹诺酮类抗菌剂,于2008年1月获批,并于2008年12月至2010年11月进行了为期2年的使用结果调查。我们研究了STFX在1452例尿路感染(膀胱炎、肾盂肾炎、尿道炎)患者中的疗效和安全性。尿路感染总有效率为91.4%(1235 / 1351)。按感染类型分类,有效率为:无合并性膀胱炎95.9%(466/486例),合并性膀胱炎87.2%(511/586例),无合并性肾盂肾炎96.1%(49/51例),合并性肾盂肾炎93.5%(145/155例),尿道炎87.7%(64/73例)。对头孢类药物无反应的有效率为86.0%(49/57例),对喹诺酮类药物无反应的有效率为77.4%(48/62例)。指示菌株的根除率为90.5%(545/602株)。主要致病菌的根除率为;大肠杆菌92.7%(294/317株)、粪肠球菌86.0%(43/50株)、铜绿假单胞菌66.7%(16/24株)、肺炎克雷伯菌95.2%(20/21株)、沙眼衣原体88.9%(8/9株)。不良反应(adr)发生率为2.71%(37/ 1365例)。主要不良反应为腹泻(0.88%,12例)和肝功能障碍(0.51%,7例)。1例出现严重不良反应(肝功能异常),停用STFX治疗后肝功能恢复正常。综上所述,STFX是一种有效的抗菌药物,对尿路感染的有效率为91.4%,对复杂性膀胱炎的最低有效率为87.2%,安全性方面没有严重问题。
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引用次数: 0
[Future outlook on the guidelines for the management of pneumonia--special reference to development of higher quality clinical guidelines (discussion)]. [肺炎治疗指南的未来展望——特别提到制定更高质量的临床指南(讨论)]。
Pub Date : 2012-10-01
Yoshinori Hasegawa, Shigeru Kawano, Kazunori Asano, Masahiro Yoshida
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引用次数: 0
Comparison of four reading methods of broth microdilution based on the clinical and laboratory standards institute M27-A3 method for Candida spp. 基于临床和实验室标准协会M27-A3法的肉汤微量稀释4种读数方法对念珠菌的比较。
Pub Date : 2012-10-01
Hiromi Morishige, Yoko Mano, Toyoko Oguri, Nobuhiko Furuya

This study aimed to compare the susceptibilities of 5 reference strains and 28 isolates of Candida spp., to micafungin, amphotericin B, flucytosine, fluconazole, itraconazole, voriconazole, and miconazole, obtained by visually determined minimum inhibitory concentration (MIC) using the agitation method (V-A), as described in the Clinical and Laboratory Standards Institute M27-A3 document; visual determinations without agitation (V-NA); and spectrophotometric determinations for the presence or absence of agitation (SP-A and SP-NA, respectively). Our results indicate that when the V-NA, SP-A, and SP-NA-the 3 alternative microdilution procedures for MIC endpoint determinations-were compared with the V-A, excellent agreements were observed between the V-NA and V-A rather than with the spectrophotometric methods (between the SP-A or SP-NA, and V-A). Furthermore, many errors occurred while using the SP-A method in the presence of agitation and some isolates showed major errors. Three of 5 isolates that showed very major errors between the spectrophotometric SP-A or SP-NA, and the reference V-A method were trailing isolates. Therefore, it was suggested that the MICs of Candida spp. obtained by the V-NA method were more precise than those by the conventional SP-A method.

本研究旨在比较5株参考菌株和28株假丝酵母菌对米卡芬金、两性霉素B、氟胞嘧啶、氟康唑、伊曲康唑、伏立康唑和咪康唑的敏感性,这些药物采用搅拌法(V-A)通过视觉测定最低抑菌浓度(MIC)获得,详见临床与实验室标准协会M27-A3文件;无搅拌目视测定(V-NA);和分光光度法测定是否存在搅拌(SP-A和SP-NA分别)。我们的研究结果表明,当V-NA、SP-A和SP-NA(用于MIC终点测定的3种替代微量稀释方法)与V-A进行比较时,V-NA和V-A之间的一致性优于分光光度法(SP-A或SP-NA与V-A之间)。此外,SP-A方法在存在搅拌的情况下出现了许多误差,一些分离物出现了较大的误差。在分光光度法SP-A或SP-NA与参考方法V-A误差较大的5株分离株中,有3株为尾随分离株。因此,与传统的SP-A法相比,V-NA法对念珠菌的mic测定精度更高。
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引用次数: 0
[Morphological changes in penicillin-resistant Streptococcus pneumoniae and beta-lactamase-nonproducing, ampicillin-resistant Haemophilus influenzae after exposure to oral antibacterial agents]. [接触口服抗菌剂后耐青霉素肺炎链球菌和不产生β -内酰胺酶、耐氨苄西林流感嗜血杆菌的形态学变化]。
Pub Date : 2012-10-01
Naoko Chiba, Miyuki Morozumi, Kimiko Ubukata

Morphological changes in penicillin-resistant Streptococcus pneumoniae (PRSP) and beta-lactamase-nonproducing, ampicillin-resistant Haemophilus influenzae (BLNAR) after exposure to oral antibacterial agents could be observed over time under a phase-contrast microscope. Morphological changes in BLNAR were also observed using a scanning electron microscope. The organisms used in this study were ME19F strain identified as genotypic(g) gPRSP (serotype: 19F) and JPH002 strain identified as gBLNAR (serotype: b). The antibacterial agents used were amoxicillin (AMPC), cefditoren (CDTR), tebipenem (TBPM), and tosufloxacin (TFLX). The concentration of each antibacterial agent to which the bacteria were exposed was set at the blood level one hour after Cmax when administered to children at the usual dose. Bacteriolysis of gPRSP cells started after exposure of only 20minutes to TBPM, and 90% of the cells were lysed within 2 hours. A high bactericidal action of TBPM on gPRSP was supported by these findings. When gBLNAR was exposed to AMPC and TBPM, lysis from spheroplasts and cells with vacuoles were sometimes observed. In contrast, after gBLNAR was exposed to CDTR, lysis occurred after marked filamentation in the cells, but after exposure to TFLX, cells deduced to be killed after mild filamentation without lysis. Time-dependent morphological changes that reflect the differences in bactericidal activity and PBP affinity among beta-lactams provide beneficial information to select antibacterial agents.

在相对比显微镜下,可以观察到暴露于口服抗菌药物后,耐青霉素肺炎链球菌(PRSP)和不产生β -内酰胺酶的耐氨苄西林流感嗜血杆菌(BLNAR)的形态学变化。扫描电镜下观察BLNAR的形态学变化。本研究使用的微生物为基因型(g)的ME19F菌株gPRSP(血清型:19F)和基因型为gBLNAR的JPH002菌株(血清型:b)。使用的抗菌药物为阿莫西林(AMPC)、头孢地托伦(CDTR)、替比培南(TBPM)和托苏沙星(TFLX)。这些细菌接触到的每一种抗菌剂的浓度被设定为Cmax后一小时的血液水平,以常规剂量给孩子服用。gPRSP细胞仅在TBPM作用20分钟后开始细菌溶解,90%的细胞在2小时内被溶解。这些发现支持了TBPM对gPRSP的高杀菌作用。当gBLNAR暴露于AMPC和TBPM时,有时会观察到球质体和液泡细胞的裂解。相比之下,gBLNAR暴露于CDTR后,细胞在明显的丝化后发生裂解,但暴露于TFLX后,细胞在轻度丝化后未发生裂解而被杀死。随时间变化的形态变化反映了β -内酰胺之间的杀菌活性和PBP亲和力的差异,为选择抗菌剂提供了有益的信息。
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引用次数: 0
[Antibacterial susceptibility surveillance of Haemophilus influenzae isolated from pediatric patients in Gifu and Aichi prefectures (2009-2010)]. 2009-2010年岐阜县和爱知县儿童流感嗜血杆菌的抗菌药敏监测
Pub Date : 2012-10-01
Mariko Takakura, Yoshiko Fukuda, Nobuhiko Nomura, Junichi Mitsuyama, Kazukiyo Yamaoka, Yuko Asano, Haruki Sawamura, Kouichi Katsuragawa, Hikonori Hashido, Yoko Matsukawa, Shigenori Matsubara, Hirotoshi Oota, Kunitomo Watanabe, Yuka Yamagishi, Hiroshige Mikamo

We investigated the susceptibility to antibacterial agents of 197 strains of Haemophilus influenzae isolated from pediatric patients at medical facilities in Gifu and Aichi prefectures between 2009 and 2010. Those strains were also examined for the mutations of ftsI coding for penicillin-binding protein 3, presence of bla TEM-1, serotype and beta-lactamase producing ability. Among the 197 strains, the most prevalent serotype was non-typeable (89.8%), followed by serotype b (8.1%), e (1.5%) and f (0.5%). Based on the susceptibility among the 197 strains to antibacterial agents, beta-lactamase nonproducing ampicillin-susceptible H. influenzae (BLNAS) accounted for 27.4%, beta-lactamase nonproducing ampicillin-resistant H. influenzae (BLNAR) for 62.4%, beta-lactamase producing ampicillin-resistant H. influenzae (BLPAR) for 6.1% and beta-lactamase producing amoxicillin/ clavulanic acid-resistant H. influenzae (BLPACR) for 4.1%. According to PCR-based genotyping, the strains were classified into 6 categories: gBLNAS, gLow-BLNAR, gBLNAR, gBLPAR, gBLPACR-I and gBLPACR-II. The incidences of each resistant class were 17.3% for gBLNAS, 6.6% for gLow-BLNAR, 66.0% for gBLNAR, 5.6% for gBLPAR and 4.6% for gBLPACR-II. The combined incidence of gLow-BLNAR and gBLNAR was 72.6%, which was higher than that of BLNAR (62.4%). The MIC90s of antibacterial agents against the 197 strains were as follows; 0.0156 microg/mL for tosufloxacin and garenoxacin, 0.0313 microg/mL for levofloxacin and pazufloxacin, 0.0625 microg/mL for norfloxacin, 0.25 microg/mL for tazobactam/piperacillin (TAZ/PIPC) and ceftriaxone, 0.5 microg/mL for TAZ/PIPC (1:8) and cefditoren, 1 microg/mL for piperacillin, cefteram, cefotaxime, meropenem, tebipenem and minocycline, 2 microg/mL for doripenem, 4 microg/mL for cefcapene, imipenem and azithromycin, 8 microg/mL for sulbactam/ampicillin, clavulanic acid/amoxicillin (1:2, CVA/AMPC) and cefdinir, 16 microg/mL for CVA/AMPC (1:14), flomoxef and clarithromycin, 32 microg/mL for ampicillin. Although there was no rapid increase in the antibacterial resistance, the prevalence of BLNAR was still over 50%. In order to ensure the appropriate chemotherapy, it is important to continue the surveillance of susceptibility among H. influenzae.

我们调查了2009年至2010年岐阜县和爱知县医疗机构儿童患者分离的197株流感嗜血杆菌对抗菌药物的敏感性。这些菌株还检测了编码青霉素结合蛋白3的ftsI突变,bla TEM-1的存在,血清型和β -内酰胺酶产生能力。197株中以不可分型为主(89.8%),其次为b型(8.1%)、e型(1.5%)和f型(0.5%)。根据197株菌株对抗菌药物的敏感性,不产生氨苄西林的-内酰胺酶敏感流感嗜血杆菌(BLNAS)占27.4%,不产生氨苄西林的-内酰胺酶耐药流感嗜血杆菌(BLNAR)占62.4%,产生氨苄西林的-内酰胺酶耐药流感嗜血杆菌(BLPAR)占6.1%,产生阿莫西林/克拉维酸的-内酰胺酶耐药流感嗜血杆菌(BLPACR)占4.1%。根据pcr基因分型将菌株分为6类:gBLNAS、glo - blnar、gBLNAR、gBLPAR、gBLPACR-I和gBLPACR-II。gBLNAS、gLow-BLNAR、gBLNAR、gBLPAR和gBLPACR-II耐药发生率分别为17.3%、6.6%、66.0%、5.6%和4.6%。gBLNAR和gBLNAR的合并发病率为72.6%,高于BLNAR的62.4%。各抗菌药物对197株病原菌的mic90值分别为:左氧氟沙星和帕唑沙星0.0156微克/mL,左氧氟沙星和帕唑沙星0.0313微克/mL,诺氟沙星0.0625微克/mL,他唑巴坦/哌拉西林(TAZ/PIPC)和头孢曲松0.25微克/mL, TAZ/PIPC(1:8)和头孢地托伦0.5微克/mL,哌拉西林、头孢特仑、头孢噻肟、美罗培南、替比培南和米诺环素1微克/mL,多利培南2微克/mL,头孢capene、亚胺培南和阿奇霉素4微克/mL,舒巴坦/氨苄西林、克拉维酸/阿莫西林(1:2),CVA/AMPC)和头孢地尼,CVA/AMPC (1:14) 16 μ g/mL,氟莫昔和克拉霉素,氨苄西林32 μ g/mL。虽然耐药性没有迅速上升,但BLNAR的患病率仍在50%以上。为了确保适当的化疗,继续监测流感嗜血杆菌的敏感性是很重要的。
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The Japanese journal of antibiotics
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