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Acinetobacter baumannii (AB) es un bacilo gram negativo, no fermentador,con frecuencia oportunista, ubicuo en el medio ambiente, con capacidad para sobrevivir en condiciones medioambientales adversas promoviendo su persistencia y diseminación en diferentes áreas de un hospital. Ha sido relacionado con múltiples brotes de infecciones asociadas al cuidado de la salud como neumonía, bacteriemias, contaminación de heridas quirúrgicas o infecciones del tracto urinario, especialmente entre pacientes con comorbilidades graves, como aquellos que motivan el ingreso a unidades de cuidados intensivos (UCI). Las cepas más problemáticas son aquellas resistentes a los carbapenémicos, resistencia causada por enzimas de la clase de las oxacilinasas (bla OXA) cromosómicas o plasmídicas y más recientemente bla NDM-1. La aparición de estas cepas deja escasos antimicrobianos activos (colistin, minociclina, tigeciclina; amikacina) que son limitados en su eficacia y su uso se asocia con toxicidad. A esto se agrega, como en la paciente que se describe, que desarrolló una meningitis posquirúrgica, la limitada capacidad de difusión en el sistema nervioso central (SNC) de estas últimas opciones. Una de las alternativas terapéuticas, es buscar asociaciones como sulbactam/avibactam que mostraron una adecuada actividad sinérgica y bactericida en asilamientos resistentes a ampicilina/sulbactam en base a una significativa reducción de la CIM que permite administrar dosis habituales, con mejor tolerancia y lograr concentraciones terapéuticas en SNC. Se presenta una paciente que desarrolló una meningitis posquirúrgica debida a una cepa de AB multirresistente.
Acinetobacter baumannii (AB) is a non-fermenting gram-negative bacillus, largely opportunistic, ubiquitous in the environment, with the ability to survive in adverse environmental conditions, promoting its persistence and dissemination in different areas of the hospital. It has been implicated in many outbreaks of healthcare-associated infections such as pneumonia, bacteremia, surgical wounds contamination, or urinary tract infections, especially among patients with previous severe illnesses such as those requiring admission to intensive care units (ICU). The most problematic strains are those resistant to carbapenems, resistance caused by chromosomal or plasmid oxacillinase class (bla OXA), and more recently bla NDM-1. The appearance of these strains leaves few active antimicrobials (Colistin, Minocycline, Tigecycline; Amikacin) that are limited in their efficacy and toxic. To this we must add, as is the case of our patient who presented post-surgical meningitis, the limited diffusion capacity in the central nervous system (CNS) of these last options. One of the therapeutic alternatives is to search for synergistic associations such as sulbactam/avibactam that showed rapid synergistic and bactericidal activity in isolates resistant to ampicillin/sulbactam due to a significant reduction in its MIC, which allows us to administer usual, better tolerated doses that reach therapeutic concentrations in CNS. Here, we present a patient who developed a post-surgical meningitis due to multiresistant AB
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Humans , Female , Adult , Sulbactam/therapeutic use , Acinetobacter baumannii , Drug Synergism , Meningitis/therapyABSTRACT
Drug-resistant Acinetobacter baumannii is a frightening reality. The aim of this study is to examine the expression profiles of blaOXA-51 gene in carbapenemases producing A. baumannii treated with imipenem/sulbactam combination. Carbapenemases producing A. baumannii was identified among clinical isolates of A. baumannii obtained from patients at Shahid Rajaee hospital, Gachsaran, Iran, from January to June 2018. Synergism testing of imipenem/sulbactam on carbapenemases producing A. baumannii was carried out by broth microdilution method. Eventually, the expression of blaOXA-51 gene was carried out to investigate the inhibitory properties of imipenem/sulbactam combination against carbapenemases producing A. baumannii using quantitative real time RT-PCR. Among A. baumannii isolates, 24% were carbapenemases producing A. baumannii. Imipenem/sulbactam combination revealed synergistic and partial synergistic effect for all tested isolates (FIC= 0.313-0.75). Finally, imipenem/sulbactam combination displayed significant down-regulation of blaOXA-51 gene in carbapenemases producing A. baumannii. Imipenem synergizes with sulbactam against carbapenemases producing A. baumannii by targeting of the blaOXA-51 gene.
Subject(s)
Sulbactam/agonists , Imipenem/agonists , Acinetobacter baumannii/drug effects , Patients/classification , In Vitro Techniques/instrumentation , Pharmaceutical Preparations/analysis , Hospitals/classification , MethodsABSTRACT
OBJECTIVE：To i nvestigate the clini cal ch aracteristics of anaphylactic shock induced by piperacillin and its compound preparation ，and to provide reference for prevention and treatment of the severe ADR. METHODS ：A case of anaphylactic shock induced by piperacillin and sulbactam were analyzed in our hospital ，meanwhile ADR literatures about piperacillin alone and its compound preparation-induced anaphylactic shock were collected from Medline ，CNKI，Wanfang database and VIP during the inception to Jul. 2020. Gender and age of patients ，allergic history ，primary disease and treatment ，skin test ， administration route and dosage of piperacillin and its compound preparation ，occurrence time and main manifestations of anaphylactic shock ，treatment measure and prognosis were analyzed ，then prevention and treatment suggestions were put forward. RESULTS：The patient in this case was transferred to the ICU after partial hepatectomy. The use of piperacillin and sulbactam to prevent postoperative infection caused anaphylactic shock. A total of 28 literatures about anaphylactic shock induced by piperacillin and its compound preparations were collected from the database （involving 28 patients）. Among totally 29 patients，there were 12 male and 17 female；the majority of patients were 50-59 years old （6 cases，20.69％）. Three patients had allergic history （food， latex gloves ，etc.），and most of the primary diseases were infectious diseases or the drug used in perioperative period. Skin tests were carried out in 22 patients（75.86％）before medication and the results were negative. The possible allergenic drugs of 27 cases which were administered by intravenous route included piperacillin ，piperacillin sulbactam and piperacillin tazobactam. The dosage was different according to the primary disease and severity. 14 patients（55.56％）developed anaphylactic shock within 5 minutes after drug exposure. The main symptoms were systemic allergic reaction ，mainly involving the circulatory system. Except for two death cases ，the other patients ’symptoms were relieved after treatment. CONCLUSIONS ：Allergic history and skin test results may have limitation in predicting anaphylactic shock induced by piperacillin and its compound preparation. Close monitoring needs to be taken in patients during these medications. Rescue therapy should be prepared in advance and countermeasures need to be carried out promptly in case of anaphylactic shock.
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Background: Complicated UTIs (cUTIs) are leading causes of the gram negative bacteraemia. The objective of this study was to compare efficacy and safety Cefotaxime/ Sulbactam (CTS) and Piperacillin/ Tazobactam (PT) combinations in complicated Urinary Tract Infections.Methods: Total 80 patients admitted in the hospital due to cUTI were enrolled. 31 patients were given CTS while 49 patients were given PT. Clinical symptoms were registered and scored as mild (1) moderate (2) or severe (3). The follow-up of were done daily till the patient is discharged. Thereafter, one follow up visit was done within 4 to 9 days of after discharge, termed as test of cure (TOC), and, one late follow up visit after 6 to 8 weeks was done, known as late follow up visit (LFU). Clinical assessments and microbiological analysis were done at the time of TOC and LFU.Results: At TOC visit, in CTS and PT groups, clinical scores were 1.25�47 and 0.86�35, respectively (p<0.005). Rate of clinical improvement at TOC visit was 92.00% and 92.68% while microbiological clearance was 84.00% and 87.80% with CTS and PT groups respectively. At LFU visit, clinical scores CTS and PT in groups were 1.30�56 and 1.32�37, respectively, suggesting significant improvement from baseline (p<0.005). Clinical cure rate at LFU visit was 88.00% and 87.80% while microbiological cure rate at LFU visit was 76.00% and 82.91% in CTS and PT groups respectively.Conclusions: Results suggest that both regimens have no significant difference for the treatment of cUTI. CTS and PT both are equally efficacious in treatment of cUTI.
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Objective@#To explore the clinical efficacy of thymalfasin on the immune function and inflammatory response in the treatment of patients with severe pneumonia.@*Methods@#From June 2015 to June 2018, 86 patients with severe pneumonia in the Hospital of Zhejiang Provincial General Team of Armed Police were enrolled in the study.According to different treatment methods, they were divided into control group and treatment group, with 43 cases in each group.The control group was treated with cefoperazone/sulbactam sodium on the basis of conventional treatment.The treatment group was treated with thymalfasin on the basis of the treatment of the control group.The expression of monocyte human leukocyte antigen-DR (mHLA-DR), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured before and after treatment.At the same time, CD4+, CD8+, CD4+/CD8+ before and after treatment were examined in the two groups.The efficacy and bacterial clearance rate of the two groups were evaluated.The adverse reactions were recorded.@*Results@#After treatment, the levels of IL-6 and TNF-α in the two groups were significantly lower than those before treatment [treatment group: (44.9±11.8)ng/L, (42.9±13.1)ng/L vs. (86.5±27.9)ng/L, (79.6±28.6)ng/L, control group: (71.5±14.2)ng/L, (65.9±22.6)ng/L vs. (87.1±28.6)ng/L, (78.8±29.1)ng/L, t=9.005, 7.650, 3.203, 2.295, all P<0.05]. The expression level of mHLA-DR in the treatment group after treatment [(44.8±5.7)%] was significantly higher than that before treatment [(27.1±3.4)%, t=17.487, P=0.000]. The changes of the indicators in the treatment group were significantly better than those in the control group (t=9.447, 5.773, 8.725, all P<0.05). After treatment, the CD4+ level of the two groups were higher than those before treatment, and the CD8+ levels of the two groups were significantly lower than those before treatment, the differences were statistically significant(t=3.050, 3.429, 6.965, 13.327, all P<0.05), and the CD4+/CD8+ of the two groups were significantly increased (t=0.370, 3.314, all P<0.05). The indicators of the treatment group were improved more significantly than the control group (t=4.416, 12.355, 3.089, all P<0.05). The bacterial clearance rate of the treatment group was 88.89% (32/36), which was significantly higher than that of the control group [67.65% (23/34), χ2=4.686, P=0.030]. The clinical efficacy of the treatment group was 93.02%(40/43), which was significantly higher than 76.74%(33/43) of the control group (χ2=6.095, P=0.047). The incidence of adverse reactions between the two groups had no statistically significant difference (χ2=0.212, P=0.645).@*Conclusion@#Thymalfasin in the treatment of patients with severe pneumonia can improve the immune function, reduce the inflammatory response, improve the bacterial clearance rate and clinical efficacy, and will not increase the adverse reactions, so it is worthy of promoting.
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OBJECTIVE： To study the efficacy and economics of cefoperazone/sulbactam combined with moxifloxacin and amikacin versus cefoperazone/sulbactam combined with tigecycline in the treatment of pneumonia with multidrug-resistant Acinetobacter baumannii （MDRAB）. METHODS： By prospective study， 150 MDRAB pneumonia patients were selected from Jingmen Second People’s Hospital during Jan. 1st， 2016-Aug. 31st， 2019， and then randomly divided into control group and observation group， with 75 cases in each group. Control group was given Cefoperazone/sulbactam sodium for injection （3 g， q8 h， ivgtt） combined with Tigecycline for injection （first dose 100 mg， maintenance dose 50 mg， q12 h， ivgtt）. Observation group was give Cefoperazone/sulbactam sodium for injection （3 g， q8 h， ivgtt） combined with Moxifloxacin hydrochloride and sodium chloride injection （400 mg， qd， ivgtt） and Amikacin sulfate injection （0.6 g， qd， ivgtt）. The treatment lasted for 14 days in both groups. The time for body temperature to return to normal， lung rales disappearance， WBC to return to normal and PCT to return to normal， clinical efficacy， bacterial clearance rate and the occurrence of ADR were compared between 2 groups. Cost-effectiveness analysis was used to evaluate the cost- effectiveness ratio （C/E） and incremental cost-effectiveness ratio （ΔC/ΔE） of 2 groups using antibiotics cost as cost. Sensitivity analysis was performed by reducing drug cost by 15％. RESULTS： There was no statistical significance in the time for body temperature to return to normal， lung rales disappearance， WBC to return to normal and PCT to return to normal between control group and observation group （P＞0.05）. Clinical response rates of 2 groups were 85.33％ and 81.33％， and bacterial clearance rate were 89.33％ and 82.67％， with statistical significance （P＞0.05）. No serious ADR occurred in either group. The antibacterial cost of control group and observation group were 32 371.49 yuan/person and 9 367.82 yuan/person. C/E of clinical response rate were 379.37 and 115.18， and C/E of bacterial clearance rate were 362.38 and 113.32 in 2 groups， respectively. ΔC/ΔE of clinical response rate and bacterial clearance rate between control group and observation group were 5 750.92 and 3 454.00. Sensitivity analysis supported cost-effectiveness analysis results. CONCLUSIONS： Cefoperazone/sulbactam combined with moxifloxacin and amikacin versus cefoperazone/sulbactam combined with tigecycline in the treatment of pneumonia with MDRAB has similar efficacy， but cefoperazone/sulbactam combined with moxifloxacin and amikacin has economic and social benefits.
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Objective To explore the clinical efficacy of thymalfasin on the immune function and inflammatory response in the treatment of patients with severe pneumonia.Methods From June 2015 to June 2018,86 patients with severe pneumonia in the Hospital of Zhejiang Provincial General Team of Armed Police were enrolled in the study.According to different treatment methods,they were divided into control group and treatment group,with 43 cases in each group.The control group was treated with cefoperazone/sulbactam sodium on the basis of conventional treatment.The treatment group was treated with thymalfasin on the basis of the treatment of the control group.The expression of monocyte human leukocyte antigen-DR (mHLA-DR),tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured before and after treatment.At the same time,CD4+,CD8+,CD4+ /CD8 + before and after treatment were examined in the two groups.The efficacy and bacterial clearance rate of the two groups were evaluated.The adverse reactions were recorded.Results After treatment,the levels of IL-6 and TNF-α in the two groups were significantly lower than those before treatment [treatment group:(44.9 ± 11.8)ng/L,(42.9 ± 13.1) ng/L vs.(86.5 ± 27.9) ng/L,(79.6 ± 28.6) ng/L,control group:(71.5 ± 14.2)ng/L,(65.9 ±22.6)ng/L vs.(87.1 ±28.6)ng/L,(78.8 ±29.1)ng/L,t =9.005,7.650,3.203,2.295,all P ＜ 0.05].The expression level of mHLA-DR in the treatment group after treatment [(44.8 ± 5.7) ％] was significantly higher than that before treatment [(27.1 ± 3.4) ％,t =17.487,P =0.000].The changes of the indicators in the treatment group were significantly better than those in the control group (t =9.447,5.773,8.725,all P ＜ 0.05).After treatment,the CD4+ level of the two groups were higher than those before treatment,and the CD8+ levels of the two groups were significantly lower than those before treatment,the differences were statistically significant(t =3.050,3.429,6.965,13.327,all P ＜ 0.05),and the CD4 +/CD8 + of the two groups were significantly increased (t =0.370,3.314,all P ＜0.05).The indicators of the treatment group were improved more significantly than the control group (t =4.416,12.355,3.089,all P ＜ 0.05).The bacterial clearance rate of the treatment group was 88.89％ (32/36),which was significantly higher than that of the control group [67.65％ (23/34),x2 =4.686,P =0.030].The clinical efficacy of the treatment group was 93.02％ (40/43),which was significantly higher than 76.74％ (33/43) of the control group (x2 =6.095,P =0.047).The incidence of adverse reactions between the two groups had no statistically significant difference (x2 =0.212,P =0.645).Conclusion Thymalfasin in the treatment of patients with severe pneumonia can improve the immune function,reduce the inflammatory response,improve the bacterial clearance rate and clinical efficacy,and will not increase the adverse reactions,so it is worthy of promoting.
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OBJECTIVE:To observe therapeutic efficacy and safety of cefoperazone sodium and sulbactam sodium combined with Shenmai injection in the treatment of elderly stroke associated pneumonia(SAP). METHODS:A total of 84 SAP patients in Dazhou Municipal Central Hospital during Mar. 2016-Mar. 2017 were divided into control group(42 cases)and observation group (42 cases)according to random number table. Based on routine treatment,control group was additionally given Cefoperazone sodium and sulbactam sodium for injection 3 g added into 5% Glucose injection 100 mL,intravenously,twice a day;suitable antibiotics were selected according to the results of pathogenic examination and drug sensitivity test. Observation group was additionally given Shenmai injection 100 mL added into 5% Glucose injection 250 mL intravenously,once a day,on the basis of control group. Both groups were treated for consecutive 2 weeks. Clinical efficacies of 2 groups were observed,and the levels of T-lymphocyte subsets(CD4+,CD8+,CD4+/CD8+)and inflammatory markers(TNF-α,hs-CRP,PCT),length of hospital stay before and after treatment. The ADR was recorded. RESULTS:The total response rate(95.24%)and marked response rate (47.62%)of observation group were significantly higher than those of control group(83.33%,23.81%);length of hospital stay in observation group [(15.24±3.53)d] was significantly shorter than control group [(18.43±4.21)d],with statistical significance (P<0.05).After treatment,the levels of CD4+and CD4+/CD8+in 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group;the levels of CD8 +,TNF-α,hs-CRP and PCT in 2 groups were significantly lower than before treatment;the observation group was significantly lower than the control group,with statistical significance(P<0.05);there was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Based on routine treatment,cefoperazone sodium and sulbactam sodium combined with Shenmai injection treat SAP significantly,can effectively improve immune function, reduce inflammation level and shorten the length of hospital stay without increasing the occurrence of ADR.
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Objective To investigate the in vitro antibacterial activity of single cefoperazone,ceftazidime,imipenem,tigecycline and colistin and their combination with sulbactam against clinical isolates of Acinetobacter baumannii (A.baumannii).Methods Twentythree meropenem-resistant A.baumannii strains and 21 meropenem-sensitive strains from the Study for Monitoring Antimicrobial Resistance Trends (SMART) during 2011 and 2012 were collected,and their combination susceptibility tests were performed by the checkerboard dilution method.The fractional inhibitory concentration (FIC) index was calculated to evaluate the combination effect of antibiotics.Results No antagonism effect was observed for all of combinations.The combination of sulbactam with cefoperazone or tigecycline mainly produced synergistic effect on A.baumannii,and the strains with FIC index ≤0.5 accounted for 56.8％ and 50.0％,respectively.The combination of sulbactam with imipenem or colistin showed synergistic or partially synergistic effect on A.baumannii,and the strains with FIC index ＜ 1 accounted for 61.4％ and 52.3％,respectively.However,the combination of sulbactan with ceftazidime didn't show any interation,and the strains with FIC index ≥4 accounted for 63.6％.Conclusion The combination of sulbactam with cefoperazone has the best synergistic effect on A.baumannii,especially on carbapenem-sensitive A.baumannii.The combination of sulbactam with imipenem or tigecycline may enhance the antibacterial activity on carbapenem-resistant A.baumannii.The combination of sulbactam with imipenem or tigecycline may be helpful for the treatment of carbapenem-resistant A.baumannii infection.
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Objective To observe the effect of cefoperazone sulbactam on the efficacy inflammatory factors in patients with sepsis. Methods 80 cases of sepsis patients from January 2014 to April 2015, were double-blindly, randomized divided into control group(41 cases) and observation group(39 cases). The control group was treated with conventional treatment methods, the observation group was treated with cefoperazone sulbactam. After treatment, Leukocyte IL-6, IL-10, IL-1 and C- reactive protein (CRP) levels of interleukin and curative effect in the two groups were analyzed. Results After treatment, the levels of IL-6, IL-10, IL-1, CRP in the observation group were lower than those in the control group (t=15.555;t=11.122; t=9.379; t=34.782), the difference was statistically significant (P<0.05); The total effective rate in the observation group was 95.12%, which was significantly higher than that in the control group (76.93%), and the difference was statistically significant (P<0.05); The proportion of painless and severe pain in the observation group was significantly lower than that in the control group(76.93%), and the difference was statistically significant (P<0.05). Conclusion Cefoperazone sulbactam is effective in the treatment of sepsis, can improve the efficacy of treatment, it is a safe and effective treatment, should be promoted and used in clinical.
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Objective:To detect the neutrophil extracellular traps (NETs) formation in the peripheral blood of the patients with recurrent respiratory tract infection,and to evaluate the effect of sulbactam sodium/cefoperazone sodium on the formation of NETs.Methods:A total of 36 patients with recurrent respiratory tract infection (case group) and 30 healthy volunteers (healthy control group) were selected.The NETs formation of subjects in two groups was detected by confocal microscope and scanning electron microscope (SEM).According to the appearance of neutrophils,the formation of NETs was classified as grade Ⅰ,Ⅱ and Ⅲ,the number of NETs formation cells of subjects in two groups was calculated.The formation of NETs of the patients in case group were detected before and after treated with sulbactam sodium/cefoperazone sodium.Results:The number of NETs formation cells of grade Ⅰ and Ⅱ of the patients in case group was more than that in healthy control group (P<0.05);while the number of NETs formation cells of grade Ⅲ of the patients in case group was less than that in healthy control group (P<0.05).The number of NETs formation cells of grade Ⅰ and Ⅱ of the patients in case group were significantly decreased (P<0.05),while the number of NETs formation cells of grade Ⅲ was significantly increased (P<0.05) after treated with sulbactam sodium/cefoperazone sodium.Conclusion:A lot of NETs with high antibacterial function can be formed in the patients with recurrent lower respiratory tract infection,and sulbactam sodium/cefoperazone sodium can inhibit the formation of NETs.
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Objective To evaluate the reliability of using imipenem,meropenem,cefoperazonesulbactam,piperacillin-tazobactam in the treatment of hospital-acquired Gram-negative bacterial infections with Monte Carlo simulation(MCS).Methods The MIC of the four agents collected from hospital-acquired infections were detected in accordance with broth dilution method of Clinical and Laboratory Standard Institute (CLSI).MCS were conducted with MICs and the pharmacokinetics parameters of the four agents based on conventional dose regimens.The cumulative fraction of response (CFR) of time over MIC target attainment in different dosing regimen were generated.Results A total of 2 541 strains,including 2 093 strains of Enterobacteriaceae and 448 strains of glucose non-fermentative bacilli were collected.The MIC90 of imipenem and meropenem against Enterobacteriaceae were less than 1 mg/L in general,whereas MICg0 of two agents with β-1actamase inhibitors was around 64 mg/L.As to glucose non-fermenting bacteria,MICs of all the four agents were very high,especially to Acinetobacter baumannii,which indicated MIC50 more than 32 mg/L.MCS revealed that carbapenems had significantly higher CFR than those with β-1actamase inhibitors.Imipenem and meropenem (1 g,q8 h) obtained CFRs of 74.69％ and 81.42％,respectively.The CFR of cefoperazone-sulbactam (2 g,q8 h) and piperacillin-tazobactam (4 g,q6 h) (both excluding β-1actamase inhibitors) were just 49.59％ and 27.66％ respectively,which increased after excluding A.baumannii in piperacillin-tazobactam.Conclusions The conventional dose regimens of imipenem and meropenem are reliable for the empiric therapy of Gram-negative hospital-acquired bacterial infections.Piperacillin-tazobactam is suggested to use with higher doses or prolonged infusion time to satisfy the time of drug concentration exceeded the MIC (T ＞ MIC) requirement.More clinical studies of cefoperazone-sulbactam should be conducted to optimize its regimen and guarantee its efficacy.
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Objective: To develop a model for rapid and non-destructive determination of amoxilcillin sodium and sulbactam sodium for injection using the analysis of near infrared diffuse reflectance spectroscopy (NIR) and chemometrics.Methods: Totally 41 batches of commercial samples and 20 batches of laboratory samples were analyzed by NIR and the legal methods.The first derivative and vector normalization were selected as the preprocessing methods and 8 720-5 446 cm-1 was selected as the frequency range.Results: The quantitative model was constructed based on 16 batches of commercial samples and 15 batches of laboratory samples (0.75 g) and the content ranged from 4.45% to 61.82% for amoxilcillin and 15.75% to 30.25% for sulbactam.The root mean square errors of cross validation (RMSECV), determination coefficients (R 2) and root mean square errors of prediction (RMSEP) respectively was 0.858 , 0.998 1 and 0.936 for amoxilcillin, and respectively was 0.541 , 0.988 1 and 0.423 for sulbactam.The model was tested based on 5 batches of commercial samples and 5 batches of laboratory samples (0.75 g) and the results well met with those of the legal methods with difference ≤ 1.5 %.The model also applied in 10 batches of commercial samples (1.5 g) and 2 batches of samples from the other manufacturers.Conclusion: The non-destructive quantitative NIR methods are accurate with good reproducibility, and applicable for the rapid analysis of amoxilcillin sodium and sulbactam sodium for injection.
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Objective To investigate the cost-effectiveness of cefoperazone sulbactam sodium in treating nosocomial infection (lower respiratory tract infection).Methods 80 cases of nosocomial infection in Jincheng Second People's Hospital from January 2014 to January 2017 were treated as the subjects: the observation group was treated with cefoperazone sulbactam sodium and the control group was treated with cefodizime sodium.The data of two groups of patients were recorded and the data were analyzed statistically.The cost-effectiveness of cefoperazone sulbactam sodium in hospital infection was discussed.Results There was no significant difference in the clinical curative effect between the two groups.The cost of observation group (cefoperazone sulbactam sodium) was lower than that of the control group (cefodizime sodium), the difference was statistically significant (P< 0.05).Conclusion Patients with nosocomial infection choose to use cefoperazone sulbactam sodium as the treatment method, which has exact clinical efficacy, high cost-effectiveness.It is worthy of clinical wide application.
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OBJECTIVE:To study antibacterial activities of meropenem(MPN)combined with cefoperazone sulbactam(SCF) to 3 kinds of multidrug resistance (MDR) Gram-negative bacteria. METHODS:Each 50 strains of MDR-Escherichia coli (MDR-EC),MDR-Klebsiella pneumoniae (MDR-KPN) and MDR-Acinetobacter baumannii (MDR-AB) were isolated from spu-tum,blood,urine,ascites or drainage specimens of patients during Jan. to Dec. in 2016 from the affilidated hospital of Taishan medical university. The agar dilution method and board method were used to determine MIC50,MIC90 and MICG of MPN,SCF, MPN+SCF to MDR-EC,MDR-KPN,MDR-AB and calculate fractional inhibitory concentration (FIC). Drug sensitivity test was conducted by K-B disk method. RESULTS:In terms of the MICG to MDR-EC,MDR-KPN,MDR-AB,MPN alone were respec-tively 36.82,82.45,34.32 μg/mL;SCF alone were respectively 42.14,112.67,24.11 μg/mL;MPN combined with SCF were re-spectively 25.97,56.64,11.36 μg/mL. In terms of MICG to MDR-EC,MDR-KPN,MICG showed that MPN+SCF0-0.5 (78.00%),>0-0.5(72.00%),>0.5-1.0 (82.00%). CONCLUSIONS:MPN combined with SCF can effectively improve antibacterial activities to MDR Gram-negative bac-teria as MDR-EC,MDR-KPN,MDR-AB. MPN combined with SCF has synergistic effects.
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OBJECTIVE: To retrospectively study the clinical efficacy and safety of sulbactam sodium in treatment of extensively drug resistant Acinetobacter baumannii(XDRAB) infection. METHODS: Collect cases of XDRAB infection treated with sulbactam Sodium in our hospital from January 2014 to January 2016. Basic information of patients, infection sites, therapeutic strategies, drug combination, clinical outcomes and adverse reactions were analyzed retrospectively. RESULTS: A total of 7 cases were collected, including 4 cases of pulmonary infection, 2 cases of intracranial infection, 1 case of abdominal infection, therapeutic strategies for sulbactam sodium-based combination therapy. The total mortality rate was 42.8%; 1 case showed adverse drug reactions may correlated with sulbactam sodium. CONCLUSION: Mortality associated with XDRAB infection is high, and the clinical outcome is associated with host factors, because this article included in the number of cases is less, so difficult to evaluate the effectiveness of sulbactam sodium. Sulbactam sodium can be associated with other antimicrobial drugs for the treatment of XDRAB infection and provided more choices.
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Abstract Acute localized exanthematous pustulosis is a localized variant of acute generalized exanthematous pustulosis, which is characterized by the eruption of multiple scattered pustules following drug administration. A 72-year-old woman presented with multiple erythematous pustules on her face, which had appeared two days after using cefoperazone and sodium sulbactam. Histopathological findings showed subcorneal pustules and mixed inflammatory cell infiltration in the dermis. The pustules resolved within about two weeks after the patient discontinued the antibiotics. This report discusses the case of a woman with a cutaneous drug reaction consistent with acute localized exanthematous pustulosis that occurred after cefoperazone and sodium sulbactam were administered.
Subject(s)
Humans , Female , Aged , Sulbactam/adverse effects , Cefoperazone/adverse effects , Acute Generalized Exanthematous Pustulosis/etiology , Acute Generalized Exanthematous Pustulosis/pathology , Anti-Bacterial Agents/adverse effects , Skin/pathology , Time Factors , BiopsyABSTRACT
Objective To evaluate clinic efficacy and safety of tigecycline combined with cefoperazone/sulbactam for treatment of intracranial infection with drug-resistant Acinetobacter baumannii (DRAB).Methods 12 patients with DRAB intracranial infection admitted in a department of neurosurgery between January 2014 and April 2015 were analyzed retrospectively,clinic efficacy and safety of tigecycline combined with cefoperazone/sulbactam for treatment of DRAB intracranial infection were evaluated.Results After patients received tigecycline combined with cefoperazone/sulbactam for 12-62 days (39.5 days on average), clinical symptoms and signs (including body temperature,signs of meningeal irritation)of most patients were significantly improved compared with before treat-ment,3 cases were cured,5 were markedly effective,4 abandoned or ineffective(death).The overall effective rate was 66.67%(8/12),mortality was 33.33% (4/12);bacterial clearance rate of cerebrospinal fluid (CSF)was 83.33%(10/12).Causes of death:2 were with failure of brain stem following craniocerebral trauma,1was extensive parenchymal infection,1was recurrence of intracranial infection and formation of brain abscess after withdrawing an-timicrobial agents.No significant adverse reaction occurred during the treatment period.Conclusion On the basis of keeping CSF drainage unobstructed,long course treatment of tigecycline combined with cefoperazone/sulbactam can effectively eliminate DRAB from CSF,and has a good safety.
ABSTRACT
OBJECTIVE:To provide reference for clinical rational use of piperacillin sulbactam for the anti-infection of Pseudo-monas aeruginosa. METHODS:105 inpatients with normal liver and kidney functions that the pathogen was diagnosed as P. aerugi-nosa and susceptible to PIP/SBT from Jul. 2013 to Jun. 2014 were chose,dosing regimens were collected,the minimum inhibitory concentration (MIC) of piperacillin sulbactam for P. aeruginosa was 1 mg/L based on a one compartment pharmacokinetic mode, the standard value of the percentage of the duration of plasma concentration more than MIC(T>MIC)to dosing interval time was 45%,T>MIC was calculated with pharmacokinetic formula of both single dose and multiple dose repeated intravenous administra-tion to analyze the situation of reaching the standard of T>MIC;and the dosing interval time of the original scheme was prolonged appropriately to investigate the situation of reaching the standard of the percentage of (T>MIC) to dosing interval time. RE-SULTS:47 patients’dosing regimens were given 3.0 g PIP/SBT once every 8 hours,and the others were given 3.0 g PIP/SBT once every 12 hours;for P. aeruginosa,the percentages of T>MIC to dosing interval time were respectively 99.93% and 73.13% with pharmacokinetic formula of single dose intravenous administration,and 99.98%and 68.08%with pharmacokinetic formula of multi-ple dose repeated intravenous administration;and the percentages of the interval time prolonged to 16 h were respectively 54.84%and 51.06%,both reached the standard value. CONCLUSIONS:Quantitative analysis of PK/PD prediction parameters can be used to evaluate and optimize the clinical dosing regimens and guide the clinical practice.
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OBJECTIVE:To evaluate the pharmacoeconomics of cefathiamidine, ceftriaxone sodium, cefuroxime sodium, amoxicillin sodium/clavulanate potassium and cefoperazone sodium/sulbactam sodium in the treatment of pediatric bronchopneumo-nia,and to provide reference for rational drug use in the clinic. METHODS:By retrospective study,338 children with broncho-pneumonia were divided into groups A,B,C,D and E according to different therapy regimens. There were 75,65,76,66 and 56 cases in groups A,B,C,D and E,and they were given cefathiamidine,ceftriaxone sodium,cefuroxime sodium,amoxicillin sodium/clavulanate potassium and cefoperazone sodium/sulbactam sodium intravenously. The pharmacoeconomics of therapy regi-mens in group A,B,C,D and E were evaluated by cost-effectiveness analysis and decision tree analysis model. RESULTS:The effective rates of groups A,B,C,D and E were 93.33%,90.77%,96.05%,87.88% and 87.50%,respectively. The treatment cost of those groups were 1 929.09,2 173.73,1 611.91,1 661.42,1 801.32 yuan,respectively. The cost/effectiveness(C/E)ratio of those groups were 20.67,23.95,16.78,18.91,20.59,respectively. The treatment cost of group C was the smallest,so was the C/E. Results of cost-effectiveness analysis were supported by sensitivity analysis. CONCLUSIONS:Cefuroxime sodium is the best treatment for pediatric bronchopneumonia among 5 antibiotics in respect of cost-effectiveness.