Clinical therapeutic effect of tigecycline combined with cefoperazone/sulbactam on treatment of multiple drug resistant strains and pandrug-resistant acinetobacter baumannii infection / 中国综合临床

Objective To explore the efficacy of tigecycline combined with cefoperazone/sulbactam in the treatment of infections due to multiple drug resistant strains and pandrug-resistant acinetobacter baumannii, so as to guide the reasonable clinical medication.Methods A total of 16 cases of ventilator associated pneumonia caused by multiple drug resistant strains and pandrug-resistant acinetobacter baumannii treated in the First Hospital of Shijiazhuang from November 2012 to November 2014 were retrospectively analyzed, and the severity of the infection, clinical efficacy and mortality were observed.Results The multiple drug resistant strains and pandrugresistant acinetobacter baumannii were frequently detected in the 16 patients.Fifteen cases had been used other antibiotics before tigecycline, such as imipenem, cefoperazone/Shubatan, minocycline etc.The severity of underlying disease was assessed with the acute physiology and chronic health score(APACHE Ⅱ sore) within 24 h of admission, on the first day of tigecycline (TGC) therapy and after 7 days of TGC therapy.It showed that the average APACHE Ⅱ score were (25±6.0), (24.2±6.4) and (17.8±6.6) within 24 hours of admission(P＜0.01), on the first day of TGC therapy and after 7 days of TGC therapy.Thirty days after application of the TGC, the bacterial eradication rate was 56.25％ (9/16).The effective rate was 87.5％ (14/16).The failure rate was 12.5％ (2/16).Conclusion The effect of the tigecycline combined with cefoperazone/sulbactam on the clearance of the multiple drug resistant strains and pandrug-resistant acinetobacter baumanniiis is satisfied.

Analysis on Distribution and Drug Resistance of Acinetobacter baumannii in Our Hospital during 2012-2015 / 中国药房

OBJECTIVE:To investigate the distribution and drug resistance of Acinetobacter baumannii in our hospital,and provide reference for rational use of antibiotics. METHODS:Clinical specimen of inpatients in our hospital from Jan. 2012 to Dec. 2015 was collected,the identification of strains and drug sensitivity test were performed by the VITEK-2 microorganism analyzer;use rate of antibiotics and detection of multidrug-resistant and pandrug-resistant A. baumannii for inpatients in our hospital were an-alyzed,and their correlation was detected by Pearson correlation analysis. RESULTS:Totally 2 468 strains of A. baumannii were isolated in our hospital during 2012-2015,mainly derived from sputum samples (88.2%),distributed in respiratory medicine de-partment(47.0%)and ICU(13.1%);A. baumannii showed totally high drug resistance to common antibiotics,and only sensitive to tigecycline. Totally 386(79.3%),434(61.6%),358(53.4%)and 291(48.0%)strains multidrug-resistant A. baumannii were detected every year in our hospital;and pandrug-resistant A. baumannii were 336(69.0%),385(54.7%),331(49.3%)and 256 (42.2%) strains,respectively. There was a positive correlation between the percentage of multidrug-resistant and pandrug-resistant A. baumannii in total strains and use rate of antibiotics (r=0.987、0.981,P<0.05). CONCLUSIONS:A. baumannii has emerged as an important pathogen in hospital acquired infections,which mainly caused respiratory system infection;the drug resistance situ-ation is not optimistic,tigecycline can be used as one of the best choice for treatment of A. baumannii infections;our hospital should continue to control the use of antibiotics to decrease the emerging of drug resistance strains.

The risk factor profile of pneumonia caused by pandrug-resistant Acinetobacter baumannii in intensive care unit / 中国感染与化疗杂志

Objective To investigate the risk factor profile of pneumonia caused by pandrug-resistant Acinetobacter baumannii (PDRAB)in intensive care unit for better distinction between PDRAB infection and colonization.Methods The clinical data of 99 patients diagnosed as A.baumannii pneumonia between February 2009 and March 2012 in Fangcun Hospital,a branch of Guangdong Provincial Hospital of Traditional Chinese Medicine,were reviewed and analyzed retrospectively.The risk factors associated with pandrug-resistance in A.baumannii were examined with multivariate logistic regression analysis.Results ICU stay,duration of invasive ventilation,longer duration of treatment with carbapenems,beta-lactam/beta-lactamase inhibitor,or quinolone antibiotics,use of ≥3 classes of antimicrobial agents,≥3 invasive procedures (including indwelling gastric canal, catheterization,central venous catheter,arterial sheath),and fiberoptic bronchoscopic treatment were associated with PDRAB pneumonia (P <0.05).Multivariate logistic regression analysis showed that use of ≥3 classes of antibiotics,fiberoptic bron-choscopic treatment,and longer duration of treatment with beta-lactam/beta-lactamase inhibitor were independent risk factors predicting the emergence of PDRAB pneumonia.Conclusions We should pay more attention to these risk factors in clinical prac-tice for better differentiation between PDRAB infection and colonization so that appropriate control measures can be taken pro-actively.

Detection and homology analysis of virulence genes in pandrug-resistant Pseudo-monas aeruginosa / 中国感染与化疗杂志

Objective To study the prevalence and sequence homology of virulence genes exoU and exoS in 53 strains of pan-drug-resistant Pseudomonas aeruginosa .Methods The virulence genes exoU and exoS were detected by PCR.Sequence homo-logy was analyzed by BOX-PCR.Results Of the 53 clinical isolates of pandrug-resistant Pseudomonas aeruginosa ,the exoS+/exoU- genotype was identified in 40 strains,exoU+/exoS - genotype in 10 strains,exoS +/exoU+ genotype in 1 strain, and exoS-/exoU- genotype in 2 strains.BOX-PCR results showed that 41 exoS+ isolates belonged to 24 genotypes,and 11 exoU+ strains could be grouped into 7 genotypes.Conclusions The prevalence of virulence genes is high in clinical isolates of pandrug-resistant Pseudomonas aeruginosa .BOX-PCR fingerprint analysis combined with sequence homology analysis is help-ful for effective monitoring and control of hospital pandrug-resistant pseudomonas aeruginosa infection.

Emergence and control of multidrug resistant organisms in small cities in India: A wake up call.

Context: Urinary tract infections (UTIs) is one of the most common bacterial infections in general practice. Antimicrobial resistance in urinary pathogens, particularly the most common being Escherichia coli, is directly associated with prescribing in primary care. Diagnosis of UTI requires laboratory examination of urine sample in addition to clinical evaluation, which may lead to higher cost of treatment, but the proper treatment of the case that will lead to complete recovery with no recurrence episodes far outweigh the cost issue of microbiological investigation. Even though UTIs are a very common diagnosis, management of this condition is not consistent in general practice. This study was conducted in an effort to see the extent of presence of multi drug resistant organisms in local set up . Aims: To describe the common urine isolates observed in the small cities of India and also to test for drug resistance among them with simple manageable tests in small-scale laboratories. Materials and Methods: A retrospective review was conducted of Gram negative bacilli and Gram positive cocci isolated from the clinical urine samples collected from various hospitals and private practitioners in Shimoga City, Karnataka and Jamshedpur City, Jharkhand. The study period was between November 2011 to January 2012. Results: A total of 788 urine samples were included in the study. It was seen that 55.8% of the total isolated organisms were multidrug resistant (MDR) in Shimoga city, Karnataka and 38.8% of the total isolated organisms were MDR in Jamshedpur city, Jharkhand. Conclusions: Only with the combined efforts of the local laboratories and clinicians, the looming threat of the pandrug resistant organisms in small cities can be avoided. However, more such studies are required from both clinicians and laboratory health care professionals in order to arrive at a common consensus, and uniformity can be brought about in the community regarding prescription practices.

Typing of Pandrug-resistant Acinetobacter baumannii in Hospital by Randomly Amplified Polymorphic DNA / 中华医院感染学杂志

OBJECTIVE To study the homology of the pandrug-resistant Acinetobactor baumannii(PRABA) by randomly amplificed polymorphic DNA(CRPD) to guide the control of the nosocomial infection and epidemology investigation.METHODS Eighteen strains of PRABA were collected from Jul 2008 to Mar 2009 in our hospital.The bacteria were examined by DADE BEHRING Microscan WalkAway 96SI;DNA extracted from all isolates was amplified by polymerase chain reaction using random primers.In addition epidemology investigation and antimicrobial susceptibility testing were also under taken.RESULTS Fifteen strains were divided into 6 RAPD profiles.There were two clonal strains derived,respectively,from two intensive care units.One strain was isolated from a patient in surgical ward who was transferred from ICU1,showing same homology with that in the ICU1.The homology was different from sensitive strains and drug-resistant strains obviously.CONCLUSIONS An outbreak of PRABA happens in intensive care unit.

Preliminary analysis on the treatment of infection caused by pandrug-resistant Acinetobacter baumannii / 中国感染与化疗杂志

Objective To analyze the clinical features of pandrug-resistant Acinetobacter baumannii (PDR-Ab) in a hospital and compare the efficacy of different antibiotic treatments on patients with pneumonia caused by PDR-Ab.Methods Data were ret- rospectively collected from all isolated PDR-Ab strains in our hospital from February 2004 to March 2005.The clinical features and outcomes were reviewed.Results A total of 77 strains of PDR-Ab were collected, 45 of which were pathogens causing clini- cal infections (35 strains from lower respiratory tract, 6 from bloodstream, 3 from drainage fluid, and 1 from wounds).Lower respiratory tract was the most common source of PDR-Ab.More than 90% of the isolated PDR-Ab strains produced OXA-23 type?-lactamase.Cefoperazone-sulbactam plus minocyeline showed good efficacy for patients with PDR-Ab pneumonia.The total clinical cure rate was 68.4%.Bacterial eradication rate was 42.1%.The factors influencing bacterial clearance were pro- longed mechanical ventilation prior to positive culture (17.5 d vs 5.5 d).mixed infection (100% vs 12.5%) and lower GCS score (9.1?0.7 vs 13.2?2.1).Concomitant septic shock (OR=13.8) and APACHEⅡscore (OR=2.1) were independent factors of clinical outcome.Conclusions Nosocomial infections caused by PDR-Ab are not untreatable.Our analysis suggests that cefoperazone-sulbactam plus minocycline may be an effective treatment for lower respiratory tract infections caused by PDR-Ab in our hospital.