外科感染患者细菌分布及耐药性的单中心研究

目的 分析外科感染患者细菌分布及其对常用抗菌药物的耐药性,为外科感染的规范化治疗提供依据.方法 回顾性调查分析2008年1月至201 1年12月外科感染患者送检标本的细菌鉴定及药物敏感性检测结果.结果 3257份临床标本共分离菌株3829株,革兰阴性杆菌占62.4％(以大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌为主);革兰阳性球菌占37.6％(以肠球菌、金黄色葡萄球菌及凝固酶阴性葡萄球菌为主),其中金黄色葡萄球菌、粪肠球菌检出率呈升高趋势.大肠埃希菌及肺炎克雷伯菌对亚胺培南、阿米卡星、哌拉西林/他唑巴坦等抗菌药物耐药率较低;铜绿假单胞菌和鲍曼不动杆菌对头孢类、碳青霉烯类及喹诺酮类抗菌药物耐药率较高,呈多药耐药性;所有葡萄球菌、粪肠球菌对万古霉素和替考拉宁敏感(100％),但耐万古霉素屎肠球菌检出率呈上升趋势(1.9％～7.5％).产超广谱β-内酰胺酶(ESBL)大肠埃希菌检出率为45.6％ ～61.5％;产ESBL肺炎克雷伯菌检出率呈波动表现;耐甲氧西林金黄色葡萄球菌检出率较高(21.1％ ～55.8％),耐甲氧西林表皮葡萄球菌检出率明显高于其他阳性球菌.结论 我院外科临床感染病原菌以革兰阴性杆菌为主,临床分离细菌耐药现象较为普遍,铜绿假单胞菌和鲍曼不动杆菌药物耐药率较高.     

4066株病原菌分布及耐药性检测结果分析

目的回顾性分析临床分离的病原菌种类分布及对抗菌药物的耐药现状,以指导临床合理使用抗菌药物。方法对解放军第202医院2013年1月至12月临床送检的各类标本进行分离培养,采用DL-96细菌测定系统进行细菌鉴定及药敏试验,判定依据按照CLSI 2012标准判定。结果共分离出病原菌4 066株,以革兰阴性杆菌为主,病原菌前4位依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞和金黄色葡萄球菌。产ESBLs大肠埃希菌和肺炎克雷伯菌检出率分别为41.1%和66.9%。肠杆菌科细菌对氨苄西林/舒巴坦、哌拉西林/他唑巴坦及阿米卡星的耐药率均10.0%,且对碳青霉烯类抗菌药物具有高度敏感性,这些仍可作为肠杆菌科细菌引起重症感染的首选抗菌药物。铜绿假单胞菌对头孢吡肟、左氧氟沙星、阿米卡星、哌拉西林/他唑巴坦、亚胺培南和美洛培南具有较高的敏感性。鲍曼不动杆菌对所有抗菌药物的耐药率均较高,多重耐药非发酵菌检出呈逐年上升。MRSA检出率为27.2%,MRCNS检出率为54.9%。未检出耐万古霉素、替考拉宁和利奈唑胺的葡萄球菌和肠球菌,但屎肠球菌的检出率远高于粪肠球菌,屎肠球菌对青霉素、氨苄西林、环丙沙星和左氧氟沙星的耐药率显著高于粪肠球菌。结论细菌耐药现象日趋严重,及时准确监测病原菌变化及耐药趋势,针对不同耐药菌的耐药情况,合理选择抗菌药物,预防和延缓耐药菌的产生和传播。     

腹腔感染病原菌分布与细菌耐药性监测研究（附310例报告）

目的 分析腹腔感染病人腹腔引流液中病原菌布及其耐药性。方法 收集2012年1月至2014年12月大连医科大学附属第一医院收治的310例腹腔感染病人的腹腔引流液标本,对其进行细菌鉴定及耐药分析,分析病原菌分布与细菌耐药性变化。结果 腹腔引流液标本分离出病原菌578株,其中革兰阴性菌377株（65.2%）,革兰阳性菌156株（27.0%）,真菌45株（7.8%）;3年总分离数量最高的前5位病原菌为大肠埃希菌（19.6%）、肺炎克雷伯菌（11.4%）、鲍曼不动杆菌（10.2%）、屎肠球菌（8.1%）、铜绿假单胞菌（7.3%）;屎肠球菌对多数被测药物的耐药率高于粪肠球菌,对氨苄青霉素、环丙沙星、左氧氟沙星、红霉素耐药率均>80%,葡萄球菌对复方新诺明、氯霉素的敏感率>90.0%,3年均未发现耐万古霉素及利奈唑胺的革兰阳性菌;肠杆菌科细菌中产超广谱β内酰胺酶的检出率>55.0%,对碳青霉烯类药物、阿米卡星、β-内酰胺类联合酶抑制剂敏感率较高,对三代头孢菌素耐药严重,碳青霉烯类耐药的肠杆菌科细菌的检出率呈逐年上升趋势;鲍曼不动杆菌除对米诺环素（11.9%）、头孢哌酮/舒巴坦（37.3%）耐药率较低外,对其他测试药物耐药率均>60.0%,其中对碳青霉烯类药物耐药率>70.0%,对头孢曲松、头孢噻肟耐药率>80.0%,对庆大霉素耐药率>90.0%,而铜绿假单胞菌对碳青霉烯类药物、头孢他啶、头孢吡肟、哌拉西林/他唑巴坦、阿米卡星的耐药率低于鲍曼不动杆菌。结论 腹腔感染病人腹腔引流液病原菌以肠杆菌科为主,非发酵菌所占比例亦较高,部分细菌耐药率有逐年升高趋势,应严密监测以指导合理使用抗菌药物。     

血培养病原菌分布及耐药性分析

目的分析医院血流感染病原菌的分布特点和耐药情况,为临床预防和控制感染提供依据。方法回顾性分析2011年6月至2014年6月本院临床血培养标本中病原菌的感染特点及其药敏。采用BD BACTEC 9120血培养仪进行血培养,BD Phoenix 100全自动细菌鉴定/药敏分析系统对菌株进行鉴定和药敏试验,真菌药敏采用K-B纸片法,用WHONET 5.6软件进行数据分析。结果 9 116例血培养标本中共检出病原菌896株,阳性检出率为9.8%,其中革兰阴性杆菌491株,革兰阳性球菌350株,真菌37株,厌氧菌9株以及革兰阳性杆菌9株;大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南和头孢哌酮/舒巴坦敏感率较高,大肠埃希菌和肺炎克雷伯菌产ESBLs菌株分别为49.5%和38.5%;鲍曼不动杆菌的耐药率高于铜绿假单胞菌,多重耐药和泛耐药鲍曼不动杆菌的检出率分别为32.6%和20.9%,多重耐药铜绿假单胞菌的检出率为18.4%;耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为44.4%和70.4%;未发现耐万古霉素、替考拉宁和利奈唑胺的葡萄球菌和肠球菌;粪肠球菌对抗菌药物的耐药率显著低于屎肠球菌。结论本院血流感染病原菌以肠杆菌科细菌为主,凝固酶阴性葡萄球菌感染不容忽视。临床应高度重视早期血培养,合理使用抗菌药物,有效减少耐药菌株的产生。     

肛周脓肿病原菌分布及耐药性分析

为探讨肛周脓肿病原菌分布及对常用抗菌药物的耐药性,选取山东省千佛山医院肛肠科2013年9月23日至2014年4月23日收治58例肛周脓肿患者进行研究,对其脓液进行革兰染色、病原菌培养及药敏试验。结果显示,58例患者中,4例未培养出细菌,其余54例共分离出病原菌67株（其中革兰阴性菌54株,占80．6％;革兰阳性菌13株,占19．4％）;检出菌株数居首位的为大肠埃希菌（41株,61．2％）,其次为肺炎克雷伯菌（7株,10．4％）。大肠埃希菌及肺炎克雷伯菌对常用抗菌药物敏感率较低,耐药性较高,尤其是对氨苄西林的耐药性较强,但对头孢西丁、美罗培南、亚胺培南、阿米卡星、厄他培南、替卡西林／克拉维酸、哌拉西林／他唑巴坦高度敏感。多重耐药11例,其中9例为大肠埃希菌感染多重耐药（ESBLS阳性）,2例为葡萄球菌感染多重耐药。9例ESBLS阳性大肠埃希菌感染者对头孢噻肟100％耐药,对头孢西丁、美罗培南、亚胺培南、阿米卡星、哌拉西林／他唑巴坦、厄他培南、替卡西林／克拉维酸未见耐药。结果表明,肛周脓肿病原菌以革兰阴性杆菌为主,治疗时应首选抗革兰阴性杆菌的药物,并采取积极办法应对病原菌的多重耐药,可选替卡西林／克拉维酸、哌拉西林／他唑巴坦等含酶抑制剂的抗菌药物。     

肝硬化合并自发性细菌性腹膜炎的病原学和耐药情况1

目的监测肝硬化合并自发性细菌性腹膜炎的病原学和耐药情况。方法回顾性分析首都医科大学附属北京地坛医院2010年1月至2011年12月诊断为肝硬化自发性腹膜炎的送检腹水标本共452例，统计分析病原谱的分布和抗菌药物的敏感性。结果收集腹水标本中分离到的94株致病菌，培养阳性率为20.8%（94/452）。其中革兰阴性杆菌49株（52%），革兰阳性球菌42株（45%），真菌3株（3%）。病原菌以肠道来源细菌占优势，革兰阴性杆菌以肠杆菌科为主，其中大肠埃希菌19株（20%）、肺炎克雷伯菌6株（6%），革兰阳性球菌中以肠球菌和凝固酶阴性葡萄球菌检出率最高，其中凝固酶阴性葡萄球菌12株（13%）、屎肠球菌10株（11%）和粪肠球菌8株（9%）。3株真菌均为白念珠菌。革兰阴性杆菌敏感率在80%以上的抗菌药物有阿米卡星（93%，40/43）、亚胺培南（81.4%，35/43）和美罗培南（83.7%，36/43），敏感率在60%以上的有头孢他啶（62.8%，27/43）和哌拉西林/他唑巴坦（68.2%，15/22）。对革兰阳性球菌敏感率在80%以上的有万古霉素（96.9%，30/31）、替考拉宁（89.7%，26/29）、利奈唑胺（87.9%，29/33）和奎奴普丁/达福普汀（100%，18/18），敏感率在60%以上的有复方新诺明（70%，21/30）和甲氧苄胺（76.5%，13/17）。结论肝硬化自发性细菌性腹膜炎的病原体以肠源性细菌多见，主要为大肠埃希菌和肠球菌，分离株对常见抗菌药物明显耐药。     

2019～2021年某三级综合医院泌尿道感染病原菌分布及耐药性分析

目的探讨某三级综合医院的泌尿道感染病原菌分布及耐药性, 为临床合理使用抗菌药物及院内感染监控提供指导。方法从本院检验系统中筛选2019年1月1日至2021年12月31日泌尿道感染患者的4 748例尿标本培养结果, 回顾性分析其病原菌分布及耐药性。结果 4 748例尿培养标本共分离出1 026株病原菌, 其中革兰阴性菌812株(79.14%), 革兰阳性菌210株(20.47%), 真菌4株(0.39%)。病原菌占比前5位分别是大肠埃希菌610株(59.45%)、屎肠球菌81株(7.89%)、粪肠球菌76株(7.41%)、肺炎克雷伯菌60株(5.85%)、彭氏变形菌51株(4.97%);大肠埃希菌对碳青霉烯类的耐药率<2%, 对阿米卡星、哌拉西林/他唑巴坦的耐药率<10%;粪肠球菌对氨苄西林、呋喃妥因的耐药率<10%, 屎肠道球菌对青霉素类、喹诺酮类、红霉素等的耐药率>90%, 粪肠球菌对青霉素类、呋喃妥因的耐药率<10%, 未检出对万古霉素、利奈唑胺、替加环素耐药的菌株。结论泌尿道感染病原菌以大肠埃希菌为主, 其次为屎肠球菌、粪肠球菌。菌群分布及耐药性监测...     

肝移植围手术期腹腔与胸腔感染病原学分析

目的探究肝移植术后腹、胸腔感染常见病原菌分布及耐药情况。 方法回顾性分析首都医科大学附属北京朝阳医院肝胆外科2011年1月至2017年12月343例行同种异体原位肝移植术受者临床资料,分析围手术期腹腔和胸腔感染情况、常见病原菌及耐药情况。腹、胸腔感染常见病原菌分布比较采用卡方检验,P<0.05为差异有统计学意义。 结果343例肝移植受者中,围手术期48例单独发生腹腔感染,61例单独发生胸腔感染,10例同时发生腹、胸腔感染,15例因感染导致死亡。发生腹腔感染的受者腹腔引流液共培养出106株病原菌,屎肠球菌、鲍曼不动杆菌和溶血葡萄球菌为最常见的病原菌,分别占19.8%(21/106)、15.1%(16/106)和11.3%(12/106)。发生胸腔感染的受者胸腔引流液共培养出99株病原菌,鲍曼不动杆菌、铜绿假单胞菌和肺炎克雷伯菌为最常见的病原菌,分别占26.3%(26/99)、18.2%(18/99)和17.2%(17/99)。腹、胸腔感染常见病原菌(鲍曼不动杆菌、屎肠球菌、溶血葡萄球菌、铜绿假单胞菌和肺炎克雷伯菌)感染分布差距均有统计学意义(χ²＝3.92、135.62、162.14、11.09和6.81,P均<0.05)。药敏试验结果示鲍曼不动杆菌对青霉素类、喹诺酮类和碳青霉烯类抗生素均已耐药(>90%),仅对替加环素较为敏感(27%);铜绿假单胞菌对碳青霉烯类和替加环素耐药率最低(11%);肺炎克雷伯菌对阿米卡星和替加环素耐药率最低(6%);革兰阳性球菌(屎肠球菌和溶血葡萄球菌)对替考拉宁、万古霉素和替加环素最为敏感;真菌对氟康唑最敏感。 结论肝移植术后围手术期腹、胸腔感染发生率均较高,且病原学分布各有特点,术后应积极反复进行相关病原学检查,并根据药敏试验结果合理使用抗生素。     

胃癌根治术后腹腔感染的病原学分析

目的：对胃癌患者行根治性切除术后腹腔感染的病原学特征进行回顾性分析。方法回顾性分析479例胃癌患者根治术后腹腔感染的病原学种类及药敏结果。结果479例患者中32例术后出现腹腔感染（6.68%）,病原学阳性者27例,阳性率为84.38%。检出病原菌32株,其中革兰阴性菌24株（75.00%）,包括大肠埃希菌15株（46.86%）,肺炎克雷伯菌3株（9.38%）,普通变形杆菌、奇异变形杆菌、阴沟肠杆菌、普城沙雷菌、不动杆菌及铜绿假单胞菌各1株（各占3.13%）;革兰阳性菌7株（21.88%）,包括粪肠球菌4株（12.50%）,耐久肠球菌、金黄色葡萄球菌及溶血性葡萄球菌各1株（3.13%）;真菌1株（3.13%）。药敏结果显示32株病原菌中,对常用抗菌药物的耐药率较高,其中革兰阴性菌对美洛培南敏感性最高（91.67%）,而革兰阳性菌对万古霉素最为敏感（85.71%）。结论大肠埃希菌、粪肠球菌、肺炎克雷伯菌是胃癌患者根治术后腹腔感染最主要的致病菌,临床上应注意合理使用抗菌药物。     

重症急性胰腺炎术后胰腺感染病原菌及药物敏感性分析

目的分析因重症急性胰腺炎行引流手术且术后合并胰腺感染患者的细菌学及药敏报告，为重症急性胰腺炎术后感染的抗生素应用提供临床参考。方法收集2003年1月—2006年4月间86例重症急性胰腺炎术后患者腹腔引流物标本，对标本进行细菌培养，检测菌株对抗生素的耐药情况。结果86例患者中共分离出276株细菌，检出率分别为阴沟肠杆菌（12．3％）、铜绿假单胞菌（10．9％）、金黄色葡萄球菌（9．4％）、其他葡萄球菌（9．4％）、D群链球菌（9．4％）、粪肠球菌（8．7％）、大肠埃希菌（8．7％）、表皮葡萄球菌（6．5％）、肺炎克雷伯菌（4．3％）、屎肠球菌（4．3％）。药敏分析及耐药试验表明重症急性胰腺炎术后胰腺感染耐药严重，对于革兰阳性球菌，万古霉素和替考拉宁尚保持了较好的抗菌活性，对于革兰阴性杆菌仅碳青酶烯类抗生素对其存在较好的抗菌活性。结论对重症急性胰腺炎术后胰腺感染患者，大部分菌株广泛耐药，临床上应依据细菌药物敏感性结果，不断调整抗生素。     

In vitro susceptibilities of aerobic and facultative gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: the 2002 Study for Monitoring Antimicrobial Resistance Trends (SMART)

BACKGROUND: The Study for Monitoring Antimicrobial Resistance Trends (SMART) was begun in 2002 to monitor international drug-resistance patterns among aerobic and facultative gram-negative bacilli isolated from patients with intra-abdominal infections. METHODS: In 2002, 40 medical centers from 17 countries collected consecutive non-duplicate isolates from intra-abdominal infections for susceptibility testing against 12 antimicrobial agents using the broth microdilution methods recommended by the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards). RESULTS: A total of 3,134 aerobic and facultative gram-negative bacilli were isolated. Enterobacteriaceae accounted for 82% of the total and were most consistently susceptible to amikacin and the carbapenems. Escherichia coli (45%) and Klebsiella spp. (17%) were the most common species. The susceptibility rates of these organisms to the 12 antimicrobial agents differed among geographic regions, with isolates from the Asia/Pacific and Latin American regions usually having the highest rates of resistance. Ampicillin/sulbactam was the agent least frequently active against E. coli (56% susceptible) and Klebsiella spp. (73% susceptible). Extended-spectrum beta-lactamases (ESBLs) were detected phenotypically in 7% of E. coli, 13% of Klebsiella spp., and 18% of Enterobacter spp. Producers of ESBL overall had a more antibiotic-resistant profile than non-producers but were usually susceptible to carbapenems. CONCLUSIONS: Antimicrobial resistance rates among gram-negative bacilli isolated from intra-abdominal infections differed among geographic regions. The carbapenems were consistently active in vitro against Enterobacteriaceae worldwide, including ESBL producers.     

感染性眼病的病原菌分布及耐药性分析

目的探讨感染性眼病的主要病原菌分布及其耐药性。方法回顾性分析2009年1月_2011年12月天津市眼科医院眼病感染性样本2397份,对其进行细菌、真菌和阿米巴的培养与鉴定,分析病原菌的分布及其耐药性。结果在2397份送检样本中,培养阳性799份,阳性率为33．33％。其中,细菌培养阳性701份,占87．73％（701／799）;真菌培养阳性95份,占11．89％（95／799）;阿米巴培养阳性3份,占0．36％（3／799）。701株细菌中,革兰阳性球菌占76．03％（533／701）,表皮葡萄球菌所占比例最高为46．15％（246／533）;革兰阴性杆菌占19．69％（138／701）,以非发酵菌居多,其中铜绿假单胞菌占28．98％（40／138）;革兰阳性杆菌占4．28％（30／701）。95株真菌以丝状真菌为主,占97．89％（93／95）,最常见的丝状真菌为镰刀菌属（54／95,56．84％）、链格孢霉（13／95,13．68％）和曲霉菌属（17／95,17．88％）。体外药敏试验结果显示,表皮葡萄球菌对米诺环素和万古霉素的耐药率为0;铜绿假单胞菌对氨苄西林／舒巴坦、复方磺胺甲嗯唑和头孢噻肟的耐药率达100％,对阿米卡星、多黏菌素E、美罗培南、哌拉西林／他巴唑坦、妥布霉素的耐药率为0;真菌中茄病镰刀菌对两性霉素B的耐药率较低。结论细菌是感染性眼病的主要病原菌,其中以革兰阳性球菌最常见,其对万古霉素敏感;眼部致病真菌最常见的是镰刀菌属,其对两性霉素B敏感。     

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??Pathogen distribution and drug resistance in patients with intro-abdominal infection??A report of 310 cases DAI Xiao-ming*??SHI Kun??WU Xiang-dong??et al. *Intensive Care Unit??the First Affiliated Hospital of Dalian Medical University??Dalian 116011??China
Corresponding author??TAN Guang??E-mail??tanguang009@sina.com
Abstract Objective To investigate the distributions and antimicrobial resistances of the bacteria in abdominal drainage fluid in intro-abdominal infection??IAI??. Methods The abdominal drainage fluid specimen of 310 cases of IAI admitted from January 2012 to December 2014 in the First Affiliated Hospital of Dalian Medical University was collected. The bacterial distributions and antimicrobial resistances were analyzed. Results A total of 578 clinical isolates were collected??of which gram-negative organiams, gram-positive cocci and fungi accounted for 65.2% ??377 strains????27.0% ??156 strains??and 7.8% ??45 strains?? respectively. The top five most prevalent isolated pathogens were escherichia coli??19.6%????klebsiella pneumonia??11.4%??, acinetobacter baumannii??10.2%????enterococcus faecium??8.1%????pseudomonas aeruginosa??7.3%??. The resistance rate of E. faecium to most antibiotics was higher than that of E. faecalis. The resistance rates of E.faecium and E. faecalis against to ampicillin, ciprofloxacin, levofloxacin and erythromycin were all above 80%??and the sensitive rates of sulfamethoxazole and chloromycetin against staphylococcus were above 90%. No strain was found resistant to vancomycin or linezolid. The prevalence of ESBLs in enterobacteriaceae was above 55%, and the sensitive rates were higher in carbapenems, amikacin and β-Lactamase inhibitors, but severely resistant to the third generation cephalosporin. The prevalence rate of carbapenem-resistant enterobacteriaceae (CRE) was increasing year by year. The resistance rates of minocycline and cefperrazone-sulbactam against acinetobacter baumannii were 11.9% and 37.3%??which of other antimicrobial drugs were above 60%??of carbapenem was above 70%??of ceftriaxone and cefotaxime above 80%, of gentamicin above 90%. The sensitive rates of carbapenem??ceftazidime??cefepime??piperacillin sodium and tazobactam sodium??amikacin against pseudomonas aeruginosa were higher than those against acinetobacter baumannii. Conclusion The enterobacteriaceae and non-fermentative bacterias are the chief bacteria in IAI. Multi-drug resistant bacteria is serious??and the resistance rate is increasing year by year. Extensive and dynamical monitoring of pathogens resistance should be performed and rational use of antibiotics are advocated.     

外科感染常见菌群分布及致病菌耐药性监测

目的了解武汉地区外科感染致病菌的菌群分布及其对抗生素的耐药现状。方法将武汉地区１３所医院所做的抗生素对外科分离菌的抑菌结果即抑菌圈直径输入计算机。采用“ＷＨＯＮＥＴ３”软件进行统计和分析,根据１９９３年美国临床实验室标准委员会（ＮＣＣＬＳ）发布的标准判断细菌耐药性。结果１９９６年共收集外科感染菌株９５７株。金黄色葡萄球菌、铜绿假单胞菌、大肠杆菌和凝固酶阴性葡萄球菌（ＣＮＳ）是主要菌种。１２４％的金黄色葡萄球菌对苯唑西林耐药,对其它抗生素的耐药性也有所增加。肠杆菌科菌株对氨苄西林的耐药率＞７５％,克雷伯菌属对此的耐药率达９３％。大多数革蓝阴性（Ｇ－）杆菌,包括肠杆菌科和铜绿假单胞菌对亚胺配南、头孢他啶、阿米卡星和环丙沙星敏感。结论在外科领域开展细菌耐药性监测工作,并随时掌握细菌耐药动态具有重要的临床意义     

In vitro susceptibilities of Escherichia coli isolated from patients with intra-abdominal infections worldwide in 2002-2004: results from SMART (Study for Monitoring Antimicrobial Resistance Trends)

BACKGROUND: Since 2002, the worldwide Study for Monitoring Antimicrobial Resistance Trends (SMART) has tracked resistance patterns among aerobic and facultative gram-negative bacilli isolated from patients with intra-abdominal infections. Escherichia coli has been by far the most frequently isolated species. METHODS: Antimicrobial susceptibilities for consecutive non-duplicate isolates of aerobic and facultative gram-negative bacilli recovered from intra-abdominal infections were determined by standard broth microdilution techniques. A subanalysis was performed for E. coli isolates from the first three years of the study. RESULTS: A total of 7,002 E. coli isolates were recovered, most commonly from the peritoneal cavity followed by the biliary tract. Susceptibility rates to the 12 antimicrobial agents tested differed among geographic regions, with isolates from Asia/Pacific generally having the highest resistance rates. Overall, extended-spectrum beta-lactamase (ESBL)-producers had a more antibiotic-resistant profile than non-ESBL-producers but usually were susceptible to the carbapenems and amikacin. Community-acquired E. coli strains comprised slightly more than one-half of the isolates and were susceptible to the agents tested more frequently than were hospital-acquired E. coli. CONCLUSIONS: The prevalence of antimicrobial resistance among E. coli isolated from intraabdominal infections is not inconsequential, especially in the Asia/Pacific region. The carbapenems and amikacin were consistently active in vitro against E. coli isolates worldwide, including ESBL-producers.     

Multiple-locus variable number of tandem repeats (VNTR) fingerprinting (MLVF) and antibacterial resistance profiles of extended spectrum beta lactamase (ESBL) producing Pseudomonas aeruginosa among burnt patients in Tehran

Extended spectrum β-lactamase (ESBL)-producing trait was present in 48 out of the 112 (42.8%) Pseudomonas aeruginosa isolates collected from burn wound infections during a 12-month period. The presence of oxa-10, per-1, veb-1 and ges genes and the multiple-locus variable number of tandem repeats (VNTR) fingerprinting (MLVF) of 112 P. aeruginosa strains were determined by PCR and multiplex PCR. Disk diffusion methods were used to determine the susceptibility of the isolates to antimicrobial agents as instructed by CLSI. All ESBL isolates were resistant to aztreonam, cefepime, cefotaxime, cefpodoxime, ceftazidime, ceftriaxone and ofloxacin. Fewer than 60% of ESBL isolates were resistant to imipenem, meropenem, and piperacillin-tazobactam but more than 90% were resistant to amikacin, ciprofloxacin, levofloxacin, ticarcillin and tobramycin. The most prevalent ESBL genes included oxa-10 (70%) and per-1 (50%) followed by veb-1 (31.3%). The gene encodes GES enzyme did not detect in any isolates. A total of 100 P. aeruginosa strains were typed by MLVF typing method. MLVF produced 42 different DNA banding patterns. These data indicate that different MLVF types infect burn wounds in patients at a hospital in Tehran and also suggest an alarming rate of ESBL-producing isolates in this test location.     

青少年尿路感染细菌分布以及耐药性分析

【摘要】 目的 探究近一年来深圳光明新区尿路感染青少年患者细菌分布情况和耐药情况。方法将2014年7月到2015年7月就诊光明新区医院的18~20岁尿路感染患者44例作为研究对象,收集中段尿分离培养细菌共得1382株菌落,分析尿路感染细菌的种类、分布和通过药敏试验分析耐药性。结果〓革兰氏阳性菌20.12%,真菌3.04%,革兰氏阴性菌76.85%;屎肠球菌37.41%,近平滑假丝酵母菌38.10%,大肠埃希菌50.47%。金黄色葡萄球菌对环丙沙星耐药性最强,屎肠球菌耐药性最强的为左氧氟沙星,粪肠球菌耐药性最强的为克林霉素,大肠埃希菌耐药性最强的为头孢曲松,铜绿假单胞菌耐药性最强的为氨曲南,肺炎克雷伯菌耐药性最强的为头孢曲松,柠檬酸杆菌耐药性最强的为环丙沙星。结论〓对于18~20的青少年岁的尿路感染患者,革兰氏阴性菌尤其是大肠埃希菌为主产生耐药性较为广泛。     

急性胆管炎患者胆汁培养结果和药敏分析

目的研究急性胆管炎患者胆汁培养的病原学现状,病原体分布特点以及药敏情况为急性胆管炎的治疗提供更为合理的抗生素指导方案。方法回顾性分析2015年1月~2018年1月湛江地区我院收治符合病例研究纳入标准共314例急性胆管炎患者的临床病例资料,对其胆汁培养的病原菌分布及耐药性进行分析。结果 314例急性胆管炎胆汁培养的病原菌阳性率为82.80%,共检出病原菌358株,革兰氏阴性菌230株,革兰氏阳性菌122株,真菌6株。最常见的细菌是大肠埃希菌129株(36.0%)、粪肠球菌59株(16.5%)、铜绿假单胞菌27株(7.5%)、肺炎克雷伯菌肺炎亚种24株(6.7%)以及屎肠球菌17株(4.7%)。胆道培养为革兰氏阴性致病菌总体上对碳氢酶烯类(厄他培南耐药率0%,亚胺培南耐药率8.41%,美罗培南耐药率22.22%)及氨基糖苷类(阿米卡星耐药率1.35%,庆大霉素耐药率20.00%、妥布霉素10.19%)相对敏感度较高。胆道培养为革兰氏阳性致病菌总体上对临床上常用的大部分抗生素耐药率较低,譬如对米诺环素、莫西沙星、氨苄西林、头孢曲松耐药率均低于10%。而对于临床上较少应用的抗菌素如克林霉素、红霉素耐药率则高于40%。结论急性胆管炎患者胆汁培养的病原学现状仍然以革兰阴性菌为主,而药敏以碳氢酶烯类及氨基糖苷类相对敏感度较高,故临床上对其应用抗菌素治疗时要重视加强管理及监控。     

尿路感染中段尿病原菌的分布及耐药性

Objective To analyze the distribution and antimicrobial resistance of pathogenic bacteria in urinary tract infection (UTI) so as to provide evidence for appropriate selection of antimicrobial agents in clinical practice. Methods From January 2001 to December 2008 in Shanghai Ruijin Hospital, 4683 strains of pathogenic bacteria isolated from urine samples were detected by ATB system; drug susceptibility test was performed with disk diffusion method and pathogenic bacteria distribution and drug resistance was analyzed with WHO NET 5.3 software. Results Among 4683 strains of pathogenic bacteria, most was gram-negative bacilli, accounting for about 77.8%, of which predominant strain was Escherichia coli (68.7%, 3217/4683). The predominant strain of gram-positive bacteria was Enterococcus faecalis, accounting for 10.0% (468/4683). Escherichia coli showed high resistance rates to ampicillin, piperacillin and compound sulfamethoxazole (SMZ-TMP), which were 76.6%, 61.7% and 57.4% respectively, while a low resistance to imipenem, cefoperazone-sulbactam, piperacillin-tazobactam. Enterococcus faecalis showed high resistance rates to erythromycin, gentamicin and levofloxacin, which were 65.8%, 43.2% and 31.1% respectively, and were most susceptive to vancomycin and teicoplanin, both with resistance rates of 0. The susceptibility rate of Enterobacteriaceae to imipenem was 100%. From 2006 to 2008, the detection rate of extend-spectrum ?茁-lactamases ESBLs -producing Escherichia coli in outpatient increased year by year, from 28.7% to 43.3% (P<0.05), whereas no significant change was found in inpatients. The detection rate of (ESBLs)-producing Escherichia coli in inpatients was significantly higher than that in outpatients (P<0.05). The detection rate of ESBLs-producing Escherichia coli was 23.6%. The antimicrobial resistance rate in elderly patients was significantly higher than that in overall antimicrobial resistance rate (P<0.05). Conclusions The predominant bacteria of UTI are still gram-negative bacteria, main of which is Escherichia coli. Bacteria are resistant to a variety of antibiotics. Approximate selection of antibiotics in clinical practice should be made on the basis of susceptibility test results.