老年患者常见革兰阳性球菌耐药性监测

目的 了解安徽省2008-2010年老年患者临床分离革兰阳性球菌的耐药性,以指导临床合理使用抗菌药物.方法 收集2008-2010年安徽省细菌耐药监控中心网络医院门诊或住院老年患者临床分离菌,采用琼脂稀释法对分离的革兰阳性球菌进行药敏试验,按CLSI 2010年版判断结果.结果 2008-2010年共收集老年患者革兰阳性球菌311株,金黄色葡萄球菌89株,占28.6％,溶血葡萄球菌53株,占17.0％,表皮葡萄球菌44株,占14.1％;耐甲氧西林金黄色葡萄球菌(MRSA)的检出率51.7％,MRSA耐药严重,除万古霉素、替考拉宁和利奈唑胺外,对各种抗菌药物的耐药率均≥67.4％;甲氧西林敏感金黄色葡萄球菌(MSSA)对大部分抗菌药物耐药率均＜30.0％;3年未发现万古霉素、替考拉宁及利奈唑胺耐药株;肠球菌属除对万古霉素、替考拉宁及利奈唑胺较为敏感外,对其他各种抗菌药物耐药率均≥57.1％,未发现耐利奈唑胺肠球菌.结论 老年患者革兰阳性球菌耐药严重,加强细菌耐药性监测对指导临床用药十分重要.     

医院呼吸道感染金黄色葡萄球菌的耐药性分析

目的 分析探讨医院呼吸道感染金黄色葡萄球菌的耐药性.方法 对医院2011年4-6月检出的金黄色葡萄球菌对常用抗菌药物的敏感性进行分析总结,同时分析比较甲氧西林敏感金黄色葡萄球菌(MSSA)与耐甲氧西林金黄色葡萄球(MRSA)的耐药性.结果 金黄色葡萄球菌对万古霉素、替考拉宁、利奈唑胺、呋喃妥因4种抗菌药物的敏感性较高,其敏感性分别为100.00％、100.00％、100.00％、94.56％;对另外16种抗菌药物均出现了高达50.00％的耐药率;MSSA对苯唑西林、阿莫西林、哌拉西林等抗菌药物的耐药率明显低于MRSA(P＜0.01).结论 医院呼吸道感染金黄色葡萄球菌对多种常见的抗菌药物均有较强的耐药性,给临床治疗带来了较大的困难,为减少耐药菌株的产生,合理的应用抗菌药物是重要的有效预防措施.     

重症监护室耐甲氧西林金黄色葡萄球菌耐药性及联合药敏分析

目的了解38株分离自重症监护室的耐甲氧西林金黄色葡萄球菌（MRSA）分布及联合药物体外抗菌活性,以指导临床合理选择抗菌药物。方法以常规方法培养分离细菌,用金黄色葡萄球菌乳胶试剂盒及VITEK Ⅱ细菌分析仪鉴定到种;采用乳胶凝集试剂盒鉴定MRSA。以微量稀释法测定利奈唑胺等5种抗菌药物对MRSA的体外抗菌活性,按美国临床实验室标准化研究所标准进行。结果38株MRSA对利奈唑胺、万古霉素和替考拉宁均敏感;对左氧氟沙星和利福平的耐药率分别为100.00%和78.95%。利福平分别与利奈唑胺、万古霉素和替考拉宁联合,联合抑菌指数（FIC）＜1者占13.16%～31.58%;左氧氟沙星分别与利奈唑胺、万古霉素和替考拉宁联合,FIC＜1者占2.63%～36.84%;各组联合药物间差异有统计学意义（P＜0.01）。结论对ICU病区MRSA感染者治疗时,应参考药敏试验结果并结合患者个体情况合理选择抗菌药物,制定个体优化治疗方案。     

ICU耐甲氧西林金黄色葡萄球菌的感染现状及耐药性

目的探讨医院重症医学科中耐甲氧西林金黄色葡萄球菌(MRSA)的感染现状及耐药性,为临床合理使用抗菌药物提供必要的病原学依据。方法对医院ICU 2008年1月-2011年2月医院感染的385株金黄色葡萄球菌及其耐药性进行回顾性分析。结果 MRSA检出357株,检出率为92.8%;金黄色葡萄球菌对常用抗菌药物产生了不同的耐药性,其中对青霉素G耐药率最高,达98.6%,对万古霉素、替考拉宁和利奈唑胺敏感率最高,为100.0%。结论重症医学科中金黄色葡萄球菌的感染及耐药问题日益严重,需要加强ICU耐药菌监控,预防医院感染暴发流行。     

金黄色葡萄球菌耐药性统计分析

目的:统计分析我院临床分离的金黄色球菌对常用抗菌药物的耐药性,以期为由金黄色葡萄球菌引起的感染性疾病的临床治疗提供依据。方法:应用VITEK32微生物自动鉴定分析系统,采用纸片扩散法(K—B法)对我院各科室临床分离的112株金黄色葡萄球菌进行14种抗菌药物的敏感性测试。结果:金黄色球菌对替考拉宁,利奈唑胺,万古霉素,氨苄西林,苯唑西林,红霉素,克林霉素,利福平,头孢噻吩,青霉素,四环素,阿米卡星,头孢他啶,头孢曲松的敏感性分别为100.00%,100.00%,100.00%,74.23%,80.18%,51.38%,61.62%,94.23%,75.51%,16.00%,36.70%,85.44%,47.92%,67.06%。结论:金黄色球菌对替考拉宁,利奈唑胺,万古霉素的敏感性最大,在临床上监测病菌耐药性对于合理用药具有重要意义。     

Mohnarin2011年报告:西北地区细菌耐药监测

目的 了解2011年西北地区医院临床分离菌构成以及对常用抗菌药物的耐药性,为临床用药提供参考依据.方法 西北10所医院的临床分离菌采用K-B纸片扩散法或自动化仪器法进行抗菌药物敏感试验,按CLSI2011年标准(肠杆菌科细菌对碳青霉烯类抗菌药物敏感性的判断参照2010年标准),采用WHONET5.6软件进行统计分析.结果 共分离细菌13429株,革兰阳性菌占29.3％,革兰阴性菌占70.7％;葡萄球菌属中MRSA和MRCNS检出率分别为61.4％和84.0％,未发现万古霉素、替考拉宁和利奈唑胺耐药株,屎肠球菌的分离率、耐药性均高于粪肠球菌,屎肠球菌对万古霉素、替考拉宁和利奈唑胺的耐药率分别为2.9％、0.8％和0.7％,粪肠球菌分别为1.3％、0和0.5％;肠杆菌科细菌对碳青霉烯类抗菌药物保持较好的敏感性(＞95.4％),鲍氏不动杆菌对头孢哌酮/舒巴坦的耐药率最低为30.5％,对亚胺培南的耐药率为49.6％;铜绿假单胞菌对阿米卡星耐药率最低为11.2％,对亚胺培南的耐药率为20.6％.结论 西北地区医疗机构细菌耐药性呈增长趋势,定期进行耐药性监测有助于了解细菌耐药性,为临床用药提供参考.     

神经外科术后患者脑脊液中革兰阳性菌的分布及耐药性分析

目的 了解2011-2015年神经外科术后脑脊液培养阳性患者的革兰阳性菌临床分布情况与耐药性.方法 对2011年1月至2015年12月首都医科大学附属北京天坛医院神经外科术后患者脑脊液培养阳性的革兰阳性菌进行分析,且分别对临床诊断真感染的凝固酶阴性葡萄球菌(CoNS)、金黄色葡萄球菌、粪肠球菌与屎肠球菌的耐药情况进行分析.结果 2011-2015年,神经外科术后分离出革兰阳性菌共1 284株,分离率为4.53％,其中表皮葡萄球菌、人葡萄球菌和金黄色葡萄球菌的分离率最高,依次为38.32％、12.31％和10.75％;共分离出987株CoNS,其中真感染210株(21.28％).药敏试验结果显示,革兰阳性菌对万古霉素、利奈唑胺与替考拉宁敏感度最高均大于90.00％;真感染CoNS对万古霉素与利奈唑胺无法达到100.00％敏感率,对阿米卡星与利福平的敏感率大于90.00％;金黄色葡萄球菌对苯唑西林和四环素耐药率较高,肠球菌对多种药物均有较高耐药率.结论 神经外科术后革兰阳性菌感染问题较为严重,由于CoNS的感染不确定性,以及金黄色葡萄球菌与肠球菌感染的严重性,临床治疗时需特别注意.万古霉素、替考拉宁与利奈唑胺治疗神经外科术后革兰阳性菌感染较有效.     

2011年金黄色葡萄球菌耐药性分析

目的 了解医院2011年金黄色葡萄球菌的耐药性,为临床合理使用抗菌药物提供依据.方法 采用纸片扩散法进行药敏试验,并采用Etest法测定万古霉素对耐甲氧西林金黄色葡萄球菌(MRSA)的最低抑菌浓度(MIC),以CLSI 2010年标准判断结果,WHONET5.6软件分析数据.结果 全年共分离金黄色葡萄球菌255株,其中MRSA检出率为51.4％,以神经外科、ICU检出率最高,分别为85.4％、80.1％,门诊患者最低为15.2％;甲氧西林敏感金黄色葡萄球菌(MSSA)对青霉素高度耐药,对红霉素耐药率为41.7％,对其余抗菌药物均高度敏感,敏感率＞ 70.0％;MRSA对抗菌药物的耐药率明显高于MSSA,MRSA除对万古霉素、替考拉宁、利奈唑胺敏感率100.0％外,对磺胺甲噁唑/甲氧苄啶、利福平敏感率分别为92.0％、80.4％;Etest结果显示MRSA对万古霉素MIC50和MIC90分别为1.0、2.0 μg/ml,MIC＞ 1.0 μg/ml菌株所占比例为44.3％,未发现有万古霉素非敏感株.结论 神经外科和ICU是MRSA感染的高危部门,MRSA对抗菌药物耐药性高,应重视MRSA万古霉素MIC的监测.     

金黄色葡萄球菌致肺部感染的耐药谱分析

目的调查引起肺部感染金黄色葡萄球菌的耐药谱。方法收集确诊为金黄色葡萄球菌肺部感染病例的痰培养标本及临床资料,进行药敏试验。结果 100例由金黄色葡萄球菌引起的肺部感染患者中,70.0%为老年患者;85株为耐甲氧西林金黄色葡萄球菌(MRSA);金黄色葡萄球菌对多种抗菌药物呈普遍耐药,但所有分离株对万古霉素、利奈唑胺、替考拉宁、喹奴普汀/达福普汀及呋喃妥因均敏感,此外耐药率<20.0%的抗菌药物仅1种,为磺胺甲噁唑/甲氧苄啶;MRSA对红霉素、克林霉素等药物的耐药率显著高于MSSA(P<0.01)。结论金黄色葡萄球菌引起的肺部感染易发生于老年患者,MRSA呈多药耐药性,但对万古霉素等药仍保持较高敏感性。     

血流感染金黄色葡萄球菌的耐药谱分析

目的 调查血流感染金黄色葡萄球菌的耐药谱,为临床治疗金黄色葡萄球菌血流感染提供指导.方法 收集确诊金黄色葡萄球菌血流感染病例的临床资料,金黄色葡萄球菌分离自血液培养,利用全自动微生物分析仪对金黄色葡萄球菌进行菌种鉴定和药敏试验.结果 共从87例血流感染的患者血液中分离出87株金黄色葡萄球菌,均无非重复株;有66例存在严重基础疾病;87株金黄色葡萄球菌中,36株为耐甲氧西林金黄色葡萄球菌(MRSA),占41.4%;金黄色葡萄球菌对多种抗菌药物呈普遍耐药,对青霉素和氨苄西林的耐药率已>95.0%,对磺胺甲()唑/甲氧苄啶和利福平的耐药率<20.0%,对万古霉素、利奈唑胺、替考拉宁及喹奴普汀/达福普汀均100.0%敏感;MRSA的耐药率显著高于甲氧西林敏感金黄色葡萄球菌(MSSA)(P<0.05).结论 金黄色葡萄球菌引起的血流感染易发生于有基础疾病的患者,MRSA呈多药耐药性,但对万古霉素、利奈唑胺、替考拉宁及喹奴普汀/达福普汀敏感仍保持较高敏感性.     

Identification of picobirnavirus from faeces of Italian children suffering from acute diarrhea

Polyacrylamide gel electrophoresis of nucleic acid extracted from stool samples of diarrhoeic children revealed in 3 out of 690 (0.43 %) specimens two electrophoretic bands with a migration pattern characteristic of picobirnavirus ds-RNA. In none of the 92 control children were similar bands detected. No other potential enteric pathogens were found in the patients with picobirnavirus infection.     

Absorption of calcium from tortilla meals prepared from low-phytate maize

BACKGROUND: Calcium fortification of maize has been achieved for millennia in Central America by the process of nixtamalization. Bioavailability of calcium is, however, compromised by phytate, which is present in large quantities in maize kernels and is only modestly reduced by nixtamalization. OBJECTIVE: The objective was to compare the absorption of calcium from tortilla meals prepared from low-phytate maize with that from meals prepared from maize with typical phytate content. DESIGN: At 1-mo intervals, 5 healthy adult women were fed 2 test meals of approximately 140 g tortillas in lieu of breakfast. On one occasion, the tortillas were prepared from maize with approximately 60% phytate reduction, and, on the other occasion, they were prepared from the matching isohybrid wild-type maize. Beginning midway through the test meal, (44)Ca (0.3 mg/kg body wt) was administered in water as an extrinsic label; (42)Ca (0.06 mg/kg body wt) was administered intravenously immediately after the test meal. Isotope ratios of (42)Ca to (43)Ca and of (44)Ca to (43)Ca were measured by inductively coupled plasma mass spectrometry in urine collected as an 8-h pool from the period 16-24 h after intravenous tracer administration and prepared by the oxalate precipitation method. Fractional absorption of calcium was determined by using a dual-isotope ratio technique. RESULTS: Mean fractional absorption of calcium from tortillas prepared from the low-phytate maize (0.50 +/- 0.03) was significantly (P = 0.003) greater than that from tortillas prepared from the control maize (0.35 +/- 0.07). CONCLUSION: The increase in the quantity of calcium absorbed could be of practical importance for calcium nutriture when the intake of dairy products is limited.     

Demographics of disenrollment from SCHIP: evidence from NJ KidCare

The State Children's Health Insurance Program (SCHIP) provides health insurance coverage for children in low-income families. Although there is evidence of substantial disenrollment from SCHIP, few studies have examined how disenrollment varies by demographic characteristics. This study uses data from administrative records of all 41,881 children enrolled prior to April 2000 in NJ KidCare (New Jersey's SCHIP) separate state plans for families with incomes between 133% and 350% of the Federal Poverty Level. Survival methods were used to analyze disenrollment according to demographic and plan characteristics. Reasons for disenrollment were also studied. Overall, 18.9% of children disenrolled within 12 months of enrollment. Disenrollment was higher among non-Hispanic black children, children aged 1 to 5, and children without siblings in NJ KidCare than among their counterparts. Surprisingly, English speakers had the highest disenrollment rate of all language groups. Children in families with moderate income categories for whom premium contributions were required were 3 times as likely as lower-income children to disenroll, principally due to non-payment of premiums. To maximize retention in SCHIP and ensure access to care and continuity of care for low-income children, research is needed concerning why some groups disenroll more quickly.