气单胞菌中检出多种耐药基因

目的研究临床感染气单胞菌的耐药性及耐药机制，为临床治疗提供科学依据。方法选择分离自肝病患者及腹泻患者的耐药气单胞菌19株，PCR及琼脂糖凝胶电泳法检测了β内酰胺酶TEM，OXA；质粒AmpC酶MOX／CMY，FOX，LAT／CMY及氨基苷类修饰酶aac（3）-Ⅰ，aac（3）-Ⅱ，aac（16′）-Ⅰ，ant（3″）-Ⅰ等耐药基因。结果本组19株气单胞菌中，包括嗜水气单胞菌10株，温和气单胞菌6株，豚鼠气单胞菌3株。气单胞菌耐药严重，对氨苄西林，头孢唑林，头孢曲松，头孢噻肟，头孢吡肟，头孢美唑，左氧氟沙星，复方磺胺甲嗯唑，氯霉素，阿米卡星和亚胺培南的耐药率分别为89．5％、63．2％、31．6％、26．3％、31．6％、84．2％、21．1％、68．4％、15．8％、5．3％和0％。检测19株耐药气单胞菌的耐药基因TEM阳性11株，OXA阳性2株，质粒AmpC酶MOX／CMY阳性7株，FOX及LAT／CMY均阴性；氨基苷类修饰酶nnf（3）-Ⅰ基因阳性2株，aac（3）-Ⅱ基因阳性2株，aac（6′）-Ⅰ基因阳性4株，ant（3″）-Ⅰ基因阳性6例，其中1株温和气单胞菌同时检出上述4种耐药基因。结论气单胞菌的耐药基因以TEM型β内酰胺酶最高，其次是质粒AmpC酶MOX／CMY，氨基苷修饰酶4种基因型均存在，提示气单胞菌的耐药严重，有多种耐药基因存在，需引起重视。     

2010—2020年临床分离维氏气单胞菌的临床特点和耐药性分析

目的 分析10年间维氏气单胞菌引起住院患者感染的临床特点及耐药情况.方法 收集中南大学湘雅二医院2010—2020年感染维氏气单胞菌的住院患者病历,回顾性分析患者的临床特征和临床分离菌株耐药情况.结果 共收集50例非重复维氏气单胞菌感染的住院患者,科室分布以普外科为主,标本来源以胆汁为主.最常见的基础疾病是恶性肿瘤、肝...     

气单胞菌不同种的流行及耐药性

目的：加强对气单胞菌感染的认识，我们分析了141株气单胞菌不同种感染的分布特点、对抗菌药物的耐药率及不同种耐药率的比较．为临床估计病情及选择抗菌药物提供客观依据。方法：有感染的临床表现者标本常规进行培养、分离和鉴定，同时用纸片扩散法及琼脂稀释法测定了气单胞菌对常用抗菌药物的敏感性。结果：气单胞菌的构成占肠道外分离菌的6．9％．占肠道感染菌的3．2％。气单胞菌主要来源于血液，其次为粪便和腹水。141株气单胞菌，包括嗜水气单胞菌54株(38．3％)、温和气单胞菌53株(37．6％)、豚鼠气单胞菌19株(13．5％)及简氏气单胞菌和杀鲑气单胞菌等其他气单胞菌15株(10．6)。主要发生夏秋季．71．6％产生β-溶血素。气单胞菌对抗菌药物的耐药，以氨苄西林最严重为78．3％，其次为头孢唑林48．0％、复方磺胺甲噁唑28．8％和头孢美唑30．5％，对亚胺培南及第三代头孢菌素也有一定程度的耐药。肠道感染的气单胞菌虽然均为院外感染，但除对氯霉素、磷霉素及左氧氟沙星外的其他抗菌药的耐药率均在10％以上。气单胞菌3个种的耐药率比较，无明显差别。结论：气单胞菌感染以嗜水气单胞菌及温和气单胞菌为主．易发生于夏秋季节，致病性强．对抗生素的耐药较普遍，气单胞菌3个种的耐药率比较多无明显差别。临床医师应根据药敏试验结果选用抗菌药物。     

气单胞菌不同菌种胆汁耐受特征分析

  目的  分析气单胞菌不同菌种胆汁的耐受特征,探讨嗜水气单胞菌与其他气单胞菌感染部位不同的原因。  方法  挑取8个种共20株气单胞菌,测定这些菌的胆汁最低抑菌浓度（MIC）和最低杀菌浓度（MBC）,并描述常见气单胞菌的在不同胆汁浓度下、厌氧或需氧环境下的生长情况。  结果  气单胞菌不同菌种对胆汁的耐受能力不同,维氏气单胞菌及肠棕气单胞菌对胆汁适应性最好,MIC为9%~11%,MBC为11%~12%;嗜水气单胞菌、豚鼠气单胞菌、中间气单胞菌及双壳类气单胞菌对胆汁适应性较差,MIC为4%,MBC为6%~10%。 达卡气单胞菌不同来源菌株间胆汁耐受有差异。增加气单胞菌的初始菌量,气单胞对胆汁耐受性增加;其中,嗜水气单胞菌对胆汁的耐受性最好。 厌氧环境更利于气单胞菌早期对胆汁的适应。  结论   气单胞菌不同菌种对胆汁的耐受能力不同;初始菌量及氧气影响气单胞对胆汁的耐受。     

嗜麦芽窄食单胞菌感染的临床治疗及耐药性研究

【目的】了解嗜麦芽窄食单胞菌易感因素、临床分布、耐药情况及抗感染治疗的效果。【方法】对29例嗜麦芽窄食单胞菌感染患者的临床资料和细菌培养结果进行回顾性分析。【结果】29例患者中28例为医院内感染,多数为呼吸道感染,93.1%（27/29）的患者患有基础疾病,其中慢性阻塞性肺疾病（COPD）合并呼吸衰竭最常见。96.5%（28/29）的患者曾使用过广谱抗生素,41.4%（12/29）曾接受侵入性检查和治疗。药敏试验表明该菌高度耐药,仅复方新诺明有较高的敏感率（75%）,临床经验治疗多数效果不佳。【结论】嗜麦芽窄食单胞菌已成为医院感染尤其是呼吸道感染的重要致病菌之一,常发生于住院周期长、免疫功能低下、有慢性基础疾病、接受激素及长期广谱抗菌药物治疗的老年病人。嗜麦芽窄食单胞菌对多种抗生素耐药,治疗颇为困难,临床经验用药可首先考虑加酶抑制剂（克拉维酸）抗生素与复方新诺明联用。     

气单胞菌耐消毒剂基因的研究

[目的]研究临床感染气单胞菌的耐药性及耐消毒剂及磺胺药基因的存在状况。[方法]选择分离自肝病患者及腹泻患者的耐药气单胞菌19株，PCR及琼脂糖凝胶电泳法检测了耐消毒剂及磺胺药基因（qacE△l-sull）。[结果]19株气单胞菌90％为多重耐药，以氨苄西林、头孢美唑、复方磺胺甲嗯唑及头孢唑林的耐药率最高，均在60％以上，未发现耐亚胺培南者。19株多重耐药气单胞菌中qacE△l-sull的阳性率为36．8％，包括3株嗜水气单胞菌，2侏豚鼠气单胞菌，温和气单胞蔺和维隆气单胞菌各1株。[结论]我围首次检测到气单胞菌中的qacE△l-sull基因，而且携带率辅高，需引起医院高度重视。     

2017年安徽省马鞍山市环境来源气单胞菌的分子特征和耐药分析

目的了解2017年安徽省马鞍山市环境来源气单胞菌的流行特征、毒力基因特征及耐药状况。方法2017年对来自马鞍山市监测的海水产品、包装食品、生活用水、游泳池水样、食物中毒样本等进行气单胞菌分离检测,采用管家基因rpoD序列分析进行种水平鉴定,PCR检测气单胞菌6种毒力基因（Fla、Elastase、hlyA、ast、act和ascF-G）、脉冲场凝胶电泳（PFGE）分型分析分子型别,药敏试验检测药物敏感性。结果共检测样品869份,气单胞菌检出率为7.6%（66/869）,检出率最高的是农村生活用水、食物中毒样品和海水产品。 66株气单胞菌分为7个种,最多的种是维氏气单胞菌（36.4%,24/869）、嗜水气单胞菌（19.7%,13/869）和简氏气单胞菌（19.7%,13/869）。 64株气单胞菌携带至少1种毒力基因,Fla和act总检出率最高（53.1%）,Fla在豚鼠气单胞菌中检出率最高（83.3%）,act在嗜水气单胞菌检出率最高（69.2%）。 66株气单胞菌分为64个PFGE带型,表现为多样性。 药敏实验显示,气单胞菌对头孢替坦等7种抗生素100%敏感,对头孢唑啉等5种抗生素部分敏感（耐药率1.5% ~ 21.2%）,而对氨苄西林、氨苄西林/舒巴坦的耐药率均高达90.0%。结论2017年马鞍山地区气单胞菌污染较为严重,携带较高比例的多种毒力基因,并且对多种抗生素耐药性较高,应该加强对气单胞菌及其耐药性的监测。     

上海市浦东新区腹泻病例中气单胞菌的流行和耐药特征研究

目的 了解上海市浦东新区腹泻病例中气单胞菌的流行及抗生素耐药特征。方法 2014年,在辖区内11家临床机构采集腹泻病例样本进行包括气单胞菌在内的腹泻多病原菌的检测,应用改良K-B法检测气单胞菌分离菌株对12种抗生素纸片的耐药性。结果 基于腹泻病例的实验室多病原诊断从1846份腹泻样本中共确认73例气单胞菌感染病例:单一型感染42例(57.6%),其中嗜水气单胞菌(嗜水)8例、维隆气单胞菌温和生物变种(温和)26例、豚鼠气单胞菌(豚鼠)8例;混合型感染31例(42.4%),总感染阳性率为4.0%。感染优势菌型为温和(P0.05),感染峰值为年度6-8月间(9.0%),病例的男女性别比差异无统计学意义,病例的年龄组以0~4岁和40~91岁人群居多。有65.8%(48/73)的气单胞菌对至少1种抗生素产生耐药性,以阿莫西林/克拉维酸(38.4%)和四环素(34.2%)的耐药率为最高,发现的3株多重耐药(MDR)株均为温和气单胞菌,其中1株对6种抗生素多重耐药(包括头孢噻肟、环丙沙星和左氧氟沙星)。结论 浦东新区和食源性感染性腹泻相关的气单胞菌病例存在较高的混合感染现象,发病有显著的季节特征,5岁以下幼儿和中老年人较为易感,温和气单胞菌是优势菌型,其对抗生素的多重耐药水平有升高趋势。     

医院感染嗜麦芽窄食单胞菌的耐药研究

目的监测医院感染嗜麦芽窄食单胞菌的分布和耐药状况,为临床用药和控制医院感染提供参考。方法收集2006年7月1日-2009年6月30日104株非重复的医院感染嗜麦芽窄食单胞菌,复核后采用琼脂稀释法进行体外敏感试验,按照美国临床实验室标准化协会（CLSI）2007年的标准测定MIC,以MIC90和MIC50表示抗生素的抗菌活性,并计算耐药率（R%）、中介率（I%）和敏感率（S%）。结果14种抗生素嗜麦芽窄食单胞菌敏感率较高的有：莫西沙星、左氧沙星、环丙沙星以及头孢哌酮。结论嗜麦芽窄食单胞菌是一种多重耐药且耐药率较高的细菌,临床上应根据药敏结果选用抗生素。     

耐三代头孢菌素的肠道病原菌的增长趋势和耐药谱

目的监测我院2001—2010年与腹泻有关的耐三代头孢菌素肠道病原菌的增长趋势和耐药谱。为本地区的流行病学研究及临床合理用药提供依据。方法通过大便标本培养,致病菌经生化及血清学进一步鉴定到种或群．并以纸片扩散法测定抗菌药物的敏感性。采用WHONET5．3软件对药敏结果进行统计和分析。结果10年分离出219株耐三代头孢菌素的腹泻病原菌,占同期整个肠道致病菌的9．91％,包括沙门菌9株（4．11％）、志贺菌120株（54．79％）、气单胞菌20株（9．13％）、类志贺毗邻单胞菌2株（0．91％）、致泻大肠埃希菌40株（18．26％）及弧菌28株（12．79％）,检出率由2001年的1．5％上升至2010年的近30．0％。219株耐三代头孢菌素病原菌对广谱青霉素和复方新诺明的耐药率均在85．0％以上．对头孢吡肟、头孢美唑、氟喹诺酮类、氯霉素的耐药率在20．0％～36．5％,对磷霉素的耐药率最低（6．7％）。福氏志贺菌、致泻大肠埃希菌、气单胞菌和弧菌对氟喹诺酮类的耐药率明显高于宋内志贺菌;气单胞菌和弧菌对头孢美唑的耐药率高于福氏志贺菌、致泻大肠埃希菌和宋内志贺菌;气单胞菌对磷霉素的耐药率显著高于其他致病菌。结论耐三代头孢菌素的肠道病原菌上升迅速,耐药广泛,不同种属的耐药性不同,应重视监测,加强防治。     

Surgical infections in the critically ill

Surgical infections in the critically ill patient population are a significant cause of morbidity and mortality. Intra-abdominal and surgical soft-tissue infections are responsible for a significant proportion of the disease burden. Multiple risk factors have been identified that are associated with the development of surgical infections and subsequent morbidity and mortality. The microbiologic spectrum associated with these infections is broad and is determined by the site from which the infection arises and whether the infection is community acquired or nosocomial in origin. The diagnosis and management of these infections require a high index of suspicion, prompt surgical intervention, and adequate antibiotic therapy and resuscitation. Therefore, these infections present a challenge to the intensivist caring for a critically ill patient.     

A systematic approach to diabetic foot infections

Foot infection is the most common reason for hospitalization and subsequent lower extremity amputation among persons with diabetes. Foot ulceration caused by diabetic neuropathy, trauma, and peripheral vascular disease can lead to a limb- or life-threatening infection. The optimum treatment of these potentially devastating conditions depends on a multidisciplinary approach that addresses the related or underlying disorders and thus ensures proper wound healing and a positive outcome. In addition to antibiotic therapy, severe soft-tissue or bone infections may necessitate surgical treatment, including drainage, débridement, and vascular reconstruction. Initial (empiric) antibiotic therapy should provide coverage against staphylococci and streptococci and should be revised according culture results. Antibiotic therapy is not indicated in clinically noninfected wounds. The duration of antibiotic treatment can range from 1 week for mild infections to 6 weeks or more for residual osteomyelitis and severe deep tissue infections. Aggressive (and sometimes repeated or staged) surgical intervention and appropriate antibiotic therapy can reduce the likelihood of a major amputation and the duration of hospitalization.     

糖尿病足抗生素规范化治疗

糖尿病足（diabeticfoot, DF)是糖尿病最常见的并发症之一,临床表现主要为足部溃疡、感染和坏疽,常常给患者带来巨大痛苦和沉重的经济负担,严重者常导致截肢甚至危及生命。因此, 糖尿病足的治疗需要一个规范化的标准。糖尿病足的发病是多种因素共同作用的结果,包括神经病变、血管病变、感染等,其中感染是较复杂且不易控制的因素,这就涉及到抗生素的应用,本文主要阐述糖尿病足抗生素规范化治疗。     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Reduction in antibiotic prescribing for respiratory tract infections is needed!

In general practice, approximately 25% of consultations are related to infectious diseases. The emergence and spread of resistant bacteria are related to antibiotic use on an individual and on a community level. Antibiotic prescribing differs profoundly from one European country to the next, though there is no evidence of differences in the prevalence of infectious diseases. Most respiratory tract infections are self-limiting conditions, and recent evidence shows that antibiotics only slightly modify the course of most respiratory tract infections. The general practitioner should focus on patients with more severe symptoms who might benefit more from antibiotic treatment. In general, antibiotics should be prescribed for acute pneumonia. In addition, we may offer antibiotics to a selected group of patients with more severe symptoms of maxillary sinusitis, pharyngotonsillitis and acute exacerbation of chronic obstructive pulmonary disease/chronic bronchitis. In the diagnostic procedure, rapid tests of Streptococcus pyogenus and C-reactive protein may be valuable in carefully selected cases. Penicillins (penicillin V, amoxycillin) should be the first choice in most respiratory tract infections. Larger studies in general practice are needed to analyse the impact of antibiotic prescribing on morbidity, the occurrence of rare complications and spread of resistance. The greatest challenge will be to implement current knowledge in daily praxis.     

Reduction in antibiotic prescribing for respiratory tract infections is needed!

In general practice, approximately 25% of consultations are related to infectious diseases. The emergence and spread of resistant bacteria are related to antibiotic use on an individual and on a community level. Antibiotic prescribing differs profoundly from one European country to the next, though there is no evidence of differences in the prevalence of infectious diseases. Most respiratory tract infections are self-limiting conditions, and recent evidence shows that antibiotics only slightly modify the course of most respiratory tract infections. The general practitioner should focus on patients with more severe symptoms who might benefit more from antibiotic treatment. In general, antibiotics should be prescribed for acute pneumonia. In addition, we may offer antibiotics to a selected group of patients with more severe symptoms of maxillary sinusitis, pharyngotonsillitis and acute exacerbation of chronic obstructive pulmonary disease/chronic bronchitis. In the diagnostic procedure, rapid tests of Streptococcus pyogenus and C-reactive protein may be valuable in carefully selected cases. Penicillins (penicillin V, amoxycillin) should be the first choice in most respiratory tract infections. Larger studies in general practice are needed to analyse the impact of antibiotic prescribing on morbidity, the occurrence of rare complications and spread of resistance. The greatest challenge will be to implement current knowledge in daily praxis.     

Pneumonia due to Aeromonas hydrophila-complex: epidemiologic, clinical, and microbiologic features

Review of published data examining the various types of infections produced by strains of the Aeromonas hydrophila-complex demonstrates a paucity of information on lower respiratory tract infections due to this organism. Although it is rarely cited as a cause of pneumonitis, we have been able to collect epidemiologic, clinical, and microbiologic data on eight patients who have had evidence of Aeromonas pneumonia. Interestingly, seven of the eight patients were male, and the average age for the group was 54.3 years. In contrast to reports showing a prevalence of other types of A hydrophila infections during the summer months, five of the pneumonitis cases occurred during late fall and early winter. Infections were both community-acquired and nosocomial. A proven or suspected history of aspiration was present in six patients. Preexisting medical conditions were noted in all patients, the majority having multiple predisposing factors, which included alcohol abuse and alcoholic liver disease, cardiovascular and cerebrovascular disease, and chronic lung disease. Three patients died of their acute pulmonary infection. Based on in vitro antimicrobial susceptibility testing, aminoglycoside therapy would seem appropriate in the treatment of these infections.     

A fatal case of necrotizing Aeromonas schubertii fasciitis after penetrating injury

Necrotizing fasciitis is an uncommon but life-threatening condition with a high associated mortality and morbidity. Most infections are polymicrobial, another distinct form of necrotizing fasciitis that occurred by penetrating freshwater trauma, such as fishing or wading in wet fields. Aeromonas species are responsible. The rapidity of the infectious process is similar to that of clostridial infection, but gas production is not a consistent feature. We report a patient who presented with fever, chills, and bullae on left forearm, despite antibiotics and wound debridement; the infection extend to mid humerus with a rapid onset of skin necrosis and progressive sepsis. Aeromonas schubertii fasciitis is particularly virulent. An apparent superficial cellulitis that fails to respond to standard therapy must raise suspicion of a more extensive underlying subcutaneous infection. Aggressive surgical debridement and antibiotic coverage for gram-negative rods are the essential features of treatment. Delay caused by a mistaken diagnosis of cellulitis and subsequent inadequate debridement would likely prove fatal.     

Cost of Gram-negative resistance

OBJECTIVE: It is unclear that infections with Gram-negative rods resistant to at least one major class of antibiotics (rGNR) have a greater effect on patient morbidity than infections caused by sensitive strains (sGNR). We wished to test the hypothesis that rGNR infections are associated with higher resource utilization. DESIGN: Retrospective observational cohort study of prospectively collected data. SETTING: University hospital surgical intensive care unit and ward. PATIENTS: Surgical patients with at least one GNR infection. MEASUREMENTS: We compared admissions treated for rGNR infection with those with sGNR infections. Primary outcomes were total hospital costs and hospital length of stay. Other outcomes included antibiotic treatment cost, in-hospital death, and intensive care unit length of stay. After univariate analysis comparing outcomes after rGNR infection with those after sGNR infection, multivariate linear regression models for hospital cost and length of stay were created to account for potential confounders. MAIN RESULTS: Cost data were available for 604 surgical admissions treated for at least one GNR infection (Centers for Disease Control and Prevention criteria), 137 (23%) of which were rGNR infections. Admissions with rGNR infections were associated with a higher severity of illness at the time of infection (Acute Physiology and Chronic Health Evaluation II score, 17.6 +/- 0.6 vs. 13.9 +/- 0.3), had higher median hospital costs ($80,500 vs. $29,604, p < .0001) and median antibiotic costs ($2,607 vs. $758, p < .0001), and had longer median hospital length of stay (29 vs. 13 days, p < .0001) and median intensive care unit length of stay (13 days vs. 1 day, p < .0001). Infection with rGNR within the first 7 days of admission was independently predictive of increased hospital cost (incremental increase in median hospital cost estimated at $11,075; 95% confidence interval, $3,282-$20,099). CONCLUSIONS: Early infection with rGNR is associated with a high economic burden, which is in part related to increased antibiotic utilization compared with infection with sensitive organisms. Efforts to control overuse of antibiotics should be pursued.