两种亚胺培南不敏感非发酵菌的耐药性分析

目的探讨亚胺培南不敏感铜绿假单胞菌及鲍曼不动杆菌的耐药性,为临床用药提供参考。方法对本院2010年1月~2014年12月间分离的亚胺培南不敏感铜绿假单胞菌及鲍曼不动杆菌进行统计分析。结果 403株亚胺培南不敏感鲍曼不动杆菌对常用抗菌药物耐药率很高,仅对头孢哌酮/舒巴坦、米诺环素和多粘菌素B保持较高的敏感性;113株亚胺培南不敏感铜绿假单胞菌对抗菌药物的敏感率高于亚胺培南不敏感鲍曼不动杆菌,对头孢他啶、头孢哌酮/舒巴坦、多粘菌素B、抗假单胞菌青霉素及其复合制剂有较高敏感性。结论两种亚胺培南不敏感非发酵菌对多数抗菌药物的耐药严重,应根据药敏结果选择抗菌药物,同时应采取恰当控制感染措施,以减少耐药菌株的产生与传播。     

耐亚胺培南鲍曼不动杆菌产碳青霉烯酶及耐药性变迁研究

目的研究临床分离的耐亚胺培南鲍曼不动杆菌产碳青霉烯酶以及菌株耐药性变迁情况。方法改良的Hodge试验检测耐亚胺培南鲍曼不动杆菌产碳青霉烯酶情况;K-B纸片扩散法对临床分离的耐亚胺培南鲍曼不动杆菌菌株进行药敏分析,了解耐药性变迁情况。结果临床分离的62株耐亚胺培南鲍曼不动杆菌改良Hodge试验阳性15株,阳性率为24.19%,且耐亚胺培南鲍曼不动杆菌产碳青霉烯酶率逐年上升。临床分离菌株主要来源于痰液及分泌物,病区以ICU最多(占20.97%),其次为急诊科和神经外科。耐亚胺培南鲍曼不动杆菌对常用17种抗菌药物的耐药性逐年升高,且以头孢哌酮/舒巴坦最低,其次为多粘菌素E。结论耐亚胺培南鲍曼不动杆菌耐药性升高主要是由于产生了碳青霉烯酶;头孢哌酮/舒巴坦对碳青霉烯类耐药鲍曼不动杆菌有较好的抗菌活性,可作为此类细菌感染的治疗药物。     

2007～2009年我院临床分离的鲍曼不动杆菌分布特征及耐药性分析

目的观察2007～2009年我院鲍曼不动杆菌感染情况及耐药特点,为临床合理应用抗菌药物提供依据。方法对2007年1月～2010年6月在我院住院患者所分离的鲍曼不动杆菌的科室分布、标本来源和耐药性进行回顾性分析。结果共分离获得256株鲍曼不动杆菌,主要分布于ICU和呼吸内科、最常见于痰标本中;其对多种抗菌药物严重耐药,对亚胺培南和美洛培南耐药率低于国内相关报道。结论 2007～2009年我院鲍曼不动杆菌感染及耐药性均呈逐渐增加趋势,临床应注意加强监测、及时应用敏感抗生素。     

二级医院鲍曼不动杆菌感染的临床特征和同源性分析

目的：研究二级医院鲍曼不动杆菌感染患者的临床特征,对耐碳青霉烯鲍曼不动杆菌进行同源性分析,为临床治疗和医院感染控制提供依据。方法收集临床分离的115株非重复性鲍曼不动杆菌,回顾性分析患者的临床资料和细菌药敏资料。采用 Vitek2 Compact 对115株鲍曼不动杆菌进行19种抗菌药物的敏感性检测。采用肠杆菌科基因间一致重复序列聚合酶链技术(ERIC-PCR)对其中的耐碳青霉烯鲍曼不动杆菌进行基因分型和同源性分析。结果115例患者主要集中在 ICU、干部病房和呼吸科病房。患者的平均年龄为(75±16)岁。平均住院时间52.1 d。最常见的合并症为COPD 和糖尿病。72例(62.61%)患者曾接受侵入性操作。86例(74.78%)患者病程中使用过2种及以上的抗生素。48例(41.74%)患者接受机械通气。115株鲍曼不动杆菌对多黏菌素 B 耐药率最低,为0%,其次为替加环素,耐药率7.83%。仅头孢哌酮/舒巴坦、阿米卡星耐药率低于40%,对其他常用抗生素的耐药率均高于50%。对亚胺培南和美罗培南的耐药率分别达56.52%和58.26%。ERIC-PCR 技术将67株耐碳青霉烯鲍曼不动杆菌分为9个基因型。结论二级医院鲍曼不动杆菌感染患者的临床特征为：高龄,住院时间长,合并基础疾病,接受侵入性操作,接受机械通气及使用多种抗生素。对常用的抗生素高度耐药。多重耐药鲍曼不动杆菌及广泛耐药鲍曼不动杆菌存在院内接触传播的现象,因此应该提高医护人员消毒意识,加强耐药性监测及合理使用抗菌药物。     

耐亚胺培南鲍曼不动杆菌耐药性分析

目的了解64株临床分离的耐亚胺培南鲍曼不动杆菌对18种常用抗生素的耐药性。方法采用Micro Scanwalk Away-40微生物分析仪进行菌株鉴定和药敏试验,头孢哌酮/舒巴坦及米诺环素药敏试验采用K-B法。结果亚胺培南耐药的鲍曼不动杆菌对头孢哌酮/舒巴坦的耐药率最低为37.5%,其次为米诺环素54.7%,对头孢噻肟、头孢曲松、哌拉西林、哌拉西林/他唑巴坦的耐药率最高为100.0%,其余抗菌药物的耐药率均大于81.1%。结论亚胺培南耐药的鲍曼不动杆菌多重耐药严重,部分为泛耐药菌株,仅对头孢哌酮/舒巴坦较为敏感。     

耐亚胺培南鲍曼不动杆菌OXA-23基因检测及分析

目的了解临床分离的耐亚胺培南鲍曼不动杆菌OXA-23摹因的存在状况。方法收集我院临床分离的非重复耐亚胺培南鲍曼不动杆菌16株,采用纸片扩散法确定其耐药率,以PCR对亚胺培南耐药菌株进行OXA-23基因的检测并测序,序列与基因库比对。结果16株耐亚胺培南鲍曼不动杆菌中,OXA-23基因阳性11株,阳性率为68．8％。随机抽取2株OXA-23基因阳性株进行测序后,经网EGenBank比对,与OXA-23标准株100％同源。结论分离菌株主要来源于痰标本,耐亚胺培南鲍曼不动杆菌OXA-23雄因的携带率较高,分离菌株的耐药性可能与OXA-23型碳青霉烯酶基因有关。     

ICU肺炎患者中泛耐药鲍曼不动杆菌的感染危险因素及耐药性分析

目的：调查ICU肺炎患者中泛耐药鲍曼不动杆菌的感染危险因素,分析其耐药性情况。方法：2013年1月到2016年2月选择入住我院ICU病房后诊断为泛耐药鲍曼不动杆菌肺炎患者98例作为观察组,同期按照2:1的比例选择在我院ICU病房诊治的非泛耐药鲍曼不动杆菌肺炎患者49例作为对照组,两组都采集痰液标本进行耐药性分析,同时调查了泛耐药鲍曼不动杆菌感染的危险因素与预后情况。结果：观察组对于头孢噻肟、哌拉西林、亚胺培南、庆大霉素、左氧氟沙星、四环素、头孢他啶都高度耐药,仅对多粘菌素敏感。除哌拉西林、多粘菌素外,对照组对其他抗菌药物的耐药率均明显低于观察组(P<0.05)。单因素分析显示糖尿病、感染前住院时间、入院24h内APACHEⅡ评分、GCS评分、深静脉置管、机械通气等因素与 ICU 内泛耐药鲍曼不动杆菌性肺炎显著相关(P<0.05)。非条件 Logistic回归分析,结果显示糖尿病、感染前住院时间、入院24h内APACHEⅡ评分、GCS评分导致泛耐药鲍曼不动杆菌感染的独立危险因素(P<0.05)。结论：ICU肺炎患者中泛耐药鲍曼不动杆菌感染比较常见,糖尿病、感染前住院时间、入院24h内APACHEⅡ评分、GCS评分为主要的危险因素,其对于绝大多数抗菌药物有耐药性,可导致患者预后变差与随访死亡率增加。     

鲍曼不动杆菌所致感染的临床分析

目的了解鲍曼不动杆菌的临床分布情况及细菌对抗生素的耐药情况。方法分析126株鲍曼不动杆菌标本的来源、科室分布、抗生素耐药性。结果 95例鲍曼不动杆菌感染最常见的为呼吸系统疾病,标本以痰液为最多;耐药情况较重,耐药率最低的为多粘菌素B,其次为丁胺卡那及米诺环素,亚胺培南、美罗培南及头孢哌酮舒巴坦耐药率较高;患者全部有应用抗生素病史;多重耐药及泛耐药鲍曼不动杆菌共占菌株数的96.03%。结论加强对鲍曼不动杆菌耐药性的监控,减少耐药菌株的产生。     

住院患者呼吸道感染鲍曼不动杆菌耐药性变迁及机制探究

目的探究住院患者呼吸道感染鲍曼不动杆菌耐药性变迁及机制,指导临床抗感染防治及耐药性发展控制。方法收集本院524例呼吸道疾病住院患者资料,分离鲍曼不动杆菌,K-B法测定鲍曼不动杆菌耐药性,PCR法检测耐药基因,电镜观察鲍曼不动杆菌耐药株和敏感株形态。结果分离121株鲍曼不动杆菌,分离率23.09%,2015-2017年分别为32、51和38株。鲍曼不动杆菌对头孢吡肟、头孢噻肟、头孢他啶、阿米卡星、亚胺培南、左氧氟沙星、环丙沙星、庆大霉素、氨苄西林、氨曲南的耐药率分别为28.10%、30.58%、28.93%、8.26%、5.79%、25.62%、24.79%、25.62%、33.06%和22.31%。耐药基因OXA-23、OXA-58、TEM、PER、IMP分别检出12、9、8、5和8株。经电镜观察,分离菌敏感株单独分布,耐药株间形成了生物膜结构。结论鲍曼不动杆菌耐药可能与耐药基因传播及生物膜形成有关。     

老年鲍曼不动肺部感染患者的临床和耐药性分析

目的分析我院老年住院病人呼吸道分离鲍曼不动杆菌株对常用抗菌药的耐药率,指导临床用药。方法收集我院老年住院患者下呼吸道分离菌株,药敏试验采用K-B扩散法,同时对其临床资料进行分析。结果共分离出158株鲍曼不动杆菌,其中,美罗培南、亚胺培南、米诺环素、头孢哌酮/舒巴坦的敏感率较高。对头孢类、喹诺酮类及氨基糖苷类均有较高耐药性。结论加强细菌及耐药性检测,熟悉其耐药特征,控制老年患者的鲍曼不动杆菌的肺部感染具有重要的现实意义。     

Control of intraabdominal hemorrhage and shock: a comparison of fluid resuscitation, MAST, and balloon occlusion

Our study examined the efficacy of four treatment modalities in controlling hemorrhage and achieving hemodynamic stabilization in hemorrhagic shock: intravenous fluid replacement (IV); military antishock trousers used concomitantly with fluids (MAST); balloon occlusion at the level of the diaphragm with concomitant fluid replacement (balloon); and a combination of MAST inflation, balloon occlusion, and fluid resuscitation (MAST and balloon). Twenty-eight mongrel dogs were anesthetized, and the spleen was exposed and completely crushed. The abdomen was closed, and treatment was initiated and continued for four hours or until the dog died. For all conditions the hematocrit dropped during the course of the experiment; balloon occlusion was effective at slowing this drop (P less than .0001), but MAST had no statistically significant effect. Animals with balloons bled more slowly into the abdominal cavity than did animals in the other two groups (P less than .0001). MAST also were effective at slowing the bleeding (P less than .05). Of the balloon and the MAST and balloon dogs, all except one survived the entire four hours; this difference between balloon and nonballoon dogs is significant (P = .002). MAST did not have a statistically significant effect on survival. Perfusion pressure (PP) declined during the course of the experiment, and the balloon was effective at slowing this decline (P less than .0001); none of the other comparisons was statistically significant.     

A Call to Action to Enhance Filovirus Disease Outbreak Preparedness and Response

The frequency and magnitude of recognized and declared filovirus-disease outbreaks have increased in recent years, while pathogenic filoviruses are potentially ubiquitous throughout sub-Saharan Africa. Meanwhile, the efficiency and effectiveness of filovirus-disease outbreak preparedness and response efforts are currently limited by inherent challenges and persistent shortcomings. This paper delineates some of these challenges and shortcomings and provides a proposal for enhancing future filovirus-disease outbreak preparedness and response. The proposal serves as a call for prompt action by the organizations that comprise filovirus-disease outbreak response teams, namely, Ministries of Health of outbreak-prone countries, the World Health Organization, Médecins Sans Frontières, the Centers for Disease Control and Prevention—Atlanta, and others.     

Interplay between interferon-mediated innate immunity and porcine reproductive and respiratory syndrome virus

Innate immunity is the first line of defense against viral infection, and in turn, viruses have evolved to evade host immune surveillance. As a result, viruses may persist in host and develop chronic infections. Type I interferons (IFN-α/β) are among the most potent antiviral cytokines triggered by viral infections. Porcine reproductive and respiratory syndrome (PRRS) is a disease of pigs that is characterized by negligible induction of type I IFNs and viral persistence for an extended period. For IFN production, RIG-I/MDA5 and JAK-STAT pathways are two major signaling pathways, and recent studies indicate that PRRS virus is armed to modulate type I IFN responses during infection. This review describes the viral strategies for modulation of type I IFN responses. At least three non-structural proteins (Nsp1, Nsp2, and Nsp11) and a structural protein (N nucleocapsid protein) have been identified and characterized to play roles in the IFN suppression and NF-κB pathways. Nsp's are early proteins while N is a late protein, suggesting that additional signaling pathways may be involved in addition to the IFN pathway. The understanding of molecular bases for virus-mediated modulation of host innate immune signaling will help us design new generation vaccines and control PRRS.     

Disease Pandemics and Major Epidemics Arising From New Encounters between Indigenous Viruses and Introduced Crops

Virus disease pandemics and epidemics that occur in the world’s staple food crops pose a major threat to global food security, especially in developing countries with tropical or subtropical climates. Moreover, this threat is escalating rapidly due to increasing difficulties in controlling virus diseases as climate change accelerates and the need to feed the burgeoning global population escalates. One of the main causes of these pandemics and epidemics is the introduction to a new continent of food crops domesticated elsewhere, and their subsequent invasion by damaging virus diseases they never encountered before. This review focusses on providing historical and up-to-date information about pandemics and major epidemics initiated by spillover of indigenous viruses from infected alternative hosts into introduced crops. This spillover requires new encounters at the managed and natural vegetation interface. The principal virus disease pandemic examples described are two (cassava mosaic, cassava brown streak) that threaten food security in sub-Saharan Africa (SSA), and one (tomato yellow leaf curl) doing so globally. A further example describes a virus disease pandemic threatening a major plantation crop producing a vital food export for West Africa (cacao swollen shoot). Also described are two examples of major virus disease epidemics that threaten SSA’s food security (rice yellow mottle, groundnut rosette). In addition, brief accounts are provided of two major maize virus disease epidemics (maize streak in SSA, maize rough dwarf in Mediterranean and Middle Eastern regions), a major rice disease epidemic (rice hoja blanca in the Americas), and damaging tomato tospovirus and begomovirus disease epidemics of tomato that impair food security in different world regions. For each pandemic or major epidemic, the factors involved in driving its initial emergence, and its subsequent increase in importance and geographical distribution, are explained. Finally, clarification is provided over what needs to be done globally to achieve effective management of severe virus disease pandemics and epidemics initiated by spillover events.     

Barrett's Esophagus: Where Do We Stand?

Barrett''s esophagus (BE) is a precursor for esophageal adenocarcinoma, which has an increased incidence rate over the last few decades. Its importance stems from the poor five-year survival of esophageal adenocarcinoma and current data that suggest a survival benefit when surveillance programs are implemented. In this review, we will cover the pathophysiology and natural history of BE and the different endoscopic findings. The prevalence of BE in different geographic areas and the incidence of high-grade dysplasia and adenocarcinoma in this patient population is reviewed. Recent recommendation for screening and surveillance of BE has been covered in this review as well as the efficacy of nonconventional imaging modalities and endoscopic ablation therapies.     

The Technology Transfer from Europe to China in the 17th–18th Centuries: Non-Invasive On-Site XRF and Raman Analyses of Chinese Qing Dynasty Enameled Masterpieces Made Using European Ingredients/Recipes

Two masterpieces of the Qing Dynasty (1644–1912 CE), one in gilded brass (incense burner) decorated with cloisonné enamels stylistically attributed to the end of the Kangxi Emperor’s reign, the other in gold (ewer offered by Napoleon III to the Empress as a birthday present), decorated with both cloisonné and painted enamels bearing the mark of the Qianlong Emperor, were non-invasively studied by optical microscopy, Raman microspectroscopy and X-ray microfluorescence spectroscopy (point measurements and mapping) implemented on-site with mobile instruments. The elemental compositions of the metal substrates and enamels are compared. XRF point measurements and mappings support the identification of the coloring phases and elements obtained by Raman microspectroscopy. Attention was paid to the white (opacifier), blue, yellow, green, and red areas. The demonstration of arsenic-based phases (e.g., lead arsenate apatite) in the blue areas of the ewer, free of manganese, proves the use of cobalt imported from Europe. The high level of potassium confirms the use of smalt as the cobalt source. On the other hand, the significant manganese level indicates the use of Asian cobalt ores for the enamels of the incense burner. The very limited use of the lead pyrochlore pigment (European Naples yellow recipes) in the yellow and soft green cloisonné enamels of the Kangxi incense burner, as well as the use of traditional Chinese recipes for other colors (white, turquoise, dark green, red), reinforces the pioneering character of this object in technical terms at the 17th–18th century turn. The low level of lead in the cloisonné enamels of the incense burner may also be related to the use of European recipes. On the contrary, the Qianlong ewer displays all the enameling techniques imported from Europe to obtain a painted decoration of exceptional quality with the use of complex lead pyrochlore pigments, with or without addition of zinc, as well as cassiterite opacifier.     

Formoterol Delivered via the Dry Powder Aerolizer® Inhaler Versus Albuterol MDI and Placebo in Mild-to-Moderate Asthma: A Randomized, Double-Blind, Double-Dummy Trial

The objectives of this study were to compare the efficacy and tolerability of twice-daily formoterol dry powder 12 µg and 24 µg (Foradil) delivered via Aerolizer inhaler with four times daily albuterol (salbutamol) 180 µg delivered via metered dose inhaler (MDI) and placebo. A total of 554 adolescents and adults (ages 12-75 years) with mild-to-moderate asthma were randomized to this 12-week, multicenter, double-blind, double-dummy, placebo-controlled, parallel-group study. Twelve-hour spirometry measurements were taken at weeks 0, 4, 8, and 12. A total of 484 patients completed the study (122, 116, 127, and 119 given formoterol 12 µg, formoterol 24 µg, albuterol, and placebo, respectively). For the primary efficacy variable, the forced expiratory volume in 1 second (FEV₁), both formoterol 12 µg and 24 µg were statistically superior to placebo at all time points on all test days (p ≤ 0.017) and to albuterol at most time points on all test days (p ≤ 0.001). The onset of improvement in FEV₁ was rapid, with 15% increase within 5 min in 57%, 71%, and 65% of formoterol 12 µg, formoterol 24 µg, and albuterol patients, respectively. Formoterol was also superior to placebo and albuterol in terms of secondary efficacy variables: FEV₁ area under the curve, percentage of predicted FEV₁, forced vital capacity and forced expiratory flow, asthma symptom scores, and peak expiratory flows. In conclusion, both formoterol doses were superior to placebo in all lung function measurements. Overall, compared with albuterol, both formoterol doses produced superior bronchodilation. Formoterol and albuterol were safe and well-tolerated.