多重耐药大肠埃希菌毒力基因研究

目的 探讨多重耐药大肠埃希菌中7种相关毒力基因存在情况.方法 用pcr方法检测多重耐药大肠埃希菌中7种毒力基因(papa、cnf1、cnf2、cfab、ipab、hofq和ompt),并研究pcr阳性基因在biocyc基因组数据库31株已完成全基因组测序的大肠埃希菌中的分布.结果 20株多重耐药大肠埃希菌中仅检测到hofq、ompt两种毒力基因,检出率分别为95.0％ (19/20)和55.0％( 11/20).biocyc基因组数据库的31株大肠埃希菌中,21株存在hofq基因,阳性率为67.7％;15株存在ompt基因,阳性率为48.4％.结论 多重耐药大肠埃希菌中毒力基因hofq和ompt的携带率较高. abstract： objective to investigate the distribution of virulence-related genes in multidrug resistant escherichia coli.methods seven virulence genes papa,cnf1,cnf2,cfab,ipab,hofq and ompt were detected by pcr in 20 strains of multidrug resistant escherichia coli clinically isolated,and the positive genes were further searched in 31 strains of escherichia coli in biocyc database whose genomies had been fully sequenced.results virulence genes hofq and ompt were detected in 20 strains of escherichia coli with a positive rate of 95.0％ (19/20) and 55.0％ ( 11/20),respectively.among 31 strains of escherichia coli in biocyc,21 (67.7％) were positive for hofq gene and 15 (48.4％) were positive for ompt gene.conclusion hofq and ompt genes are prevalent in multidrug resistant escherichia coli.     

大肠埃希菌耐药相关基因和可移动遗传元件指标与样本聚类分析

目的 调查多重耐药大肠埃希菌耐药相关基因与可移动遗传元件的相互关系,以及菌株间的亲缘性关系.方法 收集浙江省磐安县人民医院2009年6月-2010年6月临床分离的多重耐药大肠埃希菌共20株,采用聚合酶链反应(pcr)分析β-内酰胺类与氨基糖苷类耐药相关基因以及可移动遗传元件,并对检测结果作指标与样本聚类分析.结果 20株多重耐药大肠埃希菌共检出4种β-内酰胺类耐药相关基因,4种氨基糖苷类耐药相关基因,以及5种可移动遗传元件的遗传标记.指标聚类分析显示,耐药基因tem、ctx-m-1、aada5与可移动遗传元件traa、is26、isecpl相关联,耐药基因oxa-1、aac(6′)-Ⅰb、ant(3″)-Ⅰ、rmtb与可移动遗传元件trbc、is903相关联.样本聚类分析显示,本院20株耐药大肠埃希菌可分为两个群,并且两群菌株演化明显.结论 多重耐药大肠埃希菌耐药相关基因与可移动遗传元件有关,对菌株进行样本聚类分析可获得菌株亲缘性关系,对控制医院感染意义重大. abstract： objective to investigate the correlation between drug-resistant genes and mobile genetic elements in multi-drug resistant escherichia coli,and to explore phylogeny among the strains.methods totally 20 strains of multi-drug resistant escherichia coli were collected from pan' an hospital,zhejiang province during june 2009 and june 2010.beta-lactam-resistance genes,aminoglycoside-resistance genes,genetic markers of mobile genetic elements were analyzed by pcr.index and sample cluster analysis were performed on above results. results in 20 strains of escherichia coli,4 kinds of beta-lactamresistance genes,4 kinds of aminoglycoside-resistance genes,and 5 kinds of genetic markers of mobile genetic elements were detected.index cluster analysis showed that correlation existed between resistance genes tem,ctx-m-1,aada5 and mobile genetic elements traa,is26,isecpl; and correlation also existed between resistance genes oxa-1,aac(6′)-Ⅰ b,ant(3")-Ⅰ,rmtb and mobile genetic elements trbc,is903.sample cluster analysis showed that this group of escherichia coli could be divided into 2 groups which were genetically different.conclusions drug-resistant genes in multi-drug resistant escherichia coli are correlated with mobile genetic elements.sample cluster analysis can reveal phylogeny among the strains,which is important for hospital infection control.     

肠出血性大肠埃希菌致病机制及其感染的研究进展

大肠埃希菌是人和动物肠道正常菌群的主要成员,但其中有些带有致病基因的血清型会引起人类肠道感染、泌尿道感染,并可引发致死性并发症,如溶血性尿毒综合征(haemolytic uraemic syndrome,hus).根据其血清型别、毒力和临床症状可将致腹泻的大肠埃希菌分为肠毒素型( enterotoxigenic escherichia coli,etec)、肠致病型(enteropathogenic escherichia coli,epec)、肠侵袭型(enteroinvasive escherichia coli,eiec)、扩黏型(diffusely adherent escherichia coli,daec)、肠出血型(enterohemorrhagic escherichia coli,ehec)及肠凝聚型(enteroaggregative escherichia coli, eaggec)六类[1].ehec为致病性大肠埃希菌中最严重的一种,自1983年以来曾多次在世界各地区广泛流行,对人类健康构成极大威胁.     

支气管肺泡灌洗液312份细菌定量培养及药物敏感性分析

目的 分析支气管肺泡灌洗液(balf)细菌定量培养中病原菌的分布及其对常用抗菌药物的敏感情况.方法 将312份balf样本用10μl取菌环分别划线接种于巧克力平板、血平板及麦康凯平板进行定量培养,细菌菌落数大于104 cfu/ml为致病菌,用vitek 2-compact全自动微生物分析系统鉴定菌株,并用k-b法、etest法和稀释法进行药敏试验.结果 312份balf样本共分离出病原菌216株,检出率为69.2％.革兰阴性杆菌以铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌和大肠埃希菌为主,革兰阳性球菌以金黄色葡萄球菌、肺炎链球菌及表皮葡萄球菌为主.药敏试验结果显示,铜绿假单胞菌对氨曲南等耐药率较高,对哌拉西林/他唑巴坦、亚胺培南、头孢吡肟、左氧氟沙星、头孢他啶和阿米卡星的耐药率均在30％以下;金黄色葡萄球菌对红霉素、青霉素及克林霉素的敏感情况较差,而对呋喃妥因、万古霉素、喹奴普汀/达福普汀、替加环素和利奈唑烷均完全敏感.结论 balf培养阳性率较高,常见致病菌为铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、金黄色葡萄球菌和大肠埃希菌等,各病原菌对常用抗菌药物的耐药情况严重. abstract： objective to investigate the distribution and antibiotic susceptibilities of quantitatively cultivated bacteria from bronchoalveolar lavage fluid (balf) samples. methods totally 312 balf samples were streak inoculated to chocolate,blood and mac plates with 10 μl annulus,and the bacterial colony ＞ 104 cfu/ml was considered pathogenic bacteria. the identification of pathogenic bacteria was carried out with vitek 2-compact,and kirby-bauer disc agar diffusion method,etest and dilution method were used for antibiotics sensitivity test.results totally 216 (69.2％) strains of pathogenic bacteria were isolated.the major gram-negative strains were pseudomonas aeruginosa,acinetobacter baumannii,klebsiella pneumoniae and escherichia coli, and the major gram-positive strains were staphylococcus aureus,streptococcus pneumoniae and staphylococcus epidermidis.the resistance rate of pseudomonas aeruginosa to aztreonam was high,but lower than 30％ to piperacillin/tazobactam,imipenem,cefepime,ofloxacin,ceftazidime and amikacin.staphylococcus aureus was highly resistant to erythromycin,benzylpenicillin and clindamycin,but it was sensitive to furadantin,vancomycin,quinupristin/dalfoprisdn,tigecycline and linezolid.conclusion the positive rate of balf cultivation is high,and the main pathogenic bacteria pseudomonas aeruginosa, acinetobacter baumannii, klebsiella pneumoniae, staphylococcus aureus and escherichia coli are resistant to several commonly used antibiotics.     

泌尿系统感染主要病原菌分布及耐药性分析

目的 了解南京医科大学第一附属医院泌尿系统感染的主要病原菌分布及耐药情况.方法 收集2011年1月1日-12月31日南京医科大学第一附属医院泌尿系统感染患者的中段尿培养阳性菌株,采用api系统鉴定菌种,并用纸片扩散法进行药敏试验.结果 分离的1129株菌株中,革兰阴性菌667株,占59.1％;革兰阳性菌266株,占23.5％;假丝酵母菌属196株,占17.4％.革兰阴性菌中,大肠埃希菌、肺炎克雷伯菌及奇异变形杆菌对碳青霉烯类抗生素高度敏感;鲍曼不动杆菌与铜绿假单胞菌对头孢类及青霉素酶抑制剂等大部分抗菌药物的耐药率都在50％以上.革兰阳性球菌中粪肠球菌和鸟肠球菌对万古霉素和替考拉宁完全敏感,对利奈唑胺耐药率较低(＜10％).假丝酵母菌中的白假丝酵母菌和光滑假丝酵母菌主要对伏立康唑及氟康唑耐药率较高,为47.2％～60.0％,对两性霉素和制霉菌素全部敏感.结论 南京医科大学第一附属医院泌尿系统感染以革兰阴性菌为主,耐药形势严峻. abstract： objective to investigate the distribution and drug resistance of major pathogens for urinary tract infections in the first affiliated hospital of nanjing medical university.methods strains from midstream urine culture of patients with urinary tract infections were collected during january 1 and december 31,2011.all strains were identified by api system,and disk diffusion method was used for drug sensitivity test.results totally 1129 strains were isolated,in which 667 (59.1％ ) were gram-negative strains,266 (23.5％) were gram-positive strains,and 196 (17.4) were candida.among gram-negative strains,escherichia coli,klebsiella pneumoniae and proteus mirabilis were highly sensitive to carbapenem antibiotics; while acinetobacter baumannii and pseudomonas aeruginosa were highly resistant to most antibiotics including cephalosporins and penicillinase inhibitor,and the resistance rates were over 50％.among gram-positive strains,the major strains enterococcus avium and enterococcusfaecalis were completely sensitive to vancomycin and teicoplanin,and highly sensitive to linezolid (resistance rate below 10％ ).candida albicans and candida glabrata were highly resistant to voriconazole and fluconazole (with the resistance rates of 47.2％ - 60.0％ ), but were completely sensitive to amphotericin and nystatin.conclusion gram-negative strains account for most urinary tract infections in the first affiliated hospital of nanjing medical university with high drug resistance rates.     

婴幼儿眼部感染肺炎链球菌的群体结构研究

目的 研究婴幼儿眼部感染肺炎链球菌的群体结构,包括对抗菌药物的耐药性、耐药基因、血清型和分子分型.方法 用k-b法和etest检测39株肺炎链球菌对10种抗菌药物的耐药性,乳胶凝集试验检测血清型,pcr法检测大环内酯类药物耐药基因mefe和ermb,并选择20株菌株进行多位点序列(mlst)分型.结果 39株肺炎链球菌中,30株(76.9％)对3种或3种以上药物耐药,未检测到对万古霉素、青霉素和头孢噻肟耐药的菌株.33株检出ermb耐药基因,4株检出mefe基因.共检出12种血清型,主要为19型( 8/39)和14型(4/39),17株包含在pcv7疫苗内,疫苗覆盖率为43.6％.mlst分型发现国际耐药克隆taiwan19f-14和spain23f-1.结论婴幼儿眼部感染的肺炎链球菌包含国际流行耐药克隆,血清型和分子分型较为分散,克隆分布以散发为主,对眼部常用抗菌药物有较高的耐药性. abstract： objective to determine the population structure of streptococcus pncumoniae isolates collected from infants with eye infections,including drug resistance,resistance genes, serotypes and molecular types.methods the susceptibility of 39 isolates to 10 antibacterial agents was tested by k-b disk diffusion and etest.latex agglutination test was performed to determine the serotype of the strains,and pcr was carried out to detect macrolides resistance genes mefe and ermb.molecular types of the 20 strains were determined by multilocus sequence typing (mlst).results a total of 39 streptococcus pneumoniae isolates were obtained,in which 30 (76.9％) were resistant to 3 or more antibacterial agents,and no vancomycin,penicillin or cefotaxime resistant strain was found.ermb gene was found in 33 strains and mefe gene was found in 4 strains.twelve serotypes were found,and the most frequent serotypes were 19 (8/39) and 14 (4/39). seventeen strains (43.6％) were covered in pcv7 vaccine. the international clone taiwan19f-14 and spain23f-1 were found by mlst. conclusions streptococcus pneumoniae isolates from infants with eye infections include international resistance clones.the distribution of serotype and molecular type are dispersed, and the clones are sporadic. the isolates are highly resistant to commonly used antibacterial agents.     

老年患者大肠埃希菌菌株亲缘性分析

大肠埃希菌已成为医院感染的重要病原菌。尽管国内已有关于大肠埃希菌部分耐药基因的报道,但鲜见菌株亲缘性分析。笔者对20株老年患者大肠埃希菌分离株进行了29种耐药基因（TEM、SHV、     

男性泌尿系统感染产超广谱β-内酰胺酶和AmpC酶的大肠埃希菌基因分型研究

目的:了解本院男性泌尿系感染产超广谱β-内酰胺酶(ESBLs)和AmpC酶大肠埃希菌(E.coli)的基因型分布。方法:收集2004年1月~2005年6月本院临床分离的尿培养阳性大肠埃希菌共187株,用CLSI/NCCLS推荐的纸片扩散法(包括筛选和确认实验)进行耐药表型检测,三维酶试验检测ESBLs和AmpC酶,PCR扩增质粒型ESBLs和ampC基因,肉汤交配法检测质粒型ampC基因的接合传递性。结果:产ESBLs大肠埃希菌检出率为24.6%(46/187)。在三维试验中,46株均产分解头孢三嗪(CRO)的β-内酰胺酶,其中3株产ESBLs和AmpC两种酶,其余43株单产ESBLs酶。在PCR扩增试验中,44株扩增出ESBLs基因b laTEM、b laCTX-M、b laOXA3型中的1型或1型以上基因片段,未扩增出b laSHV型基因片段;3株扩增出质粒介导的ampC基因,2株为C IT型,1株为DHA型。携带质粒型ampC基因的菌株均将耐药性传递给受体菌。结论:南京地区男性泌尿系感染产ESBLs大肠埃希菌以CTX-M型为主;质粒介导AmpC酶已在大肠埃希菌中出现,其耐药性能够水平传播,给临床抗感染治疗带来严重威胁。     

耐药铜绿假单胞菌临床分离株发现aac(6')-Ⅰb-cr基因

目的 调查耐药铜绿假单胞菌中氨基糖苷类修饰酶基因(ame)和16s rrna甲基化酶基因的存在情况.方法 对分离自江苏省淮安市第一人民医院住院患者送检痰液和伤口分泌物样本的耐药铜绿假单胞菌共20株,采用聚合酶链反应(pcr)及序列分析研究8种氨基糖苷类修饰酶基因[aac(3)-Ⅰ、aac(3)-Ⅱ、aac(6')-Ⅰ b、aac(6')-Ⅱ、ant(2")-Ⅰ、ant(3")-Ⅰ ant(4')-Ⅰ、aph(3')-Ⅱb]和6种16s rrna甲基化酶基因(arma、rmta、rmtb、rmtc、rmtd、npma).结果 20株铜绿假单胞菌共检出4种ame基因:aac(6')-Ⅱ8株(40.0%)、ant2"-Ⅰ 8株(40.0%)、aac(3)-Ⅱ5株(25.0%)、aac(6')-Ⅰ b 2株(10.0%),以及1种16s rrna甲基化酶基因:rmtb 1株(5.0%),其余9种基因未检出.对2株aac(6')-Ⅰ b基因pcr阳性产物进行测序,证实有1株单独携带aac(6')-Ⅰ b经典型,1株单独携带aac(6')-Ⅰ b-cr双功能酶基因.结论 在耐药铜绿假单胞菌中存在aac(6')-Ⅰ b-cr型基因,且对氨基糖苷类和喹诺酮类药物均有修饰作用. abstract： objective to investigate the distribution of aminoglycoside modifying enzyme genes (ames) and 16s rrna methylase genes in drug-resistant strains of pseudomonas aeruginosa. methods twenty strains of drug-resistant pseudomonas aeruginosa were isolated from sputum and wound secretion samples collected from the first people's hospital of huai' an in jiangsu province. eight ames [aac(3)-Ⅰ , aac(3)-Ⅱ, aac(6')-Ⅰb,aac(6')-Ⅱ, ant{2")-Ⅰ ,ant(3")-Ⅰ , ant(4')-Ⅰ , aph(3')-Ⅱb] and 6 16s rrna methylase genes (arma, rmta, rmtb, rmtc, rmtd, npma) were analyzed by pcr and verified by dna sequencing. results out of 20 strains of pseudomonas aeruginosa, aac(6')-Ⅱ was positive in 8 strains (40.0% ) , ant2"- Ⅰ in 8 strains (40.0% ) , aac(3)-Ⅱ in 5 strains (25.0% ) , aac(6')- Ⅰ b in 2 strains (10.0% ) and rmtb in 1 strains (5.0% ) , respectively. the rest 9 genes were not detected. among 2 strains harboring aac(6')- Ⅰ b, dna sequencing confirmed that 1 was aac(6')- Ⅰ b (the clssical type) and another was aac(6')- Ⅰ b-cr. conclusion gene aac(6')- Ⅰ b-cr exists in drug-resistant pseudomonas aeruginosa, and it has modifying effect on both aminoglycosides and quinolones.     

肺炎克雷伯菌与植生克雷伯菌喹诺酮类耐药基因研究

目的 分析宁波大学医学院附属医院克雷伯菌属的耐药性及其对喹喏酮类药物的耐药机制.方法 收集2009年10月-2011年3月分离出的20株克雷伯菌属菌株,经鉴定确认18株为肺炎克雷伯菌,2株为植生克雷伯菌.采用k-b纸片扩散法检测其对药物的敏感性.pcr法检测染色体介导的gyra、parc基因和质粒介导的aac(6’)-Ⅰ b-cr、qnra、qnrb、qnrs、qepa基因,pcr阳性产物采用pcr直接全自动荧光法测序.结果 20株克雷伯菌属菌对β-内酰胺类、氨基糖苷类、喹诺酮类抗菌药物均表现为多重耐药性(耐药率均在80％以上),其中植生克雷伯菌对亚胺培南和美罗培南敏感.18株(90％)菌株存在gyra、parc基因突变;aac(6’)-Ⅰ b-cr阳性12株(60％),qnrb和qnrs阳性均为4株(20％).结论 本组20株克雷伯菌属菌对喹诺酮类药物耐药主要与gyra和parc基因突变相关. abstract： objective to investigate the multi-drug resistance of klebsiella strains and its mechanism.methods twenty strains of klebsiella were isolated from the affiliated hospital of medical college,ningbo university from october 2009 to march 2011,in which 18 isolates were klebsiella pneumonia and 2 were klebsiella planticola. drug sensitivity was determined by k-b tests. drug resistant genes gyra,parc (chromosome mediated) and aac( 6′)-i b-cr,qnra,qnrb,qnrs,qepa (plasmid mediated) were amplified by pcr and verified by direct automated fluorogenic sequencing. results resistance to β-1actams,aminoglycosides and quinolones was observed in 20 strains,and resistant rates were all above 80％.klebsiella planticola strains were sensitive to imipenem and meropenem.mutations of gyra and parc genes existed in 18 strains (90％),and the positive rates of aac (6') -i b-c r,qnrb and qnrs were 60％ (12/20),20％ (4/20) and 20％ (4/20),respectively.conclusion the mutations ofgyra and parc genes may be the main cause of the resistance to quinolones in these strains.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.