食品中检出致病性弧菌的耐药性分析

[目的]了解温州地区食品中致病性弧菌污染程度和耐药性,为控制致病性弧菌相关的食源性疾病和临床合理使用抗生素提供科学依据。[方法]药敏试验采用Kirby-Bauer纸片扩散法,结果判断按CLSI抗微生物药物敏感性试验执行标准。[结果]8种117株致病性弧菌对大多抗菌药物敏感,耐药率最高的是氨苄西林,为89.7%,利福平次之,为45.3%;多重耐药性菌株33株,占总菌株数的28.2%;各类致病性弧菌对被检测的抗菌药物在耐药程度上存在一定差异,以嗜水、非O1群霍乱弧菌及豚鼠3种致病性弧菌的耐药性较高。[结论]温州地区各类食品中携带致病性弧菌情况较为普遍,药敏试验证实8种致病性弧菌对抗菌药物的耐药现象较为普遍,应引起相关部门的重视。可选择氨基糖甙类、头孢菌素类和氟喹诺酮类等抗菌药物治疗致病性弧菌引起的食源性疾病。     

1例创伤弧菌创面感染后继发感染性休克的分析

目的归纳总结1例创伤弧菌创面感染后继发感染性休克的临床特征和诊治方法,为临床治疗创伤弧菌感染提供经验。方法回顾性分析于2016年9月-10月诊治的1例创伤弧菌创面感染后继发感染性休克的症状、体征、体温变化及实验室检查结果和诊治过程;采集该患者的静脉血和创面进行培养,VITEK 2 Compact对培养的细菌进行鉴定和药敏试验。结果创面培养和血培养的细菌均是创伤弧菌,根据药敏结果选择敏感抗菌药物加上外科手术治疗后患者体温、肝肾功能、降钙素原等指标恢复正常。结论创伤弧菌能穿过破损的皮肤感染人类,引起伤口感染和血流感染,早期的创面培养和血培养是必须的。尽早行外科手术加抗感染治疗是创伤弧菌感染后治疗的关键,防止继发感染性休克危及到患者生命。     

创伤病人感染病原菌及药物敏感性分析

为了解引起创伤感染的病原菌及其对常用抗菌药物的敏感性,以便有针对性地选用创伤治疗药物,对1988年12月至1995年10月从创伤患者分离细菌的分类及其药敏资料进行分析,报告如下:1 材料和方法 全部菌株均自创伤感染患者的创面分泌物、脓液、抽取液常规方法分离。药物敏感性试验用K—B     

烧伤合并海水浸泡动物感染细菌及药敏实验研究

目的探讨烧伤合并海水浸泡动物感染的细菌及对抗菌药物敏感性。方法制作兔烧伤动物感染实验模型。细菌鉴定用手工法和全自动微生物分析仪,药敏试验用K-B纸片琼脂扩散法。结果创面感染的细菌有大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌、鲍曼不动杆菌、溶藻弧菌、副溶血性弧菌、金黄色葡萄球菌和表皮葡萄球菌等,血液感染的细菌有大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌、副溶血性弧菌和金黄色葡萄球菌。革兰阴性菌药敏敏感率80%的有阿米卡星、奈替米星、头孢他啶、头孢噻肟、头孢哌酮、头孢吡肟、左氧氟沙星、头孢哌酮/舒巴坦和亚胺培南,革兰阳性球菌药敏敏感率80%的有左氧氟沙星、阿米卡星、奈替米星、替考拉宁和万古霉素。结论烧伤合并海水浸泡后可导致多种细菌感染,感染出现时间早、程度重,应尽早使用抗菌药物进行治疗。     

女性泌尿生殖道解脲脲支原体感染现状及耐药性调查

目的了解女性泌尿生殖道解脲脲支原体(Uu)感染状况及耐药性,为临床合理用药提供试验依据。方法对601例泌尿生殖道感染标本采用珠海迪尔生物有限公司生产的试剂盒进行支原体属培养和药敏试验。结果 Uu培养阳性率为31.1%,Uu对12种抗菌药物的药敏试验结果表明,Uu对氟喹诺酮类抗菌药物环丙沙星和氧氟沙星敏感率最低为9.1%、15.0%,对四环素、交沙霉素、多西环素、克拉霉素、米诺环素敏感率均>70.0%。结论 Uu对常用抗菌药物已产生了不同程度的耐药性,因此,将支原体属培养和药敏试验纳入常规检测项目,对临床医师正确诊断疾病和针对性抗感染治疗非常必要。     

儿童泌尿道感染病原菌分析及抗菌药物应用探讨

目的探讨小儿泌尿道感染常见病原菌变化以及抗菌药物的应用.方法对我院38例泌尿道感染患儿进行回顾性分析,用K-B法进行药敏分析,并按NCCLS标准判断细菌耐药性.结果病原菌以革兰阴性杆菌为多,大肠埃希菌占42.1%,革兰阳性球菌感染比例有上升趋势,占26.3%;细菌对常用抗菌药物产生多重耐药性,氨苄西林耐药性高,头孢哌酮/舒巴坦、阿米卡星、万古霉素、亚胺培南是目前最敏感抗菌药物.结论重视泌尿道感染病原菌耐药性检测,以药敏试验选用抗菌药物进行治疗十分重要.     

鲍氏不动杆菌感染的临床分布及耐药性分析

目的了解医院鲍氏不动杆菌感染的分布及药敏情况,为临床治疗提供依据。方法对医院2008年1月-2009年12月临床分离鲍氏不动杆菌标本来源、分布科室及药敏试验结果进行回顾性分析。结果共检出196株鲍氏不动杆菌,分离率居前3位的临床科室依次为ICU、神经内科、呼吸内科,分别占24.5%、18.4%、15.3%;痰标本鲍氏不动杆菌的检出率最高,达78.1%;对14种常用抗菌药物的耐药率除头孢哌酮/舒巴坦、亚胺培南、美罗培南和阿米卡星较低外,其余抗菌药物耐药率均>50.0%。结论鲍氏不动杆菌对头孢哌酮/舒巴坦、亚胺培南、美罗培南、阿米卡星较敏感,对其他抗菌药物耐药情况严重,临床上应根据其临床分布特点和药敏试验结果选用合理抗菌药物。     

非淋菌性泌尿生殖道炎患者支原体感染及耐药性分析

目的了解解脲脲支原体(Uu)和人支原体(Mh)的耐药情况,为临床治疗提供合理的抗菌药物。方法应用支原体培养、鉴定药敏试剂盒检测从患者中分离培养的支原体对12种抗菌药物的药敏情况,并对结果进行分析。结果735例患者中支原体阳性者411例,阳性率为55.92%,Uu、Mh及两者混合感染率分别为46.12%、1.77%和13.88%,单纯Uu感染显著高于Mh感染和混合感染(P0.05);药敏结果分析,对交沙霉素、米诺环素、多西环素敏感率高,而对红霉素、环丙沙星、罗红霉素、左氧氟沙星敏感率差。结论泌尿生殖系统支原体感染主要以Uu为主,应重视培养、鉴定及药敏结果,以合理选择敏感药物进行治疗。     

铜绿假单胞菌医院感染的调查与耐药性分析

目的探讨铜绿假单胞菌医院感染的分布情况及耐药性。方法收集2015年1月-2016年12月铜绿假单胞菌医院科室临床分离株170株,采用琼脂扩散法(K-B法)对170株铜绿假单胞菌进行药敏试验,分析铜绿假单胞菌的标本来源分布及对15种常用抗菌药物的药敏率,并探讨抗菌药物单独用药与联合用药对铜绿假单胞菌的治疗效果。结果铜绿假单胞菌标本来源主要为呼吸道标本,检出率为59.4%,其次为尿液,检出率为12.4%,且铜绿假单胞菌医院感染主要集中在ICU、神经外科、呼吸内科等科室;药物敏感试验显示铜绿假单胞菌对临床中常用的15种抗菌药物均有严重耐药性,其中对氨苄西林/舒巴坦的耐药率最高,达到74.7%,其次为头孢噻肟,耐药率为70.6%,对环丙沙星的耐药率最低,为18.8%;6组联合抗菌药物协同累加率为43.52%~88.47%,联合抗菌治疗效果最佳为头孢他啶与环丙沙星,达到92.9%,其次为环丙沙星与哌拉西林他唑巴坦钠的联合,达到78.8%,抗菌药物联合应用敏感率与单独用药敏感率呈现显著差异(P<0.05)。结论铜绿假单胞菌有较高的耐药性,应加强临床监测与控制,对铜绿假单胞菌给予抗菌药物联合给药,增强体外抗菌活性。     

临床分离肠球菌的耐药性监测与分析

目的监测临床分离的140株肠球菌对16种常用抗菌药物的敏感性,为临床治疗肠球菌感染提供依据. 方法采用琼脂稀释法测定各抗菌药物对肠球菌的MIC,计算MIC50、MIC90和敏感率,采用快速硝噻吩纸片显色法对140株肠球菌进行β-内酰胺酶测定.结果万古霉素、替考拉宁对粪肠球菌和屎肠球菌的敏感性最高,均为100%,粪肠球菌对氨苄西林/舒巴坦、亚胺培南和氨苄西林敏感率分别为91.9%、90.8%和90.8%;屎肠球菌对氨苄西林/舒巴坦、亚胺培南和氨苄西林分别为92.7%、82.9%和90.2%;粪肠球菌、屎肠球菌以及其他肠球菌对头孢吡肟的敏感率最低分别为14.9%、9.8%和0;青霉素和氨苄西林对粪肠球菌、屎肠球菌的药敏结果可推测对亚胺培南的敏感性. 结论万古霉素和替考拉宁仍是治疗肠球菌感染最有效的药物,临床应用亚胺培南前必须进行药物敏感试验.     

2018-2019年茂名市水产品中创伤弧菌的分子特征和耐药性分析

目的 对茂名地区2018-2019年水产品中分离的创伤弧菌进行毒力相关基因、耐药性分析和分子基因分型,初步建立该菌区域病原学特征数据库和耐药谱,为创伤弧菌的溯源和临床用药提供依据。方法 采用PCR技术进行毒力相关基因和生物型、血清分型的鉴定;脉冲场凝胶电泳技术（PFGE）和微量肉汤稀释法进行基因分子分型和药物敏感性（AMS）分析。结果 175份水产品分离出51株创伤弧菌,阳性率为29.14%。41株创伤弧菌毒力相关基因vcg C/E和16S rRNA A/B分型结果显示共有3种型别,分别为CB型、EA型、CAB型;生物分型全为BT1型。药敏结果显示该菌对头孢类抗生素出现较多耐药株。PFGE指纹图谱结果显示41株创伤弧菌有41种分子型别。结论 茂名市水产品中创伤弧菌污染较为严重。毒力基因型别以CB型为主;PFGE型别多,菌株存在遗传多样性。因此,需对茂名水产品中创伤弧菌的食品安全进行风险评估和耐药监测,预防食源性疾病的暴发。     

A case of fatal food-borne septicemia: can family physicians provide prevention?

BACKGROUND: Vibrio vulnificus, a common bacteria found in undercooked seafood and seawater, is the leading cause of food-borne death in Florida. Fatal cases of V vulnificus infection have also been reported in most states. METHODS: The literature was searched using the key words "Vibrio vulnificus," "septicemia," "wound infections," "seafood," "immunocompromise," and "patient education." A case of fatal V vulnificus septicemia is described. RESULTS AND CONCLUSIONS: V vulnificus, part of the natural flora of temperate coastal waters and one of the most abundant microorganisms found in seawater, has been isolated from waters off the Gulf, Pacific, and Atlantic coasts of the United States. Infections in noncoastal regions have been traced to consumption of seafood derived from Gulf Coast waters. Seawater exposure and consumption of inadequately cooked seafood are routes most commonly associated with V vulnificus infection. Exposure to V vulnificus is life-threatening for chronically ill or immunocompromised patients, who are most likely to develop fatal septicemia. Currently a combination of doxycycline and intravenous ceftazidime is recommended treatment. Mortality rates from V vulnificus continue to be high in immunocompromised patients. Family physicians can help prevent this outcome by counseling high-risk patients.     

汕头地区4例散发创伤弧菌感染的实验室诊断

目的了解汕头市某院创伤弧菌（VV）感染患者的病原微生物学特征及药物敏感性。方法回顾性分析汕头市某院2013年6月—2014年6月收治的4例VV感染患者，采集患者血标本进行培养，采集患者疱液或棉拭子采集伤口分泌物接种于血平板、麦康凯平板及TCBS平板，对分离的菌株进行鉴定和药敏试验。结果4例VV感染患者，其中死亡3例，治愈1例；分别因进食腌蟹、蒸扇贝或外伤后接触海产品，而引起原发性败血症及下肢感染。患者A、B疱液，患者C伤口分泌物，患者D血培养均分离出氧化酶阳性、TCBS平板上生长呈绿色的革兰阴性菌，均鉴定为VV。VV对头孢唑林耐药或中介，对头孢替坦均为中介，1株VV对头孢吡肟耐药。结论4例VV感染患者病死率高（3/4），疱液或伤口分泌物培养阳性率较血培养高；及时就诊、尽早开始抗菌药物治疗及积极清创有助于治疗该病。     

Efficiency of real-time polymerase chain reaction assay to detect Vibrio vulnificus in seawater

The growth of Vibrio vulnificus in an enriched culture of seawater during the summer in Japan was monitored by a plating technique used as the culture method and a real-time polymerase chain reaction (PCR) assay as the molecular method. V. vulnificus was detected by the real-time PCR assay in the samples of August and September but not by the culture method. Vibrio parahaemolyticus, however, was detected among all of the samples with both the culture method and real-time PCR assay. In the analysis of the bacterial populations in enrichment culture, it was demonstrated that the growth of V. vulnificus on agar media was inhibited by the rapid growth of V. parahaemolyticus after 4h of incubation and the 100 times larger initial populations of bacteria other than V. vulnificus and V. parahaemolyticus. These findings demonstrate that V. vulnificus detection by culture methods is a failure, and molecular methods are effective and detect V. vulnificus accurately.     

2009年新乡地区临床分离菌耐药性监测

目的调查新乡地区医院临床分离菌的耐药现状,指导临床合理使用抗菌药物。方法收集新乡地区5所医院临床分离菌药物敏感性结果,用WHONET 5.4统计软件对数据进行处理分析。结果 2009年新乡地区5所医院临床分离菌共计6281株,耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌分别占69.6%和81.7%,粪肠球菌和屎肠球菌对高浓度庆大霉素耐药者分别占70.5%和77.9%;肠杆菌科中大肠埃希菌和肺炎克雷伯菌ESBLs阳性率分别为46.2%和31.0%;肠杆菌科对亚胺培南、美罗培南的耐药率为5.4%和8.3%;铜绿假单胞菌对亚胺培南、美罗培南的耐药率为33.1%、18.6%,鲍氏不动杆菌对其耐药率已上升至49.1%和38.0%,铜绿假单胞菌、鲍氏不动杆菌中泛耐药株检出率依次为1.2%和1.8%,多黏菌素对泛耐药株呈现良好抗菌活性。结论细菌耐药有一定地域性,加强临床分离菌耐药监测,对指导临床合理使用抗菌药物,控制地区多药耐药菌及泛耐药菌的传播与暴发流行有重要意义。     

The evolution of genetic structure in the marine pathogen, Vibrio vulnificus

Multi-locus sequence types (MLST) from a global collection of Vibrio vulnificus isolates were analysed for the contribution of recombination to the evolution of two divergent clusters of strains and a human-pathogenic hybrid genotype, which caused a disease outbreak in Israel. Recombination contributes more substantially than mutation to generating strain diversity. For allelic diversity within loci, the ratio of recombination to mutation events is approximately 2:1. The role of recombination relative to mutation in the generation of new MLST variants of V. vulnificus within the clusters is comparable to that of other highly recombining bacteria such as Neisseria meningitidis. However, across the divide between the two major clusters of V. vulnificus strains, there is substantial linkage disequilibrium, lower estimates for recombination rates and shorter estimates of recombination tract length. We account for these differences between V. vulnificus and N. meningitidis by attributing them to the presence of the unusual genetic structure within V. vulnificus. The reason for the presence of distinct and divergent genomes remains unresolved. Two possible explanations put forward for future study are first, ecologically based population structure within V. vulnificus and second, a recombination donor from a phenotypically differentiated species.     

2010—2012年梧州市区食品中食源性致病菌监测情况

目的了解梧州市食品中食源性致病菌污染状况,为制定相应的防控措施提供科学依据。方法根据广西的监测方案,选择梧州市区大型超市、零售店、餐饮店、农贸市场作为采样点。按照《食源性致病菌监测工作手册》进行检验。结果共监测11类581份食品,检出8种105株食源性致病菌,检出率为18.07%,分别为沙门菌、金黄色葡萄球菌、单核细胞增生李斯特菌、副溶血性弧菌、创伤弧菌、腊样芽孢杆菌、阪崎肠杆菌、大肠杆菌O157。致病菌检出率最高是大肠杆菌O157,为32.00%;其次是副溶血性弧菌、蜡样芽孢杆菌、创伤弧菌、金黄色葡萄球菌,检出率分别为26.92%、23.13%、18.18%、5.32%。结论梧州市区食品中食源性致病菌污染较严重,相应的监管部门应加强对食品的监督管理。     

2010年舟山市市售海虾中创伤弧菌的定量检测及其基因分型

目的:为了解舟山市海虾中创伤弧菌(Vibrio vulnificus,VV)污染状况及其致病基因型别。方法:从舟山市区三大菜场采集市售海虾114份进行VV定性、定量分析及其致病基因检测。结果:114份样品检出23份VV,检出阳性率为20.18%。不同月份检出率有统计学意义(χ2=32.92,P<0.05),8月份检出率最高为56.7%。17株VV菌株为溶血素A基因(vvhA)核酸阳性,vcgC/E和16S rRNA A/B分型结果显示,CAB型8株,CB型5株,CA型4株。结论:舟山市售海虾中VV污染状况夏季较为严重,基因型呈多样性,检出临床分离的主要基因型CB型5株。应对海虾中VV引起食源性感染的潜在风险进行评估,预防VV食源性疾病暴发的发生。     

Vibrio vulnificus infection reporting on death certificates: the invisible impact of an often fatal infection.

This study assessed accuracy of (a) recording Vibrio vulnificus infection on death certificates and (b) International Classification of Disease (ICD)-9 codes for V. vulnificus. Patients with microbiologically confirmed V. vulnificus infection were identified as part of co-ordinated surveillance in four USA Gulf Coast states between 1989 and 1993. Of 60 deaths, 51 death certificates were reviewed and V. vulnificus was recorded as the immediate cause of death on 11 (22%). There was no ICD-9 code for V. vulnificus infection, thus no patients had an ICD-9 code indicating V. vulnificus infection. Of 23 certificates where V. vulnificus was recorded on the death certificate, only 5 (22%) were coded for Gram-negative, septicaemia. This study highlights the importance of teaching physicians how to provide epidemiologically meaningful data on death certificates and the need for accurate ICD mortality codes.     

2010—2011年北京市大兴区感染性腹泻监测

目的探讨北京市大兴区腹泻病例中肠道致病菌感染状况,分析其流行病学特征,为预防控制及临床治疗提供科学依据。方法采集监测点医院就诊的腹泻病例粪便标本,进行9种肠道致病菌的检测并对检出的志贺菌进行的药敏试验。结果2年共采集样本760份,检出肠道致病菌167株,阳性率为21．97％,检出以志贺菌为主,其次为沙门菌、副溶血性弧菌。志贺菌对部分药物耐药性加强,对三代喹诺酮类药物保持敏感,但有所下降。结论近2年肠道致病菌阳性率上升,志贺菌菌型发生变化,目前以D群为主。夏季副溶血性弧菌感染增多,志贺菌对抗生素的耐药性发生一定程度改变,敏感性呈现整体下滑的趋势。