胎膜早破产妇胎膜细菌培养及药敏结果分析

目的:分析胎膜早破(PROM)产妇胎膜细菌培养及药敏结果,为围生期感染用药提供科学依据。方法:对2016年7月至12月在我院分娩的1041例PROM产妇胎膜标本进行细菌培养及药敏试验。结果:1041例PROM患者胎膜细菌培养中,369例(35.4%)培养阳性,革兰阴性菌占66.7%,革兰阳性菌占33.1%。足月PROM期待时间延长,培养阳性率无相应升高的趋势(P>0.05);未足月PROM(PPROM)期待时间延长,培养阳性率呈增高趋势(P<0.05)。产前未使用抗生素组培养菌株种类35种,多于产前使用抗生素组培养菌株种类17种。主要感染病菌为大肠埃希菌,占59.7%。大肠埃希菌对哌拉西林、氨苄西林、四环素耐药明显,耐药率均在45.0%以上,对其余抗菌药物的较敏感。大肠埃希菌产前使用抗生素组较未使用抗生素组药物耐药率升高(P<0.05)。革兰阳性球菌对呋喃妥因、替考拉宁、万古霉素、利奈唑胺耐药率为0。结论:胎膜早破产妇胎膜感染以革兰阴性杆菌为主,主要感染菌为大肠埃希菌。经验性预防使用抗生素可能会增加细菌耐药率,应根据病原学特征合理应用抗生素。     

女性泌尿系统细菌性感染的菌种构成与耐药性分析

目的 了解我国女性泌尿系统细菌性感染患者菌种分布及耐药性.方法 采用纸片法、稀释法或浓度梯度琼脂扩散试验(E试验)检测最小抑菌浓度,测定细菌对抗生素的敏感性,使用WHONET 5.4软件进行分析,对卫生部全国细菌耐药性监测网所属86家三级甲等医院于2006年6月1日至2007年5月31日分离的临床女性泌尿系统细菌性感染尿培养菌株进行分析.结果 共收集6071株病原菌,其中细菌5958株,分离量最多的依次为大肠埃希菌3529株(59.23%)、肠球菌属细菌938株(15.74%)和肺炎克雷伯菌394株(6.61%);大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶的发生率分别为35.7%和34.0%,两者对氟喹诺酮类药物的耐药率分别约为70%和40%.屎肠球菌对多数抗菌药物的耐药率高于粪肠球菌,粪肠球菌、屎肠球菌对万古霉素的耐药率分别为0.9%、3.8%,对替考拉宁的耐药率分别为2.7%、4.8%;表皮葡萄球菌导致的女性泌尿系统细菌性感染较金黄色葡萄球菌多,两者对头孢西丁的耐药率分别为79.1%和75.0%,未发现对糖肽类中介或耐药的金黄色葡萄球菌,表皮葡萄球菌对替考拉宁的中介率为4.9%.随着患者年龄的增长,致病菌对喹诺酮类药物的耐药率呈增加的趋势;重症监护室(ICU)的致病菌耐药率高于普通病房和门、急诊.结论 我国女性泌尿系统感染主要致病菌耐药现象严重,临床抗菌药物不合理应用需要加以纠正,参照细菌敏感性选择抗菌药物具有非常重要的意义.     

温州地区儿童血培养病原菌分布及耐药性调查

摘要：目的　了解儿童败血症病原菌分布和耐药情况，指导临床合理使用抗生素。方法　对2005年1月至2007年12月温州医学院育英儿童医院血培养阳性的检出菌和药敏结果进行回顾性调查。结果　11 122份儿童血培养标本中，分离出病原菌670株，其中革兰阳性（G+）菌500株，占74.6%；革兰阴性（G-）菌154株，占23.0%；真菌16株，占2.4%。G+菌以凝固酶阴性葡萄球菌为主，其次分别为粪肠球菌、金黄色葡萄球菌、屎肠球菌 、肺炎链球菌。G-菌检出率较高的分别是大肠埃希菌、肺炎克雷伯菌、沙门菌属、 嗜麦芽窄食单胞菌 。G+菌除屎肠球菌对左旋氧氟沙星的耐药率达60.0%外，其余细菌对万古霉素和左旋氧氟沙星的敏感性均较高。G-菌中大肠埃希菌和肺炎克雷伯菌的产ESBLs的百分率分别为39.0%和80.8%，敏感性较高的抗生素有丁胺卡那霉素、环丙沙星、亚胺培南以及哌拉西林/他唑巴坦,沙门菌属的细菌对常用抗生素的敏感性均较好。结论　儿童败血症感染的细菌以G+球菌为主，应合理使用抗生素，加强耐药性监测。     

2012年观澜街道儿童社区获得性肺炎955例细菌病原及耐药性分析

目的了解儿童社区获得性肺炎（CAP）细菌病原及耐药情况,为临床医师合理使用抗生素提供理论依据。方法对年龄大于28 d的住院患儿采集痰标本进行细菌培养和药敏试验,并对结果进行统计分析。结果送检痰标本955例,检出细菌178株（18．64％）,其中革兰阴性杆菌102株（57．30％）,且以肺炎克雷伯肺炎亚种为主,40株（22．47％）,其中大肠埃希菌多见于＜3个月小婴儿,主要的革兰阴性菌对常用的氨苄西林和氨苄西林/舒巴坦、磺胺耐药率高（＞50．00％）,对哌拉西林/他唑巴坦、丁胺卡拉霉素、亚胺培南、头孢吡肟、头孢他啶耐药率低（＜10％）。革兰阳性球菌76株（42．70％）,均为金黄色葡萄球菌和肺炎链球菌,前者多见于＜3个月小婴儿,后者多见于＞3个月婴儿,两者对青霉素耐药率均高（＞50％）,前者对红霉素耐药率为39．47％,后者对红霉素高度耐药,耐药率为100％,两者对万古霉素、利奈唑安、左氧氟沙星均敏感,耐药率为0％。结论 CAP患儿病原分布中革兰阴性杆菌和革兰阳性球菌感染概率基本相同,主要病原菌耐药情况存在一定变迁。     

儿童肠球菌耐药表型和耐药基因检测分析

摘要：目的　研究儿童粪肠球菌和屎肠球菌的耐药表型及多种耐药基因。方法　对2004年7月至2005年11月北京儿童医院门诊和住院患儿临床标本中分离的152株病原菌,采用琼脂稀释法测定肠球菌的最低抑菌浓度（MIC）,聚合酶链反应检测ermB、mefA、TetM、TEM、aac（6'）-aph（2″） 、ant（6）-I基因。结果　屎肠球菌对氨苄西林、阿莫西林/克拉维酸、环丙沙星的耐药率分别为96.8%、95.2%和84.1%,粪肠球菌对上述3种抗生素的耐药率分别为23.6%、18.0%和49.4%,屎肠球菌的耐药率明显高于粪肠球菌（P < 0.001）;肠球菌高水平庆大霉素耐药（HLGR）和高水平链霉素耐药（HLSR）检出率高,屎肠球菌中HLGR和HLSR的比例分别为84.1%和66.3%,分别高于粪肠球菌的68.3%和49.4%;粪肠球菌出现2株万古霉素MIC为8 mg/L,粪肠球菌和屎肠球菌对替可拉宁全部敏感。肠球菌中耐药基因检出率高,粪肠球菌中ermB、TetM、aac（6'）-aph（2″） 、ant（6）-I基因检出率分别为73.0%、64.1%、84.3%和64.9%,高于屎肠球菌的57.1%、59.5%、82.5%和58.7%;仅有1株屎肠球菌检测到mefA基因,屎肠球菌TEM基因检出率高于粪肠球菌。结论　儿童肠球菌的耐药状况十分严重,肠球菌对多种抗菌药物耐药率高,屎肠球菌耐药比粪肠球菌严重。     

新生儿细菌性肺炎的病原学研究

目的:探讨新生儿细菌性肺炎的常见致病菌及其药物敏感性。方法:回顾性分析自贡市妇幼保健院2007年10月至2010年9月收治的378例新生儿细菌性肺炎患儿的临床资料,对痰培养、细菌的药物敏感分析结果等资料进行统计分析。结果:378例新生儿细菌性肺炎患儿取标本416份检出病原菌325株,阳性率78%。革兰阴性菌(G-)256株,占78.77%,肺炎克雷伯菌、大肠埃希菌和铜绿假单胞菌是主要病原菌,对亚胺培南、丁胺卡那霉素、哌拉西林他唑巴坦敏感性较高;革兰阳性菌(G+)69株,占21.23%,其中主要是肺炎链球菌和表皮葡萄球菌,对万古霉素敏感。结论:新生儿细菌性肺炎致病菌中以G-菌为主,其中,以肺炎克雷伯菌和大肠埃希菌最常见;G+球菌主要是肺炎链球菌和表皮葡萄球菌;所有病原菌对多数抗菌药物耐药,但G-菌对亚胺培南、丁胺卡那霉素和哌拉西林他唑巴坦敏感,G+菌对万古霉素敏感。     

不孕妇女生殖道支原体感染情况及药敏分析

目的 了解不孕妇女解脲支原体、人型支原体感染状况及其药物敏感情况。方法 对146例不孕妇女进行解脲支原体、人型支原体培养及其药物敏感性试验。结果 不孕妇女解脲支原体阳性率33．56％、人型支原体阳性率18．49％。其对交沙霉素、多西环素、四环素敏感性强，敏感率分别为98．55％、95．65％、92．75％。结论 不孕妇女生殖道支原体感染率高，对多种抗生素耐药，临床有必要做支原体培养与药敏试验。     

母婴同室新生儿皮肤感染的病原菌检测及耐药性分析

目的 探讨母婴同室病房新生儿皮肤感染的病原菌及其耐药情况,为临床合理使用抗菌药物提供依据. 方法 对2009年1月至2010年12月北京市大兴区人民医院产科母婴同室病房206例发生皮肤感染的新生儿皮损分泌物进行细菌培养、鉴定,分析致病菌及其对抗生素的耐药性.采用卡方检验比较组间差异. 结果 研究期间共分娩新生儿9131例,均为母婴同室,发生皮肤感染206例,发生率2.3％.新生儿的皮肤感染类型有2种,其中新生儿脓疱疮192例(93.2％),脐炎14例(6.8％).在所有患儿中,共检出病原菌154株,其中革兰阳性球菌95株(61.7％),革兰阴性杆菌59株(38.3％).革兰阳性球菌以金黄色葡萄球菌最常见,占检出病原菌的29.2％(45/154),其次为表皮葡萄球菌、溶血葡萄球菌;头孢唑林、阿莫西林/克拉维酸及哌拉西林/他唑巴坦对葡萄球菌具有良好的抗菌活性,而青霉素、氨苄西林和红霉素等耐药率相当高.革兰阴性杆菌以阴沟肠杆菌最常见,占检出病原菌的12.3％(19/154),其次为大肠埃希菌、肺炎克雷伯菌.革兰阴性杆菌对青霉素类、氨基糖苷类、头孢菌素类抗生素耐药率较高,而对哌拉西林/他唑巴坦、氨苄西林/舒巴坦、碳青霉烯类和喹诺酮类敏感率高. 结论 母婴同室病房新生儿皮肤感染病原菌以革兰阳性球菌为主,金黄色葡萄球菌居于首位.检出细菌提示多重耐药现象严重,临床应及时根据药物敏感试验的结果调整抗生素.     

52例婴幼儿肺炎痰培养和药敏试验回顾性分析

目的了解婴幼儿肺炎病原菌的感染情况及对常用抗生素的敏感性。方法对52例婴幼儿肺炎痰培养阳性资料进行回顾性分析。结果 52例患儿检测出6种菌株,其中肺炎克雷伯菌、大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、阴沟肠杆菌、产气肠杆菌感染率分别为36.54%,34.62%,19.23%,5.77%,1.92%,1.92%;所检测出的主要致病菌对氨苄青霉素均耐药,对氨基糖苷类抗生素、喹诺酮及第三代、第四代头孢菌素保持较高的敏感性,其中革兰阴性菌对泰能的敏感率均达100%,金黄色葡萄球菌对万古霉素100%有效。结论婴幼儿肺炎病原菌已发生变迁,革兰阴性杆菌已成为主要病原菌,且大部分对第三代、第四代头孢抗生素敏感。     

妊娠期需氧菌性阴道炎的诊断与治疗

需氧菌性阴道炎（aerobic vaginitis,AV）是由于阴道内乳杆菌水平下降,需氧菌过度繁殖导致的阴道炎症。妊娠期AV常见致病菌为B族链球菌、大肠埃希菌、粪肠球菌和金黄色葡萄球菌,可引起早产、胎膜早破、绒毛膜羊膜炎、新生儿感染等不良母儿结局。有症状及无症状但既往有感染相关流产或者早产病史的高风险妊娠女性需进行AV筛查。妊娠期AV可依据临床特征结合湿片镜下AV评分法或革兰染色涂片结合临床特征的联合诊断标准进行诊断。妊娠期AV应在权衡治疗获益与潜在风险的情况下进行治疗,可采用妊娠期安全的抗菌药物,也可选用乳杆菌制剂和中成药等辅助治疗。     

用PowerBuilder建立新生儿感染病原菌及抗菌药物药敏变化动态监测系统

【摘要】目的建立动态实时监测系统，了解本地区新 生儿感染致病菌谱和抗菌药物耐药模式变迁情况，为长期跟踪动态监测和预测提供基础和平台。方法用PowerBuilder软件根据2247条原始数据 建立数据库，编写程序建立监测系统，并用该系统进行监测及预测分析。结果2000—2004年5年间，我院新生儿最常见的病原菌为肺炎克雷伯菌 (20.7%)、大肠埃希菌(18.0%)和凝固酶阴性葡萄球菌(16.2%)。机会致病菌的比例逐年增高。院内感染和院外感染致病菌谱差异越来越小 (P>0.05)。抗菌药物耐药越来越严重，尤其是头孢类抗生素。产超广谱β 内酰胺酶细菌(70.9%)和甲氧西林耐药葡萄球菌(58.0%)是最突出的 耐药问题。5年间大部分抗菌药物敏感率变化无显著性(P>0.05)，呈轻微下降趋势，但近两年部分抗菌药物敏感率轻微回升。监测抗菌药物敏感 率时序变化能被估计和预测，精确度较好(MAPE<50)。结论该监测系统能直观地从时间轴上监测新生儿细菌感染致病菌及抗菌药物敏感率的动态 变化趋势，较好预测该变化，通过以上信息能及时评价经验用药、对异常发现提出新的研究假设，初步成功建立监测系统。     

Prevalence of asymptomatic genital infection among pregnant women in Benin City,Nigeria

The prevalence of asymptomatic genital infection among pregnant women and their susceptibility to antibacterial agents was investigated to provide baseline data on common asymptomatic genital microorganisms and identify potentials for development of clinical disease among this cohort of patients. High vaginal swabs were obtained from five hundred consecutive and consenting pregnant women attending the antenatal clinic of the University of Benin Teaching Hospital (UBTH) and the Central Hospital, both in Benin City, Nigeria. A total of three hundred specimens showed significant microbial growth, giving a prevalence rate of 60% for asymptomatic genital infections. Candida albicans (65%), Staphylococcus aureus (51.8%) and Enterobacteriacae (E. coli and Klebsiella species) were predominantly isolated, followed by Trichomonas vaginalis and Neisseria gonorrhoea. Most of the bacterial isolates were susceptible to ciprofloxacin, ceftazidime, cotrimoxazole, norfloxacin and augmentin. All the isolates except Streptococcus faecalis were resistant to ampicillin. These results show a high rate of asymptomatic genital tract infections among pregnant women in Benin City, which have implications for adverse maternal and neonatal outcomes.     

Microbiology and management of polymicrobial female genital tract infections in adolescents

This review describes the microbiology and management of female genital tract infections in adolescents. These infections include vulvovaginitis, vulvovaginal pyogenic infections (abscesses of Bartholin's and Skene's glands, infected labial inclusion cysts, labial abscesses, furunculosis, and hidradenitis), endometritis, pyometritis, salpingitis, pelvic inflammatory disease, and tubo-ovarian and pelvic abscess. Anaerobes can be cultured in 50% to 90% of females with a variety of genital infections and are the exclusive isolates in 20% to 50%. Obligate anaerobes are particularly common in closed-space infections, such as tubo-ovarian and vulvovaginal abscesses. The most common anaerobes found in these infections are gram-negative bacilli (especially P. bivia and P. disiens) and anaerobic cocci. Anaerobes generally are not the only pathogens found, but are usually mixed with aerobes. The most common aerobic pathogens are members of the Enterobacteriaceae family, especially E. coli, and aerobic or microaerophilic streptococci. Sexually acquired infections include Neisseria gonorrhoeae, Gardnerella vaginalis, Trichomonas vaginalis, Chlamydia trachomatis, herpes simplex, and Condyloma accuminata. Treatment regimens must provide antimicrobial coverage for N gonorrhoeae, C trachomatis, anaerobes, streptococci, and gram-negative facultative bacteria.     

Trends and antimicrobial resistance of pathogens causing bloodstream infections among febrile neutropenic adults with hematological malignancy.

BACKGROUND AND PURPOSE: The microbiological spectrum in cancer patients with febrile neutropenia has changed over the past several decades in western countries. The growing incidence of antimicrobial resistance is an inevitable consequence of the widespread use of antibiotics in medical settings. The aim of this study was to clarify the trends and antimicrobial resistance among pathogens causing bloodstream infections in febrile neutropenic adults with hematological malignancies. METHODS: The characteristics of pathogens causing bloodstream infection isolated from patients with febrile neutropenia who were treated at National Taiwan University Hospital from 1996 to 2001 were reviewed. A total of 1174 pathogens were isolated from 3093 admissions to a hematological ward during this period. Among them, 738 isolates were recovered from patients with febrile neutropenia. RESULTS: The majority (93%) of these neutropenic febrile patients had underlying acute leukemia or lymphoma. Gram-negative bacteria accounted for 57% of isolated pathogens, followed by Gram-positive bacteria (32%), fungi (7%), and anaerobes (3%). In decreasing frequency, Escherichia coli (13%), Klebsiella pneumoniae (12%), Enterobacter cloacae (7%), Pseudomonas aeruginosa (6%), and Acinetobacter baumannii (5%) were the predominant Gram-negative bacteria, while coagulase-negative staphylococci (13%), viridans group streptococci (4%), and Staphylococcus aureus (4%) were the major Gram-positive pathogens. Two-thirds (20/30) of S. aureus isolates were resistant to oxacillin. No vancomycin-resistant enterococci were isolated. Resistance to cefotaxime was found in 63% of E. cloacae, 13% of K. pneumoniae and 10% of E. coli. Overall, 33% of E. coli and 13% of K. pneumoniae were resistant to ciprofloxacin. CONCLUSIONS: This study indicates that the microbiological spectrum of microorganisms causing bloodstream infections in neutropenic febrile patients with hematological malignancies at National Taiwan University Hospital is different from western countries in that Gram-negative bacteria remain the predominant pathogens. Antimicrobial resistance among these pathogens is high and E. coli and K. pneumoniae isolates with resistance to third-generation cephalosporins and ciprofloxacin are increasing.     

Antimicrobial susceptibility of Gram-negative uropathogens isolated from obstetric patients

OBJECTIVE: To evaluate the antimicrobial susceptibility of Gram-negative uropathogens isolated from pregnant women. METHODS: We performed a snapshot cohort study of women receiving care in the University of Florida prenatal clinics during March 2000. Subjects with asymptomatic bacteriuria or cystitis were identified and the antimicrobial susceptibility of each pathogen was recorded. Data were analyzed using chi-square, Fisher's exact test and ninety-five percent confidence intervals, as appropriate. RESULTS: Ninety-five positive cultures were identified. Isolates were more often susceptible to trimethoprim-sulfamethoxazole (TMP-SMX) (87%) and nitrofurantoin (89%) than to ampicillin (72%) (p < 0.03). Escherichia coli accounted for 71 (75%) cases and was more often susceptible to nitrofurantoin (100%) than to TMP-SMX (87%) (p < 0.01). Proteus isolates were all susceptible to TMP-SMX and resistant to nitrofurantoin (p < 0.01). CONCLUSIONS: Both TMP-SMX and nitrofurantoin are superior to ampicillin for empiric treatment of lower urinary tract infection in pregnant women. Nitrofurantoin is superior to TMP-SMX for treatment of infections caused by E. coli. For suspected or confirmed cases caused by Proteus organisms, TMP-SMX is the preferred agent.     

Virulence factors of Escherichia coli isolated from female reproductive tract infections and neonatal sepsis

OBJECTIVE: The presence of enterobacteria such as Escherichia coli in the vagina of normal women is not synonymous with infection. However, vaginal E. coli may also cause symptomatic infections. We examined bacterial virulence properties that may promote symptomatic female reproductive tract infections (RTI) and neonatal sepsis. METHODS: E. coli isolated as the causative agent from cases of vaginitis (n = 50), tubo-ovarian abscess (n = 45) and neonatal sepsis (n = 45) was examined for selected phenotypic and genetic virulence properties. Results were compared with the frequency of the same properties among fecal E. coli not associated with disease. RESULTS: A significantly greater proportion of infection E. coli exhibited D-mannose resistant hemagglutination compared with fecal E. coli (p < 0.01). This adherence phenotype was associated with the presence of P fimbriae (pap) genes which were also significantly more prevalent among isolates from all three infection sites (p < 0.01). The majority of pap+ isolates contained the papG3 allele (Class II) regardless of infection type. Increased frequency of Type IC genes among vaginitis and abscess isolates was also noted. No significant differences in frequency of other bacterial adherence genes, fim, sfa, uca (gaf or dra were observed. E. coli associated with vaginitis was significantly more likely to be hemolytic (Hly+) than were fecal isolates (p < 0.05). The Hly+ phenotype was also more prevalent among tubo-ovarian abscess and neonatal sepsis isolates (p < 0.08). CONCLUSIONS: E. coli isolated from female RTI and neonatal sepses possess unique properties that may enhance their virulence. These properties are similar to those associated with other E. coli extra-intestinal infections, indicating that strategies such as vaccination or bacterial interference that may be developed against urinary tract infections (UTI) and other E. coli extra-intestinal infections may also prevent selected female RTI.     

Evaluation of the Gram stain as a screening tool for maternal carriage of group B beta-hemolytic streptococci. The Vaginal Infections and Prematurity Study Group.

To determine the usefulness of the vaginal Gram stain as a screen for maternal group B streptococcal carriage, we compared the presence of gram-positive cocci on Gram stain with a cervicovaginal culture in 7755 women at 23-26 weeks' gestation and in 1452 women at delivery. Group B streptococci were isolated from 18.4% of women at 23-26 weeks and 14.9% of women at delivery. The sensitivity, specificity, positive predictive value, and negative predictive value of the Gram stain were 28, 69, 17, and 81%, respectively, in mid-gestation and 34, 72, 18, and 86%, respectively, at delivery. The presence of gram-positive cocci on Gram stain was strongly associated with the isolation of Gardnerella vaginalis and with the presence of bacterial vaginosis. We conclude that most gram-positive cocci seen on Gram stain are probably anaerobes or micrococci and that the vaginal Gram stain is neither sensitive nor specific enough to be of use as a tool in the diagnosis of maternal group B streptococcal carriage.     

小儿复杂上尿路感染的因素及致病菌分析

目的 了解小儿复杂上尿路感染的因素及致病菌的耐药现状。方法 1999年1月至2004年3月在复旦大学附属儿科医院住院治疗的复杂上尿路感染患儿178例，分析其尿培养阳性的因素、致病菌分布及其对抗生素的耐药性。结果 复杂上尿路感染患儿的年龄以≤1岁为主，占46.6%。致病因素中以膀胱输尿管反流为主，占61.8%,40例肾瘢痕患儿中有92.5%存在反流。复杂上尿路感染致病菌中以大肠埃希菌为主，占33%，但与单纯上尿路感染相比所占比例明显下降(P<0.001)；克雷白杆菌与绿脓假单孢菌感染所占比例明显高于单纯上尿路感染所占比例(分别P<0.01,P<0.05)。产超广谱β-内酰胺酶(ESBLs)菌株占革兰阴性杆菌的28%，以大肠埃希菌易产生ESBLs。革兰阴性杆菌对未加β-内酰胺酶抑制剂的青霉素类及第1、2、3代头孢菌素类抗生素耐药率均高，而ESBLs菌株交叉耐药情况更为严重。结论 复杂上尿路感染以婴儿期多见，膀胱输尿管反流是复杂上尿路感染及肾瘢痕的主要因素，大肠埃希菌仍是其主要致病菌，但克雷白杆菌、绿脓假单胞菌比例明显上升，致病菌耐药性高，产ESBLs菌株多重耐药严重。 Abstract Objective To investigate the factors and resistance of the pathogens of complicated upper urinary tract infection (UTI) in children.Methods Distribution and resistance of pathogens,complicated factors in 178 urinary culture positive UTI patients hospitalized from 1999 to 2004 were analyzed.Results Infants with complicated upper UTI accounted for 46.6%.Among the complicated factors,vesicoureteric reflux (VUR) accounted for 61.8%,and 37 of 40 children with venal scar had VUR.E.coli in the complicated upper UTI accounted for 33% of all the pathogens,which was significantly lower than in simple upper UTI (P<0.001)However,Klebsiella and Pseudomonas aeruginosa accounted for 15.8% and 8.1% respectively,which were significantly higher than in simple upper UTI (5.6% and 2.4% respectively,P<0.01 and 0.05 respectively).Nearly 28% of the Gram negative bacilli were the ESBLs producing strain,most of which were E.coli.Gram negative bacilli had a high resistance rate towards not only the penicillin uncombined with the beta lactamases inhibitors but also the first,second and third generations of cephalosporins.Furthermore,the multi cross resistance of the ESBLs strains was even more serious.Conclusion The complicated upper UTI is predominant in infants and VUR induces complicated upper UTI and renal scar.E.coli is still the major pathogen,while the proportion of Klebsiella,Pseudomonas aeruginosa are significantly increasing.The pathogens have high drug resistance and the ESBLs producing strains have serious multi resistance. Key wordsUpper urinary tract infectionPathogenResistance     

Anaerobic infections of the female genital tract.

Anaerobic bacterial organisms are a frequent cause of female genital tract infections. There has been a lack of appreciation of the significant role anaerobes play in obstetric and gynecologic infections. Utilization of newer appropriate anaerobic culture techniques has shown the importance of these organisms as pathogens in serious infections of the genital tract. Many species of anaerobic bacteria appear to be part of the normal microflora of the lower genital tract in female subjects. Similar organisms are frequently isolated from pelvic infections. Bacteroides, anaerobic cocci, and Clostridia are the most commonly isolated anaerobes associated with clinical infections. The clinician must recognize the presence of anaerobic infections, utilize proper anaerobic culture methods, and institute appropriate antibiotic and/or surgical therapy.     

宝鸡市区儿童下呼吸道感染细菌病原和药物敏感性的多中心研究

目的总结宝鸡市区小儿急性下呼吸道感染(ALRI)细菌病原谱的构成和细菌药敏情况。方法收集2010-08/2011-07宝鸡市三区五大医院儿科住院的急性下呼吸道感染患儿6234例的痰细菌培养鉴定和药物敏感试验结果进行汇总分析。结果 (1)6234例送检标本中,1827例份结果阳性,阳性率29.31%。共培养出致病菌1882株23种,检出前5位致病菌分别为大肠埃希菌(20.72%)、肺炎克雷伯菌(17.48%)、肺炎链球菌(16.84%)、铜绿假单胞菌(6.59%)、金黄色葡萄球菌(6.32%)。(2)宝鸡市区AL-RI致病菌66.05%是G-菌,其中绝大多数是肠杆菌科细菌占86.56%,且大肠埃希菌、肺炎克雷伯菌高居前2位占57.84%;而G+球菌共占29.05%;真菌位居第7位。(3)大肠埃希菌、肺炎克雷伯菌,对阿莫西林/克拉维酸、替卡西林/棒酸、头孢西丁、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦均高度敏感,可作为经验治疗首选的抗菌药物。所有G-杆菌对亚胺培南均无耐药。铜绿假单胞菌在本地区对头孢他啶高度敏感。肺炎链球菌对青霉素耐药率为70.57%,对一至四代头孢菌素、阿莫西林/克拉维酸等均高度敏感。本地区儿童下呼吸道痰葡萄球菌检出者,主要是金黄色葡萄球菌和凝固酶阴性葡萄球菌(CNS),对苯唑青霉素耐药率依次为92.69%、82.69%,在本地区链球菌属导致的儿童细菌性ALRI仅占到3.03%,对青霉素类抗生素高度敏感,仍是首选抗生素。(4)作为导致儿童ALRI占主要病原的肠杆菌科细菌耐药情况严重,条件致病菌、机会致病菌感染率有增高趋势。结论宝鸡市区儿童ALRI细菌病原谱复杂,有其明确的地域性和时代性特点。肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、肺炎链球菌这4类细菌是宝鸡市区0～14岁儿童各年龄组ALRI的常见致病菌;致病菌以革兰阴性肠杆菌为主,各年龄组又各有其特点;对抗菌药物敏感性也有明显的特点,耐药问题也很严峻。