Factores clínicos asociados a enfermedad pulmonar por Aspergillus spp. en pacientes con enfermedad pulmonar obstructiva crónica

ObjectiveTo explore the clinical and epidemiological characteristics of chronic obstructive pulmonary disease (COPD) patients with Aspergillus spp. isolation from respiratory samples, and to identify which factors may help us to distinguish between colonisation and infection.MethodsA retrospective cohort study was performed. All patients with COPD and respiratory isolation of Aspergillus spp. over a 12-year period were included. Patients were assigned to 2 categories: colonisation and pulmonary aspergillosis (PA), which includes the different clinical forms of aspergillosis. A binary logistic regression model was performed to identify the predictive factors of PA.ResultsA total of 123 patients were included in the study: 48 (39.0%) with colonisation and 75 (61.0%) with PA: 68 with probable invasive pulmonary aspergillosis and 7 with chronic pulmonary aspergillosis. Spirometric stages of the GOLD classification were not correlated with a higher risk of PA. Four independent predictive factors of PA in COPD patients were identified: home oxygen therapy (OR: 4.39; 95% CI: 1.60-12.01; P = .004), bronchiectasis (OR: 3.61; 95% CI: 1.40-9.30; P = .008), hospital admission in the previous three months (OR: 3.12; 95% CI: 1.24-7.87; P = .016) and antifungal therapy against Candida spp. in the previous month (OR: 3.18; 95% CI: 1.16-8.73; P = .024).ConclusionsContinuous home oxygen therapy, bronchiectasis, hospital admission in the previous three months and administration of antifungal medication against Candida spp. in the previous month were associated with a higher risk of pulmonary aspergillosis in patients with COPD.     

白酒中敌敌畏的固相微萃取

用大口径毛细管柱气相色谱法、氢焰离子化检测器进行分析测定。该方法在０．５～１２ｍｇ／Ｌ浓度范围内有很好的线性关系。相关系数为０．９９８３；最低检测浓度可达０．０５ｍｇ／Ｌ。本方法把样品的萃取浓缩与进样分析一体化完成。整个分析过程不使用任何萃取溶剂     

空气中三氯苯胺的采集与分析方法的研究

空气中三氯苯胺用５０％乙醇吸收，经ＯＶ－１７和ＯＶ－２１０混合色谱柱分离，电子捕获检测器检测测定。对采样及测定条件，用正交试验进行了优选。方法的检出限为０．０１ｍｇ／Ｌ，当标准溶液浓度为０．５～１０ｍｇ／Ｌ时，相对标准偏差为４．３％～３．７％。线性范围为０．０２～４０ｍｇ／Ｌ。采样效率为９９．１％～１００％。样品在采样管中可稳定１５天以上。通过现场试验和验证试验，证明该方法准确可靠、快速简便，完全适用于空气中三氯苯胺的测定。各项试验指标符合劳动卫生监测要求。     

Nasopharyngeal carriage of Haemophilus influenzae

OBJECTIVE: Nasopharyngeal colonization of Haemophilus influenzae (H. influenzae) in young children may be important in developing countries. METHOD: In this study, we screened school going children for carriage of H. influenzae. A total of 44 H. influenzae isolates out of a collection of 162 were characterized for biotypes, capsular serotypes and antibiotic resistance. RESULTS: A significant proportion of H. influenzae (25/44) isolates were serotype b. High antibiotic resistance was observed against commonly administered antibiotics like ampicillin (79%), chloramphenicol (20%), trimethoprim sulfamethoxazole (84%) and erythromycin (95%). Comparison of antibiotic resistance profile of nasopharyngeal isolates was observed to be correlated with those of H. influenzae from disease. CONCLUSION: Multidrug resistant nasopharyngeal H. influenzae in young healthy children may act as reservoir. Monitoring of antibiotic resistance among nasopharyngeal H. influenzae as a surrogate for invasive H. influenzae seems an attractive option.     

Quinolones and colonization resistance in human volunteers

The suppression of alimentary canal flora by the three quinolones nalidixic acid, ciprofloxacin and pefloxacin was investigated in fifteen volunteers. They received the three quinolone compounds in tablet form both uncoated and colon-coated.Escherichia coli suppression was poor under nalidixic acid, but complete under ciprofloxacin and pefloxacin for both administration forms. The indigenous anaerobic flora contributing to the control of aerobicStreptococcus faecalis andCandida albicans in the intestines ('colonization resistance') was not affected by nalidixic acid and pefloxacin, and only slightly by ciprofloxacin. Out of the three quinolone compounds, only colon-coated pefloxacin was associated with a considerable absorption rate at colonie level. Using these criteria of successfulEscherichia coli clearing from the intestinal canal - left the indigenous flora more or less intact (in a 'selective' way) - and a good absorption rate, pefloxacin is found to be superior to ciprofloxacin and nalidixic acid. These results suggest that a colon-coated tablet with a low dose of pefloxacin is a promising administration form in the therapy of recurrent urinary tract infections and diarrhoeal diseases and in the prevention of gut colonization in immunocompromised hosts.     

<Emphasis Type="Italic">Pseudomonas aeruginosa</Emphasis> carriage,colonization, and infection in ICU patients

Objective We evaluated whether Pseudomonas aeruginosa associated nosocomial infections in our ICU originate mainly from patients' endogenous flora or from exogenous cross-transmission. Design and setting A 6-month prospective surveillance survey was performed according to standardized protocols at the interdisciplinary ICU of the Azienda Ospedaliera Cannizzaro. Patients The study analyzed 121 patients and focused on three different states: carriage upon admission, colonization of sterile sites, and infections during ICU stay. Results We identified 138 P. aeruginosa isolates from 45 patients. The cumulative incidence of P. aeruginosa sustained colonization in the ICU was 29.9/100 patients, and the incidence density was 16.2/1,000 patient-days. The cumulative incidence of P. aeruginosa-sustained infections in the ICU was 36.7/100 patients, and the incidence density was 19.9/1,000 patient-days. The most frequent infection type was ventilator-associated pneumonia. PFGE analysis of P. aeruginosa isolates led to the identification of a major clone represented by 60.8% of isolates involving 45.9% of patients. The impact of cross-transmission, i.e., the preventable proportion of P. aeruginosa acquisition, was estimated to be at least 59.5% of all colonization or infection episodes. Acquisition of multidrug-resistant P. aeruginosa was significantly associated with cross-transmission. Conclusions Our results suggest that the ICU personnel and environment served as reservoirs for cross-transmission and emphasize the importance of exogenous acquisition of multidrug-resistant P. aeruginosa, of reduction in antibiotic pressure, and prompt enforcement of infection control measures. This work was supported by grants to A. A. from the University of Catania, Italy.     

Risk factors for acquisition of Methicillin-resistant Staphylococcus aureus among patients from a burn unit in Brazil

Methicillin-resistant Staphylococcus aureus (MRSA) is an important agent of colonization and infection in burn units. In order to identify risk factors for MRSA acquisition in a Brazilian burn unit, we performed two retrospective studies. In the first (“cohort” study), 175 patients who were not colonized with MRSA on admission were followed to assess risk factors for MRSA acquisition. In the second (“case–case–control” study), 143 individuals from the previous study who were negative for both MRSA and Methicillin-susceptible S. aureus (MSSA) on admission were followed. Case–control studies were performed to investigate risk factors for MRSA and MSSA acquisition. MRSA and MSSA were recovered from 75 and 23 patients, respectively. In the “cohort” study, only the number of wound excisions (Odds Ratio [OR] = 1.55, 95% Confidence Interval [CI] = 1.21–1.98, P = 0.001) was associated with MRSA acquisition. In the “case–case–control” study, burns involving head (OR = 3.43, 95%CI = 1.50–7.81, P = 0.003) and the number of wound excisions (OR = 1.83, 95%CI = 1.27–2.63, P = 0.001) were significant risk factors for MRSA. Burns involving perineum were negatively associated with MSSA acquisition (OR = 0.16, 95%CI = 0.03–0.75, P = 0.02). In conclusion, the acquisition of MRSA was related to the site of the burn and to the surgical manipulation of tissues, but not to the use of antimicrobials.     

尿培养芳香黄杆菌11例分析

目的回顾性分析尿培养芳香黄杆菌阳性患者的临床特点及菌株耐药情况,帮助临床正确解读芳香黄杆菌尿培养结果。方法对2007年1月到2009年3月间住院患者尿培养标本及其分离出的细菌进行鉴定和耐药分析。用WHONET5.4软件进行统计学分析。结果共分离出芳香黄杆菌11株,培养阳性患者中留置尿管或造瘘管的患者占100%。结论芳香黄杆菌耐药率很高,尿培养芳香黄杆菌培养阳性的危险因素为留置导尿管或肾造瘘管,但芳香黄杆菌尿可能仅表示细菌的定植而无需治疗。     

Current problems in the diagnosis and treatment of hospital-acquired methicillin-resistant Staphylococcus aureus pneumonia

PURPOSE: We aimed evaluate clinical problems in the diagnosis and treatment of hospital-associated pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA-HAP) at a single institute. METHODS: Forty-two patients, diagnosed with MRSA-HAP by a primary physician, who had received antimicrobial therapy during a period of 18 consecutive months at University Hospital, Kyoto Prefectural University of Medicine, were enrolled in the study. For comparison, 36 patients in whom MRSA was recovered from the respiratory tract during the same period, but who were not treated for pneumonia, were chosen as untreated controls. A clinical pulmonary infection score (CPIS) was calculated retrospectively by a chart review. The CPIS was calculated on day 1 and day 3. In the treated group, serum concentrations of each therapeutic drug used were also evaluated. RESULTS: The day-1 and day-3 CPIS showed a similar trend in the two at groups, at 2.5 +/- 1.8 and 3.9 +/-1.9, respectively, in the treated group and 2.9 +/- 1.9 and 3.8 +/- 1.6 in the control group. Only two (5%) patients in the treated group showed a CPIS of more than 6 on day 1. Only five patients (12%) in the treated group were treated with antimicrobials at appropriate target therapeutic serum concentrations. The 30-day mortality in the treated group was significantly higher than that in the control group, even when we matched the baseline morbidity of patients using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. CONCLUSION: This study revealed the clinical problems in our setting, in that MRSA colonization in the respiratory tract was frequently treated as pneumonia, and antimicrobial dosage was frequently insufficient. Prudent differential diagnosis of and treatment for HAP due to MRSA infection should be considered.     

新生儿重症监护室金黄色葡萄球菌定植菌株的耐药性及生物膜形成能力研究

摘要：目的 研究北京儿童医院新生儿重症监护病房(NICU)患儿鼻前庭金黄色葡萄球菌(简称金葡菌)的定植情况及定植菌 株的药物敏感性、生物膜形成能力。方法 前瞻性收集2015年5月至2016年3月于北京儿童医院NICU住院患儿鼻前庭分离出的 金葡菌,前期已进行分子分型,本次实验利用E-test 法检测金葡菌对临床常用抗菌药物的药物敏感性,结晶紫染色实验检测定 植菌株的生物膜形成能力。结果 536例鼻拭子分离出96株金葡菌,定植率为17.9%。其中,耐甲氧西林金葡菌(MRSA) 28株, 甲氧西林敏感金葡菌(MSSA)有68株。MRSA菌株对青霉素、苯唑西林、头孢曲松、红霉素和夫西地酸耐药率分别为100%、 57.1%、78.6%、92.9%和3.6%。MSSA菌株对青霉素、头孢曲松、红霉素、庆大霉素的耐药率分别为82.4%、8.8%、47.1%和 16.2%。MRSA中有14.3%苯唑西林敏感甲氧西林耐药金葡菌(OS-MRSA)。定植菌株的生物膜阳性率91.7%,MRSA和MSSA在生 物膜形成能力方面没有显著差异,不同ST型菌株生物膜形成能力存在差异(P=0.0276),产膜菌株与非产膜菌株的药物敏感性无 明显差异。结论 定植的金葡菌常对青霉素、红霉素耐药,对其他临床常用抗菌药物敏感性较好,有一定比例OS-MRSA。定 植菌株生物膜阳性率高,不同分型菌株生物膜形成能力不同。