成人肾小管性骨软化症13例临床分析

13例成人肾小管性骨软化症计有杭维生素D佝偻病5例和肾小管性酸中毒骨软化8例。13例中8例(61.5％)误诊,诊断为风湿性或类风湿关节炎4例,原发性醛固酮增多症、肾性骨营养不良、原发性甲状旁腺机能亢进及维生素D缺乏各1例。应对本病有明确认识和各种完善的检查才能避免误诊。     

Clinical index to predict bacteraemia caused by staphylococci

Abstract. Objectives. To define risk factors associated with bacteraemia caused by Staphylococcus aureus or coagulase-negative staphylococci; and to use them to define patients in need of empiric anti-staphylococcal antibiotic treatment. Design, Derivation set: observational, prospective study; validation set: retrospective analysis of a prospectively collected database. Setting. Derivation set: Beilinson Medical Centre, Petah Tiqva, Israel—a 900-bed university hospital. Validation set: St Thomas's Hospital, London, UK—an 800-bed teaching hospital. Subjects. All episodes of bacteraemia detected at Beilinson Medical Centre between March 1988 and September 1990 (derivation set, n = 1410), and at St Thomas's Hospital during 1987–1990 (validation set, n = 1040). Interventions. None. Main outcome measures. Percentage of staphylococcal bacteraemia in groups of patients defined by the models. Results. The following factors were associated with Staphylococcus aureus bacteraemia: focus of infection (whether high or low risk), haemodialysis, intravenous drug abuse and infection acquired in the orthopaedic ward. A logistic model was used to divide the derivation set into three groups with percentages of Staphylococcus aureus bacteraemia of 1.8%, 13.2% and 33.7% (P < 0.0001); and the validation group 2.5%, 18.2% and 53.2% (P < 0.0001). Factors associated with coagulase-negative staphylococcal bacteraemia were: central or peripheral intravenous catheter as the focus of infection, a preterm neonate, the presence of a central intravenous catheter, low temperature, and a low white blood cell count. A second model including those factors was used to divide the derivation set into three groups with percentages of coagulase-negative staphylococcal bacteraemia of 1.9%, 22.8%, and 43% (P < 0.0001). In the validation set, the percentages were 2.9%, 22.4% and 31.0% (P < 0.001). Conclusions. The present study defines groups at high risk for staphylococcal bloodstream infection, in which empiric treatment should include an anti-staphylococcal drug.     

Macrolide–lincosamide–streptogramin B resistance phenotypes and genotypes among Staphylococcus aureus clinical isolates in Japan

In total, 269 methicillin-resistant Staphylococcus aureus (MRSA) and 434 methicillin-susceptible S. aureus (MSSA) isolates were investigated to determine their macrolide-lincosamide-streptogramin B (MLS(B)) resistance phenotypes and genotypes. The constitutive phenotype (61.3% in MRSA, 1.3% in MSSA) and erm(A) gene predominated among the 261 erythromycin-resistant MRSA isolates, while the inducible phenotype (38.7% in MRSA, 94.0% in MSSA) and erm(C) gene were more prevalent among the 150 erythromycin-resistant MSSA isolates. There was a higher incidence of the MLS(B) inducible phenotype compared with other countries, perhaps because MLS(B) antibiotics are not recommended as first-line agents against S. aureus in Japan.     

纳米抗菌剂抑菌杀菌性能研究

目的：检测纳米抗菌剂对标准菌株的杀菌、抑菌性能和高温对其抑菌效果的影响。方法：目标菌为大肠杆菌、金黄色葡萄球菌和白色念珠菌，通过悬液定量杀灭试验和抑菌环试验检测纳米抗菌剂的杀菌、抑菌能力。结果：水溶性纳米抗菌膜溶于5ml灭菌水中作用l0min可杀灭95．39％的金黄色葡萄球菌和93．28％的白色念珠菌，复合了纳米银的抗菌医用棉条、烧烫伤贴、创伤贴对大肠杆菌和金黄色葡萄球菌的抑菌环直径大于l0mm，对白色念珠菌的抑菌环直径大于7mm。结论：纳米抗菌剂对细菌繁殖体和白色念珠菌具有良好的抑菌、杀菌作用，高压灭菌处理对纳米银抗菌剂抑菌效果影响不大，但织物构造对其抑菌效果有影响。     

金黄色葡萄球菌儿童株耐药性分析

目的 了解儿童中金黄色葡萄球菌所致疾病的分布及其对常用抗生素的敏感情况。方法 收集连续12个月的临床致病株，根据菌落形态、革兰染色特点和乳胶凝集实验对金黄色葡萄球菌进行初步筛选，用细菌自动鉴定系统Vitek GPI卡和GPS-101卡进行菌株鉴定和药敏试验。结果 分离到金黄色葡萄球菌145株，其中来自呼吸道感染患儿痰或咽拭子培养109株，占75．17％，来自血培养16株，占11．03％，来自脓液、阴道分泌物培养分别占6．21％和5．51％。药敏试验显示92．4l％的菌株产生β-内酰胺酶，96．55％的菌株对青霉素耐药，但耐苯唑西林的仅占6．21％。99．31％和100％的菌株分别对利福平和万古霉素敏感，对环丙沙星、阿莫西林／棒酸、头孢唑林、复方新诺明、庆大霉素和林可霉素的敏感率分别为95．86％、93．10％、92．41％、86．21％、84．83％和80．69％，37．93％的菌株对红霉素耐药。结论金黄色葡萄球菌常引起儿童呼吸道感染，对苯唑西林的耐药率低．该药仍是治疗小儿会黄色葡萄球菌感染的有效药物。     

医院内携带的葡萄球菌对8种抗生素的敏感度

测定216株葡萄球菌(126株金葡菌,90株凝固酶阴性葡萄球菌)对8种临床常用抗生素药敏。结果为:医院内携带的金葡菌对青霉素G、红霉素、林可霉素耐药率分别为76.42%、61.36%、27.26%,对头孢噻啶、利福霉素敏感性较好。医院内表葡菌对青霉素G、红霉素、林可霉素耐药率分别达65.29%、58.82%、50%。故治疗医院内金葡菌、表葡菌感染时要选用有效药物。医院内携带的金葡菌产酶率81.40%,CNS产酶率71.11%,绝大多数产酶株对青霉素G耐药,头孢噻啶对产酶株有良好的抗菌活性。     

Characterisation of non-multiresistant methicillin-resistant Staphylococcus aureus (including EMRSA-15) in Kuwait Hospitals

This study characterised non-multiresistant methicillin-resistant Staphylococcus aureus (nmMRSA) isolates from Kuwait hospitals to ascertain whether they were community-acquired MRSA (CA-MRSA). Forty-two nmMRSA isolates obtained between July 2001 and October 2003 were analysed by staphylococcal cassette chromosome mec (SCCmec) typing, bacteriophage typing, production of Panton-Valentine leukocidin (PVL), urease and staphylococcal enterotoxins A, B, C and D, TSST-1, and by pulsed-field gel electrophoresis (PFGE). Forty-one isolates were SCCmec type IV, and one isolate was SCCmec type III. The isolates belonged to six PFGE patterns, with two types, A and D, distributed in six and four hospitals, respectively. Most (n = 26; 61.9%) isolates produced urease. These isolates were mainly from wound and skin infections, showed low-level methicillin resistance (MIC 8-48 mg/L), and nine carried genes for PVL. These characteristics, together with their carriage of the type-IV SCCmec, identified the isolates as CA-MRSA. Ten of the 16 urease-negative isolates produced staphylococal enterotoxin C; 12 reacted weakly with phage 75, and were resistant to clindamycin and/or erythromycin, which are characteristics of EMRSA-15. Thus, this study identified the co-existence of two types of nmMRSA, i.e., CA-MRSA and EMRSA-15, in Kuwait hospitals.     

Antibiotic resistance in Staphylococcus aureus colonising the intestines of Swedish infants

Staphylococcus aureus has become a frequent coloniser of the intestinal tract of infants, but the health effects of such colonisation are not clear. In this study, the antibiotic resistance patterns of 116 S. aureus strains from the commensal intestinal microflora were determined. The strains were obtained from 81 Swedish infants who had been followed with regular stool samples and registration of antibiotic usage during their first year of life. The faecal population levels of the individual strains and the duration of their persistence in the microflora had been determined previously. The prevalence of antibiotic resistance among the 116 strains was modest: methicillin, 0%; penicillin G, 78%; erythromycin A, 3%; tetracycline, 2%; clindamycin, 0.9%; and fusidic acid, 0.9%. Colonisation by antibiotic-resistant strains was unrelated to antibiotic consumption by individual infants. Antibiotic-resistant strains were as capable of persisting in the intestinal microflora and reaching high faecal population levels as fully susceptible strains. No strain lost or acquired resistance during the colonisation period. Thus, antibiotic-resistant strains of S. aureus seem to be as fit for competition in the large bowel microflora as susceptible strains, even in the absence of selective pressure from antibiotics. This may aggravate the ecological consequences of antibiotic resistance development.     

金黄色葡萄球菌 eap 基因的克隆与表达

 目的 构建携带 eap 基因的原核表达载体，诱导表达具有活性的重组 EAP 融合蛋白。 方法 PCR 法扩增金黄色葡萄球菌基因组 DNA，回收、 纯化的扩增产物与 pMD18-T 载体相连接得重组质粒 pMD18-T-EAP，转化 E.coli BL21（DE3）感受态细胞，酶切鉴定；未酶切组作为对照组重组质粒 pMD18-T-EAP 和 pET28a（+）表达载体分别用 Nde I 和 Xho I 限制性内切酶双酶切、连接，转化 E.coli BL21（DE3）感受态细胞，酶切鉴定；空载体作为对照组。用不同浓度（终浓度 1、2、4、8 mmol/L）和不同诱导时间（1、2、3、4、5、6 h）的异丙基-β-D-硫代半乳糖苷（IPTG）对阳性重组菌进行表达优化，分别取 E.coli上清液和沉淀做电泳分析。应用 MagneHis^TM 蛋白纯化系统纯化重组 EAP 融合蛋白，并通过薄层扫描测定蛋白质的浓度。 结果 所获 eap 基因与 GeneBank 的基因序列同源性 > 99%；氨基酸同源性达 100%。重组质粒经 IPTG 诱导，阳性重组菌转化子均有表达；当吸光度（A ）值等于 0.6 ~ 0.8 时，相对分子质量约 70 000 处出现目的蛋白条带。破碎的重组菌 pET28a-EAP上清液中目的蛋白条带较清楚，沉淀中几乎看不到。终浓度 1 mmol/L 为最佳蛋白表达工作浓度。IPTG 诱导 1 h 重组 EAP 融合蛋白有一定量的表达，随着时间的延长，表达量增加不明显，3 h 时的表达量达最高，之后，蛋白表达量变化不明显。表达的重组 EAP 融合蛋白含量占全菌体蛋白的 29.6%。 结论 成功地克隆和表达了金黄色葡萄球菌重组 EAP 融合蛋白，为进一步研究以 EAP 蛋白作为免疫原预防和治疗由金黄色葡萄球菌引起的疾病奠定基础。