耐氨苄西林/舒巴坦鲍曼不动杆菌菌血症的危险因素及预后分析#br#

目的 探讨耐氨苄西林/舒巴坦鲍曼不动杆菌菌血症的危险因素及预后。方法 回顾分析2016年1月-2017年12月华西医院114例鲍曼不动杆菌菌血症患者的临床资料。结果 ①114例患者耐药63例(55.26%),非耐药51例(44.74%)。②入住重症监护室(ICU)、机械通气、多肽暴露、复方制剂暴露、抗真菌药物暴露是耐药鲍曼感染的影响因素但均不是独立危险因素。③单因素分析显示影响预后的危险因素：住院时间、氨苄西林/舒巴坦耐药,机械通气,复方制剂暴露、抗真菌药物暴露、RBC、HGB、PLT。多因素分析：合并PLT减低是预后独立危险因素。结论 合并PLT减低是影响鲍曼不动杆菌菌血症患者预后的独立危险因素。     

Correlation between ampicillin-sulbactam resistance and penicillin-binding protein gene variation in acinetobacter baumannii北大核心CSCD

Objective To determine the susceptibility of Acinetobacter baumannii isolates to commonly used antibiotics, characterize mutation status of penicillin-binding protein (pbp) gene and analyze the association between pbp gene and ampicillinsulbactam resistance. Methods A total of 67 A. baumannii strains were collected from four teaching hospitals in Shanghai. The minimum inhibitory concentrations of antibiotics were determined for A. baumannii by agar dilution method. PCR and gene sequencing were conducted to analyze 7 pbp genes in all stains. The nucleotide sequence was compared between the strains susceptible to ampicillin-sulbactam and the strains resistant to ampicillin-sulbactam. Results The A. baumannii isolated from patients showed high resistance rate to common antibiotics, 67.6% resistant to ampicillin-sulbactam. Sequencing analysis showed that no amino acid variation was found for all 7 pbp genes whether the strains were susceptible or resistant. Conclusions Clinical isolates of A. baumannii are highly resistant to ampicillin-sulbactam, while pbp gene is not involved in the mechanism of ampicillinsulbactam resistance. © by Editorial Department of Chinese Journal of Infection and Chemotherapy.     

E试验检测氨苄西林-舒巴坦、克林霉素和头孢哌酮的体外抗菌活性

目的了解氨苄西林-舒巴坦、克林霉素、头孢哌酮对目前社区及住院患者常见临床分离菌的体外抗菌活性。方法采用E试验测定3种抗菌药物对待测菌株的MIC。结果对氨苄西林-舒巴坦,MSSA、粪肠球菌、A群链球菌、流感嗜血杆菌、青霉素敏感肺炎链球菌(PSSP)、卡他莫拉菌和厌氧菌(拟杆菌属10株、痤疮丙酸杆菌2株、迟缓真杆菌1株、无害梭杆菌1株、消化链球菌2株)100%敏感,非产ESBLs肺炎克雷伯菌和非产ESBLs大肠埃希菌(NESBL-ECO)分别为86.7%和53.3%敏感,鲍曼不动杆菌和屎肠球菌分别为23.3%和25.0%敏感。对克林霉素、MSSA、厌氧菌、PSSP和A群链球菌敏感率分别为60.0%、31.2%、30.0%和10.0%。对头孢哌酮、非产ESBLs大肠埃希菌、MSSA和非产ESBLs肺炎克雷伯菌为96.7%～100%敏感,铜绿假单胞菌40%敏感,鲍曼不动杆菌未见敏感菌株。结论氨苄西林-舒巴坦对MSSA、粪肠球菌、A群链球菌、非产ESBLs肺炎克雷伯菌、流感嗜血杆菌、PSSP、卡他莫拉菌和厌氧菌的体外抗菌活性较好。MSSA对克林霉素的敏感率为60.0%,其他所研究的细菌敏感率较低。头孢哌酮对MSSA、非产ESBLs大肠埃希菌、非产ESBLs肺炎克雷伯菌的体外抗菌活性好。这3种抗菌药物可经验用于社区获得性感染治疗。