肺部感染病原菌分布及耐药性分析

目的分析肺部感染患者病原菌分布及耐药性,为临床合理使用抗菌药物提供依据。方法回顾性分析肺部感染患者痰标本分离出的802株病原菌及药敏结果。结果 802株病原菌中革兰阴性杆菌686株(85.54%),排在前四位的细菌分别为铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、大肠埃希菌。其中铜绿假单胞菌对头孢哌酮/舒巴坦、阿米卡星、头孢吡肟的敏感率分别为94.53%、92.58%、90.23%;大肠埃希菌产ESBLs酶的阳性率为59.52%,肺炎克雷伯菌产ESBLs酶的阳性率为34.30%,两者对亚胺培南、美罗培南的敏感率均为100%,肺炎克雷伯菌对头孢哌酮/舒巴坦、阿米卡星的敏感率较高;鲍曼不动杆菌对头孢哌酮/舒巴坦、米诺环素、氨苄西林/舒巴坦的敏感率分别为98.35%、92.31%、84.62%。革兰阳性球菌以金黄色葡萄球菌为主,未检出耐万古霉素的菌株。结论肺部感染病原菌主要为革兰阴性杆菌,且呈多重耐药的菌株日趋增加,这与抗菌药物的不合理使用有关。     

渭南地区1103株革兰阴性杆菌耐药状况监测分析

目的:了解渭南地区革兰阴性杆菌的分布情况和耐药现状,为临床合理使用抗生素提供依据。方法:对分离得到的1 892例菌株中的1 103株革兰氏阴性杆菌,采用API系列鉴定,K-B方法药敏纸片进行药敏试验,判断常用抗生素的耐药情况。结果:1 103株革兰氏阴性杆菌占全部分离菌株的58.30%(1 103/1 892),其中,检出率最高的是大肠埃希菌28.92%(319株),其他常见菌依次为铜绿假单胞菌17.68%(195株),肺炎克雷伯菌12.33%(136株),鲍曼不动杆菌11.51%(127株),产酸克雷伯菌5.08%(56株),产气肠杆菌3.81%(42株),阴沟肠杆菌3.80%(41株),嗜麦芽窄食单胞菌3.17%(35株),洛菲不动杆菌2.17%(24株)。分离出的主要肠杆菌科细菌对头孢他啶、阿米卡星、头孢吡肟、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率低,大肠埃希菌、肺炎克雷伯菌、产气肠杆菌对以上几种药物的耐药率低于22%,阴沟肠杆菌对以上几种药物的耐药率略高但也低于40%。分离出的主要肠杆菌细菌未检到对亚胺培南和美罗培南耐药的耐药株。铜绿假单胞菌对头孢他啶、头孢吡肟、亚胺培南、美罗培南、头孢哌酮/舒巴坦、阿米卡星的耐药率较低,低于30%。鲍曼不动杆菌对亚胺培南、美罗培南、头孢哌酮/舒巴坦的耐药率较低,低于30%。产ESBLs大肠埃希菌、肺炎克雷伯菌、产酸克雷伯菌的检出率分别为36.99%、21.32%、17.86%。结论:由于常见菌株的耐药现象严重且耐药率不断增高,应当加强病原菌的耐药性监测,合理规范使用抗菌药物。     

综合性医院革兰阴性杆菌的分布和耐药性分析

目的了解医院革兰阴性杆菌的分布以及耐药现况。方法对本院2010年分离革兰阴性杆菌的分布和耐药性进行统计描述与分析。结果 5 795株分离细菌中革兰阴性菌3 371株,占58.2%;大肠埃希菌和肺炎克雷伯菌产ESBLs率分别为59.1%和33.7%。产ESBLs大肠埃希菌和肺炎克雷伯菌对哌拉西林/他唑巴坦、亚胺培南、头孢替坦、阿米卡星的耐药率均小于10%;铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌、洋葱假单胞菌对常用抗菌药物耐药率较低的分别为头孢他定(9.1%)、哌拉西林/他唑巴坦(13.8%)、左氧氟沙星(3.0%)、哌拉西林/他唑巴坦(13.8%)。结论碳青霉烯类药仍可作为治疗肠杆菌科细菌感染的首选药物,哌拉西林/他唑巴坦可作为治疗非发酵菌感染的经验用药。     

重症监护病房患者病原菌培养结果及其耐药性分析

目的分析重症监护病房(ICU)患者病原菌培养结果及耐药性情况,为临床医师经验性使用抗菌药物提供依据。方法对我院2013年5月~2014年2月ICU送检标本所分离病原菌及其耐药性进行回顾性分析。结果标本主要来源为痰液、中段尿和全血,分别占81.8%、10.5%、5.5%。分离出220株病原菌,其中革兰阴性杆菌182株(82.7%)、革兰阳性球菌27株(12.3%)、真菌11株(5.0%)。革兰阴性杆菌中非发酵菌和肠杆菌占主要地位,前5位依次为铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌、奇异变形杆菌和大肠埃希菌;多数革兰阴性杆菌对亚胺培南、美罗培南、替卡西林/克拉维酸、哌拉西林/他唑巴坦和阿米卡星呈高度敏感;革兰阳性球菌以溶血性葡萄球菌、金黄色葡萄球菌为主,分别占6.4%、3.6%,其中耐甲氧西林葡萄球菌(MRSA)检出率为75.0%;革兰阳性球菌对万古霉素、替考拉宁和夫西地酸均高度敏感。结论 ICU病原菌主要是革兰阴性杆菌,其次为革兰阳性球菌、真菌。革兰阴性杆菌中非发酵菌和肠杆菌占主要地位,前5位依次为铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌、奇异变形杆菌和大肠埃希菌。病原菌呈现多药耐药特点,革兰阴性杆菌对亚胺培南、美罗培南、替卡西林/克拉维酸、哌拉西林/他唑巴坦和阿米卡星呈高度敏感;革兰阳性球菌对万古霉素、替考拉宁和夫西地酸均高度敏感。     

急危重症感染患者革兰阴性杆菌药物敏感性监测

从我院急危重症病房感染患者分离到 10 0株革兰阴性杆菌 ,采用Etest法测定 12种抗菌药物的最低抑菌浓度 ,用WHONET 4计算机软件完成数据分析。 5 1%为肠杆菌科细菌 ,4 9%为非发酵菌。 12种抗菌药物敏感覆盖率较高的是亚胺培南 (91% ) ,阿米卡星 (81% ) ,其次是头孢他啶(79% )和头孢哌酮 /舒巴坦 (79% )。 3 1株大肠埃希菌和肺炎克雷伯菌中 ,初筛产超广谱 β 内酰胺酶 8株 (2 5 .8% )。 5 2 .6%的大肠埃希菌耐环丙沙星 ,68.4 %耐庆大霉素。本组监测数据为革兰阴性杆菌急危重症感染的经验用药提供参考和依据。     

革兰阴性杆菌耐药状况研究——2008中国美罗培南敏感性监测(CMSS)报告

目的监测2008年中国革兰阴性(G-)杆菌的耐药性。方法收集2008年9月至12月国内10家教学医院收集的1057株非重复的G-杆菌。菌株经中心实验室复核后,采用琼脂稀释法测定美罗培南等广谱抗菌药物的最低抑菌浓度。结果10种抗菌药物对于715株肠杆菌科细菌的抗菌活性,敏感性排在前3位的依次为美罗培南(敏感性99.4%)、亚胺培南(敏感性99.3%)、阿米卡星(90.4%)。对于大肠埃希菌和肺炎克雷伯菌,抗菌活性最高的是:美罗培南、亚胺培南(97.9%～100%)、哌拉西林/三唑巴坦(87.2%～97.9%)、阿米卡星(82.3%～92.9%)。对于阴沟肠杆菌、产气肠杆菌、弗劳地枸橼酸菌,活性最高的依次为美罗培南、亚胺培南(97.4%～100%)、阿米卡星(87.2%～91.9%)、头孢吡肟(82.4%～93.5%)。对于铜绿假单胞菌,活性最高的药物为阿米卡星(77.4%)、美罗培南(76%)、哌拉西林/三唑巴坦(70.5%)和亚胺培南(70.5%)。鲍曼不动杆菌对于亚胺培南、美罗培南、头孢哌酮/舒巴坦的敏感性最高,分别为58.6%、57%、49.2%。对于洋葱伯克霍尔德菌,抗菌活性较高的是头孢他啶(77.4%)、美罗培南(75.5%)、哌拉西林/三唑巴坦(69.8%)。结论碳青霉烯类对肠杆菌科仍保持高活性,但鲍曼不动杆菌和铜绿假单胞菌的耐药性增加,尤其是鲍曼不动杆菌对碳青霉烯类的耐药性显著增加,值得关注。     

长春地区老年人下呼吸道感染常见革兰阴性杆菌耐药监测

目的了解长春地区老年人下呼吸道感染常见革兰阴性杆菌的耐药情况。方法采用VITEK-2微生物自动分析仪进行细菌鉴定;使用纸片琼脂扩散法进行药物敏感试验;采用WHONET-5软件对药敏数据进行分析。结果共分离革兰阴性杆菌910株,其中铜绿假单胞菌210株(23.1%),大肠埃希菌190株(20.9%),克雷伯菌170株(18.7%),不动杆菌100株(11.0%),阴沟肠杆菌60株(6.6%),其他革兰阴性杆菌180株(19.8%)。所有革兰阴性杆菌,对抗菌药物的耐药率由低至高依次为亚胺培南5.5%、美罗培南6.6%、头孢哌酮/舒巴坦15.2%、哌拉西林/三唑巴坦18.4%、头孢吡肟20.1%、左氧氟沙星29.8%。所有革兰阴性杆菌对三代头孢头孢噻肟、头孢曲松的耐药率高达50%以上。结论长春地区老年患者下呼吸道感染常见革兰阴性杆菌多重耐药非常严重,因此应定期监测该地区革兰阴性杆菌的耐药趋势,对指导临床合理使用抗生素是非常必要的。     

头孢哌酮－舒巴坦体外抗菌作用研究

为评价头孢哌酮（ｃｅｆｏｐｅｒａｚｏｎｅ，ＣＰＺ）－舒巴坦（ｓｕｌｂａｃｔａｍ，ＳＢＴ）合剂的体外抗菌作用，观察了ＣＰＺ－ＳＢＴ对１１４６株临床分离菌的抗菌活性，并与ＣＰＺ及其他抗菌药物进行比较。ＣＰＺ－ＳＢＴ对产β－内酰胺酶菌株的抗菌活性高于ＣＰＺ，在需氧革兰阴性杆菌８３４株中，对ＣＰＺ耐药者１６５株，其中９４株（５７．０％）对ＣＰＺ－ＳＢＴ呈现敏感。ＣＰＺ－ＳＢＴ扩大了抗菌谱，其对不动杆菌属、脆弱类杆菌等具有良好抗菌作用。与受试的其他抗菌药物相比，该合剂对肠杆菌科、绿脓杆菌和不动杆菌属等的抗菌活性与头孢他啶、阿米卡星、环丙沙星相仿，较亚胺培南略差；对脆弱类杆菌等厌氧菌的作用则与亚胺培南、替门汀和甲硝唑相仿。上述结果提示ＣＰＺ－ＳＢＴ为一新的广谱抗菌药，具有良好的临床应用前景，可用于耐头孢哌酮革兰阴性杆菌（包括绿脓杆菌）而对本合剂呈现敏感菌所致的严重感染的治疗。     

烧伤外科住院病人细菌感染特点及耐药性

目的分析了解烧伤外科住院病人细菌感染的特点与耐药性。方法通过细菌分离鉴定技术、药物敏感性试验及耐药检测方法,对烧伤外科住院病人进行标本采集,送检进行病原学检测与临床分析。结果烧伤组共检出细菌297株,其中创面分泌物195株、痰液9株、血液57株、尿液3株、穿刺引流液2株、各类导管插管31株。感染的各类型的病原菌为革兰阳性球菌、肠杆菌科细菌和非革兰阴性杆菌。分离菌中革兰阳性球菌分离率最高(112株);再次是肠杆菌科细菌(104株);非革兰阴性杆菌分离率最低(81株)。烧伤外科分离的主要阳性球菌金黄色葡萄球菌、肠球菌属严重耐药,凝固酶阴性葡萄球菌耐药率相对较低,尚未发现万古霉素耐药株。超广谱β-丙酰胺酶(ESBLs)(+)在试验中可以表现出对内酰胺类抗生素高度耐药,ESBLs(-)的耐药率相对较低,ESBLs对青霉稀类抗生素敏感度较高,耐药性为0,对其他药物有不同程度的耐药性。铜绿假单胞菌对多种药物高度耐药,尤其对复方磺胺甲噁唑100%耐药;鲍曼不动杆菌除对亚胺培南为0%的耐药外,对其他药物均有不同程度的敏感度。结论烧伤病房住院病人临床分离菌株主要为革兰阳性球菌、肠杆菌科细菌及非发酵革兰阴性杆菌。及时进行药物敏感试验对治疗过程中正确使用抗菌药物,有效预防和控制烧伤外科住院病人的细菌感染、降低死亡率具有重要的临床治疗意义。     

血液感染革兰阴性菌临床分布及耐药性分析

目的研究血培养中常见的革兰阴性细菌分布及耐药性,为革兰阴性菌感染的临床用药提供依据。方法 2012年10月至2015年9月临床送检血液标本分离出革兰阴性菌958株,均采用BACTEC-FX BD全自动血培养仪进行血培养,阳性标本BD全自动微生物鉴定/药敏仪Phoenix-100进行鉴定,应用WHONET5.5软件检测抗生素耐药性。结果血培养分离出革兰阴性菌958株,占前5位分别是大肠埃希菌(ECO)(23.6%)、肺炎克雷伯菌(KPN)(19.21%)、铜绿假单胞菌(PAE)(7.30%)、阴沟肠杆菌(ECL)(5.11%)、鲍曼不动杆菌(ABA)(5.00%),PAE对阿米卡星及四环素的耐药率低于2%,ABA对粘菌素的耐药率最低,敏感率为100%,ECL对亚胺培南和美罗培南的耐药率最低,为2%。产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌检出率分别为64.5%和32.6%,产ESBLs菌株的耐药率(亚胺培南、美洛培南除外)明显高于非产ESBLs菌株,差异有统计学意义(P0.05)。结论深入了解细菌耐药特点,定期对耐药性数据进行分析,有助于了解细菌耐药性变迁,为合理使用抗菌药物提供依据。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.