2016年北京市海淀医院细菌耐药性监测

目的 了解北京市海淀医院2016年临床分离细菌对抗菌药物的耐药性.方法 共收集2268株非重复分离菌株,自动化仪器法进行药敏试验,按CLSI 2016年版标准判读药敏结果,采用WHONET 5.6软件进行数据分析.结果 2268株细菌中,革兰阴性菌占75.6％,革兰阳性菌占24.4％.10种最常见的细菌分别为:大肠埃希菌(16.8％),肺炎克雷伯菌(13.4％),铜绿假单胞菌(11.6％),鲍曼不动杆菌(10.1％),凝固酶阴性葡萄球菌(8.0％),屎肠球菌(6.7％),阴沟肠杆菌(5.1％),嗜麦芽窄食单胞菌(3.8％),粪肠球菌(3.4％),金黄色葡萄球菌(金葡菌)(3.2％).耐甲氧西林金葡菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)的检出率分别为34.2％和70.7％.耐甲氧西林葡萄球菌对β内酰胺类和其他抗菌药物的耐药率明显高于甲氧西林敏感葡萄球菌.未发现对万古霉素、替加环素和利奈唑胺耐药的葡萄球菌.粪肠球菌(除四环素外)对大多数抗菌药物的耐药率明显低于屎肠球菌.发现少数万古霉素耐药肠球菌(VRE),未发现对利奈唑胺耐药的肠球菌.分离到的45株无乳链球菌对青霉素的敏感率为100％.肺炎链球菌对红霉素的耐药率为100％.克雷伯菌属对亚胺培南和美罗培南的耐药率为20.2％和19.6％,其它肠杆菌科细菌对碳青霉烯类仍高度敏感,总耐药率≤6.9％.多重耐药肺炎克雷伯菌的检出率为47.5％.铜绿假单胞菌对亚胺培南的耐药率为26.6％,对阿米卡星的耐药率1.5％.鲍曼不动杆菌亚胺培南的耐药率为42.3％,对阿米卡星的耐药率为2.4％.多重耐药鲍曼不动杆菌和铜绿假单胞菌的检出率分别是42.4％和28.9％.结论 细菌对抗菌药物的耐药率呈下降趋势,特别是多重耐药的鲍曼不动杆菌下降明显,应持续采取有效的医院感染控制措施和加强抗菌药物的合理使用,进一步降低多重耐药菌的比例.     

1995～2002年阴沟肠杆菌临床分离株的耐药性分析

目的：调查1995～2002年阴沟肠杆菌临床分离株对临床常用抗菌药物的耐药性变化。方法：药物敏感性试验采用纸片扩散法，耐药性数据分析采用WHONET5软件。结果：1995年1月1日至2002年12月31日。国家细菌耐药性监测网医院共收集阴沟肠杆菌临床分离菌5558株。标本来源主要为痰、尿液及和伤口及其分泌物，分别占53％～65％、9％～12％和2％～13％。阴沟肠杆菌对临床常用抗菌药物的耐药率，除亚胺培南和美洛培南外，8年间都有不同程度的增加。头孢曲松、头孢噻肟、头孢他啶、环丙沙星、庆大霉素和阿米卡星等抗菌药物的耐药率增加了20％以上。2002年的结果表明，碳青霉烯类抗生素、阿米卡星、头孢吡肟和头孢哌酮／舒巴坦对阴沟肠杆菌临床分离株有较好的抗菌活性。此外，阴沟肠杆菌临床分离株对头孢噻肟和头孢他啶双重敏感率在逐年下降，双重耐药率在逐年增加。头孢噻肟和头孢他啶抑菌圈直径的均值也在逐年减小。结论 菌耐药性问题是抗感染治疗的主要威胁，合理使用抗菌药物以降低耐药性和采取有效措施控制其传播是非常重要的。     

2012年深圳市光明新区人民医院细菌耐药监测

目的了解2012年深圳市光明新区人民医院临床分离菌对常用抗菌药物的耐药性。方法采用Microscanauto4鉴定及药敏系统对临床常规细菌进行监测．按CLSl2009年版标准判断药敏结果．并用WHONET5．4软件统计分析。结果全年共分离细菌1818株,其中革兰阳性菌占35．6％,革兰阴性菌占58．O％。葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）占18．3％,凝固酶阴性葡萄球菌（MRCNS）占71．9％。肺炎链球菌中青霉素非敏感的肺炎链球菌（PNSSP）占20．7％。大肠埃希菌和肺炎克雷伯杆菌产ESBLs菌株分别占43．2％和22．4％。检出5株亚胺培南耐药的肠杆科细菌。铜绿假单胞菌和鲍曼不动杆菌对头孢他啶、哌拉西林、妥布霉素、阿米卡星、环丙沙星、亚胺培南的耐药率均低于10％。结论本院常见致病菌耐药性不是十分严重,尤其是院内感染的铜绿假单胞菌和鲍曼不动杆菌对常用抗菌药物耐药率较低。     

亚胺培南耐药鲍曼不动杆菌同源性分析及其耐药机制的研究

鲍曼不动杆菌(Acinetobacter baumannii)是导致院内感染的重要条件性致病菌,其分离率仅次于铜绿假单胞菌.研究表明亚胺培南是治疗鲍曼不动杆菌感染的有效药物,而一旦出现亚胺培南耐药也就意味着对绝大多数常用抗菌药物耐药.近年来我院鲍曼不动杆菌对亚胺培南耐药性逐渐上升[1],本研究拟从菌株同源性分析着手,在了解菌株分子流行病学特征的同时联合检测几种β-内酰胺酶编码基因,以明确本地区菌株对亚胺培南的耐药特性.     

神经外科医院感染及产超广谱β-内酰胺酶菌株感染分析

目的 研究神经外科医院感染的主要病原菌分布及其耐药情况，以及产超广谱β-内酰胺酶（ESBLs）菌株感染特点，为临床治疗提供依据。方法 通过对患者病历及细菌培养和药敏试验结果的统计分析，计算各种病原菌的构成比和各种抗菌药物的耐药率，不同年份比例的变化趋势采用趋势检验。结果 2003～2005年神经外科281倒患者分离菌株共408株，其中革兰阴性菌占77．2％，革兰阳性菌22．8％。G^-菌对常用的大多数头孢类抗生素耐药率极高，对亚胺硫霉素的敏感率93．7％。G^＋菌对青霉素类抗生素已基本耐药，对万古霉素的敏感率80．6％。分离产ESBLs菌株36株，各年产ESBLs菌占各年总菌株数的比例呈逐年上升趋势。36株产ESBLs菌株对临床常用抗生素耐药率普遍较高，对亚胺硫霉素无耐药。结论 G^- 菌是神经外科医院感染的主要病原菌；病原菌耐药性普遍较高；产ESBLs菌株引起的感染率逐年升高；预防细菌耐药．必须积极采取综合措施，建立细菌耐药监测系统，合理使用抗菌素，以求达到控制或延缓细菌耐药。     

2017年我院肠杆菌科细菌临床分布及耐药性分析

目的 分析宝山区中西医结合医院2017年所分离肠杆菌科细菌在临床标本中的分布和对常用抗菌药物的耐药性。方法 菌株来源于2017年1月1日~12月31日临床送检各类标本中分离出的肠杆菌科细菌1054株。剔除同一患者相同部位的重复菌株。用西门子的MicroScan WalkAway96全自动微生物鉴定/药敏测试系统进行细菌鉴定和药物敏感试验,K-B纸片扩散法作为药敏补充实验,依照CLSI制定的最新的判断标准判断药敏试验结果。结果 2017年分离出的肠杆菌科细菌1054株,主要来源于痰液标本和中段尿标本,分别占39.85%和31.03%;分离率最高的是肺炎克雷伯杆菌和大肠埃希菌,分别占39.94%和35.67%;其次是奇异变形杆菌和阴沟肠杆菌,分别占6.83%和5.79%;肺炎克雷伯菌亚胺培南和美罗培南的耐药率较高,分别为38.24%和 39.43%,敏感率均为59.86%;奇异变形杆菌亚胺培南的耐药率高于美罗培南。肺炎克雷伯菌ESBLs检出率为45.84%,大肠埃希菌45.74%,奇异变形杆菌为45.83%。结论 我院2017年分离的肠杆菌科细菌中以肺炎克雷伯菌和大肠埃希菌为主,细菌的耐药问题日趋严重,医院应引起高度重视,加强细菌耐药性的监测,指导临床合理用药。     

2017年贵州省某综合型医院细菌耐药性监测及动态分析

目的 分析2017年贵州省某综合型医院细菌耐药情况,并提出抗菌药物使用的合理性建议,以促进临床合理、安全的用药。方法 采用纸片扩散法（KB法）对7697株临床分离菌株作药敏实验,以2017年CLSI标准判断药敏试验结果,采用WHONET 5.6 软件,进行统计分析,结合我院细菌耐药结果对我院抗菌药物应用的合理性做出评价。结果 2017年我院共分离出病原菌7697株,其中革兰阴性菌4047株（52.58%）,革兰阳性菌为2706株（35.16%）。MRSA的检出率为36.46%,未发现耐万古霉素的菌株;肠球菌属中,屎肠球菌和粪肠球菌均出现对万古霉素和替考拉宁耐药的菌株。肠杆菌科中大肠埃希菌对亚胺培南的耐药率为0.53%,肺炎克雷伯菌对亚胺培南的耐药率为15.94%;非发酵菌中铜绿假单胞菌对亚胺培南耐药率为22.99%,鲍曼不动杆菌对亚胺培南耐药率为67.31%。结论 目前我院细菌耐药率不断攀升,长期进行细菌耐药监测有助于了解耐药情况,同时结合药物特点,为临床合理用药提供依据。     

临床分离4364株细菌的分布特征和耐药性变迁分析

目的了解2003—2005年分离的4364株细菌的分布特征及耐药性变迁，为合理使用抗菌药物提供依据。方法大多数分离细菌的鉴定和药敏试验利用BD Phoenix仪，少数利用手工鉴定和K-B法药敏试验。数据分析用WHONET5．0软件。结果葡萄球菌对万古霉素和替考拉宁的敏感率一直为100％，对其他抗菌药物的耐药率大多逐年上升，甲氧西林耐药率也逐年上升，金黄色葡萄球菌从40．8％上升到61．6％，表皮葡萄球菌从69．7％上升到79．8％。G^-杆菌合计，大多数抗菌药物的耐药率逐年升高，耐药率一直低于30％的为美洛培南、亚安培南、头孢哌酮／舒巴坦、哌拉西林-他唑巴坦和头孢他啶。大肠埃希菌和肺炎克雷伯菌体外产ESBLs的检出率一直居高不下，为29．5％～45．5％。结论本院肠杆菌科产ESBLs比例、葡萄球菌甲氧西林耐药率和非发酵菌碳青霉烯类耐药率均较高，应加强抗菌药物的合理使用和采取有效的隔离措施以降低耐药率及多重耐药菌的扩散。     

儿科患者中对碳青霉烯类不敏感肠杆菌科细菌耐药性和耐药基因的研究

目的 研究儿科临床分离的对碳青霉烯类抗生素不敏感的肠杆菌科细菌耐药性和产生碳青霉烯酶的耐药基因特征.方法 收集2008年1月至2010年12月北京儿童医院住院患儿分离出的46株对碳青霉烯类抗生素不敏感的肠杆菌科细菌.使用琼脂稀释法进行药敏试验,测定抗菌药物的最低抑菌浓度(MIC)值,按照临床实验室标准化研究所(CLSI) 2011年推荐标准判断结果.使用改良Hodge试验和双纸片协同试验,进行产碳青霉烯酶的表型确证.使用PCR方法进行碳青霉烯酶相关耐药基因的检测.采用WHONET5.6软件进行数据分析.结果 46株对碳青霉烯类抗生素不敏感的肠杆菌科细菌,26株为肺炎克雷伯菌,占56.5％,13株为阴沟肠杆菌,占28.3％,7株为大肠埃希菌,占15.2％.对亚胺培南和美罗培南不敏感率分别为肺炎克雷伯菌69.2％和80.8％,阴沟肠杆菌76.9％和100％,大肠埃希菌85.7％和100％.46株肠杆菌科细菌,改良Hodge试验阳性40株(87.0％),双纸片协同试验阳性41株(89.1％).IMP基因阳性38株(82.6％),其余8株均未扩增出特异性条带检测均为阴性.结论 目前儿科临床分离对碳青霉烯类抗生素不敏感菌株中,肺炎克雷伯菌最多,占56.5％.肺炎克雷伯菌、阴沟肠杆菌和大肠埃希菌对碳青霉烯类抗生素亚胺培南不敏感程度低于美罗培南,对碳青霉烯不敏感肠杆菌科细菌主要产生B类金属酶,均为IMP基因型.     

烧伤患者阴沟肠杆菌感染原因及药敏分析

目的通过调查阴沟肠杆菌引起医院感染的情况，探讨其对控制烧伤患者医院感染的意义。方法对本院烧伤病区2006年6月5日至2006年8月13日12例重度烧伤患者血液、创面分泌物进行细菌培养及药物敏感试验，对阴沟肠杆菌引起医院感染的原因、耐药率采取MIC法进行统计分析。结果12例重度烧伤患者中同期检出阴沟肠杆菌感染3例，1例死亡。结论阴沟肠杆菌对阿米卡星、亚胺培南敏感率较高。进一步加强医院感染管理及消毒隔离工作，合理应用抗菌药物，能控制烧伤患者医院感染。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The case for allele‐specific recognition by the TCR

There is a sharp difference in how one views TCR structure–function–behaviour dependent on whether its recognition of major histocompatibility complex‐encoded restriction elements (R) is germline selected or somatically generated. The generally accepted or Standard model is built on the assumption that recognition of R is by the V regions of the αβ TCR, which is not driven by allele specificity, whereas the competing model posits that recognition of R is allele‐specific. The establishing of allele‐specific recognition of R by the TCR would rule out the Standard model and clear the road to a consideration of a competing construct, the Tritope model. Here, the case for allele‐specific recognition (germline selected) is detailed making it obvious that the Standard model is untenable.