铜绿假单胞菌的耐药监测和抗生素用药分析

目的 了解我院5年内铜绿假单胞菌的耐药性,并对其耐药性与抗菌药物用量的关系进行分析.方法 分析我院2006年1月至2010年12月病房分离的铜绿假单胞菌的耐药率,并对5年中8种抗生素的年用量与这些药物对铜绿假单胞菌的耐药性进行统计分析.结果 对铜绿假单胞菌最敏感的抗菌药物为哌拉西林/他唑巴坦和阿米卡星,敏感率分别为62％～79％和70％～76％;三代头孢中最敏感的为头孢他啶,敏感率为52％～69％;左氧氟沙星敏感率为42％～64％;碳青霉烯的敏感率仅为36％～62％.铜绿假单胞菌对头孢哌酮钠/舒巴坦、碳青霉烯类抗生素的耐药率与其用药频度呈正相关(r=1,P＜0.05).结论 我院铜绿假单胞菌耐药性和头孢哌酮钠/舒巴坦、碳青霉烯类抗生素的大量应用有直接关系,必须严格控制该类药物应用;同时应用抗生素轮换和替换策略、合理应用抗菌药物、严格执行消毒隔离制度等,防止耐药菌的产生和传播.     

我院2009至2012年常见非发酵菌耐药性动态分析

目的我院2009~2012年呼吸科分离的非发酵菌对抗菌药物的耐药性。方法采用统一的材料及方法(K-B法)和判断标准(M100-21)进行耐药性监测。结果共分离出非发酵菌共629株,其中铜绿假单胞菌占49.3%(310/629);铜绿假单胞菌对多粘菌素及阿米卡星的敏感性最高,均80%;鲍曼不动杆菌对大部分抗菌药物的耐药率在50%以上,但对多粘菌素、米诺环素及替加环素仍保持较高的敏感性;嗜麦芽窄食单胞菌分离株最少,对四种推荐抗菌药物的敏感率均60%。结论呼吸科分离的非发酵菌耐药率高,应加强对非发酵菌的耐药监测。     

血流感染老年住院患者血液标本非发酵革兰阴性杆菌分布及耐药性观察

目的 了解2016—2020年某三甲医院血流感染老年患者血液标本分离的非发酵革兰阴性杆菌分布及耐药性情况，为老年患者血流感染早期经验用药提供参考。方法 收集2016—2020年某三甲医院老年患者血液标本分离的非发酵革兰阴性杆菌资料，保留同一患者每种细菌第一株，剔除重复菌株后纳入分析。用仪器和纸片扩散法进行药敏试验。结果 2016—2020年某三甲医院老年患者血液标本分离的非发酵革兰阴性杆菌检出率较高的包括铜绿假单胞菌、鲍曼不动杆菌杆菌、嗜麦芽窄食单胞菌。铜绿假单胞菌对多黏菌素、阿米卡星、庆大霉素敏感率较高；鲍曼不动杆菌对抗菌药物的敏感率普遍较低，敏感率较高的是庆大霉素、妥布霉素；嗜麦芽窄食单胞菌对米诺环素、左氧氟沙星、复方磺胺甲恶唑敏感性均较高。耐碳青霉烯铜绿假单胞菌与耐碳青霉烯鲍曼不动杆菌的检出率分别为45.45%、72.22%。铜绿假单胞菌对常见抗菌药物的耐药率随患者年龄增长呈升高趋势；鲍曼不动杆菌和嗜麦芽窄食单胞菌对各种抗菌药物的耐药率在不同年龄组间差异无统计学意义（P均>0.05）。结论 2016—2020年某三甲医院血流感染老年患者血液标本分离的非发酵革兰阴性杆菌主要为...     

两种亚胺培南不敏感非发酵菌的耐药性分析

目的探讨亚胺培南不敏感铜绿假单胞菌及鲍曼不动杆菌的耐药性,为临床用药提供参考。方法对本院2010年1月~2014年12月间分离的亚胺培南不敏感铜绿假单胞菌及鲍曼不动杆菌进行统计分析。结果 403株亚胺培南不敏感鲍曼不动杆菌对常用抗菌药物耐药率很高,仅对头孢哌酮/舒巴坦、米诺环素和多粘菌素B保持较高的敏感性;113株亚胺培南不敏感铜绿假单胞菌对抗菌药物的敏感率高于亚胺培南不敏感鲍曼不动杆菌,对头孢他啶、头孢哌酮/舒巴坦、多粘菌素B、抗假单胞菌青霉素及其复合制剂有较高敏感性。结论两种亚胺培南不敏感非发酵菌对多数抗菌药物的耐药严重,应根据药敏结果选择抗菌药物,同时应采取恰当控制感染措施,以减少耐药菌株的产生与传播。     

哌拉西林-舒巴坦等七种药物对非发酵菌体外抗菌活性的研究

目的 评价哌拉西林-舒巴坦等7种药物对非发酵菌的体外抗菌活性.方法 采用微量肉汤稀释法测定哌拉西林-舒巴坦对细菌的体外抗菌作用.结果 广州地区6家医院共收集菌株770株,其中铜绿假单胞菌216株,鲍曼不动杆菌242株,嗜麦芽窄食单胞菌100株,洋葱伯克霍尔德菌119株,黄杆菌属57株,产碱杆菌属36株.对所有铜绿假单胞菌,哌拉西林-舒巴坦的敏感性最高(71.9%),而亚胺培南、头孢吡肟、头孢他啶、头孢哌酮-舒巴坦敏感性均低于50%.对亚胺培南不敏感的铜绿假单胞菌,哌拉西林-舒巴坦敏感性仍可达55.8%.对碳青霉烯敏感的鲍曼不动杆菌,哌拉西林-舒巴坦和头孢哌酮-舒巴坦敏感性最高,分别为71.0%和73.0%.对嗜麦芽窄食单胞菌,26%和20%的菌株对哌拉西林-舒巴坦和哌拉西林-他唑巴坦的最低抑菌浓度(MIC)≤16 mg/L.对洋葱伯克霍尔德菌,69%的菌株对哌拉西林-舒巴坦的MIC≤16 mg/L.对黄杆菌属和产碱杆菌属,哌拉西林-舒巴坦、头孢哌酮-舒巴坦和哌拉西林他唑巴坦3种加酶复合制剂敏感性最高,分别为70.2%、63.2%、57.9%和94.4%、94.4%、91. 7%.结论 哌拉西林-舒巴坦对多种非发酵菌尤其是碳青霉烯不敏感的铜绿假单胞菌具有良好的体外抗菌活性.     

2009～2011年儿科住院患者感染病原菌的菌种及耐药性分析

目的 观察儿科住院患者主要感染病原菌的菌种及其对常用抗菌药物的耐药性.方法 对2009 ～ 2011年湖北省妇幼保健院儿科住院患者各类标本中分离的全部菌株进行培养并鉴定,采用纸片扩散法对细菌进行药敏试验.结果 共分离11150株病原菌,其中革兰阴性杆菌7862株(占70.51％),主要是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌,其对临床常用抗菌药物均有不同程度耐药,肠杆菌科细菌对碳青霉烯类抗菌药物最敏感,鲍曼不动杆菌对碳青霉烯类抗菌耐药率＞9.60％.结论 革兰阴性杆菌是儿科感染的主要病原菌,其中以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌为主,并对临床常用抗菌药物有不同程度耐药.     

下呼吸道非发酵菌耐药性分析及抗感染治疗对策

目的分析我院非发酵菌感染的耐药情况，以指导临床合理使用抗菌药物。方法回顾性总结2002-2003年我院分离出的374株非发酵菌，对其检出率及药敏结果进行统计、分析。结果下呼吸道非发酵菌检出率为36．2％，其中铜绿假单胞菌最常见（54．3％），其次为鲍曼不动杆菌（23．5％），嗜麦芽窄食单胞菌呈上升趋势（6．5％）；铜绿假单胞菌和鲍曼不动杆菌耐药性较高。结论我院下呼吸道感染中非发酵菌检出率高且耐药性强，头孢哌酮／舒巴坦等含酶抑制荆的复食型抗菌药物对非发酵菌有较高的敏感性。     

碳青霉烯类抗生素对重症监护病房老年患者耐药菌的体外抑菌效果

目的监测该院重症监护病区老年患者革兰阴性菌的耐药情况及比较不同碳青霉烯类抗生素针对耐药革兰阴性菌体外抑菌效果。方法临床搜集重症监护老年患者标本分离的革兰阴性细菌菌株,进行分离、培养,按照CLSI2010标准,采用K-B纸片扩散法测定比阿培南、美罗培南、亚胺培南-西司他丁及头孢吡肟的体外抑菌效果。结果大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌对4代头孢菌素耐药率分别为46.8%,18.8%,47.8%,79.0%;大肠埃希菌对比阿培南、美罗培南、亚胺培南-西司他丁的耐药率均为0,肺炎克雷伯菌的耐药率分别为4.3%,2.9%,4.3%,铜绿假单胞菌的耐药率分别为57.8%,54.4%,63.3%,鲍曼不动杆菌的耐药率均为67.9%。三种碳青霉烯类抗生素针对四种病原菌的抗菌活性无统计学差异。结论肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌对4代头孢具有不同程度的耐药性。大肠埃希菌、肺炎克雷伯菌对碳青霉烯类仍保持较高敏感性,铜绿假单胞菌、鲍曼不动杆菌对碳青霉烯类已经产生了较高耐药性;三种碳青霉烯类抗生素针对四种革兰阴性病原菌的抗菌活性无统计学差异。     

铜绿假单胞菌耐药性及产碳青霉烯酶研究

目的了解医院2010年分离的铜绿假单胞菌的耐药性及耐亚胺培南菌株产碳青酶烯酶情况。方法 K-B纸片扩散法进行药敏试验;碳青霉烯酶检测采用改良Hodge试验。结果 2010年分离铜绿假单胞菌145株,主要来自呼吸道标本、脓汁及分泌物。药敏结果显示铜绿假单胞菌氨苄西林耐药率最高,达88.97%。对阿莫西林/克拉维酸、头孢噻肟、环丙沙星和头孢他啶的耐药率均超过50%。对洛美沙星和头孢哌酮/舒巴坦较敏感;耐亚胺培南铜绿假单胞菌31株,耐药率21.38%,改良Hodge试验阳性10株,阳性率为32.26%。结论分离的铜绿假单胞菌耐药性和产碳青霉烯酶率均较高,铜绿假单胞菌耐药严重     

2005年至2007年中国CHINET脑脊液的分离菌及其耐药性

目的 了解2005年至2007年中国CHINET监测网脑脊液分离菌的分布及其耐药性.方法 对CHINET监测网2005年1月至2007年12月所有脑脊液标本按常规方法进行分离、培养、鉴定.按统一方案用Kirby-Bauer纸片扩散法进行抗菌药物敏感试验.结果 2005年至2007年脑脊液标本获分离菌941株,其中革兰阳性菌588株.占62.5%;革兰阴性菌349株,占37.1%;真菌4株,占0.4%.革兰阳性菌所占比例由2005年的59.9%增至2007年的64.6%,革兰阴性菌所占比例由2005年的39.6%降至2007年的35.4%.最常见的分离菌依次分别为凝固酶阴性葡萄球菌、不动杆菌属、肠球菌属、铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌、克雷伯菌属、肠杆菌属、肺炎链球菌、链球菌属和其他假单胞菌.葡萄球菌属和肠球菌属中未发现万古霉素耐药株,肺炎链球菌对青霉素的耐药率为42.9%.肠杆菌科细菌对碳青霉烯类高度敏感,不动杆菌属和铜绿假单胞菌对碳青霉烯类耐药率为24.1%～29.3%.结论 2005年至2007年脑脊液分离菌中革兰阳性菌多于革兰阴性菌,脑脊液分离株对常用抗菌药物耐药明显.     

Handoff from recombinase to replisome: Insights from transposition

Bacteriophage Mu replicates as a transposable element, exploiting host enzymes to promote initiation of DNA synthesis. The phage-encoded transposase MuA, assembled into an oligomeric transpososome, promotes transfer of Mu ends to target DNA, creating a fork at each end, and then remains tightly bound to both forks. In the transition to DNA synthesis, the molecular chaperone ClpX acts first to weaken the transpososome's interaction with DNA, apparently activating its function as a molecular matchmaker. This activated transpososome promotes formation of a new nucleoprotein complex (prereplisome) by yet unidentified host factors [Mu replication factors (MRF alpha 2)], which displace the transpososome in an ATP-dependent reaction. Primosome assembly proteins PriA, PriB, DnaT, and the DnaB--DnaC complex then promote the binding of the replicative helicase DnaB on the lagging strand template of the Mu fork. PriA helicase plays an important role in opening the DNA duplex for DnaB binding, which leads to assembly of DNA polymerase III holoenzyme to form the replisome. The MRF alpha 2 transition factors, assembled into a prereplisome, not only protect the fork from action by nonspecific host enzymes but also appear to aid in replisome assembly by helping to activate PriA's helicase activity. They consist of at least two separable components, one heat stable and the other heat labile. Although the MRF alpha 2 components are apparently not encoded by currently known homologous recombination genes such as recA, recF, recO, and recR, they may fulfill an important function in assembling replisomes on arrested replication forks and products of homologous strand exchange.     

Learning from health system reforms: lessons from Burkina Faso

OBJECTIVES: Burkina Faso has implemented a macroeconomic adjustment programme (MAP) along with an ambitious reform of the health care system. Our aim was (1) to verify whether MAPs led to a reduction in health resources, and (2) to analyze the consequences of health policies implemented. METHOD: Cross-sectional and retrospective study, spanning the years 1983-2003. The macro aspect is based upon documents from national and international sources, a database of secondary socioeconomic data, and interviews of key informants working in upper management. Household and health facility surveys were conducted in three regions covering 53 communities. RESULTS: Within the reforms, the health sector benefited from an important flow of resources. There were significant increases in public expenditures, health care staff, the number of primary care facilities and the availability of generic drugs. However, health facilities in the public sector remain underused and major inequities subsist. Access to health care is constrained by the population's ability to pay. Health expenditures impoverish households, creating new poor and impoverishing the already poor. CONCLUSIONS: The success of reforms depends largely on the extent to which they remove financial barriers to access to services. The experience of Burkina Faso also reveals the need for fundamental changes that will motivate staff, improve productivity, and ensure good quality services. Integrating health development policies with strategic plans for poverty reduction can provide new opportunities for African countries to redesign their health systems within this type of perspective.     

Learning More from Microarrays: Insights from Modules and Networks

Global gene expression patterns can provide comprehensive molecular portraits of biologic diversity and complex disease states, but understanding the physiologic meaning and genetic basis of the myriad gene expression changes have been a challenge. Several new analytic strategies have now been developed to improve the interpretation of microarray data. Because genes work together in groups to carry out specific functions, defining the unit of analysis by coherent changes in biologically meaningful sets of genes, termed modules, improves our understanding of the biological processes underlying the gene expression changes. The gene module approach has been used in exploratory discovery of defective oxidative phosphorylation in diabetes mellitus and also has allowed definitive hypothesis testing on a genomic scale for the relationship between wound healing and cancer and for the oncogenic mechanism of cyclin D. To understand the genetic basis of global gene expression patterns, computational modeling of regulatory networks can highlight key regulators of the gene expression changes, and many of these predictions can now be experimentally validated using global chromatin-immunoprecipitation analysis.     

Methane emissions from Alaska in 2012 from CARVE airborne observations

We determined methane (CH₄) emissions from Alaska using airborne measurements from the Carbon Arctic Reservoirs Vulnerability Experiment (CARVE). Atmospheric sampling was conducted between May and September 2012 and analyzed using a customized version of the polar weather research and forecast model linked to a Lagrangian particle dispersion model (stochastic time-inverted Lagrangian transport model). We estimated growing season CH₄ fluxes of 8 ± 2 mg CH₄⋅m⁻²⋅d⁻¹ averaged over all of Alaska, corresponding to fluxes from wetlands of 56−13+22 mg CH₄⋅m⁻²⋅d⁻¹ if we assumed that wetlands are the only source from the land surface (all uncertainties are 95% confidence intervals from a bootstrapping analysis). Fluxes roughly doubled from May to July, then decreased gradually in August and September. Integrated emissions totaled 2.1 ± 0.5 Tg CH₄ for Alaska from May to September 2012, close to the average (2.3; a range of 0.7 to 6 Tg CH₄) predicted by various land surface models and inversion analyses for the growing season. Methane emissions from boreal Alaska were larger than from the North Slope; the monthly regional flux estimates showed no evidence of enhanced emissions during early spring or late fall, although these bursts may be more localized in time and space than can be detected by our analysis. These results provide an important baseline to which future studies can be compared.Recent studies have raised concerns about an increase in methane (CH₄) emissions from Arctic regions as temperatures warm (1–3). Carbon stocks in polar regions are estimated to be as large as 1,700 Pg of soil organic carbon (4), preserved by cold, wet conditions that inhibit decomposition. Over the last 20 y, temperatures have increased more rapidly at these latitudes than the rest of the world (5); continuation of this trend will lead to permafrost warming and thawing (6), potentially releasing vast quantities of carbon dioxide (CO₂) and CH₄ into the atmosphere (7–10). A recent synthesis of carbon emissions predicted by permafrost models reported releases in the range of 120 ± 85 Pg C by 2100 (11). Large uncertainties are likewise associated with estimates of CH₄ emissions (12–90 Tg CH₄⋅y⁻¹) (12). The potential for large increases in CH₄ emissions are a particular concern because CH₄ strongly impacts both atmospheric chemistry and climate (13). Estimates of the impact of permafrost carbon emissions on future global temperatures range from ∼0.1–0.2 °C (14) to 0.3 ± 0.2 °C (11) by 2100, with increased carbon emissions expected to continue after 2100 (11).Recent global inversion studies find no evidence for increasing CH₄ emissions from these regions in the last 10 y (15, 16), despite warming, similar to earlier studies (17–19) and some biogeochemical models (14). Surface CH₄ flux observations across the pan-Arctic from 1990–2006 have ranged widely and measurement locations have changed, making it difficult to detect any trend over those years (ref. 20; cf. ref. 21).The present paper derives estimates of CH₄ surface fluxes in Alaska from May to September 2012, based on an extensive program of regional-scale airborne measurements of atmospheric CH₄, the Carbon in Arctic Reservoirs Vulnerability Experiment (CARVE). We quantify the monthly mean CH₄ emissions from Alaska during the growing season, providing a snapshot of the interactions between climate and the vast reservoir of preserved soil organic matter in the Arctic.