Bloodstream infections among transplant recipients: results of a nationwide surveillance in Spain.

Bloodstream infections (BSIs) are a major cause of morbidity and mortality in transplant recipients. The aim of this study is to describe the incidence, microbiology and outcomes of BSIs in transplant recipients in Spain. The Spanish Network for Research on Infection in Transplantation (RESITRA) is formed by 16 centers with transplant program in Spain. The incidence and characteristics of BSIs in transplant patients were obtained prospectively from the cohort. We included 3926 transplant recipients (2935 solid organ and 991 hematopoietic stem cell transplants). Overall, 730 episodes of BSIs were recorded with an incidence rate ranging from 3 episodes per 10 000 transplant days in kidney recipients to 44 episodes per 10 000 transplant days in allogeneic hematopoietic stem cell transplantation (HSCT). The most frequent sources were intravascular catheters and the most frequent microorganisms isolated were coagulase-negative staphylococci. Crude mortality of BSIs was 7.8%, being highest in liver recipients (16%). Multidrug resistant nonfermentative gram-negative BSIs had significantly worse prognosis than those caused by their susceptible counterparts (p = 0.015), but no differences were found between resistant and susceptible gram-negative enteric bacilli, S. aureus or Candida spp. BSIs are still a major concern in transplant recipients. The increasing isolations of multiresistant microorganisms represent a challenge for the next years.     

Risk Factors for Infection with Extended-Spectrum and AmpC β-Lactamase-Producing Gram-Negative Rods in Renal Transplantation

Increasing prevalence of infections caused by multi-resistant gram-negative enteric bacilli due to synthesis of extended-spectrum β-lactamase (ESBL) or to desrepressed chromosomic AmpC β-lactamase (AmpC) is a major concern in the hospitalized patient population . Renal transplant recipients are especially susceptible to these infections. A cohort observational study in a 3-year period was performed. ESBL-production was determined by phenotypic analysis based on the CLSI recommendations. A multi-variate logistic regression analysis was performed to identify independent variables associated with multi-resistant gram-negative bacilli infection. The study included 417 patients (61 double kidney-pancreas recipients). The incidence of ESBL-producing and desrepressed chromosomic AmpC β-lactamase resistance was 11.8% (49 patients). The most frequent bacteria isolated was E. coli (35/60 isolations), followed by Klebsiella spp (12/60 isolations). Double kidney-pancreas transplantation (OR 3.5, CI95% 1.6–7.8), previous use of antibiotics (OR 2.1,CI95% 1.1–4.1), posttransplant dialysis requirement (OR 3.1, CI95% 1.5–6.4) and posttransplant urinary obstruction (OR 5.8, CI95% 2.2–14.9) were independent variables associated with these multi-resistant gram-negative enteric bacilli infections. The incidence of ESBL-producing and desrepressed AmpC β-lactamase gram-negative enteric bacilli infection in our population was high. These infections are associated with significant morbidity after renal transplantation.     

泌尿外科住院患者中段尿培养病原菌分布及耐药性分析

目的 了解泌尿外科住院患者尿培养病原菌的分布和耐药性,为临床合理用药提供依据.方法 回顾性统计2014年1月至2015年6月本院泌尿外科患者中段尿培养的临床资料,进行耐药性分析.结果 泌尿外科共送检1624份尿标本,其中532份分离出病原菌,阳性率为32.76％.532份阳性标本共分离病原菌566株,其中革兰氏阴性杆菌449株,占79.33％,革兰氏阳性球菌93株,占16.43％,真菌24株,占4.24％.分离率居前五位的细菌分别是大肠埃希菌(53.53％)、屎肠球菌(5.65％)、铜绿假单胞菌(4.77％)、粪肠球菌(4.24％)、肺炎克雷伯菌(3.89％).大肠埃希菌对头孢菌素类、喹诺酮类、四环素类、磺胺类药物均表现为较高的耐药率;屎肠球菌对氨苄西林、高浓度庆大霉素、喹诺酮类药物耐药率较高.结论 泌尿外科住院患者尿培养病原菌以大肠埃希菌为主,细菌耐药情况严重,加强尿培养监测及定期对细菌耐药性进行总结分析对指导临床规范、合理使用抗菌药物具有非常重要的意义.     

重症急性胰腺炎细菌和真菌的分布状况研究

目的 探讨重症急性胰腺炎(SAP)患者细菌和真菌在不同部位的分布情况.方法 前瞻性分析2000年1月至2008年12月收治的符合入选标准的205例SAP患者的一般资料,计算患者发病4周内的胰腺坏死组织、体液和中心静脉导管的细菌、真菌培养感染率.每周对体液、胰腺坏死组织(脓液或腹腔内渗液)进行两次细菌和真菌培养;中心静脉导管留置2周时拔除行细菌和真菌培养;对高热患者(T≥39℃)的血液进行细菌和真菌培养.观察发病28 d内SAP患者细菌、真菌在不同部位以及整体构成比.结果 共检出病原菌937株,革兰阴性菌菌株数量多于革兰阳性菌和真菌(P<0.05),后两者感染率接近.坏死组织(55.2%)、胆汁(55.4%)、血液(68.1%)和中心静脉导管(44.4%)内革兰阴性菌感染率分别高于革兰阳性菌(30.2%、33.9%、23.4%、38.9%)和真菌(14.6%、10.7%、8.5%、16.7%)(P<0.05);尿液内真菌感染率(59.6%)高于革兰阴性菌(24.0%)和革兰阳性菌(16.3%)(P<0.05);痰液内革兰阴性菌感染率(53.2%)高于真菌(27.1%)和革兰阳性菌(19.7%)(P<0.05).坏死组织、胆汁、血液、中心静脉导管和痰液内非发酵菌(铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食假单胞菌)的感染率高于肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌(P<0.01);而尿液内发酵菌(大肠埃希菌、肺炎克雷伯菌)感染率高于非发酵菌(铜绿假单胞菌、鲍曼不动杆菌)(P<0.01).坏死组织和痰液内金黄色葡萄球菌、表皮葡萄球菌和溶血葡萄球菌感染率高于粪肠球菌和屎肠球菌(P<0.05);而胆汁和尿内屎肠球菌感染率显著高于其他革兰阳性球菌(P<0.05);血液内革兰阳性球菌之间差异无统计学意义,但中心静脉导管内的表皮葡萄球菌感染率显著升高(P<0.05).坏死组织、胆汁、尿液和痰液内假丝酵母菌感染率显著高于丝状菌(P<0.05).体液微生物培养感染率高峰在发病后2～3周.结论 不同部位革兰阴性菌、革兰阳性菌和真菌以及三者内部的构成比各异,三者感染高峰在发病后2～3周.     

肠外瘘并发腹腔感染的致病菌谱与耐药性分析

目的 研究肠外瘘并发腹腔感染的主要致病菌谱及致病菌对常用抗生素的耐药特点.方法 取226例肠外瘘并发腹腔感染患者的腹腔脓液进行细菌培养和抗生素药物敏感试验.结果 获取菌株520株,其中革兰阴性菌333株,革兰阳性菌180株,真菌7株.前10位的为大肠埃希菌131株,金黄色葡萄球菌62株,肠球菌59株,铜绿假单胞菌50株,肺炎克雷伯杆菌23株,鲍曼不动杆菌18株,阴沟肠杆菌17株,奇异变形杆菌15株,摩氏摩根菌15株,粪肠球菌12株.大肠埃希菌和肺炎克雷伯杆菌中表达超广谱13内酰胺酶阳性菌株分别为102株和17株.甲氧两林耐药金黄色葡萄球菌60株.结论 肠外瘘并发腹腔感染的致病菌谱以革兰阴性菌为主,超广谱β内酰胺酶阳性率较高;金黄色葡萄球菌则基本对甲氧西林耐药.     

Gram-positive cocci in the urinary tract. Do they influence the postoperative course of transurethral prostatectomy?]

The influence of gram-positive cocci on the postoperative course of transurethral prostatectomy was analysed on 463 patients. The half of isolated cocci was Enterococcus, followed by S. epidermidis and S. aureus. The rates of postoperative urinary infection by gram-negative bacilli were nearly the same for patients with preoperative gram-positive cocci infection and those without any of bacteria (3/79 vs. 9/310). Patients who developed new infection with gram-negative bacilli had fever, in contrast to patients with new gram-positive cocci infection. Gram-positive cocci prolonged the postoperative pyuria but not so long as gram-negative bacilli. All these findings suggest that infection caused by gram-positive cocci is not so severe as that caused by gram-negative bacilli.     

Pneumonia After Lung Transplantation in the Resitra Cohort: A Multicenter Prospective Study

The aim of the present study is to evaluate the epidemiology, etiology and prognosis of pneumonia in lung transplant (LT) recipients. This is a prospective, multicenter study of a consecutive cohort of LT recipients in Spain. From September 2003 to November 2005, 85 episodes of pneumonia in 236 LT recipients were included (incidence 72 episodes per 100 LT/year). Bacterial pneumonia (82.7%) was more frequent than fungal (14%) and viral pneumonia (10.4%). The most frequent microorganisms in each etiological group were Pseudomonas aeruginosa (n = 14, 24.6%), CMV (n = 6, 10.4%) and Aspergillus spp. (n = 5, 8.8%). Incidence of Aspergillus spp. and CMV pneumonia is lower than previously reported, probably due to the spread of universal prophylaxis. Pneumonia caused by viruses appeared significantly later than pneumonia due to gram-negative bacilli, fungi and those without known etiology (p < 0.01, p = 0.03 and p = 0.02, respectively). The routine use of ganciclovir has changed the natural history of CMV infection, so that pneumonia appears later, once prophylaxis is suspended. The probability of survival during the first year of follow-up was significantly higher in the multivariate analysis in LT recipients who did not have a pneumonia episode compared with those that had at least one episode (p < 0.01).     

����ǵ����ע��Һ�ڸ����е�����������������Һ�е�Ӧ��

目的分析重症加强治疗病房呼吸机相关性肺炎(VAP)的病原菌分布特点及变迁。方法对中国医科大学附属第一医院重症加强治疗病房(ICU)2003年1月至2006年12月间VAP病人的痰培养病原菌及药敏结果进行回顾性分析。结果4年中ICU中VAP发生率为19.1%。铜绿假单胞菌为最常见菌,洋葱伯克霍尔德菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌4年中均排在前6位。金黄色葡萄球菌在2003-2005年间逐年增加,2006年有所下降;脑膜败血黄杆菌在2005、2006年分离率明显下降;近两年肺炎克雷伯杆菌的分离率增加。2004年铜绿假单胞菌对多种抗生素耐药率高(均在75%以上)。4年中对亚胺培南的耐药率均超过40%。鲍曼不动杆菌对亚胺培南和左氧氟沙星耐药率较低,嗜麦芽窄食单胞菌对复方磺胺甲恶唑、环丙沙星和左氧氟沙星耐药率较低。分离出的金黄色葡萄球菌中,耐甲氧西林金黄色葡萄球菌(MRSA)所占比例高。结论铜绿假单胞菌、洋葱伯克霍尔德菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌等非发酵菌仍为VAP主要致病菌。4年中VAP致病菌的分布特点和耐药性发生了改变。     

Etiology of bacterial infections in febrile neutropenic patients: the role of the laboratory in the diagnosis

EPIDEMIOLOGICAL EVOLUTION: Until the mid-eighties, infectious complications (pneumonia, septicemia) observed in neutropenic patients were, in 70% of cases, of bacterial origin with Gram negative bacillae (Escherichia coli, Klebsiella sp, Pseudomonas aeruginosa) isolated 8 times out of 10. Among the Gram positive bacteria, Staphylococcus aureus predominated. The etiological profile of bacterial infections has since evolved with a predominance (60 to 70%) of Gram positive bacteria (coagulase-negative staphylococci, viridans streptococci) and a change in the epidemiology of the Gram positive bacteria notably with a lesser frequency of P. aeruginosa infections. THE GRAM POSITIVE BACTERIA: Coagulase-negative staphylococci are among the first germs responsible for nosocomial bacteremia (central venous catheters) and they are usually multiresistant. Viridans streptococci are a frequent cause of bacteremia; they are generally sensitive to antibiotics active on Gram positive bacteria, but the incidence of resistant strains is increasing. Enterococci are in majority responsible for colonisation in neutropenic patients and less frequently for infections; they raise the problem of resistance to antibiotics, notably to glycopeptides. Other Gram positive bacteria can be responsible for infections in neutropenic patients; it is crucial that they be identified because they require treatment with an appropriate antibiotic. GRAM NEGATIVE BACTERIA: Among the enterobacteria, Escherichia coli is predominantly isolated and raises the problem of the increasing incidence of resistance to fluoroquinolone. Pseudomonas aeruginosa, less frequently responsible today, remains associated with a far greater rate of mortality than that observed with the other microorganisms. Other Gram negative bacteria can be identified; they require an adapted antibiotherapy because they are often naturally multiresistant to antibiotics. THE ROLE OF THE LABORATORY: For the diagnosis of infections in neutropenic patients, the microbiology laboratory has a determinating role. The laboratory ensures the analysis of various biological examinations: blood cultures, methods permitting the diagnosis of an infection on a permanent catheter, copro-cultures (research for common enteropathogens, quantification in the case of digestive decontamination, screening for multiresistant bacteria), cytobacteriological examination of urine, samples of respiratory origin, cytobacteriological examination of cerebro-spinal fluid...).     

烧伤患者细菌耐药性的监测

目的 监测烧伤患者中细菌的耐药性,方法 （１）用纸片法进行药物敏感试验,并以有关临床实验室标准数值作为判断耐药标准。（２）用舒巴坦２０μｇ加入于４种头孢菌素纸片内,对多重药的铜绿假单胞菌及肺炎克雷伯村菌进行药敏试验,检测超广谱β－内酰胺酶的产生,并与未加舒巴坦的药敏纸片进行对照。结果 从烧伤患者中分离到细菌菌株２２７株,其中革兰阴性杆菌有１９５株,占８６％,经药敏试验显示各种细菌均有较高耐药性,且     

Antimicrobial activity of lidocaine against bacteria associated with nosocomial wound infection.

The authors characterized the in vitro antibacterial properties of clinical doses of lidocaine on isolates of a variety of bacterial pathogens commonly encountered in the setting of nosocomial wound infection (Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus) as well as a number of resistant strains of methicillin-resistant S. aureus and vancomycin-resistant enterococci. Time-kill studies were carried out on bacteria exposed to various clinical concentrations of lidocaine (0%, 1%, 2%, and 4%) with and without epinephrine (1:100,000). Minimum inhibitory concentrations and minimum bactericidal concentrations were determined for some strains using a broth macrodilution method recommended by the National Committee of Clinical Laboratory Standards. Lidocaine demonstrated a dose-dependent inhibition of growth for all strains of bacteria tested. The greatest sensitivity to lidocaine was shown by gram-negative organisms; the least sensitive was S. aureus. The addition of epinephrine to the local anesthetic had no effect on the susceptibility of the bacteria to lidocaine. These observations suggest that the surgical benefit of local anesthesia may extend beyond its analgesic properties and may have a role in the prophylaxis and, in the case of methicillin- and vancomycin-resistant bacteria, the treatment of surgical wound infection, mandating a wider application of this modality.     

急性胆道感染患者胆汁病原菌分布及耐药率变迁

目的探讨急性胆道感染患者胆汁病原菌分布和耐药率的变化趋势。方法回顾性分析2009年7月至2019年7月于上海交通大学医学院附属新华医院普通外科行胆囊穿刺或内镜下逆行胰胆管造影引流的223例急性胆道感染患者的临床资料,男性141例,女性82例,年龄67.3岁(范围:28~93岁)。每例患者抽取胆汁3~5 ml,送至检验科细菌培养室,对胆汁进行细菌培养、鉴定和药物敏感性试验。按照患者就诊时间分为前、后两组,前组(n=124)的收治时间为2009年7月至2014年7月,后组(n=99)的收治时间为2014年8月至2019年7月,对比两组患者的病原菌分布及常见细菌的耐药率变化趋势。采用WHO细菌监测网提供的WHONET软件对药物敏感性试验结果进行分析。不同时间段耐药率的比较采用χ²检验。结果本研究包括急性胆管炎患者147例,急性胆囊炎患者76例,共培养出病原菌376株。其中革兰阳性菌98株(26.1%),革兰阴性菌269株(71.5%),真菌9株(2.4%)。革兰阳性菌中前3位为屎肠球菌(49.0%,48/98)、粪肠球菌(20.4%,20/98)、铅黄肠球菌(7.1%,7/98);革兰阴性菌中前5位为大肠埃希菌(33.5%,90/269)、肺炎克雷伯菌(13.8%,37/269)、铜绿假单胞菌(13.0%,35/269)、鲍曼不动杆菌(12.6%,34/269)、阴沟肠杆菌(4.8%,13/269)。2009年至2019年急性胆道感染患者胆汁中革兰阳性菌(前组∶后组为25.3%∶28.2%)与革兰阴性菌(前组∶后组为74.7%∶71.8%)的比例无明显变化。革兰阳性菌以肠球菌属(85.7%,84/98)为主,革兰阴性菌以大肠埃希菌(33.5%,90/269)为主。前组中鲍曼不动杆菌占革兰阴性菌比例为7.8%(11/142),后组为18.1%(23/127),比例较前5年上升10.3%;铜绿假单胞菌在前组中比例为16.9%(24/142),后组为8.7%(11/127),比例下降8.2%;其余菌株变化不显著。常见革兰阴性菌中,肺炎克雷伯菌对大部分抗菌药物的耐药率呈上升趋势(前组:0/15~4/13,后组:55.0%~70.0%;χ²=3.996~16.942,P=0.000~0.046);鲍曼不动杆菌的耐药率总体较高,但在前、后两组中的耐药率无较大变化;铜绿单胞菌属对抗菌药物的耐药率有升有降;大肠埃希菌的总体耐药率较平稳,呈轻度上升趋势。结论急性胆道感染患者胆汁病原菌中以革兰阴性菌为主,2009年至2019年各种革兰阴性菌的构成比无明显变化,但耐药率呈上升趋势;革兰阴性菌中,大肠埃希菌是最主要病原菌,感染比例无明显变化,鲍曼不动杆菌的感染比例大幅上升,铜绿假单胞菌的感染比例呈下降趋势。     

Clostridium difficile colitis after kidney and kidney-pancreas transplantation

OBJECTIVE: To determine the timing and risk factors involved in the development of Clostridium difficile (CD) colitis in kidney and kidney-pancreas transplant recipients. BACKGROUND DATA: The incidence of CD colitis after kidney and kidney-pancreas transplantation has not been studied in detail. The question of whether the immunosuppressed transplant recipient is more prone to CD colitis and its complications (i.e., megacolon, perforations) and the risk factors involved have not been determined. METHODS: We retrospectively reviewed our experience in kidney and kidney-pancreas recipients who received transplants between January 1, 1985 and December 31, 1994. We divided these recipients into three groups: pediatric kidney recipients, adult kidney recipients, and kidney-pancreas recipients. For each group, we assessed the timing of infection, primary disease, colitis treatment, and any concurrent complications or risk factors. RESULTS: Of 1932 transplants, 159 recipients developed post-transplant CD colitis. 132 charts were available for review. Forty-three pediatric kidney recipients developed CD colitis. Their mean age was 3.2 yr; 74% (n = 37) of them developed their colitis during their initial hospital stay, with the mean timing of infection being 33 d. Forty-one (95%) had undergone intra-abdominal placement of the graft, with renal artery anastomoses to the aorta. Fifty adult kidney recipients developed CD colitis. Thirteen (26%) developed colitis during their initial hospital stay, with the mean timing of infection (for all adult kidney recipients) being 15 months. Thirty-nine kidney-pancreas recipients developed CD colitis. Mean timing of infection was 6 months. The overall incidence of CD colitis was 8%, with 16% in the pediatric kidney group, 15.5% in the kidney-pancreas group, and 3.5% in the adult kidney group. The difference in mean timing of infection was significant between the three groups (p < 0.001 for pediatric versus adult kidney recipients, p = 0.002 for pediatric kidney versus kidney-pancreas recipients, and p = 0.2846 for adult kidney versus kidney-pancreas recipients). CONCLUSION: The incidence of CD colitis is increased in pediatric kidney and kidney-pancreas recipients. Young recipient age ( < 5 yr), female gender, treatment of rejection with monoclonal antibodies, antibiotic use, and intra-abdominal graft placement have been shown to increase the incidence of this disease. Further studies concerning prevention in the high-risk groups are needed.     

Selective bowel decontamination results in gram-positive translocation

Colonization by enteric gram-negative bacteria with subsequent translocation is believed to be a major mechanism for infection in the critically ill patient. Selective bowel decontamination (SBD) has been used to control gram-negative infections by eliminating these potentially pathogenic bacteria while preserving anaerobic and other less pathogenic organisms. Infection with gram-positive organisms and anaerobes in two multivisceral transplant patients during SBD led us to investigate the effect of SBD on gut colonization and translocation. Methods: Twenty-four rats received enteral polymixin E, tobramycin, amphotericin B, and parenteral cefotaxime for 7 days (PTA + CEF); 23 received parenteral cefotaxime alone (CEF), 19 received the enteral antibiotics alone (PTA), 21 controls received no antibiotics. Cecal homogenates, mesenteric lymph node (MLN), liver, and spleen were cultured. Results: Only 8% of the PTA + CEF group had gram-negative bacteria in cecal culture vs 52% CEF, 84% PTA, and 100% in controls. Log Enterococcal colony counts were higher in the PTA + CEF group (8.0 + 0.9) vs controls (5.4 + 0.4) P less than 0.01. Translocation of Enterococcus to the MLN was significantly increased in the PTA + CEF group (67%) vs controls (0%) P less than 0.01. SBD effectively eliminates gram-negative organisms from the gut in the rat model. Overgrowth and translocation of Enterococcus suggests that infection with gram-positive organisms may be a limitation of SBD.     

Evolving trends in multiple-antibiotic-resistant bacteria in liver transplant recipients: A longitudinal study of antimicrobial susceptibility patterns

The incidence, sources, impact on outcome, and temporal trends in multiple-antibiotic-resistant bacteria in liver transplant recipients over the last decade (from 1990 through 1999) were assessed. Of 165 consecutive patients who underwent transplantation, 31% (51 of 165 patients) had at least 1 infection caused by multiple-antibiotic-resistant bacteria. Overall, 69% (66 of 96 infections) of all bacterial infections were multiple-antibiotic resistant. Ninety-one percent (45 of 49 isolates) of the Staphylococcus aureus isolates, 50% (6 of 12 isolates) of the enterococci, and 54% of the gram-negative bacteria (47%; 7 of 15 Pseudomonas aeruginosa, and 60%; 12 of 20 Enterobacteriaceae) were multiple-antibiotic resistant. A significant trend toward an increase in infections caused by multiple-antibiotic-resistant bacteria (P = .003), largely caused by an increase in gram-positive infections, was documented through the decade. There was a significant increase in infections caused by methicillin-resistant S aureus (P = .0001) and vancomycin-resistant enterococci (P = .04) over time. The proportion of gram-negative isolates that were multiple-antibiotic resistant (P = .447) did not increase significantly over time. However, a strikingly high frequency of resistance to piperacillin or ceftazidime suggests that extended-spectrum β-lactamase production in our Enterobacteriaceae may have been more prevalent than realized. Mortality at 1 year was significantly greater in patients with multiple-antibiotic resistant bacteria compared with all other patients (P = .001). These longitudinal trends have implications not only for guiding therapeutic practices, but ultimately for devising strategies to curtail multiple-antibiotic resistance in liver transplant recipients. (Liver Transpl 2001;7:22-26.)     

Characterization of the organ donor with bacteremia

INTRODUCTION: The presence of bloodstream infection in the donor is a common finding that could be transmitted to the recipient. To safely expand the donor pool, we examined its relevance. MATERIALS AND METHODS: We described the clinical characteristics of organ donors grafted in our center between 1997 and 2006 who had bacteremia detected in blood cultures obtained during organ procurement. RESULTS: Among 1353 organ donors, 75 were non-heart-beating donors type II and the others brain-dead donors. Only 186 donors (14%) showed bacteremia during retrieval. This mean age was 49.8 years (range 12 to 86 years, SD 18) including 63% men. Causes of death were cerebrovascular accident in 60%; craneoencephalic trauma, 25%; and other causes, 15%. The average length of the intensive care unit stay was 3 days (interquartile range: 2 to 7 days). Twenty-nine percent of donors presented previous infectious complications (90% from respiratory origin). The most prevalent pathogen isolated in blood cultures was coagulase negative Staphylococci (46,2%), followed by S aureus (15%), Streptococcus group viridans (9.1%), enterobacteria (9%), Enterococcus faecalis (7.5%) and gram-negative bacilli nonfermentative (6.2%). In 3.1%, the bloodstream infections were polymicrobial. The bronchial aspiration cultures were positive in 50% of cases and the urine culture in 8,6%. In 17% of donors the isolated microorganism was coincident between blood and bronchial cultures. Pseudomonas spp and S aureus were more common than the others (P = .004 and P = .058, respectively). CONCLUSIONS: The incidence of bacteremia in our cohort was 14%. The respiratory tract was the most common clinical focus. Pseudomonas spp or S aureus isolated in bronchial cultures are risk factors to develop bacteremia. According to these findings, it is important to start specific antibiotics against those microorganisms in the donor and the recipients.     

Bacterial and fungal pneumonias after lung transplantation

OBJECTIVE: The aim of this study was to evaluate the epidemiology of bacterial and fungal pneumonia in lung transplant (LT) recipients and to assess donor-to-host transmission of these microorganisms. MATERIALS AND METHODS: We retrospectively studied all positive cultures from bronchoalveolar lavage (BAL) of 49 lung transplant recipients and their donors from August 2003 to April 2007. RESULTS: There were 108 episodes of pneumonia during a medium follow-up of 412 days (range, 1-1328 days). The most frequent microorganisms were: Pseudomonas aeruginosa (n = 36; 33.3%), Staphylococcus aureus (n = 29; 26.8%), and Aspergillus spp. (n = 18; 16%). Other fungal infections were due to Fusarium spp., Cryptococcus neoformans, and Paracoccidioides brasiliensis. Of the 31 donors with positive BAL, 15 had S. aureus. There were 21 pretransplant colonized recipients (43%) and 16 of them had suppurative underlying lung disease. P. aeruginosa was the most frequent colonizing organism (59% of pretransplant positive cultures). There were 11 episodes of bacteremia and lungs were the source in 5 cases. Sixteen deaths occurred and 6 (37.5%) were due to infection. Statistical analyses showed association between pretransplant colonizing microorganisms from suppurative lung disease patients and pneumonias after lung transplantation (RR = 4.76; P = .04; 95% CI = 1.02-22.10). No other analyzed factor was significant. CONCLUSIONS: Bacterial and fungal infections are frequent and contribute to higher mortality in lung transplant recipients. P. aeruginosa is the most frequent agent of respiratory infections. This study did not observe any impact of donor lung organisms on pneumonia after lung transplantation. Nevertheless, we demonstrated an association between pretransplant colonizing microorganisms and early pneumonias in suppurative lung transplant recipients.     

Bactericidal activity of Trovafloxacin and Moxifloxacin against Gram-negative anaerobic bacilli

Anaerobes are often involved in human pathology, including oral infections. The therapy of anaerobic infection requires certain antibiotics such as: metronidazole, tetracycline or amoxicillin. But the incidence of resistant strains among anaerobes is continuously increasing and it is necessary to find some new agents effective against these bacteria. The aim of our study was to establish the bactericidal activity of two new quinolones against 14 strains of gram-negative anaerobic bacilli. The MIC of tested strains was first detected and then time-kill kinetics was determined by using Miles and Misra methodology. Ciprofloxacin was used as standard-quinolone. The results show that trovafloxacin and moxifloxacin have good activity against anaerobes, better than that of ciprofloxacin. Bactericidal curves suggest a rapid action of moxifloxacin (within the first 4 hours), but a prolonged cidal activity for trovafloxacin (24 hours). For both agents, the antimicrobial effect is concentration-dependent. As previous studies suggest, the new quinolones have good activity against both aerobic and anaerobic bacteria so they are useful in the treatment of mixed infections (common feature of anaerobic infections).     

������Ⱦ��ԭ������Կ����������Ա仯���о�

目的了解胆道感染时胆汁中致病菌菌群及其对抗生素敏感性的变化,为临床选择用药提供参考和依据。方法将2002年1月至2003年12月培养阳性的264例胆汁标本323株病原菌及药敏结果进行统计分析。结果323株细菌中包含了52种细菌,其中革兰阴性杆菌占594%,革兰阳性球菌占406%。排列前6位的细菌依次为肠球菌220%,大肠埃希菌195%,克雷白菌属118%,葡萄球菌属108%,假单孢菌属87%,肠杆菌属84%。59例混合感染中,大肠埃希菌和铜绿假单孢菌各占12例和10例。细菌对青霉素类、头孢类、喹诺酮类、大环内酯类抗生素敏感性普遍下降,对亚胺培南、美罗培南、万古霉素、替考拉宁仍保持相当高的敏感率。阿米卡星对细菌敏感性也较高,尤其对铜绿假单孢菌有效率仍达687%。结论胆道感染致病菌菌群不断在改变,细菌数量和种类在增加,其对药物敏感性普遍下降;治疗胆道感染应动态监测菌群和药物敏感性的变化及合理应用抗生素。     

胰十二指肠切除术后腹腔感染的临床研究

目的探讨胰十二指肠切除术后腹腔内微生物感染的特点及术后腹腔感染发生的影响因素。方法回顾性分析2008年9月至2013年9月期间笔者所在医院施行的200例胰十二指肠切除术患者的临床资料,探讨胰十二指肠切除术后腹腔内微生物感染的特点及术后腹腔感染发生的影响因素。结果 200例患者中,有78例患者腹腔引流液标本细菌培养结果呈阳性,其中42例（21.0%）患者符合腹腔感染的诊断标准。术后腹腔引流液经微生物培养,共分离出菌株185株,其中革兰阳性球菌64株,占34.6%;革兰阴性杆菌103株,占55.7%;真菌18株,占9.7%。培养菌株数量在前5位的细菌依次为金黄色葡萄球菌（31株）、铜绿假单胞菌（28株）、大肠埃希菌（22株）、肺炎克雷伯菌（18株）和屎肠球菌（14株）。病原菌大多呈多重耐药。铜绿假单胞菌对亚胺培南的耐药率达60.7%（17/28）。大肠埃希菌和肺炎克雷伯菌中超广谱β-内酰胺酶（ESBLs）的检出率分别为22.7%（5/22）和33.3%（6/18）。金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为45.2%（14/31）。多因素logistic回归分析结果显示,胰瘘（OR=16.252,P=0.003）和肺部感染（OR=2.855,P=0.017）是腹腔感染发生的独立危险因素,胰瘘分级重、有肺部感染者的腹腔感染率较高。结论胰十二指肠切除术后腹腔引流液的微生物培养结果以革兰阴性杆菌为主,大多数细菌呈多重耐药;积极防治胰瘘和肺部感染可降低腹腔感染的发生率。