麻醉科医务人员鼻、咽部机会致病菌携带情况调查与干预

目的了解麻醉科医务人员鼻、咽部带菌情况,以加强对麻醉科医务人员医院感染的预防与控制。方法采用常规方法对在麻醉科工作的28名医务人员分别进行鼻前庭或咽拭子培养和菌种鉴定及抗生素敏感度检测。结果从14份咽拭子中分离到肺炎克雷伯菌1株,对氨苄青霉素和氧哌嗪青霉素耐药。14份鼻前庭拭子中分离到表皮葡萄球菌8株,对多种抗生素耐药,金黄色葡萄球菌1株,对红霉素耐药。结论麻醉科医务人员鼻前庭机会致病菌携带率较高,表皮葡萄球菌对抗生素耐药率高,应建立麻醉科医务人员医院感染监测和预警制度,提高麻醉科医务人员的职业劳动保护意识和从源头上更好地控制医院感染的发生。     

医务人员鼻前庭携带革兰阳性菌及其耐药性分析

摘要 目的 <\b>研究医务人员鼻前庭标本分离的革兰阳性菌及其耐药特点。方法 <\b>通过对医务人员鼻前庭标本分离鉴定和药敏试验方法,对天津市部分医院医务人员鼻前庭带菌状况及其耐药性进行检测与分析。结果 <\b>共采集天津市医院的医务人员鼻前庭标本1 030人份,共检出革兰阳性菌553株,平均检出率为53.69%。检出的革兰阳性球菌中,多重耐药菌占42.50%;检出数居首位的表皮葡萄球菌中,多重耐药菌比例更高。医务人员鼻前庭分离的革兰阳性球菌对临床常用抗菌药物不同程度产生耐药,发现部分菌株出现对万古霉素耐药。结论 <\b>天津市医院的医务人员鼻前庭携带革兰阳性菌比例较高,多重耐药菌占40%以上,耐药情况普遍,建议加强对医务人员鼻前庭带菌及其耐药性监测并采取控制措施。     

耐甲氧西林金黄色葡萄球菌感染的流行病学及耐药性研究

目的了解耐甲氧西林金黄色葡萄球菌感染的流行病学及耐药性。方法采用回顾性调查方法,对本医院住院患者22850份不同标本培养结果进行统计分析。结果在22250份不同标本中,检出3504株金黄色葡萄球菌,其中耐甲氧西林菌株3245株,占92.61%,其分离率有逐年增长的趋势(P0.05)。在痰、血、尿等3种标本中,分离到耐甲氧西林金黄色葡萄球菌的构成比分别为94.98%、3.08%、1.94%。该菌株对临床常用15种抗生素的耐药率为70%以上,但对万古霉素的敏感率为100%。结论耐甲氧西林金黄色葡萄球菌在医院感染病人标本中分离率较高,以痰标本检出率最高;该菌株对临床常用抗生素70%以上耐药,已成为老年患者医院感染的主要致病菌。     

SARS患者继发G+球菌感染的分离和耐药性分析

目的分析SARS患者继发G+球菌感染的细菌谱和耐药性.方法选择我院收治的SARS患者的痰、气管分泌物、血、引流液和尿液培养出的G+球菌为研究对象,并对此作药敏分析.结果分离的54株G+球菌中表皮葡萄菌的分离率为40.7%,人葡萄球菌为16.6%,溶血葡萄球菌为11.1%,少见葡萄球菌为11.1%.耐药性分析显示各类葡萄球菌对青霉素类、亚胺硫霉素均耐药;对环丙氟哌酸、复方新诺明的耐药率也很高,万古霉素仍是各类G+球菌最敏感的抗生素,仅1株表皮葡萄球菌和1株溶血葡萄球菌对万古霉素耐药.结论G+球菌在SARS患者的继发细菌感染中很常见,对大部分抗生素耐药,万古霉素可作为首选抗生素.     

医护人员鼻前庭带菌情况及其耐药性研究

摘要 目的 了解天津市医疗机构医护人员鼻前庭部带菌情况及其耐药性。方法 采用现场采样、细菌分离鉴定技术和药敏试验方法,对天津市医疗机构部分医护人员鼻前庭带菌情况及其耐药性进行研究。结果 1 085名医护人员鼻前庭带菌率为72.53%,其中女性组带菌率显著低于男性组,低学历组带菌率低于其他两组,春夏季带菌率明显低于秋季。检出的908株致病菌中,革兰阴性菌269株,革兰阳性菌639株,革兰阴性菌耐药性最高的是氨苄西林(82.90%),其次是头孢唑林(50.93%)、四环素(21.56%)和头孢噻肟(15.61%),对左氧氟沙星、诺氟沙星和庆大霉素等耐药率较低。革兰阳性菌总体耐药率为78.40%,89株金黄色球葡萄菌中,12株为耐甲氧西林金黄色葡萄球菌(MRSA),7株金黄色葡萄球菌对万古霉素耐药。结论 天津市医疗机构医护人员鼻前庭带菌情况严重,且对主要抗菌药物耐药率较高,应加强医护人员鼻前庭卫生清洁,减少由鼻前庭带菌所致医院感染的发生。     

某三甲医院住院患者鼻前庭带菌情况调查

目的了解医院住院患者鼻前庭定植细菌的种类及其耐药情况。方法采用棉拭涂抹采样和细菌检测分离鉴定方法,对某三甲医院住院患者的鼻前庭定植菌进行了检测。结果在2010年5月的某日共采集433例住院患者鼻前庭标本,检出阳性标本385份,总带菌率为88.9%。共分离出456株菌,其中革兰阳性球菌412株,革兰阴性杆菌39株,真菌5株。主要致病菌种类有凝固酶阴性葡萄球菌369株,耐甲氧西林的金黄色葡萄球菌16株;肠杆菌科细菌22株,铜绿单胞杆菌10株,鲍曼不动杆菌7株,白色念珠菌5株。结论该医院住院患者鼻前庭细菌携带率较高,以革兰阳性球菌为主,凝固酶阴性葡萄球菌所占比重最高。     

某医院患者感染创面检出葡萄球菌分布与耐药性分析

目的研究患者创面感染葡萄球菌分布及其耐药性情况,为临床合理选用抗菌药物提供依据。方法采用细菌分离培养和药敏试验方法,对某医院临床送检创面感染标本葡萄球菌进行检测与分析。结果从该医院临床送检的患者创面标本中共检出葡萄球菌224株,包括金黄色葡萄球菌128株和表皮葡萄球菌96株。创面分离的表皮葡萄球菌对所试验的34种常用抗菌药物中的10种耐药率均超过50%;金黄色葡萄球菌仅对青霉素G耐药率超过50%。两种葡萄球菌对万古霉素、吗啉恶酮、利奈唑胺和奎奴普汀/达福普汀全部敏感。结论该医院临床创面标本金黄色葡萄球菌分离率较高,但表皮葡萄球菌耐药更普遍且耐药率更高,提示加强监测和药敏试验。     

1069株葡萄球菌耐药状况分析

[目的]了解我院医院感染葡萄球菌耐药状况。[方法]将分离到的葡萄球菌采用K—B法做药敏试验，按CLSI／NC—CLS 2000标准判断结果。[结果]2001年1月～2005年12月共检出葡萄球菌1069株，其中金黄色葡萄球菌594株，对苯唑西林耐药532株，耐药率为89．56％；表皮葡萄球菌308株，对苯唑西林耐药237株，耐药率为76．94％；溶血性葡萄球菌161株，对苯唑西林耐药132株，耐药率为81．99％。检出的葡萄球菌对青霉素、红霉素、克林霉素、复合磺胺均呈高度耐药，只有万古霉素100％敏感。[结论]了解医院感染葡萄球菌的耐药状况，对临床合理选择抗生素十分重要，万古霉素可作为葡萄球菌重症感染的首选药物。     

天津市部分医院医护人员鼻前庭携带革兰阴性菌耐药性观察

目的了解天津市部分二级以上医院医护人员鼻前庭携带革兰阴性菌耐药情况,以加强医院感染的预防与控制。方法通过直接采集医护人员鼻前庭标本进行分离鉴定,对分离菌株作药敏试验,观察重点科室医护人员的鼻前庭带菌及其耐药情况。结果在2007-2009年调查期间,共检测587人份标本,107人份标本检出革兰阴性杆菌,医务人员鼻前庭革兰阴性杆菌携带率为18.23%,共检出革兰阴杆菌135株。在检出的革兰阴性杆菌中,主要优势菌为肺炎克雷伯菌和产气肠杆菌,占64.44%。药敏试验显示,革兰阴性杆菌多数对氨苄西林和头孢唑啉耐药,对庆大霉素较敏感。结论天津市医护人员鼻前庭携带的革兰阴性杆菌对抗生素耐药较严重,应加强医护人员自身感染因素管理,采取有效措施加以控制。     

IS256与医院感染表皮葡萄球菌耐氨基糖苷类抗菌药物的关系

目的了解医院感染表皮葡萄球菌对不同类型氨基糖苷类抗菌药物的敏感特征,分析插入序列(IS)256与表皮葡萄球菌耐氨基糖苷类抗菌药物的关系。方法收集2007年2月至2007年7月外科病区中引起医院感染的表皮葡萄球菌48株,利用纸片扩散法测定细菌对4种氨基糖苷类抗菌药物(庆大霉素、奈替米星、链霉素和阿米卡星)药敏特征;构建IS256特异性引物,利用聚合酶链反应(PCR)检测48株细菌中IS256分布状况。结果48株临床分离的表皮葡萄球菌对4种氨基糖苷类抗菌药物的药敏特征分别为:对庆大霉素的耐药率为69%,敏感率为31%;对奈替米星的耐药率为8%,敏感率为79%,中介率为13%;对链霉素的耐药率为42%,敏感率为35%,中介率为23%;对阿米卡星的耐药率为15%,敏感率为75%,中介率为10%。全部临床分离株中,有25株细菌检出IS256。在庆大霉素耐药菌株中,IS256检出率高达70%,与敏感菌相比差异具有统计学意义(P<0.01);而对其他3种抗菌药物耐药的菌株中,IS256的检出与耐药无明显相关性(P>0.05)。结论表皮葡萄球菌临床分离株对氨基糖苷类抗菌药物存在不同程度耐药。IS256与表皮葡萄球菌对庆大霉素耐药密切相关。     

早孕宫颈拭子166株表皮葡萄球菌耐药性与SCCmec分型

  目的   了解2015－2017年从北京市朝阳区早孕宫颈拭子中分离的166株表皮葡萄球菌耐药性与耐药基因携带情况以及葡萄球菌染色体mec盒（SCCmec）型别,为合理用药及预防感染提供依据。  方法  回顾性分析2015－2017年从北京市朝阳区早孕宫颈拭子中分离的166株表皮葡萄球菌耐药情况,分别采用K-B法对头孢西丁,微量肉汤稀释法对其他11种抗菌药物进行药敏试验,采用聚合酶链式反应（PCR）对红霉素类、喹诺酮类、磺胺类、氨基糖苷类、大环内酯类、四环素类耐药基因和SCCmec的基因型和亚型进行检测,使用SPSS 22.0软件,用χ2检验对表皮葡萄球菌耐药率和耐药基因携带情况进行统计分析。  结果  166株表皮葡萄球菌药敏试验结果对万古霉素100.00% 敏感、对达托霉素93.37% 敏感,对青霉素、苯唑西林、红霉素的耐药率在90%以上,对其他抗菌药物均有不同程度的耐药;多重耐药比例为72.89%;mecA基因携带率45.78%;耐药基因携带率以norA1（100.00%）和norA2（95.78%）较高,其次为msrA（71.08%）;76株mecA阳性表皮葡萄球菌中,以SCCmecⅢ型（40.79%）为主,其次为SCCmecⅤ型（22.37%）。  结论  健康人群早孕宫颈拭子表皮葡萄球菌的携带率超过50%,耐甲氧西林的表皮葡萄球菌菌株比例达24.70%,有必要回溯往期孕期妇女宫颈分泌物携带菌株分型及耐药情况,对多重耐药菌株需长期加大抗生素监管,以减少耐药菌株产生,降低新生儿败血症感染风险。     

表皮葡萄球菌败血症96例临床分析

目的：探讨表皮葡萄球菌（表葡菌）败血症的临床特点和防治方法。方法：对９６例表葡菌败血症的临床资料进行分析。结果：表葡菌败血症多见地婴幼儿，部分还有基础疾病及并发症。原发病灶以呼吸道和皮肤粘膜为多，表葡菌时多种抗生素对耐药，结论：环丙沙星是治疗表葡菌败血症较敏感药物，可选用环丙沙星及阿米卡星，庆大霉素等联合进行初步治疗，然后根据药敏结果及时调整。     

Evolution of nasal carriage of methicillin-resistant coagulase-negative staphylococci in a remote population

Nasal carriage of methicillin-resistant coagulase-negative staphylococci (MR-CoNS) is highly prevalent in community subjects, but its dynamic has been little investigated. Nasal swabbing was performed in 2006 and 2008 in 154 Amerindians living isolated in French Guiana. MR-CoNS strains were identified and characterized by non-β-lactam susceptibility testing and staphylococcal cassette chromosome mec element (SCCmec) typing, characterizing the associations of ccr and mec gene complex allotypes, and for MR Staphylococcus epidermidis (MRSE), multilocus variable number of tandem repeats analysis (MLVA) was used. The impact of sociodemographic and medical characteristics on the persistence of MR-CoNS carriage was assessed by bivariate analysis. Prevalence of MR-CoNS carriage was 50.6% in 2006 and 46.8% in 2008. The 274 MR-CoNS isolates, including S. epidermidis (n = 89, 62 MLVA patterns), Staphylococcus haemolyticus (n = 78), and Staphylococcus hominis (n = 72), exhibited 41 distinct ccr and mec gene complex associations. Persistent carriage (in 2006 and 2008), intermittent carriage (either in 2006 or 2008), and noncarriage were documented in 25.3, 47.4, and 27.3% of the participants, respectively. Persistent carriage of a given MRSE isolate was rarely observed (n = 8 isolates). Furthermore, no epidemiological factor, including antibiotic exposure, was associated with persistent carriage. The high diversity of MRSE clones and their ccr and mec gene complex associations contrasted with the high carriage rates in this isolated community, which might reflect the occurrence of SCCmec rearrangement and the generation of new MR-CoNS strains.     

Multiplex PCR assays for the detection of clinically relevant antibiotic resistance genes in staphylococci isolated from patients infected after cardiac surgery. The ESPRIT Trial

Multiresistant staphylococci (82 Staphylococcus aureus and 114 coagulase-negative staphylococci) were characterized by testing with rapid multiplex polymerase chain reaction (PCR) assays for species identification and detection of associated antibiotic resistance genes. These 196 staphylococci were isolated from 149 adult patients who developed wound infection after elective coronary artery bypass grafts and/or valve surgery. The multiplex PCR assays allowed identification of the most common staphylococcal species with S. aureus- and Staphylococcus epidermidis-specific primers as well as the detection of the erythromycin resistance genes ermA, ermB, ermC and msrA, the aminoglycoside resistance gene aac(6')-aph(2"), the oxacillin resistance gene mecA and the penicillin resistance gene blaZ. There was a very good correlation between the genotypic analysis by PCR and the phenotype determined by standard methods of susceptibility testing and identification of staphylococcal species: 100% for erythromycin resistance, 98.0% for gentamicin resistance, 99.0% for oxacillin resistance, 100% for penicillin resistance and 100% for S. aureus and S. epidermidis species identification. This study suggests that the incidence and distribution of the tested clinically relevant antibiotic resistance genes in staphylococci associated with infections after cardiac surgery do not differ from those in strains from other infections. These multiplex PCR assays may be used as diagnostic tools to replace or complement standard methods of susceptibility testing and identification of staphylococci.     

Bacterial colonization or infection in chronic sinusitis

The aim of this study was the determination of bacteria present in maxillary and ethmoid cavities in patients with chronic sinusitis and to correlate these findings with bacteria simultaneously present in their nasopharynx. The purpose of this correlation was to establish the role of bacteria found in chronically inflamed sinuses and to evaluate if the bacteria present colonized or infected sinus mucosa. Nasopharyngeal and sinus swabs of 65 patients that underwent functional endoscopic sinus surgery were cultivated and at the same time the presence of leukocytes were determined in each swab. The most frequently found bacteria in nasopharynx were Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp., Streptococcus viridans and Streptococcus pneumoniae. Maxillary or ethmoidal sinus swabs yielded bacterial growth in 47 (72.31%) patients. The most frequently found bacteria in sinuses were Staphylococcus epidermidis, Staphylococcus aureus, Klebsiella spp. and Streptococci (pneumoniae, viridans and spp.). The insignificant number of leukocytes was present in each sinus and nasopharyngeal swab. Every published microbiology study of chronic sinusitis proved that sinus mucosa were colonized with bacteria and not infected, yet antibiotic therapy was discussed making no difference between infection and colonization. Chronic sinusitis should be considered a chronic inflammatory condition rather than bacterial infection, so routine antibiotic therapy should be avoided. Empiric antibiotic therapy should be prescribed only in cases when the acute exacerbation of chronic sinusitis occurs and the antibiotics prescribed should aim the usual bacteria causing acute sinusitis. In case of therapy failure, antibiotics should be changed having in mind that under certain circumstances any bacteria colonizing sinus mucosa can cause acute exacerbation of chronic sinusitis.     

陕西省ST4821克隆群的B群 脑膜炎奈瑟菌的发现

目的 针对一起流行性脑脊髓膜炎疫情的处理,对患者标本及其接触者进行脑膜炎奈瑟菌检验,了解感染原因、分析密切接触者的脑膜炎奈瑟菌携带情况及菌株的分子流行病学特征。 方法 对患者标本和接触者的咽拭子标本同时进行分离培养并提取核酸,PCR检测脑膜炎奈瑟菌;分离菌株和患者血清核酸进行血清分群及多位点序列分型(MLST)分析。 结果 患者血清及4份咽拭子标本核酸检测ctrA基因阳性。其中密切接触者中分离到3株脑膜炎奈瑟菌;患者血清标本及分离菌株均为B群脑膜炎奈瑟菌;MLST分型显示患者血清为ST4821序列型、其余3株细菌分别为ST7623、ST4821、ST5586。 结论 实验显示一种高致病性的ST4821型脑膜炎奈瑟菌已存在于陕西省健康人群中并引发感染病例致患者死亡,应全面了解本地区脑膜炎奈瑟菌的健康携带和病例状况。     

静脉导管病原菌感染及耐药性分析

目的：探讨该院静脉导管相关性感染的病原菌分布及耐药状况,为临床合理使用抗菌药物提供依据。方法回顾性分析2009年1月至2012年12月该院送检的369份静脉导管标本的细菌培养和药敏结果。结果369份静脉导管标本中,共分离病原菌161株,阳性率为43．6％,革兰阳性菌83株,占51．6％,其中表皮葡萄球菌分离最高;革兰阴性杆菌63株,占39．1％,其中以肺炎克雷伯菌和鲍曼不动杆菌为主;真菌15株,占9．3％,以近平滑念珠菌分离最多。未检出耐万古霉素和耐利奈唑胺的革兰阳性球菌,碳青霉烯类抗菌药物对革兰阴性杆菌有较好的抗菌活性。结论该院表皮葡萄球菌和肺炎克雷伯菌是静脉导管感染的主要病原菌,应引起重视。     

广东省深圳市健康人群肺炎链球菌带菌调查及耐药分析

目的了解深圳市健康人群肺炎链球菌(Sp)的带菌状况,分析Sp的耐药性,为制定有效的预防和临床用药方案提供依据。方法将健康人群分为0～、5～、15～、25～和60～岁5个年龄组,采集鼻咽拭子,分离、鉴定Sp,用全自动生化及药敏鉴定分析仪测定Sp的抗生素敏感性。结果深圳市健康人群Sp带菌率为7.7%(40/521),0～、5～、15～、25～和60～岁5个年龄组分别为13.3%、11.7%、5.0%、3.1%、2.4%。所有菌株对盖替沙星、莫西沙星、力奈唑烷、万古霉素、利福平敏感;对青霉素G、复方新诺明、红霉素、四环素耐药性高,分别为52.5%、72.5%、92.5%、95.0%,有多重耐药现象。结论深圳市健康人群鼻咽部Sp携带率为7.7%,Sp菌株对大环内酯类、磺胺类、青霉素类药物耐药情况严重,在临床和预防用药时,应慎重使用。     

放化疗后肿瘤患者并发医院血流感染38例分析

目的研究放化疗后肿瘤患者并发医院血流感染情况，为临床合理选用抗生素提供依据。方法选取2001年11月-2004年03月患恶性肿瘤并发医院血流感染者38例，对其血液中病原菌种类及药敏情况进行分析。结果感染病原菌依次为大肠埃希菌、克雷伯菌属、表皮葡萄球菌、金黄色葡萄球菌及真菌等。革兰阴性菌及革兰阳性菌对青霉素及头孢菌素类均不同程度耐药。38例医院血流感染好转率55．3％．病死率39．5％。结论放化疗后肿瘤患者医院血流感染病原菌主要为大肠埃希菌、克雷伯菌属、真菌及葡萄球菌等。其血流感染临床表现不典型，具有隐匿性特点。故对肿瘤放化疗患者应合理选用抗菌药物，重视血流细菌感染及细菌耐药性监测工作，提高抗菌药物合理使用水平。     

Report of a case with polymicrobial endocarditis related to multiresistant strains

We present a patient with polymicrobial endocarditis who had been operated on previously for a mycotic aneurysm and was seen at the cardiology clinic because of palpitations related to effort. A transesophageal echocardiogram revealed a 15-mm vegetation on his aortic valve. Staphylococcus epidermidis and Corynebacterium striatum were isolated from the blood cultures. Both strains were multiresistant (susceptible to 3 antibiotics at most) against chemotherapy in vitro. Microbiological eradication was not achieved from blood cultures even after applying antimicrobial therapy with effective antibiotics as determined with an antibiotic susceptibility test. For this reason, the patient underwent valve replacement. He was discharged from hospital in fairly good health.