我院重症监护室铜绿假单胞菌感染趋势及其耐药性分析

目的 铜绿假单胞菌(Pseudomonas aeruginosa,PA)为院内感染的重要代表菌及临床分离率较高的菌株,在我院PA占所有菌株检出率的24.5%、占革兰阴性杆菌检出率的35.4%.通过对我院2006年1月-2009年6月期间4个重症监护室铜绿假单胞菌的感染情况及其耐药性进行分析,并与同期非重症监护室的病区进行比较,分析PA产碳青霉烯酶水解碳青霉烯类抗生素后同时携带多种耐药基因对其他药物敏感性的影响.方法 采用Micro Scan全自动细菌鉴定和药敏分析仪,数据的分析采用WHONET软件.结果 4年间我院重症监护室铜绿假单胞菌检出数为559株,依次为:内科ICU 272株、外科ICU 149株、急诊ICU 126株、儿科ICU 12株.药敏结果显示:铜绿假单胞菌对大部分抗生素的敏感性呈逐年下降的趋势,尤其是重症监护室感染菌株.PA对碳青霉烯类抗菌素耐药的菌株产生多重甚至广泛耐药的几率较高.结论 4年间我院重症监护室铜绿假单胞菌对抗生素的耐药状况严重,尤其对头孢菌素.氨基糖苷类抗生素耐药率明显增加.对亚胺培南的耐药株同时携带多种耐药机制,产生多重耐药甚至泛耐药.多重耐药株和泛耐药株的检出亦呈逐年上升的趋势.     

医院感染铜绿假单胞菌脉冲场凝胶电泳分析

目的确定铜绿假单胞菌不同基因型与抗菌谱的联系,以追踪院内感染中铜绿假单胞菌菌株在分子水平上的相关性。方法对2002年1月～2004年12月自该院住院患者各种标本中分离获得216株铜绿假单胞菌,用脉冲场凝胶电泳分析耐亚胺培南铜绿假单胞菌的同源性;液体稀释法测定携带blaIMP基因铜绿假单胞菌菌株的最小抑菌浓度,纸片扩散法检测亚胺培南敏感株和耐药株对10种常用抗菌药物的耐药性。结果分离的铜绿假单胞菌主要来自呼吸道标本,对常用抗菌药物的耐药率高,多重耐药现象严重。携带blaIMP基因与不携带blaIMP基因的铜绿假单胞菌对亚胺培南的耐药性差异有显著性,未携带blaIMP基因的铜绿假单胞菌菌株在PFGE上表现出不同的分型,而携带blaIMP基因的10株中9株具有相同的PFGE分型。结论blaIMP基因在铜绿假单胞菌的耐药机制中起主要作用,了解铜绿假单胞菌的耐药现状,有利于为临床合理用药提供依据,抗生素的合理使用可减少细菌耐药性的产生,降低医院感染的发病率。     

166株铜绿假单胞菌的耐药谱分析

对1997年1月至1998年1月从临床标本分离培养的166株铜绿假单胞菌,应用K-B法测定该分离菌株对18种抗生素的耐药性。选择出其中113株作对7种首选抗生素的多重耐药分析。结果表明铜绿假单胞菌对青霉素类抗生素、一代头孢菌素、二代头孢菌素高度耐药,对三代头孢菌素和喹诺酮类抗生素比较敏感,该菌多重耐药有上升趋势。结果提示临床合理使用抗生素可避免或减少耐药菌株的出现。     

重症监护病房铜绿假单胞菌随机扩增多态性DNA研究

目的建立随机扩增多态性DNA(RAPD)基因分型方法监测重症监护病房(ICU)铜绿假单胞菌医院感染。方法收集2005年1月~6月从各科ICU内分离出的21株铜绿假单胞菌,提取DNA后进行RAPD分型,同时进行抗生素敏感性试验。结果全部菌株均能产生指纹图谱,分型率100%。21株铜绿假单胞菌共分为14型,其中9株6型分布于脑外科,3株同型分布于神经内科,4株4型分布于呼吸科,5株3型分布于普外科。抗生素敏感性试验表明21株铜绿假单胞菌均为多重耐药菌株,对哌拉西林、头孢菌素类、喹诺酮类及阿米卡星等耐药,仅对亚胺培南/西司他丁、头孢哌酮/舒巴坦等敏感。结论ICU内存在铜绿假单胞菌感染局部流行,RAPD分型技术分型率高、简便快速。     

78株铜绿假单胞菌耐药分析

目的了解铜绿假单胞菌(Pseudomonas aeruginosa,PA)临床分离株的耐药现状,指导临床合理使用抗生素。方法采用美国德灵公司Microscan Autoscan-4鉴定仪进行菌株鉴定及药敏试验,并进行统计分析。结果78株铜绿假单胞菌对抗生素前5位的耐药率分别为头孢曲松66.67%、头孢噻肟52.56%、氨曲南23.08%、哌拉西林/他唑巴坦16.67%、头孢吡肟15.38%。其中5株粘液型铜绿假单胞菌除对上述抗生素高度敏感,同时对复方新诺明、氨苄青霉素、氨苄青霉素/舒巴坦、头孢呋辛均敏感。检出1株全耐药菌株。结论铜绿假单胞菌对碳青霉烯类、氨基糖苷类、喹诺酮类、脲基青霉素及其β-内酰胺酶抑制复合剂保持较低的耐药率。要加强对粘液型和多重耐药性铜绿假单胞菌的耐药监测和研究,合理选择抗菌药物。     

对碳青霉烯耐药与敏感的铜绿假单胞菌耐药谱比较分析

目的了解耐碳青霉烯铜绿假单胞菌的分布,比较铜绿假单胞菌对碳青霉烯耐药与敏感菌株的耐药谱特性,以指导临床合理使用抗生素。方法采用稀释法对在2004年1月至12月间从临床分离的铜绿假单胞菌进行12种常用抗生素敏感性测定,采用卡方检验比较碳青霉烯耐药组与敏感组铜绿假单胞菌耐药性的差别。结果91株铜绿假单胞菌中有28株对碳青霉烯耐药,主要来源于痰标本(88．3%)；分别来自神经外科、呼吸科重症监护病房(RICU)、重症监护病房(ICU)等病区。碳青霉烯耐药株对包括头孢吡肟、头孢他啶、氨曲南、环丙沙星在内的其余9种抗生素的耐药率均明显高于敏感株(P值均＜0．01)。结论对碳青霉烯耐药的铜绿假单胞菌对大多数常用抗生素呈更强的耐药性,且其多重耐药状况非常严重,治疗时宜参考药敏结果合理选用抗生素。     

166株铜绿假单胞菌的耐药谱分析

对1997年1月至1998年1月从临床标本分离培养的166株铜绿假单胞菌，应用K-B法测定该分离菌株对18种抗生素的耐药性。选择出其中113株作对7种首选抗生素的多重耐药分析。结果表明：铜绿假单胞菌对青霉素类抗生素、一代头孢菌素、二代头孢菌素高度耐药，对三代头孢菌素和喹诺酮类抗生素比较敏感，该菌多重耐药有上升趋势。结果提示：临床合理使用抗生素可避免或减少耐药菌株的出现。     

广东地区医院内铜绿假单胞菌感染的临床分析

目的：了解广东地区住院病人医院内感染铜绿假单胞菌临床分布及耐药性变迁情况,为临床治疗铜绿假单胞菌院内感染提供参考依据。 方法：回顾性分析广东省中医院所属四家医院2006年至2010年间住院病人分离铜绿假单胞菌病区分布、不同来源菌株药敏结果、连续五年耐药性变化及耐药组合分析情况。 结果：五年间铜绿假单胞菌分离率最高的科室分别为重症监护室、呼吸内科和脑外科。痰标本检出铜绿假单胞菌最多,占83.7%,且痰标本分离铜绿假单胞菌比其他标本分离菌株更为耐药。药敏结果显示氨曲南、 左氧氟沙星、环丙沙星、头孢他啶、头孢吡肟、庆大霉素、妥布霉素、阿米卡星耐药率呈逐年下降的趋势。耐药组合分析发现所分离铜绿假单胞菌对3种以上抗生素耐药的多重耐药菌占35.0%,对所分析抗生素全部耐药的菌株占总数的8.4%。 结论：医院内获得铜绿假单胞菌感染以下呼吸道感染为主,且耐药性明显高于其他部位分离菌株。铜绿假单胞菌多重耐药菌株检出比例较高,耐药机制复杂,临床应根据其分布特点和药敏结果合理用药。     

医院内铜绿假单胞菌感染的临床分布及耐药性变迁

目的 了解医院内感染铜绿假单胞菌的临床分布及耐药性变迁情况,为临床治疗铜绿假单胞菌院内感染提供参考依据.方法 回顾性分析广东省中医院所属四家医院2006-2010年间住院患者分离铜绿假单胞菌病区分布、不同来源菌株药敏结果、连续5年耐药性变化及耐药组合分析情况.结果 5年间铜绿假单胞菌分离率最高的科室分别为重症监护室、呼吸内科和脑外科.痰标本检出铜绿假单胞菌最多,占83.7%,且痰标本分离铜绿假单胞菌比其他标本分离菌株更耐药.药敏结果显示氨曲南、左氧氟沙星、环丙沙星、头孢他啶、头孢吡肟、庆大霉素、妥布霉素、阿米卡星耐药率呈逐年下降的趋势.耐药组合分析发现所分离铜绿假单胞菌对3种以上抗生素耐药的多重耐药菌占35.0%,对所分析抗生素全部耐药的菌株占总数的8.4%.结论 医院内获得铜绿假单胞菌感染以下呼吸道感染为主,且耐药性明显高于其他部位分离菌株.铜绿假单胞菌多重耐药菌株检出比例较高,耐药机制复杂,临床应根据其分布特点和药敏结果合理用药.     

应用VNTR分析方法对院内感染铜绿假单胞菌分子分型的研究

目的 探讨以多位点可变数目串联重复序列(VNTR)分析方法行多重耐药铜绿假单胞菌分子分型的效果。方法 选择2015年5月至2017年5月分离自本院13个病区的多重耐药铜绿假单胞菌78株,提取菌株DNA。在铜绿假单胞菌基因组中随机选择8个位点,以VNTR扩增物扩增菌株DNA,产物毛细管电泳。对扩增产物相对分子质量及菌株在不同位点的VNTR重复数进行计算,并实施聚类分析及同源性分析。结果 8个VNTR位点重复基序大小为7～128 bp,多态性指数为0.47～0.89,分布较为均匀;VNTR分析法将78株多重耐药铜绿假单胞菌分为5个群;6例患者不同分离株在8个位点重复数均一致。结论 在铜绿假单胞菌基因分型及溯源研究中VNTR分析法的应用价值高,可为控制院内感染提供依据及技术方法,需引起关注。     

Characterization of multidrug-resistant and metallo-beta- lactamase-producing Pseudomonas aeruginosa isolates from a paediatric clinic in China

Background In the present study, we characterized multidrug-resistant Pseudomonas aeruginosa （MDRP） clinical isolates from a paediatric facility and investigated the types and features of the metallo-β-lactamases （MBLs） produced by carbapenem-resistant strains. Methods Four hundred and ninety-eight strains of Pseudomonas aeruginosa were isolated from patients at Beijing Children＇s Hospital between January 2005 and December 2006. The minimal inhibition concentrations （MICs） of the strains for 13 antibiotics were measured. A combination of the E test and PCR amplification/DNA sequencing was used to define the carbapenem-resistant strains. Results We found that 24.1% （120/498） of the isolates were MDRP. The frequencies of resistance to imipenem and meropenem were 34.2% and 35.8%, respectively, and the MIC50 and MIC90values for the two antibiotics were identical at 4 pg/ml and 32 pg/ml, respectively. The detection rate for carbapenem resistance was 49.2% （59/120）. Among the 59 carbapenem-resistant Pseudomonas aeruginosa strains, 39 （66.1%） were positive for the MBL genotype; 35 （89.7%） strains carried the blaiMp gene and 4 （10.3%） strains carried the blavm gene. Neither blasPM nor blaGiM was amplified from any of the 59 isolates. DNA sequencing revealed that IMP-1 was present in 35 IMP-producing isolates and VIM-2 was detected in four VIM-producing isolates. Conclusions These MDRP isolates exhibited high frequencies of resistance to carbapenems among clinical isolates from a paediatric facility in Beijing, China. The production of MBL appears to be an important mechanism for carbapenem resistance in Pseudomonas aeruginosa.     

ESBLs与MDR铜绿假单胞菌流行现状及其关系研究

目的 探索产ESBLs与MDR铜绿假单胞菌流行现状及相互关系.方法 2008年7月-2009年6月对广州市某两个三级甲等医院进行为期1年的铜绿假单胞菌感染的监测,对分离出的铜绿假单胞菌采用CLSI(2009年版)推荐的纸片扩散法筛选试验和确证试验检测其超广谱β-内酰胺酶,并按照NCCLS标准进行药物敏感试验.结果 监测...     

DNA fingerprinting of methicillin-resistant Staphylococcus aureus (MRSA) by pulsed-field gel electrophoresis (PFGE) in a teaching hospital in Malaysia

Methicillin-resistant Staphylococcus aureus (MRSA) has been prevalent in our hospital over the last three years. Differentiation among MRSA strains by DNA typing in addition to antibiotic resistance pattern surveillance is crucial in order to implement infection control measures. The aim of this study was to characterize MRSA isolates from patients admitted to Hospital Universiti Kebangsaan Malaysia (HUKM) by phenotypic (analyses of antibiotic susceptibility pattern) and genotypic (PFGE) techniques to determine the genetic relatedness of the MRSA involved and to identify endemic clonal profiles of MRSA circulating in HUKM. Seventy one MRSA strains collected between January to March 2000 from patients from various wards in HUKM were tested for antimicrobial resistance and typed by pulsed-field gel electrophoresis (PFGE). Four major types of PFGE patterns were identified (A, B, C and D) among MRSA strains. Two predominant PFGE types were recognised, Type A (59.2%) and Type B (33.8%). Most of these strains were isolated from ICU, Surgical wards and Medical wards. MRSA strains with different PFGE patterns appeared to be widespread among wards. Strains with the same antibiotype could be of different PFGE types. Most of isolates were resistant to ciprofloxacin, erythromycin, gentamicin and penicillin. One isolate with a unique PFGE pattern Type D and susceptible to gentamicin was identified as a different clone. Some isolates obtained from the same patient showed different PFGE subtypes suggesting that these patients were infected/colonized with multiple MRSA strains. PFGE analysis suggests that MRSA strains with different PFGE types was propagated within our hospital. The relationship between antibiotic susceptibility and PFGE patterns was independent. The ability of PFGE technique in differentiating our MRSA strains make it a method of choice for investigating the source, transmission and spread of nosocomial MRSA infection, and thus an appropriate control programme can be implemented to prevent the spread of MRSA infection.     

铜绿假单胞菌临床分离株的耐药性分析

目的　对某院分离的铜绿假单胞菌的耐药性及变化趋势进行研究 ,为临床用药提供依据。方法　对 14 6株铜绿假单胞菌选用 12种常用抗生素进行药敏实验 ,实验采用K B法按NCCLS标准进行。结果　亚胺培南、妥布霉素、阿米卡星、哌拉西林 /三唑巴坦、头孢他啶对铜绿假单胞菌抗菌活性较强 ( >70 %) ,铜绿假单胞菌最敏感的抗生素为亚胺培南 ( 86 3 %)。抗菌作用较差的抗生素为头孢噻肟 ( 6 8%)、头孢曲松 ( 11 0 %)。结论　某院铜绿假单胞菌的临床分离株和耐药率逐年上升 ,应根据药敏结果合理选用抗生素     

呼吸病房下呼吸道感染病原菌及药敏现状分析

目的了解该院呼吸病房住院患者下呼吸道感染病原菌分布及药物敏感情况。方法收集2003年1月～2004年12月该院呼吸病房下呼吸道感染住院患者痰菌(或纤维支气管镜吸取分泌物)培养阳性标本结果进行回顾性统计分析。结果分离出细菌20余种共522株,革兰阴性杆菌411株(78.7%),主要为铜绿假单胞菌、流感嗜血杆菌、不动杆菌、副流感嗜血杆菌和克雷伯菌;革兰阳性球菌111株(21.3%),主要为表皮葡萄球菌、肺炎链球菌及金黄色葡萄球。流感及副流感嗜血杆菌对三代头孢菌素敏感;铜绿假单胞菌、不动杆菌、克雷伯菌对美洛培南、舒普深、头孢吡肟敏感,对三代头孢菌素敏感性较差;葡萄球菌对万古霉素均敏感;肺炎链球菌对美洛培南、左氟沙星敏感性好,对青霉素大部分耐药。结论下呼吸道感染以革兰阴性杆菌感染为主,且常见病原菌耐药现象较严重,临床上应合理应用抗生素以延缓细菌耐药性的产生。     

Epidemiologic Study of Pseudomonas aeruginosa in critical patients and reservoirs

BACKGROUND: Pseudomonas aeruginosa is a common cause of nosocomial infections, particularly in intensive care units (ICUs). The aim of this study was to characterize P. aeruginosa clinical isolates by comparing antimicrobial susceptibility patterns with the presence of plasmids and to establish the clonal relatedness by pulsed-field gel electrophoresis (PFGE) typing. METHODS: The patients included those with isolation of P. aeruginosa hospitalized for more than 48 h in the ICU from April to May 1998. Environmental and staff cultures were obtained simultaneously. Minimal inhibitory concentrations, plasmid DNA profiles, and PFGE genomic patterns of enzyme restriction chromosomal DNA were compared. RESULTS: Sixty P. aeruginosa isolates were obtained from 197 clinical specimens, 178 environmental samples, and 47 hand cultures of personnel. Antimicrobial resistance was as follows: tobramycin 100%; ticarcillin, cefotaxime, ceftriaxone, ceftazidime, and gentamicin 80%; cefepime 60%; amikacin, ticarcillin/clavulanate, imipenem, and meropenem 40%; piperacillin and norfloxacin 20%; carbenicillin 12%, and ciprofloxacin 0%. Plasmids were detected in 11 isolates (18%). PFGE typing showed that 23 isolates belonged to a common clone (pattern A), identified from five patients, two nurses, and 10 environmental samples. Ten isolates were grouped in four clusters and 27 isolates had unrelated genomic patterns. There was no relationship among DNA genomic patterns, plasmid profiles, and susceptibility patterns. CONCLUSIONS: PFGE demonstrated the existence of a common clone in a critical care area. Reinforcement of infection control measures is needed to avoid horizontal transmission and severe infections.     

Phenotypes of isolates of Pseudomonas aeruginosa in a diabetes care center

BACKGROUND: Pseudomonas aeruginosa is an invasive organism that frequently causes severe tissue damage in diabetic foot ulcers. A major problem in P. aeruginosa infection may be that this pathogen exhibits a high degree of resistance to a broad spectrum of antibiotics. Some researchers feel that P. aeruginosa is a homogeneous species, whereas others have suggested that they are panmictic. Here we characterized P. aeruginosa populations isolated from diabetic foot ulcer and from hospital environment specimens, both from a tertiary diabetes care center in Chennai, India. METHODS: Phenotypic methods like antibiotic susceptibility determinations using Kirby-Bauer's disc diffusion test and minimum inhibitory concentration (MIC) as well as outer membrane protein SDS-PAGE analysis of P. aeruginosa were performed. RESULTS: Twenty three isolates (29.8%) of P. aeruginosa from 77 diabetic foot ulcers and two environmental isolates (13.3%) from 15 different hospital fomites were detected. Both environmental isolates were sensitive to antibiotics than those isolated from clinical specimens by Kirby-Bauer's disk-diffusion method, which correlated the resistance levels by MIC determination. Outer membrane proteins (OMP) corresponding to 21, 23, 43, 46, 50, and 70 kDa were detected. CONCLUSIONS: The study is captivative as the resistance in P. aeruginosa from diabetic foot ulcers seems very common and because all the isolates were resistant to at least one or more antibiotics tested. Disk-diffusion and MIC results shows that piperacillin, amikacin and imipenem retain high levels of antipseudomonal activities and amikacin two times more active than the aforementioned antibiotics to enable itself as a potent antipseudomonal agent in diabetic foot infections. The OMP profile has revealed that clinical isolates were different from hospital environment isolates, which suggests that the origin of infections by P. aeruginosa is mainly due to growth of bacterial strains acquired by patients prior to hospital admission.     

铜绿假单胞菌医院分布及药敏分析

目的探讨该院分离的铜绿假单胞菌的耐药情况,为临床控制医院感染及合理用药提供可靠依据。方法从临床标本中分离出铜绿假单胞菌1036株并采用英国先德荧光快速微生物分析鉴定/药敏系统进行鉴定并进行药敏实验,按照美国临床实验室标准化研究所2010年版操作和判读结果采用WHNET5.4软件对结果进行分析统计。结果铜绿假单胞菌以重症ICU检出率最高,其次为神经外科,标本分布以痰液为主,该菌主要对磺胺、庆大耐药,耐药率为75.1%和48.8%。对美罗培南耐药率最低,耐药率2.9%。结论铜绿假单胞菌的耐药性比较严重,医院应加强对感染的预防和控制,合理使用抗生素,延缓细菌耐药性的产生。     

Metallo beta-lactamase producing pseudomonas species--a major cause of concern among hospital associated urinary tract infection

Multidrug resistant pseudomonas strains are isolated in high frequency from urinary samples in hospitalised patients. With the occurrence of extended spectrum beta-lactamases (ESBLs) and metallo beta-lactamase (MBL)-producing Pseudomonas aeruginosa being increasingly reported worldwide, this study evaluated the resistance pattern of pseudomonad strains to carbapenam and other antipseudomonal antibiotics isolated from patients with hospital associated urinary tract infections along with clinical usefulness of various MBL screening methods (combined disc diffusion test, E-test and modified Hodge test). Presence of ESBL and AmpC beta-lactamases in the isolates was also determined. Of the 87 isolates, 81 (93.1%) were Pseudomonas aeruginosa, 4 (4.6%) were Pseudomonas putida, 2 (2.3%) were Burkholderia cepacia. Thirty-one isolates (35.6%) were resistant to imipenem and 61% of these 31 isolates, were MBL producers by combined disc diffusion test, while 48% were detected by E-test method. Overall, in 30% and 54% strains, production of AmpC and ESBL respectively was observed.     

广东省中山市2017年沙门菌耐药菌谱及分子分型分析

目的 了解中山市2017年沙门菌的耐药特征及分子分型,为临床合理用药和食源性疾病的溯源提供科学依据。方法 对中山市2017年食源性疾病监测（3个哨点医院）的沙门菌分离株采用微量肉汤稀释法进行14种抗生素药敏试验,运用脉冲场凝胶电泳（PFGE）技术对肠炎沙门菌进行分子分型。 结果 中山市2017年食源性疾病监测检出的285株沙门菌对14种抗生素敏感性试验结果显示,237株（占83.16％）沙门菌对13种抗生素呈现不同程度的耐药性,未发现对亚胺培南（IPM）耐药菌株。耐药抗生素最多的种类达到11种,耐药率较高（40 %以上）的抗生素为氨苄西林（AMP）、四环素（TET）、氨苄西林/舒巴坦（SAM）、氯霉素（CHL）;共有87类耐药谱型,其中多重耐药谱型75类（86.21%）,多重耐药菌株数为176株（61.75%）。25株肠炎沙门菌的PFGE分为5种带型,相似度为63.9%~100.0%。结论 中山市2017年食源性疾病监测显示沙门菌耐药状况较为严重,呈多重性和多态性,应采取综合措施控制耐药性;肠炎沙门菌PFGE的相似度较高,存在优势带型。