Multidrug-resistant <Emphasis Type="Italic">Pseudomonas aeruginosa</Emphasis> isolated from the urine of patients with urinary tract infection

We report the clinical courses of 3 patients with urinary obstruction who developed acute pyelonephritis caused by multidrug-resistant (MDR) Pseudomonas aeruginosa. Genome fingerprinting was performed to clarify the route of cross-infection, and an imipenem-resistance gene was detected by the polymerase chain reaction (PCR) method. The study included 17 patients at our institute who had urinary tract infections caused by P. aeruginosa between January and December 1997. MDR was defined as that when all the minimum inhibitory concentrations (MICs) were determined to show resistance according to the breakpoints recommended by the National Committee for Clinical Laboratory Standards (NCCLS) for P. aeruginosa. Pulse-field gel electrophoresis (PFGE) was carried out for genome fingerprinting. PCR was used to detect the metallo-β-lactamase gene (bla _IMP). Three strains were revealed for MDR. The strains were isolated from the 3 patients with urinary tract obstruction who developed acute pyelonephritis. The treatment consisted of urinary drainage for the obstructed urinary tract and parenterally administered antimicrobials. Although none of the strains was susceptible to any antimicrobials, all patients had favorable outcomes. PFGE revealed that two strains had an identical genotype, implying cross-infection between the patients. The bla _IMP gene was not detected in any of the three strains. In febrile patients with urinary tract infection caused by MDR P. aeruginosa, treatment for urinary obstruction is strongly recommended. Initial empirical chemotherapy with antimicrobials to which the organism is not susceptible is often inevitable. Because there was epidemiological evidence of cross-infection with MDR P. aeruginosa, countermeasures against nosocominal infection are warranted. Received: April 26, 2001 / Accepted: September 1, 2001     

In vitro susceptibility of enterococci strains isolated from urine samples to fosfomycin and other antibiotics

Enterococci are mostly isolated from urinary tract infections (UTIs). Increasing antibiotic resistance affects the success rate in empirical treatment, thus makes antibiotic susceptibility tests important. The aim of this study was to determine the species distribution and resistance patterns of Enterococcus strains isolated from urine samples to antibacterial agents including fosfomycin in a teaching hospital, Istanbul. The identification of 100 Enterococcus strains were determined by using conventional methods and API 20 Strep (bioMerieux France). The susceptibility testing was performed by disk diffusion and Etest. The majority of isolates were E. faecalis (67%), followed by E. faecium (33%). The ratio of E. faecalis to E. faecium was 2.03/1. E. faecalis and E. faecium strains were resistant to penicillin (38.8, 93.9%), ampicillin (4.8, 84.8%), vancomycin (1.5, 18.2%), teicoplanin (1.5, 18.2%), gentamicin (13.4, 58%), ciprofloxacin (34.3, 84.8%), levofloxacin (34.3, 87.9%), norfloxacin (38.8, 84.8%), tetracycline (89.6, 48.5%), nitrofurantoin (1.5, 39.4%), and fosfomycin (2.3, 0%) (p < 0.0001), respectively. Resistance to fosfomycin was observed in neither E. faecium strains, nor vancomycine-resistant enterococci strains. It was concluded that, enterococci are important pathogens for UTI; species identification and periodic evaluation of antibiotic susceptibility pattern would be guide for early empirical treatment and in uncomplicated UTI, fosfomycin could be an alternative option for therapy.     

Nosocomial infection of β-lactam antibiotic-induced vancomycin-resistant Staphylococcus aureus (BIVR)

We report here an outbreak of β-lactam-induced vancomycin-resistant methicillin-resistant Staphylococcus aureus (MRSA; BIVR) at one of the Cancer-Institute-affiliated hospitals in Tokyo. We examined a total of 500 strains (100 per year) of clinically isolated MRSA from 1998 to 2002. The detection rates of BIVR in the years 1998, 1999, 2000, 2001, and 2002 were 10%, 9%, 49%, 15%, and 19%, respectively. To investigate the cause of the high incidence of BIVR detection in the year 2000, we carried out pulsed-field gel electrophoresis (PFGE) of the SmaI-digested chromosomal DNA of BIVR and MRSA. The results showed that 96% of the BIVR strains isolated in 2000 were classified as an identical DNA type “A”, while only 47% of the MRSA strains were classified as this type. We concluded, based on these results, that this hospital had a nosocomial infection of BIVR in the year 2000. An important message given by this study would be that nosocomial BIVR infection could occur in any hospital where MRSA infection is treated with vancomycin and β-lactam antibiotics.     

Hospital outbreak of MEN-1-derived extended spectrum β-lactamase-producing Klebsiella pneumoniae

An outbreak of Klebsiella pneumoniae resistant to broadspectrum cephalosporins occurred in a hospital in the Kinki area in Japan. During 18 months, from February 1998 to July 1999, 23 strains were isolated from 21 patients (10 with pneumonia, 4 with urinary tract infection, 1 with sepsis, 1 with vaginosis, 1 with a wound infection, and 1 with both pneumonia and sepsis; 3 patients showed noninfective colonization with K. pneumoniae) in seven wards, including the intensive care unit. MEN-1-derived gene was detected by polymerase chain reaction from the majority of the strains. Ninety-nine strains of K. pneumoniae were isolated during this period. The isolation rate of K. pneumoniae resistant to broad spectrum cephalosporins was 21%. We distinguished three clones by pulsed-field gel electrophoresis and randomly amplified polymorphic DNA analysis, and one of them was isolated from 18 patients. The presence of an R-plasmid of more than 160 kb was confirmed by plasmid analysis, but it was not possible to obtain transconjugants from all strains. This outbreak of K. pneumoniae was immediately confirmed by genetic analysis, and it was promptly ended by the infection control procedures. This is the first hospital outbreak of MEN-1-producing K. pneumoniae in Japan. Received: August 17, 2000 / Accepted: January 16, 2001     

Sensitivities of major causative organisms isolated from patients with acute uncomplicated cystitis against various antibacterial agents: results of subanalysis based on the presence of menopause

We investigated whether the presence of menopause influenced the species and distribution of causative bacteria isolated from patients with acute uncomplicated cystitis (the most common urinary tract infection), and we also investigated the sensitivity of the isolated species to antibacterial agents. Using multivariate analysis, we also investigated risk factors for infection with quinolone-resistant Escherichia coli, because its frequency has increased and it is now a clinical problem in Japan. Six hundred and thirty-four strains were isolated from 489 premenopausal patients (mean age 32.3 ± 10.1 years). Major causative bacteria detected were Escherichia coli (65.0 %), Enterococcus faecalis (12.0 %), Streptococcus agalactiae (5.5 %), and Klebsiella pneumoniae (1.6 %). From 501 postmenopausal patients (mean age 68.7 ± 10.29 years), 657 strains were isolated, and the major causative bacteria detected were E. coli (61.5 %), E. faecalis (13.7 %), K. pneumoniae (5.2 %), and S. agalactiae (4.0 %). The sensitivities to fluoroquinolones (FQs) and cephems of E. coli isolated from premenopausal patients were both ≥90 %, while the sensitivities to FQs of E. coli isolated from postmenopausal patients were about 5 % lower. In regard to infection with quinolone-resistant E. coli (minimal inhibitory concentration of levofloxacin [LVFX] ≥4 μg/mL), significant risk factors were observed in patients with more than two episodes of cystitis within a year (p = 0.0002), patients to whom antibacterial agents were used previously for this episode of cystitis (p = 0.0175), and patients who had a history of FQ administration within 1 month. Although the species and distribution of causative bacteria of acute uncomplicated cystitis were the same regardless of the presence of menopause, the sensitivities to FQs of E. coli detected in postmenopausal patients were significantly lower than those in the premenopausal women. The major risk factors for infection with quinolone-resistant E. coli were a history of FQ administration and the morbidity of cystitis rather than the menopausal status. It was considered that taking an appropriate history including the morbidity of cystitis and history of FQ administration, and the appropriate selection of an antibacterial agent, would be important when empirical therapy is required.     

Significance of methicillin-resistant Staphylococcus aureus (MRSA) survey in a university teaching hospital

 We experienced a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in two wards at our medical school teaching hospital during the period of July–September 1997. To determine whether these MRSA clinical isolates were associated with environmental factors, we conducted two sequential MRSA surveys of the hospital staff and surroundings in wards with outbreaks (wards 1 and 2) and in one ward without an outbreak (ward 3) in April 1998 (ward 1 only) and in March 1999 (wards 1, 2, and 3). In the two sequential surveys, MRSA strains were detected mainly from white coats. MRSA strains isolated from fingers in the first survey were decreased in the second survey. The pulsed-field gel electrophoresis (PFGE) patterns of the strains isolated in the two surveys were classified into five types (A–E). Type D, including the outbreak pattern of the MRSA in ward 1 in 1997, was reduced between the first and second surveys by managing microbiological hygiene, suggesting that the outbreak was controlled in ward 1. On the other hand, the strains isolated in the second survey in ward 2 were mainly type E, which was also common among clinical isolates from ward 2 during the latter half of 1998 to 1999. This suggested a high probability of cross-infection between the patients and the hospital staff in the ward. Our observations suggest that doctors and nurses should be cautious that their coats might be contaminated with the prevailing strains of MRSA. We also concluded that the surveys were very useful for the successful management of MRSA infections. Received: July 29, 2002 / Accepted: December 6, 2002 RID="*" ID="*" Yasuyuki Yoshizawa (chairman), Yukio Oshima, Fujio Numano, Kenichi Sugihara, Kenichi Shinomiya, Naoki Yamamoto, Nobuo Nara, Kimiyoshi Hirakawa, Keisuke Amou, Masato Yasuhara, Junko Koike, Kiyoshi Noda, Fumiaki Marumo, Kozo Takase, Toru Sakamoto, and Takasuke Imai RID="*" ID="*" Hospital Infection Control Committee members Acknowledgments We appreciate Dr. Vernon L. Moore for his critical review and Dr. M. Nishibori for the survey methods, and the staff of the Division of Microbiology, Hyogo Prefectural Institute of Public Health, for performing the software analysis.     

2007-2011年浙江萧山地区尿路感染患者大肠埃希菌的分离及产超广谱-内酰胺酶和耐药性分析

目的 调查和分析浙江萧山医院尿路感染患者中大肠埃希菌的临床分布、产超广谱-内酰胺酶(extended spectrum -lactamase,ESBLs)和耐药特性,为临床合理利用抗菌药物提供依据。 方法 调查2007-2011年尿培养检出的大肠埃希菌, 对其临床分布进行分析;使用VITEK-60全自动微生物分析仪作细菌鉴定;采用K-B琼脂扩散法检测耐药情况。 结果 共分离出771株大肠埃希菌,其中52.5%(405/771)产ESBLs,主要来源于泌尿外科、内科和肾病科等科室,超过总分离菌株的60.0%,产ESBLs大肠埃希菌检出率从2007年的44.2%增高到2011年的61.2%(P0.01),且2007-2011年大肠埃希菌对多种抗菌药物的耐药率都有增高趋势,尤以对三、四代头孢菌素的增幅更为明显。ESBLs阳性株对氨苄西林、头孢唑啉、头孢他啶等16种药物的耐药率均高于ESBLs阴性株,差异有统计学意义(P0.01)。 结论 尿路感染大肠埃希菌对头孢类药物耐药率逐年升高,产ESBLs菌株检出率也呈逐年增高趋势,且表现为多重耐药,临床应合理使用抗生素。     

Sterile versus clean urinary catheterisation is not associated with post-transplantation infection

The objective of this study is to determine if there was a difference in rate of post-transplantation urinary tract infection (UTI) in patients who have an indwelling catheter inserted using sterile versus clean technique. UTI is the most common nosocomial infection in the post-transplantation period. We aim to describe risk factors associated with postoperative UTI in our institution and determine if there was a difference between those who have an indwelling catheter inserted using sterile versus clean technique. Risk factors for UTIs can be divided into recipient, donor, and procedure related factors. While an indwelling urinary catheter increases the risk of infection, it is vital for post-operative fluid balance monitoring. Given the morbidity of UTIs in transplant recipients, a number of studies have investigated modifiable risk factors; however, investigation of the technique of indwelling catheter insertion at the time of renal transplantation is yet to be examined. A retrospective analysis of a contemporaneously maintained database was performed of renal transplant recipients over a 2-year period from 2019–2021. Patients were divided into sterile versus clean technique, defined as the use of sterile gloves, gown and fenestrated drape following a surgical scrub, or sterile gloves alone following the use of alcohol-based hand sanitiser respectively. A p value of <0.05 was considered statistically significant. One hundred sixty-nine patients were included in analysis, with 31 UTIs (18.3%) within 30 days of renal transplantation. Female gender and autosomal dominant polycystic kidney disease were associated with a higher rate of UTI. One hundred twenty-three patients had a catheter inserted via sterile technique, and 46 with clean technique, with no significant difference in rate of post-operative UTI (p = 0.52). Inserting an indwelling catheter either by sterile or clean technique at the time of renal transplantation was not associated with the rate of postoperative UTI within 30 days.     

Urinary tract infection during pregnancy affects the level of leptin,ghrelin and insulin in maternal and placental blood

Abstract

Aim. We examined ghrelin, leptin and insulin in maternal blood during normal pregnancy and pregnancy complicated by urinary tract infection (UTI), as well as in cord blood at labor. Methods. A total of 36 delivering women with history of UTI during the third trimester of pregnancy were enrolled in the study; 12 healthy pregnant women served as a control. Infection markers (CRP and procalcitonin) were determined in maternal blood during the course of UTI and at labor. Ghrelin, leptin and insulin were determined during labor in venous maternal and in umbilical cord blood. Results. We found negative correlation between infection markers in maternal blood during UTI, and level of tested hormones in cord blood, indicating potential risk of placental impairment due to energetic imbalance. We noted lower level of leptin in mothers with UTI and no change in leptin from umbilical blood comparing subjects with and without UTI. Low level of ghrelin was observed in maternal and cord blood when pregnancy was complicated by UTI. Insulin concentrations were high in mothers with UTI and low in their newborn's cord blood. Increased maternal insulin level could indicate peripheral insulin resistance caused by the infection. Conclusion. UTI during pregnancy affects the concentration of hormones responsible for regulating energetic homeostasis within the placenta.     

老年尿路感染产超广谱β-内酰胺酶大肠埃希菌耐药性分析

目的探讨老年尿路感染患者中产超广谱β-内酰胺酶（ESBLs）大肠埃希菌的耐药性。方法回顾性分析2008年至2009年117例ESBLs（＋）老年尿路感染患者中段尿标本结果。结果大肠埃希菌产ESBLs率自2008年的49.1%上升到2009年的53.9%。产ESBLs大肠埃希菌对氨基糖苷类,二、三代头孢菌素以及酶抑制剂抗生素的耐药性呈上升趋势。产ESBLs大肠埃希菌对第二、三代头孢菌素,氨苄西林,环丙沙星耐药率高,对头孢哌酮舒巴坦、丁胺卡那敏感,对碳青酶类无耐药。结论老年尿路感染患者中产ESBLs大肠埃希菌检出率和耐药性非常高,头孢哌酮舒巴坦是此类患者较为理想的选择。     

ICU院感监测铜绿假单胞菌耐药率和同源性分析

目的分析2015年1-6月牡丹江市第一人民医院重症监护病房(ICU)检出的铜绿假单胞菌耐药率及其同源性,明确该菌在ICU流行情况,为合理的院感防控提供依据。方法采用Vitek-2Compact全自动微生物鉴定仪对2015年上半年ICU通过不同途径检出的126株铜绿假单胞菌进行耐药性分析,根据脉冲场凝胶电泳法对所有菌株进行同源性分析。结果 2015年1-6月ICU进行2次院感监测,从护士手、换药车及监护室门把手的物体表面检出4株铜绿假单胞菌且均为敏感株;110例ICU住院患者中,共检出122株铜绿假单胞菌,其中在18例ICU住院患者中检出多重耐药株38株。38株多重耐药株及4株院感监测检出菌株同源性分析可以分为5组(A~E),以A、C、D这3个克隆型为主,院感监测检出菌株均为B克隆型。4例患者检出多个亚型感染。结论铜绿假单胞菌感染形势在ICU比较严峻,院感监测检出菌株未存在暴发流行,住院患者间存在多克隆株交叉流行现象。     

Enterococcus faecalis colonisation and endocarditis in five intensive care patients as late sequelae of selective decontamination

Objective To describeEnterococcus faecalis colonisation and endocarditis in 5 intensive care patients after treatment with selective decontamination (SDD).Setting Intensive care unit (ICU) in a general hospital.Patients The patients were admitted to the ICU because of adult respiratory distress syndrome, polytrauma (2 patients), abdominal aortic surgery and gastrointestinal surgery. Because these patients needed mechanical ventilation they received systemic cefotaxime and SDD (polymyxin E, amphotericin B and norfloxacin).Results Colonisation withE. faecalis was documented in all patients. Intravascular catheter-related infection withE. faecalis occurred in 4 patients. None of the patients received antibiotics active against,E. faecalis, because body temperature normalised after catheter removal.In the course of his ICU stay one patient died. Autopsy showedE. faecalis endocarditis. The other 4 patients recovered from their primary illness, but had to be readmitted after several months because ofE. faecalis endocarditis. One of these patients died. One patient recovered of endocarditis, but one year later valve surgery was necessary. The other 2 patients needed acute valve replacement. The latter 3 patients survived.Conclusion We observed 5 patients withE. faecalis endocarditis as a late and severe sequela of SDD during their ICU stay.     

Investigation of nosocomial respiratory infection due to Pseudomonas cepacia by Arbitrarily primed polymerase chain reaction

We used DNA fingerprinting by the arbitrarily primed polymemse chain reaction (AP-PCR) technique for an epidemiologic investigation of Pseudomonas cepacia nosocomial isolates obtained from patients attending our hospital. This approach was compared with conventional phenotypic typing and pulsed-field gel electrophoresis (PFGE). The patterns of gel electrophoresis of the products of AP-PCR differed significantly according to differences in the concentration of Mg²⁺ and in pH. AP-PCR and PFGE was identical in their resolving power, as the two methods generated four different profiles and identified the same group of strains. The AP-PCR method constitutes an easy alternative to the well-establislted PFGE method.     

Risk factors of urinary tract infection caused by extended spectrum β-lactamase-producing Escherichia coli in emergency department

Objectives

The incidence of urinary tract infection (UTI) due to extended-spectrum β-lactamase (ESBL)-producing Escherichia coli has increased over recent years. Initial empirical therapy is often ineffective for these resistant isolates resulting in prolonged hospitalization and increased mortality. This study was conducted to determine the risk factors of UTI caused by ESBL E. coli in the emergency department (ED).

The nationwide study of bacterial pathogens associated with urinary tract infections conducted by the Japanese Society of Chemotherapy

This study was conducted by the Japanese Society of Chemotherapy and is the first nationwide study on bacterial pathogens isolated from patients with urinary tract infections at 28 hospitals throughout Japan between January 2008 and June 2008. A total of 688 bacterial strains were isolated from adult patients with urinary tract infections. The strains investigated in this study are as follows: Enterococcus faecalis (n = 140), Escherichia coli (n = 255), Klebsiella pneumoniae (n = 93), Proteus mirabilis (n = 42), Serratia marcescens (n = 44), and Pseudomonas aeruginosa (n = 114). The minimum inhibitory concentrations of 39 antibacterial agents used for these strains were determined according to the Clinical and Laboratory Standards Institute (CLSI) manual. All Enterococcus faecalis strains were susceptible to ampicillin and vancomycin. Although a majority of the E. faecalis strains were susceptible to linezolid, 11 strains (7.8%) were found to be intermediately resistant. The proportions of fluoroquinolone-resistant Enterococcus faecalis, Escherichia coli, Proteusmirabilis, and S. marcescens strains were 35.7%, 29.3%, 18.3%, and 15.2%, respectively. The proportions of E.coli, P.mirabilis, K.pneumoniae, and S.marcescens strains producing extended-spectrum β-lactamase were 5.1%, 11.9%, 0%, and 0%, respectively. The proportions of Pseudomonas aeruginosa strains resistant to carbapenems, aminoglycosides, and fluoroquinolones were 9.2%, 4.4%, and 34.8%, respectively, and among them, 2 strains (1.8%) were found to be multidrug resistant. These data present important information for the proper treatment of urinary tract infections and will serve as a useful reference for periodic surveillance studies in the future.     

187例医院内尿路感染病原分布和抗生素耐药分析

目的 :了解医院内尿路感染的病原分布和对抗生素的耐药情况及其比较与院外尿路感染的差别 ,企图以此指导临床用药。方法 :收集 187例医院内尿路感染和同期住院的 14 5例院外尿路感染进行比较。结果 :医院内尿路感染的优势菌依次为 :大肠埃希菌 2 8.2 4 % ,肠球菌 2 1.37% ,念珠菌 14 .89% ,克雷伯杆菌 8.0 2 % ,假单胞菌 7.2 5 %和链球菌 4 .96 %。其中医院内念珠菌的感染率较院外显著升高 (P <0 .0 1)。有尿路操作者中大肠埃希菌 33.33% ,肠球菌 16 .92 % ,念珠菌 16 .4 1%和假单胞菌8.2 1%。其中念珠菌和假单胞菌的感染率显著高于无尿路操作者 (P <0 .0 5 ,P <0 .0 1)。在院内感染者中 ,大肠埃希菌对环丙沙星和头孢哌酮的耐药性 ,肠球菌对青霉素的耐药性药明显高于院外感染者 (P <0 .0 5 ,P <0 .0 5 ,P <0 .0 5 )。结论 :院内尿路感染中有较多尿路操作和广谱抗生素的使用史 ,念珠菌的感染率明显升高 ,细菌对抗生素耐药的情况较多 ,应注意调整治疗方案。     

Association between the number of blood cultures and appropriateness of care for suspected bacteremic urinary tract infection in the elderly

The objective of this study was to evaluate the association between the number of blood cultures collected and the appropriateness of care for suspected bacteremic community-acquired urinary tract infection (UTI) in the elderly. We retrospectively evaluated the medical records of 129 patients with UTI >65 years old admitted to a large community-based training hospital in Japan from 1 January 2006 to 31 December 2009. We assessed the association between the number of blood cultures collected and the appropriateness of care received, as well as other factors. Two-thirds of the patients were women, and patients >85 years old accounted for 45.0% of the cases. Most of the organisms isolated from the urine and blood were Escherichia coli (65.4–67.0%). More than two blood cultures were collected 79.1% of the time, and 66.7% of the cases were evaluated as having been treated appropriately. The appropriateness of care was not significantly related to the number of blood cultures. The appropriateness of care received in the general internal medicine department was significantly higher (p = 0.016) than that in other departments. Thus, the appropriateness of care for suspected bacteremic UTI in the elderly was not significantly associated with the number of blood cultures. However, the department of hospitalization may have influenced the appropriateness of care.     

Exposure to co-amoxiclav as a risk factor for co-amoxiclav-resistant Escherichia coli urinary tract infection

The objective of the study was to define whether individual exposure to co-amoxiclav is a risk factor for selecting co-amoxiclav-resistant Escherichia coli in vivo. One hundred and eight patients were included in our study as soon as they were found to have a urinary tract infection (UTI) due to E. coli. Stool probes were also undertaken for some of these patients. Co-amoxiclav administration in the month before diagnosing the UTI, and any treatment to cure the current UTI were recorded for all patients. When co-amoxiclav-resistant E. coli was detected in the stools after diagnosis of E. coli UTI, isolates were compared with urinary E. coli isolates in terms of clonal relatedness, beta-lactam susceptibility and mechanisms of beta-lactam resistance. The patients who had taken co-amoxiclav in the month before the reported E. coli UTI had a significantly higher risk of being infected with co-amoxiclav-resistant E. coli. Those patients treated with amoxicillin for a current infection were at greater risk of intestinal carriage of co-amoxiclav-resistant E. coli; those treated with co-amoxiclav had a greater risk of intestinal carriage of co-amoxiclav-resistant Gram-negative bacilli than patients treated with third-generation cephalosporins or fluoroquinolones. Hence, individual exposure to co-amoxiclav is a risk factor for UTIs caused by co-amoxiclav-resistant E. coli or for carrying co-amoxiclav-resistant Gram-negative bacilli in the digestive tract.     

Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria

Aim: Urinary tract infection (UTI) caused by resistant bacteria is becoming more prevalent. We investigate characteristics and associated risk factors for UTIs resulting from extended‐spectrum beta‐lactamase (ESBL)‐producing enterobacteria. Methods: Retrospective study of urinary tract isolates of ESBL‐producing enterobacteria in adults (2009 and 2010). We included 400 patients and 103 controls (UTI caused by non‐ESBL Escherichia coli). Clinical and demographic information was obtained from medical records. Comorbidity was evaluated using Charlson Index (CI). Strains were identified using VITEK 2 system. Results: A total of 400 isolates were obtained (93%E. coli and 7%Klebsiella spp). In 2009, 6% of cultures were ESBL‐producing E. coli and 7% in 2010. 37% of patients were men and 81% were aged ≥ 60 years. CI was 2.3 ± 1.8 (high comorbidity: 42.8%). 41.5% of strains were susceptible to amoxicillin‐clavulanate, 85.8% to fosfomycin and 15.5% to ciprofloxacin. The total number of ESBL E. coli positive urine cultures during hospital admission was 97 and, compared with 103 controls, risk factors for UTI caused by ESBL‐ E. coli strains in hospitalised patients were nursing home residence (p < 0.001), diabetes (p = 0.032), recurrent UTI (p = 0.032) and high comorbidity (p = 0.002). In addition, these infections were associated with more symptoms (p < 0.001) and longer admission (p = 0.004). Conclusions: Urinary tract infection caused by ESBL are a serious problem and identifying risk factors facilitates early detection and improved prognosis. Male sex, hospitalisation, institutionalisation, diabetes, recurrent UTI and comorbidity were risk factors and were associated with more symptoms and longer hospital stay.     

应用重复PCR指纹技术调查肺科ICU鲍曼不动杆菌的暴发流行

为调查鲍曼不动杆菌在医院感染中的流行情况 ,分别采用抗生素敏感谱试验及重复PCR指纹技术对从 2 4名病人分离的 2 8株鲍曼不动杆菌作分型研究。结果发现 2 8株共分成 3种抗生素敏感谱模式或 5种基因型 ,以Ⅰ型抗生素敏感谱或基因型A为主 ,从肺科ICU分离的菌株均为基因型A。结果表明基因型A鲍曼不动杆菌是此次暴发流行的菌株。基因分型较抗生素敏感谱分型更为灵敏、特异 ,且具有简便、快速、可靠的特点。在医院感染流行病学调查中颇具应用价值。