血流感染金黄色葡萄球菌耐药性分析及对患者预后影响

目的探讨佛山南海医院血流感染金黄色葡萄球菌(金葡菌)耐药状况及对患者预后的影响。方法回顾性收集2011年1月—2014年12月,该院临床科室诊断为金葡菌血流感染患者及其临床资料。分析致血流感染金葡菌耐药性及影响患者预后的相关因素。结果共纳入64例患者,以医院感染为主(53例,占82.8%),64例患者中培养出金葡菌64株,其中耐甲氧西林金葡菌(MRSA)22株,占34.4%,甲氧西林敏感金葡菌(MSSA)42株,占65.6%。MRSA对常用抗菌药物的耐药性要高于MSSA菌株,均未发现对万古霉素、替考拉宁、利奈唑胺耐药株。MRSA组年龄、糖尿病、中心静脉置管、机械通气、不恰当用药显著高于MSSA组(P均0.05);MRSA组病死率高于MSSA组(27.3%对14.3%),但差异无统计学意义(P=0.312);患者高龄OR 1.1(95%CI 1.004~1.108,P=0.036),不恰当用药OR 6.1(95%CI 1.2~35.2,P=0.048)是影响患者预后的独立危险因素。结论该院金葡菌血流感染以医院感染为主,金葡菌对抗菌药物呈现多重耐药性。高龄、不恰当用药是影响患者预后的独立危险因素。     

儿科院内感染细菌分布及耐药性监测

目的:了解儿科院内感染常见细菌分布并监测其耐药性.方法:收集惠儿标本,进行常规细菌培养及K-B法药敏试验.结果:分离出238株痛原菌,以克雷伯菌属为最多123株(51.7%).其次为凝固酶阴性葡萄球菌(coagulase negative staphylococci,CNS)50株(21.0%);123株克雷伯菌属中产ESBLs的菌株96株(78.0%);19株大肠埃希菌中产ESBLs的菌株12株(63.2%).产ESBLs克雷伯菌属和大肠埃希菌对抗菌药物的耐药率明显高于非产ESBLs的相应细菌.检出41株(80.2%)凝固酶阴性耐甲氧西林葡萄球菌(meahicillin resistant coagulase negative staphylococci,MRCNS),未检出耐甲氧西林的金黄色葡萄球菌(meahicillin resistant staphylococcus aureus,MRSA).凝固酶阴性葡萄球菌和金黄色葡萄球菌对青霉素全部耐药.结论:儿科的院内感染革兰阴性茵以克雷伯菌属最多见,革兰阳性菌以凝固酶阴性葡萄球菌居多,两类痛原菌多重耐药现象比较严重.     

2010年中国CHINET葡萄球菌属细菌耐药性监测和分析

目的 了解国内不同地区医院葡萄球菌属细菌临床分离株对抗菌药物的耐药性.方法 中国14所综合性医院,按统一方案进行葡萄球菌属细菌的耐药性监测和分析.结果 7 530株葡萄球菌属细菌临床分离株中,金葡菌占59.1％;凝固酶阴性葡萄球菌占40.9％(均分离自血液和无菌体液).后者中有表皮葡萄球菌(21.6％)、人型葡萄球菌(7.3％)和溶血葡萄球菌(4.5％)等.金葡菌和凝固酶阴性葡萄球菌中耐甲氧西林菌株分别占51.7％(11.5％～77.6％)和74.8％ (62.7％00～95.5％).60％以上的甲氧西林耐药金葡菌(MRSA)对磷霉素和甲氧苄啶-磺胺甲(啞)唑敏感.甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)中分别有68.7％和87.8％菌株对磷霉素和利福平敏感.重症监护病房患者中,MRSA和MRCNS检出率最高,尤其在某些医院中的某些科室有相对集中趋势.未发现对糖肽类抗生素和利奈唑胺耐药的菌株.结论 国内临床上甲氧西林耐药葡萄球菌属的检出率较高,细菌对抗菌药物的耐药率不同医院和地区间存在较大的差异,须重视对异质性万古霉素耐药金葡菌(hVISA)和万古霉素耐药金葡菌(VRSA)的检测.     

血液病患者血流感染病原菌分布及耐药性分析

目的分析本院血液科住院患者血流感染病原菌的分布和耐药情况,为临床合理使用抗菌药物,减缓细菌耐药性产生提供依据。方法应用BACT/ALERT3D全自动血培养仪对临床送检的血培养标本进行培养,使用VITEK2Compact全自动微生物分析系统对血培养阳性标本分离菌株进行菌种鉴定及药敏试验,应用WHONET 5.6软件对病原菌分布和药敏结果进行统计分析。结果 2017年10月～2018年9月本院血液科住院患者血培养阳性标本中共分离病原菌101株,其中革兰阴性菌77株(76.24%),主要为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌;革兰阳性菌23株(22.77%),主要为凝固酶阴性葡萄球菌(CNS)和金黄色葡萄球菌(金葡菌);真菌1株(0.99%),为热带假丝酵母菌。移植和非移植患者病原菌分布构成略有不同。产超广谱β-内酰胺酶(ESBLs)菌株在大肠埃希菌和肺炎克雷伯菌中的检出率分别为42.9%和55.0%。检出亚胺培南耐药的大肠埃希菌1株(2.9%),肺炎克雷伯菌3株(15%)。铜绿假单胞菌对常用抗菌药物的耐药率均较低。6株金葡菌中检出耐甲氧西林金葡菌2株(33.3%)。12株CNS中检出8株耐甲氧西林凝固酶阴性葡萄球菌(66.7%)。主要革兰阳性菌对万古霉素、利奈唑胺、替加环素和奎奴普丁/达福普汀敏感率均达100%。结论本院血液科血流感染病原菌种类复杂多样、革兰阴性菌所占比例居多,且多重耐药菌检出率高,及时监测病原菌的菌属分布和耐药变迁,可指导临床合理、规范地使用抗菌药物。     

重组溶葡萄球菌酶体外诱导的金黄色葡萄球菌耐药株生物学特征

目的探究重组溶葡萄球菌酶体外诱导金黄色葡萄球菌(金葡菌)耐药发生规律和机制。方法用3株临床分离金葡菌,体外以亚抑菌浓度重组溶葡萄球菌酶一步法诱导耐药,观察耐药株对多种抗菌药物的药敏改变情况,测序分析肽聚糖甘氨酸五肽桥联的关键合成酶编码基因femABX。并观察其中1株耐甲氧西林金葡菌(MRSA)和1株甲氧西林敏感金葡菌(MSSA)的生长曲线、小鼠感染毒力情况。结果金葡菌耐药发生频率为10-4~10-8水平,与原代株比较,耐药株体外生长速率和小鼠体内毒力显著降低,对β内酰胺类敏感性提高2~4 000倍。测序结果显示耐药株femA编码基因存在突变,可致终止密码子提前。结论重组溶葡萄球菌酶体外可诱导金葡菌耐药性产生,但耐药株生长繁殖力、致病力及抵抗β内酰胺类抗生素的能力显著降低。     

647株金黄色葡萄球菌儿童分离株的分布和耐药性分析

目的了解儿童金黄色葡萄球菌(金葡菌)分离株耐药情况,为临床治疗用药提供依据。方法采用微生物检验报告系统统计分析金葡菌分离株中耐甲氧西林金葡菌(MRSA)比率,并分析MRSA和甲氧西林敏感金葡菌(MSSA)对主要抗菌药物的耐药性差异。结果共分离到647株金葡菌,其中MRSA194株,占29.98%。MRSA和MSSA对万古霉素、替加环素、替考拉宁、利奈唑胺、奎奴普丁-达福普汀和呋喃妥因均100%敏感,对甲氧苄啶-磺胺甲口恶唑、阿米卡星、青霉素的耐药率差异无统计学意义;MRSA对大多β内酰胺类药物及其含酶抑制剂、红霉素、四环素、利福平、庆大霉素、环丙沙星和左氧氟沙星的耐药率较MSSA高,差异有统计学意义。结论金葡菌儿童临床感染形势严峻,MRSA和MSSA对多种抗菌药物耐药率差异明显,儿童金葡菌相关性感染可根据病情及参考药敏结果选用敏感的抗菌药物治疗。     

金黄色葡萄球菌血流感染111例的临床特征和预后

目的 探讨金黄色葡萄球菌(金葡菌)血流感染的临床特征和影响预后的危险因素,为控制细菌感染及耐药提供依据.方法 回顾性分析2014年7月—2020年7月内蒙古自治区人民医院金葡菌血流感染的临床特征和预后不良的危险因素,以及细菌耐药性和调整用药与死亡率的关系.结果 111例金葡菌血流感染患者中,耐甲氧西林金葡菌(MRSA)...     

2008—2010年血液科临床分离细菌分布及耐药性监测

目的了解山西医科大学第二医院血液科2008—2010年临床分离病原菌的分布特点及其对常用抗菌药物的耐药情况。方法细菌分离按常规方法进行,抗菌药物敏感试验按CLSI 2008年、2009年、2010年版进行并判断结果。结果 943株临床分离菌中,革兰阳性球菌429株,占45.5%,革兰阴性杆菌514株,占54.5%。革兰阳性菌中,凝固酶阴性葡萄球菌(CNS)为血液科分离菌株的第1位。葡萄球菌属细菌中耐甲氧西林金葡菌(MRSA)和耐甲氧西林CNS(MRCNS)检出率分别为17.6%和64.5%,万古霉素对革兰阳性球菌的抗菌活性最强,未发现万古霉素中介金葡菌(VISA)和耐万古霉素金葡菌(VRSA)菌株。屎肠球菌对测试药物的耐药率普遍高于粪肠球菌,未发现对万古霉素、替考拉宁耐药株。革兰阴性菌中,肺炎克雷伯菌为血液科分离菌株的第1位(占12.8%),大肠埃希菌位居第2。亚胺培南对革兰阴性杆菌的抗菌活性最强。鲍曼不动杆菌对亚胺培南和美罗培南耐药率分别为13.2%和11.6%。铜绿假单胞菌对头孢他啶、阿米卡星、环丙沙星耐药率较低,对其他测试抗生素的耐药率均在20%以上,并呈现多重耐药。结论血液病患者易并发医院感染,应引起临床和实验室的高度重视,合理选用抗菌药物是治疗和预防细菌耐药的关键。     

金黄色葡萄球菌临床感染与耐药性分析

目的了解金黄色葡萄球菌(以下简称金葡菌)的临床感染分布及其对抗菌药物的耐药性变化趋势,以指导临床合理用药。方法回顾性分析2007年1月至2010年12月临床各类送检标本中金葡菌的感染分布情况,并分别对甲氧西林敏感金葡菌(MSSA)和甲氧西林耐药金葡菌(MRSA)的耐药性进行分析。结果 999例金葡菌感染患者主要分布于老年病区和外科病房,标本来源以呼吸道分泌物和创面分泌物为主。金葡菌感染患者发生MRSA感染的有524例,检出率为52.5%;发生MSSA感染的病例为475例,检出率为47.5%。MRSA分离率连续4年分别为65.2%、57.8%、46.2%和43.9%,大致呈逐年下降趋势(P<0.05);MRSA对复方新诺明耐药率有上升趋势(P<0.05),对亚胺培南、庆大霉素、利福平、环丙沙星、克林霉素的耐药率呈下降趋势(P<0.05)。MSSA对常见的16种抗菌药物耐药率无显著性变化(P>0.05)。所有金葡菌感染患者中未分离到万古霉素耐药株。结论金葡菌感染患者多为老年患者和外科病房呼吸道感染及伤口感染,病情严重且呈多重耐药趋势;同时应加强对MRSA的主动筛查与综合管理,以防止该菌株在医院内暴发流行。     

新生儿耐甲氧西林凝固酶阴性葡萄球菌败血症120例分析

目的探讨耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)在新生儿败血症中的分布及耐药特点,为临床治疗提供参考。方法应用全自动血培养系统(BACTEC-9120),VITEK-AMS细菌鉴定仪,对120例MRCNS感染新生儿败血症血培养进行细菌鉴定,采用K-B纸片扩散法测定MRCNS对青霉素等18种抗生素的耐药性。结果120株MRCNS中表皮葡萄球菌56株占46.7%,溶血葡萄球菌30株占25%,人葡萄球菌12株占10%,沃氏葡萄球菌9株占7.5%,其它葡萄球菌13株占10.8%。药敏结果显示MRCNS多重耐药。结论凝固酶阴性葡萄球菌(CNS)已成为新生儿血培养的第一检出菌,主要为表皮葡萄球菌和溶血葡萄球菌,MRCNS占主导地位,成为新生儿院内感染的主要致病菌,药敏显示MRCNS为多重耐药,治疗可选用糖肽类和碳青霉烯类。MRCNS所致的院内感染值得引起关注。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.