厌氧菌培养鉴定与药敏试验在口腔颌面部间隙感染中的应用

目的：调查口腔颌面部间隙感染中厌氧菌培养与药敏试验的必要性。方法采集2010年7月至2013年9月门诊、住院口腔颌面部间隙感染患者的脓汁标本256份,进行厌氧菌的培养及体外药敏试验。结果256份标本中184份厌氧菌培养阳性,248株厌氧菌,阳性率为71．9％;以普雷沃菌、拟杆菌属、梭杆菌属、消化性链球菌居多。在药敏试验中,以甲硝唑的敏感性最高,克林霉素次之。结论口腔颌面部感染,进行厌氧菌培养鉴定与药敏试验很有必要,在培养结果报告之前抗厌氧菌治疗应首选甲硝唑、克林霉素。     

应用固相微萃取/气相色谱方法快速诊断下呼吸道厌氧菌感染

目的：应用固相微萃取／气相色谱(SPME／GC)技术测定厌氧菌代谢产物短链脂肪酸(SCFA)，建立快速诊断呼吸道厌氧菌感染的方法。方法：临床下呼吸道标本186份，整夜痰66例，晨一口痰80例，纤维支气管镜吸取液40例，直接应用SPME／GC法检测SCFA，并与液-液萃取法／气相色谱和厌氧菌培养法比较，同时测定80例含嗽口水作为对照。结果：样品中检出SCFA(异丁酸、丁酸、异戊酸、戊酸、异己酸、己酸)两种以上者，可在1h内判断有无厌氧菌感染，厌氧菌培养、SPME／GC法、液-液萃取/气相色谱法痰液标本阳性率分别为97、5％、63．75％和18．75％，而含嗽水标本阳性率分别为100％、0．0％和0．0％。结论：厌氧菌培养法假阳性高，液-液萃取／气相色谱法灵敏度低，而SPME／GC法灵敏度高、特异性好，SPME／GC法明显优于厌氧菌培养法和液-液萃取／气相色谱法，是目前快速、简便诊断下呼吸道厌氧菌感染的有效方法。     

不同病原体血流感染血清降钙素原水平研究

目的分析血流感染早期血清降钙素原(PCT)水平与血流感染病原体的相关性,为临床预测病原体种类提供依据。方法收集北京同仁医院2018年1月至2020年10月526份血培养阳性样本为研究对象,其中革兰阳性球菌238株、革兰阴性杆菌245株、真菌28株和厌氧菌15株,统计患者第一次血培养阳性采血时间之前24 h内血清PCT水平。通过绘制不同病原体血流感染患者PCT水平的受试者工作特征(ROC)曲线,确定预测不同病原体血流感染的PCT水平最佳截断值。结果革兰阳性球菌血流感染患者PCT水平为0.76(0.26,3.93)ng/mL,革兰阴性杆菌血流感染患者PCT水平为4.86(0.97,24.94)ng/mL,真菌血流感染患者PCT水平为0.80(0.30,1.44)ng/mL,厌氧菌血流感染患者PCT水平为2.96(2.25,5.07)ng/mL。预测革兰阳性球菌、革兰阴性杆菌、真菌、厌氧菌血流感染的PCT水平最佳截断值分别为1.38、7.83、1.22、3.76 ng/mL。结论 PCT水平与不同种类病原体存在一定关系,根据PCT水平可以预测病原体的种类。     

间接免疫荧光抗体法快速检测脓液中的厌氧菌

用脆弱、多形和不解糖类杆菌3种常见厌氧菌标准株的免疫血清,以间接免疫荧光抗体法(IFA)检测75份脓液中的厌氧菌,与厌氧培养结果比较,IFA3种菌的敏感性为72.7％,阳性符合率为88.9％,阴性符合率为81.4％.少数IFA阳性与培养鉴定结果不完全一致。3份IFA阳性培养阴性.IFA方法简便,2小时内可得结果,是一种快速、特异和敏感的厌氧菌检测方法.     

胆道厌氧菌感染的中西医结合治疗

<正> 厌氧菌感染几乎遍及临床各科,熊德鑫51份腹部感染标本中,G(一)脆弱类菌占45％。我院69份胆道感染标本中,类杆菌占74.6％,为肠源性,均与需氧菌混合感染。外科感染标本中,厌氧菌与需氧菌检出率之比为1.1:1。厌氧菌能产生β—内酰胺酶对多种抗生素不敏感,故对厌氧感染的预防,诊断和治疗,是临床医生经常面临的困难。由于它常与需氧菌混合感染,发生互相协同作用。加剧病情的复杂性,难治性。因需氧菌消耗病灶中的氧,致组织缺氧坏死,降低组织氧化还原电位,为厌氧菌繁殖创造条件,厌氧菌能抑制和破坏机体的免疫力,使感染加剧并有利于扩散,如厌氧菌能抑制白细胞的吞噬     

需氧与厌氧配对培养在血流感染诊断中的价值

目的探讨需氧与厌氧配对培养在临床血流感染中的诊断价值。方法采用含树脂需氧瓶和含溶血素厌氧瓶配对培养,统计分析2012年7月至2014年6月送检的11 603份血培养中1 303份阳性菌株的分布和报阳时间。结果 1 303份血培养阳性标本中,厌氧瓶与需氧瓶均生长的有603株,仅需氧瓶生长的483株,仅厌氧瓶生长的217株。双瓶培养阳性率11.23%(1 303/11 603)与仅用单需氧瓶阳性率9.36%(1 086/11 603)或单厌氧瓶培养阳性率7.07%(820/11 603)比较,差异均有统计学意义(P0.01)。在厌氧瓶中还检出专性厌氧菌10例。双瓶均报阳的603株不同种属分离菌的厌氧瓶报阳时间均值早于需氧瓶。临床常见分离菌属两种培养瓶报阳时间比较具有统计学意义(P0.05)。结论需氧瓶与厌氧瓶配对培养在增加厌氧菌检出的同时,还能提高血培养的阳性率并缩短检出时长,为临床血流感染诊断和治疗提供依据,可指导临床合理使用抗菌药物。     

临床厌氧菌感染的病原学探讨

临床厌氧菌感染的病原学探讨解放军第一六九医院陆秀荣，李本连，唐银，何学贤，黄金元厌氧菌感染为正常菌群所引起的内源性感染，日益受到重视（１）。我们采集疑有厌氧菌感染者的标本４２１份进行培养，以探讨其病原学诊断问题。１材料与方法１．１培养基改良ＧＡＭ羊血...     

厌氧菌864株的分离鉴定

总结三年来半对住院患儿多临床感染标本的厌氧培养,提高病原菌的检出率,应用ＡＰＩ２０Ａ鉴定系统对分离到的厌氧菌菌种进行鉴定,取２１０２份各种感染感染标本作厌氧培养,共分离出８６４株厌氧菌,经鉴定归１４个属,计５２个种,最常见的厌氧菌是革兰阴性杆菌,占阳性总数５３．９％（４６６／８６４）,其次阳性球菌占２６．４％（２２８／８６４）阳性无芽胞杆菌,阴性球菌和阳性芽胞梭菌分别为１０．３％（８９／８６４）。     

替硝唑抗菌素糊剂治疗根尖周炎的疗效评价

大量文献资料显示,根尖周感染的优势菌种是革兰阴性厌氧菌。而替硝唑(tinidazole简称TNZ)对所有的致病厌氧菌均有较强的杀灭作用。TNZ对90％厌氧菌的最小抑制浓度(MIC_(90))仅为2μg/ml。我科从1997年5月起,用TNZ另加红霉素、地塞米松糊剂治疗尖周病取得了满意的结果。现报道如下。     

细菌型及细菌L型混合感染及药敏试验分析

从标本中培养出细菌是确立感(传)染性疾病诊断和治疗的基本依据,单一需氧菌的培养方法易遗漏厌氧菌和缺壁细菌,不能概括致病菌的全貌[1],使多种类细菌的混合性感染不能准确诊断和治疗.我室于去年接待了用常规方法仅培养部分需氧菌或未培养出细菌的标本3份(血1份、腹水1份、尿1份),同时进行需氧菌、厌氧菌及细菌L型培养,检测结果报告如下.     

急诊ICU内二重感染的监控与防治

急诊ＩＣＵ内４例严重深部真菌感染，分析讨论了ＩＣＵ内二重感染的原因及预防措施。加强基础护理及支持疗法，可减少内源性感染；建立完整的管理体系和严密的消毒隔离制度，可防止外源性感染；合理应用抗生素与严格无菌技术，可预防医源性感染。早期加强预防和及时有效控制感染对患者预后有重要意义     

Prevention,recognition and management of neonatal HSV infections

Neonatal HSV is most commonly transmitted at the time of delivery with the risk being dramatically higher if the mother has first-episode genital HSV and does not have an elective Cesarean section. Maternal HSV type-specific serology can be used to differentiate first-episode from recurrent infection in this setting, allowing for use of empiric acyclovir for the highest risk infants. There is a need for new strategies as current methods of prevention of transmission of HSV to neonates have limited effectiveness, as they do not account for the fact that the majority of transmission occurs from asymptomatic women. After transmission has occurred, early recognition of neonatal HSV improves the prognosis. Diagnosis needs to be considered in all infants who develop vesicles, unexplained seizures, or possible sepsis in the first 5 weeks of life.     

原发性脊柱感染的分析和治疗

目的 探讨原发性化脓性脊柱感染(PSI)、结核性脊柱感染(TSI)和布氏杆菌性脊柱感染(BSI)临床特征。方法 回顾性分析河北医科大学第三医院从2016年1月至2020年12月收治的79例原发性脊柱感染患者的临床资料并对其进行统计学分析。结果 PSI组入院时中性粒细胞百分比,C反应蛋白,降钙素原高于TSI组与BSI组,PSI组白细胞计数高于BSI组;TSI组较PSI组起病时间时间长,红细胞沉降率低,差异均有统计学意义(P<0.05);原发性脊柱感染最常见的临床症状是颈或背部疼痛69例(87.3%),其次为发热或寒颤39例(49.4%)。PSI组出现发热或寒颤症状的患者比例高于TSI组,差异有统计学意义(P<0.017);3组中最常累及的部位均为腰骶部,分别为28例(87.5%)、16例(57.1%)和16例(84.2%)。然而,颈胸段受累在TSI组较PSI组中更为常见,差异有统计学意义(P<0.017)。TSI组出现椎旁脓肿和腰大肌脓肿的比例高于PSI组和BSI组,差异有统计学意义(P<0.017)。结论 出现发热或寒颤、非特异性炎症指标大幅升高,起病急提示PS...     

Preventing nosocomial infection in paediatric wards

• Nosocomial infection is potentially a major problem in paediatric wards. However, there are methodological difficulties which hinder researchers in identifying the true extent of nosocomial infection.
• Respiratory infections pose the greatest challenge, with the respiratory syncytial virus (RSV) being particularly problematic. However, RSV can be contained by strict implementation of isolation procedures.
• Other major pathogens such as enteric bacteria and viruses can similarly be controlled through vigorous attention to hand-washing and isolation.
• Health-care staff are implicated in the nosocomial spread of many other infectious agents, and should pay particular care to personal practice.

     

对医院感染高危科室病人、护士病毒感染的调查研究

目的了解医院感染高危科室的病人、护士病毒感染情况,以便采取有效预防措施。方法采用桥联酶标法直接测定8种呼吸道病毒抗原,用Ellsa法测定血清2种病毒特异性抗体,分别对病人699人次,护士316人次和正常人群253人次对照,3组间进行比较、分析。结果病人组呼吸道病毒抗原阳性者明显高于护士组和正常对照组(P<0.05),而护士组与正常对照组无明显差异;柯萨奇B组病毒(CoxB)感染,护士组明显高于正常对照组(P<0.05)巨细胞病毒(CMV)感染IgG 3组间无差异,Ig M只有少数病人阳性,其他2组均阴性。结论呼吸道病毒感染在护士与病人之间较易控制,而病人间容易交叉感染;护士感染CoxB的危险性(RR)为正常对照组的2.62倍;CMV对护士则影响不大;故护士在进行护理技术操作及护理病人时,应严格执行无菌操作及消毒隔离制度,对预防医院感染至关重要。     

Sonication of Explanted Cardiac Rhythm Management Devices for the Diagnosis of Pocket Infections and Asymptomatic Bacterial Colonization

Background: Correct diagnosis of the causative organism is critical for the treatment of pacemaker and defibrillator pocket infections. No gold standard for this exists, although swab and tissue cultures are frequently used. The purpose of this study was to determine the value of ultrasonication of explanted generators in the diagnosis of pocket infections and asymptomatic bacterial colonization. Methods: Samples were prospectively collected during pacemaker and defibrillator generator extractions for elective replacements, upgrades, or pocket infections. The devices were placed in an ultrasonicator for 5 minutes and the fluid sent for culture, along with swab and tissue cultures. Results: Eighty‐two patients with pacemakers (n = 46) or defibrillators (n = 36) underwent generator explantation, 66 of these for elective reasons and 16 for pocket infection. In patients with pocket infection, 15 (94%) received a definitive bacterial diagnosis using a combination of all three‐culture modalities. Cultures were positive in 15 sonicated fluid, 13 tissue, and 11 swab samples, with Staphylococcus aureus and other skin flora commonly seen. In asymptomatic patients, 14 (21%) had positive cultures. Cultures were positive in 11 sonicated fluid, eight tissue, and two swab samples. Skin flora was commonly seen, but three of the sonicated fluid cultures grew gram‐negative rods. No patients with asymptomatic colonization developed clinical infection during the follow‐up period. Conclusions: Ultrasonication is an inexpensive and simple technique that improves the bacteriologic diagnosis of device pocket infections. It also identifies a significant proportion of patients with asymptomatic colonization, although this is not a marker of future pocket infection. (PACE 2011; 34:143–149)     

基于感染管理护士为主体的医院感染管理实践

目的探讨基于感染管理护士为主体的医院感染管理实践的效果。方法设立感染管理护士的组织架构,选拔、培训感染管理护士,进一步培训感染管理相关人员,实施全院感染管理并注重持续改进。结果设置感染管理护士后,相关人员手卫生依从率和正确率、感染控制相关知识得分均提高(P0.01),而呼吸机相关肺炎、导管相关血流感染、导尿管相关尿路感染发生率差异无统计学意义(P0.05)。结论基于感染管理护士为主体的医院感染管理实践有助于医院感染管理工作的落实,有效促进多学科合作。     

An outbreak of Ralstonia insidiosa bloodstream infections caused by contaminated heparinized syringes

IntroductionRalstonia insidiosa, a gram-negative waterborne bacteria able to survive and grow in any type of water source, can cause nosocomial infections, and are considered emerging pathogens of infectious diseases in hospital settings. In this study, we report an outbreak of R. insidiosa at our center related to contaminated heparinized syringes.Material and methodsThe present study was conducted in a tertiary care university hospital in Turkey. An outbreak analysis was performed between September 2021 and December 2021. Microbiological samples were obtained from environmental sources and from patient blood cultures. Species identification was performed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). To investigate the clonality of strains, all confirmed isolates were sent to the National Reference Laboratory and pulsed-field gel electrophoresis (PFGE) was used to perform molecular typing.ResultsSeventeen R. insidiosa isolates were identified from the blood cultures of 13 patients from various wards and intensive care units. Isolates from seven patient blood cultures and two heparinized blood gas syringes were characterized by PFGE. All isolates were found to belong to the same clone of R. insidiosa.ConclusionR. insidiosa was identified as the cause of a nosocomial infection outbreak in our hospital, which was then rapidly controlled by the infection-control team. When rare waterborne microorganisms grow in blood or other body fluid cultures, clinicians and the infection-control team should be made aware of a possible outbreak.