853份中段尿培养及耐药性分析

目的分析泌尿系统感染患者中段尿病原菌的分布及耐药情况,为临床合理应用抗菌药物提供依据。方法对该院2014年1~12月送检的853份中段尿标本进行培养,并对分离病原菌进行细菌鉴定和耐药性分析。结果共245份中段尿标本分离出病原菌,阳性率为28.7%;共检出病原菌菌株269株,以革兰阴性菌为主(60.2%),其次为革兰阳性菌(33.8%)、真菌(5.9%)。检出产超广谱β-内酰胺酶(ESBLs)大肠埃希菌48株,产ESBLs肺炎克雷伯菌3株;耐甲氧西林表皮葡萄球菌(MRSE)和耐甲氧西林金黄色葡萄球菌(MRSA)检出率分别为17.6%、35.8%;未检出耐万古霉素的葡萄球菌。结论临床医生要依据细菌药物敏感试验结果科学合理地选用抗菌药物,防止盲目经验用药,减少及控制ESBLs阳性菌株和其他耐药菌株的产生及传播。     

新生儿病房病原菌分布及耐药性分析

目的了解本院新生儿病房病原菌的分布及耐药性,为临床用药提供依据。方法回顾性调查分析2010年6月至2011年12月新生儿病房送检标本中分离的245株病原菌,用Vitek-2全自动微生物鉴定系统进行鉴定及药敏试验。结果 245株病原菌中,革兰阳性球菌84株(占34.3%),革兰阴性杆菌158株(占64.5%),以咽拭子检出率最高(40.0%)。主要病原菌为肺炎克雷伯菌、大肠埃希菌、表皮葡萄球菌、金黄色葡萄球菌。革兰阴性杆菌和葡萄球菌属对常用抗菌药物耐药严重,且呈多药耐药。革兰阴性杆菌产超广谱β-内酰胺酶(ESBLs)的检出率为70.9%;未检出耐甲氧西林金黄色葡萄球菌(MRSA),耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率为58.5%,无耐万古霉素葡萄球菌检出。结论新生儿病房病原菌以革兰阴性杆菌为主,对常用抗菌药物耐药严重,应动态监测病原菌流行株及其耐药情况,合理使用抗菌药物。     

医院住院患者下呼吸道感染的病原菌分布与耐药性研究

目的 了解我院下呼吸道感染住院患者的病原菌群的基本构成及其耐药性,为临床合理用药提供依据.方法对我院2006年1月至2009年12月住院患者的下呼吸道感染患者痰菌培养及药敏结果进行回顾性统计分析.结果本组标本共检出病原菌2 133株,其中革兰阴性杆菌1 032株(48.4%),革兰阳性菌464株(21.8%),真菌637株(29.9%).耐甲氧西林金黄色葡萄球菌株的检出呈上升趋势,达77.4%;超广谱β-内酰胺酶(ESBLs)在大肠埃希菌和克雷伯菌属中的总检出率分别59.1%和32.6%.革兰阳性球菌中万古霉素和替考拉宁的抗菌活性最强.肠杆菌科细菌对碳青霉烯类仍高度敏感,非发酵革兰阴性杆菌对头孢哌酮/舒巴坦的耐药率最低.结论定期进行细菌耐药性监测,对指导临床合理应用抗菌药物,积极有效地控制医院感染具有重要意义.     

急性阑尾炎患者脓液培养病原菌分布及耐药性分析

目的探讨引起急性阑尾炎患者感染的病原菌分布及耐药情况,为临床合理使用抗菌药物提供科学依据。方法标本经分离培养,用细菌鉴定仪对病原菌进行鉴定和药敏试验,用WHONET5.4软件对病原菌的药敏结果进行统计分析。结果共检出病原菌300株,其中革兰阴性杆菌218株(72.7%),革兰阳性菌77株(25.7%)。以大肠埃希菌检出率最高153株(51.0%),其次为金黄色葡萄球菌33株(11.0%)。产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌的检出率52.9%和25.0%,耐甲氧西林金黄色葡萄球菌检出率为22.1%。药敏结果显示,病原菌对抗菌药物存在不同程度耐药性。结论急性阑尾炎患者感染主要致病菌为大肠埃希菌,不同病原菌对抗菌药物的敏感性不同,对脓液进行细菌培养和耐药性分析对临床合理选药非常重要。     

2013-2015年某结核病专科医院常见病原菌分布及耐药监测分析

目的 对2013-2015年某结核病专科医院临床分离病原菌进行分析,了解病原菌分布特点及耐药性.方法 采用VITEK2-compact检测系统对分离的细菌进行鉴定和药敏实验.采用WHONET5.6软件对细菌鉴定及药敏实验结果进行分析.结果 共检出革兰阴性菌2 991株,占90.4%,革兰阳性菌317株,占9.6%.连续3年检出率居前三位的病原菌依次为肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌.2013-2015年,产超广谱β内酰胺酶(ESBLs)大肠埃希菌检出率分别为40.4%、48.2%和38.3%,产ESBLs肺炎克雷伯菌检出率分别为16.9%、8.4%和11.6%.未检出亚安培南耐药大肠埃希菌.肺炎克雷伯菌对亚安培南的耐药率平均为1.6%.甲氧西林耐药金黄色葡萄球菌(MRSA)检出率分别为53.8%、54.3%、42.9%.甲氧西林耐药凝固酶阴性葡萄球菌(MRCNS)检出率分别为84.5%、82.7%、85.9%.未检出万古霉素、利奈唑胺、替加环素耐药葡萄球菌.肠球菌对庆大霉素、利奈唑胺、替加环素、万古霉素比较敏感.结论 碳青霉烯类抗菌药是抗肠杆菌科细菌最有效药物.万古霉素、利奈唑胺和替加环素是抗葡萄球菌较好的药物.肺炎克雷伯菌、鲍曼不动杆菌检出率逐年上升.需加强耐药监测以控制多药耐药菌的传播.     

血液病患者呼吸道感染病原谱及耐药性分析

目的了解血液病患者呼吸道感染病原谱特点及耐药性。方法对苏州大学附属第一医院血液科2011~2013年血液病患者呼吸道分泌物标本分离的病原性细菌分布及耐药性进行分析。结果共分离到1 434株病原菌,其中革兰阴性菌947株(66.0%),肺炎克雷伯菌是居首位的病原菌,占20.0%,产ESBLs的大肠埃希菌和肺炎克雷伯菌的检出率分别为89.3%、70.4%。肠杆菌科对头孢唑林、头孢呋辛、头孢噻肟、头孢曲松、头孢哌酮耐药率均大于70.0%;表皮葡萄球菌和溶血葡萄球菌对甲氧西林的耐药率分别为97.8%和98.4%;粪肠球菌对高浓度庆大霉素、四环素和环丙沙星耐药率分别为46.4%、55.4%和50.0%;屎肠球菌对青霉素G、氨苄西林和环丙沙星耐药率均为71.9%。结论血液病患者呼吸道感染主要病原菌以革兰阴性菌为主,表现为呼吸道感染产ESBLs肠杆菌科非常严重;革兰阳性菌以凝固酶阴性葡萄球菌为主,耐甲氧西林严重;粪肠球菌与屎肠球菌间表现出不同的耐药类型;应引起重视,根据敏感性试验选择合理抗菌药物治疗呼吸道感染。     

2008年某院临床分离的常见细菌耐药性监测

目的调查包头医学院第一附属医院2008年临床分离常见细菌对常用抗菌药物的耐药情况。方法收集2008年1～12月临床分离的常见细菌,采用纸片扩散法进行抗菌药物敏感性试验,数据用WHONET5.4进行统计分析。结果 720株临床分离细菌中,其中革兰阳性球菌165株(22.9%),革兰阴性杆菌555株(77.1%)。革兰阳性球菌中前3位分别是肠球菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌。革兰阴性杆菌前3位分别是大肠埃希菌、铜绿假单胞菌、克雷伯菌属。耐甲氧西林金黄色葡萄球菌检出率为45.5%,耐甲氧西林凝固酶阴性葡萄球菌检出率为52.6%。未检出耐糖肽类抗菌药物的革兰阳性球菌。大肠埃希菌和克雷伯菌属中产超广谱β-内酰胺酶(ESBLs)菌株检出率分别为59.1%、53.9%;产ESBLs菌株耐药率均高于非产ESBLs菌株。其他肠杆菌对多数抗菌药物耐药率较高。非发酵糖革兰阴性杆菌的耐药率均较高。结论临床常见病原菌以革兰阴性杆菌为主,革兰阳性球菌对糖肽类抗菌药物耐药率最低;肠杆菌科细菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐药率较低。     

重症监护室产超广谱β-内酰胺酶革兰阴性菌耐药性监测

目的探讨重症监护室革兰阴性杆菌的产ESBLs菌株,同时监测其耐药性,从而指导此类细菌感染的抗菌药物的应用.方法采用双纸片协同试验法,对重症监护室分离的116株革兰阴性菌做ESBLs的检测,并比较亚胺培南等12种抗菌药物体外抗菌作用.结果重症监护室产ESBLS耐药株占全部分离菌的353%,其中阴沟肠杆菌占44.4%,肺炎克雷伯菌占43.2%,大肠埃希菌占37.5%产ESBLs耐药菌对三代头孢菌素有较高的耐药性,对氨基糖苷类,喹喏酮类和磺胺类有交叉耐药,亚胺培南对产ESBLs耐药菌有较强的抗菌作用,是目前治疗产ESBLs耐药菌的首选药物.结论检测ESBLs菌株,有助于临床治疗此类细菌引起的感染,防止医院感染产ESBLs病原菌的暴发性流行.     

2011年病原菌临床分离株分布及耐药性分析

目的 了解该院病原菌临床分离株的分布及耐药性.方法 回顾性分析2011年病原菌的检出情况及药敏试验结果.结果 2 187份临床标本中分离获得病原菌431株,分离率19.7%;标本病原菌阳性检出率由高到低依次为痰、分泌物、咽拭子、血和尿.检出肠杆菌科细菌202株(占46.8%),非发酵菌73株(占16.9%),革兰阳性球菌123株(占28.5%),真菌28株(占6.5%);大肠埃希菌和肺炎克雷伯菌超广谱β-内酰胺酶阳性率分别为44.4%和48.4%.检出金黄色葡萄球菌45株,其中甲氧西林耐药金黄色葡萄球菌检出率为28.6%,未检出万古霉素耐药葡萄球菌.结论 细菌耐药性监测有助于指导临床合理用药,减少耐药菌株的产生和传播及有效控制院内感染.     

血液病粒细胞缺乏症患者医院感染病原菌的分布及药敏分析

目的:探讨血液病粒细胞缺乏症患者医院感染病原菌的分布及药敏情况,为临床合理使用抗菌药物提供依据。方法:收集2015年5月-2018年5月兰州大学第一医院血液科发生医院感染的504例次血液病粒细胞缺乏症住院患者的病原学资料,对临床分离病原菌的分布及药敏结果进行回顾性分析。结果:共分离病原菌184株,其中168株(91.30%)来自急性白血病患者,16株(8.7%)来源于非急性白血病患者;阳性标本主要来源于血流,分离菌81株(44.00%),其次为痰和咽拭子,分别为54株(29.30%)和35株(19.00%);病原菌中革兰阴性菌126株占68.48%,最常见的为肺炎克雷伯菌、大肠埃希菌及铜绿假单胞菌,革兰阳性菌23株占12.50%,以金黄色葡萄球菌及表皮葡萄球菌为主;真菌35株占19.02%,以白假丝酵母菌为主。产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌和肺炎克雷伯菌检出率分别为40.0%和22.2%,均对阿米卡星100%敏感,对碳青霉烯类抗菌素的耐药率达27.8%;肺炎克雷伯菌对阿米卡星的敏感率最高,达94.44%,对氨苄西林的耐药率达97.22%;大肠埃希菌对碳青霉烯类100%敏感,对氨苄西林耐药率最高,达80%;铜绿假单胞菌对所检测抗菌药物的敏感率均在80%以上。革兰阳性菌中检出耐甲氧西林的金黄色葡萄球菌及耐甲氧西林的凝固酶阴性葡萄球菌各1株。主要革兰阳性菌对万古霉素、利奈唑胺的敏感率达100%,对青霉素100%耐药。结论:血液病粒细胞缺乏症患者医院感染的病原菌以革兰阴性菌为主,病原菌对抗菌药物有不同耐药性,掌握常见病原菌的分布及药敏情况,对合理选择抗菌药物,控制医院感染起着重要作用。     

恶性血液病患者医院真菌感染的分析及预防

目的探讨恶性血液病患者医院真菌感染的原因和易感因素与防治。方法采用回顾性调查方法对我院血液科病房16例恶性血液病患者进行调查和统计分析。结果恶性血液病患者院内真菌感染患者感染部位以消化道为主,占44%。引起恶性血液病患者院内真菌感染的主要致病菌以条件致病真菌为主,占56%,其次为霉菌,占44%。结论强调合理使用抗生素,积极提高患者机体免疫能力,改善环境,开展患者自我卫生教育是预防恶性血液病患者医院真菌感染关键所在。     

1741例血液病患者中721株病原菌感染临床分析

目的：探讨血液病患者医院感染的发病率、感染的好发部位、病原菌的分布情况。方法：用KB纸片扩散法对1741例血液病患者中分离的721株病原菌进行药敏试验统计分析。结果：从1741例标本中,分离得到致病菌721株,阳性率为41.4%,其中革兰阳性菌216株,占病原菌的30.0%,革兰阴性菌218株,占病原菌30.2%,白色念珠菌113株,占病原菌15.7%,其他病原菌174株,占病原菌的24.1%。其中白色念珠菌、肠球菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌、大肠埃希菌、铜绿假单胞菌为常见菌。结论：恶性血液病患者医院感染发生率较高,应加强治疗过程的环境保护,及时使用恰当的支持治疗,合理有效应用抗生素,减少恶性血液病患者的医院感染发生率。     

恶性血液病患者的医院感染特点及易患因素分析

目的 了解恶性血液病患者发生医院感染的特点和易患因素。方法 对208例恶性血液病患者医院感染情况 ,进行回顾性分析。结果 208例病人发生102例感染。多部位感染17例。感染导致死亡18例。感染部位以呼吸道口腔粘膜最多见。感染病原菌主要为G-菌和真菌。大剂量化疗、白细胞减少、广谱抗菌素使用、住院时间延长 ,是医院感染的易患因素。 结论 恶性血液病患者 ,应加强监护。白细胞<2.0×109/L者 ,注意保护性隔离。应强调合理使用抗生素     

Nontuberculous mycobacterial infections in cancer patients in a medical center in Taiwan, 2005-2008

Data on the nontuberculous mycobacterial (NTM) species that cause infection and the characteristics of disease caused by these pathogens in cancer patients are limited, so we perform this study to investigate the species distribution of NTM isolates from various clinical specimens and to elucidate the epidemiologic trends in NTM isolates and diseases among cancer patients. From 2005 through 2008, cancer patients with NTM infections as defined by the American Thoracic Society/Infectious Diseases Society of America criteria were identified at the National Taiwan University Hospital. The medical records of all patients were reviewed. During the study period, a total of 219 cancer patients with NTM infections were identified. Among them, 133 (60.7%) patients were older than 65 years, most of whom were men. Lung cancer was the most common type of cancer, followed by hematologic cancer and gastrointestinal tract cancer. Pulmonary NTM infection was the most common type of infection in 205 (93.6%) patients, followed by skin and soft tissue infections (n = 7, 3.2%), disseminated infections (n = 4, 1.8%), and genitourinary tract infection (n = 3, 1.4%). Disseminated infections occurred exclusively in patients with hematologic cancer. Mycobacterium avium complex (MAC) caused the majority of pulmonary NTM infections in cancer patients; in contrast, M. abscessus was the most common causative pathogen of extrapulmonary NTM diseases, followed by MAC. In conclusion, physicians need to be aware of the possibility of co-existing pulmonary NTM infection in patients with lung cancer. In addition, disseminated NTM infection should be considered in patients with hematologic cancer.     

国产两性霉素B治疗侵袭性真菌感染

目的观察国产静脉用两性霉素B对血液系统恶性肿瘤患者侵袭性真菌感染(IFI)的临床疗效及安全性。方法40例恶性血液病患者使用华北制药厂生产的两性霉素B,剂量为5￣50mg/d,用药天数8￣66d,中数22d。结果两性霉素B临床总有效率为75%,真菌清除率63.6%,不良反应发生率中寒战、发热57.5%,低血钾40%,消化道反应20%,肾功能损害15%。结论两性霉素B抗菌谱较广,且疗效好,为治疗IFI的高效药物,但因其不良反应较大,限制其使用。研究表明:只要合理用药,定期监测肝肾功能,该药仍是一相对较为安全有效的药物。     

血液肿瘤患者化疗后肛周感染危险因素病例对照研究

目的 探讨血液肿瘤患者接受化疗后发生肛周感染的危险因素.方法 采用回顾性病例对照研究的方法,对四川省某三级甲等医院血液内科2020年12月—2021年5月收治的进行化疗的348例血液肿瘤住院患者相关资料(人口学特征、疾病特征、医疗及护理病例记录、实验室检查结果)予以回顾性分析,根据出院诊断发生肛周感染的病例作为病例组,...     

Acinetobacter baumannii infection in patients with hematologic malignancies in intensive care unit: risk factors and impact on mortality

Purpose

We investigated the characteristics of Acinetobacter baumannii infection in critically ill patients with hematologic malignancies.

Materials and Methods

The prospectively collected data of patients with hematologic malignancies admitted to a medical intensive care unit of a university hospital from 2007 through 2010 were reviewed retrospectively.

Results

One hundred twenty-eight patients were included in the study, among whom 35 (27%) developed 39 A baumannii infections. Pneumonia was the most common infection site of A baumannii. Presence of neutropenia, underlying hematologic malignancy, and the disease status did not affect the acquisition of the infection. Advancing age, prior exposure to aminoglycosides, central venous catheterization, and presence of nasogastric tube were the independent risk factors for the development of A baumannii infections. The mortality rate was higher in patients with A baumannii infections compared with the ones without (P = .009). However, in multivariate analysis, low Glasgow coma scale, prior immunosuppressive treatment, neutropenia, invasive mechanical ventilation, and severe sepsis were independently associated with mortality, whereas presence of A baumannii infection was not.

Conclusions

Despite the high mortality rate in critically ill patients with hematologic malignancies, presence of A baumannii infection was not an independent risk factor for mortality.     

血NAP活性联合HsCRP检测在恶性血液病发热原因鉴别中临床应用价值的探讨

目的探讨血NAP活性联合HsCRP检测在恶性血液病发热原因鉴别中的临床应用价值。方法对近两年来本科住院的300例恶性血液病伴有发热的患者分析,最后经病原微生物证实为真菌感染28例,细菌感染160例,混合感染47例,非感染者65例（无病原微生物证据,抗生素治疗无效,且给予激素以及原发病治疗有效）。对所有患者发热时常规进行的血NAP活性联合HsCRP进行回顾性分析。结果真菌感染患者的血NAP积分中位数165,阳性率82％,HsCRP水平为12mg／dl,而细菌感染组、混合感染组、非感染组患者的血NAP积分中位数分别为126、147、36,阳性率分别为68％、76％、32％,HsCRP水平分别为11．6mg／dl、10．8mg／dl、0．8mg／dl。恶性血液病患者合并真菌或者细菌抑或混合感染的患者,血NAP活性以及HsCRP水平均明显高于非感染患者,相互比较差异有统计学意义;在合并感染患者当中,真菌感染患者血NAP活性较细菌感染患者升高更为明显,混合感染介于其中,相互比较差异均有统计学意义;HsCRP真菌感染患者略高,但相互比较差异无统计学意义。结论血NAP活性联合HsCRP检测有助于恶性血液病患者发热原因分析,在未获得病原微生物以前,为临床医师治疗是否选择抗生素,以及是否抗真菌治疗提供了有力证据,有利于及早控制感染以及避免不必要的抗生素使用。     

Clinical predictors of Pseudomonas aeruginosa or Acinetobacter baumannii bacteremia in patients admitted to the ED

The identification of clinical characteristics that could identify patients at high risk for Pseudomonas aeruginosa or Acinetobacter baumannii bacteremia would aid clinicians in the appropriate management of these life-threatening conditions, especially in patients admitted to the emergency department (ED) with community-onset infections. To determine clinical risk factors for P. aeruginosa or A. baumannii bacteremia in patients with community-onset gram-negative bacteremia (GNB), a post hoc analysis of a nationwide bacteremia surveillance database including patients with microbiologically documented GNB was performed. Ninety-six patients with P. aeruginosa or A. baumannii bacteremia were compared with 1230 patients with Escherichia coli or Klebsiella pneumoniae bacteremia. A solid tumor or hematologic malignancy was more likely to be associated with P. aeruginosa or A. baumannii bacteremia, whereas concurrent neurologic disease was less frequently seen. In regards to the site of infection, pneumonia was more common in P. aeruginosa or A. baumannii bacteremia, whereas a urinary tract infection was less frequently seen. Factors associated with P. aeruginosa or A. baumannii bacteremia in multivariate analysis included pneumonia (odds ratio [OR], 3.60; 95% confidence interval [CI], 1.86-6.99), hematologic malignancy (OR, 2.71; 95% CI, 1.26-5.84), male sex (OR, 2.17; 95% CI, 1.31-3.58), solid tumor (OR, 1.89; 95% CI, 1.15-3.12), and health-care-associated infection (OR, 1.88; 95% CI, 1.48-2.41). Our data suggest that an initial empirical antimicrobial coverage of P. aeruginosa or A. baumannii bacteremia should be seriously considered in patients with pneumonia, a hematologic malignancy, solid tumor, or health-care-associated infection, when GNB is suspected, even in community-onset infections.     

Current roles for allogeneic hematopoietic cell transplantation following nonmyeloablative or reduced-intensity conditioning

Nonmyeloablative and reduced-intensity conditioning regimens followed by allogeneic hematopoietic cell transplantation (HCT) have been evaluated in patients with hematologic malignancies who were not considered candidates for conventional HCT because of age or medical comorbidities and in selected patients with metastatic renal cell carcinoma. The regimens have relied more on graft-versus-tumor effects than on chemoradiation therapy to facilitate engraftment and eradicate malignant cells. While nonmyeloablative HCT has been associated with reduced regimen-related toxicities and has been curative for a number of patients with hematologic malignancies, challenges have remained in regard to graft-versus-host disease, infections, and disease progression. In this article, we review data from a number of published phase I and II studies that describe the results of allogeneic HCT after nonmyeloablative conditioning.