2015—2020年兰州大学第一医院血流感染中鲍曼不动杆菌流行特征、耐药性及其感染危险因素分析

目的 分析2015—2020年兰州大学第一医院血流感染中鲍曼不动杆菌的临床分布特征、抗菌药物耐药性变迁及感染的危险因素,为医院感染的控制和临床合理治疗提供参考。方法 对2015—2020年兰州大学第一医院住院感染患者血培养阳性标本中分离出的鲍曼不动杆菌菌株的科室分布、抗菌药物耐药性特点及危险因素进行分析。结果 2015—2020年兰州大学第一医院住院感染患者血培养阳性标本中共分离到104株鲍曼不动杆菌,主要来源于重症监护病房（ICU）、老年病科、血液科。鲍曼不动杆菌对多种抗菌药物的耐药率超过90%以上。基础疾病、入住ICU、侵袭性操作及使用抗生素成为影响鲍曼不动杆菌血流感染的危险因素。结论 血流感染中分离的鲍曼不动杆菌对常见抗菌药物普遍耐药,应加强医院感染控制,防止耐药菌播散性。     

2015—2017年某综合医院鲍曼不动杆菌耐药性监测

目的对某综合医院2015—2017年鲍曼不动杆菌分布及耐药性变化趋势进行分析,为临床合理用药提供参考依据。方法收集某医院2015—2017年临床标本中所分离的鲍曼不动杆菌,对不同时间段、不同病区来源鲍曼不动杆菌的耐药情况进行统计分析。结果共分离出鲍曼不动杆菌232株,分离率从2015年10.4%上升到2017年13.0%。标本来源以痰液最多,占76.3%;儿科、ICU、神经外科及呼吸内科是感染的高发病区。不同时间段分离鲍曼不动杆菌对抗菌药物耐药性具有一定波动,2016年的耐药性最低,2017年的耐药率最高。2017年鲍曼不动杆菌对头孢曲松、头孢他啶、氨苄西林/舒巴坦、头孢吡肟、亚胺培南的耐药率较2015年有增高趋势;左氧氟沙星、环丙沙星、妥布霉素和庆大霉素的耐药率保持稳定;复方磺胺甲噁唑的耐药率呈现下降趋势。来源于ICU病区鲍曼不动杆菌对抗菌药物的耐药性最为严重,神经外科及呼吸科病区耐药性次之,儿科病区耐药性最低。结论三年间该医院鲍曼不动杆菌分离率逐年增加,鲍曼不动杆菌对部分抗菌药物耐药性呈上升趋势,不同病区分离鲍曼不动杆菌对抗菌药物的耐药性具有差异,临床应及时进行细菌培养,根据病原菌耐药性的特点,合理使用抗菌药物。     

98株鲍曼不动杆菌医院感染分布及耐药性分析

目的：了解鲍曼不动杆菌在医院感染中的分布、构成比及其耐药性。方法：按常规方法对临床各种标本进行细菌培养、分离、鉴定;药物敏感试验采用K-B法,结果按美国临床实验室标准化委员会标准进行;采用回顾性方法统计分析98株鲍曼不动杆菌标本来源、感染科室分布及耐药状况。结果：98株鲍曼不动杆菌有62株来自于下呼吸道标本（痰）,占63.2%;分离鲍曼不动杆菌的科室分别为ICU占48.9%,呼吸内科占27.5%,肿瘤科占14.2%;药敏结果显示鲍曼不动杆菌对磺胺类、喹诺酮类、β-内酰胺类、氨基糖苷类均有很高的耐药率,而对碳青酶烯类、头孢哌酮/舒巴坦有较低的耐药率,最低为亚胺培南15.3%。结论：鲍曼不动杆菌临床分离株多来源于呼吸道痰标本和ICU病房,并对多种抗菌药物的耐药率较高,且出现一定比例的对亚胺培南耐药株,多重耐药性明显,临床应加强对鲍曼不动杆菌耐药性的监测并防止多重耐药株的流行。     

多重耐药鲍曼不动杆菌感染64例病原学特点、耐药情况及危险因素分析

目的 了解多重耐药鲍曼不动杆菌感染的病原学特点、耐药性及其感染相关危险因素,为基层医院防控鲍曼不动杆菌的感染提供参考。方法 统计分析2016年6月至2018年7月庐江县人民医院64例多重耐药鲍曼不动杆菌和70例一般鲍曼不动杆菌感染病人的基本信息、住院治疗情况、药敏资料等数据。结果 64例多重耐药鲍曼不动杆菌感染病人所患基础疾病主要为颅脑损伤及老年慢性疾病(心、肺、脑血管),恶性肿瘤也占一定比例;标本主要来源为痰液(占96.88％);病人分布科室按构成比从高到低排列依次为ICU、神经外科、呼吸内科;病人病原学标本耐药性监测从低到高依次为头孢哌酮/舒巴坦、阿米卡星,其他药物的耐药率均大于77.19％;危险因素分析显示:侵入性操作是多重耐药鲍曼不动杆菌感染发生的最主要危险因素。结论 危重症及老年慢性病并发呼吸系统感染病人是多重耐药鲍曼不动杆菌感染的重点人群;耐药率高;侵袭性操作、昏迷以及广谱抗菌药物应用是多重耐药鲍曼不动杆菌感染的危险因素。     

196例鲍曼不动杆菌的临床分布及耐药性检测

目的探讨本院鲍曼不动杆菌的临床分布特征及耐药性情况,旨在有效的控制和治疗鲍曼不动杆菌感染。方法对各个科室送检的分泌物、痰液、脑脊液、脓液等5033例标本进行鲍曼不动杆菌分离、培养、鉴定及耐药性检测。结果 5033例标本中共分离出鲍曼不动杆菌196株,约占3.9%。其中标本来源中,痰液所占比例最高,共分离出161株,约占82.1%。分布科室中,ICU所占比例最高,共分离出69株,约占35.2%。耐药性检测中,鲍曼不动杆菌对常用抗菌药物的耐药性较高,而对头孢派酮/舒巴坦及亚胺培南的耐药率低于25%。结论鲍曼不动杆菌在本院对常规抗菌药物耐药情况较严重,应加强对该菌的监测,从而减少多重耐药菌株的出现。     

鲍曼不动杆菌医院感染危险因素分析

目的分析鲍曼不动杆菌医院感染的危险因素,为制订医院感染的防控措施提供依据。方法回顾性分析2019年1—12月台州恩泽医疗中心(集团)恩泽医院感染科1272例患者的临床资料,调查鲍曼不动杆菌医院感染发生率,将发生鲍曼不动杆菌医院感染者作为感染组,其他患者作为非感染组,分析患者发生鲍曼不动杆菌医院感染的危险因素。结果在本次调查期间,共调查1272例患者,发生鲍曼不动杆菌感染48例,发病率为3.77%。单因素分析显示,年龄、联合应用广谱抗菌药物、留置胃管/尿管、深静脉置管、机械通气及住院时间是鲍曼不动杆菌感染的危险因素。多因素logistic回归分析发现,联合应用广谱抗菌药物、深静脉置管、机械通气、住院时间是鲍曼不动杆菌感染的独立危险因素。结论感染科患者鲍曼不动杆菌感染的危险因素较多,要采取有针对性的综合干预措施进行防控。     

某三级综合医院鲍曼不动杆菌感染分布及耐药性分析

目的 研究某三级综合医院鲍曼不动杆菌的感染分布和耐药性变迁,为有效控制感染和指导临床合理应用抗菌药物提供依据.方法 采用回顾性方法统计分析2012-2014年临床分离的鲍曼不动杆菌的标本来源、感染科室分布及药敏试验结果.结果 2012-2014年某三级综合医院共分离出551株鲍曼不动杆菌,分离率呈逐年上升趋势.标本来源主要为痰和咽拭子等呼吸道标本,占77.3％.科室分布主要为重症监护病房(ICU),其次是呼吸内科和神经外科.鲍曼不动杆菌对青霉素类、头孢菌素类、氨基糖苷类、喹诺酮类耐药率基本在50％以上,亚胺培南和美罗培南等碳青霉烯类耐药率也接近50％,多粘菌素B、米诺环素和头孢哌酮/舒巴坦抗菌活性较好.鲍曼不动杆菌耐药率总体呈逐年上升趋势.结论 鲍曼不动杆菌感染率和耐药率不断上升,因此需要加强该菌耐药性监测,指导临床合理应用抗菌药物,以提高疗效及减缓耐药菌株的产生.     

145例鲍曼不动杆菌的临床分布及耐药性分析

目的了解本院鲍曼不动杆菌的临床分布及对抗菌药物的耐药性。方法对本院2012年至2014年分离的145株不重复鲍曼不动杆菌进行鉴定及药敏试验,药敏试验采用MIC法,结果按CLSI 2010年版标准判断其敏感性。结果鲍曼不动杆菌主要来源于临床各种标本,尤其是肺部感染重要的病原菌。鲍曼不动杆菌对多类抗菌药物均表现出较高的耐药率,其中检出多重耐药鲍曼不动杆菌(MDR-AB)27株,占检出的鲍曼不动杆菌的18.6%。结论鲍曼不动杆菌是引起肺部及其他部位感染的主要致病菌之一,并且,鲍曼不动杆菌存在严重的耐药性,临床应对感染进行细菌培养和耐药性监测,合理用药。     

鲍曼不动杆菌感染及耐药性变化的趋势

目的了解鲍曼不动杆菌感染及耐药性变化的趋势。方法分析2002-2004年分离自住院患者标本的鲍曼不动杆菌及其耐药性资料。结果3年间共分离到鲍曼不动杆菌160株，以呼吸道感染为主，对亚胺培南耐药率最低，2004年为6．7％，对其他抗生素均有较高的耐药率，尤以头孢菌素类为甚。结论警惕并重视鲍曼不动杆菌感染，注意病原菌及耐药率的监测，规范抗生素应用，保持敏感抗生素的抗菌活性。     

多重耐药鲍曼不动杆菌耐药性分析及治疗策略

目的了解多重耐药鲍曼不动杆菌耐药谱和特点。方法分析2004年6月至2006年12月来自住院患者标本的鲍曼不动杆菌耐药性资料及其治疗情况。结果从192株标本中分离出181株多重耐药鲍曼不动杆菌,对头孢哌酮/舒巴坦耐药率最低(25·41%),其次是亚胺培南(38·12%)。结论对多重耐药鲍曼不动杆菌感染的患者应以亚胺培南/西司他汀和β-内酰胺酶抗菌抑制剂作为第一线抗菌药物。病情严重尤其是全耐药时可联合用药,可提高疗效。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

---

Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.