下呼吸道感染患者革兰阴性杆菌耐药性分析

目的 分析医院下呼吸道感染患者的革兰阴性杆菌细菌构成和耐药情况.方法 通过常规细菌培养分析革兰阴性杆菌的分布,并用K-B法测定282株革兰阴性杆菌对14种抗菌药物的耐药率.结果 分离率前3位分别为铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌,检出率分别为23.76%、15.96%、12.76%;超广谱β-内酰胺酶(ESBLs)在肺炎克雷伯菌、大肠埃希菌中的检出率分别占35.56%、51.85%;除流感嗜血菌对常用抗菌药物的敏感性较高外,其余革兰阴性杆菌均显示了不同程度的耐药性,鲍氏不动杆菌对头孢菌素类和磺胺甲噁唑/甲氧苄啶的耐药率>50.00%,革兰阴性杆菌对含酶抑制剂的药物哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率均<35.82%,氨基糖苷类药物阿米卡星对几种革兰阴性杆菌耐药率均<26.09%,临床可选择使用.结论 应加强革兰阴性杆菌耐药性的动态检测,为临床医师合理使用抗菌药物提供科学依据.     

青岛地区革兰阴性杆菌的分布及耐药性监测

目的了解青岛地区常见革兰阴性杆菌的种类、分布及耐药状况,为临床用药提供依据。方法收集青岛地区4所医院临床分离的2362株革兰阴性杆菌,采用ATB Expression自动细菌鉴定系统对菌种进行鉴定,用K-B法进行药物敏感性实验。结果分离出的革兰阴性杆菌中,主要以大肠埃希菌（ECO）、铜绿假单胞菌（PAE）、肺炎克雷伯菌（KPN）、不动杆菌属（AC-）、阴沟肠杆菌（ECL）多见;大多数革兰阴性杆菌对广谱青霉素、第三代头孢菌素、氨基糖苷类和喹诺酮类抗菌药物的耐药率高;头孢吡肟（FEP）对革兰阴性非发酵菌抗菌作用差,对肠杆菌科细菌耐药率较低,为17.5%-33.9%;头孢哌酮/舒巴坦（CFS）和哌拉西林/他唑巴坦（TZP）对革兰阴性杆菌的抗菌作用强,耐药率分别为9.9%-24.6%和9.3%-29.2%;亚胺培南（IMP）对革兰阴性杆菌的抗菌活性最强,除PAE外,细菌耐药率均〈5%。结论革兰阴性杆菌对常用抗菌药物耐药性较高,开展地区性细菌耐药监测十分重要。     

Contamination of detergent cleaning solutions during hospital cleaning

Twenty-two detergent cleaning solutions from different ward areas were sampled for bacteria when freshly prepared, during use and at discard. Contamination, mainly by Gram-negative bacilli, was found in 10 freshly prepared solutions and in 21 of the 22 at discard. Preliminary studies showed that the detergent solution was bactericidal to Staphylococcus aureus but allowed the survival but not multiplication of Escherichia coli.     

Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing.

The effectiveness of various hand washing and disinfection methods in removing transient skin bacteria was studied in hospital after dry or moist contamination of the hands when nursing burn patients. The results were compared with those of laboratory tests with volunteers. A fairly good correlation of the bacterial reductions existed between hospital and laboratory tests. All other methods removed Staph. aureus from the hands more effectively than liquid soap. Gram-negative bacilli were more easily removed than staphylococci, even with soap wash alone. In hospital, none of the washing and disinfection methods always removed all patient-borne bacteria from the hands. After dry or moist contamination and subsequent washing with soap only, colonies of Staph. aureus were often detected in finger-print samples. Staphylococci were more often completely removed by a 4% chlorhexidine detergent scrub and alcoholic solutions (either with or without previous soap wash) than by liquid soap, hexachlorophene or iodophor preparations. Gram-negative bacilli were more easily removed by all the washing and disinfection methods. After moist contamination, Gram-negative bacilli were more often completely removed from the hands by ethanol than by other treatments. The results of the present study emphasize the importance of always using gloves when nursing a profuse spreader of bacteria or one who must be protected from infection.     

Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing

The effectiveness of various hand washing and disinfection methods in removing transient skin bacteria was studied in hospital after dry or moist contamination of the hands when nursing burn patients. The results were compared with those of laboratory tests with volunteers. A fairly good correlation of the bacterial reductions existed between hospital and laboratory tests. All other methods removed Staph. aureus from the hands more effectively than liquid soap. Gram-negative bacilli were more easily removed than staphylococci, even with soap wash alone. In hospital, none of the washing and disinfection methods always removed all patient-borne bacteria from the hands. After dry or moist contamination and subsequent washing with soap only, colonies of Staph. aureus were often detected in finger-print samples. Staphylococci were more often completely removed by a 4% chlorhexidine detergent scrub and alcoholic solutions (either with or without previous soap wash) than by liquid soap, hexachlorophene or iodophor preparations. Gram-negative bacilli were more easily removed by all the washing and disinfection methods. After moist contamination, Gram-negative bacilli were more often completely removed from the hands by ethanol than by other treatments. The results of the present study emphasize the importance of always using gloves when nursing a profuse spreader of bacteria or one who must be protected from infection.     

Relationship between cytomegalovirus and colonization of the oropharynx by gram-negative bacilli following renal transplantation.

Numerous investigators have reported an increased incidence of pneumonia caused by Gram-negative bacilli and other secondary pathogens in transplant recipients infected by cytomegalovirus (CMV). To determine if CMV infections are related to colonization of the upper respiratory tract by Gram-negative bacilli, we examined prospectively 22 renal transplant recipients with sequential bacteriological, virological and biochemical examinations performed just prior to and at various times after transplantation. Only 11% of subjects had Gram-negative bacilli isolated from gargle specimens prior to transplantation, as compared to 54% after transplantation. More importantly, after transplantation, subjects with active CMV infections were more likely to have prolonged oropharyngeal carriage of Gram-negative bacilli than subjects without CMV infections (36% v. 25%). During active CMV infections, the rate at which Gram-negative bacilli were isolated from gargle specimens rose from 28 to 47%. During culture-positive CMV infections, the isolation rate reached 57% and was significantly different from that of CMV-negative samples (P less than 0.01). The increased rate of Gram-negative bacillary isolation from gargle specimens during CMV infections was not a function of type of immunosuppressive agents used, rejection episodes, antibiotic administration, concomitant hepatitis B, Epstein-Barr (EBV) virus, or herpes simplex virus infections, or alterations in salivary fibronectin concentrations.     

头孢哌酮/舒巴坦对非发酵革兰阴性杆菌的抗菌活性

目的 调查头孢哌酮/舒巴坦对医院非发酵革兰阴性杆菌的体外抗菌活性情况,了解头孢哌酮/舒巴坦的体外抗菌作用.方法 收集医院2008年6月1日-2009年6月1日临床标本中分离到非发酵菌362株,并检测其对9种抗菌药物的耐药性.结果 医院非发酵菌感染以铜绿假单胞菌、鲍氏不动杆菌、嗜麦芽寡养单胞菌、洋葱伯克霍尔德菌为主;其对头孢哌酮/舒巴坦的耐药率分别为29.2%、20.8%、25.0%、27.3%,其抗菌活性优于亚胺堵南和美罗培南,更强于哌拉西林/他唑巴坦.结论 医院非发酵菌感染耐药率高,且多药耐药严重,头孢哌酮/舒巴坦对治疗多药耐药非发酵菌感染具有广阔的临床应用前景.     

产超广谱β-内酰胺酶革兰阴性菌对12种抗菌药物耐药性分析

目的分析产超广谱β-内酰胺酶(ESBLs)革兰阴性菌对12种抗菌药物的耐药情况及临床意义. 方法采用VITEK ESBLs检测试验及双纸片协同试验,对从临床标本中分离的204株革兰阴性菌作ESBLs的检测,比较12种抗菌药物对产ESBLs革兰阴性菌体外抗菌作用. 结果产ESBLs革兰阴性菌占全部分离菌的23%;其中多重耐药菌占87.5%,亚胺培南及美罗培南对产ESBLs革兰阴性菌抗菌作用最强;头孢吡肟对产ESBLs阴性菌有较弱的抗菌作用;头孢西丁对产ESBLs肺炎克雷伯菌有强的抗菌作用;哌拉西林/他唑巴坦对产ESBLs肺炎克雷伯菌及铜绿假单胞菌有较强的抗菌作用;氨基糖苷类抗生素对产ESBLs肺炎克雷伯菌有较强的抗菌作用;氧氟沙星对产ESBLs肺炎克雷伯菌呈现出较好的抗菌作用. 结论碳青酶烯类抗生素可作为产ESBLs阴性菌感染的首选治疗.     

1115株革兰阴性杆菌的耐药性分析

目的了解咸宁市第一人民医院2012-2013年临床分离的常见革兰阴性杆菌的耐药状况,为临床抗感染治疗和合理选择抗菌药物提供依据。方法利用VITEK-32全自动细菌鉴定仪对临床分离得到的菌株进行鉴定,并对临床分离菌株进行药物敏感试验。结果 2年共分离革兰阴性杆菌1 115株,占临床细菌总分离率的65.4%。常见的革兰阴性杆菌依次为大肠埃希菌（352株）、肺炎克雷伯菌（224株）、肠杆菌属细菌（165株）、铜绿假单胞菌（160株）、不动杆菌属细菌（152株）。在大肠埃希菌中,检出产超广谱β-内酰胺酶（ESBLs）140株,产酶率为39.8%;在肺炎克雷伯菌中,检出产ESBLs菌株44株,产酶率为19.6%。药敏结果显示,革兰阴性杆菌对亚胺培南和哌拉西林/他唑巴坦的耐药率较低,对氨苄西林、头孢唑林、庆大霉素等抗生素具有较高的耐药率,并且多重耐药现象比较严重。结论革兰阴性杆菌的分离率较高,耐药现象严重。临床医生在抗感染治疗中应根据药敏实验结果,合理选择抗菌药物,以提高抗感染的治疗效果。     

主要革兰氏阴性杆菌分布及耐药状况研究

目的了解医院常见Gˉ杆菌分布和耐药性,为临床抗感染治疗和合理使用抗菌药物提供依据。方法常规方法进行细菌培养及鉴定,Kirby-Bauer法检测革兰氏阴性杆菌对抗菌药物的药敏结果。结果从送检的2035例标本中共分离出768株阳性菌,分离率占37.7%,其中革兰氏阴性杆菌620株,占80.7%,检出革兰氏阴性杆菌中占前三位的依次为大肠埃希氏菌、铜绿假单胞菌、肺炎克雷伯氏菌。大肠埃希菌对哌拉西林/他唑巴坦耐药率较低为3.1%。肺炎克雷伯氏菌仅对复方磺胺药物、哌拉西林、头孢呋辛、头孢噻肟有较高的耐药性,对其余药物耐药率均低于30%。铜绿假单胞菌最敏感的抗菌药物是头孢哌酮舒/巴坦、头孢吡肟,对复方磺胺类药物呈现高度耐药性,耐药率高达92.8%。结论加强革兰氏阴性杆菌的监测和药敏试验,对合理使用抗菌药物和减缓耐药菌株的产生尤为重要。     

下呼吸道感染革兰阴性杆菌的耐药现状分析

目的 了解医院下呼吸道感染主要病原菌的分布及其耐药性,指导临床合理使用抗菌药物.方法 617株革兰阴性杆菌采用法国生物梅里埃公司VITEK全自动微生物分析系统和GNI鉴定卡进行菌种鉴定;采用K-B法进行药敏试验,按照美国临床实验室标准化研究所2007年版操作和判读结果.结果 分离率居前6位的革兰阴性杆菌依次为:铜绿假单胞菌(43.3%)、鲍氏不动杆菌(15.9%)、肺炎克雷伯菌(15.4%)、大肠埃希菌(8.2%)、嗜麦芽寡养单胞菌(8.2%)、肠杆菌属(4.0%);以上菌株对常用抗菌药物均产生了严重的耐药性,产超广谱β-内酰胺酶细菌总检出率为54.1%;铜绿假单胞菌和鲍氏不动杆菌泛耐药菌株检出率分别为3.4%和6.1%.结论 下呼吸道感染多为多药耐药菌,应熟悉细菌耐药特点及耐药机制,根据病原学检查结果合理选用抗菌药物.     

321株非发酵革兰阴性杆菌耐药性报道

目的了解医院感染常见非发酵革兰阴性杆菌的分布和耐药情况。方法常规方法进行细菌培养及鉴定,Kirby-Bauer法检测非发酵革兰阴性杆菌对12种抗菌药物的药敏结果,2001年版NCCLS标准判断。结果321株菌中铜绿假单胞菌占53.9%;不动杆菌属占17.4%,嗜麦芽寡养单胞菌占12.5%,3种主要非发酵革兰阴性杆菌共占83.8%;铜绿假单胞菌耐药率为28.3%~87.3%,耐药率低的抗菌药物是亚胺培南、哌拉西林、阿米卡星、头孢他啶;不动杆菌属耐药率为14.3%~78.5%,耐药率较低的抗菌药物是亚胺培南、环丙沙星、哌拉西林;嗜麦芽寡养单胞菌耐药率为37.5%~82.5%,耐药率低的抗菌药物是头孢他啶,其他均存在较高耐药率。结论铜绿假单胞菌、不动杆菌属、嗜麦芽寡养单胞菌是引起医院感染的主要非发酵革兰阴性杆菌,对多种抗菌药物存在高耐药率,是临床面临的严峻问题,应加强监测。     

Ralstonia pickettii: a persistent gram-negative nosocomial infectious organism

Non-fermenting Gram-negative bacilli create a significant problem in clinical settings, being a widespread cause of nosocomial infections. They are opportunistic pathogens that take advantage of underlying conditions and diseases. Ralstonia pickettii, a non-fermenting Gram-negative bacillus, is regarded as being of minor clinical significance; however, many instances of infections with this organism are reported in the literature. Infections can include bacteraemia/septicaemia caused by contaminated solutions, e.g. distilled water, water for injection and aqueous chlorhexidine solutions. Cases of pseudobacteraemia have been recorded in association with R. pickettii, as have many cases of unusual infections, some of which were very invasive and severe, e.g. meningitis, septic arthritis and osteomyelitis. Six cases of death in four separate instances have also been recorded related to R. pickettii. This review illustrates that R. pickettii is a more important pathogen than was thought previously.     

医院感染革兰阴性杆菌的分布及耐药性分析

目的 了解医院革兰阴性杆菌的分布及耐药性,为临床合理使用抗菌药物提供参考依据.方法 革兰阴性杆菌分离自2007年1月～2008年12月医院住院患者送检的各类感染性样本、细菌分离、鉴定按<全国临床检验操作规程>进行;药物敏感性试验采用K-B法.结果 分离出革兰阴性杆菌358株,分离率居前5位的主要病原菌为大肠埃希菌161株(45.0%)、铜绿假单胞菌52株(16.7%)、肺炎克雷伯菌42株(13.5%)、鲍氏不动杆菌36株(11.6%)、阴沟肠杆菌20株(6.4%);病原菌检出率较高的科室为神经外科、神经内科、胸外科、呼吸内科;药敏试验显示,革兰阴性杆菌对碳青酶烯类抗菌药物亚胺培南、美罗培南敏感性较高,对其他常用抗菌药物耐药率呈上升趋势.结论 革兰阴性杆菌耐药性已十分严重,医院应重视病原学及耐药性检测,预防医院感染暴发流行.     

218株下呼吸道院内感染的病原菌分布及药敏分析

目的研究本院下呼吸道院内感染病原菌种类及药敏情况。方法采集晨起合格痰或经气管插管采集的下呼吸道分泌物,用血平皿和巧克力平皿接种培养分离出病原菌,或血培养,用法国生物梅里埃API鉴定系统鉴定,药敏试验采用K-B法。结果共分离出病原菌218株,其中以革兰阴性杆菌为主,共183株,占83.9%,革兰阳性球菌共35株,占16.1%。革兰阴性杆菌对碳青霉烯类抗生素和β-内酰胺类抗生素/酶抑制剂复合制剂(头孢哌酮/舒巴坦)的敏感度较高。革兰阳性球菌主要是金黄色葡萄球菌,耐甲氧西林的金黄色葡萄球菌(MRSA)占73.1%,其对青霉素、苯唑西林、左氧氟沙星、红霉素、克林霉素有很高的耐药率(78.9～100.0%),最为敏感的是去甲万古霉素。结论本院的下呼吸道院内感染中,以革兰阴性杆菌为主,对常见抗生素耐药性较高。     

218株下呼吸道院内感染的病原菌分布及药敏分析

目的研究本院下呼吸道院内感染病原菌种类及药敏情况。方法采集晨起合格痰或经气管插管采集的下呼吸道分泌物,用血平皿和巧克力平皿接种培养分离出病原菌,或血培养,用法国生物梅里埃API鉴定系统鉴定,药敏试验采用K—B法。结果共分离出病原菌218株,其中以革兰阴性杆菌为主,共183株,占83．9％,革兰阳性球菌共35株,占16．1％。革兰阴性杆菌对碳青霉烯类抗生素和β-内酰胺类抗生素／酶抑制剂复合制剂（头孢哌酮／舒巴坦）的敏感度较高。革兰阳性球菌主要是金黄色葡萄球菌,耐甲氧西林的金黄色葡萄球菌（MRSA）占73．1％,其对青霉素、苯唑西林、左氧氟沙星、红霉素、克林霉素有很高的耐药率（78．9～1000％）,最为敏感的是去甲万古霉素。结论本院的下呼吸道院内感染中,以革兰阴性杆菌为主,对常见抗生素耐药性较高．     

1465份血液普通细菌培养的病原菌分布及耐药性分析

目的探讨引起血液感染的病原菌的分布情况以及耐药率。方法血液培养标本用BACTEC9120全自动血液培养仪进行培养，阳性标本用德灵MicroScan Walk-Away96全自动微生物鉴定仪进行鉴定和药敏试验。结果在1465份血液培养标本中分离出病原菌154株，阳性检出率为10．53％。病原菌以革兰阳性球菌居首位（51．30％），革兰阴性杆菌次之（30．52％），真菌（15．58％），革兰阳性杆菌（2．60％）。分离率居前十位的为大肠埃希菌、金黄色葡萄球菌、表皮葡萄球菌、人葡萄球菌、白色念珠菌、肺炎克雷伯菌、热带念珠菌、溶血葡萄球菌、肺炎链球菌、甲型副伤寒沙门菌。结论血液培养病原菌以革兰阳性球菌为主，革兰阴性杆菌次之；革兰阳性球菌对万古霉素、吗啉恶酮及奎奴普丁／达福普丁的耐药率最低；而革兰阴性杆菌对亚胺培南耐药率较低。     

临床分离革兰阴性杆菌耐药性监测

目的了解我院G-杆菌的分布及耐药情况.方法药敏试验采用K-B纸片法,判断按NCCLS标准.结果 1999～2003年临床分离的致病菌以G-杆菌为主,占74.9%,其中大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌居前3位;对18种抗菌药物程度不同的耐药,产超广谱β-内酰胺酶(ESBLs)菌株的耐药性明显增高.结论 G-杆菌是医院感染的主要致病菌,监测G-杆菌耐药性对于临床合理选择抗菌药物十分重要.     

医院尿路感染细菌分布及耐药性研究

目的对照分析研究医院尿路感染细菌分布及耐药性。方法随机抽取医院尿路感染革兰阴性杆菌45例,革兰阳性菌18株;门诊非医院尿路感染革兰阴性杆菌42株,革兰阳性菌19株,进行细菌分布及耐药性的统计分析。结果革兰阴性杆菌医院感染组与非医院感染组均主要为大肠埃希菌,分别占62.2%和66.6%;葡萄球菌属医院感染组和非医院感染组均主要为表皮葡萄球菌,分别占33.3%和68.4%;革兰阳性菌医院感染组细菌分布多于非医院感染组,两组细菌分布差异有统计学意义(P<0.05);革兰阴性杆菌医院感染组耐药菌株最多的前5种抗菌药物,耐药率均>53.3%;革兰阴性杆菌医院感染组与非医院感染组对抗菌药物耐药率差异有统计学意义(P<0.05)。结论葡萄球菌属医院感染组与非医院感染组的分布差异,反映医院内各种感染患者较为集中,可能存在交叉感染;革兰阴性杆菌医院感染组与非医院感染组在细菌对抗菌药物耐药率有明显差异,反映医院内在使用抗菌药物方面还需进一步掌握适应证,防止抗菌药物的滥用,以减少耐药菌株的发生。     

产AmpC酶革兰阴性杆菌的分布与耐药性研究

目的了解产AmpC酶革兰阴性杆菌的分布及其耐药特征,指导临床合理使用抗菌药物. 方法采用双纸片法检测了493株革兰阴性杆菌的AmpC酶,并用仪器法测定了产酶菌对17种抗菌药物的耐药性. 结果革兰阴性杆菌产AmpC酶总阳性率为38.3%,以铜绿假单胞菌和阴沟肠杆菌为主,分别占产酶菌的54.0%和24.3%;病区分布以重症监护病房为最高(34.4%),感染部位以呼吸道多见(55.6%);产AmpC酶菌对青霉素类和一至三代头孢类抗菌药物耐药率高达37%～100%;对亚胺培南、头孢吡肟和哌拉西林/他唑巴坦的耐药率较低,在9%～28%之间;其他抗菌药物耐药率各有差异. 结论产AmpC酶革兰阴性杆菌有较严重的耐药性,合理使用抗菌药物十分重要.