29株血流感染凝固酶阴性葡萄球菌的临床分析和耐药性研究

目的分析29株血流感染凝固酶阴性葡萄球菌(CNS)的临床意义及耐药性。方法回顾性分析从2011年1月—2011年12月煤炭总医院临床送检血培养标本中分离出的64株凝固酶阴性葡萄球菌,其中29株确定为血流感染致病菌。结果 64株CNS中,35株CNS判断为污染菌,污染率54.7%。29株血流感染致病菌中,表皮葡萄球菌15株最多,占到51.7%。耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)20株占69.0%,全部产β-内酰胺酶;甲氧西林敏感凝固酶阴性葡萄球菌(MSCNS)9株占31.0%,其中有7株产β-内酰胺酶(产酶率77.8%)。MRCNS除了对万古霉素和利奈唑胺还保持敏感外,对绝大多数抗生素都有较高的耐药率。结论 CNS已为血流感染重要致病菌,污染率高,耐药情况严峻。临床应严格无菌操作,抽双侧两套血培养瓶送检,合理使用抗生素。     

医院感染凝固酶阴性葡萄球菌耐药性研究

目的研究医院感染凝固酶阴性葡萄球菌（CNS）分布规律及耐药性。方法对临床分离的CNS进行鉴定并以K-B法检测药敏。结果在186株CNS中,检出表皮葡萄球菌86株,占46.2%;耐苯唑西林凝固酶阴性葡萄球菌（MRCNS）116株,占62.4%,MRCNS对12种抗菌药物耐药性明显高于MSCNS;所有CNS对万古霉素均敏感。结论CNS以为重要医院感染菌,适时进行病原学和耐药性检测对临床合理用药具有重要意义。     

408株凝固酶阴性葡萄球菌菌谱与耐药性分析

目的分析医院感染凝固酶阴性葡萄球菌（CNS）的分布及耐药性。方法对2007～2009年医院住院患者各类标本分离到的凝固酶阴性葡萄球菌作药敏试验和甲氧西林耐药性测定。结果在408株CNS中,检出表皮葡萄球菌152株,占37.26%（152/408）;耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）286株（70.10%）,其中产β-内酰胺酶280株（产酶率97.90%）;检出对甲氧西林敏感的凝固酶阴性葡萄球菌（MSCNS）122株（29.90%）,其中有17株产β-内酰胺酶（产酶率13.93%）,两者比较差异有显著性（P〈0.01）。MRCNS对13种抗菌药物耐药性明显高于MSCNS（P〈O.01）;所有CNS对万古霉素敏感。结论CNS已成为重要医院感染菌;CNS耐药性增高与产β-内酰胺酶有关;临床应积极进行病原学和耐药性监测,合理用药。     

儿童血培养凝固酶阴性葡萄球菌的分布及耐药性分析

目的探讨儿童血培养中凝固酶阴性葡萄球菌(CNS)的分布状况及对抗菌药物的耐药情况,为临床合理使用抗菌药物提供科学依据。方法应用全自动血培养仪Bact/Alert 3D 120进行血液细菌培养,分离菌株鉴定及药敏试验均采用法国生物-梅里埃公司VITEK-2Compact全自动微生物分析仪来进行,按美国CLSI 2008年版药敏标准判定结果。结果 2008年1月至2012年12月从住院儿童血培养标本中共分离出CNS 839株,其中表皮葡萄球菌394株(46.96%),人葡萄球菌240株(28.61%),溶血葡萄球菌117株(13.95%),其他葡萄球菌株62株(7.39%),耐甲氧西林凝固酶阴性的葡萄球菌(MRCNS)的检出率为80.10%(672/839),药敏结果显示,CNS对青霉素、红霉素高度耐药,对万古霉素、喹努普汀/达福普汀敏感性高,未检出对利奈唑胺耐药的菌株。结论 CNS已成为儿童血流感染的首位病原菌,MRCNS发生率高,万古霉素、利奈唑胺、喹努普汀/达福普汀是治疗MRCNS感染的首选药物。     

678株凝固酶阴性葡萄球菌的耐药性分析

目的 分析凝固酶阴性葡萄球菌(CNS)的耐药性,比较苯唑西林耐药的CNS (MRCNS)与苯唑西林敏感的CNS (MSCNS)的药物敏感性. 方法 收集2007年1 ～ 12月临床分离CNS,琼脂纸片扩散法检测其对9种抗菌药物的敏感性,MRCNS的检测采用头孢西丁纸片法,诱导性克林林霉素耐药的检测采用D实验. 结果共分离出CNS 678株,检出MRCNS 296株,占43.7%,诱导性克林林霉素耐药72株,占10.7%. MRCNS对红霉素的耐药率高达94.9%, 对复方磺胺甲恶唑的耐药率为70.3%,对环丙沙星、克林霉素和四环素的耐药率在63.7%～69.3%,对庆大霉素的耐药率较低,为20.7%,与MSCNS比较差异有统计学意义. MRCNS与MSCNS对青霉素的耐药率均＞90%,未见对替考拉宁和万古霉素耐药菌株. 结论 CNS引起的感染日益增多;MRCNS对常用抗菌药物的耐药率高于MSCNS,糖肽类抗菌药物是治疗MRCNS的首选药物;临床抗感染治疗应依据抗菌药物敏感试验合理用药.     

凝固酶阴性葡萄球菌耐药性分析

目的:了解和探讨凝固酶阴性葡萄球菌(CNS)的耐药现状,为临床合理使用抗菌药物提供实验室依据.方法:运用血平板进行常规接种培养,用ATB细菌鉴定仪作菌株鉴定.药敏试验采用纸片扩散法(K-B法)进行,依据NCCLS/CLSI 2004年规则判断结果.结果:临床标本分离出CNS共275株,耐甲氧西林凝固酶阴性葡萄球菌(MRC-NS)分离率为59.3%.MRCNS耐药率明显高于甲氧西林敏感凝固酶阴性葡萄球菌(MSCNS).所有CNS对万古霉素敏感,对利福平、复方新诺明有一定的敏感性.结论:CNS已成为临床感染的病原菌之一,MRCNS检出率高且呈多药耐药,提示万占霉素是治疗MRCNS感染的首选药物.     

463株血培养阳性病原菌分布及耐药分析

目的:分析我院2014年检出的463株血培养阳性菌的分布及耐药状况。方法:回顾经BD 9240和Bact/Alert3D 240血培养系统进行培养,使用Vitec2 compact对分离菌株鉴定及药敏试验。数据分析采用Whonet 5.6软件。结果:463株非重复分离菌中革兰阴性菌286株(61.77%);革兰阳性菌156株(33.69%);真菌21株(4.54%)。本研究共检出金黄色葡萄球菌29株,其中耐甲氧西林金黄色葡萄球菌(MRSA)7株(24.14%);甲氧西林敏感金黄色葡萄球菌(MSSA)22株(75.86%);凝固酶阴性葡萄球菌(CNS)92株,其中耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)81株(88.04%),甲氧西林敏感凝固酶阴性葡萄球菌(MSCNS)11株(11.96%)。MSSA与MRSA在庆大霉素、利福平、万古霉素、利奈唑胺、替考拉宁、环丙沙星、左氧氟沙星耐药率方面有差异(P<0.05)。MRCNS与MSCNS在万古霉素、利奈唑胺、替考拉宁、庆大霉素、环丙沙星、左氧氟沙星、复方磺胺甲唑耐药率方面有差异(P<0.05)。屎肠球菌对青霉素耐药率为90.9%,未检出对万古霉素耐药的屎肠球菌。产超广谱β内酰胺酶(ESBLs)大肠埃希菌占比52.59%。产ESBLs肺炎克雷伯菌占比40.32%。产ESBLs大肠埃希菌菌株与非产ESBLs菌株在氨曲南、头孢他啶、氯霉素、环丙沙星、头孢曲松、头孢噻肟、头孢吡肟、头孢唑林及左氧氟沙星耐药率方面有差异(P<0.05)。产ESBLs肺炎克雷伯菌菌株与非产ESBLs菌株在氨曲南、头孢他啶、氯霉素、环丙沙星、头孢曲松、头孢噻肟、头孢吡肟、头孢唑林、左氧氟沙星、头孢西丁及氨苄西林-舒巴坦耐药率方面有差异(P<0.05)。铜绿假单胞菌检出3株泛耐药菌株(15.78%),鲍曼不动杆菌泛耐药菌株4株(22.22%),沙门氏菌耐药率均低于6.5%。结论:血培养阳性分离菌分布广泛,不同病原菌间耐药性亦不相同。应加强对血培养病原菌分布和耐药性的监测。     

Mohnarin2009年度报告：中南地区细菌耐药监测

目的 分析中南地区2009年度临床分离菌株对常用抗菌药物的耐药性.方法 用纸片扩散法,进行药物敏感性试验,经Whonet 5.5软件进行数据分析.结果 48468株细菌中,革兰阴性菌32523株,占67.1％;革兰阳性菌15945株,占32.7％.大肠埃希菌和肺炎克雷伯菌的ESBLs发生率分别为60.9％和46.8％;耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为60.5％和62.9％.金葡菌中,未发现对万古霉素、替考拉宁和利奈唑胺的耐药菌株;凝固酶阴性葡萄球菌对替考拉宁的耐药率为1.4％;未发现对万古霉素和利奈唑胺的耐药菌株.粪肠球菌和屎肠球菌对万古霉素的耐药率分别为2.3％和5.6％;对替考拉宁的耐药率分别为1.4％和0.7％;未发现对利奈唑胺的耐药菌株.肠杆菌科细菌中,发现对亚胺培南的耐药菌株;大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对亚胺培南的耐药率分别为0.2％,1.2％和0.8％.结论 肠杆菌科细菌中出现了对碳青霉稀类抗生素的耐药菌株;革兰阳性菌种出现了对替考拉宁耐药的凝固酶阴性葡萄球菌和对万古霉素耐药的肠球菌.     

新生儿耐甲氧西林凝固酶阴性葡萄球菌败血症37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性特点.方法应用BacTAlert 240血培养仪和ATB细菌鉴定仪,根据美国临床实验室标准化委员会(NCCLS)标准,从78例新生儿血培养阳性瓶中分离出37株MRCNS.应用ATB药敏系统,测定菌株的耐药性.结果78株细菌中,分离出37株MRCNS(占47.4%),其中溶血葡萄球菌15株(40.5%)居首位,人葡萄球菌8株(21.6%),表皮葡萄球菌5株(13.5%),其他葡萄球菌9株(24.%).结论药敏显示多重耐药,万古霉素、替考拉宁、利福平是治疗MRCNS感染的敏感药物.     

112株新生儿败血症致病菌的分布及耐药性分析

目的:分析新生儿败血症的病原学分布及其耐药变迁情况,为临床及时明确病原、正确选用抗菌药物提供参考。方法:对苏州市立医院2009年6月—2012年6月间确诊的111例新生儿败血症病例的资料、血培养结果和药敏试验情况进行回顾性分析。结果:111例患者中检出病原菌112株,其中革兰阳性菌为78株(69.64%),革兰阴性菌为34株(30.36%);革兰阳性菌以凝固酶阴性葡萄球菌(CNS)为主,革兰阴性菌以肺炎克雷伯菌、大肠埃希菌为常见;革兰阳性球菌对青霉素、红霉素、苯唑西林的耐药性较高,对万古霉素、利奈唑胺未发现产生耐药;革兰阴性杆菌对氨苄西林产生耐药,对亚胺培南、阿米卡星、哌拉西林-他唑巴坦具有较高的敏感性。结论:CNS是导致新生儿败血症的主要病原菌,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和产超广谱β-内酰胺酶(ESBLs)肺炎的克雷伯菌、大肠埃希菌的比例呈上升趋势,临床应重视新生儿败血症的病原菌耐药性检测,根据血培养药敏结果合理选用抗菌药物。     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg.kg) or i.p. (50 mg.kg) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) l.h. kg in the male rat and 10.6 (95% CI: 7.5, 15.0) l.h. kg in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p 0.001) in plasma obtained from the male (8.8 2.0%) compared with the female rat (11.7 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Quantitative in vivo and in vitro sex differences in artemisinin metabolism in rat

1. The pharmacokinetics of the antimalarial compound artemisinin were compared in the male and female Sprague-Dawley rat after single dose i.v. (20 mg x kg(-1)) or i.p. (50 mg x kg(-1)) administration of an emulsion formulation. 2. Plasma clearance of artemisinin was 12.0 (95% confidence interval: 10.4, 13.0) 1 x h(-1) x kg(-1) in the male rat and 10.6 (95% CI: 7.5, 15.0) 1 x h(-1) x kg(-1) in the female rat suggesting high hepatic extraction in combination with erythrocyte uptake or clearance. Artemisinin half-life was approximately 0.5 h after both routes of administration in both sexes. Values for plasma clearance and half-lives did not statistically differ between the sexes. 3. After i.p. administration artemisinin AUCs were 2-fold higher in the female compared with male rat (p < 0.001). Artemisinin disappearance was 3.9-fold greater in microsomes from male compared with female livers and it was inhibited in male microsomes by goat or rabbit serum containing antibodies against CYP2C11 and CYP3A2 but not CYP2B1 or CYP2E1. 4. The unbound fraction of artemisinin in plasma was lower (p < 0.001) in plasma obtained from the male (8.8 +/- 2.0%) compared with the female rat (11.7 +/- 2.2%). 5. The possibility of a marked sex difference, dependent on the route of administration, has to be taken into account in the design and interpretation of toxicological studies of artemisinin in this species.     

Interindividual variability in metabolic activation in humans in vivo

In assessing interindividual variability in metabolic activation, the toxic metabolite is often too unstable for conventional analysis. Possible alternatives include a stable product of the reactive metabolite e.g. cysteinyl derivatives of N-acetyl-4-benzoquinoneimine, the toxic metabolite of paracetamol, adducts with DNA or protein, and indirect measurement of the activity of the enzyme(s) producing the active metabolite. An example of the last approach is the use of furafylline, a highly specific inhibitor of human CYP1A2, to determine the extent of the metabolic activation of the cooked food mutagens PhIP and MeIQx. The extent of inhibition, determined from levels of unchanged amine in urine, is an indirect measure of the activity of the activation pathway. Further refinement of this approach, allied to improved measures of the biological process of interest should prove of value in evaluating interindividual variability and its role in the risk assessment process.     

Theophylline kinetics in peripheral tissues in vivo in humans

Several biochemical and cellular effects have been described for methylxanthines under in vitro conditions. However, it is unknown, whether threshold concentrations required to exert these effects are attained in target tissues in vivo. We therefore employed the microdialysis technique for measuring theophylline concentrations in peripheral tissues under in vivo conditions.Following in vitro and in vivo calibration, microdialysis probes were inserted into the medial vastus muscle and into the periumbilical subcutaneous adipose layer of healthy volunteers. Following single oral dose administration of 300 mg or i.v. infusion of 240 mg theophylline, in vivo time courses of theophylline concentrations were monitored in tissues and plasma. Major pharmacokinetic parameters (c_max, t_max, AUC) were calculated for plasma and tissue time courses. The mean AUC_tissue /AUC_plasma-ratio was 0.56 (p.o.) and 0.55 (i.v.) for muscle and 0.55 (p.o.) and 0.72 (i.v.) for subcutaneous adipose tissue.We conclude that microdialysis provides important information on the distribution and the tissue pharmacokinetics of theophylline.Abbreviations FPIA Fluorescence polarisation immuno assay - AUC Area under the curve - t_max Time to peak concentration - c_max Peak concentration     

休克时血中氧自由基的变化

本实验测定10名休克患者血浆和红细胞的丙二醛(MDA)、血浆总抗的氧化活性(AOA)的含量。结果表明:休克病人红细胞膜和血浆 MDA 含量(4.298±0.722;5.348±0.834)与对照组(3.235±0.682;4.356±1.081)比较明显增高(P<0.05);血浆 AOA(39.65±7.858)与对照组(48.21±10.81)比较明显降低(P<0.01)。提示:休克时,患者机体内自由基反应增强是引起组织细胞损伤的原因之一。     

Changes in angiopoietin expression in glomeruli involved in glomerulosclerosis in rats with daunorubicin-induced nephrosis

AIM: To study the potential pathological role of endogenous angiopoietins in daunorubicin-induced progressive glomerulosclerosis in rats. METHODS: Seventy male Wistar rats were allocated randomly into a daunorubicin group (DRB; n=40) or a control group (n=30). The rats in the DRB group were injected with DRB (15 mg/kg), in their tails. Subsequently, at intervals of 1, 2, 4, 6, 8, and 12 weeks, 5 male Wistar rats in each group were chosen randomly for 24 h urinary protein quantitative measurements (24 h UPQM), and determination of plasma tumor necrosis factor alpha (TNF-alpha), angiopoietin-1 (Ang1), and angiopoietin-2 (Ang2) levels. Kidney sections were examined by electron microscopy, Periodic Acid Schiff (PAS) staining, immunohistochemical staining and in situ hybridization histochemistry. RESULTS: As glomerulosclerosis progressed in the DRB group, expression of Ang1 mRNA and protein in glomeruli decreased and expression of TNF-alpha protein, Ang2 mRNA and protein in glomeruli increased. Expression of Ang1 mRNA and protein in glomeruli were negatively correlated with 24 h UPQM, Fn protein expression, and mean area of extracellular matrix (MAECM). In comparison, expression of Ang2 mRNA and protein in glomeruli were positively correlated with 24 h UPQM, Fn protein expression and MAECM; furthermore, there was a positive correlation between plasma Ang2 and 24 h UPQM. Plasma TNF-alpha and expression of TNF-alpha in glomeruli were positively correlated with expression of Ang2 mRNA and protein in glomeruli. There was a negative correlation between Ang1 protein expression and Ang2 protein expression in glomeruli. CONCLUSION: During DRB-induced glomerulosclerosis, podocyte injury led to a shift in the balance of Ang1 and Ang2 in glomeruli. Increased TNF-alpha in plasma and glomeruli may upregulate Ang2 expression in glomeruli. Elevated Ang2 in both plasma and glomeruli may mediate protein permeability through the glomerular filtration barrier. Moreover, local expression of Ang2 may facilitate the progress of glomerulosclerosis by upregulating a component expression of extracellular matrix.     

Trichinellosis in immigrants in Switzerland

We describe a case of trichinellosis diagnosed at the Division of Infectious Diseases, Hospital of Lugano, in January 2009. This case was associated with a cluster of cases and was traced to the consumption of contaminated meat after a wild boar hunt in Bosnia.