Susceptibility testing of biliary bacteria obtained before bile duct manipulation

Over a 3 3/4-year period, bile culture and susceptibility studies were performed on 41 patients before any instrumentation or manipulation of the biliary tract for retained biliary stone extraction. At least one bile bacterium was identified in 90% of the patients examined. As many as seven organisms were identified in one patient. Of the organisms, 62% were Gram-negative aerobes, the most representative being Klebsiella pneumonia; 27% were Gram-positive aerobes, the Enterococcus grouping being the most representative. Nine percent of the isolates were anaerobic bacteria and 2% yeast. Fifteen percent of the patients developed signs of sepsis. Three of these patients had manipulation of their bile ducts with a choledochoscope and grew out positive blood cultures; all were treated successfully and recovered uneventfully. Susceptibility testing on all aerobic bacteria was performed, indicating 97% effective coverage of both Gram-positive and Gram-negative bacteria using synergistic antibiotics of ampicillin and an aminoglycoside. Even with 9% of the isolated bacteria being anaerobes, the effective coverage using the same two drug combinations was about 88%. Because of the relatively high percentage (15%) of patients developing signs and symptoms of sepsis, synergistic prophylactic antimicrobial therapy is recommended in patients who are debilitated, in instrumentation of obstructed bile ducts, or with choledoschoscopy.     

Combined immunomodulator and antimicrobial therapy eliminates polymicrobial sepsis and modulates cytokine production in combined injured mice

Purpose: A combination therapy for combined injury (CI) using a non-specific immunomodulator, synthetic trehalose dicorynomycolate and monophosphoryl lipid A (STDCM-MPL), was evaluated to augment oral antimicrobial agents, levofloxacin (LVX) and amoxicillin (AMX), to eliminate endogenous sepsis and modulate cytokine production.

Materials and methods: Female B6D2F₁/J mice received 9.75 Gy cobalt-60 gamma-radiation and wound. Bacteria were isolated and identified in three tissues. Incidence of bacteria and cytokines were compared between treatment groups.

Results: Results demonstrated that the lethal dose for 50% at 30 days (LD_50/30) of B6D2F₁/J mice was 9.42 Gy. Antimicrobial therapy increased survival in radiation-injured (RI) mice. Combination therapy increased survival after RI and extended survival time but did not increase survival after CI. Sepsis began five days earlier in CI mice than RI mice with Gram-negative species predominating early and Gram-positive species increasing later. LVX plus AMX eliminated sepsis in CI and RI mice. STDCM-MPL eliminated Gram-positive bacteria in CI and most RI mice but not Gram-negative. Treatments significantly modulated 12 cytokines tested, which pertain to wound healing or elimination of infection.

Conclusions: Combination therapy eliminates infection and prolongs survival time but does not assure CI mouse survival, suggesting that additional treatment for proliferative-cell recovery is required.     

Surveillance of bacterial causes of hospital infections during periods of war and peace

Surveillance based on laboratory findings of bacteria isolated from hospitalized patients is an important activity in epidemiologic surveillance of nosocomial infections. It provides the insight into the circulation and management of some causative agents of nosocomial infections in hospitals, which facilitates defining of proper measures for the prevention and suppression of nosocomial infections caused by these agents. The aim of this study was to analyze and compare surveillance data collected in Military Medical Academy (MMA) during June 1999 (the period of war), and June 2000 (the period of peace). Isolation frequency of bacteria that were the most common agents of nosocomial: Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, Acinetobacter spp. and Enterococcus spp., was monitored in patients from 5 various surgical wards of MMA. In the war period, the increase of number of isolates of all these bacteria was registered, but the increase of isolated Acinetobacter spp. was the most significant. The total number of isolates was greater in June 1999, in comparison to June 2000. Most isolates were recovered from wound cultures, when the increased number of Enterococcus spp. Methicillin-resistant Staphylococcus aureus isolated from the blood was registered. In the period of peace isolates of Pseudomonas aeruginosa manifested reduced resistance to quinolones, imipenem and 3rd generation cephalosporins. Barrier infection control measures are necessary in preventing nosocomial transmission, particularly in the wartime. Thus, preventive medicine is important for performing efficient surveillance, and suggesting the adequate measures for prevention and repression of nosocomial infections, particularly in the period of war.     

Bacteria recovered from patients admitted to a deployed U.S. military hospital in Baghdad, Iraq

The predominant bacteria and antimicrobial susceptibilities were surveyed from a deployed, military, tertiary care facility in Baghdad, Iraq, serving U.S. troops, coalition forces, and Iraqis, from August 2003 through July 2004. We included cultures of blood, wounds, sputum, and urine, for a total of 908 cultures; 176 of these were obtained from U.S. troops. The bacteria most commonly isolated from U.S. troops were coagulase-negative staphylococci, accounting for 34% of isolates, Staphylococcus aureus (26%), and streptococcal species (11%). The 732 cultures obtained from the predominantly Iraqi population were Klebsiella pneumoniae (13%), Acinetobacter baumannii (11%), and Pseudomonas aeruginosa (10%); coagulase-negative staphylococci represented 21% of these isolates. These differences in prevalence were all statistically significant, when compared in chi2 analyses (p < 0.05). Antimicrobial susceptibility testing demonstrated broad resistance among the Gram-negative and Gram-positive bacteria.     

我院1120株细菌耐药性分析

目的了解我院2009年1～12月全年临床分离菌对各类抗菌药物的耐药性,以指导临床合理使用抗菌药物。方法使用纸片扩散法和CLSI/NCCLS判断标准进行抗菌药物监测。结果临床分离1120株细菌中革兰阳性细菌占28.5%,革兰阴性细菌占71.5%;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（MRCONS）分别占81.3%和77.3%。产超广谱β-内酰胺酶细菌（ESBLs）株中大肠埃希菌和肺炎克雷伯菌检出率分别为44.6%和47.2%,铜绿假单胞菌对碳青霉烯类亚胺培南耐药率为37%。结论本组资料对本院细菌性感染的治疗和抗菌药物的合理选用具有重要的参考价值。     

305株手工法血培养病原菌分布情况及耐药性分析

目的了解医院血培养分离出的病原菌的分布情况及耐药性,为合理用药提供依据。方法对2006-01至2011-01血培养结果进行回顾性分析。手工法培养血液标本,阳性者分离所得菌株采用国产半自动微生物仪进行生化和药敏试验。结果 2300份送检标本检出305株病原菌,阳性率13.3%。其中革兰阴性杆菌172株,占56.39%;革兰阳性球菌114株,占37.38%;真菌19株,占6.23%。革兰阴性杆菌对美洛培南、哌拉西林/他唑巴坦、左氧氟沙星、阿米卡星、磷霉素敏感性较高;万古霉素仍然是阳性球菌最敏感的抗生素。结论对血行感染的病原菌进行耐药性检测,对指导合理应用抗生素具有重要意义。     

血液感染的病原菌分布及耐药性分析

目的：对南充市中心医院2006年血培养中病原菌的分布及药物敏感情况进行分析,为临床治疗提供用药依据。方法：血培养用BacT/ALERT120全自动血培养仪,用VITEK-32全自动微生物分析系统和API/ATB进行细菌鉴定及药敏分析。结果：1803份血液标本中分离出病原菌242株,总阳性率为13.4%;革兰阳性菌检出率为8.7%,主要为凝固酶阴性葡萄球菌,占病原菌的38.4%,其次是金黄色葡萄球菌,占病原菌的14.9%;革兰阴性杆菌检出率为4.3%,其中以大肠埃希菌检出率较高,占病原菌的14.5%。血培养中葡萄球菌对万古霉素较为敏感,革兰阴性杆菌对阿米卡星、亚胺培南较敏感。结论：应加强血培养中病原菌及其对抗菌药物的耐药性监测。     

2006年度临床常见细菌分布及耐药性监测分析

目的了解2006年度本院细菌分布及对抗菌药物耐药情况,为临床抗感染治疗提供依据。方法药物敏感性试验采用琼脂纸片扩散法,耐药性分析采用WHONET 5.4软件。结果2006年度我院共收集患者首次分离株细菌1 497株,革兰阴性菌878株,革兰阳性菌400株,真菌219株。铜绿假单胞菌、大肠埃希菌、表皮葡萄球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、粪肠球菌、阴沟肠杆菌是最常见菌,检出率分别为17.0%、13.2%、8.9%、7.0%、6.9%、4.7%、3.7%、3.2%。耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的比例分别为63.9%、82.1%,未发现对万古霉素和替考拉宁耐药的葡萄球菌。肠球菌对万古霉素耐药率为1.0%,对替考拉宁耐药率为3.8%。革兰阴性菌对亚胺培南-西拉司丁钠的敏感性最好,产超广谱β-内酰胺酶的大肠埃希菌和克雷伯菌株的检出率分别为26.1%和34.2%。在痰标本中铜绿假单胞菌检出率最高,为22.2%,对亚胺培南-西拉司丁钠和头孢他啶敏感性最好;在血标本中大肠埃希菌检出率最高,共9株,占血标本阳性率的18.4%,对万古霉素敏感性最好,耐药率为0。结论加强细菌耐药性监测,以推动临床抗菌药物的合理使用。     

单中心血液科细菌感染病原菌分布及耐药性分析

目的探讨血液科患者细菌感染的特点,为临床治疗提供病原学依据。方法采用回顾性分析方法对北京友谊医院血液科2008年7月-2011年7月住院患者临床分离出细菌的情况进行分析。结果共培养出细菌232株,革兰阴性杆菌占62.9%,革兰阳性球菌占37.1%。革兰阴性杆菌主要来源:血29.4%,痰46.6%,尿10.3%;革兰阳性球菌主要来源:血14.0%,痰47.7%,尿10.4%。革兰阴性杆菌对碳青霉烯类抗生素敏感率达到90%以上。铜绿假单胞菌亚胺培南耐药率为19.0%,鲍曼不动杆菌亚胺培南耐药率为14.3%,而丁胺卡那霉素和妥布霉素对铜绿假单胞菌和鲍曼不动杆菌敏感率为100.0%。革兰阳性球菌对克林霉素和各种喹诺酮类抗生素均显示出很高的耐药性,但对利奈唑胺和万古霉素较敏感。屎肠球菌对万古霉素的敏感率只有71.4%,而对利奈唑胺敏感率为100.0%。结论血液病患者是院内感染的高发人群,致病菌以革兰阴性杆菌为主,呼吸道是主要感染部位。对合并感染的血液病患者应及时留取标本寻找病原学证据,并依据药敏试验调整用药,以便有效地控制感染和防止耐药性的产生。     

Treatment of wound sepsis in irradiated mice

Infections in the immunocompromised host are difficult to treat. The local and systemic effect of penicillin therapy, supplemented by immunoglobulins, and pentoxifylline on wounds infected by Staphylococcus aureus was evaluated in mice irradiated with 6.5 Gy 60Co gamma-rays. Three days after irradiation a suspension of S. aureus was inoculated subcutaneously over the gluteus muscle of anesthetized mice. The skin and the muscle were incised at the site of the inoculation. Treatment with 62.5 mg/kg penicillin-G was administered for 10 days. Numbers of bacteria per mg muscle and presence of organisms in spleens and livers were determined. Numbers of bacteria were significantly reduced from 7.3 (+/- 0.3) to 5.3 (+/- 0.4) log10 CFU/mg (+/- SEM) muscle in treated animals. Administration of immunoglobulin G i.v. or pentoxifylline i.p. alone, or in addition to penicillin-G, did not further reduce the number of bacteria. Increase in the dose of penicillin to 250 mg/kg decreased the number of bacteria more than 62.5 mg/kg. Bacteria were recovered from spleens and/or livers of all 13 untreated mice, and only in six of the 13 penicillin-treated mice (P less than 0.05). Penicillin therapy reduced the systemic spread of S. aureus. The model provides a means to evaluate regimens for treatment of bacterial wound infections in irradiated animals. The data illustrated the ability of antimicrobial agents to contain but not cure the infection in the immunocompromised host, and the lack of efficacy of immunoglobulins in neutropenic mice.     

化工企业成批烧伤患者感染病原菌的特点及耐药性分析

目的 回顾性分析本单位近年来成批烧伤患者和非成批烧伤患者院内感染的主要病原菌分布特点及其耐药性的流行病学变化。方法 将本科2008年1月-2014年12月收治的316例成批烧伤患者与同时期收治的361例非成批烧伤患者的病历资料进行对比,分析两组患者各年度创面分泌物、血液、痰液、气管套管及深静脉置管标本中的主要病原菌菌种、分布特点及其耐药性变化。结果 成批烧伤组感染革兰氏阳性(G＋)球菌与革兰氏阴性（Gˉ）杆菌的患者共176例（55.70%）,非成批烧伤组感染革兰氏阳性球菌与革兰氏阴性杆菌的患者共135例（37.40%）,成批烧伤组的感染发生率明显高于非成批烧伤组。成批烧伤组检出主要病原菌253株（52.93%）,其中革兰氏阳性球菌139株（54.94%）,分别为金黄色葡萄球菌91株,表皮葡萄球菌48株;革兰氏阴性杆菌105株（41.50%）,分别为大肠埃希菌63株,铜绿假单胞菌42株;真菌9株（3.56%）。非成批烧伤组检出主要病原菌225株（47.07%）,其中革兰氏阳性球菌127株（56.44%）,分别为金黄色葡萄球菌101株,表皮葡萄球菌26株;革兰氏阴性杆菌90株（40.00%）,与成批烧伤组略有不同,分别为铜绿假单胞菌51株,大肠埃希菌39株;真菌8株（3.56%）。成批烧伤组检出耐甲氧西林金黄色葡萄球菌（methicillin-resistant staphylococcus aureus,MRSA)59株（64.84%）,耐甲氧西林表皮葡萄球菌（methicillin-resistant staphylococcus epidermis,MRSE）31株（64.58%）;非成批烧伤组检出耐甲氧西林金黄色葡萄球菌 61株（60.40%）,耐甲氧西林表皮葡萄球菌16株（61.54%）。金黄色葡萄球菌、表皮葡萄球菌、大肠埃希菌和铜绿假单胞菌等常见致病菌对常用抗生素的耐药性均增加,并呈多重耐药性。结论 成批烧伤患者的感染发生率较非成批烧伤患者明显增加,且金黄色葡萄球菌、表皮葡萄球菌、大肠埃希菌和铜绿假单胞菌等常见致病菌对常用抗生素的耐药性均增加,并呈多重耐药性。     

应用湿性医疗技术对烧伤创面菌群特点及其耐药性分析

目的：探讨应用烧伤湿性医疗技术（MEBT／MEBO）处理烧伤创面的病原菌特点及其耐药性情况,评价及指导临床治疗。方法：回顾、总结、分析本院2003年～2005年期间应用MEBT／MEBO治疗118例烧伤创面的病原菌特点、耐药性及发生侵袭性感染的情况。结果：烧伤创面的菌群特点以格兰氏阴性杆菌为主,而且耐药情况较严重,创面发生侵袭性感染7例（5．93％）,全身脓毒血症2例（1．69％）。结论：烧伤创面病原菌对多数抗生素普遍耐药,采用MEBT／MEBO规范处理创面和选择高效、低毒、短程使用抗生素是对付耐药菌群的良好对策。     

2008年临床常见细菌耐药性监测

目的了解2008年我院细菌分离和耐药情况,为临床治疗提供依据。方法细菌鉴定采用VITEK微生物分析仪,药物敏感性试验采用BIOMIC药敏测定仪,耐药性分析采用WHO NET 5.4软件。结果 2008年我院收集患者首次分离株1 983株,革兰阴性菌1 157株,革兰阳性菌443株,真菌383株。铜绿假单胞菌、大肠埃希菌、白色假丝酵母菌为主要分离菌,占检出菌的45.7%;耐甲氧苯青霉素金黄色葡萄球菌（MRSA）和耐甲氧西林表皮葡萄球菌（MRSE）分别为72.7%和78.0%。铜绿假单胞菌对头孢他啶敏感性最好,耐药率为26.0%。大肠埃希菌对亚胺培南敏感性最好,其次是哌拉西林/他唑巴坦,敏感率分别为97.4%和90.6%。白色假丝酵母菌对两性霉素B敏感性最好。鲍曼不动杆菌对亚胺培南的敏感性最好,但对多种抗生素的耐药率均较高,多在50%以上。未发现对万古霉素和替考拉宁耐药的葡萄球菌。肠球菌对万古霉素的耐药率为2.4%,对替考拉宁的耐药率为9.2%。结论定期进行耐药性监测有助于了解我院细菌耐药性变迁,为临床经验用药提供理论依据。     

重型颅脑损伤并严重多发性创伤的救治研究

目的探讨重型颅脑损伤并严重多发性创伤有效可靠的救治方法,以提高治愈率,降低死亡率。方法回顾性总结分析我院自2007年6月—2012年6月收治的GCS 3～8分重型颅脑损伤并严重多发性创伤病人的临床资料。结果本组71例,恢复良好28例(39.4%)、中残11例(15.5%)、重残15例(21.1%)、植物生存1例(1.4%)、死亡16例(22.5%)。结论迅速查明伤情,早期诊断,妥善处理合并伤,迅速解除脑受压,多科室良好的协作,早期维持患者生命体征,是成功救治的关键。     

创面修复门诊患者创面病原微生物分布及耐药性分析

目的 分析创面修复门诊患者创面病原微生物的分布特点及耐药性,为创面专科规范化建设提供依据.方法 采用回顾性病例对照研究分析2017年12月至2019年10月上海交通大学医学院附属瑞金医院收治的365例门诊创面患者临床资料,其中男220例,女145例;年龄18～98岁[(58.8 ±18.9)岁].首诊患者92例,复诊患...     

我院下呼吸道感染病原菌耐药谱的研究

目的了解医院临床下呼吸道标本分离病原菌的耐药谱与耐药机制,为合理用药提供依据。方法分离的病原菌用VITEKⅡCampack鉴定,药敏用K-B法,数据分析用WHONET5.4软件。结果2285株病原菌中前5位为铜绿假单胞菌（20.3%）、金黄色葡萄球菌（10.8%）、肺炎克雷伯菌（8.7%）、鲍曼不动杆菌（8.7%）、大肠埃希菌（6.2%）;在G-杆菌中,头孢哌酮／舒巴坦耐药率最低（6.8%）,美罗培南耐药率为23.5%,大肠埃希菌和肺炎克雷伯菌产ESBLs的阳性率分别为42%和33.2%;G＋球菌中,万古霉素和替考拉宁敏感率均为100%,金黄色葡萄球菌和凝固酶阴性葡萄球菌耐苯唑西林分别为85.1%和85.2%。结论医院临床分离病原菌产ESBLs和耐苯唑西林比率高,应加强抗菌药物的合理使用和采取有效的隔离措施以降低耐药率及多药耐药菌的扩散。     

降阶梯治疗对烧伤创面菌群的影响

目的：调查严重烧伤患者早期采用降阶梯治疗后创面细菌学及其药敏情况的变化，为抗生素合理应用提供理论依据。方法：对2000年-2003年我科收治的48例大面积危重烧伤病人采用降阶梯治疗方案，并在抗生素治疗前、治疗后第三天、第七天采集创面分泌物行动态细菌学和药物敏感调查。结果：送检144份样本共检出细菌94份（65．3％），治疗前48份创面分泌物送检细菌学培养加药物敏感性测定，其中46份为阳性（95．8％），以表皮葡萄球菌、金葡菌、大肠杆菌、绿脓杆菌多见，对大多数抗生素敏感。第三天48份标本有17份阳性（35．4％），以阴沟肠杆菌、变形杆菌、假单孢菌类多见，对部分抗生素耐药。第七天48份标本31份阳性（64．5％），以不动杆菌、假单孢菌、肠杆菌、真菌多见，对大多数抗生素耐药。大面积烧伤患者早期采用降阶梯治疗后，创面菌群发生显著变化，在一周左右耐药菌株的检出率显著增高，结论：严重烧伤降阶梯治疗一周左右，应该及时停用或更换抗生素。     

腹膜透析相关性腹膜炎发病因素及耐药特征分析

目的探讨持续性不卧床腹膜透析（CAPD）相关性腹膜炎发生的影响因素和药敏特点。方法从患者性别、年龄、基础疾病、营养状况、致病菌种类以及抗药性方面,回顾性分析我院收治的58例次CAPD相关性腹膜炎病例资料。结果腹膜炎的发生率在40岁以下、无糖尿病、Hb〉90 g/L和Alb〉35 g/L患者显著低于其他患者（P〈0.05）。培养出细菌28例次,阳性率为48.3%,最常见的病原菌为表皮葡萄球菌和金黄色葡萄球菌;革兰阳性菌对利福平、万古霉素耐药率最低;革兰阴性菌对阿米卡星、亚胺培南耐药率最低。结论 CAPD相关性腹膜炎致病菌仍以革兰阳性菌为主,必须根据病原学选择敏感抗生素治疗该病。     

'War surgery at sea': maritime trauma experience in the Gulf War 2003

During the second Gulf War in 2003, the Primary Casualty Receiving facility onboard R.F.A. Argus treated thirty six patients with injuries sustained in the conflict, including thirty Iraqi enemy prisoners of war and displaced persons. Their injuries and operative management are reported. Eighteen casualties sustained fragmentation injuries, six casualties sustained gunshot wounds and seven casualties suffered a combination of both. In addition to penetrating missile injuries five casualties from road traffic accidents were treated. All wounds were managed following the established principles of war surgery. The extremities were involved in twenty eight patients (78%) including nine open, multifragmented long bone fractures which were managed with external skeletal fixators. Two laparotomies and one thoracotomy were performed. The average duration of surgery was one hundred and thirty two minutes with the longest procedure lasting for six hours and ten minutes. This was the first time that the Primary Casualty Receiving Facility had been used to surgically manage war casualties and it fulfilled this role to good effect.     

重症监护病房革兰阴性菌流行分布及耐药性监测

目的分析沈阳军区总医院呼吸内科重症监护室(RICU)革兰阴性菌的流行分布及其对抗菌药耐药的状况。方法对2009年1月—2011年12月RICU收住患者的所有分离菌株进行分析,试验方法严格按照NCCLS最新标准进行。结果 RICU共分离出277株革兰阴性菌,其中铜绿假单胞菌90株(32.49%)、不动杆菌65株(23.47%)、肺炎克雷伯杆菌56株(20.22%),嗜麦芽窄食假单胞菌20株(7.22%),其次为黏质沙雷菌和大肠埃希菌;革兰阴性菌对碳青酶烯类、头孢他啶、头孢哌酮-舒巴坦钠、头孢吡肟、哌拉西林-他唑巴坦和左氧氟沙星仍高度敏感,但不动杆菌的耐药率却不断增高。结论加强革兰阴性菌耐药性的动态监测,对临床医生合理使用抗菌药十分必要。