甲氧西林耐药凝固酶阴性葡萄球菌抗生素耐药性及耐药基因的研究

目的 了解新生儿感染和携带凝固酶阴性葡萄球菌(CNS)的抗生素敏感性情况,并对耐甲氧西林CNS株(MRCNS)的mecA基因进行检测。方法 应用常规生化鉴定及微生物的微量鉴定系统(API)法进行MR-CNS分离株菌属鉴定;采用K-B纸片扩散法对114株CNS分离株进行11种抗生素敏感性检测;并建立PCR方法对MRCNS株的mecA耐药基因进行检测。结果 79.8％的CNS分离株对甲氧西林耐药;MRCNS对青霉素、红霉素、头孢唑啉、四环素、复方新诺明、庆大霉素、环丙沙星、氯霉素等8种抗生素耐药率明显高于甲氧西林敏感株(MSCNS),且多重耐药率高达92.3％。MRCNS分离株耐药率高的前三位分别是溶血葡萄球菌、表皮葡萄球菌和人型葡萄球菌,占分型总数(56例)的78.6％(44/56);在91株MRCNS中检出62株mecA基因阳性,检出率为68.1％。结论 我国新生儿感染CNS甲氧西林耐药情况同国外相似,MRCNS对多种抗生素交叉耐药现象十分严重。PCR方法检测mecA基因是一种方便、快速的检测方法,对指导临床治疗很有帮助,值得推广。     

葡萄球菌败血症病原菌药敏检测与抗生素的选择

１９９４年１２月～２０００年１２月我科共收治葡萄球菌败血症７６例 ,男５６例 ,女２０例。血培养及药敏 :金黄色葡萄球菌３６株 ,表皮葡萄球菌４０株 ;耐甲氧西林葡萄球菌 (ＭＲＳ)４０株 ,其中耐甲氧西林金葡萄菌 (ＭＲＳＡ)１８株 ,耐甲氧西林表皮葡萄球菌 (ＭＲＳＥ)２２株 ;甲氧西林敏感葡萄球菌 (ＭＳＳ)３６株 ,金葡菌和表皮葡萄球菌各１８株。药敏结果显示ＭＲＳＡ和ＭＲＳＥ具有多重耐药性 ,临床常用抗菌药中仅对丁氨卡那霉素的敏感率较高 (６６．７%和７７．３ % )。有研究资料表明 ,耐甲氧西林的凝固酶阴性葡萄球菌 (ＭＲＣＮ…     

感染性心内膜炎30例临床及预后分析

为探讨感染性心内膜炎（IE）的临床特及预后因素，对15年来的收治的30例IE患儿的所有资料进行回顾性调查，结果30例IE患儿治愈9例，死亡5例；持续发热为其主要表现，血培养阳性18例（60．0％），其中金葡菌9例（50．0％）；超声检查发现赘生物21例，有赘生物及基础心脏病组死亡率为23．8％和25．0％，无赘生物和无基础心脏病组无死亡；栓塞组死亡21．4％，无栓塞组为12．5％；血培养阳性组死亡22．2％，阴性组为8．3％。提示IE的显著症状是持续发热，金葡菌感染占首位，预后与赘生物、栓塞、基础心脏病存在和血培养阳性有关。     

Duke标准在小儿感染性心内膜炎诊断中的价值

目的：探讨Duke标准对小儿感染性收内膜炎诊断的价值。方法：应用Duke标准对50例临床诊断为感染 心内膜炎并经超声心动图检查的患儿及其中经手术证实为IE的患儿进行分组分析。结果：连续2次或2次以上血培养阳性并为相同致病菌的有15例（30％）,1次血培养阳性10例（205）,39例（78％）超声心动图检出赘生物,其中26例的螯生物呈摆动状态。有1例伴瓣膜穿孔,1例伴室间隔缺损补片脱落,按Duke标准,50例患儿中21例（42％）被确诊为IE。其中12例符合2项主要指标。9例符合1项主要和≥3项次要指标。1例被排除IE。在13例经手术证实的IE必中按Duke标准诊IE5例（385）,8例为可能IE,其中6例符合1项主要和2项次要指标,2例符合1项主要和1项次要指标。手术证实为IE的13例患儿中,10例血培养阴性,2例赘生物不摆动。结论应用超声心动图检出赘生物对IE诊断有重要意义,在儿科病例中螯生物的确定不必限于摆动的团块。曾用抗生素治疗,有典型心内膜受累的超心动图表现,另具备Duke标准中2项临床次要指标的可确诊为IE,这样将会进一步提高Duke标准诊断IE的敏感性。     

携带Panton-Valentine杀白细胞素基因金黄色葡萄球菌致新生儿软组织化脓性感染三例

目的 研究引起新生儿软组织化脓性感染的病原菌.方法 常规方法分离细菌,全自动微生物分析仪进行菌种鉴定和药物敏感试验,多重PCR检测Panton-Valentine杀白细胞素基因,用另一种多重PCR检测SCCmec基因型,采用多位点测序技术检测基因序列型.结果 2例从软组织化脓性感染的新生儿从其脓液中分离出2株金黄色葡萄球菌,另1例从其血液和脓液中分别分离出2株金黄色葡萄球菌.4株金黄色葡萄球菌都为携带PVL基因的耐甲氧西林金黄色葡萄球菌,SCCmec基因型都为SCCmec ⅢA型,序列型为ST88,4株MRSA除红霉素外,其余耐药谱相同.结论 3例新生儿的软组织化脓性感染是由携带PVL杀白细胞素的MRSA同一克隆株引起,该克隆株为ST88-SCCmecⅢA-MRSA.     

儿童凝固酶阴性葡萄球菌感染菌种分布及耐药监测

目的 探讨浙江省湖州市妇幼保健院儿童凝固酶阴性葡萄球菌( coagulase negative staphylococcus,CNS)感染菌种分布及耐药情况.方法 应用BacT/AlerT3D全自动血培养仪、法国生物梅里埃公司API微生物分析鉴定系统进行培养鉴定,采用法国生物梅里埃公司ATB药敏系统进行药敏试验.结果 2007年1月至2010年12月从儿科病房血培养标本中共分离CNS 266株,其中表皮葡萄球菌151株(56.77％),人葡萄球菌44株(16.54％),溶血葡萄球菌30株(11.28％),其他葡萄球菌41株(15.41％);耐甲氧西林凝固酶阴性葡萄球菌(methicillin resistant coagulase negative staphylococcus,MRCNS)检出率为71.80％(191/266),MRCNS药敏结果显示多重耐药;未发现对万古霉素耐药的CNS.结论 儿童感染CNS菌种以表皮葡萄球菌和人葡萄球菌为主,MRCNS检出率高且呈多重耐药,糖肽类抗生素是治疗MRCNS感染的首选药物.     

凝固酶阴性葡萄球菌致儿童茵血症的菌种分布及耐药性监测

目的 探讨凝固酶阴性葡萄球菌(CNS)致儿童菌血症的菌种分布及耐药件现状.方法 应用BacT/AlerT 120全自动血培养仪、法国生物梅里埃公司VITEK-2微生物分析鉴定系统进行培养鉴定,采用纸片琼脂扩散法进行药敏试验,采用WHONET-5.3软件对耐药性数据进行分析.结果 2004年1月-2007年12月从儿科病房血液标本中共分离出凝固酶阴性葡萄球菌351株,其中表皮葡萄球菌235株(66.95%),沃氏葡萄球菌46株(13.11%).耐甲氧西林凝固酶阴件葡萄球菌(MRCNS)检出率为85.75%(301/351).MRCNS药敏结果显示多重耐药.结论 CNS已位居儿童血流感染病原菌的首位,MRCNS检出率高且呈多重耐药,糖肽类抗生素是治疗MRCNS感染的首选药物.     

新生儿败血症病原菌十年变迁及耐药性分析

目的 了解本院近10年来新生儿败血症病原菌及其耐药性变迁,以指导临床用药.方法 对1997年3月至2002年3月收治的新生儿败血症(第1组)血培养检出茵、药敏试验结果进行回顾性调查,并与2002年4月至2007年3月的调查结果(第2组)进行比较.结果 10年来新生儿败血症血培养阳性的患儿296例,第1组155例,第2组141例,病原菌以革兰阳性细菌为主,近5年来凝固酶阴性葡萄球菌(CNS)感染率明显增加(x2=14.15,P＜0.01),金葡茵感染率显著下降(x2=10.88,P＜0.01),对青霉素、苯唑西林及红霉素有较高的耐药率,多重耐药较明显,耐甲氧西林的凝固酶阴性葡萄球菌(MRCNS)及耐甲氧西林的金葡菌(MRSA)感染增多,对万古霉素敏感性较高.革兰阴性杆菌对氨苄西林普遍耐药,对亚胺培南、氨曲南高度敏感,对氨基糖甙类、喹诺酮类及三代头孢菌素敏感性较高,但耐药菌株有增加的趋势.结论 CNS是本院新生儿败血症最主要的病原菌,对青霉素等常用抗生素普遍耐药,多重耐药菌株增加,根据病原茵药敏结果合理使用抗生素.是有效抗感染和延缓耐药菌株产生的必要条件.     

凝固酶阴性葡萄球菌致儿童菌血症的菌种分布及耐药性监测

目的 探讨凝固酶阴性葡萄球菌（CNS）致儿童菌血症的菌种分布及耐药性现状。方法 应用BacT/AlerT 120全自动血培养仪。法国生物梅里埃公司VITEK-2微生物分析鉴定系统进行培养鉴定,采用纸片琼脂扩散法进行药敏试验,采用WHONET5.3软件对耐药性数据进行分析。结果 2004 年1月 - 2007年12月从儿科病房血液标本中共分离出凝固酶阴性葡萄球菌351株,其中表皮葡萄球菌235株（66.95%）,沃氏葡萄球菌46株（13.11%）。耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）检出率为85.75%（301/351）。MRCNS 药敏结果显示多重耐药。结论 CNS 已位居儿童血流感染病原菌的首位,MRCNS 检出率高且呈多重耐药,糖肽类抗生素是治疗MRCNS 感染的首选药物。     

儿科金黄色葡萄球菌感染现况及耐药谱分析

目的分析住院患儿耐甲氧西林金黄色葡萄球菌(MRSA)与甲氧西林敏感金黄色葡萄球菌(MSSA)检出状况。方法对首都儿科研究所2005—2009年间35352份标本中检出的金黄色葡萄球菌鉴定结果和药敏试验进行回顾性分析。结果共分离出463株金黄色葡萄球菌,培养标本总检出率1.31%。金黄色葡萄球菌来源构成比中,前3位标本依次为脓液(24.26%)、分泌物(7.32%)和呼吸道标本(6.73%),血液标本仅为0.20%。463株金黄色葡萄球菌中MRSA48株,占10.37%;MSSA415株,占89.63%。2005—2009年度检出率分析结果显示,MRSA株检出率呈逐年上升趋势。研究中发现1株耐万古霉素的金黄色葡萄球菌,但对利奈唑胺敏感。26株MRSA药敏分析提示,92.3%为多重耐药株。结论儿科MRSA阳检率虽低于成人,但呈现逐年上升趋势,提示儿科需加强对MRSA株与药敏情况监测,尤其是对利奈唑胺等新药监测。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.