急性阑尾炎脓液细菌培养及药敏试验结果分析

目的探讨急性阑尾炎脓液的致病细菌种类构成及其耐药性。方法对58例急性阑尾炎患者的脓液进行细菌鉴定和药敏试验。结果 43例有细菌检出,检出率为74.1%,培养所得到的主要致病细菌为大肠埃希菌、肺炎克雷伯菌及产气肠杆菌三种,阿米卡星、哌拉西林/他唑巴坦、亚胺培南、美罗培南是针对大肠埃希菌的敏感药物。结论氨基糖苷类抗生素阿米卡星对大肠埃希菌具有较高的敏感率,且价格相对便宜,推荐在基层医院临床广泛使用。     

产超广谱β-内酰胺酶大肠埃希菌与肺炎克雷伯菌的耐药性分析

目的了解产超广谱β-内酰胺酶(ESBLs)大肠埃希菌与肺炎克雷伯菌的耐药性,为临床合理使用抗菌药物提供依据。方法采用美国德灵Microscan WalkAway40 S1自动微生物分析仪(W/A40)及专用NC21鉴定药敏复合板检测产超广谱β-内酰胺酶和药敏试验。结果 341株菌中共检测出ESBLs细菌150株,检出率43.99%,其中大肠埃希菌118株,检出率49.79%,肺炎克雷伯菌32株,检出率30.77%,产ESBLs菌株对大部分抗菌药物耐药,对亚胺培南、哌拉西林/他唑巴坦、阿米卡星、头孢西丁耐药性较低。结论及时监测产ESBLs菌的发生率及其耐药趋势,指导临床合理用药,亚胺培南、哌拉西林/他唑巴坦、阿米卡星、头孢西丁是目前治疗产ESBLs菌感染的有效抗菌药物。     

ICU产ESBLs大肠埃希菌与肺炎克雷伯菌感染的分布及耐药性分析

目的了解本地区ICU分离的产ESBLs大肠埃希菌和肺炎克雷伯菌的分布及对常用抗菌药物的耐药性,为临床抗菌药物的合理使用提供依据。方法采用K-B纸片扩散法,检测2013年-2015年ICU感染类标本分离的无重复的778株大肠埃希菌和570株肺炎克雷伯菌的耐药情况,并对结果进行统计分析。结果 2013年-2015临床标本中产ESBLs大肠埃希菌和肺炎克雷伯菌的检出率分别为52.96%和44.74%,ICU产ESBLs大肠埃希菌对美罗培南、亚胺培南、阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率为0.00%~30.34%。产ESBLs肺炎克雷伯菌对美罗培南、亚胺培南、阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率为0.00%~23.53%。ICU产ESBLs菌株耐药率明显高于非产ESBLs菌株,差异有统计学意义(P0.05)。结论 ICU产ESBLs大肠埃希菌与肺炎克雷伯菌对各类抗菌药物呈现不同程度耐药,并具多药耐药特点,碳青霉烯类仍是最敏感的药物;应加强产ESBLs菌株的监测及耐药性分析,以指导临床合理应用抗菌药物,对控制产ESBLs菌株的播散以及耐药基因的传播具有重要意义。     

235株血流感染大肠埃希菌耐药性分析

目的分析某院血流感染患者标本分离的大肠埃希菌耐药性,为临床合理应用抗菌药物提供依据。方法采用BacT/Alert全自动血培养仪、VITEK2细菌鉴定仪对患者血标本进行培养、鉴定;K-B药敏纸片测定法进行药敏试验并筛选出产超广谱β-内酰胺酶(ESBLs)细菌。结果 2009—2011年共分离血流感染大肠埃希菌235株,ESBLs阳性90株,阳性率38.30%。产ESBLs菌株对氨苄西林、头孢噻肟、头孢曲松100%耐药;对亚胺培南/西司他丁、美罗培南敏感率均为100%,对头孢美唑、阿米卡星敏感率90%。非产ESBLs菌株耐药率最高的是氨苄西林,达70.63%;对亚胺培南/西司他丁、美罗培南敏感率均为100%,对阿米卡星、头孢噻肟、头孢美唑敏感率95%。产ESBLs菌株的耐药率均明显高于非产ESBLs菌株。在含有β-内酰胺酶抑制剂的复合抗菌药物中,只有头孢哌酮/舒巴坦对产ESBLs大肠埃希菌的敏感率90%,哌拉西林/他唑巴坦和替卡西林/克拉维酸的敏感率均未超过80%。结论血流感染大肠埃希菌产ESBLs株的耐药性较高,临床用药应根据患者感染菌的耐药情况制定合理的个体化治疗措施。     

产超广谱β-内酰胺酶大肠埃希菌耐药谱的连续监测

目的了解产超广谱β-内酰胺酶大肠埃希菌耐药谱的变化,为临床经验用药提供依据。方法采用法国Bio-Merieux公司的VITEK-60全自动细菌鉴定仪鉴定细菌,K-B单片琼脂扩散法做药敏试验,WHONET5.0分析软件对产超广谱β-内酰胺酶(ESBLs)大肠埃希菌的药敏试验进行统计。结果检出912株大肠埃希菌,其中产ESBLs 386株,占42.3%;体外试验显示亚胺培南、美罗培南、阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢西丁、头孢他啶对产ESBLs大肠埃希菌有较高的抗菌活性;产ESBLs大肠埃希菌的耐药率均明显高于非产ESBLs菌。结论我院大肠埃希菌产ESBLs株主要是头孢菌素型(CTX-M型),ESBLs尚未有效控制,仍然处于较高水平;3年间产ESBLs大肠埃希菌耐药谱变化不大,亚胺培南、美罗培南对产ESBLs株未发现耐药,阿米卡星及哌拉西林/他唑巴坦具有良好的治疗效果。     

2008-2009年革兰阴性杆菌敏感性监测

目的 监测深圳地区革兰阴性杆菌的耐药情况.方法 细菌鉴定及药敏试验采用MicroScan40/96全自动微生物鉴定仪,数据分析采用MicroScan Labpro2.41软件进行统计分析.结果 971株肠杆菌科细菌中,大肠埃希菌、肺炎克雷伯菌、奇异变形菌产超广谱β-内酰胺酶(ESBLs)的检出率分别为52.1％、42.7％和6.5％;未检出耐亚胺培南的肠杆菌科细菌;大肠埃希菌对测试抗菌药物敏感率较高的有阿米卡星94.0％、哌拉西林/他唑巴坦93.0％;肺炎克雷伯菌对哌拉西林/他唑巴坦和阿米卡星的敏感率分别为81.0％和80.5％;阴沟肠杆菌和产气肠杆菌对阿米卡星的敏感率在81.5％～91.0％;奇异变形菌和褪色沙雷菌对阿米卡星、头孢他啶、头孢曲松、头孢噻肟、头孢吡肟、哌拉西林/他唑巴坦和替卡西林/克拉维酸的敏感率均＞85.0％;铜绿假单胞菌对亚胺培南和哌拉西林/他唑巴坦的敏感率＞93.0％,对头孢他啶、哌拉西林、阿米卡星和妥布霉素的敏感宰＞82.5％;未检出耐亚胺培南的鲍氏不动杆菌,鲍氏不动杆菌对氨苄西林/舒巴坦、替卡西林/克拉维酸的敏感率分别80.5％和74.0％;嗜麦芽寡养单胞菌抗菌活性较高的有磺胺甲噁唑/甲氧苄啶和左氧氟沙星,敏感率分别为83.0％和78.0％,磺胺甲噁唑/甲氧苄啶的敏感率有逐年降低的趋势.结论 肠杆菌科细菌、铜绿假单胞菌和鲍氏不动杆菌对亚胺培南仍有较高的抗菌活性;多药耐药的鲍氏不动杆菌不断增加,肠杆菌科细菌呈示较高的多药耐药性;产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌也逐年增加,值得关注.     

产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的耐药性分析

目的了解大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)株的耐药性.方法采用Microscan autoscan-4鉴定仪(AS-4)及专用药敏板NC21检测超广谱β-内酰胺酶及药敏试验.结果产ESBLs株对亚胺培南、哌拉西林/他唑巴坦、阿米卡星耐药率分别为0、5.6%～34.0%、10.1%～46.0%,其余抗菌药物有不同程度的耐药.结论重视产ESBLs细菌的检测,根据药敏试验结果合理用药,亚胺培南、哌拉西林/他唑巴坦、阿米卡星是目前治疗ESBLs株有效药物.     

下呼吸道感染患者中产超广谱β-内酰胺酶菌株的药敏分析

目的 了解下呼吸道感染患者中肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶(ESBLs)及产ESBLs菌株的药敏情况。方法 收集2000年10月～2001年10月从我院下呼吸道感染患者中分离出的肺炎克雷伯菌和大肠埃希菌240株，用表型确认试验检测ESBLs；用Kirby—Bauer琼脂扩散法作药敏试验。结果 240株肺炎克雷伯菌和大肠埃希菌中，共检出产ESBLs菌78株，检出率为32．50％，其中肺炎克雷伯菌为28.57％，大肠埃希菌为34．62％；除亚胺培南、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦和头孢美唑外，产ESBLs菌对其他10种抗生素的耐药率均显著高于非产ESBLs菌(P＜0.01)；亚胺培南、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦和头孢美唑对产ESBLs菌的耐药率最低。结论 下呼吸道感染患者中肺炎克雷伯菌和大肠埃希菌产ESBLs情况严重；产ESBLs菌对大多数抗生素耐药性比非产ESBLs菌严重，亚胺培南、头孢哌酮／舒巴坦、哌拉西林／他唑巴坦和头孢美唑是治疗由产ESBLs菌引起感染的有效抗生素。     

尘肺患者感染产超广谱β-内酰胺酶细菌调查

目的 调查尘肺患者产超广谱β-内酰胺酶(ESBLs)细菌感染情况,为控制院内感染提供依据.方法 选择某医院并发肺部感染的尘肺患者291人,对痰标本分离得到的273株革兰阴性杆菌进行ESBLs检测,并对产ESBLs细菌进行药物敏感性试验.结果 检出产ESBLs细菌67株,占全部菌株的24.54%(67/273);其中肺炎克雷伯菌31株、大肠埃希菌29株、铜绿假单胞菌6株、阴沟肠杆菌1株.产ESBLs细菌对氨苄西林耐药率为97.01%,对亚胺培南耐药率为2.98%,对头孢噻肟、头孢他定、头孢哌酮等第3代头孢菌素类耐药率高,对头孢哌酮,舒巴坦耐药率较低,产ESBLs肺炎克雷伯菌及大肠埃希菌对头孢西丁耐药率为22.58%和34.48%.铜绿假单胞菌对亚胺培南不敏感,产ESBLs的肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌对亚胺培南均敏感.结论 产ESBLs肺炎克雷伯菌和大肠埃希菌是引起尘肺感染的主要致病菌,且对亚胺培南敏感.     

肠杆菌科细菌感染的耐药性分析及分布特点

目的 了解引起临床感染的肠杆菌科细菌对常用抗菌药物的耐药情况,及其临床分布特点,为临床治疗提供参考依据。方法 对2013年1月至2014年8月临床分离的肠杆菌科细菌应用全自动微生物分析仪进行菌株鉴定和药敏试验,采用WHONET5.6软件对药敏结果进行统计分析。对厄他培南或亚胺培南不敏感的菌株,采用改良Hodge试验检测其产碳青霉烯酶情况。结果 从各类标本中共分离出肠杆菌科细菌705株,其中肺炎克雷伯菌298株(42.3%),大肠埃希菌224株(31.8%),阴沟肠杆菌79株(11.2%),产气肠杆菌36株(5.1%),其它种类肠杆菌科细菌68株(9.6%)。对厄他培南或亚胺培南不敏感的菌株20株,采用改良Hodge试验检测有14株阳性。肺炎克雷伯菌对氨苄西林耐药率最高（100.0%）,大肠埃希菌对氨苄西林、复方新诺明、头孢曲松的耐药率分别为86.2%、62.1%、60.3%,肠杆菌属对亚胺培南、阿米卡星的耐药率最低（0.0%）。结论 肠杆菌科细菌的临床感染以肺炎克雷伯菌和大肠埃希菌为主,对常用抗菌药物呈现不同程度耐药。碳青霉烯类仍是肠杆菌科细菌最敏感的药物,但已出现碳青霉烯耐药菌,应加强对肠杆菌科细菌的耐药性监测,以指导临床合理使用抗菌药物,控制医院感染的发生。     

弧菌显色培养基对副溶血弧菌检测效果的初步评估

目的评估弧菌显色培养基对副溶血弧菌检测效果。方法通过弧菌显色培养基(chromID Vibrio)同硫代硫酸盐-柠檬酸盐-胆盐-蔗糖(TCBS)琼脂培养基进行比对,采用阳性菌株污染、人工污染样品和实际样品检测的方法,对chromID Vibrio的灵敏性、特异性和检测效果进行了初步评价。结果得到粉红色副溶血弧菌典型菌落;阳性菌株污染中,在稀释度为10-7CFU/ml时,chromID Vibrio能检测出目标菌,而TCBS平板未能检测;对人工污染样品,稀释度10-8CFU/ml chromID Vibrio有检出、TCBS平板未检出;对采集的150份实际样品进行检测,用ChromID Vibrio方法检出副溶血弧菌12株,比TCBS方法检出的检测效率高。结论chromID Vibrio灵敏性和TCBS相当,并具有较好的特异性,大大提高副溶血性弧菌的检测效率。     

提高外环境水体中霍乱弧菌检出率的方法研究

目的 了解外环境水体标本在庆大霉素平板上的菌群分布及优势菌的耐药谱,研究提高霍乱弧菌检出率的方法.方法 采集闽江水体用庆大平板分离培养,用K-B法检测20种抗菌药物对优势菌的敏感性;选择痢特灵,将不含霍乱弧菌的水样一代以及二代增菌液作为稀释液,对不同型别的霍乱弧菌进行倍比稀释,观察其在庆大平皿上的生长情况.结果 330份标本共检出优势菌151株,其中79.5％为气单胞菌.151株优势菌对阿米卡星、诺氟沙星、环丙沙星等9种抗菌素的敏感率达80％以上.在一代增菌液为稀释介质的生长试验中,当痢特灵的浓度≥4μg/mL时,不同型别的霍乱弧菌能检测到的最低菌浓度均有一定的提高;而以二代增菌液为稀释介质时,痢特灵的浓度需≥8μg/mL或16 μg/mL.结论 在庆大霉素琼脂平皿中加入不同浓度的痢特灵,在一定程度上能提高霍乱弧菌的检出率.     

不同培养基对肠球菌检出率的影响

用pH9.6葡萄糖肉汤、6.5％NaCl琼脂平板、3％—5％羊血琼脂平板三种不同培养基,从同一份样品中分离肠球菌,检出率有显著差别。pH9.6葡萄糖肉汤对检样选择性增菌后,再用6.5％NaCl琼脂平板分离肠球菌,其检出率明显高于现正普遍用于肠球菌初代分离的3％～5％血琼脂平板(P<0.05),也高于单纯使用6.5％NaCl琼脂平板(P<0.05);后两者间无显著差别(P>O.05)。属中种的构成在不同培养基上检出情况也不同。 关键词:培养基 肠球菌 检出率 肠球菌广泛存在于自然界,是水、空气、尘     

Validation of a method for simultaneous isolation of Shiga toxin-producing Escherichia coli O26, O103, O111, and O145 from minced beef by an international ring-trial

An isolation method described by Possé et al. (FEMS Microbiol Lett 2008;282:124-131) was satisfactorily validated in an international ring-trial using artificially contaminated minced beef samples. Until now, no validated method existed for the simultaneous isolation of Shiga toxin-producing Escherichia coli serogroups O26, O103, O111, and O145 in food. Twelve laboratories from five European countries participated and received 16 inoculated beef samples contaminated with cold-stressed cells of the four serogroups O26, O103, O111, and O145 in two levels (approximately 30 and 300 CFU 25?g?1) in duplicate. In addition, they received four non-inoculated samples. The isolation protocol comprised a selective enrichment step, a selective isolation step on a non-O157 agar plate differentiating the serogroups by color, followed by confirmation by plating on confirmation agar media and agglutination. All laboratories were able to isolate the inoculated serogroups from the samples, both for the high and the low inoculation level. Results did not differ whether in-house-prepared or ready-to-use non-O157 agar plates were used, demonstrating that by following the instructions laboratories managed to perform the complete protocol with success.     

Comparison of three methods to recover vancomycin-resistant enterococci (VRE) from perianal and environmental samples collected during a hospital outbreak of VRE.

OBJECTIVE: To establish an efficient and sensitive technique for recovering vancomycin-resistant enterococci (VRE) from perianal and environmental samples collected during implementation of control measures for an outbreak of VRE. DESIGN: Perianal and environmental samples were collected in triplicate on sterile swabs. One swab was used to inoculate a selective broth medium containing 6 pg of vancomycin and 8 pg of ciprofloxacin per mL, one to inoculate Campylobacter agar containing 10 microg/mL of vancomycin, and one to inoculate Enterococcosel agar containing 8 microg/mL of vancomycin. SETTING: Samples were collected in the intensive care units of a 600-bed university hospital over a period of 2 months. SAMPLE SELECTION: Patients and their immediate environment were sampled if they resided in a ward with a patient known to be colonized or infected with VRE. RESULTS: Of the 88 perianal samples obtained from 63 patients, 37 were positive for VRE by broth culture, with 36 also recovered on both types of solid media (sensitivity, 97.3%; negative predictive value, 98.1%). Of the initial samples collected from each of the 63 patients, 20 were positive for VRE by all methods. Of the 500 environmental samples cultured, 139 were positive for VRE in broth, with only 33 recovered on Campylobacter agar (sensitivity, 23.7%; negative predictive value, 77.2%) and 22 on Enterococcosel agar (sensitivity, 15.8%; negative predictive value, 75.2%). CONCLUSIONS: Our data indicate that, when performing surveillance cultures during an outbreak of VRE, use of an enrichment broth medium is required to recover VRE contaminating environmental surfaces; however, direct inoculation to selective solid medium is adequate to recover VRE in patient perianal specimens.     

腹泻病原菌的分离与鉴定

目的 为了提高腹泻病原菌实验室诊断水平.方法 利用SS琼脂、山梨醇-麦康凯琼脂(SMAC)、TCBS琼脂、血琼脂之间的功能瓦补作用,把腹泻粪便同时接种上述4种培养基分离病原菌.结果 近3年医院腹泻病原菌检出率达48.2%,分离到的菌种范围不只局限于沙门菌属和志贺菌属,而且致泻性大肠埃希菌、弧菌、金黄色葡萄球菌、白色假丝酵母菌及在平板上呈优势生长的克雷伯菌、变形菌属、柠檬酸杆菌属、铜绿假单胞菌等被陆续检出.结论 选择合适的培养基,扩大肠道病原菌的检测范围,在临床微生物检验中非常重要.     

科玛嘉显色培养基和XLD、SS、HE分离食品中沙门菌效果比较

目的比较沙门菌科玛嘉显色培养基（简称CAS,下同）、XLD、SS和HE培养基在分离食品中沙门菌的效果。方法使用73株沙门菌分别接种CAS、XLD、SS和HE培养基,观察生长和显色情况。同时使用上述4种培养基对153份食品进行沙门菌的分离鉴定,比较其分离效果。结果所有接种的沙门菌在CAS上均生长,并具有典型的菌落特征。从153份食品标本中共分离出26株沙门菌。CAS分离沙门菌的敏感性为84．62％,特异性为94．49％,与SS和HE比较有非常显著性差异（P〈0、005）。在CAS上生长的非沙门菌可疑菌落主要有气单胞菌属和变形杆菌。结论CAS分离食品中沙门菌具有高敏感性和特异性,是理想的沙门菌选择性培养基。推荐使用CAS和XLD同时作为食品中沙门菌的分离培养基。     

Studies on the isolation of Salmonella dublin.

Abattoir drain swabs, bovine faeces and a few other veterinary samples were examined for the presence of Salmonella dublin. Three selective agar media and four enrichment broths were investigated. The two most efficient plating media were deoxycholate citrate agar and brilliant green MacConkey agar. Wilson and Blair''s bismuth sulphite agar (de Loureiro''s modifications) was least successful. Selenite F broth, whether incubated at 37 or 43 degrees C., was better than the other enrichment broths used which contained a triphenyl methane dye as one of the selective ingredients.     

The isolation of salmonellas from British pork sausages and sausage meat.

Between 1969 and 1974, 1467 packets (3309 samples) of pork sausages and sausage meat produced by two large and two medium sized manufacturers and several local butchers were examined for the presence of salmonellas. Of these, 435 packets (786 samples) were found to contain salmonellas, but there was a wide variation in the isolation rates according to the producer. The salmonella incidence in samples from several small and two medium sized producers was low (0-11%) while the results from the two large producers investigated showed a striking difference, the rate of salmonella contamination in the product of one was low (about 2%) and in that of the other consistently high (40-60%). A comparison of liquid enrichment media, incubation temperatures and selective agar media was also carried out to determine the most efficient combination for the isolation of salmonellas from minced meat products. The results showed that (a) incubation of enrichment cultures at 43 degrees C. yielded a consistently greater number of salmonella isolations that at 37 degrees C., regardless of plating medium, (b) tetrathionate broth A (Rolfe) was superior to selenite broth as en enrichment medium at both 37 and 43 degrees C. and (c) brilliant green agar gave better results than deoxycholate citrate sucrose agar and bismuth sulphite agar as a selective medium.     

空肠弯曲菌分离培养基改良CCD琼脂的性能测试研究

目的:比较空肠弯曲菌(Campylobacter jejuni)在国内外四个厂家的改良CCD琼脂上生长的灵敏度及回收率。方法:用哥伦比亚血平板作为参照培养基,根据ISO/TS11133.2-2003标准检验方法对空肠弯曲菌分离培养基进行性能测试。结果:样品本底测试显示,在四个厂家培养基中测试的样品均没有检出可疑的空肠弯曲菌,但厂家②对杂菌的抑制能力较差;各厂家的的改良CCD琼脂灵敏度均可达到10 CFU以内;环凯、厂家①、厂家②、OXOID四个厂家的改良CCD琼脂的回收率分别为83.4%、46.4%、32.4%、89.4%,均能达到ISO/TS11133.2-2003标准检验方法的要求。结论:环凯和OXOID的改良CCD琼脂分离空肠弯曲菌的效果无明显差异,但均优于国内其他两个厂家(P<0.05)。