某院大肠埃希菌的耐药性分析

目的动态监测院内分离大肠埃希菌的耐药性及分布,为临床经验用药及控制感染提供理论依据。方法采用WHONET 5.6对2015年1月1日~2015年3月31日本院临床分离的224株大肠埃希菌对临床常用的19种抗菌药物的耐药性及分布进行分析。结果分离的224株大肠埃希菌对氨苄西林、头孢唑啉、环丙沙星、头孢呋辛、左氧氟沙星、头孢噻肟、庆大霉素、氨曲南、头孢吡肟、妥布霉素、头孢他啶、阿莫西林/克拉维酸、头孢西丁、头孢哌酮/舒巴坦、阿米卡星、哌拉西林/他唑巴坦、厄他培南、美罗培南和亚胺培南的耐药率分别为84.4%(189株)、60.3%(135株)、57.1%(128株)、57.1%(128株)、53.1%(119株)、52.7%(118株)、45.1%(101株)、42.0%(94株)、41.1%(92株)、37.1%(83株)、26.3%(59株)、15.2%(34株)、12.1%(27株)、6.7%(15株)、4.0%(9株)、4.0%(9株)、1.3%(3株)、1.3%(3株)和1.3%(3株)。59.4%(133株)的标本来源于尿液,17.0%(38株)的标本来源于痰液;26.8%(60株)的标本分布在泌尿内科病房。结论本院已发现对碳青霉烯类抗菌药物耐药的大肠埃希菌,临床应动态监测大肠埃希菌的耐药性及分布,以提高经验用药的准确率。     

院内大肠埃希菌耐药性分析及分布

目的：了解院内大肠埃希菌对临床常用抗菌药物的耐药性及分布,为临床合理使用抗菌药物提供理论依据。方法应用WHONET 5.6软件对2012年1月至2012年12月本院临床分离的742株大肠埃希菌对亚胺培南等16种抗菌药物的耐药性及分布进行回顾性分析。结果742株大肠埃希菌对氨苄西林、复方新诺明、环丙沙星、头孢噻肟、妥布霉素、左氧氟沙星、庆大霉素、氨曲南、头孢吡肟、头孢他啶、替卡西林/克拉维酸、阿莫西林/棒酸、头孢西丁、阿米卡星、哌拉西林/他唑巴坦和亚胺培南的耐药率依次为89.1%（661/742）、66.7%（495/742）、64.2%（476/742）、61.5%（456/742）、54.7%（406/742）、53.8%（399/742）、52.2%（387/742）、50.4%（374/742）、48.4%（359/742）、36.3%（269/742）、33.7%（250/742）、25.3%（188/742）、15.5%（115/742）、8.1%（60/742）、6.1%（45/742）和0.4%（3/742）。本研究中43.7%标本来源于尿液、23.7%标本来源于痰液、11.1%标本来源于血液。科室分布情况：分别有18.1%和16.2%的标本来源于儿内科病房和泌尿内科病房。结论院内大肠埃希菌主要引起泌尿道和呼吸道感染,其次是血流感染。对临床部分常用抗菌药物的耐药性较高,临床医师应根据药敏试验结果合理选用抗菌药物。     

肛周脓肿患者感染大肠埃希菌耐药性分析

回顾性分析肛周脓肿患者感染大肠埃希菌的耐药情况及产超广谱β-内酰胺酶(ESBLs)的发生率,以指导临床合理选择抗菌药物。对近4年确诊肛周脓肿患者的脓液标本中分离出的276株大肠埃希菌(肛周脓肿组)进行耐药性分析,用纸片扩散法表型确证试验检测ESBLs,以非肛周脓肿患者大肠埃希菌感染为对照组。肛周脓肿组ESBLs阳性率为46.0%,明显高于对照组(31.0%,P0.05)。肛周脓肿组对哌拉西林、头孢唑啉、头孢呋辛、头孢噻肟、头孢曲松、环丙沙星、左氧氟沙星、碘胺甲噁唑/甲氧苄啶耐药率较高,均60.0%,对环丙沙星、左氧氟沙星、哌拉西林、头孢曲松、头孢唑林、头孢吡肟、头孢噻肟、头孢呋辛、碘胺甲噁唑/甲氧苄啶的耐药率明显高于对照组(P0.05)。肛周脓肿感染大肠埃希菌对多种抗菌药物的耐药率较高,临床应根据药敏试验结果合理使用抗菌药物。     

耐左氧氟沙星大肠埃希菌的耐药性分析

目的了解本院临床分离的大肠埃希菌的耐药情况,分析耐左氧氟沙星细菌的耐药性。方法对2009年8月至2010年8月本院临床分离的154株大肠埃希菌用Kirby-Bauer琼脂扩散法进行药物敏感试验。结果 154株大肠埃希菌中共检出耐左氧氟沙星菌76株,检出率49.35%。在各类标本中,尿液中耐左氧氟沙星菌株分离率最高（51.32%）,其次为痰（23.68%）。除亚胺培南、美罗培南、头孢西丁、哌拉西林/他唑巴坦和阿米卡星外,耐左氧氟沙星菌株对氨苄西林、头孢唑啉、头孢吡肟、头孢噻肟、头孢他啶、庆大霉素、头孢哌酮/舒巴坦的耐药率明显高于非耐左氧氟沙星菌株（P〈0.05）。结论本院耐左氧氟沙星大肠埃希菌株对多种药物表现出较高的耐药率,应加强对耐左氧氟沙星大肠埃希菌的耐药性监测,严格掌握抗菌药物的使用指征,防止耐药菌株的传播流行。     

大肠埃希菌与男性不育

综述了大肠埃希菌的生物学特性、致病性、与不育的关系及其诊断和治疗方法 ,着重讨论了大肠埃希菌的致病机理。对于深入研究大肠埃希菌与男性不育的关系具有一定的指导意义。     

223株大肠埃希菌的耐药性分析及分布

目的：了解临床分离的大肠埃希菌的耐药性及分布,为临床经验用药提供理论依据。方法对2011年1月至2012年10月本院临床分离的223株大肠埃希菌对临床常用抗菌药物的耐药性及分布进行分析。结果223株大肠埃希菌对亚胺培南、哌拉西林/他唑巴坦、阿米卡星、头孢西丁、阿莫西林/棒酸、头孢他啶、妥布霉素、左氧氟沙星、头孢吡肟、头孢噻肟、氨曲南、庆大霉素、环丙沙星、头孢唑啉、复方新诺明和氨苄西林的耐药率依次为0.45%（1株）、4.04%（9株）、9.42%（21株）、13.00%（29株）、14.80%（33株）、39.46%（88株）、41.70%（93株）、48.43%（123株）、51.12%（114株）、54.71%（122株）、55.16%（123株）、55.16%（123株）、57.40%（128株）、62.78%（140株）、71.75%（160株）和86.10%（192株）。本研究中40.81%（91株）的标本来源于尿液、30.94%（69株）的标本来源于痰液、9.87%（22株）的标本来源于血液。结论本院大肠埃希菌主要引起泌尿道和呼吸道感染,对临床常用的抗菌药物的耐药性相差很大,临床应根据药敏试验结果合理选用抗菌药物。     

284株产Esbls的大肠埃希菌的耐药性分析

目的:了解产超广谱β-内酰胺酶(ESbls)大肠埃希菌的耐药性,为临床合理选用抗菌药物提供依据.方法:对海南省人民医院2011年1月～2011年12月439株大肠埃希菌药物敏感检测结果进行统计分析.结果:439株大肠埃希菌中产ESBLs细菌株为284株,占64.7％.其对青霉素类氨苄西林和哌拉西林的耐药率分别为98.2％和97.5％,对头孢菌素类抗生素也有较高的耐药率,如头孢克洛、头孢唑林、头孢曲松、头孢噻肟、头孢呋辛、头孢他啶/棒酸、头孢噻肟/棒酸分别为97.9％、98.9％、96.5％、98.6％、97.5％、100％、100％,对亚胺培南、美罗培南敏感性高达100％.结论:临床大肠埃希菌耐药率逐渐增强,与临床不合理使用抗生素有一定关系,实验室应高度重视产ESBLs株的检测和细菌耐药性监测,指导临床合理选用抗生素,以及时有效控制ESBLs菌株的传播和流行.     

尿路致病性大肠埃希菌多位点序列分型与耐药谱型的相关性

目的探讨尿路致病性大肠埃希菌（UPEC）的多位点序列分型（MLST）与抗菌药物耐药的关系。 方法以上海中医药大学附属普陀医院2015年3月至2016年12月住院患者为研究对象,收集清洁中段尿样本中分离培养的大肠埃希菌,应用MLST方法进行菌株分型研究。采用Vitek-2 Compact全自动微生物分析系统检测UPEC对7种常用抗菌药物的敏感性及超广谱β-内酰胺酶（ESBLs）。 结果93株UPEC对亚胺培南耐药率为0%,对厄他培南、阿米卡星、哌拉西林/他唑巴坦耐药率为1.1%~3.2%,保持高度敏感性。对头孢他啶、头孢吡肟、氨曲南、庆大霉素和妥布霉素均有一定敏感性,耐药率低于50%。对头孢曲松、环丙沙星、左氧氟沙星和复方SMZ耐药率> 50%。产ESBLs菌株59例（63.4%）,ESBLs阴性菌株34株（36.6%）。分离株共有33个已知序列型（STs）,1例未知ST型,其中最多的克隆群为ST131（23/93、24.7%）,ST648（9/93、9.7%）,ST405（7/93、7.5%）和ST1193（7/93、7.5%）。 结论UPEC具有多药耐药性,MLST分型提示UPEC菌株具有多样性,ESBLs与UPEC抗菌药物耐药有一定相关性,ST型与耐药谱型无相关性。     

院内大肠埃希菌和肺炎克雷伯菌的耐药性分析及分布

目的：了解本院院内大肠埃希菌和肺炎克雷伯菌的耐药性及分布情况,为临床合理使用抗菌药物提供理论依据。方法应用鑫科细菌鉴定仪进行细菌鉴定,采用XK-96A-C药敏板进行药敏试验。结果2012年10月至2013年8月本院临床共分离34株大肠埃希菌和32株肺炎克雷伯菌。其中34株大肠埃希菌对氨苄西林、哌拉西林、头孢唑林、复方新诺明、头孢呋辛、头孢噻肟、氨曲南、头孢吡肟、洛美沙星、环丙沙星、头孢他啶、庆大霉素、妥布霉素、左氧氟沙星、呋喃妥因、头孢西丁、阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和亚胺培南的耐药率依次为70.6%（24/34）、67.6%（23/34）、64.7%（22/34）、58.8%（20/34）、55.9%（19/34）、55.9%（19/34）、52.9%（18/34）、52.9%（18/34）、52.9%（18/34）、50.0%（17/34）、44.1%（15/34）、44.1%（15/34）、38.2%（13/34）、29.4%（10/34）、14.7%（5/34）、11.8%（4/34）、11.8%（4/34）、5.9%（2/34）、2.9%（1/34）和2.9%（1/34）。32株肺炎克雷伯菌对氨苄西林、哌拉西林、呋喃妥因、头孢唑林、头孢呋辛、洛美沙星、庆大霉素、头孢噻肟、头孢吡肟、妥布霉素、环丙沙星、氨曲南、头孢他啶、复方新诺明、阿米卡星、左氧氟沙星、头孢西丁、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦和亚胺培南的耐药率依次为100%（32/32）、37.5%（12/32）、31.3%（10/32）、28.1%（9/32）、28.1%（9/32）、25%（8/32）、21.9%（7/32）、21.9%（7/32）、18.8%（6/32）、18.8%（6/32）、18.8%（6/32）、15.6%（5/32）、15.6%（5/32）、15.6%（5/32）、12.5%（4/32）、12.5%（4/32）、9.4%（3/32）、6.3%（2/32）、6.3%（2/32）和0.0%（0/32）。58.8%（20/34）的大肠埃希菌标本来源于尿液,68.8%（22/32）的肺炎克雷伯菌标本来源于痰液。结论本院大肠埃希菌主要引起泌尿道感染,肺炎克雷伯菌主要引起呼吸道感染。临床可根据耐药监测常用的抗菌药物治疗肺炎克雷伯菌引起的感染,部分抗菌药物治疗大肠埃希菌引起的感染应根据药敏试验。     

Febrile urinary tract infection: Escherichia coli susceptibility to oral antimicrobials

Empirical treatment is indicated for young children with febrile urinary tract infection (UTI). In this clinical setting, oral antibiotics are as safe and effective as intravenous therapy. The aim of this study was to investigate in children with febrile UTI whether there were longitudinal changes in the prevalence of bacteria and in the pattern of Escherichia coli susceptibility to oral antimicrobial agents. Two hundred and eighty-seven positive urine cultures from children (1 month to 12 years) with febrile UTI collected over three periods (1986–1989, 1990–1991, and 1997) were studied. E. coli was the most-prevalent microorganism in all three study-periods (n=228). The susceptibility pattern of E. coli to nitrofurantoin (92%, 95%, 94%) and nalidixic acid (85%, 92%, 95%) did not present any statistically significant differences (P>0.05) over time. There was a significant increase (P<0.05) in E. coli susceptibility to cephalexin (65%, 54%, 81%). The E. coli susceptibility to trimethoprim-sulfamethoxazole (40%, 85%, 40%) behaved differently. Initially there was a significant rise (P<0.05), followed by a significant decrease (P<0.05). Empirical oral treatment with nitrofurantoin or nalidixic acid can safely be started in children with febrile UTI seen in the Emergency Department, Hospital de Clínicas de Porto Alegre, Brazil. Received: 20 December 2000 / Revised: 26 November 2001 / Accepted: 27 November 2001     

一县级医院泌尿道感染的病原菌分布及耐药性分析

为给临床治疗尿路感染提供依据,我们对2007年5月至2010年4月我院中段尿分离菌的分布及耐药性进行回顾分析,现报道如下.一、对象和方法1.一般资料:中段尿培养分离的不重复菌株264株,其中205株来源于女性,59株来源于男性.     

Escherichia coli strains causing urinary tract infection in uncircumcised infants resemble urosepsis-like adult strains

PURPOSE: Urinary tract infection (UTI) is the most frequent bacterial infection in infants younger than 90 days, and mainly affects uncircumcised males. In an attempt to unravel further the pathophysiology of UTI in this age group we used molecular methods to characterize Escherichia coli strains responsible for community acquired UTI in male and female infants and in adults. MATERIALS AND METHODS: A total of 79 E. coli isolates from uncircumcised male and female infants with UTI and no urinary tract abnormalities and 41 E. coli pyelonephritis isolates from nonhost compromised adults with bacteremia were characterized in terms of phylogenic relatedness and virulence factors. RESULTS: Males were infected by strains with a genetic background and virulence factors different from those affecting females but similar to those of adult pyelonephritis strains. CONCLUSIONS: Our molecular approach indicates that uncircumcised male infants are at higher risk for infection with highly virulent uropathogenic E. coli strains than are females. Preputial colonization may have a key role in the selection of such strains.     

脑卒中患者尿路感染病原菌分布及耐药性分析

目的调查本院脑卒中患者合并尿路感染的病原菌分布及耐药状况,以指导临床合理应用抗菌药物。方法选择本院2009年1月至2012年6月共145例脑卒中合并尿路感染住院患者,按照《全国临床检验操作规程》进行尿细菌培养,药敏试验采用K-B方法。结果脑卒中患者尿路感染分离病原菌均有不同程度的耐药,主要病原菌为大肠埃希菌、粪肠球菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌和真菌等,分别占48.97%（71/145）、13.10%（19/145）、6.89%（10/145）、6.21%（9/145）、4.83%（7/145）和8.97%（13/145）,其中部分大肠埃希菌呈多药耐药。结论脑卒中患者多为老年人,该类患者基础疾病多,自理能力差,多合并神经源性膀胱,尿路感染发病率高,病原菌耐药性不断增加,须采取有效的干预措施预防和控制感染的发生。     

Innate immunity of surfactant protein A and D in urinary tract infection with uropathogenic Escherichia coli

Objective To investigate the role of surfactant protein (SP) - A and SP - D in urinary tract infection mouse model, and evaluate the effects of SP-A and SP-D absence on urinary tract infection. Methods SP-A and SP-D double knockout (SP-A/D KO) mice were made. SP-A/D KO and wild-type (WT) C57BL/6 female mice were used for this study. The expression of SP-A and SP-D in kidney was detected by immunohistochemistry (IHC). The levels of p - p38 and p38 protein in kidneys were measured by Western blotting. Uropathogenic Escherichia coli or buffer was delivered into the bladder of female mice. At 24 and 48 h after inoculation, CFU of Escherichia coli in the kidney and urine of the treated and control mice were measured. Histological, cellular and molecular analysis were performed by several methods of H/E staining, IHC and Western blotting. The effects of SP-A and SP-D on bacterial growth were studied in vitro. Results SP-A and SP-D in kidney were located in the proximal tubules and collecting tubules. Compared with WT mice, infected SP - A/D KO mice with UPEC had higher CFU in kidneys and urine at 24 h and 48 h, increased inflammatory cells infiltration in kidneys（P＜0.05）. Compared with WT mice, SP - A/D KO mice had higher p38 MAPK phosphorylation levels in kidneys（P＜0.05）. Growth of Escherichia coli was greatly inhibited by both SP-A and SP-D（P＜0.05）. Conclusions Both SP-A and SP-D are expressed in kidney. SP-A and SP-D can attenuate UTI induced by UPEC which may be through inhibiting bacterial growth and modulating renal inflammation.     

Distribution of afaE adhesins in Escherichia coli isolated from Japanese patients with urinary tract infection

PURPOSE: Afimbrial adhesin is known to be one of the most prevalent virulence factors in uropathogenic Escherichia coli. A recent report showed that the new subtype afaE8 predominated in afa positive isolates from patients with pyelonephritis (55.6%), suggesting that this subtype may be an important factor in ascending urinary tract infections. MATERIALS AND METHODS: A total of 457 E. coli strains consisting, of 194, 76 and 107 isolates from patients with cystitis, pyelonephritis and prostatitis, respectively, and 80 isolates from the rectal flora of healthy individuals were subjected to polymerase chain reaction to determine the afa operon as well as afaE subtypes.RESULTS: We identified 32 afa positive isolates of 377 strains (8.5%) and 2 of 80 strains (2.5%) from urinary tract infection isolates and normal flora, respectively. When afaE subtypes were determined, the afaE3 subtype predominated in afa positive isolates from cystitis (64.7%), pyelonephritis (66.7%) and prostatitis (50%). However, the afaE8 subtype was absent from urinary tract infection isolates, while only 1 isolate from the stool of a healthy adult harbored this subtype. CONCLUSIONS: Our data show that the afaE3 subtype predominated in pyelonephritis as well as in other urinary tract infections, indicating that the afa gene may be important in urinary tract infection. However, the distribution of afaE subtypes may be diverse in different areas of the world.