Gram-positive bloodstream infections in liver transplant recipients: incidence, risk factors, and impact on survival

The objective of the study was to assess the incidence, risk factors, and survival of gram-positive bloodstream infections (GP-BSI(s)) among liver transplant recipients during the first year after transplantation. Between October 2000 and September 2006, 42 episodes of GP-BSI(s) occurred in 205 patients with an overall incidence of 0.20 episodes/patient. Coagulase-negative staphylococci were detected in 45.2% of cases, Enterococcus species in 42.9% (E faecalis, eight; E faecium, seven; E avium, two; E gallinarum, one) and Staphylococcus aureus in 11.9%. Retransplantation was the only independent risk factor for GP-BSI (odds ratio [OR], 0.253; 95% confidence interval (CI), 0.089 to 0.715; P = .009). Thirty-day mortality rate was 28.5% and S aureus infections were related to a poorer outcome. It is noteworthy that all the isolates of S aureus were methicillin-resistant. Ampicillin was inactive against all the strains of E faecium and 50% of E avium isolates, but active against all E faecalis and E gallinarum strains. All the isolates were glycopeptide-susceptible. No significant differences in mortality rate were observed in relation to sex, etiologies of end-stage liver disease, cytomegalovirus infection/reinfection, type of donor, rejection, or retransplantation. GP-BSI, the only independent risk factor for death (OR, 0.262; 95% CI, 0.106 to 0.643; P = .003), reduced the survival rate by 26% in the first year posttransplant. In conclusion, GP-BSI(s) impact significantly on morbidity and mortality posttransplant, particularly among retransplantations. Control measures are required to reduce the incidence of GP-BSI(s) in liver transplant recipients. These findings must be considered when empirical antimicrobial therapy is indicated while awaiting blood-culture results.     

Significant increase in the isolation of glycopeptide-resistant enterococci from patients hospitalized in the transplant surgery ward in 2004-2005

Enterococci despite their low pathogenicity are the third cause of hospital infections. Enterococci resistant to glycopeptides present special risks. The aim of this work was to determine the frequency of isolates of all enterococci versus enterococci resistant to glycopeptides from patients in the Transplant Surgery Ward. Moreover, vancomycin-resistant enterococci (VRE) were characterized with respect to the type of van and ddl genes as well as vancomycin and teicoplanin MIC values. Among 160 enterococcal strains isolated in 2004, only 2 were resistant to glycopeptides (1.3%). In 2005, among 244 enterococci, 44 strains were resistant (18%). All resistant strains were Enterococcus faecium, as confirmed by detection of the ddl gene specific for E. faecium. Moreover, among all enterococci isolated from these patients, E. faecium dominated (over 50% in 5 subsequent years). All examined VRE possessed VanA type of resistance with high vancomycin and teicoplanin MIC values. All of them possessed the vanA ligase gene. The investigated VRE were characterized by high resistance to most antibiotics: penicillin and amoxicillin, rifampicin, ciprofloxacin, and high concentrations of streptomycin, but susceptible to linezolid and quinupristine/dalfopristine. Strains differed in their susceptibility to tetracycline, nitrofurantoin, and high concentrations of gentamicin.     

Occurrence of glycopeptide-resistant enterococci in transplant medicine internal wards in 2001-2005

The appearance of vancomycin-resistant enterococci (VRE) has caused serious therapeutic problems. In Poland, the frequency of VRE isolation is lower than in the United States or some other European countries. The aim of our work was to analyze the occurrence and characterization of VRE isolated from patients of 2 transplant medicine wards. These wards contained liver or kidney transplant patients. This study examined 5 years, including 235 to 313 enterococcal isolates per year. In 2001-2002, none of the isolated enterococci was confirmed as VRE, which appeared in 2003 (11 strains) and continued on a similar level (from 4% to 6%) in the next 2 years. Among all isolated enterococci, Enterococcus faecalis predominated. In 2003 and 2004, the numbers of E. faecium and E. faecalis among isolated VRE strains were similar, but in 2005, we observed significant predominance of E. faecium. Among VRE strains examined by polymerase chain reaction for the presence of vanA, vanB, vanD, vanE, and vanG ligases, only vanA was found in all cases. The examined strains represented several patterns of resistance to other antibiotics.     

Drug Susceptibility of Isolates from Severe Postoperative Intraperitoneal Infections Causing Multiple Organ Failure

Purpose To select the most appropriate antibiotic regimens for life-threatening postoperative infections, we obtained isolates from patients with severe postoperative infections over a 12-year-period, and examined their drug susceptibility.Methods The subjects of this study were 55 patients with multiple organ failure (MOF) caused by postoperative infection.Results All strains of Methicillin-resistant Staphylococcus aureus (MRSA) were susceptible to Vancomycin (VCM) and Teicoplanin (TEIC). Only 0.3% of all the Pseudomonas aeruginosa strains were resistant to Imipenem (IPM), but 53.6% of the strains from the severe infections were resistant to IPM. On the other hand, there were few P. aeruginosa strains resistant to Meropenem (MEPM), Ceftazidime (CAZ), Ciprofloxacin (CPFX), and Pazufloxacin (PZFX), even among strains isolated from severe infections. The resistant rate of Bacteroides fragilis to Clindamycin (CLDM) was 35.9%, but there were strains resistant to IPM and Panipenem.Conclusion These findings suggest that VCM or TEIC are most appropriate for severe abdominal abscess caused by MRSA, whereas MEPM, CAZ, CPFX, and PZFX are more effective against P. aeruginosa infections. The only antibiotic effective against B. fragilis infections in this study was IPM.     

Annual changes of bacteria isolated from urinary tract infections and their susceptibility to new quinolone agents]

Statistical analyses were conducted on bacterial strains isolated from the urine of patients with urinary tract infections (UTI) in the Department of Urology at Aichi Medical University from January 1988 through December 1991. The drug sensitivity of the bacterial strains isolated from patients with complicated UTI between 1988 and 1991 was analyzed and compared. Among the outpatients with uncomplicated UTI, a total of 352 strains were isolated. E. coli was isolated the most frequently (90.1%). Among the outpatients with complicated UTI, a total of 829 strains were isolated. Enterococcus sp. was isolated the most frequently (21.2%). P. aeruginosa and S. aureus showed a tendency to increase. Among the inpatients with complicated UTI, a total of 671 strains were isolated. Enterococcus sp. was isolated the most frequently (22.5%). P. aeruginosa and S. aureus showed a tendency to increase, while E. coli and Enterobacter sp. showed a tendency to decrease. E. coli was highly sensitive to all drugs except ampicillin (ABPC). Proteus sp. and Klebsiella sp. were highly sensitive to norfloxacin (NFLX). P. aeruginosa was highly sensitive to gentamicin (GM). The frequency of NFLX-sensitive P. aeruginosa significantly dropped from 84.6% to 40.9% among the outpatients (P < 0.01), and from 75.0% to 44.4% among inpatients (P < 0.05). S. aureus was highly sensitive only to minocycline (MINO). The frequency of NFLX-sensitive S. aureus significantly dropped from 66.6% to 23.3% among inpatients (P < 0.05). Enterococcus sp. was highly sensitive to ABPC and MINO. Of the new quinolones, tosufloxacin (TFLX) had the strongest antimicrobial activity followed by (ciprofloxacin) CPFX on all the bacterial strains tested.     

Clinical glycopeptide-resistant enterococci isolated from patients after solid organ transplantation

The aim of this study was to confirm the identification and resistance to vancomycin and teicoplanin of nosocomial enterococcal strains using molecular biology methods. Glycopeptide-resistant enterococci (GRE) strains were isolated from clinical specimens of hospitalized patients. Bacterial identification was performed in an automatic ATB Expression system (bioMérieux SA). Susceptibility to glycopeptides was determined by the disc diffusion method and Etest (AB BIODISK, Sweden). We performed polymerase chain reactions (PCR) for Enterococcus faecium and E. faecalis identification and van genes detection. Fifteen GRE strains were cultured over 2 years (2003-2004). Fourteen isolates were highly resistant to vancomycin (MIC range, 128->256 mg/L) and teicoplanin (MIC range, 32->256 mg/L). Twelve strains harbored van A gene (Van A phenotype). Seven isolates were identified as E. faecium and seven as E. faecalis by the multiplex-PCR method. One strain-E. casseliflavus-showed low resistance to vancomycin (MIC 8 mg/L) with retained susceptibility to teicoplanin (MIC 4 mg/L). It harbored the van C2/C3 gene and was identified as the Van C2/C3 phenotype. GRE strains were more often isolated from hospitalized patients in Poland. Constant monitoring by reliable microbiological methods has become necessary to prevent the spread of these strains in the hospital environment.     

Prevention and treatment of MRSA infection in emergency surgical ward]

During two years of 1990 and 1991, methicillin-resistant Staphylococcus aureus (MRSA) strains were isolated from 121 patients who were admitted to our emergency ward with infection rate of 7% (121/1843). The end results were miserable and the mortality rate was 28%. The infection rate was significantly higher than that of general surgical ward (2%). Specimens of respiratory tract such as coughed-up sputum and tracheal secretion showed high rate of MRSA isolation, especially in patients who underwent tracheal intubation or tracheostomy. All of these MRSA strains were strongly resistant to antibiotics and were typed as coagulase II. MRSA strains were isolated from nostril of medical staff and in-ward patients while admission with rate of 9% and 3%, respectively. Meanwhile, the MRSA strains were also isolated from the materials surrounding the infected patients such as bed, door, gowns and hands of in-charge nurses. To prevent inter-patient transmission, the infected patients were placed in isolation room and cared with isolation technique. Handwashing with benzalkonium chloride-alcohol is strongly recommended. Intravenous injection of IPM and CEZ or VCM is indicated. Local use of MINO was reported to be useful. In conclusion, MRSA infection often occurs in the immunodepressive patients and is hard to cure.     

Clinical observation of bacterial isolates from urine specimens of outpatients

Changes of bacterial isolates from urine specimens of outpatients with urinary tract infections (UTI) from 1977 through 1984 were studied. Organisms which were isolated from patients with bacteriuria of over 10(3) bacteria per ml of urine regardless of grade of pyuria were studied. The incidence of UTI, especially that of acute cystitis was decreased during the recent 8 years. E. coli was the most predominant isolate in acute UTI with an isolation frequency of over 70% every year, followed by S. epidermidis nearly every year. Citrobacter spp., Klebsiella spp., P. mirabilis and S. aureus were also isolated steadily every year. Bacterial isolates in acute UTI were generally composed of these six species of bacteria. Although many kinds of bacteria were isolated in chronic UTI, E. coli was the most frequent species with an isolation frequency of 17-37%, followed by E. faecalis except in 1981 and 1982. The tendency of gram-negative rods to increase in acute and chronic UTI was observed except in 1981 and 1982. A slight decrease in sensitivity of E. coli and P. mirabilis against ampicillin (ABPC) and sulbenicillin (SBPC) was observed in acute UTI. In chronic UTI, the tendency of the sensitivity of E. coli against ABPC, SBPC and nalidixic acid to recover and the tendency of the sensitivity of P. aeruginosa against dibekacin to decrease were observed. E. faecalis was estimated to be sensitive to gentamicin, cefazolin, minocycline and fosfomycin. However, unlike those species mentioned above, many strains of E. faecalis showed a positive disc sensitivity to these drugs.     

青少年尿路感染细菌分布以及耐药性分析

【摘要】 目的 探究近一年来深圳光明新区尿路感染青少年患者细菌分布情况和耐药情况。方法将2014年7月到2015年7月就诊光明新区医院的18~20岁尿路感染患者44例作为研究对象,收集中段尿分离培养细菌共得1382株菌落,分析尿路感染细菌的种类、分布和通过药敏试验分析耐药性。结果〓革兰氏阳性菌20.12%,真菌3.04%,革兰氏阴性菌76.85%;屎肠球菌37.41%,近平滑假丝酵母菌38.10%,大肠埃希菌50.47%。金黄色葡萄球菌对环丙沙星耐药性最强,屎肠球菌耐药性最强的为左氧氟沙星,粪肠球菌耐药性最强的为克林霉素,大肠埃希菌耐药性最强的为头孢曲松,铜绿假单胞菌耐药性最强的为氨曲南,肺炎克雷伯菌耐药性最强的为头孢曲松,柠檬酸杆菌耐药性最强的为环丙沙星。结论〓对于18~20的青少年岁的尿路感染患者,革兰氏阴性菌尤其是大肠埃希菌为主产生耐药性较为广泛。     

T管胆汁细菌培养及对抗生素敏感性分析

目的：了解临床已无感染症状病人的T管引流胆汁的细菌感染情况及对抗生素的敏感性。方法：对2001年12月至2002年12月116例术后已无感染症状病人的T管引流胆汁的细菌培养和抗生素敏感性试验结果作统计分析。结果：T管胆汁细菌培养的阳性率为59．91％。158株微生物中包括23种细菌和3种真菌。肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、表皮葡萄球菌、金黄色葡萄球菌、粪肠球菌和尿肠球菌占胆道细菌的72．75％，24例混合感染中13例感染铜绿假单胞菌，同时发现嗜麦芽窄食单胞菌和鲍曼不动杆菌等条件致病菌感染。细菌对头孢类抗生素具有较高的耐药率，对亚胺培南、万古霉素、阿米卡星有较高的敏感性。在不同病人相同菌种的药敏试验结果有较大差异，提示菌株不同。结论：临床无感染症状病人的T管引流胆汁具有较高的细菌感染率，二重感染和耐药菌株的增加是一旦发生胆汁性腹膜炎时严重感染的基础。     

泌尿外科住院患者中段尿培养病原菌分布及耐药性分析

目的 了解泌尿外科住院患者尿培养病原菌的分布和耐药性,为临床合理用药提供依据.方法 回顾性统计2014年1月至2015年6月本院泌尿外科患者中段尿培养的临床资料,进行耐药性分析.结果 泌尿外科共送检1624份尿标本,其中532份分离出病原菌,阳性率为32.76％.532份阳性标本共分离病原菌566株,其中革兰氏阴性杆菌449株,占79.33％,革兰氏阳性球菌93株,占16.43％,真菌24株,占4.24％.分离率居前五位的细菌分别是大肠埃希菌(53.53％)、屎肠球菌(5.65％)、铜绿假单胞菌(4.77％)、粪肠球菌(4.24％)、肺炎克雷伯菌(3.89％).大肠埃希菌对头孢菌素类、喹诺酮类、四环素类、磺胺类药物均表现为较高的耐药率;屎肠球菌对氨苄西林、高浓度庆大霉素、喹诺酮类药物耐药率较高.结论 泌尿外科住院患者尿培养病原菌以大肠埃希菌为主,细菌耐药情况严重,加强尿培养监测及定期对细菌耐药性进行总结分析对指导临床规范、合理使用抗菌药物具有非常重要的意义.     

胆道感染患者胆汁培养与药敏分析和抗生素的选择应用

目的分析胆道感染患者胆汁中细菌群情况及其对抗生素的敏感性,为临床选择抗生素提供指导。方法将2004年1月至2005年12月住院患者胆汁培养阳性的326株细菌的分布及药敏结果采用WHONET5.3软件进行统计分析。结果革兰阴性杆菌占54%(176/326),革兰阳性球菌占42.6%(139/326),真菌属占3.4%(11/326)。引起胆道感染常见的病原菌依次为大肠埃希菌(23.6%,77/326),屎肠球菌(12.6%,41/326),粪肠球菌(10.4%,34/326),葡萄球菌(10.1%,33/326),肺炎克雷伯菌(6.7%,22/326)等。药敏结果显示:革兰阴性菌对亚胺培南总耐药率最低(12%),其次为美洛培南(12.1%),头孢哌酮-舒巴坦(16.6%),阿米卡星(19.1%),而对氨苄西林,哌拉西林,氨苄西林-舒巴坦,头孢唑啉,环丙沙星等高度耐药。革兰阳性菌对万古霉素及替考拉宁耐药最低(0),其次为氯霉素(12%),呋喃妥因(15.6%),磷霉素(18.2%)。结论胆道感染中的革兰阴性杆菌仍占主要地位,革兰阳性球菌呈上升趋势,临床常用的抗生素的耐药性明显增加,要有针对性地合理选用抗生素。     

Clinical studies of efficacy of imipenem/cilastatin sodium against urinary tract infections with ureterocutaneostomy]

Clinical efficacy of IPM/CS against urinary tract infections (UTI) was evaluated on 19 patients with malignancies (bladder tumor: 15, prostate cancer: 3, uterus cancer: 1) and 1 patient with a benign disorder (ureter stenosis) who had undergone ureterocutaneostomy between January, 1988 and December, 1990. Their ages ranged from 42 to 79 years. Postoperatively, they had UTI with pyuria of greater than or equal to 5/hpf and bacteriuria of greater than or equal to 10(4)/ml. IPM/CS was administered at a dose of 0.5 g (0.25g/0.25 g) twice a day through intravenous drip infusion. Its efficacy was evaluated according to the UTI criteria for clinical evaluation as ruled by the Japanese Society of Chemotherapy. Overall clinical value was rated "excellent" in 4 (20%), "moderate" in 9 (45%) and "poor" in 7 (35%) cases for a total of 65%. The efficacy by types of infection was 33% and 70.6% in the group of single infection and in the group of mixed infection, respectively. As to bacteriological efficacy 34 of the 38 strains (89.5%) isolated were eradicated following its administration. The eradication rate was 84.6% for P. aeruginosa, and 84.6% for E. faecalis. Microbes which appeared after its dosing amounted to 6 classes of 17 strains, 6 NFB strains of which were identified. As a side effect, elevation of serum GPT (5%) was noted. Regardless of the underlying conditions (malignant diseases and ureterocutaneostomy), clinical efficacy of IPM/CS was appreciable. In addition, the MIC for (P. aeruginosa, E. faecalis) of IPM/CS was lower than that of PIPC.     

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??Pathogen distribution and drug resistance in patients with intro-abdominal infection??A report of 310 cases DAI Xiao-ming*??SHI Kun??WU Xiang-dong??et al. *Intensive Care Unit??the First Affiliated Hospital of Dalian Medical University??Dalian 116011??China
Corresponding author??TAN Guang??E-mail??tanguang009@sina.com
Abstract Objective To investigate the distributions and antimicrobial resistances of the bacteria in abdominal drainage fluid in intro-abdominal infection??IAI??. Methods The abdominal drainage fluid specimen of 310 cases of IAI admitted from January 2012 to December 2014 in the First Affiliated Hospital of Dalian Medical University was collected. The bacterial distributions and antimicrobial resistances were analyzed. Results A total of 578 clinical isolates were collected??of which gram-negative organiams, gram-positive cocci and fungi accounted for 65.2% ??377 strains????27.0% ??156 strains??and 7.8% ??45 strains?? respectively. The top five most prevalent isolated pathogens were escherichia coli??19.6%????klebsiella pneumonia??11.4%??, acinetobacter baumannii??10.2%????enterococcus faecium??8.1%????pseudomonas aeruginosa??7.3%??. The resistance rate of E. faecium to most antibiotics was higher than that of E. faecalis. The resistance rates of E.faecium and E. faecalis against to ampicillin, ciprofloxacin, levofloxacin and erythromycin were all above 80%??and the sensitive rates of sulfamethoxazole and chloromycetin against staphylococcus were above 90%. No strain was found resistant to vancomycin or linezolid. The prevalence of ESBLs in enterobacteriaceae was above 55%, and the sensitive rates were higher in carbapenems, amikacin and β-Lactamase inhibitors, but severely resistant to the third generation cephalosporin. The prevalence rate of carbapenem-resistant enterobacteriaceae (CRE) was increasing year by year. The resistance rates of minocycline and cefperrazone-sulbactam against acinetobacter baumannii were 11.9% and 37.3%??which of other antimicrobial drugs were above 60%??of carbapenem was above 70%??of ceftriaxone and cefotaxime above 80%, of gentamicin above 90%. The sensitive rates of carbapenem??ceftazidime??cefepime??piperacillin sodium and tazobactam sodium??amikacin against pseudomonas aeruginosa were higher than those against acinetobacter baumannii. Conclusion The enterobacteriaceae and non-fermentative bacterias are the chief bacteria in IAI. Multi-drug resistant bacteria is serious??and the resistance rate is increasing year by year. Extensive and dynamical monitoring of pathogens resistance should be performed and rational use of antibiotics are advocated.     

Clinical evaluation of sultamicillin in the treatment of urinary tract infections

Sultamicillin, a new semisynthetic oral beta-lactam antibiotic, was evaluated for its antibacteria susceptibility and clinical efficacy against urinary tract infection (UTI), and the following results were obtained. The sensitivity of sultamicillin (SBTPC) on 518 strains of clinical isolates from the urine were tested and compared to ampicillin (ABPC). S. aureus, S. epidermidis, Enterococcus sp., Streptococcus sp., E. coli, K. pneumoniae, K. oxytoca, P. mirabilis, M. morganii and Acinetobacter sp. showed high sensitivity to SBTPC. The antibacterial activity of SBTPC was superior to that of ABPC in most strains and especially more superior in beta-lactamase producing strains. The clinical effectiveness rate on a total of 15 patients with acute uncomplicated cystitis was 93.3% and the eradication rate of causative organisms was 93.3%. On 15 patients with chronic complicated UTI, the clinical effectiveness rate was 73.3% and eradication rate was 76.5%. Side effects (diarrhea) were observed in 3 cases, but this symptom was not severe and soon disappeared. Abnormal laboratory data due to the drug were not observed.     

腹腔感染病原菌分布与细菌耐药性监测研究（附310例报告）

目的 分析腹腔感染病人腹腔引流液中病原菌布及其耐药性。方法 收集2012年1月至2014年12月大连医科大学附属第一医院收治的310例腹腔感染病人的腹腔引流液标本,对其进行细菌鉴定及耐药分析,分析病原菌分布与细菌耐药性变化。结果 腹腔引流液标本分离出病原菌578株,其中革兰阴性菌377株（65.2%）,革兰阳性菌156株（27.0%）,真菌45株（7.8%）;3年总分离数量最高的前5位病原菌为大肠埃希菌（19.6%）、肺炎克雷伯菌（11.4%）、鲍曼不动杆菌（10.2%）、屎肠球菌（8.1%）、铜绿假单胞菌（7.3%）;屎肠球菌对多数被测药物的耐药率高于粪肠球菌,对氨苄青霉素、环丙沙星、左氧氟沙星、红霉素耐药率均>80%,葡萄球菌对复方新诺明、氯霉素的敏感率>90.0%,3年均未发现耐万古霉素及利奈唑胺的革兰阳性菌;肠杆菌科细菌中产超广谱β内酰胺酶的检出率>55.0%,对碳青霉烯类药物、阿米卡星、β-内酰胺类联合酶抑制剂敏感率较高,对三代头孢菌素耐药严重,碳青霉烯类耐药的肠杆菌科细菌的检出率呈逐年上升趋势;鲍曼不动杆菌除对米诺环素（11.9%）、头孢哌酮/舒巴坦（37.3%）耐药率较低外,对其他测试药物耐药率均>60.0%,其中对碳青霉烯类药物耐药率>70.0%,对头孢曲松、头孢噻肟耐药率>80.0%,对庆大霉素耐药率>90.0%,而铜绿假单胞菌对碳青霉烯类药物、头孢他啶、头孢吡肟、哌拉西林/他唑巴坦、阿米卡星的耐药率低于鲍曼不动杆菌。结论 腹腔感染病人腹腔引流液病原菌以肠杆菌科为主,非发酵菌所占比例亦较高,部分细菌耐药率有逐年升高趋势,应严密监测以指导合理使用抗菌药物。     

某院多重耐药菌菌群分布及耐药性分析

目的分析本院2014年5月至2015年4月多重耐药菌菌群分布及耐药性,为临床抗感染治疗提供理论依据。 方法采用法国梅里埃公司生产的Vitek-32型微生物自动分析仪及其配套的鉴定卡进行菌株分离与鉴定,并进行药敏试验,分析多重耐药菌株的来源、菌群分布及其耐药性。 结果共分离多重耐药菌株624株,其中甲氧西林凝固酶阴性葡萄球菌（MRCNS）293株、耐碳青霉烯鲍曼不动杆菌（CRABA）71株、大肠埃希菌（E. coli）57株、肺炎克雷伯菌（KNP）38株、金黄色葡萄球菌（MRSA）34株、耐碳青霉烯铜绿假单胞菌（CRPAE）27株、耐万古霉素肠球菌（VRSE2株以及奇异变形杆菌（PM）2株。阳性球菌中以MRCNS多重耐药所占比例最高（占77.7%）,其次为MRSA（占55.7%）、VRSE最低（占4.5%）;阴性杆菌中E. coli多重耐药最为显著（占68.6%）,其次为CRABA（65.1%）、CRPAE（21.3%）和PM（13.3%）耐药均不显著。耐甲氧西林的葡萄球菌中,MRCNS对环丙沙星（CIP）、庆大霉素（GEN）、青霉素（PEN）、克林霉素（CLI）、米诺环素（MNO）和左氧氟沙星（LVX）的耐药性均显著高于MRSA（χ² = 27.210、77.496、17.341、26.098、10.882、32.475,P均< 0.001）;E. coli、KNP和PM等对亚胺培南（IPM）均100%敏感,对阿米卡星（AMK）、头孢西丁（FOX）和头孢哌酮-舒巴坦（CSL）敏感性也较高;CRPAE与CRABA仅对哌拉西林（PIP）和CSL的耐药率低,对其他抗菌药物耐药性较强。 结论临床多重耐药菌感染发生率日益升高,且耐药机制越来越复杂,导致抗感染疗效受到很大限制。     

Efficacy of sodium imipenem/cilastatin on patients of complicated urinary tract infections--following the failure of prior antimicrobial agents]

Clinical efficacy of sodium imipenem/cilastatin was studied on 45 patients with complicated urinary tract infections, on whom prior antimicrobial agents were ineffective. A 0.5g dose of IPM/CS was administered by drop infusion twice a day for 5 days. The clinical efficacy was evaluated according to the criteria of the Japanese UTI committee. Of a total of 65 strains, 29 strains of gram positive bacteria and 36 strains of gram negative bacteria, were detected as causative microbials. Bacteriologically, 23 strains of gram positive bacteria (79%) and 34 strains of gram negative bacteria (94%) were eradicated following the treatment. S. aureus, E. faecalis and Flavobacterium sp. were less sensitive to IPM/CS. Overall clinical effectiveness rate of IPM/CS in the present study was 87%. Adverse drug side effects were observed in six patients, namely they were eruption, headache and slight elevation of serum transaminase. These findings suggest that IPM/CS is an effective agent for the treatment of complicated UTI even when the prior medicine was ineffective.     

Emergence of resistance of vancomycin-resistant Enterococcus faecium in a thermal injury patient treated with quinupristin-dalfopristin and cultured epithelial autografts for wound closure

Vancomycin-resistant Enterococcus faecium and faecalis (VRE) remains a major complication among critically ill patients. A 26-year-old patient with 65% total body surface area burns (TBSA) was infected with several E. faecium strains during his admission that were resistant to vancomycin. Because chloramphenicol was the standard treatment at this time, this drug was initiated until, the organism was identified as E. faecium and reported as susceptible to quinupristin-dalfopristin. Given these data, it was then decided to discontinue the chloramphenicol therapy. Quinupristin-dalfopristin therapy resulted in initial reduction of fever and white blood cell counts that continued over the next 5 days. However, on day 7 of quinupristin-dalfopristin therapy, a return of fever and elevation of the white blood cell count was noted and a repeated E. faecium blood culture demonstrated sudden resistance to quinupristin-dalfopristin (Bauer-Kirby zone size <14 mm). Chloramphenicol was restarted and the patient improved slowly over a period of 16 days. Our indigenous VRE had limited exposure to quinupristin-dalfopristin in the recent past; however, resistance emerged with the first commercial use of this agent in our burn treatment center. High-dose chloramphenicol treatment did not appear to impair engraftment of cultured epithelial autografts (CEA) in this patient.     

Ketolides and oxazolidinones. Mechanisms of action and antibacterial spectrum

CHANGING RESISTANCE OF GRAM-POSITIVE COCCI: Several new families of antibiotics are under development in response to the changing resistance of Gram-positive cocci. Linezolide, the leading member of the oxazolidinone family and telithromycin and ABT-773, leading members of the ketolide family have reached an advanced stage of development. INHIBITION OF PROTEIN SYNTHESIS: Oxazolidinones and ketolides inhibit protein synthesis at different levels. Oxazolidinones inhibit formation of the 70S initiation complex and ketolides block the protein elongation step by inhibiting peptidyl transferase. MECHANISMS OF RESISTANCE: To date, no cross resistance of linezolide with other antibiotic families used for the treatment of Gram-positive bacteria has been observed. It is quite difficult to obtain resistant mutants in the laboratory but two point mutations on the 23S ribosome fraction have been described in vivo. Resistance of Gram-positive cocci to macrolides occur via mechanisms altering the target (methylation of 23S rRNA or ribosome protein mutations) or via mechanisms involving active efflux. LINEZOLIDE: Linezolide is highly active in vitro against meticillin-resistant Staphylococcus aureus (MRSA), against Streptococcus including resistant pneumococcal strains, and against glycopeptide-resistant E. faecium and E. faecalis strains. TELITHROMYCIN AND ABT-773: These ketolides are active against Streptococcus and Pneumococcus strains exhibiting erythromycin-inducible resistance and resistance by active efflux. In addition, these antibiotics are highly active against other bacteria causing respiratory tract infections (Moraxella and Haemophilus), anaerobic germs and intracellular germs (Legionella).