Agents for the Decolonization of Methicillin-Resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) bacteria are a common cause of hospital- and community-acquired infections. Persons may have asymptomatic colonization with MRSA in the nares, axillae, perineum, or groin. Since MRSA colonization often precedes infection, and infection is associated with significant morbidity and mortality, there is great interest in preventing the transmission of MRSA and decolonizing persons who harbor these bacteria. We provide an evidence-based review of MRSA decolonization agents. Our search strategy included the databases of the Cochrane Central Register of Controlled Trials, MEDLINE (1962-May 2008), and EMBASE (1980-May 2008). To identify unpublished trials, abstract books from appropriate major scientific meetings were hand searched, manufacturers were contacted, and pharmacology references were researched for available commercial products, formulations, adverse events, and dosing. The most extensive research in MRSA decolonization has been conducted with mupirocin, which is applied to the anterior nares 2–3 times/day for 5 days. Increased use is correlated to resistance development; therefore, routine decolonization is not prudent unless MRSA colonization is confirmed in the nares or other site. Retapamulin is under investigation for use in nares decolonization. If total body decolonization is necessary, bathing or showering with an antiseptic agent such as chlorhexidine gluconate is recommended in combination with mupirocin applied to the nares to improve the likelihood of eradication. Oral antibiotics have been evaluated for use in decolonization of the skin and nares but should be considered only in conjunction with topical agents and when all other decolonization attempts and environmental controls have been exhausted. Homeopathic and investigational agents may also be effective. Although mupirocin is the standard of care for decolonization of MRSA, several agents demonstrate efficacy and many merit further investigation.     

腹腔镜手术在急性盆腔炎患者中的临床效果

目的探讨腹腔镜手术对急性盆腔炎患者的临床效果。方法将72例急性盆腔炎患者随机分为实验组(37例)和对照组(35例),实验组患者采用腹腔镜手术联合抗生素治疗,对照组患者只采用抗生素治疗。观察两组患者体温恢复、症状消失时间、住院时间和复发情况。结果实验组患者体温恢复、症状消失时间、住院时间均低于对照组,差异有统计学意义(P<0.05);随访6个月实验组患者复发例数少于对照组,差异有统计学意义(P<0.05)。结论腹腔镜手术联合抗生素对急性盆腔炎效果显著,复发率低,对急性盆腔炎的治疗具有较好的应用价值。     

First Genome-Based Characterisation and Staphylococcal Enterotoxin Production Ability of Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus Strains Isolated from Ready-to-Eat Foods in Algiers (Algeria)

Staphylococcus aureus is a pathogenic microorganism of humans and animals, able to cause foodborne intoxication due to the production of staphylococcal enterotoxins (SEs) and to resist antibiotic treatment as in the case of methicillin-resistant S. aureus (MRSA). In this study, we performed a genomic characterisation of 12 genetically diverse S. aureus strains isolated from ready-to-eat foods in Algiers (Algeria). Moreover, their ability to produce some classical and new staphylococcal enterotoxins (SEs) was investigated. The 12 S. aureus strains resulted to belong to nine known sequence types (STs) and to the novel ST7199 and ST7200. Furthermore, S. aureus SA46 was assigned to the European clone MRSA-ST80-SCCmec-IV. The 12 strains showed a wide endowment of se and sel (staphylococcal enterotoxin-like toxin) genes (sea, seb, sed, seg, seh, sei, selj, sek, sem, sen, seo, seq, ser, selu2, selw, selx, sey, sel30; ψent1-ψent2), including variants and pseudogenes, and harboured the enterotoxin gene cluster (egc) types 1 and 5. Additionally, they produced various amounts of SEA (64.54–345.02 ng/mL), SEB (2871.28–14739.17 ng/mL), SED (322.70–398.94 ng/mL), SEH (not detectable–239.48 ng/mL), and SER (36,720.10–63,176.06 ng/mL) depending on their genotypes. The genetic determinants related to their phenotypic resistance to β-lactams (blaZ, mecA), ofloxacin (gyrA-S84L), erythromycin (ermB), lincomycin (lmrS), kanamycin (aph(3′)-III, ant(6)-I), and tetracyclin (tet(L), tet(38)) were also detected. A plethora of virulence-related genes, including major virulence genes such as the tst gene, determinant for the toxic shock syndrome toxin-1, and the lukF-PV and lukS-PV genes, encoding the panton-valentine leukocidin (PVL), were present in the S. aureus strains, highlighting their pathogenic potential. Furthermore, a phylogenomic reconstruction including worldwide foodborne S. aureus showed a clear clustering based on ST and geographical origin rather than the source of isolation.     

耐甲氧西林金黄色葡萄球菌肺炎小鼠感染模型的建立与评估

目的 本研究采用临床分离鉴定的ST239型耐甲氧西林金黄葡萄球菌(MRSA)感染BALB/c小鼠,建立小鼠肺炎模型,对小鼠的临床症状、肺载菌量与组织病理学变化进行时相性监测,并用该模型验证万古霉素对小鼠的治疗效果.方法 取35只小鼠随机分成MRSA感染组、药物组和对照组,通过滴鼻方式分别滴入50μL细菌(前两组)与PBS(对照组);感染一天后对药物组用同样的方式滴入万古霉素,CT检测肺部的变化,并对肺载菌量和组织病理学变化进行观察.结果 与对照组比较,CT和细菌计数等结果表明MRSA感染组和药物组的肺组织有明显的炎症反应,载菌量较高;与感染组相比,药物组小鼠肺部的载菌量明显降低,气管和肺部的组织病理学症状明显减轻.结论 本实验结果表明小鼠MRSA肺炎模型成功建立,并可用于药物疗效的比较评估.该模型的建立,将为进一步研究临床分离的MRSA的病原特性、发病机理、治疗方法等,提供可靠的小动物模型.     

喹诺酮类药物高剂量序贯治疗妇科急性盆腔炎疗效评价

目的评价喹诺酮类药物治疗妇科急性盆腔炎的疗效和安全性。方法将173例带有13种157株致病菌的急性盆腔炎患者随机分为两组,治疗组(123例)中用莫西沙星治疗40例,加替沙星治疗41例,左氧氟沙星治疗42例,均采取高剂量序贯疗法,对照组(50例)用氧氟沙星治疗,两组疗程均为7～14d。结果治疗组与对照组临床有效率分别为98.4%(121/123)和88.0%(44/50),致病菌清除率分别为93.86%(107/114)和83.72%(36/43),平均疗程分别为(6.06±1.22)d和(8.33±1.66)d,两组比较,P均<0.05。莫西沙星和加替沙星抗菌谱几乎能覆盖盆腔炎的13种致病菌,左氧氟沙星对军团菌、衣原体、支原体作用稍差,高剂量序贯疗法短期足量用药亦能有效治疗妇科急性盆腔炎。治疗过程中未出现严重不良反应。结论莫西沙星、加替沙星、左氧氟沙星治疗妇科急性盆腔炎安全、有效。     

腹腔镜联合中药治疗慢性盆腔炎的疗效

目的:探究慢性盆腔炎患者行腹腔镜手术联合中药红藤败酱汤治疗的临床效果。方法:择取2018年4月~2019年12月期间来某院妇科就诊的慢性盆腔炎患者共100例,以其入院时间先后顺序为依据进行分组,分为对照组与观察组各50例。两组分别行腹腔镜手术及联合红藤败酱汤治疗,比较两组临床疗效、复发率及中医症状积分。结果:治疗前两组患者中医症状积分无差异(P>0.05),治疗后观察组临床疗效、复发率及中医症状积分显著优于对照组(P<0.05)。结论:慢性盆腔炎患者的临床治疗中开展腹腔镜手术与中药红藤败酱汤联合治疗的效果理想,值得在临床中进行推广。     

一株抗耐甲氧西林金黄色葡萄球菌(MRSA)的海洋放线菌的鉴定及系统发育分析

从海南三亚海域的海绵中分离到一株抗耐甲氧西林金黄色芎芍merhieillin-resistant Staphylococcus aureus(MRSA)的海洋放线茵A115。该菌株在燕麦片琼脂上插片培养孢子丝螺旋形，孢子长圆形，表面有稀疏的短刺；菌株细胞壁含LL—DAP，糖型C；16S rDNA序列分析及系统发育分析表明，分离菌株A115与Streptomyces albogriseolus属同一分支．同源性为99．0％．但形态学、生理生化鉴定及活性情况存在一些差异。由此推断菌株A115为S．albogriseolus的海洋变种．命名为Streptomyces albogriseolus var．marine。     

柏薏灌肠液联合花红片治疗湿热瘀结型慢性盆腔炎的疗效观察

目的 观察柏薏灌肠液用于治疗湿热瘀结型慢性盆腔炎的临床疗效。方法将160例诊断为湿热瘀结型慢性盆腔炎的患者随机分为观察组和对照组,各80 例,对照组给予花红片,一次4片,每日3次。观察组在花红片的基础上联合使用柏薏灌肠液,每日1次250ml灌肠治疗。两组均月经结束后3~5天开始用药14天,连续用药2个月经周期。观察治疗前后患者症状、体征及相关指标变化情况,比较两组间疗效。结果 观察组和对照组的痊愈率和总有效率分别为56.3%,92.5%和33.8%,81.4%,两组相比差异有统计学意义(P < 0. 05);观察组中医证候和局部体征改善情况优于对照组,治疗后阴道分泌物和B超检查盆腔积液、包块改善情况优于对照组,差异均具统计学意义( P < 0. 05)。结论 柏薏灌肠液用于湿热瘀结型慢性盆腔炎疗效确切,与花红片联合应用有协同作用,能提高疗效,值得临床推广。     

抗菌药物短程预防策略控制盆腔炎产妇剖宫产手术部位感染的效果评价

目的:评价围手术期短程(<24h)抗菌药物使用策略预防盆腔炎产妇剖宫产后手术部位感染的效果。方法:选择于我院接受剖宫产术后存在盆腔炎的产妇227例,将患者按预防方式分为短程(<24h)组109例和长程(>48h)组118例。对2组患者产妇孕程、体质量指数、住院前时间、术前白细胞数,是否初产、胎膜早破、妊娠高血压综合征(妊高征)、以及手术部位感染、术后子宫内膜炎、产褥病率、血象变化、抗菌药的使用频度(DDDs)和费用、新生儿评分与感染进行比较。结果:2组产前基本情况、手术时间、术中出血差异无统计学意义(P>0.05);2组均未见手术部位感染,子宫内膜炎、产褥病率及血象升高等差异无统计学意义(P>0.05);短程与长程预防策略用于抗菌药的费用支出差异有统计学意义(P<0.01),短程策略抗菌药物的DDDs仅约是长程策略的1/7(P<0.01);同时新生儿评分与感染等差异亦无统计学意义(P>0.05)。结论:头孢唑啉或联合甲硝唑短程策略(<24h)预防盆腔炎产妇手术部位感染效果与长程用药策略(>48h)相当,抗菌药物费用和用量明显下降。     

In-Host Emergence of Linezolid Resistance in a Complex Pattern of Toxic Shock Syndrome Toxin-1-Positive Methicillin-Resistant Staphylococcus aureus Colonization in Siblings with Cystic Fibrosis

Methicillin-resistant Staphylococcus aureus (MRSA) can cause chronic lung infections in patients with Cystic Fibrosis (CF). One option for managing them is the use of linezolid. We hereby report the in-host emergence of linezolid resistance (LR) in MRSA in CF siblings via a population analysis. A collection of 171 MRSA strains from 68 samples were characterized by determining their linezolid Minimal Inhibitory Concentrations (MICs), analyzing the locus of staphylococcal protein A (spa) and whole genome sequencing. Courses of linezolid were retraced. Strains belonged to three spa types (t002, t045, t127) and two sequence types (ST1, ST5). Emergence of LR occurred under treatment, one year apart in both siblings, in the CC5-MRSA-I Geraldine clone harboring the toxic shock syndrome toxin-1-encoding gene. Resistance was related to a G2576T substitution present in a variable number of 23S rRNA gene copies. Susceptible and resistant strains were co-isolated within samples. Single Nucleotide Polymorphism-based analysis revealed complex colonizations by highly diversified, clonally related populations. LR remains rare in MRSA and there are very few longitudinal analyses documenting its emergence. Analyzing a large MRSA collection revealed new aspects of LR emergence: it emerges in specific subclonal lineages resulting from adaptive diversification of MRSA in the CF lung and this heterogeneity of intra-sample resistance may contribute to compromising antibiotic management.