菌血症中耐碳青霉烯肺炎克雷伯菌的同源性及侵袭力分析

目的:分析耐碳青霉烯肺炎克雷伯菌(CR-KP)的同源性和侵袭力,对临床监测CR-KP传播和致病情况以及预防提供依据。方法:对2014-01—2015-12血培养检出的28例CR-KP进行收集,先对细菌和其耐碳青霉烯进行确证,再利用重复片段聚合酶链式反应进行同源性分析判断菌株的来源及流行因素,然后对其不同的毒力基因进行检测,判断其侵袭力状况。结果:28例CR-KP改良Hodge试验阳性率85.7%(24/28)。可将28株CR-KP分为7种类型。其中A-E均有多株细菌存在,有院内流行的趋势,C型3株细菌均在新生儿重症监护病房(NICU)检出。重症监护病房(ICU)和NICU均有多株CR-KP存在,也有多种不同类型存在。毒力基因分析显示,uge、iutA、rmpA、ycfM、kpn、entB基因均有不同程度的检出。其中ycfM、entB基因检出率达到100%,rmpA、kpn基因检出率为82.1%,uge基因检出率为60.7%。结论:CR-KP有不同程度的院内感染趋势,耐药机制主要为产碳青霉烯酶。本院的CR-KP存在不同的毒力基因,编码脂多糖的uge、ycfM基因和跟黏附有关的rmpA、kpn基因以及铁采集有关的entB基因有较高的检出率。     

重症监护病房老年患者耐甲氧西林金黄色葡萄球菌的基因分析

目的 为了解重症监护病房(ICU)老年患者感染耐甲氧西林金黄色葡萄球菌(MRSA)的分子流行病学特点、菌株的变异情况及耐药性.方法 采用K-B法药敏实验、SCCmec多重PCR技术和ERIC-PCR技术对13株呼吸道感染老年患者MRSA进行分析,并运用NTSYS-PC2.0对ERIC-PCR扩增产物结果进行聚类分析.结果 13株MRSA中,12株鉴定为SCCmecⅠA型,1株鉴定为SCCmecⅡ型.13株MRSA的DNA同源性在44%到88%之间,同源性在69%以上可分为3类.结论 ICU老年患者感染的MRSA主要流行型为SCCmec IA型,但是并不存在聚集性人群感染发生.     

重症监护病房并发医院感染现状及危险因素分析

目的探讨重症监护病房(ICU)并发医院感染现状及危险因素。方法选择2013年5月至2015年9月内江市第一人民医院ICU收治的患者621例,调查患者基线资料、发生医院感染情况,并对样本进行病原菌培养,采用Logistics回归分析医院感染的危险因素。结果 ICU住院患者医院感染的发生率为29.79%;共分离出病原菌198株,其中真菌61株(30.81%)、革兰阳性菌45株(22.73%),革兰阴性菌92株(46.46%);ICU住院患者发生医院感染中以下呼吸道最常见(70.27%),其次为泌尿道(10.81%)、胃肠道(8.11%)及血管内导管感染(7.03%)。单因素分析显示,年龄、住院时间、有无侵袭性操作、有无使用抗菌药物与ICU患者发生医院感染有关(P<0.05),性别、合并疾病与ICU患者发生医院感染无关(P>0.05);多因素Logistics回归分析显示,年龄>60岁、住院时间>11 d、接受侵袭性操作是ICU病房发生医院感染的危险因素(P<0.05)。结论 ICU病房医院感染的发生率高,以下呼吸道感染最常见,年龄>60岁、住院时间>11 d及接受侵袭性操作是ICU患者发生医院感染的危险因素。     

老年病房住院患者院内感染相关因素分析

为进一步探讨老年病房住院患者发生院内感染相关因素 ,我们对我院痰培养及环境中各类微生物进行了前瞻性跟踪监测调查。　　一、资料与方法　　 1 标本来源 :对 1996年 1月至 1997年 12月老年病房1840例住院患者的 36 77份痰液及普通病房 970 5例住院患者的 10 6 5份痰液标本进行培养监测。对老年病房 10个病区 9、14号病室及普通病房 4个病区 1、6号病室每月 9日作空气培养。每月抽查病房环境 :包括患者出院后同一床单位在紫外线照射 30ｍｉｎ前、后 ,2个床单位进行常规湿扫前、后 ,1次床头柜及医师听诊器 ,10名工作人员 (包括医生、护士、…     

云南省恙虫病与肾综合征出血热混合感染的诊断及分析

目的 调查云南省不明原因发热患者中是否存在恙虫病与肾综合征出血热混合感染病例.方法 采用间接免疫荧光法和胶体金法检测不明原因发热患者血清中的恙虫病东方体(OT)抗体及肾综合征出血热(HFRS)病毒抗体,用巢式PCR扩增患者血液中的OT 基因sta56片断与汉坦病毒(HV)基因L片断.结果 79例患者中,实验室确诊HFRS 5例,恙虫病3例,HFRS与恙虫病混合感染4例;巢式PCR检测到HV L片断核酸2例(DLR2和DLR6), 序列分析两者间的同源性100%,DLR2与老挝汉城病毒L0199株核苷酸序列同源性最高为94.6%, 与中国汉城病毒L99株的同源性80.5%, 与云南汉坦病毒YN06-256的同源性69.8%.结论 首次证实云南省存在恙虫病与肾综合征出血热混合感染病例,其HFRS病原体遗传进化关系与老挝汉城病毒L0199株密切相关.     

基于LASSO回归的重症急性胰腺炎患者肺炎克雷伯杆菌感染风险预测模型建立

目的建立SAP患者肺炎克雷伯杆菌(KP)感染风险列线图预测模型。方法回顾性分析2016年3月至2021年12月间上海市第一人民医院收治的109例SAP患者的临床资料, 根据是否发生KP感染将患者分为感染组(25例)和非感染组(84例), 比较两组患者的临床特征。对单因素分析有统计学意义的变量采用最小绝对值收敛和选择算子算法(LASSO)进行降维处理, 将LASSO回归模型优化后得到的特征纳入多变量logistic回归分析并建立列线图预测模型。绘制列线图的受试者工作特征曲线(ROC), 计算曲线下面积(AUC), 使用一致性指数(C-index)评估预测模型的诊断能力。结果 109例SAP患者分离出KP 25株, 其中21株(84.0%)显示出泛耐药、多重耐药现象。单因素分析结果显示, 20个风险因素(SOFA评分、APECHEⅡ评分、Ranson评分、MCTSI评分、机械通气时间、禁食时间、腹腔引流管留置时间、深静脉置管留置时间、侵袭性操作次数、是否有外科干预、是否行ERCP术、高级别抗生素使用种类、胃肠功能障碍、凝血异常、代谢性酸中毒、胰腺坏死、腹腔出血、腹腔高压、ICU住院时间、住...     

神经科重症监护病房导管相关感染调查

目的:了解神经科重症监护病房(NICU)与导管相关的感染情况.方法:对403例NlCU住院患者病历资料进行回顾性分析,了解与机械通气、泌尿道插管及深静脉留置导管相关的医院感染情况.结果:403例患者中,81例发生感染,其中56例在NICU内发生医院感染,感染率13.9%.与3种导管相关的感染48例,占85.7%.其中与机械通气相关感染38例.有插管比未插管的患者医院感染概率较高(P均<0.05).细菌学检查金黄色葡萄球菌检出率最高,占细菌总数26.8%,其次是铜绿假单胞菌23.9%,鲍曼不动杆菌21.1%.结论:侵入性操作特别是机械通气是NICU医院感染发生率高的主要原因.     

ICU机械通气患者多重耐药菌定植与感染状况调查分析

目的研究重症监护病房机械通气(mechanical ventilation,MV)患者多重耐药菌主动筛查及定植与感染状况调查分析。方法从2012年3月到2013年3月,选择128例住院患者作为研究对象。使用MRSA和ESBILs及VRE型显色培养基对样本中大肠埃希菌(Eschericia coli,EC)和肺炎克雷伯菌(Klebsiella pneumoiae,KP),以及耐甲氧西林金黄色葡萄球菌(Methicillin-resistant Staphylococcus aureus,MRSA)和耐万古霉素肠球菌(Vancomycin-resistant enterococci,VRE)等细菌进行筛查。结果 128份送检标本中共分离多重耐药菌株共计132株。其中EC 114株,占比86.36%;MRSA 8株,占比6.06%;KP 5株,占比3.79%;VRE 5株,占比3.79%。132株多重耐药菌中,整体而言,定植与感染均以EC为主;进入ICU≤48h时,共有110例患者监测到多重耐药菌,经分离后得到112株,其中由社区带入者占比56.36%(62/110),由院内其他病室带入者占比43.64%(48/110),两者对比差异无统计学意义(P0.05)。此外,社区和院内分别在EC、MRSA、KP及VRE等方面对比,差异均无统计学意义(均P0.05)。进入ICU48 h后,共有18例患者被监测出含有多重耐药菌,并分离耐药菌株20株。结论强化对ICU机械通气患者多重耐药菌的筛查与分析十分必要,此举有助于临床准确诊断和治疗,值得临床推荐应用。     

慢性阻塞性肺疾病急性加重期患者病原菌分布特点

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者病原菌分布情况,为临床规范合理使用抗菌药物提供参考。 方法回顾性分析唐都医院呼吸与危重症医学科2014年01月至2017年10月住院的435例AECOPD患者病原菌分布特点。同时分析比较采用侵入性方法(纤维支气管镜)留取分泌物的149例患者及非侵入性方法(自然深部咳痰)留取分泌物的286例患者的病原菌检测情况。 结果275例(63.22%)患者分离出病原菌,其中单一病原菌感染241例,混合感染34例;混合感染中,细菌混合感染16例,细菌合并真菌感染18例。870份痰样本中,合格痰标本452份,占51.95%。共检出病原菌309株,阳性率为68.36%,G^＋ 60株(19.42%),金黄色葡萄球菌24株、肺炎链球菌17株、溶血链球菌10株;G^－ 193株(62.45%),铜绿假单胞菌56株、鲍曼/溶血不动杆菌36株、肺炎克雷伯27株;真菌56株(18.13%),其中曲霉27株、白色念珠菌25株、热带念珠菌4株。149例患者侵入法留取分泌物分离出病原菌阳性者124例,检出136株病原菌,占83.22%;286例患者用非侵入法分离出病原菌阳性者151例,检出173株病原菌,占52.80%。 结论AECOPD患者以革兰阴性杆菌感染为主,主要是铜绿假单胞菌、鲍曼/溶血不动杆菌,但不能忽视真菌感染。支气管镜下吸取分泌物可显著提高病原菌检出率(P<0.01),AECOPD患者两种方法留取分泌物培养均以G^－杆菌感染为主,病原菌分布无统计学差异。     

二级医院鲍曼不动杆菌感染的临床特征和同源性分析

目的：研究二级医院鲍曼不动杆菌感染患者的临床特征,对耐碳青霉烯鲍曼不动杆菌进行同源性分析,为临床治疗和医院感染控制提供依据。方法收集临床分离的115株非重复性鲍曼不动杆菌,回顾性分析患者的临床资料和细菌药敏资料。采用 Vitek2 Compact 对115株鲍曼不动杆菌进行19种抗菌药物的敏感性检测。采用肠杆菌科基因间一致重复序列聚合酶链技术(ERIC-PCR)对其中的耐碳青霉烯鲍曼不动杆菌进行基因分型和同源性分析。结果115例患者主要集中在 ICU、干部病房和呼吸科病房。患者的平均年龄为(75±16)岁。平均住院时间52.1 d。最常见的合并症为COPD 和糖尿病。72例(62.61%)患者曾接受侵入性操作。86例(74.78%)患者病程中使用过2种及以上的抗生素。48例(41.74%)患者接受机械通气。115株鲍曼不动杆菌对多黏菌素 B 耐药率最低,为0%,其次为替加环素,耐药率7.83%。仅头孢哌酮/舒巴坦、阿米卡星耐药率低于40%,对其他常用抗生素的耐药率均高于50%。对亚胺培南和美罗培南的耐药率分别达56.52%和58.26%。ERIC-PCR 技术将67株耐碳青霉烯鲍曼不动杆菌分为9个基因型。结论二级医院鲍曼不动杆菌感染患者的临床特征为：高龄,住院时间长,合并基础疾病,接受侵入性操作,接受机械通气及使用多种抗生素。对常用的抗生素高度耐药。多重耐药鲍曼不动杆菌及广泛耐药鲍曼不动杆菌存在院内接触传播的现象,因此应该提高医护人员消毒意识,加强耐药性监测及合理使用抗菌药物。     

An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. II. Epidemiologic studies.

Studies to determine the epidemiologic behavior of strains of Staphylococcus aureus resistant to methicillin and aminoglycosides (MARS) were conducted over a period of two and one-half years, during which MARS were isolated from 201 patients at a hospital in the midwestern United States. Most cases of infection or colonization with MARS (156 of 201) occurred in patients with burns. In the burn unit, MARS were recovered from the air, from the hair and hands of personnel, and from inanimate objects. Nasal (72%) and rectal (66%) colonization were common among burned patients with infected or colonized burn wounds but occurred in only six of 74 burn unit personnel. When compared with two control periods, the prophylactic use of antistaphylococcal agents in patients with burns increased markedly at the time the outbreak began. Of the 45 patients without burns from whom MARS were isolated, 42 (93%) were surgical patients. MARS were not demonstrated in the air or environment of patients with infected surgical wounds. None of 334 non-burn unit hospital personnel were found to be carriers of MARS. Four phage types (83A, 6/75/85, 29/52/80, and 92) were recovered during the outbreak. A determinant of antibiotic resistance was probably transmitted among strains of S. aureus.     

kDNA markers define two major Trypanosoma rangeli lineages in Latin-America.

Trypanosoma rangeli is a hemoflagellate parasite of man, domestic and wild animals in Central and South America. The genus Rhodnius is particularly susceptible to infection by T. rangeli and transmission by salivary inoculation has been demonstrated in 12 of 14 nominal species of naturally and experimentally infected insects. This report describes the molecular characterization of 37 strains of T. rangeli isolated from vertebrate and invertebrate hosts. Strains were analyzed by hybridization with kinetoplast DNA (kDNA) probes, polymerase chain reaction (PCR) amplification of kDNA minicircles and random amplification polymorphic DNA (RAPD). Strains isolated from Rhodnius prolixus present KP1, KP2 and KP3 minicircle amplification products but strains isolated from R. colombiensis or Panstrongylus megistus present amplification products derived only from KP2 and KP3 minicircles. The two T. rangeli groups defined as KP1(+) and KP1(-) present a high genetic divergence as they have probably been co-evolutioned with different adaptive radiated lines of the genus Rhodnius in Latin-America. The data obtained from insects with intestinal and salivary glands infections confirm that each Rhodnius species select the sub-population of T. rangeli KP1(+) or KP1(-) which is susceptible to transmit it by salivary inoculation to the vertebrate host.     

Vancomycin-resistant enterococci in neonates.

Fecal-oral transmission of vancomycin-resistant strains of Enterococci (VRE), which colonize the human gastrointestinal tract, has led to nosocomial epidemics in recent years. The aim of this study was to establish the incidence and associated factors of fecal colonization with VRE in neonates. In our hospital 110 rectal swab specimens collected in the neonatal intensive care unit (NICU) were examined for VRE. For comparison, rectal swabs collected from 42 healthy neonates on the obstetrics ward were also analyzed. Of the NICU patients, 8 had VRE MICs of 8-64 microg/ml for vancomycin and 2-32 microg/ml for teicoplanin, whereas none of the healthy newborns, had VRE (p < 0.05). All patients positive for VRE had factors known to be associated with VRE carriage, such as low birth weight or long-term antibiotic therapy.     

Epidemiological study of methicillin-resistant Staphylococcus aureus isolated from the urology ward in 2003--nosocomial infection and community-acquired infection

Methicillin-Resistant Staphylococcus aureus (MRSA) strains with the exception of urinary strains were isolated from the inpatients in urology ward hospitalized in 2003 and medical workers. Biotype according to the production of coagulase, enterotoxin and mupirocin sensitivity, and genotype by pulsed field gel electrophoresis (PFGE), and clinical background were determined for the MRSA strains to analyze the transmission route of the infection. In 34 medical workers in urology ward, MRSA were isolated in 6 (17.6%) workers from the nasal cavity, and the rate of colonization in doctors was higher than in nurses. Furthermore, mupirocin-resistant strains were isolated from two medical workers. 18 MRSA strains were isolated in 2003 and the accounting was 8 strains from wounds, 6 strains from sputum or nasal cavity, 3 strains from blood, and 2 strains from urinary tract. Most of the patients with MRSA had operations under general anesthesia or were under severe conditions with malignant tumors. No MRSA was detected at the same time from the same rooms. There were some rooms in which the MRSA detected rate was high, however no MRSA was isolated from hospital environments and dumping bacteria. These results suggest that the involvement of the medical workers and the spread of MRSA in the society might be important as infection source and for transmission of MRSA in hospital.     

导管相关血流感染临床分析

目的 分析我院2008年1月至2010年12月重症监护病房(ICU)和普通病房导管相关血流感染(CRBSI)的发生情况,为CRBSI的预防和治疗提供依据.方法 将我院131例CRBSI病例分为ICU组和普通病房组,对临床资料、病原菌、导管位置、预后等进行回顾性分析.结果 ICU组(88例)和普通病房组(43例)在年龄和...     

Nosocomial acquisition of beta-lactamase--negative, ampicillin-resistant enterococcus.

BACKGROUND--A recent prospective study at the Department of Veterans Affairs Medical Center, Martinez, Calif, revealed that 9% of enterococcal clinical isolates were ampicillin resistant. We prospectively studied 100 patients hospitalized in one general medicine ward and in the medical intensive care unit to study determinants of acquisition of ampicillin-resistant enterococcus. METHODS--Rectal swabs and urine cultures were obtained from patients within 72 hours of admission to the study ward and twice weekly until discharge from the ward or the intensive care unit. Cultures were obtained from the hands of personnel and from environmental surfaces in the general medical ward and the intensive care unit. Ampicillin-resistant enterococcal isolates were examined for molecular relatedness by plasmid DNA analysis. RESULTS--The cultures from 23 patients yielded ampicillin-resistant enterococci. The rectal swabs yielded ampicillin-resistant enterococci before the urine cultures did except in one patient whose urine and rectal cultures were both positive on the same day. Acquisition of ampicillin-resistant enterococci was significantly associated with previous antimicrobial agents, Foley catheterization, and being bedridden. Resistant enterococci were not isolated from hospital personnel or environmental surfaces. Plasmid analysis by gel electrophoresis demonstrated nine strains, two of which predominated. Rectal and urine isolates from the same patient had identical plasmid electrophoresis patterns. CONCLUSIONS--We conclude that ampicillin-resistant enterococci are common in the rectal flora, can spread to the urinary system, are associated with patient characteristics that predipose to nosocomial infection, and may become an emerging clinical problem.     

Epidemiological studies of nosocomial infections with Pseudomonas aeruginosa using a DNA probe

A DNA probe encoding the Pseudomonas aeruginosa pilin gene has been developed in the authors' laboratory and has been shown to be a useful epidemiological tool. In the present study this technology, together with other typing methods, has been used to define relatedness and possible transmission routes of P aeruginosa strains isolated in several hospital wards. Clusters of P aeruginosa infections, suspected to be the result of nosocomial transmission, developed in a general intensive care unit (ICU) and a neurosurgical ward/ICU, as well as in a burn unit, were studied using antibiograms, lipopolysaccharide-serotyping, and gene probe analysis. Results of these studies demonstrated that each of the general and neurosurgical ICU isolates were different, making nosocomial transmission very unlikely. However, within the burn unit, patient isolates had identical profiles, suggesting that spread between patients was occurring or that a common source of infection was present. Changes in infection control measures within the unit were introduced and may have contributed to eradication of the outbreak. DNA probe studies were valuable in clarifying epidemiological relatedness of isolates that was not evident with the other typing strategies and identified a possible burn-associated strain.     

Surveillance of infection status of drug resistant Staphylococcus aureus in an Indian teaching hospital

Objective

To access nosocomial and community accounts of multidrug resistant strains of Staphylococcus aureus (S. aureus) isolated by surveillance in a teaching hospital, over a period of 30 months.

Methods

Clinical samples from nosocomial sources, i.e., wards and cabins, intensive care unit (ICU) and neonatal intensive care unit (NICU) sources, as well as community or outpatient department (OPD) sources of a hospital were used for isolating strains of S. aureus resistant to methicillin/oxacillin and vancomycin, over a period, November 2009-April 2012.

Results

Of a total of 1 507 S. aureus isolates, 485 strains from community and 1 022 isolates were from nosocomial sources; Out of 485 (100%) OPD S. aureus isolates, 390 (80.41%) were MRSA strains. Similarly, from wards and cabins of 564 (100%) isolates, 461 (81.73%) strains were MRSA; whereas of 458 (100%) isolates obtained from ICU and NICU, 363 (79.25%) strains were MRSA. It was ascertained with χ²-tests of independence that MRSA strains were equally distributed in “community” or “wards and cabins” or “ICU and NICU” sources, alike rest other drug-resistant S. aureus strains. Antibiotic sensitivity patterns of isolated strains with 16 antibiotics were ascertained. Out of 390 (100%) MRSA strains isolated from OPD, 80 (20.51%) were vancomycin resistant (VRSA) and 173 (44.35%) strains were moderately sensitive to vancomycin or called, vancomycin intermediate strains (VISA). Similarly, from nosocomial sources, out of 461 (100%) MRSA isolates obtained from wards and cabins, 110 (23.86%) strains were VRSA and 208 (45.11%) were VISA strains, whereas out of 363 MRSA isolates obtained from ICU and NICU, 61 (16.8%) VRSA strains and 164 (45.17%) VISA strains were found. A progressive increase of percent values of drug resistance to 16 antibiotics used for antibiotic profiling revealed its subtle infection dynamics.

Conclusions

This study revealed the appalling state of occurrence of MRSA and VRSA in a resource-limited setting. A progressive increase of percent values of drug resistance to 16 antibiotics used revealed its subtle infection dynamics.     

Distribution and transmission of Pseudomonas aeruginosa and Burkholderia cepacia in a hospital ward

Genotyping and antibiotic susceptibility testing were used to analyze Pseudomonas aeruginosa and Burkholderia cepacia strains from sink drain from 14 pediatric patients with cystic fibrosis (CF) and from hospital personnel as part of a 4 week prospective study of strain transmission in a pediatric ward. A total of 87.5% of all washbasin drains were contaminated with P. aeruginosa [10² to 10⁵ colony forming units (CFU)/ml sink fluid], whereas B. cepacia was found only once in a sink drain. From the eight CF patients already infected with P. aeruginosa upon entering the ward, we isolated six genotypes that were identical with strains found in sink drains of the ward. Four of the 16 members of the personnel had one positive P. aeruginosa hand culture. B. cepacia was never found in patients or on personnel hands. Hand washing in contaminated sinks (≥ 10³ CFU/ml) led to positive P. aeruginosa or B. cepacia hand cultures. P. aeruginosa or B. cepacia embedded in sputum were transmissable by hand shaking for up to 180 min, whereas both pathogens suspended in physiological saline were transmissable to other hands only up to 30 min. Genotyping of P. aeruginosa revealed strain transmission from CF patients or the environment to other patients or the personnel, as well as one transmission from the environment to a CF patient. The ability of CF sputum to prolong survival of P. aeruginosa and B. cepacia may be important for strain transmission. The results suggest that improved hygienic measures are required to prevent routes of bacterial transmission via the hands and sink drains. Pediatr Pulmonol. 1996; 21:90–100. © 1996 Wiley-Liss, Inc.