2007-2009年医院感染铜绿假单胞菌的耐药性分析

目的 了解医院铜绿假单胞菌对临床常用抗菌药物的耐药率,为临床经验性治疗及控制医院感染提供依据.方法 对2007-2009年1694株铜绿假单胞菌感染病例及耐药率进行回顾性调查与统计,采用常规方法对临床送检的标本进行细菌分离、培养、鉴定及药敏试验.结果 铜绿假单胞菌主要来源于痰液,占68.0％;3年间对16种抗菌药物耐药水平差异均有统计学意义(P＜0.05); 1694株铜绿假单胞菌对16种抗菌药物总耐药率为:环丙沙星26.9％、头孢哌酮/舒巴坦33.0％、美罗培南33.5％、头孢他啶33.7％、亚胺培南/西司他丁39.6％、氨曲南39.2％、头孢吡肟42.0％、左氧氟沙星42.8％、阿米卡星46.4％、哌拉西林/他唑巴坦48.4％、头孢哌酮50.7％、哌拉西林56.2％、庆大霉素59.8％、头孢曲松64.1％、替卡西林/克拉维酸64.6％、头孢噻肟69.3％.结论 铜绿假单胞菌对临床常用抗菌药物耐药现象严重,仅环丙沙星、头孢哌酮/舒巴坦、美罗培南、头孢他啶、氨曲南、亚胺培南/西司他丁保持相对高的抗菌活性.     

Pseudomonas aeruginosa: a multicentric study of antibiotic resistance (1999-2000)

A retrospective multicentric study was carried out over a period of 2 years (1999-2000). 2659 strains of Pseudomonas aeruginosa were collected from 4 university hospitals (Charles Nicolle Hospital, Pediatric Hospital and National Centre of Bone Marrow Transplantation in Tunis, Habib Bourguiba Hospital in Sfax). Epidemiological profile and antibiotic susceptibility were analysed. All bacteria were identified by conventional methods and antibiotic susceptibility tests were performed according to CA-SFM guidelines. The strains were recovered essentially from surgical wards (33%) and intensive care units (22%). Pseudomonas aeruginosa was isolated mainly from pus (36%), urine (32%) and respiratory samples (18%). 25% of strains were resistant to ticarcilline, 18% to cefsulodine, 9% to ceftazidime, 14% to imipenem and amikacin and 25% to ciprofloxacin. Moreover, the resistance rates varied from hospital to hospital and from unit to another. The resistant strains were isolated particularly from urology and intensive care units: respectively 62% and 39% for ticarcilline; 26% and 13% for ceftazidime. The acquired resistance to b-lactams seems largely due to penicillinase production. The frequency of resistance to ceftazidime was the lowest and seems associated to chromosomal cephalosporinase over production.     

致细菌性阴道病凝固酶阴性葡萄球菌的耐药性现状分析

目的研究凝固酶阴性葡萄球菌(CNS)的耐药性及其与细菌性阴道病的关系。方法常规培养细菌性阴道病患者的阴道分泌物,应用微生物分析系统MicroScan AutoScan-4进行鉴定及配套PC12板进行药敏试验。结果134例CNS中,耐药率在50%以上的抗生素有氨苄西林、环丙沙星、庆大霉素、红霉素、青霉素、四环素、诺氟沙星、苯唑西林等8种,其中氨苄西林、青霉素、苯唑西林等3种抗生素的耐药率高达90%以上,分别为93.3%、92.5%和94.0%;仅对万古霉素、阿莫西林/克拉维酸保持敏感,耐药率在10%以下,分别为9.2%和4.5%,而51例金黄色葡萄球菌的耐药性与之相比,无显著性差异(P>0.05)。结论CNS耐药性的改变,可能为其致细菌性阴道病的原因之一。     

Policies for the use of antibiotic in 99 Southwestern French hospitals in 2002

OBJECTIVE: Increasing antimicrobial resistance in bacteria is a major health problem and requires the implementation of stringent policies to optimize the use of antibiotics. DESIGN: In 2003 the authors conducted a study in southwestern French hospitals, using a questionnaire to assess the implementation of antibiotic policies according to national guidelines issued by the French government in 2002. RESULTS: The most frequent actions quoted by the 99 respondents were: issuing of a list of available antibiotics, issuing of information regarding antibiotic consumption and bacterial resistance, and control of antibiotics dispensation. Local guidelines were available in 45% of hospitals for curative treatment and in 87% for antibioprophylaxis in surgery. The evaluation of antibiotic use and computer links between clinical settings, pharmacy and microbiology lab were the less widespread measures. The number and type of actions were related to hospital size and activity. CONCLUSIONS: These findings support that policies for an appropriate use of antimicrobials should be reinforced by issuing treatment guidelines and specific tools for dispensation and evaluation. This survey also emphasizes the need for appropriate policies relating to the size and medical activities of healthcare institutions.     

Effect of reduction in ciprofloxacin use on prevalence of meticillin-resistant Staphylococcus aureus rates within individual units of a tertiary care hospital

Previous studies have shown a correlation between fluoroquinolone use in hospitals and rates of meticillin-resistant Staphylococcus aureus (MRSA) infection. This study examined the effect on MRSA infection rates within individual adult units of a tertiary care teaching hospital after instituting a programme to decrease ciprofloxacin use. Clinical specimens positive for S. aureus were determined on all adult inpatient units between 1 January 2004 and 31 December 2005. Units with >10 isolates of S. aureus per year were included in the analysis. Ciprofloxacin use, measured in defined daily doses per 1000 patient-days, was determined for each unit during the same time period. Ciprofloxacin use and MRSA rates for 2004 and 2005 were compared. In the 17 units studied, ciprofloxacin use decreased by 31.2% (P<0.0001). The MRSA rate in these units decreased from 59.6% to 54.2% (P=0.122). There was a correlation between ciprofloxacin use and the MRSA rate within these units (r=0.70; 95% confidence interval -0.01-0.94; P=0.053). Within individual units, there was a variable response. In seven of the units, there was an increase in the MRSA rate despite a reduction in ciprofloxacin use, suggesting that other factors (length of stay, infection control and community-acquired MRSA) may have contributed. Although many factors are associated with high MRSA rates, ciprofloxacin use appears to be a contributing factor. Reducing the use of ciprofloxacin may be a means of controlling MRSA in the hospital setting.     

嗜麦芽寡养单胞菌对新生儿呼吸机相关性肺炎的影响

目的研究嗜麦芽寡养单胞菌(Sm)与新生儿呼吸机相关性肺炎(NVAP)的关系. 方法分析新生儿科近5年NVAP呼吸道分泌物的细菌培养结果及临床资料. 结果 Sm为NVAP第1位病原菌,占总例数的23.8%;药敏结果示Sm对替卡西林/克拉维酸耐药率最低(0),其次是环丙沙星(23.5%)和头孢他啶(25%)、再次为阿米卡星(42.1%);对亚胺培南/西司他丁、庆大霉素、氨苄西林及头孢唑林全部耐药. 结论 Sm是本院NVAP的主要病原菌,且耐药率高,值得重视.     

Characteristics of coagulase-negative staphylococci isolated from hemocultures

The authors investigated 352 strains of coagulase-negative staphylococci isolated from hemo-cultures of patients with assumed bacteraemia who were hospitalized in standard hospital departments and intensive care units. The strains were identified using STAPHYtest 16 and 14 different species and subspecies of coagulase-negative staphylococci were found. Most frequent were strains of Staphylococcus epidermidis (53%), strains of S. hominis subsp. hominis (22%) and S. haemolyticus (13%). In the strains the production of slime and delta-haemolysin was investigated. The formation of these two important factors of virulence was recorded in 95% strains (incl. major slime production in 13.4%), and 50% strains resp. The resistance to 13 antibiotics was also assessed. A total of 91% strains were resistant to penicillin, 63% to oxacillin and amoxicillin with clavulanic acid, 67% to gentamicin and 66% to erythromycin. In the group 15 strains of a recently described subspecies S. hominis subsp. novobiosepticus was identified. These isolates displayed most frequently resistance: they were resistant in 100% to five antibiotics (penicillin, oxacillin, erythromycin, clindamycin and amoxicillin with clavulanic acid) and with a single exception to another three antibiotics (chloramphenicol, gentamicin and ciprofloxacin). In these strains most frequently slime as well as delta-haemolysin was found. The authors assume, consistent with previous work, that it is important to focus attention on the incidence of strains of S. hominis subsp. novobiosepticus which very probably play an important role as agents in hospital infections. The authors describe also detection of one strain of S. cohnii subsp. urealyticum which was resistant to 10 of 13 antibiotics. The authors are convinced that also classical phenotypic analysis can contribute in an effective manner to the solution of the problem of infections caused by coagulase-negative staphylococci.     

Prevalence of nosocomial infection and antibiotic use at a university medical center in Malaysia.

BACKGROUND AND OBJECTIVE: Most reports of nosocomial infection (NI) prevalence have come from developed countries with established infection control programs. In developing countries, infection control is often not as well established due to lack of staff and resources. We examined the rate of NI in our institution. METHODS: A point-prevalence study of NI and antibiotic prescribing was conducted. On July 16 and 17, 2001, all inpatients were surveyed for NI, risk factors, pathogens isolated, and antibiotics prescribed and their indication. NIs were diagnosed according to CDC criteria. Cost of antibiotic acquisition was calculated by treatment indication. SETTING: Tertiary-care referral center in Malaysia. PATIENTS: All inpatients during the time of the study. RESULTS: Five hundred thirty-eight patients were surveyed. Seventy-five had 103 NIs for a prevalence of 13.9%. The most common NIs were urinary tract infections (12.2%), pneumonia (21.4%), laboratory-confirmed bloodstream infections (12.2%), deep surgical wound infections (11.2%), and clinical sepsis (22.4%). Pseudomonas aeruginosa, MRSA, and MSSA were the most common pathogens. Two hundred thirty-seven patients were taking 347 courses of antibiotics, for an overall prevalence of antibiotic use of 44%. NI treatment accounted for 36% of antibiotic courses prescribed but 47% of antibiotic cost. Cost of antibiotic acquisition for NI treatment was estimated to be approximately 2 million per year (Malaysian dollars). CONCLUSION: Whereas the rate of NI is relatively high at our center compared with rates from previous reports, antibiotic use is among the highest reported in any study of this kind. Further research into this high rate of antibiotic use is urgently required.     

大肠埃希菌临床感染的分布及耐药性分析

目的了解临床各种标本分离的大肠埃希菌的耐药特点及差异,为临床合理使用抗菌药物提供依据。方法 收集2008年1月-2009年12月从305位患者中分离自中段尿,呼吸道及分泌物等标本的大肠埃希菌,采用天地人微生物分析系统及相配套的药敏试验卡进行细菌鉴定及药敏测定,并统计比较各种不同标本所检出大肠埃希菌对抗菌药物的耐药率。结果共检出大肠埃希菌305株,其中中段尿检出121株,呼吸道88株,分泌物等96株。中段尿与呼吸道分离的大肠埃希菌对复方新诺明（85.12%,70.45%）、庆大霉素（67.77%,50.00%）、阿莫西林/克拉维酸（33.88%,60.23%）的耐药率差异均有统计学意义;中段尿与分泌物及其它分离大肠埃希菌对复方新诺明（85.12%,69.79%）、头孢他啶（37.19%,9.38%）、妥布霉素（42.15%,8.33%）、阿莫西林/克拉维酸（33.88%,15.62%）的耐药率差异均有统计学意义;呼吸道与分泌物及其它分离的大肠埃希菌对头孢他啶（43.18%,9.38%）、环丙沙星（73.86%,88.54%）、阿莫西林/克拉维酸（60.23%,15.62%）的耐药率差异有统计学意义。结论不同标本分离的大肠埃希菌对同一抗菌药物耐药率不同,治疗不同部位大肠埃希菌引起的感染,要考虑由于感染部位不同而产生的耐药性以及药物有效浓度的差异,临床应依据药敏结果合理使用抗菌药物。     

Antimicrobial susceptibility of Listeria monocytogenes food isolates from different cities in Colombia

One hundred eight Listeria monocytogenes food isolates from four cities in Colombia and previously confirmed by multiplex polymerase chain reaction were characterized for antimicrobial susceptibility. Isolates were evaluated against 17 antimicrobials contained in the MICroSTREP plus(?)3 panel (MicroScan system). Susceptibility found for ampicillin, amoxicillin/clavulanic acid, and chloramphenicol was 100%, whereas it was 98% for other antimicrobials such as trimethoprim/sulfamethoxazole, 97% for azithromycin, 92% for vancomycin, 90% for erythromycin, 86% for tetracycline, 84% for penicillin, 70% for ciprofloxacin, 57% for rifampin, 56% for meropenem, and 32% for clindamycin. Natural resistance to cephalosporins was confirmed in all cases, and 16% of isolates were nonsusceptible to penicillin. Using Staphylococcus spp. or Enterococcus spp. breakpoints, 48% of isolates displayed multidrug resistances, and the major resistance phenotypes were against rifampin, clindamycin, ciprofloxacin, azithromycin, and erythromycin. Colombian food isolates displayed high resistance to clindamycin, meropenem, rifampin, and ciprofloxacin (30%-65%), and the primary drugs of choice against listeriosis remain effective for most of isolates (84%).     

The epidemiology of ciprofloxacin resistance in coagulase-negative staphylococci in CAPD patients.

Ciprofloxacin was used as empirical therapy for peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD) for 26 months, providing an opportunity to study the epidemiology of ciprofloxacin resistance amongst coagulase-negative staphylococci (CNS). Swabs were collected from the CAPD patients, staff, and clinic environment before, during and after the time this antibiotic was prescribed. Clinical isolates were also studied, and records kept of patient hospital attendance. Ciprofloxacin-resistant staphylococci were typed by antibiogram, biotype, plasmid profile, SDS-PAGE, and immunoblotting. No resistant strains were detected before the use of ciprofloxacin. During its use 30% of patients became skin carriers, and resistant strains caused 8% of peritonitis episodes in 7% of patients (38% of carriers). Resistant strains were isolated from the environment, but never from attending members of staff. A total of 208 resistant isolates with MIC's between 8 and 128 mg/l was collected and identified as Staphylococcus epidermidis or S. haemolyticus. Sixteen strain types were distinguished. There was epidemiological evidence for selection of resistant strains derived from the host commensal flora and also for cross-colonization, and cross-infection. Carriage of resistant strains fell to 15% of patients, 6 months after the use of ciprofloxacin had ceased.     

260株金黄色葡萄球菌的耐药性分析

目的:了解金黄色葡萄球菌对常用抗菌药物的耐药情况,指导临床合理用药。方法:对各类感染标本分离的260株金黄色葡萄球菌,采用纸片扩散法进行药敏试验。结果:260株金黄色葡萄球菌中,万古霉素和替考拉宁100%敏感,未发现耐药;MRSA对氨卞西林/舒巴坦、阿莫西林/克拉维酸、头孢呋辛、头孢噻肟、青霉素均100%耐药。MRSA中复方新诺明的敏感率88%,利福平的敏感率7%。MSSA中左氧沙星、利福平、复方新诺明、环丙沙星的耐药率均保持在较低水平。MRSA体外抗菌活性较好的有万古霉素、替考拉宁、复方新诺明、磷霉素和利奈唑烷。MSSA除青霉素、红霉素和庆大霉素外,体外抗菌活性均较好。结论:临床分离的金黄色葡萄球菌对常用抗菌药物多重耐药,应根据分离株耐药特点选用不同的治疗方案。