某三甲专科医院住院患者皮损部位的多重耐药性分析及变化趋势

目的 了解三甲专科医院皮肤病住院患者皮损感染的一般情况、多重耐药及医院感染情况。方法 收集整理2019年10月—2022年9月南方医科大学皮肤病医院住院患者皮损部位培养检出菌株的临床数据,分析多重耐药菌(MDRO)、主要特殊耐药菌、检出数居前5位的病原菌的年度变化、耐药情况等。结果 三年间的皮损标本培养共检出3 331株病原菌,其中革兰阳性菌占77.72%,革兰阴性菌占17.35%,真菌占4.92%。皮损培养阳性患者中占比最高的疾病类型为湿疹性皮肤病(27.32%)。检出菌株数前5的病原菌为金黄色葡萄球菌、表皮葡萄球菌、铜绿假单胞菌、白色念珠菌和肺炎克雷伯菌,其中金黄色葡萄球菌和表皮葡萄球菌的构成比呈逐年增长趋势(均P<0.05)。3年间金黄色葡萄球菌多重耐药检出率、耐甲氧西林金黄色葡萄球菌(MRSA)的检出率呈下降趋势(P<0.05)。MDRO总检出率为45.39%,医院感染总发生率为0.67%,MDRO医院感染发生率呈逐年下降趋势(χ²=26.26,P<0.05)。结论 葡萄球菌等革兰阳性菌是皮损感染中最常见的病原菌,经验性使用抗生素时应首先...     

肺结核并MDRO肺部感染耐药情况及其危险因素分析

目的 探讨肺结核并多重耐药菌(MDRO)肺部感染耐药情况及其危险因素。方法 选取2018年1月—2021年9月河北省胸科医院收治的220例耐药肺结核并肺部感染患者进行回顾性研究,根据是否为MDRO肺部感染分为MDRO组、非MDRO组,分析MDRO组病原菌与耐药情况,比较两组临床资料,采用多因素Logistic回归方程分析肺结核并MDRO肺部感染的相关影响因素,采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析Logistic回归模型预测肺结核并MDRO肺部感染价值。结果 121例肺结核并MDRO肺部感染患者共分离出132株MDRO,其中包括革兰阴性菌94株(71.21%),革兰阳性菌38株(28.79%);主要革兰阳性菌有溶血葡萄球菌、金黄色葡萄球菌、表皮葡萄球菌,三者均对替考拉宁、万古霉素敏感;主要革兰阴性菌有肺炎克雷伯氏菌、铜绿假单胞菌、大肠埃希菌,肺炎克雷伯氏菌、大肠埃希菌均对头孢哌酮舒巴坦敏感,铜绿假单胞菌对常用抗菌药物耐药率均较高;两组肺结核耐药类型、慢性阻塞性肺疾病、糖尿病、癌症、抗结核治疗遵医行为、抗肺部感染药物数量比较,差异有统计学意义(P<0.05);...     

2007年和2008年北京天坛医院痰细菌培养及其药敏结果比较

目的了解北京天坛医院患者痰病原菌分布及其常见病原菌耐药情况。方法2007年和2008年对北京天坛医院急诊及住院患者4225例留取清晨痰标本共3960株进行细菌培养。对病原菌进行细菌学鉴定、药敏试验。对耐甲氧苯青霉素葡萄球菌进行超广谱β内酰胺酶确证试验。结果2007年送检标本中分离到病原菌1706株,其中革兰氏阳性菌687株,占总数的40％,革兰氏阴性菌1019株,占60％。2008年送检标本中分离到病原菌2254株,其中革兰氏阳性菌767株,占总数34％,革兰氏阴性菌1487株,占66％。2007年占前4位的菌株依次为金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希氏菌。2008年占前4位的菌株依次为金黄色葡萄球菌、鲍曼不动杆菌、铜绿假单胞菌、大肠埃希氏菌。耐药明显。主要的革兰氏阳性菌（排名前4位）均对万古霉素敏感,对青霉素类均不敏感。结论患者体内分离到的病原菌显著增加,且革兰氏阴性菌所占比例也明显增加。鲍曼不动杆菌由第3位升至第2位,成为占革兰氏阴性菌比例最多的细菌。这些病原菌对青霉素耐药,对万古霉素多敏感。     

319株ICU病原菌分布特点及抗菌药物敏感率分析

目的：探讨ICU病区病原菌分布特点及药物敏感率情况,为临床合理选用抗菌药物提供参考。方法统计2012年7月~12月北京天坛医院ICU检出病原菌的种类、数量、标本来源及药敏结果等数据,并分析这一时段ICU病原菌的流行特点及药敏和耐药特点。结果ICU分离的病原菌来源主要是痰标本,占79.0%。病原菌种类革兰氏阴性菌占76.2%,革兰氏阳性菌占23.8%。常见革兰氏阴性菌前3位依次是铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌。其中鲍曼不动杆菌耐药严重,对美罗培南的敏感率只有9.8%。革兰氏阳性菌中以金黄色葡萄球菌为主,占81.6%。金黄色葡萄球菌中耐甲氧西林的金黄色葡萄球菌（MRSA）占61.3%;凝固酶阴性葡萄球菌中耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）占45.5%。结论由于ICU抗菌药物使用频率高、剂量大、时间长等原因,导致病原菌敏感率低,耐药严重。医院应加强ICU抗菌药物使用的监督和管理,避免耐药率上升。     

99例复杂皮肤软组织感染的病原学分析

目的 分析复杂皮肤软组织感染的病原菌及对抗生素的敏感性。方法 回顾性分析99例复杂皮肤软组织感染住院患者的临床资料和病原学检验结果。结果 复杂皮肤软组织感染共99例,共检出99株病原菌,其中革兰阳性菌51株,葡萄球菌是主要致病菌,该菌对红霉素、青霉素G、氯洁霉素、苯唑西林、左氧氟沙星有较高的耐药率,其中红霉素的耐药率达95.45%、青霉素G 72.73%;对替考拉宁、万古霉素、利拉唑胺、夫西地酸、莫西沙星敏感性较高;葡萄球菌中社区获得性感染对复方磺胺甲噁唑、四环素、环丙沙星的敏感性高于医院感染（P < 0.05）;发现耐甲氧西林金黄色葡萄球菌11株。革兰阴性菌48株,铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌等为主要的致病菌;革兰阴性菌对左氧氟沙星、复方磺胺甲噁唑、庆大霉素有较高的耐药性,医院感染尤为突出;对碳青霉烯类、妥布霉素、哌拉西林、他唑巴坦敏感性较好。结论 复杂皮肤软组织感染的病原菌种类繁多,耐药性较高,应在药物敏感试验指导下合理用药。     

汶川地震致头皮伤口感染细菌谱及耐药性分析

目的探讨地震灾害引起的开放性头皮损伤伤121感染的病原菌分布,耐药性特点及抗生素治疗措施。方法回顾分析5·12汶川地震后,四川大学华西医院神经外科收治的38例开放性颅伤患者头皮伤口感染的病原学资料。结果全组38例开放性头皮伤口感染的病原菌菌株51株,革兰阳性菌35株（68．63％）,分别是金黄色葡萄球菌21株（41．18％）,表皮葡萄球菌14株（27．45％）;革兰阴性菌16株（31．37％）,分别是阴沟肠杆菌8株（15．69％）,肺炎克雷伯杆菌4株（7．84％）,绿脓杆菌2株（3．92％）,深红沙雷氏菌2株（3．92％）。这些菌株对临床常用抗生素都有不同程度的耐药。经彻底清创及应用敏感抗生素,能有效控制感染。结论地震引起的开放性头皮伤口感染的病原菌,多以革兰阳性的金黄色葡萄球菌感染为主。早期彻底清创,营养支持,应用敏感抗生素能提高治疗效果。     

艾滋病并发复数菌败血症患者12例临床分析

目的观察艾滋病并发复数菌败血症患者临床特征和药物敏感试验结果。方法回顾性分析本院12例艾滋病并发复数菌败血症患者的合并症、炎症指标、预后情况、病原菌分布及药敏结果。结果 12例艾滋病患者有10种合并症,检测血清降钙素原(4.75±9.43)μg/L,仅5例升高,院内感染7例,死亡3例;共检出24株菌株,革兰阴性菌8株(33.3%),多重耐药的大肠埃希菌和肺炎克雷伯菌共6株,产超广谱β-内酰胺酶5株;革兰阳性菌13株(54.2%)以溶血性葡萄球菌和金黄色葡萄球菌多见。结论艾滋病合并复数菌败血症患者合并症多样,病死率高,革兰阴性菌耐药比重大,应积极预防及处理。     

皮肌炎和多发性肌炎患者并发医院感染的临床特点及相关因素分析

目的:探讨皮肌炎(dermatomyositis,DM)和多发性肌炎(polymyositis,PM)患者并发医院感染的临床特点及其相关因素。方法:对75例DM和PM住院患者进行回顾性调查、分析及总结。结果:75例DM和PM患者住院186例次,发生医院感染者89例次,医院感染率47.8%。医院感染最常见的部位是上呼吸道(28.1%),其次分别是肺部(25.8%)和皮肤黏膜(12.4%)。医院感染病原体中,革兰阴性菌28株(53.9%),革兰阳性菌20株(38.5%),真菌4株(7.6%);位于前3位的病原菌分别是铜绿假单胞菌(17.3%)、肺炎克雷伯菌(13.5%)及金黄色葡萄球菌(9.7%)。病原体药敏试验示阿米卡星、氨曲南和亚安培南对革兰阴性菌疗效好,且耐药率低;而万古霉素及克林霉素对革兰阳性菌疗效好,且耐药率低。患者住院时间、糖皮质激素及免疫抑制剂治疗、血清白蛋白水平、是否并发糖尿病和侵袭性操作等是DM和PM患者并发医院感染的高危因素。结论:DM和PM患者并发医院感染发生率高,且主要病原菌为革兰阴性菌。应针对相关高危因素采取合理措施,以有效预防其感染的发生,促进患者早日康复。     

皮肤溃疡感染创面376例细菌培养结果及耐药性分析

目的了解皮肤溃疡创面培养细菌的分布及其耐药情况。方法收集本科2013年1月-2015年12月分离培养的细菌共376株,并用EXCEL及SPSS软件分析金黄色葡萄球菌和铜绿假单胞菌的耐药情况。结果金黄色葡萄球菌在各年所占比例均在20%以上,铜绿假单菌检出率各年分别为16.80%、17.24%、13.21%。检出的金葡菌对万古霉素、利奈唑胺、替加环素耐药率为0,对青霉素、红霉素耐药率分别为88.12%和77.23%;铜绿假单胞菌对哌拉西林/他唑巴坦、亚胺培南、阿米卡星耐药率均为0,对氨苄西林、氨苄西林/舒巴坦、头孢唑林、头孢替坦、复方新诺明、呋喃妥因耐药率均高于95%。结论金黄色葡萄球菌和铜绿假单菌在皮肤溃疡创面分离的细菌中占前两位;细菌感染类型及细菌耐药性的变化值得大家关注。     

急诊科病房分离病原菌及细菌耐药性的临床分析

目的 了解急诊科病房临床分离病原菌的特点及细菌耐药性。方法对急诊科195株病原菌及其细菌耐药性进行回顾性分析。结果感染优势菌为革兰氏阴性杆菌,所占比例为51．3％,真菌比例为39．0％,革兰氏阳性球菌为9．7％;排名前7位的病原菌分别为白色念珠菌24．1％,大肠杆菌14．4％,鲍曼氏不动杆菌12．8％,热带念珠菌11．3％,肺炎克莱布斯氏杆菌8．2％,铜绿假单胞菌7．2％,金黄色葡萄球菌4．6％。大肠杆菌的超广谱β-内酰胺酶检出率为81．0％,肺炎克莱布斯氏杆菌为27．3％。结论革兰氏阴性杆菌仍为急诊科的优势病原微生物,尤以大肠杆菌最多。真菌所占比例超过革兰氏阳性球菌。碳青霉烯类对肠杆菌科细菌的产酶与非产酶株均显示强大的抗菌活性。     

Suprathel-antiseptic matrix: in vitro model for local antiseptic treatment?

Acetic acid is a traditional antiseptic agent that has been used for more than 6000 years. The main goal of this study was to demonstrate the suitability of Suprathel (PolyMedics Innovations GmbH, Denkendorf, Germany) in combination with various antiseptic agents to create an "antiseptic-matrix" especially designed for problematic microorganisms such as Proteus vulgaris, Acinetobacter baumannii, or Pseudomonas aeruginosa, which are frequently associated with burns. The study was designed to test the in vitro antimicrobial effect of a "Suprathel-antiseptic matrix" (Suprathel combined with acetic acid 3%, povidone-iodine 11% [Betaisodona], polyhexanide 0.04% [Lavasept], phenoxyethanol 2%/octenidine dihydrochloride 0.1% [Octenisept], mafenide acetate 5%, and chlorhexidine gluconate 1.5%/cetrimid 15% [Hibicet]). As a means to assess the typical bacterial spectrum of a burn unit, the following Gram-negative and Gram-positive bacteria strains were tested: Escherichia coli, P vulgaris, P aeruginosa, A baumannii, Enterococcus faecalis, Staphylococcus epidermidis, Staphylococcus aureus, methicillin-resistant S aureus, and β-hemolytic streptococcus groups A and B. The tests showed a positive bactericidal effect of the Suprathel-antiseptic matrix, particularly with problematic Gram-negative bacteria such as P vulgaris, P aeruginosa, and A baumannii, except for the combination of Suprathel and mafenide acetate. It can be concluded that Suprathel-antiseptic matrix appears to be suitable as a local antiseptic agent, but clinical studies need to be performed to confirm these in vitro observations. The authors' previous studies have shown that acetic acid demonstrates a wide antiseptic spectrum for microorganisms typically found in burn patients. The combination of Suprathel and acetic acid worked well in this study and appears to be promising for future clinical application.     

Face and body sponges: beauty aids or potential microbiological reservoir?

Small natural or synthetic sponges are commonly used in daily hygiene and in removing make-up. In our study we try to assess the role of sponges as reservoirs and vehicles in the transmission of potentially pathogenic bacterial species. We demonstrate that numerous Gram-negative and Gram-positive bacterial species are detectable in sponges after normal use by the healthy population. The most common bacteria to be found are Staphylococcus epidermidis, Staphylococcus aureus and Escherichia coli in both cellulose and nylon sponges; this observation supports the idea that the environmental factors (humidity, temperature) favour bacterial growth more than the different materials the sponges are made of. Sponges should be restricted to personal use, regularly washed, completely dried and kept in a dry place.     

Microbiology of infected pustular psoriasis lesions

BACKGROUND: Bacterial infections can occur in lesions of pustular psoriasis (PP). The objective of this study was to establish the aerobic and anaerobic microbiology of secondarily infected PP. METHODS: A retrospective 10-year review was carried out of clinical and microbiology laboratory records from patients with secondarily infected PP lesions, whose specimens of infected sites were processed for the presence of aerobic and anaerobic bacteria. RESULTS: Bacterial growth was noted in 23 specimens. Aerobic or facultative anaerobic bacteria only were present in 12 patients (52%), anaerobic bacteria only in four (17%), and mixed anaerobic-aerobic flora was present in seven (30%). Thirty-six isolates were recovered (1.6 per specimen), 23 aerobic or facultative bacteria and 13 strict anaerobes. The predominant aerobic and facultative bacteria were Staphylococcus aureus (15 isolates), Group D Enterococcus (two isolates), and Escherichia coli (two isolates). The predominant anaerobes were Peptostreptococcus spp. (six isolates) and Bacteroides fragilis group, Propionibacterium acnes, and pigmented Prevotella spp. in two each. Single bacterial isolates were recovered in 14 patients (61%), 11 of which were S. aureus. Nineteen of the organisms isolated from 18 patients (78%) produced the enzyme beta-lactamase. S. aureus was isolated from all body sites. Organisms that resided in the mucous membranes close to the lesions predominated in these infections. Enteric Gram-negative rods and Bacteroides fragilis group predominated in lesions on the legs and buttocks. Group A beta-hemolytic streptococci, pigmented Prevotella, and Fusobacterium spp. were most frequently recovered in lesions of the hand. CONCLUSIONS: The polymicrobial etiology of secondarily infected PP lesions and the association of bacterial flora with the anatomic site of the lesions were demonstrated.     

Microbiology of infected poison ivy dermatitis

We report the aerobic and anaerobic microbiology of secondarily infected poison ivy dermatitis. The study involved retrospective review of clinical and microbiology laboratory records of patients with secondarily infected poison ivy lesions. Bacterial growth was noted in 33 specimens. Aerobic or facultative anaerobic bacteria only were present in 18 (55%) patients, anaerobic bacteria only in seven (21%), and mixed anaerobic-aerobic bacteria in eight (24%). Forty-five isolates were recovered (1.4 per specimen): 27 aerobic or facultative anaerobic bacteria, and 18 strict anaerobes. The predominant aerobic and facultative anaerobic bacteria were Staphylococcus aureus (13 isolates) and group A beta-haemolytic streptococci (six). The predominant anaerobes were Peptostreptococcus spp. (seven isolates), pigmented Prevotella and Porphyromonas spp. (four) and Fusobacterium spp. (two). Single bacterial isolates were recovered in 18 (55%) patients, eight of which were S. aureus. Nineteen of the organisms isolated from 16 (48%) patients produced the enzyme beta-lactamase. Organisms that resided in the mucous membranes close to the lesions predominated in those infections. Enteric gram-negative rods and Bacteroides fragilis group predominated in leg and buttock lesions. Group A beta-haemolytic streptococci, pigmented Prevotella and Porphyromonas and Fusobacterium spp. were most frequently recovered from lesions of the finger, face and neck. The polymicrobial aetiology of secondarily infected poison ivy lesions, and the association of bacterial flora with the anatomical site of the lesions, are demonstrated.     

Quantitation of skin bacteria: lethality of the wash solution used to remove bacteria.

A widely used technique for the quantitative removal of bacteria from the skin uses a detergent, Triton X-100 (p, t-octylphenoxynonaethoxyethanol), to remove and suspend the bacteria. We determined the half-life for the survival of five common skin bacteria suspended in the solution. The shortest-lived was Streptococcus pyogenes with a half-life of 0.9 hours. All of the others (Propionibacterium acnes, Staphylococcus epidermidis, Staphylococcus aureus, and Klebsiella pneumoniae) had half-lives of 1.5 hours or longer. K. pneumoniae, the only Gram-negative species tested, had a half-life of more than 30 hours. Thus, a one hour delay in plating and incubation of samples suspended in this detergent solution inhibits quantitation of most species tested.     

高强度窄谱蓝光对寻常痤疮表皮分离菌的抗菌作用研究

目的 评价高强度窄谱蓝光对寻常痤疮致病菌的抗菌作用.方法 取67例轻、中度痤疮患者皮损内容物进行细菌培养、分离并鉴定菌种.用高强度窄谱蓝光对培养所得的各种细菌进行照射,观察照光前后细菌数量、形态及超微结构的变化.结果 皮损处检出痤疮丙酸杆菌(32.4%)、颗粒丙酸杆菌(6.9%)、表皮葡萄球菌(35.3%)、金黄色葡萄球菌(4.9%)、溶血葡萄球菌(7.8%)、孔氏葡萄球菌(1.0%)、棒状杆菌(9.8%)及肺炎克雷伯菌(1.0%)和B群链球菌(1.0%).照光后痤疮丙酸杆菌和表皮葡萄球菌较未照光组菌量显著减少(P<0.05),菌落明显变小.结论 高强度窄谱蓝光有抗痤疮表皮分离菌作用.     

The phototoxic inhibitory effect and phototoxic killing effect of micro-organisms

The toxic and phototoxic growth inhibitory and killing effect of Staphylococcus aureus, S. epidermidis, Escherichia coli, Pseudomonas aeruginosa, Streptococcus pyogenus gr. A, St. viridans, Pityrosporum ovale and Candida albicans were studied. P. ovale and St. viridans were the only micro-organisms with any toxic effect against the other micro-organisms tested. P. ovale inhibited the growth of S. aureus, S. epidermidis, Ps. aeruginosa and E. coli. St. viridans inhibited the growth of S. aureus, S. epidermidis, Ps. aeruginosa, E. coli, St. pyogenus gr. A and P. ovale. This effect was only growth inhibitory and not direct killing. The activity was increased by UVA on S. aureus, S. epidermidis and Ps. aeruginosa but not on E. coli and St. pyogenes gr. A. These effects of P. ovale and St. viridans may be of importance in the defense against infections.