Hospital bath basins are frequently contaminated with multidrug-resistant human pathogens

The hospital environment is increasingly recognized as a reservoir for hospital-acquired pathogens. During a 44-month study period, a total of 1,103 basins from 88 hospitals in the United States and Canada were sampled. Overall, 62.2% of the basins (at least 1 basin at each hospital) were contaminated with commonly encountered hospital-acquired pathogens.     

ICU肺部感染患者的病原菌及耐药性特点分析

目的探讨重症医学科(ICU)患者肺部感染致病菌分布情况及耐药性特点,以指导临床合理使用抗菌药物。方法2009年1月～2012年5月在我院ICU收治的128例肺部感染患者的痰病原菌细菌谱,并对药敏结果进行分析。结果共检出病原菌167株,其中革兰氏阴性菌139株,占83.2%,革兰氏阳性菌28株,占10.8%。其中革兰氏阴性菌最主要的病原菌依次是阴沟杆菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯氏菌。结论 ICU肺部感染患者的病原菌以革兰氏阴性菌为主,特点是多重耐药的阴沟杆菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯氏菌更显著,革兰氏阳性菌及念珠菌检出率不高,这对抗菌药物的合理使用具有指导意义。     

某医院2017—2018年眼科感染病原菌分布及耐药性分析

目的 分析佛山市第二人民医院眼科诊治感染患者的病原菌菌株分布情况及耐药性,了解眼科主要致病菌的耐药性。方法 选择我院2017年1月—2018年12月眼科送检阳性病原菌培养样本共106例,分析眼科致病菌分布及耐药特征。结果 2017年共监测阳性标本56例,其中革兰阳性菌37例(66.0%),革兰阴性菌15例(26.7%),真菌4例(7.1%)。2018年共监测阳性标本50例,其中革兰阳性菌36例(72.0%),革兰阴性菌12例(24.0%),真菌2例(4.0%)。表皮葡萄球菌排在眼科革兰阳性致病菌的第1位。铜绿假单胞菌排在眼科革兰阴性致病菌的第1位。表皮葡萄球菌对苯唑西林、左氧氟沙星、四环素保持较高耐药率,对万古霉素具有较高敏感性。铜绿假单胞菌对亚胺培南和阿米卡星均有较高敏感性,对头孢吡肟、哌拉西林/他唑巴坦、左氧氟沙星有一定耐药现象。结论 2017—2018年我院眼科感染病原菌以革兰阳性菌为主,对万古霉素敏感,革兰阴性菌对左氧氟沙星有一定的耐药性。为预防术后感染发生,应严格术前消毒,依据药物敏感试验检测结果合理使用抗生素。     

胸腔闭式引流术后感染患者病原菌分布、危险因素分析及干预措施研究

目的分析胸腔闭式引流术后感染患者病原菌分布特征以及感染危险因素,探讨预防术后感染的措施。方法回顾性选择2014年6月至2018年12月于我院行胸腔闭式引流术的362例患者临床资料,根据是否发生术后感染,将患者分为感染组和未感染组。统计术后感染患者病原菌分布情况,Logistic回归分析胸腔闭式引流术后感染的危险因素,总结预防感染的有效措施。结果本组术后感染32例,感染率8.84%,感染病原菌以细菌(59.38%)为主,65.63%为多重病原菌感染。G-菌株和G+菌株分别以肺炎克雷伯菌(20.00%)和金黄色葡萄球菌(14.55%)检出率最高。单因素分析,年龄、自发性气胸、合并糖尿病、低蛋白血症、慢性阻塞性肺疾病、有创机械通气、引流管留置时间、引流管个数、引流瓶液体、引流口敷料更换时间、围术期抗生素使用时间、联合应用抗生素与胸腔闭式引流术后感染有关(P<0.05),Logistic回归分析示年龄≥65岁(OR=1.857,95%CI 1.032~5.172)、合并糖尿病(OR=2.232,95%CI 1.354~6.275)、合并慢性阻塞性肺疾病(OR=2.036,95%CI 1.245~6.029)、有创机械通气(OR=2.547,95%CI 1.524~8.569)、引流管留置时间≥72h(OR=3.028,95%CI 1.842~12.347)是胸腔闭式引流术后感染的高危因素(P<0.05)。结论胸腔闭式引流术后感染率较高,高龄、合并糖尿病和慢性阻塞性肺疾病、有创机械通气以及长时间留置引流管,是导致感染的危险因素,临床加强对胸腔闭式引流患者感染监测,合理使用抗生素,做好引流管护理,以降低感染率。     

2007～2008年荆州市食源性致病菌监测分析

目的了解荆州市食品中食源性致病菌的污染状况,为预防和控制食源性疾病提供技术依据。方法参照中华人民共和国国家标准《食品卫生微生物学检验》GB/T4789-2003（以下简称＂国标＂）以及中国疾病预防控制中心营养与食品安全所颁发的有关检测程序,对荆州市6类食品进行了沙门氏菌、单增李斯特菌、大肠埃希氏菌O157∶H7、副溶血性弧菌、金黄色葡萄球菌和空肠弯曲菌的检测分析。结果在119份样品中检出致病菌20株,总检出率为16.8%,其中沙门氏菌检出率13.4%（16/119）,副溶血性弧菌检出率9.1%（1/11）,金黄色葡萄球菌检出率5.9%（1/17）,大肠埃希氏菌O157∶H7检出率1.3%（1/75）,单增李斯特氏菌检出率0.8%（1/119）,未检出空肠弯曲菌。致病菌检出率最高的为生畜肉,为40.5%（15/37）,生禽肉为13.3%（2/15）,水产品为8.3%（1/12）、面米食品为11.8%（2/17）,即时食品和蔬菜沙拉均未检出致病菌。结论荆州市食品食源性致病菌生畜肉和水产品的污染较为严重,应引起有关部门的重视,以防止食源性疾病的发生。     

Carriage by the German cockroach (Blattella germanica) of multiple-antibiotic-resistant bacteria that are potentially pathogenic to humans, in hospitals and households in Tripoli, Libya

Using standard bacteriological procedures, 403 cockroaches (Blattella germanica) collected in Tripoli, from hospitals or the households surrounding the hospitals, were examined for bacteria that are potentially pathogenic to humans. Almost all of the cockroaches (96.1% of the 253 from hospitals and 98.7% of the 150 from households) were found to be carrying potentially pathogenic bacteria, with similar mean burdens of 3.2 x 10(5) colony-forming units (cfu) (range=0-1.4 x 10(7)) for each hospital cockroach and 1.9 x 10(5) cfu (range=0-3.1 x 10(6)) for each household cockroach (P>0.05). Overall, 27 and 25 species of potential pathogen were isolated from the hospital and household cockroaches, respectively, with Klebsiella, Enterobacter, Serratia and Streptococcus predominant. Carriage of species of Serratia was significantly more common among the hospital cockroaches than among the household cockroaches, whereas carriage of Klebsiella, Enterobacter, Citrobacter and Aeromonas was significantly more common among the household cockroaches than among the hospital. Multiple resistance, to at least six different antibiotics, was more commonly observed among the enteric bacteria isolated from the hospital cockroaches than among those recovered from the household cockroaches. Overall, >30% of the isolates of Enterobacteria recovered were each resistant to at least four antimicrobial agents, and 95% of the Pseudomonas isolates were each resistant to at least eight such agents. Cockroaches may play an important role in the spread of multiple-antibiotic-resistant, bacterial pathogens within the hospitals and surrounding communities of Tripoli and other, similar cities. The local health and environmental authorities need to be encouraged to treat B. germanica infestations seriously and to control them quickly and effectively.     

2011年湘雅医院临床分离病原菌分布及耐药性分析

目的了解2011年中南大学湘雅医院临床常见分离菌的分布及耐药性,为临床合理使用抗菌药物提供依据。方法采用全自动微生物鉴定系统Vitek-2对临床分离病原菌进行鉴定及药敏试验,用WHONET5.4软件对实验结果进行分析。结果 2011年湘雅医院共分离菌株7 272株,其中革兰阳性菌2 85株,占28.67%;革兰阴性菌4 109株,占56.51%;真菌1 078株,占14.82%。葡萄菌属中耐甲氧西林金黄葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRSCN)的检出率分别为51.37%和68.16%,未检出对万古霉素、替考拉宁及利奈唑胺耐药株;屎肠球菌和粪肠球菌对万古霉素的耐药率分别均为3.91%和3.83%;大肠埃希菌和肺炎克雷伯菌中超广谱β-内酰胺酶(ESBLs)的检出率分别为78.30%和63.10%,肠杆菌科细菌对碳青霉烯类抗菌药物仍高度敏感(耐药率<6.00%),首次监测到泛耐药肠杆菌科细菌;与2010年相比,铜绿假单胞菌和鲍曼不动杆菌中泛耐药株数显著增加。结论临床分离病原菌以革兰阴性杆菌为主;分离菌株耐药性十分严重;泛耐药肠杆菌科细菌的出现及泛耐药非发酵革兰阴性杆菌的增加,应引起临床高度重视,并及时采取防控措施。     

Carriage by the housefly (Musca domestica) of multiple-antibiotic-resistant bacteria that are potentially pathogenic to humans, in hospital and other urban environments in Misurata, Libya

Using standard microbiological procedures, bacteria that are potentially pathogenic to humans were isolated from 150 houseflies collected in the Libyan city of Misurata (50 flies each from the Central Hospital, streets and abattoir). Salmonella spp., Yersinia enterocolitica and Edwardsiella tarda were isolated from flies collected on the streets and in the abattoir but not from those collected in the hospital. Shigella sonnei was detected in just one fly, which was collected in the abattoir. Of the flies collected in the hospital, streets and abattor, 42%, 42% and 32% were positive for Escherichia coli, 70%, 50% and 62% for Klebsiella spp., 2%, 20% and 10% for Aeromonas spp., 96%, 36% and 34% for Pseudomonas spp., 20%, 12% and 16% for Staphylococcus spp., and 24%, 22% and 18% for Streptococcus spp., respectively.When the antibiotic susceptibilities of the fly isolates were investigated, the Enterobacteria isolated from the houseflies collected in the hospital were found to be resistant to significantly more of the commonly used antibiotics that were tested than the Enterobacteria isolated from the flies caught in the streets or abattoir. Whatever the source of the flies from which they were collected, the Pseudomonas isolates frequently showed resistance to multiple antibiotics, with >50% each being resistant to at least 10 antimicrobial agents. Two isolates of Sta. aureus (both from flies collected in the hospital) were resistant to methicillin.The present study supports the belief that the housefly is a potential vector of multiple-antibiotic-resistant, pathogenic bacteria, including methicillin-resistant Sta. aureus, in the hospital environment. Given their mobility, it seems likely that houseflies carry such pathogens from hospitals to surrounding communities, and vice versa.     

Alcohol-induced endothelial changes are associated with oxidative stress and are rapidly reversed after withdrawal

BACKGROUND: Although heavy alcohol drinkers are at an increased risk of developing cardiovascular events, moderate alcohol intake is associated with reduced incidence of cardiovascular death. This paradox might reflect a dose-related effect of different alcohol intakes on endothelial function and this, in turn, might depend on changes in oxidative stress. METHODS: We tested the effects of alcohol withdrawal in heavy alcohol consumers and compared the plasma levels of endothelin-1, nitric oxide, plasminogen activator inhibitor-1, von Willebrand factor, malondialdehyde, and intracellular glutathione with those of alcoholics that did not modify their alcohol intake and teetotalers. In human endothelial cells that had been cultured for 2 weeks in the presence of different concentrations of ethanol, we assessed the same parameters after withdrawal of ethanol exposure. RESULTS: Alcohol increased the levels of endothelin-1, nitric oxide, and plasminogen activator inhibitor-1 and decreased the levels of von Willebrand factor both in vivo and in vitro. These changes were dose dependent, rapidly reversed after withdrawal of exposure, and associated with the presence of increased oxidative stress as indicated by increased levels of both malondialdehyde and intracellular glutathione. Blockade of oxidative stress by incubation of endothelial cells in the presence of oxidants' scavengers prevented the alcohol-induced functional modifications of the endothelium. CONCLUSIONS: Alcohol affects endothelial function with an effect that is mediated by an activated oxidative stress and is rapidly reversed after withdrawal. Dose-related endothelial responses to different alcohol intakes might translate in either vascular protection or vascular damage.     

2型糖尿病合并医院获得性肺炎病原学特点及药物敏感试验分析

目的了解2型糖尿病(T2DM)并发医院获得性肺炎(HAP)的病原学情况,分析药物敏感性,以指导临床抗生素合理使用。方法留取78例T2DM并发HAP患者合格痰标本,行痰培养及药物敏感试验检查并对结果进行分析。结果痰培养病原菌以革兰氏阴性杆菌(G-)为主,占76.7%,其中铜绿假单胞菌30.2%、大肠杆菌26.7%、肺炎克雷伯菌12.8%。两种细菌混合感染占15.4%;细菌与真菌并存占9.0%。对G-敏感性最高的抗生素依次为亚胺培南88.7%;美罗培南85.1%;哌拉西林/他唑巴坦78.6%。G+球菌对抗生素的敏感性依次为:万古霉素100%;替考拉林96.8%;米诺环素79.5%。结论 T2DM合并HAP有独特的病原学特点,以G-感染为主,应及时行病原学及药敏检测,合理有效使用抗生素。     

慢性阻塞性肺疾病急性加重期住院患者病原菌分布及耐药分析

目的分析我院呼吸内科慢阻肺急性加重期住院患者痰细菌培养、病原菌分布及耐药情况,为临床医师经验性合理应用抗菌药物提供参考依据。方法回顾性分析我院2013年9月-2015年9月呼吸内科住院1046例AECOPD患者痰细菌培养、药敏及耐药情况。结果 1046例AECOPD患者痰培养分离出病原菌224株,阳性率21.41%。其中,革兰氏阴性菌188株,占83.93%,常见病原菌依次为:肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌;革兰氏阳性菌3株,占病原菌总分布1.35%,分别为:金黄色葡萄球菌、肺炎链球菌、草绿色链球菌;真菌33株,占14.72%,依次为:白色念珠菌、酵母样真菌、曲霉菌、丝状真菌。结论 AECOPD患者病原菌以革兰氏阴性菌为主;临床上对反复感染及病情严重的住院患者应选用广谱β-内酰胺类、氨基糖苷类、喹诺酮类敏感抗菌药物或联合用药;并高度警惕真菌感染。     

Ohnologs in the human genome are dosage balanced and frequently associated with disease

About 30% of protein-coding genes in the human genome are related through two whole genome duplication (WGD) events. Although WGD is often credited with great evolutionary importance, the processes governing the retention of these genes and their biological significance remain unclear. One increasingly popular hypothesis is that dosage balance constraints are a major determinant of duplicate gene retention. We test this hypothesis and show that WGD-duplicated genes (ohnologs) have rarely experienced subsequent small-scale duplication (SSD) and are also refractory to copy number variation (CNV) in human populations and are thus likely to be sensitive to relative quantities (i.e., they are dosage-balanced). By contrast, genes that have experienced SSD in the vertebrate lineage are more likely to also display CNV. This supports the hypothesis of biased retention of dosage-balanced genes after WGD. We also show that ohnologs have a strong association with human disease. In particular, Down Syndrome (DS) caused by trisomy 21 is widely assumed to be caused by dosage effects, and 75% of previously reported candidate genes for this syndrome are ohnologs that experienced no other copy number changes. We propose the remaining dosage-balanced ohnologs on chromosome 21 as candidate DS genes. These observations clearly show a persistent resistance to dose changes in genes duplicated by WGD. Dosage balance constraints simultaneously explain duplicate gene retention and essentiality after WGD.     

老年慢性阻塞性肺病急性加重期患者呼吸道致病菌分布及耐药性分析

目的探讨老年慢性阻塞性肺病急性加重期(AECOPD)患者呼吸道致病菌分布与耐药性,为临床用药提供有效依据。方法对380例AECOPD患者进行呼吸道致病菌鉴定与药敏试验,以分析其菌群分布与耐药性。结果 380例患者中痰培养阳性者150例(39.47%),单一感染120例(80.00%)(细菌感染72例、真菌感染48例),混合感染30例(真菌混合感染2例、细菌合并真菌感染21例、细菌混合感染7例)。检出病原菌178株,革兰阴性杆菌134株(75.28%),以铜绿假单胞菌(35株)与鲍曼不动杆菌(26株)最为多见;革兰阳性球菌32株(17.98%),以金黄色葡萄糖球菌(17株)最为多见;另见真菌12株(6.74%)。铜绿假单胞菌对碳青霉烯类、β-内酰胺酶抑制剂复合物敏感性较高,对氨苄西林、头孢曲松耐药性较高;鲍曼不动杆菌对头孢哌酮/舒巴坦、碳青霉烯类、米诺环素耐药率较低,对其他抗生素耐药性较高;肺炎克雷伯杆菌对阿莫西林、氨苄西林、复方新诺明药物耐药性较高,对第四代头孢类抗生素、碳青霉烯类抗生素、β-内酰胺酶抑制剂复合物敏感性较高;金黄色葡萄糖球菌及肠球菌对万古霉素、替考啦宁、利奈唑胺敏感性较高。结论老年AECOPD患者呼吸道致病菌以革兰阴性杆菌为主,对抗菌药物耐药性较高,细菌培养与耐药性检测对指导临床合理用药具有重要意义。     

急性胆囊炎患者胆汁病原菌感染特点及其对抗菌药物的耐药性分析*

目的分析急性胆囊炎患者胆汁病原菌感染特点。方法自2010年1月~2013年12月江苏省泰州地区6家综合医院诊治的急性胆囊炎患者1878例,取胆汁行细菌培养及药敏鉴定。结果2010年共获细菌培养529份,革兰阴性菌占63.14%,革兰阳性菌占35.16%;2011年共获细菌培养576份,革兰阴性菌占58.16%,革兰阳性菌占39.76%;2012年共获细菌培养572份,革兰阴性菌占55.07%,革兰阳性菌占43.53%;2013年共获细菌培养537份,革兰阴性菌占51.96%,革兰阳性菌占45.44%。革兰阴性菌主要以大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌为主,革兰阳性菌主要以屎肠球菌、粪肠球菌、金黄色葡萄球菌为主,真菌感染较少,只有白色念珠菌、假丝酵母菌检出。结论急性胆囊炎患者胆汁以革兰阴性杆菌感染居多,但革兰阳性球菌呈逐年上升趋势,对抗菌药物的耐药性明显增加。在临床上应加强感染监测,重视药敏结果,警惕多重耐药菌的出现。     

呼吸科院内尿路感染患者病原菌及耐药分析

目的分析呼吸科院内尿路感染患者的病原菌种类分布及其耐药性,为合理用药提供参考。方法回顾性分析呼吸科明确诊断的院内尿路感染患者35例,分析其尿培养病原菌结果。结果 35例患者共分离出58株病原菌,其中革兰阴性菌27株,占46.55%,革兰阳性菌10株,占17.24%,真菌21株,占36.21%。病原菌按检测率排序前3位依次是大肠埃希菌(18.97%)、白色念珠菌(17.24%)、肺炎克雷伯杆菌(10.34%),药物敏感试验显示:革兰阴性菌及革兰阳性菌耐药性严重。结论呼吸科院内尿路感染病原菌以革兰阴性菌为主,且呈多重耐药现象。真菌感染检出率明显增高,临床需加以重视。     

老年COPD并社区获得性肺炎常见病原菌及耐药性分析

目的了解老年慢性阻塞性肺疾病（COPD）病人并发社区获得性肺炎常见病原菌及其耐药性的情况,为临床治疗提供参考。方法对我院70例老年COPD并发社区获得性肺炎患者的合格痰标本进行痰培养及药敏试验,对结果进行统计。结果70例患者痰培养阳性者共有40例,共获得致病菌株42株,革兰阴性杆菌占55．0％,其中铜绿假单胞菌最多（22．5％）,其次为肺炎克雷伯菌、大肠埃希菌。革兰阳性球菌以肺炎链球菌最多（17．5％）,其次为溶血性链球菌及金黄色葡萄球菌。革兰阴性杆菌对三代头孢霉素耐药严重,对头孢他定、头孢哌酮／舒巴坦或碳青霉烯类的抗生素较敏感。而革兰阳性球菌对青霉素几乎全部耐药,未发现对万古霉素耐药。结论老年COPD患者并发社区获得性肺炎的患者常见致病菌以革兰阴性杆菌多见,且耐药严重,临床选择抗生素时应加以注意。     

下呼吸道感染的病菌检测与耐药性相关分析

目的对下呼吸道感染的致病菌进行监测和耐药性分析。方法选取在我院住院的确诊下呼吸道感染的患者181例的痰液标本分离出的菌株进行分析,观察181株致病菌的分布结果和药敏试验结果。结果我院下呼吸道感染以革兰阴性菌为主,绝大多数的菌株均有不同程度的耐药。结论下呼吸道感染的发病率仍居高不下,严格地对科室内造成感染的致病菌进行监控与合理使用抗生素,以控制感染和避免耐药菌株的产生。     

慢性阻塞性肺疾病患者继发真菌性肺炎的特点及耐药情况

目的探讨慢性阻塞性肺疾病患者继发真菌性肺炎的真菌分布特点和耐药情况。方法分析2010年10月至2015年10月收治的60例慢性阻塞性肺疾病且伴有继发性真菌感染肺炎的患者的真菌感染情况。另选60例慢性阻塞性肺疾病无真菌感染的患者作为对照分析影响真菌感染的危险因素。结果 60例慢性阻塞性肺疾病且伴有继发性真菌感染肺炎患者的呼吸道分泌物样本中共检出475株真菌,其中主要为白色念珠菌,占63.58%。5种常用的抗真菌药物的抗菌活性不同,其中抗菌活性最好的是两性霉素B和伊曲康唑。经过统计分析后发现高龄、机械通气、长时间入住ICU、长期使用抗生素和糖皮质激素以及两种以上器官功能衰竭等是影响慢性阻塞性肺疾病患者继发真菌性肺炎的独立危险因素。结论慢性阻塞性肺疾病且伴有继发性真菌感染肺炎主要为感染白色念珠菌,抗真菌药物活性最好的是两性霉素B和伊曲康唑。对于此类患者应尽早发现病原性真菌、选择合适的抗真菌药物同时减少影响继发真菌感染的危险因素。