多重耐药鲍曼不动杆菌感染危险因素分析

目的：了解本地区多重耐药鲍曼不动杆菌感染的危险因素及耐药状况。方法回顾性分析80例多重耐药鲍曼不动杆菌患者与48例非多重耐药鲍曼不动杆菌感染患者的基本资料,以及菌株药敏试验检测结果;采用Logistic回归分析方法分析多重耐药菌株感染的独立危险因素。结果多重耐药鲍曼不动杆菌感染的独立危险因素包括入住重症监护病房（IC U ）、侵入性操作、两种及其以上抗菌药物序贯使用或联合使用。多重耐药鲍曼不动杆菌对左氧氟沙星、氨苄西林/舒巴坦、亚胺培南、替卡西林/克拉维酸的耐药率均大于60％,对除上述4种药物以外抗菌药物的耐药率均超过90％。结论多重耐药鲍曼不动杆菌感染的独立危险因素包括入住IC U、侵入性操作、两种及其以上抗菌药物序贯使用或联合使用。严格进行医院环境的消毒和医院感染的监测,合理使用抗菌药物,是控制多重耐药鲍曼不动杆菌感染的重要手段。     

非小细胞肺癌患者化疗后多重耐药鲍曼不动杆菌感染的危险因素分析

目的 探讨非小细胞肺癌(NSCLC)患者化疗后多重耐药鲍曼不动杆菌(MDR-AB)感染的危险因素,为临床预防提供参考.方法 回顾性选择2016年2月至2019年8月该院肿瘤内科收治的357例化疗后感染NSCLC患者,其中68例发生MDR-AB感染(MDR-AB组),289例未发生MDR-AB感染(对照组).统计MDR-...     

Evolution of multidrug-resistant Acinetobacter baumannii isolates obtained from elderly patients with respiratory tract infections

OBJECTIVES: To study the evolution between 1999 and 2002 and mechanisms of antibiotic resistance in a multidrug-resistant Acinetobacter baumannii clone predominant in isolates from elderly patients with respiratory tract infections. METHODS: Susceptibility to antimicrobials was determined using an agar dilution method. Bacterial clones were identified by PCR-fingerprinting and PFGE with ApaI. Carbapenemases were detected by phenotypic tests; by PCR with primers specific for bla (OXA-40), bla(IMP), bla(VIM-1) and bla(VIM-2); and by hybridization with DNA probes. Class 1 integrons were detected using PCR. RESULTS: In 1999 isolates were grouped into two main genotypes: clone I (33%) and clone II (55%). These were also detected in 2002 with a different distribution: clone I (69%), clone II (22%). Resistance to amikacin, meropenem and imipenem increased significantly in clone I over this time, whereas clone II was not affected. In 2002, the incidence of bla(OXA-40) rose to 91% in clone I isolates with some also harbouring bla(VIM-2) and bla(IMP) genes. Different class 1 integrons were detected ranging in size from 550 to 1200 bp. No relationship was found between carbapenemases and class 1 integrons. CONCLUSIONS: In elderly patients, a single clone became predominant among A. baumannii isolates, coinciding with an increase in antibiotic resistance rates. The majority of isolates harboured the bla(OXA-40) carbapenemase gene and some of them also harboured bla(VIM-2) and bla(IMP) genes. The presence of class 1 integrons also increased over time.     

多重耐药鲍曼不动杆菌对氯己定醇手消毒剂的抗性研究

摘要 目的 研究多重耐药鲍曼不动杆菌对氯己定醇手消毒剂的抗性变化,为科学实施医院消毒提供依据。方法 采用最小抑菌浓度测试方法,检测2种氯己定醇消毒剂对临床分离多重耐药鲍曼不动杆菌最小抑菌浓度(MIC),分析其抗性变化。结果 A、B 2种消毒剂含醋酸氯己定分别为1 750.00 mg/L和5 000.00 mg/L,含乙醇均为体积分数67.3%。以醋酸氯己定标示MIC值,消毒剂A对临床分离鲍曼不动杆菌、大肠杆菌和铜绿假单胞菌标准株的MIC值依次为43.75 mg/L、17.50 mg/L和29.20 mg/L;消毒剂B对上述3种细菌的MIC值依次为125.00 mg/L、50.00 mg/L和83.30 mg/L。结论 临床分离多重耐药鲍曼不动杆菌对氯己定醇手消毒剂的耐受浓度明显高于大肠杆菌和铜绿假单胞菌标准菌株,提示其抗力有增强趋势。     

慢性阻塞性肺疾病合并耐药鲍曼不动杆菌感染患者的护理

随着各种广谱抗生素的过度应用,导致多重耐药菌的出现并日益增多,多重耐药菌的感染,不仅加重了患者的病情,给患者带来了更大的痛苦,同时也是临床治疗的一大难题\[1\]。鲍曼不动杆菌是一种不能运动的革兰阴性杆菌,属于条件致病菌,该病菌耐药性高、定植较快、生命力强,可引起下呼吸道、血液、尿道及脑脊液等医院内感染,并且随着抗生素的广泛应用,鲍曼不动杆菌的耐药性日渐升高,出现了多重耐药菌株甚至是泛耐药菌株,而老年人由于身体机能下降,免疫力较差,更容易引起鲍曼不动杆菌感染。因此在对鲍曼不动杆菌的临床针对性治疗同时更应注重护理,防止鲍曼不动杆菌在院内传播和爆发流行\[2\]。我院于2013年1月-2014年1月收治20例慢性阻塞性肺疾病合并耐药鲍曼不动杆菌感染患者,经积极治疗和精心护理好转出院,未发生院内感染。现将护理体会报告如下。     

血液病患者鲍曼不动杆菌的耐药性分析及其耐药基因检测

目的了解血液病患者临床分离鲍曼不动杆菌的耐药表型和多种耐药基因的携带情况。方法收集2011年临床分离的非重复鲍曼不动杆菌120株,采用纸片扩散法进行药敏试验,试验结果按照CLSI 2011年版标准判读,采用WHONET 5.6软件进行数据分析;应用聚合酶链反应及测序方法检测10种耐药相关基因（blaOXA-51-like、blaOXA-23-like、blaOXA-24-like、blaOXA-58-like、blaTEM、blaampC、armA、ISAba1、intI 1和intI 2）。结果鲍曼不动杆菌对13种抗菌药物的耐药率范围为48.3%~94.2%,对碳青霉烯类抗菌药物亚胺培南和美罗培南的耐药率分别为51.7%和48.3%;耐药相关基因blaOXA-51-like、blaOXA-23-like、blaTEM、blaampC、armA、ISAba1和intI 1的阳性率分别为100%、60.0%、46.7%、85.8%、75.8%、86.7%和85.0%,而未检出blaOXA-24-like、blaOXA-58-like和intI 2。结论碳青霉烯类抗菌药物对鲍曼不动杆菌仍具有较好的体外抗菌活性,鲍曼不动杆菌多重耐药相关基因的携带率较高,多重耐药现象非常严重,应加强其耐药性监测,合理使用抗菌药物。     

Morbidity and mortality risk factors in emergency department patients with Acinetobacter baumannii bacteremia

BACKGROUND: Acinetobacter baumannii (AB) bacteremia is an increasingly common and often fatal nosocomial infection. Identification of morbidity and mortality risk factors for AB bacteremia in emergency department (ED) patients may provide ways to improve the clinical outcomes of these patients.     

肺炎患者痰液分离鲍曼不动杆菌耐药基因分析

目的分析呼吸内科肺炎患者痰液分离鲍曼不动杆菌携带β-内酰胺酶基因及主动外排泵基因情况。方法收集经生化鉴定为醋酸钙-鲍曼不动杆菌复合体的菌株160株,将鲍曼不动杆菌特异性片段(Ab-ITS)的二重PCR法确认为鲍曼不动杆菌者纳入研究。用PCR法检测鲍曼不动杆菌β-内酰胺酶基因和主动外排泵基因,包括A类β-内酰胺酶(bla_TEM、bla_PER和bla_CARB)、B类β-内酰胺酶(bla_IMP和bla_VIM)、C类β-内酰胺酶(bla_ADC和bla_DHA)、D类β-内酰胺酶(bla_OXA-23、bla_OXA-24、bla_OXA-51和bla_OXA-58)和主动外排泵相关基因(adeB、adeJ、macB、emrB、emrA、abeS、abeM和craA)。以微量肉汤稀释法检测加入外排泵抑制剂羰基氰化氯苯腙(CCCP)前后,携带adeB基因鲍曼不动杆菌对亚...     

耐药鲍曼不动杆菌临床分离株对胍类消毒剂抗性的研究

摘要 目的 分析比较临床分离的多重耐药菌鲍曼不动杆菌对胍类消毒剂（聚六亚甲基单胍和聚六亚甲基双胍）的抗性,为医院环境选择使用该类消毒剂提供科学依据。方法 收集山东省济南市和临沂市的46株耐药鲍曼不动杆菌临床分离菌株,采用消毒剂最小抑菌浓度（MIC）和最小杀菌浓度（MBC）试验测定多重耐药鲍曼不动杆菌临床分离菌株对胍类消毒剂的抗性,并与标准菌株大肠杆菌（8099）和鲍曼不动杆菌（ATCC 10501）进行比较。结果 44株多重耐药鲍曼不动杆菌临床分离菌株对聚六亚甲基单胍和双胍的MIC结果中位数分别是6.25 mg/和12.5 mg/L。36株鲍曼不动杆菌临床分离菌株对聚六亚甲基单胍和双胍的MBC结果中位数分别是100 mg/L和400 mg/L。结论 多重耐药鲍曼不动杆菌临床分离菌株对聚六亚甲基双胍的抗性强于聚六亚甲基单胍,说明聚六亚甲基单胍对多重耐药鲍曼不动杆菌临床分离菌株抑菌和杀菌能力要强于聚六亚甲基双胍。     

鱼腥草素钠联合阿米卡星体外抗多重耐药鲍曼不动杆菌的作用分析

目的 探讨鱼腥草素钠(SH)联合阿米卡星(AMK)对多重耐药鲍曼不动杆菌(MDR-AB)的体外抑制作用.方法 从川北医学院附属医院微生物室收集10株MDR-AB菌株,采用棋盘法设计实验,以微量肉汤稀释法、琼脂稀释法分别测定两种药物不同水平组合对MDR-AB的最低抑菌浓度(MIC)值,计算部分抑菌浓度指数(FICI)及抑...     

A systematic review of predictors and screening instruments to identify older hospitalized patients at risk for functional decline

Aims and objectives. To determine a valid, reliable and clinical user‐friendly instrument, based on predictors of functional decline, to identify older patients at risk for functional decline. The predictors of functional decline are initially considered and, subsequently, the characteristics and psychometric qualities of existing screening instruments are investigated. Background. Functional decline is a common and serious problem in older hospitalized patients, resulting in a change in quality of life and lifestyle. Studies have shown that 30–60% of older people develop new dependencies in activities of daily living (ADL) during their hospital stay. Adverse health outcomes such as mortality, a prolonged hospital stay, nursing home placement and increased dependency of older people at home are the results. Not only are the personal costs high but also, in a rapidly growing older population, the impact on health‐care costs is also high. Results. Age, lower functional status, cognitive impairment, preadmission disability in instrumental activities of daily life (IADL), depression and length of hospital stay were identified as predictors of functional decline. Three screening instruments to identify hospitalized patients at risk for functional decline were found in the literature: the Hospital Admission Risk Profile, the Identification of Seniors at Risk and the Care Complexity Prediction Instrument. The reported validity was moderate. Reliability and the ease of use in the clinical setting were not well described. Conclusion. These three instruments should be further tested in a hospitalized older population. Relevance to clinical practice. Screening is a first step to identify patients at risk for functional decline and this will make it possible to treat patients who are identified so as to prevent functional decline. Because of their ability to observe and to guide the patients and the overall view they have, nurses play a key role in this process.     

Clinical predictors of Pseudomonas aeruginosa or Acinetobacter baumannii bacteremia in patients admitted to the ED

The identification of clinical characteristics that could identify patients at high risk for Pseudomonas aeruginosa or Acinetobacter baumannii bacteremia would aid clinicians in the appropriate management of these life-threatening conditions, especially in patients admitted to the emergency department (ED) with community-onset infections. To determine clinical risk factors for P. aeruginosa or A. baumannii bacteremia in patients with community-onset gram-negative bacteremia (GNB), a post hoc analysis of a nationwide bacteremia surveillance database including patients with microbiologically documented GNB was performed. Ninety-six patients with P. aeruginosa or A. baumannii bacteremia were compared with 1230 patients with Escherichia coli or Klebsiella pneumoniae bacteremia. A solid tumor or hematologic malignancy was more likely to be associated with P. aeruginosa or A. baumannii bacteremia, whereas concurrent neurologic disease was less frequently seen. In regards to the site of infection, pneumonia was more common in P. aeruginosa or A. baumannii bacteremia, whereas a urinary tract infection was less frequently seen. Factors associated with P. aeruginosa or A. baumannii bacteremia in multivariate analysis included pneumonia (odds ratio [OR], 3.60; 95% confidence interval [CI], 1.86-6.99), hematologic malignancy (OR, 2.71; 95% CI, 1.26-5.84), male sex (OR, 2.17; 95% CI, 1.31-3.58), solid tumor (OR, 1.89; 95% CI, 1.15-3.12), and health-care-associated infection (OR, 1.88; 95% CI, 1.48-2.41). Our data suggest that an initial empirical antimicrobial coverage of P. aeruginosa or A. baumannii bacteremia should be seriously considered in patients with pneumonia, a hematologic malignancy, solid tumor, or health-care-associated infection, when GNB is suspected, even in community-onset infections.     

Whole-genome pyrosequencing of an epidemic multidrug-resistant Acinetobacter baumannii strain belonging to the European clone II group

The whole-genome sequence of an epidemic, multidrug-resistant Acinetobacter baumannii strain (strain ACICU) belonging to the European clone II group and carrying the plasmid-mediated bla(OXA)(-)(58) carbapenem resistance gene was determined. The A. baumannii ACICU genome was compared with the genomes of A. baumannii ATCC 17978 and Acinetobacter baylyi ADP1, with the aim of identifying novel genes related to virulence and drug resistance. A. baumannii ACICU has a single chromosome of 3,904,116 bp (which is predicted to contain 3,758 genes) and two plasmids, pACICU1 and pACICU2, of 28,279 and 64,366 bp, respectively. Genome comparison showed 86.4% synteny with A. baumannii ATCC 17978 and 14.8% synteny with A. baylyi ADP1. A conspicuous number of transporters belonging to different superfamilies was predicted for A. baumannii ACICU. The relative number of transporters was much higher in ACICU than in ATCC 17978 and ADP1 (76.2, 57.2, and 62.5 transporters per Mb of genome, respectively). An antibiotic resistance island, AbaR2, was identified in ACICU and had plausibly evolved by reductive evolution from the AbaR1 island previously described in multiresistant strain A. baumannii AYE. Moreover, 36 putative alien islands (pAs) were detected in the ACICU genome; 24 of these had previously been described in the ATCC 17978 genome, 4 are proposed here for the first time and are present in both ATCC 17978 and ACICU, and 8 are unique to the ACICU genome. Fifteen of the pAs in the ACICU genome encode genes related to drug resistance, including membrane transporters and ex novo acquired resistance genes. These findings provide novel insight into the genetic basis of A. baumannii resistance.     

苏州地区重症监护病房多重耐药鲍曼不动杆菌感染的危险因素分析

目的 探讨重症监护病房( ICU)多重耐药鲍曼不动杆菌感染的危险因素,并对分离菌株进行耐药性分析,为预防其感染及治疗提供依据.方法 回顾性调查分析本医院综合性重症监护室(SICU) 2009年1月至2011年3月多重耐药鲍曼不动杆菌和非多重耐药株感染的药敏结果和相关因素的暴露情况.调查内容包括:年龄、基础疾病、手术史、感染前急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯性器官功能衰竭(SOFA)评分、侵入性操作、抗生素的使用情况等.选择同时期非多重耐药菌株感染患者作为对照.采用t检验和x2检验及多因素logistic回归进行分析.回顾性调查分析ICU内患者分离的鲍曼不动杆菌的耐药率.结果 多重耐药组比非多重耐药组APACHEⅡ评分、SOFA评分的升高;气管插管/切开、使用三代头孢、碳青霉烯抗生素以及抗生素使用＞7天者比非多重耐药组高.多因素logistic回归分析,第3代头孢抗生素的使用(OR =2.379,95％CI=1.098～5.155),APACHEⅡ评分(OR=1.332,95％CI=1.123～1.581)、SOFA评分(OR=0.706,95％CI =0.530～0.941)的升高、气管切开/插管(OR=2.636,95％ CI=1.118～6.216)是发生多重耐药鲍曼不动杆菌感染的独立危险因素.分离的鲍曼不动杆菌进行抗菌药物的耐药率分析,发现其对临床常用抗菌药物的耐药率多在50％以上,对头孢哌酮/舒巴坦较敏感,耐药率为12.2％.结论 第3代头孢的使用,APACHEⅡ评分、SOFA评分的升高,气管切开/插管是发生多重耐药鲍曼不动杆菌感染的危险因素.     

Outcomes of critically ill cancer patients with Acinetobacter baumannii infection

AIM: To describe the intensive care unit(ICU) outcomes of critically ill cancer patients with Acinetobacter baumannii(AB) infection.METHODS: This was an observational study that included 23 consecutive cancer patients who acquired AB infections during their stay at ICU of the National Cancer Institute of Mexico(INCan), located in Mexico City. Data collection took place between January 2011, and December 2012. Patients who had AB infections before ICU admission, and infections that occurred during the first 2 d of ICU stay were excluded. Data were obtained by reviewing the electronic health record of each patient. This investigation was approved by the Scientific and Ethics Committees at INCan. Because of its observational nature, informed consent of the patients was not required.RESULTS: Throughout the study period, a total of 494 critically ill patients with cancer were admitted to the ICU of the INCan, 23(4.6%) of whom developed AB infections. Sixteen(60.9%) of these patients had hematologic malignancies. Most frequent reasons for ICU admission were severe sepsis or septic shock(56.2%) and postoperative care(21.7%). The respiratory tract was the most frequent site of AB infection(91.3%). The most common organ dysfunction observed in our group of patients were the respiratory(100%), cardiovascular(100%), hepatic(73.9%) and renal dysfunction(65.2%). The ICU mortality of patients with 3 or less organ system dysfunctions was 11.7%(2/17) compared with 66.6%(4/6) for the group of patients with 4 or more organ system dysfunctions(P = 0.021). Multivariate analysis identified blood lactate levels(BLL) as the only variable independently associated with inICU death(OR = 2.59, 95%CI: 1.04-6.43, P = 0.040). ICU and hospital mortality rates were 26.1% and 43.5%, respectively.CONCLUSION: The mortality rate in critically ill patients with both HM, and AB infections who are admitted to the ICU is high. The variable most associated with increased mortality was a BLL ≥ 2.6 mmol/L in the first day of stay in the ICU.     

寻常型天疱疮合并鲍曼不动杆菌感染病人的护理

报告2例天疱疮合并鲍曼不动杆菌感染病人的护理。护理要点:严密观测病情变化,及时准确地给予抗感染、营养支持及对症治疗,针对皮损的程度实施皮肤创面综合护理,防止发生传染,制订营养计划,给予情感支持,做好药物治疗护理等。