广州地区380例儿童脓疱疮病原菌培养及药敏分析

目的了解广州地区儿童脓疱疮的病原菌分布及药物敏感性。方法对380例脓疱疮患儿的脓疱疮液做细菌培养,并对分离出的368株金黄色葡萄球菌(简称金葡)进行12种抗生素的药敏试验。结果分离出病原菌分别为金葡368株(96.8%),凝固酶阴性葡萄球菌2株(0.5%),产气杆菌2株(0.5%),大肠埃希菌2株(0.5%),摩根摩根菌1株(0.3%)。对368株金葡菌进行的药敏试验结果显示:金葡菌对青霉素、红霉素、克林霉素的耐药率>63.6%。对万古霉素、阿米卡星、头孢呋辛钠、头孢唑林、头孢西丁、苯唑西林、阿莫西林/克拉维酸、头孢曲松、头孢他啶则高敏感率,敏感率>95.4%。结论广州地区儿童脓疱疮的主要致病菌为金葡菌,青霉素、红霉素、克林霉素的耐药性较高,已不适于治疗本地区由金葡菌感染引起的脓疱疮。     

脓疱疮的病原菌分离及耐药性分析

目的观察脓疱疮的病原菌分布，监测耐药菌尤其是耐甲氧西林金黄色葡萄球菌的流行情况，为临床选择合理而有效的治疗方案提供依据。方法对 246例脓疱疮患者皮损进行病原菌分离，并对分离出的 212株金黄色葡萄球菌 (简称金葡菌 )进行 15种抗生素的琼脂稀释法药敏试验。结果从 246例脓疱疮患者皮损分离出病原菌 233株，单纯金葡菌占 87.0％；单纯 A组β－溶血性链球菌占 1.6％；金葡菌与 A组β－溶血性链球菌混合感染占 2.0％；表皮葡萄球菌占 4.1％。对 212株金葡菌进行的药敏试验结果显示，金葡菌对青霉素 100％耐药，对红霉素为 87.7％，对克林霉素为 75.5％，对四环素、氯霉素、优力欣、苯唑西林、环丙沙星耐药率依次为 63.2％、 54.2％、 44.8％、 30.2％和 12.8％，对头孢噻肟、夫西地酸、庆大霉素均为 0.9％耐药，对头孢唑啉、头孢呋辛、莫匹罗星、万古霉素均未发现耐药菌。从 212株金葡菌分离出 64株耐甲氧西林金葡菌，未发现耐万古霉素菌株。结论青霉素、红霉素、克林霉素、四环素、氯霉素和优力欣等种类的药物在本地区已不适于治疗金葡菌感染的脓疱疮。莫匹罗星、夫西地酸和头孢菌素可以作为治疗脓疱疮的局部或全身用药。     

肤光方及其加减方体外抗金黄色葡萄球菌活性研究

目的 观察肤光方及其加减方在体外对金黄色葡萄球菌（金葡菌）甲氧西林敏感株和耐药株的抑制作用.方法 运用纸片扩散法和平板打孔法观察肤光方及其加减方对体外分离培养金黄色葡萄球菌甲氧西林敏感株和耐药株生长的影响,采用琼脂稀释法测各组方对两型金葡菌的最小抑菌浓度（MIC）.结果 纸片法结果显示除清热燥湿方外,其余各组方对金葡菌甲氧西林敏感株和耐药株均有抑制作用（P＜0.05）,打孔法结果显示各组方对金葡菌甲氧西林敏感株和耐药株具有一定的抑菌活性（P＜0.05）.结合各组方的MIC值发现,肤光方、祛风止痒方、收敛解毒方、清热解毒燥湿方、清热解毒方和清热燥湿方抑菌活性依次减弱,其中收敛解毒方和清热解毒燥湿方之间差异无统计学意义（P＞0.05）.结论 肤光方及其加减方对金葡菌甲氧西林敏感株和耐药株均具有抑菌活性.     

北京地区儿童皮肤感染金黄色葡萄球菌的耐药研究

目的 分析儿童皮肤感染金黄色葡萄球菌的耐药现状及社区获得性耐甲氧西林金黄色葡萄球菌的流行情况。方法 对600例感染性皮肤病患儿皮损分泌物进行细菌培养。应用琼脂稀释法检测抗生素及环丙沙星对培养出的金黄色葡萄球菌的最小抑菌浓度。结果 600例患儿皮损共培养出金黄色葡萄球菌451株，对13种抗生素及环丙沙星的药敏试验结果显示，对青霉素耐药率为93.8%，对红霉素耐药率为87.6%，对克林霉素为71.6%，对四环素、氯霉素、庆大霉素和环丙沙星的耐药率依次为37.3%，13.3%，6.4%和2.2%，对苯唑西林、头孢唑啉、头孢呋辛和莫匹罗星耐药率分别为1.6%，0.4%，0.2%和0.2%，未发现头孢曲松、万古霉素和夫西地酸耐药菌株。结论 儿童社区获得性耐甲氧西林金黄色葡萄球菌分离率为1.6%。治疗社区来源的皮肤金黄色葡萄球菌感染性皮肤病，全身治疗首选耐青霉素酶的半合成青霉素和头孢菌素，外用治疗可选择莫匹罗星或夫西地酸。     

皮肤金黄色葡萄球菌感染的抗菌药物选择

常见由金黄色葡萄球菌引起的感染性皮肤病有脓疱疮、毛囊炎、疖、痈和葡萄球菌烫伤样皮肤综合征等。目前临床上系统治疗建议首选耐青霉素酶半合成青霉素和头孢类抗生素,慎重选择红霉素。耐甲氧西林金葡菌感染时推荐使用夫西地酸或万古霉素等糖肽类抗生素,备选用药为利奈唑胺。浅表、局限金葡菌感染时可外用药物莫匹罗星,其他如夫西地酸、喹诺酮类抗生素和复方多黏菌素B等也是可供选择的外用药。鉴于金葡菌对多种抗生素的耐药性增加,应进行流行病学监测,根据耐药结果调整经验治疗。     

皮肤细菌感染440例患者的病原菌及药敏分析

目的:了解皮肤细菌感染的菌种分布特征及对常用抗菌药的敏感性,为指导临床用药提供依据。方法:收集2011—2012年天津市长征医院皮肤科住院患者常规细菌培养阳性结果共440例,记录其细菌培养及药敏结果。从而了解该院皮肤科患者的病种分布、细菌分布现状及耐药情况。结果:革兰阳性菌为主要致病菌且对红霉素、青霉素耐药率较高;革兰阴性球菌对左氧氟沙星和环丙沙星的耐药率较高;对亚胺培南和阿米卡星较敏感;金黄色葡萄球菌(SA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)二者的药敏结果存在差异,差异具有统计学意义(P0.05)。结论:皮肤科住院患者细菌培养的耐药问题较严重;通过药敏试验结果进一步了解患者病原菌的变化和耐药情况,并根据细菌的种类和耐药情况为进一步合理、准确地使用抗生素,指导临床个性化用药提供了一定的依据。     

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。     

皮肤软组织感染分离菌的分布及耐药性

目的　观察皮肤软组织感染分离菌分布情况 ,检测耐药菌流行情况 ,为临床选择合理有效的治疗方案提供依据。方法　对 66例皮肤感染者进行病原菌分离 ,并对分离出的 70株病原菌以琼脂扩散法测定药敏。结果　从 66例皮肤感染的皮损中分离出病原菌 70株 ,革兰阳性菌占 71.4% ,其中苯唑西林耐药凝固酶阳性金黄色葡萄球菌 (MRSA )占 3 7.1% ,苯唑西林耐药凝固酶阴性葡萄球菌 (MRSE)占 2 1.4% ;革兰阴性菌占 2 5 .7% ,其中溶血性大肠埃希菌占 10 % ;真菌占 2 .9%。药敏试验显示MRSA对阿奇霉素、罗红霉素、红霉素、复方磺胺甲 口恶唑、青霉素、克林霉素耐药率依次为92 .3 %、84.6%、76.9%、73 .1%、69.2 %、65 .4% ;MRSE的耐药率依次为 86.7%、86.7%、73 .3 %、73 .3 %、60 .0 %、73 .3 % ;溶血性大肠埃希菌对氨苄西林、四环素、呋喃妥因、头孢呋辛、头孢唑啉耐药率依次为 85 .7%、71.4%、5 7.1%、5 7.1%、5 7.1%。结论　红霉素、阿奇霉素、罗红霉素、复方磺胺甲 口恶唑等已不适于治疗革兰阳性菌感染 ,氨苄西林、呋喃妥因、头孢唑啉、四环素等已不适于治疗革兰阴性菌感染。     

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。     

湿疹与特应性皮炎皮损处细菌学研究

目的 探讨湿疹和特应性皮炎(AD)皮损处的细菌学特点及金黄色葡萄球菌(金葡菌)在湿疹及AD发病中的作用。方法 多中心随机双盲对207例湿疹患者和119例AD患者皮损及非皮损处取材做细菌培养,并对所分离到的金葡菌进行常规药敏试验和噬菌体分型。结果 207例湿疹患者皮损处的细菌检出阳性率、金葡菌的比例及定植均明显高于非皮损处,差异有显著性(P<0.01)。119例AD患者皮损处的细菌检出阳性率及金葡菌的定植明显高于非皮损处,差异有显著性。对分离到的141株金葡菌进行噬菌体分型。Ⅰ组占6.3%,Ⅱ组占7.0%,Ⅲ组占3.5%,Ⅴ组占0.7%,杂组占1.4%,不能分型占56%,MRSA分型噬菌体26株混合组占6.3%。药敏试验结果表明在常用的6种外用抗菌药物中莫匹罗星对金葡菌和表皮葡萄球菌的抗菌活性最强,其MIC范围、MIC₉₀和MIC₅₀是6种抗菌药物中最低的。且莫匹罗星对金葡菌及其中的各噬菌体分型和表皮葡萄球菌中的耐甲氧西林和耐甲氧西林凝固酶阴性菌株也有较好的抑菌能力。结论 湿疹和AD的发病与细菌感染密切相关,其中金葡菌是最重要的细菌,对湿疹和AD患者外用药治疗合并使用外用抗菌药物是必要的,根据对金葡菌抗菌活性的测定,莫匹罗星的效果较好。     

The antibacterial activity of topical retinoids: the case of retinaldehyde

BACKGROUND: Retinoids such as retinoic acid (RA), retinol (ROL) and retinaldehyde (RAL) are currently used in many formulations and indications ranging form acne to skin aging. Most if not all their pharmacological activities occur through binding to nuclear receptors with subsequent modulation of the activities of several genes. Little attention has been given to the many other potential actions on the surface of the skin. AIM: To analyse the potential anti-infective activities of topical ROL, RAL and RA. METHODS: Microbial minimal inhibitory concentrations (MIC) of ROL, RAL and RA were determined by a microdilution method on reference strains including Staphylococcus aureus, Staphylococcus epidermidis, Micrococcus flavus, Propionibacterium acnes, Micrococcus luteus, Enterococcus faecium, Staphylococcus hominis, Escherichia coli, Pseudomonas aeruginosa, Candida albicans and 133 clinical strains including methicillin-resistant S. aureus, methicillin-sensitive S. aureus, coagulase-negative Staphylococcus, Streptococcus group B, Enterococcus faecalis, vancomycin-resistant E. faecalis, vancomycin-resistant E. faecium and Pseudomonas/Klebsiella. In two clinical trials in healthy human volunteers, skin bacterial densities were evaluated in samples obtained with the cylinder scrub method: (1). 2 and 5 h after a single application of 0.05% RAL or vehicle on the forearm and (2). in a single-blind randomized study where 0.05% RAL or vehicle were applied daily for 2 weeks on the forehead of 22 volunteers. Paired results from treated (or vehicle) and untreated areas were analysed. RESULTS: Of the three retinoids tested, only RAL showed a significant in vitro antibacterial activity; this activity was found against reference strains of gram-positive bacteria like S. aeureus, Micrococcus spp. or P. acnes. No activity was found against gram-negative bacteria. These results on reference strains were confirmed on 133 clinical isolates. MIC(50) and MIC(90) values for RAL were 8 and 16 mg/l, respectively, for methicillin-sensitive S. aureus and 4 and 8 mg/l for methicillin-resistant S. aureus. The two in vivo studies showed that areas treated with RAL had a significant decrease in the bacterial counts. In the forehead study, the median decrease was 10(2) log/cm(2) for P. acnes and 10(1.8) log/cm(2) for staphylococci. No resistant bacteria were found after 2 weeks of topical use. Preliminary results suggest that the antibacterial effect of RAL is due, in part, to the aldehyde group in the lateral chain, since non-retinoid pseudo-analogues of the chain, like citral and hexenal, showed a similar antibacterial activity. CONCLUSION: We have shown that RAL differs from parent natural retinoids such as ROL and RA in demonstrating significant antibacterial activities upon topical use. This activity is likely due to the aldehyde group in the isoprenoic lateral chain, which illustrates the potential bifunctional properties of some retinoids.     

The antibacterial efficacy of econazole nitrate in interdigital toe web infections

Twenty-four patients with severe interdigital toe web infections and no evidence of dermatophyte colonization received randomized treatment with either econazole nitrate (Spectazole) or its vehicle. Of the patients treated with econazole nitrate, 88% had good to excellent responses, whereas no patient treated with the vehicle showed improvement. The total aerobic flora in the econazole group decreased 93%, with decreases in the large-colony diphtheroids, lipophilic diphtheroids, and gram-negative bacteria. The results of this study demonstrate that the antibacterial activity of econazole nitrate makes it an effective agent for the treatment of severe interdigital bacterial infections uncomplicated by dermatophyte colonization.     

武汉地区门诊皮肤软组织感染患者中甲氧西林敏感金黄色葡萄球菌PVL基因携带及耐药性检测

目的 探讨从武汉地区门诊皮肤软组织感染（SSTI）患者中分离的甲氧西林敏感金黄色葡萄球菌（MSSA）携带杀白细胞毒素（PVL）基因及耐药特征。 方法 收集2011—2013年在武汉市5所医疗机构门诊就诊SSTI患者中分离的182株MSSA,采用纸片扩散法进行药敏试验,多重PCR法检测mecA基因和PVL基因。结果 182株MSSA中有65株PVL阳性,阳性率为35.71%。不同病种PVL阳性率差异有统计学意义（χ2 = 49.76,P = 0.00）,其中疖/痈（7/7）、毛囊炎（3/3）、脓肿（55.53%,30/57）和脓疱疮（2/4）的检出率较高。PVL阳性患者年龄［（35.40 ± 19.31）岁］小于PVL阴性患者［（43.21 ± 20.75）岁］,差异有统计学意义（t = 2.50,P = 0.01）。在65株PVL阳性MSSA菌株中,耐药率居前3位的依次是氨苄西林（87.69%）、青霉素（53.85%）、红霉素（41.54%）。在117株PVL阴性MSSA菌株中,耐药率居前3位的依次是克林霉素（26.50%）、青霉素（20.51%）、氨苄西林（12.82%）。PVL阳性MSSA菌株对青霉素（χ2 = 21.19）、氨苄西林（χ2 = 97.97）、多西环素（χ2 = 11.61）、环丙沙星（χ2 = 8.07）、红霉素（χ2 = 25.04）、庆大霉素（χ2 = 10.86）的耐药率高于PVL阴性MSSA菌株,差异均有统计学意义（P < 0.05）。 结论 武汉地区门诊MSSA SSTI患者中,PVL阳性率较高,对大多数β内酰胺类抗菌药物耐药,经验治疗可选择氟氯西林、复方磺胺甲恶唑片或多西环素。     

Evaluation of in vitro activity of ciclopirox olamine,butenafine HCl and econazole nitrate against dermatophytes,yeasts and bacteria

Background In many instances, a cutaneous fungal infection may exist concomitantly with bacterial involvement. In this study we compared the in vitro activity of three antifungal agents against the dermatophytes, yeasts and bacteria recovered most commonly from cutaneous mycoses and bacterial infections. Methods Using a microdilution method adapted from the National Committee for Clinical Laboratory Standards (NCCLS), we determined the minimum inhibitory concentrations (MICs) of ciclopirox olamine, econazole nitrate and butenafine HCl against a panel of dermatophyte fungi and yeasts (n = 39) and bacterial isolates (n = 45). Results All three antifungals demonstrated comparable activity against the dermatophytes tested, with a MIC range of 0.03–0.25 µg/ml for ciclopirox, < 0.001–0.25 µg/ml for econazole and 0.03–0.25 µg/ml for butenafine. For yeasts, ciclopirox showed activity against all isolates, with an MIC range of 0.001–0.25 µg/ml, whereas econazole had a broader range of 0.125–> 0.5 µg/ml. Butenafine displayed limited activity against the yeast Candida albicans and no activity against Malassezia furfur. For the antibacterial activity studies, ciclopirox demonstrated activity against all isolates tested with a range of 0.06–2 µg/ml, while econazole showed activity against Gram‐positive bacteria only, with a MIC range of 0.004–0.25 µg/ml. Butenafine HCl had a limited activity against bacterial isolates tested, showing activity against β‐hemolytic Streptococcus Group A and Corynebacterium only. Neither econazole nitrate nor butenafine HCl demonstrated activity against any of the Gram‐negative strains evaluated in this study. Conclusions The data suggest that ciclopirox olamine has the broadest in vitro activity, in comparison to econazole and butenafine HCl, against bacteria, yeasts and bacteria. These findings may have implications in the use of these antimycotics in the treatment of mixed cutaneous infections where bacteria or yeasts are present in addition to dermatophytes.     

银屑病皮损鳞屑中两种微生物的检测及外用派瑞松效果

目的探讨银屑病发病与金黄色葡萄球菌(简称金葡菌)、糠秕孢子菌感染的关系及观察外用派瑞松治疗效果。方法对银屑病病人皮损进行细菌培养及真菌真接镜检,并外用派瑞松治疗。结果银屑病患者金葡菌和糠秕孢子菌带菌率均高于正常对照(P<0.01;P<0.05),治疗后带菌率明显下降;治愈率和有效率分别为18.0%,72.0%。结论金葡菌、糠秕孢子菌在银屑病的发病和发展中起一定作用,派瑞松是治疗银屑病较好的药物之一。     

曲安奈德益康唑乳膏长疗程间歇疗法治疗局限性慢性湿疹

目的 探讨外用糖皮质激素长疗程间歇疗法治疗局限性慢性湿疹的疗效、安全性及复发情况,以指导临床用药。方法 选取门诊局限性慢性湿疹患者,外用曲安奈德益康唑乳膏短程治疗。症状积分下降指数（SSRI）≥90％的患者进入长疗程,随机分两组,分别外用曲安奈德益康唑乳膏和润肤霜,间歇用药,共治疗8周。长疗程治疗4周、8周时及长疗程治疗停药12周时各随访1次。结果 长疗程治疗8周及停药12周时,曲安奈德益康唑组SCORAD评分均显著低于润肤霜组（t值分别为3.076和2.367,P值均 < 0.05）。长疗程治疗4周、8周及停药12周时,曲安奈德益康唑组复发率均显著低于润肤霜组（χ2值分别为4.426、7.683、8.199,P值均 < 0.05）。治疗期间不良反应发生率3.1％,无严重不良事件。结论外用糖皮质激素长疗程间歇治疗慢性湿疹,有防止症状加重、延缓湿疹复发的作用。     

曲安奈德益康唑乳膏长疗程间歇疗法治疗局限性慢性湿疹

目的 探讨外用糖皮质激素长疗程间歇疗法治疗局限性慢性湿疹的疗效、安全性及复发情况,以指导临床用药.方法 选取门诊局限性慢性湿疹患者,外用曲安奈德益康唑乳膏短程治疗.症状积分下降指数(SSRI)≥190%的患者进入长疗程,随机分两组,分别外用曲安奈德益康唑乳膏和润肤霜,间歇用药,共治疗8周.长疗程治疗4周、8周时及长疗程治疗停药12周时各随访1次.结果 长疗程治疗8周及停药12周时,曲安奈德益康唑组SCORAD评分均显著低于润肤霜组(t值分别为3.076和2.367,P值均<0.05).长疗程治疗4周、8周及停药12周时,曲安奈德益康唑组复发率均显著低于润肤霜组(x2值分别为4.426、7.683、8.199,P值均<0.05).治疗期间不良反应发生率3.1%,无严重不良事件.结论 外用糖皮质激素长疗程间歇治疗慢性湿疹,有防止症状加重、延缓湿疹复发的作用.     

曲安奈德益康唑乳膏长疗程间歇疗法治疗局限性慢性湿疹

目的 探讨外用糖皮质激素长疗程间歇疗法治疗局限性慢性湿疹的疗效、安全性及复发情况,以指导临床用药.方法 选取门诊局限性慢性湿疹患者,外用曲安奈德益康唑乳膏短程治疗.症状积分下降指数(SSRI)≥190%的患者进入长疗程,随机分两组,分别外用曲安奈德益康唑乳膏和润肤霜,间歇用药,共治疗8周.长疗程治疗4周、8周时及长疗程治疗停药12周时各随访1次.结果 长疗程治疗8周及停药12周时,曲安奈德益康唑组SCORAD评分均显著低于润肤霜组(t值分别为3.076和2.367,P值均<0.05).长疗程治疗4周、8周及停药12周时,曲安奈德益康唑组复发率均显著低于润肤霜组(x2值分别为4.426、7.683、8.199,P值均<0.05).治疗期间不良反应发生率3.1%,无严重不良事件.结论 外用糖皮质激素长疗程间歇治疗慢性湿疹,有防止症状加重、延缓湿疹复发的作用.     

2018-2020年皮肤科住院患者金黄色葡萄球菌感染状况及MRSA与MSSA耐药性分析

目的:研究我院住院患者中皮肤软组织感染者(SSTIs)金黄色葡萄球(SA)感染情况及MR-SA与MSSA耐药特点.方法:选取我院2018年1月1日至2020年12月31日入院时存在SSTIs且进行细菌培养及药敏试验的患者,分析SA及MRSA检出率、病种分布,以及MRSA与MSSA耐药性的差异.结果:共分析1455例患者...