新生儿重症监护室新生儿呼吸机相关性肺炎的临床分析

目的：探讨新生儿重症监护室（NICU）新生儿呼吸机相关性肺炎（NVAP）的危险因素、病原菌分布、耐药情况及患儿预后。方法选择2012年10月至2013年9月安徽医科大学附属六安医院 NICU收治并进行机械通气（MV）的80例患儿的临床病历资料为研究对象,按照患儿是否并发 NVAP,将其分为NVAP组（n=20）和非 NVAP组（n=60）。两组患儿的性别等一般临床资料比较,差异无统计学意义（P＞0.05）。回顾性分析 NICU患儿的 NVAP发生情况、危险因素、病原菌特点、耐药情况及预后,NVAP 的危险因素采用非条件多因素 logistic回归分析（本研究遵循的程序符合安徽医科大学附属六安医院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与之签署临床研究知情同意书）。结果本组80例患儿 NVAP发生率为41.7‰。胎龄、MV治疗时间为 NVAP的独立危险因素[OR=0.366,95%CI（0.149~0.844）,P=0.026;OR=1.051,95%CI（1.008~1.090）,P=0.020],早期使用肺表面活性物质（PS）和血浆为 NVAP的保护因素[OR=0.048,95%CI（0.004~0.653）,P=0.023;OR=0.071,95%CI（0.008~0.628）,P=0.017]。病原菌分布以革兰阴性菌为主（18/26,69.2%）,其中前3位分别为鲍曼不动杆菌（30.8%,8/26）、肺炎克雷伯杆菌（15.4%,4/26）、大肠埃希菌（11.5%,3/26）, NVAP组患儿存在多重感染,均为合并真菌感染（23.1%,6/26）。NVAP 组患儿的住院时间、住院费用显著高于非 NVAP组,且差异均有统计学意义（t=2.832,P=0.006;t=3.656,P=0.000）,但两组患儿的病死率比较,差异无统计学意义（χ2=1.667,P=0.197）。结论 NICU收治患儿的 NVAP 发生率较高,其发生与多种因素密切相关,主要致病菌为革兰阴性菌且耐药率较高。需提高临床医师对 NVAP 的防治意识,加强抗菌药物的合理使用并采取综合干预措施防治 NVAP。     

某三甲医院2015-2016年医院感染病原菌分布及耐药性分析

目的 了解永州市中心医院院内感染病原菌的分布情况及耐药性,为指导临床合理用药和降低医院感染发生率提供依据。 方法 回顾性分析该医院2015-2016年医院感染病例,对其院内感染病原菌的分布及耐药情况进行统计分析。 结果 医院感染发生率为2.14%,医院感染病例共分离病原菌1 873株,分离培养阳性率居前六位的科室分别是神经内科(20.59%)、神经外科(20.41%)、胃肠外科(17.10%)、烧伤外科(15.11%)、肝胆外科(14.65%)和重症医学科(14.44%)。医院感染病原菌主要是肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌和金黄色葡萄球菌。肺炎克雷伯菌对头孢类、喹诺酮类、氨基糖苷类药物耐药率较高,为20%~56%;大肠埃希菌对氨苄西林的耐药率为88.46%,对庆大霉素、复方新诺明和喹诺酮类药物耐药率较高,大于40%;鲍曼不动杆菌对氨苄西林/舒巴坦、头孢他啶、头孢替坦、庆大霉素和喹诺酮类药物耐药率较高,高于42%,铜绿假单胞菌对大多数抗菌药物的耐药率都较低,低于30%。亚胺培南对革兰阴性菌仍具有较好的抗菌活性。主要革兰阳性菌对青霉素G的耐药率最高,对万古霉素、利奈唑胺的耐药率均为0%。 结论 医院感染病原菌中多重耐药菌较多,应了解科室感染病原菌分布特点,加强耐药菌监测,防止医院感染暴发。     

胆道感染的病原菌分布及耐药性分析

目的 了解胆道感染的病原菌分布及对抗菌药物的耐药性,为临床合理用药提供依据.方法 将胆道感染患者的胆汁标本进行细菌培养、鉴定及药敏试验,对结果进行统计分析.结果 共分离出364株病原菌,其中革兰阴性杆菌242株,占66.5%,主要为大肠埃希菌(26.1%)、肺炎克雷伯菌(8.3%)、阴沟肠杆菌(7.4%)、铜绿假单胞菌(6.9%);革兰阳性球菌120株,占33.0%,主要为粪肠球菌(13.0%)、屎肠球菌(9.6%)、葡萄球菌属(6.6%);药敏结果显示,革兰阴性杆菌对亚胺培南、美罗培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢吡肟的耐药率较低(0～29.5%),对青霉素类、喹诺酮类、氨曲南耐药率较高(33.3%～88.9%);革兰阳性球菌对万古霉素、替考拉宁敏感率为100.0%,对青霉素类、喹诺酮类、大环内酯类等耐药率较高(38.3%～85.7%).结论 胆道感染主要以革兰阴性杆菌为主.病原菌分布广,耐药严重,应加强病原菌和耐药性监测,以提高治疗成功率.     

新生儿败血症病原菌分布特点及耐药分析

目的 探讨新生儿败血症病原学特点及病菌耐药情况.方法 对2010年1月至2014年12月陕西省人民医院新生儿科的298例新生儿败血症患儿临床资料进行回顾性分析,并根据细菌培养阳性结果 及药敏情况进行药物分析.结果 在298例新生儿败血症患儿中,血培养共获得108株病原菌,其中革兰阴性菌最多,占61.11%(66/108);革兰阳性菌占24.07%(26/108),真菌占14.82%(16/108).在革兰阴性菌中前3位细菌为肺炎克雷伯菌29.63%(32/108)、大肠埃希菌13.89%(15/108)、铜绿假单胞菌6.48%(7/108);其对哌拉西林及哌拉西林他唑巴坦耐药率均高达90%以上,而对头孢西丁、头孢哌酮/舒巴坦耐药率较低;未检出对碳青霉素类抗生素耐药菌.在革兰阳性菌中以表皮葡萄球菌12.96%(14/108)、屎肠球菌3.70%(4/108)、溶血葡萄球菌2.78%(3/108)检出率最高;对红霉素、苯唑西林的的耐药率较高;对头孢唑啉的耐药率较低,尚未发现对糖肽类抗生素万古霉素、替考拉宁耐药的葡萄球菌.结论 新生儿败血症病原菌以革兰阴性杆菌为主,且耐药率较高,同时真菌败血症的发生率有上升趋势,需警惕.     

重症监护病房病原菌分布及耐药性监测

目的 研究医院2009年重症监护病房(ICU)患者病原菌分布及耐药性的特征. 方法 对医院2009年ICU分离病原菌进行回顾性分析,采用K-B法和CLSI标准(2007版)判断病原菌耐药性. 结果 分离出的200株病原菌中以革兰阴性杆菌为主,占63.0%,其次为革兰阳性球菌24.5%、真菌12.5%;革兰阴性杆菌中非发酵菌占主要地位,以铜绿假单胞菌和鲍氏不动杆菌为主;分离的革兰阳性球菌以肠球菌属居多,所分离出的病原菌对常用抗菌药物大多数呈现多药耐药趋势,革兰阴性杆菌中的铜绿假单胞菌对亚胺培南耐药率50.0%,对美罗培南耐药率为43.3%;鲍氏不动杆菌除对亚胺培南、美罗培南、头孢哌酮/舒巴坦和米诺环素耐药率≤25.0%外,对其余抗菌药物的耐药率均>75.0%. 结论 ICU患者感染病原菌多药耐药情况严重,临床医师应参考ICU病原菌类型及耐药性,结合患者感染状况正确、合理用药.     

腹水分离菌株及耐药性分析

目的 了解我院患者腹水样本中病原菌种类及其对抗生素的耐药情况,为临床合理应用抗生素和经验用药提供参考.方法 对我院2008年1-12月临床送检的腹水样本中分离培养的病原菌分布情况和耐药性进行回顾性分析.结果 在1653份腹水样本中共分离到病原菌151株,阳性检出率为9.13%,其中革兰阴性菌占66.23%,革兰阳性菌占25.17%,真菌占8.61%.分离到的病原菌中前4名依次为大肠埃希菌(53.64%)、表皮葡萄球菌(10.60%)、丝状真菌(7.95%)、藤黄微球菌(6.62%).革兰阴性菌以大肠埃希菌为主,其对氨苄西林、哌拉西林、氨苄西林/舒巴坦、庆大霉素的耐药率分别为78.26%、55.56%、46.67%、39.62%,对阿米卡星、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦耐药率较低.革兰阳性菌以表皮葡萄球菌为主,其对氨曲南和哌拉西林耐药率为100%,对万古霉素、氨苄两林、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢唑林等无耐药.真菌以丝状真菌为主,感染率较高(7.95%).结论 腹水样本中病原菌呈明显多样化.大肠埃希菌是我院腹水感染的主要致病菌,对阿米卡星,哌拉西林/他唑巴坦,头孢哌酮/舒巴坦较敏感.表皮葡萄球菌对氨曲南100%耐药,对万古霉素、氨苄西林、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢唑林等敏感.     

四川省凉山州西昌地区新生儿败血症血培养检出菌及耐药性分析

目的 探讨四川省凉山州西昌地区新生儿败血症血培养病原菌分布及其常见病原菌对抗菌药物的耐药情况.方法 收集2005年5月至2010年10月在本院就诊的254例新生儿败血症患儿的临床病历资料,采取回顾性分析方法对经血堵养分离出的254株阳性菌株进行构成比及其对抗菌药物耐药状况分析(本研究程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准).结果 254株检出菌中,革兰阳性(G+)菌为237株,占93.3%,其中,以凝固酶阴性葡萄球菌(CNS)为主,占革兰阳性菌的82.3%(195/237),占总分离率的76.8%(195/254);革兰阴性(G)菌为17株,占6.7%,其中以大肠埃希菌居多,占总分离率的5.5%(14/254).本组检出率最高的3种G+病原菌(表皮葡萄球菌、溶血葡萄球菌、人葡萄球菌)及检出率最高的G-病原菌(大肠埃希菌)的药敏试验结果显示,G+菌(表皮葡萄球菌、溶血葡萄球菌、人葡萄球菌)对青霉素耐药率最高,其次为红霉素、氨苄西林、头孢唑啉、阿莫西林/克拉维酸、复方磺胺甲(口恶)唑(SMZ-TMP),对万古霉素、利福平敏感.G-菌(大肠埃希菌)对氨苄西林及头孢噻肟耐药率较高,其次为头孢唑啉、庆大霉素及氯霉素;对亚胺培南敏感性很高.结论 四川省凉山州西昌地区新生儿败血症的血培养检出病原菌以G+菌为主,CNS是主要G+病原菌,G菌则以大肠埃希菌为主.该病对常用抗菌药物的耐药现象比较严重.     

肝病并感染性休克患者感染病原菌的分布及耐药性分析

/他唑巴坦耐药率相对较低;大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)比率分别为53.3%和7.7%;真菌感染最常见病原菌为曲霉菌属及光滑假丝酵母菌,对氟康唑耐药率较高.结论 肝病并感染性休克患者感染病原菌常为多药耐药株,病原菌的监测工作对临床治疗有着重要意义.     

儿童呼吸道感染病原菌分布及耐药性分析

目的 了解桂林地区呼吸道感染患儿咽部病原菌分布和抗菌药物耐药情况,以便有效指导临床合理用药.方法 对住院呼吸道感染患儿的痰及咽拭子标本进行病原菌分离培养及鉴定,用K-B纸片扩散法进行药敏分析.结果 检出病原菌733株,前3位病原菌分别为:流感嗜血菌165株(22.51%)、大肠埃希菌136株(18.55%)、酿脓链球菌51株(6.96%);流感嗜血菌对复方新诺明耐药率59.39%,对氨苄西林耐药率36.36%,但对头孢菌素类,喹诺酮类药物的敏感率高,大肠埃希菌对亚胺培南、喹诺酮类及阿米卡星敏感率高,链球菌属对青霉素G、红霉素、克林霉素、复方新诺明耐药率高,分别达56.79%～69.63%.结论 G-菌上升为儿童呼吸道感染的主要致病菌,临床医师应根据近年病原菌谱变迁及药敏结果合理选用抗菌药物.     

重症肝病监护病房患者感染病原菌分布及耐药性分析

目的 分析重症肝病监护病房患者合并感染的病原菌分布及耐药情况,为临床治疗提供参考.方法 对2005年10月-2006年12月医院重症肝病监护病房206例重症肝病患者感染情况作回顾性分析,病原菌的鉴定及药敏采用MicroScan Auto-4全自动系统.结果 70.87%重症肝病患者发生感染,部分为混合感染;感染部位包括呼吸道、血液及腹腔等,分离数居前5位的病原菌是大肠埃希菌(12.8%)、肺炎克雷伯菌(9.9%)、溶血葡萄球菌(8.5%)、铜绿假单胞菌(7.8%)、嗜麦芽寡养单胞菌(6.4%);分离到的革兰阴性菌对多种抗菌药物有不同程度耐药,对哌拉西林/他唑巴坦及亚胺培南耐药率相对较低,溶血葡萄球菌大多为耐甲氧西林菌株(MRSH)(50.0%),仅对青霉素、氨苄西林及万古霉素敏感度较高.结论 重症肝病患者感染病原菌常为多药耐药株,病原菌的监测工作对临床治疗有着重要意义.     

浙江地区耐多药结核分枝杆菌基因突变特征分析

目的 分析浙江地区耐多药结核分枝杆菌(M.tuberculosis complex,MTBC)异烟肼(isoniazid,INH)和利福平(rifampicin,RIF)耐药相关基因突变特征.方法 对患者痰标本阳性培养物进行菌种鉴定,提取耐多药菌株DNA,应用PCR法对inhA、katG和rpoB RRDR区进行扩增,...     

消毒湿巾对新生儿病房环境物体表面消毒的效果

目的比较消毒湿巾与含氯消毒剂的消毒效果,为改进医院感染防控措施提供依据。方法按消毒方法分为伽玛卫生湿巾组、洁力佳表面消毒巾组和84消毒剂组,分别对新生儿病房床单位进行清洁消毒,在消毒前及消毒后5、10、30、60 min五个时间点对新生儿病房床单位表面采样,每组每个时间点分别采集标本30份,比较组间细菌菌落数、杀灭率和消毒合格率,同时筛查物体表面耐甲氧西林金黄色葡萄球菌(MRSA)检出情况。结果消毒后5、10、30 min,床单位物体表面三组间细菌菌落数及杀灭率比较,差异无统计学意义(P0.05)。消毒后60 min,细菌菌落数伽玛卫生湿巾组[(2.61±0.41)CFU/cm~2]、洁力佳表面消毒巾组[(2.71±0.42)CFU/cm~2]低于84消毒剂组[(4.08±0.33)CFU/cm~2],差异有统计学意义(P0.05);细菌杀灭率伽玛卫生湿巾组[(72.36±3.90)%]、洁力佳表面消毒巾组[(71.49±4.77)%]优于84消毒剂组[(55.92±3.22)%],差异有统计学意义(P0.05)。床单位物体表面消毒合格率伽玛卫生湿巾组(86.67%)优于84消毒剂组(63.33%),差异有统计学意义(P0.05)。三种消毒方法均能有效清除物体表面MRSA。结论消毒湿巾消毒效果可靠,且能有效杀灭新生儿病房床单位物体表面多重耐药菌,适用于新生儿等高风险环境。     

Prevalence of antimicrobial resistance genes in Listeria monocytogenes isolated from dairy farms

Antimicrobial resistance of Listeria monocytogenes (n = 38) isolated from the four dairy farms to 15 antimicrobial agents was evaluated. All 38 L. monocytogenes isolates from the four farms evaluated were resistant to more than one antimicrobial in different combinations. All L. monocytogenes isolates evaluated were resistant to cephalosporin C (minimum inhibitory concentration [MIC] > or = 512 microg/mL), streptomycin (MIC > or = 32) and trimethoprim (MIC > or = 512). Most L. monocytogenes isolates were resistant to ampicillin (92%, MIC > or = 2), rifampicin (84%, MIC > or = 4), rifamycin (84%, MIC > or = 4), and florfenicol (66%, MIC > or = 32) and some were resistant to tetracycline (45%, MIC > or = 16), penicillin G (40%, MIC > or = 2) and chloramphenicol (32%, MIC > or = 32). All L. monocytogenes isolates were susceptible to amoxicillin, erythromycin, gentamicin, kanamycin and vancomycin. Susceptibility of L. monocytogenes to the antimicrobials evaluated was quite consistent among the dairy farms evaluated. However, some variability in antimicrobial susceptibility among dairy farms was noted. Nineteen of 38 L. monocytogenes isolates contained more than one antimicrobial resistance gene sequence. A high frequency of floR (66%) was found in L. monocytogenes followed by penA (37%), strA (34%), tetA (32%), and sulI (16%). Other tetracycline resistance genes (tetB, tetC, tetD, tetE, and tetG) and other antimicrobial resistance genes (cmlA, strB, aadA, sulI, vanA, vanB, ampC, ermB, ereA, and ereB) were not found in any of the L. monocytogenes isolates from the four dairy farms. Results of the present study demonstrated that L. monocytogenes isolated from the dairy farm environment were resistant to many antimicrobials and contained one or more antimicrobial resistance genes.     

Estimating the burden of shigellosis in Thailand: 36-month population-based surveillance study

OBJECTIVE: To estimate incidence of shigellosis in the Kaengkhoi district, Saraburi Province, Thailand. METHODS: Population-based surveillance of shigellosis based in treatment centres. The detected rates of treated shigellosis were corrected for the number of cases missed due to the low sensitivity of microbiological culture methods and participants' use of health-care providers not participating in the study. FINDINGS: The overall uncorrected incidence of shigellosis was 0.6/1000 population per year (95% confidence interval (CI) = 0.5-0.8). The unadjusted incidence of treated shigellosis was highest among children less than 5 years old (4/1000 children per year; 95% CI = 3-6) and significantly lower among people aged > 5 years (0.3/1000 population per year; 95% CI = 0.2-0.5; P < 0.001). Adjusting for cases likely to be missed as a result of culture and surveillance methods increased estimates approximately five times. The majority of Shigella isolates (122/146; 84%) were S. sonnei; the rest were S. flexneri. Of the 22 S. flexneri isolates, the three most frequently encountered serotypes were 2a (36%), 1b (23%) and 3b (28%). A total of 90-95% of S. sonnei and S. flexneri isolates were resistant to tetracycline and co-trimoxazole. In contrast to S. sonnei isolates, more than 90% of the S. flexneri isolates were also resistant to ampicillin and chloramphenicol (P < 0.0001). CONCLUSION: Estimates of incidence of Shigella infection in the community are 10-fold to 100-fold greater than those found from routine government surveillance. The high prevalence of Shigella strains resistant to multiple antibiotics adds urgency to the development of a vaccine to protect against shigellosis in this region of Thailand.     

rpoB gene sequencing and spoligotyping of multidrug-resistant Mycobacterium tuberculosis isolates from India

Multi drug-resistant Mycobacterium tuberculosis (MDR TB) has been well studied in outbreaks in settings of low endemicity in developed countries. However, the characteristics of MDR TB in the community with high endemicity such as India have not been well investigated. Mutations in the 81-bp rifampicin resistance-determining region of the rpoB gene were analyzed by DNA sequencing of 187 M. tuberculosis clinical isolates (149 resistant and 38 sensitive) from different parts of India. 146-Point mutations and two insertions were found in 146 of 149 resistant isolates in seven codons. The most common mutations were in codons 531 (59%), 526 (22%), and 516 (11.5%). Mutations were not found in three (2%) of the resistant isolates. N-terminal sequencing in these isolates showed no mutation at codon V176. None of the drug-susceptible isolates showed any mutation in the 437-bp rpoB gene segment sequenced. Genotypic analysis revealed a total of 80 different spoligotypes. A unique pattern was found in 65 (43.6%) isolates, whereas 84 (56.4%) were in 15 clusters. Comparison with an international spoligotype database showed ST26, Delhi type (18.1%), ST1, Beijing type (9.4%), and ST11 (5.4%), as the most common. The majority of isolates in the Beijing genotype (13/14) were associated with mutation 531TTG and similar drug-resistance patterns while other major clusters showed that the nature and frequency of occurrence of mutations in the rpoB gene were independent of spoligopatterns.     

2010—2011年广东地区人源主要血清型沙门菌喹诺酮耐药特征分析

目的了解广东省沙门菌对喹诺酮耐药特征及其基因突变情况。方法选用2010—2011年广东省非伤寒沙门菌监测收集的4种主要血清型沙门菌,采用半定量药敏检测法测定2010—2011年收集的沙门菌临床株对萘啶酸和环丙沙星的最小抑菌浓度（MIC）;通过PCR扩增鼠伤寒沙门菌株的gyrA和parC的基因,并对序列进行测定,对比野生株,发现突变位点及突变类型。结果共对2010—2011年收集的496株鼠伤寒沙门菌、鼠伤寒沙门菌变种、肠炎沙门菌和斯坦利沙门菌进行耐药性分析,75.4%（374/496）沙门菌对萘啶酸耐药,其中鼠伤寒沙门菌、鼠伤寒沙门菌变种、肠炎沙门菌、斯坦利沙门菌耐药率分别为82.5%（207/251）、84.0%（84/100）、79.5%（70/88）、22.8%（13/57）;5.4%（27/496）沙门菌对环丙沙星耐药,其中鼠伤寒沙门菌、鼠伤寒沙门菌变种、肠炎沙门菌的耐药率分别为8.0%（20/251）、5.0%（5/100）、2.3%（2/88）。71.7%（180/251）鼠伤寒沙门菌发生基因突变,其中86.1%（155/180）发生gyrA上突变,37.2%（67/180）发生parC上突变,23.3%（42/180）发生双基因突变。环丙沙星耐药株、中敏株、敏感株分别有7株（35.0%,7/20）、1株（3.1%,1/32）、6株（3.0%,6/199）发生gyrA Ser83位点突变,3组间Ser83位点突变率差异有统计学意义（P〈0.01）;环丙沙星耐药株、中敏株、敏感株分别有15株（75.0%,15/20）、21株（65.6%,21/32）、111株（55.8%,111/199）发生gyrA Asp87位点突变,3组间突变率差异无统计学意义（P〉0.05）。5株parC Ser80位点突变株均突变为Arg,此突变的菌株均伴有Ser83Phe及Asp87Asn;9株parC Thr57突变株均对萘啶酸耐药。结论广东省沙门菌对萘啶酸普遍耐药,对环丙沙星仍普遍敏感;gyrA和parC中可能影响沙门菌耐药的突变位点应进一步确认其对耐药的影响。     

湘雅医院细菌耐药性监测

目的了解中南大学湘雅医院2009年临床常见分离菌的分布及耐药性。方法采用Vitek 2全自动微生物鉴定分析系统对临床分离菌株进行鉴定及药敏试验,WHONET 5.4统计软件对数据进行分析。结果 7 841株临床分离菌株中,革兰阳性菌占28.5%（2 237/7 841）,革兰阴性菌占55.7%（4 369/7 841）,真菌占15.8%（1 235/7 841）。革兰阳性球菌居前五位的分别为凝固酶阴性葡萄球菌、金黄色葡萄球菌、粪肠球菌、屎肠球菌和血液链球菌。耐甲氧西林金黄色葡萄球菌（MRSA）和凝固酶阴性葡萄球菌（MRCNS）的检出率分别为63.7%和67.2%,未发现万古霉素耐药或中介的葡萄球菌,但分离到万古霉素耐药肠球菌（VRE）7株。革兰阴性杆菌中分离率居前五位的依次为铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌和阴沟肠杆菌。肠杆菌科细菌中,大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌对碳青霉烯类抗生素的耐药率最低（〈2.3%）,大肠埃希菌、肺炎克雷伯菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率〈13.0%,而阴沟肠杆菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率分别达40.0%和28.4%。非发酵菌中,铜绿假单胞菌对美洛培南、头孢哌酮/舒巴坦的耐药率较低,分别为9.1%和12.4%;鲍曼不动杆菌对头孢哌酮/舒巴坦、左氟沙星及氨苄西林/舒巴坦耐药率较低,分别为7.0%、7.6%和16.3%,对美洛培南耐药率达28.8%;对其他抗菌药物耐药率均超过40%。结论该院常见病原菌以革兰阴性杆菌为主;病原菌对多种临床常用抗菌药物耐药,尤其是对万古霉素耐药肠球菌的出现及对碳青霉烯类耐药非发酵菌的增加,应引起临床高度重视,及时采取有效措施,控制耐药菌在医院内播散和暴发流行。     

R plasmids conferring multiple drug resistance from shigella isolated in Korea.

The majority (85%) of shigella isolated in 1980 and 1981 in Korea were Shigella flexneri, the others were Sh. sonnei (14%) with only a small number of Sh. dysenteriae. Only 14 of the 459 strains of shigella isolated were susceptible to all 12 drugs tested, and 445 were resistant to three or more drugs. Strains multiply resistant to the six drugs, chloramphenicol (Cm), tetracycline (Tc), streptomycin (Sm), sulfisomidine (Su), ampicillin (Ap) and trimethoprim (Tp) were most frequently encountered, followed by those resistant to Cm, Tc, Sm, Su and Tp. The complete patterns of resistance to drugs except nalidixic acid and rifampin in approximately 73% of drug-resistant strains were co-transferred to Escherichia coli by conjugation, indicating that the resistance was R plasmid-mediated. Randomly selected R plasmids conferring various patterns of resistance markers were tested for the incompatibility groups, and almost all of them were classified into Inc FII. Two of three R plasmids conferring resistance to Cm, Tc, Sm and Su were classified into Inc B and one to Inc FII. Two R types with resistance markers of Cm, Tc, Sm and Ap were not classified with our standard plasmids used.     

Simultaneous persistence of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus in a neonatal ward of a Warsaw Hospital

Fifty-seven methicillin-resistant Staphylococcus aureus (MRSA) isolates from babies (N = 31), carriers amongst health care workers (N = 16; 10% of all staff members) and the environment (N = 10); 39 MSSA isolates, from babies (N = 18), health care workers (N = 5) and environment (N = 16) were analysed. The strains were from the neonatal ward of a teaching hospital in Warsaw and were collected over a period of 16 months (1993/1994). The isolates were characterized by phage-typing, arbitrary-primed polymerase chain reaction (AP PCR), DNA repeat polymorphism within the protein A gene and the resistance pattern to antimicrobial agents. The presence of the mecA gene was determined by PCR. MRSA were classified as heterogeneously resistant to methicillin, susceptible to other antimicrobial agents and, except for three isolates, appeared to be genotypically almost identical. The first example of mupirocin resistant MRSA in Poland was documented. Amongst MSSA isolates, increased variability was seen, however, the persistence of one predominate clone of MSSA was shown. In this particular hospital environment, several different strains of both MRSA and MSSA were capable of maintaining persistent colonization.