微量知释法对肿瘤患者术后合并感染ESBLs菌株的检测验证

用新型微量稀释法肿瘤患者术后并感染广谱β－内酰胺酶菌株进行检测验证。方法双纸片法衬试微量稀释法验证，对２７株肺炎克雷伯氏菌和３２株大肠埃希氏菌进行超广谱β－内酰胺酶检测。     

肿瘤患者超广谱酶菌株的检测及其意义

目的了解肿瘤患者体内分离出的肠杆菌产生超广谱β-内酰胺酶的机理、耐药特征以及耐药菌株的来源,从而指导临床用药.方法对本院1999年2～12月108名住院患者血、尿、痰标本中分离出的肺炎克雷伯氏菌、大肠埃希氏菌进行了分析,用琼脂扩散法测定标本对8种β-内酰胺类抗生素的敏感性,检出产生超广谱酶的菌株.结果肿瘤患者体内分离出的肺炎克雷伯氏菌、大肠埃希氏菌产生超广谱β-内酰胺酶的菌株高达56.48%.结论肿瘤患者产生超广谱β-内酰胺酶明显高于非肿瘤患者并有院内爆发流行的趋势.     

肿瘤患者合并产超广谱β-内酰胺酶细菌感染的耐药性分析

目的:探讨肿瘤患者合并产超广谱β-内酰胺酶（extended-spectrum β lactamases,ESBLs）的大肠埃希菌和肺炎克雷伯菌的发生比例及对临床常用抗菌药物的耐药情况。方法:收集2013年6月至2014年9月郑州人民医院各类临床标本中所得到的大肠埃希菌和肺炎克雷伯菌进行分析。结果:肿瘤患者共分离出大肠埃希菌116株,其中42株产ESBLs,比例为36.2%;分离出肺炎克雷伯菌102株,其中24株产ESBLs,比例为23.5%。两年来,大肠埃希菌ESBLs阳性菌对临床常用抗菌药物表现出较高的耐药性,耐药率上升非常显著;非产ESBLs大肠埃希菌对大多数抗菌药物仍保持较高的敏感率;但2014年未产ESBLs大肠埃希菌的耐药性比2013年明显上升。肺炎克雷伯菌的情况与大肠埃希菌相似。结论:合理使用抗菌药物对控制肿瘤合并ESBLs患者具有重要意义。     

消化道肿瘤患者血流感染革兰氏阴性菌分布和耐药情况

目的 分析消化道肿瘤在院治疗患者发生血流感染革兰氏阴性菌的分布和耐药情况,为临床用药及控制院内感染提供合理的指导。方法 选取2019年1月到2021年12月送检的573例消化道肿瘤患者的719例次血培养阳性标本,剔除同一患者的重复菌株共654株革兰氏阴性菌,回顾性分析患者的临床特征、细菌分布及耐药变迁情况。结果 革兰氏阴性菌共654株（100.0%）,其中,大肠埃希菌275株（42.0%）,肺炎克雷伯菌181株（27.7%）,阴沟肠杆菌57株（8.7%）,铜绿假单胞菌24株（3.7%）,鲍曼不动菌9株（1.4%）,变形杆菌5株（0.8%）,其他（15.7%）。大肠埃希菌、肺炎克雷伯菌是医院检出率最高的革兰氏阴性菌,常见革兰氏阴性菌对亚胺培南、美罗培南、阿米卡星、多黏菌素、哌拉西林/他唑巴坦、氨苄西林/舒巴坦等抗菌药物敏感性较高,对头孢类抗菌药耐药性较高;产超广谱β内酰胺酶[extended-spectrum β-lactamases（+）,ESBLs（+）]大肠埃希菌、ESBLs（+）肺炎克雷伯菌未检出对亚胺培南、美罗培南、多黏菌素耐药的菌株;耐碳青霉烯类大肠埃希菌、肺炎克雷伯菌、铜绿...     

急性白血病患儿化疗后血流感染的临床特点、病原菌分布和耐药性分析

目的 探讨急性白血病患儿化疗后血流感染的临床特点、病原菌分布和耐药性。方法 选取化疗后发生血流感染的64例急性白血病患儿,收集临床资料,分析病原菌分布特点、药敏试验结果及预后。结果 64例患儿发生血流感染时均处于粒细胞缺乏期。64株病原菌中以革兰阴性（G-）菌为主,占51.6%(33/64),革兰阳性（G+）菌占45.3%(29/64),真菌占3.1%(2/64)。G-菌中前3位依次是肺炎克雷伯菌肺炎亚种、大肠埃希菌、产酸克雷伯菌,G+菌中前4位依次是G+杆菌、表皮葡萄球菌、人葡萄球菌人亚种、草绿色链球菌。51例急性淋巴细胞白血病（ALL）患儿的病原菌中G-菌占51.0%(26/51),G+菌占45.1%(23/51),真菌占3.9%(2/51);13例急性髓细胞性白血病（AML）患儿的病原菌中G-菌占53.8%(7/13),G+菌占46.2%(6/13)。64株病原菌中耐药菌占32.8%(21/64),其中G-菌中检出产超广谱β内酰胺酶大肠埃希菌占21.2%(7/33),产超广谱β内酰胺酶肺炎克雷伯菌占15.2%(5/33),耐碳青霉烯类肺炎克雷伯菌（CRKP）占9.1%(3/33)...     

ROLE OF SIALIC ACID RESIDUES IN IRON BINDING BY HUMAN LACTOFERRIN

ＲＯＬＥＯＦＳＩＡＬＩＣＡＣＩＤＲＥＳＩＤＵＥＳＩＮＩＲＯＮＢＩＮＤＩＮＧＢＹＨＵＭＡＮＬＡＣＴＯＦＥＲＲＩＮ－αＬｉＺｈｅｎｐｕ李振甫；ＰｈｉｌｉｐＦｕｒｍａｎｓｋｉ（ＢｅｉｊｉｎｇＩｎｓｔｉｔｕｔｅｆｏｒＣａｎｃｅｒＲｅｓｅａｒｃｈ，ＴｈｅＳｃｈ...     

干扰素甲地孕酮配合EP方案与单纯EP方案治疗晚期非小细胞肺癌的对比研究

目的：较ＩＭ－ＥＰ方案与ＥＰ方案对初始ⅢＢ～Ⅳ期非小细胞肺癌（ｎｏｎ－ｓｍａｌｌ ｃｅｌｌ ｈｕｎｇ ｃａｎｃｅｒ,ＮＳＣＬＣ病人的疗效,毒性及生活质量的改善情况。方法：Ａ组（３３例）接受ＩＭ－ＥＰ方案治疗,Ｂ组（３５例）接受ＥＰ方案治疗。两组均以每４周为一周期,重复３个。客观疗交与毒性反应接ＷＨＯ标准进行评价,生活质量根据临床受益疗效来评价。结果：Ａ、Ｂ两组客观疗效（ＣＲ＋ＰＲ）分别为２７．３％     

Special Reports and Review ONCOGENES AND CELL IMMUNOGENITY：v－H－ras SUPPRESSING MHC CLASS I EXPRESSION IN MOUSE FIBROBLAST

ＳｐｅｃｉａｌＲｅｐｏｒｔｓａｎｄＲｅｖｉｅｗＯＮＣＯＧＥＮＥＳＡＮＤＣＥＬＬＩＭＭＵＮＯＧＥＮＩＴＹ：ｖ－Ｈ－ｒａｓＳＵＰＰＲＥＳＳＩＮＧＭＨＣＣＬＡＳＳＩＥＸＰＲＥＳＳＩＯＮＩＮＭＯＵＳＥＦＩＢＲＯＢＬＡＳＴＬｕＹｏｕｙｏｎｇ；吕有勇；Ｓｈｒａｇ...     

中国南方鼻咽鳞状细胞癌与EB病毒感染的关系

目的：探讨中国南方鼻咽癌高发区鼻咽鳞状细胞癌或称角化性鳞状细胞癌（Ｋｅｒａｔｉｎｉｚｉｎｇ ｓｑｕａｍｏｕｓ ｃｅｌｌ ｃａｒｃｉｎｏｍａ,ＫＳＣＣ）是否也如非角化性癌那样与ＥＢ病毒感染有密切的关系。方法：应用ＰＣＲ Ｓｏｕｔｈｅｒｎ ｂｌｏｔｔｉｎｇ、原 位分子杂交和免疫组化法检测３８例鼻咽鳞状细胞癌细胞中有ＥＢ病毒ＤＮＡ及其产物ＥＢＮＡ－１,ＥＢＮＡ－２,ＥＢＥＲＳ,ＬＭＰ－１,ＺＥＢＲＡ,Ｅ     

肿瘤专科医院多重耐药菌医院感染的动态分析研究

目的:动态观察我院从2009年到2012年,4年间多重耐药菌的检出率和耐药性。方法:采用美国临床实验室标准化委员会(NCCLS/CLSI)推荐的纸片扩散确证法检测ESBLs与MRSA。MIC法做药敏试验,利用WHONET5.4分析软件对药敏试验进行统计分析。结果:4年来ESBLs阳性率大肠埃希菌由59.3%升至72.1%;肺炎克雷伯菌由21.2%升至46.7%;奇异变形杆菌阳性率偏低。ESBLs阳性株对碳青霉烯类、阿米卡星和β-内酰胺类/β-内酰胺酶抑剂类的耐药率较低;MRSA阳性率由53.3%降至29.8%;MRCNS阳性率由54.7%升至56.6%,无明显变化。但MRSA呈多重耐药性,对MRSA菌株的治疗首选糖肽类抗菌药物;多重耐药非发酵菌的检出率呈上升趋势。结论:4年来,大肠埃希菌和肺炎克雷伯菌中ESBLs阳性率逐年上升;MRSA阳性率呈现下降趋势,而MRCNS阳性率则变化不大;多重耐药非发酵菌的检出率呈上升趋势。     

Comparison of disk diffusion, E-test and broth microdilution test in determination of susceptibility of Aspergillus species to amphotericin B, itraconazole and voriconazole

In response to the recent increase in Aspergillus infections, new antifungal agents have become available accompanied by studies on antifungal susceptibility tests for epidemiological follow-up. The aim of this study was to compare the efficacy of Clinical Laboratory Standards Institute (CLSI) M 38-A broth microdilution test with the disk diffusion and E-test in determining the susceptibility of Aspergillus spp. to amphotericin B, itraconazole and voriconazole. The study was carried out on 18 A. fumigatus, 7 A. flavus, 5 A. niger and 2 A. versicolor strains isolated from clinical samples. The microdilution method was performed by following the instructions of CLSI M 38-A. The E-test and disk diffusion tests were performed according to the instructions of their manufacturers. The percent agreement between the E-test and CLSI M38-A broth microdilution test at 24 (48) h within +/- 2 dilutions was, respectively, 81% (69%) for amphotericin B, 75% (72%) for itraconazole and 85% (81%) for voriconazole. The disk diffusion test showed good correlation with the E-test but poor correlation with the broth microdilution test for the three antifungal agents we tested. In conclusion, E-test and disk diffusion test have their advantages such as ease of application and interpretation, but their correlation with the broth microdilution should be improved.     

Antimicrobial Activity of Ro 41-1879, a New Catechol Cephalosporin

Summary

The antimicrobial activity and spectrum of Ro 41-1879, a new 7’-catcchol substituted cephalosporin, was assessed in a broth microdilution system against 312 clinical isolates. Ro 41-1879 demonstrated a slightly superior spectrum of activity (2- to 32-fold) compared to ceftazidime against Gram-positive cocci, Pscudotnonas spp. and Xanthomonas maltophilia. Enterobacteriaceae strains were more susceptible (97% versus 96%) to ceftazidime at S16 ≤ μg/ml. These results represent a preliminary potency/spectrum analysis for Ro 41-1879 since the screening studies were performed with an in vitro system unlikely to detect the potency contributed by active drug transport (tonB system) into bacterial cells. This new class of cephalosporins shows some therapeutic promise.     

Sensitivity and specificity of various beta-lactam antibiotics and phenotypical methods for detection of TEM, SHV and CTX-M extended-spectrum beta-lactamases

The aim of this study was to compare the sensitivity and specificity of six different beta-lactam antibiotics using five phenotypical tests for detection of extended spectrum beta-lactamases (ESBLs) based on synergism of beta-lactam antibiotics and clavulanate.Experiments were performed on a set of 80 Klebsiella pneumoniae strains and 105 Escherichia coli strains with previously characterized ESBLs (SHV, TEM and CTX-M). ESBLs were detected by five different phenotypical methods: MIC (minimum inhibitory concentration) determination of beta-lactam antibiotics with and without clavulanate, double-disk synergy test (DDST), inhibitor-potentiated disk-diffusion test (IPDDT), CLSI-Clinical and Laboratory Standard Institution (former NCCLS) combined-disk-test, and modified MAST-disk-diffusion test (MAST-DD-test). Seven antibiotics were tested as indicators of ESBL production: ceftazidime, cefotaxime, ceftriaxone, aztreonam, ceftibuten, cefpodoxime and cefepime. Ceftazidime and aztreonam were the best indicators for SHV-5, SHV-12 and TEM beta-lactamases whereas cefotaxime and ceftriaxone were the most sensitive in detection of SHV-2 and CTX-M beta-lactamases in DDST, IPDDT and CLSI test. MIC determination of beta-lactam antibiotics with and without clavulanate was the most sensitive method. DDST was the least sensitive test. Double-disk synergy test, which is the most frequently used test for detection of ESBLs in routine laboratories, was the least sensitive independently of the indicator antibiotic. Since MIC determination is a very laborious and time consuming method, we would recommend the NCCLS combined disk test or IPDD test for detection of ESBLs in routine laboratories with 5 mm zone augmentation breakpoint.     

Comparison of Disk Diffusion,E-Test and Broth Microdilution Test in Determination of Susceptibility of Aspergillus Species to Amphotericin B,Itraconazole and Voriconazole

Abstract

In response to the recent increase in Aspergillus infections, new antifungal agents have become available accompanied by studies on antifungal susceptibility tests for epidemiological follow-up. The aim of this study was to compare the efficacy of Clinical Laboratory Standards Institute (CLSI) M 38-A broth microdilution test with the disk diffusion and E-test in determining the susceptibility of Aspergillus spp. to amphotericin B, itraconazole and voriconazole.

The study was carried out on 18 A. fumigatus, 7 A. flavus, 5 A. niger and 2 A. versicolor strains isolated from clinical samples. The microdilution method was performed by following the instructions of CLSI M 38-A. The E-test and disk diffusion tests were performed according to the instructions of their manufacturers.

The percent agreement between the E-test and CLSI M38-A broth microdilution test at 24 (48) h within ± 2 dilutions was, respectively, 81% (69%) for amphotericin B, 75% (72%) for itraconazole and 85% (81%) for voriconazole. The disk diffusion test showed good correlation with the E-test but poor correlation with the broth microdilution test for the three antifungal agents we tested.

In conclusion, E-test and disk diffusion test have their advantages such as ease of application and interpretation, but their correlation with the broth microdilution should be improved.     

The resazurin microplate method for rapid detection of vancomycin resistance in enterococci

Vancomycin-resistant enterococci (VRE) are a serious challenge for physicians because of the limited treatment options for infections caused by this organism. Prevention of VRE transmission in hospitals requires early detection of infected or colonized patients. Therefore rapid and correct detection of vancomycin resistance is essential. In this study, we use the resazurin microplate method (RMM), which is a modification of the NCCLS and BSAC broth microdilution methods to rapidly determine the susceptibilities of clinical enterococci isolates to vancomycin. The alteration in the RMM was relevant to the final bacterial count. In this method, inoculum that was 10-fold higher than standard methods was used. A total of 80 enterococci, including 11 VRE isolates and 6 vancomycin intermediate isolates, were screened with this modified colorimetric broth microdilution method. After 4 h of incubation 30 microl of 0.01% resazurin solution were added to each well and the plates were reincubated for color change for 5-10 min. The MICs were obtained at the 4th h. The results were in exact agreement with the NCCLS and the BSAC microdilution methods. Absolute and essential agreements were 100% and there were no minor, major or very major errors. In conclusion, this modified colorimetric broth microdilution method can be used as a reliable, easy, cheap and rapid method for early detection of VRE. Moreover, this method has the potential of being used to test the susceptibilities of different bacteria to other antibiotics.     

Cytology,High-Risk Human Papillomavirus Testing and Serum CA19-9 in a Large Cohort of Patients with Invasive Cervical Adenocarcinomas: Correlation with a New Pathogenetic Classification

Aims: This study aims to investigate the screening value of cytology, high-risk human papillomavirus (hrHPV) testing and serum CA19-9 in cervical adenocarcinomas. Materials and Methods: We employed HPV RNA in situ hybridization and immunohistochemistry to reclassify 209 cervical adenocarcinomas according to the International Endocervical Adenocarcinoma Criteria and Classification (IECC). We analyzed the diagnostic value of cytology, hrHPV testing and serum CA19-9 in these tumors and their detection variance among IECC histotypes. Results: We found that the sensitivity of cytology or hrHPV test alone was 74.1% (129/174) or 72% (131/182), respectively. Non-HPV related adenocarcinoma showed a lower detection rate of cytology (60%, 27/45 vs. 79.1%, 102/129, p=0.017) or hrHPV testing (9.8%, 4/41 vs. 90.1%, 127/141, p<0.0001), compared to HPV-related adenocarcinomas. The cytology and hrHPV co-testing significantly demonstrated a higher sensitivity (151/165, 91.5%) than single test alone (p<0.001). Nevertheless, the sensitivity of co-testing was substantially lower for gastric-type adenocarcinoma (GAC) (74.1%, 20/27) than that for non-GAC (94.9%, 131/138) (p=0.001). Serum CA19-9 (>40 U/mL) identified 44.1% (15/34) GACs including 75% (6/8) that were missed by co-testing, much higher than for non-GACs (10.7%, 19/177; p<0.001). The combination of cytology, hrHPV test and serum CA19-9 enhanced the detection rate of GACs (92.9%, 26/28). Conclusion: We conclude that cytology and hrHPV co-testing is not very effective for non-HPV related adenocarcinoma, particularly for GAC. As such, additional serum CA19-9 should be given in women with potential cancer risks.     

Improving Participation in Colorectal Cancer Screening: a Randomised Controlled Trial of Sequential Offers of Faecal then Blood Based Non-Invasive Tests

Background: Poor participation rates are often observed in colorectal cancer (CRC) screening programs utilising faecal occult blood tests. This may be from dislike of faecal sampling, or having benign bleeding conditions that can interfere with test results. These barriers may be circumvented by offering a blood-based DNA test for screening. The aim was to determine if program participation could be increased by offering a blood test following faecal immunochemical test (FIT) non-participation. Materials and Methods: People were invited into a CRC screening study through their General Practice and randomised into control or intervention (n=600/group). Both groups were mailed a FIT (matching conventional screening programs). Participation was defined as FIT completion within 12wk. Intervention group non-participants were offered a screening blood test (methylated BCAT1/IKZF1). Overall participation was compared between the groups. Results: After 12wk, FIT participation was 82% and 81% in the control and intervention groups. In the intervention 96 FIT nonparticipants were offered the blood test - 22 completed this test and 19 completed the FIT instead. Total screening in the intervention group was greater than the control (88% vs 82%, p<0.01). Of 12 invitees who indicated that FIT was inappropriate for them (mainly due to bleeding conditions), 10 completed the blood test (83%). Conclusions: Offering a blood test to FIT non-participants increased overall screening participation compared to a conventional FIT program. Blood test participation was particularly high in invitees who considered FIT to be inappropriate for them. A blood test may be a useful adjunct test within a FIT program.     

In-vitro activity of ceftriaxone combined with newer agents against MRSA

In this study, in vitro synergism in combinations of agents as ceftriaxone/dalbavancin, ceftriaxone/linezolid and ceftriaxone/daptomycin against MRSA strains were investigated. Thirty clinical MRSA strains were tested. The minimum inhibitory concentrations of all antibiotics were determined using reference broth microdilution method. In-vitro activities of antibiotics combined against the strains were tested using two-dimensional checkerboard microdilution method. Results were interpreted as follows: synergy = FICI ≤0.5; ‘no interaction’ effect = FICI ?0.5-≤4; antagonism = FICI ?4. The MIC₅₀, MIC₉₀ and MIC_range of ceftriaxone, daptomycin, dalbavancin and linezolid were found as 128, 1024 and 16-2048 mg/L; 1, 1 and 0.5–1 mg/L; 0.12, 0.12 and 0.03–0.12 mg/L; and 1, 2 and 1–2 mg/L, respectively. Our results showed that the frequency of synergistic effects (FICI: ≤0.5) of three combinations were all at the same rate of 77% (23/30). No in vitro antagonism (FICI >4) was observed.     

Comparison of microdilution and disc diffusion methods in assessing the in vitro activity of fluconazole and Melaleuca alternifolia (tea tree) oil against vaginal Candida isolates

The in vitro activity of fluconazole and Melaleuca alternifolia (tea tree) oil was evaluated against 99 vaginal Candida strains by the broth microdilution and disc diffusion methods. The microdilution method was performed in accordance with NCCLS-M27A guidelines. An investigational method was used for the disc diffusion test. Fluconazole and tea tree oil minimum inhibitory concentrations (MICs) obtained at 48 h tended to increase 1- to 2-fold or remain the same compared to 24 h readings for most of the isolates tested. C. krusei and C. norvegensis had significantly higher MICs and smaller inhibition zones for fluconazole compared to other species. Tea tree oil MICs were found to be similar, in general, for all Candida spp. tested. The geometric mean MIC of tea tree oil for all isolates was 2.2% (range, 0.25-4%) at 24 h and 3.0% (range, 1-8%) at 48 h. Tea tree oil mean inhibition zone diameter was 24 mm (range, 14-42 mm) at 24 h and 15.8 mm (range, 10-35 mm) at 48 h. In vitro activity of tea tree oil against fluconazole-resistant Candida strains was of particular interest. The isolates had similar tea tree oil MICs and inhibition zone diameters regardless of their fluconazole susceptibility profile. Tea tree oil MIC ranges (inhibition zone diameter ranges) were 2-4% (12-21 mm) and 2% (35 mm) at 48 h for C. krusei and C. norvegensis, respectively. These results suggest that tea tree oil MICs of the fluconazole-resistant isolates are comparable to those of fluconazole-susceptible isolates. This in vitro finding is promising for potential use of topical tea tree oil formulations in the treatment of candidiasis due to fluconazole-resistant strains.     

Antimicrobial activity of Ro 41-1879, a new catechol cephalosporin.

The antimicrobial activity and spectrum of Ro 41-1879, a new 7'-catechol substituted cephalosporin, was assessed in a broth microdilution system against 312 clinical isolates. Ro 41-1879 demonstrated a slightly superior spectrum of activity (2- to 32-fold) compared to ceftazidime against Gram-positive cocci, Pseudomonas spp. and Xanthomonas maltophilia. Enterobacteriaceae strains were more susceptible (97% versus 96%) to ceftazidime at less than or equal to 16 micrograms/ml. These results represent a preliminary potency/spectrum analysis for Ro 41-1879 since the screening studies were performed with an in vitro system unlikely to detect the potency contributed by active drug transport (tonB system) into bacterial cells. This new class of cephalosporins shows some therapeutic promise.