Epidemiology of Aeromonas species in a hospital

The occurrence of Aeromonas spp. in a hospital water supply, in patients and in the local community was investigated. In healthy persons outside the hospital the isolation rate was 3.6% and among hospital patients it was 6%. Seven per cent of water samples yielded Aeromonas strains. Isolates were typed by sodium dodecyl sulphate polyacrylamide gel electrophoresis of sulphur-35 methionine labelled proteins of Aeromonas isolates. No relationship between water and human isolates could be established, even when a strain of A. hydrophila producing Vero cell cytotoxin contaminated enteral feeds given to patients in the intensive care unit.     

某综合医院四年间临床分离4种病原菌的耐药性分析

目的了解医院临床菌株常用抗菌药物的耐药情况,为临床合理使用抗菌药物提供参考。方法采用回顾调查方法对医院2012年1月-2015年12月4种条件致病菌(肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌及鲍氏不动杆菌)的耐药情况进行分析。结果经χ2趋势检验,肺炎克雷伯菌对亚胺培南、哌拉西林/他唑巴坦、头孢吡肟、头孢唑林、妥布霉素、氨苄西林及环丙沙星的耐药率呈增高趋势(P0.05),对磺胺甲噁唑/甲氧苄啶的耐药率呈降低趋势(P0.05);大肠埃希菌对亚胺培南、头孢吡肟、头孢唑林、妥布霉素、阿米卡星的耐药率均呈上升趋势(P0.05);铜绿假单胞菌对头孢吡肟、妥布霉素、左氧氟沙星、庆大霉素、环丙沙星及阿米卡星的耐药率均呈下降趋势(P0.05);鲍氏不动杆菌对头孢他啶、头孢曲松及环丙沙星的耐药率均呈上升趋势(P0.05),对磺胺甲噁唑/甲氧苄啶及左氧氟沙星的耐药率呈降低趋势(P0.05)。结论两种致病菌对头孢吡肟、头孢唑林及妥布霉素的耐药率均呈增高趋势,条件致病菌中鲍氏不动杆菌对磺胺甲噁唑/甲氧苄啶的耐药率呈下降趋势,临床用药时可参照药敏结果临床菌株的耐药趋势,选择合适的的抗菌药物。     

综合性医院金黄色葡萄球菌分布及耐药趋势

目的了解医院金黄色葡萄球菌临床分布及耐药性,为合理应用抗菌药物提供依据。方法收集2008-2011年医院临床与门诊患者送检标本分离出的金黄色葡萄球菌,细菌鉴定采用VITEK微生物分析仪,药物敏感性试验采用BIOMIC药敏测定仪,耐药性分析采用WHONET5.4软件。结果近4年医院检出金黄色葡萄球菌1 252株,其中MRSA 898株占71.7%;金黄色葡萄球菌检出以痰液标本为主占63.3%,检出病区内科36.5%、外科12.4%;内科病区除磺胺甲噁唑/甲氧苄啶和左氧氟沙星外,对其他抗菌药物耐药率均高于外科病区;金黄色葡萄球菌对利奈唑胺和万古霉素未发现耐药株,对呋喃妥因和磺胺甲噁唑/甲氧苄啶耐药率<30.0%;对青霉素耐药率>90.0%,痰标本中金黄色葡萄球菌对抗菌药物的耐药率除利奈唑胺、万古霉素、呋喃妥因、磺胺甲噁唑/甲氧苄啶外均高于总标本中金黄色葡萄球菌的耐药率。结论 MRSA耐药性高,应规范临床用药,加强MRSA耐药性监测,有效控制感染。     

某三级综合医院2017年度细菌耐药性监测分析

目的了解2017年临床检出病原菌的耐药性,为指导临床合理使用抗菌药物提供理论依据。方法利用微生物分离鉴定系统及纸片扩散法(K-B法)等,对2017年医院门急诊和住院患者临床检出病原菌的分布情况及耐药性进行回顾性分析。结果 2017年共分离病原菌4 547株,其中革兰阴性菌3 163株占69.56%,革兰阳性菌983株占21.62%,真菌401株占8.82%。检出前五位的病原菌分别为大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、金黄色葡萄球菌和铜绿假单胞菌。大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率分别<3.00%和10.00%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为14.67%和6.00%;鲍氏不动杆菌对亚胺培南和美罗培南的耐药率分别高达78.88%和79.37%。结论 2017年临床分离病原菌主要以革兰阴性菌为主,且革兰阴性菌的耐药形势非常严峻,合理选用抗菌药物具有重要意义。     

综合医院暴发疥疮感染的流行病调查与分析

目的分析综合医院疥疮感染暴发的特点,为综合医院预防控制疥疮暴发及预防提供警示。方法对综合性医院疥疮感染暴发事件的流行病学调查和分析。结果疥疮感染16例患者,属于医院感染暴发事件,保洁员是主要的传播者。结论保洁人员防护意识差、医务人员疥疮防治知识匮乏,误诊是暴发疥疮的主要原因,医务人员的值班室是造成间接传播的重要场所。     

2004-2011年综合医院传染病发病流行病学分析

目的 探讨综合医院传染病发病趋势和病种分布特点,为传染病预防控制提供依据.方法 对2004-2011年医院传染病报告卡,按照4种传播途径和病种进行分类统计分析.结果 报告传染病1316例,来自于4个门诊科室和43个住院部科室,其中感染性疾病科报告病例705例,占总数的53.57％;传染病病种29个,其中呼吸道传染病病种和病例数均居首位;发病数居前5位病种是手足口病、甲型H1N1流感、水痘、肺结核、梅毒,占总数的78.80％;住院部血源及性传播传染病发病数多于门诊部(P＜0.05);2008年手足口病和2009年甲型H1N1流感暴发时期传染病发病趋势有大幅度上升.结论 综合医院传染病发病呈逐年上升趋势,传染病病种多,科室分布广,呼吸道传染病是防控重点,感染性疾病科在传染病筛查中发挥了重要作用.     

综合性教学医院ICU病原菌分布及耐药性变迁

目的了解综合性教学医院ICU病原菌的分布及耐药性,为指导临床合理用药提供依据。方法回顾性分析2009年1月-2011年12月医院ICU住院患者送检标本中所分离的病原菌及其耐药性,采用法国生物梅里埃公司VITEK-2微生物分析系统进行细菌鉴定,药敏试验采用MIC稀释法,头孢西丁测定采用K-B法,结果按CLSI标准进行判定。结果 3年共检出病原菌4 166株,以革兰阴性菌为主占83.2%,革兰阳性菌占16.8%;革兰阴性菌中排前3位的依次为铜绿假单胞菌、嗜麦芽寡养单胞菌和鲍氏不动杆菌,分别占18.9%、16.3%和15.5%;革兰阳性菌以金黄色葡萄球菌、凝固酶阴性葡萄球菌、肠球菌属为主,分别占7.2%、5.6%和3.5%;肠杆菌科对碳青霉烯类的耐药性最低;产ESBLs肺炎克雷伯菌和大肠埃希菌分别为56.2%和75.6%;MRSA、MRCNS的检出率分别为100.0%和97.9%,葡萄球菌属和肠球菌属对万古霉素、替考拉宁、利奈唑胺的耐药性最低,对其他抗菌药物的耐药性较高。结论 ICU菌谱分布以革兰阴性菌为主,耐药性严重,且耐药率呈上升趋势,应依据药敏试验来选择用药。     

综合医院铜绿假单胞菌的感染与耐药性

目的了解综合性医院铜绿假单胞菌(PAE)临床分布及对常用抗菌药物的耐药性,为临床医师合理选用抗菌药物提供依据。方法对2007年9月-2009年9月,医院分离的229株铜绿假单胞菌的基本特征及耐药性进行回顾性分析。结果铜绿假单胞菌的检出率为12.83%,居第2位;感染部位以下呼吸道感染最常见;检出的主要科室是呼吸科、重症监护病房;主要是老年及有基础疾病的患者;该菌对亚胺培南、左氧氟沙星、头孢哌酮/舒巴坦敏感性较好,耐药率分别为20.96%、17.90%、10.92%;对其他抗菌药物的耐药性均较高。结论应加强对铜绿假单胞菌感染率和耐药性的监测,以降低其感染发生率和耐药性。     

综合性医院病原菌培养分布特征与耐药性研究

目的 了解中山市综合性医院送检标本和病原菌的分布特征及耐药动态,探讨其耐药机制,指导临床合理用药.方法 对医院2010年培养标本的来源、病原菌分布、耐药性进行统计、分析.结果 27 376份送检标本中血液和骨髓占42.1％;5795株分离病原菌中革兰阴性杆菌占58.2％、革兰阳性球菌占31.8％、真菌占10.0％;耐甲氧西林葡萄球菌对万古霉素和利奈唑胺的耐药率为0;产ESBLs大肠埃希菌和肺炎克雷伯菌对哌拉西林/他唑巴坦、亚胺培南、头孢替坦、阿米卡星的耐药率均＜10.0％;铜绿假单胞菌、鲍氏不动杆菌、嗜麦芽寡养单胞菌、洋葱伯克霍尔德菌耐药率最低的抗菌药物为头孢他啶、哌拉西林/他唑巴坦、左氧氟沙星、哌拉西林/他唑巴坦分别为9.1％、13.8％、3.0％、13.8％.结论 综合性医院感染病原菌构成存在地区差异,耐药性日趋严重,临床应重视病原菌培养标本送检,加强病原菌耐药性监测,合理选用抗菌药物.     

Epidemiology and susceptibility of serratia marcescens in a large general hospital over an 8-year period

Over the 8 year period 1988-1995, 1367 isolates of Serratia marcescens were isolated from 582 patients on 12 different wards of a large Dublin hospital and were particularly associated with the surgical intensive care unit. The annual incidence was over 200 isolates from 1990 to 1992 but fell to below 100 following the opening in April 1992 of a replacement surgical hospital incorporating a new intensive care unit on the same site. The most common source of S. marcescens was sputum from patients. Strain identities were determined by serotyping and phage typing at least one isolate from each of 311 of the 582 patients. The results showed that a single epidemic strain of serotype O14:K14 was present in 69% of these patients, and persisted throughout the hospital for the whole of the eight-year period. This strain was recovered from a variety of clinical specimens, including blood cultures. A minor outbreak involving a serotype O16:K28 strain also occurred and this strain also persisted from at least 1989 to 1994. Extensive surveillance failed to reveal an environmental source or faecal carriage. The likely mode of transmission appears to have been via staff hands from both symptomatic and asymptomatic patients acting as reservoirs of the organism, as has commonly been reported for this species.     

综合性医院ICU常见病原菌的分布及耐药性分析

目的 了解某综合性医院所有专科ICU送检感染病原菌类型、分布及对抗菌药物耐药性,以指导临床合理使用抗菌药物.方法 对2009年1月-2011年12月ICU住院患者各类感染性标本分离的4116株病原菌分布及耐药性进行回顾性分析.结果 在分离出的4116株病原菌中革兰阴性菌2791株占67.81％;革兰阳性菌979株占23.78％;真菌346株占8.41％,其中常见病原菌前5位为鲍氏不动杆菌802株占19.48％;金黄色葡萄球菌699株占16.98％;铜绿假单胞菌640株占15.55％;肺炎克雷伯菌468株占11.37％;大肠埃希菌303株占7.36％;肺炎克雷伯菌和大肠埃希菌中产超广谱β-内酰胺酶菌株分别占61.54％和68.65％,金黄色葡萄球菌中MRSA占91.42％;耐万古霉素屎肠球菌4.09％,未发现耐万古霉素金黄色葡萄球菌.结论 在ICU内感染的病原菌以革兰阴性杆菌为主,药敏试验对多种药物耐药,治疗上应根据药敏结果选择敏感抗菌药物,加强抗菌药物合理使用.     

综合医院病原菌分布及耐药性分析

目的分析综合医院临床各科室病原菌感染部位分布及耐药性。方法对2009年医院临床科室送检病原菌培养标本,采用VITEK-ATB细菌鉴定仪及K-B纸片琼脂扩散法进行菌株鉴定及药敏试验,并对其结果进行统计分析。结果临床细菌送检培养标本主要来源于呼吸道、泌尿道、皮肤与软组织、血液,分别占32.7%、19.7%、19.4%、12.5%;分离出前4位主要病原菌依次为凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌,分别占20.0%、17.6%、16.6%、9.7%;革兰阳性菌中,葡萄球菌属耐药率前3位的是青霉素83.3%、头孢西丁65.3%、红霉素66.2%,链球菌属耐药率前3位的是红霉素49.2%、克林霉素47.7%、青霉素7.7%,肠球菌属耐药率前3位的是红霉素64.8%、四环素62.5%、青霉素33.0%;革兰阴性菌中,大肠埃希菌、肺炎克雷伯菌耐药率前3位的均是氨苄西林85.8%和97.2%、哌拉西林84.6%和64.0%、头孢唑林73.5%和54.2%,铜绿假单胞菌耐药率前3位的是氨苄西林/舒巴坦60.8%、哌拉西林26.5%、替卡西林/克拉维酸24.3%。结论随着病原微生物的变迁及细菌耐药性发生变化,临床及时对患者感染部位进行病原微生物检测及耐药性分析,在感染性疾病诊治及控制医院感染中具有非常重要的意义。     

Nasal carriers of coagulase-positive staphylococci in a Nigerian hospital community

Nasal swabs taken from 324 subjects in a Nigerian hospital were examined for the presence of coagulase-positive staphylococci. The subjects used in this study included the patients, staff and “auxiliaries” aged from one day to 70 years. The results obtained show that approximately 50% of all the subjects were nasal carriers of Staphylococcus aureus and that age, occupation and length of the subjects' stay in hospital had a significant effect on this figure. It was also found that there is no significant difference between the prevalence of nasal carriage of S. aureus amongst the hospital staff and the patients.     

Resistant coagulase-negative staphylococci in hospital patients

Patients admitted to a district general hospital for general surgery were examined on admission and at weekly intervals for carriage of Staphylococcus aureus and coagulase-negative staphylococci (CNS) in the anterior nares. Thirty-two of 100 patients were colonized with CNS resistant to three or more antibiotics on admission to hospital. Two weeks later, 16 of 22 patients who remained in hospital carried resistant CNS; in 11 of these 16 patients the resistant strain was selected or acquired while the patient was in hospital.     

Registration and prevention of hospital infections in a general hospital

Active surveillance in a 270-beds general hospital in the period 1984-1988 yielded 1,547 episodes of hospital-acquired infections among 26,079 patients admitted, i.e. 5.9 infections per 100 admissions (5.1 infections/1,000 days in the hospital). Infections of the urinary tract (3.0/100 admissions), surgical wounds (1.0%), the respiratory tract (0.8%) and bloodstream infections (0.5%) predominated. The incidence of infections was highest among patients of 75 years and older (13.0%), lowest in the age group 1-14 years (1.2%). Escherichia coli, Staphylococcus aureus, enterococci and coagulase-negative staphylococci were isolated most frequently. Specific measures to limit the occurrence of urinary tract infection resulted in a decline in the rate of hospital-acquired infections, from 7.6% in 1984 to 4.9% in 1988 (35.5%). We conclude that active surveillance of hospital-acquired infections contributes to our awareness of these infections and provides the basis for preventive action. (Micro)computers constitute important aids for these activities.     

Antimicrobial resistance patterns among urine isolates from patients in a geriatric hospital and from older patients in a general hospital in Jerusalem

INTRODUCTION AND RATIONALE: Urinary tract infection is the most common cause of nosocomial infections in patients hospitalized in chronic care facilities. The changing spectrum of microorganisms involved in urinary tract infections and the emerging resistance require continuous monitoring to provide crucial information to guide empirical therapy and encourage prudent use of antibiotics. The aim of this survey was to assess the antimicrobial resistance profile of urine isolates from patients hospitalized in a geriatric hospital and from elderly patients hospitalized in an acute care hospital in order to guide empirical therapy of urinary tract infections. METHODS: The survey was performed in two hospitals in Jerusalem: a university-affiliated geriatric hospital- Herzog -and an acute secondary- and tertiary-care university hospital- Hadassah. We performed a retrospective analysis of antimicrobial resistance of all positive urine cultures obtained from patients in the geriatric division of Herzog Hospital and from patients aged 65 years and older hospitalized in the Internal Medicine departments in Hadassah Hospital during a 1-year period. RESULTS: The most common bacteria isolated from urine specimens in Herzog Hospital were, in order of frequency, Escherichia coli, Proteus mirabilis, and Pseudomonas aeruginosa. We demonstrated a high rate of antimicrobial resistance of those bacteria in both hospitals. The pattern we observed necessitates recommending ceftazidime as the most appropriate empirical therapy for urinary tract infection in Herzog Hospital. In Hadassah Hospital we recommend cefuroxime for those patients in good general condition and ceftazidime for those who present with clinical sepsis. Antimicrobial resistance patterns should be assessed periodically and recommendations modified accordingly. Infection control guidelines should be implemented in order to try to decrease the rate of antimicrobial resistance. Further research is requested to assess the efficacy of such interventions in long-term care facilities.     

综合医院医院感染的病原菌分布及耐药性分析

目的了解综合医院感染的病原菌分布及其耐药性,为有效预防和控制医院感染、合理使用抗菌药物提供可靠依据。方法从患者血、痰、尿、手术切口分泌物中分离出的病原菌进行分析,并检测其耐药性。结果 2009年1月-2010年12月33 689例出院患者中,发生医院感染1641例,医院感染率为4.87%;1641例患者主要分布于重症监护病房、呼吸科、老年科及神经内科,分别占14.32%、13.47%、12.13%及11.09%;共培养、分离出487株病原菌,革兰阳性菌95株,占19.51%,革兰阴性菌288株,占59.14%,真菌104株,占21.35%;分离的革兰阴性菌大多有多药耐药性,其中以鲍氏不动杆菌更为显著;金黄色葡萄球菌和表皮葡萄球菌对青霉素、红霉素、庆大霉素和头孢菌素耐药率>80.00%,提示医院感染病原菌对抗菌药物均有较广的耐药性。结论通过对综合医院耐药菌分析,发现医院感染病原菌具有越来越广泛的耐药性,提示必须控制耐药菌株的产生和播散,从而减少不必要的抗菌药物应用。