Antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae isolated from patients with community-acquired pneumonia and molecular analysis of multidrug-resistant serotype 19F and 23F strains in Japan

A nationwide study was undertaken to determine the susceptibility to penicillin and serotypes of Streptococcus pneumoniae in Japan. S. pneumoniae was isolated from 114 adult patients with community-acquired pneumonia over 22 months at 20 hospitals and medical centres in different regions in Japan. All but five isolates were from sputum. Forty-eight isolates (42.1%) were susceptible, 40 (35.1%) showed intermediate resistance (MIC, 0.12-1.0 microg/ml) and 26 (22.8%) were resistant (MIC, >or=2.0 microg/ml) to penicillin G. All isolates were susceptible to ceftriaxone (breakpoint 1 microg/ml), imipenem (4 microg/ml) and vancomycin (4 microg/ml). Most were resistant to erythromycin, clarithromycin and azithromycin; only two were resistant to levofloxacin. Differences were found in the distribution of serotypes among isolates showing susceptibility to penicillin (predominant types 3, 6B, and 19F), intermediate resistance (6B, 14, 19F, and 23F) and full resistance (19F and 23F). PFGE typing showed that 14 of the 25 strains of serotype 19F had a single DNA profile, pattern A, a pattern closely similar to that of the Taiwan multidrug-resistant 19F clone. Twelve pattern A strains were not susceptible to penicillin but carried the macrolide resistance gene mef(A). The DNA profiles of the 15 strains of 23F were also heterogeneous but six were highly similar (pattern b) yet distinct from the Spanish multidrug-resistant 23F clone although possibly related to the Taiwan multidrug-resistant 23F clone. The pattern b strains were not susceptible to penicillin and also harboured either mef(A) or erm(B). Our results indicate that multidrug-resistant pneumococci are spreading rapidly in Japan. Efforts to prevent the spread of the pandemic multidrug-resistant serotypes should be intensified.     

接种13价肺炎球菌结合疫苗对就诊儿童肺炎链球菌血清型和耐药性的影响

目的 了解就诊儿童肺炎链球菌(Streptococcus pneumoniae, Spn)血清型分布和耐药特征,探索接种13价肺炎球菌结合疫苗(13-valent pneumococcal conjugate vaccine, PCV13)对Spn的影响。方法 收集2017―2019年苏州大学附属儿童医院疫苗接种信息明确的就诊儿童的Spn菌株,根据疫苗接种情况进行分组,并采用荚膜肿胀法进行血清分型,E-test法检测菌株抗生素的耐药性,比较是否接种PCV13对Spn血清型和耐药性的差别。结果 共收集692株Spn,其中20株分离自接种PCV13儿童。接种组中常见的血清型为19F、6B、19A、23F,对照组中常见的血清型为19F、6B、23F、19A、14,两组血清型分布差别无统计学意义(P=0.868),PCV13血清型覆盖率分别为70.0%和72.4%(P=0.491)。所有菌株对红霉素、四环素、克林霉素高度耐药,且多重耐药率达98.5%。接种组和对照组的Spn菌株对青霉素的不敏感率分别为5.0%和9.1%(P=0.804)。结论 苏州大学附属儿童医院监测就诊儿童Spn血清型以PC...     

Molecular epidemiology of multiple drug resistant type 6B Streptococcus pneumoniae in the Northern Territory and Queensland, Australia

The emergence of type 6B Streptococcus pneumoniae resistant to five antibiotics (penicillin, chloramphenicol, trimethoprim sulphamethoxazole, erythromycin and tetracycline) in both the Northern Territory and Queensland prompted an investigation of the genetic relatedness and patterns of migration of the isolates. Pulsed field gel electrophoresis of genomic DNA of 74 multiple drug-resistant (MDR) isolates cultured in both regions between August 1988 and June 1997 showed that 100% of MDR isolates from the Northern Territory and 96% of MDR strains from Queensland were genetically indistinguishable or closely related to the index strain. None of a further 65 type 6B isolates that were resistant to one or two, or susceptible to all of the above antibiotics, were clonally related to the MDR pneumococci. The geographical distribution of the MDR type 6B clone increased over time. The index strain, first isolated in Darwin in August 1988, was identified in Brisbane, 2900 km distant, less than 4 years later and subsequently in other Queensland centres. Surveillance programmes are important to monitor the emergence and spread of potentially invasive MDR pneumococcal clones in countries that are well serviced by air and road transport.     

耐碳青霉烯类肺炎克雷伯菌耐药基因检测及同源性

目的探讨耐碳青霉烯类肺炎克雷伯菌(CRKP)耐药基因型及同源性。方法收集某院2015年9月—2016年2月临床标本分离的38株CRKP,采用聚合酶链反应(PCR)方法检测耐药基因型,脉冲场凝胶电泳(PFGE)分析菌株同源性。结果 38株CRKP主要来源于重症监护病房(ICU)及外科重症监护病房(SICU),分别占39.48%、34.21%。38株CRKP均检出blaKPC和blaSHV耐药基因,6株检出blaCTX耐药基因。PFGE显示共分成A、B、C、D4个谱型,其中以C型为主(65.78%,25/38)。A型菌株中菌株14、15、16携带blaKPC-2型、blaSHV型、blaCTX-M-15耐药基因,此3株细菌均是SICU患者分离的,菌株14和15分离自同一天,菌株16分离时间延后一周;C型菌株中,菌株10、18、25、28的同源性为100%,菌株10、18分离自ICU患者,菌株25、28分离自神经内一科患者(均从ICU转出),均是在ICU住院期间检出,且分离时间相差1 d。结论该院CRKP耐药基因型以blaKPC及blaSHV为主,存在克隆株医院内流行。     

小儿肺炎链球菌的耐药性及其血清学特征

目的　了解小儿肺炎链球菌的耐药性及其血清型分布情况 ,为小儿上呼吸道感染的临床抗生素合理治疗提供依据。　方法　肺炎链球菌自小儿上呼吸感染者的鼻咽拭子标本分离取得 ,并用标准 E- test法和琼脂稀释法测定其耐药性 ;采用 Quellung反应方法对其血清分型 ;采用 BOX- PCR和琼脂糖电泳技术对其进行基因特征分析。　结果　研究了 1999年至 2 0 0 1年期间从患儿鼻咽拭子标本中分离出来的 84株肺炎链球菌。 78.6% ( 66株 )的菌株对青霉素敏感 ,也同时对其他的 β-内酰胺类抗生素敏感。仅有 2 1.4 % ( 18株 )的菌株对青霉素耐药 ,其中 ,88.9% ( 16株 )的是低度耐药 ,11.1% ( 2株 )是高度耐药。几乎所有的菌株对利福平和万古霉素是敏感的。但大多数菌株对四环素、氯霉素、复方新诺明、红霉素表现出多重耐药性。占 60 .6%的肺炎链球菌其血清型是 6A( 14 .3 % )、2 3 F( 13 .1% )、19F( 11.9% )、15 B( 7.1% )、14( 7.1% ) ,不能分型 ( 7.1% ) ,而 18株青霉素耐药菌株的血清型是 2 3 F、19F、6B、14不能分型 ,以 2 3 F为主 ,它们有相似的BOX基因指纹图谱和耐药谱。　结论　本研究小儿肺炎链球菌对青霉素的耐药率较其他地区高 ,耐药模式以四环素、氯霉素、复方新诺明、红霉素、氯林可霉素为主。 2 3 F血清型是     

DNA restriction patterns produced by pulsed-field gel electrophoresis in Moraxella catarrhalis isolated from different geographical areas.

Pulsed field gel electrophoresis (PFGE) of the genomic DNA of Moraxella catarrhalis was done in 172 strains isolated from sputum of patients with respiratory infections in Nagasaki (130 strains), Europe (14 strains), Thailand (6 strains), Uganda (3 strains), Bangladesh (5 strains) and Kuwait (14 strains). Restriction endonuclease with SmaI generated 4-16 DNA fragments ranging from 1000 kb to 24.25 kb and was classified into 31 major groups. It was found that there were wide variations of DNA restriction patterns of strains isolated from the same and different geographical areas. DNA restriction patterns of strains isolated in Nagasaki during the last 12 years showed dynamic changes of the predominant strains in each time period. We conclude from this study that PFGE is a suitable method to document interstrain variation in M. catarrhalis.     

血流感染肺炎克雷伯菌对碳青霉烯类抗菌药物耐药机制研究

目的了解临床血流感染肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药机制,为其治疗提供实验依据。方法收集浙江省人民医院2016年1月-12月门诊及住院患者血流感染肺炎克雷伯菌72株,应用法国梅里埃VITEK 2 Compact检测肺炎克雷伯菌药物敏感性;应用PCR法检测相关碳青霉烯酶耐药基因(blaKPC、blaNDM、blaVIM、blaIMI、blaIMP和blaOXA-48),应用MLST方法检测菌株克隆型别。结果 2016年1月-12月门诊及住院患者血流感染肺炎克雷伯菌72株,其中碳青霉烯敏感肺炎克雷伯菌(CSKP) 48株,占66.7%,碳青霉烯耐药肺炎克雷伯菌(CRKP) 24株,占33.3%;肺炎克雷伯菌对常用抗菌药物敏感性均较低,特别是β-内酰胺类抗菌药物。替加环素体外显示出极高敏感性,仅4.2%菌株耐药;24株菌株全部检出blaKPC-2基因,其他耐药基因未检出。结论本院血流感染肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药机制主要是产KPC-2酶。碳青霉烯耐药肺炎克雷伯菌在本院呈克隆播散趋势,应引起临床高度重视。     

182株儿童患者肺炎链球菌的分子生物学鉴定及分型

目的对来自患儿的肺炎链球菌进行分型,为肺炎链球菌疫苗的正确选择提供科学依据。方法收集2014年来自河北省儿童医院的182株肺炎链球菌,普通PCR对肺炎链球菌进行种属鉴定,应用多重PCR方法对菌株进行菌型分析。结果经PCR检测182株菌的cpsA基因扩增均为阳性;经多重PCR检测,除8株未分型菌株外,其余174株肺炎链球菌中,以19F、19A和6A/6B型数量最多,分别为68株(37.36%)、33株(18.13%)和26株(14.28%),其余型别有35B型、14型、6C/6D型、23F型、15B/15C型等。结论 182株肺炎链球菌的菌型主要为19F、19A和6A/6B,为该省肺炎链球菌疫苗的正确选择和制订使用策略提供了科学依据。     

91株肺炎链球菌的血清型分布及耐药性分析

目的 了解重庆地区肺炎链球菌临床分离株的血清型分布及药物敏感性.方法 采用荚膜肿胀试验进行肺炎链球菌血清学分型,并计算疫苗(PVC7、PVC11、PVC13)覆盖率;肉汤稀释法测定抗菌药物的最低抑菌浓度(MIC).结果 91株肺炎链球菌的临床分离患者年龄呈典型双峰分布,以＜5岁婴幼儿与＞50岁中老年人群为主,占51.7％、27.5％;90株肺炎链球菌共鉴定出20个血清型,1株未能血清分型,常见的肺炎链球菌血清型为19F、19A、6B,PVC13覆盖率为74.4％;91株肺炎链球菌均表现出较高的耐药率,在67株β-内酰胺类抗菌药物不敏感株(BLAs)中,青霉素不敏感菌株(PNSP)占53.8％.结论 重庆地区肺炎链球菌临床分离株以19F、19A、6B血清型为主,PVC13的预防作用更显著;肺炎链球菌耐药性高尤其是大多数菌株呈多药耐药趋势,临床应注意合理选择用药.     

Plasmid characterization of drug-resistant Shigella dysenteriae 1 from an epidemic in Central Africa

A widespread epidemic of severe dysentery in Zaire and neighbouring Central African countries was caused by a multiply drug-resistant strain of Shigella dysenteriae 1. Early isolations were resistant to ampicillin, chloramphenicol, streptomycin, sulphonamides and tetracyclines (R-type = ACSSuT). Later in the epidemic strains resistant to trimethoprim (Tm) became prevalent and a few strains resistant to kanamycin (K) or nalidixic acid were also isolated. All resistances except nalidixic acid were encoded by plasmids of incompatibility groups X (ACT) or I1 (ACSSuTTm) and the epidemic strain also carried an SSu plasmid and a number of cryptic plasmids. The Inc X plasmid from this epidemic is the same as that in Sh. dysenteriae 1 strains isolated in Somalia in 1976 whereas the epidemic strains from the Shiga outbreaks in Central America, 1969 to 1971, and Sri Lanka, 1979, carried plasmids of group B. This epidemic demonstrates that when a multiresistant strain includes resistance to trimethoprim, nalidixic acid is a suitable alternative therapeutic agent.     

Plasmid characterization of drug-resistant Shigella dysenteriae 1 from an epidemic in Central Africa.

A widespread epidemic of severe dysentery in Zaire and neighbouring Central African countries was caused by a multiply drug-resistant strain of Shigella dysenteriae 1. Early isolations were resistant to ampicillin, chloramphenicol, streptomycin, sulphonamides and tetracyclines (R-type = ACSSuT). Later in the epidemic strains resistant to trimethoprim (Tm) became prevalent and a few strains resistant to kanamycin (K) or nalidixic acid were also isolated. All resistances except nalidixic acid were encoded by plasmids of incompatibility groups X (ACT) or I1 (ACSSuTTm) and the epidemic strain also carried an SSu plasmid and a number of cryptic plasmids. The Inc X plasmid from this epidemic is the same as that in Sh. dysenteriae 1 strains isolated in Somalia in 1976 whereas the epidemic strains from the Shiga outbreaks in Central America, 1969 to 1971, and Sri Lanka, 1979, carried plasmids of group B. This epidemic demonstrates that when a multiresistant strain includes resistance to trimethoprim, nalidixic acid is a suitable alternative therapeutic agent.     

Genetic diversity and clonal relationships of Acinetobacter baumannii strains isolated in a neonatal ward: epidemiological investigations by allozyme, whole-cell protein and antibiotic resistance analysis.

Sixty-five strains of Acinetobacter baumannii which had been isolated from patients and the indoor environment of a neonatal intensive care unit and, for comparative purposes, isolates from three other wards, were examined by means of electrotyping and analysis of whole-cell protein and antibiotic resistance patterns. Fourteen different electrotypes were determined. The predominant type, a multiply resistant acinetobacter clone, persisted in the neonatal ward over several months. The results underline the usefulness of electrophoretic subtyping, in particular by means of allozyme pattern and as a supplement to whole-cell protein pattern analysis, in epidemiological investigations into the routes of transmission of nosocomial A. baumannii infections.     

院内不同标本类型肺炎克雷伯菌耐药性分析

目的监测院内不同标本类型和不同病区分离肺炎克雷伯菌的耐药性,为临床合理使用抗菌药物提供理论依据。 方法用WHONET5.6对2016年1月1日至12月31日间我院临床主要标本类型来源分离的非重复肺炎克雷伯菌(痰液445株、尿液118株、血液58株)和不同病区分离的肺炎克雷伯菌(儿科病房143株、ICU病房74株、神经外科病房71株)进行耐药性分析。 结果血液标本、痰液标本和尿液标本类型分离的肺炎克雷伯菌对碳青霉烯类抗菌药物亚胺培南的耐药率分别为5.17%、6.07%和7.63%。ICU病房、神经外科病房和儿内科病房分离的肺炎克雷伯菌对碳青霉烯类抗菌药物亚胺培南的耐药率分别为14.86%、8.48%、8.39%。 结论我院不同标本类型和不同病区分离的肺炎克雷伯菌对临床部分常用抗菌药物的耐药率相差较大,临床医师及时了解不同来源肺炎克雷伯菌的耐药性,可提高临床医师经验用药的准确率。     

2017-2019年苏州地区儿童肺炎链球菌血清分型及耐药特征

目的 了解苏州大学附属儿童医院呼吸道感染儿童肺炎链球菌菌株的血清型分布及耐药特征,为制定肺炎链球菌相关疾病的治疗和预防接种策略提供参考.方法 采用乳胶凝集和荚膜肿胀试验对肺炎链球菌菌株进行血清分型,采用E-test法检测菌株对多种抗生素的耐药性.结果 2017年1月-2019年7月共收集3 652株肺炎链球菌,主要来自...     

ICU分离的铜绿假单胞菌血清分型及耐药性分析

目的确定重症监护室(ICU)铜绿假单胞菌流行菌株血清型别及其对抗菌药物的耐药情况,为研究铜绿假单胞菌感染的控制措施,合理应用抗菌药物提供依据。方法采用日本生研株式会社的铜绿假单胞菌血清分型试剂盒,对某院呼吸内科、神经内科、麻醉科ICU住院患者痰液及相关环境标本中分离的铜绿假单胞菌进行血清学分型及耐药性监测。结果3个ICU共检出铜绿假单胞菌88株,对其中80株进行了血清学分型,分型率90.91%;所占比率较大的血清型为:B型52.27%,G型22.73%,未分型菌9.09%。各型对10种抗菌药物的耐药种类数为:B与G型10种,未分型菌9种,D与E型8种,F型7种,I,M与K型<3种;铜绿假单胞菌对10种抗菌药物总的耐药率分别为:头孢曲松67.05%,阿洛西林61.36%,头孢吡肟44.32%,替卡西林/他唑巴坦54.55%,阿米卡星56.82%,头孢哌酮46.59%,左氧氟沙星54.55%,头孢哌酮/舒巴坦6.82%,亚胺培南55.68%,头孢他啶28.41%;B型菌的耐药率高于其他各型。结论该院ICU铜绿假单胞菌血清分型以B型为主;以多重耐药菌株多见;对头孢哌酮/舒巴坦和头孢他啶耐药率较低,此两种药可作为铜绿假单胞菌感染治疗的首选药物。     

2008／2009年度山东省流行性脑脊髓膜炎病原学监测资料分析

[目的]了解脑膜炎奈瑟菌菌群分布、变异及耐药情况,为流行性脑脊髓膜炎（流脑）防治工作提供科学依据。[方法]对2008／2009年度山东省流脑疑似病例及流脑监测点流行期检测资料进行分析。[结果]调查健康人群1097人。从咽拭子检出脑膜炎双球菌13人,带菌率为1．19％,分离菌株中,A群3株,B群1株,C群1株,W135群4,I群2株,X群2株。带菌率,15～19岁为5．77％,其他年龄为0．43％（P〈0．01）。检测10例流脑病例脑脊液（或血清）,其密切接触者咽拭子30份,“两脑”项目哨点医院送检脑炎、脑膜炎疑似病例脑脊液（或血清）标本184份,RT—PCR检出l株A群菌（流脑病例）、3株C群菌（“两脑”病例）。用分离的9株菌株进行药敏试验,1株B群菌株对12种抗生素均敏感;其他8株对氨苄青霉素、阿齐霉素、美洛培能、头孢曲松、头孢噻肟、阿齐霉素、氯霉素、利福平、萘啶酸均敏感,对复方新诺明均耐药,对青霉素1株耐药．对环丙沙星6株耐药,对左氧氟沙星6株耐药。[结论]目前山东省流脑疫情以A群、C群为主,从健康人群中检出W135群菌株,部分菌株对常用抗菌药物表现耐药。     

8株医院血流感染肺炎克雷伯菌的PFGE分型

目的应用脉冲场凝胶电泳（PFGE）技术对某医院同一外科病房临床分离的8株肺炎克雷伯菌进行同源性分析,为医院感染控制提供依据。方法对此8株肺炎克雷伯菌,采用微量肉汤稀释法和K B法进行药物敏感试验,并以PFGE技术进行基因分型。结果药物敏感试验结果显示,除菌株Kp1外,菌株Kp2等其他7株肺炎克雷伯菌对11种抗菌药物具有相同的药敏谱,且为多重耐药菌;PFGE分析亦显示此7株菌为同一谱型。结论此外科病房临床分离的8株肺炎克雷伯菌中有7株来源于同一克隆株,提示可能是一次医院感染暴发流行。     

儿童下呼吸道感染病原菌分布及耐药性

目的了解某儿童医院住院患儿下呼吸道感染的常见病原菌及其耐药情况,为临床合理用药提供依据。方法采用法国生物梅里埃VITEK2compact鉴定及药敏仪,对2010年2-9月住院的下呼吸道感染患儿痰培养所分离的菌株进行鉴定,并对主要菌种做药敏试验。结果11 785份痰标本共分离病原菌4 094株(34.74％),其中革兰阴性(G-)杆菌2 826株(69.03％),主要为肺炎克雷伯菌（1 012株）、大肠埃希菌（574株）、鲍曼不动杆菌（438株）、阴沟肠杆菌（221株）等;革兰阳性(G+)球菌1 167株(28.50％),主要为金黄色葡萄球菌（402株） 、肺炎链球菌（296株） 、表皮葡萄球菌（193株）等;真菌101株(2.47％)。肺炎克雷伯菌与大肠埃希菌中产超广谱β 内酰胺酶株检出率分别为23.91％和22.13％;G-杆菌对亚胺培南高度敏感,耐药率为0.00%~2.97%。金黄色葡萄球菌中耐甲氧西林株占12.19％,表皮葡萄球菌中耐甲氧西林株占35.75%,溶血葡萄球菌中耐甲氧西林株占47.87%,上述细菌对万古霉素均高度敏感,耐药率为0.00%。检出耐万古霉素肺炎链球菌8株（2.70%）,但其对利奈唑胺敏感,耐药率为0.00%。结论该儿童医院下呼吸道感染患儿存在多重耐药菌感染。临床应与微生物室密切配合,及时掌握细菌的耐药机制与变迁,根据药敏结果正确、合理使用抗菌药物,尽量减少新的耐药菌产生。     

52株阴沟杆菌的分布和耐药状况

目的 了解某院阴沟杆菌的分布及对常用抗菌药物的耐药率。方法 将各科送检的各类标本进行接种培养，生化鉴定；将分离出的52株阴沟杆菌用K—B纸片扩散法进行药物敏感试验。结果 52株阴沟杆菌主要来自于痰(19株)、脓(18株)、尿(1l株)标本；对氨苄西林、复方磺胺甲基嗯唑、头孢唑啉、头孢曲松的耐药率依次为96．15％，76．92％，73．08％和61．54％，产ESBLs菌株检出率为48．38％。结论 阴沟杆菌为多重耐药菌株，除对亚胺培南敏感外，对常用抗菌药物耐药率高。     

腹泻标本中肺炎克雷伯菌的分离鉴定和16S rDNA系统进化分析

目的 探讨腹泻标本中肺炎克雷伯菌属亚种的分类和鉴定.方法 腹泻标本使用麦康凯和SS培养基划线培养,挑取可疑菌落分纯后使用细菌生化鉴定仪鉴定到亚种;提取菌株的全基因组DNA,以克雷伯菌16S rDNA引物PCR扩增菌株的1500 bp 16S rDNA序列,扩增产物进行测序,测序结果 经截取后,使用Blastn程序在GenBank库中搜索16S rDNA序列的相似性匹配;用PHYLIP程序建立分离菌株及GenBank库中16S rDNA序列的进化发生树并进行分析.结果 113份腹泻标本中,经生化鉴定有25株(分离率22.2%)肺炎克雷伯菌株,其中,肺炎亚种21株(分离率18.6%)、鼻炎亚种4株,未分离到鼻硬结哑种.这些标本中未分离到常见腹泻病原菌.生化鉴定的肺炎亚种菌株均对青霉素G耐药,而对多黏菌素敏感,对呋喃坦叮、头孢噻吩、卡那霉素和妥布霉素有部分耐药.菌株的16S rDNA序列在GenBank库中搜索发现,生化鉴定为鼻炎哑种的4株菌株与沙门菌等肠道致病菌株有最大相似性匹配;16S rDNA序列系统进化树将生化鉴定的肺炎亚种聚为一群,但不能将肺炎克雷伯菌属的3个亚种完全区分开来.结论 16S rDNA序列进化分析在肺炎克雷伯菌的鉴定和分类中有一定意义.