393例儿童感染铜绿假单胞菌耐药性分析

目的了解湖南省儿童医院临床分离的铜绿假单胞菌感染分布及耐药情况。方法回顾性分析该院2010年1月至2010年12月住院患儿的各类临床标本中分离出的铜绿假单胞菌分布情况及其对16种抗菌药物的耐药情况。结果共分离出铜绿假单胞菌393株,主要来源于痰及咽拭子、血液;集中在心血管内科、急诊综合科、新生儿科、感染科、重症监护科等;对氨苄西林、头孢唑啉、氨苄西林-舒巴坦、呋喃妥因等不敏感,敏感率均<10%,对头孢吡肟、哌拉西林-他唑巴坦、氨曲南、环丙沙星、左氧氟沙星、美罗培南等耐药率较低,耐药率均<10%。结论铜绿假单胞菌是医院感染的主要病原菌之一,耐药形势严峻;应高度重视重点病区感染流行的监测及消毒工作,结合药敏试验结果,合理使用抗菌药物。     

中国西部地区老年患者临床分离菌的耐药及分布特点

目的 了解中国西部地区10所医院2016—2017年老年患者临床分离菌的分布特点及其对抗菌药物的耐药性。方法 按统一方案,采用纸片扩散法或自动化仪器法进行细菌药敏试验,按照美国临床和实验室标准化协会(Clinical and Laboratory Standards Institute,CLSI)2017年标准判读结果。结果 共收集临床分离菌121374株,其中老年患者41448株,占34.1%。其中革 兰阳性菌9499株,占22.9%;革兰阴性菌31949株,占77.1%。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄 球菌(MRCNS)的检出率分别为37.1%和79.3%。未发现万古霉素、替考拉宁和利奈唑胺耐药葡萄球菌。除四环素、克林霉素和利 奈唑胺外,屎肠球菌对其他抗菌药物耐药率均高于粪肠球菌;两者中均有少数万古霉素、替考拉宁和利奈唑胺耐药株,耐药率 均＜3%。碳青霉烯类抗生素依然对肠杆菌科细菌保持良好的抗菌活性,耐药率均＜10%。肺炎克雷伯菌对亚胺培南、美罗培南 的耐药率分别为7.1%和9.9%,比2011年明显升高。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为18.9%和17.8%。鲍曼不 动杆菌对亚胺培南和美罗培南的耐药率均＞60%,高于全国平均水平(60.0%,2016年)。结论 老年患者临床分离菌的耐药及分 布特点不同于全国平均水平。经验用药应参考老年人群耐药监测数据,根据药敏试验结果合理选用抗菌药物。     

Antibiotic resistance among enterococcal strains isolated from clinical specimens

The distribution and resistance patterns of clinical isolates of enterococci from hospital patients were compared with those obtained from outpatients. Of 235 enterococcal isolates 212 (90.2%) were identified as Enterococcus faecalis and 23 (9.8%) as E. faecium. E. faecium occurred more frequently in specimens from hospitalized patients than from outpatients (P < 0.001). Over 90% of all E. faecalis isolates were susceptible to ampicillin. Resistance to ampicillin occurred in 66.7% of hospital strains of E. faecium. High-level resistance to gentamicin (MIC > 500 mg/l) was seen in 37.03% of inpatients' and in 11.5% of outpatients' E. faecalis isolates and in 76.2% of hospital isolates of E. faecium. High-level streptomycin resistance (MIC > 2000 mg/l) occurred in 52.8% of E. faecalis and 76.2% of E. faecium hospital isolates. There were no isolates resistant to vancomycin. The community acquired strains isolated from outpatients were more susceptible than isolates from hospitalized patients to all antimicrobial agents tested.     

儿童细菌性皮肤病的病原菌分布与耐药性分析

目的 分析细菌感染性皮肤病住院患儿病原菌分布及耐药性,指导临床合理用药.方法 对253例细菌性皮肤病住院患儿进行细菌分离培养,VITEK-AMS60微生物鉴定仪进行病原菌鉴定和药敏试验.结果 从253例患儿标本中分离出病原菌216株,其中葡萄球菌211株,占97.7%,A组β-溶血性链球菌(GABHS)5株,占2.3%.葡萄球菌药敏试验结果显示,对氨苄西林/克拉维酸、苯唑西林、头孢唑林、红霉素、环丙沙星和复方磺胺甲噁唑,前3年组(2004-2006年)的耐药率分别为96.6%、94.3%、94.3%、82.8%、21.5%和25.3%,后3年组(2007-2009年)的耐药率分别为97.6%、95.2%、96.8%、91.1%、25.0%和31.5%,各组间差异无统计学意义(P＞0.05);但前3年组对克林霉素和庆大霉素的耐药率分别为44.8%和26.4%,后3年组的耐药率分别为81.5%和65.3%,后3年组耐药率高于前3年组(P＜0.01和P＜0.01);5株GABHS中,4株对红霉素耐药、4株对阿奇霉素耐药,对青霉素、莫匹罗星全部敏感.尚未发现耐万古霉素的菌株.结论 葡萄球菌是细菌性皮肤病的主要病原菌;葡萄球菌具有多重耐药性,对克林霉素和庆大霉素的耐药性在增高.     

Antibiotic susceptibility of bacterial strains isolated from patients with community-acquired urinary tract infections.

Isolates from urine samples obtained during 1999 were identified and their susceptibility to antimicrobial agents studied along with any production of extended-spectrum beta-lactamases (ESBL) by Escherichia coli and Klebsiella pneumoniae. A total of 13774 samples were analysed using an automatic system for the detection of bacterial ATP (Coral, USA). Of these samples, 49% were reported to be positive and uncontaminated; bacteria most frequently isolated were E. coli (47%), Proteus mirabilis (7%), Enterococcus faecalis (6%) and K. pneumoniae (5%). The susceptibility studies showed 37% E. coli strains resistant to amoxycillin+clavulanate 33% to cotrimoxazole and 22% to ciprofloxacin. Seven strains of E. coli produced ESBL. Thirteen per cent of strains were resistant to cefuroxime but only (1%) to fosfomycin. Resistance to nitrofurantoin in K. pneumoniae was 38%. P. mirabilis showed 52% resistance to cotrimoxazole and 13% Staphylococcus aureus, were methicillin-resistant. E. faecalis did not show any special resistance to normal medication. Fosfomycin continued to show high activity against Gram-negative bacilli. However, enterococci, some species of staphylococci and yeasts were difficult to treat empirically. ESBL were detected in the isolates of E. coli and there were some methicillin-resistant strains of S. aureus.     

胸腹水标本分离菌株及耐药性分析

目的了解胸腹水标本中病原菌种类及其对抗菌药物的耐药情况,为临床合理用药提供参考。方法对我院2005年1月-2007年3月送检的胸腹水标本进行分离培养,并对分离菌用Micro Scan WalkAway-40全自动微生物鉴定仪进行鉴定及药敏试验。结果在1186份胸腹水标本中分离到病原菌共计186株,阳性检出率为15．7％,G^-菌占59．1％,G^-菌占29．0％,真菌占11．8％,主要以大肠埃希菌（20．4％）、铜绿假单胞菌（18．3％）、葡萄球菌（16．1％）、白假丝酵母菌（8．6％）、肠球菌（6．5％）、嗜麦芽窄食单胞菌（5．4％）为主。多数革兰阴性菌对三代头孢菌素的耐药率较高,对哌拉西林／他唑巴坦、阿米卡星、环丙沙星耐药率较低,大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌对亚安培南的耐药率分别为2．6％、5．9％、12．5％。嗜麦芽窄食单胞菌对多种抗菌药物耐药,但对复方新诺明耐药率较低（20％）。金黄色葡萄球菌耐甲氧西林的占40％,对万古霉素100％敏感。结论胸腹水标本中病原菌呈明显多样化。大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌对亚胺培南最敏感,嗜麦芽窄食单胞菌对复方新诺明最敏感,革兰阳性球菌对万古霉素最敏感。     

上饶地区淋病奈瑟菌临床耐药性分析

目的了解上饶地区近年淋病奈瑟菌(NG)的耐药特点及产β-内酰胺酶淋病奈瑟菌(PPNG)的流行状况,为本地区淋病治疗合理选用抗生素提供指导。方法采用K-B琼脂扩散法,测定临床分离鉴定的NG对8种常用抗生素的敏感性;应用硝基噻吩显色法检测PPNG。结果 116株NG对8种抗生素的耐药率从高到低依次为:氧氟沙星(91.4%)、四环素(83.6%)、氨苄青霉素(55.2%)、头孢噻吩(18.9%)、头孢呋辛(12.0%)、头孢噻肟(7.8%)、头孢曲松(6.9%)和大观霉素(4.3%);检测出PPNG54株(46.6%)。结论氧氟沙星、四环素和氨苄青霉素不宜作为本地区淋病治疗药物,大观霉素和第三代头孢菌素可作为首选药物,但要加强耐药性检测。     

Antibiotic resistance genes in phage particles isolated from human faeces and induced from clinical bacterial isolates

Phage particles have emerged as elements with the potential to mobilise antibiotic resistance genes (ARGs) in different environments, including the intestinal habitat. This study aimed to determine the occurrence of ARGs in phage particles present in faecal matter and induced from strains isolated from faeces. Nine ARGs (bla_TEM, bla_{CTX-M-1 group}, bla_{CTX-M-9 group}, bla_OXA-48, qnrA, qnrS, mecA, sul1 and armA) were quantified by qPCR in the phage DNA fractions of 150 faecal samples obtained from healthy individuals who had not received antibiotic treatment or travelled abroad in the 3 months prior to sample collection. On the suspicion that the detected particles originated from bacterial flora, 82 Escherichia coli and Klebsiella pneumoniae isolates possessing at least one identified ARG (bla_TEM, bla_{CTX-M-1 group}, bla_{CTX-M-9 group}, armA, qnrA, qnrS and sul1) were isolated and their capacity to produce phage particles carrying these ARGs following induction was evaluated. Of 150 samples, 72.7% were positive for at least one ARG, with bla_TEM and bla_{CTX-M-9 group} being the most prevalent and abundant. Of the 82 isolates, 51 (62%) showed an increase in the number of copies of the respective ARG in the phage fraction following induction, with bla_TEM, bla_{CTX-M-1 group}, bla_{CTX-M-9 group} and sul1 being the most abundant. Phages induced from the isolates were further purified and visualised using microscopy and their DNA showed ARG levels of up to 10¹⁰ gene copies/mL. This study highlights the abundance of phage particles harbouring ARGs and indicates that bacterial strains in the intestinal habitat could be source of these particles.     

2018年四川省儿童患者细菌耐药监测分析

摘要：目的 了解2018年四川省儿童患者主要病原菌分布及对常用抗菌药物耐药性,为临床合理选择抗菌药物提供依据。方法 收集2018年全国细菌耐药监测网四川省成员单位报告的儿童患者病原菌数据并进行分析总结。结果 2018年共分离出细菌46387株,其中革兰阳性菌19012株(占41.0%),以肺炎链球菌、金黄色葡萄球菌和凝固酶阴性葡萄球菌为主,检出率分别是17.3%、15.7%和2.1%;革兰阴性菌27375株(占59.0%),主要是流感嗜血菌、大肠埃希菌和黏膜炎莫拉菌,检出率分别是21.2%、10.4%和8.3%。非脑脊液标本分离的肺炎链球菌对红霉素的耐药率高达95.9%。耐甲氧西林金黄色葡萄球菌的检出率为26.7%,耐甲氧西林凝固酶阴性葡萄球菌的检出率为79.1%,未发现万古霉素和利奈唑胺耐药肺炎链球菌和葡萄球菌。粪肠球菌对万古霉素的耐药率为0.6%,未发现替考拉宁耐药的粪肠球菌;屎肠球菌对万古霉素的耐药率为0.6%,对替考拉宁的耐药率为2.1%。流感嗜血菌对氨苄西林、复方磺胺甲噁唑以及头孢克肟的耐药率高。黏膜炎莫拉菌对阿奇霉素的非敏感率为72.5%。肺炎克雷伯菌对亚胺培南、美罗培南耐药率分别为7.7%和11.6%。结论 2018年四川省儿童细菌感染的主要病原菌中,耐红霉素的肺炎链球菌、耐甲氧西林凝固酶阴性葡萄球菌、耐氨苄西林的流感嗜血菌以及耐碳青霉烯的肺炎克雷伯菌检出率高,需加强感染防控。     

Antibiotic resistance of bacterial biofilms

A biofilm is a structured consortium of bacteria embedded in a self-produced polymer matrix consisting of polysaccharide, protein and DNA. Bacterial biofilms cause chronic infections because they show increased tolerance to antibiotics and disinfectant chemicals as well as resisting phagocytosis and other components of the body's defence system. The persistence of, for example, staphylococcal infections related to foreign bodies is due to biofilm formation. Likewise, chronic Pseudomonas aeruginosa lung infection in cystic fibrosis patients is caused by biofilm-growing mucoid strains. Characteristically, gradients of nutrients and oxygen exist from the top to the bottom of biofilms and these gradients are associated with decreased bacterial metabolic activity and increased doubling times of the bacterial cells; it is these more or less dormant cells that are responsible for some of the tolerance to antibiotics. Biofilm growth is associated with an increased level of mutations as well as with quorum-sensing-regulated mechanisms. Conventional resistance mechanisms such as chromosomal β-lactamase, upregulated efflux pumps and mutations in antibiotic target molecules in bacteria also contribute to the survival of biofilms. Biofilms can be prevented by early aggressive antibiotic prophylaxis or therapy and they can be treated by chronic suppressive therapy. A promising strategy may be the use of enzymes that can dissolve the biofilm matrix (e.g. DNase and alginate lyase) as well as quorum-sensing inhibitors that increase biofilm susceptibility to antibiotics.     

Antibiotic resistance in Salmonella enterica subsp. enterica strains isolated in Poland from 1998 to 1999.

A total of 326 Salmonella enterica subsp. enterica strains representing 29 serotypes, isolated from human stool specimens during 1998-1999 in sanitary-epidemiological units in Poland were tested for antibiotic susceptibility by a standard disk diffusion method. The antibiotics used were ampicillin, cefotaxime, chloramphenicol, tetracycline, streptomycin, gentamicin, kanamycin, nalidixic acid, ciprofloxacin, furazolidone, cotrimoxazole, sulphonamides and trimethoprim. In addition, 201 strains belonging to the five most commonly isolated serotypes (S. Enteritidis, S. Typhimurium, S. Hadar, S. Infantis and S. Virchow) also had minimal inhibitory concentrations (MICs) determined for amoxycillin/clavulanic acid. Selected strains were screened for production of extended spectrum beta-lactamases (ESBLs). There were 49.4% of Salmonella enterica subsp. enterica strains resistant to two or more antibiotics, with the highest prevalence of multiple resistant strains among serotypes Typhimurium, Hadar and Virchow. Resistance to ampicillin, streptomycin, tetracycline, nalidixic acid, furazolidone and sulphonamides occurred most frequently. Over 93% of S. Virchow strains were resistant to furazolidone. No strains resistant to ciprofloxacin by disk-diffusion method were detected but 31.3% of isolates of the 201 strains representing the five most common serotypes had reduced ciprofloxacin susceptibility (MICs ranging 0.125-0.5 mg/l). One strain (S. Mbandaka) was resistant to cefotaxime and produced ESBL.     

Primary resistance to clarithromycin in clinical strains of Helicobacter pylori isolated from children in Poland.

Helicobacter pylori resistance to clarithromycin is an important factor in the failure of eradication therapy. The resistance results from point mutations in the 23S rRNA gene of H. pylori. The prevalence of primary resistance of H. pylori to clarithromycin in children and mutations associated with resistance were studied and it was found that 23.5% (23/98) of H. pylori strains isolated in our hospital during 1998-2000 were resistant to clarithromycin. The primary resistance was mainly caused by an A2143G mutation, but the isolates with an A2142G mutation had higher MICs for clarithromycin compared with those with an A2143G mutation: median MIC 256 versus 16 mg/l. Comparison of our data with previous results showed that the prevalence of H. pylori resistance to clarithromycin in children has increased in Poland over the last three years, however the difference was not significant (23.5 vs. 17%, P=0.22).     

Antibiotic selective pressure and development of bacterial resistance

This study evaluates the development of resistance in Gram-negative rods to cefotaxime and ceftazidime, ofloxacin and ciprofloxacin, gentamicin and amikacin, meropenem and ampicillin/sulbactam over a five year period of use (1994-1998) at the University Hospital in Olomouc, Czech Republic. The development of bacterial resistance was linked with antibiotic use and hence selective pressure which was specific for the type of antibiotic and the bacterial species. Statistically significant correlations were found for the use of ofloxacin and resistance in Escherichia coli, Proteus vulgaris and Providencia rettgeri; cefotaxime and Enterobacter cloacae; ceftazidime and Acinetobacter spp., Enterobacter agglomerans and Proteus vulgaris; and gentamicin and Proteus mirabilis.     

Antibiotic resistance in urinary bacteria isolated in central Scotland

The levels of antibacterial amongst 991 strains responsible for significant bacteriuria, isolated in central Scotland at the end of 1990, have been determined by breakpoint sensitivity testing. Overall resistance to the commonly used antibacterials for UTI, trimethoprim and ampicillin was 23% and 36%, revealing that resistance to these agents in central Scotland had not significantly changed over the last ten years. High levels of ampicillin resistance have led to the widespread use of amoxicillin in combination with the β-lactamase inhibitor clavulanic acid. The effectiveness of this approach was demonstrated by the fact that resistance among these urinary isolates to amoxicillin/clavulanic acid was only 6%. More detailed examination of Escherichia coli isolates, which were ampicillin-resistant, revealed that the addition of clavulanic acid restored sensitivity in 97.5% of the strains.     

2008年我院568株细菌耐药情况分析

目的分析本院2008年分离的致病菌的菌株特点及其耐药情况。方法收集临床各科送检的标本,按常规方法分离出致病菌株,并对其进行药物敏感试验。结果共分离出致病菌株568株,其中革兰阳性（G^＋）球菌143株（占25．2％）,革兰阴性（G^-）杆菌425株（74．8％）。结论细菌对常用抗菌药物的耐药率增高,临床需加强细菌耐药性监测。     

临床微生物标本分离菌耐药性分析

目的：了解临床分离菌对抗生素的耐药现状。提示重视抗生素的合理应用，防止多重耐药、交叉耐药。方法：对临床送检标本671株分离菌，按WHO推荐K－B纸片扩散法进行药敏试验，并按NCCLS标准分别进行ESBLs、MRSA、MRCNS菌检测。结果：分离病原菌671株，其中革兰阴性菌361株（占53．8％），革兰阳性菌310株（占46．2％）。最常见的菌种为大肠埃希菌、凝固醇阴性葡萄球菌、金黄色葡萄球菌等，病原菌分布在痰占42．2％，咽拭子占18．1％等。结论：我院临床标本分离出细菌均存在不同程度的多重耐药和交叉耐药，提示临床在疾病治疗上，应减少联合用药，有针对性地合理选择抗生素。     

Antibiotic resistance in the cultivable plaque microbiota of children from different ethnic groups

The presence of ampicillin-, penicillin-, erythromycin- and tetracycline-resistant bacteria in the dental plaque of White, South Asian and Japanese children was investigated. There was a high prevalence of antibiotic-resistant bacteria in children from diverse ethnic groups. The median percentage of the cultivable plaque microbiota that was resistant to tetracycline was greater in South Asian (2.9%, range 0.1-17.5%) and Japanese (7.7%, range 1.3-56.2%) children than in White children (0.7%, range 0-5.6%), suggesting that ethnic differences exist in the oral load of tetracycline-resistant bacteria (P<0.01). Multiresistant bacteria were frequently isolated, with 42% of isolates exhibiting resistance to two or more antibiotics. This study has demonstrated that antibiotic-resistant bacteria can be readily isolated from the plaque microbiota of children from different ethnic groups.