肿瘤患者术后手术部位感染的病原菌分布及其耐药性研究

目的:调查我院近5年肿瘤患者术后手术部位感染的病原菌分布及其耐药性,为临床合理选用抗生素提供参考依据.方法:选取我院于2008年10月至2013年9月接受手术治疗的肿瘤患者750例,严格按《全国临床检验操作规程》进行细菌分离培养及鉴定和药敏试验,采用伤口拭子法采集标本,药敏试验采用纸片扩散法,分别对葡萄球菌属甲氧西林耐药株和肠杆菌科细菌产生的超广谱3-内酰胺酶(ESBLs)菌株进行检测,计算不同致病菌的耐药率和产耐药酶菌株的比例.结果:750例患者中共分离出病原菌845株,其中G-杆菌占64.85％(548/845),G+球菌占31.72％(268/845),G-杆菌和G+球菌分别以大肠埃希菌和凝固酶阴性的葡萄球菌为主;可产生超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌比例分别为48.65％(72/148)和22.89％(19/83),阴沟肠杆菌产生高产头孢菌素酶(AmpC)的菌株占22.58％(14/62),铜绿假单胞菌产生金属β内酰胺酶的菌株占21.84％(19/87),甲氧西林耐药株分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的26.67％(20/75)和20.45％(18/88),未发现MRSA和MRCNS对万古霉素的耐药株;万古霉素和碳青霉烯类药物仍然分别是G+球菌和肠杆菌科细菌最敏感的药物.结论:本院肿瘤患者术后感染以G-杆菌为主;细菌耐药性以产生超广谱β内酰胺酶的大肠埃希菌和肺炎克雷伯菌、产AmpC酶的阴沟肠杆菌、产金属β内酰胺酶的铜绿假单胞菌、鲍曼不动杆菌、耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌比较严重,其他细菌也分别存在不同程度的耐药情况,临床微生物实验室应继续加强耐药性监测调查,为临床合理选用抗菌药物提供依据.     

鼻咽癌肿瘤干细胞样细胞亚群的分离及初步鉴定

  目的   分离和鉴定具有肿瘤干细胞特性的鼻咽癌球形成细胞亚群。   方法   利用无血清干细胞球悬浮培养技术从不同分化程度鼻咽癌细胞株中分离成球细胞,然后利用MTT法,软琼脂克隆形成实验,分别评价成球细胞的耐药性、克隆形成能力,最后利用RT-PCR和免疫荧光细胞技术分析干性基因及Wnt信号通路关键转录因子β-catenin在成球及未成球细胞中的表达情况。   结果   低分化鼻咽癌细胞含有较高成球细胞,而高分化细胞株CNE-1中未见成球细胞。与CNE-2相比较,CNE-2S（来源于CNE-2的成球细胞）具有较强的抗肿瘤药物耐药性、克隆形成能力、高表达干性基因,且β-catenin在胞浆和核内都呈高表达。   结论   本研究分离到干细胞样鼻咽癌成球细胞亚群,为最终靶向杀灭鼻咽癌肿瘤干细胞提供了可能。      

妇科肿瘤患者医院感染病原菌分布及耐药性分析

目的:对妇科肿瘤患者医院感染病原菌的分布特点及耐药性进行分析,为临床治疗提供依据。方法:回顾性分析2010年1月至2017年7月住院治疗的妇科肿瘤患者851例,对其感染的病原菌分布及药敏进行分析统计。结果:发生医院感染72例,感染率为8.46%;共检出83株病原菌,革兰阴性菌（57株）占68.68%,革兰阳性菌（21株）占25.30%,真菌（5株）占6.02%;大肠埃希菌对头孢唑林及氨苄西林的耐药率较高,铜绿假单胞菌对氨苄西林、头孢唑林、复方新诺明的耐药率较高,金黄色葡萄球菌对青霉素、红霉素的耐药率较高。结论:妇科肿瘤患者医院感染以革兰氏阴性杆菌为主,革兰氏阳性菌次之,细菌耐药现象严重,临床上要根据药敏结果合理选用抗菌药物,有效提高疗效。     

肿瘤患者感染病原菌的分布及耐药性分析

目的：了解肿瘤患者感染病原菌的分布及耐药性分析,为合理用药提供依据。方法：对本院肿瘤患者送检的合格标本分离菌株进行培养鉴定和耐药性分析。结果：405株病原菌中G-杆菌228株,占56．3％;G＋球菌67株,占16．5％;真菌110株,占27．2％;药敏试验结果提示G-杆菌对亚胺培南、美罗培南高度敏感,对氨苄西林、哌拉西林耐药率很高。结论：肿瘤患者易发生院内感染且易产生耐药株,在选择抗生素时应依据药敏实验结果合理选用药物,控制病原菌的耐药性。     

肿瘤患者感染病原菌的分布及耐药性分析

目的:了解肿瘤患者感染病原菌的分布及耐药性分析,为合理用药提供依据。方法:对本院肿瘤患者送检的合格标本分离菌株进行培养鉴定和耐药性分析。结果:405株病原菌中G-杆菌228株,占56.3%;G+球菌67株,占16.5%;真菌110株,占27.2%;药敏试验结果提示G-杆菌对亚胺培南、美罗培南高度敏感,对氨苄西林、哌拉西林耐药率很高。结论:肿瘤患者易发生院内感染且易产生耐药株,在选择抗生素时应依据药敏实验结果合理选用药物,控制病原菌的耐药性。     

前列腺癌PC-3多西紫杉醇耐药细胞株的蛋白组学分析

  目的  比较前列腺癌PC-3细胞株对多西紫杉醇(docetaxel)耐药前后的蛋白质差异性表达, 了解前列腺癌PC-3细胞株耐药性产生机制。  方法  利用逐渐加量的方式培养前列腺癌PC-3多西紫杉醇耐药细胞株, 利用双向荧光差异凝胶电泳(DIGE)定量筛选PC-3细胞敏感株与耐药株的差异蛋白, 并用基质辅助激光解吸电离飞行时间质谱技术(MALDI-TOF/TOF-MS)对差异位点蛋白进行成分鉴定。  结果  利用DIGE结合MALDI-TOF/TOF-MS质谱技术分析, PC-3细胞耐药株较敏感株成功分离出49种差异表达蛋白质, 29种表达上调, 20种表达下调。其中ATP synthase、Galectin-1等参与肿瘤血管的生成, Calreticulin、CathepsinD、Coflin-1蛋白参与肿瘤的转移; 78 kDa glucose-regulated protein(GRP78)、Microtubule-associated protein-6等参与肿瘤的耐药性调节。  结论  人前列腺癌PC-3细胞株多西紫杉醇耐药前后存在蛋白质的差异性表达, 为进一步发现前列腺癌转移及耐药性的分子机制以及晚期激素非依赖性前列腺癌的靶向药物治疗提供实验依据。      

215例早期胃癌淋巴结转移的危险因素分析

  目的   探讨早期胃癌淋巴结转移的危险因素。   方法   回顾性分析2005年1月至2010年12月安徽医科大学附属省立医院普外科收治的215例早期胃癌患者的临床病理资料, 并研究早期胃癌淋巴结转移与临床病理因素的关系。   结果   215例患者中淋巴结转移者36例, 单因素分析显示: 肿瘤最大直径(P=0.022)、浸润深度(P=0.003)、Hp感染情况(P=0.004)均与早期胃癌淋巴结转移有关。Logistic多因素回归分析显示: 肿瘤的浸润深度与早期胃癌淋巴结转移有关(P=0.002)。   结论   肿瘤的浸润深度是影响早期胃癌淋巴结转移的独立危险因素。      

术前血清CA19-9水平对胃癌患者生存预后的影响

  目的   探讨胃癌患者术前检测血清CA19-9的必要性及其对患者预后评估的意义。   方法   收集2003年1月至2008年10月间天津医科大学肿瘤医院收治的513例术前检测血清CA19-9的胃癌患者的临床病理资料，分析CA19-9水平与临床病理因素的关系及其与预后的关系。   结果   513例患者中CA19-9升高者86例（16.8%），CA19-9升高与高龄、大体分型（BorrmannⅢ、Ⅳ型）、组织学类型（低分化、未分化）及浸润深度相关。CA19-9正常（< 39 U/mL）和升高（≥39 U/mL）患者5年生存率分别为45.7%和25.6%，差异有统计学意义（P < 0.001）。分层分析显示，CA19-9水平仅与TNM Ⅲ期患者预后相关（P=0.001）。多因素预后分析证实，CA19-9升高是影响胃癌患者根治术后生存的独立危险因素（HR=1.47，P=0.008）。   结论   术前检测血清CA19-9可为胃癌患者预后评估提供信息，CA19-9升高可能是胃癌根治术后影响患者预后的独立危险因素。      

采用保留乳腺方式治疗副乳腺癌的临床分析

  目的   探讨采用保留乳腺手术方式治疗副乳癌的相关注意事项及预后。   方法   收集从2003年9月至2013年6月天津医科大学肿瘤医院收治的副乳腺癌患者23例,分析采用不同手术方式治疗副乳腺癌的术前检查、术后治疗及预后。   结果   采用保留同侧乳腺手术方式的10例患者术前均行乳腺相关检查,证实双乳未见恶性病灶。术后3例行放疗,接受放疗的患者均有不同程度放射性皮炎的发生。随访至2013年10月,2例出现骨转移。13例采用乳腺癌根治术中1例出现肺转移。   结论   副乳腺癌确诊时,如双侧乳腺未及异常,可采用保留同侧乳腺治疗副乳腺癌的手术方式,术后放疗应注意放射性皮炎发生的可能。      

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。     

Cefaclor: A Contemporary Look at Susceptibility of Key Pathogens from Around the Globe

Abstract

The orally administered cephalosporin antibiotic, cefaclor, has been available for clinical use in many countries since 1979. Because widespread antibiotic use is often cited as a factor in the emergence of bacterial resistance to antibiotics, we sought to determine the degrees of resistance to cefaclor expressed by key pathogens recently isolated in 10 countries widely distributed around the world. Using the E-test ®, minimal inhibitory concentrations (MIC) were determined for cefaclor and several comparator antibiotics against approximately 700 fresh clinical isolates of each of six bacterial species. The results demonstrated that > 90% of Haemophilus influenzae (β-lactamase producing and non-producing), Haemophilus parainfluenzae (β-lactamase producing and non-producing), Moraxella catarrhalis (> 90% β-lactamase producing), and methicillin-susceptible Staphylococcus aureus, and 85% of Escherichia coli were susceptible to cefaclor at the NCCLS interpretive breakpoints. MIC distributions showed that there has been no change in the activity of cefaclor against penicillin-susceptible strains of Streptococcus pneumoniae since 1977.     

An observational study on the epidemiology of respiratory tract bacterial pathogens and their susceptibility to four injectable beta-lactam antibiotics: piperacillin, piperacillin/tazobactam, ceftazidime and ceftriaxone

Bacterial infections of the respiratory tract account for a large proportion of total medical consultations in general practice. In recent years, antibiotic resistance has increased alarmingly in a number of bacterial species that are common causes of these infections. The aim of this observational study was to determine the antibiotic resistance of microbial agents isolated from patients with acute or acutely exacerbated respiratory infections. Subjects recruited as potential sources of bacteria were either outpatients seen in a number of specialized clinics and hospital practices, or hospitalized patients. Overall, 648 consecutive patients (67% male, mean age 48.1+/-27.0 years) with infection of the upper or lower respiratory tract were observed during a 13-month period. A total of 551 pathogenic microbial strains were isolated and tested for their in vitro susceptibility to piperacillin, piperacillin/tazobactam, ceftazidime, and ceftriaxone. Among all isolates, the four most frequent pathogens were Pseudomonas aeruginosa (132 isolates, 24%), Streptococcus pyogenes (99 isolates, 18%), Staphylococcus aureus (93 isolates, 17%), and Klebsiella pneumoniae (46 isolates, 8%). The susceptibility of gram-positive isolates ranged from 97.5% to 95.1%, and no remarkable difference was found in the antibacterial activity of tested b-lactam antibiotics. The susceptibility of gram-negative isolates to piperacillin and piperacillin/tazobactam was also similar: 96.5% and 97.1%, respectively. In contrast, differences were found between piperacillin (or piperacillin/tazobactam) and either ceftazidime (p=0.003) or ceftriaxone (p<0.0003) in gram-negative isolates. We conclude that, despite the extensive use of beta-lactam antibiotics (piperacillin, ceftazidime, and ceftriaxone) in medical practice during the past three decades, the susceptibility of the most common pathogens involved in the etiology of upper and lower respiratory tract infections to these antibiotics is still high. In particular, bacterial resistance developed by gram-positive organisms against piperacillin is negligible and not alarming.     

An Observational Study on the Epidemiology of Respiratory Tract Bacterial Pathogens and Their Susceptibility to Four Injectable Beta-Lactam Antibiotics: Piperacillin,Piperacillin/Tazobactam,Ceftazidime and Ceftriaxone

Abstract

Bacterial infections of the respiratory tract account for a large proportion of total medical consultations in general practice. In recent years, antibiotic resistance has increased alarmingly in a number of bacterial species that are common causes of these infections. The aim of this observational study was to determine the antibiotic resistance of microbial agents isolated from patients with acute or acutely exacerbated respiratory infections. Subjects recruited as potential sources of bacteria were either outpatients seen in a number of specialized clinics and hospital practices, or hospitalized patients. Overall, 64-a8 consecutive patients (67% male, mean age 48.1 ± 27.0 years) with infection of the upper or lower respiratory tract were observed during a 13-month period. A total of 551 pathogenic microbial strains were isolated and tested for their in vitro susceptibility to piperacillin, piperacillin/tazobactam, ceftazidime, and ceftriaxone. Among all isolates, the four most frequent pathogens were Pseudomonas aeruginosa (132 isolates, 24%), Streptococcus pyogenes (99 isolates, 18%), Staphylococcus aureus (93 isolates, 17%), and Klebsiella pneumoniae (46 isolates, 8%). The susceptibility of Gram-positive isolates ranged from 97.5% to 95.1%, and no remarkable difference was found in the antibacterial activity of tested b-lactam antibiotics. The susceptibility of Gram-negative isolates to piperacillin and piperacillin/tazobactam was also similar: 96.5% and 97.1%, respectively. In contrast, differences were found between piperacillin (or piperacillin/tazobactam) and either ceftazidime (p=0.003) or ceftriaxone (p<0.0003) in Gram-negative isolates.

We conclude that, despite the extensive use of beta-lactam antibiotics (piperacillin, ceftazidime, and ceftriaxone) in medical practice during the past three decades, the susceptibility of the most common pathogens involved in the etiology of upper and lower respiratory tract infections to these antibiotics is still high. In particular, bacterial resistance developed by Gram-positive organisms against piperacillin is negligible and not alarming.     

A Comparison of the Activity of Ciprofloxacin and Levofloxacin with Other Agents Against Respiratory Tract Pathogens

Abstract

In a study involving 15 UK hospitals, sequential respiratory tract isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis were studied. The susceptibility of these strains to two fluoro-quinolones, ciprofloxacin and levofloxacin were compared to those of currently used macrolides and β-lactams.

The activity of ciprofloxacin and levofloxacin against S. pneumoniae was not statistically significantly different (geometric mean MIC 0.978 and 0.95 mg/L respectively). β-lactam resistance did not affect fluoroquinolone susceptibility. H. influenzae and M. catarrhalis were highly susceptible to both fluoro-quinolones.     

Antimicrobial Resistance and Prevalence of Extended Spectrum β-Lactamase Among Clinical Isolates of Gram-Negative Bacteria in Riyadh

Abstract

The activity of ciprofloxacin, imipenem and 12 other commonly used antibiotics was evaluated against 106 documented clinical isolates from a medical Intensive Care Unit (ICU). The resistance rates to ceftriaxone, cefotaxime, aztreonam and ceftazidime were 42, 25, 24 and 21%, respectively. Apart from Pseudomonas aeruginosa, all isolates were sensitive to ciprofloxacin and imipenem. Complete cross resistance among tested β-lactam groups was uniformly evident in Enterobacter cloacae, Citrobacter freundii and P. aeruginosa. On the other hand, penicillins and second generation cephalosporins showed cross resistance among Escherichia coli and Klebseilla pneumoniae isolates. Induction experiments indicate that 70 and 62% of P. aeruginosa and E. cloacae or C. freundii produce class I cephalosporinase, respectively.

Among all tested isolates, plasmid mediated extended spectrum β-lactamase (ESBL) was detected in one isolate of K. pneumoniae. The plasmid mediated β-lactamase is transferable and inhibited by β-lactamase inhibitors. The transconjugates not only expressed resistance to extended spectrum β-lactams and aztreon-am but also toward tested aminoglycoside antibiotics, with the exception of gentamicin. The obtained transconjugates conferred high level resistance to cef-tazidime and aztreonam but considerably low resistance to ceftriaxone and cefotaxime. The isoelectric point for the extended-spectrum β-lactamase is 8.2.     

Extended-Spectrum β-Lactamases Conferring Resistance to Monobactams and Oxyimino-Cephalosporins in Clinical Isolates of Serratia marcescens

Abstract

We studied antibiotic resistance patterns and extended-spectrum β-lactamases (ESβLs) production in Serratia marcescens strains isolated in our hospital during 1993. We examined 210 S. marcescens isolates. Of these, 172 were obtained from 49 patients admitted to an intensive care ward; 157 out of 172 were obtained from February to October and presented the same pattern of antibiotic resistance, including monobactams and oxyimino-cephalosporins. The remaining 15 out of 172 isolates (obtained from September to December) were susceptible to all drugs tested, with the exception of first generation cephalosporins. Thirty-eight additional isolates were recovered, during the same period, from 28 patients admitted to wards other than the intensive care unit; also these strains showed the high susceptibility pattern reported above.

Epidemic strains of S. marcescens produced three different types of β-lactamase with pI 5.4, 5.5, and 8.4. In contrast, non-epidemic strains produced only one type of β-lactamase with pI 8.4. Conjugation experiments showed that the β-lactamases having a pI of 5.4 and 5.5 (but not the one with pI 8.4) were plasmid-mediated. Since the β-lactamase with pI 5.5 was capable of hydrolyzing monobactams and oxyimino-cephalosporins it was classified as ESβL. Electrophoretic analysis showed that plasmids obtained from multiresistant strains were of about 54 kb; these plasmids appeared also to code for aminoglycoside resistance. Our data indicate that the plasmid-mediated production of ESβLs may contribute to the epidemic spread of Serratia marcescens in high-risk wards.     

近端胃腺癌中DKK-1和β-catenin的表达及其相关性

  目的   探讨DKK-1和β-catenin蛋白表达在胃近端癌发生过程中的作用。   方法   采用免疫组织化学S-P方法分别检测61例胃近端癌、癌旁组织及20例正常胃黏膜组织的DKK-1和β-catenin蛋白表达,并分析其临床意义。   结果   胃近端癌中DKK-1阳性表达率和β-catenin异常表达率分别为34.4%（21/61）和68.9%（42/61）,癌旁组织中DKK-1阳性表达率和β-catenin异常表达率分别为8.2%（5/61）和6.6%（4/61）,正常组织中DKK-1阳性表达率和β-catenin异常表达率分别为15.0%（3/20）和10.0%（2/20）。胃近端癌的表达明显高于其他两者（P < 0.05）,胃近端癌中DKK-1和β-catenin的表达呈正相关（r=0.454,P < 0.05）,而在癌旁组织及正常胃黏膜中的表达无明确相关性。   结论  DKK-1高表达和β-catenin异常表达上升与胃近端癌的发生密切相关。      

Comparative In Vitro Activity of Telithromycin and β-Lactam Antimicrobials Against Bacterial Pathogens from Community-Acquired Respiratory Tract Infections: Data from the First Year of PROTEKT (1999-2000)

Abstract

The In Vitro activity of telithromycin, a new ketolide, was compared with β-lactam antimicrobials against pathogens commonly associated with community-acquired respiratory tract infections. These pathogens were collected during 1999-2000 as part of the ongoing PROTEKT surveillance study. Globally, penicillin non-susceptibility among Streptococcus pneumoniae (n=3362) was 36.3%, ranging from 21.5% (Australasia) to 68.0% (Far East). Telithromycin showed higher potency (MIC₉₀ 0.12 mg/L) than β-lactams against S. pneumoniae; 99.9% of all and 99.6% of multi-resistant isolates were susceptible to telithromycin. Among Streptococcus pyogenes isolates (n=1485), 100% were susceptible to β-lactams, and the telithromycin MIC₅₀ and MIC₉₀ were both 0.015 mg/L. Among Haemophilus influenzae (n=2948), 16.6% produced β-lactamase, which reduced the activity of ampicillin, cefaclor and cefprozil. 99.9% of H. influenzae were susceptible to telithromycin and the MIC range for M. catarrhalis was 0.004-0.5 mg/L. The first year results of PROTEKT confirmed high potency for telithromycin against common respiratory tract pathogens, including β-lactam-resistant strains.     

Pattern of antibiotic resistance of Streptococcus pneumoniae in a hospital in the Eastern Province of Saudi Arabia

The objective of the study was to evaluate the pattern of antibiotic resistance of Streptococcus pneumoniae at Saudi Aramco Medical Services Organization (SAMSO) in the Eastern Province of Saudi Arabia. We identified, retrospectively, S. pneumoniae isolates from January 1999 to December 2002. Antimicrobial susceptibility and clinical data were collected and analyzed. A total of 162 isolates of S. pneumoniae were identified in the study period. Of these isolates, 94 (58%) isolates were obtained from out-patients and 68 (42%) were obtained from in-patients. Thirty-five percent of isolates were from blood, 46% from the respiratory tract, and the remainder were obtained from other sites. Of these isolates, 83 (51%) were penicillin-susceptible and the remaining 79 (48.8%) were not penicillin susceptible. High-level resistance to penicillin existed in 19.8% of the total isolates. Prevalence of resistance to erythromycin, tetracycline and trimethoprim-sulfamethoxazole was 25%, 29%, and 42% respectively. None of the isolates was resistant to vancomycin or ceftriaxone. However, 12% of the isolates showed multi-drug resistance. Streptococcus pneumoniae shows 19.8% high-level penicillin resistance and 12% multi-drug resistance. These findings call for wiser use of antibiotics.