获得性免疫缺陷综合征合并结核病患者对结核分枝杆菌二线药物耐药特征分析

目的了解获得性免疫缺陷综合征（AIDS）合并结核病（TB）患者感染结核分枝杆菌二线药物耐药特点。 方法选取2010年4月至2012年10月于北京大学地坛医院教学医院住院的艾滋病合并结核病患者标本,由中国疾病预防控制中心培养鉴定。进行4种一线药物（异烟肼、利福平、链霉素、乙胺丁醇）和4种二线药物（卷曲霉素、卡那霉素、氧氟沙星、乙硫异烟胺）药敏试验监测,并对所有菌株在gyrA、gyrB、rrs、tlya、eis和ethA基因位点进行DNA测序以检测基因多态性。 结果经培养鉴定共得到31株结核分枝杆菌,其中12株耐卷曲霉素,8株耐氧氟沙星,4株耐卡那霉素,5株耐乙硫异烟胺,耐药率分别为38.71%、25.81%、12.90%和16.13%。7株菌为耐多药菌株,1株菌为广泛耐药菌株,耐药率分别为22.58%和3.23%。耐药菌株最常见的突变位点是rrs₁₄₀₁,gyrA₉₄和gyrA₉₀。一线敏感菌株中氧氟沙星的耐药率显著低于一线耐药菌株（P = 0.012）。性别与结核分枝杆菌耐药差异无统计学意义（P = 0.533）,年龄> 40岁组的氧氟沙星耐药率低于其余两组（P = 0.043）。结核初治组与复治组患者二线耐药率、CD4水平差异无统计学意义（P = 0.333、0.307）。 结论AIDS合并TB患者存在二线抗结核药物原发耐药,其中卷曲霉素耐药率最高,其次是氧氟沙星。     

多药耐药鲍曼不动杆菌对氯霉素、四环素、利福平和复方磺胺甲恶唑耐药相关基因分析

目的 探讨多药耐药鲍曼不动杆菌（multi-drug resistant Acinetobacter baumannii,MDR-ABA）对氯霉素、利福平、四环素和复方磺胺甲恶唑等广谱抗菌药物的耐药性,并进行耐药相关基因分析.方法 临床分离62株MDR-ABA,采用K-B纸片扩散法测定它们对22种抗菌药物的敏感性,并用PCR及序列分析法检测氯霉素耐药相关基因catB、cmlA.利福平耐药相关基因arr-2/3,四环素耐药相关基因tetA、tetB,复方磺胺甲恶唑耐药相关基因sul1、dfrA1、dfrA5、dfrA7/17、dfrA12和dfrB5,抗菌化合物外排泵蛋白基因tehA、emrB、emrD、emrE、smr-2和其他广谱的抗菌药物外排泵mafA基因等17种基因.结果 62株MDR-ABA对氯霉素、利福平、四环素和复方磺胺甲恶唑的耐药率分别为100.0%（62/62）、100.0%（62/62）、90.3%（56/62）和82.3%（51/62）,mafA、tetB、sull和tehA基因阳性株数和阳性率分别为62株（100.0%）、46株（74.2%）、36株（58.1%）和8株（12.9%）,其余13种基因均为阴性.任选2株tetB、sull、tehA和mdfA基因阳性菌株进行DNA测序,并作BLASTn比对,与已登录于美国GenBank的序列一致.结论 MDR-ABA临床分离株对氯霉素、利福平、四环素和复方磺胺甲恶唑等广谱抗菌药物的耐药性很高,其多药耐药表型与携带mayA基因密切相关.     

金黄色葡萄球菌临床分离株功能基因及其二元分型研究

目的 研究一组金黄色葡萄球菌临床分离株毒力基因和耐药基因的存在状况.方法 连续收集浙江省宁波市第一医院2013年7至9月临床分离的金黄色葡萄球菌共40株,采用聚合酶链反应（PCR）的方法分析42种毒力基因和11种耐药基因,再以10类毒力基因和1种耐药基因mecA检测结果作二元分型.结果 40株金黄色葡萄球对青霉素的敏感率为12.5％ （5/40）,对红霉素的敏感率为42.5％（17/40）,对其余15种抗菌药物的敏感率均大于65.0％.除了人主要组织相容性复合体（M HC）类似蛋白编码基因map未检出,其他几类毒力基因：黏附素、细胞毒素、荚膜抗原、超抗原、丝氨酸蛋白酶均有检出,检出率为2.5％～100.0％.耐β-内酰胺类、氨基糖苷类、红霉素类、四环素类、季铵盐消毒剂、抗菌肽的耐药基因均有检出,检出率为2.5％～37.5％.40株菌株经二元分型可分为16种阳性基因检出模式,每株菌最少检出3类毒力基因,最多检出7类毒力基因和1类耐药基因mecA.结论 本组菌株耐药表型和耐药基因型符合率较高,菌株携带多种毒力基因和耐药基因.     

基于全基因组序列的耐碳青霉烯鲍曼不动杆菌的耐药与毒力研究

目的明确耐碳青霉烯类鲍曼不动杆菌（CRAB）临床主要流行株CC92克隆复合群（CC92）基因组中耐药基因和毒力基因的分布,并探讨CRAB耐药和毒力的分子特征。 方法本研究共纳入2019年1～7月自首都医科大学附属北京地坛医院检验科分离的33株CRAB分离株,行细菌全基因组测序研究。利用CLC Genomics Workbench v10.0软件对全基因组测序数据进行序列的质量修整后,开展序列拼接、组装与注释,并进行耐药基因与毒力基因研究,分析CC92克隆复合群CRAB基因组中携带的耐药基因和毒力基因的分布。 结果基因组测序数据分析表明,33株CRAB菌株中30株为CC92型克隆复合群（包括ST195、ST208、ST369和ST540）,2株为ST229型,1株为国际上未报道新序列型别。以上CRAB中包括大量的耐药基因,包括大环内酯类、四环素和链霉素耐药基因在内的8～18个耐药基因,以及包括编码与侵袭和黏附等毒力功能相关的12种毒力基因。同时,本研究发现CC92克隆复合群,除携带碳青霉烯类耐药基因以外,还携带了其他非CC92克隆群不具备的耐药基因（如bla_OXA-66和bla_TEM-1D）和毒力基因（如bauA和bap基因）。此外,在CC92克隆复合群中可能存在大环内脂类耐药基因[msr（E）和mph（E）]、氨基糖苷类的耐药基因（armA）、链霉素耐药基因（strA、strB）与四环素耐药基因[tet（B）]的重组。 结论CC92克隆复合群的CRAB基因组存在大量耐药基因和毒力基因,且存在耐药基因重组现象,迫切需要对CRAB进一步开展全基因组水平监测,为临床病原诊断和治疗提供必要的依据。     

57株流感嗜血杆菌的耐药性分析及分布

目的：了解本院急性呼吸道感染患者临床分离出的流感嗜血杆菌的耐药性及菌株分布情况,为临床合理使用抗菌药物提供依据。方法采用法国梅里埃API NH鉴定条进行菌株鉴定,头孢硝噻吩检测菌株产β-内酰胺酶情况,纸片扩散法检测菌株的药敏情况。结果2012年4月至2012年7月本院临床分离的57株流感嗜血杆菌中有38株对氨苄西林耐药,耐药率66.7%;29株β-内酰胺酶阳性,占50.9﹪;对复方新诺明、头孢呋辛、四环素、阿莫西林/克拉维酸和氯霉素的耐药率依次为82.5%（47/57）、22.8%（13/57）、15.8%（9/57）、12.3%（7/57）和8.8%（5/57）,对头孢噻肟、美罗培南、左氧氟沙星和阿奇霉素均敏感。57株流感嗜血杆菌中有12株（21.1%）来源10岁以下患儿,4株（7.0%）来源于30～40岁的患者,41株（71.9%）来源于50岁以上的患者。结论流感嗜血杆菌对临床常用抗菌药物的耐药率相差很大,本院引起的呼吸道感染多见于老年和儿童患者,临床上应根据本院的流行特点合理选用抗菌药物。     

尿路致病性大肠埃希菌多位点序列分型与耐药谱型的相关性

目的探讨尿路致病性大肠埃希菌（UPEC）的多位点序列分型（MLST）与抗菌药物耐药的关系。 方法以上海中医药大学附属普陀医院2015年3月至2016年12月住院患者为研究对象,收集清洁中段尿样本中分离培养的大肠埃希菌,应用MLST方法进行菌株分型研究。采用Vitek-2 Compact全自动微生物分析系统检测UPEC对7种常用抗菌药物的敏感性及超广谱β-内酰胺酶（ESBLs）。 结果93株UPEC对亚胺培南耐药率为0%,对厄他培南、阿米卡星、哌拉西林/他唑巴坦耐药率为1.1%~3.2%,保持高度敏感性。对头孢他啶、头孢吡肟、氨曲南、庆大霉素和妥布霉素均有一定敏感性,耐药率低于50%。对头孢曲松、环丙沙星、左氧氟沙星和复方SMZ耐药率> 50%。产ESBLs菌株59例（63.4%）,ESBLs阴性菌株34株（36.6%）。分离株共有33个已知序列型（STs）,1例未知ST型,其中最多的克隆群为ST131（23/93、24.7%）,ST648（9/93、9.7%）,ST405（7/93、7.5%）和ST1193（7/93、7.5%）。 结论UPEC具有多药耐药性,MLST分型提示UPEC菌株具有多样性,ESBLs与UPEC抗菌药物耐药有一定相关性,ST型与耐药谱型无相关性。     

男性泌尿生殖道感染患者分离的金黄色葡萄球菌耐药性及耐消毒剂基因流行特性研究

目的:研究男性泌尿生殖道感染患者尿道分泌物中分离的金黄色葡萄球菌对常用抗菌药物和消毒剂的耐药情况及消毒剂耐药基因携带情况。方法:收集男性泌尿生殖道感染患者尿道分泌物标本中分离的金黄色葡萄球菌152株,琼脂稀释法检测临床常用抗菌药物以及消毒剂氯已定对其最低抑菌浓度(MIC),同时采用头孢西丁纸片扩散法和mecA基因扩增法确定其中的耐甲氧西林金黄色葡萄球菌(MRSA);多重PCR对MRSA菌株进行SCCmec耐药基因盒(SCCmec)分型,PCR扩增耐消毒剂基因qac;脉冲场凝胶电泳(PFGE)分析qacA/B基因阳性MRSA菌株间的同源性。结果:152株金黄色葡萄球菌中,MRSA占59.9%(91/152);SCCmec分型结果显示以SCCmecⅤ型为主,占63.7%(58/91),Ⅰ型8株(8.8%),Ⅱ型2株(2.2%),Ⅲ型19株(20.9%),Ⅳ型4株(4.4%)。临床分离的金黄色葡萄球菌对青霉素、红霉素、环丙沙星、左氧氟沙星非敏感率较高,依次是:95.4%、72.4%、42.8%、44.7%,对呋喃妥因、替考拉宁、利奈唑胺以及万古霉素具有较高的敏感性。琼脂稀释法测得氯已定对152株菌的MIC值范围为0.25~16μg/ml;对MRSA菌株的MIC50=2.0μg/ml,MIC90=4.0μg/ml,对MSSA菌株的MIC50和MIC90均为1.0μg/ml;152株金黄色葡萄球菌中,有72株(47.4%)携带qacA/B基因,6株(3.9%)携带smr(qacC+qacD)基因,9株(5.9%)携带qacEΔ1基因,2株(1.3%)携带qacH基因,未检出qacG、qacJ基因。PFGE结果显示qacA/B基因阳性MRSA菌株呈多克隆分布。结论:临床分离的金黄色葡萄球菌对常用抗菌药物表现出不同程度耐药,部分菌株对消毒剂氯已定耐受力较强,耐消毒剂基因以qacA/B为主,临床医生应该合理使用抗菌药物和体外消毒剂。     

创伤患者碳青霉烯耐药铜绿假单胞菌耐药机制研究

目的研究分离自本院创伤患者的碳青霉烯类耐药铜绿假单胞菌耐药特性及耐药机制。方法采用琼脂稀释法对收集的162铜绿假单胞菌进行碳青霉烯类药物耐药菌株筛选,微量肉汤稀释法对获得的碳青霉烯类耐药铜绿假单胞菌检测对临床抗菌药物的敏感性;PCR检测碳青霉烯类耐药铜绿假单胞菌的耐药基因并进行分析。结果通过对162株铜绿假单胞菌进行碳青霉烯来耐药菌株筛选,共获得5株碳青霉烯类耐药铜绿假单胞菌。5株菌均表现为多重耐药表型,对碳青霉烯类药物MIC值为8μg/ml以上,对粘菌素均表现为敏感。PCR检测及测序比对分析发现,菌株PA1826携带有bla NDM-1,菌株PA1701和PA1912携带有bla IMP-1,菌株PA1932和PA1969携带有bla VIM-2。结论尽管本院创伤患者分离的碳青霉烯类耐药铜绿假单胞菌检测率较低,但临床医生仍需要严格合理使用抗菌药物避免抗菌药物耐药性的发生。     

医院感染金黄色葡萄球菌的耐药性和SCCmec基因型分析

目的 了解天津市肿瘤医院医院感染金黄色葡萄球菌对抗菌药物的耐药状况和葡萄球菌盒式染色体mec（SCCmec）基因型特点。方法检测89株医院感染金黄色葡萄球菌对抗菌药物的敏感性及其mecA携带率,用多重PCR法对mecA阳性菌株进行SCCmec基因分型。结果89株金黄色葡萄球菌中表型甲氧西林耐药率为23．6％（21／89）,mecA基因检出率为43．8％（39／89）,两者比较差异有统计学意义（X^2=8．146．P=0．004）。耐甲氧西林金黄色葡萄球菌（MRSA）表现出多药耐药特点,未发现万古霉素耐药株。SCCmec基因型以Ⅲ型最为常见,占66．7％（26／39）。结论天津市肿瘤医院分离的MRSA具有多重耐药特点,SCCmec基因型以Ⅲ型为主。     

耐左氧氟沙星大肠埃希菌的耐药性分析

目的了解本院临床分离的大肠埃希菌的耐药情况,分析耐左氧氟沙星细菌的耐药性。方法对2009年8月至2010年8月本院临床分离的154株大肠埃希菌用Kirby-Bauer琼脂扩散法进行药物敏感试验。结果 154株大肠埃希菌中共检出耐左氧氟沙星菌76株,检出率49.35%。在各类标本中,尿液中耐左氧氟沙星菌株分离率最高（51.32%）,其次为痰（23.68%）。除亚胺培南、美罗培南、头孢西丁、哌拉西林/他唑巴坦和阿米卡星外,耐左氧氟沙星菌株对氨苄西林、头孢唑啉、头孢吡肟、头孢噻肟、头孢他啶、庆大霉素、头孢哌酮/舒巴坦的耐药率明显高于非耐左氧氟沙星菌株（P〈0.05）。结论本院耐左氧氟沙星大肠埃希菌株对多种药物表现出较高的耐药率,应加强对耐左氧氟沙星大肠埃希菌的耐药性监测,严格掌握抗菌药物的使用指征,防止耐药菌株的传播流行。     

A high prevalence of mupirocin and macrolide resistance determinant among Staphylococcus aureus strains isolated from burnt patients

Infections due to Staphylococcus aureus have become increasingly common among burn patients. The antibiotic resistance profile of S. aureus isolates and inducible resistance against clindamycin were investigated in this study. The presence of mecA gene, mupA gene and macrolide resistance genes were detected using PCR and multiplex-PCR. The resistance rate to methicillin, erythromycin and mupirocin were 58.5%, 58% and 40%, respectively. The prevalence of constitutive and inducible resistance among macrolide resistant isolates was 75% and 25%, respectively. Ninety five percent of the isolates were positive for one or more erm genes. The most common genes were ermA (75%), ermC (72%) and ermB (69%), respectively. The ermA gene predominated in the strains with the inducible phenotype, while ermC was more common in the isolates with the constitutive phenotype. The msrA gene was only found in one MRSA isolate with the constitutive phenotype. A total of 27 isolates (25%) carried the mupA gene. All the mupirocin resistant isolates and almost all the erythromycin resistant isolates were also resistant against methicillin which may indicate an outbreak of MRSA isolates with high-level mupirocin and erythromycin resistance in the burn unit assessed.     

Oral streptococcal strains isolated from odontogenic infections and their susceptibility to antibiotics

The aim of this study was to identify at species level and to investigate the antibiotic susceptibility of oral streptococcal strains isolated from 100 pus samples collected from Romanian patients with different odontogenic infections. The isolates were identified at species level using the Rapid ID 32 STREP system and their susceptibility was testing by the Etest, against: penicillin G, ampicillin, erythromycin, clindamycin and tetracycline. For the investigation of erythromycin resistance phenotype the disk diffusion test was used. The isolates belonged to several species, with Streptococcus anginosus and Streptococcus oralis predominating. Reduced susceptibility to beta-lactam antibiotics was found only among the isolates belonging to S. mitis and S. sanguinis groups. Resistance to erythromycin was detected among all species, except for: S. constellatus, S. intermedius and S. gordonii, and the M phenotype was established, while resistance to tetracycline was detected within all species but S. gordonii. In contrast, clindamycin was fully active. As most odontogenic infections are mixed infections, often involving strictly anaerobic bacteria, which are frequently beta-lactamase producers, the association of a penicillin and a beta-lactamase inhibitor, like Amoxiclav, is recommended when the antimicrobial treatment is necessary.     

Molecular epidemiology and antimicrobial resistance mechanisms of Campylobacter coli from diarrhoeal patients and broiler carcasses in Belgium

The aim of this study was to better understand the molecular epidemiology of Campylobacter coli isolated from multiple sources in Belgium, by studying the genotypic diversity and antimicrobial resistance phenotypes and resistance mechanisms of 59 C. coli isolates. Isolates from broiler carcasses and human cases were genotyped using multilocus sequence typing (MLST), porA typing, flagellin gene A restriction fragment length polymorphism (flaA–RFLP) typing, and by PCR binary typing (P‐BIT). Thirty‐two MLST sequence types, 24 flaA types, 31 porA alleles, and 29 P‐BIT types were identified among the screened isolates. Some types and alleles were shared among strains recovered from both broiler carcasses and diarrhoeal patients. Both porA typing and MLST revealed a similar discriminatory power (0.969), which was the highest discriminatory power when compared to other methods. Minimum inhibitory concentrations against seven different antibiotics (ciprofloxacin, chloramphenicol, nalidixic acid, streptomycin, tetracycline, gentamicin, and erythromycin) were analysed. Strains were most frequently resistant to tetracycline (81.4%), followed by: ciprofloxacin and nalidixic acid (76.3%); streptomycin (33.9%); erythromycin (27.1%); and chloramphenicol (3.4%). All isolates were sensitive to gentamicin. Multidrug resistance was observed in 24 of 59 C. coli isolates (40.7%). Molecular screening of antimicrobial resistance mechanisms revealed the predominance of the gyrA T86I substitution among ciprofloxacin‐ and nalidixic acid‐resistant isolates, the tet(O) gene among tetracycline‐resistant isolates and the 23S rRNA A2075G mutation among erythromycin‐ resistant isolates. Furthermore, some erythromycin‐resistant isolates harboured a diverse array of resistance mechanisms, including the presence of ermB, 23S rRNA A2074G mutation, and point mutations the rplD and rplV ribosomal genes, and the cmeABC multidrug efflux pump genes.     

1186例慢性前列腺炎且不育患者前列腺按摩液中病原体检测及耐药性分析

目的:探讨慢性前列腺炎伴不育患者EPS中分离的细菌菌谱分布及衣原体和支原体感染情况,为临床提供用药依据。方法:对临床采集的慢性前列腺炎且不育患者EPS标本进行培养、鉴定、药物敏感试验,用荧光PCR法检测沙眼衣原体,并对所得结果进行统计学分析。结果:1 186例患者的EPS标本中,病原体总阳性率51.7%,其中革兰阳性球菌364例;革兰阴性杆菌20例;其他菌株5例;支原体157例,其中溶脲脲原体116例、人型支原体41例;沙眼衣原体DNA阳性67例。分离到的葡萄球菌对万古霉素全部敏感;对青霉素类耐药率最高,为76.9%~100%。无乳链球菌对红霉素及克林霉素的耐药率最高,为100%;对β-内酰胺类、氨基糖苷类、复方新诺明、利福平、万古霉素全部敏感。溶脲脲原体对环丙沙星耐药率最高,为59.5%;对交沙霉素、四环素、磷霉素耐药率最低,为1.7%。人型支原体对红霉素的耐药率最高,为100%;对强力霉素、磷霉素全部敏感。结论:慢性前列腺炎伴不育患者EPS中有很大部分可分离到细菌及支原体和衣原体,表明感染是引起男性不育的一个重要因素,分离菌株对不同抗菌药物耐药性有较大差异。     

Antibiotic susceptibility of Neisseria gonorrhoeae isolated in Johannesburg.

The susceptibility of 175 clinical isolates of Neisseria gonorrhoeae to penicillin G, ampicillin, erythromycin, tetracycline and spectinomycin was determined. Almost one-fifth of strains were relatively resistant to penicillin G. Relative resistance to penicillin G was significantly correlated with resistance to ampicillin, tetracycline and erythromycin, but not with resistance to spectinomycin. No penicillinase-producing or spectinomycin-resistant strains were encountered in this study. The relevance of the findings to the management of gonococcal urethritis is discussed.     

Antibiotic susceptibility patterns of Neisseria gonorrhoeae isolates in Port Elizabeth.

OBJECTIVE: To survey the antibiotic susceptibility of Neisseria gonorrhoeae isolates. DESIGN: This was a cohort analytical study. SETTING: Three clinics serving different areas in Port Elizabeth. Outcome measures. Prevalence of antibiotic-resistant N. gonorrhoeae isolates. RESULTS: Twenty-one of the 35 isolates (60%) were resistant to ciprofloxacin, while 28 (80%) showed resistance to erythromycin, 17 (48.6%) to penicillin, 3 (8.6%) to doxycycline, 11 (31.4%) to spectinomycin and 33 (94.3%) to tetracycline. CONCLUSION: To ensure effective treatment of gonorrhoea, continued surveillance of antimicrobial susceptibility is necessary.     

Serotype and antimicrobial susceptibility patterns of Haemophilus influenzae isolates from inpatients and outpatients in Johannesburg

During the 6-month period July 1987-January 1988, 934 isolates of Haemophilus influenzae were collected from 6 laboratories in Johannesburg. On the basis of counter-immuno-electrophoresis, 30 of the isolates were serotype b, with 9 of 36 (25%) cerebrospinal fluid isolates being type b. Overall, 11.7% of the isolates produced beta-lactamase. The prevalence of resistance based on a disc diffusion test was ampicillin 14%, chloramphenicol 2.3%, cefaclor 4.4%, erythromycin 84.9%, tetracycline 4.7% and co-trimoxazole 9.7%. Problems were encountered with the disc diffusion testing of augmentin- and minimum inhibitory concentrations (MICs) were determined. The MICs of 40 isolates were compared with their zone diameters. Good correlation between these two methods of antimicrobial susceptibility testing was found with all the antimicrobials tested excluding augmentin (correlation coefficient 0.1234) and cefaclor (correlation coefficient -0.2473).     

Human Cytomegalovirus (CMV) UL97 D605E Mutation Has a Higher Prevalence in Infants With Primary CMV Infection Compared With Transplant Recipients With CMV Recurrence

Mutations in the UL97 gene are a major mechanism of human cytomegalovirus (CMV) resistance to gancyclovir (GCV). Some mutations may show different regional distributions. To analyze UL97 mutations in Chinese people, we scanned the UL97 gene fragment among virus isolates from 27 infants as well as blood samples from 28 solid organ transplant (SOT) and 42 bone marrow transplant (BMT) recipients with active CMV infections as defined by DNAemia or PP65 antigenemia. Only a known GCV-resistant mutation M406V was found in a BMT recipient. However, the D605E mutation was identified in 18 of 27 (66.7%) infants as well as 11 of 28 (39.3%) SOT and 17 of 42 (40.5%) BMT recipients. It was significantly different between the infants and transplant recipients (P < .05). So far, the influence of D605E mutation on GCV-resistance is controversial. In this study, 18 D605E mutants, 9 wild type (WT) isolates, and AD169 controls cultured in fibroblasts were tested for phenotypic drug resistance using a plaque reduction assay. The dose of GCV required for 50% inhibition of plaque formation (IC50) was 1.20 ± 0.67 μmol/L (D605E), 1.71 ± 0.64 μmol/L (WT), and 1.43 ± 0.70 μmol/L (AD169), respectively. This small difference could be caused by analytical error. We concluded that the UL97 D605E mutation showed a different prevalence between infants with primary CMV infection and transplant recipients with CMV recurrence. However, it was not related to a resistant phenotype to GCV.     

糖尿病合并不同临床表型肺部感染者的细菌谱分析

目的探讨糖尿病合并不同临床表现肺部感染者的细菌分布情况,有针对性地制定抗感染对策。 方法根据208例糖尿病合并肺部感染者的不同临床表现分为呼吸道症状组（RS）、全身症状组（SS）及综合症状组（CS）共3组,取其痰分泌物进行病原学培养,培养菌株232株,统计学分析采用SPSS软件。 结果CS组混合感染（19.13%）较RS组（4.00%）和SS组患者（11.39%）显著上升（χ²= 5.41,P=0.01）;RS组患者革兰阳性球菌（G⁺C）感染仅占20%,SS组患者G⁺C感染占69.6%,CS组患者G⁺C感染为33.9%（χ²= 9.90,P=0.001）;RS组患者革兰阴性杆菌（G^－B）感染占76%,SS组患者G^－B感染仅占25.3%,CS组患者G^－B感染为59.3%（χ²= 14.87,P=0.001）;RS组患者葡萄球菌对莫西沙星、阿奇霉素、克林霉素、庆大霉素、左氧氟沙星、环丙沙星、四环素、青霉素、利福平、头孢呋辛和头孢唑肟耐药率显著低于SS组和CS组（P均< 0.05）。SS组患者链球菌对莫西沙星、阿奇霉素、克林霉素、四环素、头孢呋辛及头孢唑肟耐药率显著低于CS组（P均< 0.05）;SS组患者ECO对莫西沙星、庆大霉素及头孢唑肟耐药率显著低于CS组（P均< 0.05）;RS组患者肺炎克雷伯菌对亚胺培南、头孢哌酮舒巴坦、哌拉西林他唑巴坦、头孢吡肟、头孢噻汚、头孢他啶、头孢唑肟、庆大霉素、环丙沙星、左氧氟沙星、氨曲南和氨苄西林耐药率显著低于SS组和CS组患者（P均< 0.05）;RS组患者中铜绿假单胞杆菌和鲍曼/溶血不动杆菌对头孢哌酮舒巴坦、哌拉西林他唑巴坦、头孢吡肟、头孢噻汚、头孢他啶、头孢唑肟、庆大霉素、环丙沙星、左氧氟沙星、氨曲南及氨苄西林耐药率显著低于SS组和CS组患者（P均< 0.05）。 结论糖尿病合并不同临床表型肺部感染患者的细菌谱分布存在差异;针对以上感染特点有助于指导临床进行抗感染治疗。     

Emerging infections with community-associated methicillin-resistant Staphylococcus aureus in outpatients at an Army Community Hospital

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection typically occurs in chronically ill patients requiring long-term antimicrobial therapy or hospitalization. However, community-associated MRSA (CA-MRSA) necrotizing soft tissue infections seem to be increasing in incidence. Our aim was to describe the incidence and microbiologic characteristics of CA-MRSA isolates collected at an army community hospital. METHODS: We report a retrospective review of MRSA isolates identified during 1998-2003 at the microbiology laboratory of Moncrief Army Community Hospital that serves a community of approximately 40,000 transient residents yearly in Fort Jackson, South Carolina. We evaluated the incidence of MRSA in our laboratory during 1998-2003. For MRSA isolates from 2003, we evaluated antimicrobial susceptibility patterns. Six selected isolates were evaluated by molecular typing, resistance gene analysis, and toxin analysis. RESULTS: During 1998-2003, 241 (23%) of 1041 S. aureus isolates identified at the hospital microbiology laboratory were resistant to methicillin. Of these 241 MRSA isolates, 223 were cultured from outpatients. The incidence of MRSA in our population increased from 12% of S. aureus isolates in 1998 to 43% in 2003. In 2003, MRSA was cultured from 76 different patients. Isolates of MRSA were often resistant to erythromycin (91%), although resistance to other agents was less common: Ciprofloxacin (14%), levofloxacin (14%), clindamycin (3%), tetracycline (3%), and trimethoprim sulfamethoxazole (1%). No isolates were resistant to vancomycin, gentamicin, nitrofurantoin, or rifampin. Six CA-MRSA isolates were compared by pulsed-field gel electrophoresis (PFGE). Five were PFGE type USA300, and one was PFGE type USA100, based on the U.S. Centers for Disease Control and Prevention (CDC) classification scheme. The five USA300 isolates carried SCCmec type IV, and the USA100 carried SCCmec II. None of the isolates were positive by PCR for genes encoding enterotoxins A-E and H, or toxic shock syndrome toxin (TSST-1), but the five USA300 isolates carried the gene coding for Panton-Valentine leukocidin toxin. CONCLUSIONS: The incidence of MRSA at our institution is increasing. Isolates of MRSA show resistance patterns and microbiologic characteristics consistent with CA-MRSA isolates from the United States. Clinicians should consider the possibility of CA-MRSA in patients with soft-tissue infections who do not respond to initial therapy with beta-lactam antimicrobial agents.