抗菌肽天蚕素B对铜绿假单胞菌感染小鼠创面的抗菌作用

目的观察抗菌肽天蚕素B对小鼠铜绿假单胞菌感染创面的抗菌效果。方法于30只ICR小鼠背部切除全层皮肤(创面为1 cm×1 cm),将铜绿假单胞菌菌液涂抹于创面制成感染模型,并随机分为对照组、磺胺米隆组、抗菌肽组,伤后3 h分别用含等渗盐水、100 g／L磺胺米隆溶液、1g／L天蚕素B的纱布湿敷,每组10只。伤后1～4 d对各组小鼠创面行大体观察;伤前和伤后4 d测量体温,抽取血液观察白细胞变化;伤后4 d检测痂下肌肉组织细菌定量和观察存活情况。结果对照组创面分泌物多、创面潮湿;磺胺米隆组、抗菌肽组创面结痂、干燥、无明显分泌物。各组小鼠术后体温多数上升、白细胞计数均减少。抗菌肽组痂下肌肉组织细菌定量为(42±50)集落形成单位(CFU)／g,明显少于磺胺米隆组(886±804)CFU／g(P<0．05),两组均明显低于对照组(41±28)×105CFU／g(P<0．01)。对照组小鼠伤后4 d存活数明显少于抗菌肽组、磺胺米隆组(P<0．05)。结论天蚕素B对ICR小鼠铜绿假单胞菌感染创面有明显的抗感染作用,可明显降低其死亡率。     

Complicated urinary tract infection caused by Pseudomonas aeruginosa in a single institution (1999–2003)

BACKGROUND: Pseudomonas aeruginosa has been an important uropathogen that causes complicated urinary tract infection. We investigated the clinical characteristics of complicated urinary tract infection caused by Pseudomonas aeruginosa in a single institution. METHODS: We studied those patients who had basal disease in their urinary tract that was diagnosed as urinary tract infection caused by more than 10(4) colony forming units (CFU)/mL of Pseudomonas aeruginosa isolated from their urine. In those patients, we analysed infectious risk factors, treatment methods including the use of antimicrobial agents, the presence of a urinary tract catheter, and the relationship between febrile infection and urinary tract catheter. In addition, we examined the various antimicrobial susceptibilities against Pseudomonas aeruginosa. RESULTS: We studied 76 patients (59 men and 17 women). Of their basal diseases of the urinary tract, bladder tumor was the most prevalent (42.1%). Of the 39 patients who had an indwelling urinary tract catheter, 26 (66.7%) experienced a high-grade fever, a higher rate than that of the 37 patients who were not catheterized (40.5%). Seven patients were treated with anticancer chemotherapy drugs and 31 cases of urinary tract infection caused by Pseudomonas aeruginosa were diagnosed in the perioperative period. Piperacillin showed lower susceptibility against Pseudomonas aeruginosa in these 2 years (P<0.05). CONCLUSIONS: Our results indicated that those patients with urinary tract catheterization had a higher incidence of fever than patients without catheterization. Therefore, we must improve not only the antimicrobial treatment of Pseudomonas aeruginosa but also our management of catheters.     

基层医院院内下呼吸道感染铜绿假单胞菌和鲍曼不动杆菌耐药分析

目的：了解基层医院院内下呼吸道感染铜绿假单胞菌和鲍曼不动杆菌的耐药情况,为合理使用抗生素提供依据。方法 BACT/ALERT 3D select抗菌药物敏感测定箱法检测淮南新华医院2007年1月至2011年12月痰标本分离获得的铜绿假单胞菌和鲍曼不动杆菌对亚胺培南等16种抗菌药物的药敏结果,并按美国国家临床实验室标准委员会2009年标准进行判断,用WHONET 5.0软件分析数据。结果本院近5年共分离出铜绿假单胞菌796株、鲍曼不动杆菌101株。耐药性分析显示铜绿假单胞菌对亚胺培南的敏感率最高（3.85%～14%）、其次为阿米卡星（12.7%～27.5%）;鲍曼不动杆菌对所有抗菌药物的敏感率均较低（＜40%）。结论铜绿假单胞菌和鲍曼不动杆菌的耐药在基层医院很严重,需要严格掌握抗菌药物使用。     

Nosocomial infections in an Iranian burn care center

Burn patients are obviously at high risk for nosocomial infections due to the immunocompromizing effects of burn injury. Pseudomonas aeruginosa is an important life-threatening nosocomial pathogen in burn units. The aim of this study was to determine nosocomial infections in the Tohid Burn Center in Tehran, Iran. Materials of this study were samples of burn wounds and blood from 582 patients who required hospitalization during March 1996 and September 1998. Burn wound samples were taken on admission day, 3 and 7 days after admission. Frequency of culture positive on admission day, 3 and 7 days after admission were 15, 66, and 88%, respectively. Frequency of P. aeruginosa and Staphylococcus aureus on admission day were 35 and 34%, on the third day after admission 73 and 15%, and at the end of the first week of admission 87 and 9%, respectively. Frequency of blood culture positive was 36% (19/53) of which 89% were P. aeruginosa. Overall mortality rate was 18.5% (108/582). Of these patients, frequency of positive wound culture was 92% (99/108). In conclusion, our results show that P. aeruginosa is the leading cause of nosocomial infections in our burn center. It is also necessary to introduce urgent measures for restriction of the spread of P. aeruginosa infections in our burn center.     

输血对乳腺癌患者术后感染的影响观察

目的　观察输血对乳腺癌患者术后感染的影响。方法　选择 3 11例乳腺癌手术患者进行临床观察 ,其中 10 9例患者术中输注浓缩红细胞 ,112例输注去白细胞浓缩红细胞 ,90例未输血 ,对三组患者术后感染率进行比较。结果　浓缩红细胞输血组术后感染率为 5 .5 0 % ,去白细胞浓缩红细胞输血组术后感染率为 0 .89% ,与浓缩红细胞输血组比较差异有显著性 (P <0 .0 1) ,未输血组患者术后感染率为 1.11% ,与浓缩红细胞输血组比较差异有显著性 (P <0 .0 1) ,而与去白细胞浓缩红细胞输血组比较差异无显著性 (P >0 .0 5 )。结论　乳腺癌患者术中输注浓缩红细胞较输注去白细胞浓缩红细胞患者及未输血患者术后感染率高 ,且术后感染率与浓缩红细胞输注量密切相关。     

Delayed infection of a lymphocele following mastectomy with immediate breast reconstruction: Report of a case

We report herein a rare case of delayed infection of a lymphocele following mastectomy with immediate breast reconstruction. A 38-year-old woman presented to our hospital 7 months after undergoing a left-modified radical mastectomy with an immediate breast reconstruction, following the sudden development of a giant mass in the left thoracoabdominal region as well as a high fever and shivering. Ultrasonography and a computed tomographic scan revealed massive fluid retention extending from the left axilla to the lower abdominal region. Puncture drainage was performed three times and the injection of an antibiotic directly into the cyst resulted in resolution of the fluid. This massive retraction of fluid was considered to have resulted from a delayed infection of an axillary lymphocele. Received: July 1, 1999 / Accepted: May 30, 2000     

Wound infection in breast augmentation: The role of prophylactic perioperative antibiotics

Infection after augmentation mammoplasty is not common, with the reported incidence between 1% and 7%. The use of prophylactic antibiotics, however, is widespread in plastic surgery: It was documented in a 1975 survey in which 43% of responding plastic surgeons used prophylactic antibiotics. Fifteen years since this survey, surgeons have witnessed an explosion in antibiotic variety and have participated in their increased use. For many procedures, the use of antibacterials has evolved by convention and personal preference, based often on only anecdotal information. This report is our study of the routine use of antibiotics to prevent wound infection after augmentation mammoplasty.     

对烧伤感染的认识

Burn infection occurs when pathogenic bacte-ria colonized on the burn wound surfate,and they then invaded the viable tissue causing sepsis or sepsis with blood stream inva-sion.This infection pattern is particular to burn injury.Both in a model of pseudomonas burn wound sepsis and a clinical study of early eschar excision for bacteria quantification indicate that the bacteria not only are located on the burn wound surface but also invaded the deeper tissues.Finally,the bacteria penetrate into the neighboring viable tissue and even blood ves-sels.Therefore,we can say that burn infection is from local wound infection to invasive infection.and finally sepsis is devel-oped,and it is termed as burn wound sepsis.The cutoff count of subeschar tissue bacteria is 105/g.However,the burn wound sepsis may not occur when the number of subeschar tissue bacteria reaches 105/g.The criteria for the diagnosis of burn wound sepsis are mainly listed as below:(1)The number of bacteria in the subes-char reaches≥105/g.(2)Bacteria can be detected in the biopsy specimen.(3)Sepsis associated symptoms and signs.However,the sepsis associated symptoms and signs must be obvious in patients to make the clinical diagnosis of burn wound sepsis.If the sepsis associated symptoms and signs do not ap-pear.we should not make the diagnosis of burn wound sepsis e-ven with the number of bacteria in the subeschar tissue reaching 105/g or bacteria can be found in the biopsy specimen.Sepsis has been defined as the body's response to bacteria and their products.The occurrence of sepsis depends primarily on immune function and stress response intensity.and it is closely related to wound infection degree such as bacteria density and invasion depth in the burn wound,or plasma endotoxin level to certain extent.     

铜绿假单胞菌感染致移植肾假性动脉瘤一例并文献复习

目的探讨感染所致肾移植术后吻合口假性动脉瘤的临床表现、治疗及预后。方法回顾性分析一例因铜绿假单胞菌感染致肾移植术后假性动脉瘤受者的临床资料,并进行文献复习。结果受者于肾移植术后2个月出现右下腹疼痛,超声造影检查示动脉吻合口处有一假性动脉瘤,在行抗感染和抗排斥治疗无明显效果后予以手术探查治疗,术中发现移植肾动脉吻合口处有一个4.0 cm×3.5 cm的假性动脉瘤。评估无保留价值后,行移植肾及假性动脉瘤切除术,瘤壁菌培养提示铜绿假单胞菌感染。术后受者恢复良好,等待二次移植。结论移植肾假性动脉瘤是肾移植术后十分罕见的并发症,由铜绿假单胞菌感染所致则更为罕见,在中国大陆地区少见文献报道。该类受者具有移植物高失活率和受者死亡率高的特点,及时予以手术切除治疗能有效防止病情恶化。     

A PEGylated fibrin hydrogel‐based antimicrobial wound dressing controls infection without impeding wound healing

Combat injuries are associated with a high incidence of infection, and there is a continuing need for improved approaches to control infection and promote wound healing. Due to the possible local and systemic adverse effects of standard 1% cream formulation (Silvadene), we had previously developed a polyethylene glycol (PEGylated) fibrin hydrogel (FPEG)‐based wound dressing for the controlled delivery of silver sulfadiazine (SSD) entrapped in chitosan microspheres (CSM). In this study, we have evaluated the antimicrobial and wound healing efficacy of SSD‐CSM‐FPEG using a full‐thickness porcine wound infected with Pseudomonas aeruginosa. Infected wounds treated with a one‐time application of the SSD‐CSM‐FPEG wound dressing demonstrated significantly reduced bacterial bioburden over time (99·99% of reduction by day 11; P < 0·05) compared with all the other treatment groups. The epithelial thickness and granulation of the wound bed was significantly better on day 7 (150·9 ± 13·12 µm), when compared with other treatment groups. Overall, our findings demonstrate that the SSD‐CSM‐FPEG wound dressing effectively controls P. aeruginosa infection and promotes wound healing by providing a favourable environment that induces neovascularisation. Collectively, sustained release of SSD using fibrin hydrogel exhibited enhanced benefits when compared with the currently available SSD treatment, and this may have significant implications in the bacterial reduction of infected wounds in military and civilian populations.     

大鼠烫伤创面感染模型的研制

目的 拟建立稳定的大鼠烫伤创面感染模型,以便于进行相关防治研究.方法 (1)取50只SD大鼠,使用恒温恒压烫伤仪,以底面积4.5 cm2、质量0.5kg的80℃圆柱形烫头垂直接触大鼠脊柱左右两侧皮肤,致伤4、6、8、10、12 s(每种致伤时间10只大鼠,左右侧烫伤时间相同)制作烫伤模型.伤后24 h,观察创面大体情况,记录左侧创面愈合时间,取右侧创面组织行组织学观察,根据结果筛选浅Ⅱ度、深Ⅱ度创面致伤时间.(2)另取36只SD大鼠,按随机数字表法分为浅Ⅱ度组、深Ⅱ度组,每组18只,按照前述方法与选定的致伤时间分别制成浅Ⅱ度、深Ⅱ度烫伤创面.伤后即刻在2组大鼠一侧创面分别接种0.1 mL含1×109、1×107、1×105CFU铜绿假单胞菌标准菌株ATCC 27853的菌液(每种菌量6只大鼠),在另一侧创面涂抹等体积生理盐水作为对照.接种细菌后24 h HE染色观察创面炎症反应情况;接种细菌后1、2、3、5、7、14 d进行革兰染色及生化反应鉴定菌种,检测并计算痂下细菌含量;记录2组大鼠创面愈合时间.对数据行t检验.结果 (1)根据大鼠创面愈合时间及组织学检查结果,筛选出烫伤6 s和8 s分别为浅Ⅱ度和深Ⅱ度创面的致伤时间.(2)浅Ⅱ度组大鼠仅接种1×109CFU细菌的创面有少许炎性细胞浸润;深Ⅱ度组接种1×109、1×107CFU细菌创面均有炎性细胞浸润,前者浸润更明显.(3)创面细菌鉴定结果为铜绿假单胞菌.浅Ⅱ度组创面接种各种菌量后14 d内,痂下细菌含量绝大多数低于1×105CFU/g;深Ⅱ度组创面接种1×109 CFU细菌后14 d内,痂下细菌含量均高于1×105CFU/g并呈持续上升趋势.(4)浅Ⅱ度组接种1×109、1×107、1×105 CFU细菌的创面与生理盐水对照创面愈合时间相近(t值分别为1.26、0.29、1.07,P值均大于0.05);深Ⅱ度组接种1×109CFU细菌创面愈合时间[(22.5±1.0)d]较生理盐水对照创面[(19.4±1.6)d]明显延长(t=2.73,P＜0.05).结论 大鼠深Ⅱ度烫伤创面接种1×109 CFU铜绿假单胞菌标准菌株ATCC 27853,可作为感染创面防治研究的实验模型,该模型稳定、重复性较高.

Abstract：

Objective To reproduce a reliable rat model of burn with infection for the study of prevention and treatment of infected wound. Methods ( 1 ) Electrical burn producing apparatus equipped with constant temperature (80 ℃ ) and pressure (0.5 kg) was used to reproduce burn injury (with area of 4.5 cm2 ) on both sides of the back in 50 SD rats for different duration (4, 6, 8, 10, 12 s) , with 10 rats for each burn duration. On post burn day (PBD) 1, gross condition of wounds was observed with naked eyes.Wounds on the left side were used to observe healing time. The wounds on the right side were used for histological observation to determine the depth of injury, and they were classified into superficial and deep partialthickness injury. (2) Another 36 SD rats were divided into A (inflicted with superficial partial-thickness burn, n = 18) and B (inflicted with deep partial-thickness burn, n = 18) groups according to the random number table. Rats in both groups were treated in accordance with method of preliminary experiment. Immediately after burn, 0. 1 mL of liquid containing 1 × 109, 1 × 107, 1 × 105 CFU Pseudomonas aeruginosa (PA) ATCC 27853 was respectively inoculated to the wounds on one side (with 6 rats for each amount) ,while the wounds on the other side were treated with the same volume of normal saline as control. Inflammatory reaction of wounds was examined with HE staining on post inoculation day (PID) 1. On PID 1, 2, 3,5, 7, and 14, the number of subeschar bacteria was respectively counted and the bacteria were identified with Gram stain and biochemical reaction. Wound healing time was recorded. Data were processed with t test. Results (1) Burn for 6, 8 s was respectively identified as injury time resulting in superficial or deep partial-thickness injury according to histological observation and wound healing time. (2) Obvious inflammatory cell infiltration was observed in the wounds in B group which were inoculated with 1 × 107 , 1 ×109 CFU PA, and the infiltration was less marked in A group with inoculation of 1 × 109 CFU PA. (3) The bacteria isolated from wounds of A and B groups was identified as PA. The subeschar bacteria count within PID 14 in A group, in which different amount of PA was inoculated, was mostly less than 1 × 105 CFU/g of tissue, while that in B group in which 1 × 109 CFU PA was inoculated was more than 1 × 105 CFU/g of tissue. (4) There was no obvious difference in wound healing time between wounds inoculated with different amount of PA and wounds treated with normal saline in A group ( with t value respectively 1.26, 0. 29, 1.07,P values all above 0.05 ). Wound healing time of wounds in B group, in which 1 × 109 CFU PA was inoculated, was longer as compared with that treated with normal saline [(22.5 + 1.0) d vs. ( 19.4 + 1.6) d, t =2.73, P ＜0. 05]. Conclusions In rat, deep partial-thickness burn wound inoculated with 1 × 109 CFU PA ATCC 27853 is a reliable model with high reproducibility for the study of infection of burn wound.     

抑制应激反应措施对严重烧伤大鼠早期创面侵袭性感染的影响

目的　观察严重烧伤大鼠早期创面遭受侵袭性感染后,抑制应激反应措施对大鼠生存率、脏器损害及其辅助性T淋巴细胞(Th)1 /Th2细胞因子格局的影响。　方法　建立30%TBSAⅢ度烧伤大鼠模型,随机分为对照组(未用冬眠合剂)和冬眠合剂组,每组36只。两组大鼠背部痂下注射1×108 集落形成单位(CFU) /ml铜绿假单胞菌菌液0. 1ml,观察两组大鼠痂下组织细菌定量、注射细菌后96h的生存率、脏器损害情况及白细胞介素(IL)2、IL 4、IL 10、γ型干扰素(IFN γ)的mRNA表达水平。　结果　两组大鼠痂下注菌后5h每克组织细菌数量>1×105 个,两组比较,差异有统计学意义(P<0. 01).冬眠合剂组大鼠生存率(66. 7±2. 6)%,明显高于对照组( 33. 3±1. 7 )% (P<0.01).冬眠合剂组大鼠脏器炎性细胞浸润和病理损害程度较对照组轻。冬眠合剂组注射细菌后即时(0h)IL 2mRNA表达水平低于对照组(P<0. 01),但注射细菌后48、96h其表达增强,对照组表达减弱(P<0. 05);对照组IFN γmRNA的表达水平低于冬眠合剂组(P<0. 01);冬眠合剂组IL 4、IL 10mRNA表达水平低于对照组(P<0. 05或0. 01)。　结论　抑制大鼠严重烧伤后早期应激反应水平对创面细菌的侵袭有保护作用,这一保护作用可能与抑制应激反应水平的同时Th1 /Th2细胞因子格局发生改变有关。     

Combined effect of clarithromycin and imipenem/cilastatin against urinary biofilm infection after pyeloplasty

The present report concerns a 38-year-old man, who had been treated with pyeloplasty and lithotomy for the improvement of urinary excretion and resolution of a kidney stone. The patient developed a biofilm infection involving Pseudomonas aeruginosa and Staphylococcus epidermidis, and had been suffering from recurrent acute pyelonephritis for one year. Combination therapy with clarithromycin (CAM) and imipenem/cilastatin (IMP/CS) consisted of administration of CAM at a dose of 400 mg/day for 1 week, followed by 500 mg/day of IMP by intravenous infusion combined with CAM (400 mg/day) for 5 days. This therapy produced an immediate antimicrobial effect and no further signs of pyuria have been seen during one year of follow-up in this patient.     

外科患者耐美罗培南铜绿假单胞菌感染的危险因素分析

目的探讨外科危重患者中美罗培南耐药的铜绿假单胞菌感染的临床危险因素。方法采用回顾性病例-对照方法，设立两对研究：美罗培南耐药铜绿假单胞菌（meropenem resistant Pseudomonas aeruginosa，MRPA）感染组和对照组，美罗培南敏感铜绿假单胞菌（meropenem sensitive Pseudomonas aeruginosa，MSPA）感染组和对照组。用多因素Logistic回归分析法检验各临床因素与感染发生的关系。结果MRPA感染的危险因素有：感染前监护室（ICU）住院时间（OR=2．234，95％CI=1．710—2．918）。第3代头孢菌素（OR=2．885，95％CI=1．133～7．345）和亚胺培南（OR=7．238，95％CI=1．469～35．659）用药史。MSPA感染的危险因素有：ICU停留时间（OR=2．284，95％CI=1．772—2．945），恶性肿瘤（OR=4．796，95％CI=2．001～11．491），曾使用喹诺酮类药物（OR=2．563，95％CI=1．499～8．468）和第3代头孢菌素（OR=3．796，95％CI=1．543～9．343）。结论尽量缩短外科监护病房住院时间，减少第3代头孢和亚胺培南的使用，可减少美罗培南耐药铜绿假单胞菌感染的发生率。     

腹腔感染细菌流行病学调查

目的监测2006年10月至2007年10月我国不同地区14家教学医院分离的腹腔感染病原菌的菌种分布及其体外药物敏感性。方法按设计方案收集来自腹腔感染的病原菌。菌株经中心实验室复核后,采用琼脂稀释法测定10类共29种抗菌药物的最低抑菌浓度（MIC）,数据输入WHONET5．4软件进行耐药性分析。结果此次监测收集的腹腔感染病例数为742例,分离出的病原菌为743株,其中革兰阴性菌占76．7％（570／743）,革兰阳性菌占23．3％（173／743）。病原菌中分离率位于前5位的分别为大肠埃希菌（38．8％）、肺炎克雷伯菌（10．2％）、铜绿假单胞菌（9．2％）、屎肠球菌（8-2％）和金黄色葡萄球菌（4．4％）。对于所有肠杆菌科菌,敏感率高于90％的抗菌药物包括美罗培南、亚胺培南、替加环素、阿米卡星和他唑西林-三唑巴坦。对产超广谱β-内酰胺酶（ESBLs）的大肠埃希菌和克雷伯菌,敏感性大于90％的药物包括亚胺培南（100％）、美罗培南（100％）、替加环素（100％）和他唑西林-三唑巴坦（91．5％～91．7％）。铜绿假单胞菌中多重耐药菌株的检出率为14．7％,鲍曼不动杆菌为61．3％。金黄色葡萄球菌中耐甲氧西林（MRSA）的发生率为69．7％,所有菌株对替加环素、万古霉素和替考拉宁均敏感。替加环素对所有粪肠球菌和屎肠球菌均保持了100％的敏感率。粪肠球菌中敏感性较高的抗菌药物还有万古霉素（100％）、替考拉宁（100％）和氨苄西林（81．5％）。屎肠球菌中敏感性较高的抗菌药物还有万古霉素和替考拉宁（96．7％）。结论引起腹腔感染的病原菌以革兰阴性菌特别是肠杆菌科菌为主。替加环素、碳青酶烯类、他唑西林-三唑巴坦和阿米卡星对腹腔感染肠杆菌科菌保持了较高的抗菌活性,非发酵的革兰阴性杆菌的耐药性令人担忧。替加环素、万     

Longitudinal development of initial,chronic and mucoid Pseudomonas aeruginosa infection in young children with cystic fibrosis

Background

While the emergence of chronic and mucoid Pseudomonas aeruginosa (Pa) infection are both associated with poorer outcomes among CF patients, their relationship is poorly understood. We examined the longitudinal relationship of incident, chronic and mucoid Pa in a contemporary, young CF cohort in the current era of Pa eradication therapy.

乳腺癌术后I期假体植入乳房重建术后使用抗生素与术后假体乳房感染的研究

目的探讨乳腺癌术后I期假体植入乳房重建术后预防性使用抗生素与术后假体感染率的关系。 方法回顾性分析2017年2月至2018年10月116例接受乳腺癌术后I期假体植入乳房重建术患者,按抗生素预防性应用的时间分为两组：<24 h组(52例)和>24 h组(64例);采用SPSS19.0软件进行统计分析,肿瘤大小、手术时间、体温变化、切口甲级愈合时间等采用( ±s)表示,独立样本t检验;假体感染发生率采用χ²或Fisher精确检验;P<0.05差异有统计学意义。 结果>24 h组和<24 h组在30 d内乳房假体感染发生率及在任何时间假体乳房感染发生率分别为12.5%、19.2%和15.6%、21.1% (P>0.05);两组手术切口达到甲级愈合的时间：>24 h组为(18.7±3.4)d; <24 h组为(18.4±4.4) d,两组差异无统计学意义(P>0.05)。 结论乳腺癌术后Ⅰ期假体植入乳房重建术后长期预防性应用抗生素并不能进一步降低术后假体乳房感染的发生率。