某医院手外科感染患者细菌培养及药敏试验结果分析

目的分析某医院手外科术后感染的常见致病菌及药敏试验结果。方法回顾性分析某医院2015-2018年手足外伤术后感染患者培养出致病菌的种类、数量、构成比及耐药性。结果共培养出致病菌80株,以G-菌感染最为多见,其中G-菌55株(68.75%),G+菌25株(31.25%)。常见致病菌是铜绿假单胞菌(12.50%)、表皮葡萄球菌(11.25%)、大肠埃希氏菌(8.75%)、粘质沙雷氏菌(7.50%)、金黄色葡萄球菌(7.50%)等。检出多重耐药菌48株,占致病菌的百分率为比60.00%,其中G-多重耐药菌27株(56.25%),G+多重耐药菌21株(43.75%)。多重耐药菌中最为常见的是耐甲氧西林的凝固酶阴性葡萄球菌(MRCNS)、铜绿假单胞菌、金黄色葡萄球菌等。致病菌中的G+菌对常用抗生素耐药率高,对万古霉素、替考拉宁、利奈唑胺的敏感性高,但出现了对替考拉宁耐药的MRCNS菌株,G-菌除恶臭假单胞菌及鲍曼不动杆菌外对常用抗生素耐药率不高。结论手足外伤术后感染患者中,MRCNS和粘质沙雷氏菌感染者增多,金黄色葡萄球菌(MRSA)及产ESBLs的大肠埃希氏菌不是手外科常见的致病菌,临床医生应熟悉本科室现阶段常见致病菌及其药物敏感情况,合理选用抗菌药物。     

脑卒中下呼吸道感染患者多药耐药菌分布状况及其护理探讨

目的探讨卒中多药耐药菌下呼吸道感染患者细菌分布状况、耐药性及其护理措施。方法对从92例卒中下呼吸道感染患者分离的多药耐药菌进行分类,统计耐药率,总结护理措施。结果 92例感染患者共分离出多药耐药菌115株,革兰阴性菌占79.1%,革兰氏阳性菌占20.9%,所有细菌耐药性均很强。结论卒中下呼吸道感染患者常为多重耐药菌感染,在进行敏感抗生素药物治疗时必须加强医护人员多药耐药菌知识的培训,实施必要的护理干预,确保患者康复。     

脑卒中下呼吸道感染患者多药耐药菌分布状况及其护理探讨

目的探讨卒中多药耐药菌下呼吸道感染患者细菌分布状况、耐药性及其护理措施。方法对从92例卒中下呼吸道感染患者分离的多药耐药菌进行分类,统计耐药率,总结护理措施。结果 92例感染患者共分离出多药耐药菌115株,革兰阴性菌占79.1%,革兰氏阳性菌占20.9%,所有细菌耐药性均很强。结论卒中下呼吸道感染患者常为多重耐药菌感染,在进行敏感抗生素药物治疗时必须加强医护人员多药耐药菌知识的培训,实施必要的护理干预,确保患者康复。     

肺炎克雷伯菌血流感染的临床特征及耐药性分析

近年来,随着抗生素的广泛应用、侵入性诊疗技术的开展和免疫抑制剂的应用,血流感染已成为医院的重要感染性疾病,如不进行及时有效的治疗,严重威胁患者生命. 在一些研究中,肺炎克雷伯菌已成为血流感染的第二大细菌[1] ,该菌还可引起肺炎、泌尿系统和手术部位感染等. 研究认为,肺炎克雷伯菌血流感染患者尤其是碳青霉烯耐药肺炎克雷伯菌（ CRKP）血流感染患者治疗失败率较高,且医疗费用昂贵[ 2-3 ]. CRKP血流感染患者病死率高达27.8％～66.7％[4-5] ,已严重危胁公众健康[6]. 入住重症监护病房（ ICU ）、住院时间延长、抗生素联合使用、器官功能较差、器官移植、多部位侵入性操作和接触CRKP携带者是CRKP血流感染的高危因素[7-8]. 本研究主要对我院肺炎克雷伯菌血流感染的临床特征和耐药性进行分析,并探讨其碳青霉烯耐药机制.     

不动杆菌新近流行趋势与耐药机制及其治疗策略的研究进展

近年来，国内外陆续出现了多重耐药的不动杆菌在烧伤病房内流行的报道，引起众多学者的关注。不动杆菌属是致病力较低的条件致病菌，广泛存在于水、土壤、医院环境和人体的皮肤表面，已成为医院获得性感染的主要致病菌之一。随着广谱抗菌药物的广泛应用，抗生素选择压力逐渐加大，多重耐药不动杆菌日趋增多，特别是在重症监护病房（ICU）、严重烧伤病房。耐药菌株对目前常用的抗生素几乎均可耐药，并且容易通过交叉感染在医院内爆发流行，给临床抗感染治疗带来很大困难。笔者对不动杆菌（以鲍氏不动杆菌为主）的新近流行趋势及其可能的耐药机制作一简单阐述，并提出相关治疗策略供同道参考。[第一段]     

呼吸机相关性肺炎主要致病菌调查及护理对策

目的总结呼吸机相关性肺炎(VAP)的主要致病菌及其耐药率,为预防性护理提供依据。方法对206例VAP患者的痰标本进行病原菌及其主要抗生素耐药率的检测。结果VAP患者的病原菌以铜绿假单孢菌、金黄色葡萄球菌、肺炎克雷伯杆菌和阴沟肠杆菌为主,其耐药率的药物排位与我国细菌耐药监测研究组的监测结果基本一致,但细菌耐药率均高于监测结果。结论预防性护理对于切断VAP感染途径和减少感染率尤为重要。     

嗜麦芽窄食单胞菌的耐药分析

随着科学技术的发展,广谱抗生素不断推出新的品种应用于临床,细菌的耐药菌株不断增加,其机理越来越复杂.各种抗生素敏感性下降,临床感染的细菌也逐渐发生了变迁.嗜麦芽窄食单胞菌(Stenotrophomonas maltophilia)的临床分离率近年来已进入我院临床病原菌感染的前10位.嗜麦芽窄食单胞菌作为一种条件致病菌,主要导致高龄、免疫功能下降及长期使用广谱抗菌药物的患者感染.该菌对常用的抗生素具有高效的耐药性,临床上治疗很困难,患者病死率较高;为了给临床有效治疗这类感染提供依据,我们对我院近2年来分离的32株嗜麦芽窄食单胞菌的药物敏感情况进行分析.     

肠外瘘并发腹腔感染的致病菌谱与耐药性分析

目的 研究肠外瘘并发腹腔感染的主要致病菌谱及致病菌对常用抗生素的耐药特点.方法 取226例肠外瘘并发腹腔感染患者的腹腔脓液进行细菌培养和抗生素药物敏感试验.结果 获取菌株520株,其中革兰阴性菌333株,革兰阳性菌180株,真菌7株.前10位的为大肠埃希菌131株,金黄色葡萄球菌62株,肠球菌59株,铜绿假单胞菌50株,肺炎克雷伯杆菌23株,鲍曼不动杆菌18株,阴沟肠杆菌17株,奇异变形杆菌15株,摩氏摩根菌15株,粪肠球菌12株.大肠埃希菌和肺炎克雷伯杆菌中表达超广谱13内酰胺酶阳性菌株分别为102株和17株.甲氧两林耐药金黄色葡萄球菌60株.结论 肠外瘘并发腹腔感染的致病菌谱以革兰阴性菌为主,超广谱β内酰胺酶阳性率较高;金黄色葡萄球菌则基本对甲氧西林耐药.     

呼吸内科院内感染患者耐药菌的感染原因及治疗分析

目的：对呼吸内科院内感染患者耐药菌感染原因进行分析,探讨有效治疗和干预措施。方法选取我院呼吸内科近2年来57例多重耐药菌感染患者作为观察组,同期收治的57例未出现多重耐药菌感染患者为参考组,分析观察组耐药菌感染原因,给予针对性治疗措施。结果两组年龄、住院时间、侵入性治疗、抗生素调换次数、抗生素连续使用时间、激素的不合理使用、合并慢疾病等因素观察结果比较差异均极显著或显著（P＜0.01或P＜0.05）。结论年龄、住院时间、侵入性治疗、合并慢性疾病以及抗生素和激素的不合理使用等是导致呼吸内科患者院内耐药菌感染的危险因素,因此在患者住院期间要针对危险因素给予相应治疗和干预,合理使用抗生素,预防耐药菌感染的发生。     

器官移植中耐碳青霉烯类肺炎克雷伯菌感染的研究进展

肺炎克雷伯菌（KP）是一种常见的条件致病菌,也是引起免疫功能低下患者感染常见的病原菌之一,其感染率呈逐年递增的趋势。碳青霉烯类抗生素是控制KP感染的有效药物,但随着碳青酶烯类抗生素的广泛使用,耐碳青霉烯类肺炎克雷伯菌（CRKP）出现并逐年增长。器官移植受者由于免疫系统受抑制,是CRKP感染的高危人群,一旦发生耐药菌感染,往往难以控制,导致移植器官存活率降低,给临床治疗带来巨大的挑战。本文就器官移植中CRKP感染的现状、治疗进展作一综述。     

烧伤病房病原菌分布与抗药性分析及对策

目的研究烧伤病区病原菌分布及耐药情况,以探索对策。方法以2003年1月至2005年12月烧伤病区送检标本中的阳性菌作为研究对象,对其菌种分布特点及耐药性进行分析。结果革兰阴性菌比例高于革兰阳性菌,其中革兰阳性菌292株（42．8％）,金黄色葡萄球菌分离率占首位（16．7％）,金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）的分离率较高（82．5％）;革兰阴性菌372株（54．5％）,分离率较高的分别为铜绿假单孢菌（12．5％）、大肠埃希菌（11．1％）、鲍曼复合醋酸钙不动杆菌（9．1％）和阴沟肠杆菌（8．2％）;超广谱B．内酰胺酶（ESBLs）在大肠埃希菌和肺炎克雷伯菌中的检出率分别为60．8％和42．9％;真菌检出18例（2．6％）,后两年较第一年有所下降。病原菌中条件致病菌增多;各种病原菌对抗生素的耐药性逐年上升。结论烧伤病区细菌耐药问题严重,抗生素的应用状况与病原菌的分布和耐药性相关,需要严格抗生素的应用指征,并采用良好的消毒隔离措施,以有效控制细菌感染和耐药性的扩散。     

Antibiotic treatment for prevention of infectious complications in joint replacement

Prophylactic antibiotic treatment is mandatory in every operation involving an orthopedic implant. Carefully selected and correctly administered antibiotics can provide effective protection of the implant from bacterial colonization. The prevention of deep wound infection in joint replacement includes several procedures and measures which constitute three basic groups: 1) Promotion of patient's ability to resist infection (careful pre-operative preparation, elimination of potential infectious loci, good nutritional status, etc). 2) Optimal conditions for the operative wound (surgical technique, prophylactic antibiotics). 3) Reduction of the number of bacteria brought in the wound (control measures, super-sterile operating theatres). Clear rules for the system of prophylactic antibiotic treatment should be adopted. A program in which responsibility for antibiotic administration was shifted from the nursing staff to the anesthesiologist in the operating theatre showed improved outcomes and reduced costs. Poor timing of prophylactic antibiotic administration is one of the basic mistakes. If the wound happened to be contaminated during surgery, the first three post-operative hours would be most decisive for the development of infection. An effective bactericidal concentration of antibiotic should be present in tissues and serum immediately after surgery has begun. Therefore the appropriate time for antibiotic application is before a skin incision is made, and not after the operation has started; the highest serum and bone tissue levels appear 20 to 30 min. after intravenous antibiotic injection. To allow antibiotics to reach target tissues, they should be introduced at least 10 min. before tourniquet application. For long surgical procedures or when blood loss is high, an additional dose of antibiotics is recommended during the operation. If a sample for bacterial cultivation is required, antibiotic administration is postponed until during surgery. However, this is used only in indicated cases when deep infection is suspected and no assessment of the causative agent is available. Otherwise this approach carries a high risk of infectious complications in aseptic revision arthroplasty. Long-term, unjustified administration of antibiotics leads to an increase in resistance to the antibiotic involved. Some studies show that a day's course is as effective as a seven-day one. A shorter antibiotic course decreases the costs, reduces side-effects and minimizes the development of resistance. An optimal duration of antibiotic treatment has not been defined yet, and is still a hot issue for discussion. Many authors recommend one pre-operative antibiotic dose and, according to the kind of antibiotic, agree to its 24-hour administration in order to lower the toxic effect of antibiotic and to prevent selection of resistant microorganisms. The choice of suitable antibiotics for prophylactic treatment should be based on the range of agents causing joint replacement infections and the pharmacological properties of the drug. This should have minimal toxicity, should be well tolerated by the patient and, from the epidemiological point of view, should have a low risk of inducing resistance because of frequent use. Naturally, it is not possible to include all antibiotics against all causative agents and therefore attention should be paid, in the first place, to Gram-positive bacteria, i. e., staphylococci and streptococci, which are the most common causes of infectious complications associated with joint replacement. Because of difficulties related to the right choice of antibiotic, it is recommended to keep a record of complications in each patient in order to provide feedback and to facilitate the establishment of reliable antibiotic-based prevention. The prevention of infection in orthopedics is a comprehensive issue. It cannot be expected that prophylactic antibiotic treatment will compensate for mistakes made in operative protocols, for inadequate operative techniques, for shortcomings in operating theatre equipment or insufficient preparation of patients.     

Antimicrobial resistance in the intensive care unit: the use of oral non-absorbable antimicrobials may prolong the antibiotic era

Antimicrobial resistance is a significant problem in the intensive care unit. Ill patients carry abnormal bacteria, amongst which are the causative organisms of many of the nosocomial infections. Overgrowth of these bacteria predisposes to infection. Further, the excretion of systemically administered antibiotics into the gut selects resistant bacteria from this population. In eliminating overgrowth, oral non-absorbable antibiotics prevent infections and prevent the development of antibacterial resistance. This paper discusses the limited effect of traditional approaches in preventing antibiotic resistance. These rely on restriction of classes of antibiotics used, or by restricting antibiotic use by more specific (often invasive) diagnostic techniques (such as protected brush specimens) for the diagnosis of pneumonia. In contrast we describe the experience of three centres using oral non-absorbable antibiotics finding that antibiotic resistance is not a significant clinical problem. In one 20-bed paediatric intensive care, admitting 1000 children per year, of 390 admissions who stayed more than four days 12 episodes of infection (in eight individuals) were caused by antibiotic resistant bacteria. Oral non-absorbable antibiotics prevent both infections and the emergence of antibiotic resistant bacteria.     

肾结石并尿路感染215例病原菌分布及耐药性分析

目的 探讨肾结石合并尿路感染病原菌分布以及常用抗生素的药物敏感性.方法 对2010～2011年我院因肾结石合并尿路感染住院患者215例行尿液细菌培养,对培养结果阳性46例患者进行病原菌及对主要抗生素的耐药情况进行分析.结果 尿培养病原菌分布依次为大肠埃希菌(58.7％)、铜绿假单孢菌(10.9％)、肠球菌(8.7％)等;对阿米卡星的敏感率为77.8％;头孢哌酮耐药率为62.9％.结论 目前肾结石并尿路感染最常见的病原菌仍为大肠埃希菌,对头孢类抗生素耐药率逐渐增高,治疗上应以病原菌培养和药物敏感结果为依据,合理选择抗生素.     

手外科患者伤口分泌物的病原菌分布及耐药性分析

目的：对本院手外科患者伤口分泌物中病原菌的分布及其耐药性进行研究分析,为临床用药提供有利依据。方法对2012年1月—2013年5月本院手外科患者伤口分泌物的病原菌进行鉴定及药敏检测。结果本组823份伤口分泌物标本中分离培养出致病菌542份,阳性率为66%,共检测出致病菌株602株,其中包括一份标本有两种以上致病菌株。其中革兰氏阴性杆菌374株,占62%,革兰氏阳性球菌187株,占31%,真菌41株,占7%。革兰氏阴性杆菌前几位为大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、阴沟肠杆菌;革兰氏阳性球菌以金黄色葡萄球菌为主。45%的大肠埃希菌产超广谱β-内酰胺酶（ESBLs）,对很多抗生素耐药。28%的金黄色葡萄球菌为耐甲氧西林菌株,没有耐万古霉素的金黄色葡萄球菌株。结论本院手外科患者伤口分泌物标本中以革兰氏阴性杆菌为主,耐药问题比较严重,应对抗生素的合理应用给予足够的重视。     

Prevention of infectious complications in surgical patients: potential role of probiotics

Infectious complications in surgical patients often originate from the intestinal microflora. In the critically ill patient, small bowel motility is disturbed, leading to bacterial overgrowth and subsequent bacterial translocation due to dysfunction of the gut mucosal barrier. The optimal prophylactic strategy should act on all these factors, but such a strategy is not yet available. For several decades, antibiotic prophylaxis to prevent translocation of pathogenic bacteria has been studied with conflicting results. Selective decontamination of the digestive tract has shown good results, but fear for bacterial multiresistance has prevented worldwide implementation. In recent years, probiotics, living bacteria with a potential beneficial effect to their host, have shown promising results in several randomized placebo-controlled trials. Currently, in vitro and experimental research focuses on the effects of probiotics on the microflora responsible for gut-derived infections, structural mucosal barrier function and the immune system.     

胆道感染患者196例胆道细菌培养及耐药分析

目的：了解胆道感染患者胆汁中主要致病菌的分布及其抗生素敏感情况。方法对福建医科大学附属龙岩第一医院2008年1月至2012年1月间收治的196例胆道感染患者进行胆汁细菌培养和抗生素敏感情况分析。结果从164例患者的胆汁中共分离171株需氧菌,总阳性率为83.67%（164/196）。171株中革兰阴性菌112株,占65.50%;革兰阳性菌59株,占34.50%。革兰阴性菌的主要致病菌包括大肠埃希菌（35.00%）、肠球菌（27.49%）、肺炎克雷白菌（10.00%）和铜绿假单胞菌（4.00%）。革兰阴性菌对碳青酶烯类药物、阿米卡星、头孢哌酮/舒巴坦仍比较敏感,耐药率分别为低于1.8%、3.5%、11.1%;革兰阳性菌对氨苄西林、阿莫西林/克拉维酸钾的耐药率分别为低于6.1%、0。耐万古霉素的肠球菌（VRE）检出率依然较低,粪肠球菌、屎肠球菌对万古霉素的耐药率分别为2.6%、0。结论头孢哌酮/舒巴坦、阿米卡星可作为治疗胆道感染的首选用药。当革兰阳性菌如肠球菌或耐甲氧西林凝固酶阴性葡萄球菌为致病菌时,应根据胆汁培养结果选用窄谱抗生素。     

烧伤感染的现状、对策与防治新动向

1 烧伤感染的现状2006年6月在昆山召开的第四届全国烧伤救治专题研讨会上,不同地区的烧伤中心或单位提供的微生物学调查资料中有不少共同点,其中很主要的一点就是:铜绿假单胞菌和金黄色葡萄球菌仍是烧伤检出菌中的主要细菌,也是我国近50年来大面积深度烧伤救治工作中难以清除的病原菌,不变中的变化是其耐药性不断增长。甲氧西林耐药金黄色葡萄球菌因被专门命名,人们对其认识较深刻,而革兰阴性杆菌耐药性的快速增长也不容忽视。革兰阴性杆菌对许多抗生素已由多重耐药性逐步发展为全耐药性;而且在多种新型抗生素的压力下,又筛选、激活了一些此前未被注意的机会致病菌。当前应特别注意的是鲍氏不动杆菌和嗜麦芽窄食单胞菌,它们正逐步成为医院感染的重要细菌。上述细菌毒力并非特别强,只因其存在天然耐药性,一旦过度繁殖,可能成为"无药可治"的难治菌。在此有必要强调,"医院感染"的含义是"患者住院后获得新的感     

普通外科感染的菌种变迁及耐药性检测

目的 了解普通外科感染的菌种变迁和耐药情况。方法 分析1993年6月至1997年7月我院普通外科感染患者送检细菌培养阳性的557例。结果 分离革兰阴性（G^-)菌38种1045株（71.4%),其中除最常见的大肠埃利希菌外,阴沟肠杆菌的检出率明显增高,列第3位,革兰阳性（G^ )菌8种418株（28.6%),金黄色葡萄球菌和表皮葡萄球菌分别占第1、2位,粪肠球菌列第3位。阴沟肠杆菌和粪肠球菌系多重耐药菌种,细菌的药敏测定表明：G^-菌的敏感药物为氟喹诺酮类或第3代头孢菌素类药物;对G^ 菌抗菌活性较高的则是万古霉素、利福平等。结论 当前重视抗菌药物的合理应用对延缓菌种变迁和耐药性增长是有重要意义。     

Selective decontamination of the digestive tract as infection prevention in the critically ill. Does it lead to resistance?

Several meta-analysis showed the efficacy of selective decontamination of the digestive tract (SDD) in the reduction of infections in critically ill patients, particularly for ventilator associated pneumonia and bloodstream infections, thereby reducing mortality and morbidity. The principle of SDD is that by means of application of non-absorbable antibiotics in the intestinal canal and oropharyngeal cavity, potentially pathogenic microorganisms are eliminated, thereby reducing the incidence of organ site infections. The endogenous anaerobic flora is preserved as a factor contributing to defence against colonization. The potential induction of antibiotic resistance (AR) due to SDD is a major concern in ICU. This review evaluates the onset of clinically relevant AR after SDD. The results of a recent meta-analysis and of several studies, which confirmed the virtual absence of any reported AR with SDD and that did not find AR after stopping SDD, are presented. The eradication of the reservoir of abnormal bacteria located in the gut by topical non-absorbable antibiotics appears to significantly reduce morbidity, mortality and resistance. Using only systemic antibiotics in ICU may contribute to maintain an abnormal population of bacteria among which AR is encouraged.