基层医院大肠埃希氏菌和肺炎克雷伯杆菌的分布及耐药分析

目的探讨基层医院大肠埃希氏菌和肺炎克雷伯杆菌的分布和耐药性。方法采用常规方法进行菌株的分离和鉴定,根据美国临床实验室标准化委员会（NCCLS）相关文件判断结果。结果246株大肠埃希氏菌和152株肺炎克雷伯杆菌对常用抗菌药物产生了不同的耐药性,大肠埃希氏菌和肺炎克雷伯杆菌产超广谱β-内酰胺酶（ESBLS）率分别为30．8％和18．4％,大肠埃希氏菌对亚胺培南的耐药率为0．4％,对氨苄西林的耐药率为78．0％;而肺炎克雷伯杆菌对亚胺培南的耐药率为0．0％,对氨苄西林的耐药率达96．1％。结论基层医院大肠埃希氏菌和肺炎克雷伯杆菌耐药性已十分严重,应开展耐药性监测。     

健康人群肠道大肠埃希菌耐药性调查研究

目的 研究健康人群肠道大肠埃希菌对抗生素的耐药性。方法 健康人肛拭子标本150份取自深圳市健康人群，按《预防医学微生物学及检验技术》的方法分离大肠埃希菌，K-B法测定细菌对15种抗生素的耐药性。结果 健康人群大肠埃希菌对四环素、萘啶酸、磺胺甲基异恶唑、氨苄西林、复方新诺明等抗生索有耐受性，耐药率分别为63．33％、49．33％、40．67％、38．67％和35．33％；对阿米卡星、氨曲南的耐药率分别为0和0．67％，对头孢类抗生素的耐药率为0～6．67％。其中121株（占80．67％）对1种以上抗生素耐药，87株（占58．00％）对2种以上抗生素耐药，36株（占24．00％）对5种以上抗生素耐药，2株（占1．33％）对9种抗生索耐药。结论 深圳市健康人群肠道大肠埃希菌耐药性较严重，故应严格控制抗生索使用并继续做好耐药性监测工作，及时掌握细菌对抗生素耐药性变化情况。     

三联疗法根除幽门螺杆菌治疗对肠道微生态的影响

目的 探讨抗幽门螺杆菌(Hp)治疗对患者肠道菌群状态(肠道微生态)及耐药性的影响。方法 分别称取60例患者治疗前后新鲜粪便0．5g，选择肠道菌群中具代表性的4种需氧菌和6种厌氧菌分别进行需氧和厌氧培养，从培养出的菌落中挑选相同的菌株进行治疗前后药敏试验。结果 (1)治疗后肠道菌群中肠杆菌、葡萄球菌、拟杆菌、双歧杆菌、消化球菌、梭菌、乳杆菌、真杆菌均较治疗前明显降低(P＜0．05)；(2)治疗后肠道菌群中大肠埃希氏菌、消化链球菌、赛氏葡萄球菌、普氏梭杆菌、肺炎致病性链球菌群、产气真杆菌等对庆大霉素、红霉素、环丙沙星、特美丁、头孢噻肟钠等药耐药率明显增加，且存在多重耐药(P＜0．05)；(3)治疗后超广谱β—内酰氨酶阳性的消化链球菌、表皮葡萄球菌、普氏梭杆菌、肺炎致病性链球菌群、赛氏葡萄球菌等较治疗前分别增加26．2％、33．3％、28．6％、35．3％、28．6％。结论 三联抗Hp治疗后肠道菌群失调、耐药菌株的增加、传播与扩散对广大人群存在潜在危险。     

糖尿病肾病并发尿路感染的临床与细菌学特点

对72例经清洁中段尿细菌培养阳性，细菌计数≥10^5／ml，确诊为UTI的DN病人的临床特点与细菌学进行分析。结果：72例DN并UTI病人中有症状者14例，占19．44％（14／72），有典型膀胱刺激征（尿急、尿频、尿痛）者仅5例，（6．94％），9例临床表现均不典型。其余58例无任何临床症状仅为无症状性菌尿（ASP），占80．55％，（58／72）。UTI的致病菌以革兰氏阴性杆菌为主，占81．33％，大肠埃希氏菌为优势菌株，占50．67％（38／75），其次为变形杆菌9．33％（7／75），枸橼酸杆菌5．34％（4／75），肺炎克雷白氏杆菌9．33％（7／75）。球菌占16．00％（12／75），其中肠球菌8．00％（6／75），表皮葡萄球菌4．00％（3／75）。白色念珠菌2．67％（2／75）。大肠埃希氏菌对氨苄青霉素、头孢唑林、环丙沙星、左氧氟沙星、庆大霉素等抗生素的耐药率较高。结论：DN并UTI者的临床症状不典型，以无症状性菌尿（ASP）为多见。以革兰氏阴性杆菌为主．耐药率高。     

北京市肠道门诊腹泻患者病原谱分析北大核心CSCD

目的了解北京市肠道门诊腹泻患者的病原学特征。方法2013年7月至2014年6月在2家哨点医院肠道门诊收集腹泻患者的粪便标本595份。对沙门菌、志贺菌、副溶血性弧菌、01和0139群霍乱弧菌、致泻大肠埃希菌进行分离培养,对轮状病毒、诺如病毒、星状病毒和肠道腺病毒进行核酸检测。采用描述性流行病学方法对病原的时间分布、人群分布、血清型别等特征进行分析。组间率的比较采用χ2检验。结果595份样本中,128份细菌检测阳性,检出率为21.5％,其中致泻大肠埃希菌检出率为11．4％（68／595）,其次为副溶血性弧菌（6．9％,41／595）、沙门菌（2．4％,14／595）和志贺菌（2．2％,13／595）,霍乱弧菌未检出。112份样本腹泻病毒核酸检测阳性,检出率为18．8％,其中诺如病毒检出率为9．1％（54／595）,其次为轮状病毒（8．7％,52／138）,星状病毒（1．8％,11／595）和肠道腺病毒（o．7％,4／595）。致泻大肠埃希菌以肠致病性大肠埃希菌、肠产毒素性大肠埃希菌、肠黏附性大肠埃希菌为主,副溶血性弧菌血清型别主要为04：K8。6～g月份为病原菌检出的高峰期,当年11月至次年3月为腹泻病毒检出的高峰期。结论诺如病毒、轮状病毒亦是肠道门诊腹泻患者的主要病原,应予以重视。     

大肠埃希菌药敏分析及qnr基因分布情况研究

目的了解衡水地区大肠埃希菌的药敏情况以及qnr基因的存在情况。方法采用肉汤稀释法测15种抗菌药物最低抑菌浓度（MIC）并计算其MIC50和MIC90;采用聚合酶链反应（PCR）检测qnr基因。结果15种抗菌药物中仅亚胺培南、哌拉西林／他唑巴坦和头孢哌酮／舒巴坦对大肠埃希菌敏感,245例大肠埃希菌中检出5株存在qnrB基因,占2．O％,1株存在qnrS基因,占0．4％。结论我院检出的大肠埃希菌存在多重耐药。少数菌株中,存在qnrB和qnrS基因,临床应加强监测。     

糖尿病并发尿路感染的临床与病原学分析

对84例经清洁中段尿细菌培养阳性，细菌计数≥10^3／ml，确诊为UTI的DM病人的临床特点与病原菌进行分析。结果84例DM并UTI病人中有典型膀胱刺激征者32例，占38％（32／84）。其余52例为ASP，占61．9％（52／84），UTI的致病菌以革兰氏阴性杆菌为主，占83．3％。大肠埃希氏菌为优势菌株，占60．7％，其次为变形杆菌9．5％，枸橼酸杆菌8．3％，球菌占11．9％。其中表皮葡萄球菌占4．8％。金葡萄球菌占3．5％，酵母菌占4．8％。大肠埃希菌对氨苄青霉素、庆大霉素、环丙沙星、左氧氟沙星的耐药率较高。结论：DM合并UTI者，以ASP为多见，以革兰氏阴性杆菌为主，耐药率高。     

糖尿病并发尿路感染的临床与病原学分析

对84例经清洁中段尿细菌培养阳性，细菌计数≥10^3／ml，确诊为UTI的DM病人的临床特点与病原菌进行分析。结果84例DM并UTI病人中有典型膀胱刺激征者32例，占38％（32／84）。其余52例为ASP，占61．9％（52／84），UTI的致病菌以革兰氏阴性杆菌为主，占83．3％。大肠埃希氏菌为优势菌株，占60．7％，其次为变形杆菌9．5％，枸橼酸杆菌8．3％，球菌占11．9％。其中表皮葡萄球菌占4．8％。金葡萄球菌占3．5％，酵母菌占4．8％。大肠埃希菌对氨苄青霉素、庆大霉素、环丙沙星、左氧氟沙星的耐药率较高。结论：DM合并UTI者，以ASP为多见，以革兰氏阴性杆菌为主，耐药率高。     

2019—2020年酒泉市致泻大肠埃希氏菌分子分型和耐药性分析

目的 了解2019—2020年甘肃省酒泉市腹泻病例粪便标本中致泻大肠埃希氏菌（DEC）的耐药情况、毒力基因型别以及时间、人群分布情况和分子分型特征,为DEC监测、暴发预警以及耐药抗生素规避使用提供依据。方法 收集2019—2020年酒泉市哨点医院送检的腹泻患者粪便标本,分离疑似致泻大肠埃希氏菌株,采用多重PCR和毛细管凝胶电泳相结合的方法进行毒力基因分型、MIC微量肉汤稀释法药敏试验及PFGE脉冲场凝胶电泳分子分型试验。结果腹泻患者粪便标本219份,检出致泻大肠埃希氏菌27株、检出率12.33%,其中肠聚集性埃希氏菌20株、占74.07%,肠致病性埃希氏菌4株、占14.81%,肠产毒性埃希氏菌3株、占11.11%;以夏季发病为主、占74.08%;人群普遍易感,以19岁～组和0岁～组人群为主,分别占44.44%和29.63%;对氨苄西林和四环素耐药分别占84.19%和74.07%,对萘啶酸、头孢唑啉和复方磺胺耐药分别占66.67%,66.67%和62.96%;27株致泻性大肠埃希氏菌分为27个型别。结论 酒泉市腹泻患者中致泻大肠埃希氏菌PFGE指纹图谱表现出多态性,感染型别以EAEC为主...     

呼吸内科病房医院获得性肺炎的病原学分析

目的探讨呼吸内科住院患者医院获得性肺炎（Hospital acquired pneumonia HAP）的临床和病原学特点。方法对呼吸内科普通病房及呼吸监护病房的2001年1月～2007年2月确诊并明确病原的HAP患者进行调查分析。结果HAP患者279例，明确病原学117例。老年患者（〉65岁）所占比例较高（82／117、70．1％），HAP的病原学以鲍曼不动杆菌、铜绿假单孢菌、肠杆菌及大肠埃希菌最常见，球菌和真菌所占比例较小，革兰阴性杆菌中肺炎克雷伯杆菌和大肠埃希氏菌中ESBLS检出率高达32．94％，在晚发HAP、呼吸机相关性肺炎（Ventilator—associated pneumonia，VAP）及合并慢性呼吸道疾病患者更为常见。结论呼吸内科病房的HAP病原以G-杆菌为主。耐药菌多，治疗难度大，应合理使用抗生素。     

T cell specificity and cross reactivity towards enterobacteria, Bacteroides, Bifidobacterium, and antigens from resident intestinal flora in humans

BACKGROUND: T cell responses to normal intestinal bacteria or their products may be important in the immunopathogenesis of chronic enterocolitis. AIMS: To investigate the T cell specificity and cross reactivity towards intestinal bacteria. PATIENTS/METHODS: T cell clones were isolated with phytohaemagglutinin from peripheral blood and biopsy specimens of inflamed and non-inflamed colon from five patients with inflammatory bowel disease (IBD) and two controls. T cell clones were restimulated with anaerobic Bacteroides and Bifidobacteria species, enterobacteria, and direct isolates of aerobic intestinal flora. T cell phenotype was analysed by single-cell immunocyte assay. RESULTS: Analysis of 96 T cell clones isolated from peripheral blood and biopsy specimens from two patients with IBD showed that both Bifidobacterium and Bacteroides species specifically stimulate proliferation of CD4+TCRalphabeta+ T cell clones from both sites and that cross reactivity exists between these anaerobic bacteria and different enterobacteria. Analysis of 210 T cell clones isolated from three patients with IBD and two controls showed that indigenous aerobic flora specifically stimulate T cell clones from peripheral blood and biopsy specimens from a foreign subject. Some of these flora specific T cell clones were cross reactive with defined enterobacteria. In addition, T cell clones stimulated by their own indigenous aerobic flora were identified in patients with IBD. CONCLUSION: Immune responses to antigens from the intestinal microflora involve a complex network of T cell specificities.     

肝硬化患者肠道菌群的研究

目的:研究肝硬化患者肠道菌群的变化、并分析血内毒素水平与肠道细菌的关系。方法:对37例肝硬化患者和18例健康者粪便中8种常见的厌氧菌及需氧菌进行定量研究,以偶氮基质显色法测外周血内毒素。结果:(1)肝硬化患者双歧杆菌、拟杆菌、真杆菌量明显低于正常组,而大肠杆菌、产气荚膜梭菌量高于正常组(P<0.05);(2)肝硬化患者肠菌失调程度与肝功能Child-Pugh分级有关;(3)肝硬化患者血内毒素水平与大肠杆菌量存在相关性。结论:肝硬化患者存在肠道菌群失调,具有代表性的厌氧菌减少,需氧菌增多。需氧革兰阴性杆菌大量繁殖可能是引起肝硬化肠源性内毒素血症的一个重要因素。     

急慢性腹泻患者肠道菌群的改变

目的探讨急慢性腹泻患者肠道菌群的变化及其差异。方法对20例慢性腹泻、31例急性腹泻及20例对照组的粪便进行肠杆菌、肠球菌、双歧杆菌、乳酸杆菌及类杆菌的培养及检测分析。结果与对照组比较,急性腹泻患者肠杆菌增加,肠球菌、双歧杆菌、乳酸杆菌及类杆菌减少(P<0.01),慢性腹泻患者肠杆菌增加,乳酸杆菌减少(P<0.05)。急性腹泻与慢性腹泻比较,类杆菌和乳酸杆菌减少更明显(P<0.05)。结论急慢性腹泻患者均存在肠道菌群失调,其中急性腹泻更严重。     

肝硬化患者肠道菌群的研究

目的研究肝硬化患者肠道菌群的变化，并分析血浆内毒素水平与肠道细菌的关系。方法对３７例肝硬化患者和１８例健康者粪便中８种常见的厌氧菌及需氧菌进行定量研究，以偶氮基质显色法测外周血内毒素。结果（１）肝硬化患者双歧杆菌、拟杆菌、真杆菌量明显低于正常组，而大肠杆菌、产气荚膜杆菌量高于正常组（Ｐ＜０．０５）：（２）肠菌失调程度与肝功能Ｃｈｉｌｄ－Ｐｕｇｈ分级有关；（３）内毒素水平与大肠杆菌量存在相关性。结论肝硬化患者存在肠道菌群失调，具有代表性的厌氧菌减少，需氧菌增多。需氧革兰氏阴性杆菌大量繁殖可能是引起肝硬化肠源性内毒素血症的一个重要因素。     

慢性腹泻脾胃湿热证与肠道菌群的关系

[目的]研究慢性腹泻脾胃湿热证与肠道菌群的关系.[方法]用选择性培养基对慢性腹泻脾胃湿热证及脾虚证患者和正常人大便肠杆菌、肠球菌、酵母菌、双岐杆菌、乳杆菌、拟杆菌、消化球菌等进行培养,同时计算双岐杆菌和肠杆菌比值(B/E).[结果]与脾虚证组比较,脾胃湿热证组肠道需氧菌肠杆菌、肠球菌、B/E比值及厌氧菌双岐杆菌、乳杆菌均升高.[结论]慢性腹泻脾胃湿热证与脾虚证患者存在不同的肠道菌群失调.     

酪酸梭菌-双歧杆菌二联活菌胶囊对腹泻的临床疗效观察

目的评估酪酸梭菌-双歧杆菌二联新型活菌制剂对腹泻的临床疗效。方法分别随机选取急性腹泻与慢性腹泻病例各38例,给临床腹泻患者口服酪酸梭菌-双歧杆菌二联活菌胶囊,每次2粒,每日3次,分别于第5天和第14天末观察病人腹痛、腹胀、腹泻等情况。同时检测慢性腹泻患者服药前后的肠道菌群变化。结果服用该药品后,与治疗前相比,接受治疗的急性腹泻患者有效率为100%;慢性腹泻患者中,治疗有效率为89.47%。所有患者的腹痛、腹胀明显改善。该药品能明显调节肠道菌群,表现为患者服用药品后,粪便中肠杆菌、肠球菌的数量明显减少,拟杆菌、双歧杆菌、乳杆菌的数量明显增加,其中肠球菌、肠杆菌、拟杆菌和双歧杆菌的变化有明显显著性(P0.05)。结论酪酸梭菌-双歧杆菌二联活菌制剂对腹泻有良好的疗效,能明显改善患者的肠道菌群。     

Nitrate-Reducing Bacteria in Diversion Colitis (A Clue to Inflammation?)

A pathogenic role of nitric oxide has beensuggested in acute and chronic intestinal inflammation.We took the opportunity offered by studies in patientswith excluded colon, which represents a model of chronic intestinal inflammation with noexogenous nitrite or nitrate supply, to evaluate thequantity and the quality of nitrate reducers indiversion colitis. Thirty patients (17 men, 13 women,mean age 45 years) having an excluded colonfor variousreasons were sampled by rectal swabs and compared to 30healthy controls (11 men, 19 women, mean age 28 years).The percentage of nitrate-reducers among the total count of subcultured bacteria was 46± 41% (mean ± SD) in patients withdiversion colitis as compared to 19 ± 24% inhealthy controls. This difference was significant (P< 0.05) despite great heterogeneity in individual values. In patientswith diversion colitis, 75/254 (29.5%) differentisolated bacterial strains were nitrate-reducers ascompared to 61/294 (21%) (P < 0.05) in controls.Among the 75 nitrate-reducing strains isolated frompatients with diversion colitis, 55 were aerobes.Pseudomonas species were only encountered in thispopulation. The predominant group was enterobacteriawith a high isolation rate of species belonging tothe genera Proteus, Providencia, and Morganella . Inhealthy controls nitrate-reducing anaerobes were nearlyas frequent as aerobes. The most frequent species was Eubacterium lentum, followed by Clostridiumperfringens. It could be suggested that nitric oxidesynthase might produce a bacterial substrate increasingthe growth of bacteria with a high pathogenic potential, creating conditions for chronicinflammation and infection in patients with excludedcolon.     

Comparison of O-serotype distribution of Escherichia coli isolated from faecal specimens of patients with sporadic diarrhea and healthy persons and regional difference in Japan

To investigate the isolation frequency of O-serotype of Escherichia coli, a total of 1,563 faecal specimens obtained from patients with sporadic diarrhea in Ishikawa between July 1997 and June 1998, were examined. As a result of O-serotyping of isolated strains using commercially E. coli antisera (43 different types), 247 strains of 29 different O-serotypes were isolated. Isolation rate was 15.8%. Most predominant O-serotype was O1 (128 strains, 52%), followed by O18 (26 strains, 11%), O6 (17 strains, 7%), O111 (16 strains, 6%), and these 4 different O-serotypes took up three quarters of the isolated E. coli. Between August 1996 and May 1997, E. coli isolation from faecal samples of 51,893 healthy persons and O-serotyping of isolated strains using commercial antisera to 6 predominant O-serotypes (O-26, 111, 114, 128, 157 and O1) of VTEC/EHEC were carried out. Among 6 O-serotypes, the most predominant O-serotype was O1 (93% of isolates), followed by O26, 111, 128 (6%) and O114, 157 (1%). These isolation frequencies in patients were 80%, 18%, 2%, respectively, have resembled each other in healthy persons in many points. In a similar way, of these distributions of O-serotype of strains hemolysed on Beutin's blood agar plates, we compared patients with healthy persons. Fifty-six strains (3.6% of the total) of E. coli of different O-serotypes were isolated from 1,563 patients and 57 strains (2.8% of the total) belonging to 11 serotypes from 2,036 healthy persons. As a result of O-serotype frequency, both groups resembled each other. O18 and O6, the most predominant O-serotypes, occupied 64% of the isolated strains in patients and 74% in healthy persons. Next in patients, O1, 26 were 7%--level, O28 ac, 152, 157 were 4%--level, respectively, and in healthy persons. O1 was 5%--level, O28 ac, 55, 146, 152 were 4%--level respectively. In the comparison of O-serotype frequency of E. coli isolated from sporadic diarrhea in other 5 areas (Kanto district, Tokyo, Oita, Aichi and Ishikawa), O1, 6, 8, 18, 25, 26, 55, 86a, 111, 125, 126, 127a, 128, 146, 148, 157 and 166 (17 types) have covered a wide area. On the other hand, O29, 44, 78, 112ac, 115, 136, 143, 152, 168 and 169 (10 types) have a tendency to distribute in local areas, we believe that there are regional differences even in the same Japanese territory.     

High prevalence of adherent-invasive Escherichia coli associated with ileal mucosa in Crohn's disease

BACKGROUND & AIMS: Adherent-invasive Escherichia coli (AIEC) pathovar has been identified in the intestinal mucosa of patients with Crohn's disease (CD). AIEC reference strain LF82 is able to adhere to intestinal epithelial cells, to invade epithelial cells via a mechanism involving actin polymerization and microtubules, and to survive and replicate within macrophages. This study was performed to assess the prevalence of AIEC associated with intestinal mucosa of patients with CD, ulcerative colitis (UC), and of controls. METHODS: A search for E. coli strains was performed with ileal specimens of 63 patients with CD and 16 controls without inflammatory bowel disease (IBD), and with colonic specimens of 27 patients with CD, 8 patients with UC, and 102 controls. The abilities of E. coli strains to invade epithelial cells and to survive and replicate within macrophages were assessed using the gentamicin protection assay. Bacterial uptake by epithelial cells was analyzed using cytoskeletal inhibitors. Bacterial adhesion was quantified with Caco-2 and Intestine-407 cells. The presence of known E. coli virulence genes was assessed by polymerase chain reaction and DNA hybridization. RESULTS: In ileal specimens, AIEC strains were found in 21.7% of CD chronic lesions vs. in 6.2% of controls. In neoterminal ileal specimens, AIEC strains were found in 36.4% of CD early lesions (P = 0.034 vs. controls) and 22.2% of healthy mucosa of CD patients. In colonic specimens, AIEC strains were found in 3.7% of CD patients, 0% of UC patients, and 1.9% of controls. CONCLUSIONS: AIEC strains are associated specifically with ileal mucosa in CD.     

肠道菌群调节剂的研究进展

肠道菌群失调可致人体许多疾病。保持肠道微生态平衡是维持人体健康所必需的。微生态调节剂指益生菌及其代谢产物和生长促进物质制成的制剂。它包括：益生菌、益生元、合生素三部分。微生态制剂临床应用广泛，对急性腹泻，如病毒性肠炎，旅游者腹泻、抗生素相关性肠炎等有肯定疗效，对慢性腹泻肠易激综合征有很好疗效，对炎症性肠病，囊袋炎治疗评价尚需进一步临床观察，微生态制剂发展方向有筛选新的益生菌菌种，开发复合制剂，构建基因工程菌菌种等。本文对肠道菌群调节剂的近期研究进展进行综述。