Antimicrobial resistance in Neisseria gonorrhoeae

Despite a declining incidence of gonorrhea in much of the industrialized world, antimicrobial resistance continues to present a challenge to the treatment of gonococcal infections. Although no clinically significant resistance to the broad-spectrum cephalosporins has been identified, fluoroquinolone-resistant gonococcal strains are now prevalent in Australia and much of the Far East. Ongoing surveillance for antimicrobial resistance is crucial to obtain the information needed to choose effective empiric therapies for gonorrhea.     

铜绿假单胞菌耐药性分析及耐药基因检测

目的观察杭州市第一人民医院临床分离的铜绿假单胞菌的耐药性变迁及相关耐药基因。方法采用WHONET软件对2003-2007年临床分离的1489株铜绿假单胞菌的药物敏感性试验结果进行统计分析;用琼脂稀释法测定11种抗菌药物对36株多药耐药铜绿假单胞菌的最低抑菌浓度（MIC）;用PCR法检测β-内酰胺酶、氨基糖苷类修饰酶等编码基因,并对PCR扩增产物进行测序分析。结果铜绿假单胞菌对氨曲南、亚胺培南、头孢他啶、头孢吡肟、哌拉西林、哌拉西林／他唑巴坦、头孢哌酮／舒巴坦、环丙沙星、左氧氟沙星、庆大霉素和阿米卡星的耐药率由2003年的13．4％、10．6％、8．7％、7．9％、12．7％、12．7％、6．7％、15．8％、20．5％、24．7％和10．9％分别增至2007年的35．3％、40．9％、18．4％、32．4％、32．9％、32．0％、21．9％、37．8％、38．6％、39．4％和34．8％;11种抗菌药物对多药耐药铜绿似单胞菌的MIC90均≥128μg/mL。36株多药耐药铜绿假单胞菌中,β-内酰胺酶编码基因阳性占58．3％（21／36）,氨基糖苷类修饰酶基因阳性占88．9％（32／36）,oprD2基因缺失率为80．6％（29／36）。结论铜绿假单胞菌对常用抗菌药物的耐药率呈增高趋势,多药耐药情况严重,临床上应给予高度重视。多药耐药铜绿假单胞菌携带多种β-内酰胺酶编码基因及氨基糖苷类修饰酶基因,oprD2基因的缺失率高。     

肝硬化合并自发性细菌性腹膜炎的病原学和耐药情况1

目的监测肝硬化合并自发性细菌性腹膜炎的病原学和耐药情况。方法回顾性分析首都医科大学附属北京地坛医院2010年1月至2011年12月诊断为肝硬化自发性腹膜炎的送检腹水标本共452例,统计分析病原谱的分布和抗菌药物的敏感性。结果收集腹水标本中分离到的94株致病菌,培养阳性率为20.8%（94/452）。其中革兰阴性杆菌49株（52%）,革兰阳性球菌42株（45%）,真菌3株（3%）。病原菌以肠道来源细菌占优势,革兰阴性杆菌以肠杆菌科为主,其中大肠埃希菌19株（20%）、肺炎克雷伯菌6株（6%）,革兰阳性球菌中以肠球菌和凝固酶阴性葡萄球菌检出率最高,其中凝固酶阴性葡萄球菌12株（13%）、屎肠球菌10株（11%）和粪肠球菌8株（9%）。3株真菌均为白念珠菌。革兰阴性杆菌敏感率在80%以上的抗菌药物有阿米卡星（93%,40/43）、亚胺培南（81.4%,35/43）和美罗培南（83.7%,36/43）,敏感率在60%以上的有头孢他啶（62.8%,27/43）和哌拉西林/他唑巴坦（68.2%,15/22）。对革兰阳性球菌敏感率在80%以上的有万古霉素（96.9%,30/31）、替考拉宁（89.7%,26/29）、利奈唑胺（87.9%,29/33）和奎奴普丁/达福普汀（100%,18/18）,敏感率在60%以上的有复方新诺明（70%,21/30）和甲氧苄胺（76.5%,13/17）。结论肝硬化自发性细菌性腹膜炎的病原体以肠源性细菌多见,主要为大肠埃希菌和肠球菌,分离株对常见抗菌药物明显耐药。     

Antimicrobial resistance in cystic fibrosis: A Delphi approach to defining best practices

BackgroundAntimicrobial susceptibility testing (AST) is a cornerstone of infection management in cystic fibrosis. However, there is little evidence that AST predicts the clinical outcome of CF antimicrobial treatment. It has been suggested there is a need for careful consideration of current AST use by the CF community.MethodsWe engaged a group of experts consisting of pulmonary (adult and pediatric) and infectious disease clinicians, microbiologists, and pharmacists representing a broad international experience. We conducted an iterative systematic survey (Delphi) to determine and quantify consensus regarding key questions facing CF clinicians in the use of respiratory culture results including what tests to order, when to obtain them, and how to act upon the results of the testing.ResultsConsensus was reached for many questions but there was not universal agreement to the questions that were addressed. There were some differences with respect to cultures obtained for surveillance compared to when there is clinical worsening. Areas of general consensus include when and how respiratory cultures should be performed, what information should be reported, and when AST should be performed. A key finding is that clinical response to treatment is used to guide treatment decisions rather than AST results.ConclusionsRecommendations are presented regarding questions related to microbiology testing for patients with CF. We have also offered recommendations for priority research questions.     

2006-2010年医院血流感染病原菌的分布与耐药性监测分析

目的:分析我院血流感染病原菌的分布特点及耐药性变迁,为临床抗感染的预防与控制提供实验室依据.方法:收集解放军总医院第一附属医院2006年1月-2010年12月临床分离自血液的725株不重复细菌,细菌鉴定及药敏试验采用全自动细菌生化分析仪(VITEK2 COMPACT).根据美国临床实验室标准化协会(CLSI)2010年...     

Antimicrobial resistance of uropathogens in women with acute uncomplicated cystitis from primary care settings

We assessed the antimicrobial resistance patterns of all urine samples submitted for culture from outpatient women aged ≥14 years with diagnosis of uncomplicated cystitis over a 24-month period (2007–2009) in the city of Fortaleza, Brazil. Only bacterial growth of a single uropathogen with ≥10⁵ CFU/mL was considered for analysis. The Pearson’s chi-square test was used for bivariate correlations. Escherichia coli presented the highest prevalence (64.7%). Coagulase-negative staphylococcus was more common in younger than in older women (P = 0.003). Gentamicin presented the lowest overall resistance pattern (3.5% resistant), followed by ceftriaxone (5%) and norfloxacin (7.5%). Ampicillin and trimethoprim-sulfamethoxazole were the least active agents with 63.7% and 39.8% of resistance, respectively. The resistant rate to trimethoprim-sulfamethoxazole was significantly higher among E. coli than non-E. coli isolated. Among ciprofloxacin-resistant E. coli strains, only 3.4% were resistant to nitrofurantoin. We conclude that trimethoprim-sulfamethoxazole follows a worldwide tendency of antimicrobial increasing resistance and it should be avoided as first-line empirical treatment for urinary tract infections.     

Antimicrobial management of complicated skin and skin structure infections in the era of emerging resistance

BACKGROUND: Complicated skin and skin structure infections (cSSSIs) are among the most common infections treated in the hospital setting. The mainstays of treatment continue to be antimicrobial therapy combined with appropriate surgical intervention. Due to increasing resistance among pathogens commonly implicated in cSSSIs, the objectives of this review were to describe the potential pathogens causing skin infections, the implications of resistance to currently used drug therapy, and the role of new antibiotics with activity for pathogens causing cSSSIs. METHODS: Relevant information from the primary literature and review articles were identified through a MEDLINE search of the medical literature (1980 to the present) using the terms abscess, wound infection, skin and skin structure infection, antibiotics, resistance, quinupristin- dalfopristin, linezolid, daptomycin, tigecycline, oritavancin, and dalbavancin. Meeting posters and slides were identified from the Interscience Conference of Antimicrobial Agents and Chemotherapy (1998-2004) for supplemental data. RESULTS: The most commonly implicated pathogens in cSSSIs include gram-positive bacteria, specifically Staphylococcus aureus. Gram-negative and mixed organisms are additionally encountered in serious cSSSI. Antimicrobial resistance among both gram-positive and gramnegative bacteria has increased significantly during the last decade, with methicillin resistance among S. aureus approaching 60% in hospitals and becoming more frequent in the community as well. As a result, resistance is the driving factor for treatment failure and rising costs for infection management. Few antimicrobial agents are available currently to treat resistant bacteria in cSSSIs; vancomycin is currently the drug of choice against resistant grampositive cocci; however, resistance to this agent has appeared in enterococci and S. aureus. Several new antibiotics such as linezolid and daptomycin are now available for the management of cSSSIs. Other agents such as tigecycline are under investigation and should be available soon to increase treatment options for cSSSIs caused by resistant bacteria. CONCLUSIONS: Although the resistance of cSSSI pathogens is problematic, new antibiotics with broad-spectrum activity against resistant gram-positive and gram-negative bacteria are promising for the management of severe cSSSIs.     

Antimicrobial resistance of Pseudomonas aeruginosa from otorrhea of chronic suppurative otitis media patients

Objective

Pseudomonas aeruginosa (PA) is one of the most common pathogenic bacteria in hospital-acquired infections and chronic suppurative otitis media (CSOM). Drug resistance of PA has been found to increase along with its frequency. We sought to determine the isolation rate and antibiotic susceptibility patterns of PA from otorrhea of CSOM and general clinical samples.

Study Design

Cross-sectional study.

Setting

CSOM patients had been treated at six hospitals. General clinical samples were from a single tertiary teaching hospital.

Subjects and Methods

We assessed 1103 CSOM patients treated at six hospitals and 3177 clinically pustular samples from one tertiary teaching hospital in Korea from 2004 to 2008.

Results

PA was the organism most frequently isolated from otorrhea patients (25.8%), with the annual isolation rate remaining constant over time. In contrast, PA was isolated from 11.2 percent of general clinical samples, and the annual PA isolation rate from general clinical samples decreased over time. The PA isolation rate from otorrhea was significantly higher than that from general clinical samples. PA isolates from both otorrhea and general clinical samples showed similar antibiotic susceptibility patterns, but susceptibilities to a few antibiotics were quite different. Although the annual PA isolation rate from general clinical samples from a single hospital tended to decrease over time, the rate from otorrhea samples did not.

Conclusion

Changes in isolation rate and susceptibility patterns of PA suggest the need for regular surveillance of PA isolates, including antibiotic susceptibility tests, to choose empirical antibiotics and reduce the spread of multidrug-resistant strains.     

金黄色葡萄球菌耐药性及mecA、qacA／B和pvl基因检测

金黄色葡萄球菌是临床上最常见的致病菌之一,可产生多种毒素和酶,包括凝固酶、葡萄球菌溶血素、杀白细胞素、肠毒素和表皮溶解毒素等。耐甲氧西林金黄色葡萄球菌（MRSA）具有多药耐药特征,是导致医院感染的主要革兰阳性菌,已成为临床抗感染治疗的难题。监测金黄色葡萄球菌的耐药现状,了解金黄色葡萄球菌的耐药和致病机制,以及分析感染的危险因素与治疗对策具有重要的临床意义。