草绿色链球菌致病性及耐药性的4年变迁

草绿色链球菌是人体正常菌群，可以引起机会性感染。近年来，由于免疫抑制剂和广谱抗菌药物的广泛应用，草绿色链球菌的分离率逐年升高，我们回顾性分析了本院2002年1月至2006年1月4年问草绿色链球菌的分离率、易感部位及耐药性。     

缓症链球菌感染的抗生素治疗

缓症链球菌（streptococcus mitis）为革兰阳性球菌,是人体正常菌群之一。缓症链球菌可致败血症、亚急性心内膜炎、脑膜炎,也可致肺炎、心包炎、腹膜炎、唾腺炎,以及面部感染、牙源性感染、中耳炎、鼻窦炎等,但常因培养误定为草绿色链球菌而漏诊。作者2010年以来,先后诊断治疗缓症链球菌感染患者5例,其中菌血症2例,肺炎2例,泌尿系感染1例。5例患者均为男性,年龄12~88岁,平均53.6岁,均采用抗感染治疗,应用磷霉素取得了很好效果。报告如下。     

154株B群链球菌的耐药性及其感染的临床特征

为了解我院检出的Ｂ群链球菌对产妇、新生儿及其他患者的感染和治疗情况,我们分析了我院1995～1998年4年中的154株Ｂ群链球菌对抗生素的敏感性和菌株的来源及分布情况。一、材料和方法1菌株来源:154株Ｂ群链球菌,其中104株来自门诊病人,其他50株来自住院病人。包括泌尿生殖道、呼吸道分泌物标本,脓液、引流液、血液标本。2抗生素:青霉素、氨苄西林、头孢噻肟、头孢曲松、红霉素、万古霉素。以上抗生素纸片均为Ｏｘｏｉｄ公司产品。3菌株鉴定:所有菌株均经ＣＡＭＰ试验阳性,必要时用法国梅里埃公司链球菌玻片法分群试剂盒做确证试验。4药敏试…     

链球菌感染与风湿热

链球菌感染与风湿热中山医科大学附属第三医院（５１０６３０）余步云１风湿热是甲组乙型溶血性链球菌感染后的一种自身免疫性疾病，这一观点虽已得到普遍接受，但链球菌感染后通过什么机制导致风湿热的发作；链球菌感染证据的确证及其测定方法在风湿热诊断上的意义以及风...     

儿童肺炎链球菌感染的临床特征及药敏结果分析

目的了解肺炎链球菌感染患儿的临床特征及药敏结果,为进一步研究临床肺炎链球菌的定植、治疗及预防提供依据。方法回顾性分析2012年1~12月四川大学华西第二医院172例肺炎链球菌感染的临床及微生物学资料,并以年龄、性别匹配的健康儿童作为对照组,比较2组患儿的炎性反应特征差异。结果 172例患者标本主要来源于痰液(96.5%),以男性患儿为主(68.0%),中位年龄为14个月(0~109个月),11种临床常用抗生素均出现耐药现象,其中红霉素、克林霉素、四环素、复方磺胺甲噁唑等药物耐药率均高达90%以上,左氧氟沙星、氯霉素、万古霉素等敏感性较高。与同年龄组健康体检儿童相比,肺炎链球菌感染患儿均出现程度不一的炎性反应。结论肺炎链球菌感染以3岁以下男性患儿(占80.8%)为主,且急性期炎性反应特征明显,临床分离株对大多数抗生素有耐药现象,甚至已经出现耐万古霉素的菌株。     

警惕肺炎链球菌引起的老年脑膜炎

肺炎链球菌广泛分布于自然界 ,主要寄生于人类呼吸道及鼻咽腔中 ,是引起儿童和成人大叶性肺炎的重要致病菌 ,也是引起中耳炎 ,副鼻窦炎 ,脑膜炎的主要致病菌 ,尤其是小儿和老年人机体免疫力较弱 ,易成为脑膜炎的主要致病菌 ,我们从 3例老年患者脑脊液中分离出肺炎链球菌。一、病例资料病例 1:患者男 ,72岁。因头痛 ,发热 ,呕吐 2 0ｈ ,神志不清 6ｈ ,抽搐 2次 ,于 2 0 0 0年 11月 4日入院。体检 :体温39 .5℃。对光反射迟钝 ,巴氏征、克氏征、布氏征均 (+)。血常规白细胞 42 .3× 10 9/Ｌ ,Ｎ :0 .9、Ｌ :0 .1。脑脊液 (ＣＳＦ)检查 :白色浑…     

肺炎链球菌感染的临床特征与耐药性分析

目的对我院肺炎链球菌分离株的分布特点及耐药率变迁进行分析,为临床治疗提供病原学依据。方法对2014-2018年南昌大学第二附属医院送检标本采用VITEK-2 Compact鉴定分析仪,VITEK MS质谱仪、Optochin试验及胆汁溶菌试验对细菌进行鉴定;用AST-GP68药敏卡及纸片扩散法对抗菌药物进行体外药敏试验,并用E-test进行青霉素补充药敏试验,使用WHONET5.6软件分析临床特征和耐药性。结果共分离获得448株肺炎链球菌,标本主要来源于痰液标本(63.17%),脓液标本(27.68%)和血液标本(3.79%);收集标本中儿童组(14岁)、老年组(60岁)和14～60岁组患者肺炎链球菌分离率分别为7.36%、51.79%和40.85%;此外,春冬季检出率明显高于夏秋季,其中春、夏、秋、冬季检出率分别为30.14%、18.30%、18.97%和32.59%;分析药敏结果显示,肺炎链球菌对复方新诺明、四环素和红霉素的5年平均耐药率最高,分别为55.48%、69.56%和90.66%,对左氧氟沙星(2.05%)、头孢曲松(9.97%)和美罗培南(13.47%)的5年平均耐药率较低,未发现泰利霉素、莫西沙星、万古霉素和利奈唑胺耐药株;依据非脑膜炎口服给药折点判读显示,我院近5年分离的肺炎链球菌对青霉素耐药率均≥25.00%,不同年份肺炎链球菌对临床常见抗菌药物的耐药率略有差别。结论我院肺炎链球菌主要来源较广,以痰液为主,老年人为主要易感人群,感染好发于春冬季;肺炎链球菌对青霉素耐药性较严重,对左氧氟沙星、头孢曲松及美罗培南敏感性较高,未发现泰利霉素、莫西沙星、万古霉素和利奈唑胺耐药株。     

B群链球菌感染与胎膜早破

目的观察胎膜早破（PROM）的孕妇感染B群链球菌（GBS）的情况并分析药物敏感实验的结果。方法收集胎膜早破孕妇的阴道分泌物进行细菌培养、分离鉴定和药物敏感试验,并对药敏结果进行统计分析。结果 875例标本共检出GBS60株,GBS带菌率为6.9%。常用抗菌药物中敏感度最高的是青霉素G、氨苄西林和万古霉素,最低的是四环素和红霉素。结论 B群链球菌感染所引起的胎膜早破威胁母婴安全,应重视GBS筛查,降低母婴风险。     

Predicting bacteremia caused by Streptococcus anginosus group: A new scoring method

BackgroundViridans group streptococci (VGS) are the most common causative organisms of infective endocarditis. Among VGS, the Streptococcus anginosus group (SAG) is often associated with abscess formation, and delayed diagnosis leads to increased morbidity and mortality. This study aims to examine the factors associated with SAG bacteremia and develop a predictive scoring method.MethodsThis single-center retrospective case-control study of patients with VGS bacteremia compared the background and clinical characteristics between the SAG and non-SAG groups. The univariate analysis used the χ² test and t-test. The multivariate analysis was conducted using logistic regression.ResultsOut of 161 patients, 95 had SAG and 66 had non-SAG bacteremia. Age >63 years: 2 points (odds ratio [OR] = 3.52, 95% confidence interval [CI]: 1.64–7.54); solid tumor: 2 points (OR = 4.44, 95% CI: 1.42–6.77); C-reactive protein >7.61 mg/dL: 3 points (OR = 5.40, 95% CI: 2.49–11.72), and white blood cell count >8550/μL: 2 points (OR = 2.76, 95% CI: 1.29–2.91) were found to be independently associated with SAG bacteremia. After totaling the above variables and adding 1 point for diabetes mellitus, the area under the receiver operating curve was 0.81 (95% CI: 0.74–0.88). The sensitivity and specificity were 51% and 88%, respectively, at a cut-off of 6 points.ConclusionsIn patients with VGS bacteremia, a score of 6 points or higher using this method predicts SAG with high specificity.     

Garenoxacin treatment of experimental endocarditis caused by viridans group streptococci

The activity of garenoxacin was compared to that of levofloxacin or penicillin in a rabbit model of Streptococcus mitis group (penicillin MIC, 0.125 microg/ml) and Streptococcus sanguinis group (penicillin MIC, 0.25 microg/ml) endocarditis. Garenoxacin and levofloxacin had MICs of 0.125 and 0.5 microg/ml, respectively, for both study isolates. Rabbits with catheter-induced aortic valve endocarditis were given no treatment, penicillin at 1.2x10(6) IU/8 h intramuscularly, garenoxacin at 20 mg/kg of body weight/12 h intravenously, or levofloxacin at 40 mg/kg/12 h intravenously. For both isolates tested, garenoxacin area under the curve (AUC)/MIC and maximum concentration of drug in serum (Cmax)/MIC ratios were 368 and 91, respectively. Rabbits were sacrificed after 3 days of treatment; cardiac valve vegetations were aseptically removed and quantitatively cultured. For S. mitis group experimental endocarditis, all studied antimicrobial agents were more active than no treatment (P<0.001), whereas for S. sanguinis group endocarditis, no studied antimicrobial agents were more active than no treatment. We conclude that AUC/MIC and Cmax/MIC ratios may not predict activity of some quinolones in experimental viridans group endocarditis and that garenoxacin and levofloxacin may not be ideal choices for serious infections caused by some quinolone-susceptible viridans group streptococci.     

老年医院感染患者监测及临床分析

目的探讨影响老年医院感染患者监测的相关因素,并分析医院感染监控对临床治疗的指导价值。方法对4 866例老年患者出院病历就医院感染发生率、感染部位、菌群分析、漏报率等进行调查分析。结果老年患者医院感染发生率为6.04%,医院感染漏报率15.64%,感染部位以呼吸道感染为主,占63.27%;其次是泌尿道、胃肠道。病原菌中以革兰阴性菌杆菌为主,占51.65%,主要是铜绿假单胞菌、肺炎克雷伯氏菌、大肠埃希氏菌、肠杆菌属;革兰阳性球菌占5.14%;真菌占31.87%。结论加强老年医院感染病例的报告制度管理,降低漏报率,将有利于减少医院感染发生。     

Efficacy of levofloxacin in the treatment of experimental endocarditis caused by viridans group streptococci

Levofloxacin was investigated against viridans group streptococci in vitro and in rats with experimental aortic endocarditis. The MIC(90)s of levofloxacin and ciprofloxacin for 20 independent isolates of such bacteria were 1 and 8 mg/L, respectively. Rats were infected with two types of organism: either fully susceptible to levofloxacin MIC < or = 0.5 mg/L) or borderline susceptible (MIC 1-2 mg/L). Fully levofloxacin-susceptible bacteria comprised one penicillin-susceptible (MIC 0.004 mg/L) Streptococcus gordonii, and one penicillin-tolerant as well as one intermediate penicillin-resistant (MIC 0.125 mg/L) isogenic strains. Borderline levofloxacin-susceptible bacteria comprised one penicillin-susceptible Streptococcus sanguis and one highly penicillin-resistant Streptococcus mitis (MIC 2 mg/L). Rats were treated for 5 days with drug dosages simulating the following treatments in humans: (i) levofloxacin 500 mg orally once a day (q24 h), (ii) levofloxacin 500 mg orally twice a day (q12 h), (iii) levofloxacin 1 g orally q24 h, (iv) ciprofloxacin 750 mg orally q12 h, and (v) ceftriaxone 2 g iv q24 h. Levofloxacin was equivalent or superior to ceftriaxone, and was successful in treating experimental endocarditis irrespective of penicillin resistance. Nevertheless, standard levofloxacin treatment equivalent to 500 mg q24 h in human was less effective than twice daily 500 mg or once daily 1 g doses against borderline-susceptible organisms. Ciprofloxacin, used as a negative control, was ineffective and selected for resistant isolates. This underlines the importance of MIC determinations when treating severe streptococcal infection with quinolones. In the case of borderline-susceptible pathogens, total daily doses of 1 g of levofloxacin should be considered.     

儿童脓毒症合并噬血细胞综合征诊断学特征分析

目的探讨儿童脓毒症合并噬血细胞综合征的诊断学特征。 方法回顾性分析2016年1月至2020年7月广东省妇幼保健院儿科重症监护室收治并确诊的37例脓毒症合并噬血细胞综合征患儿的临床症状及实验室检测结果。 结果37例脓毒症合并噬血细胞综合征患儿最常见的临床症状为发热(100.00%)，峰值38 ℃以上，其余主要特征包括肝大(32.43%)、皮疹(32.43%)、浅表淋巴结肿大(27.03%)和三凹征(21.62%)。实验室检查中，37例患儿均出现了不同程度的丙氨酸转氨酶、D-二聚体及血清铁蛋白水平升高，血红蛋白水平及血小板计数降低29例(78.38%)，B淋巴细胞比例升高23例(62.16%)，NK细胞比例降低24例(64.86%)，天冬氨酸转氨酶升高34例(91.89%)，骨髓中均发现噬血细胞。29例(78.38%)患儿病原体检测阳性；EB病毒检出率最高(48.65%)；真菌以白念珠菌为主(18.92%)。单一原发感染部位以呼吸道感染为主(37.84%)。经治疗，治愈出院15例，转院治疗8例，放弃治疗12例，死亡2例。 结论脓毒症合并噬血细胞综合征患儿的临床表现复杂多样，实验室及病原体检测中易出现高铁血红蛋白血症和(或)EB病毒感染，早期诊断对救治患儿的生命有重大作用。     

Antimicrobial therapy of experimental endocarditis caused by nutritionally variant viridans group streptococci.

Rabbits with nutritionally variant viridans group streptococcal experimental endocarditis were treated three times daily for 3 days with procaine penicillin (1.2 X 10(6) U) alone or together with low-dose streptomycin (2 mg/kg), high-dose streptomycin (8 mg/kg), low-dose gentamicin (0.32 mg/kg), or high-dose gentamicin (1.05 mg/kg). The mean 0.5-h serum concentrations of streptomycin were 5.3 and 22.5 micrograms/ml in the low- and high-dose group, respectively, and the concentrations of gentamicin were 0.7 and 2.5 micrograms in the low- and high-dose groups, respectively. The combination of procaine penicillin with each dose of aminoglycoside was significantly more effective (P less than 0.001) than was procaine penicillin alone. In combination with procaine penicillin, the higher dose of streptomycin was significantly more effective (P less than 0.02) than the lower dose of streptomycin. The higher dose of streptomycin was not significantly more effective than either dose of gentamicin. The results of treatment with the high or low dose of gentamicin were virtually identical.     

老年急腹症的临床特点及诊治要点

目的探讨老年急腹症的临床特点及诊治要点。方法回顾性分析老年急腹症216例（老年组）和中青年156例（中青年组）的临床资料,对其病情、症状、伴随疾病、实验室及辅助检查、诊断与治疗、住院时间等进行比较分析。结果老年组以腹胀、肛门停止排气和排便、腹腔积液居多（P〈0．01）,中青年组则以体温升高、腹部压痛、反跳痛及肌紧张多见（P〈0．01）;老年组伴随疾病发生率为92．1％,中青年组为29．5％,两组比较差异有统计学意义（P〈0．01）;老年组手术治疗161例,非手术治疗55例,治愈或好转209例,死亡7例;中青年组手术治疗149例,非手术治疗7例,均治愈出院。老年组平均住院时间（25．5±2．5）d,中青年组（16．5±1．5）d,两组比较差异有统计学意义（P〈0．01）。结论老年组急腹症临床表现不典型、伴随疾病多、病情变化快,应重视各种辅助检查,及时早期诊断,合理选择个体化治疗方案,是提高老年急腹症治愈率的关键。     

老年人自发性气胸48例临床分析

目的分析老年人自发性气胸的临床特点。方法对我院肺科1990年1月至2007年2月收治的48例老年人、42例青年人自发性气胸患者临床资料进行回顾性分析。结果老年组多存在肺部基础病变,以慢性阻塞性肺部疾病和肺结核多见,紫绀、呼吸困难较青年组明显。老年人自发性气胸病情往往较重,并发症多于年轻人。结论老年自发性气胸临床表现复杂,容易误诊和漏诊,及时发现和治疗可降低病死率。     

Prevention and management of oral infections in cancer patients

 The successful prevention and management of oral infections and infections from the oral cavity in cancer patients are based on identification of risk patients, selection of patients for prophylactic measures, diagnosis of infection and implementation of directed or empiric antimicrobial therapy. Identification of patients at risk for infection is based on each patient's type of oral microbial colonization and the presence of latent viral infections. Systemic and local resistance to infection will be decisive, and in many patients the risk can be estimated from the expected myelosuppressive effect of anticancer treatment. Diagnosis of infection is often based on clinical findings together with the results of microbiological investigations. Biopsies could be useful, but can seldom be obtained. Blood samples are mandatory for isolation of microorganisms involved in systemic infections in myelosuppressed patients. Prevention of infection requires both local and systemic measures. Elimination of the risk of a breach in the first line of defence is urgent, and the maintenance of mucosal integrity is important. Monitoring microbial colonization is common, as is the institution of antiviral prophylaxis in patients with increased anti-HSV IgG (ELISA >10 000). Antifungal prophylaxis, to avoid colonization and superinfection, should be instituted in patients with low neutrophil counts. Gastrointestinal prophylaxis with quinolones is also commonly used in these patient groups. Treatment of oral infections in cancer patients should include systemic antimicrobial agents in most cases. Special attention should be directed to oral infections in neutropenic (<0.5×l0⁹/l) patients in whom oral microorganisms are the leading cause of bacteraemia. Invasive fungal infections of the oral cavity can be associated with systemic fungal infection and are indications for the use of liposomal amphotericin B. Published online: 21 May 1999     

老年严重缓慢性心律失常的临床分析

目的　探讨老年严重缓慢性心律失常的临床特征。方法　对 2 0 2例老年严重缓慢性心律失常患者的一般资料、心电图及动态心电图 ,心律失常的类型和治疗方法进行回顾分析。结果　①病态窦房结综合征 10 9例 (5 4 .0 % ) ,高度房室传导阻滞 5 2例 (2 5 .7% ) ,心房颤动伴长R R间歇 4 1例 (2 0 .3% ) ,晕厥 73例(36 .1% ) ,接近晕厥或黑 71例 (35 .2 % ) ,脑供血不足 5 8例 (2 8.7% )。②动态心电图长R R间歇 2 .1～ 9s ,平均 3.3s ;≥ 2s的长R R间歇 3～ 30 2次 /2 4h ;平均 4 1次 /2 4h ;合并快速房性和室性心律失常 71例(35 .2 % )。③均给予永久心脏起搏治疗 ,合用抗心律失常药物治疗 73例 (36 .1% )。结论　严重缓慢心律失常引起老年患者严重症状 ;动态心电图可更全面了解患者心律和心率 ,明确晕厥原因 ,便于临床合理选择治疗方法。永久心脏起搏合用抗心律失常药物是控制缓慢心律失常合并快速心律失常的有效方法。