儿科四株多重耐药鲍曼不动杆菌基因的表达与临床资料分析

目的 探讨感染患儿携带多重耐药鲍曼不动杆菌(AB)耐药基因的特点与临床治疗转归.方法 对呼吸道感染患儿深部痰标本进行细菌鉴定,对检出的4株AB进行药敏试验,PCR法检测耐药基因.结果 4株多重耐药AB除对环丙沙星和左氧氟沙星有3株敏感、对亚胺培南2株敏感、对哌拉西林/他唑巴坦和氨苄西林/舒巴坦有1株敏感外,对其余抗生素的不敏感率均达到100%.TEM、aac(3)-Ⅱ、aac(6')-Ⅰ b、ant(3")-Ⅰ和aac(6")-Ⅱ、qacE△1-sull、Int Ⅰ 1、merA等8种基因均有阳性检出,其余13种基因阴性.经耐药基因检测结果聚类分析提示,4株均有亲缘关系,其中2株为同一克隆传播.4例患儿送检标本前均使用过不同的抗生素,应用对AB敏感的抗生素后,患儿临床症状均有好转.结论 4株多重耐药AB携带多种耐药基因,耐药机制复杂,应根据药敏结果合理使用抗生素.     

鲍曼不动杆菌对常用抗菌药物耐药机制

近年来鲍曼不动杆菌院内感染常常暴发流行,已成为全球共同关注的重要公共卫生问题之一。鲍曼不动杆菌可以对各类临床常用抗菌药物呈现高度的天然耐药性和获得性耐药,导致治疗选择极其有限。临床医生已经开始进一步关注其耐药机制。本文就鲍曼不动杆菌对临床常用抗菌药物的耐药机制作一综述。     

多重耐药鲍曼不动杆菌的耐药机制及治疗进展

近年来随着广谱抗生素的大量使用,多重耐药细菌、甚至是泛耐药及全耐药细菌不断产生.鲍曼不动杆菌是一种常见的条件致病菌,目前多重耐药鲍曼不动杆菌(multidrug-resistant acinetobacter baumannii,MDRAB)的院内感染已成为最为棘手的问题之一.MDRAB的耐药机制主要在于产生抗菌药物灭活酶、靶位或细胞功能改变、外膜屏障及药物主动外排泵作用.治疗MDRAB感染的药物包括舒巴坦制剂、碳青霉烯类、多黏菌素类、四环素类及其他药物.但是由于缺乏大规模的临床研究,目前对于MDRAB的治疗尚无统一的规范,儿科的临床经验更少.     

鲍曼不动杆菌感染的治疗进展

鲍曼不动杆菌近年来已成为院内获得性感染的常见致病菌,成为 PICU、NICU 等危重患儿集中收治病房的优势致病菌种之一。鲍曼不动杆菌耐药问题的日益严重给治疗、防控都带来了前所未有的挑战,及时恰当的抗生素治疗,尤其针对碳青霉烯耐药菌株或泛耐药菌株的治疗策略能显著改善预后。     

新生儿重症监护病房鲍曼不动杆菌感染的临床调查与耐药现状

目的了解我院新生儿重症监护病房鲍曼不动杆菌感染的临床情况及其对常见抗生素耐药率的变迁。方法回顾性分析2005—2011年温州医学院附属育英儿童医院新生儿重症监护病房收治的鲍曼不动杆菌感染患儿的临床资料及鲍曼不动杆菌的药敏试验结果。结果 7年间共有98例患儿发生鲍曼不动杆菌感染,检出部位包括肺部82例(83.7%),血液11例(11.2%),其他部位5例(5.1%)。新生儿鲍曼不动杆菌感染病死率16.3%。分离出的173株鲍曼不动杆菌对12种常见抗生素的耐药率呈递增趋势,2011年对碳青霉烯类抗生素耐药率达52.4%,对三代头孢抗生素耐药率达61.9%,均较2005—2007年显著增高,差异有统计学意义(P<0.001);2011年对头孢哌酮/舒巴坦耐药率为2.6%,与2005—2007年比较差异无统计学意义(P>0.05)。肺部感染鲍曼不动杆菌患儿中,与对碳青霉烯类抗生素敏感者比较,耐药者特点为低体重[1055g(901～1562)g比1572g(1201～2800)g,P=0.001],低胎龄[28.3周(27.0～31.7)周比32.4周(28.7～38.7)周,P=0.002],住院时间长[70天(46～98)天比46天(20～73)天,P=0.006],手术史比例高[6/19比3/63,P=0.001],感染前使用过碳青霉烯类抗生素的比例高[10/19比17/63,P=0.037],机械通气时间长[20天(8～42)天比8天(5～17)天,P=0.014]。Logistic回归分析显示,感染耐碳青霉烯类抗生素鲍曼不动杆菌的独立危险因素是低胎龄(OR=7.24,95%CI1.83～28.57,P=0.005)和手术史(OR=10.72,95%CI1.77～65.04,P=0.01)。结论新生儿鲍曼不动杆菌耐药率呈递增趋势,多重耐药甚至泛耐药鲍曼不动杆菌逐渐增多;新生儿发生鲍曼不动杆菌感染时病死率较高,低胎龄和有手术史的患儿需警惕耐碳青霉烯类抗生素鲍曼不动杆菌的感染。     

新生儿鲍曼不动杆菌感染状况及耐药性监测

目的 探讨鲍曼不动杆菌引起新生儿感染的特点及对常用抗生素的耐药谱.方法采用法国BioMérieux 公司API细菌鉴定分析系统对住院新生儿临床分离细菌进行鉴定,并采用纸片扩散法选用13种常用抗生素进行体外药物敏感试验.结果 2007年1月-2008年6月从新生儿的痰、胃液、血液及各种分泌物、引流物等送检标本中共分离出107株鲍曼不动杆菌,其中来源于痰71株,胃液19株,分泌物11株,血液5株,胸水引流物1株.临床病区以NICU为主,占82.2%(88/107株),84株(78.5%)来自早产儿.对亚胺培南、美罗培南、阿米卡星、环丙沙星、哌拉西林/他唑巴坦等的敏感率较高,达70%以上;对哌拉西林、头孢他啶、头孢吡肟、庆大霉素、复方磺胺甲NFDF9唑等的敏感率次之,为40%～65%.结论鲍曼不动杆菌是引起新生儿医院感染的最常见病原菌之一,对抗生素呈多重耐药,临床治疗应结合新生儿的特点合理选用抗生素,以减少耐药株的出现与扩散.     

儿科患者分离鲍曼不动杆菌耐药性及分子流行病学研究

目的分析儿科患者分离出的鲍曼不动杆菌的耐药性及分子流行病学特征。方法以2016年1月至2018年6月内蒙古医科大学附属医院住院患者分离的医院感染鲍曼不动杆菌作为研究对象,采用Vitek-2 Compact全自动微生物鉴定及药敏分析系统进行鉴定及药敏试验,采用脉冲场凝胶电泳(PFGE)方法及多位点序列分型(MLST)进行菌株同源性分析。结果共收集鲍曼不动杆菌临床分离株94株,其中42株来自儿科患者,52株来自成人患者。儿科分离株对亚胺培南、美罗培南和替加环素耐药率分别为7.1%、7.1%和0,成人分离株对这3种抗生素耐药率分别为67.3%、54.8%和5.5%。PFGE分型结果显示,94株菌共分为49个基因型(X1~X49型),52株成人分离株分布于22个基因型,42株儿童分离株分布于33个基因型中。优势基因型为X23型(21株,22.3%),其中成人分离株为18株(85.7%),儿童分离株为3株(14.3%)。X23基因型菌株对碳青霉烯类耐药率为100%,明显高于其他基因型菌株。MLST分型结果显示,X23基因型为ST195,归属于克隆复合体92(CC92)克隆群。结论内蒙古医科大学附属医院鲍曼不动杆菌儿童分离株总体耐药率明显低于成人分离株,基因型多样化特征明显,优势基因型归属CC92克隆群,为我国多地分离优势克隆株。     

鲍曼不动杆菌感染的诊断与防治

鲍曼不动杆菌近年来已成为院内获得性感染的常见致病菌,成为PICU、NICU等危重患者集中收治病房的优势致病菌种之一.鲍曼不动杆菌耐药问题的日益严重,给治疗、防控都带来了前所未有的挑战,及时恰当的诊断和治疗及感染的预防及流行播散的有效控制对减少该病原的危害非常重要.     

2006～2008年武汉地区儿童分离鲍曼不动杆菌的耐药分析

目的：了解武汉地区儿童分离鲍曼不动杆菌对常见抗生素的耐药性变迁。方法：使用K-B法对2006~2008年期间武汉市儿童医院分离的非重复的679株鲍曼不动杆菌株进行抗菌药物敏感试验,参照美国临床实验室标准化委员会(CLSI)2008年版规则判断结果。结果：与2006年相比,2007年分离的鲍曼不动杆菌对哌拉西林/他唑巴坦、头孢吡肟、头孢他啶的非敏感率显著增加（P<0.05）。而与2007年相比,2008年分离菌对哌拉西林/他唑巴坦、头孢吡肟、头孢哌酮/舒巴坦、头孢他啶、亚胺培南、美洛培南的耐药率均显著增加,差异有统计学意义（P<0.05）。结论：武汉地区儿童分离鲍曼不动杆菌对β-内酰胺类抗生素的非敏感率2006~2008年期间逐年增加。［中国当代儿科杂志,2010,12（8）：613-615］     

儿科重症监护病房鲍曼不动杆菌感染的危险因素与耐药性分析

目的了解儿童重症监护病房(PICU)鲍曼不动杆菌感染的危险因素及耐药情况。方法总结2006年1月至2011年9月PICU中99例鲍曼不动杆菌感染患儿的资料,对鲍曼不动杆菌感染的发生率、发生时间及感染部位进行分析,了解PICU鲍曼不动杆菌感染的危险因素及耐药情况。结果 PICU共收治危重患儿4 762例,鲍曼不动杆菌感染患儿99例,发生率为2.08%(99/4762),死亡14例,病死率14.14%(14/99)。发生鲍曼不动杆菌的时间为入PICU后(12.4±9.3)d。主要为肺部感染93例(93.94%);伤口感染4例(4.04%);尿路感染2例(2.02%)。发生鲍曼不动杆菌感染的危险因素为长期使用广谱抗生素、儿童危重病例评分低、机械通气及留置导尿管。近三年(2009—2011年)耐药水平比前三年(2006—2008年)有明显上升趋势。结论鲍曼不动杆菌易引起院内感染,主要为肺部感染,且耐药性明显上升。应加强抗生素的合理应用、加强病区的管理和侵入性操作时的无菌管理。     

儿科重症监护病房鲍曼不动杆菌感染临床及耐药性分析

<正>鲍曼不动杆菌是继铜绿假单胞菌之后临床分离出的第二大非发酵菌,已经成为医院获得性感染的主要致病菌之一,主要引起医院获得性肺炎,尤其是呼吸机相关性肺炎,以及菌血症、尿路感染、继发性脑膜炎等[1]。     

鲍曼不动杆菌耐药性及防治策略

随着抗生素的广泛应用,多重耐药的鲍曼不动杆菌(MDR-AB)感染发生率迅速上升,对碳青霉烯类抗生素耐药的不动杆菌菌株超过48%,甚至出现对常用抗菌药物全耐药现象.细菌耐药主要是由于产生抗菌药物的灭活酶、外膜蛋白缺失和膜通透性下降以及靶位或外排泵功能改变.对MDR-AB的治疗可选择药物很少,根据药物敏感试验,可选择含舒巴坦制剂、多黏菌素、替加环素、碳氢酶烯类等药物,重症病例建议联合用药.最好的解决耐药性现状的办法是防止耐药菌的传播.良好的手卫生、标准的预防措施、适当的隔离措施、耐药性监测、抗生素管理等是有效的预防方法 .     

多重耐药菌的发展趋势

多重耐药菌感染呈现增长趋势,已成为全球性棘手问题,抗菌药物选择方案很少.传统糖肽类药物抗菌活性已呈现下降趋势.虽然新的抗菌药物包括利奈唑胺、达托霉素和替加环素对某些革兰阳性菌感染有较强的抗菌活性,但对于多重耐药革兰阴性菌,包括耐碳青霉烯类铜绿假单胞菌、鲍曼不动杆菌和肠杆菌的治疗,有效药物仅限于多黏菌素和替加环素.多重耐药菌的分布呈动态变化,近年来,多数医疗机构特别是重症监护病房监测的菌株中,以革兰阴性细菌为主,部分地区多重耐药/泛耐药铜绿假单胞菌、鲍曼不动杆菌等呈现迅速增多趋势.应重视和执行多重耐药菌感染的监测、预防、隔离和抗菌药物选择等综合防控策略,以减少多重耐药菌的扩散.     

Clinical implications of unstable DNA repeat sequences

In this article we review the clinical and genetic features characteristic of a number of diseases recently explained by a novel genetic mechanism: unstable segments of the genome containing trinucleotide repeat sequences. Disorders identified to date are mostly progressive, and display unusual inheritance patterns such as anticipation. Anticipation is manifested as an earlier age at onset or a more severe phenotype in later generations of a family, and can be correlated to an increased repeat expansion size. Thus in later generations the disease onset can take place in childhood whereas affected individuals in earlier generations had only adult symptoms. Paediatric cases of typically adult disorders have been shown to be caused by exceptionally long repeat sequences. Anticipation has been observed in a number of disorders not yet identified at the molecular level. Such disorders could be caused by repeat expansions, and are presently subject to intense research efforts. If repeat sequence expansions are related to these disorders, the longest expansions should be seen in the childhood cases, making these the optimal cases to study. Various DNA-based methods have been developed for the detection of these mutations, making possible preclinical and prenatal diagnostics as well as detection of novel expansions.     

The evaluation of clusters of hospital infections due to multidrug-resistant Salmonella enterica serovar typhimurium in the neonatal unit: a two-year experience

Seven clusters of hospital infection due to Salmonella enterica serovar typhimurium were documented in the neonatology clinic of a children's hospital between April 2002 and March 2004. Eighty-one neonates were infected. Three cases were asymptomatic, 73 cases had gastroenteritis as the only clinical condition, and 5 cases had bacteremia associated with gastroenteritis. All isolates from stool and blood samples (n=86) were identified as Salmonella enterica serovar typhimurium. Extended-spectrum beta-lactamase (ESBL) production was determined by clavulanate disk potentiation assay in all isolates. Enterobacterial Repetitive Intergenic Consensus polymerase chain reaction (ERIC-PCR) was performed in 26 selected isolates, which were chosen as being representative of different clusters, to determine the clonal relationship. PCR, isoelectric focusing and sequence analysis revealed the production of CTX-M-3, TEM-1 and SHV-12 by these isolates in 23%, 76.9% and 100%, respectively. None of the isolates had PER beta-lactamase production. Standard infection control measures such as handwashing and disinfection procedures were implemented in initial clusters. During the two-year period, the infection control policy of the hospital was improved with appropriate actions such as assignment of an infection control nurse and increasing the number of staff of the clinic, and finally, with the establishment of an active surveillance program, the clusters were stopped.     

Prenatal diagnosis of alpha-thalassaemia by analysis of enzymatically amplified DNA sequences

A new method using enzymatically amplified DNA sequences for the prenatal diagnosis of alpha-thalassaemia was evaluated. DNA from a foetus at risk for alpha(0)-thalassaemia was analysed to detect the presence of alpha-globin genes. The procedure involved amplification of a 136-base-pair (bp) region of the alpha-globin gene complex between the psi alpha and alpha 2 region. Amplification was performed using a pair of oligonucleotide primers and a heat stable DNA polymerase which allowed repeated cycles of DNA synthesis at 72 degrees C. A 136 bp product was detected by gel electrophoresis indicating the foetus was not positive for Bart's hydrops foetalis. The result was confirmed using the gene mapping technique. Prenatal diagnosis of alpha-thalassaemia by DNA amplification offers two advantages over the gene mapping technique since radionucleotides are not used and results can be obtained in 3 days.     

Management of newly diagnosed diabetes: home or hospital?

Type 1 diabetes is one of the most common chronic childhood disorders, occurring with increasing frequency. Diabetes management involves the child and family learning how to inject insulin and monitor blood glucose, and adhere to a diet containing healthy food choices. Medical interventions necessary to stabilise newly diagnosed diabetes depend upon the clinical condition of the child at presentation. Hospital admission is necessary if intravenous therapy is required to correct dehydration, electrolyte imbalance, and ketoacidosis, with progression to oral fluids and subcutaneous insulin administration as the child's condition improves. If the child is mildly to moderately symptomatic and clinically well, subcutaneous insulin and oral diet and fluids may be begun from the time of diagnosis, and stabilisation at diagnosis does not necessarily require hospital admission. This article reviews the evidence concerning hospital or home based treatment at diagnosis for children with type 1 diabetes. The Cardiff approach to home management is briefly described, and the benefits and disadvantages of different approaches to initial management are discussed.