Genotypic and phenotypic properties of coagulase-negative staphylococci causing dialysis catheter-related sepsis

Sixty coagulase-negative staphylococcus (CNS) isolates were recovered from the blood cultures or peritoneal dialysate effluent of 43 patients on renal dialysis. The patients had either renal dialysis catheter-related sepsis (CRS) or continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis. Isolates were characterized by biotyping, and genotyped by pulsed-field gel electrophoresis (PFGE). Phenotypic properties of the strains were also investigated. Several genotypes were identified with no one specific strain of CNS being associated with CRS. However, closely related strains were isolated from several patients within the units studied, suggesting horizontal transfer of micro-organisms. Genotypic macro-restriction profiles did not concur with phenotypic profiles or biotypes, confirming that genotyping is required for epidemiological studies. All staphylococcal strains were investigated for the production of phenotypic characteristics. Significant differences were predominantly seen in the production of lipase, esterase and elastase in strains isolated from the renal patients with CRS and CAPD-associated peritonitis, compared with a non-septic control group. These phenotypic characteristics may therefore have a role in the maintenance of CRS in renal patients.     

Risk factors for oxacillin/methicillin resistance in coagulase-negative staphylococci

The clinical variables associated with isolation of oxacillin- and methicillin-resistant, coagulase-negative staphylococci (CNS) from blood cultures of hospitalized patients were studied. One hundred CNS strains (49 oxacillin-susceptible; 51 oxacillin-resistant) isolated consecutively from one of two or more sets of blood cultures were collected. Only two variables were independently associated with recovery of oxacillin/methicillin-resistant strains by a multivariate analysis: length of hospital stay >10 days (OR 5·2, 95% CI = 1·7–15·7), and administration of antimicrobial agents in the previous 14 days (OR 4·5, 95% CI = 1·7–11·7). Analysis of the antibiotics administered indicated that only β-lactams were associated with a statistically significant risk of resistance to oxacillin/methicillin (OR of β-lactams vs no antibiotics = 6·94, 95% CI = 1·9–25·3; OR of non-β-lactams vs no antibiotics = 2·64, 95% CI = 0·8–8·3). Length of hospital stay (especially >10 days) and prior administration of antimicrobial agents (mainly β-lactams) independently predicted the presence of oxacillin/methicillin-resistant CNS in blood cultures.     

白细胞计数、降钙素原和C-反应蛋白检测在日间非卧床腹膜透析相关性腹膜炎诊疗中的应用价值

目的探讨白细胞计数(WBC)(腹膜透析液及外周血)、C-反应蛋白(CRP)和降钙素原(PCT)检测在日间非卧床腹膜透析(DAPD)相关性腹膜炎诊疗中的应用价值。方法选取2015年7月-2018年6月在本院进行DAPD腹膜透析2012例患者,其中216例为DAPD相关性腹膜炎患者,114例为腹膜透析无相关性腹膜炎患者,同期选择健康体检者100例为对照组,检测WBC(腹膜透析液及外周血)、CRP、PCT 3项炎性指标,并动态观察这些指标在DAPD相关性腹膜炎患者治疗前后的变化。结果DAPD相关性腹膜炎组WBC(腹膜透析液)、PCT和CRP水平明显高于非腹膜炎组、健康对照组,差异有统计学意义(P<0.05)。DAPD相关性腹膜炎组治疗后PCT和CRP水平下降明显,治疗前后比较差异有统计学意义(P<0.05)。结论WBC(腹膜透析液)、PCT和CRP水平在DAPD相关性腹膜炎患者中明显升高,是DAPD相关性腹膜炎良好的早期诊断指标;而PCT和CRP水平在DAPD相关性腹膜炎有效治疗后下降明显,是DAPD相关性腹膜炎良好的疗效监测指标。     

腹膜透析相关性感染状况及预后分析

目的:了解腹膜透析(PD)相关性腹膜炎、隧道感染的菌种及预后.方法:统计腹透患者腹膜炎及隧道感染的发生率、细菌种类、治疗效果和预后.结果:自2000年始至今收住的46例腹透患者共发生腹透相关性腹膜炎27人次,病原菌以金黄色葡萄葡球菌(37.0%)和表皮葡萄球菌(25.9%)为主,隧道感染7人次(3例金葡菌、2例绿脓杆菌、1例表葡菌、1例大肠杆菌).经治疗,25人次腹膜炎治愈,2例因严重的霉菌性腹膜炎而拔管,6人次隧道感染治愈,1例绿脓杆菌感染合并腹膜炎未愈而拔管.结论:感染的病原菌种类影响预后.     

腹膜透析相关性腹膜炎病原菌分布及耐药性

目的回顾性分析海南医学院第二附属医院腹膜透析相关性腹膜炎(Peritoneal dialysis related peritonitis,PDRP)病原菌连续三年的变化情况,为临床抗感染治疗工作提供研究依据。方法选取2015年3月-2017年12月海南医学院第二附属医院的89例PDRP患者作为研究对象,对其腹膜透析透出液中的病原菌分布、耐药性和临床转归情况进行回顾性分析。结果共发生感染186例次,其中,110例次感染中的透出液病原菌培养结果为阳性,阳性率为59.14%,共检出138株病原菌,2015年度、2016年度、2017年度分别检出50株、47株、41株病原菌,不同年度凝固酶阴性葡萄球菌的构成比差异有统计学意义(P<0.05),2017年度的凝固酶阴性葡萄球菌构成比低于2015年度,差异有统计学意义(P<0.05)。不同病原菌所致PDRP患者的治愈率和死亡率差异均有统计学意义(P<0.05),其中,病原菌培养阴性患者的治愈率高于其他三类病原菌培养阳性的患者(P<0.05),革兰阴性菌感染患者的治愈率高于真菌感染患者(P<0.05)。真菌感染的死亡率高于病原菌培养阴性患者(P<0.05)。结论在PDRP患者透出液的病原菌中,凝固酶阴性葡萄球菌等条件致病菌的比例在近三年内出现下降,金黄色葡萄球菌、肺炎克雷伯菌、真菌等高耐药性病原菌的比例在近三年出现上升,而真菌感染患者的预后较差,临床医生应给予高度关注并及时采取有效的治疗措施,以改善患者的预后。     

The laboratory interpretation of coagulase-negative staphylococcal bacteraemia in neonates

In an attempt to detect markers of significance of coagulase-negative staphylococci (CNS) isolated from neonatal blood cultures, epidemiological data and the rate of appearance of positive blood cultures were examined. The main epidemiological factor studied was the relative abundance of the different biotypes of CNS in blood cultures, on neonatal skin and the hands of neonatal unit staff. Our results showed that the relative recovery rates of biotypes found from these sources showed no significant differences. The number of positive blood culture bottles in each set and the number of days taken for growth to appear showed wide variations. A higher proportion of aminoglycoside-resistant strains were found in the group showing both blood culture bottles positive and in the group where isolates were obtained by 24 h of incubation. We conclude that there is no advantage in biotyping CNS in assessing clinical significance, but the association of aminoglycoside resistance with the isolation pattern of CNS in neonatal blood cultures requires further examination.     

新管理模式下腹膜透析病人的随访和生存情况分析

目的 探讨腹膜透析病人门诊随访管理对生存的影响.方法回顾性分析比较腹膜透析中心144例随访达标的病人和209例随访未达标病人的生存状况以及对影响病人随访达标的因素进行分析.结果 随访末达标病人的死亡风险是随访达标病人的3.691倍(P<0.001).活动能力差的病人,没有医疗保障的病人,外地的病人随访情况较差.结论 加强腹膜透析的门诊管理,提高透析病人的随访率是改善腹膜透析病人生存的关键.     

女性家庭持续非卧床腹膜透析患者腹膜炎发生原因分析及对策

目的探讨女性家庭持续性非卧床腹膜透析患者发生腹膜炎的相关因素并分析原因及护理对策。方法分析2017年6月~2019年12月我院肾内科收治的60例女性家庭持续性非卧床腹膜透析患者腹膜炎发生原因,对患者及家属进行深度访谈法,收集发生腹膜炎的相关资料,并进行归类整理及分析。结果女性家庭持续性非卧床腹膜透析患者腹膜炎发生原因:患者及家属无菌观念淡薄、操作不规范23例,占比38.33%;营养不良18例,占比30.00%;肠道感染10例,占比16.67%;合并糖尿病9例,占比15.00%。结论女性家庭持续性非卧床腹膜透析患者腹膜炎发生原因中患者及家属无菌观念淡薄、操作不规范占比例最高,应加强年女性家庭持续性非卧床腹膜透析患者健康教育及完善随访,提高她们的无菌意识,严格执行无菌技术操作,积极治疗基础疾病,加强营养,增加机体免疫力,尽可能降低发生腹膜炎的概率,提高其生活质量。     

腹膜透析初始阶段的精神障碍5例

目的:探讨分析腹透初始阶段精神障碍的原因.方法:对5例精神障碍患者行多方面的分析研究.结论:心理因素及抑郁症为主要原因.     

Dynamics of coagulase-negative staphylococcal colonization in patients and employees in a surgical intensive care unit

Because there is little information about the frequency of carriage of various species of coagulase-negative staphylococci (CNS) in hospital staff, we prospectively investigated nasal CNS in patients and personnel in a Surgical Intensive Care Unit (SICU). The majority of CNS from personnel were Staphylococcus epidermiditis. The CNS species from patients on admission were more diverse and included multiply antibiotic-resistant S. haemolyticus. Patients' CNS became more like CNS colonizing personnel after admission with respect to both antimicrobial susceptibility and speciation. Plasmid and antibiotic sensitivity profiles of S. epidermidis resistant to multiple antibiotics from five patients were identified as those from one employee, but there was no evidence that this was of clinical significance. A variety of factors influence nasal colonization by CNS in SICUs. The nasal CNS of patients change after admission and may become more resistant and less diverse. The factors influencing changes in the antibiotic susceptibility and the aetiology of CNS infection require further study.     

Investigation into the repeated recovery of coagulase-negative staphylococci from blood taken at the end of cardiopulmonary by-pass

Forty-six strains of coagulase-negative staphylococci (CNS) were typed by biochemical reactivity, antibiotic susceptibility pattern, macrorestriction analysis by pulsed-field gel electrophoresis (PFGE) and arbitrary primed polymerase chain reaction (AP PCR). Twenty-four strains were obtained in 1993 from blood cultures of as many patients coupled to a heart-lung machine during cardiac surgery. Since over 30% of the latter belonged to a single type, it was concluded that during the year of analysis a single clone of CNS persisted in this hospital setting. Subsequent epidemiological surveillance putatively identified four possible carriers among surgical personnel. For this reason, 22 strains collected from the hands and nose of two cardiac surgeons and two perfusionists were also tested; none were identical to the persistent clone. Thus either the operation equipment was colonized longitudinally or the causative CNS had disappeared from the suspect individuals' flora. Longitudinal monitoring of CNS infections by various techniques gives a valuable insight into nosocomial epidemiology and elucidates the complexity of the CNS colonization.     

预防腹膜透析术后感染的护理体会

目的:预防慢性肾功能不全终末期患者腹膜透析术后感染.方法:通过对35例此类患者进行"讲解、示范、练习、考核、宣教、记录"六个环节的护理及家庭随访.结果:仅1例发生早期腹腔内感染,经及时抗炎治疗感染控制,余34例患者未出现任何感染征象.结论:注重六个环节的护理能有效防止腹膜透析术后腹腔内感染及隧道感染的发生.     

腹膜透析相关感染性腹膜炎的病原菌及耐药性分析

目的 分析医院腹膜透析相关感染性腹膜炎的病原菌及对常用抗菌药物的耐药性,为防治腹膜透析相关感染提供数据支持.方法 对医院2006年10月-2010年10月所发生的39例次腹膜透析相关感染性腹膜炎患者检出的病原菌及对常用抗菌药物的耐药性进行分析.结果 39例次感染患者的腹膜透出液细菌培养阳性34例,占87.1％,对培养出的病原菌进行分离鉴别,检出54株病原菌,其中革兰阳性球菌19株占35.2％,革兰阴性杆菌19株占35.2％,真菌9株占16.7％;检出病原菌除革兰阳性菌及革兰阴性菌分别对万古霉素和亚胺培南100.0％敏感外,对其他抗菌药物均产生了不同程度的耐药性.结论 定期对医院感染病例进行致病菌谱及耐药性分析,可以指导临床医师经验用药的准确性,提高对医院感染的预防、治疗效果.     

腹膜透析相关性腹膜炎致病菌及耐药性分析

目的探讨持续性非卧床腹膜透析(CAPD)相关性腹膜炎的致病菌及其耐药性。方法回顾性分析49例CAPD腹膜炎患者的病原菌、耐药性和转归。结果 31例培养阳性,透出液培养阳性率为63.27%;共培养菌株34株,其中革兰阳性菌22株,革兰阴性菌9株,真菌3株,最常见的病原菌为表皮葡萄球菌和大肠埃希菌;革兰阳性菌对阿米卡星、利奈唑胺、万古霉素、替考拉宁耐药率最低,分别为0、0、4.76%、5.56%,其次为头孢唑林、左氧氟沙星、哌拉西林/他唑巴坦,分别为35.00%、36.36%、37.50%;革兰阴性菌对阿米卡星、亚胺培南耐药率最低,均为0,其次为哌拉西林/他唑巴坦、头孢哌酮/舒巴坦,均为37.50%,对头孢他啶的耐药率为77.78%。结论腹膜透析相关性腹膜炎致病菌仍以革兰阳性菌为主;腹膜炎患者经验治疗可选用哌拉西林/他唑巴坦单一用药;头孢唑林联合头孢哌酮/舒巴坦;左氧氟沙星联合头孢哌酮/舒巴坦;无残存肾功能者可单独选用阿米卡星。     

Colonization with coagulase-negative staphylococci in two neonatal units

Episodes of septicaemia due to coagulase-negative staphylococci (CNS) were more frequent in a level III than in a level II neonatal unit in Stockholm, Sweden. Colonization with CNS during the first 2 weeks of life was investigated in 10 infants from each unit. As the use of antibiotics differed between the two units, the aim was to correlate colonization and antimicrobial resistance patterns to antibiotic usage. Antimicrobial susceptibility of CNS to isoxazolylpenicillins, co-trimoxazole, erythromycin, clindamycin, chloramphenicol and gentamicin was determined. Selected isolates were typed with restriction endonuclease analysis of plasmid DNA and of genomic DNA. Infants were frequently colonized with multiple strains and species of CNS, and transmission of strains from patient to patient occurred within the unit. Qualitative and quantitative differences in antibiotic use were not correlated with colonization. The prevalence of resistant isolates, mostly of Staphylococcus haemolyticus, was higher in the level II unit with lower use of antibiotics. Staphylococcus epidermidis, which is generally more virulent, prevailed in the level III unit, where there were more severely ill children and invasive procedures were more frequently performed.     

Meticillin resistance in orthopaedic coagulase-negative staphylococcal infections

Orthopaedic infections due to coagulase-negative staphylococci (CoNS) and meticillin-resistant strains may be increasing. We assessed secular trends of CoNS infections and factors associated with meticillin resistance by performing a 13-year retrospective cohort study of orthopaedic patients with CoNS infections from January 1995 to December 2007. Of 60 CoNS infections, 57 (95%) were implant-related. Median follow-up after end of treatment was 5.1 years (range: 2.4–13.8). During the study period, 44,237 orthopaedic procedures were performed, 21,299 (48%) with implants. The overall cumulative incidence of CoNS-associated infection was 0.14% and 0.28% for implant-related procedures. There were non-significant changes in the absolute number or cumulative incidence of CoNS infection (chi-squared test, P values for trend: 0.45 and 0.97, respectively). Forty-five episodes (75%) were due to meticillin-resistant strains. The proportion of meticillin resistance remained stable over time (P for trend: 0.65). Whereas few (4/15) meticillin-susceptible strains were associated with prior prophylaxis that covered the causative pathogen, 28/45 meticillin-resistant strains were associated with inadequate prophylaxis (P = 0.03). The cumulative incidence of orthopaedic CoNS infection is low and stable in our institution and almost exclusively implant-related. The proportion of meticillin resistance among CoNS has remained stable over the last decade with a favourable clinical outcome.     

Vitamin, mineral and trace element supplementation of children on chronic peritoneal dialysis

This study was initiated to assess the dietary intakes of particular vitamins (A, D, B,2) and trace minerals (iron, zinc and copper) which we do not routinely supplement in children undergoing chronic peritoneal dialysis. Eight children were studied and all were receiving protein and energy supplements. The mean dietary intakes of the above micronutrients with the exception of Vitamins A and B₁₂ were below UK RDA values for chronological age but all were comparable to age and sex matched controls. No clinical deficiencies were detected in the short term but patients on long-term dialysis may require a more comprehensive vitamin and trace mineral supplement.     

血液透析和腹膜透析患者生活质量调查

目的：了解血液透析和腹膜透析病人的生活质量及与生活质量有关的因素。方法：采用健康生活量表36项（SF-36）问卷调查31例腹膜透析病人和46例血液透析病人。结果：两组病人的一般资料和生活质量无显著差异。多元逐步回归分析发现,教育程度和治疗依从程度进入回归模型。结论：血液和腹膜透析这两种方式在体力、精神方面均无显著差异,受教育程度高和治疗依从性好可显著提高患者生活质量。     

终末期肾病血液透析和腹膜透析治疗经济学评价研究综述

为了给我国终末期肾病透析治疗经济学评价研究的发展提供可借鉴的经验,对国内外前期开展的血液透析和腹膜透析治疗的经济评价进行综合评述。通过比较发现,我国现有的评价研究在研究设计和方法选择方面存在不足,建议参考国外最新研究进展,进行严谨的评价项目设计,并选取适宜的分析方法。