凝固酶阴性葡萄球菌检测在慢性前列腺炎中的意义

目的　研究慢性前列腺炎与凝固酶阴性葡萄球菌 (CNS)的关系 ,探讨前列腺液中CNS检测的临床意义。　方法　对 4 2 8例慢性前列腺炎患者采用Meares Stamey四段取样法作前列腺液细菌培养和药敏试验。患者年龄 18～ 4 6岁 ,平均 31岁。病程 3～ 32个月 ,平均 6个月。慢性前列腺炎症状指数 (NIH CPSI)平均 2 3.2分。　结果　 4 2 8例均行细菌培养 ,其中 2 4 8例 (5 7.94 % )分离出细菌。革兰阳性菌 195例 (78.6 3% ) ,其中葡萄球菌 16 0例 (6 4 .5 2 % ,16 0 / 2 4 8) ,CNS 89例 (35 .89% ,89/ 2 4 8) ;CNS中以表皮葡萄球菌为主者 81例 (32 .6 6 % ) ,其次为腐生葡萄球菌 3例和溶血性葡萄球菌 2例 ;NIH CPSI积分与细菌培养结果无明显相关。CNS对常用抗菌药物 (β 内酰胺类、喹诺酮类、氨基糖苷类 )耐药率较高 (5 1.9%～ 10 0 % )。　结论　CNS为慢性前列腺炎的主要致病菌 ,应引起高度重视 ;适时监测前列腺液病原菌及药敏试验对临床诊断和治疗慢性前列腺炎具有重要意义。     

1例新生儿结膜凝固酶阴性葡萄球菌感染的护理

1　病例简介男 ,2 5 d。出生第 7天家长发现其双眼发红 ,有淡黄色粘稠状脓液溢出。当地医院用氯霉素眼药水滴眼疗效不佳 ,遂住我院。患儿发育正常 ,双眼睑充血 ,睑裂区有大量黄色粘稠脓液存留 (以左侧为重 ) ,用棉签蘸尽 ,稍许睑裂又有黄色粘稠脓液溢出 ,哭闹时脓液溢出更多 ,球结膜充血 +,角膜正常。分泌物作涂片染色 ,细菌培养和药敏试验显示为凝固酶阴性葡萄球菌结膜感染 ,对青霉素、庆大霉素、头孢唑啉、氨苄青霉素、苯唑青霉素敏感。用青霉素 2 0 0 0 U / ml局部滴眼 ,初期每 30 m in 1次 ,2 d后患儿左眼未见溢脓 ,右眼可见少许脓性…     

Ⅱ期翻修治疗凝固酶阴性葡萄球菌假体周围感染的临床观察

目的 :探讨Ⅱ期翻修治疗凝固酶阴性葡萄球菌假体周围感染失败的危险因素。方法 :回顾2005年1月至2015年6月就诊的57例因凝固酶阴性葡萄球菌造成的髋、膝关节假体周围感染而行Ⅱ期翻修患者,平均年龄(61.3±11.9)岁。根据甲氧西林是否耐药分为甲氧西林敏感(MSCo N)组及甲氧西林耐药(MRCo N)组,其中MSCo N组患者25例(9膝16髋,男12例,女13例),MRCo N组患者32例(11膝21髋,男14例,女18例);随访至少2年,比较两组炎症指标、窦道发生率和症状持续时间,以及Ⅱ期翻修治疗后再感染或持续感染率。结果:MSCo N组和MRCo N组分别经过(81.7±38.3)个月及(65.9±33.8)个月的随访,各治疗成功23例和27例,两组差异无统计学意义(P=0.643)。既往有手术史患者比无手术史患者失败的可能性高4.04倍[OR=4.04,95%CI(0.62,26.5)]。既往有窦道的患者比无窦道的患者失败的可能性高4.26倍[OR=4.26,95%CI(0.7,25.9)]。结论:在治疗甲氧西林耐药与敏感的凝固酶阴性葡萄球菌引起的假体周围感染方面,Ⅱ期翻修能取得良好的效果。甲氧西林耐药的凝固酶阴性葡萄球菌引起的假体周围感染并非Ⅱ期翻修治疗失败的危险因素,窦道及既往手术史可能是Ⅱ期翻修治疗失败的原因。     

导管室空气中黄曲霉菌含量监测

目的了解导管室空气中黄曲霉菌污染程度及规律,为制定科学的控制感染对策提供依据。方法采用平板暴露沉降法,在1年中不同季节分别选择1个月中4个星期手术日的第1台介入术后,对导管室不同环境空气中黄曲霉菌进行采集、培养、计数和分析。结果在4个季度均采集到黄曲霉菌株,以春季含量最高,其次为夏季,秋、冬季相对较少,年平均含量147.2cfu/m3。结论导管室空气中存在黄曲霉菌污染,应采取措施进行预防。     

血培养阳性报警时间联合未成熟粒细胞及C反应蛋白鉴别儿童凝固酶阴性葡萄球菌血流感染与污染

目的 评估血培养阳性报警时间(TTP)与血液未成熟粒细胞百分比(IG％)、未成熟粒细胞计数(IG#)、C反应蛋白(CRP)、白细胞总数(WBC)和中性粒细胞百分比(NE％)等炎症指标联合检测对儿童凝固酶阴性葡萄球菌(CoNS)血流感染与污染的鉴别诊断价值.方法 回顾性分析广州市妇女儿童医疗中心2019年1月～12月收集...     

心导管室空气培养细菌学分析

目的了解心导管室在连台介入检查与治疗过程中手术间空气污染状况及菌群分布情况,为制定合理可行的感染控制措施提供依据。方法采用平板暴露沉降法,对心导管室手术间术前及连台手术后空气中微生物的污染状态进行五点(即ABCDE五个点位)采集、培养、计数和分析。结果共采集样本255份;手术间各点位细菌浓度随手术台次(即人员流动人数)增加而升高(P0.01);255份空气培养共分离出294株病原菌,以凝固酶阴性葡萄球菌居首,占41.84%;其次为微球菌(占20.75%)和溶血葡萄球菌(占20.07%)。结论连续心脏介入检查及治疗过程中手术间空气微生物污染严重,应限制人员活动,并采取动态空气消毒方法,以减少空气中的微生物。     

层流手术室连台手术空气细菌检测情况分析

目的了解层流手术间首台手术与第2台手术空气细菌污染情况。方法选择一面积38m2、空气洁净度100级的层流手术间进行20个(40台次)连台无菌手术,将20个连台手术平均分成A、B两组,A组第1台手术患者麻醉时采样1次,手术开始后10min再采样1次;第1台手术结束后,常规清理术后用物,然后关闭手术间自净30min后进行第2台手术,采样时间同第1台手术。B组第1台手术结束,常规清理术后用物,立即进行第2台手术,采样时间及方法同A组。采用五点法在手术间布置细菌培养基采样。结果两组不同时间、手术台次的手术间空气细菌菌落数比较,差异无统计学意义(均P0.05);第1台、第2台手术麻醉时手术间空气细菌菌落数显著高于手术进行10min时(均P0.01)。结论在层流净化空调设备运行良好的条件下,连台手术是可以直接接台的,不需要间隔自净;手术过程中,减少人员流动和开关门次数对控制层流手术室空气中细菌数量至关重要。     

溶葡萄球菌酶对烧伤小鼠吞噬细胞功能的影响

采用小鼠Ⅲ度烧伤模型，观察了溶葡萄球菌酶对烧伤后腹腔巨噬细胞吞噬、消化鸡红细胞能力，化学发光强度以及全身碳末廓清功能的影响，旨在探讨溶葡萄球菌酶改善机体抗感染能力的作用。结果表明：烧伤后小鼠腹腔巨噬细胞吞噬消化能力和化学发光强度均明显降低；碳末廓清功能明显受损。给予溶葡萄球菌酶后，小鼠腹腔巨噬细胞吞噬和消化鸡红细胞能力明显改善，化学发光强度增强，并超过烧伤组和正常对照组。同时溶葡萄球菌酶还可增强全身碳末廓清功能，其ａ值可达１．６３×１０－２，显著高于烧伤组（８．１３×１０－４）和正常对照组（２．７６×１０－３）。提示溶葡萄球菌酶具有增强吞噬细胞功能，进而改善机体抗感染能力的作用。     

溶葡萄球菌酶对烧伤小鼠吞噬细胞功能的影响

采用小鼠Ⅲ度烧伤模型,观察了溶葡萄球菌酶对烧伤后腹腔巨噬细胞吞噬、消化鸡红细胞能力,化学发光强度以及全身碳末廓清功能的影响,旨在探讨溶葡萄球菌酶改善机体抗感染能力的作用。结果表明:烧伤后小鼠腹腔巨噬细胞吞噬消化能力和化学发光强度均明显降低;碳末廓清功能明显受损。给予溶葡萄球菌酶后,小鼠腹腔巨噬细胞吞噬和消化鸡红细胞能力明显改善,化学发光强度增强,并超过烧伤组和正常对照组。同时溶葡萄球菌酶还可增强全身碳末廓清功能,其 a 值可达1.63×10~(-2),显著高于烧伤组(8.13×10~(-4))和正常对照组(2.76×10~(-3))。提示溶葡萄球菌酶具有增强吞噬细胞功能,进而改善机体抗感染能力的作用。     

Anesthesia in the cardiac catheterization lab

Because of the increasing need for anesthesia in the CCL, anesthesiologists are often involved in diagnostic and interventional procedures in this setting. Safe delivery of anesthesia requires adequate preparation and familiarity with the procedure and its surroundings. Radiation safety is of paramount importance for the patient and the practitioner, and ready access to the services of anesthesia support personnel, the pharmacy, and the stat laboratory is a key factor for success. In the CCL, and the traditional operating room environment, anesthesiologists shall continue to advance and improve patient care while reducing morbidity and mortality.     

Primary osteomyelitis caused by coagulase-negative staphylococci

Coagulase-negative staphylococci (CONS) are occasionally cultured from foci of osteomyelitis in otherwise healthy individuals and are usually regarded as contaminants. The present report describes two children with subacute osteomyelitis of the distal tibia in which pure cultures of CONS were obtained from bone. In one patient, the infection was multifocal, and CONS were isolated from two anatomical sites at two different times. In the other patient, the infection was unifocal, and CONS were cultured from two separate specimens obtained from the same site. In both patients, the symptoms progressed until appropriate antibiotic treatment was initiated. CONS isolated from cultures of bone should not automatically be disregarded. Appropriate antibiotic therapy may result in clinical resolution.     

Antibiotic resistance of biomaterial-adherent coagulase-negative and coagulase-positive staphylococci

Whether or not bacterial populations are massively enclosed in slime, it appears that antibiotic resistance, when compared to suspension organisms, is related to surface adhesion and to the specific material of the substratum. These findings are of significance in the understanding and treatment of biomaterial-localized infections.     

The role of coagulase-negative staphylococci in chronic otitis media with effusion.

Twenty-eight middle ear effusions from 27 patients with chronic otitis media with effusion were studied for the presence of bacteria. The most common isolates were coagulase-negative staphylococci. However, biochemical and antibiotic sensitivity patterns demonstrated that these organisms represented a heterogenous group. At least three subtypes of coagulase-negative staphylococci were identified from the middle ear effusions, and in only one instance was the isolate from the ear canal identical with that of the middle ear effusion. The data presented suggest that coagulase-negative staphylococci from the middle ear effusions may not be contaminants; however, it cannot be determined from this study whether these organisms play a role as pathogens or as the result of indolent colonization.     

Spread of coagulase-negative staphylococci during cardiac operations in a modern operating room

BACKGROUND: Coagulase-negative staphylococci cause 33% to 62.5% of wound infections after cardiac operations. The aim of this study was to investigate the sources of coagulase-negative staphylococci in the sternal wound. METHODS: Twenty operations performed in zonal ventilated operating rooms were investigated prospectively. Cultures were taken from all persons present in the room, the sternal wound, and the air. Isolates macroscopically judged to be coagulase-negative staphylococci were metabolically classified, and similar isolates were investigated by pulsed-field gel electrophoresis. RESULTS: Bacterial counts in the operating room air were very low. Wound contamination was found in 13 of 20 operations. Six wound isolates could be traced, three to the patients' sternal skin, one to the patient's groin, one to the surgeon's nose, and one to the surgeon's arm and forehead and the assistant's nose. Three operating field air cultures could be traced to the scrubbed theatre staff. The single case of superficial sternal wound infection was caused by Staphylococcus aureus, which was not isolated from the wound at operation. CONCLUSIONS: In an ultraclean environment, bacteria in the sternal wound originated from the patients' own skin and from the surgical team.     

Bacteriologic evidence of infection caused by coagulase-negative staphylococci in total hip replacement

Coagulase-negative staphylococci are important agents of infected hip arthroplasties, but sample contamination from the skin flora may confuse the diagnosis. Recovery of multiple identical strains has been regarded as indication of true infection. We have evaluated 29 total hip replacement operations with cultures positive for coagulase-negative staphylococci in a prospective study, 16 with ≥3 isolates available for strain identity analysis. In 26 episodes, ≥3 cultures were positive for coagulase-negative staphylococci, but only 19 of them had strong or intermediate clinical evidence of infection. Negative clinical evidence of infection coincided with the absence of a predominating strain according to plasmid profile analysis. A reliable identity analysis may help to rule out infection when multiple cultures are positive in patients who lack clinical evidence of infection.     

Deep infection of cemented total hip arthroplasties caused by coagulase-negative staphylococci

We reviewed a series of 91 patients with deep infection of a cemented total hip arthroplasty caused by coagulase-negative staphylococci (C-NS). Of these, 72 were treated by one-stage exchange arthroplasty with a failure rate of 13% due to recurrence of infection. The other 19 patients have started or completed treatment by a two-stage exchange without failure to date. In 27 of the 91 patients multiple strains of C-NS were discovered, many being resistant to previously used antibiotics. The use of gentamicin-containing cement in the primary arthroplasty was significantly associated with the emergence of gentamicin-resistant C-NS in subsequent deep infection. Bacteriological diagnosis of such infections must take into consideration the possibility that multiple strains of the organism are involved.