我院2007～2010年革兰阴性杆菌菌群分布及耐药性分析

目的了解我院2007～2010年革兰阴性杆菌的分布及耐药情况,为临床治疗提供依据。方法采用VITEK-2全自动微生物分析仪及K-B纸片扩散法,对临床分离的革兰阴性杆菌进行鉴定及药物敏感性试验。结果本组共检出革兰阴性杆菌7897株,检出率为62.1%(7897/12707),其中肠杆菌科大肠埃希菌及肺炎克雷伯菌的检出率分别为21.4%(2723/12707)和8.9%(1126/12707),非发酵菌中铜绿假单胞菌和鲍曼不动杆菌的检出率分别为11.6%(1472/12707)和9.6%(1217/12707)。分离的肠杆菌科细菌对亚胺培南耐药率为0,非发酵菌鲍曼不动杆菌对亚胺培南耐药率较铜绿假单胞菌对亚胺培南耐药率增长的速度快且多重耐药菌株分离率高。结论定期行细菌耐药性监测有助于了解耐药性变迁,为临床用药提供理论依据。     

Molecular Characterization of Escherichia coli Strains Isolated from Retail Meat That Harbor blaCTX-M and fosA3 Genes

A total of 55 cefotaxime-resistant Escherichia coli isolates were obtained from retail meat products purchased in Shenzhen, China, during the period November 2012 to May 2013. Thirty-seven of these 55 isolates were found to harbor a bla_CTX-M gene, with the bla_CTX-M-1 group being the most common type. bla_CMY-2 was detected in 16 isolates, alone or in combination with other extended-spectrum β-lactamase (ESBL) determinants. Importantly, the fosA3 gene, which encodes fosfomycin resistance, was detected in 12 isolates, with several being found to reside in the conjugative plasmid that harbored the bla_CTX-M gene. The insertion sequence IS26 was observed upstream of some of the bla_CTX-M-55 and fosA3 genes. Conjugation experiments showed that bla_CTX-M genes from 15 isolates were transferrable, with Inc I1 and Inc FII being the most prevalent replicons. High clonal diversity was observed among the bla_CTX-M producers, suggesting that horizontal transfer of the bla_CTX-M genes among E. coli strains in retail meats is a common event and that such strains may constitute an important reservoir of bla_CTX-M genes, which may be readily disseminated to other potential human pathogens.     

Effects of Efflux Pump Inhibitors on Colistin Resistance in Multidrug-Resistant Gram-Negative Bacteria

We tested the effects of various putative efflux pump inhibitors on colistin resistance in multidrug-resistant Gram-negative bacteria. Addition of 10 mg/liter cyanide 3-chlorophenylhydrazone (CCCP) to the test medium could significantly decrease the MICs of colistin-resistant strains. Time-kill assays showed CCCP could reverse colistin resistance and inhibit the regrowth of the resistant subpopulation, especially in Acinetobacter baumannii and Stenotrophomonas maltophilia. These results suggest colistin resistance in Gram-negative bacteria can be suppressed and reversed by CCCP.     

某院2009～2011年尿培养中细菌分布及耐药性分析

目的监测和分析本院2009～2011年尿培养分离病原菌的种类、分布及耐药状况,指导临床合理运用抗菌药物。方法采用VITEK 2Compact系统对尿培养阳性标本分离菌株进行鉴定及药敏分析,应用WHONET 5.6软件分析中段尿培养标本所分离病原菌的分布及药敏情况。结果 3 571例尿培养标本中共分离出1 046株病原菌,阳性率为29.3%,其中革兰阴性菌601株,占57.5%,尤以大肠埃希菌最为常见;革兰阳性菌261株,占24.9%,以葡萄球菌和肠球菌为主;真菌184株,占17.6%。病原菌对各种抗菌药物耐药差异性较大,表现为多药耐药。结论本院尿路感染病原菌种类复杂多样、耐药程度严重,需及时监测病原菌的菌群种类分布和耐药变迁,以指导临床合理、规范地使用抗菌药物。     

Antibiotic Resistance Patterns of Metal-Tolerant Bacteria Isolated from an Estuary

Estuarine bacteria isolated on metal-containing media were also found to be antibiotic resistant; ampicillin and chloramphenicol were the antibiotics to which resistance was most common. Patterns of antibiotic resistance were found associated with a variety of taxa.     

重症监护病房主要致病细菌的菌群分布及其药敏分析

目的 :了解我院重症监护病房 (ICU)常见致病细菌的菌群分布及其耐药性状况。方法 :对我院ICU2 0 0 0年 5月至 2 0 0 3年 9月所分离致病菌的菌群分布及耐药情况进行回顾性分析。结果 :460株革兰氏阴性杆菌中铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、不动杆菌、嗜麦芽寡养单胞菌、阴沟肠杆菌的分离率最高。 2 98株革兰氏阳性球菌中金黄色葡萄球菌、凝固酶阴性葡萄球菌、肠球菌的分离率最高。革兰氏阴性致病杆菌对亚胺培南、头孢哌酮 /舒巴坦、头孢他啶敏感性较高 ;革兰氏阳性致病球菌对万古霉素、替考拉宁、氯霉素、利福平的敏感性较高。结论 :加强耐药监测 ,合理使用抗生素对有效控制ICU感染十分重要     

Assessment of the Effects of Combination Therapy with Ciprofloxacin and Fenbufen on the Central Nervous Systems of Healthy Volunteers by Quantitative Electroencephalography

The potential effects of concurrent administration of fenbufen and ciprofloxacin on central nervous system activity in healthy young subjects were investigated by electroencephalography (EEG). Visual analog scales (VAS) were used to assess subjective measures of concentration, vigilance, tension, and irritability. When ciprofloxacin was administered in combination with fenbufen, none of the EEG parameters or VAS ratings measured were significantly different from those measured when the drugs were administered alone.     

Effect of Clindamycin on the In Vitro Activity of Amikacin and Gentamicin Against Gram-Negative Bacilli

The in vitro effect of clindamycin on the inhibitory and bactericidal activity of amikacin (BB-K8) and gentamicin against Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa was examined by the checkerboard technique in microtiter plates. Clindamycin (15 μg/ml) produced statistically significant increases in the minimal bactericidal concentrations of amikacin and gentamicin against E. coli and Klebsiellae at 2 and 4 h of incubation. The minimal bactericidal concentration against P. aeruginosa was not affected. Higher concentrations of clindamycin (20 to 25 μg/ml) reduced the minimal inhibitory and bactericidal concentrations of amikacin and gentamicin for E. coli at 18 h of incubation. The synergistic bactericidal activity of amikacin and carbenicillin against E. coli, but not P. aeruginosa, was also inhibited slightly by clindamycin (15 μg/ml). The clinical implications of this inhibition of the early bactericidal in vitro activity of aminoglycosides by clindamycin remain to be determined. Although these in vitro results have not been studied in clinical infections, it is conceivable that slight interference in early bacterial killing could alter the outcome of infection in the immunosuppressed patient.     

儿童血培养病原菌的分布及耐药性研究

血培养标本用Bact/Alert 120自动血细胞分析系统和Vitek60鉴定仪进行血培养及鉴定,药敏用K-B法,用Whonet5.3软件进行分析。结果共检出386株病原菌,其中革兰阳性菌268株,占69.4%;革兰阴性菌112株,占29.0%;真菌6株,占1.6%;最常见的分离菌分别为凝固酶阴性葡萄球菌(50.0%)、大肠埃希菌(13.5%)、金黄色葡萄球菌(9.3%)、克雷伯菌属(7.8%)以及肠球菌属(6.7%)。革兰阳性菌敏感性最好的药物为万古霉素,革兰阴性菌敏感性最好的药物为亚胺培南。     

Antibiotic Resistance Among Coliform and Fecal Coliform Bacteria Isolated from the Freshwater Mussel Hydridella menziesii

Freshwater mussels (Hydridella menziesii) collected from Lakes Rotoroa, Rotoiti, and Brunner, South Island, New Zealand, contained coliform and fecal coliform bacteria. The majority of these bacteria were resistant to one or more antibiotics, but none transferred streptomycin, tetracycline, or kanamycin resistance to an antibiotic-susceptible strain of Escherichia coli K-12.     

Frequency of Resistance to Kanamycin, Tobramycin, Netilmicin, and Amikacin in Gentamicin-Resistant Gram-Negative Bacteria

In vitro evaluation of 66 epidemiologically distinct, gentamicin-resistant, gram-negative isolates from four hospitals revealed that 92% were kanamycin resistant, 44% were netilmicin resistant, 41% were tobramycin resistant, and 6% were amikacin resistant. Combined resistance to gentamicin, tobramycin, and netilmicin occurred in 30% of the strains. Although the resistance percentage to amikacin was the lowest of the three newer agents, two strains were resistant to all of the aminoglycosides tested.     

某医院下呼吸道感染分离菌分布及耐药性监测

目的研究四川大学华西医院龙泉医院下呼吸道分离菌分布及耐药情况,为临床合理用药提供指导。方法采用法国生物梅利埃VITEK2COMPACT全自动微生物鉴定分析仪对2016年6月到2018年1月本院2363例下呼吸道感染患者标本进行细菌培养鉴定,并分析其耐药情况。结果下呼吸道感染检出菌株革兰氏阴性杆菌1028株,占88.62%;革兰氏阳性球菌132株,占11.38%;普通患者革兰氏阴性杆菌检出依次以流感嗜血杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍曼不动杆菌较多;重症患者革兰氏阴性杆菌检出依次以铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、流感嗜血杆菌较多;革兰氏阳性球菌均以金黄色葡萄球菌较多。氨苄西林对常见革兰氏阴性杆菌耐药较为严重,亚胺培南、妥布霉素、哌拉西林/他唑巴坦对常见革兰氏阴性杆菌较为敏感;万古霉素在金黄色葡萄球菌、肺炎链球菌及溶血葡萄球菌均未发现耐药菌株,苯唑西林、庆大霉素对金黄色葡萄球菌、肺炎链球菌及溶血葡萄球菌耐药程度较高。结论下呼吸道感染菌群分布及耐药分析有利于流行病学监测及院感的控制,对临床抗生素的合理应用以及多重耐药菌株产生的控制有重要的临床意义。     

4754株临床分离菌菌群分布和耐药性分析

目的：了解云南云溪地区临床分离菌的菌群分布和耐药情况，指导合理用药。方法：对我院1999-2001年从血液、体液、尿液、口痰、阴拭子和粪便标本中分离的4754株病原菌作回顾性分析。结果：革兰阴性杆菌比例显著升高，条件致病菌和酵母样真菌检出机会显著增多；药敏结果显示多数临床细菌对常用抗生素的耐药趋势在不断上升；大肠埃希菌、沙门菌和枸橼酸杆菌等革兰阴性杆菌对喹诺酮类药物的耐药率迭57％～97％，亚胺培南则对阴性杆菌有较高的敏感覆盖率；耐甲氧西林葡萄球菌（MRS）对环丙沙星、诺氟沙星、氟洁霉素、四环素、红霉素、头孢唑啉和氨苄西林的耐药率分别为40．9％、42．4%、63．6％、70．2％、85．9％、100．0％和100．0％；链球菌和肠球菌对多数β内酰胺类青霉素、氨基糖苷类、大环内酯类、四环素类以厦磺胺类药物均呈高度耐药，耐药率在36％～100％。结论：临床抗生素应用中的耐药性问题十分严峻，应定期监测区城内细菌的耐药变化，指导临床合理用药。     

Mass Balance and Pharmacokinetics of [14C]Telavancin following Intravenous Administration to Healthy Male Volunteers

The mass balance and pharmacokinetics of telavancin, a semisynthetic lipoglycopeptide antimicrobial agent, were characterized in an open-label, phase 1 study of six healthy male subjects. After a single 1-h intravenous infusion of 10 mg/kg [¹⁴C]telavancin (0.68 μCi/kg), blood, urine, and feces were collected at regular intervals up to 216 h postdose. Whole blood, plasma, urine, and fecal samples were assayed for total radioactivity using scintillation counting; plasma and urine were also assayed for parent drug and metabolites using liquid chromatography with tandem mass spectrometry. The concentration-time profiles for telavancin and total radioactivity in plasma were comparable from 0 to 24 h after the study drug administration. Telavancin accounted for >95% and 83% of total radioactivity in plasma at 12 h and 24 h, respectively. By 216 h, approximately 76% of the total administered dose was recovered in urine while only 1% was collected in feces. Unchanged telavancin accounted for most (83%) of the eliminated dose. Telavancin metabolite THRX-651540 along with two other hydroxylated metabolites (designated M1 and M2) accounted for the remaining radioactivity recovered from urine. The mean concentrations of total radioactivity in whole blood were lower than the concentration observed in plasma, and mean concentrations of THRX-651540 in plasma were minimal relative to mean plasma telavancin concentrations. These observations demonstrate that most of an administered telavancin dose is eliminated unchanged via the kidneys. Intravenous telavancin at 10 mg/kg was well tolerated by all subjects.Telavancin is a once-daily injectable, semisynthetic lipoglycopeptide antibiotic with bactericidal activity in vitro against a broad spectrum of clinically important Gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA), streptococci, and enterococci (4, 5, 9, 10). Telavancin has a dual mode of action, involving inhibition of bacterial cell wall peptidoglycan biosynthesis and disruption of bacterial cell membrane functional integrity (7). In phase 3 trials, telavancin was shown to be noninferior to conventional vancomycin therapy for treatment of complicated skin and skin-structure infections (cSSSIs) and nosocomial pneumonia caused by Gram-positive bacteria and demonstrated an acceptable safety and tolerability profile (13, 15, 16). Telavancin is indicated in the United States and Canada for the treatment of adult patients with cSSSI caused by susceptible Gram-positive bacteria and is under investigation for the treatment of Gram-positive nosocomial pneumonia.Single- and multiple-dose pharmacokinetic parameters for telavancin have been evaluated in phase 1 studies, in which telavancin displayed linear and time-invariant pharmacokinetics following intravenous administration (6, 14, 17). Since telavancin is largely excreted intact in urine along with small amounts of its primary hydroxylated metabolite THRX-651540 (data on file with Theravance, Inc., South San Francisco, CA), renal clearance is thought to be the major route of elimination. The objectives of the present study were to confirm this hypothesis by characterizing the mass balance and pharmacokinetics of single-dose [¹⁴C]telavancin in human subjects.     

Antibiotic Resistance Among Coliform and Fecal Coliform Bacteria Isolated from Sewage, Seawater, and Marine Shellfish

Seawater and shellfish samples collected in the vicinity of a marine sewage outfall were examined for the incidence of antibiotic resistance among coliform and fecal coliform bacteria over a 2-year period. Seventy percent or more of these two groups of bacteria from both sources were resistant to one or more antibiotics. Forty-five percent of the isolates resistant to streptomycin or tetracycline were capable of transferring all or part of their resistance pattern to an antibiotic-susceptible strain of Escherichia coli K-12.