肺结核患者感染产β-内酰胺酶粘质沙雷菌及其耐药性研究

目的研究肺结核患者感染产β-内酰胺酶(ESBL)粘质沙雷菌临床特点及其耐药状况。方法通过回顾性调查方法,对某医院住院肺结核患者痰液标本检测资料进行了统计分析。结果某医院自2009-2013年期间从住院结核病患者送检痰标本中共检出粘质沙雷菌132株,其中含产ESBLs菌37株,占28.0%。结核病患者感染的粘质沙雷菌对常用抗菌药物有不同程度耐药,对头孢类、氨苄西林和氨曲南耐药率均60%。结论肺结核患者感染的粘质沙雷菌耐药严重,应根据药敏试验结果合理选用抗菌药物。     

支气管扩张症合并粘质沙雷菌肺炎1例

患者男 ,43岁 ,主因反复咳嗽、咳痰伴咯血 3年 ,再发半个月于 2 0 0 0年 4月 7日入院。查体一般情况尚可 ,双肺呼吸运动对称 ,双下肺语颤增强 ,叩诊呈浊音 ,并可闻及少量中湿罗音。余无明显阳性体征。本患者曾多次来我院住院诊治 ,经肺部ＣＴ及胸片检查 ,均诊断为支气管扩张症并咯血。本次入院系因受凉出现病情反复。入院后经林可霉素针 0 6ｇ静滴 ,每天 2次 ,替硝唑针 10 0ｍｌ静滴 ,每天 1次 ,以及止血、止咳化痰治疗 3ｄ ,病情无好转 ,仍咳较多量红色“血痰” ,连续多次痰找红细胞均 (-) ,痰潜血试验亦 (-)。经痰培养 :粘质沙雷菌生长 ;…     

胸水中同时分离出粪肠球菌和粘质沙雷菌

20 0 1年 12月 2 9日 ,我们从一右肺上中叶切除术后病人胸水中分离出粘质沙雷菌和粪肠球菌 ,现报告如下。1　病历摘要病人因高热、咳嗽、咳痰 ,于 2 0 0 1年 12月 2 7日就诊并以脓胸和肺部感染收入院。病人半月前曾行右肺上中叶切除术 ,3ｄ前拔除引流管 ,入院时体温 38℃ ,脉搏 78次 /ｍｉｎ,呼吸2 4次 /ｍｉｎ ,血压 12 0 /80ｍｍＨｇ ,Ｘ线显示右侧肺野密度普遍增高 ,右侧肋膈角及膈面消失 ,可见多个大小不等的液平面 ,ＷＢＣ 31 9× 10 9/Ｌ ,Ｎ 0 89,Ｌ 0 11。入院后即予头孢他啶和甲硝唑抗炎治疗。次日胸腔穿刺抽出暗红色血性胸水 2 …     

某医院粘质沙雷菌感染的临床分布及耐药性分析

摘要 目的 <\b>了解临床标本分离的粘质沙雷菌感染分布特征及其耐药情况,以便指导临床抗菌药物的合理使用。方法 <\b>通过回顾性调查方法,对某医院临床标本分离的粘质沙雷菌感染分布和药敏试验结果进行分析。结果 <\b>该医院从患者送检标本中分离出粘质沙雷菌98株,其中71株分离自病人痰液标本,占分离菌株总数的72.45%;其次为尿液和分泌物,分别占13.27%和6.12%。粘质沙雷菌感染患者主要分布在重症监护病房（ICU）,构成比为38.78%;其次为呼吸内科和脑外科,构成比分别占12.24%和10.20%。临床分离的粘质沙雷菌对多数常用抗菌药物比较敏感,对哌拉西林的耐药率为52.04%,发现2株粘质沙雷菌对碳青霉烯类抗菌药物耐药。结论 <\b>该医院临床分离的粘质沙雷菌主要来自呼吸道感染患者痰液,ICU是该菌感染的主要科室,该菌对常用抗菌药物较敏感。     

179株粘质沙雷菌的分布及耐药性分析

目的：了解粘质沙雷菌感染的分布及耐药性特征,为临床用药提供依据.方法：收集我院1998年～2004年分离的179株粘质沙雷菌的药物敏感性试验结果,进行细菌的分布及耐药性的分析.结果：分离的179株粘质沙雷菌,其中痰标本有135株（占75.4%）;粘质沙雷菌分离数不断增加;其耐药率＞95%的抗菌素有头孢噻吩、头孢唑啉和头孢呋肟;50%～70%的有氨苄西林、氨苄西林/舒巴坦和头孢泊肟;10%～20%的有哌拉西林、哌拉西林/他唑巴坦、三代头孢菌素和四代头孢菌素;＜10%的有亚胺培南、阿米卡星、庆大霉素、复方新诺明和环丙沙星.结论：粘质沙雷菌耐药机制复杂,而且对抗生素具有多重耐药性,根据药敏试验合理应用抗菌素十分重要.     

粘质沙雷菌β-内酰胺类耐药基因研究

目的 调查粘质沙雷菌临床分离株β-内酰胺类耐药基因的携带情况,研究其对β-内酰胺类抗菌药物的耐药机制.方法 采用Vitek2-Compact全自动微生物系统对临床分离菌进行鉴定,检出粘质沙雷菌287株,同时进行药敏试验,选出多重耐药粘质沙雷菌135株;采用双纸片确证试验对所有287株粘质沙雷菌进行ESBLs检测、三维试验法检测AmpC酶,采用PCR法对135株多重耐药粘质沙雷菌进行β-内酰胺类抗菌药物相关基因SHV、TEM、OXA、PER、VEB、GES、IMP、VIM、FOX、CTX、KPC、DHA、MOX和oprD2检测.结果 粘质沙雷菌对氨苄西林、头孢曲松、头孢吡肟、头孢噻肟、氨曲南、庆大霉素、环丙沙星以及哌拉西林等临床常用抗菌药物的耐药率较高,耐药率均大于60％,对亚胺培南、美罗培南、舒普深的耐药率较低,耐药率均小于10％.在287株粘质沙雷菌中,共有32株产ES-BLs,检出率为11.1％,产AmpC酶44株,检出率为15.3％,同时产ESBLs和AmpC酶细菌16株,占5.6％;PCR结果显示,在135株多重耐药的粘质沙雷菌中,检出含CTX-M基因菌株91株、TEM基因25株、SHV基因19株、DHA基因48株、KPC基因10株、MOX基因3株、OXA基因1株、oprD2基因7株.结论 本地区粘质沙雷菌多重耐药现象较为严重,其耐药基因型主要为CTX-M型和DHA基因型.     

粘质沙雷菌在我院ICU的感染现状及耐药性变迁

目的：了解近三年来粘质沙雷菌在我院重症监护病房（Icu）的感染状况及耐药率。方法：将2013—2015年送检合格标本中分离的感染菌分别进行汇总,对粘质沙雷的感染状况及耐药率（剔除同一患者相同结果）进行统计。结果：在ICU病房,连续三年粘质沙雷菌的检出量超过鲍曼不动杆菌,而成为仅次于铜绿假单胞的第二位感染菌。氨苄西林、氨苄西林／舒巴坦、氨曲南、头孢曲松、环丙沙星耐药率持续〉70％;阿米卡星、头孢他啶、头孢替坦、哌拉西林／他唑巴坦、复方新诺明、亚胺培南、美罗培南耐药率均低于30％;头孢替坦、头孢吡肟、亚胺培南、左氧氟沙星在2015年的耐药率较2013年、2014年有不同程度的升高。阿米卡星、庆大霉素、妥布霉素则呈下降趋势。结论：作为肠杆菌科细菌的粘质沙雷菌,在ICU不仅感染率高,而且耐药率也较高,尤其对于治疗产超广谱β-内酰胺酶（ESBLs）及AmpC酶等多重耐药菌株最有效药物之一的亚胺培南,其耐药率呈不同程度增长,应引起高度重视。     

粘质沙雷菌整合子检测及其与耐药表型的相关性分析

目的了解本地区粘质沙雷菌临床分离株Ⅰ、Ⅱ、Ⅲ类整合子的携带情况,探讨整合子与其耐药表型的相关性。方法收集临床分离的经VITEK-2Compact细菌分析系统鉴定的粘质沙雷菌287株,以煮沸法制备细菌DNA作为PCR扩增模板,采用聚合酶链反应(PCR)检测菌株的第Ⅰ、Ⅱ、Ⅲ类整合子,分析比较整合子阳性菌株与阴性菌株的药敏试验结果差异。结果在287株粘质沙雷菌中,有262株细菌检出Ⅰ类整合子,检出率为91.3%,3株细菌检出Ⅲ类整合子,未检出Ⅱ类整合子。药敏结果显示,第Ⅰ类整合子阳性菌株对环丙沙星和头孢噻肟的耐药率高于Ⅰ类整合子阴性菌株(P均0.05),对其他抗菌药物的耐药性,Ⅰ类整合子阳性菌株和阴性菌株间差异无统计学意义(P均0.05)。结论Ⅰ类整合子在粘质沙雷菌中普遍存在,Ⅰ类整合子与粘质沙雷菌的多重耐药无明显的相关性。     

53株耐碳青霉烯类药物粘质沙雷菌的耐药表型分析

目的 研究耐碳青霉烯药物粘质沙雷菌的耐药表型.方法 收集南京大学医学院附属鼓楼医院2018年6月～2019年9月临床分离的235株非重复粘质沙雷菌,采用Vitek 2 Compact配套GN13药敏板卡和纸片扩散法进行药物敏感性检测;采用改良碳青霉烯酶灭活试验(mCIM)和EDTA-改良碳青霉烯酶灭活试验(eCIM)对...     

Analysis of protective mechanisms against infection by Serratia marcescens

The present paper is concerned with an experimental study of effects of some agents on parameters pertinent to host resistance to infection of Serratia marcescens (S. marcescens) which was isolated from a patient. The results obtained are the following: In the control mice injected intravenously with S. marcescens, most of the bacteria were trapped in the liver, spleen and lung, the so-called reticuloendothelial system (RES), and the number of bacteria decreased gradually with time. In the kidney, the bacterial count did not decrease because of the existence of few macrophages in this organ. In the animals treated with X-irradiation and cyclophosphamide, the mortality rate increased, and the number of S. marcescens in the organs increased significantly with time. These observations were irreversible in the X-irradiated group, but were reversible in the cyclophosphamide-treated group, depending on the challenge dose. In the mice treated with carrageenan, which functions as a macrophage blocker, the mortality rate did not increase significantly, but there was a delay before the bacteria were eliminated from the liver indicating that the bacteria were not killed in the early phase. After intraperitoneal administration of proteose peptone, polymorphonuclear cells (PMNs) and macrophages accumulated in the peritoneal cavity on the 1st day and 4th day. When S. marcescens was injected intraperitoneally to these 2 groups. The 50% lethal dose (LD50) did not increase significantly in each group. After intraperitoneal inoculation of S. marcescens in a dose equal to 1.5 LD50 in normal mice, the elimination of bacteria from the peritoneal cavity was very rapid in the mice pretreated with proteose peptone.(ABSTRACT TRUNCATED AT 250 WORDS)     

Transfusion-associated Serratia marcescens infection: studies of the mechanism of action

The growth of two strains of Serratia marcescens in blood components was tested in this study. One of the strains had been implicated in the epidemic of transfusion-associated sepsis experienced in Denmark and Sweden in 1991. In whole blood with a final concentration of 100 colony- forming units per mL of S. marcescens, there was an immediate reduction of more than 95 percent of colony-forming units, but no reduction of the bacterial concentration if the blood had been white cell-reduced before inoculation. This is interpreted as an effect due to phagocytosis by white cells and as a lack of bactericidal effect of the plasma. A reduction to 10 percent of the original concentration, observed if the blood had a nominal content of white cells, was most likely due to phagocytosis. White cell reduction by filtration after inoculation further reduced the bacterial concentration of one of the strains tested, but, after a 1-week lag phase, growth accelerated to high concentrations by 6 weeks. In platelet-rich plasma prepared from S. marcescens-inoculated units, abundant growth was found after 24 hours, increasing to very high concentrations (10(12) colony-forming units/mL) during 10-day storage at 22 +/− 2 degrees C. Keeping the whole blood at ambient temperature for 20 hours before preparation of platelet-rich plasma caused only temporary reduction of bacterial concentration in the S. marcescens experiments, but resulted in a complete absence of bacteria in the platelet-rich plasma for 10 days in control experiments performed with Staphylococcus epidermidis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Antibiotic susceptibility of Serratia marcescens and Serratia liquefaciens

BACKGROUND: Over a period of 20 years, a total of 1,603 Serratia isolates were recovered from clinical specimens and examined for susceptibility to 29 antimicrobial drugs using the Bauer-Kirby agar disk diffusion test. Serratia marcescens was recovered most frequently (n = 1,409), followed by S. liquefaciens (n = 172); other Serratia species were scarce. During the 2-decade observation period there occurred 35 putative episodes/clusters of nosocomial cross-infection and 1 pseudo-outbreak due to S. marcescens, but none due to S. liquefaciens. METHODS: The antimicrobial susceptibility data for S. marcescens and S. liquefaciens were subdivided into two observation periods: I = 1980-1993, and II = 1993-1999. The crude data (series A) obtained for S. marcescens were corrected in two ways: by the omission of repetitive patient isolates (series B) and the additional removal of outbreak isolates except for index case isolates (series C). RESULTS AND CONCLUSIONS: Comparison of data obtained in series IC and IIC disclosed an increase in the susceptibility of S. marcescens to ampicillin + sulbactam, cefotaxime, chloramphenicol, doxycycline, fosfomycin, gentamicin, piperacillin, piperacillin + tazobactam, timentin and tobramycin during observation period II. Conversely, there was a decrease in susceptibility to ciprofloxacin, nalidixic acid and trovafloxacin, and slightly diminished susceptibility to norfloxacin and ofloxacin during observation period II as compared with the previous period. The crude data obtained for S. liquefaciens required no correction, as there were only a few repeat isolates. There was an increase in susceptibility to ampicillin, ampicillin + sulbactam, cefuroxime, doxycycline, fosfomycin, nitrofurantoin and polymyxin B (clear inhibition zones). However, there was an inexplicable decrease in susceptibility to piperacillin + tazobactam. Cocarde growth around polymyxin B disks was noted with 55.8% of the S. marcescens isolates as compared with 6.8% of the S. liquefaciens isolates. Slime around fluoroquinolone inhibition zones was produced by 83.4% of the S. marcescens isolates. Slime production around carbapenem inhibition zones was noted with 52% of the S. liquefaciens isolates, but with only a single isolate of S. marcescens.     

外周静脉留置针引发液化沙雷菌感染1例

1病例简介病人,男,72岁,2004年8月12日因头晕、乏力入院,诊断为高血压性心脏病。行外周静脉留置针输液,给予丹参、银杏叶,穿刺部位为左前臂肱静脉,输液过程顺利,隔日更换1次敷贴。8月17日病人诉左前臂有轻微红肿、胀痛感。无畏寒发热、无明显压痛。血常规:白细胞3.6×109/L,淋巴细胞17.6%,中性粒细胞74.3%,拔除留置针,给予双黄连清热解毒,50%硫酸镁局部湿敷。8月18日左前臂肿胀较前明显,有发热,时有寒战,无抽搐、咳嗽。体温38.5℃,意识清楚,精神疲乏,痛苦面容,全身皮肤灼热,左前臂明显红、肿、痛,无捻发波动感。考虑急性疏松结缔组织炎,请…     

超鞭毛虫支气管肺感染1例

超鞭毛虫（Hypermastiote）属于原生动物门，鞭毛虫纲，动鞭亚纲，是白蚁、蠊及一些以木质为食的昆虫消化道内共生的鞭毛虫。如寄生在白蚁肠道中的披发虫（Trichonympha）、寄生于蠊肠道内的缨滴虫（Lophomonas）。在人体内较少见，国内报道甚少，2006以来有上升趋势。为提高对超鞭毛虫感染人体的诊断及治疗，现对我院发现的1例超鞭毛虫感染支气管肺部患者的临床表现和实验室资料进行分析，报道如下。     

Resistance Plasmid Transfer by Serratia marcescens in Urine

Resistance plasmids were transferred in urine from a multi-drug-resistant Serratia marcescens to Escherichia coli. Transfer of resistance to kanamycin, tetracycline, chloramphenicol, streptomycin, ampicillin, and carbenicillin occurred readily after 4 h of incubation at room temperature (25 degrees C). The urinary catheter collection bag is postulated as a potential site for extraintestinal resistance plasmid transfer in the Enterobacteriaceae, especially for pathogens such as Serratia, which do not frequently colonize the intestinal tract.