耐甲氧西林金黄色葡萄球菌感染的流行病学及耐药性研究

目的探讨城市中心城区耐甲氧西林金黄色葡萄球菌(MRSA)感染的流行病学及耐药性。方法采用回顾性调查方法,对医院2009年住院患者进行MRSA感染的统计分析。结果在2009年40 846份标本中,检出265株金黄色葡萄球菌,检出率为0.65%;265株金黄色葡萄球菌检出MRSA 229株,检出率为86.42%;MRSA229株中9株是院内MRSA感染,占3.93%;220株为社区MRSA感染,占96.07%;该菌株对临床常用10种抗菌药物的耐药率>60.00%,但对万古霉素的敏感率为100.00%。结论城市中心城区社区MRSA感染现状已相当严重,应当和地段医院或社区医院一起加强MRSA的预防及治疗工作。     

2008-2010年耐甲氧西林金黄色葡萄球菌的耐药性变迁

目的 了解2008-2010年耐甲氧西林金黄色葡萄球菌(MRSA)的感染分布及耐药性变迁,为合理应用抗菌药物提供依据.方法 采用美国Microscan Autoscan-4微生物分析仪对细菌做鉴定及药敏试验,应用WHO-NET 5.4软件对数据进行分析.结果 2008、2009、2010年MRSA的检出率分别为37.5％、34.8％、34.2％;MRSA以外科检出最高,标本分布以分泌物为主;3年间MRSA对红霉素、庆大霉素、左氧氟沙星和环丙沙星的耐药率差异有统计学意义(P＜0.05),其他8种药物的耐药率差异无统计学意义;除万古霉素、利奈唑胺、呋喃妥因、氯霉素、利福平外,其他药物耐药率＞60.0％,且表现为多药耐药.结论 MRSA对多种抗菌药物耐药率高,应规范临床用药,加强MRSA耐药性监测,有效控制感染.     

High rates of Staphylococcus aureus USA400 infection, Northern Canada

Surveillance of Staphylococcus aureus infections in 3 northern remote communities of Saskatchewan was undertaken. Rates of methicillin-resistant infections were extremely high (146-482/10,000 population), and most (98.2%) were caused by USA400 strains. Although USA400 prevalence has diminished in the United States, this strain is continuing to predominate throughout many northern communities in Canada.     

金黄色葡萄球菌对莫匹罗星高水平耐药的研究

目的 了解金黄色葡萄球菌(SAU)对莫匹罗星高水平耐药(MUH)的状况,并探讨其耐药菌株对临床常用抗菌药物的耐药特性.方法 用美国BD公司Phoenix-100型全自动细菌鉴定药敏系统鉴定细菌及做药敏试验,该仪器可以同时检测耐甲氧西林金黄色葡萄球菌(M RSA)和莫匹罗星高水平耐药的金黄色葡萄球菌.结果 共检出金黄色葡萄球菌382株,其中MUH菌株检出25株,检出率为6.5％,其中23株为MRSA,占92.0％;莫匹罗星高水平耐药的金黄色葡萄球菌对阿米卡星等15种临床常用抗菌药物耐药率较高,均＞80％,且呈多药耐药,但对万古霉素、利奈唑胺全部敏感,呋喃妥因耐药率也较低.结论 临床分离的金黄色葡萄球菌中,已出现莫匹罗星高水平耐药的菌株,临床应加强对该类菌株的监测,以减少耐药菌株的产生和流行.     

耐甲氧西林金黄色葡萄球菌不同监测时间的对比分析

目的 通过不同监测时间比较耐甲氧西林金黄色葡萄球菌(MRSA)感染的分布及耐药性,探讨最佳监测时间.方法 采用美国Microscan Autoscan-4微生物分析仪对细菌做鉴定及药敏试验,应用WHONET 5.4软件对数据进行回顾性分析.结果 2011年共分离出金黄色葡萄球菌283株,其中MRSA100株,占35.3％,以季度、半年及年度为监测时间MRSA的检出率波动在28.1％～40.6％,差异无统计学意义;耐药性监测结果亦类似,MRSA对红霉素、环丙沙星、左氧氟沙星、利福平、庆大霉素耐药率均＞50.0％,对磺胺甲噁唑/甲氧苄啶的耐药率也＞20.0％,耐药率较低的有呋喃妥因、喹奴普汀/达福普汀,尚未见耐万古霉素和利奈唑胺的MRSA.结论 MRSA的检出率及耐药性均较高,以季度、半年及全年度监测时间结果类似,应及时监测以提高MRSA的治愈率,减少MRSA的医院感染和病死率.     

2008-2010年金黄色葡萄球菌的分布调查

目的 了解2008年1月-2010年12月某院金黄色葡萄球菌(SAU)、耐甲氧西林金黄色葡萄球菌(MRSA)的分布,预防医院感染的暴发流行.方法 筛选某院各种临床标本中分离出的SAU224株,MRSA 67株,对其临床分布进行回顾性分析,对感染病例进行动态实时监测.结果 SAU标本多来源于分泌物标本,占31.3％,痰标本占22.8％,脓液标本占6.6％,全血标本占4.9％,MRSA标本主要分离自分泌物,占37.3％,痰标本占19.4％;以骨科、普外、ICU等外科手术科室为多见.结论 通过对菌株的临床分布进行分析,提示加强医院感染前瞻性监测,对感染患者进行动态实时追踪,及时采取消毒隔离等干预性措施,有助于减少医院感染的暴发流行.     

2011—2014年鄂州市金黄色葡萄球菌耐药性分析

目的 分析金黄色葡萄球菌(staphylococcus aureus,SAU)的耐药情况,为临床合理使用抗菌药物提供科学依据.方法 收集湖北省鄂州市某院2011年1月—2014年12月期间分离的SAU菌株,采用K-B纸片扩散法进行药敏试验,以CLSI 2010年推荐标准判读药敏结果 .数据的整理和分析采用Excel 2010和SPSS 20.0软件进行.结果 共检出耐甲氧西林金黄色葡萄球菌(MRSA)277株(44.04%),主要分离来自重症监护病房(31.05%)、呼吸内科(20.58%)和神经外科(18.41%).MRSA检出率在痰标本中最高(56.13%).MRSA菌株除对替加环素、替考拉宁、利奈唑胺和万古霉素敏感外,对其他15种临床常用抗菌药物均表现出不同程度的耐药.MRSA对各种抗菌药物的耐药率要明显高于甲氧西林敏感金黄色葡萄球菌(MSSA),且差异均具有统计学意义.结论 鄂州地区SAU对多种抗菌药物耐药,临床上应根据药敏试验对SAU感染患者合理使用抗菌药物,以减少耐药菌株的产生,并需加强对MRSA菌株耐药性的监测.     

Clinical characteristics of Staphylococcus epidermidis: a systematic review

Staphylococci are known as clustering Gram-positive cocci, nonmotile, non-spore forming facultatively anaerobic that classified in two main groups, coagulase-positive and coagulase-negative. Staphylococcus epidermidis with the highest percentage has the prominent role among coagulase-negative Staphylococci that is the most important reason of clinical infections. Due to various virulence factors and unique features, this microorganism is respected as a common cause of nosocomial infections. Because of potential ability in biofilm formation and colonization in different surfaces, also using of medical implant devices in immunocompromised and hospitalized patients the related infections have been increased. In recent decades the clinical importance and the emergence of methicillin-resistant Staphylococcus epidermidis strains have created many challenges in the treatment process.     

临床感染的MRSA对万古霉素敏感性监测

目的分析耐甲氧西林金黄色葡萄球菌(MRSA)在临床标本中的检出动态,监测MRSA对万古霉素药物敏感情况,防止出现万古霉素中介金黄色葡萄球菌(VISA)和万古霉素耐药金黄色葡萄球菌(VRSA)。方法检测并比较2006～2010年各年度临床标本中MRSA的检出率,用微量肉汤稀释法监测MRSA的万古霉素MIC值变化。结果金黄色葡萄球菌MRSA的检出率逐年升高,2010年与2006年比较,MRSA的检出率差异有统计学意义(P﹤0.05)。微量肉汤稀释法监测MRSA的万古霉素MIC值,5年间差异无统计学意义(P﹥0.05)。结论 MRSA检出率显著升高,应引起临床和实验室高度重视,秦皇岛地区医院未检出VISA和VRSA,但应密切关注其发展动向。     

氯氰碘柳胺对金黄色葡萄球菌的体外抗菌活性研究

目的探讨氯氰碘柳胺对临床分离的金黄色葡萄球菌(SAU)的体外抗菌活性,为进一步探讨其在临床应用的可能性提供依据。方法临床分离的金黄色葡萄球菌102株,其中耐甲氧西林金黄色葡萄球菌(MRSA)46株,甲氧西林敏感金黄色葡萄球菌(MSSA)56株,采用微量肉汤稀释法测定氯氰碘柳胺,对金黄色葡萄球菌的体外最低抑菌浓度(MIC)值。结果氯氰碘柳胺对MRSA或MSSA的MIC值范围均为0.5～2.0 mg/ml,MIC50均为1.0 mg/ml,MIC90均为2.0 mg/ml。结论氯氰碘柳胺对MRSA或MSSA体外均有较好的抗菌活性,两者间的MIC50与MIC90差异均无统计学意义。     

A randomized clinical study of tea catechin inhalation effects on methicillin-resistant Staphylococcus aureus in disabled elderly patients

OBJECTIVES: To evaluate the effects of tea catechin inhalation on methicillin-resistant Staphylococcus aureus (MRSA) in disabled elderly patients. DESIGN: Seven days, randomized, prospective study. SETTING: Three hospitals in Japan. PARTICIPANTS: Seventy-two patients aged 78 +/- 11 years (mean age +/- standard deviation) with cerebrovascular diseases, classified as disabled according to the activity of daily living and were either bedridden or required assistance for standing, and showing presence of MRSA in sputum. INTERVENTIONS: Inhalation of 2 mL tea catechin extract solution along with saline (3.7 mg/mL catechins, 43% of catechins are composed of epigallocatechin gallate), or saline alone, 3 times daily using a handheld nebulizer for 7 days. MEASUREMENTS: The endpoint of efficacy was the reduction rates of MRSA in sputum. The safety measure was the adverse events observed during the 7 days of inhalation. RESULTS: The reduction rates calculated as the summation of decrease and disappearance of MRSA in sputum at 7 days were 47% (17 of 36 patients) in the catechin group and 15% (5 of 33 patients) in the control group; the difference in the reduction rates between the 2 groups was statistically significant (P = .014). The disappearance rate of MRSA in sputum was higher in the catechin group (31%; 11 patients) when compared with the control group (12%; 4 patients), however the difference in the disappearance rate between the 2 groups was not statistically significant (P = .091). No adverse events, such as respiratory tract obstruction, allergic bronchial spasm, or skin eruption, including laboratory changes, were observed during the study. CONCLUSION: The catechin inhalation appeared to reduce the MRSA count in sputum. However, the application of tea catechin inhalation as a supplementary treatment for controlling MRSA infection remains controversial.     

Antibiotic susceptibility and phage typing of methicillin-resistant Staphylococcus aureus clinical isolates from blood cultures of 692 patients in 15 Israeli hospitals

Six hundred ninety-two clinical isolates of Staphylococcus aureus were collected from blood cultures of 692 patients in 15 Israeli hospitals over a two year period. Antibiotic sensitivity was tested by the standard disk diffusion technique. Of these isolates, 41.6% were methicillin-resistant (MRSA). All 288 MRSA isolates were sensitive to vancomycin and pristinomycin; 98.6% were sensitive to fucidine; 97.9% to imipenem; 79% to rifampicin; 63.6% to amikacin; 54.5% to augmentin; 36.4% to clindamycin; 12.6% to ciprofloxacin; 11.9% to cotrimoxazole and ofloxacin; 10.5% to gentamicin; 9.8% to erythromycin; and 8.4% to norfloxacin. Phage typing was determined by using the international set of phages. All the isolates that were sensitive to Group I phages, and 91.8% of those sensitive to Group II phages, were sensitive to methicillin. Of the isolates that were sensitive to Group III phages, 79.2% were methicillin-resistant and 72.4% of the latter were sensitive to phages 75/85. Of the isolates that were sensitive to Group III and miscellaneous phages, 50.7% were methicillin-resistant and 71% of the latter were sensitive to phages 75/85 as well.     

Bacteraemia in surgical patients with intravenous devices: A European multicentre incidence study

A survey of the incidence of bacteraemia and the use of intravenous (IV) devices among 10,616 surgical patients was performed in 42 hospitals in eight countries. It was found that 63 per cent of the patients surveyed had an IV device inserted at some time during their hospital stay, with national variations between 40 and 99 per cent. The incidence of device related thrombophlebitis was 10·3 per cent, with national variations between 7·8 and 28·4. Among the surgical patients not given IV therapy, 1·5/1000 had a bacteraemia, 0·5/1000 of them hospital-acquired. The corresponding figures for patients with a peripheral but no central IV device were 6·9 and 3·7, and for patients with a central venous catheter (CVC) 59·0 and 44·8, respectively. Even though there was a strong correlation between the incidence of bacteraemia and certain diagnoses there was also an independent correlation between it and CVCs or peripheral IV lines. No correlation was demonstrated between the number of catheter days per site for patients with a peripheral IV device, and hospital-acquired bacteraemia. This may be due to the low mean number of catheter days per site that was observed. There was a large and not easily explained national variation in the incidence of bacteraemia in patients with CVCs of between 16 and 108/1000.     

A 4-year study of Pseudomonas aeruginosa susceptibility to antibiotics (1998-2001) in northern Lebanon

Four hundred and sixty-four Pseudomonas aeruginosa strains were isolated in northern Lebanon at the Islami Hospital Microbiology department, in Tripoli. The purpose of this study was to evaluate the susceptibility of these strains to antibiotics, to compare this susceptibility according to the nature of the sample and the year of sampling. The results show that urinary samples were the most frequent (39.3%), followed by wound samples (21.2%), and ear samples (16.5%). The average rate of susceptible strains was 39.8% to ticarcillin, 56.9% to piperacillin, 58.2% to piperacillin + tazobactam, 74.1% to imipenem, 63.3% to ceftazidime, 60.4% to cefepime, 62.1% to aztreonam, 60.3% to netilmicin, 57.5% to gentamicin, 62.2% to tobramycin, 69% to amikacin, 100% to colistin, 45.4% to pefloxacin and ofloxacin, 57.7% to ciprofloxacin and 1.3% to rifampicin. The study showed that the strains isolated from pulmonary secretions were the most resistant to antibiotics.     

2001-2010年凝固酶阴性葡萄球菌的医院感染状况及耐药性变迁

目的 了解2001 -2010年新乡市各大医院临床分离的凝固酶阴性葡萄球菌(CNS)医院感染状况及其耐药性变迁,为临床合理使用抗菌药物提供依据.方法 对3102株CNS的标本分布及耐药性进行调查分析.结果 CNS导致的医院感染以呼吸道(45.8％)及男性(20.1％)为主,CNS对糖肽类抗菌药物高度敏感耐药率＜3.0％,对呋喃妥因、利福平等耐药率较低＜30.0％,高耐药率前4位为青霉素、红霉素、阿奇霉素和罗红霉素,均＞80.0％;10年来,大部分抗菌药物的耐药率有普遍增长趋势,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的比例逐年升高,从2007年以后有下降趋势.结论 CNS对多种抗菌药物的耐药率不断提高,应及时监测,指导临床医师合理使用抗菌药物,延缓耐药菌株的产生,同时加强控制感染工作,阻止耐药菌株的传播.     

A multicentre mortality study of workers exposed to ethylene oxide

A multicentre cohort study was carried out to study the possible association between exposure to ethylene oxide and cancer mortality. The cohort consisted of 2658 men from eight chemical plants of six chemical companies in the Federal Republic of Germany who had been exposed to ethylene oxide for at least one year between 1928 and 1981. The number of subjects in the separate plants varied from 98 to 604. By the closing date of the study (31 December 1982) 268 had died, 68 from malignant neoplasms. For 63 employees who had left the plant (2.4%) the vital status remained unknown. The standardised mortality ratio for all causes of death was 0.87 and for all malignancies 0.97 compared with national rates. When local state rates were used the SMRs were slightly lower. Two deaths from leukaemia were observed compared with 2.35 expected (SMR = 0.85). SMRs for carcinoma of the oesophagus (2.0) and carcinoma of the stomach (1.38) were raised but not significantly. In one plant an internal "control group" was selected matched for age, sex, and date of entry into the factory and compared with the exposed group. In both groups a "healthy worker effect" was observed. The total mortality and mortality from malignant neoplasms was higher in the exposed than in the control group; the differences were not statistically significant. There were no deaths from leukaemia in the exposed group and one in the control group.     

Occupational exposure of pharmaceutical workers to drug actives and excipients and their effect on Staphylococcus spp. nasal carriage and antibiotic resistance

Abstract

Background: Pharmaceutical manufacturing workers are exposed to significant amounts of product ingredients, including antibiotics. Such exposure could affect their nasal microflora.

Objective: To assess the effect of exposure to various unidentified pharmaceutical ingredients in cephalosporin-manufacturing and non-cephalosporin plants on the nasal carriage of Staphylococcus spp. and their antibiotic resistance.

Methods: Nasal swab samples were collected from 39 workers in both plants on three different occasions. Staphylococci were isolated and identified to genus level. Antibiotic resistance profiles were determined and subsequent identification to species level was performed.

Results: There was complete absence of S. aureus in the samples collected from workers in both facilities. Multiple drug resistant coagulase-negative staphylococci (MDR CONS) prevalence rates were higher in the non-cephalosporin plant than in the cephalosporin plant, with resistance towards six classes of antibiotics. S. epidermidis was the prevalent species in the non-cephalosporin plant and S. haemolyticus prevailed in the cephalosporin-producing plant.

Conclusions: The observed prevalence of CONS in both production plants was the same. However, exposure to intermittent non-cephalosporin pharmaceuticals results in higher prevalence of MDR CONS compared to continuous exposure to cephalosporin.     

A study of sensitivity to antibiotics for Staphylococcus aureus strains isolated in a department of resuscitation of badly burnt patients

Methicillin resistant Staphylococcus aureus (MRSA) constitutes one of the main causes of nosocomial infections in badly burnt patients. The purpose of our study was to determine the frequency and evolution of Methicillin resistant Staphylococcus strains in the department of resuscitation of badly burnt patients of Hopital AZIZA OTHMANA. From January 1, 2000 to December 31, 2003, tests for Staphylococcus aureus proved positive in 139 patients on at least, one occasion. Mean age of patients was 34 years and their sex ratio 1.7. 59.7% of the accidents were house hold accidents, and 70% of them were of thermal native. The average burnt cutaneous surface area was 44%. Sepsis occurred 7 days on average after admission to hospital. Hospital stay for this group varied between 3 and 140 days, outcome was fatal in 13 cases. MRSA occurred in 69% of cases. As for the other families of antibiotics, the frequencies of resistance remained elevated for tetracyclines, cotrimoxazole, gentamicine, erythromycine.