Prevalence and characteristics of human and bovine verotoxigenic Escherichia coli strains isolated in Galicia (north-western Spain)

An epidemiological study was carried out to determine the incidence and the serotypes of verotoxigenic Escherichia coli (VTEC) that cause infections in Galicia (north-western Spain). Although, VTEC strains were isolated from 55 (14%) of the 387 calves sampled and the majority of bovine VTEC strains belonged to serotypes (026:H11 or H–, 091:H21, 0103:H2, 0105:H18, 0111:H–, 0113:H21, 0126:H–, 0128:H– and 0157:H7 or H–) previously associated with human haemorrhagic colitis (HC) and haemolytic uraemic syndrome (HUS) in other countries, VTEC are not a common cause of human infections in Spain. Thus, VTEC (026:H11 and 086:H10) were isolated from only 3 (0.6%) of the 482 children with diarrhoea investigated. We examined the 69 (3 humans and 66 bovines) VTEC strains that were initially isolated as E. coli producing a toxin cytotoxic to Vero and HeLa cells by polymerase chain reaction (PCR) using specific primers for VT1, VT2 and eae genes. PCR showed that 38 (55%) of VTEC strains carried VT1 genes, 18 (26%) possessed VT2 genes, and 10 (14%) carried both VT1 and VT2 genes. Three (one human and two bovine) strains which were formerly VTEC had lost the ability to produce verotoxins upon subculture and became negative for VT 1 and VT2 by PCR. In total 35 (51%) of 69 VTEC strains, including the two human VT1⁺ strains of serotype 026:H11, were positive for eae sequences when tested by PCR. Presence of the eae gene was significantly more frequent (100%; 21/21) among VTEC strains with serotypes (026:H11, 0111:H–, 0157:H–and 0157:H7) considered as enterohaemorrhagic E. coli (EHEC) than among VTEC strains with non-EHEC serotypes (29%; 14/48) (p < 0.001). Results obtained in this study indicate that cattle may be an important source of VTEC involved in human disease. However, severe clinical syndromes caused by VTEC, such as HC and HUS, are uncommon in Spain, in comparison with North America and the UK. In any case, VTEC disease can appear on the scene very suddenly, as occurred in the UK and North America in the 1980s.     

上海市2012－2013年4种致泻性大肠埃希菌监测

目的 基于临床医院开展4种致泻性大肠埃希菌(DEC)人群监测,探讨公共卫生实验室对临床实验室需求的直接技术指导的实践模式。方法 设立哨点医院,以标准化方法筛选和鉴定DEC菌型;构建DEC流行特征基线;对疑似暴发病例开展基于实验室和流行病学调查。结果 2012－2013年选择上海地区4家哨点医院检测7 204份腹泻标本确认的712例DEC感染病例,阳性率为9.9%。其中肠致病性大肠埃希菌(EPEC)感染351例;肠产毒性大肠埃希菌(ETEC)感染292例;肠侵袭性大肠埃希菌(EIEC)感染32例;产志贺样毒素大肠埃希菌(STEC/EHEC)感染6例;DEC混合感染31例。EPEC感染以1～5岁儿童最多见,菌型均为aEPEC;ETEC流行峰值在8月,阳性率>20%,感染病例2012年聚集于1～28日龄和2013年的20～60岁人群(P< 0.05),菌型以耐热肠毒素(ST)型最多(59.6%),其次为不耐热肠毒素(LT)型(27.8%)和ST/LT型(12.6%);2013年儿童感染EIEC病例明显增加(P< 0.01);未监测到EHEC O157 : H7,但确认2例EHEC O26 : H11(eae-hlyA-stx1a)儿童病例;调查确认2012年上海地区15例新生儿ETEC聚集性感染病例与四川省自贡市新生儿病例属于同一克隆(STh-CS21-CFA/I-ClyA-EatA-ST2332- SHNL0005)。结论 上海地区DEC型谱特征已发生改变,ETEC对新生儿院内感染和食源性感染性腹泻构成潜在暴发风险,需加强实验室主动监测。     

Isolation in Italy of a verotoxin-producing strain of Escherichia coli 0157:H7 from a child with hemolytic-uraemic syndrome

Verotoxin-producing Escherichia coli 0157:117 was isolated for the first time in Italy from a child with hemolytic-uremic syndrome and his asymptomatic sister. Both parents remained asymptomatic, and neither had evidence of this infection. The source of the infection was not identified, but the children had eaten ground beef during the 15 days prior to the onset of symptoms.Corresponding author.     

Virulence genotypes and serotypes of verotoxigenic Escherichia coli isolated from cattle and foods in Argentina

Virulence factors of Verotoxin-producing Escherichia coli(VTEC) strains isolated from hamburgers and ground beef were studied in Argentina by PCR. Their virulence profiles were correlated with those corresponding to strains isolated from calves and adult cattle. Most virulent profiles (VTs⁺ eae ⁺Mp⁺) were present in E. colifrom healthy and diarrheic calves corresponding to O5:H-, O5:H27, O20:H?, O26:H11, O38:H?, O103:H-, O103:H2, O111:H-, O118:H16, O165:H-serotypes. The presence of the eaegene was significantly more frequent among VTEC strains isolated from calves (20/26; 76%) than from adult cattle (1/39; 2.5%) (p< 0.005). VT2⁺ eae ^? E. coliwas prevalent in foods and adult cattle at slaughterhouse. The prevalence of the eaegene was similar between VTEC strains isolated from meat (0/21) and adult cattle (1/39; 2.5%) which constitutes the main population processed at slaughterhouses in Argentina. Serotyping showed that VTEC strains were distributed among 31 serotypes, some of which (O20:H19, O91:H21, O113:H21, O116:H21, O117:H7, O171:H2, OX3:H21) were shared between bovine and food strains. These O serogroups have been isolated from cases of haemorrhagic colitis (HC) and haemolytic-uraemic syndrome (HUS) in humans in several continental European countries. This study confirms the role of cattle as a reservoir of many VTEC serotypes other than O157:H7 and represents a base for future diagnostic, prevention and control strategies of EHEC in this country. In addition, this study affirms the advantages of PCR-based screening of E. coliisolates given the finding of so many verotoxin-producing strains.     

Incidence of E. coli O157:H7 and other enteropathogens in a spanish hospital

From January to December 1997, stools submitted for routine culture were also screened for E. coli O157:H7 to investigate its incidence in our area. Bloody and non-bloody stools were studied. E. coli O157:H7 was not recovered from any of the samples tested. We believe, therefore, that we are in a low rate of infection area, and accordingly do not recommend routine screening of this pathogen.     

An epidemiological study on Verotoxin-producing Escherichia coli (VTEC) infection among population of northern region of Iran (Mazandaran and Golestan provinces)

Faecal samples from 3268 randomly selected inhabitants of two provinces in the northern region of Iran were screened to detect Verotoxin-producing Escherichia coli (VTEC) using colony sweep polymyxin-B extraction method. Non-sorbitol fermentation phenotype and slide agglutination with O157 and H7 antisera used to detect this serotype. We found that 0.7% of the population were infected with VTEC, however none of the isolates belonged to O157:H7 serotype. We also found that children < 6 years of age were at highest risk of infection with VTEC (p < 0.05). Moreover, a significant association was found between the VTEC and diarrhoeal cases at the same age group (p < 0.001). Overall distribution of the VTEC isolates in the general population was found to be random, though a kind of clustered distribution could be noticed.     

Verocytotoxin-producing Escherichia coli in foodstuffs of animal origin

While much research effort has been targeted at the verocytotoxin-producing Escherichia coli (VTEC) serotype O157:H7, it is becoming more evident that other VTEC serotypes can also be associated with human foodborne disease. An increasing number of these non-O157 serotypes have been isolated from food sources and from humans suffering from haemolytic-uraemic syndrome and diarrhoea. The aim of our work was to investigate the prevalence of VTEC O157 and non-O157 in foodstuffs of animal origin using two rapid enzymatic procedures. Various types of food samples, 352 in total, were tested: 233 with the Premier EHEC, a screening test which directly detects the presence of verocytotoxin, regardless of serotype, while 119 of these with the Vidas ECO, which is a specific screening test for E. coli O157:H7, together with the Premier EHEC. Two samples were positive for VTEC, one of serogroup O126 and the other was non-serotypable. Another sample was positive in the test specific for E. coli O157:H7, but was not confirmed by culture. This study suggests that VTEC strains are not prevalent in Italy, and that the isolation of serogroup O157 is relatively infrequent. This leads us to conclude that there is little chance of exposure to pathogen for the average consumer in Italy.     

Effects of Japan Sea Proper Water on the growth ofLegionella pneumophila, Escherichia coli, andStaphylococcus aureus

Objective To assess whetherLegionella pneumophila serogroup 1 and serogroup 6,Escherichia coli, andStaphylococcus aureus can survive in Japan Sea Proper Water (JSPW). Methods The inhibitory effects of JSPW, surface seawater (SSW), phosphate buffer solution with 3.5% NaCl of pH 7.0 (3.5% NaCIPBS), and the 10²- and 10⁴-fold dilute solutions with purified water or phosphate buffer solution of pH 7.0, and purified water were investigated. Survival cells were counted immediately after the water and the bacteria were mixed, and at 1,3,5, and 7 days after incubation at 37°C. If the number of surviving cells was decreased more than 2 log units compared with the starting value, we judged the medium to have had an inhibitory effect on the growth of the bacteria. Results The survival cells of the bacteria in JSPW had decreased more than 2 log units compared with the starting value at 1 day after incubation. After 1 day of incubation, the cells ofLegionella pneumophila serogroup 6 andStaphylococcus aureus were found to have decreased more than 2 log units in purified water (PW) used as a control. Furthermore,Legionella pneumophila serogroup 1 in the 10²-fold dilute solution of JSPW was only 1.04 log units lower than the starting value at 7 days after incubation. In the 10²- and 10⁴-fold dilute solutions of JSPW,Escherichia coli survived for 7 days after incubation. These results were almost similar to the results in SSW and 3.5% NaCIPBS. Conclusions The present findings demonstrate thatLegionella pneumophila serogroup 1 andEscherichia coli cannot survive in undiluted JSPW for over a day at 37°C, suggesting the inhibitory effects may be due to the sodium chloride contained in JSPW.     

某院2010—2019年常见肠杆菌目细菌临床分布及耐药性变迁

目的 了解某院常见肠杆菌目细菌的分布特征及耐药情况,为临床合理使用抗菌药物提供参考。 方法 收集2010—2019年某院临床标本中检出的所有肠杆菌目细菌非重复菌株,分析不同种类细菌检出情况、临床分布、标本分布及耐药情况等。 结果 共收集19 384株肠杆菌目细菌,其中大肠埃希菌占45.32%（8 784株）,肺炎克雷伯菌占25.11%（4 867株）,阴沟肠杆菌占5.67%（1 099株）,黏质沙雷菌占3.67%（711株）,产酸克雷伯菌占3.29%（638株）,其他肠杆菌目细菌占16.95%（3 285株）。大肠埃希菌以尿标本分离最多（占42.53%）,其次为呼吸道标本（21.63%）、全血标本（16.33%）等;肺炎克雷伯菌以呼吸道标本分离最多（占69.37%）,其次为尿（9.33%）、全血标本（8.73%）等。大肠埃希菌主要来源于泌尿外科（29.16%）,其次是儿内科（8.86%）等;肺炎克雷伯菌主要来源于神经外科（22.52%）,其次是儿内科（13.71%）等。2018—2019年肠杆菌目细菌对氨苄西林、哌拉西林、头孢唑林的耐药率较高,对亚胺培南和美罗培南的耐药率上升明显,耐碳青霉烯类肠杆菌目细菌检出率逐年上升,差异有统计学意义（P < 0.05）。 结论 肠杆菌目细菌耐药情况不容乐观,临床医生应当采取有效措施预防CRE的产生,同时预防与控制医院交叉感染也至关重要。     

Enterotoxigenic Escherichia coli associated diarrhoea among infants aged less than six months in Calcutta, India

The role of enterotoxigenic Escherichia coli (ETEC) as etiologic agents of diarrhoea in infants aged less than six months was assessed in a hospital based study in Calcutta, India. Of the 218 cases examined, ETEC strains were isolated from 26 (11.9%) cases. Among these, in 17 cases ETEC was the sole infecting pathogen (p = 0.0085). Of the 26 isolates (each isolate representing a case), 24 were distributed among seven different O:K:H serotypes and two different colonization factor antigens (CFAs) I and II. Two of the remaining isolation were untypable, non-haemagglutinating, and were nonhydrophobic as measured by the salt aggregation test (SAT). Of the 26 ETEC strains detected, 15 (57.7%) produced heat-labile toxin (LT) only, 8 (30.8%) liberated heat-stable toxin (ST) only, and the remaining 3 (11.5%) produced both LT and ST. No ETEC strain was isolated from the 102 age-matched controls included in this study. All the ETEC isolates were multiple drug resistant. The study showed that the diarrhoea due to ETEC was of brief duration, mostly within the range of 3 to 7 days.     

In vitro effects of food extracts on selected probiotic and pathogenic bacteria

A panel of 148 extracts from 37 food products was prepared using organic and aqueous solvents and both neutral and acidic conditions. The panel of food products tested included fruits, vegetables, grains, herbs and spices, most of which are common in a normal European-style diet. The impact of these extracts on the growth of selected probiotic bacteria (Lactobacillus reuteri, Lactobacillus rhamnosus, Bifidobacteria lactis) and pathogenic bacteria (Escherichia coli 0157:H7 and Escherichia coli LF82) was assessed using a standard minimum inhibitory concentration method. The results showed that aqueous extractions of garlic and black peppercorns significantly enhanced the growth of one strain of probiotic bacteria (L. reuteri) whilst inhibiting both pathogenic strains of E. coli at a 1:50 dilution. Aqueous extracts of banana, apple and orange all enhanced the growth of the three probiotic strains significantly, and inhibited the pathogens to approximately 80% of the controls (not significant). Both aqueous and organic extractions of ginger significantly inhibited the growth of one or both E. coli strains, respectively (also at the 1:50 dilution).     

Review of epidemiological surveys on the prevalence of contamination of healthy cattle with Escherichia coli serogroup O157 : H7

This paper gathers and critically analyses the results of 26 published epidemiological surveys on the prevalence of contamination of cattle with verocytotoxin-producing E. coli (VTEC) serogroup O157 : H7. These surveys have been conducted since 1986 on farms in North America (10 studies), on farms in Europe (6 studies) and at slaughterhouses prior to or just after slaughter (7 studies) or after skinning and evisceration (3 studies). The purpose of this review is to understand the first stages of the epidemiology of the infection in animals and humans (the infection process being obscure in many points) and to prepare herd-based control measures to reduce the risk of O157 : H7 human infection.The different statistical methods employed in these surveys, as well as the various laboratory screening methods used for detecting positive animals are presented. The observed frequencies of infected animals (animal prevalence) and herds (herd prevalence) are given as a function of localisation, year, type of industry (beef or dairy) and age. From these measured prevalence values, the risk of contamination of ground beef by E. coli O157 : H7 in the first stages of the farm-to-fork continuum is assessed. First, we follow the evolution of contamination frequencies from the living animal on-farm to carcasses before transformation. Then, within each set of measurements (i. e., on farm or at slaughterhouse), we identify the effects of the following factors: target population, sampling strategies and laboratory procedures. We argue that the prevalence values inferred from these measurements are very likely underestimated, due to insufficient sampling and not enough sensitive laboratory procedures (one exception being the immunomagnetic bead separation technique). No firm conclusion can be drawn as to the effects of geographical localisation and season. In those surveys, the effect of hygiene level at slaughterhouse on prevalence values is not quantitatively assessed. In addition, there is growing evidence of other sources of E.coli O157 : H7 than live cattle in the farm environment, such as feed, water and water-troughs.     

全国细菌耐药监测网2014—2019年脑脊液标本细菌耐药监测报告

目的了解全国脑脊液标本分离细菌的分布及耐药性变迁。方法按照全国细菌耐药监测网(CARSS)方案,应用WHONET 5.6软件对2014—2019年所有CARSS成员单位上报的脑脊液标本分离细菌及药敏结果数据进行分析。结果2014—2019年脑脊液共分离细菌99741株,前五位依次为凝固酶阴性葡萄球菌(49902株,50.0%)、鲍曼不动杆菌(7692,7.7%)、大肠埃希菌(5561株,5.6%)、肺炎克雷伯菌(4653株,4.7%)、金黄色葡萄球菌(4295株,4.3%)。耐甲氧西林金黄色葡萄球菌(MRSA)的检出率由2014年的48.2%下降至2019年的39.9%;耐青霉素肺炎链球菌(PRSP)检出率一直在70%以上;屎肠球菌对多数测试药物的耐药率高于粪肠球菌;大肠埃希菌对头孢曲松的耐药率多数>60%,对碳青霉烯类抗生素的耐药率较低,但有上升趋势:对美罗培南的耐药率从2.6%上升至4.6%,对亚胺培南的耐药率从1.7%上升至4.5%;肺炎克雷伯菌对头孢曲松的耐药率>50%,对碳青霉烯类的耐药率快速增长:对美罗培南耐药率从13.1%上升至30.9%,对亚胺培南耐药率从12.6%上升至30.4%。鲍曼不动杆菌和铜绿假单胞菌对美罗培南耐药率均呈下降趋势,分别从74.2%下降至71.7%,32.6%下降至27.8%。结论脑脊液临床常见分离细菌的耐药性仍较强,耐药监测对中枢神经系统感染的有效治疗十分重要。     

Effect modification by vitamin C on the relation between gastric cancer and <Emphasis Type="Italic">Helicobacter pylori</Emphasis>

A hospital-based case–control study of 295 cases with histologically confirmed gastric cancer and age and sex-matched controls was conducted to evaluate the effect of dietary vitamin C intake upon the relation between Helicobacter pylori infection and gastric cancer in Korea in 1997–1998. Anti-H. pylori IgG was detected by ELISA. A food frequency questionnaire, and a questionnaire on demographic factors, including past medical history, smoking, alcohol consumption, and life style was also administered. The prevalences of H. pylori IgG in cases and controls were 80.7% and 71.2%, respectively, and the odds ratio (OR) of H. pylori for gastric cancer was 1.68 (95% confidence interval (CI): 1.14, 2.44), after adjusting for age, sex, educational level, and a past medical history of gastritis or gastric ulcer. In a stratified analysis, H. pylori seropositivity was found to be a significant risk factor for gastric cancer in the low vitamin C intake group (OR=4.68; 95% CI: 1.97, 11.1), but not in the high vitamin C intake group (OR=0.72; 95% CI: 0.32, 1.65). Vitamin C intake was found to modify the relation between H. pylori and gastric cancer.     

CRISPR1上游侧翼序列用于大肠埃希菌和志贺菌鉴定的效果评价

目的 探讨基于成簇规律间隔的短回文重复序列（CRISPR）1上游侧翼序列对大肠埃希菌和志贺菌鉴定和评价效果。方法 通过BLAST重复序列识别并获得全基因组测序大肠埃希菌和志贺菌的CRISPRs和CRISPR相关基因（CRISPR-associated,cas）,并分析其种系;选取CRISPRs上、下游各500 bp侧翼序列,使用Clustal X进行序列比对;采用PCR方法扩增CRISPR1上游侧翼序列,以确定其对大肠埃希菌和志贺菌鉴定和评价效果。结果 73.4%（149/203）的大肠埃希菌存在I-E型CRISPR/Cas系统,包含了A、B1、D种系;8.4%（17/203）的大肠埃希菌存在I-F型CRISPR/Cas、17.2%（35/203）的大肠埃希菌不存在CRISPR/Cas,这2种大肠埃希菌均属于B2种系;9株志贺菌均存在I-E型CRISPR/Cas。在大肠埃希菌（B2种系外）、志贺菌CRISPR1上游和大肠埃希菌（B2种系）各存在61 bp侧翼序列,序列一致性为99%,且有种属特异性,PCR扩增此区域鉴定大肠埃希菌和志贺菌的灵敏度和特异度均>91%。结论 基于CRISPR1上游序列可用来鉴定大肠埃希菌和志贺菌,且具有很好的效果。     

Virulence factors and O groups of Escherichia coli isolates from patients with acute pyelonephritis, cystitis and asymptomatic bacteriuria

The relationship between the presence of bacterial virulence factors and the severity of urinary tract infection (UTI) was analized in this study. The production of -hemolysin (Hly), the expression of P-fimbriae and the mannose-resistant hemagglutination (MRHA) type IVa (associated with the presence of P-fimbriae), were all detected more frequently in Escherichia coli strains from acute pyelonephritis than in strains isolated from cystitis and asymptomatic bacteriuria. In contrast, the production of cytotoxic necrotizing factor type 1 (CNF1) and the expression of MRHA types III and IVb were distributed uniformly between strains causing different clinical categories of UTI. Thus 88% of the E. coli strains from acute pyelonephritis showed some of the virulence factors investigated in this study, whereas only 60% (p < 0.01) and 56% (p < 0.01) repectively of the strains isolated from cystitis and asymptomatic bacteriuria possessed virulence factors. There were no significant differences in the prevalence of virulence properties between strains isolated from patients with or without complicating factors. Only 16% (p < 0.001) of the fecal isolates from healthy individuals showed virulence factors. The virulence factors were concentrated in strains belonging to 10 (O1, O2, O4, O6, O7, O14, O18, O22, O75 and 083) of the 12 serogroups most frequently detected in uropathogenic E.coli strains. The majority of uropathogenic O4, O6, O14, O22, O75 and O83 E.coli strains were Hly⁺CNF1⁺ and expressed P-fimbriae or MRHA type III, whereas the strains of serogroup O18 were Hly⁺CNFI^– and P-fimbriated. Among O1 and O7 strains we found Hly^– CNF1^–strains that expressed P-fimbriae. Among O2 strains we found Hly⁺CNF1⁺ strains that expressed P-fimbriae or MRHA type III and other Hly^–CNF1^–strains that possessed P-fimbriae. We conclude that E.coli strains isolated from pyelonephritis show virulence factors more frequently than those from cystitis and asymptomatic bacteriuria, and that strains that cause urinary tract infections in Spain belong to the same serogroups as uropathogenic E.coli isolated in other areas of the world. Our results support the special pathogenicity theory and suggest that many cases of serious urogenital disease may be caused by a limited number of P-fimbriated E.coli strains that usually produce -hemolysin.     

空肠/结肠弯曲菌的生物分型和质粒分析及其在流行病学中的初步应用

本文对来自成都地区的弯曲菌进行了生物分型和质粒分析,并结合血清学分型应用于弯曲菌肠炎病人家庭的调查。116株弯曲菌中,空肠弯曲菌生物1型、生物2型和结肠弯曲菌分别占58.6%、4.3%和37.1%;人源菌和鸡源菌均以空肠弯曲菌生物1型为主,猪源菌主要为结肠弯曲菌。弯曲菌质粒检出率为18.9%,检出的质粒株中,大多含2~3个质粒带,分子量﹤1.4~58×10⁶道尔顿;结肠弯曲菌的质粒检出率(34.21%)明显高于空肠弯曲菌(10.29%)。两个病家的调查结果说明:生物分型和质粒分析在追踪弯曲菌感染的传播中具有一定价值,可以作为弯曲菌感染流行病学调查的有用工具。     

全国细菌耐药监测网2014—2019年胆汁细菌耐药监测报告

目的了解全国胆道感染细菌分布和细菌耐药情况,为临床抗菌药物选择提供参考。方法按照全国细菌耐药监测网(CARSS)技术方案,利用WHONET 5.6软件对2014—2019年CARSS成员单位上报胆汁标本分离的细菌及药敏结果数据进行分析,同一患者相同细菌仅纳入第一株菌。结果共分析268016株细菌,居前8位的依次为大肠埃希菌(30.9%)、肺炎克雷伯菌(12.7%)、屎肠球菌(10.1%)、粪肠球菌(8.6%)、铜绿假单胞菌(4.9%)、阴沟肠杆菌(4.5%)、鲍曼不动杆菌(2.2%)、弗劳地柠檬酸杆菌(1.8%)。药敏结果显示,6年间,大肠埃希菌和肺炎克雷伯菌对第三代头孢菌素的耐药率分别为33.7%~65.6%、23.6%~43.5%,对喹诺酮类抗生素耐药率分别为48.9%~56.6%、22.0%~28.5%,对碳青霉烯类抗生素耐药率分别为1.1%~3.7%、3.5%~7.6%;铜绿假单胞菌和鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率分别为13.4%~19.0%、29.3%~42.7%,对碳青霉烯类抗生素耐药率分别为18.0%~28.0%、44.5%~59.9%;屎肠球菌和粪肠球菌对万古霉素耐药率分别为0.6%~1.7%、0.3%~0.7%。结论中国胆道感染病原菌以革兰阴性菌为主,主要为肠杆菌目细菌;常见病原菌对多种抗菌药物耐药明显,临床抗菌药物选择应参考耐药监测结果。     

新生儿重症监护室患儿肠道内定植的大肠埃希菌和肠球菌耐药分析

目的 了解新生儿重症监护室（NICU）患儿肠道菌定植和耐药情况,为临床用药及合理治疗提供依据。方法 2014年5月至2015年5月对北京妇幼保健院NICU新生儿采集的572份粪便样本进行肠道菌分离培养,采用VITEK-2系统进行菌株鉴定和抗生素敏感性检测,并对耐药情况进行统计分析。结果 分离得到328株大肠埃希菌和243株肠球菌。选取的199株大肠埃希菌对亚胺培南、厄他培南、阿米卡星、呋喃妥因较敏感（耐药率为0.50%~3.52%）;对氨苄西林、四环素、复方甲基异恶唑、头孢唑啉耐药率较高（耐药率为54.27%~84.92%）,未发现对美罗培南耐药菌株;产ESBL的菌株占45%;多重耐药情况统计结果显示对4类抗生素耐药性的菌株数量最多（34.6%）;有3株大肠埃希菌对7类抗生素表现耐药性。肠球菌对链阳霉素、呋喃妥因、链霉素较敏感（耐药率为0.41%~4.53%）;对氨苄西林、青霉素、环丙沙星、四环素、庆大霉素、红霉素耐药率较高（耐药率为70.78%~91.77%）,未发现对替加环素、万古霉素、利奈唑胺耐药的肠球菌;多重耐药情况统计结果显示,对5类抗生素表现耐药性的菌株数量最多（86.5%）。结论 NICU新生儿肠道定植的大肠埃希菌和肠球菌对抗生素耐药情况较严重,呈现多重耐药性,临床用药应结合药敏实验结果,合理选择抗菌药物。     

A widespread community outbreak of E coli 0157 infection in Scotland

Between the end of March and the end of May 1994, 22 cases of laboratory-confirmed infection by E coli 0157, phage type 4, verotoxin type 1 & 2, were reported to the Scottish Centre for Infection and Environmental Health. Although cases were distributed throughout six health board areas, pulsed field gel electrophoresis indicated that the causative organisms were clonal or very closely related. The eight earliest cases had a connection with a chain of butchers' shops although no organisms were isolated from food or surfaces.A case-control study of 9 cases and 27 controls showed a statistically significant association between consumption of burgers and illness, leading to a statement from the Chief Medical Officer emphasising the importance of thorough cooking of burgers and other meat. This outbreak highlights the importance of a unified approach to epidemiological investigation when several administrative areas are involved.