尿路感染中段尿病原菌的分布及耐药性

Objective To analyze the distribution and antimicrobial resistance of pathogenic bacteria in urinary tract infection (UTI) so as to provide evidence for appropriate selection of antimicrobial agents in clinical practice. Methods From January 2001 to December 2008 in Shanghai Ruijin Hospital, 4683 strains of pathogenic bacteria isolated from urine samples were detected by ATB system; drug susceptibility test was performed with disk diffusion method and pathogenic bacteria distribution and drug resistance was analyzed with WHO NET 5.3 software. Results Among 4683 strains of pathogenic bacteria, most was gram-negative bacilli, accounting for about 77.8%, of which predominant strain was Escherichia coli (68.7%, 3217/4683). The predominant strain of gram-positive bacteria was Enterococcus faecalis, accounting for 10.0% (468/4683). Escherichia coli showed high resistance rates to ampicillin, piperacillin and compound sulfamethoxazole (SMZ-TMP), which were 76.6%, 61.7% and 57.4% respectively, while a low resistance to imipenem, cefoperazone-sulbactam, piperacillin-tazobactam. Enterococcus faecalis showed high resistance rates to erythromycin, gentamicin and levofloxacin, which were 65.8%, 43.2% and 31.1% respectively, and were most susceptive to vancomycin and teicoplanin, both with resistance rates of 0. The susceptibility rate of Enterobacteriaceae to imipenem was 100%. From 2006 to 2008, the detection rate of extend-spectrum ?茁-lactamases ESBLs -producing Escherichia coli in outpatient increased year by year, from 28.7% to 43.3% (P<0.05), whereas no significant change was found in inpatients. The detection rate of (ESBLs)-producing Escherichia coli in inpatients was significantly higher than that in outpatients (P<0.05). The detection rate of ESBLs-producing Escherichia coli was 23.6%. The antimicrobial resistance rate in elderly patients was significantly higher than that in overall antimicrobial resistance rate (P<0.05). Conclusions The predominant bacteria of UTI are still gram-negative bacteria, main of which is Escherichia coli. Bacteria are resistant to a variety of antibiotics. Approximate selection of antibiotics in clinical practice should be made on the basis of susceptibility test results.     

烧伤病房肠杆菌科细菌耐药性及其危险因素分析

Objective To study the risk factors of infection of extended-spectrum beta-lactamases (ESBL) -producing strains and drug resistance of Enterobacteriaceae that infected burn patients. Methods A retrospective study was performed on clinical information of 92 patients with Enterobacteriaceae infection in our burn unit from January 2001 to December 2008. The distribution and drug resistance of Enterobacteriaceae , and the detection rate, drug resistance of ESBL-producing strains, and its risk factors of nosocomial infection were analyzed. Data were processed with Chi-square test. Results One hundred and nine strains of Enterobacteriaceae were isolated, with 38 (34.9%) strains of Enterobacter cloacae , 25 (22.9%) strains of Escherichia coli , 22 (20. 2%) strains of Klebsiella pneumoniae , 13 (11.9%) strains of Proteus mirabilis , and 11 (10. 1%) other strains of Enterobacteriaceae . Enterobacteriaceae were moderately or highly resistant to antibiotics except imipenem, resistance rate of which was less than 8. 0%. ESBL-producing strains accounted for 44. 0% in Escherichia coli , and 77. 3% in Klebsiella pneumoniae . Drug-resistance rate of ESBL-producing strains to antibiotics was obviously higher than that of non ESBL-producing strains. Length of hospital stay longer than 20 days, and use of the third-generation cephalosporin longer than 5 days, quinolone antibiotics longer than 7 days, and topical antibiotics longer than 5 days were the risk factors of nosocomial infection caused by ESBL-producing strains, comparing with non ESBL-producing strains, the difference was statistically significant (with χ2 value respectively 5.491 , 4.441, 15. 186, 4. 938 , P values all below 0. 05) . Conclusions Enterobacteriaceae strains in burn unit of our hospital are highly drug resistant, with high lactamase-producing rates, calling for intense monitor to control the risk factors that predispose the infection of ESBL-producing strains in order to lower the infection rate.     

婴幼儿眼部感染肺炎链球菌的群体结构研究

目的 研究婴幼儿眼部感染肺炎链球菌的群体结构,包括对抗菌药物的耐药性、耐药基因、血清型和分子分型.方法 用k-b法和etest检测39株肺炎链球菌对10种抗菌药物的耐药性,乳胶凝集试验检测血清型,pcr法检测大环内酯类药物耐药基因mefe和ermb,并选择20株菌株进行多位点序列(mlst)分型.结果 39株肺炎链球菌中,30株(76.9％)对3种或3种以上药物耐药,未检测到对万古霉素、青霉素和头孢噻肟耐药的菌株.33株检出ermb耐药基因,4株检出mefe基因.共检出12种血清型,主要为19型( 8/39)和14型(4/39),17株包含在pcv7疫苗内,疫苗覆盖率为43.6％.mlst分型发现国际耐药克隆taiwan19f-14和spain23f-1.结论婴幼儿眼部感染的肺炎链球菌包含国际流行耐药克隆,血清型和分子分型较为分散,克隆分布以散发为主,对眼部常用抗菌药物有较高的耐药性. abstract： objective to determine the population structure of streptococcus pncumoniae isolates collected from infants with eye infections,including drug resistance,resistance genes, serotypes and molecular types.methods the susceptibility of 39 isolates to 10 antibacterial agents was tested by k-b disk diffusion and etest.latex agglutination test was performed to determine the serotype of the strains,and pcr was carried out to detect macrolides resistance genes mefe and ermb.molecular types of the 20 strains were determined by multilocus sequence typing (mlst).results a total of 39 streptococcus pneumoniae isolates were obtained,in which 30 (76.9％) were resistant to 3 or more antibacterial agents,and no vancomycin,penicillin or cefotaxime resistant strain was found.ermb gene was found in 33 strains and mefe gene was found in 4 strains.twelve serotypes were found,and the most frequent serotypes were 19 (8/39) and 14 (4/39). seventeen strains (43.6％) were covered in pcv7 vaccine. the international clone taiwan19f-14 and spain23f-1 were found by mlst. conclusions streptococcus pneumoniae isolates from infants with eye infections include international resistance clones.the distribution of serotype and molecular type are dispersed, and the clones are sporadic. the isolates are highly resistant to commonly used antibacterial agents.     

烧伤病房肠杆菌科细菌耐药性及其危险因素分析

Objective To study the risk factors of infection of extended-spectrum beta-lactamases (ESBL) -producing strains and drug resistance of Enterobacteriaceae that infected burn patients. Methods A retrospective study was performed on clinical information of 92 patients with Enterobacteriaceae infection in our burn unit from January 2001 to December 2008. The distribution and drug resistance of Enterobacteriaceae , and the detection rate, drug resistance of ESBL-producing strains, and its risk factors of nosocomial infection were analyzed. Data were processed with Chi-square test. Results One hundred and nine strains of Enterobacteriaceae were isolated, with 38 (34.9%) strains of Enterobacter cloacae , 25 (22.9%) strains of Escherichia coli , 22 (20. 2%) strains of Klebsiella pneumoniae , 13 (11.9%) strains of Proteus mirabilis , and 11 (10. 1%) other strains of Enterobacteriaceae . Enterobacteriaceae were moderately or highly resistant to antibiotics except imipenem, resistance rate of which was less than 8. 0%. ESBL-producing strains accounted for 44. 0% in Escherichia coli , and 77. 3% in Klebsiella pneumoniae . Drug-resistance rate of ESBL-producing strains to antibiotics was obviously higher than that of non ESBL-producing strains. Length of hospital stay longer than 20 days, and use of the third-generation cephalosporin longer than 5 days, quinolone antibiotics longer than 7 days, and topical antibiotics longer than 5 days were the risk factors of nosocomial infection caused by ESBL-producing strains, comparing with non ESBL-producing strains, the difference was statistically significant (with χ2 value respectively 5.491 , 4.441, 15. 186, 4. 938 , P values all below 0. 05) . Conclusions Enterobacteriaceae strains in burn unit of our hospital are highly drug resistant, with high lactamase-producing rates, calling for intense monitor to control the risk factors that predispose the infection of ESBL-producing strains in order to lower the infection rate.     

肺炎克雷伯菌与植生克雷伯菌喹诺酮类耐药基因研究

目的 分析宁波大学医学院附属医院克雷伯菌属的耐药性及其对喹喏酮类药物的耐药机制.方法 收集2009年10月-2011年3月分离出的20株克雷伯菌属菌株,经鉴定确认18株为肺炎克雷伯菌,2株为植生克雷伯菌.采用k-b纸片扩散法检测其对药物的敏感性.pcr法检测染色体介导的gyra、parc基因和质粒介导的aac(6’)-Ⅰ b-cr、qnra、qnrb、qnrs、qepa基因,pcr阳性产物采用pcr直接全自动荧光法测序.结果 20株克雷伯菌属菌对β-内酰胺类、氨基糖苷类、喹诺酮类抗菌药物均表现为多重耐药性(耐药率均在80％以上),其中植生克雷伯菌对亚胺培南和美罗培南敏感.18株(90％)菌株存在gyra、parc基因突变;aac(6’)-Ⅰ b-cr阳性12株(60％),qnrb和qnrs阳性均为4株(20％).结论 本组20株克雷伯菌属菌对喹诺酮类药物耐药主要与gyra和parc基因突变相关. abstract： objective to investigate the multi-drug resistance of klebsiella strains and its mechanism.methods twenty strains of klebsiella were isolated from the affiliated hospital of medical college,ningbo university from october 2009 to march 2011,in which 18 isolates were klebsiella pneumonia and 2 were klebsiella planticola. drug sensitivity was determined by k-b tests. drug resistant genes gyra,parc (chromosome mediated) and aac( 6′)-i b-cr,qnra,qnrb,qnrs,qepa (plasmid mediated) were amplified by pcr and verified by direct automated fluorogenic sequencing. results resistance to β-1actams,aminoglycosides and quinolones was observed in 20 strains,and resistant rates were all above 80％.klebsiella planticola strains were sensitive to imipenem and meropenem.mutations of gyra and parc genes existed in 18 strains (90％),and the positive rates of aac (6') -i b-c r,qnrb and qnrs were 60％ (12/20),20％ (4/20) and 20％ (4/20),respectively.conclusion the mutations ofgyra and parc genes may be the main cause of the resistance to quinolones in these strains.     

支气管肺泡灌洗液312份细菌定量培养及药物敏感性分析

目的 分析支气管肺泡灌洗液(balf)细菌定量培养中病原菌的分布及其对常用抗菌药物的敏感情况.方法 将312份balf样本用10μl取菌环分别划线接种于巧克力平板、血平板及麦康凯平板进行定量培养,细菌菌落数大于104 cfu/ml为致病菌,用vitek 2-compact全自动微生物分析系统鉴定菌株,并用k-b法、etest法和稀释法进行药敏试验.结果 312份balf样本共分离出病原菌216株,检出率为69.2％.革兰阴性杆菌以铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌和大肠埃希菌为主,革兰阳性球菌以金黄色葡萄球菌、肺炎链球菌及表皮葡萄球菌为主.药敏试验结果显示,铜绿假单胞菌对氨曲南等耐药率较高,对哌拉西林/他唑巴坦、亚胺培南、头孢吡肟、左氧氟沙星、头孢他啶和阿米卡星的耐药率均在30％以下;金黄色葡萄球菌对红霉素、青霉素及克林霉素的敏感情况较差,而对呋喃妥因、万古霉素、喹奴普汀/达福普汀、替加环素和利奈唑烷均完全敏感.结论 balf培养阳性率较高,常见致病菌为铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯菌、金黄色葡萄球菌和大肠埃希菌等,各病原菌对常用抗菌药物的耐药情况严重. abstract： objective to investigate the distribution and antibiotic susceptibilities of quantitatively cultivated bacteria from bronchoalveolar lavage fluid (balf) samples. methods totally 312 balf samples were streak inoculated to chocolate,blood and mac plates with 10 μl annulus,and the bacterial colony ＞ 104 cfu/ml was considered pathogenic bacteria. the identification of pathogenic bacteria was carried out with vitek 2-compact,and kirby-bauer disc agar diffusion method,etest and dilution method were used for antibiotics sensitivity test.results totally 216 (69.2％) strains of pathogenic bacteria were isolated.the major gram-negative strains were pseudomonas aeruginosa,acinetobacter baumannii,klebsiella pneumoniae and escherichia coli, and the major gram-positive strains were staphylococcus aureus,streptococcus pneumoniae and staphylococcus epidermidis.the resistance rate of pseudomonas aeruginosa to aztreonam was high,but lower than 30％ to piperacillin/tazobactam,imipenem,cefepime,ofloxacin,ceftazidime and amikacin.staphylococcus aureus was highly resistant to erythromycin,benzylpenicillin and clindamycin,but it was sensitive to furadantin,vancomycin,quinupristin/dalfoprisdn,tigecycline and linezolid.conclusion the positive rate of balf cultivation is high,and the main pathogenic bacteria pseudomonas aeruginosa, acinetobacter baumannii, klebsiella pneumoniae, staphylococcus aureus and escherichia coli are resistant to several commonly used antibiotics.     

烧伤病房鲍氏不动杆菌耐药性趋势和同源性分析

Objective To monitor genotypes and drug-resistance trend of Acinetobacter baumannii (AB) isolated from burn wards. Methods Twenty-six strains of AB isolated from wound secretion, venous catheter, and blood were collected from burn patients hospitalized in our burn wards from November 2008 to February 2009, and June to September 2010. Homogeneous genotype analysis was performed with repetitive extragenic palindromic PCR, and drug-resistance rate to 13 antibiotics including amikacin, gentamicin, etc. , which were commonly used in clinic, was tested by K-B paper disk diffusion. The data of drugresistance rate were processed with chi-square test. Results ( 1 ) Sixteen AB strains were multi-drug resistant (MDR), 9 AB strains were pan-drug resistant (PDR). Among all strains, the resistance rate to gentamicin, piperacillin, piperacillin/tazobactam, cefuroxime, cefotaxime, ceftazidime, cefepime, ciprofloxacin, imipenem, and meropenem was respectively higher than 90.00%; the resistance rate against cefoperazone/sulbactam was the lowest (11/26, 42.31% ). There were obvious difference among the drug-resistance rates of AB strains to 13 antibiotics (with rates from 42.31% to 100.00% , x 2 = 97. 371, P ＜ 0.05 ). (2)There were 7 genotypes among 26 AB strains, respectively type A ( 17), type B (3), type C (2) , type D (1), type E (1), typeF (1), and typeG (1). Out of the 17 AB strains inAgenotype, 1 strain was from 2008, 1 strain was from 2009, 15 strains were from 2010, and among them 11 strains were collected from wound secretion and 6 strains were obtained from blood and venous catheter. Conclusions AB strains in A genotype are dominant in our burn wards in recent years, which are MDR or PDR to commonly used antibiotics. Cefoperazone/sulbactam is the drug of choice for burn patients with AB infection.     

烧伤病房鲍氏不动杆菌耐药性趋势和同源性分析

Objective To monitor genotypes and drug-resistance trend of Acinetobacter baumannii (AB) isolated from burn wards. Methods Twenty-six strains of AB isolated from wound secretion, venous catheter, and blood were collected from burn patients hospitalized in our burn wards from November 2008 to February 2009, and June to September 2010. Homogeneous genotype analysis was performed with repetitive extragenic palindromic PCR, and drug-resistance rate to 13 antibiotics including amikacin, gentamicin, etc. , which were commonly used in clinic, was tested by K-B paper disk diffusion. The data of drugresistance rate were processed with chi-square test. Results ( 1 ) Sixteen AB strains were multi-drug resistant (MDR), 9 AB strains were pan-drug resistant (PDR). Among all strains, the resistance rate to gentamicin, piperacillin, piperacillin/tazobactam, cefuroxime, cefotaxime, ceftazidime, cefepime, ciprofloxacin, imipenem, and meropenem was respectively higher than 90.00%; the resistance rate against cefoperazone/sulbactam was the lowest (11/26, 42.31% ). There were obvious difference among the drug-resistance rates of AB strains to 13 antibiotics (with rates from 42.31% to 100.00% , x 2 = 97. 371, P ＜ 0.05 ). (2)There were 7 genotypes among 26 AB strains, respectively type A ( 17), type B (3), type C (2) , type D (1), type E (1), typeF (1), and typeG (1). Out of the 17 AB strains inAgenotype, 1 strain was from 2008, 1 strain was from 2009, 15 strains were from 2010, and among them 11 strains were collected from wound secretion and 6 strains were obtained from blood and venous catheter. Conclusions AB strains in A genotype are dominant in our burn wards in recent years, which are MDR or PDR to commonly used antibiotics. Cefoperazone/sulbactam is the drug of choice for burn patients with AB infection.     

糖尿病足多重耐药铜绿假单胞菌感染情况及危险因素分析

目的 分析糖尿病足感染创面分离的多重耐药铜绿假单胞菌的耐药特点及其感染的危险因素.方法 选择2008年1月-2010年12月从天津医科大学代谢病医院428份糖尿病足感染创面样本中分离的85株铜绿假单胞菌进行药敏试验,并采用多因素非条件logistic回归分析多重耐药铜绿假单胞菌感染的危险因素.结果 85株铜绿假单胞菌中共检出多重耐药菌株28株,阳性率为32.94％.多重耐药铜绿假单胞菌对第三代头孢菌素、喹诺酮类和氨基糖苷类抗菌药物的耐药率较高,分别为42.86％ ～67.86％、32.14％～ 57.57％和42.86％～ 67.86％.logistic回归分析显示,入院前抗菌药物使用史、高血压及贫血是多重耐药铜绿假单胞菌感染的危险因素(or=5.758,0.257和0.270,p=0.006,0.014和0.013).结论 多重耐药铜绿假单胞菌的耐药率较高,入院前使用过抗菌药物、高血压及贫血的糖尿病足患者更容易感染多重耐药铜绿假单胞菌. abstract： objective to investigate the infection and risk factors of multidrug-resistant pseudomonas aeruginosa in diabetic foot.methods totally 85 strains of pseudomonas aeruginosa were isolated from 428 samples of diabetic foot ulcers in tianjin metabolic diseases hospital from jan 2008 to dec 2010.drug sensitivity tests were performed and multivariate logistic regression analysis was used to examine the risk factors of multidrug-resistant pseudomonas aeruginosa infection. results in 85 strains of pseudomonas aeruginosa, 28 (32.94％ ) were multidrug resistant. multidrug-resistant pseudomonas aeruginosa showed high resistance to 3rd generation cephalosporins,quinolones and aminoglycosides with resistant rates of 42.86％-67.86％,32.14％ -57.57％,and 42.86％-67.86％,respectively. logistic analysis indicated that previous antibiotic treatments, hypertension and anemia were associated with multidrug-resistant pseudomonas aeruginosa infection ( or =5.758,0.257 and 0.270,p =0.006,0.014 and 0.013 ). conclusion multidrug-resistant pseudomonas aeruginosas isolated from diabetic foot are highly resistant to several commonly used antibiotics,and previous antibiotics use,hypertension and anemia are risk factors for multidrug-resistant pseudomonas aeruginosa infections.     

Further evidence of endogenous hydrogen sulphide as a mediator of relaxation in human and rat bladder

We investigated the expression of hydrogen sulphide （H2S） in human and rat lower urinary tract （including bladder, prostate and urethra） tissues, and we sought to determine whether H2S induces relaxation of human and Sprague-Dawley （SD） rat bladder strips. Human normal lower urinary tract tissue was obtained for the evaluation of endogenous H2S productivity using a sulphide-sensitive electrode and for the analysis of the expression levels of all three synthases of endogenous H2S, cystathionine β-synthase （CBS）, cystathionine y lyase （CSE） and 3-mercaptopyruvate sulphur transferase （MPST, as known as 3-MST） by Western blot assay. CBS, CSE and MPST were located in human sample slides by immunohistochemistry. Human and male adult SD rat bladder strips were tested for H2S function with a transducer and recorded. All experiments were repeated six times. The endogenous H2S productivity and the H2S synthases had various distributions in the human and rat lower urinary tract tissues and were located in both epithelial and stromal sections. L-cysteine （L-Cys, a substrate of CBS, CSE and MPST） elicited relaxation in a dose-dependent manner on human bladder strips ere-contracted by acetylcholine chloride. This effect could be diminished by the ATe-sensitive potassium ion （KATe） channel blocker glibenclamide （GLB）, the CSE inhibitor DL-propargylglycine （PEG） and the CBS inhibitor hydroxylamine （HA）. H2S and its three synthases were present in the human and rat lower urinary tract tissues and relaxed human and rat bladder strips, which implied that endogenous H2S might play a role in physiological function and pathological disorders of the lower urinary tract symptoms （LUTS） or overactive bladder （OAB）.