Évolution de la résistance aux antibiotiques de 1997 à 2005 à la Réunion

Objective

The groupe hospitalier Sud Reunion (GHSR) is a 1130-bed hospital center, located on the Reunion Island, (Indian Ocean). We studied the profiles of antibiotic resistance in 2005, and compared those with previous data collected in 1997–1998, and with Metropolitan France and European data.

Material and methodology

All bacteriological strains isolated from diagnostic samples in 2005 were analyzed according to CA-SFM recommendations.

Results

Since 1997, the rates of resistance to enterobacteria (betalactam, aminoside, quinolone, trimethoprim-sulfamethoxazole), Pseudomonas aeruginosa (ticarcillin, amikacin, ciprofloxacin, fosfomycin), Acinetobacter baumanii (amikacin) has decreased significantly. The rate of methicillin-resistant Staphylococcus aureus (1997: 3.6 %, 2005: 13.4 %) has increased but less than in Metropolitan France. The rate of Streptococcuspneumonia with decreased susceptibility to penicillin has increased (1997: 25.5 %, 2005: 42.9 %), as for Haemophilusinfluenzae which present an important increase of betalactam resistance (1997: 15.5 %, 2005: 37.8 %).

Conclusion

By comparing our data to 1997 and Metropolitan French data, it seems that the GHSR has managed to protect its hospital-based microbial ecology. However, community germs showed increasing resistance, probably because of an increasing antibiotic pressure, but with resistance rates often inferior to Metropolitan French ones.     

Étude comparative des primo-infections à Epstein-Barr virus et à cytomégalovirus chez 52 patients immunocompétents

Objective

The objective of this study was to compare epidemiological, clinical, and biological data of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) primary infections in immunocompetent adults, admitted in the infectious disease department of the Reims Teaching Hospital between 2000 and 2005.

Patients and methods

Inclusion criteria were the presence of anti-VCA IgM antibodies or the presence of CMV specific IgM antibodies and the absence of any other positive serology. Differences in reported percentage were compared with a Khi² test or Fischer's exact test, when appropriate. Continuous variables were compared with the Mann-Whitney Test.

Results

There were no significant changes over the years in the numbers of EBV (n = 32) and CMV (n = 20) primary infections. The patient's mean age was 22.7 years (14-48 years) in EBV primary infections and 38.6 years (13-66 years) in CMV primary infections (P < 0.01). The clinical variables significantly associated with primary EBV infection were sore throat and cervical lymphadenopathy (P < 0.01). Arthromyalgia and respiratory manifestations were less frequent in EBV primary infection (P < 0.01). The biological variables significantly associated with EBV primary infection were a marked alanine aminotransferase elevation and a marked lymphocytosis with atypical lymphocytes (P < 0.001). Thrombopenia was less frequently associated with EBV primary infection (P < 0.001).

Conclusion

Clinical and biological presentations of EBV and CMV primary infections were similar. The simultaneous serologic diagnosis of these two infections remains necessary to provide a specific diagnosis, for the most efficient patient care.     

Étude des infections à VIH nouvellement découvertes entre 2000 et 2007 dans le Nord et l’Est de la France

In France, since 2003, all new HIV infection must be reported. Data collected with the declaration system is not exhaustive and only concerns epidemiological data.     

Bactériémie à Bordetella holmesii chez un patient drépanocytaire de 26 ans

Bordetella holmesii is a rare cause of bacteremia. It occurs mainly in hyposplenic patients, such as those affected by sickle cell anemia. The most frequent clinical signs are not very specific: fever, cephalalgia, cough, dyspnea, vomiting, etc. B. holmesii is frequently isolated from blood cultures. We describe the case of a 26-year-old sickle cell patient, presenting with dry cough and fever caused by a B. holmesii blood stream infection, identified by 16S rRNA gene sequencing. The outcome was favorable with amoxicillin. It is useful to know about B.  holmesii, especially for physicians managing sickle cell or hyposplenic patients, because of its variable susceptibility to beta-lactams.     

990株临床非发酵菌的种群分布及耐药谱分析 FREE

目的了解某院临床标本分离的非发酵菌菌种分布及耐药谱,为临床用药提供依据。方法回顾性分析该院2004年1月-2008年12月临床各科室送检标本分离的990株非发酵菌资料。结果990株非发酵菌分为11个菌属,其中以不动杆菌属细菌最多,占43.43%（430/990）;假单胞菌属和窄食单胞菌属次之,分别为34.75%(344/990)和10.71%(106/990)。分离最多的前4种菌依次为铜绿假单胞菌（29.19%）、洛菲不动杆菌(20.61%)、醋酸钙-鲍曼不动杆菌复合种(13.74%)和嗜麦芽窄食单胞菌(10.71%)。标本中以痰液分离菌数最多,占79.80%(790/990),其次为咽拭子7.88%（78/990）、体液6.87%(68/990)。5年来,铜绿假单胞菌对替卡西林、头孢西丁、头孢噻肟、亚胺培南、奈替米星、复方磺胺甲口恶唑、培氟沙星、庆大霉素、呋喃妥因和妥布霉素的耐药率变化显著（P＜0.005或P＜0.05）,耐药率＜30%的抗菌药物有头孢他啶和亚胺培南;不动杆菌属对阿莫西林/克拉维酸、庆大霉素、妥布霉素和复方磺胺甲口恶唑的耐药率变化显著（P＜0.005或P＜0.05）,耐药率＜30%的抗菌药物有替卡西林、亚胺培南和奈替米星。结论非发酵菌为医院感染的主要病原菌,对常用抗菌药物的耐药率高,且多重耐药现象严重,应定期监测细菌变迁和耐药性变化,指导临床合理用药。     

重症肝病合并医院真菌感染60例临床分析 FREE

目的探讨重症肝病患者医院真菌感染的临床特点。方法采用回顾性调查方法对 60例重症肝病合并医院真菌感染患者的临床资料及相关因素进行分析。结果同期住院重症肝病患者485例,其中60例(12.37%)发生医院真菌感染83例次(17.11%)。感染部位以肠道为主,占50.60%;其次为口腔(25.30%)、下呼吸道(9.64%)、腹腔(7.23%)、泌尿道(4.82%)和血液(2.41%)。 感染菌种以白假丝酵母菌为主,占61.67%;其次为近平滑假丝酵母菌,占16.67% 。60例重症肝病合并医院真菌感染者中死亡34例(56.67%),与真菌感染直接相关2例(3.33%);而未发生真菌感染的60例对照者中死亡19例(31.67%),两组病死率差异有高度显著性(χ2＝7.60,Ｐ<0.01)。结论重症肝病患者发生医院真菌感染预后差,病死率极高。预防和治疗医院真菌感染需采取综合措施。     

美国感染病学会、美国药师学会、感染病药师学会共同推荐的万古霉素治疗指南 FREE

关于万古霉素目标血药浓度达标及如何进行调整已讨论多年。根据有效血药浓度监测出万古霉素血药谷浓度和调整的初始浓度,两者均高于其最低抑菌浓度（MIC）和避免可能的耳毒性或肾毒性等副作用的浓度。前期很多研究由于缺乏设计良好的随机临床评估或缺乏某血药浓度与患者预后间的确切关系的明确资料,由此导致了监测力度不够或不监测以及如何进行剂量调整的争论。     

2008年美国医疗机构消毒灭菌指南节译（Ⅱ） ——医疗机构环境表面的清洁与消毒 FREE

美国疾病控制与预防中心2008版《医疗机构消毒灭菌指南》已出版,本指南最终目标是通过适当选择消毒灭菌方法,减少医院感染的发生。以下节选关于医疗机构环境表面的清洁与消毒内容,每条建议均根据科学证据、基本原理、实用性和联邦法律制定。其建议分级系统如下。     

2008年美国医疗机构消毒灭菌指南节译（Ⅲ） ——消毒灭菌方法选择 FREE

美国疾病控制与预防中心2008版《医疗机构消毒灭菌指南》已出版,该指南最终目标是通过选择适当的消毒灭菌方法,减少医院感染的发生。以下节选消毒灭菌方法的选择建议（表1）。     

美国 CLSI抗菌药物敏感试验操作标准(2010年版)部分变更内容 FREE

2010年美国临床实验室标准化研究所（Clinical and Laboratory Standards Institute,CLSI）更新了M100－S20文件,现将其中主要更新内容作简要介绍,供临床微生物学检验工作者在常规工作中参考。     

667例骨科手术切口目标监测与干预效果评价 FREE

目的 了解引起骨科手术切口感染的因素,采取有效措施预防与控制骨科手术切口感染。方法 分2个阶段对在洁净手术室进行的骨科手术切口进行监测,第1阶段即2008年3月1日-12月31日（调查阶段）,主要调查感染情况及相关因素;第2阶段即2009年1月1日-5月31日（干预阶段）,根据前阶段的调查结果对可干预的相关因素进行干预。比较两阶段的感染率。结果 调查阶段的手术切口感染率为5.07%（23/454）,干预阶段的手术切口感染率为1.41%（3/213）,干预阶段切口感染率显著降低（χ2=4.25,P＜0.05 ）。结论 加强洁净手术室的管理、保证手术器械及用物灭菌质量、围手术期合理使用抗菌药物、正确进行外科手消毒、严格执行换药操作规程、提高医护人员感染控制意识等干预措施可有效预防与控制骨科手术切口感染。     

医院感染发展趋势与防范策略 FREE

医院感染伴随医院产生,无论是在发展中国家还是在发达国家,都是当前医院管理中的难题。医院感染不仅威胁患者的健康和生命,同时也影响医院的医疗质量,阻碍高新技术的开展,延长住院时间和增加医疗费用,给患者、医院和国家造成巨大经济损失。加强医院感染研究,有效预防与控制医院感染势在必行。     

Infections à Bocavirus humain

Human Bocavirus (HboV) was recently cloned by a systematic screening of nasopharyngeal samples from children hospitalized for respiratory tract infections. This virus, genus Bocavirus, family Parvoviridae, was identified by screening for its DNA in 5% of nasopharyngeal aspirates, as reported in several studies. It may be responsible for upper and lower respiratory tract infections of young children under five years with a peak rate in winter. Because of a high rate of viral co-infections, its pathogenic role in these infections should be documented. Further studies are required to determine the role of this possibly systemic virus in other affections.     

一种医院感染监测系统的设计与应用 FREE

目的 开发医院感染监测软件（HIMS）,有效监控医院感染。方法结合医院的实际需求,设计一种医院感染监测系统,并与软件公司合作,开发相应的HIMS,将其嵌入医院信息系统中。结果 该系统在医院感染监测工作中得到具体应用,发挥了实时监控、预警报告的作用,取得良好效果。结论 该系统能较好地满足医院感染监测的各项基本功能需求,达到了预期效果。     

胃肠道手术部位感染目标性监测效果评价 FREE

目的 了解不同监测方法下胃肠道手术部位医院感染发病情况,为降低感染率,制定感染控制措施提供依据。方法 比较某院2007年7月-2008年6月（实施目标性监测前,对照组）及2008年7月-2009年6月（实施目标性监测后,监测组）行开腹胃肠道手术患者的手术部位感染情况。结果 对照组手术部位感染率为12.30%,监测组下降至7.00%,两组比较,感染率差异有显著性（χ2=3.98,P＜0.05）。结论 采用目标性监测方法能有效降低医院感染率。     

疱疹病毒与宿主细胞骨架间的相互作用 FREE

疱疹病毒依赖于宿主细胞骨架有效地进入细胞、复制以及从细胞中释放出来。为促使这一过程顺利完成,在细胞质和细胞核中,病毒蛋白必须与宿主细胞分子马达相互作用,以便使病毒在感染细胞中正确定位。本文就疱疹病毒如何利用宿主细胞骨架、相关的分子马达和重塑蛋白将复杂的病毒结构高效地转入或转出细胞进行简要综述。