脓疱疮:总的观点

介绍了儿童脓疱疮的发病机理、临床特征和治疗方案。脓疱疮多由金黄色葡萄球菌引起,其次为β溶血性链球菌;对复发性脓疱疮患者应当评估其金黄色葡萄球菌携带状况;抗生素的选择应当考虑对红霉素耐药的金黄色葡萄球菌的地区流行性、抗生素的价格和可利用性以及患者的依从性。     

大疱性脓疱疮1例

患儿女，13岁，因全身散在红斑、脓疱，糜烂4d，于2004年7月20日入院，患儿4d前无明显诱因躯干部出现粟粒大脓疱，部分糜烂，给予林可素及搞病毒芗治疗后皮损一度好转。入院前1d病情突然加重，皮损逐渐波及全身，并出现大脓疱。患者既往无传染病史及家庭遗传病史。     

维儿康洗液治疗儿童金黄色葡萄球菌感染性脓疱疮96例疗效观察

目的探讨维儿康洗液治疗儿童金黄色葡萄球菌感染性脓疱疮的疗效和前景。方法将入选的190例脓疱疮患儿分为两组,治疗组(96例)予维儿康洗液外洗,对照组(94例)予莫匹罗星软膏外搽患处,均2次/d,共治疗5d。对两组患者每天观察和记录治疗情况,并在治疗5d后进行病情评分和判定疗效。结果治疗组治愈率为88.54%,有效率为95.83%,治愈时间为(4.215±0.741)d;对照组治愈率为93.62%,有效率为96.81%,治愈时间为(4.122±0.635)d。两组患者的治愈率、有效率和治愈时间比较,差异均无统计学意义(P均>0.05)。结论维儿康洗液外用治疗儿童金黄色葡萄球菌感染性脓疱疮疗效确切。     

物理抗菌剂辅助治疗脓疱疮疗效观察

<正>脓疱疮是由金黄色葡萄球菌和/或乙型溶血性链球菌引起的一种急性化脓性皮肤病,俗称"黄水疮",传统治疗首选抗生素外用,但近年来随着抗生素的广泛应用,耐药金葡菌的发生率呈较快增长趋势[1]。因此,我们对确诊脓疱疮的门诊患儿采用物理抗菌剂-JUC(洁悠神,南京神奇科技开发有限公     

先锋霉素联合百多邦软膏治疗62例脓疱疮疗效观察

脓疱疮是由金黄色葡萄球菌和（或）乙型溶血性链球菌引起的一种急性化脓性皮肤病。本病可通过密切接触或自身接种传播。细菌主要侵犯表皮，引起化脓性炎症。凝固酶阳性噬菌体Ⅱ组71型金葡菌可产生表皮剥脱毒素，引起毒血症及全身泛发性表皮松解坏死。笔者采用先锋霉素联合百多邦软膏治疗脓疱疮患儿，取得明显疗效，现报告如下。     

广州地区380例儿童脓疱疮病原菌培养及药敏分析

目的了解广州地区儿童脓疱疮的病原菌分布及药物敏感性。方法对380例脓疱疮患儿的脓疱疮液做细菌培养,并对分离出的368株金黄色葡萄球菌(简称金葡)进行12种抗生素的药敏试验。结果分离出病原菌分别为金葡368株(96.8%),凝固酶阴性葡萄球菌2株(0.5%),产气杆菌2株(0.5%),大肠埃希菌2株(0.5%),摩根摩根菌1株(0.3%)。对368株金葡菌进行的药敏试验结果显示:金葡菌对青霉素、红霉素、克林霉素的耐药率>63.6%。对万古霉素、阿米卡星、头孢呋辛钠、头孢唑林、头孢西丁、苯唑西林、阿莫西林/克拉维酸、头孢曲松、头孢他啶则高敏感率,敏感率>95.4%。结论广州地区儿童脓疱疮的主要致病菌为金葡菌,青霉素、红霉素、克林霉素的耐药性较高,已不适于治疗本地区由金葡菌感染引起的脓疱疮。     

178例儿童脓疱疮皮损中金黄色葡萄球菌药敏及随机扩增多态性DNA分析北大核心CSCD

目的探讨儿童脓疱疮皮损中金黄色葡萄球菌的耐药情况,比较敏感株与耐药株的DNA指纹差异。方法对成都地区178例儿童脓疱疮患者皮损分泌物进行细菌培养,对培养出的162株金黄色葡萄球菌（简称金葡菌）进行21种抗生素的药物敏感试验,同时对162株金葡菌进行随机扩增多态性DNA分析。结果从脓疱疮患儿皮损中分离鉴定出病原菌180株,其中金葡菌162株,占90．00％。162株金葡菌中,148株为甲氧西林敏感金葡菌（MSSA）,14株为耐甲氧西林金葡菌（MRSA）。162株金葡菌进行21种抗生素体外药敏试验,敏感率前5位分别为米诺环素、替考拉宁、喹奴普汀、万古霉素、呋喃妥因。耐药率前5位分别为青霉素、红霉素、克林霉素、复方磺胺甲唔唑、四环素。未发现对夫西地酸、呋喃妥因、万古霉素、喹奴普汀、替考拉宁及米诺环素耐药。按DNA条带的大小和数量进行分型,共分为8种基因型,基因型Ⅲ最多占31．48％;基因型Ⅱ占26．54％;基因型Ⅵ占25．93％,这3种基因型占总数的65．43％（106／162）。148株MSSA的基因型有8种,基因型Ⅲ占33．78％,基因型Ⅵ占26．35％,基因型Ⅱ占22．30％。14株MRSA的基因型只有3种,分别为基因型Ⅱ10株（71．43％）,基因型VI3株（21．43％）,基因型Ⅲ1株（7．14％）,以基因型Ⅱ为主。结论成都儿童脓疱疮皮损中病原菌以金葡菌为主,对米诺环素、替考拉宁及喹奴普汀等高度敏感。其RAPD指纹共分为8型,以基因型Ⅲ最多。     

葡萄球菌性NGU的病原菌及耐药性检测

目的：研究支原体、衣原体阴性的NGU患者葡萄球菌感染的特点及耐药性。方法：采集103例支原体、衣原体阴性的男性患者尿道分泌物,分离培养并以MicroScan微生物鉴定系统鉴定,同时检测各菌株最低抑菌浓度（MIC）。结果：共分离出9种72株葡萄球菌,分离率69.90%,未发现混合感染。所有菌株均产生β-内酰胺酶。耐药率古霉素菌株。结论：葡萄球菌是支原体、衣原体阴性的NGU男性患者的重要病原体,尤其不能忽视凝固酶阴性葡萄球菌（CNS）的致病性。治疗宜首选万古霉素。     

皮肤软组织感染分离菌的分布及耐药性

目的　观察皮肤软组织感染分离菌分布情况 ,检测耐药菌流行情况 ,为临床选择合理有效的治疗方案提供依据。方法　对 66例皮肤感染者进行病原菌分离 ,并对分离出的 70株病原菌以琼脂扩散法测定药敏。结果　从 66例皮肤感染的皮损中分离出病原菌 70株 ,革兰阳性菌占 71.4% ,其中苯唑西林耐药凝固酶阳性金黄色葡萄球菌 (MRSA )占 3 7.1% ,苯唑西林耐药凝固酶阴性葡萄球菌 (MRSE)占 2 1.4% ;革兰阴性菌占 2 5 .7% ,其中溶血性大肠埃希菌占 10 % ;真菌占 2 .9%。药敏试验显示MRSA对阿奇霉素、罗红霉素、红霉素、复方磺胺甲 口恶唑、青霉素、克林霉素耐药率依次为92 .3 %、84.6%、76.9%、73 .1%、69.2 %、65 .4% ;MRSE的耐药率依次为 86.7%、86.7%、73 .3 %、73 .3 %、60 .0 %、73 .3 % ;溶血性大肠埃希菌对氨苄西林、四环素、呋喃妥因、头孢呋辛、头孢唑啉耐药率依次为 85 .7%、71.4%、5 7.1%、5 7.1%、5 7.1%。结论　红霉素、阿奇霉素、罗红霉素、复方磺胺甲 口恶唑等已不适于治疗革兰阳性菌感染 ,氨苄西林、呋喃妥因、头孢唑啉、四环素等已不适于治疗革兰阴性菌感染。     

The Antibiotic Susceptibility of Propionibacterium acnes and Staphylococcus epidermidis Isolated from Acne

We studied the susceptibility of antimicrobial agents to Propionibacterium acnes (P. acnes) and Staphylococcus epidermidis (S. epidermidis) isolated from acne patients. We measured the minimum inhibitory concentrations (MICs) of the following five drugs: roxithromycin (RXM), erythromycin (EM), clindamycin (CLDM), minocycline (MINO) and ofloxacin (OFLX), which are frequently Used to treat acne and skin infections. We found many resistant strains of S. epidermidis and some resistant strains of P. acnes. There was a correlation between the resistance of S. epidermidis and the former therapy for acne, but no distinct correlation between the resistance of P. acnes and the former therapy for acne.     

葡萄球菌性烫伤样皮肤综合征的致病金黄色葡萄球菌剥脱毒素基因型及耐药研究

目的 探讨葡萄球菌性烫伤样皮肤综合征（SSSS）致病的金黄色葡萄球菌（简称金葡菌）分泌表皮剥脱毒素（ET）的主要类型及耐药情况。方法 108株金葡菌分离自SSSS（36例）、脓疱疮（36例）及皮肤脓肿（36例）。用多重PCR法测定致病金葡菌菌株产ETA、ETB、ETD基因型，Kirby-Bauer纸片法检测其对20种抗生素的敏感性。结果 36株来源于SSSS的金葡菌 100％ （36/36）为产ET菌株，其中单产ETA 2株（6％），ETB 7株（19％），兼产ETA和ETB 27株（75％）。来源于脓疱疮的36株金葡菌78％ （28/36）为产ET菌株，单产ETA 5株（14％），兼产ETA和ETB 23株（64％），未发现单产ETB金葡菌。而分离自皮肤脓肿的36株金葡菌仅2.8%（1/36）产ET，为兼产ETA和ETB菌株。108株金葡菌均未检测到ETD。金葡菌产ET的型别分布在三组疾病间差异有统计学意义（χ2 = 89.4，P ＜ 0.01），且分离自SSSS的金葡菌株产ET的比例明显高于脓疱疮组（χ2 = 9.0，P < 0.01）和脓肿组（χ2 = 68.1，P < 0.01）。三组病例的致病金葡菌对青霉素、氨苄西林、大环内酯类及克林霉素高度耐药，但对头孢类抗生素均敏感。脓肿组发现2例耐甲氧西林金葡菌株（MRSA）。结论 SSSS及脓疱疮患儿的致病金葡菌主要为产ET菌株，并以兼产ETA和ETB菌株为主。     

Antibiotic treatment of cutaneous infections with Staphylococcus aureus in patients with atopic dermatitis: current antimicrobial resistances and susceptibilities

Background/aims: Atopic dermatitis (AD) is a common chronic inflammatory skin disease. In many patients, the disease is complicated by enhanced susceptibility to skin infections, especially with Staphylococcus aureus. The aim of this study was to determine the antimicrobial susceptibility of skin‐colonizing S. aureus strains in patients with AD and consecutively to recommend the first‐line antibiotic therapy. Methods: We studied S. aureus‐positive skin swabs (n = 102) from lesional skin of children, adolescents and adults with AD presenting to our inpatient and outpatient departments from January 2005 to June 2006. Results: Antimicrobial susceptibility testing revealed resistance against oxacillin, amoxicillin/clavulanic acid, cephalexin and cefuroxim in 3%, against tetracycline in 17%, against gentamicin in 16%, against erythromycin and clindamycin in 21%, against trimethoprim/sulfamethoxazol in 23%, against levofloxacin in 23%, against fusidic acid in 25%, against fosfomycin in 12% and against rifampicin in 16%. All strains isolated were susceptible to vancomycin. Conclusion: Currently, the first generation cephalosporin cephalexin appears to be the preferential first‐line antibiotic for the treatment of bacterial superinfections with S. aureus in children and adults with AD due to its restricted antimicrobial spectrum to Gram‐positive bacteria and a limited number of Gram‐negative strains. Cefuroxim and amoxicillin/clavulanate, which also showed 3% resistances in our patients, cover a broader range of bacterial micro‐organisms. However, a broader coverage is not required in case of AD, as S. aureus is the most frequent bacterial micro‐organism causing skin infections.     

广州地区女性泌尿生殖道感染者解脲脲原体体外耐药变化的研究

目的控制非淋菌性尿道炎的蔓延,为合理使用抗生素提供依据。方法对广州地区女性泌尿生殖道感染患者解脲脲原体(UU)的药物敏感性进行了为期4年(2000年1月~2003年12月)的连续观察。对每年分离的UU进行10种常用抗生素的药敏检测,测定其对以上药物的敏感度及耐药率。结果多西环素、米诺环素和阿奇霉素的药物敏感度无明显改变;交沙霉素的耐药率显著上升,耐药率从2000年的7.6%上升至2003年的21.0%。结论UU的耐药趋势正逐渐增强;喹诺酮类药物的高耐药率表明该类药物在非淋菌性尿道炎治疗方面要严格控制和选择;对于UU感染的患者应根据药敏结果,合理选择抗菌药物。     

Sensitivity of Staphylococcus aureus and Streptococcus pyogenes Isolated from Skin Infections in 1992 to Antimicrobial Agents

We studied the efficacy of antimicrobial agents against Staphylococcus aureus (S. aureus) and Streptococcus pyogenes (S. pyogenes) isolated from skin infections in 1992. For S. aureus, we measured the minimum inhibitory concentrations (MICs) of the following 10 drugs: methicillin (DMPPC), cefaclor (CCL), gentamicin (GM), erythromycin (EM), clindamycin (CLDM), minocycline (MINO), vancomycin (VAN), fusidic acid (FA), ofloxacin (OFLX) and nadifloxacin (NDFX); for S. pyogenes, we determined the MICs of the following 9 drugs: ampicillin (ABPC), amoxicillin (AMPC), cefpodoxime proxetil (CPDX-PR), erythromycin (EM), clindamycin (CLDM), minocycline (MINO), norfloxacin (NFLX), ofloxacin (OFLX) and nadifloxacin (NDFX). These drugs are frequently used to treat skin infections, either systemically or topically. NDFX is a new synthetic fluoroquinolone, recently developed for use as a topical acne medication in Japan. It is used NDFX for acne, but not for skin infections. There were no strains of S. aureus resistant to NDFX, VAN or FA. The resistance (≧12.5 µg/ml) of S. aureus was highest to GM and lowest to OFLX. Four strains of methicillin-resistant (≧12.5 µg/ml) S. aureus (MRSA) were found. In contrast, no resistant strains of S. pyogenes were found except to MINO. Only two strains of S. pyogenes were susceptible to MINO. The sensitivity of S. pyogenes to ABPC, AMPC, CPDX-PR, EM and CLDM was very good. All the strains were susceptible at a MIC below ≧0.05 µg/ml. However, the S. pyogenes strains were not very sensitive to the new quinolones, especially NFLX. We concluded that penicillins, cephalosporins and macrolides are still effective against streptococcal infections. In contrast, we found S. aureus to be resistant to several kinds of antimicrobial agents. Accordingly, we need to check the sensitivity of S. aureus, before using antimicrobial agents for staphylococcal infections. Roughly speaking, the drugs that are strongly effective against S. aureus are not effective against S. pyogenes. For example, the efficacy of MINO against S. aureus was very good, but almost all S. pyogenes strains were resistant to it. The pattern is much the same for the new quinolones.     

单纯疱疹病毒耐药的流行趋势及其耐药机制的研究进展

单纯疱疹病毒是引起单纯疱疹和生殖器疱疹的主要病原体。近年来关于单纯疱疹病毒的耐药时有报道。大量研究证明,胸苷激酶和DNA聚合酶缺陷是导致单纯疱疹病毒耐药的主要机制。就近年来对HSV耐药的相关研究初步探讨单纯疱疹病毒耐药的流行趋势及其耐药机制。     

湿疹与特应性皮炎皮损处细菌学研究

目的 探讨湿疹和特应性皮炎(AD)皮损处的细菌学特点及金黄色葡萄球菌(金葡菌)在湿疹及AD发病中的作用。方法 多中心随机双盲对207例湿疹患者和119例AD患者皮损及非皮损处取材做细菌培养,并对所分离到的金葡菌进行常规药敏试验和噬菌体分型。结果 207例湿疹患者皮损处的细菌检出阳性率、金葡菌的比例及定植均明显高于非皮损处,差异有显著性(P<0.01)。119例AD患者皮损处的细菌检出阳性率及金葡菌的定植明显高于非皮损处,差异有显著性。对分离到的141株金葡菌进行噬菌体分型。Ⅰ组占6.3%,Ⅱ组占7.0%,Ⅲ组占3.5%,Ⅴ组占0.7%,杂组占1.4%,不能分型占56%,MRSA分型噬菌体26株混合组占6.3%。药敏试验结果表明在常用的6种外用抗菌药物中莫匹罗星对金葡菌和表皮葡萄球菌的抗菌活性最强,其MIC范围、MIC₉₀和MIC₅₀是6种抗菌药物中最低的。且莫匹罗星对金葡菌及其中的各噬菌体分型和表皮葡萄球菌中的耐甲氧西林和耐甲氧西林凝固酶阴性菌株也有较好的抑菌能力。结论 湿疹和AD的发病与细菌感染密切相关,其中金葡菌是最重要的细菌,对湿疹和AD患者外用药治疗合并使用外用抗菌药物是必要的,根据对金葡菌抗菌活性的测定,莫匹罗星的效果较好。     

天疱疮患者206例皮损分泌物病原学及药敏结果分析

目的分析天疱疮患者糜烂面皮损的病原菌组成及药敏情况,为临床早期合理选用抗生素提供依据。方法对本科2004年1月-2011年12月收治的206例天疱疮患者皮损分泌物细菌培养和药敏结果进行回顾性分析。结果分离出细菌200株中,金黄色葡萄球菌107株,耐甲氧西林金黄色葡萄球菌11株;50%以上金黄色葡萄球菌对青霉素、红霉素、克林霉素耐药,100%对万古霉素敏感,80%以上对利福平、复方新诺明敏感;29例多部位取材共检出病原菌53株。结论天疱疮糜烂面细菌主要由金黄色葡萄球菌构成,多数对青霉素、红霉素及克林霉素耐药,对万古霉素、利福平和复方新诺明敏感;病程长且多次就诊者易感染耐甲氧西林金黄色葡萄球菌;抗生素早期使用可参考皮损主要累及部位及该部位常见定植菌种类选择。