160株儿童肺炎链球菌分离株的大环内酯类抗生素耐药特性研究

目的　研究 2 0 0 1年春季北京和西安市部分 0～ 5岁急性上呼吸道感染儿童鼻咽部肺炎链球菌分离株对红霉素及新型大环内酯类抗生素耐药特性。方法　使用超细鼻咽拭子从后鼻腔采取分泌物 ,用Optochin纸片做敏感性试验鉴定。采用E test方法及K B纸片扩散法对 16 0株肺炎链球菌分别进行 5种大环内酯类、6种其它相关抗生素敏感性检测。结果　 16 0株肺炎链球菌分离株中 ,90 6 %菌株的红霉素MIC等于或大于 1μg·mL-1为耐药株。在红霉素耐药的肺炎链球菌中 ,仅有 2 8%菌株的红霉素MIC在 1～ 4 μg·mL-1,为低水平耐药 ,97 2 %菌株的红霉素MIC在 16～≥ 2 5 6 μg·mL-1,为高水平耐药 ,其中 98 6 %耐药株的红霉素MIC≥ 2 5 6 μg·mL-1为极重度耐药。分离株对阿奇霉素、克拉霉素、罗红霉素、螺旋霉素耐药率与红霉素相似 ,分别为 90 6 %、89 4 %、88 1%和 88 1%。红霉素耐药表型分析显示 :以MLSB 耐药表型为主 ,占 97 2 % ;M耐药表型株仅为 2 8%。红霉素耐药分离株对克林达霉素、四环素、复方新诺明共同耐药率及多重耐药发生率分别为 96 6 %、97 2 %、85 6 %和 99 3% ,明显高于红霉素敏感组肺炎链球菌的 13 3%、73 3%、2 6 7%和 0。结论　北京和西安两地急性上呼吸道感染儿童鼻咽部肺炎链球菌分离株对红     

A族链球菌与急性坏死性筋膜炎

近年来由A族链球菌(group A streptococcus,GAS)引起的急性坏死性筋膜炎(acute necrotizingfascilitis,ANF)等严重感染逐渐增多,可占GAS感染总数的30%,此类GAS严重感染称为侵袭性GAS感染[1,2]。食肉菌(flesh_eating bacteria)一词最早出现在上世纪90年代国外一些小报上,特指引起进行性坏死性感染的病原菌,之后也被医学界采用作为非专有名词[3]。近十余年来,国外关于食肉菌感染的报道甚多,国内重视程度不够。一、ANF的流行病学和临床表现ANF是食肉菌感染的最典型代表,是一种进展迅速、伴有皮下组织和脂肪进行性坏死的播散性深部筋…     

A族链球菌严重全身性感染

20世纪50年代至80年代早期,由于准确及时的诊断和抗生素的广泛使用,A族链球菌(group Astreptococcus,GAS)感染率及严重后遗症的发生率显著下降,人类对GAS感染的关注也随之减少。然而从20世纪80年代后期开始,由GAS引起的坏死性筋膜炎、链球菌肌炎、链球菌中毒性休克综合征(streptococcal toxic shock syndrome,STSS)和恶性猩红热等严重全身性感染又逐渐增多,可占GAS感染总数的30%,此类GAS严重感染称为侵袭性GAS感染。尽管在墨西哥湾和东南亚包括中国香港等地,某些弧菌也被认为是坏死性筋膜炎的病原菌,但绝大多数情况下坏死性筋膜炎…     

Necrotizing fasciitis due to Streptococcus pyogenes

Necrotizing fasciitis is a severe infection, with systemic involvement and tissue necrosis. The clinical course is rapid and often fatal. Although this entity is uncommon, early recognition and treatment is essential to improve prognosis. Necrotizing fasciitis should be suspected when there are symptoms of toxicity and there is severe pain, frequently out of proportion to the clinical findings. In addition, in the last few years the incidence of invasive disease due to Streptococcus pyogenes in children has increased. Treatment is based on life support, aggressive debridement, and antimicrobial therapy. Intravenous immunoglobulin (IVIG) as adjunctive therapy seems useful and reduces mortality. The case of an infant with necrotizing fasciitis of four extremities is presented.     

Streptococcus pyogenes pyomyositis

Group A beta-hemolytic Streptococcus pyomyositis continues to be an uncommon disease. We present a case of a 7-year-old boy with an M protein type 1, streptococcal pyrogenic exotoxin A and B, Streptococcus pyogenes pyomyositis and streptococcal toxic shock syndrome.     

Streptococcus pyogenes meningitis

Group A Streptococcus (GAS) is a rare cause of meningitis. Although it has a high mortality, the condition is easily treatable if diagnosed early since the bacteria retains its sensitivity to many antimicrobials. The authors report here two cases of GAS meningitis along with a review of world literature.