肝硬化并发自发性细菌性腹膜炎的临床特征及病原菌耐药分析

目的探讨肝硬化合并自发性细菌性腹膜炎(SBP)的临床特征及病原菌耐药情况。方法分析135例肝硬化合并SBP患者在抗感染治疗前后体温、腹部症状和体征、血常规、腹水白细胞及多核细胞数变化、腹水培养及药物敏感试验。结果 82.2%患者有发热,90.4%有腹部症状,88.9%有中等以上腹水7,0.4%有顽固性腹水;21.5%外周血白细胞数≥10.0×109/L,63.7%中性粒细胞0.7;45.2%腹水白细胞数0.5×109/L,57.8%多核细胞0.5;25.4%(30/118)细菌培养阳性,其中革兰氏阴性菌25例(83.3%),革兰氏阳性菌5例(16.7%),检测出的革兰氏阴性菌对大部分常用的抗菌药物耐药;治愈40例(29.63%),好转48例(35.56%),无效、恶化或自动出院47例(34.81%),其中死亡15例。结论肝硬化合并SBP的临床症状不典型,腹水培养阳性率低,以革兰阴性菌为主。除应尽早行腹水培养外,需根据临床症状、体征、血常规、腹水常规检查等综合分析,及时应用有效抗生素治疗,以提高患者的生存率。     

磷霉素对革兰阴性菌的体外抗菌活性研究

[目的] 了解磷霉素对革兰阴性菌的体外抗菌活性.[方法] 应用K-B纸片扩散法对革兰阴性菌进行体外敏感性实验.[结果] 大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌和产气肠杆菌对磷霉素耐药率为10%～22%;其他肠杆菌、铜绿假单胞菌及鲍曼不动杆菌分别为35%～41%、71%和95%.产ESBLs的大肠埃希菌和肺炎克雷伯菌对磷霉素的耐药率为16%和22%;肺炎克雷伯产酶菌耐药率(22%)明显高于非产酶菌(4%).对磷霉素敏感株而言,磷霉素对大肠埃希菌抑菌环直径远大于肺炎克雷伯菌.[结论] 对产ESBLs大肠埃希菌、肺炎雷伯菌、阴沟肠杆菌和产气肠杆菌引起的感染,可选用磷霉素,磷霉素对大肠埃希菌的抗菌活性高于肺炎克雷伯菌.对非发酵菌则不宜选用磷霉素进行临床治疗.     

医院革兰阴性菌感染的防治策略

医院感染30%以上为革兰阴性菌感染,其中肠杆菌科细菌最常见,而多耐药细菌如铜绿假单胞菌、鲍曼不动杆菌、产超广谱β-内酰胺酶或产碳青霉烯酶肠杆菌科细菌在全球范围有增加流行的态势。该文针对此类细菌所引起的下呼吸道感染、血流感染和尿路感染,综合新近文献资料,提供一套有循证医学基础的抗感染用药方案,供临床选用。     

2007-2009年我院3种非发酵革兰阴性杆菌药物敏感性调查

目的:了解鲍曼不动杆菌、铜绿假单胞菌、嗜麦芽窄食单胞菌对常用抗菌药物的耐药性。方法:K-B法对分离菌株进行抗菌药物药敏试验。结果:分别分离铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌745、367和25株。鲍曼不动杆菌耐药率达90%(头孢哌酮/舒巴坦例外,18%)。铜绿假单胞菌对复方新诺明、头孢噻肟、庆大霉素、哌拉西林耐药率80%。嗜麦芽窄食单胞菌分离率不高,对环丙沙星、头孢哌酮/舒巴坦、复方新诺明耐药率小于35%,对头孢噻肟、氨曲南、哌拉西林耐药率均超过80%。多重耐药菌株数分离率呈上升趋势,2009年58.54%菌株对5种抗生素均耐药。结论:3种非发酵糖革兰阴性杆菌耐药性严重,临床应根据药敏结果合理使用抗生素。     

外科病房革兰阴性杆菌耐的药性分析

目的了解我院外科病房革兰阴性杆菌的分布和耐药性情况。方法使用K-B纸片扩散法对276株临床分离菌进行抗菌药物敏感试验。结果分离出最常见的5种菌依次为:不动杆菌属、大肠埃希氏菌、克雷伯菌属、铜绿假单胞菌、和嗜麦芽窄食单胞菌。ESBLs在大肠埃希氏菌和克雷伯菌属中的检出率分别为41.1%和52.2%。非发酵菌对大多数抗菌药物高度耐药。结论加强耐药性监测,合理使用抗生素十分重要。     

Peptidoglycan activation of the proPO-system without a peptidoglycan receptor protein (PGRP)?

Recognition of microbial polysaccharide by pattern recognition receptors triggers the prophenoloxidase (proPO) cascade, resulting in melanin synthesis and its deposition on the surface of invading pathogens. Several masquerade-like proteins and serine proteinase homologues have been shown to be involved in the proPO activation in insects. In this study, a novel serine proteinase homologue, Pl-SPH2, was found and isolated as a 30 kDa protein from hemocytes of the freshwater crayfish, Pacifastacus leniusculus, by its binding property to a partially lysozyme digested or TCA-treated insoluble Lysine (Lys)-type peptidoglycan (PGN) and soluble polymeric Lys-type PGN. Two other proteins, the Pl-SPH1 and lipopolysaccharide- and β-1,3-glucan-binding protein (LGBP) were also found in the several different PGN-binding assays. However no PGRP homologue was detected. Neither was any putative PGRP found after searching available crustacean sequence databases. If RNA interference of Pl-SPH2, Pl-SPH1 or LGBP in the crayfish hematopoietic tissue cell culture was performed, it resulted in lower PO activity following activation of the proPO-system by soluble Lys-type PGN. Taken together, we report for the first time that Lys-type PGN is a trigger of proPO-system activation in a crustacean and that two Pl-SPHs are involved in this activation possibly by forming a complex with LGBP and without a PGRP.     

Invertebrate immune diversity

The arms race between hosts and pathogens (and other non-self) drives the molecular diversification of immune response genes in the host. Over long periods of evolutionary time, many different defense strategies have been employed by a wide variety of invertebrates. We review here penaeidins and crustins in crustaceans, the allorecognition system encoded by fuhc, fester and Uncle fester in a colonial tunicate, Dscam and PGRPs in arthropods, FREPs in snails, VCBPs in protochordates, and the Sp185/333 system in the purple sea urchin. Comparisons among immune systems, including those reviewed here have not identified an immune specific regulatory “genetic toolkit”, however, repeatedly identified sequences (or “building materials” on which the tools act) are present in a broad range of immune systems. These include a Toll/TLR system, a primitive complement system, an LPS binding protein, and a RAG core/Transib element. Repeatedly identified domains and motifs that function in immune proteins include NACHT, LRR, Ig, death, TIR, lectin domains, and a thioester motif. In addition, there are repeatedly identified mechanisms (or “construction methods”) that generate sequence diversity in genes with immune function. These include genomic instability, duplications and/or deletions of sequences and the generation of clusters of similar genes or exons that appear as families, gene recombination, gene conversion, retrotransposition, alternative splicing, multiple alleles for single copy genes, and RNA editing. These commonly employed “materials and methods” for building and maintaining an effective immune system that might have been part of that ancestral system appear now as a fragmented and likely incomplete set, likely due to the rapid evolutionary change (or loss) of host genes that are under pressure to keep pace with pathogen diversity.     

重症监护病房革兰阴性杆菌分布及耐药分析

目的 了解本院ICU革兰阴性杆菌的分布及耐药性,为临床合理使用抗感染药提供依据.方法 采用美国德灵MicroScan walkaway 96全自动微生物鉴定仪对本院2009年1月至2011年6月ICU患者分离的1472株革兰阴性杆菌进行鉴定及药敏试验.结果 我院ICU检出的革兰阴性杆菌以非发酵菌为主,其中铜绿假单胞菌比例为30.0％(442株),鲍曼不动杆菌比例为26.2％(385株).肠杆菌以奇异变形杆菌、肺炎克雷伯菌、大肠埃希氏菌为主,所占比例分别为11.6％(171株)、6.9％(1 01株)、5.6％(82株).各类细菌对常用抗感染药耐药性严重.结论 本院ICU检出的革兰阴性杆菌耐药率高,应进行定期监测,为临床合理使用抗感染药提供依据.     

多药耐药鲍曼不动杆菌——21世纪革兰阴性菌的“MRSA”

不动杆菌是一类非发酵、严格需氧的革兰阴性杆菌,普遍存在于自然界中。不动杆菌属至少可分为32个基因种型,其中,鲍曼不动杆菌、醋酸钙不动杆菌、不动杆菌基因种型3及13TU通过常规表型鉴定难以区分,合称为鲍曼一醋酸钙不动杆菌复合体。近年来,不动杆菌属在临床样本中的分离率逐年提高,而鲍曼不动杆菌约占其中的80％～90％。     

肺部感染革兰阴性杆菌耐药性研究

目的：监测我院门诊及住院患者G^-杆菌分布和耐药性状况。方法：采用接种血平板、巧克力平板、中国蓝平板,按美国临床实验室标准化委员会（CLSI／NCCLS）标准,判断药敏试验。结果：碳青霉烯类仍是对革兰阴性杆菌（除嗜麦芽窄食单胞菌）抗菌作用最强的一类抗生素。头孢吡肟、头孢西丁对大肠埃希菌、肺炎克雷伯杆菌也有较强的抗菌作用,阿米卡星对革兰阳性菌也有较强的抗菌作用。结论：碳氨酶类仍是对革兰阴性杆菌作用最强的一类抗生素,尤其是治疗ESBLS（＋）阴性菌的首选药物,但对于嗜麦芽窄食单胞菌耐药率较高。