双歧三联活菌联合蒙脱石散治疗小儿急性腹泻疗效观察

目的：探讨双歧三联活菌联合蒙脱石散治疗急性腹泻对患儿排便次数及症状改善的影响。方法选择2012年8月至2013年8月在我院接受治疗的急性腹泻患儿132例作为研究对象。根据随机数表法将患儿分成观察组和对照组各66例。对照组患儿给予蒙脱石散治疗,观察组在此基础上采用双歧三联活菌进行治疗。比较两组患儿治疗前后的腹泻排便次数、疗效以及症状改善情况。结果观察组患儿治疗后5d的腹泻排便次数明显少于对照组,差异有统计学意义(P<0.05);观察组患儿的显效率和总有效率分别为65.15%,98.48%,均明显高于对照组的45.45%,86.36%,差异均有统计学意义(P<0.05);观察组患儿的腹痛消失时间、呕吐消失时间、退热时间及大便常规的正常时间均少于对照组,差异均有显著统计学意义(P<0.01)。结论双歧三联活菌与蒙脱石散联合治疗小儿急性腹泻可明显减少患儿排便次数,改善其临床症状,疗效明显,值得临床上推广应用。     

Role of fine‐needle aspiration cytology and fluid cytology in extra‐pulmonary tuberculosis

Extra‐pulmonary tuberculosis is the presence of disease in an organ without obvious involvement of the lungs (World Health Organization, Tuberculosis Fact sheet, 2006). The present article focuses on the incidence of extra‐pulmonary tuberculosis as an emerging and clinically significant disease to be reckoned with in the present era. It also highlights fine‐needle aspiration cytology (FNAC) as an inexpensive, less invasive procedure for early diagnosis of such tuberculosis and timely initiation of specific therapy. All cases of proved tuberculosis presenting to the M.V.J. Medical College and Research Hospital were recorded over a period of two years (2008–2010); and categorized as pulmonary and extra‐pulmonary cases. A total of 96 cases of tuberculosis were observed; extra‐pulmonary tuberculosis was seen in 64 cases. Of these 56 cases were from lymphnodes and 8 from extra‐nodal sites which included tuberculous dactylitis (two cases), tuberculous mastitis (two cases), tuberculous synovial effusion (one case), pericardial effusion (one case), epididymo‐orchitis (one case), and cold abscess (one case). The cytology patterns observed included granulomatous inflammation and necrosis with or without acid fast bacilli. Diagn. Cytopathol. 2013. © 2012 Wiley Periodicals, Inc.     

Direct determination of carbapenem-resistant Enterobacteriaceae and Pseudomonas aeruginosa from positive blood cultures using laser scattering technology

Delays in appropriate antimicrobial treatment contribute to increased mortality of septic patients. We aimed to develop a methodology for detection of carbapenem resistance in Gram-negative bacteria directly from positive blood cultures (BCs). Initially, meropenem-resistant Enterobacteriaceae (n?=?13) and Pseudomonas aeruginosa (n?=?32) isolates as well as the same numbers of meropenem-susceptible isolates were used to establish the detection of carbapenem resistance from agar cultures. Growth-based phenotypic detection of meropenem resistance was performed by a laser scattering (LS) method using a BacterioScan?216R instrument. A subset of the strain collection consisting of meropenem-susceptible and -resistant isolates (each comprising seven P. aeruginosa and three Klebsiella pneumoniae) was used for determination of carbapenem resistance directly from positive BCs. Lysis/centrifugation and filtration/dilution methods were investigated for processing of positive BCs. Four different statistical approaches to discriminate between susceptible and resistant bacteria in real-time were applied and were compared regarding their sensitivity and specificity. After 3?h and 4?h of incubation, respectively, detection of carbapenem resistance in Enterobacteriaceae (sensitivity, 100%; specificity, 100%) and P. aeruginosa (sensitivity, 100%; specificity, ≥90%) agar cultures was attainable. Detection of carbapenem resistance directly from positive BCs was achievable with 100% sensitivity and 100% specificity after 4?h and 5?h, respectively, applying lysis/centrifugation and filtration/dilution methods. In conclusion, LS technology combined with lysis/centrifugation and appropriate statistical real-time analyses represents a promising option for rapid detection of carbapenem resistance in Gram-negative rods directly from positive BCs.     

Is gentamicin safe and effective for severe community-acquired pneumonia? An 8-year retrospective cohort study

Gram-negative bacilli are the causative organisms in a significant proportion of patients with severe community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU). Clinical guidelines recommend broad-spectrum antimicrobials for empirical treatment despite alarming global trends in antimicrobial resistance. In this study, we aimed to assess the safety and efficacy of gentamicin, an aminoglycoside with potent bactericidal activity, for empirical Gram-negative coverage of severe CAP in patients admitted to the ICU. A retrospective cohort study was performed at a university teaching hospital where the severe CAP guideline recommends penicillin, azithromycin and gentamicin as empirical cover. Ceftriaxone plus azithromycin is used as an alternative. Adults with radiologically-confirmed severe CAP were included, comparing those who received gentamicin in the first 72?h of admission with those who did not. Participants were identified using ICD-10 codes for bacterial pneumonia and data manually extracted from electronic medical records. Of 148 patients admitted with severe pneumonia, 117 were given at least one dose of gentamicin whereas the remaining 31 were not. The two groups were well matched in terms of demographics, co-morbidities and disease severity. There were no significant differences between the gentamicin and no-gentamicin groups in the incidence of acute kidney injury [60/117 (51%) vs. 16/31 (52%), respectively], hospital mortality [20/117 (17%) vs. 7/31 (23%)] and secondary outcomes including relapse and length of hospital stay. In conclusion, gentamicin is safe and has similar outcomes to alternative Gram-negative antimicrobial regimens for empirical coverage in severe CAP patients admitted to the ICU.     

痰标本分离革兰阴性杆菌整合子分布及分型研究

目的研究临床痰标本分离革兰阴性杆菌中整合子的分布与分型。方法用Ⅰ类、Ⅱ类和Ⅲ类3种整合酶基因通用引物扩增398株痰标本分离革兰阴性杆菌的相应基因;用琼脂对倍稀释法检测临床菌株的MIC。结果Ⅰ类整合酶基因总阳性率为48.7%,Ⅱ类整合酶基因总阳性率为2.3%,未检出Ⅲ类整合酶基因阳性菌株,Ⅰ类和Ⅱ类整合子同时阳性率为1.5%。肠杆菌科细菌Ⅰ类整合酶基因阳性率为69%,Ⅱ类整合子阳性率为2.7%;非发酵菌中Ⅰ类整合子阳性率为34%,Ⅱ类整合子阳性率为1.8%。在肠杆菌科细菌中,Ⅰ类整合酶基因阳性菌株对多种抗菌药物的耐药率均明显高于阴性菌株。结论在痰标本分离的革兰阴性杆菌中,肠杆菌科细菌Ⅰ类整合子的携带率高于非发酵菌,Ⅱ类整合子则无明显区别。     

慢性阻塞性肺疾病伴社区获得性肺炎60例病原菌及其耐药性分析

目的 对COPD伴社区获得性肺炎病原菌和耐药情况进行分析,为临床合理用药提供依据.方法 对60例COPD伴社区获得性肺炎患者的痰液标本进行病原菌检测和药敏性试验.结果 病原菌以肺炎链球菌为主24例（40％）,其次为肺炎克雷伯菌10例（13.3％）、流感嗜血杆菌8例（16.7％）、肺炎支原体6例（8.3％）、甲型溶血性链球菌5例（6.7％）、金黄色葡萄球菌4例（3.3％）、嗜肺军团菌2例（3.3％）、其它1例（1.67％）;药敏试验显示革兰阴性菌具有较高的耐药率.流感嗜血杆菌、肺炎链球菌、嗜肺军团菌体对青霉素具有较高的耐药率.肺炎支原体、肺炎克雷伯菌对阿奇霉素表现出一定的耐药率.金黄色葡萄球菌、甲型溶血性链球菌对头孢噻吩表现出耐药性.结论 COPD伴社区获得性肺炎患者感染病菌情况主要以革兰阴性菌抗生素耐药较为严重.在之后的临床使用抗生素选择其它类的抗生素,提高临床药物抗菌疗效.     

我院2012年10月-2013年3月革兰阴性杆菌产ESBLs和AmpC酶检测及耐药性分析

目的:了解我院产超广谱β-内酰胺酶(ESBLs)和头孢菌素酶(AmpC)革兰阴性杆菌的耐药性,为临床合理用药提供参考。方法:收集我院2012年10月-2013年3月临床分离出的革兰阴性杆菌。用头孢硝噻吩纸片检测革兰阴性杆菌产β-内酰胺酶情况,双纸片法检测产ESBLs情况,头孢西丁三维试验检测产AmpC酶情况,以确定产酶表型。用K-B法进行药敏检测。结果:103株革兰阴性杆菌中,单产AmpC酶菌42株(40.8%),单产ESBLs菌21株(20.4%),同时产ESBLs和AmpC酶菌12株(11.7%)。大肠埃希菌和肺炎克雷伯菌对含酶抑制剂复方制剂如哌拉西林/他唑巴坦,以及碳青霉烯类抗生素亚胺培南和氨基糖苷类抗生素阿米卡星的耐药率均较低。非发酵菌铜绿假单胞菌和鲍曼不动杆菌对各抗生素耐药率均较高。结论:各革兰阴性杆菌产酶菌株对多种抗生素的耐药率较高,产ESBLs和AmpC酶可能是导致革兰阴性杆菌耐药的主要机制之一。     

应用16SrRNA基因序列分析快速鉴定临床标本中的革兰氏阳性杆菌

目的探索一种快速鉴定临床标本中革兰氏阳性杆菌的方法。方法利用PCR技术扩增待检菌株的16SrRNA基因序列,通过分析待检菌株的16SrRNA基因序列对其进行鉴定。结果5株待检菌株的16SrRNA基因序列均成功扩增,其中4株的16SrRNA基因序列与基因库中已注册的核酸序列相似率达99．9％以上,将其鉴定到种的水平,1株的16SrRNA基因序列与基因库中雷弗森菌属的核酸序列相似率为97．09％,将其鉴定为雷弗森菌属。结论应用16SrRNA基因序列分析可快速、准确地鉴定临床标本中的革兰氏阳性杆菌。