2012—2015年1380株肝移植术后感染病原菌的分布及耐药性分析

目的了解江苏省人民医院肝移植术后感染病原菌的分布及耐药性,为临床合理用药提供参考。方法对2012年1月—2015年1月江苏省人民医院肝移植术后感染病原菌的分布及耐药性进行统计分析。结果共分离出病原菌1 380株,主要来源于痰液标本。病原菌分布以革兰阴性菌为主,占69.57%,革兰阳性菌和真菌分别占20.07%、10.36%;其中革兰阴性菌以鲍曼不动杆菌、肺炎克雷伯菌为主,革兰阳性菌以溶血葡萄球菌为主;革兰阴性菌对美罗培南、阿米卡星、亚胺培南较为敏感,耐药率均低于30%,对头孢曲松、氨曲南等的耐药率均较高;革兰阳性菌对万古霉素、利奈唑胺、替考拉宁较为敏感,耐药率均低于20%,对氨苄西林、诺氟沙星等耐药率均较高。结论肝移植术后感染病原菌的构成主要是鲍曼不动杆菌、肺炎克雷伯菌和溶血葡萄球菌,临床选择抗菌药物时建议选用病原菌表现较低耐药性的美罗培南、阿米卡星、万古霉素、利奈唑胺等药物。     

Diagnostic value of gastric aspirate smear and polymerase chain reaction in smear-negative pulmonary tuberculosis

OBJECTIVE: The aim of this study was to determine the validity of acid-fast bacilli (AFB) smear and polymerase chain reaction (PCR) from gastric aspirates for the diagnosis of smear-negative pulmonary tuberculosis. METHODOLOGY: A cross-sectional study was conducted in a university hospital. One hundred and nine patients with suspected pulmonary tuberculosis in whom either sputum smears were negative or who were not producing sputum were recruited to the study. All patients underwent gastric aspiration after an overnight fast followed by standard fibreoptic bronchoscopy. Specimens were subjected to AFB smear, culture, and pathological examination. PCR was performed on culture filtrate after 1 week of incubation. RESULTS: Eight patients did not complete the follow-up schedule. Of the 101 patients with final outcomes, a diagnosis of pulmonary tuberculosis from microbiological evidence was established in 54 patients. The gastric aspirate smear, PCR, or either one of them was positive in 34, 30, and 39 tuberculosis patients, respectively. There were 13 false positive smears from 47 non-tuberculosis patients, with five resulting from non-tuberculous mycobacteria (NTM). The PCR was falsely positive in eight patients, five of whom had previous histories of tuberculosis. The overall sensitivity, specificity, positive predictive value, and negative predictive value of gastric aspirate examination by combined smear and PCR were 72, 58, 66, and 64%, respectively. CONCLUSIONS: Gastric aspiration is a useful tool for the diagnosis of smear-negative pulmonary tuberculosis warranting institution of antituberculosis treatment. Interpretation of the results should be cautious in those who have had tuberculosis in the past or who have been at risk for acquisition of NTM.     

2015-2017年荆州市中心医院临床分离菌分布及耐药性分析

深入调查2015-2017年荆州市中心医院临床分离菌的分布及对临床常用抗菌药物的耐药性,为临床合理用药提供依据。菌株抗菌药物敏感性试验采用自动化仪器法或纸片扩散法。回顾性分析我院连续3年临床菌株药敏数据,结果判读根据2017年CLSI。3年我院临床分离株共11049株,其中革兰阳性菌和革兰阴性菌分别为30.2%和69.8%。耐甲氧西林株金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)的平均检出率分别为33.4%和75.6%。MRSA对复方磺胺甲噁唑敏感率92%~95.9%;MRCNS对利福平敏感率90.7%~90.8%,耐甲氧西林株(MRSA和MRCNS)对其他抗菌药的耐药率均高。未发现万古霉素耐药株。肠球菌属中屎肠球菌较粪肠球菌对多数测试抗菌药物(除四环素外)的耐药率均高,两者中均未检出万古霉素耐药株。肺炎链球菌非脑膜炎株儿童株中青霉素敏感株逐年下降,中介株的检出率有所上升。大肠埃希菌对碳青霉烯类抗生素仍高度敏感。肺炎克雷伯菌对亚胺培南耐药率从1.1%上升到4.5%,对美罗培南耐药率从1%上升到3.8%,耐药率稳步上升。鲍曼不动杆菌对亚胺培南的耐药率从65.5%升高到80.3%,对美罗培南的耐药率从65.4%升高到80.3%。铜绿假单胞菌对亚胺培南耐药率从13.1%升高到21.2% ,对美罗培耐药率从8.3%升高到20.1%。临床分离的耐药菌呈增长趋势,其中碳青霉烯类耐药肺炎克雷伯菌增长趋势明显,应持续进行细菌耐药监测,加强与临床和院感沟通,共同促进院感控制和规范合理用药。     

Alkylidene Oxapenem β-Lactamase Inhibitors Revisited: Potent Broad Spectrum Activity but New Stability Challenges

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革兰阴性菌中分子伴侣在双组分蛋白分泌至周质空间过程中的作用

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