Factors Predictive of Seizures Among Intensive Care Unit Patients with Gram-Negative Infections

From the medical records of 238 intensive care unit (ICU) patients who had infections with gram-negative pathogens commonly associated with serious illness, we developed a predictive score of clinical risk factors for seizures. To evaluate the predictive ability of this score, we applied it to a separate population of 645 seriously ill hospitalized patients with similar gram-negative infections who were in antibiotic clinical trials. The patients at highest risk were classified into one of the following three categories: (a) patients with major central nervous system (CNS) insults (CNS surgery, hemorrhage, infection, or other lesion within 1 month before hospital admission or any history of CNS neoplasia), (b) patients with a predisposing factor (renal impairment or a history of seizures) plus a precipitating factor (anoxic encephalopathy/coma or an acute hypotensive episode), and (c) patients with both renal impairment and a history of seizures. Receiver operating characteristic (ROC) curves were calculated in each of the two populations. The area under the ROC curve (AUC) represents the probability that the score would rank a randomly chosen patient who subsequently had a seizure as having had a greater prior level of seizure risk than a randomly chosen patient who did not experience a seizure. The AUC was 0.87 (SE = 0.05) for the original population used to develop the score and 0.81 (SE = 0.04) for the population used for the validation study. The clinical risk score, based on readily available information, provides a useful means to identify among seriously ill infectious disease service patients, those who are at highest risk for seizures. It also serves as a baseline for evaluating the non-drug-related risk factors for seizures in patients treated with antibiotics.     

Effect of Dampness on the Enteric Bacilli，SlgA and Pathological Studies in Rate

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非发酵G-杆菌院内获得性肺炎的诊治策略

随着抗生素的广泛应用，人类常见的敏感菌感染正逐步减少，而过去一些少见的非机会致病菌经抗生素的筛选，如今已成为重要的感染源。这些机会致病菌往往具有耐药性，严重威胁着病人的生命，特别是以绿脓杆菌为主的非发酵G^-杆菌的肺部感染正日益成为，临床密切关注的问题。本文就非发酵G^-杆菌院内获得性肺炎的发病情况及治疗策略作一叙述。     

Hyperaggregation of platelets in intestinal tuberculosis: Role of platelets in chronic inflammation

Eighty-eight percent (38/43) patients of intestinal tuberculosis showed significant hyperaggregation of platelets (P < 0.001). Serum and plasma from 15 patients when incubated with normal platelets caused hyperaggregation. Gel filtered platelets from 2 patients suspended in normal plasma showed hyperaggregation of platelets with arachidonic acid. Tubercular protein had no effect on platelet aggregation. A role of hyperactive platelets in chronic inflammatory response is discussed. ©1995 Wiley-Liss, Inc.     

Activity of benzalkonium chloride and chlorhexidine diacetate against wild-type and envelope mutants of Escherichia coli and Pseudomonas aeruginosa

Whole cells of wild-type (DCO) and envelope mutant (DC2) strains of Escherichia coli took up approximately equal amounts of the cationic surfactant, benzalkonium chloride, although the mutant was considerably more sensitive to this bactericide. Lower concentrations of benzalkonium were needed to induce K⁺ leakage from the mutant than from the parent cells. DCO and DC2 showed the same order of sensitivity to chlorhexidine diacetate (minimum inhibitory concentrations against single cell inocula, 1.5 and 0.4 $\text{μg}\text{ml}$, respectively) and took up approximately equal amounts of this antiseptic. K⁺ leakage was much greater from DC2 exposed to benzalkonium and slightly higher from chlorhexidine-treated DC2 than from drugtreated DCO. Similar studies with wild type (799) and envelope mutant ($\text{799}\text{61}$) strains of Pseudomonas aeruginosa showed that they took up similar amounts of benzalkonium or of chlorhexidine from solution. However, somewhat greater leakage of K⁺ occurred from $\text{799}\text{61}$ than from 799. Lysozyme-EDTA spheroplasts of a wild-type strain and its envelope mutant were equally sensitive to an antibacterial agent.     

Comparison of two sampling methods for the detection of gram-positive and gram-negative bacteria in the environment: moistened swabs versus Rodac plates

The objective of this study was to evaluate the moistened swab technique vs. Rodac plates for detecting Gram-positive and Gram-negative bacteria in the inanimate environment. Over a period of 22 months, the environment of 190 patients infected or colonized with MRSA, VRE or multiresistant Gram-negative bacteria was sampled in turn. MRSA and VRE could be detected with either method in 33 out of 54 (61.1%) patient rooms in 174 out of 706 (24.6%) environmental samples. However, multiresistant Gram-negative bacteria were found in 42 out of 136 (30.9%) rooms with a very low frequency of 89 out of 1827 (4.9%) environmental samples (p < 0.0001). The sensitivity of the swab technique for Gram-positive cocci was 54% (94/174) vs. 69.5% (121/174) for the Rodac plates, ([CI95%], 47-61% vs. 62-76%, p < 0.05). In contrast, the sensitivity of the swab technique for Gram-negative bacteria was 74.2% (66/89) vs. 42.7% (38/89) for the Rodac plates, ([CI95%], 64-83% vs. 32-54%, p < 0.05). In conclusion, environmental contamination with Gram positive cocci is detected more often than with Gram-negative bacteria. For the detection of Gram-positive cocci, Rodac plates are superior to the swab technique; whereas Gram-negative rods can be detected more often by the swab technique. All these results proved to be statistically significant.     

呼吸内科门诊革兰阴性杆菌耐药性分析

目的:研究我院呼吸内科门诊病人中分离的革兰阴性杆菌耐药情况,并探讨对耐药菌感染的治疗策略。方法:选呼吸内科门诊病人116例,男性85例,女性31例,年龄(59±s 8)a,均有使用抗生素史。采集病人的标本包括痰液78份(其中7份来自纤支镜气管吸出物)、血液3份、尿液7份、支气管灌注液26份、胸腔积液2份。采用E试验法测定116株革兰阴性杆菌对11种抗菌药物的最低抑菌浓度(MIC)。结果:116株革兰阴性杆菌对11种抗菌药物均有不同程度耐药。筛选出超广谱β-内酰胺酶(ESBLs)产生菌11株,抗菌活性最强的是亚胺培南、头孢哌酮-舒巴坦和哌拉西林-三唑巴坦,敏感率分别为89.4%、76.3%和69.1%。结论:亚胺培南、β-内酰胺类抗菌药物与β-内酰胺酶抑制药复合制剂可作为治疗产β-内酰胺酶耐药株感染的选用药物,而亚胺培南可列为首选。     

我院2005年临床分离菌菌群分布及耐药分析

目的:了解我院临床分离菌的分布及耐药情况,为指导临床合理用药提供参考依据.方法:采用Vitek-2全自动微生物分析仪及纸片扩散法(Kirby-Bauer)对2 024株分离菌进行鉴定及药敏实验.结果:2024株分离菌中革兰阴性菌占53.6%,革兰阳性菌占36.0%,真菌占10.4%,金黄色葡萄球菌及凝固酶阴性的葡萄球菌中甲氧西林耐药株各占30.2%和34.4%.革兰阳性球菌中万古霉素抗菌活性最强,粪肠球菌对万古霉素耐药率为1.7%.革兰阴性杆菌中亚胺培南抗菌活性最强,铜绿假单胞菌对其有4.6%的耐药率;大肠埃希菌及肺炎克雷伯菌超广谱β-内酰胺酶的检出率为65.0%和40.0%.结论:本资料对临床治疗及抗生素药物的选用有参考价值.     

4种非发酵糖革兰阴性杆菌氨基糖苷类修饰酶基因研究

目的 分析解放军第98医院临床分离的4种非发酵糖革兰阴性杆菌中氨基糖苷类修饰酶(AMEs)基因存在状况.方法 在2000年7月至2004年10月间从临床分离60株鲍曼不动杆菌(Ab)、30株铜绿假单胞菌(Pa)、19株嗜麦芽窄食单胞菌(Sm)和15株黄杆菌属细菌(Fb),采用PCR及序列分析法分析9种AMEs基因aac(3)-Ⅰ、aac(3)-Ⅱ、aac(3)-Ⅲ、aac(3)-Ⅳ、aac(6')-Ⅰ、aac(6')-Ⅱ、ant(3')-Ⅰ、ant(2')-Ⅰ和aph(3')-Ⅵ.结果 Ab、Pa、Sm和Fb中9种AMEs基因总阳性率分别为81.7%、86.7%、10.5% 和0.0%.Ab、Pa和Sm中分别检出8种、5种和2种基因.aac(3)-Ⅲ基因均阴性,各菌种中阳性率最高的基因分别是Pa中aac(3)-Ⅱ(76.7%)、Ab中ant(3')-Ⅰ (60.0%)、Sm 中aac(6')-Ⅱ和ant(2')-Ⅰ(均为10.5%).结论 临床分离的非发酵糖革兰阴性杆菌(除Fb外)中至少存在8种AMEs基因,Pa及Ab中AMEs基因携带率高.