63例医院感染败血症的临床特征分析

目的探索医院感染败血症的特点和预防措施. 方法对我院1998～2003年63例住院患者,医院感染败血症的临床资料进行回顾性分析. 结果医院感染败血症发生率为0.06%,病死率达33.33%,发病与基础疾病、侵入性操作和联用多种抗生素等有明显的关系,感染细菌以革兰阴性杆菌为主. 结论提高机体免疫力、减少侵入性操作和合理使用抗生素是预防住院患者医院感染败血症的主要措施.     

枯草杆菌、肠球菌二联活菌多维颗粒剂联合鲁米那钠治疗母乳性黄疸临床观察

目的:观察枯草杆菌、肠球菌二联活菌多维颗粒剂联合鲁米那钠治疗母乳性黄疸的疗效。方法:将60例母乳性黄疸患儿随机分为Ⅰ、Ⅱ组,各30例患儿。两组均维持母乳喂养,Ⅰ组同时给予枯草杆菌、肠球菌二联活菌多维颗粒剂及鲁米那钠治疗;Ⅱ组仅用鲁米那钠治疗。两组患儿均治疗7至14天,观察其黄疸消退情况、治疗前及治疗7天后血清胆红素水平变化。结果:服药后3天两组患儿黄疸均开始减轻,7天时I组33%、Ⅱ组20%的患儿黄疸消失;第14天时Ⅰ组93%、Ⅱ组63%的患儿黄疸消失。用药前,两组患儿血清胆红素水平无明显差异(P>0.05),用药7天后Ⅰ组胆红素水平较Ⅱ组明显降低(P<0.05)。结论:对母乳性黄疸患儿,联合使用枯草杆菌、肠球菌二联活菌多维颗粒剂及鲁米那钠,对改善症状和降低血清胆红素水平优于单用鲁米那钠,疗效显著。     

β-内酰胺类抗菌药物/β-内酰胺酶抑制剂复方制剂使用强度与常见革兰阴性菌耐药率关联性分析

目的 探讨 β-内酰胺类抗菌药物/β内酰胺酶(β-内酰胺酶抑制剂复方制剂)使用强度与常见革兰阴性菌耐药率的关联性,为临床合理用药提供依据.方法 回顾性分析2017年至2019年医院大肠埃希菌(ECO)、肺炎克雷伯菌(KPN)、铜绿假单胞菌(PAE)耐药性变迁情况,以及哌拉西林舒巴坦(PIS)、哌拉西林他唑巴坦(TZP)...     

2010-2013年柳州市工人医院血液科革兰阴性菌的分布与耐药性分析

目的了解广西柳州市工人医院2010-2013年血液科常见革兰阴性菌的分布及耐药趋势,以指导临床合理使用抗菌药物。方法对2010年1月-2013年12月广西柳州市工人医院血液科送检分离出的病原菌菌株及其耐药性进行回顾性调查分析。结果共分离出常见的革兰阴性菌508株,主要以大肠埃希菌和肺炎克雷伯菌为主,分别占26．2％、21．7％;铜绿假单胞菌和鲍曼不动杆菌检出率分别为16．5％、13．6％。超广谱β-内酰胺酶检测结果显示,肺炎克雷伯菌和大肠埃希菌的平均检出率分别为40．2％、60．5％。阴沟肠杆菌、肺炎克雷伯菌和大肠埃希菌对碳青霉烯类抗菌药物总体上有较高的敏感性;铜绿假单胞菌、鲍曼不动杆菌对多数抗菌药物高度耐药,且呈逐年上升趋势。结论血液科临床分离的革兰阴性菌的比例较高,对常用抗菌药物耐药严重,应加强革兰阴性杆菌耐药性的动态监测,以指导临床进行合理规范的抗感染治疗。     

2008-2012年天津市第一中心医院老年慢性阻塞性肺疾病急性加重期病原菌的分布及耐药性分析

目的了解老年慢性阻塞性肺疾病急性加重期（AECOPD）患者病原菌分布特点及耐药情况,为临床合理应用抗菌药物提供理论依据。方法对天津市第一中心医院呼吸科病房2008年1月-2012年12月老年AECOPD患者痰标本分离确认的121株病原菌构成及耐药性进行统计分析。结果共分离病原菌121株,其中革兰阴性菌84株（占69．4％）,主要有铜绿假单胞菌、肺炎克雷伯杆菌、鲍曼不动杆菌和阴沟肠杆菌;革兰阳性菌共24株（占19．8％）。药物敏感实验结果显示,碳青霉烯类抗菌药物对主要革兰阴性杆菌仍保持较高的敏感性,但革兰阴性杆菌对常用β-内酰胺类药物的耐药性明显增加。结论老年AECOPD患者感染以革兰阴性杆菌为主,且耐药严重。早期经验性选择抗菌药物应选择敏感性相对较高的药物,并根据药敏结果选择敏感药物,以减少耐药菌株的产生。     

华西医院重症监护病房连续两年院内感染革兰阴性杆菌的耐药性监测

目的调查分析我院重症监护病房（ICU）医院感染革兰阴性杆菌的菌群分布和耐药现状及耐药变迁，指导临床合理使用抗生素。方法采用E—test药敏试验测定我院重症监护病房连续两年分离的200株院内感染革兰阴性杆菌对12种抗生素的最低抑菌浓度（MIC）。结果ICU病房分离率最高的院内感染革兰阴性杆菌依次为大肠埃希菌（34％），不动杆菌属细菌（18％）,铜绿假单胞菌（15．5％），克雷伯菌属细菌（15．5％），肠杆菌属细菌（13％）；两年中总耐药率最低的是亚胺培南；呼吸道标本中最常见的为不动杆菌属细菌（23％），铜绿假单胞菌（18．7％），克雷伯菌属细菌（18．7％），大肠埃希菌（17％）；尿标本中主要分离菌为大肠埃希菌（81％）；血液标本中主要分离菌为大肠埃希菌（73％）。呼吸道标本中,2004年铜绿假单胞菌的分离率25％明显高于2003年1．4％；大肠埃希菌和肺炎克雷伯菌超广谱β-内酰胺酶（ESBLs）的发生率从2003年的47％和35．7％升高到2004年的50％和53％。结论亚胺培南对大肠埃希菌和肠杆菌属细菌均保持很高的敏感性，铜绿假单胞菌对头孢他啶和阿米卡星的敏感性最高，不动杆菌属细菌对头孢哌酮／舒巴坦、亚胺培南的敏感性最高,但对亚胺培南的耐药率呈上升趋势。因此，进行本医院、本地区的细菌耐药动态监测对指导临床抗感染经验用药是非常必要的。     

Prognostic importance of gram-negative intestinal colonization preceding pancreatic infection in severe acute pancreatitis

Objectives: To establish, firstly, whether gram-negative (re)-colonization of the gut leads to an increased risk of gram-negative pancreatic infections and whether this event is time-related and, secondly, whether the difference in the quantity and quality of micro-organisms colonizing the digestive tract influences morbidity and mortality. Design: Prospective analysis of the results of systematic semi-quantitative cultures of several body areas taken from patients with severe acute pancreatitis, during a controlled multicenter trial of adjuvant selective decontamination. Setting: Surgical intensive care units of 16 hospitals. Patients: A total of 2159 semi-quantitative cultures from the oropharynx, rectum and pancreatic tissues taken from 90 patients were analyzed. Interventions: Surveillance cultures from the oropharynx and rectum were taken on admission and repeated twice weekly and from the (peri)-pancreatic devitalized tissues (i. e. necrosis) at every relaparotomy and from drainage. Measurements and results: All gram-negative pancreatic infections were preceded by intestinal colonization with the same micro-organisms. The risk of developing a pancreatic infection following gram-negative intestinal colonization (15/42 patients) was significantly higher as compared to patients without gram-negative colonization (0/10 patiens) (p < 0.001) or to patients in whom E. coli was the only intestinal micro-organism cultured (0/30 patients) (p < 0.001). The occurrence of intestinal E. coli did not increase the risk of pancreatic infection. Gram-negative colonization of the rectum and oropharynx significantly correlated with the later development of pancreatic infection: relative risks 73.7 (p < 0.001) and 13.6 (p < 0.001), respectively. However, when both areas were evaluated simultaneously, the rectum was more significant (p < 0.001). The severity of intestinal intestinal colonization until the moment of pancreatic infection showed an increase in time in all 15 patients. In 11 of 15 patients (73 %) these infections occurred within 1 week following the first isolation from the digestive tract. Gram-negative intestinal colonization was associated with a 3.7 fold increased mortality risk (p = 0.004). Conclusions: Gram-negative intestinal colonization, E. coli excepted, is an early prognostic parameter in patients in whom pancreatic infection has not yet occurred and represents a significantly increased risk of pancreatic infections and mortality. Received: 17 June 1997 Accepted: 3 March 1998     

Inheritance and Fitness Costs of Vip3Aa19 Resistance in Mythimna separata

The “high-dose/refuge” strategy is expected to work most effectively when resistance is inherited as a functionally recessive trait and the fitness costs associated with resistance are present. In the present study, a laboratory selected Mythimna separata strain that have evolved >634.5-fold resistance to Vip3Aa19 was used to determine the mode of inheritance. To determine if fitness costs were associated with the resistance, life history parameters (larva stage, pupa stage, pupal weight, adult longevity and fecundity) of resistant (RR), -susceptible (SS) and heterozygous (R_♂S_♀ and R_♀S_♂) strains on nontoxic diet were assayed. The LC₅₀ values of R_♀S_♂ were significantly higher than that of R_♂S_♀ (254.58 μg/g vs. 14.75 μg/g), suggesting that maternal effects or sex linkage were present. The effective dominance h of F₁ offspring decreased as concentration increased, suggesting the resistance was functionally dominant at low concentration and recessive at high concentration. The analysis of observed and expected mortality of the progeny from a backcross suggested that more than one locus is involved in conferring Vip3Aa19 resistance. The results showed that significant differences in many life history traits were observed among the four insect genotypes. In short, resistance to Vip3Aa19 in M. separata was inherited as maternal and multigene and the resistance in the strain was associated with significant fitness costs. The results described here provide useful information for understanding resistance evolution and for developing resistance management strategies.     

Efficacy of adjunctive nebulized colistin in critically ill patients with nosocomial carbapenem-resistant Gram-negative bacterial pneumonia: a multi-centre observational study

ObjectivesTo investigate the association between adjunctive nebulized colistin and treatment outcomes in critically ill patients with nosocomial carbapenem-resistant Gram-negative bacterial (CR-GNB) pneumonia.MethodsThis retrospective, multi-centre, cohort study included individuals admitted to the intensive care unit with nosocomial pneumonia caused by colistin-susceptible CR-GNB. Enrolled patients were divided into groups with/without nebulized colistin as adjunct to at least one effective intravenous antibiotic. Propensity score matching was performed in the original cohort (model 1) and a time-window bias-adjusted cohort (model 2). The association between adjunctive nebulized colistin and treatment outcomes was analysed.ResultsIn total, 181 and 326 patients treated with and without nebulized colistin, respectively, were enrolled for analysis. The day 14 clinical failure rate and mortality rate were 41.4% (75/181) versus 46% (150/326), and 14.9% (27/181) versus 21.8% (71/326), respectively. In the propensity score-matching analysis, patients with nebulized colistin had lower day 14 clinical failure rates (model 1: 41% (68/166) versus 54.2% (90/166), p 0.016; model 2: 35.3% (41/116) versus 56.9% (66/116), p 0.001). On multivariate analysis, nebulized colistin was an independent factor associated with fewer day 14 clinical failures (model 1: adjusted odds ratio (aOR) 0.59, 95% CI 0.37–0.92; model 2: aOR 0.37, 95% CI 0.21–0.65). Nebulized colistin was not associated independently with a lower 14-day mortality rate in the time-dependent analysis in both models 1 and 2.ConclusionsAdjunctive nebulized colistin was associated with lower day 14 clinical failure rate, but not lower 14-day mortality rate, in critically ill patients with nosocomial pneumonia caused by colistin-susceptible CR-GNB.