涂阳患者分离分枝杆菌的种类及耐药性

目的了解吴江市痰涂片抗酸杆菌阳性（简称涂阳）患者分离分枝杆菌的种类及耐药状况,为今后结核病的防治工作提供参考依据。方法对新鲜痰涂阳性标本进行分离培养、菌种鉴定及药敏试验,比较不同菌种及初治与复治结核病患者的耐药性。结果纳入研究的分枝杆菌共103株,其中有13株为非结核分枝杆菌,其耐药率为100.00%,耐多药率为84.62%;结核分枝杆菌90株,其中人型结核分枝杆菌81株（90.00%）。结核分枝杆菌耐药率为35.56%,耐多药率为14.44%。70例初治涂阳结核患者中,耐药14例,耐药率为20.00%,耐多药率为4.28%（3/70）;20例复治涂阳结核患者中,耐药18例,耐药率为90.00%,耐多药率为50.00%（10/20）。结论该市涂阳患者分离菌株以结核分枝杆菌为主;非结核分枝杆菌耐药率及耐多药率均非常高。复治涂阳结核患者分离的结核分枝杆菌耐药率、耐多药率较初治结核患者高。     

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。     

Bacillus Calmette–Guérin treatment of urothelial carcinoma arising in the ileal neobladder after radical cystectomy

In January 2005, a 66‐year‐old man underwent radical cystectomy and ileal neobladder reconstruction for invasive bladder cancer. A total of 3 years after the cystectomy, left‐side ureteral cancer was diagnosed, and a nephroureterectomy was carried out in May 2008. In October 2011, he complained of asymptomatic macroscopic hematuria. We detected multiple papillary pedunculated and broad‐based tumors in the left side and the dome of the neobladder. The patient underwent transurethral resection of the bladder tumor, and a pathological diagnosis of high‐grade pTa urothelial carcinoma was made. A total of 4 months later, tumors recurred in the right side and anterior wall of the neobladder. We carried out transurethral resection of the bladder tumor again; the pathological diagnosis was high‐grade pTa urothelial carcinoma with carcinoma in situ. Bacillus Calmette–Guérin instillation was carried out seven times into the neobladder, without any severe side‐effects. Tumor recurrence was not observed up to 8 months after bacillus Calmette–Guérin treatment.     

Impact of in vitro evolution on antigenic diversity of Mycobacterium bovis bacillus Calmette-Guerin (BCG)

Mycobacterium bovis bacillus Calmette-Guerin (BCG), the only vaccine currently used against tuberculosis, is an attenuated derivative of M. bovis that has been propagated in vitro for more than 40 years. We have previously reported that the experimentally-verified human T cell epitopes of the M. tuberculosis complex (MTBC) are the most conserved elements of the genome; whether immune recognition is the force driving the conservation of epitopes in the MTBC is unknown. Therefore, we sequenced the genomes of 12 BCG strains to determine whether T cell epitopes were under selection pressure during BCG in vitro evolution. We constructed a genome-wide phylogeny and refined the previously-determined BCG phylogeny. Notably, we identified a new cluster between BCG Japan and BCG Russia, and repositioned the relationships of several strains within the lineage. We also compared the sequence diversity of 1530 experimentally verified human T cell epitopes in the BCG vaccines with those in the MTBC. We found 23% of the known T cell epitopes are absent, and that the majority (82%) of the absent epitopes in BCG are contained in 6 proteins encoded in 2 regions of difference (RD) unique to BCG strains. We also found that T cell epitope sequences in BCG are more conserved than non-epitope sequences in the same gene. Finally, we find evidence that epitope sequence variation in BCG potentially affects human T cell recognition. These findings provide new insight into sequence variation in a slow-growing bacterium closely related to the MTBC that has been subjected to prolonged passage outside of a mammalian host, and indicate little difference in the extent of variation in vivo and in vitro.     

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

目的探究革兰阴性菌中分子伴侣在双组分蛋白跨细菌内膜及周质空间中的作用。方法以具有代表性的双组分蛋白FhaB*/FhaC系统为例,使用不同分子伴侣蛋白的敲除菌株,制备成原生质球后,研究不同的分子伴侣对底物蛋白FhaB*分泌至周质空间的影响。结果与野生型相比,分子伴侣蛋白Skp、DegP、PpiD、YfgM单独和PpiD/YfgM同时敲除后,对双组分蛋白FhaB*蛋白的分泌基本无影响;而单独敲除分子伴侣蛋白SurA或双敲除Skp/DegP则显著影响了FhaB*蛋白跨内膜分泌至周质空间的过程。结论革兰阴性菌中可能存在由SurA蛋白介导或由Skp和DegP蛋白共同介导的两个分子伴侣途径,以介导双组分蛋白分泌系统的底物蛋白跨内膜分泌至周质空间。     

Comparisons of clinical features and outcomes between Elizabethkingia meningoseptica and other glucose non-fermenting Gram-negative bacilli bacteremia in adult ICU patients

BackgroundClinical information of Elizabethkingia meningoseptica (EM) bacteremia in intensive care unit (ICU) patients is limited and the impact on outcomes uncertain. The aim of this study was to investigate the clinical features and impact of EM bacteremia compared to other glucose non-fermenting Gram-negative bacilli (GNF-GNB) bacteremia in ICU patients.MethodsThis retrospective cohort study enrolled 70 patients who developed GNF-GNB bacteremia after ICU admission, including 19 cases of EM bacteremia (19/70, 27.1%). The main outcome measure was in-hospital mortality.ResultsThe patients with EM bacteremia had a lower rate of appropriate antibiotic therapy (15.8% vs. 62.7%, p < 0.001) and a longer time to appropriate antibiotic therapy (76.8 ± 46.4 vs. 35.1 ± 38.7 h, p < 0.001), but with a less severity in acute physiology and chronic health evaluation (APACHE) II score and shock status (p < 0.05) at the onset of bacteremia, compared to those with non-EM bacteremia. The in-hospital mortality between those with EM bacteremia and non-EM bacteremia was similar (63.2% vs. 51.0%, p = 0.363). However, primary bacteremia was more frequently noted in EM compared with non-EM group (57.9% vs. 25.5%, p = 0.011), and odds ratio 4.294 (95% confidence interval 1.292–14.277, p = 0.017) in multivariate regression analysis.ConclusionAmong the patients with GNF-GNB bacteremia, the numbers of the cases with primary bacteremia and inappropriate therapy were significantly more in EM group than those in non-EM group.