快速筛查革兰阴性杆菌β内酰胺酶

目的应用Cica-Beta-Test试剂盒快速筛查革兰阴性杆菌β内酰胺酶:超广谱β内酰胺酶(ESBILs)、金属β内酰胺酶(MBLs)和染色体介导头孢菌素酶(AmpC酶),为临床抗感染治疗提供耐药依据。方法收集2010年1月至2011年3月上海交通大学医学院附属仁济医院临床分离革兰阴性杆菌共110株,其中头孢噻肟和(或)头孢他啶不敏感大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌各20株,多重耐药鲍曼不动杆菌20株和阴沟肠杆菌30株。其中大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌用美国CLSI推荐方法确证产ESBLs;对鲍曼不动杆菌用聚合酶链反应(PCR)法检测其MBLs和AmpC酶耐药基因;对阴沟肠杆菌用表型筛选法(三维试验法)检测其AmpC酶;对所有菌株应用Cica-Beta-Test试剂盒快速筛查ESBLs、MBLs和AmpC酶。根据检测结果对试剂盒进行评估。结果应用Cica-Beta-Test试剂盒检测110株临床分离菌未发现假阳性,确诊试验总符合率为92.0%(92/100),其中与PCR法比较检测MBLs和AmpC酶结果符合率为100%;与CLSI推荐ESBLs双纸片确诊试验比较,符合率为86.7%(52/60)。30株阴沟肠杆菌用AmpC酶表型筛选法比较符合率为86.7%(26/30)。结论 Cica-Beta-Test试剂盒可对各种革兰阴性杆菌产生的β内酰胺酶进行筛查及初步分型,简便、快速,灵敏度高,准确率高,尤其能对CLSI未推荐方法的耐药革兰阴性杆菌进行β内酰胺酶快速筛查意义更大。     

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     

四川省细菌耐药监测网2011年川西地区细菌耐药性监测数据分析

目的总结分析川西地区6个市(州)17家医院2011年度临床分离病原菌的分布及对抗菌药物的耐药性。方法采用K-B法或自动化仪器分析法对临床分离细菌进行药物敏感试验,依据CLSI 2010年标准,采用WHO-NET5.4软件进行统计分析。结果共分离出病原菌株20079株,其中革兰阴性菌14454株,占分离菌的71.99%;革兰阳性菌5625株,占分离菌的28.01%。前10位病原菌依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌、表皮葡萄球菌、阴沟肠杆菌、肺炎链球菌、屎肠球菌、流感嗜血杆菌。肠杆菌科细菌对亚胺培南仍保持较高的敏感率(>93.0%)。未检测到万古霉素及利奈唑胺耐药的葡萄球菌。粪肠球菌对替考拉宁和万古霉素耐药率分别为1.30%和0.70%,屎肠球菌为5.40%和4.00%。结论产超光谱β内酰胺酶的发酵菌及多重耐药的铜绿假单胞菌和鲍曼不动杆菌呈逐年上升趋势。耐甲氧西林葡萄球菌(MRS)和耐糖肽类的肠球菌是抗菌药物治疗中的难点。临床应根据细菌的耐药表型和药敏试验结果合理选用抗菌药物。     

T细胞斑点试验在痰菌涂阴肺结核中的诊断价值

我国是全球22个肺结核高疫情国家之一,估计我国现有活动性肺结核患者150万人,每年新发肺结核患者100万人,占全球发病人数的14．3％,居全球第二位,每年死亡人数达13万例,是其他传染病患者病死率的2倍以上。肺结核的诊断主要依靠临床症状、胸部影像学检查、痰涂片／培养检查、     

2005年至2007年中国CHINET脑脊液的分离菌及其耐药性

目的 了解2005年至2007年中国CHINET监测网脑脊液分离菌的分布及其耐药性.方法 对CHINET监测网2005年1月至2007年12月所有脑脊液标本按常规方法进行分离、培养、鉴定.按统一方案用Kirby-Bauer纸片扩散法进行抗菌药物敏感试验.结果 2005年至2007年脑脊液标本获分离菌941株,其中革兰阳性菌588株.占62.5%;革兰阴性菌349株,占37.1%;真菌4株,占0.4%.革兰阳性菌所占比例由2005年的59.9%增至2007年的64.6%,革兰阴性菌所占比例由2005年的39.6%降至2007年的35.4%.最常见的分离菌依次分别为凝固酶阴性葡萄球菌、不动杆菌属、肠球菌属、铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌、克雷伯菌属、肠杆菌属、肺炎链球菌、链球菌属和其他假单胞菌.葡萄球菌属和肠球菌属中未发现万古霉素耐药株,肺炎链球菌对青霉素的耐药率为42.9%.肠杆菌科细菌对碳青霉烯类高度敏感,不动杆菌属和铜绿假单胞菌对碳青霉烯类耐药率为24.1%～29.3%.结论 2005年至2007年脑脊液分离菌中革兰阳性菌多于革兰阴性菌,脑脊液分离株对常用抗菌药物耐药明显.     

口岸卫生检疫中开放性肺结核检测模式的探讨

目的探讨适合口岸开放性肺结核的检疫模式。方法对肺部透视、痰涂片(MTB)、痰聚合酶链式反应(PCR)、基因芯片(DNA-Chips)技术、结核菌素皮试(PPD)、抗脂阿拉伯甘露塘抗体 (LAM-IgG)实验、血清可溶性白细胞介素2受体(sIL-2R)实验、TB培养等检测方法的敏感性、特异性及检测周期等因素进行分析对比。结果以上各种检测方法在口岸开放性肺结核的检疫中各有优劣,但没有一种单独的检测方法可满足检疫目的和要求。结论本文建议为提高检疫有效性和明确检测的目的性应采用多种检测方法的不同的渐进式联合检测模式。     

Detection of expanded-spectrum β-lactamases in Gram-negative bacteria in the 21st century

Emerging β-lactamase-producing-bacteria (ESBL, AmpC and carbapenemases) have become a serious problem in our community due to their startling spread worldwide and their ability to cause infections which are difficult to treat. Diagnosis of these β-lactamases is of clinical and epidemiological interest. Over the past 10 years, several methods have been developed aiming to rapidly detect these emerging enzymes, thus preventing their rapid spread. In this review, we describe the range of screening and detection methods (phenotypic, molecular and other) for detecting these β-lactamases but also whole genome sequencing as a tool for detecting the genes encoding these enzymes.     

Combination Therapy in Systemic Mycosis

Summary

One hundred eighty-four sputum specimens from the same number of patients with lower respiratory tract infections were examined to determine the bacterial count and the relationship between the microorganisms isolated and the presumptive pathology. The sputa were subdivided into three groups; “high probability”, “low probability”, and “contaminated sputa”, following the criteria of the microscopic readings: sputum with more than 25 white cells and low numbers of squamous epithelial cells represents true lower respiratory tract infections (high probability); those with fewer than 25 white cells represent non-bacterial infections or non-infected sputa (low probability) while sputa with more than 25 squamous cells per field represent contaminated specimens (contaminated sputa).

Statistical analysis was carried out to correlate these data. Haemophilus influenzae, Haemophilus parainfluenzae, Streptococcus pneumoniae, and Streptococcus pyogenes showed significant differences in the three groups considered.     

卡介菌多糖核酸治疗小儿咳嗽变异性哮喘

目的：观察卡介菌多糖核酸注射液在小儿咳嗽变异性哮喘治疗应用的疗效。方法：将本科40例咳嗽变异性哮喘患儿，随机分为治疗组和对照组（各20例）。治疗组给予BCG—PSN＋必可酮气雾剂，对照组：给予单用必可酮气雾剂吸入，连续吸入6周，观察疗效，并进行统计学处理。结果：治疗组总有效率为95％，对照组总有效率为70％，统计学处理总有效率有显著差异（P〈O．01）。结论：卡介菌多糖核酸（polysaccharide nucleic acidfraction of BCG，BCG—PSN）能有效地控制咳嗽变异性哮喘（CVA）的呼吸道的反复感染，提高免疫功能；与必可酮配合，能有效地控制CVA的复发。     

Pseudomonas aeruginosa treatment and transmission reduction

Infections caused by Pseudomonas aeruginosa can be difficult to treat and require a coordinated approach for their management. This involves quickly controlling the source of infection, establishing a correct etiologic diagnosis and administering appropriate empiric antimicrobial therapy. Once antimicrobial therapy has been initiated and susceptibilities are available, therapy should be tailored with optimized antibiotic doses for an appropriate duration in order to sufficiently treat the infection and minimize resistance emergence.