Impact of relocation and environmental cleaning on reducing the incidence of healthcare-associated infection in NICU

Background:Hospital environment remains a risk for healthcare-associated infections (HAIs).This was a prospective study to evaluate the comprehensive impact of relocating a neonatal intensive care unit (NICU) to a new facility and improved environmental cleaning practice on the presence of methicillin-resistant Staphylococcus aureus (MRSA) on inanimate surfaces and the incident rate of HAIs.Methods:New environmental cleaning measures were adopted after the NICU was moved to a new and better-designed location.The effect of moving and the new environmental cleaning practice was investigated by comparing the positive number of MRSA on ward surfaces and the incidence density of HAIs between the baseline and intervention periods.Results:Only 2.5％ of environmental surfaces were positive for MRSA in the intervention period compared to 44.0％ in the baseline period (P＜0.001).Likewise,the total incident rate of HAIs declined from 16.8 per 1000 cot-days to 10.0 per 1000 cot-days (P＜0.001).Conclusion:The comprehensive measures of relocating the NICU to a new facility design with improved environmental cleaning practice are effective and significantly reduce the incidence of HAIs.     

利奈唑胺万古霉素治疗耐甲氧西林金黄色葡萄球菌感染的疗效及安全性分析

目的:探讨利奈唑胺与万古霉素治疗耐甲氧西林金黄色葡萄球菌(MRSA)肺炎的疗效以及安全性.方法:收集2016年1月至2017年3月入院的60例耐甲氧西林金黄色葡萄球菌(MRSA)肺炎的患者采用随机数字表法分为两组,对照组患者给予万古霉素进行治疗,实验组患者则给予利奈唑胺进行治疗,比较两组患者总体治疗有效率、治疗前以及治疗后血白细胞浓度、血液C反应蛋白浓度以及两组患者不良反应(率)发生情况比较.结果:不同治疗方法:经过卡方检验,实验组较对照组患者临床总有效率比较,实验组显著升高,差异显著,具有显著统计学意义(P<0.01);不同治疗方法:经过t检验,治疗前两组WBC以及CRP比较,差异不具有统计学意义(P>0.05);治疗后两组WBC以及CRP指标均较治疗前明显降低,差异具有统计学意义(P<0.05),且治疗后观察组WBC以及CRP指标均明显低于对照组,差异具有统计学意义(P<0.05);实验组与对照组患者不良反应比较,总不良反应率差异不具有统计学意义(P>0.05),而实验组患者主要以腹泻、恶心等胃肠道不良反应为主,对照组患者主要以皮肤反应、肾功能障碍不良反应为主.结论:利奈唑胺治疗MRSA肺炎患者的效果较万古霉素而言,利奈唑胺降低炎症细胞、控制炎症反应效果都更好,治疗总有效率更高,利奈唑胺治疗主要以腹泻、恶心等胃肠道不良反应为主,而万古霉素治疗患者主要以皮肤反应、肾功能障碍不良反应为主,两组不良反应较少,安全性较高,值得临床推广,具有借鉴性.     

金葡素促进兔前交叉韧带重建后腱骨愈合的实验研究

目的 :探讨兔膝关节前交叉韧带(ACL)重建后,金黄色葡萄球菌滤液制剂(金葡素)对移植肌腱与骨隧道愈合的作用。方法:将3月龄新西兰大白兔24只(体重平均2.56 kg,雌雄不限)随机分为实验组和空白对照组,每组12只。采用兔自体趾长伸肌腱建立膝前交叉韧带重建后的腱骨愈合模型。实验组分别于术中及术后第2天向胫骨端腱骨界面处缓慢均匀注射金葡素0.1 ml,对照组以相同时间和方法注射等量0.9%Na Cl注射液。术后双膝不予制动,以青霉素注射液80万U/d连续肌肉注射3 d。分别于术后4、8和12周各处死动物8只,完整获取腱骨愈合标本并分别进行组织学分析,肉眼观察判断ACL重建大体情况,苏木精-伊红染色进行Yamakado腱骨界面组织形态分型评价,苦味酸-天狼猩红染色观察腱骨界面胶原纤维情况,血管内皮生长因子免疫组化染色定量评价腱骨界面再血管化情况,甲苯胺蓝染色定量评价腱骨界面新骨生成情况。结果:大体观察显示全部动物术后伤口Ⅰ期愈合,关节功能恢复良好,未见感染、死亡及金葡素注射不良反应。腱骨界面形态学分型结果显示术后各时间点实验组腱骨界面愈合质量均优于对照组(P0.05))。苦味酸-天狼猩红染色显示实验组胶原纤维术后4周生成少,8周大量生成,12周Sharpey纤维有序排列,集结成束,各时间点胶原纤维生成情况均优于对照组。基于血管内皮生长因子免疫组化染色和甲苯胺蓝染色的定量分析显示实验组术后4、8和12周腱骨界面新生血管面积和新骨生成面积均高于对照组(P0.05)。结论:金葡素能够在葡萄球菌肠毒素C等多种明确成分的协同作用下,通过局部启动无菌性炎症反应,加快腱骨界面血管生成和血液供应,激活骨细胞和纤维细胞大量增殖,有效促进兔ACL重建后腱骨愈合,有望成为促进ACL重建后腱骨愈合的新的临床方法。     

Antibacterial activities of chemical constituents from the aerial parts of Hedyotis pilulifera

Context: Hedyotis pilulifera (Pit.) T.N. Ninh (Rubiaceae) has been used in Vietnamese ethnomedicine; the methanol extract exhibited antibacterial activity in our preliminary screening.

Objectives: In this study, compounds from H. pilulifera were isolated and their antibacterial activity in vitro was evaluated.

Materials and methods: The aerial parts of H. pilulifera (1.4?kg) were extracted with MeOH, suspended in water and ethyl acetate extract was chromatographed on a silica gel column. The structures of isolated compounds were elucidated by the combination analyses of spectroscopy including 1D-, 2D-NMR, HRMS and in comparison with the reported NMR data in the literature. All isolated compounds were evaluated for inhibitory effect using the microdilution method toward Staphylococcus aureus, Bacillus subtilis and Mycobacterium smegmatis, and MIC values were determined.

Results: Twenty compounds were isolated, including five triterpenoids, two steroids, two aromatic compounds, three fatty acids, one quinone derivative, one lignan glycoside, one ceramide and five glycolipids. Among these, oleanolic acid showed significant antibacterial activity against M. smegmatis with the MIC value of 2.5?μg/mL. Remarkably, rotungenic acid showed strong activity against S. aureus, B. subtilis, M. smegmatis with MIC values of 2.5, 2.5 and 1.25?μg/mL, respectively. Rotundic acid exhibited significant antibacterial activity against B. subtilis with the MIC value of 5?μg/mL. To the best of our knowledge, the antibacterial activity of rotungenic acid, stigmast-4-ene-3,6-dione and (2S,3S,4R,2′R)-2-(2′-hydroxytetracosanoylamino) octadecane-1,3,4-triol was reported for the first time.

Conclusions: Oleanolic acid, rotungenic acid, and rotundic acid were considered to be useful for developing new antimicrobial therapeutic agents for human.     

五种常用消毒剂对金黄色葡萄球菌的杀灭效果评价

目的研究医院常用消毒剂乙醇、三氯片、碘伏、戊二醛、爱护佳免洗手消毒剂对医院不同来源金黄色葡萄球菌的杀灭效果,为有效控制医院感染提供科学依据。方法收集南昌大学第一附属医院临床送检标本和医护人员手及医院内周边环境物体表面采集的标本分离的金黄色葡萄球菌共48株。通过消毒剂与细菌直接接触作用,研究消毒剂在不同稀释浓度、不同作用时间、体外杀灭不同来源的金色葡萄球菌的效果。结果常规使用消毒剂如5 g/L碘伏、20 g/L戊二醛和爱护佳免洗手消毒剂(0.5%葡萄糖酸氯己定+70%乙醇)常温下作用5 min对不同来源金黄色葡萄球菌的杀灭率为100%;70%乙醇和1 g/L三氯片常温下作用5 min对不同来源金黄色葡萄球菌的杀灭率为96.5%~99.8%;但碘伏、戊二醛和免洗手消毒剂被高度稀释后即使提高作用时间但仍不能完全杀灭金黄色葡萄球菌。结论该院常规使用消毒剂能满足临床杀菌效果,但需要不断地监测消毒剂的有效浓度,防止杀菌能力降低。     

2011—2014年鄂州市金黄色葡萄球菌耐药性分析

目的 分析金黄色葡萄球菌(staphylococcus aureus,SAU)的耐药情况,为临床合理使用抗菌药物提供科学依据.方法 收集湖北省鄂州市某院2011年1月—2014年12月期间分离的SAU菌株,采用K-B纸片扩散法进行药敏试验,以CLSI 2010年推荐标准判读药敏结果 .数据的整理和分析采用Excel 2010和SPSS 20.0软件进行.结果 共检出耐甲氧西林金黄色葡萄球菌(MRSA)277株(44.04%),主要分离来自重症监护病房(31.05%)、呼吸内科(20.58%)和神经外科(18.41%).MRSA检出率在痰标本中最高(56.13%).MRSA菌株除对替加环素、替考拉宁、利奈唑胺和万古霉素敏感外,对其他15种临床常用抗菌药物均表现出不同程度的耐药.MRSA对各种抗菌药物的耐药率要明显高于甲氧西林敏感金黄色葡萄球菌(MSSA),且差异均具有统计学意义.结论 鄂州地区SAU对多种抗菌药物耐药,临床上应根据药敏试验对SAU感染患者合理使用抗菌药物,以减少耐药菌株的产生,并需加强对MRSA菌株耐药性的监测.     

Antimicrobial,modulatory and chemical analysis of the oil of Croton limae

Context: Croton sp. are plants with a well-reported antimicrobial activity. Croton limae A.P. Gomes, M.F. Sales P.E. Berry (Euphorbiaceae), known as ‘marmeleiro-prateado’, is commonly used to manage abdominal pain in Brazil.

Objective: This work evaluates the phytochemical composition, antimicrobial and modulatory activities of the essential oil of C. limae leaves (EOCL).

Materials and methods: The minimum inhibitory concentration (MIC) and the modulation of the antibiotic activity were determined using a microdilution method. The concentration of EOCL ranged between 512 and 8?μg/mL. Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumonia, Candida tropicalis, C. krusei and C. albicans strains were used in the MIC and modulation assays. The antibiotics, amikacin, gentamicin and neomycin, and the antifungals, amphotericin B, benzoylmetronidazole and nystatin, were used in concentrations ranging between 2500 and 2.5?μg/mL. The phytochemical analysis of the EOCL was performed through gas chromatography coupled to a mass spectrometer (GC/MS).

Results: Only Staphylococcus aureus was inhibited by a clinically relevant concentration of EOCL (MIC 512?μg/mL). Synergism between the EOCL and amikacin against S. aureus (9.76?μg/mL) and E. coli (39.062?μg/mL); neomycin against E. coli (2.44?μg/mL); and benzoylmetronidazole against C. krusei (256?μg/mL) were observed. The GC/MS analysis identified cedrol, eucalyptol and α-pinene as the main compounds of EOCL.

Conclusion: EOCL inhibited the growth of S. aureus and potentiated the antibiotic and antifungal effects of drugs against all bacterial and Candida strains, respectively.     

重症监护病房分离金黄色葡萄球菌的分子流行特征

目的了解某三甲医院重症监护病房(ICU)患者分离金黄色葡萄球菌的分子流行特点及其同源性,为有效控制医院感染的发生提供实验室依据。方法收集该院2013年3—8月ICU患者各类感染标本分离的62株金黄色葡萄球菌,采用PCR方法扩增7个管家基因并进行测序分析,采用多位点序列分型(MLST)技术获得菌株ST分型,对ST分型进行亲缘关系分析。结果 62株金黄色葡萄球菌均可以扩增出7个管家基因的特异性产物;共分为10个ST基因型,其中2个基因型为新发现的ST型(STn1和STn2),1个为国内新发现的ST型(ST675)。ST239是ICU患者分离的金黄色葡萄球菌主要ST型别,占74.20%,分布于6个ICU,分布范围最广;其次为ST5,分布于3个ICU。62株菌株在系统进化树上形成7个主要分支,检出耐甲氧西林金黄色葡萄球菌(MRSA)55株,占88.71%。结论医院ICU分离的金黄色葡萄球菌具有一定的同源性,并且少数型别表现出集中分布趋势。     

Pharmacokinetic drug evaluation of ceftobiprole for the treatment of MRSA

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA), while decreasing in overall incidence, is still a prominent concern world-wide. New agents coming to market in the last 10 years allow practitioners to optimize treatment for MRSA infections. Ceftobiprole is a cephalosporin agent with MRSA activity, currently approved in selected countries for the treatment of community-acquired pneumonia and hospital-acquired pneumonia.

Areas covered: Relevant literature regarding spectrum of activity, pharmacokinetics, pharmacodynamics, and clinical trials will be discussed.

Expert opinion: Ceftobiprole is an addition to a growing number of antimicrobials with activity against MRSA. Concern for appropriate dosing in critically ill patients remains due to its ineffectiveness for the treatment of ventilator-associated pneumonia (VAP). While ceftobiprole has activity against gram-negative organisms, the allowance for use of an additional agent for gram-negative infections in clinical trials limits recommendations for monotherapy for empirical treatment of HAP. Ceftobiprole’s place in therapy will lie in its activity against gram positive organisms, such as Streptococcus spp. and Staphylococcus spp.     

Safety,tolerability, and immunogenicity of a 4-antigen Staphylococcus aureus vaccine (SA4Ag): Results from a first-in-human randomised,placebo-controlled phase 1/2 study

BackgroundA prophylactic Staphylococcus aureus four-antigen vaccine (SA4Ag) is under development for prevention of invasive S. aureus disease. A preliminary S. aureus three-antigen vaccine (SA3Ag) was reformulated to include a novel manganese transporter protein (MntC or rP305A). This study describes the first-in-human dose-finding, safety, and immunogenicity results for SA4Ag.MethodsIn this double-blind, sponsor-unblind, placebo-controlled, phase 1/2 study, 454 healthy adults aged 18–64 years were randomised to receive a single dose of one of three formulations of SA4Ag with escalating dose levels of rP305A or placebo. Functional immune responses were measured using opsonophagocytic activity (OPA) killing and fibrinogen-binding inhibition (FBI) assays; antigen-specific immunogenicity was assessed using a four-plex competitive Luminex® immunoassay (cLIA).ResultsA high proportion of SA4Ag recipients met the pre-defined antibody thresholds for each antigen at Day 29. A substantial and dose-level dependent immune response was observed for rP305A, with up to 18-fold rises in cLIA titres at Day 29. Robust functional responses were demonstrated, with >80-fold and >20-fold rises in OPA assay titres at Day 29 using S. aureus strains expressing capsular polysaccharide serotypes 5 and 8, respectively. Durable antibody responses were observed through month 12, gradually waning from peak levels achieved by days 11–15. SA4Ag was well tolerated, and no vaccine-related serious adverse events were reported.ConclusionsSingle-dose vaccination of SA4Ag in healthy adults aged 18–64 years safely induced rapid and robust functional immune responses that were durable through month 12, supporting further development of this vaccine. Trial registration number: NCT01364571