Bacterial synergy in pelvic inflammatory disease

Summary Polymicrobial aerobic and anaerobic flora are responsible for pelvic inflammatory disease (PID). The most frequent pathogens appear to beNeisseria gonorrhoea and anaerobic bacteria (most commonly anaerobic cocci andBacteroides sp.). Recent studies have demonstrated the recovery ofChlamydia trachomatis in up to a third of these infections. AlthoughN. gonorrhoea is frequently recovered from cervical cultures, it is less commonly recovered from intra-abdominal sites. Recent studies have demonstrated the in-vivo synergistic relationship betweenN. gonorrhoeae andBacteroides fragilis. The growth of each component of the mixed infection was enhanced when these were present together in an abscess. Furthermore, the emergence of encapsulated strains was enhanced in these infections. This synergy enables the organisms to cause more severe local and systemic damage to the host. Therapeutic intervention should include the use of antimicrobial agents effective against both the aerobic and anaerobic components of the mixed infection. Unless such therapy is given, the infection may persist. It is also recommended to use antimicrobials that possess synergy between them against the bacterial pathogens. Agents effective against the anaerobic pathogens are metronidazole, clindamycin and cefoxitin. Antimicrobials effective against the Gram-positive aerobic pathogens andN. gonorrhoeae are spiramycin and penicillins. Aminoglycosides or third generation cephalosporins are effective against Gram-negative enterics. The combination of metronidazole and spiramycin has shown to be synergistic against mixed infections ofBacteroides sp. andN. gonorrhoeae.     

The development of a selective medium for the Brucella abortus strains and its comparison with the currently recommended and used medium

The Brucella spp. are fastidious and relatively slow-growing organisms. The isolation of such strains in a variety of specimens often requires the use of a selective medium to reduce or eliminate the growth of unexpected microorganisms. The modified Brucella selective (MBS) medium, which contains improved antibiotic mixtures, erythritol as the only carbon source, and neutral red as a pH indicator, showed good selectivity for the Brucella abortus strains, including the RB51 vaccine strain. Erythritol in the MBS medium was able to promote and/or recover the delayed growth of the B. abortus strains through the antibiotic mixtures. The Brucella colonies, which assumed a pinkish color at their central part, were easily differentiated from other organisms. The MBS medium also allows the isolation of the Brucella strains even in contaminated specimens and/or in specimens containing small numbers of viable organisms. Moreover, this medium can be applied to environmental samples for the isolation of the Brucella strains, and it can thus offer epidemiologic traceback sources for the dissemination or transfer of diseases. Therefore, the MBS medium can be applied as a useful tool of important control measures in the eradication programs.     

Serotypes and antimicrobial susceptibilities of invasive Streptococcus pneumoniae pre- and post-seven valent pneumococcal conjugate vaccine introduction in Alberta,Canada, 2000–2006

Alberta, Canada introduced the Streptococcus pneumoniae seven valent conjugate vaccine (PCV7) program for children less than 2 years of age in September 2002. We determined the rates of invasive pneumococcal disease in Alberta, Canada 2 years pre- and 4 years post-PCV7 introduction (2000–2006) as well as the rates of antibiotic resistance and serotype distribution in this same time period. Overall, PCV7 serotypes decreased 61% from 2000 to 2006. The greatest decrease in incidence of invasive pneumococcal disease occurred in children less than 2 years of age declining from a high of 96.7/100,000 (2000) to 25.8/100,000 (2006) (P < 0.0001). Non-susceptibility of S. pneumoniae isolates to penicillin dropped significantly from 14% in 2000 to 4.6% in 2006 (P < 0.0001). Non-susceptible erythromycin isolates also decreased from 8.8% (2000) to 5.8% (2006) (P = 0.13).     

6种喹诺酮类抗菌药物不良反应的调查分析

目的 分析6种喹诺酮类抗菌药物不良反应,为临床用药提供信息.方法 收集2007年2-5月门诊患者服用喹诺酮类抗菌药物(诺氟沙星、氧氟沙星、左氧氟沙星、环丙沙星、氟罗沙星、芦氟沙星)所导致不良反应的临床病例,进行回顾性调查与分析.结果 6种喹诺酮类抗菌药物不良反应主要表现在消化、神经、免疫、呼吸、泌尿系统等,其中消化与神经系统的症状较多也更加突出.结论 喹诺酮类抗菌药物的不良反应在使用中应引起重视.     

中国儿童细菌耐药监测组2018年儿童细菌感染及耐药监测

目的 了解目前中国大陆儿童细菌感染和耐药现状。方法 菌株资料来源于2018年1月1日至12月31日中国大陆11所三级甲等儿童医院。细菌抗生素敏感性试验采用自动化仪器法及KB纸片法,肺炎链球菌青霉素药物敏感试验采用E-test法,结果判断采用美国临床实验室标准化委员会(CLSI)2017年判断标准。结果 共对62 212临床分离株进行监测,革兰阳性菌和阴性菌的比例分别为42.2%和57.8%。前5位分离株分别是:肺炎链球菌(12.9%)、大肠埃希菌(12.4%)、流感嗜血杆菌(11.8%)、金黄色葡萄球菌(10.3%)和卡他莫拉菌(7.2%)。金黄色葡萄球菌是新生儿最主要的致病菌(17.0%)。57.0%的标本来源于呼吸道,其中下呼吸道主要致病菌为肺炎链球菌,上呼吸道主要致病菌为化脓性链球菌。肠杆菌科细菌中耐碳青霉烯类药物(CRE)的比例为8.7%,其中新生儿组CRE检出率远高于非新生儿组(16.8% vs 7.2%)。CRE总体耐药率较高,对Ⅰ~Ⅳ类头孢类和酶抑制剂复合制剂耐药率均>85%。鲍曼不动杆菌中,碳青霉烯类耐药的鲍曼不动杆菌(CR-ab)比例为63.2%,非新生儿组中检出率(69.7%)高于新生儿组(35.2%)。碳青霉烯类耐药的铜绿假单胞菌的比例为27.2%,在新生儿组和非新生儿组检出率分别为25.0%和27.3%,两组差异无统计学意义。耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌的比例分别为34.9%和77.3%。化脓性链球菌对青霉素不敏感率0.1%,非脑脊液来源的肺炎链球菌中青霉素不敏感菌株(PNSP)比例为21.3%。流感嗜血杆菌β-内酰胺酶阳性检出率为61.1%。结论 呼吸道感染占儿童细菌性感染的首位。碳青霉烯类耐药菌对多种抗生素呈现高水平耐药,新生儿组CRE比例高于非新生儿组,CR-ab比例低于非新生儿组。     

98例肾移植患者围手术期抗感染药物应用情况分析

目的:了解本院2005年肾移植患者住院期间抗感染药物应用情况。方法:回顾性分析肾移植患者围手术期抗感染药物应用,对其品种及相关费用进行分析。结果:肾移植患者围手术期平均住院药费为18 745.36±7 603.86元,占总住院费用的38.52%。抗感染药物平均费用为1 130.02元,占平均总药费的6.12%。肾移植术后主要应用β内酰胺类抗生素和喹诺酮类抗菌药物。DDDs排序第1位的为左氧氟沙星。结论:我院肾移植围手术期抗感染药物应用基本合理。     

我院近5年临床分离克雷伯菌属的耐药变迁

目的:了解近5年来我院临床分离克雷伯菌属的耐药变迁。方法:采用纸片扩散法进行药敏试验,根据美国临床实验室标准化研究所(CLSI)的标准判断结果;采用WHONET-5软件对耐药性数据进行分析。结果:2003～2007年我院收集克雷伯菌属840株,来自呼吸道标本、血液、分泌物者分别占59.3%、12.0%、10.1%。产超广谱β-内酰胺酶(ESBLs)克雷伯菌属检出率在51.0%～65.1%范围内。未发现对亚胺培南、美罗培南耐药的克雷伯菌属细菌,产ESBLs克雷伯菌属多重耐药严重,临床常用抗菌药物的耐药性呈逐年上升趋势。结论:应加强克雷伯菌属细菌耐药监测,了解其耐药变迁,指导临床合理用药,防止耐药菌株的传播。     

106份骨外及普外科围手术期抗菌药应用调查

目的：了解我院骨外及普外科围手术期抗菌药应用情况并作出客观评价。方法：抽取2003年10月份出院的骨外及普外科手术病历各53份，统计分析围手术期抗菌药应用情况。结果：抗菌药首次使用时间欠佳、选药起步明显偏高、用药时间明显偏长、个别联用欠妥。结论：需要加强外科围手术期合理使用抗菌药的宣传与教育。