嗜麦芽寡养单胞菌β-内酰胺酶及喹诺酮类耐药基因检测

目的 检测临床分离嗜麦芽寡养单胞菌耐药基因型并分析其与耐药表型的关系,从而为嗜麦芽寡养单胞菌感染的防治提供理论依据和对策.方法 对2005-2008年收集的102株嗜麦芽寡养单胞菌提取全基因组DNA,采用PCR方法检测β-内酰胺酶L1、L2型耐药基因和喹诺酮耐药基因qnr,分析耐药基因与耐药表型的关系.结果 102株嗜麦芽寡养单胞菌对临床常用抗菌药物耐药率以替卡西林/克拉维酸最高达到42.16％,其次为复方磺胺甲基异噁唑29.41％、氯霉素27.45％、头孢他啶22.55％,对米诺环素的耐药率最低11.76％.102株嗜麦芽寡养单胞菌L1基因阳性率76.47％,L2基因阳性率67.65％;其中L1和L2型基因共同阳性率56.86％;头孢他啶及替卡西林/克拉维酸耐药菌株均检测到L1和L2型基因.102株qnrX、qnrY和qnrZ的阳性率都是100％.结论 本地区嗜麦芽寡养单胞菌β-内酰胺酶L1和L2酶检出率较高,喹诺酮耐药基因qnr阳性率达到100％,染色体上Qnr酶单独存在并不会导致对氟喹诺酮类药物高度耐药.     

Stenotrophomonas maltophilia: a very rare cause of tropical pyomyositis

Pyomyositis is a purulent infection of skeletal muscles that arise from hematogenous spread associated with abscess formation. Most often caused by Staphylococcus aureus in more than 90–95% of cases but other rare organisms can cause this infection. Herein we report a rare case of strenotrophomonas maltophilia as a cause of pyomyositis which is a rare occurrence, especially in immunocompetent adults. Strenotrophomonas is a multidrug‐resistant aerobic non‐fermentative, non‐sporulating, Gram‐negative bacillus which usually produces nosocomial infections, but community‐acquired infections are also rarely reported. This a first case report of strenotrophomonas maltophilia causing pyomyositis in an immunocompetent adult.     

嗜麦芽窄食单胞菌感染分布及药物敏感性分析

目的统计分析医院感染嗜麦芽窄食单胞菌分布特征及耐药情况,为临床控制感染提供依据。方法回顾性分析2011年我院住院患者各类标本中检出的嗜麦芽窄食单胞菌分布及药物敏感情况。结果共检出嗜麦芽窄食单胞菌87株。主要来源是痰液（82．8％）,其次胸（腹）腔穿刺液（8．1％）;临床分布则以呼吸科（25．3％）、神经外科（17．2％）和ICU（13．8％）多见。该菌对左旋氧氟沙星、复方新诺明敏感率最高,均大于75％。结论嗜麦芽窄食单胞菌对多种抗生素耐药,应严格根据CLSI要求选择进行药敏试验的抗菌药物,并根据药敏结果选用适当药物进行治疗。     

Successful treatment of varicella zoster virus retinitis with aggressive intravitreal and systemic antiviral therapy

Aims : To describe the successful treatment of varicella zoster virus retinitis (VZVR) using intravenous cidofovir as part of an aggressive management strategy. Case reports : Two patients with bilateral VZVR were treated with a combination of intravenous cidofovir and ganciclovir with adjuvant intravitreal foscarnet or ganciclovir. Both patients maintained good vision in the less severely affected eye. Retinal detachment did not occur in either patient. Conclusions : VZVR should be treated aggressively with a combination of intravenous and intravitreal therapy to improve visual prognosis. Intravenous cidofovir, in the absence of contra-indications, should be considered as part of this aggressive therapeutic approach, especially in patients with AIDS in whom the prognosis is particularly poor.     

嗜麦芽寡养单胞菌D2株Ⅱ型分泌系统F和E基因序列测定

目的克隆并测定嗜麦芽寡养单胞菌D2株Ⅱ型分泌系统部分编码基因GspF和Gsp E的完整基因序列。方法分别根据已获得的嗜麦芽寡养单胞菌D2株部分序列,以及GenBank收录的K279a和R551株的序列依次设计3组引物,移步法PCR扩增GspF和E基因,产物纯化后连接pMD18T载体,经EcoRⅠ和HindⅢ双酶切鉴定后进行测序分析,将获得各PCR片段进行拼接,最终获得GspF和E基因的完整编码基因,并在GenBank中进行对比分析。结果 PCR先后扩增获得的3段序列,测序并拼接后发现其含有两个完整开放读码框架,分别为长1200 bp的GspF基因(GenBank收录号为GU377212.1)和长1434 bp的GspE基因(GenBank收录号为HM151387)。在GenBank中BLAST分析发现,D2株与嗜麦芽寡养单胞菌R551-3菌株的GspF基因及氨基酸序列同源性分别为93%和98%;GspE基因及氨基酸序列同源性与同菌种菌分别为92%和99%。结论成功克隆出嗜麦芽寡养单胞菌D2株Ⅱ型分泌系统基因簇中的GspF和GspE完整编码序列;嗜麦芽寡养单胞菌GspF和GspE种内高度保守,而其他细菌差异显著,提示其Ⅱ型分泌机制可能与其他革兰阴性菌有一定差异。     

耐复方新诺明嗜麦芽窄食单胞菌的研究进展

嗜麦芽窄食单胞菌是最近出现的一种重要的院内感染病原体。它广泛存在于自然界,可从正常人的咽部、粪便、痰中分离出来,是重要的条件致病菌。在非发酵革兰阴性杆菌引起的感染中位列第三,仅次于铜绿假单胞菌和鲍曼不动杆菌。该菌对氨基糖苷类和很多β内酰胺类天然耐药,复方新诺明是治疗该菌首选的敏感性药物。近年来,随着耐复方新诺明嗜麦芽窄食单胞菌的出现又给临床带来了新的难题。现就嗜麦芽窄食单胞菌对复方新诺明耐药性的发现及其耐药机制予以综述。     

Suppressive Effect Of Withania Somnifera Root Extract on the Induction of Anti-Ovalbumin IgE Antibody Response in Mice

Withania somnifera Dunal (Solanaceae) (WS), a well known Indian herbal drug, was examined for its effect on downregulation of antigen-specific IgE antibody response in mice. The extract prepared from the dried roots of WS (WSE) was administered intraperitoneally along with ovalbumin (OVA), a classical allergen, in the presence of aluminum hydroxide as an adjuvant. It exerted a significant suppression of OVA-specific IgE antibody production in BALB/c mice (H-2 d) as determined by passive cutaneous anaphylaxis (PCA). The extract also inhibited the production of OVA-specific IgE antibody, when administered 24 h prior to, and 6 h after, immunization. Further, WSE not only down-regulated OVA-specific IgE antibody response in other haplotypes of mice such as C57Bl/6 (H-2 b) and SWR/J (H-2 q), but it also suppressed the antigen-specific IgE antibody response against other allergens tested in BALB/c mice. Thus, the basic concept for its appli cation in the alleviation of different IgE mediated immunopathological conditions is supported.     

莫西沙星对临床分离嗜麦芽寡养单胞菌抗菌活性的研究

目的了解莫西沙星对临床分离嗜麦芽寡养单胞菌的抗菌活性,为临床合理用药提供理论依据。方法嗜麦芽寡养单胞菌的鉴定采用VITEK全自动细菌鉴定和药敏系统仪器,用标准琼脂稀释法测定莫西沙星等7种抗菌药物,对嗜麦芽寡养单胞菌的最低抑菌浓度。结果嗜麦芽寡养单胞菌对7种抗菌药物的耐药率为5.88%~48.64%,耐药率最高的为磺胺甲噁唑/甲氧苄啶,为48.64%,其次为头孢他啶、氯霉素和替卡西林/克拉维酸,耐药率分别为28.73%、21.27%和19.00%,米诺环素衍生物替加环素也有一定程度的耐药,耐药率为16.06%,左氧氟沙星的抗菌活性较好,耐药率仅为6.11%,抗菌活性最好的药物为莫西沙星,耐药率仅为5.88%,敏感性高达89.14%。结论莫西沙星对嗜麦芽寡养单胞菌具有很高的抗菌活性,适合临床选用。     

老年患者医院感染嗜麦芽寡养单胞菌耐药性分析

目的调查医院老年患者医院感染嗜麦芽寡养单胞菌的耐药现状,为临床医师合理用药提供试验依据。方法细菌培养严格按《全国临床检验操作规程》进行;菌株鉴定采用VITEK 32全自动细菌分析系统及鉴定卡;采用K-B法进行药敏试验,依据CLSI 2006~2008年折点判读结果;数据处理应用WHONET5.3~5.4软件分析。结果109株嗜麦芽寡养单胞菌药物敏感试验结果显示,该菌对复方新诺明耐药率最低,为17.4%;对亚胺培南耐药率为100.0%。结论嗜麦芽寡养单胞菌具有天然广谱耐药性,应对其加强监测与控制。     

广州地区2000～2003年嗜麦芽窄食单胞菌的耐药性调查

目的 了解广州地区2000～2003年嗜麦芽窄食单胞菌（Xan）的耐药性。方法 常规的方法对临床标本进行培养分离,API鉴定,K-B法进行药敏试验（结果判读对照绿脓假单胞菌的标准）,结果统计用WHONET5及SPSS软件。结果 广州地区Xan对临床常用的11种抗菌素的耐药率分别为复方磺胺甲恶唑25．4％～38．4％、替卡西林／棒酸40．3%～69．7％、头孢他啶41．8％～61．8％、头孢哌酮／舒巴坦40．3％～56．6％、环丙沙星40．3％～69．7％、头孢匹美68．6％～82．9％、哌拉西林／三唑巴坦68．6％～85．5％、阿米卡星79．1％～97．0％、头孢哌酮88．7％～91．0％、哌拉西林88．6％～100．0％、氨曲南89．5％～95．5％。四年间,哌拉西林、头孢匹美、复方磺胺甲恶唑、头孢哌酮等4种抗菌素的耐药率有显著的差异（P〈0．05）,其它7种抗菌素无差异（P〉0．05）。结论 经验治疗Xan感染可选择复方磺胺甲恶唑、替卡西林／棒酸、头孢他啶。