哌拉西林/他唑巴坦等4种抗菌药物对嗜麦芽寡养单胞菌的抗菌作用

目的 为了解哌拉西林／他唑巴坦等4种含酶抑制剂的抗菌药物对嗜麦芽寡养单胞菌的体外抗菌作用，并与其他11种抗菌药物比较，以指导临床合理用药和治疗。方法 用VITEK—32全自动细菌鉴定仪和K—B法作细菌的鉴定和药物敏感试验。结果 共分离出嗜麦芽寡养单胞菌106株。15种抗菌药物对该菌药敏试验结果显示哌拉西林／他唑巴坦、头孢哌酮／舒巴坦对嗜麦芽寡养单胞菌耐药最低分别为6．6％和7．5％，而对氨基糖苷类、β—内酰胺类及碳青酶烯类抗菌药物都出现较强的抗药性。结论 嗜麦芽寡养单胞菌为主要条件致病菌和医院感染菌之一，在临床分离菌中，嗜麦芽寡养单胞菌日益增多，哌拉西林／他唑巴坦、头孢派酮／舒巴坦复合制剂是目前治疗嗜麦芽寡养单胞菌感染较理想的抗菌药物。     

从病人痰中分离出两株嗜麦芽寡食单胞菌

１９９３年从两例呼吸道感染病人的痰中分离出两株革兰氏用性小杆菌，经系统鉴定定为嗜麦芽寡女单胞菌（Ｓｔｅｎｏｔｒｏｐｈｏｍｏｎａｓｍａｌｔｏｐｈｉｌｉａ）。因本菌误诊漏检较多，本文就此菌的鉴定经验及鉴定要点进行了观察讨论。在氧化发酵试验中呈迟缓氧化产酸或呈碱性反应，有动力的专性需氧菌，在西蒙氏柠檬酸盐琼脂中不生长，在微量（０．０１％）胨半固体中分解麦芽糖产酸快于葡萄糖，而在油封的麦芽糖管中不产酸。分解乳糖和蔗糖而不便甘露醇产酸，有的菌株半乳糖、木糖也不分解，水解吐温８０、ＤＮＡ和七叶苷。     

嗜麦芽窄食单胞菌在肺炎患者的检出率、耐药性及其治疗

目的：分析嗜麦芽窄食单胞菌在肺炎患者痰的检出率、耐药性及先福吡兰在治疗该菌感染中的价值。方法：分析187例老年肺炎痰培养的222株细菌，62株嗜麦芽窄食单胞菌药敏及18例次老年嗜麦芽窄食单胞菌肺炎应用先福吡兰治疗。结果：嗜麦芽窄食单胞菌检出率占老年院内肺炎细菌检出的第五位。多数抗生素对嗜麦芽窄食单胞菌耐药，氨苄西林、头孢唑啉钠、氨曲南、头孢呋新、亚胺培南、四环素、呋喃坦啶均为100％耐药，头孢噻肟钠耐药为95．92％；庆大霉素84．91％耐药；氧哌嗪青霉素76％耐药；丁胺卡那霉素74．58％耐药，头孢噻肟钠67．65％耐药；环丙沙星61．70％耐药；替卡西林60％耐药；替门汀60％耐药。用先福吡兰治疗18例次老年嗜麦芽窄食单胞菌肺炎，有效率为66．67％，细菌清除率为77．78％。结论：嗜麦芽窄食单胞菌占老年院内肺炎痰细菌检出的第五位；嗜麦芽窄食单胞菌对多数抗生素耐药；先福吡兰治疗老年嗜麦芽窄食单胞菌肺炎有效率为66．67％，细菌清除率为77．78％。     

Risk factors for allergic bronchopulmonary aspergillosis and sensitisation to <Emphasis Type="Italic"> Aspergillus fumigatus </Emphasis>in patients with cystic fibrosis

An increasing incidence of allergic bronchopulmonary aspergillosis (ABPA) as a complication in patients with cystic fibrosis (CF) is reported. The objective of this retrospective case-control study was to assess potential risk factors for ABPA and for Aspergillus fumigatus sensitisation (AFS). In a group of 160 CF patients, 11 (7%) fulfilled the diagnostic criteria for ABPA and 20 (13%) had evidence of AFS. They were compared to 62 control CF patients (25 for ABPA and 37 for AFS group) without evidence of ABPA or AFS using extended matching for sex, age and weight. AFS patients had received significantly higher cumulative doses of inhaled corticosteroids than their respective controls (OR 8.0; 95% CI 1.74–63). Bronchial colonisation with Stenotrophomonas maltophilia was strongly and independently associated with ABPA (OR 20; 95% CI 2.8– infinity). A longer duration of Pseudomonas aeruginosa colonisation was independently associated with AFS (OR per year 1.50; 95% CI 1.12– infinity). Conclusion: Cystic fibrosis patients with allergic bronchopulmonary aspergillosis have a more frequent isolation of S. maltophilia in their sputum than their controls. Longer duration of colonisation with P. aeruginosa is a risk factor for Aspergillus fumigatus sensitisation. Higher cumulative doses of inhaled corticosteroids are associated with Aspergillus fumigatus sensitisation and their role as a risk factor needs to be clarified.     

42株形成生物被膜的嗜麦芽窄食单胞菌的药物敏感性研究

目的 研究单独及联合使用不同种类抗生素对嗜麦芽窄食单胞菌(Stenotrophomonasmahophilia,SML)体外生物被膜的抗菌活性. 方法 收集从患者分离的非重复SML 42株,分别采用微量接种针和硅胶膜片在水解酪蛋白肉汤中构建细菌生物被膜(bacterial biofilm)的体外模型,经过抗生素(左氧氟沙星、环丙沙星、头孢哌酮/舒巴坦、头孢他啶、哌拉西林、红霉素、磺胺甲噁唑、庆大霉素)作用20 h,超声振荡并测定孵育前后6 h吸光度(A)值的变化,计算相应的细菌生物被膜抑制浓度,进而测定红霉素与左氧氟沙星、头孢哌酮/舒巴坦、哌拉西林对细菌生物被膜的联合作用. 结果 SML对左氧氟沙星、磺胺甲噁唑和哌拉西林敏感率分别为83.33%、66.67%和54.76%,其他抗生素的耐药率均在50%以上.形成生物被膜后,细菌对抗生素的生物被膜抑制浓度大于相应的最小抑菌浓度(MIC)值. 结论 42株SML呈现多重耐药现象,形成生物被膜后耐药性增强.左氧氟沙星的抗菌活性在形成生物被膜前后均优于其他抗生素,联合红霉素与左氧氟沙星有助于增强杀菌效果.     

全国细菌耐药监测网2014—2019年临床分离非发酵革兰阴性杆菌耐药性变迁

目的了解全国临床分离非发酵革兰阴性杆菌的耐药性变迁。方法按照全国细菌耐药监测技术方案要求开展耐药监测工作,参考美国临床实验室标准化协会(CLSI)标准对2014—2019年全国1000余家医院上报至全国细菌耐药监测网的非发酵革兰阴性杆菌的临床资料进行总结和分析。结果非发酵革兰阴性杆菌主要分离自呼吸道标本(痰和支气管肺泡灌洗液)、尿、脓液和血,分别占83.6%,6.5%,4.0%和3.6%。铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌和洋葱伯克霍尔德菌占分离细菌的比率分别为8.8%,7.3%,2.1%和0.5%。铜绿假单胞菌对多粘菌素B、阿米卡星和庆大霉素的敏感率分别为96.9%~98.2%,89.1%~94.0%和80.1%~86.4%;对哌拉西林和氨曲南的敏感率分别为66.7%~72.8%和58.8%~62.4%;对其余抗菌药物的敏感率维持在70.4%~81.7%。鲍曼不动杆菌对多粘菌素B、阿米卡星和米诺环素的敏感率分别为96.2%~98.0%,51.0%~58.0%和59.4%~63.4%,对其余抗菌药物的敏感率为35.8%~50.0%。嗜麦芽窄食单胞菌对米诺环素、复方磺胺甲口恶唑和左氧氟沙星的敏感率分别为93.0%~95.3%,89.3%~91.4%和85.0%~86.6%,对替卡西林/克拉维酸和氯霉素的敏感率为37.4%~50.3%和46.6%~51.1%。洋葱伯克霍尔德菌对替卡西林/克拉维酸和氯霉素的敏感率分别为18.5%~37.0%和54.4%~62.2%,对其余抗菌药物的敏感率维持在64.7%~86.8%。耐碳青霉烯类铜绿假单胞菌检出率呈下降趋势,而耐碳青霉烯类鲍曼不动杆菌检出率呈现先上升后下降的变化趋势。结论非发酵革兰阴性杆菌对常用抗菌药物的敏感性无明显变化,耐碳青霉烯类铜绿假单胞菌和鲍曼不动杆菌检出率呈下降趋势。     

Dengue co-infection in a blood stream infection caused by Stenotrophomonas maltophilia: A case report

Stenotrophomonas maltophilia (S. maltophilia) is an emerging opportunistic bacterial pathogen with resistance to several commonly used antibiotics. Owing to its multidrug resistance (MDR), management of S. maltophilia blood stream infection (BSI) is challenging and requires the selection of appropriate antibiotic therapy. The presence of thrombocytopenia and shock are independent risk factors associated with increased mortality in patients with S. maltophilia BSI. We describe an unusual case of S. maltophilia BSI in a middle-age female complicated by dengue fever. We highlight the importance of early recognition of both dengue and S. maltophilia infection in management of such cases.     

嗜麦芽寡养单胞菌医院感染现状及耐药性分析

目的了解嗜麦芽寡养单胞菌(SMA)医院感染现状,并对其耐药性进行分析。方法调查2008年1月-2009年12月临床分离的SMA的来源和病区分布,用K-B法检测对16种抗菌药物的耐药性。结果共分离SMA 104株;有7类标本检出SMA,其中检出最多的标本是痰(46.2%)、创面(24.1%)和尿液(12.5%);有11个临床科室分离到SMA,菌株构成比最高的是ICU(37.5%)、烧伤科(24.0%)和中医科(10.5%);药敏结果表明,SMA对亚胺培南和美罗培南的耐药率分别为97.1%和95.2%,头孢他啶、头孢哌酮和头孢吡肟的耐药率为50.0%～71.2%,氨基糖苷类为76.0%～93.3%,耐药率较低的药物有头孢哌酮/舒巴坦(18.3%)、磺胺甲噁唑/甲氧苄啶(18.3%)和环丙沙星(28.8%)。结论下呼吸道和烧伤创面是SMA感染的最常见临床类型;ICU、烧伤科是SMA医院感染的高危病区,SMA对常用抗菌药耐药,临床治疗应根据药敏试验结果选用。     

Comparison of microbial contamination of enteral feeding solution between repeated use of administration sets after washing with water and after washing followed by disinfection

We compared microbial contamination of in-use enteral feeding solution from repeatedly used administration sets (a delivery bag and an infusion tube) after washing with water or washing followed by disinfection. In eight hospitals where administration sets were re-used after washing with water, residual solution was collected from both the delivery bag and the distal end of the infusion tube immediately after use and the microbial contamination level and microbial species found examined. The residual enteral feeding solution (28 samples) in the delivery bag grew 10(2)-10(8) colony forming units (cfu)/mL and 36 samples from the distal end of the infusion tube grew 10(2)-10(9) cfu/mL. Re-processing was changed to washing with water followed by disinfection with 0.1% (100 ppm) sodium hypochlorite, and similar examinations were performed. The residual solutions in the bag (22 samples) and in the distal end of the infusion tube (24 samples) were contaminated with < 10(1)-10(4) cfu/mL each, a significant decrease (P < 0.01, Wilcoxon U-test) compared with washing with water alone.