肺炎支原体感染的致病机制及实验室检测

肺炎支原体对呼吸道上皮细胞的黏附以及在其上面滑动是导致肺炎发生的先决条件,机体通过抗体和补体调理吞噬并最终引起细胞毒作用和炎症反应,其中过氧化氢和社区获得性呼吸窘迫综合征毒素是肺炎支原体的重要毒力因子。肺炎支原体实验室检测包括培养、血清学实验和核酸扩增检测技术（NAATs）,由于NAATs具有高灵敏度和短周转时间,被认...     

肺炎支原体感染患儿D－二聚体检测与临床意义

目的：探讨肺炎支原体感染患儿血浆D－二聚体含量在肺炎支原体感染过程中的变化及临床意义。方法将来自深圳市宝安妇幼保健院2012年7月至2014年3月住院期间的176例肺炎支原体感染患儿依其病程分为感染组（176例）和治愈组（60例）,同时选取70例正常儿童作为对照组,分别测定其血浆D－二聚体及血清肺炎支原体抗体,并对其进行比较分析。结果肺炎支原体感染组患儿血浆D－二聚体水平较治愈组和对照组显著升高（t值分别为4．33和5．11,均P＜0．05）、肺炎支原体感染期间（肺炎支原体抗体滴度水平在1：320及以上者53例,滴度在1：160者65例,滴度1：80的58例）不同抗体水平的患儿血浆D－二聚体水平均无明显差异（t值分别为0．64、0．48和1．40,均P＞0．05）。结论肺炎支原体感染患儿体内存在着凝血、纤溶活性的异常,D－二聚体水平在感染期明显升高。     

肺炎衣原体感染与动脉粥样硬化

动脉粥样硬化性心脑血管疾病已经成为危害人类健康的头号杀手。与动脉粥样硬化相关的危险因素也成为研究的焦点,除高脂血症﹑、高血压、糖尿病、吸烟、年龄、家族遗传病史等动脉粥样硬化的传统危险因素外,近年来有越来越多的研究显示肺炎衣原体对动脉粥样硬化的发生和发展起到了至关重要的作用。众多关于肺炎衣原体感染与动脉粥样硬化的研究被报道。学者们从临床检测、动物实验、细胞分子水平等方面来证实肺炎衣原体与动脉粥样硬化的相关性。     

克雷伯氏肺炎杆菌生产1,3-丙二醇代谢途径中的酶活变化

考察了不同条件下克雷伯氏肺炎杆菌(Klebsiella.pneumoniae)合成1,3-丙二醇(1,3-PD)的3种关键酶(甘油脱氢酶(GDH)、1,3-PD氧化还原酶(PDOR)及甘油脱水酶(GDHz))的表观酶活变化。结果显示:这3种酶的酶活变化与Klebsiella.pneumoniae的1,3-PD代谢不完全相关。用SDS-PAGE电泳分析上述不同发酵条件下酶活变化,结果显示不同于3种酶的蛋白条带,Mr约为4.0×104位置的蛋白条带有明显的变化,这可能与菌体代谢过程相关,结论有待进一步深入研究。     

清热益气颗粒治疗支原体性宫颈炎的临床分析

目的探究清热益气颗粒治疗支原体性宫颈炎的临床效果。方法回顾性分析2010年5月-2012年12月收治的I20例支原体宫颈炎患者的临床资料，按治疗方式的不同分为观察组和对照组，每组各60例，观察组采用清热益气颗粒治疗，对照组采用西替沙星治疗，比较两组患者经两个疗程治疗后的临床效果。结果观察组治疗有效率为967％，明显优于对照组的76.7％，两组比较，差异有统计学意义（P〈0.05）。结论清热益气颗粒在支原体性宫颈炎患者的临床治疗中作用显著，安全性高，值得临床推广。     

双黄连对肺炎支原体感染大鼠组织中PDGF—BB影响的免疫组织化学研究

为探讨中药制剂双黄连粉针剂(双黄连)对反复肺炎支原体肺部感染大鼠肺组织中血小板衍生生长因子-BB(PDGF-BB)蛋白质水平表达的影响,给大鼠于24周内反复9次经超声雾化吸入肺炎支原体以复制其慢性肺部感染模型,并应用双黄连腹腔注射进行治疗干预;随后用PDGF-BB单克隆抗体按SABc法行免疫组织化学染色,定量图像分析。结果(1)感染组动物(n=4)支气管肺泡灌洗液肺炎支原体-PCR检测均为阳性,而对照组(n=4)和感染加双黄连治疗组(n=4)均为阴性(均为P<0．05);三组动物的支气管和肺组织常规细菌培养结果均为阴性;感染组动物透射电镜检查见肺泡间隔增宽,其中有较多胶原纤维堆积,其余两组则未见明显异常。(2)感染组动物肺间质结缔组织中以及小气道和小血管的壁上可见较强的细颗粒状或细丝网状棕黄色PDGF-BB免疫组化染色阳性表达产物,其积分光密度为23．26±3．87(n=4),显著高于正常对照组者(1．52±0．61,n=4,P<0．05)和感染加双黄连治疗组者(3．49±0．63,n=4,P<0．05)。提示双黄连可抑制反复肺炎支原体肺部感染大鼠肺组织中PDGF-BB蛋白质水平的表达,对于防止肺炎支原体肺部感染所引起的肺间质纤维化可能具有一定的作用。     

Emergence of Klebsiella pneumoniae carbapenemase-producing Proteus mirabilis in Hangzhou, China

Background Carbapenems are used to treat severe infections caused by multi-drug-resistant organisms, however, the emergence of carbapenem-resistant bacterial isolates is becoming an increasing therapeutic challenge. Since the first Klebsiella （K.） pneumoniae carbapenemase （KPC）-producing K. pneumoniae was reported in 2001, KPC-producing isolates have been found increasingly, specially in Enterobacteriaceae. The aim of this study was to characterize the mechanisms of a carbapenem-resistant Proteus （P.） mirabilis. Methods A carbapenem-resistant P. mirabilis isolate was recovered from pleural drainage fluid of a patient admitted to surgical intensive care unit. Antimicrobial susceptibility testing of the isolate was performed by disk diffusion according to Clinical and Laboratory Standards Institute guidelines, and subsequent minimal inhibitory concentrations were determined with the E-test. Amplification of the blaKPC gene generated a positive band and the PCR products were sequenced subsequently. The plasmid of the isolate was extracted and was successfully transformed into Escherichia （E.） coli DH5a. Results The P. mirabilis isolate was resistant to all detected antimicrobial agents except tigecycline. KPC-2 was confirmed by DNA sequence analysis. The transformant E. coil was resistant to carbapenems. Further study demonstrated that upstream and downstream regions of b/aKPC-2 were identical to that observed in K. pneumoniae submitted to GenBank from China in 2007. Conclusion Carbapenem resistance in the P. mirabilis isolate in this study is mainly due to production of KPC-2.     

Antimicrobial stewardship: the aspirin of the 21st Century

The increasing incidence of carbapenem-resistant Klebsiella pneumoniae (CR-KP) fundamentally alters the management of patients at risk to be colonized or infected by such microorganisms. Owing to the limitation in efficacy and potential for toxicity of the alternative agents, many experts recommend using combination therapy instead of monotherapy in CR-KP-infected patients. However, in the absence of well-designed comparative studies, the best combination for each infection type, the continued role for carbapenems in combination therapy and when combination therapy should be started remain open questions. Herein, the authors revise current microbiological and clinical evidences supporting combination therapy for CR-KP infections to address some of these issues.     

Bacterial meningitis: new therapeutic approaches

Bacterial meningitis remains a disease with high mortality and long-term morbidity. Outcome critically depends on the rapid initiation of effective antibiotic therapy. Since a further increase of the incidence of pathogens resistant to antibacterials can be expected both in community-acquired and nosocomial bacterial meningitis, the choice of an optimum initial empirical antibiotic regimen will gain significance. In this context, the use of antibiotics which are bactericidal but do not lyse bacteria, may emerge as a therapeutic option. Conversely, the role of corticosteroids, which decrease the entry of hydrophilic antibacterials into the cerebrospinal fluid, as adjunctive therapy will probably decline as a consequence of the increasing antibiotic resistance of bacteria causing meningitis. Consequent vaccination of all children at present is the most efficient manner to reduce disease burden.