Antimicrobial susceptibility among E. faecalis and E. faecium from France,Germany, Italy,Spain and the UK (T.E.S.T. Surveillance Study, 2004-2009)

Abstract

We report on antimicrobial activity against E. faecalis and E. faecium collected in France, Germany, Italy, Spain, and the UK between 2004 and 2009 as part of the Tigecycline Evaluation and Surveillance Trial (UK in vitro data not included due to low isolate numbers). Overall, 1·1% (n?=?23/2068) of E. faecalis and 11·5% (n?=?103/893) of E. faecium were vancomycin-resistant. High levels of minocycline-resistant E. faecalis were reported in Germany, Spain, France, and Italy (40·2–44·2%); levofloxacin resistance was high in Germany, Italy, and Spain (31·1–41·6%). Minocycline non-susceptibility increased significantly among E. faecalis in Spain and Italy (P<0·001). No tigecycline-resistant E. faecalis were reported. Among E. faecium, resistance ranged from 72·9% (France) to 93·3% (Germany) for ampicillin, from 56·1% (France) to 90·2% (Germany) for levofloxacin, and from 75·3% (Italy) to 94·7% (Germany) for penicillin. Levofloxacin non-susceptibility increased significantly among E. faecium in France and Spain (P<0·001). The lowest rates of antimicrobial resistance among E. faecium were reported for tigecycline (2/893; 0·2%) and linezolid (3/893; 0·3%).     

siRNA干扰血小板内皮细胞黏附因子-1表达对人鼻咽癌耐药细胞CNE1/R多药耐药性的影响

目的 探讨抑制血小板内皮细胞黏附因子-1(PECAM-1)表达对多药耐药基因1(MDR-1)及其编码产物P-糖蛋白(P-gp)的影响.方法 设计并化学合成针对PECAM-1的三条siRNA序列,命名为si-PECAM1,2,3,脂质体转染法将其转入CNE1/R,采用Semi-qRT-PCR、Western blot方法检测并筛选出抑制效果最好的si-PECAM序列,将筛选出的si-PECAM转入CNE1/R,采用Semi-qRT-PCR、Western blot方法检测抑制PECAM-1表达前后MDR-1及其编码产物P-gp的变化情况.结果 Semi-qRT-PCR的结果显示,设计三条si-PECAM序列均有效,以si-PECAM3干扰效果最明显(P<0.001),Western blot结果显示与Semi-qRT-PCR的结果一致;转染si-PECAM3 48 h后做Semi-qRT-PCR的结果显示抑制PECAM-1表达后MDR-1表达明显下调(P<0.001),Western blot结果与Semi-qRT-PCR的结果一致,抑制PECAM-1表达后MDR-1编码产物P-gp的表达也明显下调(P<0.001).结论 抑制CNE1/R中PECAM-1表达后MDR-1及其编码产物P-gp的表达均明显下调,提示PECAM-1可能参与X射线辐射诱导人鼻咽癌细胞发生多药耐药.     

195株铜绿假单胞菌的临床分布及耐药性分析

目的 了解该院铜绿假单胞菌临床来源及耐药情况,以指导临床合理用药.方法 收集该院2010年1~12月临床分离的铜绿假单胞菌,采用WHONET5.4软件分析.结果 共分离铜绿假单胞菌195株,其中从痰标本中分离121株(62.05%),分泌物中分离50株(25.64%);呼吸内科分离55株(28.21%),脑外科分离45株(23.08%).其对美罗培南耐药率最低(6.27%),对左氧氟沙星、环丙沙星、头孢吡肟耐药率也较低,分别为11.28%、13.85%、19.49%.结论 铜绿假单胞菌易产生多重耐药性,必须加强耐药监测,为临床用药提供指导.     

Identification and screening of carbapenemase-producing Enterobacteriaceae

Carbapenem-hydrolysing β-lactamases are the most powerful β-lactamases, being able to hydrolyse almost all β-lactams. They are mostly of the KPC, VIM, IMP, NDM and OXA-48 types. Their current extensive spread worldwide in Enterobacteriaceae is an important source of concern, as these carbapenemase producers are multidrug-resistant. Detection of infected patients and of carriers are the two main approaches for prevention of their spread. Phenotypic and molecular-based techniques are able to identify these carbapenemase producers, although with variable efficiencies. The detection of carriers still relies mostly on the use of screening culture media.     

高渗葡萄糖联合胰岛素局部换药治疗咽瘘的临床研究

目的观察高渗葡萄糖联合胰岛素局部换药治疗咽瘘的临床效果，探讨咽瘘的治疗经验。方法回顾性分析12例全喉切除术后并发咽瘘者应用高渗葡萄糖联合胰岛素治疗的临床资料。12例均于常规清创处理后，以50％葡萄糖注射液10～20ml加精蛋白锌胰岛素10～20U的混合液擦洗伤口2或3次，再使用混合液纱条填寒瘘腔，外覆无菌干纱布，最后对咽瘘周围组织适度加压包扎，并观察创面愈合情况和时间。结果12例创面全部达到痊愈标准，平均痊愈时间19．6d；观察6个月，无一例出现吞咽困难。结论高渗葡萄糖联合胰岛素可通过控制创面感染、清除坏死组织、促进肉芽组织和上皮细胞生长等促进全喉切除术后咽瘘创面愈合，方法简单，值得推广应用。     

Melatonin improves insulin resistance and hepatic steatosis through attenuation of alpha‐2‐HS‐glycoprotein

Melatonin plays an important role in regulating circadian rhythms. It also acts as a potent antioxidant and regulates glucose and lipid metabolism, although the exact action mechanism is not clear. The α2‐HS‐glycoprotein gene (AHSG) and its protein, fetuin‐A (FETUA), are one of the hepatokines and are known to be associated with insulin resistance and type 2 diabetes. The aim of this study was to determine whether melatonin improves hepatic insulin resistance and hepatic steatosis in a FETUA‐dependent manner. In HepG2 cells treated with 300 μmol/L of palmitic acid, phosphorylated AKT expression decreased, and FETUA expression increased, but this effect was inhibited by treatment with 10 μmol/L of melatonin. However, melatonin did not improve insulin resistance in FETUA‐overexpressing cells, indicating that improvement in insulin resistance by melatonin was dependent on downregulation of FETUA. Moreover, melatonin decreased palmitic acid‐induced ER stress markers, CHOP, Bip, ATF‐6, XBP‐1, ATF‐4, and PERK. In addition, in the high‐fat diet (HFD) mice, oral treatment with 100 mg/kg/day melatonin for 10 weeks reduced body weight gain to one‐third of that of the HFD group and hepatic steatosis. Insulin sensitivity and glucose intolerance improved with the upregulation of muscle p‐AKT protein expression. FETUA expression and ER stress markers in the liver and serum of HFD mice were decreased by melatonin treatment. In conclusion, melatonin can improve hepatic insulin resistance and hepatic steatosis through reduction in ER stress and the resultant AHSG expression.     

The emergence of Clostridium difficile PCR ribotype 078 in piglets in the Czech Republic clusters with Clostridium difficile PCR ribotype 078 isolates from Germany,Japan and Taiwan

Clostridium difficile is a major nosocomial pathogen in humans with an increasing incidence in the community. The “one-health” approach of research is needed to investigate possible reservoirs of C. difficile and route of its transmission. The objective of this study is to investigate the occurrence of C. difficile in pigs in the Czech Republic with characterisation of the isolates to determine their genetic relatedness to C. difficile isolates from European and Asian pigs. A total of 198 pig faeces samples from 23 farms were investigated and of those 57 samples (55 piglets, 2 sows) from 11 farms were confirmed as C. difficile positive. The majority of C. difficile isolates belonged to the sequence type 11 and clade 5. The predominant ribotypes were 078 (n = 23), 078-variant (n = 5), 033 (n = 10) followed by RTs 150 (n = 7), 011 (n = 5), 045 (n = 4), 126, 014, 002 (n = 1, each). All isolates were susceptible to metronidazole, vancomycin and tetracycline. Isolates of RTs 150 and 078-variant were moxifloxacin resistant (MIC≥32 mg/L) and carried the amino acid substitution Thr82Ile in the GyrA. A multi-locus variable number tandem-repeats analysis (MLVA) revealed a clonal relatedness of isolates within individual farms and in C. difficile RT078 isolates between two Czech farms. Czech C. difficile RT078 isolates clustered with German C. difficile RT078 isolates and Czech C. difficile 078-variant isolates clustered with C. difficile RT078 isolates from Japan and Taiwan. This study found an emergence of C. difficile RT078 in Czech piglets that was related genetically to C. difficile RT078 isolates from Germany, Japan and Taiwan.