对产超广谱β-内酰胺酶细菌的检测和耐药性分析

目的 :了解临床病人标本中产超广谱 β-内酰胺酶 (ESBLs)细菌的检出率及耐药情况 ,以指导临床合理使用抗生素。方法 :用NCCLS规定的表型确证试验进行ESBLs的检测。结果 :ESBLs的总阳性率为 19.9% ,大肠埃希菌为 18. 1% ,肺炎克雷伯菌为 2 2 . 7%。产ESBLs菌对 8种抗生素的耐药率与不产ESBLs菌相比有显著差异 (P <0 0 5 ) ,对 3种抗生素 (亚胺培南、头孢哌酮 /舒巴坦、哌拉西林 /他唑巴坦 )的耐药率与不产ESBLs菌相比无显著差异。结论 :临床实验室应加强对ESBLs的检测 ,治疗产ESBLs菌引起的感染 ,应选用头霉素、碳青霉烯类及含酶抑制剂的复合抗生素。     

Emergence and wide dissemination of CTX-M-type ESBLs, and CMY-2- and DHA-1-type AmpC beta-lactamases in Korean respiratory isolates of Klebsiella pneumoniae

Respiratory isolates of Klebsiella pneumoniae in Korea during 2002-2003 were studied to determine the prevalence and types of extended-spectrum beta-lactamases (ESBLs) and plasmid-mediated AmpC beta-lactamases (PABLs). ESBL-production was tested by double-disk synergy, and genotypes of beta-lactamases were determined by PCR and sequencing. ESBLs were detected in 28.4% of 373 isolates, and the most prevalent types were SHV-12 (63 isolates) and CTX-M-14 (9 isolates). Forty of 75 ESBL-producers (53.5%) also had PABLs: 21 isolates with CMY-2-like, 17 with DHA-1-like. Pulsed-field gel electrophoresis showed 19 types and 25 of 74 isolates had an identical pattern, indicating nosocomial spread. Dissemination of ESBL- and PABL-producing K. pneumoniae strains in Korea is a particular concern, as it limits the choice of antimicrobial agents for treatment of infections.     

产超广谱β-内酰胺酶肺炎克雷伯菌和大肠埃希菌引起新生儿严重感染的治疗分析

目的:探讨新生儿病房产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌和大肠埃希菌耐药特点,指导临床用药。方法:经痰、血、脑脊液培养确诊为产ESBLs肺炎克雷伯菌及大肠埃希菌引起新生儿感染23例,分析药敏试验结果及治疗情况。结果:产ESBLs菌对亚胺培南普遍敏感,对舒普深耐药率低,肺炎克雷伯菌耐药率为36.36％,大肠埃希菌为25.0％,对头孢他啶、头孢曲松、头孢噻肟及氨曲南耐药率高达75％～100％,且部分体外敏感菌株在体内却表现出临床意义的耐药,对磺胺类、氨基糖甙类、氟喹诺酮类均表现出较高的耐药性。结论:亚胺培南及含β-内酰胺酶抑制剂复合物为新生儿病房产ESBLs菌感染的首选药物。     

Comparison of in vitro activity of ertapenem with other carbapenems against extended-spectrum beta-lactamase-producing Escherichia coli and Kleibsella species isolated in a tertiary children's hospital

Objective: The purpose of this study was to evaluate the susceptibility of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae clinical isolates to ertapenem in a tertiary pediatric care center in Turkey.

Design/methods: All isolates of ESBL-producing Enterobacteriaceae were collected from clinical specimens from children, and susceptibility tests were done using the Vitek 2 compact system.

Results: Ninety-nine per cent of the ESBL-producing Escherichia coli isolates were found to be susceptible to ertapenem, 99.5% to imipenem and 100% to meropenem. In the Klebsiella species, 91.5% of the isolates were susceptible to ertapenem, 99.3% to imipenem and 100% to meropenem.

Conclusion: The results of our data, including isolates from children, showed that ertapenem had high in vitro activity against the majority of the ESBL-producing E. coli and Klebsiella species, as reported in previously published studies. However, additional clinical studies are required to assess the clinical activity of ertapenem and the clinical importance of the resistant isolates.     

610株大肠埃希菌对抗菌药物的敏感性分析

目的 探讨大肠埃希菌(ECO)的耐药现状,为临床医师合理用药提供科学参考依据.方法 严格按照《全国临床检验操作规程》对610株ECO进行培养、鉴定；采用K-B法检测ECO对抗菌药物的敏感性,并根据CLSI2009年折点判断结果.结果 ECO检出率最高的科室是神经内科和ICU,分别占25.9％、21.3％;610株ECO中ESBLs阳性207株,阳性率33.9％,产与非产ESBLs菌株均对亚胺培南及美罗培南100.0％敏感.结论 临床医师应根据药敏结果合理选用抗菌药物,以提高临床治愈率.     

产ESBLs大肠埃希菌和肺炎克雷伯菌的分布及耐药分析

目的：探究产ESBLs大肠埃希菌和肺炎克雷伯菌的分布和耐药性。方法对2013年6月—2014年6月该院住院患者送检的标本进行培养,采用VITEK细菌鉴定与药敏分析系统行菌种鉴定和药敏分析,对产ESBLs大肠埃希菌和肺炎克雷伯菌的临床分布和耐药性进行分析。结果产ESBLs大肠埃希菌和肺炎克雷伯菌主要从尿液45.94%、痰液85.29%中检出;产ESBLs菌对碳青霉烯类、阿米卡星等药物敏感性较高耐药率1.47%~22.19%。结论产ESBLs大肠埃希菌和肺炎克雷伯菌主要引起泌尿道和下呼吸道感染,并对大部分常用抗菌药物耐药。     

Epidemiology,Risk Factors,and Outcome of Bloodstream Infection Within the First Year After Kidney Transplantation

BackgroundMulti-drug resistant organisms have been emerging among kidney transplant (KT) recipients with bloodstream infections (BSI). The investigation for epidemiology, risk factors and outcome of these infections following KT was initiated.Materials and MethodsA retrospective study of all adult KT recipients who developed a BSI within the first year after KT in 2016 at a single transplant center was conducted. The cumulative incidence of BSI was estimated with Kaplan-Meier methodology. Clinical characteristics and outcome were extracted. Risk factors were analyzed with Cox proportional hazards models.ResultsAmong 171 KT recipients, there were 26 (15.2%) episodes of BSI. Fifty-nine percent were men and the mean ± SD age was 43 ± 12 years. The cumulative incidence of BSIs was 10.1% at 1 month, 13.5% at 6 months, and 15.2% at 12 months. Gram-negative bacteria were responsible for 92% of BSIs, Escherichia coli was the most common pathogen (65%) followed by Klebsiella pneumoniae (11%). Among those, 71% were resistant to extended-spectrum cephalosporins. The genitourinary tracts were the predominant source of BSIs (85%). The second kidney transplantation (HR, 4.55; 95% CI, 1.24–16.79 [P = 0.02]) and receiving induction therapy (HR, 3.05; 95% CI, 1.15‐8.10 [P < 0.03]) were associated with BSI in a multivariate analysis. One patient (4%) developed allograft rejection, allograft failure and death from septic shock.ConclusionsOne out of six KT recipients could develop BSI from gram-negative bacteria within the first year after transplant, particularly in those that received the second transplantation or induction therapy.     

Antimicrobial susceptibility of common pathogens isolated from postoperative intra-abdominal infections in Japan

The principle of empirical therapy for patients with intra-abdominal infections (IAI) should include antibiotics with activity against Enterobacteriaceae and Bacteroides fragilis group species. Coverage of Pseudomonas aeruginosa, Enterobacter cloacae, and Enterococcus faecalis is also recommended for hospital-associated IAI. A nationwide survey was conducted to investigate the antimicrobial susceptibility of pathogens isolated from postoperative IAI. All 504 isolates were collected at 26 institutions and referred to a central laboratory for susceptibility testing. Lower susceptibility rates to ciprofloxacin and cefepime were demonstrated in Escherichia coli. Among E. coli, 24.1% of strains produced extended-spectrum β-lactamase (ESBL). Carbapenems, piperacillin/tazobactam, cephamycins/oxacephem, aminoglycosides, and tigecycline had high activity against E. coli, including ESBL-producing isolates. Among E. cloacae, low susceptibility rates to ceftazidime were demonstrated, whereas cefepime retained its activity. P. aeruginosa revealed high susceptibility rates to all antimicrobials tested except for imipenem. Among B. fragilis group species, low levels of susceptibility were observed for cefoxitin, moxifloxacin, and clindamycin, and high susceptibility rates were observed for piperacillin/tazobactam, meropenem, and metronidazole. Ampicillin, piperacillin, and glycopeptides had good activity against E. faecalis. Imipenem had the highest activity against E. faecalis among carbapenems. In conclusion, we suggested the empirical use of antimicrobials with the specific intent of covering the main organisms isolated from postoperative IAI. Piperacillin/tazobactam, meropenem, or doripenem, are appropriate in critically ill patients. Combination therapy of cefepime (aztreonam in patients with β-lactam allergy) plus metronidazole plus glycopeptides, imipenem/cilastatin or cephamycins/oxacephem plus ciprofloxacin plus metronidazole are potential therapeutic options.