2017年安徽省某三甲医院细菌耐药性监测

目的 了解铜陵市人民医院2017年临床分离细菌对抗菌药物的耐药状况。方法 对2017年1-12月临床分离菌采用纸片扩散法(KB)进行药敏试验，按CLSI 2017年版标准判读药敏试验结果，采用WHONET 5.6软件进行数据分析。结果 临床分离细菌共3436株，其中革兰阳性菌719株，占20.9%；革兰阴性菌2717株，占79.1%。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为23.8%和72.3%，耐甲氧西林株对β-内酰胺类抗生素和其他测试抗菌药物的耐药率显著高于甲氧西林敏感株，未发现对万古霉素和替考拉宁耐药的葡萄球菌。粪肠球菌对青霉素、氨苄西林和呋喃妥因的耐药率较低，屎肠球菌对氯霉素的耐药率较低，5.3%屎肠球菌对万古霉素耐药。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)和奇异变形菌中ESBLs的检出率分别为41.4%、50.7%和19.4%。肠杆菌科细菌中克雷伯菌属和沙雷菌属对碳青霉烯类抗生素耐药率较高，分别为37.5%和36.0%，其他菌属的耐药率低于3%。鲍曼不动杆菌对亚胺培南和美罗培南的耐药率分别80.3%和79.1%；铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为29.7%和28.4%。肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌中广泛耐药株的检出率分别为31.3%(171/546)、0.6%(3/508)和0.7%(3/416)。结论 本院革兰阴性菌呈增多趋势，尤其广泛耐药的肺炎克雷伯菌应引起高度关注，做好细菌耐药性监测，加强临床抗菌药物的合理使用和医院感染控制。     

Neorickettsia helminthoeca associated lymphoid,enteric, and pulmonary lesions in dogs from Southern Brazil: An immunohistochemical study

Neorickettsia helminthoeca (NH), the agent of salmon poisoning disease or canine neorickettiosis (CN), is a bacterial endosymbiont of the nematode Nanophyetus salmincola, and infections are spreading among specific fish‐eating mammalians. This article describes the pathologic and immunohistochemical findings associated with spontaneous NH‐induced infections in dogs from Southern Brazil. The principal pathologic findings were hypertrophy of Peyer patches and lymphadenopathy with lymphocytic proliferation, chronic interstitial pneumonia, and chronic enteritis associated with positive intralesional immunoreactivity to antigens of NH within macrophages and histiocytes. Positive immunoreactivity against canine parvovirus‐2 (CPV‐2) or/and canine distemper virus was not detected in the evaluated intestinal segments or in the samples from the cerebellum and lungs, respectively, from the dogs evaluated. These findings demonstrated that NH was involved in the enteric, pulmonary, and lymphoid lesions herein described, and provide additional information to confirm the occurrence of this bacterial endosymbiont within this geographical location. It is proposed that chronic pneumonia should be considered as a pathologic manifestation of NH‐induced infections. Additionally, our results show that the occurrences of CN seem to be underdiagnosed in Southern Brazil due to the confusion with the incidence of CPV‐2.     

Paradox of complex diversity: Challenges in the diagnosis and management of bacterial keratitis

Bacterial keratitis continues to be one of the leading causes of corneal blindness in the developed as well as the developing world, despite swift progress since the dawn of the “anti-biotic era”. Although, we have expeditiously developed our understanding about the different causative organisms and associated pathology leading to keratitis, extensive gaps in knowledge continue to dampen the efforts required for early and accurate diagnosis, and management in these patients, resulting in poor clinical outcomes. The ability of the causative bacteria to subdue the therapeutic challenge stems from their large genome encoding complex regulatory networks, variety of unique virulence factors, and rapid secretion of tissue damaging proteases and toxins.In this review article, we provide an overview of the established diagnostic techniques and therapeutics for keratitis caused by various bacteria. We extensively report the recent in-roads through novel tools for accurately diagnosing mono- and poly-bacterial corneal infections. Furthermore, we outline the recent progress by our groups and others in understanding the sub-cellular genomic changes that lead to antibiotic resistance in these organisms. Finally, we discuss in detail, the novel therapies and drug delivery systems in development for the efficacious management of bacterial keratitis.     

Compositional analyses reveal correlations between taxon-level gut bacterial abundance and peripheral T cell marker expression in African infants

ABSTRACT

Although exclusive breastfeeding has been linked to lower rates of postnatal HIV transmission compared to nonexclusive breastfeeding, mechanisms underlying this are unclear. Across a longitudinally sampled cohort of South African infants, we showed that exclusively breastfed (EBF) infants had altered gut bacterial communities when compared to nonexclusively breastfed (NEBF) infants, as well as reduced peripheral CD4 + T cell activation and lowered chemokine and chemokine receptor expression in the oral mucosa. We further demonstrated that the relative abundance of key taxa was correlated with peripheral CD4 + T cell activation. Here, we supplement those findings by using compositional data analyses to identify shifts in the abundance of several Bifidobacteria strains relative to select strains of Escherichia, Bacteroides, and others that are associated with the transition to NEBF. We illustrate that the abundance ratio of these taxa is tightly correlated with feeding modality and is a strong predictor of peripheral T cell activation. More broadly, we discuss our study in the context of novel developments and explore future directions for the field.     

早期联用MEP和大剂量rhGH对严重烫伤大鼠肠源性感染的影响

目的探讨早期联用美罗培南(MEP)和大剂量重组人生长激素(rhGH)对严重烫伤免疫抑制大鼠肠源性感染的影响。方法Wistar大鼠54只随机分为对照组、烧伤组和治疗组(C1组、C2组、C3组),后两大组制成25%总体表面积(TBSA)Ⅲ°烫伤免疫抑制模型,伤后2h给予rhGH1.33IU/kg、MEP20mg/kg,伤后8、24h检测门静脉血清内毒素(LPS)、腔静脉血清肿瘤坏死因子-α(TNF-α)含量,肝功能变化和肠道细菌移位率。结果C3(MEP+rhGH治疗)组LPS和TNF-α含量均显著低于其他组(P<0.01),与对照组差异无统计学意义(P>0.05),C3组未发现肠道细菌移位且肝功能检测指标显著低于其他组(P<0.01),与对照组差异无统计学意义(P>0.05)。结论早期联用MEP和rhGH治疗严重烫伤免疫抑制大鼠能显著减轻或防止肠道细菌/内毒素移位,减少炎症介质释放,保护脏器功能。     

鸡抗内毒素卵黄抗体IgY的制备

目的：研究分别应用内毒素（LPS）、类脂A(LipidA)和大肠杆菌突变株15免疫鸡后其蛋黄中抗内毒素抗体IgY的产量、纯度、效价并筛选最佳免疫抗原。方法：分别应用内毒素（LPS）、类脂A(LipidA)和大肠杆菌J5突变株作为抗原免疫25周龄Leghom鸡，水溶法（WD）提取蛋黄中抗体IgY，双紫外光测定抗体含量，SDS-PSGE电泳检测抗体纯度，细胞酶联染色和ELISA检测抗体特异性、效价及筛选最佳免疫抗原。结果：3种抗内毒素IgY含量和效价分别为14.4mg/ml和1：12 800（J5）、10.61mg/ml和1：12 800（LPS）、9.26mg/ml和1：3200（LipidA），抗体纯度均为95％左右。结论：大肠杆菌突变株J5和内毒素（LPS）为最佳免疫抗原，免疫鸡后其蛋黄中抗内毒素抗体IgY的产量和效价最高。     

928株革兰阴性杆菌耐药性监测

目的：了解青岛地区临床分离的重要革兰阴性杆菌的耐药情况以指导合理用药。方法：2001年青岛3家医院临床分离的5种革兰阴性杆菌用Kirby-Bauer法进行药敏试验。结果：5种病原菌均占3家医院革兰阴性杆菌分离率的前5位，大肠埃希菌对氟喹诺酮类药物的耐药率达60％－87％，细菌对亚胺培南均呈高度敏感，但铜绿假单胞菌耐亚胺培南株占25．8％，头孢他啶的抗菌活性是三代头孢菌素中最高的；复方酶抑制剂表现出良好的抗菌活性。结论：细菌耐药问题仍是目前临床的严重问题，地域性的耐药性监测是必要的。     

慢性肝病合并细菌感染临床特点分析

目的 :分析慢性肝病合并细菌感染的特点。方法 :对 1997～ 2 0 0 2年住院的慢性重度、重症肝类及肝硬化合并细菌感染患者 52例进行回顾性分析。结果 :其中医院内感染占 2 9 8%。感染的部位 :腹腔感染 40 4% ,血液感染17 3 % ,呼吸道感染 18 1% ,肠道感染 9 6% ,胆道感染 7 7% ,口腔感染占 6 3 % ,其他感染占 3 3 % ,重型肝炎的感染率最高 ,其次为肝硬化和慢性重度肝炎。结论 :肝病患者免疫力低下 ,易于合并细菌感染 ,感染使病情加重 ,影响肝病的愈后 ;提高患者免疫力 ,增强控制医院感染的措施 ,重视潜伏感染状态病灶的处理 ,早期诊治感染可提高肝病患者的生存率     

甲磺酸帕珠沙星注射液治疗急性细菌性感染有效性和安全性的多中心临床研究

目的评价甲磺酸帕珠沙星注射液治疗急性细菌性呼吸系统、泌尿生殖系统感染的有效性、安全性。方法采用随机单盲平行对照多中心试验方法。选择急性细菌性呼吸系统、泌尿生殖系统感染患者213例，可评价病例209例，随机编人试验组或对照组。试验组101例．每日1次给予甲磺酸帕珠沙星注射液300mg，iv，gtt，bid；对照组108例，每日1次给予加替沙星注射液200mg，iv，gtt，bid。疗程7～10d。结果甲磺酸帕珠沙星组、加替沙星组有效率分别为94．06％（95／101）和90．74％（98／108）；痊愈率分别为67．33％（68／101）和70．37％（76／108）；细菌清除率分别为94．62％（88／93）和93．62％（88／94）；不良反应发生率分别为7，69％（8／104）和5．50％（6／109）。两组有效性、安全性相似（P〉0．05）。结论甲磺酸帕珠沙星注射液治疗急性细菌性呼吸系统、泌尿生殖系统感染有效、安全，与加替沙星相当。     

乌司他汀对重症急性胰腺炎血浆内毒素水平的影响及其疗效观察

目的　观察乌司他汀治疗重症急性胰腺炎对血清内毒素水平的影响。方法　 4 0例重症急性胰腺炎患者随机分为乌司他汀治疗组和一般常规治疗组两组 ,两组患者住院后分别在第 1、4、7、10天抽血测定血清淀粉酶、血浆内毒素水平 ,结合APACHEⅡ评分系统分析观察乌司他汀的临床疗效。结果　重症急性胰腺炎入院后第 1天血浆内毒素水平明显高于正常健康对照组 ,分别为 (1.10± 0 .2 3)IU/L和 (0 .2 0± 0 .5 0 )IU/L(P <0 0 0 1) ,治疗组血清淀粉酶、血浆内毒素水平下降均较对照组明显 (P <0 0 1) ,住院第 7天APACHEⅡ评分值低于对照组 (P <0 0 5 )。结论　重症急性胰腺炎患者早期存在不同程度的内毒素血症 ,乌司他汀治疗重症急性胰腺炎疗效肯定 ,并能降低患者血浆内毒素水平和改善预后