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。     

应用质粒分析探讨医院内细菌感染的流行病学特点

为探讨医院内细菌感染的流行病学特点，作者借助临床分离的６４株肺为克雷伯菌，４５株阴沟肠杆菌和６３株醋酸钙不动杆菌，进行质粒图谱分３种细菌分别有５８株，３５株和４１株含有质粒，且分别构成４６个，２１个和２３个质粒图谱型。结果表明：质粒分析为查明医院内细菌感染源和感染途径提供了较为直接，准确的客观依据，同时也看到了质粒分析的局限性。     

A study of the value of electrophoretic and other techniques for typing Acinetobacter calcoaceticus

Forty-four isolates of Acinetobacter calcoaceticus var anitratus collected during hospital outbreaks were studied using polyacrylamide gel electrophoresis (PAGE), plasmid analysis, antibiograms and biochemical tests to determine their degree of similarity. Reproducibility tests were also carried out on the PAGE and biochemical techniques to determine their validity when used to compare bacteria of the same type isolated intermittently. PAGE data was analysed densitometrically and isolates compared using a similarity matrix. All methods were able to subdivide the isolates, but results did not always correlate well between methods. Reproducibility data indicated that careful attention to technique is required when organisms are examined by PAGE sequentially. Results suggest that no single biotyping technique is likely to be adequate and that electrophoretic, biochemical and antibiogram data may complement one another and other epidemiological data in the typing of these organisms.     

Hospital outbreak caused by a carbapenem-resistant strain of Acinetobacter baumannii: patient prognosis and risk-factors for colonisation and infection

Between October 2001 and August 2002, 30 hospital patients became infected or colonised by a multiresistant (including to carbapenems) epidemic strain of Acinetobacter baumannii (AbMR) in a hospital outbreak. This study analysed the risk-factors associated with acquisition of this epidemic strain and investigated the prognosis of patients infected by AbMR, with the aim of elucidating factors which lead to mortality. A case-control study of the acquisition of AbMR in patients infected or colonised in the hospital outbreak was performed. Independent risk-factors leading to death were studied by logistic regression analysis. Multivariate analysis of the risk-factors for colonisation/infection with AbMR revealed an independent association with the presence of an arterial catheter (OR, 1.13; 95% CI, 1.03-1.25) and administration of imipenem as monotherapy (OR, 11.12; 95% CI, 2.33-53.09). Multivariate analysis of the prognostic features leading to mortality revealed a significant association with hypotension or shock (OR, 24.63; 95% CI, 1.56-387.56) at the time of bacterial isolation.     

ALP方案治疗86例耐多药结核病的疗效分析

目的通过对耐多药结核病例化疗疗效的分析,探讨MDR-TB的治疗方法.方法 86例住院的MDR-TB病人中,浸润型肺结核72例,慢性纤维空洞型肺结核14例.痰标本经Bactec-960培养、鉴定均有结核杆菌生长,药敏试验耐异烟肼、利福平(HR)26例,耐异烟肼、利福平、链霉素(HRS)及耐异烟肼、利福平、乙胺丁醇(HER)者38例,耐异烟肼、利福平、链霉素、乙胺丁醇(HRSE)22例.应用丁胺卡那霉素(A)、左旋氧氟沙星(L)及对氨基水杨酸钠(P)为基础化疗方案,加用1～2种未曾应用过的抗痨药物,平均治疗3个月.结果 86例病人痰菌阴转率70.9%,病灶吸收好转率77.9%,空洞治疗有效率58.3%.疗效较好,治疗过程中未出现严重的药物不良反应.结论 ALP组成的化疗方案对细胞内外的结核菌都有杀灭作用,三药联用协同作用好,副作用不多,是治疗MDR-TB的较好的化疗方案.     

Isolation and characterization of a monoclonal anti-P30 antibody resistant mutant of Toxoplasma gondii

Of the possible iodine-labelled Toxoplasma gondii surface proteins, P30 (apparent Mr 30,000) is the principal one recognized by acute and convalescent anti-toxoplasma sera. This protein which comprises from 3 to 5% of the total parasite protein was used to raise a panel of parasiticidal monoclonal anti-P30 antibodies. One of these monoclonal antibodies was able to select a resistant mutant from a large population of chemically mutagenized wild-type P strain parasites. This mutant retained the wild type sensitivity to other non-P30 parasiticidal monoclonal antibodies as well as polyclonal anti-P30 rabbit sera. Analysis of surface radioiodinated wild type and mutant parasites showed that the mutant had a quantitative reduction in the amount of P30. A comparison of surface biotin labelled wild type and resistant parasites by two dimensional electrophoresis showed that the mutant lacked one and possibly two of several proteins that make up wild type P30. Western blot analysis indicated that the mutant was devoid of antigenically reactive P30. These findings further support the hypothesis that antigenic variants of T. gondii can be induced and may involve the major surface membrane antigens of the parasite.