感控干预在控制多重耐药定植菌医院感染的临床研究

目的研究多重耐药定植菌与医院感染的关系以及去定植措施的效果。方法对入住ICU的患者进行多重耐药定植菌筛查,观察阳性患者和阴性患者医院感染发生率;将阳性患者随机分为对照组和试验组,对照组采用常规的预防控制措施,试验组加上安尔碘Ⅲ去鼻腔MRSA、口服金双歧去肠道产ESBLs肠杆菌措施,观察两组患者医院感染发生率以及定植菌与医院感染的关系,对比两组去定植效果。结果ICU多重耐药菌定植率为31. 16% ;多重耐药定植菌筛查阴性患者医院感染率为7. 56%,阳性患者医院感染率为15.47% （P 〈0.01）;对照组医院感染率为20.79%,试验组医院感染率为22. 22% （P 〉0. 05）;对照组定植菌医院感染率为4. 95% ,试验组定植菌医院感染为0（ P 〈0.01）;对照组产ESBLs大肠埃希菌定植自行清除率为26. 31% ,试验组产ESBLs大肠埃希菌去定植率为80. 95% （P 〈 0. 01）。结论ICU患者多重耐药菌定植率高,多重耐药菌定植患者医院感染率高,口服金双歧去肠道产ESBLs细菌干预措施有效,安尔碘Ⅲ去鼻腔MRSA效果需继续研究。     

革兰氏阴性不发酵杆菌的鉴定及其对抗生素的敏感性

本文报道从临床病人和医院内环境分离的165株革兰氏阴性不发酵杆菌的鉴定,以及这些菌对常用抗生素敏感性试验的结果。165株菌归属为五个菌属：假单胞菌属、不动杆菌属、莫拉氏菌属、无色杆菌属和产碱菌属。绝大部分菌株对于常用抗生素耐药。讨论了细菌鉴定方法和程序。提出这些菌与临床感染具有密切关系,耐药菌株对于感染症治疗和医院内感染带来的问题。     

医院空气中细菌与临床感染的关系研究

医院感染已列为国家质量管理的一个重要组成部分,感染菌的来源,主要分内源性菌,即患者自身带的菌又感染了自己。另一种是外源性菌,即外环境包括空气中的细菌、各种物品中的细菌、人员接触等。医院内感染;以呼吸道感染占首位(59％),空气传播是引起感染的重要方面,空气中病原性微生物的污染程度直接决定感染率的高低。为了弄清医院空气中菌群分布情况及从空气中和临床患者中分离出同一类菌的关系,进行了对比实验及耐药性分析,现将结果报告如下。     

重症监护病房多重耐药菌监测与控制现状分析

目的 了解北京市三级医院重症监护病房（ICU）多重耐药菌监测及防控措施落实情况。方法 制定统一调查表,对北京市38家三级医院的ICU进行现场评估。结果 38家三级医院中有35家医院的ICU开展了多重耐药菌监测;监测占首位的多重耐药菌排名为泛耐药鲍曼不动杆菌、耐甲氧西林金黄色葡萄球菌（MRSA）、耐碳青霉烯铜绿假单胞菌、产ESBLs肺炎克雷伯菌、产ESBLs大肠埃希菌。79.0%的ICU单人间病房数量不超过5个。78.9%的医院基本能做到对多重耐药菌感染患者和普通患者分开管理。结论 多重耐药的革兰阴性杆菌是ICU最常见的病原菌。医疗资源不足加大了多重耐药菌医院感染防控的难度。     

医院与社区获得性感染大肠埃希菌耐消毒剂基因比较分析

目的 比较在本地区医院感染与社区获得性大肠埃希菌中耐消毒剂基因的流行情况.方法 收集从临床标本中分离出的大肠埃希菌112株,根据感染途径不同,将其分为医院与社区获得性两组,用PCR方法检测耐消毒剂基因qacE△1,并进行组间检出率比较.结果 本地区医院与社区获得性感染大肠埃希菌耐消毒剂基因的携带率分别为58.1％(43/74)和23.7％ (9/38),组间比较差异有统计学意义(P ＜0.05);74株医院获得性大肠埃希菌中,产ESBL率为71.6％(53/74),38株社区获得性大肠埃希菌中,产ESBL率为39.5％ (15/38).医院与社区获得性产ESBL大肠埃希菌耐消毒剂基因qacE△1检出率分别为64.2％(34/53)与6.7％(1/15),组间比较差异亦有统计学意义(P＜0.01).结论 医院获得性感染大肠埃希菌耐消毒剂基因的携带率高于社区获得性大肠埃希菌,产ESBL阳性菌株的携带率显著高于产ESBL阴性菌株,这可能是由于医院环境中消毒剂选择压力和/或携带耐消毒剂基因的菌株在医院内水平传播速度较快的结果.     

医院污水中硝化细菌的筛选及高通量鉴定

为了减轻医院污水中氮元素对环境的污染,经富集驯化从医院污水样品中筛选出了呈硝化阳性的硝化菌菌群HH-C、HH-E、HH-I、HH-J,采用高通量方法对硝化菌群进行鉴定,用氨氮、亚硝酸盐和硝酸盐快速测定试剂盒对其进行定性测定,再经单菌筛选纯化出10株呈硝化阳性的硝化细菌HH-3、HH-6、HH-8、HH-12、HH-13、HH-16、HH-18、HH-19、HH-21、HH-22,经复筛对这10株菌进行功能验证,选出了3株COD和氨氮降解率高的菌HH-12、HH-13和HH-22并应用到医院污水的处理中。     

金葡菌医院内定植和感染的研究

我校附属一院小儿科病房中,金葡菌在病人、陪人和病房环境中广泛存在,金葡菌的医院内感染时有发生。为了追踪金葡菌的来源,乃在入院24小时内和5天后采集患儿和陪人鼻前庭标本,分离金葡菌作噬菌体分型,并与病房环境分离的金葡菌型别进行分析对比,刚入院的金葡菌代表原带入医院者,5天后分离的细菌则代表入院后金葡菌的定植情况。查出病房环境中金葡菌主要为94/96型(6/     

假单胞菌属引起医院感染332例临床分析

目的 了解假单胞菌医院感染状况及对抗菌药物的敏感率。方法 调查１９９４年７月～１９９８年６月４年间发生的假单胞菌医院感染３３２例,分析原发病、诱发因素、临床特点、血白细胞、疾原菌分布及Ｋ－Ｂ法药敏情况。结果 血液系统疾病、慢性阻塞性肺气肿和外伤患者易引起假单胞菌医院感染,常见感染部位为呼吸道、泌尿道。结论 机体免疫功能受损者易患假单胞菌医院感染,病原菌对环丙沙星、阿米卡星、头胞他啶、多粘菌素Ｂ的敏感性较好。     

2012—2016年心肾专科医院 医院感染情况分析

摘要：目的 分析心肾专科医院医院感染情况,为降低医院感染及临床合理使用抗菌药物提供参考。方法 回顾性分析2012—2016年郑州市第七人民医院医院感染患者病原菌分布情况,并对结果进行统计分析。结果 2012—2016年共发生医院感染1 180例,各年发病率分别为0.86%、0.92%、0.81%、0.90%、1.08%。感染发病率较高的科室依次为肾内科、ICU、心外科、心内科。医院感染主要病原菌为大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌。2012—2016年多重耐药菌中耐甲氧西林金黄色葡萄球菌（MRSA）和产超广谱β-内酰胺酶（ESBLs）病原菌的比率逐渐下降。结论 医院感染发病率有增高趋势,感染率较高的科室是肾内科和ICU,主要病原菌以革兰阴性菌为主,产ESBLs病原菌和MRSA的检出率逐渐下降。     

长沙某医院产质粒AmpC酶型肺炎克雷伯菌的多重PCR检测与分析

为了了解湖南长沙某医院临床分离的肺炎克雷伯菌中质粒介导AmpC β-内酰胺酶的产生情况及其基因型,收集了该医院2008年3月至2010年10月临床分离的多重耐药肺炎克雷伯菌104株,用头孢西丁纸片扩散法对这些菌株进行表型初筛,用多重PCR确定ampC耐药基因型;结果发现其中有19株对头孢西丁纸片不敏感,疑为产AmpC酶菌株;再经多重PCR扩增,有12株菌分别在约400 bp（11株）和约350 bp（1株）出现了阳性条带,特异性PCR证明此12株菌分别携带了DHA型（11株）和ACC型（1株）ampC耐药基因;产质粒介导AmpC酶肺炎克雷伯菌的分离率为11.5%（12/104）。该医院产质粒介导AmpC酶肺炎克雷伯菌的分离率较高,应对其检测与监测给予足够重视,以指导临床合理选用抗菌药物。     

应用PCR扩增对分枝杆菌分类鉴定及标本检测的研究

用对结核分枝杆菌特异性很强的引物 b对 2 1种分枝杆菌和 13种非分枝杆菌进行 PCR扩增 ,并对扩增产物进行琼脂糖凝胶电泳。结果表明 :受试菌种用引物 b在退火温度 6 1℃时 ,扩增的敏感性为 50 fg,且只能扩出结核分枝杆菌、胃分枝杆菌 ,且他们扩增片段的分子量也不相同。可见 ,用引物 b,必要时辅以引物a,对分枝杆菌 16 S～ 2 3S r DNA间隔区序列进行扩增 ,可以快速有效地鉴定分枝杆菌临床分离株 ,是分枝杆菌鉴定的一种新方法。     

肠原发性非何杰金淋巴瘤与结核杆菌感染

目的 探讨肠原发性非何杰金淋巴瘤（PINHL）与结核杆菌感染的关系。方法 采用聚合酶链反应（PCR）技术对20例手术切除的PINHL的瘤组织的瘤旁粘膜组织进行结核杆菌DNA（TB－DNA）检测,同时回顾临床资料,结果 20％的PINHL瘤组织和30％的瘤旁粘膜组织中检出了TB－DNA,且发现TB－DNA阳性病例多是B细胞性PINHL,发病部位多靠近回盲部。结论 结核杆菌感染与PINHL之间可能存在特殊相关性。     

应用光敏生物素标记核酸探针鉴定分枝杆菌的研究

用光敏生物素标记非结核分枝杆菌临床分离株及标准分枝杆菌全染色体ＤＮＡ制成探针,与已知标准牛分枝杆菌（ＢＣＧ株）及不同种的非结核分枝杆菌ＤＮＡ杂交,可快速将分支杆菌鉴定到种,同时以大肠埃希氏菌做阴性对照,显示良好的特异性和准确性。此种方法具有鉴定速度快、操作简便、稳定性好及对人体无害等特点,适用于结核杆菌和非结核分枝杆菌的菌种鉴定。     

Tachyplesin and CyLoP-1 as efficient anti-mycobacterial peptides: A novel finding

Mycobacterium tuberculosis is an etiological agent of tuberculosis (TB) known to be a highly contagious disease and is the major cause of mortality from a single infectious agent worldwide. Emergence of multi-drug resistant and extremely drug resistant strains of M. tuberculosis has made TB management extremely challenging eliciting the urgent need for alternative therapeutics. Peptide based therapeutic strategies are an emerging area that can be employed as a prospective alternative to the currently existing therapeutic regime for TB treatment. Here, we are reporting the anti-mycobacterial activity of two peptides, Tachyplesin and CyLoP-1, derived from marine horseshoe crab and snake toxin respectively, with potent anti-mycobacterial activity against various mycobacterium species. Both the peptides exhibit appreciable antimicrobial and anti-biofilm activities against mycobacterium species with minimum cytotoxicity towards macrophage cells. They are also effective in eliminating mycobacterium cells from infected macrophage cells. Tachyplesin acts on mycobacterium cells in a lytic manner with outer membrane disruption confirmed by propidium iodide uptake with slight membrane depolarization and reactive oxygen species (ROS) production. CyLoP-1, on the other hand, does not rupture the mycobacterium cells even at high concentrations. It seems to follow intracellular pathway of killing mycobacterium cells by production of more ROS and membrane depolarization. Both the peptides do not lead to apoptotic way of mycobacterium cell death. These results suggest an effective peptide-based antimicrobial strategy for development of future anti-TB therapeutics.     

结核分枝杆菌耐链霉素和乙胺丁醇分子机制的研究

目的:研究结核分枝杆菌耐链霉素和乙胺丁醇的rpsL和emb B基因突变情况,探讨耐药基因突变与耐药性的关系。方法:通过传统药敏实验和聚合酶链反应(PCR)--单链构象多态性(SSCP)技术初步鉴定62株临床分离株的药敏和rps L、emb B基因。结果:与结核菌标准株H37Rv对照,分析30例TB菌耐链霉素(SM)的rps L基因,发现其突变率为70.0%(21/30),分析29例耐乙胺丁醇(EMB)的emb B基因,该基因的突变率为65.5%(19/29)。结论:部分结核分枝杆菌耐SM和EMB是由于其rps L、emb B基因突变所致,PCR-SSCP银染技术可能成为测定部分结核分枝杆菌耐药的简便、快速的方法。     

Rapid identification of Mycobacterium species by lectin agglutination

The purpose of the present study is to explore the possibility that plant lectins can be used for the development of rapid and inexpensive technique for differentiation of mycobacterial species. The method is based on interaction between mycobacteria and lectins as visualized by agglutination in a microtiter plate. We employed 18 mycobacterium species and determined the minimal lectin concentration (MLC) of 23 different lectins. For some of the bacteria as a high as 1000 microg/ml of one or more lectins were required to induce agglutination, while for other strains as low as 1.95 microg/ml of the lectin were needed. A unique pattern of agglutination was observed for each species over a range of 62-1000 microg/ml lectin concentrations. There were little or no variations in MLC within strains (intraspecies) of each of two species tested. In contrast, there were marked interspecies variations in MLC. Analysis of the MLC showed that the highest score of interspecies differences with 23 lectins was obtained at 125 microg/ml lectin concentration. At this concentration it was found that the pattern of agglutinations with only two lectins was sufficient to differentiate mycobacterium species from each other. Because the bacteria-lectin interaction is adaptable to various methods of visualization, our findings may set the stage for developing a rapid and reliable tool to differentiate mycobacterium species.     

重组分枝杆菌噬菌体检测分枝杆菌的发光研究

采用生物发光方法检测重组的分支杆菌噬菌体对不同细菌的发光反应,并比较了仅在特定的温度范围内才能繁殖的温敏噬菌体Phage 88和正常噬菌体Phage 40对分枝杆菌感染活力测定时发光强度的差异,以建立用不同类型重组噬菌体检测结核分枝杆菌耐药性的方法和条件.结果显示两种噬菌体对各种分枝杆菌作用后均有发光,对非分枝杆菌发光值很低,两者差异有显著性;不同的分枝杆菌发光值有差异：卡介苗的发光值最高,结核分枝杆菌的发光值最低;温敏噬菌体Phage 88的检测灵敏度大于正常噬菌体Phage 40,差异显著.因此可认为两株噬菌体均可特异地检测结核分枝杆菌,但Phage 88的效果优于Phage 40.     

多重PCR方法特异性鉴定卡介苗菌株多糖核酸的初探

与结核分枝杆菌H37Rv菌株进行比较,BCG菌株可找到一个特殊的缺失片段RD1,它存在于所有有毒分枝杆菌中,而在所有的卡介苗菌株中均缺失。应用多重PCR方法检测RD1区的存在与否,可以区别BCG和其它有毒的分枝杆菌。卡介菌多糖核酸来源于卡介菌,检测成品中DNA是否含有RD1区,能特异性地鉴别该制品。结果显示牛分枝杆菌标准株和结核分枝杆菌H37Rv存在RD1区;而卡介菌多糖核酸注射液和国内皮内注射用BCG疫苗生产用菌株扩增产物一致,提示均缺失RD1区。因此,这种多重PCR方法适用于卡介菌多糖核酸注射液的特异性鉴别试验。     

Polycyclic aromatic hydrocarbon-degrading <Emphasis Type="Italic">Mycobacterium</Emphasis> isolates: their association with plant roots

Five environmental mycobacterium isolates that degrade polycyclic aromatic hydrocarbons (PAHs) were associated with barley root surfaces after growth of the seedlings from inoculated seed. Mycobacterium cells were detected along the total root length for four of these isolates. These PAH-degrading mycobacterium strains had hydrophilic cell surfaces, whereas one strain, MCS, that was hydrophobic had reduced association along the root length with no cells being detected from the root tips. The root-tip-competent strain, KMS, was competitive for its root association in the presence of the root-colonizing pseudomonad, Pseudomonas putida KT2440. All mycobacterium strains utilized simple sugars (fructose, glucose) and the trisaccharide 6-kestose, present in barley root washes, for planktonic growth, but they differed in their potential for biofilm formation under in vitro conditions. Mineralization of pyrene by the KMS strain occurred when the components in the barley root wash were amended with labeled pyrene suggesting to us that mineralization could occur in plant rhizospheres containing such mycobacterium strains.     

The Incidence of Non-tuberculous Mycobacterium Lung Disease in Patients with Suspected Pulmonary Tuberculosis

Non-tuberculous mycobacterium (NTM) lung disease is increasing in prevalence. We analyzed the frequency of NTM lung disease among patients who are suspected of tuberculosis. NTM was isolated from about one-fourth of the mycobacterium culture-positive patients and about half of these had NTM lung disease. Therefore, NTM isolates should be routinely identified at the species level for adequate treatment.