重症监护病房呼吸机相关性肺炎病原学以及耐药性分析

目的:探讨重症监护病房呼吸机相关性肺炎病原学以及耐药性。方法:对我院2007年2月-2011年7月ICU内出现呼吸机相关性肺炎的患者99例作为研究对象,并对取痰液标本进行病原学以及耐药性分析。结果:革兰阴性菌的检出明显高于其他菌属,在G-杆菌中铜绿假单胞菌以及大肠埃希菌最为常见,G+球菌中以金黄色葡萄球菌以及肺炎链球菌最为常见;所有菌属均对常规抗菌药物有一定的耐药性,但其对万古霉素的敏感性仍然较高。结论:加强对ICU呼吸机相关肺炎进行分离致病菌并对其进行耐药性检测,以指导合理使用抗菌药物,有助于改善患者预后。     

老年重症肺炎病原学特点以及预后相关因素分析

目的探讨老年重症肺炎病原学特点以及分析预后相关因素。方法选取我科住院的老年重症肺炎(SP)患者140例,分析患者病原菌感染的病原学特点,包括对患者痰液菌株的分离鉴定及药敏试验检测,并使用多因素logistic回归进行预后相关因素分析。结果共121株病原菌被分离,其中革兰阴性菌91株(75.20%),革兰阳性菌27株(22.31%),真菌3株(2.48%)。主要革兰阴性菌均对氨苄西林具有较高的耐药性(≥80%),对阿米卡星、环丙沙星耐药性稍低;主要革兰阳性菌对氨苄西林、头孢曲松耐药性较高(70%),对头孢哌酮/舒巴坦耐药性稍低。住院时间(P=0.025)、机械通气(P=0.021)、MODS评分(P=0.019)与血浆白蛋白含量(P=0.013)是老年重症肺炎影响预后的独立危险因素。结论革兰阴性菌为老年重症肺炎主要致病菌,以鲍曼不动杆菌、铜绿假单胞菌为主,对氨苄西林耐药性较高。患者的预后与住院时间、机械通气、MODS评分和血浆白蛋白含量具有显著相关性。     

脑卒中患者院内获得性肺炎的病原学特点及耐药性分析

目的 确定脑卒中患者院内获得性肺炎(hospital acquired pneumonia,HAP)的病原学特点及耐药性.方法 对浙江大学医学院附属第一医院2009年1月至2012年6月重症监护病房脑卒中患者发生的医院感染360例进行回顾性分析.结果 360例肺炎患者中,分离出病原菌640株,G-菌396株,前三位的是鲍曼不动杆菌,铜绿假单胞菌,肺炎克雷伯菌.G+菌184株.真菌60株,以白色念珠菌最多.结论 综合ICU病房中脑卒中患者院内获得性肺炎的主要病原菌是:鲍曼不动杆菌,铜绿假单胞菌,金黄色葡萄球菌.     

无多重耐药危险医院获得性肺炎病原菌分布特点与耐药性分析

目的分析温州医科大学附属义乌医院无多重耐药危险医院获得性肺炎（HAP）病原菌分布特点及耐药性。方法人选无多药耐药危险因素的医院获得性肺炎（HAP）患者352例,按照发病时间分为早发HAP组与晚发HAP组,采集合格痰标本,进行细菌分离、鉴定和药敏试验,并分析比较患者病原菌分布特点及耐药性。结果人选的352例患者共分离m393株病原菌,HAP最常见的病原菌排名前五位的分别是为肺炎克雷伯杆菌、大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌及鲍曼不动杆菌,早发HAP排名前五位的分别是肺炎克雷伯杆菌、大肠埃希菌、金黄色葡萄球菌、肺炎链球菌和铜绿假单胞菌,晚发HAP排名前五位的分别是肺炎克雷伯杆菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌,两组患者革兰阳性菌与革兰阴性菌所占比例差异无统计学意义（P〉0．05）,78株革兰阳性菌对常用抗生素的耐药率早发与晚发HAP差异无统计学意义（P〉0．05）,296株革兰阴性菌对常用抗生素的耐药率,早发HAP与晚发HAP除了对哌拉西林和阿莫西林克拉维酸钾的耐药率差异有统计学意义（P〈0．05）,其余的差异有统计学意义（P〉0．05）,但是晚发HAP中检出耐甲氧西林金葡菌（MRSA）、产ESBLs肺炎克雷伯杆菌及耐碳青霉烯鲍曼不动杆菌（CR—AB）比例增高。结论无多重耐药危险因素的医院获得性肺炎（HAP）患者,早发与晚发HAP感染病原菌差别不大,虽晚发HAP的耐药率相对较高,但对大部分抗菌素敏感,所以适当使用抗菌素,对于减轻选择抗菌药物的压力、减少耐药菌株的产生和二重感染有重要意义。     

肺炎链球菌致老年患者社区获得性肺炎的危险因素与临床耐药性

目的了解肺炎链球菌致老年患者社区获得性肺炎的危险因素与耐药特征,为临床合理使用抗菌药物,有效预防和控制感染提供依据。方法收集2011年1月至2014年12月金华市第二医院老年科住院患者下呼吸道标本中分离的肺炎链球菌253株,均经全自动微生物鉴定仪鉴定,药敏试验采用纸片扩散法(K-B),结果按美国临床和实验室标准协会(CLSI)标准判读,采用WHONET 5.6软件进行耐药性分析。结果调查显示感染的最危险因素是患者年龄≥60岁,主要标本来源于痰液(75.5%);药敏试验表明肺炎链球菌对克林霉素、红霉素、四环素和复方新诺明的耐药率最高,分别为90.1%、86.2%、81.4%和76.7%,而对阿莫西林、万古霉素、莫西沙星、替考拉宁和利奈唑胺的耐药率2.0%。结论肺炎链球菌是引发本院老年患者社区获得性肺炎的主要致病菌,主要检出于痰标本,其耐药情况较为严重,表现出多药耐药,临床必须加强对肺炎链球菌的耐药性监测,阿莫西林、万古霉素、莫西沙星、替考拉宁和利奈唑胺可作为治疗该菌感染的首选药物。     

呼吸科与重症监护室院内获得性肺炎预后因素分析

目的通过对浙江大学医学院附属第一医院呼吸科和监护室（ICU）院内获得性肺炎（HAP）患者资料进行回顾性分析,以寻找不同科室患者HAP发生的危险因素的异同,从而针对不同人群建立特异的预防HAP的决策。方法采取回顾性研究,收集2011年6月1日至2013年9月30日浙江大学附属第一医院呼吸科和ICU出院诊断为肺炎（年龄≥18岁）的病历资料,比较两科室患者基本资料、基础疾病等方面的差别,然后对HAP患者危险因素进行分析,对筛选出来的P〈0.05的因素再进行Logistic多因素回归分析。结果逐步Logistic回归（Backward：Wald）分析提示,呼吸科危险因素为血液及实体肿瘤病史而ICU危险因素为感染性休克与近期重大手术史。结论两科室存在不同的影响预后的危险因素,ICU院内获得性肺炎的发病率、死亡率明显高于呼吸科,这与患者基础疾病有密切关系。     

通化市食源性患者粪便中致病菌检测及耐药性

目的通过对食源性疾病病例监测为食源性疾病诊断提供病原学确证,进一步探讨食源性疾病的治疗、预防和控制措施。方法按照国标方法进行几种致病菌的分离鉴定,按照CLSI 2010进行药敏试验操作及结果判定。结果 200份样品中共检出48株致病菌,检出率为24.00%。其中致泻性大肠埃希菌37株,沙门菌6株,副溶血性弧菌3株,志贺菌2株。分离出的志贺菌和副溶血性弧菌对13种抗生素全部敏感,分离出的沙门菌仅对四环素存在耐药性;分离出的大肠埃希菌中,有19株对13种抗生素均敏感,18株对8种抗生素具有一定的耐药性,产生10种耐药谱。结论通化市人民医院的食源性疾病患者粪便标本中致泻性大肠埃希菌检出率最高,其次为沙门菌,且两者均存在耐药株,应引起相关部门重视。     

肿瘤患者经外周放置中心静脉导管相关性感染的病原菌分布、耐药性及影响因素分析

目的:研究肿瘤患者经外周放置中心静脉导管(PICC)相关性感染的病原菌分布、耐药性,并分析其影响因素。方法:以2016年1月～2019年3月于我院行PICC置管的肿瘤化疗患者450例为研究对象,分析其PICC相关性感染发生情况。采集感染患者标本进行病原学检查,并分析感染病原菌种类、分布情况以及耐药性。同时对PICC相关性感染的影响因素进行分析。结果:450例患者发生PICC相关性感染的人数为40例,占比8.89%。共检出病原菌40株,其中革兰阳性球菌12株,革兰阴性杆菌28株。革兰阳性球菌对万古霉素、利奈唑胺和呋喃妥因均不耐药(0.00%),而对青霉素耐药率最高(100.00%)。鲍曼不动杆菌、铜绿假单胞菌对头孢吡肟、四环素的耐药率最高(100.00%),而鲍曼不动杆菌、铜绿假单胞菌和洋葱伯克霍尔德菌对呋喃妥因、头孢唑林的耐药率最低(0.00%)。经单因素分析发现:穿刺次数、导管留置时间、免疫功能、化疗次数以及是否合并糖尿病均与肿瘤患者PICC相关性感染有关(均P0.05)。经多因素Logistic回归分析显示:穿刺次数≥2次、免疫功能低下、化疗次数≥5次以及合并糖尿病均是肿瘤患者PICC相关性感染的独立危险因素(均P0.05)。结论:PICC相关性感染病原菌分布主要包括革兰阳性球菌与革兰阴性杆菌,临床应针对各病原菌的耐药性合理选择抗菌药物,同时加强对危险因素的干预,以降低PICC相关性感染的发生率。     

2014—2016年大连地区血流感染肺炎克雷伯菌的耐药性特征分析

目的分析肺炎克雷伯菌所致血流感染患者的科室分布及其病原菌耐药性特征,为指导临床合理应用抗菌药物,有效控制感染提供依据。方法选择2014-2016年大连医科大学附属第一医院送检血液标本中分离得到的289株肺炎克雷伯菌,对其进行细菌鉴定、药敏试验及ESBL确认试验,分析肺炎克雷伯菌所致血流感染患者的科室分布特征及其病原菌耐药性变迁。结果患者血液中肺炎克雷伯菌检出率以急诊科(24.91%)和ICU为最高(23.88%)。3年中肺炎克雷伯菌对碳青霉烯类抗生素和阿米卡星耐药率较低,均在20.00%左右。产ESBL肺炎克雷伯菌共135株,占46.71%,对常用抗生素的耐药率均显著高于非产ESBL菌株(P<0.01)。碳青霉烯类抗生素耐药菌株对常用抗生素耐药率均高于敏感菌株(P<0.01),对四环素、复方新诺明和阿米卡星耐药率相对较低,分别为66.10%、66.10%、71.19%。结论我院2014-2016年患者血液中肺炎克雷伯菌检出率以急诊科和ICU为最高。该菌对碳青霉烯类抗生素及阿米卡星的耐药率较低,碳青霉烯类抗生素耐药菌株对四环素、复方新诺明和阿米卡星尚有一定敏感性。     

新生儿肺炎的病原学分析

目的:了解新生儿肺炎病原学的特点,为临床经验性用药提供参考.方法:分析2001年1月～2002年12月新生儿肺炎病原学的情况.结果:125例痰标本共分离出病原菌108株,多株菌混合感染不多.主要为革兰阴性杆菌,占83.3%,其次为革兰阳性球菌,占10.2%,真菌感染只占6.5%.ESBLs及MRSA的检出率较高;细菌的耐药性较强但有自己的特点.结论:新生儿肺炎的病原学有自己的特点,应积极进行细菌学检查,根据其结果合理选用抗生素.     

A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility

正Dear Editor,In December 2019, a novel human coronavirus caused an epidemic of severe pneumonia(Coronavirus Disease 2019,COVID-19) in Wuhan, Hubei, China(Wu et al. 2020; Zhu et al. 2020). So far, this virus has spread to all areas of China and even to other countries. The epidemic has caused 67,102 confirmed infections with 1526 fatal cases     

Curcuminoids as inhibitors of thioredoxin reductase: A receptor based pharmacophore study with distance mapping of the active site

Curcumin is the yellow pigment of turmeric that interacts irreversibly forming an adduct with thioredoxin reductase (TrxR), an enzyme responsible for redox control of cell and defence against oxidative stress. Docking at both the active sites of TrxR was performed to compare the potency of three naturally occurring curcuminoids, namely curcumin, demethoxy curcumin and bis-demethoxy curcumin. Results show that active sites of TrxR occur at the junction of E and F chains. Volume and area of both cavities is predicted. It has been concluded by distance mapping of the most active conformations that Se atom of catalytic residue SeCYS498, is at a distance of 3.56 from C13 of demethoxy curcumin at the E chain active site, whereas C13 carbon atom forms adduct with Se atom of SeCys 498. We report that at least one methoxy group in curcuminoids is necessary for interation with catalytic residues of thioredoxin. Pharmacophore of both active sites of the TrxR receptor for curcumin and demethoxy curcumin molecules has been drawn and proposed for design and synthesis of most probable potent antiproliferative synthetic drugs.     

Comparative morphology of the carpel in the Liliaceae: Hewardieae, Petrosavieae, and Tricyrteae

The young pistils in the melanthioid tribes, Hewardieae, Petrosavieae and Tricyrteae, are uniformly tricarpellate and syncarpous. They lack raphide idioblasts. All are multiovulate, with bitegmic ovules. The Petrosavieae are marked by the presence of septal glands and incomplete syncarpy. Tepals and stamens adhere to the ovary in the Hewardieae and the Petrosavieae but not in the Tricyrteae. Two vascular bundles occur in the stamens of the Hewartlieae and Tricyrtis latifolia. Ventral bundles in the upper part of the ovary of the Hewardieae are continuous with compound septal bundles and placental bundles in the lower part. Putative ventral bundles occur in the alternate position in the Tricyrteae and putative placental bundles in the opposite. position in the Petrosavieae. The dichtomously branched stigma in each carpel of the Tricyrteae is supplied by a bifurcated dorsal bundle.     

Enterovirus 71 3C proteolytically processes the histone H3 N-terminal tail during infection

Highlights
1. The N-terminal tail of histone H3 is specifically cleaved during EV71 infection.
2. Viral protease 3C is identified as a protease responsible for proteolytically processing the N-terminal H3 tail.
3. Our finding reveals a new epigenetic regulatory mechanism for Enterovirus 71 in virus-host interactions.     

Detection of EBV and HHV6 in the Brain Tissue of Patients with Rasmussen’s Encephalitis

Rasmussen’s encephalitis (RE) is a rare pediatric neurological disorder, and the exact etiology is not clear. Viral infection may be involved in the pathogenesis of RE, but conflicting results have reported. In this study, we evaluated the expression of both Epstein-Barr virus (EBV) and human herpes virus (HHV) 6 antigens in brain sections from 30 patients with RE and 16 control individuals by immunohistochemistry. In the RE group, EBV and HHV6 antigens were detected in 56.7% (17/30) and 50% (15/30) of individuals, respectively. In contrast, no detectable EBV and HHV6 antigen expression was found in brain tissues of the control group. The co-expression of EBV and HHV6 was detected in 20.0% (6/30) of individuals. In particular, a 4-year-old boy had a typical clinical course, including a medical history of viral encephalitis, intractable epilepsy, and hemispheric atrophy. The co-expression of EBV and HHV6 was detected in neurons and astrocytes in the brain tissue, accompanied by a high frequency of CD8⁺ T cells. Our results suggest that EBV and HHV6 infection and the activation of CD8⁺ T cells are involved in the pathogenesis of RE.     

Perinatal Vertical Transmission of Chikungunya Virus in Ruili,a Town on the Border between China and Myanmar

正Dear Editor,Chikungunya virus (CHIKV), an arbovirus in the family of Togaviridae, genus Alphavirus, is transmitted by the A.aegyptii or A. albopictus mosquito, and causes disease in humans characterized by fever, rash, and arthralgia (Silva and Dermody 2017; Suhrbier 2019). It was first reported in 1953 in Tanzania, and caused only a few outbreaks and sporadic cases in Africa and Asia in last century. However, in the epidemic in 2004, CHIKV acquired mutations that conferred enhanced transmission by the A. albopictus mosquito(Schuffenecker et al. 2006). Since then, it has successively caused outbreaks in Africa, the Indian Ocean, South East Asia, the South America, and Europe (Zeller et al. 2016).     

Development of a Novel Reverse Transcription Loop-Mediated Isothermal Amplification Method for Rapid Detection of SARS-CoV-2

In conclusion, the novel visual RT-LAMP assay is a simple, rapid, and sensitive approach for detection of SARS-CoV-2, and it is ready for application in primary care and community hospitals or health care centers, and even patients' own houses in response to the current SARS-CoV-2 epidemic because the assay does not require sophisticated equipment and skilled personnel. Furthermore, it is also ready to be used in fields for screening samples from wild animals and environments to facilitate the identification of potential intermediate hosts that mediate the cross-species transmission of SARS-CoV-2 from bats to humans.