呼吸道感染患者多重耐药菌肺炎克雷伯菌的耐药及危险因素分析

摘要 目的：探讨与分析呼吸道感染患者多重耐药菌肺炎克雷伯菌的耐药及危险因素。方法：选择2015年1月到2020年2月本院诊治的呼吸道感染患者65例作为研究对象,收集患者的临床样本进行细菌分离与耐药分析,调查患者的临床资料并进行危险因素分析。结果：在呼吸道感染患者65例中,分离出多重耐药菌肺炎克雷伯菌32株,占比49.2 %,其中下呼吸道、上呼吸道、灌洗液、血液标本分别占50.0 %、9.4 %、25.0 %、6.3 %。32株多重耐药菌肺炎克雷伯菌对头孢曲松、头孢呋辛、氨苄西林、头孢吡肟、头孢噻肟的耐药率分别为71.9 %、87.5 %、96.9 %、84.4 %、81.3 %,对阿米卡星、头孢替坦、左氧氟沙星、亚胺培南、环丙沙星的敏感率分别为59.4 %、68.8 %、81.3 %、75.0 %、81.3 %。非条件 Logistic回归分析显示血型A型、碳青霉烯类抗菌药物使用、引流、机械通气、糖尿病等为导致多重耐药菌肺炎克雷伯菌感染的独立危险因素(P<0.05)。结论：多重耐药菌肺炎克雷伯菌感染在呼吸道感染患者中比较常见,对头孢呋辛、氨苄西林的耐药率比较高,对左氧氟沙星、环丙沙星的敏感率比较高,血型A型、碳青霉烯类抗菌药物使用、引流、机械通气、糖尿病等为导致多重耐药菌肺炎克雷伯菌感染的独立危险因素。     

阿奇霉素序贯治疗联合硫酸特布他林对肺炎支原体肺炎患儿肺功能和血清IL-6、CRP、PCT水平的影响

摘要 目的：探讨阿奇霉素序贯治疗联合硫酸特布他林对肺炎支原体肺炎（MPP）患儿肺功能和血清白介素-6（IL-6）、降钙素原（PCT）、C反应蛋白（CRP）水平的影响。方法：于2018年1月-2019年12月期间,选取80例来我院就诊的MPP患儿,根据入院顺序将患儿分为对照组（40例,阿奇霉素序贯治疗）和实验组（40例,阿奇霉素联合硫酸特布他林治疗）,对比两组疗效、住院时间及临床症状缓解时间、肺功能、不良反应及血清炎症因子水平。结果：实验组的胸片恢复正常时间、住院时间、啰音消失时间、退热时间、咳嗽消失时间短于对照组（P<0.05）。实验组治疗后的临床总有效率95.00%（38/40）高于对照组的77.50%（31/40）（P<0.05）。实验组治疗后用力肺活量（FVC）、第1秒用力呼气容积（FEV₁）、呼气峰值流速（PEF）均高于对照组,IL-6、PCT、CRP均低于对照组（P<0.05）。两组不良反应发生率组间对比无明显差异（P>0.05）。结论：阿奇霉素序贯治疗联合硫酸特布他林治疗MPP患儿,可有效缓解临床症状,降低机体炎症反应,改善患儿肺功能,不良反应轻微,协同作用显著。     

肺炎链球菌感染早期IFN-β通过调节巨噬细胞炎症反应保护宿主

该文旨在探讨干扰素-β(interferon-β,IFN-β)在肺炎链球菌(Streptococcus pneumoniae,S.pn)感染早期对宿主炎症免疫的影响。使用外源重组IFN-β蛋白(recombinant IFN-β,rIFN-β)预处理WT小鼠及其腹腔渗出巨噬细胞(peritoneal exudate macrophages,PEMs),以培养基处理组作为对照。同时应用内源干扰素α/β受体(interferonα/βreceptor,IFNAR)缺陷的小鼠以及PEMs,以WT组为对照。各组分别暴露于D39菌株后,通过RT-PCR和ELISA检测白细胞介素-1β(interleukin-1β,IL-1β)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)的表达水平,并通过小鼠肺切片HE染色和肺干/湿重比评估其肺部炎症浸润和组织损伤,以分析IFN-β对宿主炎症反应的影响;为分析细菌清除率,对小鼠巨噬细胞系RAW264.7行吞噬实验、计数小鼠肺部细菌载量,最后通过小鼠生存率分析确认IFN-β对宿主抵抗S.pn的影响。结果表明,IFN-β抑制D39诱导的IL-1β和TNF-α的过度表达。与NC组比,rIFN-β预处理提高RAW264.7细胞对S.pn的吞噬能力(P<0.001),降低感染小鼠的肺部细菌负荷(P<0.01)和肺损伤评分(P<0.05)。而IFNAR–/–感染小鼠肺部菌载量相较于WT小鼠显著升高(P<0.001),持续更高水平的局部炎症反应导致其肺组织损伤加重且在9天内死亡率明显增加(P<0.05)。但各组小鼠体质量、肺干/湿重比和脾指数值差异无显著性(P>0.05)。可见,在S.pn感染早期,IFN-β通过调节巨噬细胞中促炎细胞因子的表达而维持适度的局部炎症反应,有助于宿主清除细菌,防止局部感染进展为致死性感染。     

Modulation of respiratory dendritic cells during Klebsiella pneumonia infection

Background

Klebsiella pneumoniae is a leading cause of severe hospital-acquired respiratory tract infections and death but little is known regarding the modulation of respiratory dendritic cell (DC) subsets. Plasmacytoid DC (pDC) are specialized type 1 interferon producing cells and considered to be classical mediators of antiviral immunity.

Method

By using multiparameter flow cytometry analysis we have analysed the modulation of respiratory DC subsets after intratracheal Klebsiella pneumonia infection.

Results

Data indicate that pDCs and MoDC were markedly elevated in the post acute pneumonia phase when compared to mock-infected controls. Analysis of draining mediastinal lymph nodes revealed a rapid increase of activated CD103⁺ DC, CD11b⁺ DC and MoDC within 48 h post infection. Lung pDC identification during bacterial pneumonia was confirmed by extended phenotyping for 120G8, mPDCA-1 and Siglec-H expression and by demonstration of high Interferon-alpha producing capacity after cell sorting. Cytokine expression analysis of ex vivo-sorted respiratory DC subpopulations from infected animals revealed elevated Interferon-alpha in pDC, elevated IFN-gamma, IL-4 and IL-13 in CD103⁺ DC and IL-19 and IL-12p35 in CD11b⁺ DC subsets in comparison to CD11c⁺ MHC-class II^low cells indicating distinct functional roles. Antigen-specific naive CD4⁺ T cell stimulatory capacity of purified respiratory DC subsets was analysed in a model system with purified ovalbumin T cell receptor transgenic naive CD4⁺ responder T cells and respiratory DC subsets, pulsed with ovalbumin and matured with Klebsiella pneumoniae lysate. CD103⁺ DC and CD11b⁺ DC subsets represented the most potent naive CD4⁺ T helper cell activators.

Conclusion

These results provide novel insight into the activation of respiratory DC subsets during Klebsiella pneumonia infection. The detection of increased respiratory pDC numbers in bacterial pneumonia may indicate possible novel pDC functions with respect to lung repair and regeneration.     

Intracellular and Extracellular Biomineralization Induced by Klebsiella pneumoniae LH1 Isolated from Dolomites

Abstract

The interaction between bacteria and minerals is very complicated and has been intensively studied in the laboratory and the field in the last few decades, but the processes and mechanisms of biomineralization and mineral precipitation are still not fully understood and need to be explored further. In the present work, biomineralization experiments were undertaken using Klebsiella pneumoniae LH1, collected from a natural surface environment in an area of outcrops of Cambrian dolomite, in a culture medium with various Mg/Ca molar ratios (0, 3, 6 and 12). The mineral precipitates obtained were analyzed by X-ray diffraction (XRD), scanning electron microscope (SEM), energy dispersive spectrometer (EDS), Fourier transform infrared spectrometer (FTIR), laser scanning confocal microscopy (LSCM) and X-ray photoelectron spectroscopy (XPS). Cells were analyzed with a scanning transmission electron microscope (STEM), high resolution transmission electron microscope (HRTEM) and selected area electron diffraction (SAED). The composition of amino acids in extracellular polymeric substances (EPS) was also determined. In the experiments it was found that the production of ammonia and the presence of carbonate anhydrase promoted the increase of the medium pH and that minerals are nucleated on the EPS, which consist chiefly of amino acids and negatively-charged organic functional groups. With increasing Mg/Ca ratios, the mineral phases changed, including calcite (100%) at Mg/Ca molar ratio of 0, monohydrocalcite (36.05%) + dypingite (63.95%) at Mg/Ca molar ratio of 3, monohydrocalcite (29.72%) + dypingite (15.48%) + nesquehonite (54.80%) at Mg/Ca molar ratio of 6, and monohydrocalcite (14.2%) + dypingite (1.0%) + nesquehonite (84.80%) at Mg/Ca molar ratio of 12. Some intracellular amorphous calcium- and magnesium-rich inclusions were also detected in K. pneumoniae LH1, suggesting intracellular biomineralization accompanying the extracellular mineral precipitation. This study provides further understanding of the biomineralization processes of microorganisms.     

肠道细菌弗氏柠檬酸杆菌和产酸克雷伯氏菌对斑翅果蝇生长发育和物质代谢的影响

【目的】明确弗氏柠檬酸杆菌Citrobacter freundi和产酸克雷伯氏菌Klebsiella oxytoca两种肠道共生细菌对斑翅果蝇Drosophila suzukii生长发育和物质代谢的影响。【方法】以正常饲养条件下的斑翅果蝇、构建的斑翅果蝇无菌品系以及弗氏柠檬酸杆菌和产酸克雷伯氏菌单一共生菌感染的斑翅果蝇品系为材料,检测不同品系间斑翅果蝇的卵孵化率、3龄幼虫体重和化蛹率;测定不同斑翅果蝇品系3龄幼虫体内蛋白质、氨基酸、糖原和游离脂肪酸等代谢物的含量及超氧化物歧化酶(SOD)、过氧化氢酶(CAT)和过氧化物酶(POD)的活力。【结果】正常饲养条件下的斑翅果蝇卵孵化率、3龄幼虫体重、化蛹率及3龄幼虫体内蛋白质的含量均高于其他斑翅果蝇品系,且无菌品系中的最低。弗氏柠檬酸杆菌和产酸克雷伯氏菌感染的斑翅果蝇品系3龄幼虫中的氨基酸和糖原含量均低于斑翅果蝇无菌品系和正常品系。弗氏柠檬酸杆菌感染斑翅果蝇品系3龄幼虫体内游离脂肪酸的含量较其他品系的也降到最低。弗氏柠檬酸杆菌和产酸克雷伯氏菌感染斑翅果蝇品系3龄幼虫体内POD活力显著高于无菌品系和正常品系,而CAT活力显著低于无菌品系。【结论】斑翅果蝇肠道中无肠道共生细菌时生长发育迟缓,在食物中分别添加弗氏柠檬酸杆菌和产酸克雷伯氏菌后可一定程度上促进斑翅果蝇的发育,这与添加肠道共生菌后斑翅果蝇体内代谢物的变化密切相关。     

大肠埃希菌和肺炎克雷伯菌对三种氨基糖苷类抗生素的耐药性分析

【摘 要】 目的 评价庆大霉素、妥布霉素及阿米卡星三种氨基糖苷类抗生素（AGs）对大肠埃希菌和肺炎克雷伯菌的体外抗菌活性。方法 对902株大肠埃希菌和404株肺炎克雷伯菌,采用VITEK-2全自动微生物分析仪配套的AST-GN13药敏卡进行庆大霉素、妥布霉素及阿米卡星的体外药敏试验。结果 大肠埃希菌和肺炎克雷伯菌的产超广谱β-内酰胺酶（ESBLs）菌株检出率分别为40.8％和36.6％;产ESBLs的大肠埃希菌对庆大霉素、妥布霉素及阿米卡星的敏感率分别为42.4%、39.1%和96.5%,与非产ESBLs菌株比较,敏感率差异均有统计学意义（P<0.01）;产ESBLs的肺炎克雷伯菌对庆大霉素、妥布霉素及阿米卡星的敏感率分别为64.2%、62.8%和91.9%,与非产ESBLs菌株比较,敏感率差异均有统计学意义（P<0.01）;阿米卡星对产与非产ESBLs的大肠埃希菌和肺炎克雷伯菌均高度敏感,敏感率均在91%以上。结论 本地区大肠埃希菌和肺炎克雷伯菌产ESBLs菌株流行严重,ESBLs的产生可使大肠埃希菌和肺炎克雷伯菌对AGs的耐药情况加重,提示ESBLs和AGs引起的耐药可能存在一定的相关性。     

环介导恒温扩增法检测肺炎链球菌的研究

目的 建立环介导恒温扩增(LAMP)检测肺炎链球菌的方法.方法 用LAMP技术扩增肺炎链球菌菌株,并应用50例临床标本采用传统培养法、PCR法、LAMP法进行检测,比较3种方法的检出率,同时检测方法特异性和灵敏度.结果 所测肺炎链球菌均获扩增产物,对其他非肺炎链球菌无交叉反应.LAMP检测灵敏度可达102 CFU/mL.50例临床标本使用LAMP法检出9例肺炎链球菌阳性(18.0％),使用传统培养法检出阳性4例(8.0％).结论 LAMP法较传统培养检测方法特异性强、灵敏度高、操作方便、快速,适合临床标本的肺炎链球菌检测.     

肺炎链球菌粘附和毒力因子A研究进展

肺炎链球菌（Streptococcus pneumoniae,SP）普遍定植于呼吸道,是人类重要的侵袭性病原菌之一,是社区获得性肺炎、中耳炎、脑膜炎、菌血症、鼻窦炎的主要病原菌。肺炎链球菌粘附和毒力因子A（pneumococcal adherence and virulence factor A,PavA）是肺炎链球菌早期感染和侵袭过程中关键的毒力因子。体外试验表明,缺失PavA的肺炎链球菌的突变株其粘附和侵入上皮细胞和内皮细胞的能力明显下降。作为一种保护性抗原,其诱导的细胞和体液免疫可以有效的抵抗肺炎链球菌的感染,是肺炎链球菌新一代疫苗的候选蛋白。但是,PavA在肺炎链球菌与人肺上皮细胞交互对话中作用机制的研究尚属空白,本文就肺炎链球菌粘附和毒力因子A得最新研究进展作一综述。     

肺炎支原体抗体阳性对咳嗽变异性哮喘患儿肺功能的影响研究

目的:通过探讨肺炎支原体(MP)抗体阳性感染对咳嗽变异性哮喘(CVA)患儿肺功能的影响,为临床治疗提供依据。方法:选择2012年6月~2014年6月本院收治的CVA患儿共60例,依据支原体抗体检查和肺功能检测结果,分为CVA合并MP组(合并组)和CVA组,检测两组患儿初诊时肺通气功能、支气管激发试验阳性率,分析初诊时、治疗1、3个月后MP抗体对肺功能第一秒用力呼吸容积/用力肺活量(FEV1%)的影响。结果:初诊时两组患儿肺活量(FVC)、最大呼气峰流速(PEF)、FEV1%、最大中段呼气流速(MMEF75/25)实测值均低于预测值(P0.05),合并组MMEF75/25预测值/实测值的比值较CVA组高(P0.05)。支气管激发试验阳性患儿中,合并组以轻度和极轻度为主,CVA组以重度和中度为主(P0.05)。MP抗体滴度持续阳性和阴性患儿FEV1%无统计学差异(P0.05)。结论:合并MP抗体阳性CVA患儿气道高反应性程度较低,小气道阻塞加重,对肺通气功能无影响。