广州儿童医院重症监护病房感染病原菌的分布及耐药性分析

目的探讨儿科重症监护病房（PICU）感染病原菌的分布及耐药情况,为临床合理选用抗菌药提供参考。方法对广州市儿童医院PICU病房2003年11月-2005年10月各类感染标本所分离的病原菌的分布及耐药性进行回顾性分析。结果共检出295株病原菌,其中革兰阴性杆菌213株（72．2％）,主要为铜绿假单胞菌、不动杆菌等非发酵菌;革兰阳性球菌58株（19．7％）,主要为葡萄球菌;真菌24株（8．1％）。药敏结果提示铜绿假单胞菌及不动杆菌对亚胺培南、头孢哌酮／舒巴坦、环丙沙星及阿米卡星较为敏感,铜绿假单胞菌对头孢噻肟耐药率较高,而不动杆菌对头孢哌酮、氨曲南、庆大霉素耐药严藿。肠杆菌科细菌对氨苄西林、氨苄西林／舒巴坦、哌拉西林及多种头孢菌素耐药率较高而对亚胺培南、头孢哌酮／舒巴坦、阿米卡星等较敏感。葡萄球菌对青霉素、红霉素严重耐药,但对万古霉素、替考拉宁及阿米卡星敏感性高。结论铜绿假单胞菌等非发酵菌已成为PICU病房感染的主要病原菌。根据病原菌种类及药敏结果合理应用抗菌药是有效控制危重病患儿感染和减少耐药菌株产生的重要手段。     

广州地区儿童血培养病原菌的分布及耐药性研究

目的探讨儿童血培养病原菌的分布特点及其耐药情况,为临床诊疗提供参考。方法对广州市儿童医院2005年至2006年临床各科室送检血液标本所分离病原菌的分布及药敏结果进行回顾性分析。结果共检出385株病原菌,其中革兰阳性菌208株,占54．0％,革兰阴性菌164株,占42．6％,真菌13株,占3．4％。分离率前6位的病原菌依次为凝固酶阴性葡萄球菌（CNS,35．8％）、肺炎克雷伯菌（8．8％）、不动杆菌（5．5％）、大肠埃希菌（4．9％）、铜绿假单胞菌（4、7％）、金黄色葡萄球菌（4．4％）。病原菌的病区分布特点：儿科重症监护病房以不动杆菌等非发酵菌为主要分离菌（占41．7％）,新生儿重症监护病房以CNS为主（40．5％）,血液病区以肠杆菌科细菌为主（35．7％）,新生儿病房及传染病房均以CNS为主要分离菌。CNS对青霉素、氨苄西林、红霉素耐药率均超过80％,但对万古霉素、替考拉宁和阿米卡星敏感,MRCNS检出率达72.5％。肠杆菌科细菌对哌拉西林、氨苄西林、头孢噻肟及头孢哌酮的耐药率为50％～100％,但对亚胺培南、阿米卡星和诺氟沙星耐药率较低。不动杆菌对广谱青霉素、第3代头孢菌素、氨曲南及庆大霉素的耐药率较高而对亚胺培南、头孢哌酮／舒巴坦较为敏感。结论凝固酶阴性葡萄球菌是广州地区儿童败血症最主要的病原菌。不同病区检出病原菌种类有较大差异。根据病原菌种类及药敏结果合理应用抗菌药是有效控制感染和减少耐药菌株产生的重要手段。     

Antimicrobial resistance of Campylobacter jejuni and Campylobacter coli isolates from broiler chickens isolated at an Irish poultry processing plant

AIMS: The antibiotic susceptibility of Campylobacter jejuni and Campylobacter coli isolates from broiler chickens were determined in order to evaluate the level of antibiotic resistance of Campylobacter species in the Irish poultry industry. METHODS AND RESULTS: Seventy-eight Camp. jejuni and 22 Camp. coli strains were examined for susceptibility to eight antibiotics using the disc diffusion assay. The highest level of resistance of the Camp. jejuni isolates was recorded to ampicillin (35.9%), followed by 20.5% to tetracycline, 20.5% to naladixic acid, 17.9% to ciprofloxacin, 10.2% to erythromycin, 2.5% to streptomycin and 1.2% to kanamycin. Multidrug resistance to two or more antibiotics was seen for 30.7% of Camp. jejuni strains. Resistance of the Camp. coli isolates was shown to ampicillin (9%) and tetracycline (18.2%). CONCLUSIONS: The majority of Camp. jejuni strains were susceptible to antibiotics commonly used for human therapy. Camp. coli strains showed very low resistance levels and were susceptible to six of the eight antimicrobial agents studied. SIGNIFICANCE AND IMPACT OF THE STUDY: Levels of Camp. jejuni and Camp. coli antimicrobial resistance in Irish poultry production was assessed to determine the current situation in Ireland. The prevalence of antibiotic resistance of Campylobacter strains isolated from broiler chickens was low.     

儿童肺炎链球菌和流感嗜血杆菌耐药及感染特征分析

目的 了解儿童呼吸道感染肺炎链球菌(Streptococcus pneumonia,SP)和流感嗜血杆菌(Haemophilus influenzae,Hi)的分布特征、耐药情况,及耐药菌抗生素间的相互影响,以更合理地指导临床用药.方法 对2009-2010年临床呼吸道感染患儿进行痰、咽拭子或肺泡灌洗液培养分离Hi和SP.因子需求试验鉴定Hi,头孢硝噻酚法检测β-内酰胺酶;奥普托辛和胆汁溶菌试验确认SP.两菌均采用K-B法检测常用对抗生素的耐药性.结果 收集SP 495株,Hi 515株,多见于3岁以下儿童,以呼吸科分离率最高.SP对红霉素、四环素、阿奇霉素、复方新诺明的耐药率分别为98.4％、66.1％、98％和81.6％,其对青霉素敏感性仅为9.5％.Hi有42.7％产生β-内酰胺酶,Hi对氯霉素、复方新诺明、氨苄青霉素、阿奇霉素的耐药率分别为22.1％、21.6％、36.7％和62.7％.与青霉素敏感SP和β-内酰胺酶阴性Hi相比,耐药SP和阳性Hi更易对氯霉素、四环素和复方新诺明耐药.结论 SP和Hi以婴幼儿为主,多见于呼吸科.其耐药情况严峻,青霉素耐药和产β-内酰胺酶菌株会诱导其他抗生素耐药,引发多重耐药.合理使用抗生素以及对两菌的耐药监测应引起高度重视.     

Metal tolerance and antibiotic resistance patterns of a bacterial population isolated from sea water

The total aerobic heterotrophic and metal-resistant bacterial communities were studied in marine water. The resistance patterns, expressed as MICs, for 81 bacterial isolates to eight heavy metals were surveyed by using the agar dilution method. A great proportion of the isolates were sensitive to cadmium (99%), mercury (91%), zinc (84%) and cobalt (83%). On the other hand, 94%, 40%, 35% and 22% were resistant to lead, nickel, arsenate and copper, respectively. The majority of the tested strains (95.06%) were multiple metal-resistant, with pentametal resistance as the major pattern (25.9%). The response of the isolates to 11 tested antibiotics was tested and ranged from complete resistance to total sensitivity and multiple antibiotic resistance was exhibited by 70.38% of the total isolated population. The highest incidence of metal-antibiotic double resistance existed between lead and all antibiotics (100%), copper and penicillin (95%) and nickel and ampicillin (83.3%).     

142例儿童感染肺炎链球菌的耐药性分析

目的分析儿科病房的肺炎链球菌的主要分布情况以及耐药现状。方法收集宁波市妇女儿童医院儿科病房2010年1月1日至2012年12月31日临床分离的142株肺炎链球菌,采用法国生物梅里埃公司的VITEK-60型全自动微生物分析仪进行菌株鉴定。采用纸片扩散法（K—B法）做药敏试验,用参考菌株做质量控制。药敏试验结果按NCCL2002版判断标准,对照参考菌株判断敏感,中介和耐药。结果分离的142株肺炎链球菌的送检科室以呼吸科最多62株,其次是小儿监护病房21株,新生儿科送检标本中未培养出肺炎链球菌。分离的142株肺炎链球菌的标本以痰液标本最多103株。分离的142株肺炎链球菌对克林霉素,红霉素的耐药率分别为98．5％和95．07％且呈现逐年上升;对氨苄西林、氨苄西林舒巴坦钠、头孢呋辛、头孢曲松和万古霉素的敏感率分别为84．51％、89．44％、93．66％、97．89％和100％。结论本地区住院儿童的肺炎链球菌来源仍以呼吸道为主,对广谱半合成青霉素仍较敏感,对β-内酰胺酶抑制剂的广谱半合成青霉素敏感率更高,对头孢类敏感率更高,未发现对万古霉素耐药菌株。在门急诊可选用广谱半合成青霉素作为治疗肺炎链球菌的首选用药,在病房可选用敏感性更高的头孢呋新或头孢曲松治疗肺炎链球菌．但为了延缓耐药性的产生,应动态监测肺炎链球菌的耐药情况,合理选择抗生素,提高疗效。     

Antibiotic sensitivity of beta-hemolytic streptococci isolated from throat swabs and purulent material

The aim of this study was to evaluate the prevalence and susceptibility of beta-hemolytic streptococci isolated from throat swabs (142--29.9%) and purulent material (333--70.1%) taken from patients treated at University Hospital dr. A. Jurasz in Bydgoszcz Collegium Medicum. L. Rydygier in Bydgoszcz, Nicolaus Copernicus University in Torun in 2005-2009. Of the 475 tested strains, 156 (32.8%) were identified as S. pyogenes. This species accounted for 38.8% of strains isolated from purulent material and 19.0% of swabs from the throat. Among the strains isolated from throat swabs of 62 (43.7%) were identified as Streptococcus group C. Only 5.1% strains were identified as Streptococcus group F. All strains of beta-hemolytic streptococci were susceptible to ampicillin or penicillin, fluoroquinolones, vancomycin and linezolid. Erythromycin-susceptible strains was 83.8%, and 89.1% for clindamycin. A total of 51.3% of erythromycin resistance strains had the cMLS(B) phenotype (63.3% for strains from throat swabs and 46.3% of the purulent materials). Sensitivity to tetracycline was characterized by 51.2% of strains of beta-hemolytic streptococci. The percentage of strains susceptible to this antibiotic among isolates from throat swabs was 63.1%, and purulent material--48.0%. The lowest percentage of strains susceptible to tetracycline (14.1%) were found among S. agalactiae and Streptococcus group G (33.6%) strains. During the study time, saw an increase in the percentage of strains susceptible to tetracycline and erythromycin.     

Antibiotic susceptibility of clinically relevant anaerobes in Estonia from 1999 to 2001

At present little or no data is available regarding the resistance profiles of anaerobic bacteria in relation to the general usage of antibiotics. The objective of this study was to assess whether any potential relationship exists between the dynamics of antibiotic resistance of anaerobic bacteria and the consumption of antibiotics during the last 3 years within the Estonian population. In total, 416 anaerobic isolates were investigated from various clinical samples. The anaerobes were isolated on Wilkins-Chalgren Agar, incubated in an anaerobic glove box and identified by standard methods. beta-lactamase negative strains were tested against metronidazole, clindamycin, benzylpenicillin and the positive strains were further tested against metronidazole, clindamycin, and ampicillin/sulbactam by E-tests. The results of the susceptibility tests were interpreted according to the current criteria of NCCLS. Data from the Estonian State Agency of Medicines was used to assess the antibiotic consumption rate in the population (Defined Daily Doses per 1000 inhabitants annually). The following species of anaerobes were isolated: B. fragilis group, Bacteroides sp., Fusobacterium sp., Porphyromonas sp., Prevotella sp., Peptostreptococcus sp., in addition to various unidentified Gram-positive rods. Metronidazole resistance was not found among Gram-negative bacteria despite a relatively high consumption of this antimicrobial agent in Estonia. Only ampicillin/sulbactam demonstrated excellent in vitro activity against all anaerobes. Unexpectedly despite a relatively low rate of consumption of clindamycin a high rate of resistance to this agent occurred; a similar situation was noted for penicillin. In the present study we did not observe a relationship between the changes in antibiotic consumption (DDD/1000) rate and the resistance pattern of anaerobic bacteria to metronidazole, clindamycin, penicillin and ampicillin/sulbactam during a 3-year follow-up period. High resistance to penicillin among some species and also to clindamycin is similar to the global trend and argues for limited use of these antibiotics in empirical treatment. We would suggest that monitoring of local susceptibility pattern is necessary for the selection of initial empirical therapy.     

Antibiotic resistance among coliforms and Pseudomonas spp. from bodies of water around Port Harcourt, Nigeria

Samples from municipal waste water, the Bonny River estuary and wells in and around Port Harcourt were examined for bacteriological quality over a 9 month period. A total of 157 Pseudomonas spp., 133 Escherichia coli and 282 other coliforms were isolated and tested for the incidence of resistance to 10 antibiotics. All of the Pseudomonas spp. were resistant to at least one of the antibiotics while 96.2% were resistant to two or more. Most (83.5%) of the E. coli and other coliforms (91.8%) were resistant to at least one antibiotic. All strains were susceptible to gentamicin. Minimal inhibitory concentrations of ampicillin and tetracycline for E. coli ranged from 6.25 to 50 and 6.25 to 12.5 micrograms/ml, respectively. Minimal inhibitory concentrations of ampicillin and tetracycline were 1000 and 25 micrograms/ml for the Pseudomonas strains. The high incidence of bacterial resistance to antibiotics is discussed in relation to the widespread use of antibiotics, and possible public health implications.     

Antibiotic sensitivity of Haemophilus influenzae isolated from patients with inflammatory lung diseases

In 1980-1986 the sensitivity of 2,045 H. influenzae strains isolated from the bronchial contents of patients with inflammatory lung diseases were studied. This study revealed that 60-80% of H. influenzae cultures circulating in Leningrad were sensitive to tetracyclin, chloramphenicol and erythromycin. During the period of observation the tendency towards the decrease of the number of highly sensitive H. influenzae cultures and the increase of the number of strains resistant to all antibiotic preparations was followed. Most of H. influenzae strains isolated in Leningrad were sensitive to penicillin, oleandomycin and ampicillin. In 1983 the appearance of H. influenzae strains, multiresistant to antibiotics, was noted. In 1986 these strains constituted 4.5% of all isolated cultures.     

Resistance of Shigella to antibiotics

Antibiotic sensitivity of 104 Shigella clinical strains and 104 Escherichia coli strains isolated from patients with acute dysentery not treated with antibiotics in 1986-1987 was studied. It was shown that 100 per cent of the dysentery pathogens and colon bacilli were antibiotic resistant. Strains resistant simultaneously to chloramphenicol, ampicillin, streptomycin, tetracycline, monomycin and kanamycin were the most frequent among the dysentery pathogens. Colon bacilli and dysentery pathogens isolated from the same patient had specific sets of antibiotic resistance markers. Pathogenetic therapy of dysentery and exclusion of antibiotic use for several years did not result in lower numbers of Shigella antibiotic resistant strains.     

Occurrence of Corynebacterium amycolatum strains in clinical specimens

C. amycolatum is poorly recognized and rarely described in the world literature. So, better recognizing and understanding biology of these bacteria may help effectively prevent infections caused by them. The subject within the study were 70 of C. amycolatum strains which were isolated from the clinical specimens of patients hospitalized at the State Clinical Hospital in Bydgoszcz. After initial identification of examined strains based on Gram staining results, colonial morphology, biochemical and enzymatic features included in API Coryne and API ZYM tests (bioMérieux), growth at 20 degrees C, Tween 80 requirement, DNA and tyrosine hydrolysis, occurrence in clinical specimens and origin of C. amycolatum strains were analyzed. The investigated strains were the most frequently isolated from wound swabs (61.5%), urine (14.3%), drain swabs (7.1%) and mainly (37.2%) came from patients treated at the departments of surgery.     

Interaction of neomycin with other antibiotics on selected bacterial strains

Antimicrobial combinations are used most frequently to provide broad-spectrum empirical coverage in the treatment of bacterial infections. However, combination of two antibiotics may not influence their activity, may lead to synergy or antagonism in the activity. Neomycin may be combined with one of the following antibiotics: ampicillin, procaine penicillin, gramicidin, bacitracin, polymyxin B, lincomycin, oxytetracycline, and erythromycin in some human and veterinary multiantibiotic drugs distributed in Poland. The checkerboard method has been one of the traditional assays for the measurement of antibiotic interactions. The aim of this study was to analyse the activity interaction of neomycin with second antibiotic in multiantibiotic drugs distributed in Poland on standards and clinical bacterial strains. Checkerboard results for all strains demonstrated synergism for 2.5% of combinations, only for standards strains. In one case Salmonella Enteritidis, in combination of neomycin with bacitracin, inhibition effect was observed. Additive effects were predominant--49%. In 18% neutral effects were shown, but in 26% of combinations FIC indexes were not possible to calculate, because of the resistance of clinical strains to the highest concentration of at least one antibiotic. In combination of aminoglycoside (neomycin) with beta-lactams antibiotics (ampicillin, procaine penicillin) in vitro, no synergy was observed for all examined strains. The best results were achieved for combinations of neomycin with peptide antibiotics (polymyxin, gramicidin and bacitracin)--5 for all 6 synergy effect observed.     

Antibiotic resistance among coliforms and Pseudomonas spp. from bodies of water around Port Harcourt, Nigeria

Samples from municipal waste water, the Bonny River estuary and wells in and around Port Harcourt were examined for bacteriological quality over a 9 month period. A total of 157 Pseudomonas spp., 133 Escherichia coli and 282 other coliforms were isolated and tested for the incidence of resistance to 10 antibiotics. All of the Pseudomonas spp. were resistant to at least one of the antibiotics while 96.2% were resistant to two or more. Most (83.5%) of the E. coli and other coliforms (91.8%) were resistant to at least one antibiotic. All strains were susceptible to gentamicin. Minimal inhibitory concentrations of ampicillin and tetracycline for E. coli ranged from 6.25 to 50 and 6.25 to 12.5 μg/ml, respectively. Minimal inhibitory concentrations of ampicillin and tetracycline were 1000 and 25 μg/ml for the Pseudomonas strains. The high incidence of bacterial resistance to antibiotics is discussed in relation to the widespread use of antibiotics, and possible public health implications.     

Antimicrobial resistance and species identification of staphylococci isolated from the meat of wild rabbits (<Emphasis Type="Italic">Oryctolagus cuniculus</Emphasis>) in Slovakia

In 2009, a total of 113 strains of staphylococci were isolated from the thigh muscles of ten hunted and 20 farmed wild rabbits (Oryctolagus cuniculus) in the Slovak Republic. Only two isolates (1.8%) possessed coagulase activity, the rest of 111 staphylococcal isolates were coagulase-negative. Among them, six isolates (5.4%) showed the production of DNase. In each isolate, resistance to eight antibiotics by means of agar dilution test was tested. Based on these results, 110 isolates were found to be resistant to at least one antibiotic. Only one isolate was susceptible to all eight antibiotics tested. Another two isolates were susceptible, however, they showed intermediate susceptibility to cefoxitin. Resistance to ampicillin (78.8%), erythromycin (58.4%), penicillin (51.3%) and oxacillin (46.0%) was found most frequently. Twenty-six isolates (23.0%) were resistant to novobiocin. On the other hand, resistance to cefoxitin (8.0%) and gentamicin (1.8%) were quite rare. Fifteen percent of isolates were resistant to one antibiotic, simultaneous resistance to two, three, four and five antibiotics was confirmed in 22.1%, 23.9%, 21.2% and 13.3% of isolates, respectively. Except for two coagulase-positive Staphylococcus aureus isolates (1.8%), seven species of coagulase-negative staphylococci were identified using the MALDI BioTyper (TM) sytem as follows: Staphylococcus warneri (45.1%), Staphylococcus epidermidis (21.2%), Staphylococcus pasteuri (13.3%), Staphylococcus xylosus (8.0%), Staphylococcus capitis (7.1%), Staphylococcus haemolyticus (1.8%) and Staphylococcus cohnii ssp cohnii (1.8%).     

Drug resistance of opportunistic enterobacteria isolated from various sources]

Resistance of 159 strains of opportunistic enterobacteria to 9 antibacterial drugs was studied. The strains were isolated from man and cattle. It was shown that the overwhelming majority of the isolates (93 per cent) were polyresistant irrespective of the genus. There was a high frequency of the strains resistant to the widely used antibiotics such as chloramphenicol (73 per cent), ampicillin (73.6 per cent) and rifampicin (95.6 per cent) and sulfanilamides (99.3 per cent). Gentamicin and nalidixic acid proved to be the most active against the cultures: 11.9 and 10 per cent of the resistant strains, respectively. The strains of enterobacteria isolated from different sources had a sensitivity to the antibiotics. Multiple antibiotic resistance to at least 5 drugs, variability of the spectra and high resistance were more characteristic of the isolates from the animals. The necessity of a rational use of antibacterial drugs in veterinary is indicated.     

In vitro antibiotic susceptibility of bacteria isolated from EUS-affected fishes in India

AIMS: Twelve antibiotics were evaluated for in vitro sensitivity against 16 bacterial strains isolated from surface lesions of fishes affected with epizootic ulcerative syndrome (EUS). METHODS AND RESULTS: Disc diffusion assay in Mueller-Hinton agar showed that the pseudomonads and aeromonads were mainly resistant to penicillin, ampicillin and erythromycin. Additionally, some were resistant to gentamycin and amoxycillin. However, resistance towards antibiotics previously recommended for EUS treatment, such as oxytetracycline and chloramphenicol, was not observed. Four aeromonads and two pseudomonads were found to induce ulcers when injected intramuscularly in healthy Anabas testudineus. CONCLUSIONS: All six pathogenic isolates were sensitive towards oxytetracycline, chloramphenicol and nalidixic acid. Oxytetracycline seems to be an effective antibiotic, and further investigations to determine the mode of treatment and dose appear to be worthwhile.     

Antimicrobial susceptibility of some streptococci strains of anginosus group isolated from oral and maxillofacial infections

Streptococci strains of the anginosus group isolated from various oral and maxillofacial infections (OMF) were screened for their susceptibility to the following antimicrobial agents: benzylpenicillin, ampicillin, oxacillin, cephalothin, ceftazidime, cefotaxime, cefuroxime, erythromycin, clindamycin, tetracycline, chloramphenicol, vancomycin and trimethoprime-sulphamethoxazole. The isolates were susceptable to: clindamycin, chloramphenicol, vancomycin and all beta-lactam antibiotics, except ceftazidime to which 54.5% of the strains showed intermediate susceptibility. Intermediate susceptibility to tetracycline was found in 11.3% of the strains, whereas resistance to the same antibiotic was demonstrated in 61.4%. Resistance to erythromycin and trimethoprime-sulphamethoxazole was of 2.3% for both. In conclusion, penicillin is the drug of choice in infections caused by streptococci of the anginosus group.     

Enzyme immunoassay (EIA) in the rapid diagnosis of gonorrhoea

The diagnostic value of a new, modified enzyme immunoassay (EIA) (Gonozyme; Abbott Laboratories, North Chicago III) was evaluated for the rapid antigenic detection of Neisseria gonorrhoeae in endocervical and urethral specimens. EIA results were compared with those of Gram stain (GS) and conventional culture tests. EIA sensitivity and specificity for male patients attending dermatovenerological clinic were 100% and 96.8% respectively in comparison to 86.7% and 96.8% obtained by Gram staining. For female Obstetrics-Gynaecology patients EIA sensitivity of 100% was highly significant compared to 50% sensitivity by the Gram stain. In culture, 30 strains of N. gonorrhoeae were isolated from 125 male specimens and 2 from 105 specimens from females; this suggests a prevalence of N. gonorrhoeae of 24% in males and 1.9% in females. In vitro antibiotic sensitivity testing indicated 55% resistance to penicillin and 43% to ampicillin in these isolated strains; all were sensitive to erythromycin/tetracycline. 12% of the strains were beta-lactamase producers.