静脉留置部位导管相关菌血症的病原学研究

目的调查静脉留置导管相关性血流感染病原学特点。方法回顾性调查杭州医学院附属第一医院2003年1月至2005年9月静脉留置治疗患者感染的发生情况,并对其病原菌及耐药特点进行分析。结果165例患者共送检留置导管标本184份,140份标本检有病原菌,检出率为76.1%(140/184)。在165例患者中有150例进行了血液培养,发生血流感染的有103例,感染率为68.7%(103/150)。从140份静脉留置导管标本中共分离出171株病原菌,主要为表皮葡萄球菌、金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌等。有44例患者静脉留置导管和血液培养出同一种病原菌,主要为表皮葡萄球菌。导管留置后到第一次血液培养出现阳性的时间大约为4~8d。同时从静脉留置导管和血液分离的21株表皮葡萄球菌全部对呋喃妥因和万古霉素敏感,除对利福平的耐药率较低外,对其它抗生素的耐药率都超过50%。结论静脉留置导管较易引起血流感染,引起血流感染病原菌主要以表皮葡萄菌为主,且耐药性严重。     

95例肺炎支原体快速液体培养阳性标本分析

目的:采用巢式PCR法(nPCR)及全自动微生物鉴定仪对肺炎支原体(MP)快速液体培养阳性标本进行分析,探讨MP快速培养假阳性情况及原因.方法:收集95例MP快速液体培养阳性标本,巢式PCR检测MP核酸,用全自动微生物鉴定仪检测导致培养假阳性的微生物.结果:95例MP快速液体培养阳性标本中,90例巢式PCR结果阴性,假阳性率94.7%;经全自动细菌鉴定仪鉴定,97.8%为真菌所致.结论:普通的敏感细菌在MP快速液体鉴定培养基中可以被有效抑制;真菌是引起的快速培养假阳性的主要原因.     

超声引导下行颈内静脉置管术75例临床体会

建立和维持一条安全、有效的血管通路是血液透析治疗的先决条件。目前临床使用最多的是自体动静脉内瘘,但对于需要急诊透析、内瘘未成熟的患者,颈内静脉置管术得到了广泛的应用。目前认为深静脉穿刺的一针成功率、局部血肿、渗血等并发症与穿刺人员的熟练程度有关,使这类患者的有创操作风险降至最低,防止置管并发症的发生是医护人员努力的方向。我院血液透析中心对75例患者采用超声引导下和传统解剖定位法行颈内静脉置管术,现回顾性分析其效果并报道如下。     

1 276例新生儿临床血液培养的分析

目的研究新生儿血液感染的细菌种类和培养方法（需氧、厌氧培养）。方法血标本在mini VITAL全自动血培养仪中培养,采用VITEK32自动微生物分析仪进行细菌鉴定。结果1276例新生儿血中共分离出细菌95株,阳性检出率为7．37％。95株菌分属37个菌种。其中革兰阳性球菌71株,占74．74％,革兰阴性杆菌20株,占21．05％,专性厌氧菌1株,占1．05％,感染率最高的前3位细菌是凝固酶阴性葡萄球菌、金黄色葡萄球菌和大肠埃希菌。1149例新生儿中需氧和厌氧配对培养结果,阳性83例,阳性检出率为7．24％,其中需氧和厌氧均生长者34例,占40．96％;仅需氧生长者21例,占25．30％;仅厌氧生长者28例,占33．73％。结论快速血培养技术是血液感染病原学诊断必要手段,同时做需氧、厌氧培养对培养结果至关重要。     

934株自血培养分离致病菌的病原学分析

目的了解中山大学附属第一医院2002年到2005年自血培养标本中分离的致病细菌的耐药状况和菌群分布特征。方法采用全自动血培养仪进行培养,血培养报阳后转种血平板,用VITEK-60鉴定所分离致病菌,药敏试验用K-B法。结果4年间血培养共分离出934株病原细菌,其中大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌,是该院引起血液感染的主要致病细菌。药物敏感试验显示革兰阴性杆菌对亚胺培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的敏感性最高,而革兰阳性球菌对万古霉素及替考拉宁的敏感性最高。结论血液感染患者的死亡率较高,应重视导致血液感染致病菌的病原学研究,以利于疾病的治疗。     

尿液中细菌L型检出情况及耐药性分析

目的 了解泌尿感染患者尿液标本细菌L型的检出情况,分析尿常规结果、病原菌分布情况及耐药性特点,为临床提供诊疗依据。方法 对2014年1月至2015年12月1 532例住院和门诊泌尿感染患者的清洁中段尿标本的尿常规结果和微生物培养结果进行回顾性分析。严格按照《全国临床检验操作规程》要求采集患者尿液标本,2 h内完成尿液普通培养、高渗培养、尿常规检查及尿液离心后沉渣镜检。培养出细菌L型进行菌株鉴定和药敏试验,结果采用SPSS 13.0统计软件进行分析处理。结果 共检出细菌L型132例,检出率为8.6%。132例细菌L型阳性病例中,白细胞酯酶阳性19例,阳性率14.4%;尿沉渣镜检白细胞阳性105例,阳性率79.5%。细菌L型检出率排名前三位的分别为大肠埃希菌、粪肠球菌、葡萄球菌,分别占40.9%、22.7%、12.1%。大肠埃希菌对氨苄西林、环丙沙星、左氧氟沙星、氨苄西林/舒巴坦、头孢唑啉、复方新诺明耐药率较高;粪肠球菌对克林霉素、奎奴普丁/达福普汀、红霉素、四环素耐药率较高;葡萄球菌对青霉素G、红霉素、头孢西丁、甲氧西林、环丙沙星耐药率较高。结论 尿常规、尿沉渣镜检有助于细菌L型感染的辅助诊断,临床医生应根据尿培养结果合理、足疗程选用抗菌药物。     

甲真菌病患者甲微生物群分析

目的研究甲真菌病患者甲微生物群的构成,为进一步阐明甲真菌病的发病机制提供线索。方法本研究共纳入47例甲真菌病患者及7例健康志愿者。取患者病甲的甲屑进行真菌镜检及培养鉴定;提取患者病甲、患者对侧健甲及健康人甲的DNA,对真菌rDNA ITS区及细菌16S rDNA V3-V4区PCR扩增,分析微生物群构成,并进行α多样性、β多样性、Simper分析及Spearman相关性分析。结果甲真菌病患者病甲的微生物群构成与对侧健甲及健康人甲存在差异。患者病甲的真菌菌群的丰富度高于对侧健甲。患者对侧健甲细菌菌群的多样性高于病甲及健康人甲,且患者对侧健甲细菌菌群的构成与患甲和健康人甲均有部分重叠。结论患者对侧健甲的细菌菌群构成具有由健康人甲向患者病甲转变的趋势。且在患者病甲的微生物群中,某些真菌和细菌菌属可能具有相关性。     

高通量血液透析联合血液灌流对β_2-微球蛋白的影响

目的观察高通量血液透析联合血液灌流对慢性肾功能衰竭尿毒症期规律血透患者β2-微球蛋白(β2-MG)的影响。方法将50例慢性肾功能衰竭尿毒症期规律血液透析患者随机分为常规血液透析(HD)组25例,高通量血液透析联合血液灌流(HFHD+HP)组25例,比较两组患者单次治疗后β2-微球蛋白的清除率。结果 HD组治疗前后β2-微球蛋白比较,差异无统计学意义(P0.05);HFHD+HP组治疗前后β2-微球蛋白比较,差异具有统计学意义(P0.01)。两组β2-微球蛋白清除率比较,差异具有统计学意义(P0.01)结论高通量血液透析联合血液灌流能显著降低慢性肾功能衰竭尿毒症期规律血透患者的β2-微球蛋白水平,减少患者淀粉样变风险,改善患者的生活质量及预后。     

高龄患者血液感染常见革兰阴性杆菌及其耐药性分析

目的分析本院80~100岁高龄患者血液感染常见革兰阴性杆菌的种类及其耐药状况,为本院合理使用抗生素提供依据。方法采用BacT/Alert 3D血培养仪对血液标本进行阳性鉴定;VITEK-2Compact全自动微生物鉴定仪进行鉴定;K-B纸片扩散法对抗菌药物进行敏感性测定;使用WHONET 5.4分析软件分析数据。结果本院高龄患者血液培养阳性标本中共分离出革兰阴性杆菌108株,以肠杆菌科细菌为主,其次为非发酵菌,前者主要为大肠埃希菌52株(48.15%)和肺炎克雷伯菌37株(34.26%),后者主要包括铜绿假单胞菌10株(9.26%)和鲍曼不动杆菌8株(7.41%)。其中大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率分别为1.92%和13.51%,两者对氨苄西林、氨苄西林/舒巴坦、头孢唑林、头孢呋辛的耐药率均高于50.00%;铜绿假单胞菌和鲍曼不动杆菌对亚胺培南的耐药率分别为20.00%和25.00%,后者对其他抗菌药物的耐药率均高于前者。结论碳青酶烯类抗生素可作为本院高龄患者常见革兰阴性杆菌所致血液感染的首选药物;但在治疗中应考虑细菌的耐药特点及患者的代谢特点合理选择抗生素。     

一次亲吻,交换8000万口腔细菌

<正>在接吻时,双方口腔中的细菌会随着唾液的接触而交换,不过在此之前,还没有人计算过这种细菌迁移究竟有多大的规模。而近期发表在《微生物组学》(Microbiome)期刊上的一项研究估计,一次持续10秒的亲吻会造成大约8 000万口腔细菌的"迁徙"。这项研究还发现,每日亲吻超过9次的伴侣会分享相似的口腔菌群。当然,健康人口腔中的细菌大多是无害的,在没有其他致病菌感染的情况下,这样的"细菌交换"也不大可能导致疾病。我们的身上有着多达100万亿微生物组成的生态系统,这些微生物对于我们的食物消化、营养物质的合成以及     

Gender differences in vascular access in hemodialysis patients in the United States: Developing strategies for improving access outcome

Background: Patients undergoing chronic hemodialysis (HD) require placement of permanent vascular access with the creation of an arteriovenous fistula (AVF), an arteriovenous prosthetic graft (AVG), or a tunneled central venous catheter. AVFs provide greater long-term patency, fewer complications, and lower infection rates than do either AVGs or catheters. Despite these advantages, women continue to be underrepresented among AVF patients, possibly because of concerns about smaller vascular diameters and higher rates of early primary fistula failure in female HD patients. The numerous clinical benefits of AVF suggest that a greater effort should be made to promote AVF placement in women.Objective: This review analyzes risk factors for AVF failure in women and describes clinical strategies to improve AVF utilization and success for female HD patients.Methods: English-language publications were identified through a MEDLINE database search from January 1997 to March 2007, using the search terms arteriovenous fistula, vascular access, hemodialysis, female, and gender. Reference lists of identified articles were also reviewed.Results: There are significant benefits to using AVFs instead of AVGs or catheters in HD patients: greater long-term fistula patency, superior flow rates, and fewer complications. Vascular anatomical differences between the sexes contribute to the underutilization of AVF in women. AVF placement rates can be improved if patients and staff are adequately educated and provided with the tools to facilitate AVF placement. Noninvasive preoperative screening is important to identify superior access sites in women. Intraoperative monitoring of blood flow is a reliable predictor of early radiocephalic AVF patency. Routine postoperative vascular monitoring may improve overall success with AVF, and exercise may improve vascular diameter and may be even more beneficial for women, who may have smaller preoperative veins.Conclusions: Concerns about smaller vascular diameters and reports of higher failure rates in women may prevent nephrologists and surgeons from considering AVF for female HD patients. The numerous advantages associated with AVF suggest that a greater effort should be made to increase its utilization in women. With appropriate motivation, care, and diligence by treating clinicians, the success of AVFs in women can approach the good results typically expected in men.     

血清PCT、CRP及IL-6联合检测诊断细菌性血流感染的临床价值分析

目的:探讨血清降钙素原(PCT)、C反应蛋白(CRP)及白介素-6(IL-6)联合检测诊断细菌性血流感染(BSI)的临床价值。方法:选取我院2015年8月到2016年10月收治的疑似细菌性BSI患者216例,入院后均送检血培养,根据培养结果将其分为阳性组(102例)和阴性组(114例)。统计细菌性BSI阳性率、革兰阳性菌感染率和革兰阴性菌感染率;检测血清PCT、CRP、IL-6水平,并比较两组患者的差异,同时绘制ROC曲线并计算出各指标及联合检测的灵敏度、特异度、阳性预测值、阴性预测值及约登指数值。结果:所有疑似BSI患者的细菌阳性检出率为47.22%,革兰阳性菌感染率与革兰阴性菌感染率对比无差异(P0.05);阳性组的血清PCT、CRP、IL-6水平均明显高于阴性组(P0.05);血清IL-6的AUC明显大于PCT和CRP(P0.05);PCT、CRP及IL-6联合检测的灵敏度、特异度、阳性预测值、阴性预测值及约登指数均明显高于单项检测(P0.05)。结论:血清PCT、CRP及IL-6对于BSI均有着一定诊断价值,而各指标联合检测诊断BSI的临床价值更高。     

Bacteremia caused by viridans streptococci in 71 children.

A review of the hospital records of 71 patients from whose blood viridans streptococci were isolated showed that in 13 cases the patient''s illness was definitely related to the bacteremia: 4 patients had endocarditis, 3 had pneumonia, 2 had peritonitis and 1 each had meningitis, a scalp wound infection, sinusitis and otitis media. The bacteremia may have contributed to the two deaths among these 13 patients. In 45 cases the viridans streptococci may have contributed to the patient''s illness: 15 patients had an infection of the lower respiratory tract and 7 an infection of the upper respiratory tract, 8 were neonates with suspected septicemia, 3 had soft tissue infections, 3 had leukemia and sepsis, and 9 had miscellaneous infections; the bacteremia was unrelated to the two deaths in this group. In another 13 cases the viridans streptococci could not be related to the patient''s illness. The species most frequently isolated were Streptococcus mitis, S. sanguis II and S. MG-intermedius. The outcome of the bacteremia was generally good, even among the 11 patients not treated with antibiotics. When viridans streptococci are cultured from a single blood sample, further samples of blood and, if feasible, specimens from the associated focus of infection should be obtained for culture; further blood cultures are especially important in cases of suspected endocarditis.     

858例血感染患者病原菌分布及耐药情况

目的:通过对某地区中心医院收集的临床血感染患者感染病原菌的分析,了解该地区血感染患者病原菌构成、分布及耐药特点,为临床治疗提供参考和指导。方法:收集2012年6月至2013年8月期间在某院就诊的858例血感染患者血液标本,采用BACTEC9050全自动血培养仪培养,采用VITEK 2 Compack系统和K-B琼脂纸片扩散法对阳性标本进行菌种鉴定和药敏检测。结果:血培养结果显示,在858份血培养标本中共检出阳性标本109份,每份标本都只检出一种病菌,总检出率为12.7%,革兰阳性菌占64.22%(70/109),革兰阴性菌占33.03%(36/109),真菌占0.35%%(3/109);药物敏感试验结果显示:葡萄球菌对青霉素、红霉素和复方新诺明耐药率40%;肠杆菌科细菌对氨苄西林和氯霉素耐药率40%;非发酵菌科细菌对氨苄西林,头孢他啶,头孢噻肟和氯霉素耐药率40%。结论:目前本地区临床血感染患者革兰阳性菌感染率高,以金黄色葡萄球菌和凝固酶阴性葡萄球菌为主,治疗可以首选糖肽类抗菌药物;革兰阴性菌以大肠杆菌和绿脓杆菌为主,对氨苄西林、氯霉素耐药率高,大肠杆菌对头孢类抗生素的耐受较绿脓杆菌低,两种细菌感染治疗可以考虑选择单环-内酰胺类抗生素。及时准确的血培养结果及药敏试验可为临床合理选择抗菌药物提供重要依据。     

Urgent-Start Peritoneal Dialysis and Hemodialysis in ESRD Patients: Complications and Outcomes

BackgroundSeveral studies have suggested that urgent-start peritoneal dialysis (PD) is a feasible alternative to hemodialysis (HD) in patients with end-stage renal disease (ESRD), but the impact of the dialysis modality on outcome, especially on short-term complications, in urgent-start dialysis has not been directly evaluated. The aim of the current study was to compare the complications and outcomes of PD and HD in urgent-start dialysis ESRD patients.MethodsIn this retrospective study, ESRD patients who initiated dialysis urgently without a pre-established functional vascular access or PD catheter at a single center from January 2013 to December 2014 were included. Patients were grouped according to their dialysis modality (PD and HD). Each patient was followed for at least 30 days after catheter insertion (until January 2016). Dialysis-related complications and patient survival were compared between the two groups.ResultsOur study enrolled 178 patients (56.2% male), of whom 96 and 82 patients were in the PD and HD groups, respectively. Compared with HD patients, PD patients had more cardiovascular disease, less heart failure, higher levels of serum potassium, hemoglobin, serum albumin, serum pre-albumin, and lower levels of brain natriuretic peptide. There were no significant differences in gender, age, use of steroids, early referral to a nephrologist, prevalence of primary renal diseases, prevalence of co-morbidities, and other laboratory characteristics between the groups. The incidence of dialysis-related complications during the first 30 days was significantly higher in HD than PD patients. HD patients had a significantly higher probability of bacteremia compared to PD patients. HD was an independent predictor of short-term (30-day) dialysis-related complications. There was no significant difference between PD and HD patients with respect to patient survival rate.ConclusionIn an experienced center, PD is a safe and feasible dialysis alternative to HD for ESRD patients with an urgent need for dialysis.     

A high red blood cell distribution width predicts failure of arteriovenous fistula

In hemodialysis patients, a native arteriovenous fistula (AVF) is the preferred form of permanent vascular access. Despite recent improvements, vascular access dysfunction remains an important cause of morbidity in these patients. In this prospective observational cohort study, we evaluated potential risk factors for native AVF dysfunction. We included 68 patients with chronic renal disease stage 5 eligible for AVF construction at the Department of General and Vascular Surgery, Central Clinical Hospital Ministry of Internal Affairs, Warsaw, Poland. Patient characteristics and biochemical parameters associated with increased risk for AVF failure were identified using Cox proportional hazards models. Vessel biopsies were analyzed for inflammatory cells and potential associations with biochemical parameters. In multivariable analysis, independent predictors of AVF dysfunction were the number of white blood cells (hazard ratio [HR] 1.67; 95% confidence interval [CI] 1.24 to 2.25; p<0.001), monocyte number (HR 0.02; 95% CI 0.00 to 0.21; p?=?0.001), and red blood cell distribution width (RDW) (HR 1.44; 95% CI 1.17 to 1.78; p<0.001). RDW was the only significant factor in receiver operating characteristic curve analysis (area under the curve 0.644; CI 0.51 to 0.76; p?=?0.046). RDW>16.2% was associated with a significantly reduced AVF patency frequency 24 months after surgery. Immunohistochemical analysis revealed CD45-positive cells in the artery/vein of 39% of patients and CD68-positive cells in 37%. Patients with CD68-positive cells in the vessels had significantly higher white blood cell count. We conclude that RDW, a readily available laboratory value, is a novel prognostic marker for AVF failure. Further studies are warranted to establish the mechanistic link between high RDW and AVF failure.     

综合性医院重症监护病房病原菌分离情况分析

目的探讨重症监护病房（Icu）医院内感染的临床特点及病原菌种类、分布情况,为临床合理使用抗菌药物、预防和控制医院感染提供参考和依据。方法采用前瞻性监测与回顾性调查相结合的方法,对ICU患者的临床资料进行统计分析。结果ICU病人标本中分离出病原菌593株,得出菌种分布与感染情况。结论重症监护病房医院内感染发生率高,以呼吸道感染为主,主要病原菌以革兰阴性非发酵菌为主,加强ICU患者感染的控制,可减少ICU医院内感染的发生。     

儿童血液凝固酶阴性葡萄球菌的感染情况及耐药性分析

目的了解本院儿童血培养凝固酶阴性葡萄球菌（CNS）的感染率及其药物敏感情况,为儿科合理使用抗生素提供依据。方法对本院2006年1月至2007年12月间住院及门诊儿童血液培养的结果进行回顾性统计分析。结果在1265例儿童血培养中共检出CNS117株,其中表皮葡萄球菌41株（占35．0％）,人葡萄球菌27株（占23．1％）,溶血葡萄球菌21株（占18．0％）,其他凝固酶阴性葡萄球菌28株（占23．9％）;耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）分离率为79．5％;MRCNS药敏结果显示多重耐药。结论CNS已成为儿童血液感染的重要致病菌,MRCNS检出率高且多重耐药,万古霉素、喹宁始霉素-达福普汀、呋西地酸是治疗MRCNS感染的首选药物。     

Filtration of Macrophage Migration Inhibitory Factor (MIF) in Patients with End Stage Renal Disease Undergoing Hemodialysis

BackgroundEnd stage renal disease (ESRD) patients are characterized by increased morbidity and mortality due to highest prevalence of cardiovascular disease. Macrophage migration inhibitory factor (MIF) is an inflammatory cytokine that controls cellular signaling in human physiology, pathophysiology, and diseases. Increased MIF plasma levels promote vascular inflammation and development of atherosclerosis. We have shown that MIF is associated with vascular dysfunction in ESRD patients. Whether hemodialysis (HD) affects circulating MIF plasma levels is unknown. We here aimed to investigate whether HD influences the circulating MIF pool in ESRD patients.ConclusionMIF is a dialyzable plasma component that is effectively filtrated during HD from the patient blood pool in large amounts. After removal of remarkable amounts of MIF during a single HD session, MIF plasma pool is early reconstituted after termination of HD from unknown sources.     

Chemotherapy of Campylobacter infections]

A total of 600 patients with suspected alimentary food poisoning were hospitalized. The ++clinico-laboratory findings showed that 27 (4.5 per cent) of them had Campylobacter infection. The cultures of Campylobacter jejuni and Campylobacter coli were isolated from 24 and 3 patients, respectively. The patients underwent complex pathogenetic treatment with oral rehydration saline solutions, symptomatic agents, enzymatic preparations and diet (the basic therapy) supplemented with biological bacterial preparations in less severe cases (8 patients). Antibacterial drugs such as furazolidone (roxytromycin), gentamicin and levomycetin, as well as fluoroquinolones such as ofloxacin and ciprofloxacin were additionally used in the treatment of both the patients with the generalized infection and those with more severe processes of the disease, pronounced diarrhea with blood traces and persisting isolation of Campylobacter (12 patients). The most favourable results in the treatment of more severe patients with Campylobacter infection were obtained with the fluoroquinolones used after inadequately efficient therapy with furazolidone or antibiotics especially in the cases with repeated isolation of campylobacteria.