脑卒中患者医院获得性肺炎的病原菌分布及药敏分析

目的:分析脑卒中患者医院获得性肺炎的病原菌分布及药敏性,为临床合理使用抗菌药物提供依据。方法:收集2013年3月-2015年9月我院收治的109例脑卒中并发医院获得性肺炎的临床资料,采用无菌方法收集患者晨痰或者下呼吸道分泌物进行细菌培养,并对阳性病原菌进行药物敏感性试验。结果:对痰标本或者是下呼吸道分泌物进行细菌培养187次,培养阳性152次,阳性率为81.28%,共培养出病原菌283株,其中革兰阴性菌192株占67.84%,革兰阳性菌76株占26.86%,真菌15株占5.30%。革兰阴性菌中的肺炎克雷伯菌,鲍氏不动杆菌,大肠埃希菌,铜绿假单胞菌,阴沟肠杆菌对头孢噻肟,头孢呋辛,美洛西林,美洛西林,头孢呋辛和头孢噻肟的耐药率最高,分别为66.18%,65.31%,70.97%,64.00%,71.43%;对氯霉素,哌拉西林/他唑巴坦,氯霉素,头孢吡肟,氯霉素的耐药率最低,分别为1.47%,6.12%,3.23%,8.00%,7.14%。革兰阳性菌中的金黄色葡萄球菌,肺炎链球菌,粪肠球菌对万古霉素,万古霉素,氨苄西林的耐药率最高,分别100.00%,90.00%,84.62%;对红霉素,红霉素,红霉素的耐药率最低,分别为5.26%,0.00%,0.00%。结论:革兰阴性菌是脑卒中患者医院获得性肺炎的主要病原菌,病原菌耐药性高且存在耐多药现象,临床应合理选用抗菌药物进行治疗。     

Antimicrobial resistance and in vitro gene transfer in bacteria isolated from the ulcers of EUS-affected fish in India

Aims:  The occurrence of drug resistance and plasmid-mediated transferability was investigated in 15 Aeromonas isolates collected from the ulcers of epizootic ulcerative syndrome (EUS)-affected fishes Katla ( Catla catla ), Mrigel ( Cirrhinus mrigala ) and Punti ( Puntius sp.).
Methods and Results:  Disc diffusion assay showed that all the strains were resistant to ampicillin and sensitive to streptomycin. Of the 15 isolates examined, 93·3% isolates were resistant to erythromycin, sulfadiazine and novobiocin, while 66% were resistant to rifampin and 20% to chloramphenicol. All isolates harboured plasmids with sizes ranging from 64 to 23 kbp with a 23-kbp plasmid in common. Plasmids from 11 Aeromonas strains were transferred to Escherichia coli DH5α recipient strain along with the transfer of ampicillin, erythromycin and chloramphenicol resistance determinants with frequencies ranging from 7·0 × 10⁻⁶ to 1·8 × 10⁻⁵ transconjugants per recipient cell.
Conclusions:  The resistance to ampicillin, erythromycin, sulfadiazine, novobiocin and chloramphenicol is prevalent among the bacteria isolated from EUS-affected fish, and resistant determinants of some of these antibiotics have been transferred to the bacteria of other origin.
Significance and Impact of the Study:  The emergence of antibiotic resistance bacteria and gene transfer in vitr o suggests that antibiotics should be used more cautiously to treat Aeromonas infections in aquaculture.     

侵袭性和非侵袭性肺炎链球菌耐药率的比较分析

目的研究侵袭性和非侵袭性肺炎链球菌的耐药谱的差异,指导合理应用抗生素及感染管理。方法回顾性统计分析2009至2011年来天台县人民医院就诊患者分离肺炎链球菌的标本来源及耐药性,比较侵袭性和非侵袭性肺炎链球菌耐药率之间的差异。结果共分离出肺炎链球菌642株,痰液中分离出584株,非痰液中分离出58株,其中血液中分离出32株,脑脊液中分离出20株,其他分离出6株,所有肺炎链球菌对万古霉素和利奈唑胺均敏感,对青霉素、红霉素、克林霉素、四环素及复方新诺明耐药严重,对左氧氟沙星、氯霉素比较敏感;侵袭性分离株对青霉素、红霉素、克林霉素、左氧氟沙星、四环素及氯霉素的耐药率显著高于非侵袭性肺炎链球菌。结论该院分离的肺炎链球菌主要来自痰液标本,耐青霉素肺炎链球菌的检出率高,大环内酯类耐药严重,存在一定比例的侵袭性感染,非侵袭菌株与侵袭性菌株耐药谱之间存在一定差异,临床治疗应该区别对待,系统的监测细菌耐药性,合理选择抗菌药物。     

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.     

艰难梭菌耐药性及耐药机制研究进展

艰难梭菌(Clostridium difficile)是医疗保健相关性腹泻最主要的病原菌。2002年起欧美地区艰难梭菌感染发病率和病死率均明显增高,耐药艰难梭菌的出现和传播更给临床治疗和预防带来了挑战。绝大多数临床分离菌对甲硝唑及万古霉素仍呈高度敏感,但已有异质性耐药或最低抑菌浓度上升的报道;对红霉素和莫西沙星等其他抗菌药物的耐药率在不同国家和地区则有较大差异。艰难梭菌对甲硝唑或万古霉素敏感性下降产生的耐药机制尚不明确,而对红霉素、氟喹诺酮类、四环素和利福霉素形成的耐药机制主要是因为作用靶点发生了改变。文章简述了近年来国际上艰难梭菌耐药性及耐药机制方面的研究进展。     

Effect of banning vancomycin analogue avoparcin on vancomycin-resistant enterococci in chicken farms in Taiwan

Avoparcin, a vancomycin analogue, was banned as a feed additive in Taiwan in 2000. A nationwide surveillance was conducted to study the prevalence of vancomycin-resistant enterococci (VRE) on chicken farms between 2000 and 2003. Among the 1021 E. faecalis and 967 E. faecium isolates studied, resistance to tetracycline, erythromycin, high-level aminoglycosides, ciprofloxacin and chloramphenicol either increased or remained high except vancomycin. The proportion of VRE decreased, between 2000 and 2003, from 13.7% (22/161) to 3.7% (11/299) for E. faecalis, and 3.4% (4/119) to 0% (0/300) for E. faecium. Only 8.8% (7/80) of the chicken farms surveyed harboured VRE in 2003 compared with 25% (15/60) in 2000. All VRE were resistant to tetracycline and erythromycin. All VRE possess the vanA gene but nearly all (79 of 83 isolates) were susceptible to teicoplanin, indicating VanB phenotype. Some clones were detected from different farms in various regions over the years. We conclude that the frequency of VRE in chicken farms decreased in association with a ban on avoparcin; and the continued presence of VRE may be due to the ability of some strains to persist in the farms, transfer of vancomycin resistance determinants or co-selection by the continued use of other antibiotics.     

Antimicrobial susceptibility of staphylococci isolated from the faeces of wild turkeys (Meleagris gallopavo)

AIMS: The purpose of this study was to investigate the staphylococcal flora associated with wild turkey populations. METHODS AND RESULTS: Faecal samples obtained from 26 wild turkeys over a 16-month period were inoculated onto mannitol salt agar plates to select for staphylococci. Fifty-seven randomly chosen isolates were identified as Staphylococcus lentus and their susceptibility determined against clindamycin, chloramphenicol, ciprofloxacin, erythromycin, oxacillin, penicillin G, rifampin, tetracycline, trimethoprim-sulfamethoxazole, and vancomycin. Resistance was minimal as only 3 isolates showed resistance to clindamycin, 3 isolates were resistant to oxacillin, 3 isolates were resistant to penicillin G, and 1 isolate was resistant to erythromycin. Multiple antibiotic resistance was also minimal. CONCLUSIONS: S. lentus is the predominant staphylococcal species associated with wild turkey faeces and antibiotic resistance in these organisms is not problematic. SIGNIFICANCE AND IMPACT OF THE STUDY: S. lentus has been shown as a potential causative agent of inflammatory reactions in the respiratory tract. Due to increased numbers of wild turkeys and more frequent human exposure, surveys to monitor microbial populations are warranted.     

Conjugative transfer of glycopeptide and macrolide resistant genes among Enterococci and from Enterococcus faecalis to Staphylococcus aureus

The resistance determinants were transferred from clinical strains of enterococci to Staphylococcus aureus strains. As recipients methicillin-resistant and methicillin-susceptible strains were used and the filter-mating procedure was performed. The transconjugants resistant to erythromycin were obtained in the case of all recipients, in one case the vanA determinant conferring the resistance to vancomycin was transferred together with erythromycin resistance. However the resistance was very unstable and the level was not as high as in the case of Enterococcus faecalis donor strain. The vanA determinant was easily transferred between enterococcal strains by the conjugation and a transfer occurred of vanA alone or together with erythromycin resistance.     

Conjugal transfer of antibiotic resistances and plasmids from Campylobacter jejuni clinical isolates

Six Campylobacter jejuni clinical isolates were examined for the occurrence of plasmids in association with antibiotic resistances as well as conjugal transfer. All the isolates were found to carry three similar plasmids of 78 kb, 12.6 kb and 3.3 kb in size. Multiple resistance to at least three of the antibiotics tested was observed with resistance to tetracycline most common. En bloc transfer of donor resistances at frequencies ranging from 10(-8) to 10(-4) were seen in all but one of the isolates during conjugation. The conjugal transfer of erythromycin, neomycin and streptomycin were observed to occur at frequencies similar to that of chloramphenicol, kanamycin and tetracycline. In isolate ABA94, three different antibiotic resistance phenotypes of the transconjugants were seen. In addition to en bloc transfer of the donor resistances, in approximately 10% of the transconjugants the streptomycin resistance was lost although these transconjugants carried the donor complement of three plasmids. In a further 1% of the transconjugants, resistance to kanamycin only was detected and these transconjugants did not carry any plasmids.     

The chloramphenicol resistance gene cmlA is disseminated on transferable plasmids that confer multiple-drug resistance in swine Escherichia coli

A recent study of beta-hemolytic Escherichia coli isolated from diarrheic swine found that 53% were resistant to chloramphenicol, a drug that has been prohibited from use in food animals in the US since the mid-1980s. To identify the factors governing the persistence of chloramphenicol resistance in the absence of specific selection pressure, the location of the chloramphenicol resistance gene cmlA and its linkage to other resistance determinants were investigated. Southern blot analysis of plasmid DNA from 46 swine E. coli isolates indicated that cmlA was present on large plasmids greater than 100 kbp. Fifty-two percent of the isolates were able to transfer chloramphenicol resistance to an E. coli recipient at conjugation frequencies ranging from 10(-3) to 10(-8) per recipient. Antimicrobial susceptibility tests on transconjugant strains demonstrated that resistance to sulfamethoxazole, tetracycline, and kanamycin frequently transferred along with chloramphenicol resistance. The transconjugant strains possessed at least two distinct class 1 integrons that linked cmlA to both aminoglycoside resistance genes aadA1 and aadA2 and either to sul1 or to sul3 sulphonamide resistance genes. These results suggest that in the absence of specific chloramphenicol selection pressure, the cmlA gene is maintained by virtue of gene linkage to genes encoding resistance to antimicrobials that are currently approved for use in food animals.     

Modification of in vitro metabolism of T-2 toxin by esterase inhibitors.

A shuttle vector that can replicate in both Streptococcus spp. and Escherichia coli has been constructed by joining the E. coli plasmid pACYC184 (chloramphenicol and tetracycline resistance) to the streptococcal plasmid pGB305 (erythromycin resistance). The resulting chimeric plasmid is designated pSA3 (chloramphenicol, erythromycin, and tetracycline resistance) and has seven unique restriction sites: EcoRI, EcoRV, BamHI, SalI, XbaI, NruI, and SphI. Molecular cloning into the EcoRI or EcoRV site results in inactivation of chloramphenicol resistance, and cloning into the BamHI, SalI, or SphI site results in inactivation of tetracycline resistance in E. coli. pSA3 was transformed and was stable in Streptococcus sanguis and Streptococcus mutans in the presence of erythromycin. We have used pSA3 to construct a library of the S. mutans GS5 genome in E. coli, and expression of surface antigens in this heterologous host has been confirmed with S. mutans antiserum. A previously cloned determinant that specifies streptokinase was subcloned into pSA3, and this recombinant plasmid was stable in the presence of a selective pressure and expressed streptokinase activity in E. coli, S. sanguis (Challis), and S. mutans.     

Antimicrobial drug resistance in Staphylococcus aureus isolated from cattle in Brazil

Isolates of Staphylococcus aureus obtained from apparently healthy cattle in the State of Paraiba, Brazil were characterized in relation to resistance to 21 antimicrobial agents. Among the 46 isolates obtained, resistance to penicillin was most frequent, followed by resistance to cadmium, streptomycin, arsenate, tetracycline, mercury, erythromycin and kanamycin/neomycin. All isolates were susceptible to fusidic acid, ethidium bromide, cetrimide, chloramphenicol, benzalkonium chloride, doxycycline, gentamicin, methicillin, mnocycline, novobiocin, rifamycin, tylosin and vancomycin. Only six isolates were susceptible to all the drugs tested. With respect to the antibiotics, multi-resistant isolates were uncommon. These results are probably a consequence of the peculiarities of local drug usage pressures. In relation to metal ions, resistance to mercury was rare while resistance to arsenate was relatively frequent, which contrasts with the situation for human Staph. aureus strains. After treatment with ethidium bromide, elimination of resistance to penicillin, tetracycline, streptomycin, erythromycin and cadmium was observed, which was consistent with the genetic determinants being plasmid-borne.     

临床常见病原性细菌对抗生素的耐药性分析

目的了解长春地区部分医院临床分离的致病菌对抗菌药物的耐药情况。方法收集吉林大学中日联谊医院和长春中医药大学附属医院临床分离的致病菌,采用K—B法进行抗生素敏感性试验,参照CLSI2009年版的标准判断结果。结果从这两家医院共分离细菌447株,其中革兰阴性菌353株,占78．9％,革兰阳性菌94株,占21．1％。肠杆菌科细菌对氨苄西林的耐药率在70％以上,对庆大霉素的耐药率超过了50％,但对亚胺培南保持较高的敏感性（耐药率〈5％）。金黄色葡萄球菌和表皮葡萄球菌对红霉素耐药率分别为65．2％和82．1％,对万古霉素的耐药率较低,分别为4．5％和3．6％。非发酵革兰阴性杆菌对头孢他啶的耐药率超过50％,铜绿假单胞菌对氨曲南的耐药率达到了62．9％,对他唑巴坦复合制剂、亚胺培南、美罗培南和阿米卡星较为敏感,而鲍曼不动杆菌对各类抗生素的耐药率都较高。结论细菌对抗生素的耐药性仍表现出增长趋势,加强细菌耐药性的检测,对于指导临床正确、合理使用抗生素,减少耐药菌的产生和传播具有重要意义。     

Functional interactions within 23S rRNA involving the peptidyltransferase center.

A molecular genetic approach has been employed to investigate functional interactions within 23S rRNA. Each of the three base substitutions at guanine 2032 has been made. The 2032A mutation confers resistance to the antibiotics chloramphenicol and clindamycin, which interact with the 23S rRNA peptidyltransferase loop. All three base substitutions at position 2032 produce an erythromycin-hypersensitive phenotype. The 2032 substitutions were compared with and combined with a 12-bp deletion mutation in domain II and point mutations at positions 2057 and 2058 in the peptidyltransferase region of domain V that also confer antibiotic resistance. Both the domain II deletion and the 2057A mutation relieve the hypersensitive effect of the 2032A mutation, producing an erythromycin-resistant phenotype; in addition, the combination of the 2032A and 2057A mutations confers a higher level of chloramphenicol resistance than either mutation alone. 23S rRNAs containing mutations at position 2058 that confer clindamycin and erythromycin resistance become deleterious to cell growth when combined with the 2032A mutation and, additionally, confer hypersensitivity to erythromycin and sensitivity to clindamycin and chloramphenicol. Introduction of the domain II deletion into these double-mutation constructs gives rise to erythromycin resistance. The results are interpreted as indicating that position 2032 interacts with the peptidyltransferase loop and that there is a functional connection between domains II and V.     

Multidrug-Resistant Enterococci in Animal Meat and Faeces and Co-Transfer of Resistance from an <Emphasis Type="Italic">Enterococcus durans</Emphasis> to a Human <Emphasis Type="Italic">Enterococcus faecium</Emphasis>

Forty-eight isolates resistant to at least two antibiotics were selected from 53 antibiotic-resistant enterococci from chicken and pig meat and faeces and analysed for specific resistance determinants. Of the 48 multidrug-resistant (MDR) strains, 31 were resistant to two antibiotics (29 to erythromycin and tetracycline, 1 to erythromycin and vancomycin, 1 to vancomycin and tetracycline), 14 to three (erythromycin, tetracycline and vancomycin or ampicillin) and 3 to four (erythromycin, vancomycin, ampicillin and gentamicin). erm(B), tet(M), vanA and aac (6′)-Ie aph (2′′)-Ia were the antibiotic resistance genes most frequently detected. All 48 MDR enterococci were susceptible to linezolid and daptomycin. Enterococcus faecalis (16), Enterococcus faecium (8), Enterococcus mundtii (2) and Enterococcus gallinarum (1) were identified in meat, and E. faecium (13) and Enterococcus durans (13) in faeces. Clonal spread was not detected, suggesting a large role of gene transfer in the dissemination of antibiotic resistance. Conjugative transfer of resistance genes was more successful when donors were enterococcal strains isolated from faeces; co-transfer of vanA and erm(B) to a human E. faecium occurred from both E. faecium and E. durans pig faecal strains. These data show that multidrug resistance can be found in food and animal species other than E. faecium and E. faecalis, and that these species can efficiently transfer antibiotic resistance to human strains in inter-specific matings. In particular, the occurrence of MDR E. durans in the animal reservoir could have a role in the emergence of human enterococcal infections difficult to eradicate with antibiotics.     

Emergence and characterisation of vanB vancomycin-resistant Enterococcus faecalis in Rio de Janeiro, Brazil

Here we describe the detection and characterisation of three isolates of vancomycin-resistant VanB-type Enterococcus faecalis. Sequence analysis suggested that these isolates harboured the vanB1 gene. The isolates were susceptible to the majority of antimicrobial agents tested, with the exception of chloramphenicol, erythromycin and vancomycin, and showed distinct profiles of high-level resistance to aminoglycosides. Analysis of the clonal relatedness of the vanB E. faecalis isolates showed similar pulsed-field gel electrophoresis profiles. To our knowledge, this is the first report of the occurrence of enterococcal strains carrying vanB genes in Brazil.     

Safety of <Emphasis Type="Italic">Lactobacillus plantarum</Emphasis> ST8Sh and Its Bacteriocin

Total DNA extracted from Lb. plantarum ST8Sh was screened for the presence of more than 50 genes related to production of biogenic amines (histidine decarboxylase, tyrosine decarboxylase, and ornithine decarboxylase), virulence factors (sex pheromones, gelatinase, cytolysin, hyaluronidase, aggregation substance, enterococcal surface protein, endocarditis antigen, adhesion of collagen, integration factors), and antibiotic resistance (vancomycin, tetracycline, erythromycin, gentamicin, chloramphenicol, bacitracin). Lb. plantarum ST8Sh showed a low presence of virulence genes. Only 13 genes were detected (related to sex pheromones, aggregation substance, adhesion of collagen, tetracycline, gentamicin, chloramphenicol, erythromycin, but not to vancomycin, and bacitracin) and may be considered as indication of safety for application in fermented food products. In addition, interaction between Lb. plantarum ST8Sh and drugs from different groups were determined in order to establish possible application of the strain in combination with commercial drugs. Cytotoxicity of the semi-purified bacteriocins produced by Lb. plantarum ST8Sh was depended on applied concentration—highly cytotoxic when applied at 25 μg/mL and no cytotoxicity at 5 μg/mL.     

Antibiotic resistance and molecular characterization of poultry isolates of Salmonella by RAPD-PCR

The antibiotic resistance profile of 17 poultry isolates of Salmonella was studied against 24 different antibiotics. 69–88% of the Salmonella isolates displayed a high level of resistance, particularly against penicillin, rifampicin, erythromycin, clarithromycin, clindamycin, sulphamethoxazole and vancomycin. In contrast, a relatively low or moderate level of resistance was observed against furazolidone, spectinomycin, ciprofloxacin, chloramphenicol, cefepime, carbenicillin, nalidixic acid, streptomycin, oxacillin and cephalothin (11–59%). Moreover, resistance to multiple antibiotics (2–5) was also observed among the Salmonella strains, and none of the isolates was found susceptible to all the antibiotics used. Similarity coefficient among Salmonella strains by RAPD-PCR analysis varied from 0.60 to 0.86, and all the salmonellae could be classified into seven groups on the basis of dendrogram analysis. Generally, a very high level of concordance between RAPD-PCR profile and antibiotic profile was not observed, which indicates that genes for antibiotic resistance may not always be present on genomic DNA rather may be plasmid-borne.     

Antimicrobial Susceptibility of Clostridium difficile from Different Sources

A total of 79 Clostridium difficile strains from healthy young and elderly adults, elderly patients without gastrointestinal disease, elderly patients receiving antibiotics without gastrointestinal complications, and elderly patients with antibiotic-associated diarrhea or pseudomembranous colitis were tested for their susceptibilities to 24 antimicrobial agents. All of the 79 strains were inhibited by low concentrations of rifampicin, metronidazole, fusidic acid, vancomycin, ampicillin, and penicillin G. The strains were highly resistant to aminoglycosides, trimethoprim, sulfamethoxazole, nalidixic acid, and cycloserine and often resistant to neomycin, cefoxitin, and cefalexin. Wide variations in the susceptibility of C. difficile strains to erythromycin, clindamycin, lincomycin, chloramphenicol, and tetracycline were found. Strains resistant to erythromycin, clindamycin, and lincomycin were more frequently found among strains isolated from elderly adults than those isolated from young adults, with particularly high frequency among strains isolated from elderly patients receiving antibiotics. None of the 23 strains isolated from healthy young adults was resistant to chloramphenicol. All of the 14 strains resistant to erythromycin, clindamycin, lincomycin, and chloramphenicol were sensitive to tetracycline and all of the 15 strains resistant to erythromycin, clindamycin, lincomycin, and tetracycline were sensitive to chloramphenicol. Only one out of 19 tetracycline-resistant strains was highly toxigenic, whereas 42 (70%) of 60 sensitive strains were highly toxigenic.     

分离自母婴肠道的假小链双歧杆菌的耐药性分析

【背景】由于滥用抗生素导致细菌耐药性日益严重。对于双歧杆菌,人们往往注重其益生功能的挖掘而忽视了对其耐药性的研究,存在一定的安全隐患。【目的】检测母婴肠道中假小链双歧杆菌的耐药性,探究婴儿肠道中假小链双歧杆菌耐药性的来源。【方法】利用微量肉汤稀释法测定48株分离自母婴肠道的假小链双歧杆菌对14种抗生素的耐药性,比较分离自不同家庭母婴肠道中假小链双歧杆菌的耐药性。【结果】48株母婴肠道分离株对四环素、氯霉素、新霉素、环丙沙星100%耐药,对其余10种抗生素耐药率依次为：卡那霉素98%、利福平80%、克林霉素78%、甲氧苄啶63%、红霉素59%、庆大霉素43%、链霉素16%、万古霉素14%、氨苄西林6%、利奈唑胺2%。母婴肠道分离株的耐药性无显著差异,分离自同一家庭母婴肠道的菌株具有相似的耐药表型。【结论】分离自母婴肠道的假小链双歧杆菌对多种抗生素具有耐药性,婴儿肠道中假小链双歧杆菌的耐药性可能是由母亲肠道垂直传递而来。