中山地区小儿血培养病原菌分布及耐药性分析

目的了解中山地区小儿血培养病原菌分布及其常见病原菌对抗生素的耐药情况。方法对2008年至2009年南方医科大学附属中山市博爱医院新生儿科、儿科住院患儿进行血培养,应用BacT/ALERT 3D全自动血培养仪进行检测,阳性菌株用VITEK-32全自动微生物分析仪进行菌株鉴定及药敏试验。结果 4 647例小儿血培养共检出病原菌316株,总阳性率为6.8%;革兰阳性菌258株(81.6%),其中凝固酶阴性葡萄球菌(CNS)209株(66.1%);革兰阴性菌55株(17.4%),以大肠埃希菌14株(4.4%)和肺炎克雷伯菌12株(3.8%)为主。革兰阳性菌对青霉素G耐药率高达93.4%,其次为氨苄西林/舒巴坦(82.9%)、苯唑西林(82.3%),耐药率均在80%以上。耐甲氧西林金黄色葡萄球菌(MRSA)占25%,耐甲氧西林凝固酶阴性葡萄球菌(MRSCN)占82.3%。未检出对万古霉素、利奈唑胺和呋喃妥因耐药的菌株。革兰阴性菌中大肠埃希菌、肺炎克雷伯菌ESBLs的检出率分别为50%和33%,这些菌株对头孢哌酮/舒巴坦、丁胺卡那霉素、左旋氧氟沙星和亚胺培南的敏感率分别为91.7%、100%、92.9%、100%,表现了较低耐药率。结论本地区小儿血培养病原菌以革兰阳性菌为主,且表现为多重耐药。     

内毒素和降钙素原在妇科术后尿路感染中的鉴别诊断价值

目的评价中段尿内毒素和血清降钙素原在妇科术后不同种类细菌尿路感染中的鉴别诊断价值。方法收集临床1205例妇科术后患者中段尿进行细菌培养及内毒素检测,同时对患者进行血清降钙素原检测,比较结果对尿路感染的鉴别诊断价值。结果1205份标本中尿培养出阳性350例,感染率为29．04％,其中298例为均存在留置导尿管,而在剩余400例尿培养阴性的患者中仅仅120例留置导尿管。两组之间差异有统计学意义（χ2=26．78,P〈0．05）。其中革兰阴性杆菌189例（54％）,革兰阳性菌112例（32％）,真菌49例（14％）。在三组患者中,中段尿内毒素在革兰阴性菌引起的术后尿路感染较革兰阳性菌和真菌的患者中明显升高,差异均有统计学意义（P〈0．05）。而对于血清降钙素原在革兰阴性菌和革兰阳性菌感染的患者明显高于真菌尿路感染的患者,差异均有统计学意义（P〈0．05）。而在革兰阴性菌和革兰阳性菌感染的患者中差异无统计学意义（P〉0．05）。结论妇科术后尿路感染与留置导尿管密切相关,革兰阴性菌是引起妇科术后尿路感染的主要致病菌,中段尿内毒素有助于鉴别诊断出革兰阴性菌引起尿路感染,而血清PCT升高时则有助于排除真菌尿路感染。     

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。     

Analysis of the etiological structure and dynamics of antibiotic resistance in the causative agents of suppurative inflammatory diseases in the patients at a large general hospital

The structure of the causative agents isolated from patients with pyoinflammatory infections in 1980-1983 was analysed. It was shown that the surgical and urological infections were mainly caused by gram-negative bacteria. The other pyoinflammatory infections were mainly due to gram-positive cocci. A relatively high frequency of the strains of gram-negative bacteria, especially among Pseudomonas spp. and Enterobacter spp., resistant to aminoglycoside antibiotics, such as gentamicin, sisomycin and tobramycin with preserved sensitivity to amikacin and netilmicin in the majority of the strains was shown. Among the beta-lactam antibiotics cephotaxim and cephalotin were most active against gram-negative bacteria and staphylococci, respectively. The majority of the antibiotic resistant strains of gram-negative bacteria had analogous structures and levels of resistance to 7-12 antibiotics which might indicate the occurrence of 1-2 resistance plasmids among the clinical strains.     

Microbial communities in the saturated groundwater environment II: Diversity of bacterial communities in a Pleistocene sand aquifer and their in vitro activities

Bacterial cell numbers obtained from 103 water and sediment samples from a Pleistocene sandy aquifer in the Lower Rhine region (Bocholt, FRG) were determinated on P-agar and by direct count. Below 5 m under the surface, colony-forming unit (cfu) numbers in water samples were less than 100/ml, and in many cases less than 50/ml. In sediment samples, they were 10- to 100-fold higher (10²–10⁴ cfu/g dry wt), but changing markedly between different depths. Direct cell counts yielded numbers two to three orders of magnitude higher.About 2,700 strains of bacteria from 60 samples were isolated randomly and characterized by morphological and physiological properties. Of all the isolates, 71.6% were gram-negative, and 52.2% were gram-negative straight rods. Water communities, with one exception, had low proportions of gram-positive bacteria (<11%), whereas in all but one of the sediment communities percentages of gram-positive isolates were three- to sevenfold higher (35–43%). Water and sediment communities, as well as communities from different sampling sites and communities from different depths of the same sampling site, differed in their qualitative and quantitative morphotype composition and physiological capabilities.The in vitro activities of strains within a single community were quite different, indicating that each community is composed of many diverse bacteria, several having extremely different capabilities. Thus, each community has its own specific activity pattern. Gram-positive bacteria showed on an average lower total activities than did gram-negative bacteria. Grampositive bacteria as well as gram-negative bacteria from sediment had higher values of in vitro activities than the corresponding groups isolated from water. Many water and sediment bacteria preferred the same substrates which were utilized at high rates. However, there were differences in the degradation of the various other substrates present, and each community showed preferences for particular substrates, which they degraded best.The results of cell morphology and physiology studies indicated that all eight characterized communities were very different from one another and very diversely structured.     

ICU机械通气并发下呼吸道医院感染病原菌的调查分析

目的：分析ICU机械通气并发下呼吸道医院感染病原学构成及耐药情况。为临床防治提供依据。方法：对我院1996年6月-1999年6月3间ICU收住的98例机械通气合并下呼吸道医院感染患者的致病菌及药敏结果进行回顾性调查。结果：共检出致病毒128株,其中革兰阴性细菌（G^-菌）占66.4%（85株）,革兰阳性细菌（G^ 菌）占25.8%(33株）,真菌占7.8%(10株）;前四位致病菌分别为铜绿假单胞菌（24株）,革兰阳性细菌（G^ 菌）占25.8%(33株）,真菌占7.8%(10株）;前四位致病菌分别为铜绿假单胞菌（24株）,金黄色葡萄球菌（22株）,不动杆菌属（21株）,肠杆菌属（18株）,药敏结果显示这类菌株多重耐药现象严重。结论：ICU机械通气并发下呼吸道医院感染病原体构成以G^-菌为主,其药敏试验呈多重耐药,临床应重视病原学检查,开展细菌耐药性监测,合理使用抗菌药物。     

82例极低/超低出生体重儿败血症的临床分析

目的:分析极低/超低出生体重儿败血症的临床特征、病原菌及药物敏感情况,为其早期诊断及治疗提供参考。方法:对2014年1月1日至2017年12月31日阜阳市人民医院新生儿重症监护病房(NICU)确诊的82例早产极低/超低出生体重儿败血症的临床表现、实验室检查、病原菌及药敏情况进行回顾性分析。结果:极低/超低出生体重儿败血症以早发型(≤7天)为主,晚发型以院内感染为主,临床表现缺乏特异性,实验室检查中白细胞、血小板出现减低,C反应蛋白和降钙素原增高。病原菌以革兰阴性菌为主,其次为革兰阳性菌和真菌。药敏结果显示革兰阴性菌对三代头孢、氨苄西林类抗生素100%耐药,对加他唑巴坦的抗生素耐药率较低,对碳氢酶烯类抗生素敏感。革兰阳性菌对β-内酰胺类、大环内酯类、氨基糖甙类及克林霉素等耐药率较高,对万古霉素、利奈唑烷敏感。82例败血症患儿中,死亡6例,死亡率为7.3%。结论:早产极低/超低出生体重儿败血症缺乏特异性临床表现,且发病率高,应密切观察患儿临床表现及动态监测其C反应蛋白、血小板等的变化,同时及时完善细菌培养及药敏试验,有效合理使用抗生素,以减少多重耐药菌株产生,改善患儿预后。     

Characterization of the bacterial microflora of the tympanic cavity of eastern box turtles with and without aural abscesses

Aerobic bacterial cultures of the tympanic cavity of the middle ear were performed in eight eastern box turtles (Terrapene carolina carolina) with aural abscesses and 15 eastern box turtles without aural abscesses (controls) that were admitted to The Wildlife Center of Virginia, Virginia, USA during 2003. Twenty-two bacterial isolates were identified from 17 turtles including 10 gram-negative and 12 gram-positive bacteria. Ten of 15 control animals had bacterial growth, resulting in identification of 13 bacteria, including six gram-negative and seven gram-positive agents. Seven of eight turtles with aural abscesses had bacterial growth, and 10 isolates were identified, including four gram-negative and six gram-positive organisms. The most frequently isolated bacteria from control animals were Micrococcus luteus (n = 3) and Pantoea agglomerans (n = 2). Morganella morganii (n = 2) was the only species isolated from the tympanic cavity of more than one turtle with aural abscesses. Staphylococcus epidermidis (n = 2) was the only species isolated from both groups. A trend toward greater bacterial growth in tympanic cavities of affected turtles compared with turtles without aural abscesses was noted. No single bacterial agent was responsible for aural abscesses in free-ranging eastern box turtles in this study, an observation consistent with the hypothesis that aerobic bacteria are not primary pathogens, but secondary opportunistic invaders of environmental origin.     

呼吸机相关性肺炎的常见病原菌耐药性分析

目的:探讨呼吸机相关性肺炎(VAP)的常见病原菌并分析其耐药性,为临床治疗提供依据。方法:选取我院收治的135例VAP患者的临床资料,分析其病原菌分布以及抗菌药物的耐药性。结果:135例患者中共分离出183株病原菌,其中革兰氏阴性菌135株(占73.77%),革兰氏阳性细菌33株(占18.03%),真菌15株(占8.20%)。革兰氏阴性菌主要为鲍曼不动杆菌,占35.52%,革兰氏阳性细菌主要为金黄色葡萄球菌,占9.84%,革兰阳性菌无一对万古霉素耐药,除了米诺环素总耐药率为42.42%外,其余病原菌对于常用的药物总耐药率均大于60.0%,革兰阴性菌普遍存在多药耐药现象。结论:引起VAP患者感染的主要致病菌为革兰阴性菌群,且存在严重的多重耐药现象,在临床上应加强对VAP疾病的预防和控制,合理应用抗菌药物。     

Efficacy of the Ryu nonstaining KOH technique for rapidly determining gram reactions of food-borne and waterborne bacteria and yeasts.

A simple and rapid (< 60 s) nonstaining technique with 3% potassium hydroxide to determine Gram reactions was tested with 495 food-borne and waterborne bacteria and yeasts. In KOH, suspensions of gram-negative bacteria become viscous and string out. Gram-positive bacteria are not affected. There was 100% correlation between the KOH string test results and gram-positive and gram-negative strains.     

Evolution du risque infectieux chez l'enfant atteint de leucémie.

Infection is the leading cause of illness and death in children with leukemia. The risk of infection may change over time as regimens of therapy are modified. A review of the hospital charts of 166 infants in whom leukemia had been diagnosed between 1976 and 1980 revealed an increased number of deep fungal infections (20 v. 3) during this period in comparison with the number between 1969 and 1976 in 164 patients treated at the same hospital whose leukemia was diagnosed between 1969 and 1975. The 20 severe fungal infections between 1976 and 1980 were characterized by difficulty of diagnosis (a definite diagnosis having been made three times out of four only at autopsy), an important role of Candida but also of Aspergillus (the latter having been isolated almost as often as the former) and a grave prognosis (the mortality being very high [75%] and much above that for gram-positive septicemia [6%] and that for gram-negative septicemia [31%]). This increase in frequency of fungal infections was concurrent with the introduction of phase-1 chemotherapy, which was often responsible for prolonged neutropenia. To reduce the risk of infection in children with leukemia it appears to be essential to improve diagnostic methods and approaches to therapy.     

Duplication of the tuf gene: a new insight into the phylogeny of eubacteria.

The conservation and duplication of the tuf gene encoding the elongation factor EF-Tu were used to define phylogenetic relationships among eubacteria. When the tufA gene of Escherichia coli was used as a probe in hybridization experiments, duplicate tuf genes were found in gram-negative bacteria from three major phyla: purple bacteria, bacteroides, and cyanobacteria. Only a single copy of tuf was found in gram-positive bacteria, including mycobacteria and mycoplasmas. Gram-positive clostridia were found to carry two copies of tuf.     

Nisin treatment for inactivation of Salmonella species and other gram-negative bacteria.

Nisin, produced by Lactococcus lactis subsp. lactis, has a broad spectrum of activity against gram-positive bacteria and is generally recognized as safe in the United States for use in selected pasteurized cheese spreads to control the outgrowth and toxin production of Clostridium botulinum. This study evaluated the inhibitory activity of nisin in combination with a chelating agent, disodium EDTA, against several Salmonella species and other selected gram-negative bacteria. After a 1-h exposure to 50 micrograms of nisin per ml and 20 mM disodium EDTA at 37 degrees C, a 3.2- to 6.9-log-cycle reduction in population was observed with the species tested. Treatment with disodium EDTA or nisin alone produced no significant inhibition (less than 1-log-cycle reduction) of the Salmonella and other gram-negative species tested. These results demonstrated that nisin is bactericidal to Salmonella species and that the observed inactivation can be demonstrated in other gram-negative bacteria. Applications involving the simultaneous treatment with nisin and chelating agents that alter the outer membrane may be of value in controlling food-borne salmonellae and other gram-negative bacteria.     

Nisin treatment for inactivation of Salmonella species and other gram-negative bacteria.

Nisin, produced by Lactococcus lactis subsp. lactis, has a broad spectrum of activity against gram-positive bacteria and is generally recognized as safe in the United States for use in selected pasteurized cheese spreads to control the outgrowth and toxin production of Clostridium botulinum. This study evaluated the inhibitory activity of nisin in combination with a chelating agent, disodium EDTA, against several Salmonella species and other selected gram-negative bacteria. After a 1-h exposure to 50 micrograms of nisin per ml and 20 mM disodium EDTA at 37 degrees C, a 3.2- to 6.9-log-cycle reduction in population was observed with the species tested. Treatment with disodium EDTA or nisin alone produced no significant inhibition (less than 1-log-cycle reduction) of the Salmonella and other gram-negative species tested. These results demonstrated that nisin is bactericidal to Salmonella species and that the observed inactivation can be demonstrated in other gram-negative bacteria. Applications involving the simultaneous treatment with nisin and chelating agents that alter the outer membrane may be of value in controlling food-borne salmonellae and other gram-negative bacteria.     

Microflora of nasopharynx in patients with urticaria

Microflora of nasopharynx in 117 patients with urticaria was studied. 589 cultures of gram-negative and Gram-positive bacteria were isolated. Gram-positive bacteria represented the overwhelming majority of isolates from which streptococci dominated with high level of constancy (C=91.4%) and prevalence on mucosa. Several patients had signs of chronic streptococcal infection that support the possible role of streptococci in development of urticaria.     

FT-IR microspectroscopy for early identification of some clinically relevant pathogens

AIMS: To investigate the potentials and limitations of Fourier transform-infrared (FT-IR) microspectroscopy as a tool to identify, at the level of microcolonies, pathogenic bacteria frequently isolated in the clinical environment. METHODS AND RESULTS: A total of 1570 FT-IR spectra from 164 gram-positive and gram-negative bacteria isolated from patients were recorded from 6 to 10-h old microcolonies of 50-150 microm size. A classification of 100% was obtained for the most frequent gram-positive bacteria, such as Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, and Enterococcus faecium at the species level. An average accuracy of about 80% was reached with Gram negative bacteria from the Enterobacteriaceae and Pseudomonaceae families; Enterobacter aerogenes, Enterobacter cloacae, Klebsiella spp., and Citrobacter koseri; and Proteus mirabilis and Escherichia coli. Results were comparable with FT-IR measurements on dried suspensions from 18-h cultures. CONCLUSIONS: Early identification of young microcolonies is feasible with FT-IR microscopy with a very high accuracy for gram-positive bacteria. Some improvement in the transfer of microcolonies is necessary to increase the accuracy for gram-negative bacteria. SIGNIFICANCE AND IMPACT OF THE STUDY: Combination of FT-IR microscopy and multivariate data analysis could be a complementary, rapid, and reliable tool for screening and discriminating, at species and subspecies level, micro-organisms of clinical, food-borne, or environmental origins.     

Antimicrobial properties of diacetyl.

Diacetyl preparations from three commercial sources were found to be essentially similar when tested primarily against a set of 40 cultures, including 10 of lactic acid bacteria, 4 of yeasts, 12 of gram-positive non-lactic acid bacteria, and 14 of gram-negative bacteria. The compound was effective at pH less than or equal to 7.0 and progressively ineffective at pH greater than 7.0. The lactic acid bacteria were essentially unaffected by concentrations between 100 and 350 micrograms/ml over the pH range of 5.0 to 7.0. Of the 12 gram-positive non-lactic acid bacteria, 11 were inhibited by 300 micrograms/ml at pH less than or equal to 7.0. The three yeasts and the 13 gram-negative bacteria that grew at pH 5.5 were inhibited by 200 micrograms/ml. Diacetyl was ineffective against four clostridia under anaerobic conditions. It was lethal for gram-negative bacteria and generally inhibitory for gram-positive bacteria. Nongrowing cells were not affected. The effectiveness of diacetyl was considerably less in brain heart infusion broth, Trypticase soy agar, and cooked-meat medium than in nutrient broth or plate count agar. The antimicrobial activity was antagonized by glucose, acetate, and Tween 80 but not by gluconic acid. As an antimicrobial agent, diacetyl was clearly more effective against gram-negative bacteria, yeasts, and molds than against gram-positive bacteria.     

Antibacterial Activity of the Lactoperoxidase System in Milk Against Pseudomonads and Other Gram-Negative Bacteria

Products of thiocyanate oxidation by lactoperoxidase inhibit gram-positive bacteria that produce peroxide. We found these products to be bactericidal for such gram-negative bacteria as Pseudomonas species and Escherichia coli, provided peroxide is supplied exogenously by glucose oxidase and glucose. By the use of immobilized glucose oxidase the bactericidal agent was shown to be dialyzable, destroyed by heat and counteracted, or destroyed by reducing agents. Because the system is active against a number of gram-negative bacteria isolated from milk, it may possibly be exploited to increase the keeping quality of raw milk.     

老年患者血培养病原菌分布及耐药性调查

目的了解老年患者血液感染的病原菌种类以及对抗菌药物的耐药状况。方法对2290份老年住院患者血培养标本中186例培养阳性检出菌及药敏结果进行统计学分析。结果在分离的172株细菌中,革兰阴性菌、革兰阳性菌及真菌分别占54.7%、34.9%和10.5%;革兰阴性菌中以大肠埃希菌占绝对优势(20.9%),假单胞菌其次(10.5%),革兰阳性菌中以凝固酶阴性葡萄球菌(CNS)占绝对优势(20.9%),金黄色葡萄球菌仅为2.9%。药敏试验表明老年菌血症的病原菌对常用抗菌药物的耐药严重,尤其是CNS及假单胞菌属细菌表现为较高的耐药率及多重耐药性。结论老年菌血症病原菌以机会致病菌感染比例较高,致病菌耐药问题严重,及时监测老年致病菌的变迁和耐药发展趋势以指导临床用药至关重要。