铜绿假单胞菌医院感染调查及耐药分析

目的探讨铜绿假单胞菌(PA)医院感染的临床分布及耐药性,为临床合理使用抗菌药物及控制医院感染提供依据。方法 PA的培养与鉴定严格按照《全国临床检验操作规程》进行。药敏试验采用纸片扩散法(K-B法)。结果收集的359株PA中,分离率居前3位的临床科室依次为ICU、呼吸内科和神经内科,分别占38.1%、17.5%和13.9%;临床标本中以呼吸道标本分离率最高,占62.7%;PA对头孢哌酮/舒巴坦的耐药率最低(9.7%),其次为阿米卡星(13.1%)和头孢他啶(17.8%),另12种抗菌药物的耐药率均较高。结论 PA耐药性已十分严重,临床应根据药敏结果合理使用抗菌药物并加强对细菌耐药性的全面监测。     

2018-2020年广州急性呼吸道感染患儿中腺病毒分子流行病学特征研究

为了解2018-2020年间广州地区急性呼吸道感染儿童中腺病毒的流行病学特征,收集广东省妇幼保健院番禺院区和暨南大学附属第一医院儿科住院部急性呼吸道感染患儿咽拭子标本,采用荧光定量PCR技术检测腺病毒核酸,分析腺病毒的流行病学特征。所有腺病毒阳性标本接种A549细胞进行病毒分离,获得临床分离株后,对不同型别分离株的生长特点进行研究,并比较了感染患儿的临床特征。结果显示,在收集的701份急性呼吸道感染患儿的咽拭子标本中,腺病毒阳性率为4.99%(35/701),易感人群为5岁以下儿童。系统发育分析显示主要型别为B种3型腺病毒（42.86%）与B种7型腺病毒（14.29%）。经细胞培养后获得腺病毒阳性毒株28株,分离率为80%。临床分离株感染特征分析结果显示,PCR检测B种7型腺病毒分离株病毒基因组拷贝数显著高于其他基因型。对感染患儿临床特征的分析显示,B种3型腺病毒感染患儿中性粒细胞增高伴淋巴细胞降低。上述结果表明,2018-2020年间急性呼吸道感染的住院儿童腺病毒阳性患儿中,B种3型与B种7型为优势流行基因型,病毒基因进化高度保守。临床分离株中,B种7型腺病毒生长速率较高。     

铜绿假单胞菌感染的临床流行病学研究

目的研究铜绿假单胞菌(PA)在临床感染中的分布、耐药性变化、血清学分型及相关疾病特点,以配合院内感染监控工作的开展,指导临床合理用药,减少耐药菌株产生与传播,保护易感人群.方法回顾分析荆州市第二人民医院1995～2002年感染菌的实验室与临床病历资料.结果临床分离2 050株感染菌中,革兰阴性杆菌占首位为65.5%,其中非发酵革兰阴性杆菌为35.0%.PA位居第1位,分别占全部革兰阴性杆菌的15.8%和非发酵革兰阴性杆菌的45.1%.PA主要来自呼吸道(53.0%)与尿道(22.0%),以ICU病房多见(36.8%).在临床分离的感染菌中,PA检出率为0.35%,排列于大肠埃希菌、金黄色葡萄球菌和克雷伯菌属之后,位居第4位.PA对抗菌药耐药率呈上升趋势,常用广谱抗生素耐药已升高至19.0%～42.9%,敏感率较高的抗菌药依次为亚胺培南(81.0%)、阿米卡星(78.6%)、头孢他啶(77.4%)、哌拉西林(77.4%)、妥布霉素(76.2%)、头孢哌酮(75.0%)与环丙沙星(72.6%).PA血清型以1、3、6型为主,11型次之.感染者多有原发病及诱发因素,入侵途径以呼吸道与创伤为主,临床表现与预后随入侵途径与基础疾病不同而有异.结论 PA是医院感染主要致病菌,耐药率呈上升趋势,加强耐药性监测,合理使用抗生素,重视医疗器械消毒与医院环境卫生,控制易感人群感染,是预防PA感染、延缓菌株耐药的重要措施.     

2015年宁波市医院感染现患率调查分析

摘要：目的 了解医院感染的现患率及抗菌药物使用率,为医院感染的预防和控制提供科学依据。方法 通过横断面调查方法,对宁波市医疗中心李惠利医院2015年5月5日0:00—24:00住院病人的医院感染情况进行调查分析。结果 本次调查医院感染现患率3.99%;现患率排前3位的科室分别为重症监护（40.00%）、神经外科（17.65%）、血液科（10.81%）;感染部位前3位分别为下呼吸道（69.09%）、泌尿道（12.73%）、上呼吸道（7.27%）;共分离病原菌48株,构成比前三位的分别是铜绿假单胞菌（22.92%）、 鲍曼不动杆菌（20.83%）、金黄色葡萄球菌（14.58%）;动静脉插管、使用呼吸机等侵袭性操作时,医院感染现患率均高于无这些操作的,其差异具有统计学意义（P<0.05）。结论 根据医院感染现患率调查结果可合理调整针对性监测,并提高标本送检率,进一步规范抗菌药物使用,有效降低医院感染发生率。     

2008-2010年嗜麦芽窄食单胞菌医院感染的临床分布及耐药性分析

目的了解医院感染嗜麦芽窄食单胞菌（Stenotrophomonasmaltophilia,Sm）的临床分布及耐药性情况,为临床诊治提供依据。方法采用回顾性资料,对中山大学附属第三医院2008—2010年间住院患者的各种临床标本中分离到的Sm及其药敏结果进行统计分析。结果Sm主要来源于呼吸道标本（痰及咽拭子）,占82．97％,临床分布以肝胆外科最多,占25．27％,其次为感染科（21．43％）,ICU和神经外科均占8．79％;40岁以上的中老年患者占75．82％;Sm对复方新诺明的敏感率最高,达84．40％,其次为左氧氟沙星（81．21％）,对头孢他啶和替卡西kS／克拉维酸的敏感性均较低（〈40％）。结论该院感染Sm的易感人群主要是以中老年患者为主,Sm对CLSI推荐的抗菌药物已有一定的耐药性,临床应高度重视,控制感染。     

引发下呼吸道感染的非发酵菌的菌群分布及耐药性分析

目的了解引发下呼吸道感染的非发酵菌的菌群分布及耐药性分析,为临床合理使用抗生素提供依据。方法对2011年1月至2013年9月深圳罗岗医院门诊及住院患者痰标本分离的非发酵菌的菌群分布及优势菌的耐药性进行回顾性分析。结果702株非发酵菌中铜绿假单胞菌（PA）362株,占51．6％,鲍氏不动杆菌（AB）158株,占22．5％;PA对NIT、CXM、SAM、AMP、CZO、CTF、CRO、SXT耐药率均在99．0％以上,对IPM、LVF和TZP耐药率均在15．0％以下;AB对NIT、CXM、AMP、CZO、CTT耐药率均为100％,对SAM、FEP、TOB、GEN、IPM、LVF和TZP耐药率均在15．0％以下;耐IPM的PA和AB的检出率分别为20．4％和11．4％;耐IPM的PA对NIT、CXM、SAM、AMP、CZO、CTT、CRO、SXT、1PM耐药率均为100％,对其余10种抗生素的耐药率在25．0％～84．0％;耐IPM的AB对NIT、CXM、AMP、CZO、CTT、CRO、SXT、ATM、PIP、IPM耐药率均为100％,对其余9种抗生素的耐药率在21．0％～90．0％。结论引发下呼吸道感染的非发酵菌以PA和AB为主且耐药现象严重,临床医师在选择抗菌药物前应重视病原学培养,根据药敏试验选择用药。     

连续11年深圳地区鲍曼不动杆菌感染的临床分布及耐药趋势分析

目的 了解医院鲍曼不动杆菌的耐药性变迁和临床分布特点,为合理应用抗菌药物和预防控制医院感染提供依据.方法 回顾性分析2001年1月到2011年12月临床标本中分离的l 613株鲍曼不动杆菌资料;用WHONET 5.4分析鲍曼不动杆菌的分离率和耐药率变迁.结果 鲍曼不动杆菌感染主要发生在ICU和呼吸内科,分别占43.89％和24.49％;痰标本所占比例最高(70.30％).鲍曼不动杆菌、多药耐药鲍曼不动杆菌的分离率及对临床常用的15种抗菌药物耐药率总体呈上升趋势;并且2009年呈飞跃式上升且2010和2011年居高不下,201 1年分离出泛耐药鲍曼不动杆菌,分离率高达57.55％.临床常用药氨苄西林/舒巴坦、头孢哌酮/舒巴坦和米诺环素近三年的耐药率和中介率也明显升高.结论 鲍曼不动杆菌的耐药形势严峻,多药耐药鲍曼不动杆菌和泛耐药鲍曼不动杆菌比例明显增加,重症监护病房和呼吸科是预防控制的重点科室.     

2010-2011年重症监护病房病原菌分布及耐药性分析

目的 分析综合性重症监护病房(ICU)在2010-2011年间常见病原菌的分布及其耐药现状,为临床合理用药和控制医院感染提供参考依据.方法 对2010-2011年从ICU医院感染患者的各类标本中分离出病原菌共为1949株(1079株、870株),采用K-B纸片扩散法进行药物敏感试验,检测病原菌耐药性.结果 以呼吸道标本(痰和导管)的分离率最高为72.1％、病原菌以革兰阴性杆菌为主占66.9％,分别占2010年、2011年标本总量的62.3％和72.4％,革兰阴性杆菌呈上升趋势;其次为真菌感染占19.2％( 22.0％、15.6％),革兰阳性球菌占12.2％( 14.2％、9.7％).病原菌的耐药率普遍较高,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为25.8％,大肠埃希菌和肺炎克雷伯菌的ESBLs检出率分别为61.0％和27.2％.结论 ICU医院感染患者呼吸道感染最多,以细菌为主,尿路感染其次,以真菌为主;病原菌耐药情况严重,应加强病原菌分布及耐药率的监测以减少多药耐药菌产生、降低医院感染率.     

海南岛4市县人群口腔假丝酵母菌分布情况的初步调查

目的：调查海南岛海口、三亚市、五指山市和保亭县四市县人群口腔假丝酵母菌的分布情况,为口腔假丝酵母菌分子生物学和遗传学特点研究提供基础资料。方法：分离出的假丝酵母菌经过菌落特征、制片乳酸酚棉蓝染色、芽管形成试验、厚膜孢子形成试验等初步鉴定,并用科玛嘉显色培养基培养确定。结果：海口、三亚市、五指山市和保亭县人群口腔假丝酵母菌总分离率为25．23％．其中白假丝酵母菌占54．48％,光滑假丝酵母菌占14．04％,热带假丝酵母菌占11．06％,克柔假丝酵母菌占9．36％。住院病人和健康人口腔假丝酵母菌的分离率分别为39．95％和11．61％,差异有统计学意义（P〈0．01）,结论：海南地区人群口腔假丝酵母菌的总分离率高于国内其它省份,分离出的假丝酵母菌以白假丝酵母菌为首位,病人口腔假丝酵母菌分离率明显高于健康人。     

临床分离肠球菌与肠道肠球菌的不同特性

目的 :比较临床分离肠球菌与肠道肠球菌的不同特性。方法 :分别检测 4 1株临床分离肠球菌以及 38株健康人群粪便分离肠球菌的属种分布、β溶血素检出率及耐药性情况。 结果 :临床菌株以粪肠球菌为主 (75 6 % ) ,健康人群粪便分离肠球菌以屎肠球菌为主 (73 7% ) ;临床菌株的 β溶血素检出率高于健康人群粪便分离肠球菌 (P <0 0 1) ;临床分离肠球菌的抗生素耐药性明显高于肠道肠球菌 (P <0 0 1)。结论 ;引起医院感染的肠球菌与肠道球菌特性不同。     

社区与医院感染中肺炎克雷伯杆菌和大肠埃希菌耐药性分析

目的探讨社区和医院感染中肺炎克雷伯杆菌和大肠埃希菌产ESBLs的情况及耐药特性。方法采用体外扩散确证试验检测ESBLs,同时用Micro scan wat RA way-40系统全自动细菌鉴定/药敏分析仪及K-B琼脂扩散法进行细菌鉴定和体外药敏试验。结果社区感染标本中分离出肺炎克雷伯杆菌79株,产ESBLs20株,阳性率为25.3%,大肠埃希菌177株,产ESBLs27株,阳性率为15.3%;医院感染标本中分离出肺炎克雷伯杆菌82株,产ES-BLs33株,阳性率为40.2%,大肠埃希菌135株,产ESBLs42株,阳性率为31.1%,社区与医院感染菌株产ESBLs比较差异均有统计学意义(P均<0.05);ESBLs阳性菌株对多种抗生素耐药,其耐药性明显高于ESBLs阴性菌株。结论肺炎克雷伯杆菌和大肠埃希菌产ESBLs菌株在临床分离率较高,医院感染标本要显著高于社区感染标本,并且对多种抗生素具有高度耐药性,产ESBLs菌株耐药性显著高于不产ESBLs菌株,临床上应加强对ESBLs的控制,以防感染流行。     

肛周脓肿和肛瘘患者的病原菌分布及其与血清MMP 2、IL 17A水平的相关性

目的 分析肛周脓肿与肛瘘患者的病原菌分布及其与血清基质金属蛋白酶 2(MMP 2)、白细胞介素 17A(IL 17A)的相关性。 方法 收集2017年3月至2019年11月在我院收治的肛周脓肿和肛瘘患者共69例,分为肛周脓肿组(n=23)、肛瘘病程180 d组(n=9)。收集患者脓液或瘘管分泌物进行细菌培养,同时采集血清标本检测MMP 2、IL 17A水平,分析病原菌分布与MMP 2、IL 17A表达的相关性。 结果 69份标本中有66份标本培养出细菌,阳性率为95.65%(66/69)。共分离出68株细菌,其中有2份标本出现2种细菌同时生长,混合感染率为3.03%,其余64份标本均为单一细菌生长。68株细菌中革兰阴性菌58株(85.29%),革兰阳性菌8株(11.76%),真菌2株(2.94%)。各组患者血清MMP 2、IL 17A阳性率比较差异有统计学意义(均P0.05)。血清MMP 2与IL 17A水平呈正相关(r=0.325,P=0.009)。 结论 肛周脓肿与肛瘘患者以单一病原菌感染为主。患者血清MMP 2与IL 17A水平呈正相关。     

Ecology of Enteroviruses in Tropics

A continuing surveillance on enterovirus infection in healthy infants was conducted from October 1971 through February 1973 in urban areas in Ghana, West Africa. About 40 infants were visited in every two months for collection of faecal specimens and examined for infection. Enteroviruses were recovered in tissue culture. The overall isolation rate of enteroviruses was approximately 44%, and there was no seasonal difference between rainy and dry seasons. The rate of virus isolation in urban areas was significantly higher than in rural areas. Within the urban areas, however, no difference in the rate of virus isolation was detected between densely populated and sparsely populated areas. The results of virus identification revealed that all three types of Poliovirus, many types of Echovirus and a few Coxsackieviruses were isolated during the course of the study. It was observed that improvement of sanitary facilities decreased the frequency of virus infection among infants, but the condition of water supply did not influence the virus infection rate. Neither the age of infants nor the size of siblings showed any relation to the virus isolation rate. It was suggested from the results that many types of enteroviruses have been circulating continuously in the tropical urban community throughout the year.     

新生儿病房铜绿假单胞菌感染状况及耐药性的5年监测

目的监测2005年至2009年间铜绿假单胞菌在新生儿病房的分离情况及其耐药趋势,为临床感染的预防和治疗提供实验室依据。方法回顾分析2005年至2009年间新生儿病房所有标本中铜绿假单胞菌的分离率,菌株在标本中的分布以及对常见的13种抗菌药物的耐药性。结果铜绿假单胞菌的分离率有逐年升高的趋势,从2005年的1.19%增至2009年的5.16%;其在呼吸道标本中的分离率最高(86.3%),在其他标本中的检出率都相对较低。铜绿假单胞菌的耐药株也有逐年增多的趋势,特别是对复方新诺明的耐药性已发展成为全部耐药。结论铜绿假单胞菌在新生儿病房的分离率在不断地增加,其对多种抗菌药物有较高的耐药性,加之新生儿免疫系统发育不完善,应引起临床医师的高度重视。     

2000年至2006年屎肠球菌的临床分离与耐药变迁

目的了解本地区屎肠球菌在临床的分离与耐药变迁情况,为临床抗感染的预防与治疗提供帮助。方法用WHONET 5软件统计分析我院2000年至2006年屎肠球菌临床分离株在各病区、样本中的分布与耐药性的变迁情况。结果分离率呈逐年上升趋势,从2000年的0.32%上升到2006年的0.81%;7年中以重症监护病区（ICU）分离菌株最高,占总分离菌株的68.9%,其次为肾内科病区占13.5%;在送检标本中以尿液标本分离菌株数最高,占总分离数的62.3%,其次为痰液（10.2%）。对11种抗生素的耐药性分析显示,屎肠球菌对青霉素G、氨苄西林、庆大霉素500、环丙沙星、左旋氧氟沙星呈较高的耐药率,而对四环素、呋喃妥因、链霉素2000相对较低;更值得我们注意的是对于万古霉素的耐药率呈逐年上升趋势,对于喹奴普汀/达福普汀、力奈唑烷这两类临床还未运用的抗生素已有一定的耐药率。结论屎肠球菌在临床的分离率在逐年增加,已成为医院内感染的主要病原菌之一,该菌呈多重耐药的特性,并呈不断增加趋势,临床抗感染治疗应以分离菌株的体外抗菌药物敏感性为依据。     

Quantifying the Elevation of Mitochondrial DNA Evolutionary Substitution Rates Over Nuclear Rates in the Intertidal Copepod Tigriopus californicus

Mitochondrial DNA (mtDNA) genomes generally evolve rapidly in animals, but considerable variation in the rates of evolution of mtDNA occurs among taxa. Higher levels of mutation will tend to increase the amount of polymorphism, which should also scale with population size, but there are mixed signals from previous studies on the evolutionary outcomes of the interactions of these processes. The copepod Tigriopus californicus provides an interesting model in which to study the evolution of mtDNA because it has high levels of divergence among populations and there is the suggestion that this divergence could be involved in reproductive isolation. This species also appears to have an elevated mtDNA substitution rate, but previous studies did not provide an accurate measurement. This article examines the rate of mtDNA substitution versus nuclear substitution in T. californicus and finds that the mtDNA rate for synonymous sites averages 55-fold higher, a level that exceeds the rates found in most other invertebrates. Levels of polymorphism are also examined in both mtDNA and nuclear genes, and it is shown that the effective population size of mtDNA genes is much lower than that of nuclear genes. In addition, no correlation between polymorphism in mtDNA and nuclear genes is found across populations, which suggest factors other than demography may shape polymorphism in this species. The results from this study suggest that mtDNA is evolving at a very rapid rate in this copepod species, and this could increase the likelihood that mtDNA evolution is involved in the generation of reproductive isolation.     

Hepatitis C virus infection among First Nation and non-First Nation people in Manitoba, Canada: a public health laboratory study

Demographic information and laboratory test results on 136 169 clinical serum specimens submitted to the public health laboratory in Manitoba, Canada, for hepatitis C virus (HCV) testing between January 1995 and December 2003 were analyzed. The difference in the clearance rates of HCV infection, without therapeutic intervention, and the HCV genotypes infecting First Nation and non-First Nation people were studied. The rates of co-infection of HCV-positive individuals with other hepatitis viruses were also compared between the two study groups. The results of the analyses of the data indicated that there was a 4.4-fold increase in the number of specimens tested and a 4.9-fold decrease in HCV antibody (anti-HCV) positive cases during the study period. The proportion of specimens submitted for testing from First Nation individuals was lower than their proportion in the Manitoba population. Our study also indicated that there was a significantly higher proportion of First Nation patients who had self-limiting infection (patients cleared the infection and became HCV RNA negative without anti-HCV treatment) in comparison to non-First Nation patients. The proportion of First Nation females who had self-limiting infection was significantly higher than non-First Nation females. HCV genotype 1 infection represented more than 60% of HCV infection in Manitoba. The rate of individuals positive for the hepatitis A virus antibody in the HCV-positive population was higher among First Nation than non-First Nation individuals. On the other hand, there were more HCV-infected First Nation patients than non-First Nation patients who were not immune to the hepatitis B virus. The data indicate that fewer First Nation patients seek anti-HCV therapy in comparison to non-First Nation. In conclusion, the differences in the rates of HCV self-limiting infection between First Nation and non-First Nation individuals in Manitoba may reflect the genetic differences between the two cohorts, which may consequently affect the immune response to the HCV infection.     

牙髓拟杆菌的分离,培养,鉴定

牙髓拟杆菌是产黑色素拟杆菌群中的一个新菌种。本试验通过对牙髓腔感染标本中分离、培养、鉴定各种细菌,发现牙髓拟杆菌主要分布在牙髓腔内,其存在与根尖周炎有无症状密切相关,此菌对氧敏感,用常规鉴定及气相色谱法与其它菌无法区别,而间接免疫荧光法是确定牙髓拟杆菌菌种和直接检测牙髓腔标本中有无此菌的一个快速、可靠的方法。     

Influenza A (H1N1) 2009 Antibodies in Residents of New South Wales,Australia, after the First Pandemic Wave in the 2009 Southern Hemisphere Winter

Background

The first wave of pandemic influenza A(H1N1)2009 (pH1N1) reached New South Wales (NSW), Australia in May 2009, and led to high rates of influenza-related hospital admission of infants and young to middle-aged adults, but no increase in influenza-related or all-cause mortality.

Methodology/Principal Findings

To assess the population rate of pH1N1 infection in NSW residents, pH1N1-specific haemagglutination inhibition (HI) antibody prevalence was measured in specimens collected opportunistically before (2007–2008; 474 specimens) and after (August–September 2009; 1247 specimens) the 2009 winter, and before the introduction of the pH1N1 monovalent vaccine. Age- and geographically-weighted population changes in seroprevalence were calculated. HI antibodies against four recent seasonal influenza A viruses were measured to assess cross-reactions. Pre- and post-pandemic pH1N1 seroprevalences were 12.8%, and 28.4%, respectively, with an estimated overall infection rate of 15.6%. pH1N1 antibody prevalence increased significantly - 20.6% overall - in people born since 1944 (26.9% in those born between 1975 and 1997) but not in those born in or before 1944. People born before 1925 had a significantly higher pH1N1 seroprevalence than any other age-group, and against any seasonal influenza A virus. Sydney residents had a significantly greater change in prevalence of antibodies against pH1N1 than other NSW residents (19.3% vs 9.6%).

Conclusions/Significance

Based on increases in the pH1N1 antibody prevalence before and after the first pandemic wave, 16% of NSW residents were infected by pH1N1 in 2009; the highest infection rates (27%) were among adolescents and young adults. Past exposure to the antigenically similar influenza A/H1N1(1918) is the likely basis for a very high prevalence (49%) of prepandemic cross-reacting pH1N1 antibody and sparing from pH1N1 infection among people over 85 years. Unless pre-season vaccine uptake is high, there are likely to be at least moderate rates including some life-threatening cases of pH1N1 infection among young people during subsequent winters.     

阴沟肠杆菌临床分离与耐药性的6年监测

目的了解2000年至2005年阴沟肠杆菌在临床标本中的分离情况及其耐药趋势,为临床感染的预防和治疗提供参考资料。方法回顾分析2000年至2005年间所有标本中阴沟肠杆菌的分离率,菌株在标本和病区的分布及对13种抗菌药物的耐药率。结果阴沟肠杆菌的分离率有逐年升高的趋势,从2000年的0.47%增至2005的0.69%;其在呼吸道标本的分离率最高(67.80%),其次是尿液(14.39%)、血液(9.28%);病区以重症监护室最高(29.92%),阴沟肠杆菌对13种抗菌药物的耐药率,2000年仅氨苄西林、妥布霉素、庆大霉素>50%,而到2005年13种抗菌药物除亚胺培南外的耐药率均>50%;其耐药率均呈递增的趋势,以2003年的耐药率最高。耐药率增幅列前3位分别为:头孢他啶33.8%~72.8%、氨曲南41.9%~80.2%、哌拉西林/他唑巴坦48.4%~81.5%。结论阴沟肠杆菌的临床分离率在逐年增加,对多数抗菌药物有较高的耐药性,且耐药率呈整体上升趋势,尤其出现耐亚胺培南的耐药株,应引起重视,合理使用抗菌药物以降低耐药性已经非常重要。