重症监护病房非发酵菌分布及耐药分析

目的分析医院重症监护病房非发酵菌感染的耐药情况,以指导临床合理使用抗菌药物。方法回顾性分析2008年至2009年医院自重症监护病房分离的非发酵菌,对其检出率及药敏结果进行统计分析。结果共检出4 273株非发酵菌,检出率为38%,分离率居前4位的依次是铜绿假单胞菌(44.09%)、鲍氏不动杆菌(27.64%)、嗜麦芽寡养单胞菌(10.58%)和洋葱伯克霍尔德菌(5.99%);4种常见的非发酵菌对常用抗菌药物耐药性均较高,头孢哌酮/舒巴坦等含酶抑制剂的复合型抗菌药物对非发酵菌有较高的敏感性。结论医院重症监护病房非发酵菌检出率高且耐药性强,应加强临床细菌学的检测,按照药敏试验结果合理用药。     

Comparison of the antibiotic sensitivity of lipophilic Corynebacterium sp. isolated from patients on the day of admission and during hospitalization

Lipophilic species of Corynebacterium are increasing problem in hospital infections. The aim of this study was to evaluate occurrence of these microorganisms in the materials taken from patients in the day of admission and during the hospitalization as well as comparison of their antibiotic sensitivity. The investigation included 65 strains isolated from hospitalized patients and 48 strains isolated from unchanged skin. Using Api Coryne test 5 species were identified. C. urealyticum dominated, the other were C. subsp. lipophilum and C. jeikeium. Among strains isolated from unchanged diseased skin the most C. jeikeium and C. accolens occurred. All strains were sensitive to glycopeptide, quinupristin/dalphopristin. The strains isolated from hospitalized patients were usually sensitive to fuside acid, doxycycline as well as tetracycline. Strains isolated from unchanged skin were sensitive to almost all tested antibiotics. In the group of 65 strains isolated from hospitalized patients 99.0% were multiresistant. In the group of strains isolated from unchanged skin only two strains were multiresistant. Differences in antibiotic sensitivity among analysed Corynebacterium sp. were confirmed. Majority of the "hospital strains" were characterized by multiresistance. Basing on these results it is possible to suppose, that multiresistance is main factor that favours lipophilic Corynebacterium species in the process of colonization of mucous membranes, skins as well as developing infections.     

Infectivityand resistance to antibiotics of non-fermentative rods isolated from patients hospitalised in pediatric center of Lower Silesia in Wrocław in the years 2000-2006

The aim of this study was to evaluate the frequency of isolation and antimicrobial resistance testing of non-fermentative rods isolated from clinical specimens from patients hospitalized in Korczak Pediatric Center of Lower Silesia in Wroc?aw. The susceptibility of bacteria to selected antibiotics was determined. The commonest pathogens were Pseudomonas rods (81.8%) isolated from respiratory system and urine of patients hospitalized in unit intensive care. Variety of resistance patterns were detected in bacteria. ESBL were detected the most of S. maltophilia. Strains of Pseudomonas and Acinetobacter resistant to carbapenems were detected with a frequency of 5.5% and 35.9%.     

Susceptibility and frequency of selected groups of bacteria isolated in 2001 from patients at the Holy Cross Cancer Center

The aim of the presented study was the analysis of microbiological data obtained from patients hospitalized in The Holly Cross Cancer Center in Kielce in 2001. The frequency of important nosocomial pathogens in selected specimens and their susceptibility to antibiotics were determined. The strains were identified by using commercial tests (bioMerieux) and their antibiotic susceptibility patterns were performed by disc diffusion technique. The most prevalent bacteria were Gram-negative rods of Enterobacteriaceae family (43%), mainly Escherichia coli. Only 2.7% strains of isolated Escherichia coli isolated from clinical specimens collected from hospitalized patients were beta-lactamase--positive (ESBL+). The second important group of microorganisms were Staphylococci, followed by Enterococcus spp., Pseudomonas aeruginosa and Candida spp. About twenty eight percent of Staphylococcus aureus isolates were resistant to methicillin.     

229例慢性胃炎患者幽门螺杆菌培养及耐药情况

目的了解慢性胃炎患者H.pylori感染及其耐药情况,为临床治疗提供参考。方法慢性胃炎患者胃镜活检标本培养分离H.pylori,对分离的H.pylori采用纸片扩散法进行耐药性检测。结果229例患者分离出97株H.pylori;H.pylori分离阳性率为42．36％（97／229）,其中男性分离率为43．79％（67／153）,女性分离率为39．47（30／76）;92株H.pylori对抗生素的耐药性分别为：甲硝唑8．7％,克拉霉素7．6％,阿莫西林1．1％、呋喃唑酮1．1％,阿奇霉素4．4％,左氧氟沙星0％。结论慢性胃炎患者H.pylori感染率较高,但与性别、年龄无关;慢性胃炎H.pylori对常用抗生素敏感,建议采用左氧氟沙星、阿莫西林、呋喃唑酮进行治疗。     

老年住院患者口咽部念珠菌定植状况及菌种分布调查

目的调查老年住院患者口咽部念珠菌定植状况及菌种分布特点,为有效预防念珠菌感染提供参考。方法对解放军第44医院收治的894例住院患者口咽部念珠菌定植状态进行调查分析。结果894例住院患者口咽部标本共培养出念珠菌121株,念珠菌定植率为13．5％,老年患者的定植率高于非老年患者。念珠菌定植以白色念珠菌所占比例最大,占74．5％。年龄≥80岁、肺部基础疾病的存在及使用抗菌药物患者口咽部念珠菌定植率高于普通患者,两者比较差异有统计学意义（P〈0．05）。结论老年患者口咽部念珠菌定植率较高,菌种分布以白色念珠菌最为常见。念珠菌定植与患者年龄、肺部基础疾病的存在及抗菌药物使用情况密切相关。     

Colonization of hospitalized patients with yeast-like organisms

The pharyngeal, fecal and skin carrier rates of yeast-like organisms was determined in 126 patients on the day of admission to a larger Veterans Administration Hospital. None of these patients had been hospitalized or received anti-microbial agents during the previous year Candida and Torulopsis species were most common. A small percentage of patients were carriers of various species belonging to the genera Trichosporon, Rhodotorula, Saccharomyces, Leucosporidium and Endomycopsis. Fifty of the original 126 patients remained hospitalized for a sufficient duration to permit repeat cultures on days 7 and 14. Twenty-five of these patients served as controls and did not receive antibiotics; the other 25 received at least a 4-day course of antibiotic therapy for an underlying infection. Although there was no significant difference in the carrier rates in these 2 groups, organisms other than Candida continued to be isolated from the 50 patients who remained hospitalized for 2 weeks.     

慢性肾盂肾炎L型细菌感染及耐药分析

目的了解L型细菌在慢性肾盂肾炎的感染及耐药状况。方法对71例患者清洁中段尿做普通细菌培养(B型)、L型细菌培养(L型)及耐药分析。结果细菌阳性率为77.5%,其中单独L型阳性率为49.3%、B型与L型混合感染为15.5%,而B型阳性率仅为12.7%。主要是大肠埃希菌,其次是葡萄球菌;青霉素及头孢噻肟均有较高的耐药率(88.9%及73.6%)。结论L型细菌在慢性肾盂肾炎感染中占主导,β-内酰胺类药物有较高的耐药性,临床治疗应据药敏结果合理选择及时调整抗生素。     

Prevalence of vancomycin-resistant enterococci in hospitalized patients and those living in the community in the Czech Republic

Between July 1, 2002 and December 31, 2003, rectal swabs from both hospitalized patients and community subjects in the Czech Republic were taken to ascertain the prevalence of vancomycin-resistant enterococci (VRE). The swabs were used for isolating and identifying enterococci and their susceptibility to antibiotics. Vancomycin resistance phenotypes were verified by PCR detection of vanA, vanB, vanC1 and vanC2 genes. A molecular biology analysis was performed in Enterococcus faecium VanA strains. During the observed period, 2691 rectal swabs from the hospitalized patients and 6529 rectal swabs from the subjects in community setting were examined. In total, 31 VRE of hospital origin and 13 community-population strains were isolated. The prevalence of VRE in the gastrointestinal tract was 1.9% in the hospitalized patients and 0.4% in the community subjects. The prevailing strains were Enterococcus faecium VanA (61.3%) in the VRE of hospital origin and Enterococcus gallinarum VanC (46.2%) in the community VRE. Mutual comparison between the hospital and community Enterococcus faecium VanA strains showed no similarity.     

Pneumococcal serotypes in various diseases of children

The serotyping of pneumococci isolated from different material obtained from children aged 0 to 11 years was carried out. Out of 156 patients with different diseases, hospitalized in two clinics in Moscow during February-May 1983, pneumococci were isolated from 67 patients (43%). The isolated pneumococcal strains belonged to 11 serotypes. Pneumococci of serotypes 3, 6, 9 and 19 were shown to occur most frequently in different diseases and constituted 50% of the isolated strains. The inoculation of the material by the quantitative method permitted the authors to find out the role of pneumococci as the etiological factor in the pathogenesis of some diseases. A certain dependence of diversity in the types of isolated pneumococci on the age of sick children was noted. Almost all isolated strains were found to be sensitive to penicillin, ampicillin and benzylpenicillin. But a few individual strains were sensitive only to one of these antibiotics. The data on some biological properties of pneumococci cultivated on solid culture media are presented.     

Sensitivity of Staphylococcus aureus strains isolated from the patients of the SP ZOZ Hospital in Nidzica to bacteriocidal agents

The aim of this study was to evaluate a frequency of isolation and antimicrobial susceptibility testing of Staphylococcus aureus strains isolated from clinical specimens obtained from patients hospitalized in different hospital wards (SP ZOZ) in Nidzica from 01. 09. 2000 to 31. 12. 2003. During over three years 716 Staphylococcus aureus strains were cultured out of 15517 clinical specimens supplied to the Bacteriological Laboratory of SP ZOZ in Nidzica. S. aureus strains were isolated from 4.6% of examined samples. Samples were collected from patients hospitalized in all wards (five wards). Analysis of susceptibility to antimicrobial agents of identified S. aureus strains was performed. Seventy strains (9.8%) were metihicillin-resistant (MRSA). One hundred twenty four strains (17.3%) revealed inducible resistance to macrolides, linkosamides and streptogramins B (MLS, mechanism). The greatest activity in vitro against clinical S. aureus strains showed glycopeptide antibiotic--vancomycin (100% of susceptible strains). Clinical S. aureus strains isolated from patients of hospital in Nidzica are in the majority susceptible to antibiotics/chemotherapeutics, except of penicillin. Percentage of methicillin-resistant strains (MRSA) is not high (<10). Nevertheless, constant monitoring of a drug susceptibility of nosocomial S. aureus strains is important, considering the necessity of control of current epidemiological and therapeutic situation.     

Experience in isolating Campylobacter jejuni from patients with acute intestinal diseases

Erythrite agar, a commercial culture medium produced by the Research Institute for Culture Media (Makhachkala, USSR), is suitable for the cultivation of C. jejuni after the addition of hemolized sheep blood. The addition of antibiotics to the medium permits its use for the isolation of C. jejuni from feces. By means of this medium C. jejuni has been isolated from the feces of 10% of patients hospitalized on account of acute infectious intestinal diseases.     

Antimicrobial sensivity and ability to slime production of koagulaze-negative staphylococci

The aim of this study was to assess the ability of slime production ofcoagulase-negative staphylococci (CONS) and evaluate the susceptibility of bacteria to antibiotics. Strains were isolated from clinical specimens obtained from hospitalized patients. The most frequently isolated species were S. epidermidis (51%), S. hominis (18%), S. haemolyticus (13%). The result of this study shows that 61% of S.epidermidis produce slime on CRA (Congo red agar), whereas none of the tested S. haemolyticus strains has this ability. All examined strains were susceptible to vancomycin, linezolid and quinupristin/ dalfopristin. The majority of strains were susceptible to minocycline, fusid acid, nitrofurantoin and rifampicin. Sixty six percent of isolates were determined as methicillin-resistant coagulase-negative staphylococci.     

深圳市儿童社区获得性肺炎细菌病原学及其耐药性

目的研究儿童社区获得性肺炎细菌病原学及其耐药性特征,指导临床合理应用抗菌药物。方法对2006年2月至2007年3月1年期间住院的5岁及5岁以下社区获得性肺炎病人,进行深部呼吸道吸引物细菌培养,并且检测分离菌株对常用抗菌药物的耐药性。结果1441例病人中,722例检出细菌共761株,分离阳性率为50．1％,分离菌依次为肺炎克雷伯菌170株（22．3％）、大肠埃希菌130株（17．1％）、肺炎链球菌89株（11．7％）、金黄色葡萄球菌63株（8．3％）及流感和副流感嗜血杆菌60株（7．9％）。耐甲氧西林金黄色葡萄球菌（MRSA）检出率为15．9％;对青霉素不敏感的肺炎链球菌（包括PISP和PRSP）检出率为84．3％;肺炎克雷伯菌、大肠埃希菌、粘质沙雷菌和阴沟肠杆菌产ESBLs的检出率分别为31．2％、46．2％、94．8％和16．8％;流感嗜血杆菌和副流感嗜血杆菌对氨苄西林的耐药率为36％和40％;铜绿假单胞菌和鲍曼复合不动杆菌对亚胺培南的耐药率分别为10．7％和13．2％。结论在深圳儿童社区获得性肺炎的分离菌中,革兰阴性菌明显多于革兰阳性菌,分离菌依次为肺炎克雷伯菌、大肠埃希菌、肺炎链球菌、金黄色葡萄球菌及流感和副流感嗜血杆菌。分离细菌对常用抗菌药物的耐药性较为严重。     

Selected features determine pathogenicity of Staphylococcus haemolyticus

The study have been done on S. haemolyticus strains isolated from patients hospitalized an Surgical Unit. Aim of the study was to determine pathogenic traits of S. haemolyticus: slime producing, adhesion to biomaterials, antibiotics susceptibility and the profiles of surface proteins. Among 44 S. haemolyticus strains, in the test-tube method, there have been 38% labeled as slime producing and 62% as non-producing. In the plate method at 48% slime production was noticed, while 52% strains did not produce slime. It is quite significant that all CNS strains which have an ability to produce mucus, that was proved by means of two methods (test-tube and plate), show a high level of TTC's reduction to formazan. The analysis of resistance to antibiotics in relation to slime production demonstrated more frequent antibiotic resistance of the slime-producing strains.     

Factors affecting the increase of R plasmids during hospitalization

The incidence of the TEM -lactamases among 3,010 Gram-negative rods isolated from 670 anorectal swabs was determined by immunological tests. The results from 44 persons without hospital contact were compared with results from 242 hospitalized patients and 30 nurses working in the hospital. The TEM -lactamase has been found in 10% of the strains isolated from the control group and from patients on day 0 and in 20% of the strains isolated from nurses. On day 10, the number of TEM strains had risen to 15% in hospitalized patients but remained stable in the control group. The increase of TEM-producing strains is significantly favored in patients receiving antimicrobial agents, but also occurred in patients without antibiotic therapy. Patients in surgery acquired TEM-producing strain as much as patients in internal medicine. Older patients (35 years) acquired more TEM-producing strains even if they did not receive antibiotics. The factors influencing the prevalence of TEM-type -lactamase were the duration of hospitalization and the age of the patient.     

Participation of gram-negative anaerobes in infections in hospitalized patients

The aim of the study was to assess the prevalence and antibiotic susceptibility profiles of strictly anaerobic Gram-negative bacteria isolated from clinical samples taken from hospitalized patients from 01.01.2007 to 31.12.2008. The specimens were cultured using media, incubated at 37 degrees C under anaerobic conditions. Biochemical identification and antibiotic susceptibility were done in an automated system ATB Expression (bioMerieux S.A, France). For selected strains of Bacteroides sp. sensitivity was determined using E-test (AB BIODISK, Sweden). Overall 1274 strains of obligate anaerobes were isolated. Gram-negative bacteria were cultured in number of 333 strains. Most frequently isolated was Bacteroides sp. (46,9%) and Prevotella sp. (29,7%). Isolated bacteria are still susceptible to imipenem (100%), metronidazole (100%) and beta-lactam antibiotics with beta-lactamase inhibitors: amoxicillin/clavulanate (97,8%) piperacillin/tazobactam (99,1%), ticarcillin/clavulanate (99,1%).     

铜绿假单胞菌对11种抗生素的耐药性差异

目的探讨不同标本分离铜绿假单胞菌对11种抗生素耐药性的差异,指导临床合理使用抗生素。方法按常规方法培养分离后,经VITEK-AMS60或VITEK-II自动微生物鉴定分析仪的鉴定,用Kirty-Bauer法做药物敏感试验。结果尿液与血液之间,以及尿液与伤口分泌物之间,分离株均对所检测的11种抗生素的耐药性差异有非常显著性（P〈0.01）,尿液与穿刺液分离菌对除亚胺培南和美洛培南外的9种抗生素的耐药性差异有非常显著性（P〈0.01）,血液与穿刺液、血液与伤口分泌物和穿刺液与伤口分泌物间,除穿刺液与伤口分泌物分离菌对美洛培南的耐药性差异有显著性（P〈0.05）外,其他差异均无显著性（P〉0.05）。结论不同标本来源铜绿假单胞菌对哌拉西林等11种抗生素存在耐药性差异。     

Infectivity and resistance to antibiotics of bacterial strains isolated from patients hospitalised in intensive care units

The aim of this study was to evaluate the frequency of isolation and antimicrobial resistance testing of bacterial strains isolated from clinical specimens from patients hospitalized in three Intensive Care Units in Wroc?aw. The susceptibility of bacteria (107 strains) to selected antibiotics was determined. The results clearly show that non-fermentative rods were identified as the main agents causing pneumonia (58% of isolates). The second commonest pathogens were Gram-positive cocci (29%). The P. aeruginosa and E. cloacae strains were resistant to ampicillin, amoxicillin/clavulanate, cefuroxime and cefotaxime. All isolates of A. baumanii were susceptible only to imipenem. The rods of K. pneumoniae and E. coli were resistant to ampicillin, about 55% strains of both bacteria were sensitive to other antibiotics, except piperacillin/tazobactam, imipenem and ciprofloxacin. About 90% of methicillin resistant S. epidermidis strains were resistant to all antibiotics, except vancomycin (100% isolates were sensitive). ESBL were detected among E. cloace, K. pneumoniae and E. coli. We found P. aeruginosa rods producing MBL.     

耐亚胺培南铜绿假单胞菌相关耐药基因的检测

目的对耐亚胺培南（IMP）的铜绿假单胞菌（IRPa）相关耐药基因进行检测。方法 2003年至2009年从临床标本中分离到（P.aeruginosa）共220株,采用三维试验筛选产β-内酰胺酶的铜绿假单胞菌,应用普通PCR和多重PCR分别检测碳青霉烯酶基因和质粒携带的C类头孢菌素酶（AmpC酶）耐药基因,应用荧光定量RT-PCR的方法检测oprD2基因的表达情况。结果共检出43株产β-内酰胺酶的菌株,其中产AmpC酶、超广谱β-内酰胺酶（ESBLs）、金属β-内酰胺酶（MBLs）和未知酶菌株的构成比分别58.14%（25/43）、18.60%（8/43）、4.65%（2/43）和16.28%（7/43）。74株耐亚胺培南的铜绿假单胞菌中,有2株菌携带IMP-9基因,1株菌携带DHA质粒型AmpC酶基因,其他碳青霉烯酶基因检测为阴性。40株菌株oprD2基因表达蛋白量降低,34株oprD2基因表达蛋白量正常。结论 oprD2基因的突变或蛋白表达量降低是IRPa对亚胺培南耐药的主要原因,AmpC酶可水解亚胺培南可能与铜绿假单胞菌对亚胺培南的耐药有一定的关系,而KPC-1酶和MBLs在铜绿假单胞菌对亚胺培南耐药机制中不是主要因素。