耐碳青霉烯类肠杆菌的流行病学特点与治疗现状

耐碳青霉烯类肠杆菌(carbapenem-resistant Enterobacteriaceae,CRE)是近年来检出率不断升高的一种临床常见耐药菌,是导致患者死亡的独立危险因素。CRE的出现主要是由于细菌产碳青霉烯酶,包括肺炎克雷伯菌产生的碳青霉烯酶(Klebsiella pneumoniae carbapenemase,KPC)、金属β-内酰胺酶(metallo-β-lactamase,MBL)和 苯唑西林酶(oxacillinase,OXA),少数是由于细菌外膜蛋白改变以及外排泵高表达。临床上最常见的CRE是肺炎克雷伯菌,最常暴发CRE感染的科室是重症监护室(intensive care unit,ICU),感染高危因素包括接触医疗机构、各种侵入性操作以及抗菌药物使用史。由于缺乏前瞻性临床试验数据,目前在治疗CRE感染的高危患者时多采用多药联合的经验性治疗措施,一些经典药物如多黏菌素、替加环素、磷霉素等起到了意想不到的效果,一些新药如头孢他啶-阿维巴坦也投入使用并发挥了一定作用。本文就近年来CRE感染的流行病学特点以及目前临床上主要使用的药物进行综述。     

肠杆菌科细菌肺部感染病原菌分布与耐药性监测

目的了解浙江龙游县人民医院肠杆菌科细菌肺部感染病原菌分布及耐药性,为临床合理使用抗菌药物提供依据。方法采用纸片扩散法对病原菌进行药敏试验,并进行ESBLs检测,按CLSI 2012年标准判定药敏结果,用WHONET 5.6软件分析结果。结果痰培养共分离出371株肠杆科细菌,主要为肺炎克雷伯菌、大肠埃希菌和阴沟肠杆菌,产ESBLs菌阳性率高,对碳青霉烯类抗菌药物耐药率低,均在10.00%以下,其他药物均有不同程度耐药,测试抗菌药物的耐药率差异有统计学意义（P〈0.05）。结论临床常见肠杆菌科细菌耐药率高,开展病原菌耐药性监测,对指导临床抗感染治疗合理选择抗菌药物具有重要意义。     

医院感染葡萄球菌菌种变迁与耐药性近况

目的：了解近9年来医院感染葡萄球菌菌种的变迁与近3年来葡萄球菌药状况。方法：1993年1月至2001年12月我院传染病科等13科室住院病人的各种标本采用血琼脂培养,所分离的葡萄球菌采用美国DADE公司生产的MICROSCAN WALKAY-40全自动微生物分析仪鉴定到种及其亚种。药敏试验药物有青霉素、苯唑西林、氨苄西林、哌拉西林、阿莫西林／克拉维酸（阿莫仙）、头孢唑啉、头孢噻肟、头孢哌酮／舒巴坦（舒普深）、庆大霉素、复方新诺明、环丙沙星、氧氟沙星、利福平、万古霉素、红霉素、林可霉素、四环素、伊米配能／西司他丁（泰能）共18种。采用液体稀释法测定每株葡萄球菌对受试药物的最小抑菌浓度（MIC）,操作按说明书进行。质控菌ATCC25923。依据新近NCCLS标准判读结果。结果：1993年至1998年分离的葡萄球菌中,金黄色葡萄球菌（金葡萄）占71.43%,凝固酶阴性葡萄球菌（CNS）占28.57%,包括表皮葡萄球菌（表葡菌）、腐生葡萄球菌、里昂葡萄球菌和头状葡萄球菌4种。1999年至2001年分离的424株葡萄球菌中,金葡菌仅占29.01%,CNS增至13种,占70.995,以表葡菌、溶血葡萄球菌、松鼠葡萄球菌为主。近3年来分离的各种葡萄球菌甲氧西林耐药率在73.03%-100%之间,除对舒普深、复方新诺明、利福平和万古霉素较敏感外,对其余抗菌药物的耐药率均超过60％,以金葡菌、溶血葡萄球菌、松鼠葡萄球菌的耐药率为最高。MRS耐药率普遍高于MSS,且均呈多重耐药。5.42%(23/424)菌株万古霉素MIC＞16mg/L,除1株为MSCNS外,其余22株均为MRS。结论：3年来医院感染葡萄球菌菌种构成比发生了显著变化,以CNS为主。对抗菌药物呈多重耐药,部分菌株对万古霉素敏感性降低,应予警惕。     

医院肺炎克雷伯菌耐药及分子流行病学特征研究

摘要 目的：了解医院肺炎克雷伯菌的耐药及分子流行特点,分析其基因同源性,为医院感染控制提供实验室依据。方法：收集2017年10月-2018年12月医院分离的耐碳青霉烯类肺炎克雷伯菌和碳青霉烯类敏感肺炎克雷伯菌,用梅里埃VITEK 2 Compact 全自动微生物分析系统进行细菌鉴定和药敏分析,K-B法药敏予以补充;采用赛沛Xpert?Carba-R试剂盒检测耐碳青霉烯类肺炎克雷伯菌碳青霉烯耐药基因;采用多位点序列分析技术检测菌株7个管家基因型别及其ST型别,使用eBURST软件对ST数据进行亲缘性关系分析。结果：共分离到63株耐碳青霉烯类肺炎克雷伯菌和211株碳青霉烯类敏感肺炎克雷伯菌（随机选取30株作研究）;耐药组对青霉素类、大环内酯类、头孢菌素类、喹诺酮类、含酶抑制剂类、四环素类耐药率显著高于敏感组;63株耐药株中,96.83%（61/63）产KPC酶,1.59%（1/63）产KPC酶和NDM酶,1.59%（1/63）未检测到5种碳青霉烯酶基因;耐碳青霉烯类组获得8个ST型别,包括ST11（54/63,85.71%）、ST15（2/63,3.17%）、ST392（2/63,3.17%）、ST45（1/63,1.59%）、ST147（1/63,1.59%）,ST659（1/63,1.59%）、ST3228（1/63,1.59%）、STr1（1/63,1.59%）,STr1为新发现型别,属于克隆复合体11;30株碳青霉烯敏感组获得25个ST型别,包括ST35（3/30,10.00%）,ST659（3/30,10.00%）,ST147（2/30,6.67%）,ST485、 ST34、 ST395、ST370、ST2388、ST893、ST11、ST2176、ST221、ST86、ST380、ST65、ST920、ST268、ST25、ST2154、ST2229以及5个新ST型别（STs1,STs2,STs3,STs4,STs5）各1株,分别占3.33%,两组比较,耐药组ST型别集中而敏感组离散,差异明显。结论：医院耐碳青霉烯肺炎克雷伯菌具有基因同源相关性,并呈现水平传播的趋势。     

血流感染葡萄球菌菌种分布及耐药特性分析

目的 了解血流感染中葡萄球菌的菌种分布及其耐药特性,以指导临床合理使用抗菌药物。方法 回顾性分析南昌大学第二附属医院2013年1月至2013年8月期间临床各科室送检的血培养标本中葡萄球菌的菌种分布和耐药特性。采用BACT/ALERT 3D全自动血培养仪进行培养,VITEK2-compact全自动细菌分析仪进行菌种鉴定和药敏试验。WHONET 5.6软件分析数据。结果 共分离获得176株葡萄球菌,其中金黄色葡萄球菌24株,占13.6%;路邓葡萄球菌1株,占0.6%;凝固酶阴性葡萄球菌（CNS）151株,占85.8%,人葡萄球菌53株、溶血葡萄球菌32株、表皮葡萄球菌23株及头状葡萄球菌15株居前四位。最常见的葡萄球菌分别为人葡萄球菌、溶血葡萄球菌、金黄色葡萄球菌及表皮葡萄球菌。耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林CNS（MRCNS）检出率分别为29.2%和85.4%,对青霉素耐药率均100.0%,磺胺甲噁唑对MRSA（耐药率仅14.3%）有较强的体外抗菌活性,利福平对MRCNS（耐药率仅18.2%）有较强的体外抗菌活性,均未发现耐万古霉素、利奈唑胺和替加环素的菌株。结论 葡萄球菌引起的血流感染菌种分布较广,以人葡萄球菌、溶血葡萄球菌、金黄色葡萄球菌及表皮葡萄球菌为主,人葡萄球菌较金黄色葡萄球菌耐药及多重耐药性严重,但均仍对万古霉素、利奈唑胺、替加环素保持高度敏感。     

中、西医院住院患者金黄色葡萄球菌的耐药情况分析

目的 探讨本地区中、西医两家医院金黄色葡萄球菌的耐药情况。方法 采用K-B法对两家医院收集的菌株进行药敏试验。结果 12种检测的药物中,除万古霉素、利奈唑胺以及青霉素外,其他抗菌药物耐药率西医院均高于中医院,其中左氧氟沙星、苯唑西林、利福平、庆大霉素、四环素中医院耐药率为9.1%、14.0%、15.7%、19.8%、25.6%,西医院为40.0%、52.7%、40.0%、47.7%、50.0%,差异有统计学意义（P<0.01）。结论 中医院金黄色葡萄球菌的耐药率明显低于西医院。     

肠杆菌科细菌对β-内酰胺类抗生素耐药机制的研究现状

肠杆菌科细菌是革兰阴性杆菌中最常见的一类细菌,在一定条件下可引起医院和社区感染。临床首选β-内酰胺类抗生素来抗感染,但由于抗生素的不合理使用导致肠杆菌科细菌产生相应的灭活酶及水解酶或菌株细胞结构改变,从而破坏β-内酰胺环使其对抗生素作用的敏感性下降甚至耐药,给临床抗感染治疗带来了极大的挑战;为更好地指导临床用药,拟就肠杆菌科细菌的耐药表型、对β-内酰胺类抗生素的耐药机制做一综述。     

Lack of biofilm contribution to bacterial colonisation in an experimental model of foreign body infection by Staphylococcus aureus and Staphylococcus epidermidis

The contribution of in vivo biofilm-forming potential of Staphylococcus aureus and Staphylococcus epidermidis was studied in an experimental model of foreign body infections. Increasing inocula (from 10(2) to 10(7) organisms) of ica-positive strains of S. aureus and S. epidermidis and their ica-negative isogenic mutants (the ica locus codes for a major polysaccharide component of biofilm) were injected into subcutaneously implanted tissue cages in guinea pigs. Surprisingly, bacterial counts and time-course of tissue cage infection by ica-positive strains of S. aureus or S. epidermidis were equivalent to those of their respective ica-negative mutants, in the locally infected fluids and on tissue-cage-inserted plastic coverslips.     

Relative migration rates and local adaptation in a mosquito-protozoan interaction

Theory predicts that the direction of local adaptation depends on the relative migration rates of hosts and parasites. Here we measured relative migration rates and tested for local adaptation in the interaction between a tree hole mosquito (Ochlerotatus sierrensis) and a protozoan parasite (Lambornella clarki). We found strong support for the hypothesis that the host migrates more than its parasite. Hosts colonized artificial tree holes in the field at a much higher rate than the parasite. Field releases of the parasite demonstrated that it colonizes and persists in natural tree holes where it was previously absent, suggesting that parasite distribution is limited by its migratory ability. Although the host migrates more than its parasite, we found no evidence for local adaptation by hosts and some evidence for local adaptation by parasites. Other life history traits of the host and parasite may also influence patterns in local adaptation, particularly parasite virulence and host dormancy.     

Dissemination of IncF-type plasmids in multiresistant CTX-M-15-producing Enterobacteriaceae isolates from surgical-site infections in Bangui,Central African Republic

Background

Surgical-site infection is the most frequent health care-associated infection in the developing world, with a strikingly higher prevalence than in developed countries We studied the prevalence of resistance to antibiotics in Enterobacteriaceae isolates from surgical-site infections collected in three major tertiary care centres in Bangui, Central African Republic. We also studied the genetic basis for antibiotic resistance and the genetic background of third-generation cephalosporin-resistant (3GC-R) Enterobacteriaceae.

Results

Between April 2011 and April 2012, 195 patients with nosocomial surgical-site infections were consecutively recruited into the study at five surgical departments in three major tertiary care centres. Of the 165 bacterial isolates collected, most were Enterobacteriaceae (102/165, 61.8%). Of these, 65/102 (63.7%) were 3GC-R, which were characterized for resistance gene determinants and genetic background. The bla_CTX-M-15 and aac(6′)-Ib-cr genes were detected in all strains, usually associated with qnr genes (98.5%). Escherichia coli, the most commonly recovered species (33/65, 50.8%), occurred in six different sequence types, including the pandemic B2-O25b-ST131 group (12/33, 36.4%). Resistance transfer was studied in one representative strain of the resistance gene content in each repetitive extragenic palindromic and enterobacterial repetitive intergenic consensus sequence-PCR banding pattern. Plasmids were characterized by PCR-based replicon typing and sub-typing schemes. In most isolates (18/27, 66.7%), bla_CTX-M-15 genes were found in incompatibility groups F/F31:A4:B1 and F/F36:A4:B1 conjugative plasmids. Horizontal transfer of both plasmids is probably an important mechanism for the spread of bla_CTX-M-15 among Enterobacteriaceae species and hospitals. The presence of sets of antibiotic resistance genes in these two plasmids indicates their capacity for gene rearrangement and their evolution into new variants.

Conclusions

Diverse modes are involved in transmission of resistance, plasmid dissemination probably playing a major role.     

金黄色葡萄球菌所致肺部感染的耐药特点及其Panton—Valentine杀白细胞素基因的携带状况分析

目的分析金黄色葡萄球菌所致肺部感染的耐药性特点及其Panton—Valentine杀白细胞素基因的携带状况。方法回顾性调查了温州医学院第一附属医院2005年1月至2006年1月医院感染的金黄色葡萄球菌所致肺部感染患者132例,对其体外药敏试验进行分析;并利用多重PCR检测其PVL基因,应用多位点基因序列分型（multilocus sequence typing,MLST）技术对PVL基因阳性的菌株进行序列分型。耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus,MRSA）的SCCmec基因分型采用多重聚合酶链反应。结果致肺部感染的132株金黄色葡萄球菌的耐药现象较为严重,仅对万古霉素、呋喃妥因及复方新诺明等药物的敏感率较高;其中经多重PCR筛选出10株携带PVL基因的金葡菌,全部为MRSA菌株,3株为ST239-SCCⅢ,2株为ST398-SCCmecⅢ,2株为ST398-SCCmecⅣ,ST25-SCCmecⅢ、ST59-SCCmecⅠ和ST88-SCCmecⅢ各1株。结论肺部感染的金黄色葡萄球菌对多种抗生素耐药,呈多重耐药性;其携带PVL基因占一定比例。     

耐甲氧西林金黄色葡萄球菌小鼠全身感染模型的建立与评价

目的建立稳定、可靠的MRSA全身感染小鼠模型,为MRSA疫苗的研发提供参考依据,并对系统研究MRSA感染的发病机制及其防治策略奠定实验基础。方法在采用国际标准株MRSA-252建立OD600-CFU标准曲线的基础上,经尾静脉注射途径感染BALB/c小鼠,从感染剂量的选择、小鼠的生存率和体重变化、血液及多脏器的细菌定植量以及主要组织器官病理学变化等多个层面进行时相性监测,对建立的小鼠模型进行系统评价。结果经此途径建立的小鼠模型,致死剂量为每只5.0×109CFU,亚致死剂量为每只1.0×109CFU（生存率为60%～70%）。感染后小鼠生存率下降;体重下降;血液及肝脏、脾脏和肾脏均有细菌定植,定植量在感染后第3天达到高峰;心、肝、肺和肾等主要脏器中有较明显的细胞坏死和炎性细胞浸润。结论小鼠模型的建立,将为进一步研究MRSA疫苗的有效性和安全性评价等提供可靠的技术手段。     

医院感染葡萄球菌的耐药性及D-试验研究分析

目的了解医院感染葡萄球菌的耐药性及克林霉素诱导试验（D-试验）临床意义。方法从住院患者标本中分离到的539株葡萄球菌进行药敏试验和D-试验,所得结果进行统计分析。结果葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MPSE）的检出率高,分别为65．1％和83．6％,各种葡萄球菌对万古霉素敏感率为100％,对阿奠西林头孢菌素在内的各种β-内酰胺酶类抗生素敏感率低于35％,对红霉素耐克林霉素敏感的D-试验阳性率为57．O％。结论葡萄球菌耐甲氧西林检出率,呈多重耐药,在选用大环内酯类,克林霉素类抗生素时要注意D试验,合理用药,提高疗效。     

Inter-strain comparison by pyrolysis mass spectrometry of Staphylococcus aureus isolates associated with nosocomial infection

Pyrolysis mass spectrometry was used to characterise Staphylococcus aureus isolates from an outbreak of post-operative wound infections on a mixed surgical ward. The PyMS results were compared with those of phage typing. Both suggested a single strain of S. aureus, of phage type 3C, 55,71, was responsible for six of the 13 wound infections. PyMS differentiated an isolate from a member of staff of similar phage type to the epidemic strain, which had previously been considered to be the point source for the outbreak. PyMS is a rapid and inexpensive technique for investigating nosocomial outbreaks, including those caused by S. aureus and, in this instance, was more discriminatory than phage typing.     

Characteristics of cardiac device infections in the Isala Hospital; a large volume tertiary care cardiology centre

Aims

To determine the frequency, characteristics and risk factors of cardiac device infections in the Isala Hospital.

Methods

We retrospectively studied all patients who underwent cardiac device procedures performed in the cardiac catheterisation lab and the operating room from 2010 to 2012. All patients who developed a cardiac device infection were reviewed for its characteristics.

Results

31/2026 patients developed a cardiac device infection (1.5 %). One (3.2 %) patient died within 30 days of hospitalisation. Device infection rates for procedures in the catheterisation lab and operating room were similar (p = 0.60). Positive cultures were present in 27/31 (87 %) cases. These consisted predominantly of micro-organisms that are part of the skin flora (84 %). The mean time between device procedure and infection was 14 ± 21 months (range 0–79). Cardiac device infection was significantly associated with device revision, (65 % were revisions in patients with device infection vs. 30 % revisions in patients without device infection, p = 0.011) and placement of a left ventricular lead in pacemaker implantations (59 % of patients with vs. 51 % of patients without device infection, p < 0.001).

Conclusion

The frequency of cardiac device infection was 1.5 % with a mortality of 3.2 % within 30 days, which is lower compared with other registries. Cardiac device infections were associated with device revisions and placement of left ventricular leads in pacemaker implantations.     

替考拉宁与万古霉素治疗MRSA下呼吸道感染的临床疗效和安全性分析

目的 对替考拉宁与万古霉素治疗耐甲氧西林金黄色葡萄球菌（MRSA）下呼吸道感染的临床疗效和安全性进行分析。方法 回顾性分析2013年6月至2014年12月我院收治的53例MRSA下呼吸道感染患者的临床资料,其中22例应用替考拉宁治疗（替考拉宁组）,31例应用万古霉素治疗（万古霉素组）;分别对其治疗前后的临床症状、体征、临床疗效、细菌清除情况以及不良反应进行分析,并将临床分离菌分别进行替考拉宁和万古霉素的体外药敏试验。结果 替考拉宁组治疗时间平均（9.2±3.1）d,显著性低于万古霉素组的（14.9±3.3）d（t=63517,P0.05）。替考拉宁组细菌清除率为72.7%,万古霉素组为83.9%,两组比较差异无统计学意义（2=0.972,P>0.05）。药敏试验结果显示替考拉宁和万古霉素对痰液MRSA分离菌均有极强的抗菌活性。替考拉宁组出现与药物很可能和可能有关的不良反发生率为9.1%,万古霉素组为16.1%,两组比较差异无统计学意义（2=0.062,P>0.05）。结论 替考拉宁和万古霉素治疗MRSA下呼吸道感染疗效均较好,安全性高,但替考拉宁较之万古霉素使用时间更短。     

The effects of extracellular slime from Staphylococcus epidermidis on phagocytic ingestion and killing

Abstract Extracellular slime (Ecs) from three strains of Staphylococcus epidermidis was prepared and added to fresh suspensions of polymorphonuclear neutrophils. Phagocytic ingestion and killing of opsonised and unopsonised S. epidermidis strains was assessed over time using slide preparations stained by the Gram's method and microbiological culture. Both phagocytic ingestion and killing were inhibited. Investigation as to one possible mechanism of action of Ecs on phagocytes was performed using 1 μ polystyrene spheres which were incubated overnight with Ecs. It was found that the surface tension was altered with Ecs making the beads more hydrophilic, a factor which may interfere with the phagocytic response to infection.