Microbiological monitoring for the causative agents of nosocomial infections (exemplified by resuscitation and intensive therapy units)]

More than 900 isolates from at least 1500 patients were tested within 1996-1998. Gram-negative organisms were the main pathogens isolated from patients with different forms of nosocomial complications such as late pneumonia, associated with artificial ventilation of the lungs, and various secondary wound or urinary tract infections. The prevalence of Pseudomonas aeruginosa was stated. Antibioticograms showed that the most active drugs were imipenem (more than 90 per cent of the susceptible isolates) and ticarcillin/clavulanate (48-58 per cent of the susceptible isolates). The activity of ticarcillin/clavulanate (Timentin) was practically the same as that of imipenem against 21 strains of P.aeruginosa isolated from the blood and cerebrospinal fluid of 21 patients with sepsis and 3 patients with secondary purulent meningitis.     

Comparison of linezolid and vancomycin in nosocomial pneumonia: results of the multicenter double-blind study]

The results of multicenter, randomized, double-blind comparative study of linezolid and vancomycin efficacy, safety and tolerability in the treatment of nosocomial pneumonia are presented. The trial was performed on 69 patients. Clinical efficacy of linezolid was 83 per cent, of vancomycin--79 per cent. Bacteriological effect (pathogen eradication) was 83 per cent for linezolid group and 86 per cent for vancomycin group. During the study good clinical tolerability of linezolid was demonstrated along with lower side effects incidence and shortened recovery period when compared to vancomycin.     

Normal microflora of the pharyngeal mucosa

Aerobic microflora of the throat mucosa was studied in 518 healthy persons aged 1 to 50 years. On the basis of the study results, criteria for estimating microbiocenoses of the upper respiratory tracts were defined. It was shown that the throat symbiotic flora included three groups of microorganisms playing different roles in the development of microbiocenosis. The indigenous group consisted of representatives of Streptococcus and Neisseria and was characterized by permanent (90-100 per cent) and intensive (3-8 lg CFU/ml) colonization, broad species spectrum, associations of 2-3 and more species and no significant influence of sociological, age and season factors. The representatives of the facultative group i.e. bacteria belonging to Staphylococcus, Corynebacterium and Haemophilus were less frequent (25-50 per cent). The intensity of their isolation was lower (1-4 lg CFU/ml) and their species spectrum was narrow. The microorganisms of the transitory group were characterized by low frequency (5-20 per cent) and insignificant contamination of the throat mucosa (1-2 lg CFU/ml). The nature of the colonization was monospecific. The group was more numerous by generic composition (Candida, Escherichia, Klebsiella, Citrobacter, Enterobacter, Pseudomonas, Branhamella, Moraxella and Micrococcus). However, it was generally limited by one colonization type. The facultative and transitory groups were subject to age and season variation. They were also different in urban and rural populations.     

α-溶血性链球菌在健康人群口咽部分布及 生物拮抗作用

目的通过采集健康人群口咽部分泌物,分析上呼吸道中α-溶血性链球菌的分布状况,并对革兰阳性化脓性球菌进行生物拮抗试验,为进一步研究上呼吸道益生菌提供理论基础。方法随机自愿原则,用无菌咽拭子采集沈阳市年龄在3～75岁的300名健康人群咽后壁分泌物,对α-溶血性链球菌进行鉴定和定量分析。对致病菌的生物拮抗试验采用小缸杯法。结果定量分析显示不同年龄人群咽后壁的α-溶血性链球菌检出率均较高。在咽后壁菌群中α-溶血性链球菌构成比最多的是幼儿组,达到60.3%。其中唾液链球菌群在幼儿组所占比重最大;老年组人群格氏链球菌占比较大;儿童、青年、成人以缓症链球菌和口腔链球菌为主。对革兰阳性化脓性球菌的生物拮抗试验显示,1株婴儿链球菌婴儿亚种能够拮抗8株致病菌;4株分离菌只能拮抗1株病原菌,提示不同的菌株拮抗病原菌的能力差异较大。结论α-溶血性链球菌在人群中分布广,数量多,不同年龄人群的菌群构成存在差异。并且某些菌株显示出对致病菌较强的生物拮抗作用,推测这些菌株在呼吸道黏膜保护中起到重要作用,可作为上呼吸道益生菌的备选菌株。     

RESUSCITATION OF NEWBORN PREMATURE INFANTS—A Clinical Study of the Use of Positive Pressure Respiration

The Goddard-Bennett-Lovelace hand resuscitator was used for initiating respiration in 87 newborn infants with respiratory difficulties, during a five-month period at the Los Angeles County General Hospital. On alternate days, when the respirator was not used, 126 comparable infants received resuscitation by mouth-to-tracheal pressure and other means. Neither term infants nor previable infants benefited by use of the hand resuscitator, but premature infants weighing more than 1,000 gm. had a definite advantage, with a mortality of only 13 per cent for those treated with the resuscitator against 34 per cent among the controls.Neither roentgen nor postmortem studies of the lungs disclosed any consistent effect of any resuscitative measure employed.     

The structure and antibiotic sensitivity of the causative agents of community-acquired infectious diseases of bacterial origin in children]

Four hundred and forty pediatric patients at the age of 7 days to 15 years with various infections admitted to the Hospital within a month were examined. The biological material was inoculated to blood agar on the first days of the patient admittance to the Hospital and after the growth the organisms were isolated and identified. Antibiotic susceptibility of the isolates was assayed with the disk diffusion method. 479 strains in all were tested. The most frequent cases requiring hospitalization and antibiotic therapy were those of respiratory tract infections (54.09 per cent), urinary tract infections (26.36 per cent), cutaneous and subcutaneous fat diseases, gastrointestinal diseases and others (about 25 per cent of the cases in all). The main pathogens were Streptococcus viridans, S.aureus and S.epidermidis, as well as Enterobacteriaceae (chiefly E.coli) whose frequencies were practically equal (in 25-35 per cent of the cases). The Pneumococcus isolates amounted to 6.3 per cent. Nonfermenting bacteria (Pseudomonas aeruginosa and Acinetobacter) and some representatives of Enterobacteriaceae (Citrobacter, Serratia, Morganella) were isolated from 7 per cent of the patients. The frequency of Klebsiella and Enterobacter was about 11 per cent. The main pathogens were tested for their susceptibility to amoxycillin/clavulanic acid, ampicillin, oxacillin and gentamicin. The least active antibiotic was ampicillin. 88.8 per cent of the E.coli isolates and 100 per cent of the Klebsiella, P.mirabilis, Morganella, Citrobacter, Enterobacter and Serratia isolates were resistant to it. 53.2 per cent of the Streptococcus isolates including 64.5 per cent of the Pneumococcus isolates were as well resistant to ampicillin. 59.5 per cent of the Streptococcus isolates (mainly S.viridans and Enterococcus) was susceptible to oxacillin, 22.2 per cent of them being moderately susceptible. 62.5 per cent of the Pneumococcus isolates and 78.1 per cent of the Staphylococcus isolates were also susceptible to oxacillin. The highest susceptibility of the isolates was that to amoxycillin/clavulanic acid, i.e. 90.1 per cent of the strains, 79.9 per cent of them being highly susceptible. All the isolates of Citrobacter, Serratia and Morganella and some isolates of P.aeruginosa, Acinetobacter, Enterobacter, Klebsiella and E.coli were resistant to amoxycillin/clavulanic acid. As for the latter 5 organisms their susceptibility to amoxycillin/clavulanic acid was comparable with that to gentamicin. The susceptibility of the Streptococcus and Staphylococcus isolates to amoxycillin/clavulanic acid was significantly much higher than that to oxacillin, gentamicin and ampicillin: 93 per cent of the Streptococcus isolates (62.7 per cent of the Pneumococcus isolates) and 90.7 per cent of the Staphylococcus isolates.     

Prevalence of haemolytic streptococcal infection in rhesus monkeys.

Seventy-six monkeys arriving in 10 batches were investigated within a day or two of their arrival for beta-haemolytic streptococcal infections. 10.53 per cent of monkeys yielded group A beta haemolytic streptococcus. Majority of the isolates were T pattern I. With ASO test, 44.7 per cent monkeys had low titres while with A-DNase 'B' 'test, 64.5 per cent of the monkeys had low titres.     

Resuscitation of newborn premature infants; a clinical study of the use of positive pressure respiration

The Goddard-Bennett-Lovelace hand resuscitator was used for initiating respiration in 87 newborn infants with respiratory difficulties, during a five-month period at the Los Angeles County General Hospital. On alternate days, when the respirator was not used, 126 comparable infants received resuscitation by mouth-to-tracheal pressure and other means. Neither term infants nor previable infants benefited by use of the hand resuscitator, but premature infants weighing more than 1,000 gm. had a definite advantage, with a mortality of only 13 per cent for those treated with the resuscitator against 34 per cent among the controls. Neither roentgen nor postmortem studies of the lungs disclosed any consistent effect of any resuscitative measure employed.     

Survey of Aspergillus species associated with the human respiratory tract

A comprehensive survey has been carried out on the occurrence ofAspergillus species in the respiratory tract of patients of bronchopulmonary diseases in Delhi. In all, 1238 clinical specimens, which included 1082 sputa, 143 bronchial aspirates and 13 throat swabs obtained from 812 patients, were examined. Of these 61.7 per cent patients were culturally positive yielding 29 different species ofAspergillus. The prevalence of aspergilli in sputa was significantly higher than in the bronchial aspirates.Aspergillus niger was the commonest species isolated showing a prevalence of 36.7 per cent. It was followed byA. flavus, A. nidulans, A. terreus, A. versicolor, A. sydowi, A. japonicus andA. oryzae. None of theAspergillus species showed a significant correlation with any of the diseases, or the type of treatment the patients had received. Of the 8 broad occupational groups investigated farmers and labourers showed higher prevalence ofA. niger andA. flavus. The prevalence ofAspergillus species in the throats of healthy persons was 16 per cent withA. versicolor being the commonest species followed byA. flavus, A. amstelodami, A. sydowi andA. terreus. A comparison of the prevalence ofAspergillus species in the patients, healthy individuals and atmosphere of Delhi appears to support the view that the aspergilli are transient residents in the human respiratory tract following their inhalation from the environment.     

Acinetobacter pneumonia: a review

Acinetobacter species are becoming a major cause of nosocomial infections, including hospital-acquired and ventilator-associated pneumonia. Acinetobacter species have become increasingly resistant to antibiotics over the past several years and currently present a significant challenge in treating these infections. Physicians now rely on older agents, such as polymyxins (colistin), for treatment. This paper reviews the epidemiology, treatment, and prevention of this emerging pathogen.     

Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database

Objective To determine the extent to which antibiotics reduce the risk of serious complications after common respiratory tract infections.Design Retrospective cohort study.Setting UK primary care practices contributing to the general practice research database.Data source 3.36 million episodes of respiratory tract infection.Main outcome measures Risk of serious complications in treated and untreated patients in the month after diagnosis: mastoiditis after otitis media, quinsy after sore throat, and pneumonia after upper respiratory tract infection and chest infection. Number of patients needed to treat to prevent one complication.Results Serious complications were rare after upper respiratory tract infections, sore throat, and otitis media, and the number needed to treat was over 4000. The risk of pneumonia after chest infection was high, particularly in elderly people, and was substantially reduced by antibiotic use, with a number needed to treat of 39 for those aged ≥65 and 96-119 in younger age groups. Conclusion Antibiotics are not justified to reduce the risk of serious complications for upper respiratory tract infection, sore throat, or otitis media. Antibiotics substantially reduce the risk of pneumonia after chest infection, particularly in elderly people in whom the risk is highest.     

新生儿院内获得性肺炎患者病原体特征及 危险因素分析

目的分析院内新生儿获得性肺炎患者病原体分布、药敏情况和相关危险因素,并探讨其临床意义。方法收集2015年10月至2017年4月于我院接受治疗的100例院内获得性肺炎新生儿为观察组。选择同期于我院出生的未发生院内获得性肺炎的新生儿100例为对照组。采集观察组患儿下呼吸道分泌物,利用全自动微生物分析仪进行菌株种类和数量鉴定,利用K-B纸片扩散法进行药敏试验。对院内获得性肺炎的危险因素进行单因素回归分析。结果 100例院内获得性肺炎新生儿下呼吸道分泌物共检测出病原微生物168株,其中细菌135株(80.36%),病毒30株(17.86%),真菌3株(1.78%)。细菌中革兰阴性菌116株(69.05%),以大肠埃希菌(49株,29.17%)及肺炎克雷伯菌(42株,25.00%)为主;革兰阳性菌19株(11.31%),以金黄色葡萄球菌(10株,5.95%)为主。病毒以呼吸道合胞病毒(23株,13.69%)为主。大肠埃希菌及肺炎克雷伯菌均对常用抗生素具有极高的耐药性,包括氨苄西林、头孢哌酮、头孢曲松及头孢唑林等;对氨基糖苷类、喹诺酮类、碳青霉烯类抗生素高度敏感。新生儿的住院天数、分娩方式及吸痰均与院内获得性肺炎的发生有密切联系,差异均有统计学意义(P0.05)。结论新生儿院内获得性肺炎的致病菌以革兰阴性菌为主,临床治疗时可适当选用氨基糖苷类、喹诺酮类、碳青霉烯类抗生素。住院天数、剖腹产及吸痰均为新生儿院内获得性肺炎的危险因素,应加强对上述危险因素的保护。     

呼吸道感染与甲型链球菌的相关性研究

目的：探讨呼吸道感染与甲型链球菌的相关性。方法 对呼吸道感染患者和健康对照组口腔咽后壁取样进行分析。结果 健康对照组中甲型链球菌检出率（５０％）明显高于呼吸道感染病人组（２５．７５％）,且各疾病组甲型链球菌检出率均有显著性差异（Ｐ＜０．０５）,如肺内感染１６．６７％,支气管炎１７．２４％,具有显著性差异（Ｐ＞０．０５）,但肺炎患者甲型链球菌检出率５３．８５％与健康人相比无显著性差异（Ｐ＞０．０５）     

Nosocomial infection in a children's hospital. A retrospective study

The investigations the frequency of the occurrences of hospital infections were carried in a General Pediatric Ward. Most of the infections (77 per cent) appeared in children up to one year of age. The hospital infections mostly affected children residing in rural areas. The etiological agent was E. coli (36 per cent), Proteus (22.7 per cent) Klebsiella and Staphylococcus. The infections caused by E. coli mainly appeared in girls, others- in boys. The frequency of the occurrences of hospital infections was also analysed with respect to the primary disease of a child. In most cases of additional infections were found in children with upper respiratory tract infections, pneumonia and bronchitis. The above differences are statistically valid.     

STAPHYLOCOCCIC INFECTIONS IN CHILDREN

Over 50 per cent of all staphylococcic infections are hospital-acquired. In 92 per cent of hospital-acquired infection, the organism is resistant to penicillin, and in 74 per cent to tetracycline.Chloramphenicol, bacitracin, novobiocin and erythromycin are the drugs of choice for therapy. There was good correlation between clinical response and antibiotic therapy selected on the basis of results of organism sensitivity tests done by the agar diffusion technique.Cross-resistance among the tetracyclines averaged 94 per cent. Erythromycin and magnamycin showed similar pattern.Mortality in infants less than two months old was 7.8 per cent as compared with 1.1 per cent in older children. Death was related either to pneumonia or to septicemia in the ten fatalities recorded in this series.     

Use of spiramycin in the treatment of inflammatory diseases ot the respiratory tract in children in ambulatory conditions]

Comparative efficacy of oral spiramycin and ampicillin was estimated in the treatment of 65 children at the age of 5 to 12 years with infectious inflammatory diseases of the respiratory tract, tonsils and middle ear. By the 7th day of the treatment with spiramycin the cure was stated in 97.7 per cent of the patients and 2.3 per cent of the patients showed the improvement. With the use of ampicillin the cure was recorded only by the 12th day. Marked advantages of spiramycin were observed as well with respect to the time course of the improvement of the disease main signs such as fever, pain in the throat on swallowing, intoxication and others.     

Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open,randomised controlled trial

Objective To assess the effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy.Design Open, randomised controlled trial.Setting 21 general hospitals and three academic centres in the Netherlands.Participants 300 children aged 2-8 years requiring adenotonsillectomy.Intervention Adenotonsillectomy compared with watchful waiting.Main outcome measures Episodes of fever, throat infections, upper respiratory tract infections, and health related quality of life.Results During the median follow up period of 22 months, children in the adenotonsillectomy group had 2.97 episodes of fever per person year compared with 3.18 in the watchful waiting group (difference -0.21, 95% confidence interval -0.54 to 0.12), 0.56 throat infections per person year compared with 0.77 (-0.21, -0.36 to -0.06), and 5.47 upper respiratory tract infections per person year compared with 6.00 (-0.53, -0.97 to -0.08). No clinically relevant differences were found for health related quality of life. Adenotonsillectomy was more effective in children with a history of three to six throat infections than in those with none to two. 12 children had complications related to surgery.Conclusion Adenotonsillectomy has no major clinical benefits over watchful waiting in children with mild symptoms of throat infections or adenotonsillar hypertrophy.     

Further Studies on Staphylococci in Meats, : IV. The Bacteriophage Pattern and Antibiotic Sensitivity of Isolates from Nonfrozen Meats

Of 272 isolates of Staphylococcus aureus recovered from 173 samples of 10 market meats from 27 stores, 173 (63.2%) were phage typable, employing 28 phages. Sixty per cent of the phage-typable strains belonged to group III, followed by 14.5% to mixed groups I and III, 10.4% to Group I, 8.7% to all mixed groups, 4.6% to group II, and 1.7% to group IV. The most commonly recovered patterns were 83, 53/83, and other similar combinations of 53. The nonpigmented strains which did not have bound coagulase were less phage sensitive than the pigmented strains having bound coagulase. None of the isolates were resistant to novobiocin, kanamycin, chloramphenicol, and erythromycin. Twenty-three per cent were resistant to streptomycin, 17% to ristocetin, 11% to penicillin, and 4.4% to chlortetracycline. The phage types are compared to those of other food and human isolates and found not to differ too greatly. Their possible origins into the meats are discussed.     

Acute Respiratory Infections in Children: I. An Intensive Study of Etiology in an Open Community

During a seven-month period from November 1960 to May 1961, 181 infants and children, hospitalized because of acute respiratory infections, were studied intensively to determine the responsible etiologic agents. Forty-two per cent of the illnesses in this group appeared to be caused by bacterial agents, either primary or secondary to virus. Parainfluenza viruses were identified as causes of laryngotracheobronchitis in nearly 50% of the cases. Adenoviruses were also found to be important pathogens, particularly as causes of pneumonia in infants. The over-all infection rate attributed to adenoviruses was 11.6%. An epidemic due to Influenza B virus affected approximately 40% of children in this city just following the hospital study. This study was conducted as the first step in a long-term project undertaken at the Regina General Hospital to determine the effectiveness of vaccines in the prevention and treatment of respiratory infections in children.     

多发性骨髓瘤患者医院感染临床分析

目的 探讨多发性骨髓瘤患者医院感染的临床状况和危险因素。方法 对1994年1月～2001年12月收治的62例多发性骨髓瘤患者医院感染发生情况进行调查分析。结果 多发性骨髓瘤患者发生医院感染33例。感染发生率为53．2％,好发部位为呼吸道、口腔、胃肠道和泌尿道等。结论 多发性骨髓瘤患者医院感染的发生与骨髓瘤细胞含量、疾病Ⅲ期、骨损害、白细胞减少、化疗及住院日等因素有关。应采取相应措施,避免医院感染发生。