育龄妇女泌尿生殖道无乳链球菌感染情况与耐药性分析

目的探讨育龄妇女泌尿生殖道无乳链球菌感染情况与耐药性。方法选择3 000例在我院就诊的育龄期妇女,所有患者送检泌尿道或生殖道标本,进行无乳链球菌培养及药物敏感性试验,探讨育龄妇女泌尿生殖道无乳链球菌感染情况及耐药性。结果 3 000例育龄妇女中177例感染无乳链球菌,感染率5.90%,其中肾内科患者感染率最高,达到8.97%。2012至2015年育龄期妇女无乳链球菌感染率逐年增加。无乳链球菌对四环素、克林霉素、红霉素、左氧氟沙星耐药性较高,分别达到80.80%、60.45%、56.50%、45.20%。无乳链球菌对头孢曲松、头孢他啶、亚胺培南、万古霉素未产生耐药性。结论育龄妇女无乳链球菌感染率较高,呈逐年上升趋势,防治形势严峻,无乳链球菌对多种常用抗生素耐药率较高,应根据药敏结果合理使用抗生素。     

2006～2010年泌尿生殖道炎症患者支原体感染率检测与耐药性分析

目的 了解杭州市萧山区2006～ 2010年泌尿生殖道炎症患者支原体感染及耐药情况.方法 对4 023例泌尿生殖道炎症患者用支原体鉴定及药敏试剂盒进行支原体培养及药敏试验.结果 支原体总检出率为48.1％,女性检出率51.2％明显高于男性41.8％ (P ＜0.05).支原体培养阳性患者中Uu单独感染1701例(88.0％),Mh单独感染57例(2.9％),Uu+ Mh混合感染176例(9.1％),Uu单独感染明显高于Mh单独感染和Uu+ Mh混合感染(P＜0.05).5年间支原体阳性检出率从2006年的39.4％到2010年的58.1％逐年增高,感染模式观察期内无明显变化.支原体对交沙霉素、原始霉素和强力霉素均敏感(敏感率≥91.4％),对四环素、红霉素、氧氟沙星和环丙沙星的耐药率高,均大于50％.比较2006年至2010年各种支原体对9种药物的耐药率,除四环素外耐药率呈不同程度上升,四环素耐药率2007年和2008年较高,后逐年下降,2010年为53.5％.混合感染总体耐药率比Uu或Mh单独感染耐药率高.结论 泌尿生殖道炎症患者支原体感染Uu比较常见,且女性检出率显著高于男性.临床分离支原体大多具有多重耐药性,临床治疗需根据药敏结果加以选择.     

4103例泌尿生殖道支原体感染及药敏分析

目的通过分析泌尿生殖道支原体感染及药敏情况,为临床提供用药指导。方法采用支原体检测试剂盒进行支原体属培养和药敏试验。结果4103例患者标本中,检出支原体属1336株,总阳性率为32．56％;其中单一解脲脲原体（Uu）感染1227例,阳性率为91．84％;单纯人型支原体（Mh）感染15例,阳性率为1．12％;Uu＋Mh混合合感染94例,阳性率为7．04％。解脲脲原体对阿奇霉素、红霉素、交沙霉素、罗红霉素、米诺环素、强力霉素敏感性高;单纯人型支原体对交沙霉素、米诺环素、强力霉素敏感。结论泌尿生殖道支原体感染以Uu为主。支原体大多具有多重耐药性,临床治疗需根据药敏结果选药物。     

Antimicrobial Activity,Inhibition of Urogenital Pathogens,and Synergistic Interactions Between <Emphasis Type="Italic">Lactobacillus</Emphasis> Strains

Lactobacillus fermentum strain L23 and L. rhamnosus strain L60 were selected as an alternative treatment to prevent or treat urogenital infections based on their probiotic properties and production of bacteriocins. The objectives of the present work were to study the inhibitory activities of these two bacteriocin-producing strains, and to analyze the interactions between pairs of bacteriocins that inhibit urogenital pathogens. Antimicrobial activity tests of L23 and L60 were performed by a diffusion method with 207 bacterial strains, isolated from female patients presenting a urogenital infection. Inhibitory substances interaction tests were carried out by using a streak-diffusion method on agar plates. One hundred percent of the clinical isolates showed sensitivity to the antimicrobial substances produced by L23 and L60. The selected lactobacilli produced larger inhibition halos when compared to several antibiotics commonly used for treating these infections. Synergistic interactions and indifferent interactions were recorded in 68.6% and 31.4% of the cases, respectively. No antagonistic interactions were observed. In conclusion, the bacteriocin-producing strains L23 and L60 are potential candidates for probiotic prophylaxis and treatment of urogenital disorders in women.     

Selective Medium for Moraxella nonliquefaciens

A medium is described which selectively inhibits most bacteria from the normal flora of the conjunctiva, the lid-margin, and the upper respiratory tract but permits growth of Moraxella nonliquefaciens, M. liquefaciens, and the less fastidious strains of M. lacunata. The selective conditions are obtained with thiostrepton, tyrothricin, and sodium nalidixinate as inhibitors. Incubation under increased CO(2) pressure increased the number of primary isolations. M. nonliquefaciens was isolated on the selective medium twice as many times as on other media.     

泌尿生殖系统感染支原体培养及药敏结果分析

目的 :了解解脲支原体和人型支原体在泌尿生殖系统感染中的致病作用和对抗生素的药敏情况。方法 :对 5 87例泌尿系感染患者进行支原体培养 ,并对阳性标本行 12种抗生素药敏试验。采用支原体培养、鉴定、药敏一体化试剂盒进行检测。结果 :5 87例患者中支原体阳性 16 4例 ,感染率为 2 7 9% ,解脲支原体 (Uu)、人型支原体 (Mh)及Uu +Mh混合感染的阳性率分别为 2 1 3%、1 5 %和 5 1%。女性感染率显著高于男性 (P <0 0 1)。支原体对 12种抗生素敏感性最高的是交沙毒素 (92 7% ) ,其次为可乐必妥(85 4 % )、司帕沙星 (84 8% )。结论 :泌尿生殖系统感染者支原体感染率为 2 7 9% ,主要由解脲支原体引起 (占 76 2 % ,12 5 / 16 4 ) ,泌尿生殖系感染支原体患者应首选交沙霉素治疗。     

Sensitivity of Mycoplasma hominis cultures isolated from clinical material to certain antibiotics]

Sensitivity to II antibiotics of 80 strains of M. hominis isolated from patients with various inflammatory processes of the urogenital tract was studied by the method of suppressing the metabolic activity. Inhibition of the arginine metabolism of mycoplasma was used as a test for determination of the growth suppression. All the strains tested were highly sensitive to tetracycline and lincomycin. Kanamycin and neomycin were less active against M. hominis. All the strains tested were resistant to erythromycin, oleandomycin, ristomycin, novobiocin and streptomycin. The inhibitory effect of tetracycline and lincomycin on M. hominis decreased by the 5th day.     

Lactobacillus rhamnosus L60, a potential probiotic isolated from the human vagina

The vagina has been increasingly viewed as an "ecosystem" whose normal microflora help protect it from invading pathogens, including those that cause urinary tract infections and sexually transmitted diseases. We tested new strains of lactobacilli as potential probiotics for maintenance of urogenital tract health, as well as prevention and therapy of urogenital infections. A strain of lactobacilli isolated from the vagina of nonpregnant, healthy, premenopausal women was identified as Lactobacillus rhamnosus L60 by 16S rDNA sequence homology. L60 was evaluated for antimicrobial activity, in vitro antibiotic resistance, autoaggregation, surface hydrophobicity, co-aggregation with other bacterial species, hydrogen peroxide (H(2)O(2)) production, and bacterial adherence. It displayed a wide spectrum of antimicrobial activity against urogenital pathogens, and resistance to antibiotics commonly prescribed for infections caused by these pathogens. L60 produced H(2)O(2), adhered to vaginal epithelial cells, co-aggregated with Escherichia coli and Candida albicans, and displayed self-aggregation. In view of these characteristics, L60 is considered a potential probiotic, and will be further evaluated for preventive and therapeutic application locally in the vaginal tract.     

Coaggregation of urogenital bacteria in vitro and in vivo

The working hypotheses of the present study were that (1) bacterial coaggregates exist in the urogenital tract of healthy and infected women, and (2) coaggregation reactions can occur in vitro between members of the urogenital flora. Examination of urogenital specimens from 25 healthy women showed that lactobacilli were the dominant organisms colonizing the epithelia and coaggregating with other Gram-positive and Gram-negative bacteria. In vitro light and electron microscopic studies confirmed that members of the urogenital flora could coaggregate. An examination of specimens from 9 women with urinary tract infection showed the presence of autoaggregated uropathogens free-floating in the urine and attached to epithelial cells. The phenomenon of autoaggregation was also noted in vitro for various uropathogens, suggestive that this may represent a virulence factor. It is evident that bacterial cell-to-cell binding within a strain and among different genera occurs in the urogenital tract. Further studies of the mechanisms that maintain and disrupt these microbial interactions will help to improve our understanding of disease initiation.     

Mycoplasma genitalium: an emerging cause of sexually transmitted disease in women

Mycoplasma genitalium is an emerging sexually transmitted pathogen implicated in urethritis in men and several inflammatory reproductive tract syndromes in women including cervicitis, pelvic inflammatory disease (PID), and infertility. This comprehensive review critically examines epidemiologic studies of M. genitalium infections in women with the goal of assessing the associations with reproductive tract disease and enhancing awareness of this emerging pathogen. Over 27,000 women from 48 published reports have been screened for M. genitalium urogenital infection in high- or low-risk populations worldwide with an overall prevalence of 7.3% and 2.0%, respectively. M. genitalium was present in the general population at rates between those of Chlamydia trachomatis and Neisseria gonorrhoeae. Considering more than 20 studies of lower tract inflammation, M. genitalium has been positively associated with urethritis, vaginal discharge, and microscopic signs of cervicitis and/or mucopurulent cervical discharge in seven of 14 studies. A consistent case definition of cervicitis is lacking and will be required for comprehensive understanding of these associations. Importantly, evidence for M. genitalium PID and infertility are quite convincing and indicate that a significant proportion of upper tract inflammation may be attributed to this elusive pathogen. Collectively, M. genitalium is highly prevalent in high- and low-risk populations, and should be considered an etiologic agent of select reproductive tract disease syndromes in women.     

泌尿生殖道分泌物支原体培养临床分析

探讨泌尿生殖道分泌物支原体培养的临床意义.取泌尿生殖道感染的男性尿拭子和女性宫颈分泌物1 095份进行支原体培养和药敏试验,根据药敏结果进行治疗及疗效观察.1095例患者中支原体阳性365例(33.3％),其中解脲脲原体(Ureaplasma urealyticum,Uu)感染287例,人型支原体(Mycoplasma hominis,Mh)感染55例,Uu与Mh混合感染23例.药敏试验结果显示对强力霉素、米诺环素敏感率分别为90.4％和88.8％.对林可霉素、诺氟沙星、氧氟沙星的耐药率分别为86.8％、82.5％、81.1％.男性患者根据药敏结果分别进行强力霉素和米诺环素单药治疗,其治愈率为79.5％、76.9％,女性患者联合干扰素栓剂治疗,治愈率达83.6％和82.2％.鉴于泌尿生殖道分泌物支原体的高感染率以及并不理想的临床治愈率,广泛应用分泌物支原体培养法值得商榷.     

Gonococcal Tonsillar Infections

Neisseria gonorrhoeae were cultured from tonsillar swabs in six men and six women out of 161 consecutive, unselected, Danish patients (95 men and 66 women) suffering from urogenital or rectal gonorrhoea. Gonococci were found in the tonsils in only one out of 49 foreign men with gonorrhoea. Eleven of the Danish patients admitted orogenital contact at their most recent intercourse. The gonococcal complement fixation test was negative in all except two cases. Standard singledose treatment cured the urogenital and rectal infections promptly but failed to cure the tonsillar infection in five cases, and in recalcitrant cases the organisms were demonstrable for some months.     

The first performance report for the Bio-Rad Dx CT/NG/MG assay for simultaneous detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium in urogenital samples

We evaluated the clinical performance of the Bio-Rad Dx CT/NG/MG assay for the detection of Chlamydia trachomatis, Mycoplasma genitalium and Neisseria gonorrhoeae in urogenital samples in comparison with the Roche COBAS? TaqMan? CT assay for C. trachomatis and an in-house TaqMan PCR assay for M. genitalium. Swab specimens were cultured for N. gonorrhoeae. In this prospective study, urogenital samples were obtained from symptomatic and asymptomatic patients attending the sexually transmitted disease clinic of Bordeaux, France, from January to April 2010. A total of 658 clinical specimens (259 male and 180 female urines, 191 vaginal, 21 endocervical and 7 urethral swabs) from 453 patients were analyzed. The prevalence of C. trachomatis and M. genitalium infections was 8.1% (21/260) and 1.9% (5/260) in men and 10.4% (20/193) and 2.1% (4/193) in women, respectively. The Bio-Rad Dx CT/NG/MG clinical sensitivity was 100% for C. trachomatis and M. genitalium in men and women. In male urine, the clinical specificity was 99.6% for C. trachomatis and 100% for M. genitalium. In women, the specificity was 99.5% for swabs and 100% for urines for detecting C. trachomatis and M. genitalium. All seven N. gonorrhoeae PCR-positive samples were also positive by culture. Patients were co-infected in 5/57 cases (8.8%), with C. trachomatis and M. genitalium in three cases, and C. trachomatis and N. gonorrhoeae in two cases. In conclusion, the Bio-Rad Dx CT/NG/MG assay can be recommended for the simultaneous detection of C. trachomatis, M. genitalium and N. gonorrhoeae in urogenital specimens of symptomatic and asymptomatic individuals.     

Obtaining erythrocyte diagnosticum for the detection of chlamydial antigen

It is shown possible to obtain erythrocyte diagnosticum for detection of chlamydial antigen, whose cell basis consists of a formalinized suspension of ram erythrocytes, sensibilized with hyperimmune antichlamydial sera by means of the amydol. High sensitivity and specificity of the diagnosticum, absolute correlation with the data obtained in the complex examination of patients with the urogenital tract pathology of the chlamydial etiology by other methods were determined in the course of investigation in the indirect hemagglutination test with diagnosticums of scrape specimens from these patients.     

Microbiologicaland immunological criteria for estimation of ureaplasmosis treatment efficacy in women

The role of surface and parietal vaginal microbiocenosis and immunoglobulins in development of infectious process, in prediction of resistance of causative microorganism to antibiotics and treatment efficacy was demonstrated on group of women with ureaplasmosis. Evaluation of anaerobic part of vaginal microbiota contemporary with its aerobic part reliably increased informative value of microbiological test in women with urogenital diseases. There are reasons to include interferon preparations into the complex therapy of ureaplasmosis.     

The evolution of Mycoplasma genitalium

Mycoplasma genitalium is the smallest microorganism capable of self-replication. With its small genome, M. genitalium is the best representative of a minimal cell. The comparison of genome evolution among the three urogenital mycoplasmas, M. genitalium, M. hominis, and Ureaplasma parvum, not only indicated that they share a core genome of ~250 protein-encoding genes that correspond to their basic cell metabolism, but also showed a striking difference in their energy-generating pathways. M. genitalium is a sexually transmitted organism associated with nongonococcal urethritis in men and several inflammatory reproductive tract syndromes in women, such as cervicitis, pelvic inflammatory disease, and infertility. The treatment of M. genitalium infections has not yet been standardized. Macrolides are recommended, especially single-dose azithromycin; tetracyclines are responsible for a large number of therapeutic failures without any acquired resistance demonstrated. Acquired resistance to macrolides and fluoroquinolones leading to therapeutic failure has been described.     

Decision making by general practitioners in diagnosis and management of lower urinary tract symptoms in women.

OBJECTIVE--To identify factors influencing decision making by general practitioners in the diagnosis and treatment of lower urinary tract symptoms in women. SETTING--Two suburban London general practices. SUBJECTS--Women presenting to their family doctor with lower urinary tract symptoms. DESIGN--After each consultation the doctor completed a questionnaire on presenting symptoms; clinical examination; investigations undertaken; presence of psychological, social, and menstrual problems; patients'' requests for antibiotics; antibiotic prescribing; knowledge of the patient; attitude towards the consultation; and any other factors assisting in diagnosis and management. Finally, doctors predicted the presence or absence of clinically important bacteriuria. Each woman completed a demographic questionnaire, the 12 item general health questionnaire, and the modified menstrual distress questionnaire, after which each provided a clean catch midstream urine sample. Case notes were examined for information on previous reports of results of urine analysis. RESULTS--When the general practitioners did not know the patients well they were 4.5 times more likely to assume that there was a clinically important infection. When they knew the patient well, they were four times more likely to make a correct prediction of the test result and 12 times less likely to prescribe antibiotics. Doctors were five times more likely to predict the test result correctly in patients from social classes 1 and 2 and were six times more likely to prescribe antibiotics for the older women in the sample. CONCLUSIONS--In women presenting with urinary tract symptoms, these family practitioners seemed to take no particular regard of physical, psychological, or menstrual factors in making their assessments. They were most accurate in their prediction of the result of urine analysis and least likely to prescribe antibiotics when they had a good general knowledge of the patient. Which came first, the diagnosis or prescribing, is difficult to say and probably differed in individual cases. Doctors tended to be more conservative in their management of older women and those whom they knew less well.     

Drug sensitivity of Ureaplasma urealyticum,persisting in patients with chronic inflammatory diseases of the urogenital tract

A total of 65 U. urealyticum cultures isolated from patients with chronic inflammatory diseases of the urogenital tract after their prolonged persistence of in the human body, were studied for sensitivity to medicinal preparations of different groups: tetracyclines (tetracycline and doxycycline), macrolids (erythomycin, clarithromycin, midecamycin, josamycin), quinolon (pefloxacin), amino glycoside (gentamicin), lincoamides (lincomycin, clindamycin). The majority of isolated U. urealyticun were highly sensitive to josamycin, clacide, doxycycline (89.2, 84.6, 76/9% respectively), and somewhat lesser number of these organisms were highly sensitive to midecamycin and pefloxacin (51.3 and 44.4% respectively). Among U. urealyticum strains circulating in the Moscow region some strains which persisted in patients with chronic inflammatory diseases of the urogenital tract for a long time were found to be resistant to erythromycin (23.1%), tetracycline (19.5%), and in very rare cases (1.6%) they were found to multiple drug resistance to all preparations under study. In view of the varying sensitivity of the clinical isolates of U. urealyticum to medicines and the presence of resistant forms in their population, the sensitivity of the isolated U. urealyticum should be determined in vitro prior to drug therapy.     

INDICATIONS FOR SURGICAL TREATMENT IN GENITO-URINARY TUBERCULOSIS

Proper methods of surgical treatment effect arrest of localized tuberculosis in 90 per cent of cases, but as early and latent renal tuberculosis can be controlled in 50 per cent of cases by conservative treatment, careful deliberation as to choice of method of treatment is necessary in each case. In some circumstances, operation is definitely contraindicated. These observations apply also to tuberculosis elsewhere in the urogenital tract. When surgical treatment is carried out, careful preoperative and postoperative medical care is an important factor.The primary site of urogenital tuberculosis is the kidney, from which organ the infection spreads to the ureter, the bladder and the prostate gland. The prostate gland is the initial site of invasion in the genital tract, extension to other genital structures following. This sequence of infection is an important consideration in determining the management of urogenital tuberculosis.     

Vaccines for Chlamydia infections of the female genital tract.

Genital infection with Chlamydia trachomatis is an escalating global public health concern causing considerable morbidity and socioeconomic burden worldwide. Although antibiotics are used to treat symptomatic urogenital infections, chlamydial infection remains asymptomatic in approximately 50% of infected men and 70% of infected women. The major clinical manifestations of genital chlamydial infection in women include mucopurulent cervicitis, endometritis and pelvic inflammatory disease. Genital infection with C. trachomatis markedly enhances the risk for reproductive tract sequelae in women, including tubal factor infertility, chronic pain and ectopic pregnancy. Definitive infection control of chlamydial infections will likely be achievable through a safe and efficacious vaccine. This will require identifying protective chlamydial antigens in animal models as well as identifying effective adjuvants and delivery systems that target subunit vaccines to immune inductive sites or secondary lymphoid tissues, and will be safe for use in humans.