Sensitivity to cephalosporin antibiotics of infectious causative agents in surgery

Comparison of antimicrobial effects of cephalosporins of the 1st and 2nd generations showed that the latter were advantageous with respect to gram-negative bacteria causing surgical infections. Three cephalosporins of the 3rd generation were characterized by the highest activity against such bacteria, including Enterobacter spp. and indole positive strains of Proteus spp., as well as non-enzymatic bacteria. The antimicrobial spectra and MICs of the new cephalosporins with respect to the cultures isolated from surgical patients were different which requires in vitro sensitivity assay of each antibiotic.     

Characteristics and clinical value of extended-spectrum beta-lactamases]

The literature data and the findings of the authors' studies on the role of extended-spectrum bata-lactamases (ESBL) in providing the clinical effect in the treatment of infections due to ESBL-producing organisms were analyzed. The analysis allowed to consider the NCCLS recommendations not sufficiently valid. According to these recommendations the ESBL-producing organisms (among E. coli and Klebsiella spp.) should be regarded as resistant to penicillins, cephalosporins and aztreonam. Susceptibility of 62 Enterobacteriaceae strains that were isolated in 4 therapeutic centres of Tomsk, Nazran and Moscow and proved to be ESBL-producing organisms was tested and it was shown that the 3rd and 4th generation cephalosporins could not be referred to a homogenous group. The same was confirmed by the prospective and retrospective investigations of a multiprofile hospital on the clinical and bacteriological efficacies of the 3rd generation cephalosporins and cefepime in the treatment of hospital-acquired infections due to Enterobacteriaceae strains producing ESBL.     

老年大肠埃希菌血流感染患者的临床分析

为探讨老年大肠埃希菌血流感染患者的临床特点及药敏结果,回顾性分析徐州医科大学附属医院2013年1月-2016年12月340例大肠埃希菌血流感染老年患者的临床资料及药敏结果,采用SPSS软件进行分析。结果显示,患者均合并基础疾病(恶性肿瘤、高血压病、糖尿病、肺部感染等);感染途径主要为消化道(38.5%)、呼吸道(36.8%)和泌尿道(22.6%);检出产超广谱β-内酰胺酶(extended-spectrum β-lactamase,ESBL)大肠埃希菌96例(28.2%);ESBL阳性菌对氨苄西林、复方磺胺甲恶唑、环丙沙星、哌拉西林、第3代头孢、左氧氟沙星的耐药率均高;所有菌株均对碳青霉烯类敏感。结果提示,该院老年大肠埃希菌血流感染患者均合并基础疾病,常见感染途径是消化道、呼吸道和泌尿道,ESBL阳性大肠埃希菌除对碳青霉烯类抗菌药物敏感外,对多种抗菌药物耐药。     

成人与儿童下呼吸道标本病原菌分布差异的比对与耐药性分析

目的调查研究温州市中西医结合医院温州市儿童医院成人与儿童病区下呼吸道标本病原菌的分布差异与抗生素耐药性分析。方法对2010年7月至2011年6月的所有成人与儿童下呼吸道感染患者的临床标本（痰,咽拭）进行微生物检验并统计分析。结果成人感染以非发酵细菌为主,并且出现MDR/PDR现象;儿童细菌性感染以肠杆菌细菌为主;G＋菌感染还是以金黄色葡萄为主,也有MRSA菌株出现,未超过15%,远远低于成人水平。铜绿假单胞菌检出率占成人下呼吸道感染的首位,头孢三、四代对成人铜绿假单胞菌耐药性在50%左右;阿米卡星有很好的敏感性,耐药率为5.2%;头孢哌酮/舒巴坦的耐药率已达20.59%;碳青霉烯类抗生素的耐药率在50%左右。成人鲍曼不动杆菌只有米诺环素、头孢哌酮/舒巴坦有较好的敏感性,耐药率在10%左右;并且已经出现全耐药菌株。儿童检出病原菌中对头孢哌酮/舒巴坦、碳青霉烯类抗生素未发现耐药菌株,对头孢三、四代仍有较好的敏感性,还没出现高耐菌株。头孢三、四代对成人肺炎克雷伯菌耐药性已高达75%左右;头孢哌酮/舒巴坦、碳青霉烯类抗生素的耐药率将达20%。儿童中MRSA检出率为13.32%,成人已高达72.15%,未发现对万古霉素、替考拉宁、利那唑胺耐药菌株。结论儿童与成人在下呼吸道感染病原菌分布与耐药性存在明显差异。应杜绝滥用抗生素,做到有的放矢。     

Susceptibility and molecular mechanisms of resistance to cephalosporins of Escherichia coli strains isolated from patients with nosocomial infections

Resistance to wide spectrum of antibiotics was studied and most widespread genetic determinants of resistance to beta-lactam antibiotics were revealed. Susceptibility testing was performed using serial broth microdilution method. Detection of class A expanded spectrum beta-lactamases genes (TEM, SHV, CTX) by polymerase-chain reaction method was performed in 90 strains. Carbapenems remained the most active antibacterial agents with respect to studied E. coli strains. Among the 3rd generation cephalosporins the lowest minimal inhibitory concentrations were observed for inhibition-protected combined agents (ceftazidime/clavulanic acid and cefoperazone/ sulbactam). Alone or in various combinations TEM, SHV, and CTX types of beta-lactamases were found in 58.9%, 14.4%, and 77.8% of strains. Combinations of 2 determinants were detected in 55.6% of the isolates, and all 3 determinants--in 5.6%. Most often E. coli was isolated in patients with urinary tract infections. Carbapenems and inhibition-protected combined 3rd generation cephalosporins are the most active agents against E. coli.     

130例嗜麦芽窄食单胞菌下呼吸道感染的药敏分析

目的探讨嗜麦芽窄食单胞菌下呼吸道感染的耐药情况。方法对自2002年5月～2004年5月分离出的130株嗜麦芽窄食单胞菌的药敏试验结果进行分析。结果嗜麦芽窄食单胞菌对常用抗生素广泛耐药,其中对亚胺培南100％耐药,对1、2、3代头孢大多数耐药．但对复方新诺明、替卡西林-克拉维酸钾和头孢他啶的敏感率分别为71．2％、64．0％和54．4%。结论嗜麦芽窄食单胞菌对常用抗生素广泛耐药．但对复方新诺明、替卡西林-克拉维酸钾和头孢他啶有较高的敏感性．可做为临床治疗嗜麦芽窄食单胞菌下呼吸道感染的有效抗菌药物。     

下呼吸道感染患者病原菌分布及耐药性

目的分析下呼吸道感染患者病原菌分布及耐药性,指导临床合理用药。方法收集我院2013年至2015年院内感染患者痰标本进行细菌培养和药物敏感性试验。结果 3年共收集下呼吸道痰液标本21 615份,分离病原菌5 621株,阳性率为26.0%;其中革兰阴性(G~-)菌4 249株,占75.6%,以铜绿假单胞菌居多(20.7%);真菌764株,占13.6%,以白假丝酵母居多(12.6%);革兰阳性(G~+)菌608株,占10.8%,以金黄色葡萄球菌居多(9.9%)。药物敏感试验结果显示:G~-杆菌对亚胺培南、美洛培南耐药率最低,对青霉素类、喹诺酮类和部分三代头孢类等抗菌药耐药率较高(50.0%)。G~+球菌对万古霉素、利奈唑胺耐药率为零,对青霉素类、喹诺酮类和红霉素等抗菌药耐药率较高(40.0%)。结论下呼吸道感染患者病原菌以G~-杆菌为主,耐药性呈增长趋势,临床应加大病原菌分布检测及其耐药性监测力度,及时调整抗菌药物用药。     

Characteristic features of etiology and antibiotic susceptibility of urinary tract infection pathogens in patients with diabetes mellitus]

Patients with diabetes mellitus and urinary tract infection were examined. The structure of the pathogens and their antibiotic susceptibility were investigated. Escherichia coli was shown to be the main pathogen of urinary tract infections in the patients with diabetes mellitus. The highest activity against the E. coli isolates was revealed in amoxycillin/clavulanate (92% of the susceptible strains), the 3rd and 4th generation cephalosporins, carbapenems, amikacin (100%) and fluoroquinolones (96%). At the same time the isolates were resistant to aminopenicillins and co-trimoxazole (29.3 and 16% respectively).     

Microbiological evaluation of antibiotics for empirical therapy of community-acquired infections of the lower respiratory tract]

During first 3 days after patient hospitalization with pneumonia or chronic obstruction pulmonary disease (COPD) pathogens in sputum were studied according NCCLS standards (for 1999 year). Among 93 pathogens isolated in pneumonia the most frequent were S. pneumoniae (41.9%), H. influenzae (21.5%). Among 232 pathogens isolated in COPD the most frequent were S. pneumoniae (35.5%), H. influenzae (16.8%). Other pathogens were staphylococci, moraxella, gram-negative bacteria. No penicillin-resistant S. pneumoniae, were isolated, the strains with moderate penicillin resistance were less than 3% in both groups. Among H. influenzae isolated from patients with pneumonia 25% were beta-lactamase producers, from COPD patients 21% strains produced beta-lactamase. Totally among all studied pathogens only 58% were sensitive to ampicillin in pneumonia groups and 48% in COPD groups, for azithromycin 70.7% and 71% respectively, for cefuroxime 84.5% and 85% respectively. Ampicillin efficacy for empirical treatment of community-acquired low respiratory tract infections was substantially less than that of modern antibiotics.     

Problems of etiotropic therapy of typhoid fever and approaches to their solution]

The main problems of etiotropic therapy for typhoid fever lie in underestimate of the characteristic features of its pathogenesis and particularly in development of typhoid granulomas and their histogenesis, as well as in wide spread of typhoid fever pathogenic strains resistant to the routine chemotherapeutics, i.e. polyresistant strains. Some problems are due to incorrect choice of the antimicrobials and their combinations, optimal doses, administration routes and pathogenetic therapy. In the XXth centure an increase in the emergence and a change in the nature of the typhoid fever pathogen resistance to antimicrobials were observed. It was shown that from the pharmacologic and pharmacodynamic viewpoints the highest efficacy of typhoid fever therapy should be provided by the following antimicrobials: fluoroquinolones (except for norfloxacin), 3rd and 4th generation cephalosporins, aminopenicillins, chloramhenicol (levomycetin), combinations of 2nd and 3rd generation aminoglycosides with biseptol, aminopenicillins or doxycycline, as well as chloramphenicol combinations with aminopenicillins or 2nd to 4th generation cephalosporins. Practical recommendations for the etiotropic therapy of patients with typhoid fever during its outbreak or epidemic are presented.     

The antibiotic prophylaxis of postoperative complications in breast cancer patients

The studies showed that infectious complications in patients operated for breast cancer (BC) most frequently developed after removal of the drainage tube resulting in poorer discharge favourable for development of infections. The causative agents in such cases are usually exogenous bacteria differing from endogenous ones (Staphylococcus epidermidis) inhabiting the human skin and sometimes contaminating the operative field. The endogenous bacteria are detectable bacteriologically in 60 per cent of the cases. Still, since the operation wound contains humoral and tissue immunity factors (specifically active against the host microflora) such bacteria rarely grow on artificial media (18 per cent) and even more rarely cause infections. Therefore, to prevent postoperative infections in patients with BC it should be recognized rational to use broad-spectrum antibacterial drugs such as ampiox, ampicillin, doxycycline, cephalosporins of the 2nd and 3rd generations, etc. for 5 to 6 days after the drainage removal. If an infection develops the preventive therapy should be replaced by an adequate therapy in accordance with the pathogen sensitivity.     

神经外科颅内出血患者下呼吸道感染病原菌的耐药性监测

目的了解神经外科重症监护室（NICU）颅内出血患者下呼吸道感染病原菌的种类及耐药情况,为临床合理用药提供依据。方法对2010年1月至2011年1月颅内出血的患者,其下呼吸道感染病原菌的种类及耐药性进行回顾性分析。结果分离出的374例病原菌中以革兰阴性杆菌为主,占81．8％,革兰阳性球菌占4．0％,真菌占14．2％。分离率较高的细菌依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、嗜麦芽窄食单胞菌、金黄色葡萄球菌。其中,产超广谱β-内酰胺酶（ESBLs）的肺炎克雷伯菌的检出率为50．0％;耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为73．3％。鲍曼不动杆菌和铜绿假单胞菌对丁胺卡那、妥布霉素、多粘菌素B有较好的敏感性;而金黄色葡萄球菌对复方新诺明、呋喃妥因、万古霉素耐药率较低。结论NICU颅内出血患者下呼吸道感染以多重耐药的革兰阴性杆菌为主,临床应根据药敏结果合理用药,控制和减少感染的发生。     

Characterization of adhesion associated surface properties of uropathogenicEscherichia coli

Escherichia coli was isolated from the urine of patients with pyelonephritis, with urinary tract infections other than pyelonephritis and with asymptomatic bacteriuria. Surface properties of the strains were analyzed by the salting-out aggregation test (SAT), hydrophobic interaction chromatography (HIC), Congo red binding (Crb), agglutination of erythrocytes (MRHA) and latex particles covered by digalactoside (PF) and by adherence to tissue culture cells. In addition, a DNA probe for thepap gene was used. The DNA probe detected the highest proportion of strains withpap gene in the group of patients with pyelonephritis, lower in the urinary tract infections other than pyelonephritis and the lowest in the group with asymptomatic bacteriuria. Tests for P-fimbriae (PF, MRHA) showed a similar distribution. Hydrophobicity measured by SAT and by HIC did not show differences among the tested groups of strains. The results suggest that factors other than the P-fimbriae and hydrophobicity may contribute to the persistence ofE. coli in the urinary tract.     

鲍曼不动杆菌院内感染调查与耐药性分析

目的 研究鲍曼不动杆菌院内感染情况及对常用抗生素的敏感性。方法 采用Microscan Walk Away-40全自动微生物仪及配套药敏复合板进行细菌鉴定与药敏试验。结果 46株不动杆菌中有35株为鲍曼不动杆菌,占76．09％。主要分布在ICU、康复科、呼吸内科。标本主要以脓、痰及呼吸道分泌物为主。药敏结果显示：亚胺培南、头孢吡肟、阿米卡星对鲍曼不动杆菌高度敏感,但3代头孢菌素大多数耐药。结论 鲍曼不动杆菌易引起伤口、呼吸道继发感染,且耐药现象严重,诊断与治疗有赖于细菌培养和药物敏感结果,应引起临床的高度重视。一旦发现感染株,必须迅速采取控制措施,避免引起医院感染的暴发流行。     

仙居县儿童下呼吸道感染肺炎克雷伯菌耐药性分析

目的分析仙居人民医院住院下呼吸道感染患儿临床分离肺炎克雷伯菌的耐药特征,为临床合理用药提供依据。方法选择2012年7月至2013年7月该院下呼吸道感染肺炎克雷伯菌阳性患儿81例。对患儿的临床一般资料进行分析,对临床分离菌株进行细菌鉴定,用18种抗生素进行药敏试验,采用WHONET5．4分析软件进行统计。结果2012年7月至2013年7月共分离出81株肺炎克雷伯菌,ESBLs阳性42株,检出率为51．85％。所有菌株对亚胺培南、厄他培南、左旋氧氟沙星、丁胺卡那100％敏感。对氨苄西林耐药率为100％。ESBLs阴性菌株对氨曲南、头孢曲松、头孢他啶、头孢唑啉、头孢吡肟100％敏感,而ESBLs阳性菌株则100％耐药。ESBLs阴性菌株对其他抗生素的耐药率为氨苄西彬舒巴坦（12．82％）、环丙沙星（2．56％）、头孢替坦（O％）、呋喃妥因（20．51％）、庆大霉素（5．13％）、复方新诺明（17．85％）、妥布霉素（2．56％）、哌拉西林／他唑巴坦（2．56％）;ESBLs阳性菌株对其他抗生素的耐药率为氨苄西林／舒巴坦（73．80％）、环丙沙星（2．38％）、头孢替坦（16．67％）、呋喃妥因（61．90％）、庆大霉素（28．57％）、复方新诺明（54．76％）、妥布霉素（7．14％）、哌拉西林／他唑巴坦（7．14％）。结论本地区患儿中肺炎克雷伯菌耐药性较高,临床应重视病原菌的检测。     

绍兴地区2型糖尿病尿路感染病原菌及其耐药性分析

摘要：目的 回顾分析本院2型糖尿病伴尿路感染患者的病原菌分布特点及其耐药性,为指导临床用药提供参考。方法 收集2013年1月至2014年1月2型糖尿病合并尿路感染患者186例,留取中段尿分离培养病原菌,用VITEK-2细菌鉴定仪鉴定,纸片扩散法（K-B）测定药物敏感性。结果 186例患者中段尿共培养出病原菌137株,其中革兰阴性菌102株（74.45%）,革兰阳性菌21株（15.33%）,真菌14株（10.22%）。革兰阴性菌以大肠埃希菌为主,检出79株占57.66%,对青霉素类,头孢菌素类,喹诺酮类抗菌药耐药率较高均＞50.00%,对头霉素类药物如头孢替坦、含酶抑制剂复合物如哌拉西林/他唑巴坦以及碳青霉烯类药物敏感率均达100.00%;革兰阳性球菌以无乳链球菌为主,检出10株占7.30%,对克林霉素及红霉素耐药率较高,耐药率＞50.00%,而对氯霉素、呋喃妥因、利奈唑烷、替加环素、万古霉素敏感率均达100.00%。除1株光滑假丝酵母菌对氟康唑和伊曲康唑中介,其余13株真菌对两性霉素B、5-氟胞嘧啶、伏立康唑、氟康唑、伊曲康唑这5种抗真菌药物均敏感。结论 2型糖尿病患者发生尿路感染的病原菌以大肠埃希菌为主,且有较高的耐药率。     

Sensitivity of antibiotic-resistant strains of Salmonella to new antibiotics and chemotherapeutic agents]

One hundred and sixty two antibiotic resistant strains of Salmonella isolated within 1984-1988 in Leningrad and the Leningrad Region were tested with respect to their sensitivity to new antibiotics and chemotherapeutics developed or being developed in the USSR. At the background of high numbers of circulating Salmonella strains resistant to the routinely used antibiotics such as doxycycline, streptomycin and gentamicin they appeared to be highly sensitive to amikacin, ciprofloxacin, pefloxacin and the 3rd generation cephalosporins i.e. ceftazidime and cefotaxime as well as to thienamycin. These modern antibacterial agents are possibly to be the drugs of choice in etiotropic treatment and chemoprophylaxis of septic acute intestinal infections due to Salmonella strains with multiple resistance. Resistance of individual Salmonella strains to cefotaxime and ceftazidime indicated that it was possible to use their property for additional labeling of the pathogens within a serological type of Salmonella while conducting epidemiological examinations during outbreaks of acute intestinal infections of Salmonella etiology.     

Urinary tract infections of Escherichia coli strains of chaperone-usher system

Urinary tract infections are a very serious health and economic problem affecting millions of people each year worldwide. The most common etiologic agent of this type of bacterial infections, involving the upper and lower urinary tract, are E. coli strains representing approximately 80% of cases. Uropathogenic E. coli strains produce several urovirulence factors which can be divided into two main types, surface virulence factors and exported virulence factors. Surface-exposed structures include mainly extracellular adhesive organelles such as fimbriae/pili necessary in adhesion, invasion, biofilm formation and cytokine induction. Among the surface-exposed polymeric adhesive structures there are three most invasive groups, type 1 pili, type P pili and Dr family of adhesins which are bioassembled via the conserved, among Gram-negative bacteria, chaperone-usher secretion system. Type 1 and P-piliated E. coli cause cystitis and pyelonephritis. The Dr family of adhesins recognizing DAF receptor is responsible for cystitis, pyelonephritis (especially in pregnant women) and diarrhoea (in infants). In addition, Dr-positive E. coli strains carry the risk of recurrent urinary tract infections. Pyelonephritis in pregnant women leads to a series of complications such as bacteremia, urosepsis, acute respiratory distress syndrome and even death. In the era of increasing drug resistance of bacteria, the development of vaccines, drugs termed pilicides and inhibitors of adhesion may be a promising tool in the fight against urogenital infections.     

Netilmicin in the treatment of bacterial respiratory tract infections

Netilmicin - a semisynthetic aminoglycoside - was administered to 33 patients with the acute or chronic lower respiratory tract or pulmonary infections in a daily dose of 5 mg/kg body weight for 10 days. A principle criterium of patients classification to netilmicin therapy were sensitive bacterial strains either in sputum or in BAL liquid. A significant clinical improvement was noted in 88% of the treated patients. However, elimination of pathogens from the sputum was achieved only in 52% of these patients. No improvement was observed in 4% of the treated patients. No adverse reactions were noted. Netilmicin proved safe and effective antibacterial agent in patients with respiratory infections.     

Antimicrobial susceptibility of anaerobic bacteria in Bulgaria

ObjectivesThe antimicrobial susceptibility of anaerobic bacteria isolated from clinical specimens in the referent for Bulgaria anaerobic laboratory was studied in a period of 25 years/1983–2007/.MethodsNCCLS – recommended agar dilution methods were used. β-lactamase activity was determined with nitrocefin discs.ResultsThe 29 antimicrobial agents included in the study were divided according to their in vitro activity against the anaerobic isolates into 4 main groups for guiding empirical treatment: 1st group of metronidazole, chloramphenicol, meropenem, imipenem and combinations of β-lactam antibiotics with sulbactam – with high activity and drugs of choice for treatment; 2nd group – clindamycin, cefoxitin, carbenicillin/and azlocillin, piperacillin/ – with a good activity and low percent of resistant strains; 3rd group – of tetracycline and erythromycin with higher percent of resistant strains including the new macrolides as josamycin, clarithromycin, roxithromycin and azithromycin; 4th group – penicillins/ampicillin, amoxicillin, penicillin/and cephalosporins/cefamandole, cefazolin, cefotaxime and cefoperazone/ – not suitable for treatment of infections including Bacteroides fragilis group strains, with a very high percent of resistant strains, probably due to β-lactamase activity in most of the strains.ConclusionA continued updating and a follow-up in the changes of antibiotic susceptibility are necessary in every country as resistance patterns vary not only between geographical regions but also even among medical centers and hospitals which may be connected with differences in antibiotic usage in man and animals.