2011～2015年医院呼吸内科常见革兰阴性菌耐药性分析与临床用药探讨

目的：分析2011～2015年我院呼吸内科常见革兰阴性菌的分布情况及耐药性特点,为规范抗生素的合理使用提供依据。方法选用法国梅里埃公司生产的ID 32GD试剂盒,应用ATB Expression全自动分析系统对细菌进行鉴定与药敏试验。结果2011～2015年在我院呼吸内科常见的病原菌分别为肺炎克雷伯菌（31．0％）、大肠埃希菌（21．2％）、铜绿假单胞菌（23．2％）与鲍曼不动杆菌（14．8％）。肺炎克雷伯菌对碳青霉烯类的耐药率几乎为0,对单纯的头孢菌素耐药率相对较高,但对含β‐内酰胺酶抑制剂的头孢菌素类以及阿米卡星有较强的抗菌活性;大肠埃希菌对哌拉西林耐药率高,但对含酶青霉素类有较强的抗菌活性,对碳青霉烯类的耐药率连续5年来均为零;铜绿假单胞菌对磺胺类耐药性较高,对头孢三代、头孢四代及含酶青霉素类与含酶头孢类均有较强的抗菌活性,但敏感性呈逐年下降趋势;鲍曼不动杆菌的耐药率呈逐年上升趋势,仅对含酶的头孢哌酮／舒巴坦敏感（约80％）。结论医院呼吸内科革兰阴性菌仍以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌为主。鲍曼不动杆菌耐药性逐年增长的问题已日趋严重,相关部门应定期监测细菌耐药趋势,指导临床合理用药,特别是合理应用抗生素以避免细菌耐药及减少细菌耐药性的发生。     

主要医院感染病原菌与社区感染株耐药性比较

目的比较主要医院感染(HAI)病原菌与社区感染(CAI)株的耐药性,指导合理使用抗菌药物。方法收集永康市第一人民医院2003年1月至2006年6月所有标本中分离的主要HAI菌及其CAI株,分别统计其药物敏感试验。采用美国Dade Behring Microscan Walkaway 40全自动细菌鉴定及药敏测试仪及其配套药敏鉴定板测定MIC值。全国医院感染监测网软件和χ2统计分析。结果主要HAI菌为前4种革兰阳性(G )菌依次是金黄色葡萄球菌、表皮葡萄球菌、屎肠球菌、溶血葡萄球菌,前5种革兰阴性(G-)菌依次是大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、阴沟肠杆菌。HAI株耐药率普遍高于CAI株,不同的细菌耐药率各具特点。不论HAI株还是CAI株,G 菌对万古霉素的耐药率最低,G-菌对亚胺培南的耐药率均较低,且两者耐药率差异均无显著性。金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌4种HAI株对大多数抗菌药物的耐药率明显高于CAI株,其余5种细菌HAI株仅对少数抗菌药物的耐药率高于CAI株。结论HAI菌株耐药性比CAI菌株强,临床应区分感染性质合理使用抗菌药物,有针对性控制感染,从而减少抗菌药物的滥用和细菌耐药性的产生。     

革兰阴性杆菌对头孢哌酮／舒巴坦耐药率的变迁

目的调查革兰阴性杆菌对头孢哌酮／舒巴坦的耐药率变化。方法收集2004年1月至2007年12月从我院住院患者各种临床标本中分离的革兰阴性杆菌,使用VITEK-60全自动微生物分析仪进行菌种的鉴定,采用K-B法对头孢哌酮／舒巴坦进行药敏试验,对结果进行回顾性凋查。结果肠杆菌科细菌对头孢哌酮／舒巴坦的耐药率较低,大肠埃希菌、肺炎克雷伯菌和阴沟肠杆菌对头孢哌酮／舒巴坦的耐药率分别为1．7％,7．7％和5．8％。嗜麦芽窄食假单胞菌、洋葱伯克霍尔德菌、脑膜脓毒性金黄杆菌、铜绿假单胞菌和鲍曼不动杆菌对头孢哌酮／舒巴坦的耐药率分别为27．6％、38．0％、2．3％、23．5％和4．8％。铜绿假单胞菌和鲍曼不动杆菌对头孢哌酮／舒巴坦的耐药率从2004年的35．1％和23．7％下降至2007年的12．4％和0．4％。结论头孢哌酮／舒巴坦对肠杆菌科细菌具有非常强的体外抗菌活性,铜绿假单胞菌和鲍曼不动杆菌对头孢哌酮／舒巴坦的耐药率呈下降趋势。     

常见革兰阴性杆菌的分布及耐药性分析

目的分析目前医院内常见革兰阴性杆菌的分布状况及其耐药特点,为临床合理使用抗生素和经验用药提供依据。方法对2005年中山大学附属第一医院门诊及住院患者标本,严格按操作规程采集、接种、培养、分离、鉴定菌种作药敏试验。血液及部分体液标本用BactALERT-120血培养仪培养,用VITEK-60全自动细菌鉴定仪鉴定菌种,药敏试验采用K-B法,用WHONET5．0软件进行数据分析。结果共分离出672株革兰阴性杆菌占52．9％,常见者依次为：大肠埃希菌182株,铜绿假单胞菌177株,鲍曼不动杆菌72株,肺炎克雷伯菌64株,嗜麦芽窄食单胞菌36株,阴沟肠杆菌29株。ICU、呼吸内科感染多见。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶株检出率为48．8％,对哌拉西林、头孢呋辛钠、头孢哌酮、头孢曲松、氧氟沙星、庆大霉素的耐药率显著高于非产酶株（P〈0．01）。铜绿假单胞菌、鲍曼不动杆菌对亚胺培南、美罗培南、头孢哌酮-舒巴坦的耐药率较低,嗜麦芽窄食单胞菌对头胞哌酮-舒巴坦和头孢他啶的耐药率较低,阴沟肠杆菌对亚胺培南、美罗培南耐药率较低。结论革兰阴性杆菌已成为医院主要感染病原菌,且多重耐药株上升趋势明显,加强院内感染菌的耐药监控对合理选用经验用药及减缓耐药菌的发生尤为关键。     

美罗培南对1139株革兰阴性杆菌抗菌活性研究

目的分析美罗培南对革兰阴性杆菌的抗菌活性,为临床合理使用美罗培南提供正确依据。方法将宁波市第一医院2004年6月至2005年8月的临床各种标本分离获得的革兰阴性杆菌在VITEK-32微生物自动鉴定分析仪中进行鉴定和药敏试验。用双纸片法及2-巯基丙酸抑制试验进行ESBLs、AmpC和金属酶的检测。结果共检出临床常见的革兰阴性杆菌1139株,其中肠杆菌科559株（大肠埃希菌309株,肺炎克雷伯菌186株,阴沟肠杆菌64株）,非发酵菌580株（铜绿假单胞菌227株,嗜麦芽窄食单胞菌72株,脑膜脓毒黄杆菌44株．鲍曼不动杆菌178株．洋葱伯克霍尔德菌30株,荧光假单胞菌29株）。美罗培南对大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌、脑膜脓毒黄杆菌、荧光假单胞菌的耐药率分别为0．0％、0．0％、0．0％、22．9％、23．6％、90．3％、100．0、63．3％和3．4％。结论美罗培南对革兰阴性杆菌有很强的抗菌活性,其抗菌活性要强于亚胺培南,是目前治疗肠杆菌科细菌特别是产ESBLs、AmpC酶细菌感染的危重患者的最理想用药。美罗培南耐药率呈逐年增加趋势,应引起重视。美罗培南对嗜麦芽窄食单胞菌、脑膜脓毒黄杆菌、洋葱伯克霍尔德菌活性很低,临床对于上述细菌感染不应选用美罗培南。     

革兰阴性杆菌10年耐药性变化分析

目的 对重庆医科大学附属第二医院2001年1月1日至2009年12月31日10年临床标本中分离的主要革兰阴性杆菌耐药性变化进行分析,为临床合理用药提供依据.方法 采用回顾性方法对十年间大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和不动杆菌的药敏结果用WHONET 5.4软件进行统计分析.结果 大肠埃希菌、肺炎克雷伯菌对亚胺培南耐药率小于5％;对阿米卡星、哌拉西林/他唑巴坦、头孢吡肟耐药率小于30％;对三代头孢、头孢西丁和氨曲南耐药率为40％左右;对青霉素类、喹诺酮类和磺胺类耐药率大于50％.铜绿假单胞菌对头孢他啶、头孢吡肟和亚胺培南耐药率小于40％;对其余监测抗生素耐药率大于50％.不动杆菌属对亚胺培南耐药率小于25％(2009年除外),对其余监测抗生素耐药率很高,维持在50％ ～ 96％.铜绿假单胞菌、鲍曼不动杆菌泛耐药菌检出率分别为0～14％和0～48％.结论 革兰阴性杆菌对常用抗菌药物的耐药已非常普遍,且有逐年升高的趋势;肠杆菌科对碳青霉烯类、阿米卡星、哌拉西林/他唑巴坦、头孢吡肟耐药率相对较低;非发酵菌耐药性增加明显,铜绿假单胞菌、不动杆菌泛耐菌增加明显;严格控制抗菌药物的应用及耐药菌和泛耐药菌的传播和爆发流行已迫在眉睫.     

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。     

无多重耐药危险医院获得性肺炎病原菌分布特点与耐药性分析

目的分析温州医科大学附属义乌医院无多重耐药危险医院获得性肺炎（HAP）病原菌分布特点及耐药性。方法人选无多药耐药危险因素的医院获得性肺炎（HAP）患者352例,按照发病时间分为早发HAP组与晚发HAP组,采集合格痰标本,进行细菌分离、鉴定和药敏试验,并分析比较患者病原菌分布特点及耐药性。结果人选的352例患者共分离m393株病原菌,HAP最常见的病原菌排名前五位的分别是为肺炎克雷伯杆菌、大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌及鲍曼不动杆菌,早发HAP排名前五位的分别是肺炎克雷伯杆菌、大肠埃希菌、金黄色葡萄球菌、肺炎链球菌和铜绿假单胞菌,晚发HAP排名前五位的分别是肺炎克雷伯杆菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌,两组患者革兰阳性菌与革兰阴性菌所占比例差异无统计学意义（P〉0．05）,78株革兰阳性菌对常用抗生素的耐药率早发与晚发HAP差异无统计学意义（P〉0．05）,296株革兰阴性菌对常用抗生素的耐药率,早发HAP与晚发HAP除了对哌拉西林和阿莫西林克拉维酸钾的耐药率差异有统计学意义（P〈0．05）,其余的差异有统计学意义（P〉0．05）,但是晚发HAP中检出耐甲氧西林金葡菌（MRSA）、产ESBLs肺炎克雷伯杆菌及耐碳青霉烯鲍曼不动杆菌（CR—AB）比例增高。结论无多重耐药危险因素的医院获得性肺炎（HAP）患者,早发与晚发HAP感染病原菌差别不大,虽晚发HAP的耐药率相对较高,但对大部分抗菌素敏感,所以适当使用抗菌素,对于减轻选择抗菌药物的压力、减少耐药菌株的产生和二重感染有重要意义。     

重症监护病房细菌分布及耐药性分析

目的分析永康市第一人民医院重症监护病房(ICU)感染细菌的分布及其耐药性,指导合理使用抗菌药物。方法对该院2004年1月至2005年12月感染部位标本中分离的主要细菌,采用美国Dade Behring Microscan Walkaway40全自动细菌鉴定,及其药敏测试仪及其配套药敏鉴定板测定MIC值。Microsoft Excel统计和χ2检验。结果ICU主要细菌分别是G-杆菌,前6位依次为鲍曼/溶血不动杆菌、肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、阴沟肠杆菌、嗜麦芽黄单胞菌。G 球菌前4位依次为金黄色葡萄球菌、屎肠球菌、溶血葡萄球菌、表皮葡萄球菌。6种G-杆菌除嗜麦芽黄单胞菌天然耐亚胺硫霉素外,鲍曼/溶血不动杆菌对包括亚胺硫霉素在内的抗菌药物耐药率均超过50%,其它4种细菌对亚胺硫霉素的耐药率均较低。此外,肺炎克雷伯菌和大肠埃希菌耐药性相仿,对哌拉西林/他唑巴坦、头孢西丁和阿米卡星耐药率尚低,耐药率为8.3%-25.5%;铜绿假单胞菌对氨基糖苷类、头孢吡肟、环丙沙星的耐药率尚低,耐药率为10.5%-25.0%;阴沟肠杆菌对阿米卡星的耐药率尚低36.4%;嗜麦芽黄单胞菌对SMZco的耐药率最低为14.3%。4种G 球菌对万古霉素最敏感,金黄色葡萄球菌未检到耐万古霉素菌株。表皮葡萄球菌和屎肠球菌对万古霉素的耐药率为3.7%-5.3%,其次除屎肠球菌外,其它3种G 球菌对利福平的耐药率也还较低,为5.3%-9.5%。屎肠球菌对四环素的耐药率尚低为33.3%。不同的细菌耐药率不同,与其耐药机制有关。结论多重高耐药性是ICU感染菌的重要特征,加强ICU感染菌监测,对预防和控制ICU的医院感染有重要现实意义。     

革兰阴性杆菌ESBLs和AmpC酶的检测及耐药分析

目的检测引起医院感染的革兰阴性杆菌携带产ESBLs和去阻遏AmpC酶状况,探讨各菌对临床常用抗生素的主要耐药机制及耐药性,为临床制定合理使用抗生素策略提供依据。方法采用全自动微生物分析仪（VITEK-32）做细菌鉴定和药敏试验,用纸片扩散确证法检测超广谱β-内酰胺酶（ESBLs）,用三维法检测高水平表达染色体编码的AmpC酶。结果158株革兰阴性杆菌ESBLs检出率为26．6％,主要菌为大肠埃希菌（45．2％）、肺炎克雷伯菌（42．9％）、阴沟肠杆菌（11．9％）。AmpC酶检出率为10．1％,主要为鲍曼不动杆菌（43．8％）、阴沟肠杆菌（25％）;上述产酶细菌均对青霉素和一、二、三代头孢菌素、磺胺类、喹诺酮类、氨基糖苷类耐药,对亚胺培南敏感。结论革兰阴性杆菌耐药机制主要是产超广谱β-内酰胺酶和AmpC酶,这些产酶菌株均出现多重耐药。     

六种藓类植物茎的比较解剖学研究

通过对6种藓类植物,即褶叶青藓(Brachythecium salebrosum(Web.et Mohr.)B.S.G.)、湿地匐灯藓(Plagiomnium acutum(Lindb.)Kop.)、侧枝匐灯藓(Plagiomnium maximoviczii(Lindb.)Kop.)、大凤尾藓(Fissidensnobilis Griff.)、大羽藓(Thuidium cymbifolium(Doz.et Molk.)B.S.G.)和大灰藓(Hypnum plumaeforme Wils.)嫩茎和老茎的石蜡切片和显微观察发现,同一藓类植株的嫩茎和老茎,茎结构稳定,不同种藓类植物茎横切面具有不同特征.植物体茎横切面形状、表层细胞的层数、细胞大小和细胞壁厚薄、皮层细胞大小和形状、中轴的有无以及比例等特征可以作为藓类植物的分科分类依据之一.     

Cause of Senescence of Nine Sorts of Flowers

The levels of endogenous phytohormones and respiratory rate in nine sorts of flowers such as Cymbidium faberi Rolfe, Nopalxochia ackermannii Kunth and others were investigated both at full bloom and senescence and meanwhile the effect of exogenous phytohormones on prolonging the blossoms and promoting ethylene production were tested. There is a high content of endogenous ethylene in all the long-lived flowere, about 3–16 folds higer than the short-lived ones. There is a high level of ABA at full blooming flowers of short-lived flowers, in which there is no or only some cytokinins in it, but the ratio of CTK (6BA+zeatin)/ABA is smaller(l.7). The endogenous ABA reached a much higher level at senescence in all nine sorts of flowers, so it is reasonable to consider that it is ABA which plays an important role of regulation in controlling flower's senescence. There is a much higher level of GA3 and zeatin in the long-lived flowers which is not demonstrated in the shortlived ones. The respiratory rate is one of the factors controtling the longevity of flowers, but it does not play a decided role. Application of 6BA and zeatin prolongs distinctly orchid’s longevity, however exogenous IAA through the promotive action on ethylene production, evidently extends the longevity of the flowers of the Nopalxochia ackermannii Kunth.     

龙胆科药用植物化学成分的研究现状

龙胆科植物在我国的分布范围很广,且多数为药用植物,其多数种属的药用植物,至今其化学成分尚未被系统研究。综述了目前龙胆科药用植物的化学成分的研究现状及一般提取方法,对近年来发现的环烯醚萜及裂环烯醚萜类化合物进行了总结,为本科药用植物的更深入研究提供了参考。     

The effects of glutamine of the maintenance of embryogenic cultures of Cryptomeria japonica

Summary Embryogenic tissues of sugi (Cryptomeria japonica) were induced on a modified Campbell and Durzan (CD) medium containing 1 μM 2,4-dichlorophenoxyacetic acid (2,4-D) and 600 mg l⁻¹ glutamine, and subcultured in the medium of the same composition for over 1 yr. This resulted in a mixed culture of embryogenic and non-embryogenic cells. When embryogenic cells were isolated and cultured independently, their capacity to form embryogenic aggregates was lost. Thus, the non-embryogenic cells present within a mixed culture system were essential to the formation of embryogenic aggregates. When embryogenic tissues were isolated and cultured independently on a high glutamine-containing (2400 mg l⁻¹) medium, dry weights and endogenous levels of glutamine increased, and the tissue could generate a large number of embryogenic aggregates. Amino acid analysis of embryogenic and non-embryogenic cells from the maintenance culture indicated a higher level of glutamine was present in the latter. The high endogenous level of glutamine in the non-embryogenic portion of mixed cell masses may be the supplier of glutamine for maintaining the embryogenic property of the tissues.     

Specificity of action of piperidylcholine derivatives as substrates of cholinesterases of various origin

The review deals with study of enzymologic properties of a novel highly specific acetylcholinesterase substrate, N-(β-acetoxyethyl) piperidinium iodomethylate (“piperidylcholine”), and its 30 derivatives that were tested as effectors of cholinesterases of mammals and various species of Pacific squids. It was proven for the first time that responsible for specificity of action was structure of cyclic ammonium grouping of the alcohol part of molecule of the ester substrate. Analysis of specificity is performed based on enzymatic hydrolysis parameters—activity of catalytic center of cholinesterases and bimolecular constant of the reaction rate that are determined at optimal and low substrate concentrations. Among the specially synthesized group of thioester compounds there is revealed one more highly specific acetylcholinesterase substrate—N-(β-acetoxyethyl) piperidinium.     

真菌类遗传学分析的知识结构教学

本文以认知结构理论为指导,讨论了真菌类遗传分析与高等动植物遗传分析的内在联系,认为利用这种内在联系进行教学可收到好的效果并说明了作者的具体教学过程。 Abstract:In the paper, the relationship between genetic analysis of Fungi and genetic analysis of high animal and plant was discussed.A good results were obtained when we adopted this method in the teaching.     

Photoregulation of seed germination of wild-type and of an aurea-mutant of tomato

Seed germination of an aurea mutant of tomato ( Lycopersicon esculentum Mill.) is promoted by continuous irradiation with red, far-red or long-wavelength far-red (758 nm) light as well as by cyclic irradiations (5 min red or 5 min far-red/25 min darkness). Far-red light applied immediately after each red does not change the germination behaviour. Seed germination of the isogenic wild-type, cv. UC-105, is promoted by continuous and cyclic red light while it is inhibited by continuous and cyclic far-red light and by continious 758 nm irradiation. Far-red irradiation reverses almost completely the promoting effect of red light. The promoting effect (in the aurea mutant) and the inhibitory effect (in the wild-type) of continuous far-red light do not show photon fluence rate dependency above 20 nmol m⁻² s⁻¹. It is concluded that phytochrome controls tomato seed germination throgh low energy responses in both the wild type and the au mutant. The promoting effect of continuous and cyclic far-red light in the au mutant can be attributed to a greater sensitivity to P_fr.     

The mechanism of hatching of eggs of Haemonchus contortus

Fluid collected from hatching eggs of Haemonchus contortus contained a lipase which hydrolysed 2-naphthyl laurate (about 0·7 μmol naphthol freed /h/10⁶ eggs). The fluid also hydrolysed l-leucinamide (about 2·3 μmol leucine freed/h/10⁶ eggs). The fluid when added to normal or heated eggs caused ‘hatching’. ‘Hatching’ also occurred in exsheathing fluid from infective juveniles and in a preparation of pancreatic lipase containing leucine aminopeptidase. A purified mammalian leucine aminopeptidase in combination with several different lipases did not attack egg shells.The ‘spontaneous’ hatching of eggs of H. contortus was strongly inhibited by 1,10-phenanthroline, 10^?3M, and this inhibition was reversed by Zn²⁺. However, the inhibition of ‘hatching’ of eggs in externally applied hatching fluid, or the hydrolysis of leucinamide in hatching fluid was generally less marked.