脑膜炎败血伊丽莎白菌耐药性的研究进展

脑膜炎败血伊丽莎白菌(Elizabethkingia meningoseptica, EM)可引起肺部感染、新生儿脑膜炎、菌血症等疾病,医院重症监护病房检出率较高,是院内感染的重要病原体之一。随着抗菌药物的广泛使用,EM对β-内酰胺类、氨基糖苷类、氟喹诺酮类等临床常用抗菌药物呈多重耐药,给临床治疗带来极大困难。目前EM的耐药机制研究主要集中于产生药物灭活酶、药物作用靶位改变、外排泵、形成生物膜等方面。EM可同时携带多个耐药基因,如GOB、BlaB、CME等,从而介导多重耐药。本文就国内外EM耐药现状、耐药机制进行综述,旨在为预防和控制EM的医院内感染提供参考。     

脑膜炎败血伊丽莎白菌致老年患者医院感染的危险因素、临床特征及耐药性分析

本文探讨了老年患者脑膜炎败血伊丽莎白菌(Elizabethkingia meningoseptica, EM)感染的危险因素、临床特征及耐药情况,为临床有效的治疗提供参考。分析2018年1月—2023年1月绍兴市人民医院27株分离自60岁以上老年EM感染患者的菌株,采用VITEK-2全自动微生物鉴定药敏分析仪进行菌种鉴定和药敏实验,并统计该菌的感染临床特征和耐药性。结果表明,EM主要感染住院时间长(住院天数≥4周)的患者,占66.7%,存在严重基础疾病,其中呼吸系统疾病占44.4%,恶性肿瘤占22.2%,以及长期应用广谱抗菌药物及接受过有创操作的老年患者。标本类型以痰液标本为主(85.2%),其次为尿液(11.1%);患者主要来自重症医学科(74.1%),其次是放疗科(7.4%);EM对多种广谱抗菌药物表现为高度耐药,但对多西环素100%敏感,对头孢哌酮/他唑巴坦、哌拉西林/他唑巴坦、复方新诺明、左氧氟沙星的耐药性均<30%。由此可知,存在严重基础疾病并长时间住院、联合使用广谱抗菌药物以及接受多种侵入性诊疗是老年患者感染EM的危险因素,且EM多重耐药现象严重。因此合理使用抗菌药,...     

2型猪链球菌脑膜炎小鼠模型的构建及其转录组学分析

【背景】2型猪链球菌(Streptococcus suis serotype 2, S. suis 2)可感染宿主引起严重的脑膜炎,对养猪业和人类公共卫生安全构成重大威胁。【目的】构建S. suis 2感染小鼠脑膜炎模型,并对其脑组织进行转录组学分析,为揭示S.suis2感染宿主后引起脑膜炎的分子机制和发现潜在的治疗靶点提供理论依据。【方法】采用S. suis 2感染小鼠,并对其脑组织进行病理组织学分析确认构建脑膜炎小鼠后,对其脑组织进行转录组学分析,对比S.suis2感染和未感染小鼠的差异表达基因,并对差异表达基因进行基因本体论(geneontology,GO)功能、京都基因和基因组百科全书(Kyoto encyclopedia of genes and genomes, KEGG)通路富集和韦恩分析。【结果】脑病理组织学分析结果显示,S. suis 2感染的小鼠脑膜中有大量的炎症细胞浸润,并且血管周围出现“袖套”现象,并能从感染小鼠的组织器官中再分离出攻毒的S. suis 2菌株,结果证明构建了S. suis 2感染脑膜炎小鼠模型。转录组学分析结果表明,感染S.suis2与未感染的...     

多重耐药鲍曼不动杆菌的耐药机制及防治策略

鲍曼不动杆菌是一类条件致病菌,广泛分布于自然界中。随着抗菌药物的广泛使用,鲍曼不动杆菌对抗菌药物的耐药逐年上升,己成为院内感染的重要菌株,常可引起肺炎、尿道感染、脑膜炎、菌血症等各种难治性感染。了解其耐药机制,探讨克服耐药的方法,对于临床上治疗和预防其引起的感染有重大的意义。     

B群脑膜炎球菌疫苗的研制策略

脑膜炎奈瑟菌主要引起儿童细菌性脑脊髓膜炎和败血症,有较高的发病率和病死率。现用疫苗能够控制A、C、W135和Y群脑膜炎球菌引起的感染,而由于B群荚膜多糖免疫原性弱,外膜蛋白变异性高等原因,仍无安全和具有广泛保护性的疫苗用于控制B群脑膜炎球菌的感染。目前,B群脑膜炎球菌大多已成为引起发达国家侵袭性脑膜炎疾病的主要病原体。随着研究的不断深入,B群脑膜炎球菌疫苗的研究已经取得了很大的进展,外膜囊(Out membrane vesicles,OMV)疫苗已经在控制特异性菌株爆发流行中取得了成功。然而,人们对具有广泛保护性的B群脑膜炎球菌疫苗的探索仍在继续。本文对近年来B群脑膜炎球菌基于不同型抗原疫苗的各种研制策略及其存在的问题进行了综述。     

耐药性结核性脑膜炎研究进展

结核性脑膜炎是由结核杆菌引起的中枢感染性疾病,是肺外结核病中最严重的一种,其多侵袭脑膜,有时可累及脑实质、脊髓,有很高的致死率。结核病在发展中国家中的感染趋势尤为突出。我国为人口大国,抗结核治疗和预防的形势异常严峻。随着抗结核药物的广泛使用,耐药性结核性脑膜炎患者数量增加,严重影响了结核性脑膜炎的预后。在耐药性结核性脑膜炎患者的治疗中,早期诊断、经验性治疗、调整治疗方案对患者的预后尤为重要。本文对耐药性结核性脑膜炎的分布、临床诊断、基因检测、治疗方案及预后进行系统性的总结。     

Ommaya 囊在神经外科治疗中的研究进展

Ommaya囊是巴基斯坦神经外科医师Ommaya发明的脑室引流工具,包括一个扁平状的储液器与一根引流管相接而成,其最初设计目的是在治疗真菌性脑膜炎时进行侧脑室内持续给药,因此又称为"储药囊"。Ommaya囊的引流管也可以置入患者四脑室、疆池、囊腔与脑池。其对颅脑肿瘤、脑室出血、脑膜炎等疾病的治疗、中枢神经系统感染与脑脊液药理学、细胞学的实验研究等方面也有重要意义。     

人苍白杆菌研究进展

摘要:人苍白杆菌是一种革兰氏阴性杆菌,通常被认为是一种条件致病菌,其感染多与机体全身或局部免疫低下有关,主要引起菌血症、脑膜炎、化脓性感染等疾病。近年,随着感染范围的扩大和病例数的增加,目前已成为人类常见的病原菌。由于其临床表现多样化、耐药性较广以及与某些病原有交叉凝集等特点,致使预防和临床诊疗变得较为复杂。就人苍白杆菌的生物学特性、鉴别诊断、免疫性、耐药性及基因组特征等研究进展予以概述,为该病的预防、控制和诊疗管理提供参考。     

肝肾移植术后患者隐球菌感染的临床特征分析

目的研究肝、肾移植术后患者隐球菌感染的临床特征。方法选取2010年1月到2015年7月来浙江大学医学院附属第一医院就诊的肝、肾移植术后并确诊为隐球菌感染的患者,对其临床特征进行回顾性分析。结果研究周期内有23例患者符合入组要求,其中肾移植术后21例、肝移植术后2例。对23例患者进行分析,发现单纯隐球菌肺炎6例(占26.0%)、单纯隐球菌性脑膜炎6例(占26.0%)、隐球菌性脑膜炎合并隐球菌肺炎8例(占34.7%)、隐球菌败血症2例(占8.6%),皮肤隐球菌感染1例(占4.3%)。所有隐球菌肺炎均经肺穿刺病理确诊,临床表现以发热,咳嗽咳痰,气急症状居多。胸部CT表现为结节、空洞、肿块、渗出等。所有隐球菌脑膜炎患者中9例经脑脊液培养出新生隐球菌、7例脑脊液墨汁染色见隐球菌,其中3例培养及涂片均为阳性。临床表现以头痛、发热、呕吐症状居多,1例并发癫痫,1例并发意识障碍。所有患者分别给予氟康唑、两性霉素B、氟胞嘧啶针、伏立康唑等抗真菌治疗,其中3例隐球菌脑膜炎患者予两性霉素B鞘内注射。经1~6个月治疗后,总体预后情况良好(好转22例,死亡1例)。结论肝、肾移植术后患者因免疫抑制剂的长期使用,隐球菌感染值得重视,其临床症状不典型,易误诊及漏诊,通过对其主要症状及影像学特点判断,结合肺穿刺活检、脑脊液检查、血培养等检查手段,可明显提高隐球菌感染的检出率,从而做到早诊断,早治疗,降低病死率。     

艾滋病合并隐球菌感染17例尸检材料的临床病理学研究

在１５１例艾滋病尸检材料中发现１７例合并隐球菌感染,均经病理学确诊,患者男１５名,女２名,平均４３．６岁。１２例发生脑膜炎、肺炎和淋巴结炎各７例,尚见脾（６例）、肾（５例）等器官受累。９例为播散性感染。病变为慢性肉牙肿性,其中见有隐球菌。本文描述隐球菌性脑膜炎、肺炎等临床病理学表现,并讨论其病变特征与病理诊断问题。     

呼吸重症监护病房2008年至2011年医院感染病原菌分布及危险因素分析

目的：对我院呼吸重症监护病房（RICU）临床分离的非重复性感染病原菌的耐药性进行调查,分析RICU院内感染的危险因素。方法：收集RICU 2008年-2011年临床分离的非重复性感染病原菌及相关临床资料分析医院感染的危险因素。结果：（1）2008-2011年RICU院内感染发生率为34.15%,每年分离的前3位病原菌均为鲍曼不动杆菌、金黄色葡萄球菌及铜绿假单胞菌;（2）大肠杆菌连续4年ESBLs检出率为100%,四年间肺炎克雷伯菌ESBLs检出率最高达95.5%,葡萄球菌中MRSA检出率较高（〉89.6%）;（3）RICU院内感染以下呼吸道感染最为常见,其次为泌尿道感染,血液感染位于第3位;（4）多因素非条件logistic回归分析发现机械通气、住院时间〉15天及联合应用抗菌药物是RICU医院感染的危险因素。结论：（1）连续4年RICU感染病原菌以革兰阴性杆菌为主;（2）ESBLs和MRSA检出率较高,给临床抗感染治疗带来巨大的挑战;（3）机械通气、住院时间〉15天及联合应用抗菌药物是RICU医院感染的危险因素。     

肠球菌耐万古霉素机制研究进展

肠球菌为革兰阳性（G＋）球菌,广泛分布于自然环境及人和动物消化道内,既往认为肠球菌是对人类无害的共栖菌。自20世纪80年代以来,肠球菌严重感染的发生率和病死率明显升高,肠球菌成为了院内感染的重要病原菌,不仅可引起尿路感染,皮肤软组织感染,甚至危及生命的腹腔感染、败血症、心内膜炎、脑膜炎等,在败血症中肠球菌为第三位的病原菌,仅次于凝固酶阴性葡萄球菌和金黄色葡萄球菌。由于肠球菌对多种抗菌药物具有天然耐药（固有耐药）和获得性耐药的特性,许多常用抗菌药物活性降低,往往造成临床治疗失败。为此,相研究对有关肠球菌的耐药机制的相关文献进行综述,以利于同道们进一步研究。     

Mycobacteria in drinking water distribution systems: ecology and significance for human health

In contrast to the notorious pathogens Mycobacterium tuberculosis and M. leprae, the majority of the mycobacterial species described to date are generally not considered as obligate human pathogens. The natural reservoirs of these non-primary pathogenic mycobacteria include aquatic and terrestrial environments. Under certain circumstances, e.g., skin lesions, pulmonary or immune dysfunctions and chronic diseases, these environmental mycobacteria (EM) may cause disease. EM such as M. avium, M. kansasii, and M. xenopi have frequently been isolated from drinking water and hospital water distribution systems. Biofilm formation, amoeba-associated lifestyle, and resistance to chlorine have been recognized as important factors that contribute to the survival, colonization and persistence of EM in water distribution systems. Although the presence of EM in tap water has been linked to nosocomial infections and pseudo-infections, it remains unclear if these EM provide a health risk for immunocompromised people, in particular AIDS patients. In this regard, control strategies based on maintenance of an effective disinfectant residual and low concentration of nutrients have been proposed to keep EM numbers to a minimum in water distribution systems.     

Glycopeptide resistance in enterococci.

The selective pressure resulting from the extensive use of antibiotics over the last 50 years has led to the emergence of bacterial resistance and to the dissemination of resistance genes among pathogenic microorganisms. Consequently, we are now at serious risk of suffering intractable, life-threatening infections. The progressive emergence and rapid dissemination of resistance to glycopeptides, the last resort for treating nosocomial infections with enterococci resistant to usual antibiotics, constitute one of the most dramatic examples of such resistance. Enterococci are normal human commensals, but are also a frequent cause of nosocomial urinary tract infections and nosocomial bacteremia. Enterococcus faecalis causes 80 to 90% of human enterococcal infections, while Enterococcus faecium accounts for most of the remainder. During the last decade, our understanding of the genetics and biochemical basis of resistance to glycopeptides has increased greatly. Furthermore, the application of molecular methods for the diagnosis of glycopeptide-resistant enterococci has provided new insights into the epidemiology of enterococcal infections.     

<Emphasis Type="Italic">Stenotrophomonas maltophilia</Emphasis>: Significant contemporary hospital pathogen — <Emphasis Type="Italic">review</Emphasis>

Stenotrophomonas maltophilia (Sm) plays an important role as an opportunistic pathogen in immunocompromised individuals. The growing detection rates of this bacterium in hospitalized patients are associated with the invasiveness of therapeutic and diagnostic procedures and the selection pressure of antibiotic therapy. A broad range of infections that can be caused by Sm is frequently bound to biofilm. The high level of intrinsic resistance to many unrelated antibiotics and increasing acquired resistance to the drug of choice, trimethoprim-sulfamethoxazole pose a threat for the near future when our treatment options may become depleted. Prevention of colonization and infection consists in consequent implementation of the rules governing nosocomial infection control, rational use of antibiotics including the optimization of selection and testing of antimicrobial agents suitable for the treatment of stenotrophomonad infections.     

Case-control study to evaluate the link between immunosuppression and Candida spp. infection

Candidiasis is one of the fungal infections with the highest incidence in the immunosuppressed host. The evolution of infection and the increase of antifungal medical drugs resistance could both contribute to the mortality attributable to Candida infection in the immunosuppressed host. Even though the data from international studies are well known, few studies have been published in Romania on this subject. In the case-control study we demonstrated the link between the immunosuppression and the presence of Candida infection. Further studies are to be carried out in order to identify more accurately this link and to extend the study to other fungi. There is a need to increase the microbiological diagnosis use at least at the hospital laboratory level in order to better identify the real situation of fungal infections and the link between them and the concrete status of different hosts. Continued surveillance for infections caused by C. albicans and other species of Candida among hospitalized patients is recommended. Control of antimicrobial resistance among nosocomial infections caused by C. albicans and other species of Candida requires rational policies for use of both antifungal and antibacterial agents and appropriate surveillance for the emergence of resistant strains and species.     

Public Health Risks of Multiple-Drug-Resistant Enterococcus spp. in Southeast Asia

Enterococci rank as one of the leading causes of nosocomial infections, such as urinary tract infections, surgical wound infections, and endocarditis, in humans. These infections can be hard to treat because of the rising incidence of antibiotic resistance. Enterococci inhabiting nonhuman reservoirs appear to play a critical role in the acquisition and dissemination of antibiotic resistance determinants. The spread of antibiotic resistance has become a major concern in both human and veterinary medicine, especially in Southeast Asia, where many developing countries have poor legislation and regulations to control the supply and excessive use of antimicrobials. This review addresses the occurrence of antibiotic-resistant enterococci in Association of Southeast Asian Nations countries and proposes infection control measures that should be applied to limit the spread of multiple-drug-resistant enterococci.     

Controlling Antimicrobial Resistance through Targeted,Vaccine-Induced Replacement of Strains

Vaccination has proven effective in controlling many infectious diseases. However, differential effectiveness with regard to pathogen genotype is a frequent reason for failures in vaccine development. Often, insufficient immune response is induced to prevent infection by the diversity of existing serotypes present in pathogenic populations of bacteria. These vaccines that target a too narrow spectrum of serotypes do not offer sufficient prevention of infections, and can also lead to undesirable strain replacements. Here, we examine a novel idea to specifically exploit the narrow spectrum coverage of some vaccines to combat specific, emerging multi- and pan-resistant strains of pathogens. Application of a narrow-spectrum vaccine could serve to prevent infections by some strains that are hard to treat, rather than offer the vaccinated individual protection against infections by the pathogenic species as such. We suggest that vaccines targeted to resistant serotypes have the potential to become important public health tools, and would represent a new approach toward reducing the burden of particular multi-resistant strains occurring in hospitals. Vaccines targeting drug-resistant serotypes would also be the first clinical intervention with the potential to drive the evolution of pathogenic populations toward drug-sensitivity. We illustrate the feasibility of this approach by modeling a hypothetical vaccine that targets a subset of methicillin-resistant Staphylococcus aureus (MRSA) genotypes, in combination with drug treatment targeted at drug-sensitive genotypes. We find that a combined intervention strategy can limit nosocomial outbreaks, even when vaccine efficacy is imperfect. The broader utility of vaccine-based resistance control strategies should be further explored taking into account population structure, and the resistance and transmission patterns of the pathogen considered.     

重庆地区儿童感染患者11039株大肠埃希菌的临床分布及耐药性

目的分析2010-2015年重庆地区儿童感染的11 039株大肠埃希菌的临床分布特征及耐药性,为合理应用抗菌药物和预防控制医院感染提供依据。方法分析大肠埃希菌对19种抗菌药物的耐药性,采用BD Phoenix 100 MIC法结合K-B纸片扩散法进行药敏试验,按美国临床实验室标准化委员会(CLSI)标准判断结果。结果大肠埃希菌总检出率为13.53%;大肠埃希菌在呼吸病房和新生儿病房的检出率高于其他病房;以痰标本多见,占62.22%(6869/11039);大肠埃希菌对氨苄青霉素耐药率最高(90.33%),对美罗培南、亚胺培南的耐药率低,分别为0.81%和0.78%。ESBLs平均检出率为50.98%(5628/11039)。结论大肠埃希菌的耐药性呈上升趋势,呼吸病房和新生儿病房是预防控制的重点科室。