ICU呼吸机相关性肺炎患者病原菌分布及NLR、血清磷、PCT联合检测对死亡风险的预测价值探讨

摘要 目的：研究重症监护室（ICU）呼吸机相关性肺炎（VAP）患者病原菌分布及中性粒细胞与淋巴细胞计数比值（NLR）、血清磷、降钙素原（PCT）联合检测对死亡风险的预测价值。方法：选取上海市第一人民医院于2020年1月～2022年1月收治的60例VAP患者。采集所有患者呼吸道分泌物并进行细菌培养。此外,将其按照预后的不同分为死亡组21例以及存活组39例,比较两组NLR、血清磷及PCT水平。以单因素及多因素Logistic分析VAP患者死亡的危险因素,并通过受试者工作特征（ROC）曲线分析NLR、血清磷及PCT预测死亡的效能。结果：60例VAP患者呼吸道分泌物检出病原菌共82株,以革兰阴性菌占比最高,共检出革兰阴性菌75.61%、革兰阳性菌21.95%、真菌2.44%。按照占比从高到低的顺序分别为鲍氏不动杆菌20.73%,铜绿假单胞菌18.29%,肺炎克雷伯菌17.07%,金黄色葡萄球菌13.41%,大肠埃希菌12.20%,其他革兰阴性菌7.32%,表皮葡萄球菌4.88%,肠球菌属3.66%,真菌2.44%。死亡组NLR及PCT水平均高于存活组,而血清磷水平低于存活组（P＜0.05）。单因素分析结果显示：急性生理与慢性健康评分（APACHEⅡ）评分及有创机械通气时间均和VAP患者死亡有关（P＜0.05）。多因素Logistic回归分析显示：APACHEⅡ评分较高、有创机械通气时间较长与NLR、PCT水平较高均是VAP患者死亡危险因素,血清磷水平较高是VAP患者死亡的保护因素（P＜0.05）。ROC曲线分析显示：NLR、血清磷及PCT联合预测VAP患者死亡的效能优于上述三项指标单独预测。结论：VAP患者主要病原菌为革兰阴性菌,临床应合理选用抗菌药物治疗,NLR、血清磷及PCT均和患者死亡有关,联合检测对死亡风险的预测价值较高。     

重症急性胰腺炎合并腹腔感染患者病原菌分布、药物敏感性分析及其院内死亡的危险因素探讨

摘要 目的：观察重症急性胰腺炎（SAP）合并腹腔感染（IAI）患者病原菌分布,分析药物敏感性,同时探讨其院内死亡的危险因素。方法：本研究纳入2017年1月~2022年1月期间来解放军联勤保障部队第九二二医院接受治疗并确诊的SAP合并IAI患者100例,采集患者腹水标本,观察其病原菌分布,分析药物敏感性。入院后收集患者人口学特征、实验室检查等资料,探讨患者院内死亡的危险因素。结果：100例SAP合并IAI患者腹水标本中,分离出186株病原菌,其中革兰阴性菌有108株,占比58.06%。革兰阳性菌51株,占比27.42%。真菌27株,占比14.52%。鲍曼不动杆菌对不同抗菌药物的敏感性均较低,大肠埃希菌对厄他培南、亚胺培南、哌拉西林／他唑巴坦、庆大霉素、美罗培南的敏感性较高,肺炎克雷伯菌对亚胺培南、美罗培南的敏感性较高,葡萄球菌属对替加环素、万古霉素、利奈唑胺的敏感性较高,屎肠球菌对替加环素、利奈唑胺的敏感性较高,粪肠球菌对氨苄西林、万古霉素、环丙沙星、替加环素的敏感性较高。单因素分析显示,SAP合并IAI患者院内死亡与器官障碍数目、膀胱压、入院时急性生理学与慢性健康状况评分（APACHE II）评分、白细胞计数（WBC）、血钙、红细胞压积（HCT）、总胆固醇（TC）、甘油三醋（TG）、降钙素原（PCT）、C反应蛋白（CRP）、动脉二氧化碳分压（PaCO₂）、动脉氧分压（PaO2）有关（P<0.05）。多因素Logistic回归分析结果显示：器官障碍数目偏多、血钙偏低、CRP偏高、APACHE II评分偏高、膀胱压偏高、PaO₂偏低、WBC偏高是导致SAP合并IAI患者院内死亡的危险因素（P<0.05）。结论：SAP合并IAI患者病原菌分布以革兰阴性菌为主,主要的革兰阴性菌、革兰阳性菌耐药率高。此外,器官障碍数目偏多、血钙偏低、CRP偏高、APACHE II评分偏高、膀胱压偏高、PaO₂偏低、WBC偏高是影响SAP合并IAI患者院内死亡的危险因素。     

MICROBIAL COLONIZATION ON NATURAL AND ARTIFICIAL MACROPHYTES IN A PHOSPHORUS-LIMITED,HARDWATER LAKE1

Epiphyte communities in a phosphorus-limited hard-water lake were compared over a 14-week period from Potamogeton illinoensis and structurally similar artificial plants of different leaf ages. Artificial plants were serially incubated in the lake to simulate the age of natural leaves. The physiognomy of loosely attached epiphytes appeared similar on the two substrata. Algal cell number and biovolume were 15-fold and 17-fold higher, respectively, on artificial leaves early in the growing season, but total algal density gradually became similar on natural and artificial plants. In contrast, the taxonomic composition of loosely attached algae became increasingly distinct, and mean cell biovolume on natural leaves was twice that on artificial leaves. Adnate epiphytes on both substrata developed from sparse populations of bacteria on new leaves to a community of diatoms, blue-green algae and numerous bacteria on mature and senescent leaves. Adnate community succession on natural leaves in late senescence/death differed from that on artificial leaves colonized for comparable periods in having (1) a marked increase in filamentous blue-green algae, (2) a subsequent decrease in all algae, and (3) a final fungi-dominated stage. The trends in colonization indicate that macrophytes in this oligotrophic lake provided a distinct habitat from that of artificial substrata for epiphytes throughout the growing season.     

BACTERIAL ASSOCIATIONS WITH MARINE OSCILLATORIA SP. (TRICHODESMIUM SP.) POPULATIONS: ECOPHYSIOLOGICAL IMPLICATIONS1

On three separate occasions we investigated morphological and physiological aspects of bacterial associations with planktonic aggregates of the ubiquitous marine N₂ fixing cyanobacterium Trichodesmium sp. Close associations generally characterized Trichodesmium blooms; associations were present during day- and night-time. Colonization by both rod-shaped and filamentous heterotrophic bacteria occurred on Trichodesmiun aggregates actively fixing N₂ (acetylene reduction). Scanning electron and optical microscopy showed bacteria located both around and within aggregates. Microautoradiography demonstrated that associated bacteria largely mediated utilization of trace additions of ³H-labeled carbohydrates (fructose, glucose, mannitol) and amino acids, whereas Trichodesmium utilized amino acids only. Oxygen measurements using microelectrodes revealed high localized oxygen consumption among aggregates, with rapid (within a minute) changes from supersaturated to subsaturated oxygen following the transition from photosynthetic illuminated to dark periods. Stab culturing techniques confirmed the presence of heterotrophic N₂ fixers among aggregate-associated bacteria. Parallel deployment of oxygen microelectrodes, the tetrazolium salt 2,3,5 triphenyl tetrazolium chloride (TTC) and acetylene reduction assays demonstrated microaerophilic requirements for expression of nitrogenase activity among cultured bacteria. Trichodesmium aggregates are characterized by dynamic nutrient and oxygen regimes, which promote and maintain simultaneous and contiguous oxygenic photosynthesis and N₂ fixation. In part, the above-mentioned consortial interactions with a variety of heterotrophic bacteria facilitate Trichodesmium biomass production and bloom formation in nitrogen depleted, oligotrophic tropical/subtropical waters.     

A comparison of carbon/energy and complex nitrogen sources for bacterial sulphate-reduction: potential applications to bioprecipitation of toxic metals as sulphides

Detailed nutrient requirements were determined to maximise efficacy of a sulphate-reducing bacterial mixed culture for biotechnological removal of sulphate, acidity and toxic metals from waste waters. In batch culture, lactate produced the greatest biomass, while ethanol was more effective in stimulating sulphide production and acetate was less effective. The presence of additional bicarbonate and H₂ only marginally stimulated sulphide production. The sulphide output per unit of biomass was greatest using ethanol as substrate. In continuous culture, ethanol and lactate were used directly as efficient substrates for sulphate reduction while acetate yielded only slow growth. Glucose was utilised following fermentation to organic acids and therefore had a deleterious effect on pH. Ethanol was selected as the most efficient substrate due to cost and efficient yield of sulphide. On ethanol, the presence of additional carbon sources had no effect on growth or sulphate reduction in batch culture but the presence of complex nitrogen sources (yeast extract or cornsteep) stimulated both. Cornsteep showed the strongest effect and was also preferred on cost grounds. In continuous culture, cornsteep significantly improved the yield of sulphate reduced per unit of ethanol consumed. These results suggest that the most efficient nutrient regime for bioremediation using sulphate-reducing bacteria required both ethanol as carbon source and cornsteep as a complex nitrogen source.     

含吸氢酶基因（hup）嵌合质粒的构建和吸氢酶活性在阴沟肠杆菌中的表达

以质粒ｐＲＫ４０４为载体亚克隆含大豆根瘤菌吸氢酶结构基因（ｈｕｐ）的片段,构建成嵌合质粒ｐＨＲ１１、ｐＨＲ４和ｐＨＲ１０。通过三亲本杂交将这些嵌合质粒导入无吸氢活性的Ｒｈｏｄｏｂａｃｔｅｒｓｐｈａｅｒｏｉｄｅｓ２４１菌株（Ｈｕｐ－）,均获得Ｈｕｐ＋的接合子。利用启动子检测质粒ｐＭＰ２２０证明,在ｈｕｐ对结构基因上游１．２ｋｂ内存在ｈｕｐ启动基因片段。以ｐＲＫ２０１３为助质粒可将ｐＨＲ１１导入Ｅｎｔｅｒｏｂａｃｔｅｒｃｌｏａｃａｅ和Ｋｌｅｂｓｉｅｌｌａｏｘｙｔｏｃａ等土壤固氮菌株。本文以接合子Ｅ．ｃｌｏａｃａｅＥＨ１１１３为例,通过对基因组ＤＮＡＳｏｕｔｈｅｒｎ杂交分析证明,嵌合质粒ｐＨＲ１１在ＥＨ１１１３中稳定贮存和复制。Ｈ２诱导接合子ＥＨ１１１３吸氢酶活性高表达,吸氢活性与放氢活性比值约为对照的两倍。当以延胡索酸为电子受体时,吸氢酶的吸氢作用支持菌株固氮酶活性的提高。     

Improved ethanol tolerance and production in strains of Clostridium thermocellum

Two Clostridium thermocellum strains were improved for ethanol tolerance, to 5% (v/v), by gradual adaptation and mutation. The best mutant gave an ethanol yield of 0.37 g/g substrate, with a growth yield 1.5 times more than its parent. Accumulation of acids and reducing sugars by the mutant strain with 5% (v/v) ethanol was lower than that of the parent strain with 1.5% (v/v) ethanol.     

Mechanism of aluminium-induced porphyrin synthesis in bacteria

In previous studies, aluminium was found to retard bacterial growth and enhance porphyrin formation in Arthrobacter aurescens RS-2. The aim of this study was to establish the mechanism of action of aluminium which leads to increased porphyrin production. Cultures of Arthrobacter aurescens RS-2 were incubated in the absence and presence of 0.74 mm aluminium. After 6 and 24 h of incubation, various parameters of the haem biosynthetic pathway were determined. After 6 h of incubation with aluminium, the activities of the enzymes aminolevulinate synthase (ALAS), aminolevulinate dehydratase (ALAD), porphobilinogen deaminase (PBGD) and uroporphyrinogen decarboxylase (UROD) were increased by 120, 170, 190 and 203%, respectively, while that of ferrochelatase (FC) was found to be unchanged. However, after 24 h of incubation, no change in the activities of ALAS and ALAD was noted, while an about 2-fold increase in PBGD and UROD activities were observed. FC activity was decreased by 63%. It was concluded that aluminium exerts its effect by inducing the enzymes PBGD and UROD rather than by a direct or indirect effect on ALAS. Its effect on the final step in the haem biosynthetic pathway is discussed.