良乡地区成人住院社区获得性肺炎的病原体分布及其耐药性分析

目的：调查良乡地区成人住院社区获得性肺炎（CAP）的病原菌分布状况,了解细菌的耐药情况,为CAP的经验性治疗提供依据。方法：2008年7月—2010年7月在良乡院住院的CAP患者共182例,分别留取呼吸道分泌物进行细菌学培养和血非典型病原体的检测。结果：在182例CAP患者80例（44.0%）痰细菌学检查阳性,主要病原菌为肺炎链球菌25例（13.7%）、流感嗜血杆菌15例（8.2%）。在行血清学检测的CAP患者中非典型病原体感染29例（15.9%）。肺炎链球菌对青霉素耐药率为44.0%,;流感嗜血杆菌对氨苄青霉素的耐药率为40.0%。结论：肺炎链球菌、流感嗜血杆菌和肺炎支原体是良乡地区成人CAP住院患者的主要致病菌,肺炎链球菌、流感嗜血杆菌对青霉素及大环内酯类耐药率较高。     

加替沙星治疗获得性下呼吸道感染临床观察

通过回顾性总结分析我院2004年5月-2005年8月应用加替沙星治疗社区获得性下呼吸道感染患者情况，评价加替沙星治疗社区获得性下呼吸道感染的临床疗效及安全性，认为加替沙星治疗下呼吸道感染安全、有效。报告如下：     

社区获得性MRSA下呼吸道感染临床特征分析

目的：探讨社区获得性耐甲氧西林金黄色葡萄球菌（ MRSA）下呼吸道感染的临床特征、诊断与治疗。方法回顾性分析焦作市人民医院呼吸内科收治的6例社区获得性MRSA下呼吸道感染患者的临床资料。结果6例患者均好转出院，随访3个月，1例出现肺部结构及功能受损，余无复发及不适。结论社区获得性MRSA下呼吸道感染不具备医院获得性MRSA感染的高危因素，见于免疫功能正常的青年及老年人，也可见于合并糖尿病等患者，CT具有坏死性肺炎的特征，可形成肺脓肿甚至脓气胸，糖肽类抗生素或利奈唑胺治疗有效，联合克林霉素或许能使患者受益。     

肺炎链球菌呼吸道感染的再认识

肺炎链球菌至今仍然是社区获得性呼吸道感染的重要病原体,有关肺炎链球菌的研究已经比较广泛而深入。但近年来,在肺炎链球菌的微生物学特性、流行病学、耐药机制及治疗指南等方面都有了新的认识。本文着重介绍近几年肺炎链球菌感染研究的新进展,主要从肺炎链球菌呼吸道感染的现状、青霉素折点的调整、氟喹诺酮耐药特点、生物膜耐药机制及治疗等方面进行阐述。     

左氧氟沙星治疗下呼吸道感染60例疗效分析

下呼吸道感染是一种常见病，如治疗不当可引起败血症、呼吸衰竭等不良后果。近年来社区获得性肺炎的病原菌已发生改变，主要表现在一些常见病原菌耐药性增加，如青霉素耐药或耐多药肺炎链球菌的传播。各种非典型病原体单独或与细菌混合感染发生率的升高，使肺炎链球菌、肺炎支原体、肺炎衣原体已成为导致社区获得性肺炎感染的前三位病原体^[1]。为寻找对下呼吸道感染治疗有效且安全性高的抗菌药物，我院自2002年以来用左氧氟沙星治疗下呼吸道感染，现报告如下：     

小儿支原体肺炎抗菌治疗的研究进展

肺炎支原体是小儿社区获得性呼吸道感染的主要病原体之一,小儿肺炎支原体感染约占小儿急性呼吸道感染的20%左右,且其发病率逐年升高。除引起呼吸系统病变外,还可导致患儿机体多系统器官功能障碍,甚至引起患儿死亡,临床治疗药物以抗生素、免疫制剂及中医为主,本文对小儿支原体肺炎抗菌治疗的进展作一综述。     

多重PCR荧光微球检测支气管肺洗液非典型病原体和病毒的临床意义

目的：了解下呼吸道感染患者非典型病原体和病毒感染情况。方法：采集92例肺炎和急性支气管炎患者支气管肺洗液（BALF）。采用多重PCR技术与Luminexx MAP多重分析技术平台相结合。以荧光微球为载体检测非典型病原体和多种病毒．结果：10种（14个亚型）病原体阳性检出率为50％（46／92）．其中病毒阳性检出率为33．69％（31／92），以流感病毒A为主，其占病毒阳性检出的67．74％（21／31）I非典型病原体阳性检出率为16．30％（15／92）．以MP为多，其占非典型病原体阳性检出的73．33％（11／15）。MP、病毒和细菌混合感染率为13．04％（12／92）．结论。流感病毒A和肺炎支原体是本地区社区获得性肺炎和急性气管-支气管炎重要的病原体，并有相互混合感染或与细菌混合感染，临床应予重视．     

医院获得性下呼吸道感染现患率与感染病原菌监测报告

摘要 目的 了解湖北省医院获得性下呼吸道感染的发病情况与感染病原菌特点。方法 利用医院感染监测网络系统统计和分析2014年10月77家二级及以上综合和专科性医院实施医院感染现患率调查的资料。结果 发现77家医院中共1 090例医院获得性下呼吸道感染,感染患病率为1.43%;14 880例手术患者中有241例肺部感染,手术后肺炎患病率为1.62%。医院获得性下呼吸道感染高发的科室是综合ICU、神经外科、新生儿科、血液科、胸外科。从送检的病原学标本中共分离阳性感染病原体666株,其中革兰阴性菌占77.93%,革兰阳性菌占14.41%,真菌占6.31%,主要检出病原菌铜绿假单胞菌和鲍曼不动杆菌分别占23.42%和21.92%。结论 综合ICU、神经外科、新生儿科、血液科、胸外科为医院获得性下呼吸道医院感染的高危科室,铜绿假单胞菌和鲍曼不动杆菌为医院获得性下呼吸道医院感染的主要病原菌,各医院感染管理办公室应与相关科室建立目标责任制管理措施,主动提高控制医院获得性下呼吸道感染的能力。     

1197例患者呼吸道感染病原体IgM检测结果分析

目的探讨9项呼吸道感染病原体IgM抗体检测在成人急性呼吸道感染中的作用,为临床提供早期诊断依据。方法选取成都军区昆明总医院呼吸道感染患者1 197例,通过9项呼吸道感染病原体IgM抗体试剂检测住院成人患者血清病原体抗体,分析9项呼吸道感染病原体在不同年龄段及性别患者血清中的检出情况。结果1 197例患者血清IgM抗体阳性共371例,总阳性率为30.99%(371/1 197);肺炎支原体(MP)阳性率最高,为16.96%(203/1 197);其次为乙型流感病毒(IFB),阳性率为16.21%(194/1 197);副流感病毒(PIV)、甲型流感病毒(IFA)阳性率分别为10.03%、7.44%。病原体合并感染170例,阳性率为14.20%(170/1 197),占阳性病例的45.82%(170/371)。结论昆明地区呼吸道感染的病原体主要为MP、IFB、PIV及IFA等,且病原体的检出率和年龄具有相关性。     

45例新生儿社区获得性感染的原因分析及管理

目的：探讨新生儿社区获得性感染的原因,并进行分析,明确此类患儿出院指导的方向,并提出住院期间控制措施,最大限度减少院内交叉感染的发生,保障患儿安全。方法：45例患儿经痰培养及药物敏感实验后有针对性地选用抗生素,并分别进行呼吸道或接触隔离。结果：45例患儿无1例发生其他感染,痊愈出院。结论：知识缺乏,教育滞后是社区获得性感染的重要原因,有针对性的进行健康教育,改变不良习惯,严格执行感染控制措施,可有效减少社区获得性感染的发生。     

儿童下呼吸道感染病原菌检测结果影响因素的探讨

目的探讨不同季节、不同年龄儿童下呼吸道感染的病原菌分布特点。方法对2014年9月至2015年8月在中山市博爱医院儿科门诊或住院诊疗的下呼吸道感染患儿细菌培养结果进行回顾性分析,统计不同年龄段和不同月份儿童下呼吸道感染病原菌的检出情况。结果全年4 629份下呼吸道标本共分离致病菌2 809株,检出率为60.7%。不同年龄段儿童下呼吸道感染病原菌分布情况不同,29d至7岁儿童下呼吸道感染均以流感嗜血杆菌排第一位,为33.3%。流感嗜血杆菌、卡他莫拉菌、肺炎链球菌的检出率有明显的季节性,金黄色葡萄球菌、副流感嗜血杆菌的检出率则没有明显的季节差异。结论儿童下呼吸道感染病原菌与成人不同,受年龄与季节变化的影响。     

Antimicrobial resistance in respiratory tract pathogens

Antimicrobial resistance has been a problem ever since the introduction of antimicrobial agents 60 years ago. Today, this problem is increasing so rapidly that the end of the antimicrobial era is being predicted. The increasing problems caused by antimicrobial resistance can be illustrated by those seen in bacterial pathogens that cause community acquired respiratory tract infections, which are among the most common and important infections seen by clinicians. Bacterial pathogens causing community acquired respiratory tract infections have a number of resistance mechanisms such as β-lactamases. Recognition of these resistance mechanisms allows them to be targeted, such as with β-lactamase inhibitors. Newly recognized resistance mechanisms such as efflux may also be targeted in the future.     

Determining the factors affecting serum presepsin level and its diagnostic utility: A cross-sectional study

IntroductionThis study aimed to identify factors affecting presepsin levels and to determine their diagnostic utility.MethodsThis cross-sectional study was conducted at an outpatient clinic and emergency department at an acute care hospital in Japan between January 2015 and December 2017. We enrolled 1,840 consecutive outpatients with at least one measurement of serum presepsin, who were suspected of having bacterial infection. The outcome variables were bacterial infection, lower respiratory tract infection, urinary tract infection, cholangitis, and other infections diagnoses, based on the chart review. We collected blood analysis data on the patients’ presepsin levels.ResultsThere was a significant association between presepsin level and the diagnosis of bacterial infection even when adjusted for age, sex, renal function, and biliary enzyme levels. An increase of 1 unit in the log of presepsin values resulted in a relative risk ratio of 1.71 (1.09–2.66), 2.1 (1.58–2.79), 2.93 (2.05–4.19), 4.7(2.90–7.61), and 2.41(1.70–3.43), for bacterial infection, lower respiratory tract infection, urinary tract infection, cholangitis, and other infections, respectively.ConclusionsPresepsin showed a statistically significant increase in the diagnosis of bacterial infections (lower respiratory tract infections, urinary tract infections, cholangitis, and non-severe patients) in a community hospital setting. However, in patients with renal dysfunction, presepsin levels should be interpreted with caution.     

Antimicrobial resistance in respiratory tract pathogens

Antimicrobial resistance has been a problem ever since the introduction of antimicrobial agents 60 years ago. Today, this problem is increasing so rapidly that the end of the antimicrobial era is being predicted. The increasing problems caused by antimicrobial resistance can be illustrated by those seen in bacterial pathogens that cause community acquired respiratory tract infections, which are among the most common and important infections seen by clinicians. Bacterial pathogens causing community acquired respiratory tract infections have a number of resistance mechanisms such as beta-lactamases. Recognition of these resistance mechanisms allows them to be targeted, such as with beta-lactamase inhibitors. Newly recognized resistance mechanisms such as efflux may also be targeted in the future.     

Efficacy and safety of low dose aztreonam in the treatment of moderate to severe gram-negative bacterial infections

One hundred and fifty-three patients with moderate to severe infections due to Gram-negative bacteria, including septicaemia (60 cases), lower respiratory tract infection (32 cases), intra-abdominal infection (40 cases) and urinary tract infection (21 cases), were treated with aztreonam 1 g every 12 h. This dosage is lower than usual. Criteria for inclusion included documented Gram-negative bacterial infections, and assessment of the severity of the disease by a scoring system for both community and hospital acquired infections. No other antibiotic active against Gram-negative bacteria was allowed. In 71 patients, in whom Gram-positive or anaerobic organisms were detected or suspected, additional agents effective against these organisms were administered. One hundred and forty-one patients (92.2%) were cured with a mean duration of treatment of 10.9 +/- 4.0 days. None of the Gram-negative bacteria initially isolated became resistant to aztreonam. Colonization, generally by a Gram-positive organism, was observed in 27 patients and superinfection in five. Aztreonam was well tolerated. This study suggests that a daily dosage of 2 g of aztreonam should be sufficient in the treatment of moderate to severe Gram-negative bacillary infections due to sensitive organisms.     

成人耐大环内酯类抗生素肺炎链球菌的实验研究

目的了解近年我国成人患者中分离的肺炎链球菌的耐药现状,为社区获得性呼吸道感染的抗菌药物选用提供依据。方法对临床明确诊断为社区获得性肺炎（CAP）及慢性气管炎急性加重（AECB）患者中分离获得肺炎链球菌;采用微量稀释法测定15种常用抗菌药物对肺炎链球菌的体外药敏结果;进行克林霉素诱导耐药性D试验;PCR扩增方法检测耐药基因。结果71株肺炎链球菌中,青霉素敏感肺炎链球菌（PSSP）70株（70／71）,占98．6％,青霉素中介肺炎链球菌（PISP）1株（1／70）,占1．4％。大环内酯类抗生素耐药肺炎链球菌（MRSP）60株（60／71）,占84．5％,MRSP中以cMLSn型耐药的菌株为主,有54株,占90％,其次为iMLS B型,占8．3％（5／60）,1株为M型,占1．7％（1／60）。60株MRSP中ermB基因阳性检出率最高,占98．3％（59／60）。结论我国成人引起社区获得性呼吸道感染的肺炎链球菌对大环内酯类抗生素的耐药率高,大环内酯类抗生素在CAP治疗中可依据体外药敏试验结果选用,并需与β内酰胺类抗生素联合应用。     

口腔颌面肿瘤术后呼吸道感染相关因素分析

目的 调查和分析口腔颌面肿瘤患术后呼吸道感染的相关因素，探讨有效控制和降低呼吸道感染发病率的措施。方法 采用回顾性调查方法对我院口腔颌面肿瘤病区2000年1月-2001年12月63例院内获得性呼吸道感染病例进行调查、统计和分析。结果 口腔颌面肿瘤患术后呼吸道感染以下呼吸道为主，好发于老年患，往往与机体免疫力低下(恶性肿瘤本身或化疗放疗所致)、侵入性操作、制动(组织游离移植术后需要制动)、误吸史(手术创伤致吞咽功能丧失，造成误吸)；及细菌耐药等因素相关。结论 (1)加强患围术期管理(包括严格病区环境、术前后的健康教育、呼吸理疗等)；(2)提高侵入性操作的规范性；(3)认真执行无菌操作原则；(4)合理应用抗生素，是降低口腔颌面肿瘤患院内获得性呼吸道感染的有效措施。     

医院内下呼吸道真菌感染临床特点分析

目的：分析医院内下呼吸道真菌感染的发生率，菌种分布，易感因素和防治措施。为其早期诊断和治疗提供依据。方法：回顾性调查我院1999年1月至2001年12月3年间住院患发生医院内下呼吸道真菌感染的病例。并进行跟踪调查。对相应资料进行统计学分析。结果：3年内共发生医院内下呼吸道真菌感染205例。其感染发生率按年份统计分别为0.28%,0.34%和0.39%。居医院内同期深部真菌感染的首位，占58.53%。其中以白念珠菌感染率最高，单因素和多因素Logistic回归分析皆表明，医院内下呼吸道真菌感染的常见易感因素为老年患，基础疾病，长期应用广谱抗菌药物和免疫抑制剂以及侵袭性操作等。结论：医院内下呼吸道真菌感染发生率呈逐年上升趋势。白念珠菌是主要的病原菌。积极控制易感因素是降低下呼吸道真菌感染发生率的关键。早诊，早治是预防医院内下呼吸道真菌感染和改善预后的重要手段。     

Correlation between Branhamella catarrhalis adherence to oropharyngeal cells and seasonal incidence of lower respiratory tract infections

Bacterial colonization of the oropharynx is the initial event in most lower respiratory tract infections. To study the role of bacterial adherence in lower respiratory tract infections caused by Branhamella catarrhalis (B. catarrhalis) in winter, in vitro adherence assays of the organism to human oropharyngeal cells were carried out in winter, spring, summer and autumn. A total of 57 adults of both sexes were studied from January to December 1985. Forty eight persons of 57 had chronic pulmonary diseases and the remaining 9 persons had other clinical entities and served as the control group. Predominance of lower respiratory tract infections caused by B. catarrhalis with high adherence rate was observed in winter. Adherence activity was moderate in spring and autumn and low in summer and accompanied by a similar incidence of lower respiratory tract infections with this bacteria. In addition, similar results were found in patients in whom investigations were done successively in the above four seasons. Bacterial adherence activity to cells however, was weak in winter in the control group. These results indicate that seasonal variation plays a significant role in the ability of B. catarrhalis to adhere to oropharyngeal cells. This is an important pathogenic factor correlated with the incidence of lower-respiratory tract infections in these patients.     

下呼吸道感染中非发酵菌耐药性分析

目的：探讨非发酵菌所致下呼吸道感染的临床特点及细菌耐药性。方法：分析天津市区10所医院呼吸科收治的494例非发酵菌致下呼吸道感染资料。结果：所收治的494例中．社区获得性肺炎占多数。高龄、重症基础疾病、长期应用抗生素或激素、气管插管及导管留置时间过长是非发酵菌导致下呼吸道感染的危险因素。其临床表现缺乏特异性。检出非发酵菌各属细菌的比例依次为不动杆菌属(57．3％)、铜绿假单胞菌(33．5％)、嗜麦芽窄食单胞菌(4．6％)、其他假单胞菌(2．4％)和其他(2．2％)。药敏结果显示非发酵菌严重耐药，亚胺培南耐药性最低。非发酵菌对第三代头孢菌素及氨曲南、氨苄西林高度耐药。加用β内酰胺酶抑制剂的第三代头孢菌素的耐药率大大低于未加用者。结论：非发酵菌致下呼吸道感染临床表现无特异性．治疗时应根据药敏结果选择应用抗生素。