2型糖尿病合并血流感染的病原菌分布及耐药性分析

目的分析T2DM合并血流感染的病原菌分布及其药敏特征,为临床早期诊断及选用抗菌药物提供依据。方法回顾性分析2009年1月至2014年12月66例T2DM合并血流感染病例的临床资料,并进行比较。结果入选病例共培养分离出病原菌66株,其中,革兰氏阴性菌47株(71.2%)、革兰氏阳性菌19株(28.8%);革兰氏阴性菌以大肠埃希菌(19株)和肺炎克雷伯菌(16株)为主,产超广谱β内酰胺酶(ESBLs)菌检出率为29.8%;感染部位以呼吸道(23例)、泌尿道(17例)及胆道(11例)多见;多数革兰氏阳性菌属对青霉素及氨苄西林耐药率高,对万古霉素和替考拉宁敏感性高;大肠埃希菌及肺炎克雷伯菌对氨苄西林耐药率分别为68.4%及100%,对亚胺培南和美罗培南敏感性为100%。结论 T2DM患者合并血流感染病原菌以革兰氏阴性菌多见,主要为大肠埃希菌及肺炎克雷伯菌,临床应结合血培养结果合理选择抗菌药物。     

我院COPD急性加重患者病原菌分布及耐药性分析

目的了解亳州市人民医院慢性阻塞性肺疾病急性加重(AECOPD)住院患者感染病原菌的分布情况及耐药性特点。方法分析亳州市人民医院2018年1月-2018年12月280例AECOPD住院患者痰培养的检出病原菌分布和耐药特征。结果 280例AECOPD患者痰标本共分离病原菌301株,其中革兰阴性菌和革兰阳性菌分别占79. 4%和1. 66%,真菌占18. 94%。革兰阴性菌排名前3位的病原菌分布为铜绿假单胞菌(28. 57%)、肺炎克雷伯菌(14. 29%)、大肠埃希菌(12. 62%),革兰阴性菌对氨苄西林和头孢类抗生素耐药率高,其中铜绿假单胞菌和大肠埃希菌对氨苄西林、头孢曲松的耐药率均超过90%;肺炎克雷伯菌对氨苄西林耐药率100%;鲍曼不动杆菌对氨苄西林、头孢曲松耐药率均为100%,对亚胺培南耐药率为44. 44%。革兰阳性菌以金黄色葡萄球菌和肠球菌为主,其中金黄色葡萄球菌对万古霉素、利奈唑胺均敏感。前三位真菌为白假丝酵母菌(13. 29%)、热带假丝酵母菌(3. 99%)、曲霉菌(1%),白假丝酵母菌为主,对氟康唑、伏立康唑均敏感,耐药率较低。结论亳州市人民医院AECOPD患者病原菌以革兰阴性菌占绝对优势,且耐药性严重,真菌感染在AECOPD患者占一定比例,临床上应根据病原菌分布及耐药性、合理选择抗生素,有利于提高临床诊疗。     

ICU下呼吸道医院感染细菌耐药性监测结果分析

目的 了解重症监护病房(ICU)患者下呼吸道感染病原菌分布特点及耐药情况.方法 分析入住我院ICU患者送检的痰标本中分离出的病原菌,并用纸片扩散法进行药物敏感试验,进行病原菌耐药性分析.结果 分离出病原菌144株,以革兰氏阴性杆菌为主,共95株占65.97%,其中鲍曼不动杆菌、铜绿假单胞菌、大肠埃希菌和肺炎克雷伯菌为主,鲍曼不动杆菌、铜绿假单胞菌对头孢哌酮/舒巴坦耐药率较低,分别为64.71%、42.86%,大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南均敏感,耐药率为0;革兰氏阳性球菌41株,占28.47%,以金黄色葡萄球菌为主,真菌8株占5.56%,白色念珠菌对常见抗真菌药耐药率为0,克柔假丝酵母菌对氟康唑耐药率为100%.结论 监测ICU患者下呼吸道感染病原菌种类及其耐药性的变化,可合理使用抗菌药物.     

肛周脓肿伴糖尿病患者脓液中细菌分布及药敏结果分析

回顾性分析2019年1月～2019年12月43例肛周脓肿伴糖尿病患者临床资料,结果主要病原菌为大肠埃希菌24株,占55.81％,肺炎克雷伯菌13株,占30.23％.大肠埃希菌对氨苄西林、头孢曲松、复方磺胺甲恶唑、庆大霉素具有较高耐药率,对哌拉西林他唑巴坦、亚胺培南、替加环素未发现耐药菌株;肺炎克雷伯菌对氨苄西林、头孢曲...     

ICU肺部感染患者的病原菌及耐药性特点分析

目的探讨重症医学科(ICU)患者肺部感染致病菌分布情况及耐药性特点,以指导临床合理使用抗菌药物。方法2009年1月～2012年5月在我院ICU收治的128例肺部感染患者的痰病原菌细菌谱,并对药敏结果进行分析。结果共检出病原菌167株,其中革兰氏阴性菌139株,占83.2%,革兰氏阳性菌28株,占10.8%。其中革兰氏阴性菌最主要的病原菌依次是阴沟杆菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯氏菌。结论 ICU肺部感染患者的病原菌以革兰氏阴性菌为主,特点是多重耐药的阴沟杆菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯氏菌更显著,革兰氏阳性菌及念珠菌检出率不高,这对抗菌药物的合理使用具有指导意义。     

肺部感染病原菌检测与抗菌药物耐药状况分析

目的探讨引起肺部感染的病原菌及其耐药状况。方法对187例肺部感染患者痰液标本进行病原菌鉴定及药敏试验检测,分析结果。结果 187份标本共检出病原菌164株,培养阳性率为87.70%,其中革兰氏阴性菌占71.95%,革兰氏阳性菌占18.29%,真菌占9.76%,革兰阴性菌中以铜绿假单胞菌、肺炎克雷伯菌、大肠埃希氏菌、肠杆菌属、鲍曼不动杆菌为主,革兰氏阳性菌中以金黄色葡萄球菌、肺炎链球菌、溶血性葡萄球菌为主,真菌主要为白色假丝酵母菌,占7.93%;检出的革兰氏阴性菌对亚胺培南、美罗培南、阿米卡星耐药率低,铜绿假单胞菌对氨苄西林、氨苄西林/舒巴坦完全耐药,肺炎克雷伯菌对氨苄西林完全耐药,肠杆菌属对头孢呋辛酯完全耐药,鲍曼不动杆菌对氨曲南、头孢呋辛酯完全耐药;检出的革兰氏阳性菌对万古霉素、夫西地酸、莫西沙星耐药率低,金黄色葡萄球菌对红霉素、克林霉素完全耐药,肺炎链球菌对红霉素完全耐药,溶血性葡萄球菌对青霉素、氨苄西林、氨苄西林/舒巴坦、亚胺培南、红霉素、克林霉素、环丙沙星、庆大霉素、磷霉素均完全耐药。结论引起肺部感染患者的病原菌主要以铜绿假单胞菌、肺炎克雷伯菌、大肠埃希氏菌、肠杆菌属、鲍曼不动杆菌为主的革兰氏阴性菌为主,检出病原菌均对临床常用抗菌药物存在一定耐药性。     

不同组别慢性阻塞性肺疾病急性加重期的常见致病菌及耐药性分析

目的：探讨不同组别慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)的常见病原体,并对其耐药性进行分析,为临床经验性选择抗生素提供指导。方法收集我院2010—2014年收住入院的 AECOPD 患者536例,按照2013年 GOLD指南综合评估分为 A、B、C、D 4组。对536例 AECOPD 患者的痰标本进行细菌培养和药敏检测。结果536例患者中共有311例患者痰标本检出病原菌,检出率为58.02%,共检出病原菌368株,有45例同时检出两株或两株以上的病原菌。其中革兰阳性球菌115株,检出率最高的为金黄色葡萄球菌、肺炎链球菌;革兰阴性杆菌224例,病原菌依次为肺炎克雷伯菌、绿脓杆菌、大肠埃希菌、流感嗜血杆菌;真菌共检出29株。A 组检出率最高的细菌为肺炎链球菌及金黄色葡萄球菌。B 组为流感嗜血杆菌及卡他莫拉菌。C 组为肺炎克雷伯菌、大肠埃希菌。D 组为绿脓杆菌、肺炎克雷伯菌、大肠埃希菌等。药敏结果显示革兰阳性菌对阿奇霉素、复方新诺明、红霉素、阿莫西林克拉维酸、头孢曲松耐药率均较高,未发现对万古霉素及利奈唑胺耐药菌株。碳青霉烯类抗生素耐药肠杆菌科细菌逐年增加,此类细菌往往对临床常用的抗生素呈现耐药。绿脓杆菌对亚胺培南的耐药率高达35.6%。结论不同组别的 AECOPD 患者的致病菌不一样,且目前细菌耐药现状严峻,临床医师使用抗生素时应根据患者的综合评估、细菌耐药性情况,制定合理的抗感染治疗方案。     

2型糖尿病足感染的病原菌分析

235例2型糖尿病足合并感染患者的细菌谱和药敏进行分析.结果共分离出282株病原菌,革兰阳性菌126株,占44.68%;革兰阴性菌150株,占53.19%;真菌6株,占2.13%.其中金黄色葡萄球菌86株,占30.50%;大肠埃希菌72株,占25.54%.耐甲氧西林金黄色葡萄菌大于60%,肺炎克雷伯菌和大肠埃希菌对β-内酰胺类药物耐药率为44%～65%.结论糖尿病足感染主要以金黄色葡萄菌和大肠埃希菌多见,革兰阳性球菌感染呈上升之势.主要病原菌对常用抗菌药耐药率高.     

肝硬化合并自发性细菌性腹膜炎医院感染及社区感染病原学研究

目的 探讨肝硬化合并自发性细菌性腹膜炎(SBP)患者中医院感染与社区感染病原菌分布特点及耐药情况.方法 纳入北京地坛医院2001年1月至2008年12月腹水细菌培养阳性的肝硬化合并SBP患者226例,鉴定细菌并行药物敏感试验,数据行卡方检验和t检验.结果 医院感染的SBP患者共86例,占38.0%;社区感染的140例,占62.0%;Child-Pugh分级C级在医院感染和社区感染中各占97.7%和82.8%(x2=11.489,P=0.001),病死率分别为50.0%和30.0%(x2=9.081,P=0.003).腹水细菌培养出病原菌共232株、28种,其中医院感染SBP及社区感染SBP病原菌均以革兰阴性菌为主,分别占77.5%和76.9%,列前两位的均是大肠埃希菌和肺炎克雷伯菌,革兰阳性菌分别占19.1%和21.7%,真菌占3.4%和1.4%(P＞0.05).医院感染的SBP 32株大肠埃希菌和14株肺炎克雷伯菌中,分别有19株和5株产β-内酰胺酶(ESBL);社区感染的SBP60株大肠埃希菌和32株肺炎克雷伯菌中,只有11株大肠埃希菌产ESBL(P＜0.05).医院感染SBP革兰阴性菌对头孢菌素及喹诺酮耐药率明显高于社区感染SBP(P＜0.05),但均对亚胺培南较敏感(P＞0.05);医院感染SBP及社区感染SBP的革兰阳性菌株中,未发现对万古霉素耐药.结论 Child-Pugh C级肝硬化患者更易发生医院感染的SBP,且预后差;医院感染SBP及社区感染SBP病原菌群分布相似,以大肠埃希菌和肺炎克雷伯菌为主,但产ESBL阳性率明显升高.     

下呼吸道感染细菌分布及耐药性分析

目的了解安徽医科大学第一附属医院住院患者2009-2013年下呼吸道感染主要病原菌的分布和耐药性,为临床合理应用抗菌药物提供依据。方法收集我院住院患者痰培养及药敏结果,分析下呼吸道感染主要病原菌的分布和耐药性。结果我院下呼吸道感染常见病原菌以革兰阴性菌为主,占90.6%,主要病原菌为鲍曼不动杆菌(22.2%),铜绿假单胞菌(19.9%)、肺炎克雷伯菌(15.3%)、大肠埃希菌(7.5%)、嗜麦芽窄食单胞菌(6.2%)、阴沟肠杆菌(5.2%);革兰阳性菌占9.4%,主要病原菌为金黄色葡萄球菌(7.6%)、肺炎链球菌(1.2%)、屎肠球菌(0.2%)。耐药性分析结果显示:鲍曼不动杆菌对米诺环素、头孢哌酮/舒巴坦耐药率27%;铜绿假单胞菌对哌拉西林耐药率高达98.5%,对头孢吡肟、头孢哌酮/舒巴坦、阿米卡星耐药率19%;嗜麦芽窄食单胞菌对左氧氟沙星、米诺环素耐药率在15%左右;大肠埃希菌和肺炎克雷伯杆菌对β-内酰胺酶抑制剂复方制剂具有较高的敏感性,耐药率在15%左右,大肠埃希菌对碳青霉烯类耐药率5%,肺炎克雷伯杆菌对碳青霉烯类耐药率10%;葡萄球菌属对氨基苷类、喹诺酮类、头孢菌素类抗生素耐药率60%,未发现万古霉素、利奈唑胺、替加环素耐药株。结论下呼吸道感染病原菌以革兰氏阴性菌为主,耐药率高,应根据药敏结果合理选择抗生素指导治疗,以提高疗效及减少耐药菌株的产生。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.