一所教学医院重症监护病房病原及其耐药性分析

目的 了解2013年某教学医院重症监护病房（ICU）患者感染常见病原菌的分布及对抗菌药物的耐药性。方法 收集2013年某教学医院ICU患者临床分离的1379株非重复细菌,进行分析。 结果 共分离病原菌1379株,革兰阴性菌827株占60%,革兰阳性菌461株占33.4%,真菌91株占6.6%。最常见的菌种分别为鲍曼不动杆菌（26.4%）、金黄色葡萄球菌（17.8%）、铜绿假单胞菌（11.2%）、凝固酶阴性葡萄球菌（CNS,7.5%）、肺炎克雷伯菌（6%）、大肠埃希菌（5.7%）嗜麦芽窄食单胞菌（5.5%）和屎肠球菌（3.1%）。耐甲氧西林金葡菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为88.4%和88.3%,未发现对万古霉素、替考拉宁和利奈唑胺不敏感的葡萄球菌。粪肠球菌对所测抗菌药物的耐药率均明显低于屎肠球菌。检出2株耐万古霉素的屎肠球菌（VRE）,未发现对替考拉宁和利奈唑胺耐药的肠球菌。大肠埃希菌和肺炎克雷菌产ESBLs检出率分别为70%和36%。产ESBLs菌株对测试药物的耐药率明显高于非产ESBLs菌株。肠杆菌科细菌中发现1株耐碳氢酶烯类的肺炎克雷伯菌。铜绿假单胞菌对亚胺培南和美洛培南的耐药率分别为62.3%和60.4%,对其他测试药物的耐药率也都在42.9%以上。鲍曼不动杆菌对上述2种碳青霉烯类抗菌药物的耐药性分别为93.7%和94.2%,泛耐药鲍曼不动杆菌的检出率达到47.5%。真菌以白念珠菌为主,对5种抗真菌药物耐药率均小于5.9%。分离细菌的标本来源主要是痰液（58%）,其次是血液（16%）、引流液（10%）、尿液（7%）,以及胸水、腹水等。 结论 该教学医院ICU分离的细菌耐药现象严重,特别是多耐药革兰阴性杆菌,应加强病原学和耐药性监测,为临床合理应用抗菌药物和预防医院感染提供一定的参考依据。     

2005年我院1 341株医院感染病原菌分布及耐药性分析

对我院2005年各类感染标本中分离的1341株病原菌的分布及耐药情况进行回顾性分析。结果革兰阳性球菌476株,以凝固酶阴性葡萄球菌（205株）、金黄色葡萄球菌（117株）为主,耐甲氧西林的葡萄球菌与红霉素可诱导可林霉素耐药的菌株分别占葡萄球菌的46.1%、35.1%;革兰阴性杆菌727株,依次为大肠杆菌、绿脓杆菌、不动杆菌、肺炎克雷伯菌等,其中产超广谱β-内酰胺酶（ESBLs）的大肠杆菌和肺炎克雷伯菌比例较高,并出现多重耐药的绿脓杆菌和鲍曼不动杆菌;真菌分离率增高;药敏结果分析亚胺培南、美罗培南、万古霉素、替考拉宁仍保持较高的敏感性。提示抗感染治疗应根据药敏结果合理应用抗生素。     

2009年山东大学附属省立医院细菌耐药性监测及分析

目的了解山东大学附属省立医院2009年临床分离菌株分布及耐药谱。方法收集山东大学附属省立医院2009年首次非重复分离株1 821株,细菌鉴定采用VITEK鉴定系统,药敏试验采用纸片扩散法,数据采用WHONET 5.4软件进行统计分析。结果大肠埃希菌和肺炎克雷伯菌对碳青霉烯类药物最敏感;柠檬酸杆菌属、沙雷菌属对碳青霉烯类药物敏感率较高,肠杆菌属和柠檬酸杆菌属对头孢西丁的耐药率分别为98.6%和85.7%,而沙雷菌属耐药率仅为30%;铜绿假单胞菌对哌拉西林/他唑巴坦、头孢吡肟、哌拉西林、头孢他啶、美罗培南、亚胺培南和头孢哌酮/舒巴坦较敏感,对其他药物敏感率均〈70%;鲍曼不动杆菌对亚胺培南、美罗培南敏感率为82.3%、73.2%,对头孢哌酮/舒巴坦耐药率为11.6%,对其他药物耐药率在15.0%~67.8%;葡萄球菌对万古霉素和利奈唑胺100%敏感,耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌检出率分别为45.0%和86.8%;屎肠球菌和粪肠球菌对万古霉素和利奈唑胺最敏感。结论肠杆菌科细菌对碳青霉烯类药物仍最为敏感,但不发酵糖菌对其耐药率升高;葡萄球菌属中均未发现耐万古霉素菌株。     

新生儿病房病原菌分布及耐药性分析

目的分析新生儿临床分离病原菌的分布及耐药特点。方法住院新生儿3118例,疾病分类中以新生儿肺炎为主（65．3％）。收集其呼吸道、血液及其他体液、引流物等标本,采用VITEK2Compact鉴定及药敏系统或ATB鉴定及药敏系统对分离菌进行鉴定和药敏试验。结果共分离不重复菌株5586株,其中革兰阴性杆菌占68．O％,革兰阳性球菌占25．1％,分离率占前3位的为肺炎克雷伯菌、大肠埃希菌和金黄色葡萄球菌。标本来源中,呼吸道标本占绝大多数,其次为血液、胃液等。肠杆菌科细菌对碳青霉烯类（亚胺培南、美罗培南等）仍表现出高度敏感性,但已经出现耐药菌株。肺炎克雷伯菌、大肠埃希菌产超广谱B-内酰胺酶（ESBLs）的检出率分别为70．8％和57．4％,产ESBLs菌株对各种药物的敏感性由高到低依次为：亚胺培南、美罗培南、阿米卡星、环丙沙星、头孢哌酮／舒巴坦、哌拉西彬他唑巴坦。铜绿假单胞菌、鲍曼不动杆菌对亚胺培南的敏感率分别为95．3％、75．4％,嗜麦芽窄食单胞菌对左氧氟沙星、复方新诺明、米诺环素的敏感率为94．3％～98．1％。流感嗜血杆菌Es—BLs的产酶率为34．8％,对氧氟沙星、头孢噻肟均100％敏感。葡萄球菌中耐甲氧西林葡萄球菌（MRS）的总分离率为41．9％,其中耐甲氧西林金黄色葡萄球菌（MRSA）占6．5％,耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）占93．5％。MRS尚未出现对万古霉素、替考拉宁、利奈唑胺、阿米卡星等耐药的菌株。屎肠球菌对抗菌药物的耐药性较严重,已经出现耐万古霉素的屎肠球菌。非脑膜炎肺炎链球菌中,青霉素的耐药率为7．7％。结论及时开展新生儿病原学监测,了解细菌分布及其耐药趋势,对合理选择抗菌药物、预防和控制耐药菌株产生、保障新生儿生命安全具有重要意义。     

2187株病原菌耐药性分析

目的了解2 187株临床分离菌对抗菌药物的耐药性。方法按照常规方法留取临床标本,VITEK-32全自动微生物分析仪鉴定及药敏定量。结果共收集到病原菌2 187株,其中革兰阴性菌1 374株（62.8%）,革兰阳性菌813株（37.2%）。金黄色葡萄球菌和凝固酶阴性葡萄球菌中耐甲氧西林菌株分别占72.2%和88.0%,耐甲氧西林的金黄色葡萄球菌和耐甲氧西林的凝固酶阴性葡萄球菌对β内酰胺类抗生素和其他抗菌药物的耐药率高于甲氧西林敏感株,均未发现对万古霉素和利奈唑烷耐药株。粪肠球菌和屎肠球菌分别有0.9%和11.6%对万古霉素耐药,但对利奈唑烷和链霉素2000高度敏感;大肠埃希菌、肺炎克雷伯菌中产超光谱β内酰胺酶（ESBLs）菌株检出率分别为45.6%和45.1%。结论随着大量广谱抗菌药物在临床广泛应用,机会病原菌成为致病病原菌,铜绿假单胞菌、大肠埃希菌位居致病菌第一、二位,医院病原菌耐药性明显。     

重症监护病房病原菌分布及耐药性分析

目的:了解2013年我院重症监护病房(ICU)患者病原菌的分布及对抗菌药物的耐药性。方法:收集我院2013年ICU感染患者临床分离的1379株非重复细菌、并进行分析。结果:分离细菌的标本来源主要是痰液(58%),其次是血液(16%)、引流液(10%)、尿液(7%),以及胸水、腹水等。共分离病原菌1379株,G-菌827株占60%,G+菌461株,占33.4%,真菌91株,占6.6%。最常见的菌种分别为鲍曼不动杆菌(26.4%)、金黄色葡萄球菌(17.8%)、铜绿假单胞菌(11.2%)、凝固酶阴性葡萄球菌(CNS,7.5%)、肺炎克雷伯菌(6%)、大肠埃希菌(5.7%)、嗜麦芽窄食单胞菌(5.5%)和屎肠球菌(3.1%)。其中耐甲氧西林金葡菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为88.4%和88.3%,未发现对万古霉素、替考拉宁和利奈唑胺不敏感的葡萄球菌。粪肠球菌对所测抗菌药物的耐药率均明显低于屎肠球菌。检出2株耐万古霉素的屎肠球菌(VRE)。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)的检出率分别为70%和36%。肠杆菌科细菌中发现1株耐碳青霉烯类的肺炎克雷伯菌。铜绿假单胞菌对亚胺培南和美洛培南的耐药率分别为62.3%和60.4%,对其他测试药物的耐药率也都在42.9%以上。鲍曼不动杆菌对上述2种碳青霉烯类抗菌药物的耐药性分别为93.7%和94.2%,泛耐药鲍曼不动杆菌的检出率达到47.5%。真菌以白色念珠菌为主,对5种抗真菌药物耐药率均小于5.9%。结论:我院ICU分离的细菌耐药现象严重,特别是多耐药革兰阴性杆菌,应加强病原学和耐药性监测,为临床合理应用抗菌药物和预防医院感染提供一定的参考依据。     

老年患者医院获得性肺炎耐药性临床分析

目的 分析老年患者医院获得性肺炎致病菌的菌群分布及其对抗生素的耐药情况,为临床合理使用抗生素提供依据.方法 对我院2006年6月至2009年9月160例老年患者医院获得性肺炎的临床资料进行回顾性分析,明确病原学特点及对抗生素的耐药情况.结果 共分离出180株病原菌,其中革兰阴性菌108株(60.0%),革兰阳性菌48株(26.7%),真菌24株(13.3%).革兰阴性菌中铜绿假单胞菌检出率最高(20.5%),革兰阳性菌中金黄色葡萄球菌检出率最高(11.1%).长期使用抗生素、广谱抗生素的慢性患者真菌检出率增高.革兰阴性杆菌对三代头孢菌素均耐药,产超广谱β内酰胺酶的大肠埃希菌、肺炎克雷伯菌对青霉素类、青霉素+酶抑制剂、头孢菌素类和单酰胺类抗生素均耐药,铜绿假单胞菌耐药严重,但对头孢他啶尚敏感.革兰阴性菌对阿米卡星、哌拉西林+他唑巴坦、头孢哌酮+舒巴坦、亚胺培南、美洛培南的敏感性较高.耐甲氧西林金黄色葡萄球菌(MRSA)占92.6%,革兰阳性菌对阿奇霉素、环丙沙星、氨苄西林、氨苄西林+舒巴坦的耐药率多在76%以上,而对万古霉素、利奈唑胺、替考拉宁敏感性高,尚未发现耐万古霉素、利奈唑胺、替考拉宁的葡萄球菌菌株.结论 老年患者医院获得性肺炎以革兰阴性杆菌为优势菌株,产超广谱β内酰胺酶的大肠埃希菌、肺炎克雷伯菌呈逐年增高趋势,且耐药性日趋严重,其对阿米卡星、哌拉西林+他唑巴坦、头孢哌酮+舒巴坦、亚胺培南、美洛培南敏感性较高.革兰阳性球菌感染宜用万古霉素、利奈唑胺或替考拉宁.     

2005年湖北地区三级医院成人细菌耐药性分析

目的分析2005年湖北地区三级医院成人临床分离菌的耐药情况，为临床合理用药提供依据。方法对湖北省细菌耐药监测协作组提供2005年湖北地区三级医院细菌耐药性监测资料（成人组）进行临床分析。结果2005年共分离临床细菌10131株，革兰阳性球菌占30．9％，革兰阴性杆菌占69．1％。耐苯唑西林金黄色葡萄球菌（MRSA）和耐苯唑凝固酶阴性葡萄球菌（MRCNS）分别占金黄色葡萄球菌（SA）和凝固酶阴性葡萄球菌（CNS）的50％和64．4％。大肠埃希菌产超广谱β～内酰胺酶（ESBLs）株占41．1％，克雷伯菌属产ESBLs株占35．4％。结论2005年湖北地区细菌耐药率高，及时准确检测病原菌，并对耐药菌株进行监测，有助于临床医师合理使用抗菌药物。     

临床标本病原菌分布及药敏试验分析

了解不同临床标本病原菌的分布情况，以及主要致病菌的药物敏感性，为合理使用抗生素提供依据。方法统计分析四川省人民医院2006—01／12分离的主要病原菌种类及药敏试验结果。结果检出的2494株病原菌中，主要病原菌依次为大肠埃希菌（17．8％），克雷伯菌属（15．8％），金黄色葡萄球菌（15．2％），真菌（14．8％），凝固酶阴性葡萄球菌（13．3％），假单胞菌属（10．3％）。革兰阳性球菌对万古霉素、替考拉宁的耐药率较低，革兰阴性杆菌耐药率最低的是亚胺培南和美洛培南。结论耐药菌株不断增加，细菌耐药性问题日趋严重，真菌检出率增高，应加强临床抗生素合理使用，以减少耐药菌及耐药菌感染的发生和发展。     

老年住院患者感染病原菌及其耐药情况分析

2008年1月~2009年12月本院70岁以上老年住院患者共检出细菌211株,菌株数前5位的依次是大肠埃希菌(51株)、肺炎克雷伯菌(33株)、鲍曼不动杆菌(20株)、表皮葡萄球菌(17株)和阴沟肠杆菌(14株);感染部位以下呼吸道为主,其次是泌尿道和血液。64.71%的大肠埃希菌(33株)产超广谱β-内酰胺酶(ESBLs),耐甲氧西林金黄葡萄球菌(MRSA)占63.64%(7株)。革兰阳性球菌未发现万古霉素耐药菌株,革兰阴性杆菌未发现亚胺培南和美罗培南耐药菌株。老年住院患者检出菌以革兰阴性菌为主,且存在不同程度的耐药。     

The role of beta-lactamase in mixed infections in mice in relation to treatment with ampicillin

Beta-lactamase-producing Staphylococcus aureus and Bacteroides fragilis in a localized mixed infection has been found to degrade the beta-lactam antibiotic at the focus of infection, thus protecting both the bacteria and pathogens susceptible to the antibiotic. To determine if beta-lactamase produced by Hemophilus influenzae and Branhamella catarrhalis have similar importance in mixed infections, a thread infection model in mice was used to evaluate the capacity of beta-lactamase produced by S. aureus, B. catarrhalis, or H. influenzae to hydrolyze ampicillin in a mixed infection with Streptococcus pneumoniae in mice. For both S. aureus and B. catarrhalis, the ampicillin concentrations at infection sites where beta-lactamase was produced were lower than at sites where beta-lactamase was not produced; however, this difference was not found when clavulanic acid was added to the ampicillin. In mixed infections with strains that did not produce beta-lactamase, ampicillin concentrations were similar with or without clavulanic acid. S. aureus was the best "protector" followed by B. catarrhalis. The beta-lactamase produced by H. influenzae failed to protect the S. pneumoniae. No bactericidal effect of clavulanic acid was found.     

儿童社区获得性肺炎细菌病原学特点分析研究

目的：探讨儿童社区获得性肺炎（ CAP ）细菌病原学特点及药敏情况,指导临床肺炎诊治。方法系统分析956例住院CAP患儿的临床特征,细菌病原学特点和微生物敏感性试验情况。结果956例CAP患儿痰培养中革兰阴性（ G－）杆菌为653例,占68．3％;革兰阳性（ G＋）球菌为303例,占31．7％。主要有大肠埃希杆菌253例（26．5％）,肺炎克雷伯杆菌166例（17．4％）,流感嗜血杆菌78例（8．2％）,鲍曼不动杆菌53例（5．5％）,铜绿假单胞杆菌41例（4．3％）,肺炎链球菌47例（4．9％）和金黄色葡萄球菌41例（4．3％）。二级医院CAP常见病原为流感嗜血杆菌、卡他莫拉菌、肺炎链球菌;而三级医院则为大肠埃希杆菌、肺炎克雷伯杆菌、鲍曼不动杆菌、凝固酶阴性葡萄球菌。铜绿假单胞杆菌对泰能和美罗培南均有耐药,鲍曼不动杆菌对泰能有一定的耐药率。肺炎链球菌对青霉素、复方磺胺甲恶唑、克林霉素、红霉素及阿奇霉素均耐药。金黄色葡萄球菌对青霉素全耐药,对复方磺胺甲恶唑、氨苄西林、红霉素、阿奇霉素及四环素也有较高的耐药率。结论儿童CAP病原菌中革兰阴性杆菌并不少见,对抗菌药物耐药率高,需引起重视。     

医疗机构相关性肺炎病原学特征分析

目的 分析医疗机构相关性肺炎（HCAP）的病原菌特征,以提高其治疗效果.方法 回顾性收集我院284例住院肺炎患者资料,比较HCAP和社区获得性肺炎（CAP）病原菌感染情况.结果 284例肺炎患者（CAP组183例,HCAP组101例）共培养出病原菌487株;CAP组前五位病原菌为肺炎链球菌43株（32.6％）,肺炎支原体24株（18.2％）,流感嗜血杆菌19株（14.4％）,铜绿假单胞菌8株（6.1％）,金黄色葡萄球菌4株（3.0％）;HCAP组前五位病原菌为铜绿假单胞菌121株（34.1％）,金黄色葡萄球菌57株（16.1％）,鲍曼不动杆菌50株（14.1％）,肺炎克雷伯菌31株（8.7％）,大肠埃希菌25株（7.0％）;HCAP组培养出革兰阴性杆菌288（81.1％）株,革兰阳性球菌67（18.9％）株,革兰阴性杆菌和革兰阳性球菌中又分别以铜绿假单胞菌[121株（42.0％）]和金黄色葡萄球菌[57株（85.1％）]最为常见.结论 HCAP病原菌种类不同于CAP,提高对HCAP病原菌种类的认识可为合理初始经验性抗生素治疗提供可靠的依据.     

Studies on respiratory infections in primary care clinic (IV). Antibiotic sensitivity of bacteria isolated from patients with respiratory infections visiting 21 private clinics in the Tohoku District of Japan

We determined the MICs of ampicillin, methicillin, cefaclor, cefixime, cefteram, ofloxacin and ciprofloxacin against a total of 1,448 strains from 11 species: 464 strains of Staphylococcus aureus, 306 strains of Streptococcus pneumoniae, 114 strains of Streptococcus pyogenes, 37 strains of Branhamella catarrhalis, 329 strains of Haemophilus influenzae, 32 strains of Escherichia coli, 66 strains of Klebsiella pneumoniae, 26 strains of Enterobacter cloacae, 20 strains of Serratia marcescens, 12 strains of Pseudomonas aeruginosa and 42 strains of Acinetobacter calcoaceticus, isolated from the throat swab and the sputum of 2,539 patients with respiratory infections who visited 21 private clinics in Tohoku district of Japan during the period from January to April in 1989. Ciprofloxacin and ofloxacin were more active against S. aureus, B. catarrhalis, P. aeruginosa and A. calcoaceticus than other antibiotics. Ampicillin and cefteram were more active against S. pneumoniae and S. pyogenes than other antibiotics. New-quinolones and cephems of new-generation were active against H. influenzae, E. coli, K. pneumoniae, E. cloacae and S. marcescens. Of 30 strains of S. aureus which were resistant (MIC greater than or equal to 12.5 micrograms/ml) to ampicillin, only one strain was resistant (MIC greater than or equal to 12.5 micrograms/ml) to methicillin. Twenty strains (6.5%) of S. pneumoniae and 49 strains (14.9%) of H. influenzae were resistant (MIC greater than or equal to 1.56 micrograms/ml) to ampicillin. Of 101 strains of H. influenzae of which their beta-lactamase activity was determined by Nitrocephin-method, 27 (26.7%) were beta-lactamase-positive strains. The above results indicated that MRSA is only rarely found in primary care clinics but the incidence of ampicillin-resistant H. influenzae in primary care clinics is almost the same as that of the intensive care clinic, i.e. medical school-affiliated hospitals. Therefore caution should be exercised as regards antibiotic resistance of the causative organism even in primary care clinics.     

下呼吸道感染患儿肺泡灌洗液的病原菌分布及其耐药模式

目的:了解2016年至2018年我国下呼吸道感染患儿的肺泡灌洗液病原菌分布及其对抗菌药物的耐药情况。方法:采集2016年1月至2018年12月10家三级医院收治的年龄<18岁的下呼吸道感染患儿的肺泡灌洗液标本,培养分离获得病原菌。采用纸片扩散法或最低抑菌浓度法对分离菌株进行药物敏感试验,分析病原菌的分布情况,以及菌株来...     

Studies on respiratory infections in primary care clinic (II). Distribution and antibiotic sensitivity to 45 agents of bacteria isolated from patients with respiratory infections visiting a doctor in private practice

The bacteriology of the isolates from the sputum or the throat swab of patients with respiratory infections visiting a doctor in private practice in Sendai city during the period from March in 1988 to February in 1989 was documented, and their sensitivity to 45 antimicrobial agents was determined. Of the 568 patients, 514 cases had acute pharyngitis, 8 cases each had acute tonsillitis and acute bronchitis, 7 cases were acute pneumonia, 6 cases had herpangina, 18 cases had hand-foot-mouth disease with the signs of respiratory infections, 5 cases had varicella with the signs of respiratory infections and 2 cases were mumps with the signs of respiratory infections. Three hundred strains of potential (greater than or equal to 10(7) CFU/ml) pathogens were recovered from 293 of the 568 cases, which consisted of 124 strains of Haemophilus influenzae, 58 strains of Streptococcus pneumoniae, 45 strains of Staphylococcus aureus, 26 strains of Branhamella catarrhalis, 25 strains of Streptococcus pyogenes, 9 strains of Klebsiella pneumoniae and 13 strains of other species, not including non-fermentile gram-negative bacteria such as Pseudomonas aeruginosa and Acinetobacter calcoaceticus. Staphylococcus aureus and other strains were documented simultaneously in 6 out of 7 cases in which multi-organisms were recovered. Many strains of Staphylococcus aureus were isolated from young patients throughout the year. On the other hand many strains of Branhamella catarrhalis were isolated from elderly patients in winter. The sensitivity of 45 antimicrobial agents of 231 of 300 strains was determined by sensitivity disks (EIKEN, Japan). No strain of the Haemophilus influenzae in this study was resistant to ampicillin. None of the Streptococcus pneumoniae and Streptococcus pyogenes was resistant to ampicillin or cefazolin. None of the Staphylococcus aureus was resistant to cloxacillin, cefazolin, gentamicin or ofloxacin. We conclude from the above results that antibiotic-resistant strains are found presumably only in a very few cases in primary care clinic.     

Investigate of nasopharyngeal flora in highly aged patients

To clarify the bacteriological interpretation of flora in the nasopharynx of highly aged patients (n = 107), healthy nasopharyngeal swabs were obtained from subjects of advanced age. Chief pathogenic bacteria isolated from highly aged persons were coagulase negative Staphylococcus (43 strains), Corynebacterium spp. (14 strains), methicillin-susceptible Staphylococcus aureus (beta-lactamase production and non-production) (16 strains), methicillin-resistant Staphylococcus aureus (beta-lactamase production) (6 strains). Chief nonpathogenic bacteria isolated from highly aged persons were alpha-streptococcus (14 strains), Neisseria sp (3 strains). Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis which are the chief bacteria isolated from children, demonstrated only 3 strains for each bacteria. In cases showing detection of multiple detected bacteria, common combinations were non-pathogenic bacteria and weakly pathogenic bacteria and enteric bacteria and pathogenic bacteria. The differences between nasopharyngeal flora of children and highly aged persons are suspected to be due to the differences in immunological and anatomical factors. We should actively examine these factors in highly aged subjects.     

Therapy of chronic recurrent respiratory tract infections

In 1987, the most frequently identified pathogens in chronic respiratory tract infections in our clinic were Haemophilus influenzae, Pseudomonas aeruginosa, Branhamella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus and Klebsiella pneumoniae. Recurrent infection is a common phenomenon in patients with chronic respiratory tract infections, including chronic bronchitis, chronic bronchiolitis and bronchiectasis. H. influenzae is the most common pathogen in such patients. Macrolides, tetracyclines and new quinolones were effective to protect against recurrent infection of H. influenzae and these finding suggested that L-forms of H. influenzae may be significant in the recurrence of infection in patients with chronic respiratory tract infection. Bacterial colonization of the oropharynx is the initial event in most lower respiratory tract infections. Gargling protects against bacteria colonization of the oropharynx and occurrence of acute exacerbation.     

Microbiology of sinusitis

Most sinus infections are viral, and only a small proportion develops a secondary bacterial infection. Rhinoviruses, influenza viruses, and parainfluenza viruses are the most common causes of sinusitis. The most common bacteria isolated from pediatric and adult patients with community-acquired acute purulent sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes. Staphylococcus aureus and anaerobic bacteria (Prevotella and Porphyromonas, Fusobacterium and Peptostreptococcus spp.) are the main isolates in chronic sinusitis. Pseudomonas aeruginosa and other aerobic and facultative gram-negative rods are commonly isolated from patients with nosocomial sinusitis, the immunocompromised host, those with HIV infection, and in cystic fibrosis. Fungi and Pseudomonas aeruginosa are the most common isolates in neutropenic patients. The microbiology of sinusitis is influenced by the previous antimicrobial therapy, vaccinations, and the presence of normal flora capable of interfering with the growth of pathogens.     

PROTEKT 1999-2000: a multicentre study of the antimicrobial susceptibility of respiratory tract pathogens in Japan.

DESIGN: A six-centre study in Japan during the winter of 1999-2000 assessed the in vitro activity of >20 antimicrobial agents against the common respiratory pathogens Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, and Moraxella catarrhalis. The minimum inhibitory concentrations (MIC) of each antimicrobial was determined against these isolates using National Committee for Clinical Laboratory Standards (NCCLS) methodology. RESULTS: Among S. pneumoniae isolates, 44.5% were penicillin resistant. The macrolide resistance rate was 77.9% with 90.5% of penicillin-resistant strains also being macrolide resistant. Resistance mechanisms in macrolide-resistant isolates were identified as mef(A) or erm(B) in 42.5% and 52.5%, respectively. Of the fluoroquinolone-resistant isolates (1.3%), most were also penicillin and macrolide resistant. All strains were inhibited by telithromycin at 相似文献