4种菌落形态铜绿假单胞菌药物敏感性比较

摘要:目的　比较4种菌落形态铜绿假单胞菌的药物敏感性。方法　采用VITEK2 compact全自动细菌鉴定系统及配套的GN、GN16和E-test、K-B纸片等方法对菌株进行鉴定和药物敏感性试验,并用χ2检验进行统计分析。结果　1188株铜绿假单胞菌对亚胺培南和哌拉西林/他唑巴坦敏感率均大于80%;对阿米卡星敏感率为78.3%;对头孢他啶、头孢吡肟、妥布霉素、庆大霉素和左氧氟沙星敏感率均在53.2%～64.9%;对氨曲南敏感率仅为47.2%。黏液型铜绿假单胞菌对常见抗菌药物敏感性均高于典型菌落组,侏儒型铜绿假单胞菌除头孢他啶、头孢吡肟和阿米卡星外,药物敏感性均低于典型菌落组,而大肠菌样型铜绿假单胞菌除了亚胺培南敏感率较低外,其余药物敏感率与典型菌落组相差不大。结论　不同菌落型铜绿假单胞菌药物敏感性不同,希望临床医生在治疗铜绿假单胞菌感染的过程中,尽量根据实验室结果选用合适的抗菌药物,避免诱导铜绿假单胞菌产生对抗菌药物的广泛耐药。     

老年患者肺部感染病原菌及药物敏感性分析

目的了解老年患者肺部感染的病原菌分布及药物敏感性情况,指导临床合理选择抗菌药物。方法分离细菌经VITEK-2鉴定后,采用K-B法进行药物敏感试验,WHONET5.0软件进行统计分析,按CLSI 2008年标准判断药物敏感率。结果 10 970株病原菌经鉴定有62种,分离率前10位的菌株有10 305株(93.94%),其中90.0%为革兰阴性菌,以铜绿假单胞菌为首;分离前5位的细菌中肺炎克雷伯菌对抗菌药物的敏感率较高,而金黄色葡萄球菌除对万古霉素、替考拉宁和利奈唑胺的敏感率为100.00%外,对其他药物的敏感率<30.00%;铜绿假单胞菌、鲍氏不动杆菌对多种抗菌药物的敏感率<60.00%。结论老年患者肺部感染病原菌以革兰阴性菌为主,对抗菌药物表现出不同程度的耐药,临床应结合药敏试验结果进行选药。     

486株铜绿假单胞菌分离情况及耐药性分析

目的了解长沙市第一医院486株铜绿假单胞菌分离情况及耐药性,以指导临床用药。方法采用回顾性分析方法,收集2007年7月20日-2010年7月20日本院临床送检的痰、伤口分泌物、尿液等标本培养的资料,分析细菌鉴定及药敏试验。细菌鉴定采用法国梅里埃公司VITEK-32全自动微生物分析系统鉴定;药敏试验方法,采用K-B(Kirby-Bauer)法,严格按照CLSI标准判定敏感菌株。结果共分离到铜绿假单胞菌486株。药敏结果提示,铜绿假单胞菌对氨苄西林、阿莫西林及头孢曲松高度耐药,其敏感率均不到50%;β-内酰胺类及第三代、四代头孢菌素类其耐药率明显上升,而β-内酰胺类加酶抑制剂复合制剂则敏感率有所增加,尤其是舒普深具有较高的药物敏感率,其敏感率高达95.7%。碳青霉烯类抗生素如:美罗培南、亚胺培南等药物由于临床大量应用,明显增加了铜绿假单胞菌对其耐药性,应引起临床高度重视。结论铜绿假单胞菌对常用抗菌药物耐药情况严重,临床应加强药敏测定,合理应用抗菌药物,减少细菌耐药性的产生。     

PAE产金属β-内酰胺酶分离株与新生儿感染耐药性

目的:了解该院新生儿感染产金属β-内酰胺酶铜绿假单胞菌的情况并分析其耐药性。方法:标本纯培养后采用法国梅里埃公司的VITEK-32全自动细菌鉴定系统鉴定到种,协同法检测铜绿假单胞菌产生金属β-内酰胺酶的发生率,K-B法测定铜绿假单胞菌对抗菌药物的耐药性。结果:分离的266株铜绿假单胞菌,检出51株产金属β-内酰胺酶铜绿假单胞菌,占19.17%(51/266)。产酶株对哌拉西林、头孢他啶、头孢哌酮、左氧氟沙星的耐药率远远高于不产酶菌株,对阿米卡星的耐药率相对较低,对头孢哌酮/舒巴坦、头孢吡肟、环丙沙星部分敏感。结论:产金属β-内酰胺酶在新生儿感染铜绿假单胞菌耐药率呈逐年上升趋势,产酶株和不产酶株相比,对同一种抗菌药物的耐药率明显不同,二者差异有统计学意义。实验室重视对金属β-内酰胺酶的检测可帮助临床合理选用抗菌药物并减少细菌耐药性的产生。     

2011-2013年铜绿假单胞菌临床分离株的耐药性变迁分析

目的了解2011-2013年临床分离的铜绿假单胞菌对抗菌药物的耐药性变迁,为临床医师选择敏感抗菌药物治疗感染性疾病提供参考依据。方法调查统计医院2011-2013年临床分离的612株铜绿假单胞菌在各类感染性标本中的分布,以及铜绿假单胞菌对临床抗菌药物的耐药率,临床标本的正确采集运送、菌株分离培养及鉴定严格按照《临床微生物学操作技术流程》进行;药敏操作技术和数据界定采用K-B法及CLSI当年新的折点进行;数据采用WHONET5.5-5.6统计软件处理。结果 2011-2013年临床标本中共分离出铜绿假单胞菌612株,其中分离自呼吸道338株、泌尿道133株,分别占55.2%、21.7%;2011-2013年耐碳青霉烯类铜绿假单胞菌检出率分别为8.5%、10.2%、12.4%,泛耐药铜绿假单胞菌检出率分别为8.5%、8.7%、9.2%;2011-2013年耐药率上升幅度较大的抗菌药物为氨曲南、头孢他啶、环丙沙星;耐药率基本持平的抗菌药物为阿米卡星和庆大霉素;耐药率有所下降的抗菌药物为磺胺甲噁唑/甲氧苄啶、头孢哌酮/舒巴坦。结论 2011-2013年临床分离的铜绿假单胞菌对大多数抗菌药物耐药率表现出逐年上升趋势,因此,动态监测细菌耐药性已成为医院管理的重要项目,务必实施抗菌药物科学管理,力图扭转细菌耐药性非正常增长的不良趋势。     

2011-2013年患者呼吸道感染铜绿假单胞菌耐药监测分析

目的了解大庆地区患者呼吸道感染铜绿假单胞菌对临床常用抗菌药物的耐药性,为临床合理用药提供依据。方法比较2011-2013年呼吸道感染患者分离的1 623株铜绿假单胞菌对临床常用抗菌药物耐药性,使用法国生物梅里埃公司VITEK-2全自动细菌鉴定及药敏分析仪进行菌种鉴定,药敏试验采用手工测定法。结果2011年共分离铜绿假单胞菌496株,铜绿假单胞菌对阿米卡星敏感性最高,敏感率为78.48%,其次为美罗培南,敏感率为77.61%;2012年分离出铜绿假单胞菌496株,铜绿假单胞菌对阿米卡星敏感性仍最高,敏感率为92.03%,其次为妥布霉素,敏感率为91.58%;2013年分离出铜绿假单胞菌631株,铜绿假单胞菌对阿米卡星敏感性仍最高,敏感率为86.42%,其次为环丙沙星,敏感率为76.72%。结论铜绿假单胞菌对常用抗菌药物较敏感,传统敏感药物亚胺培南、头孢吡肟及头孢他啶敏感率呈逐年下降趋势,但仍保持约60.00%的敏感性,而阿米卡星及环丙沙星仍保持较高敏感性,可供临床选择。     

ICU下呼吸道感染铜绿假单胞菌耐药分析

近年来随着抗菌药物的广泛使用,铜绿假单胞菌引起医院感染逐渐增多,耐药现象较为严重,故对ICU下呼吸道感染患者的痰标本中分离出的116株铜绿假单胞菌的耐药性进行分析,指导临床合理使用抗菌药物. 1资料与方法 1.1菌株来源 菌株来自2009年9月-2011年7月ICU下呼吸道感染标本分离出116株铜绿假单胞菌. 1.2细菌鉴定与药教试验细菌鉴定为常规鉴定方法.药敏方法采用K-B纸片扩散法,根据NCCLS标准判读结果,质控菌株为铜绿假单胞菌ATCC27853,药敏纸片为德辰公司提供. 2结果     

呼吸内科病房感染铜绿假单胞菌的耐药分析

目的 了解医院呼吸内科病房患者感染铜绿假单胞菌耐药谱的变化,指导呼吸内科合理用药. 方法 收集2007年1月-2008年12月呼吸内科送检的感染患者标本,分离铜绿假单胞菌,分析各类标本分离的铜绿假单胞菌构成比;采用MicroScan NC31、NC33鉴定药敏复合板进行鉴定和药敏试验,按美国临床实验室标准化研究所标准对常用的25种抗菌药物进行耐药性分析. 结果 共分离出196株铜绿假单胞菌,主要来源于痰液,占96.4%,铜绿假单胞菌对加替沙星较敏感,敏感率为100.0%;对头孢噻肟、头孢曲松的敏感率在10.0%～15.0%;对头孢他啶等其他11种药物的敏感率在60.0%～85.0%;14种抗菌药物中4种抗菌药物敏感率下降9种抗菌敏感率略有上升,加替沙星尚未出现耐药现象. 结论 医院呼吸内科铜绿假单胞菌耐药情况控制较好,临床应继续根据药敏结果合理使用抗菌药物.     

2007年医院临床常见病原菌耐药性监测及分析

目的 了解医院2007年临床分离菌对常用抗菌药物的耐药情况. 方法 常规分离、培养并鉴定细菌,运用纸片扩散法对细菌进行药物敏感试验. 结果 1124株分离菌中,革兰阳性菌株占23.1%,革兰阴性菌株占76.9%;耐甲氧西林菌株在金黄色葡萄球菌和凝固酶阴性葡萄球菌中的检出率分别为55.7%和75.0%;屎肠球菌的耐药率明显高于粪肠球菌,肠杆科细菌对碳青酶烯类抗菌药物仍然高度敏感,产ESBLs菌株在大肠埃希菌和克雷伯菌属中的检出率分别为44.6%和32.4%;铜绿假单胞菌对亚胺培南和美罗培南的耐药率比较高,分别达到38.1%和41.0%,不动杆菌属细菌对亚胺培南和美罗培南的耐药率相对较低,分别为13.3%和17.2%. 结论 耐甲氧西林菌株和产ESBLs菌株的检出率高,加强细菌耐药性监测有助于临床医师合理使用抗菌药物,防止耐药菌株的流行和传播.     

产ESBLs铜绿假单胞菌耐药性分析 FREE

目的了解某院临床分离的铜绿假单胞菌产超广谱β 内酰胺酶(ESBLs)情况及其耐药性。方法对2007年7月1日-2008年6月30日间分离的细菌,采用API半自动微生物鉴定系统进行鉴定和药敏试验;采用改良三相水解试验检测产ESBLs铜绿假单胞菌。结果共收集64株铜绿假单胞菌,其中ESBLs阳性株33株,占51.56%;ESBLs阳性菌株对青霉素及头孢菌素类抗生素大多耐药,而对美罗培南敏感（耐药率18.18%）;ESBLs阳性菌株对多种抗菌药物的耐药率显著高于ESBLs阴性菌株（P＜0.01或P＜0.05）。结论铜绿假单胞菌产ESBLs率较高,这也是其对青霉素及头孢菌素类抗生素耐药的重要机制;及时监测产ESBLs铜绿假单胞菌的发生率及耐药趋势对指导临床用药至关重要。     

也门亚丁港地下水及其净化水质量分析

目的:从亚丁郊区深水井和纯净水站采集样品进行检测,为护航编队补给生活及饮用淡水提出建议。方法:进行pH、水温、电导率、肉眼可见物、色度、臭和味、总硬度、重金属(Fe、Pb、Cd、Cr)、阴离子(F-,Cl-,SO24-,NO3-)、COD和微生物项目检测,并进行比较。结果:井水中的氯离子含量在336 mg/L~627 mg/L之间,硬度在700 mg/L~850 mg/L之间,远远超出WHO、也门共和国和我国饮水水质标准的限值,不能直接饮用,同时,个别水源中氟元素、硝酸根离子和铅的含量偏高,但经过净化处理后,各项指标都在生活饮用水卫生标准限值范围内。结论:净化水能适用于远洋船只的补给和饮用。     

吉布提等城市及码头给水卫生质量的调查分析

目的:了解护航编队停靠码头及城市供水水质情况,为舰艇停靠补给提供科学依据。方法:在亚丁、塞拉莱和吉布提的城市和对应港口,调查了59个供水点的基本卫生情况,抽检85样品,进行电导率、pH值、肉眼可见物、重金属、阴离子和菌落总数等23个项目分析,并进行比较分析。结果:结果显示,塞拉莱码头地下水,吉布提和亚丁地下水和城市供水的电导率、CL-、SO42-和总硬度指标远超出我国和WHO标准限值。只有净化水和塞拉莱城市供水的各项指标均符合《生活饮用水卫生标准》(GB/T 5749-2006)。结论:仅有净化水和塞拉莱城市供水可用于船舶生活饮用水补给。     

A case of fatal food-borne septicemia: can family physicians provide prevention?

BACKGROUND: Vibrio vulnificus, a common bacteria found in undercooked seafood and seawater, is the leading cause of food-borne death in Florida. Fatal cases of V vulnificus infection have also been reported in most states. METHODS: The literature was searched using the key words "Vibrio vulnificus," "septicemia," "wound infections," "seafood," "immunocompromise," and "patient education." A case of fatal V vulnificus septicemia is described. RESULTS AND CONCLUSIONS: V vulnificus, part of the natural flora of temperate coastal waters and one of the most abundant microorganisms found in seawater, has been isolated from waters off the Gulf, Pacific, and Atlantic coasts of the United States. Infections in noncoastal regions have been traced to consumption of seafood derived from Gulf Coast waters. Seawater exposure and consumption of inadequately cooked seafood are routes most commonly associated with V vulnificus infection. Exposure to V vulnificus is life-threatening for chronically ill or immunocompromised patients, who are most likely to develop fatal septicemia. Currently a combination of doxycycline and intravenous ceftazidime is recommended treatment. Mortality rates from V vulnificus continue to be high in immunocompromised patients. Family physicians can help prevent this outcome by counseling high-risk patients.     

北京市359例腹泻病原菌分布和耐药性分析

目的:分析2010年北京市359例腹泻病原菌分布和耐药情况,为本地区流行病学研究和临床合理用药提供依据。方法:粪便样本进行病原菌分离培养,鉴定到种、群和型,用纸片扩散法测定对药物的耐药性。结果:细菌性腹泻青壮年多发,7月-8月高发,实验室检出率最高的为志贺菌。腹泻病原菌对利福平、磺胺甲恶唑、萘叮酸耐药性较高;对氟喹诺酮类药物,除福氏志贺菌对诺氟沙星72.7%耐药、环丙沙星63.6%耐药外,其他均低于35%;对各类头孢菌素均小于20%。结论:北京市腹泻病原菌种类繁多,有年龄、季节分布特点,耐药性不同,应重视监测。     

创伤合并海水浸泡动物感染实验研究

目的了解创伤合并海水浸泡动物细菌感染的特点。方法制作兔背部创伤动物实验模型并分成对照组和实验组。实验组致伤后放海水浸泡20 min,对照组致伤后不浸泡。用手工法和全自动微生物分析仪进行细菌学鉴定,用微生物动态快速测定系统检测血浆内毒素含量,全血白细胞数用显微镜计数法。结果创伤合并海水浸泡后,伤口如果不经过消毒处理,12 h后细菌数量显著增加,主要细菌为大肠埃希菌、鲍曼不动杆菌、创伤弧菌和金黄色葡萄球菌;血液中可检出大肠埃希菌和创伤弧菌;内毒素含量和白细胞数显著升高。结论创伤合并海水浸泡后可导致多种细菌感染,感染时间提前且程度加重。     

Bacterial load of cockroaches in relation to urban environment.

Sanitation is an important problem in relation to the control of pests in urban environments. This investigation analysed the potential risk related to the presence of cockroaches and their capacity for disseminating bacteria in six different types of buildings: hospital nursing area and out-patient area, swimming-pool pool-side and toilet area, low-income flats and food-handling places. Fifty-six species of bacteria were identified from 157 samples, 14 of these have previously been reported as potentially pathogenic for man and vertebrates. Similarities were found between samples collected in (a) the hospital out-patient area and food-handling establishments and (b) the hospital nursing area and flats. Pool-sides possessed a poorer bacterial flora. There was a greater bacterial specific diversity in food-handling establishments, flats and swimming-bath toilet area. Enterobacter cloacae. Klebsiella pneumoniae and Klebsiella oxytoca were dominant species in flats and the hospital nursing area. Therefore, cockroaches can play a role in disseminating bacteria, which they can carry passively on their cuticle.     

Evaluation of ecotoxicity and fate of methylated butyltins in sediments and seawater from Tokyo Bay, Japan

We analyzed the fate of organotins in seawater and sediments from Tokyo Bay, Japan, by gas chromatography/inductively coupled plasma mass spectrometry. We also measured the toxicity of methylated butyltins by in vitro bioassays, the retinoid X receptor (RXR) activation method, and the marine luminescent bacterium Vibrio fischeri. Concentrations of tributyltin (TBT) and tributylmonomethyltin (TBMMT) in seawater were 0.0636 to 0.419 and 0.0050 to 0.108 ng Sn/L and in sediment were 7.51 to 17.8 and 3.67 to 6.87 ng Sn/wet weight g, respectively. Methylated butyltins did not activate RXR and were not toxic to bacteria. Tributylmonomethyltin in seawater would elute from sediment since TBMMT-to-TBT ratios showed a positive correlation (r(2) = 0.858) between sediment and deep seawater. Both methylation and debutylation of TBT seem to be major routes of decomposition of TBT in sediment. Methylation of TBT would not only cause subsequent volatilization but also decrease the toxicity of TBT species in the marine environment.     

福建闽江细菌种类及分布的调查

目的：了解福建闽江江水细菌的种类及分布情况。方法：采集闽江不同水域的水样,经增菌培养、细菌分离,进行细菌学鉴定。结果：从闽江中分离出细菌320株,其中肠杆菌科细菌189株（59.1%）,弧菌科细菌41株（12.8%）,非发酵菌35株（10.9%）,革兰阳性杆菌29株（9.1%）,革兰阳性球菌26株（8.1%）。结论：闽江细菌种类多、分布广泛,此项调查对于该水域细菌感染的防治具有重要意义。     

Metal Pollution in Seaweed and Related Sediment of the Persian Gulf,Iran

Nickel, cadmium, copper and lead in the sediment and seven species of algae from six locations in the Bushehr Province on the Coast of the Persian Gulf were determined. Sampling sites represent areas of importance in seaweed harvest and areas near sources of anthropogenic pollution. The mean concentrations of metals in the sediment (across all six collection sites, and collection periods) were: Pb (42.4 ± 2.7), Cd (7.4 ± 1), Ni (38.1 ± 3.7), and Cu (8.3 ± 1.2) μg g(-1) dry weight. High significant positive correlations existed between metals in cervicornis, corticata, and pavonica algae and the sediment, suggesting these species of algae are suitable for biomonitoring of the area.     

A possible role of crows in the spread of diarrhoeal diseases in Aden.

The Indian House Crow (Corvus splendens) has increased dramatically in number in Aden. These birds pollute the environment by dropping their faecal material all over the city. They may accordingly be related to important public health problems. The present work aimed at investigating the possibility that they play a role in the spread of diarrheal diseases. One hundred and fifty crows were collected and their liver, intestine and cloaca examined bacteriologically for Enterobacteriaceae and Vibrionaceas as well as for parasites. Different members of Enterobacteriaceae including Salmonella, and Shigella serotypes and Proteus strains as well as members of Vibrionaceae and Pseudomonads were isolated from a great proportion of crows. Some of them were found identical to the strains previously isolated from patients suffering from diarrhea in Aden. Giardia lamblia cysts and Hymenolepis nana ova were also recovered from crows. It was concluded that crows may participate in the spread of diarrheal diseases in Aden.