急性坏死性胰腺炎合并感染的病原菌及耐药性分析

目的：研究急性坏死性胰腺炎（ANP）合并感染的病原菌分布及耐药性,并探讨其对ANP患者预后的影响。 方法：回顾性分析2010年10月—2014年10月收治的72例有明确病原学依据的ANP合并感染患者的临床资料。 结果： 72例ANP患者中,腹腔及腹膜后感染47例（65.28%）,呼吸道感染37例（51.39%）,血流感染32例（44.44%）,其中血流感染与患者死亡密切相关（P<0.05）。检出病原菌235株,其中革兰阴性细菌159株（67.66%）,革兰阳性细菌60株（25.53%）,真菌16株（6.81%）。获得的病原菌中排名前6位的依次是：鲍曼不动杆菌（24.68%）,铜绿假单胞菌（8.94%）,肺炎克雷伯菌（8.09%）,屎肠球菌/粪肠球菌（8.09%）,大肠埃希菌（7.66%）,金黄色葡萄球菌（4.68%）。耐药性分析显示,鲍曼不动杆菌和铜绿假单胞菌对亚胺培南耐药率分别达95.92%和52.63%,对头孢哌酮/舒巴坦的耐药率分别为59.26%和50.00%。肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶（ESBLs）检出率分别为64.29%和80.00%,对头孢哌酮/舒巴坦的耐药率分别为31.58%和18.75%,而对亚胺培南的耐药率分别为23.08%和7.14%。19株屎肠球菌/粪肠球菌中仅1株对万古霉素耐药,对利奈唑烷尚未发现耐药菌株。耐甲氧西林金黄色葡萄球菌检出率为72.73%,对万古霉素、利奈唑烷和呋喃妥因尚未发现耐药菌株。16株真菌对常用抗真菌药物均未发现耐药菌株。 结论：血流感染是ANP患者死亡的重要原因。ANP患者的病原菌仍以革兰阴性菌为主,但革兰阳性菌和真菌的比例不容忽视。多重耐药菌已成为ANP合并感染的巨大的挑战。     

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is associated with low levels of insulin resistance among heart failure patients

Background and aimsHeart failure (HF) patients are at risk of developing type 2 diabetes. This study examined the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and insulin resistance among U.S. adults with HF.Methods and resultsUsing data from National Health and Nutrition Examination Survey 1999–2016 cycles, we included 348 individuals aged 20+ years with HF and no history of diabetes. DASH diet adherence index quartile 1 indicated the lowest and quartile 4 indicated the highest adherence. The highest level of insulin resistance was defined by the upper tertile of the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Associations between level of insulin resistance and DASH diet adherence and its linear trends were examined using logistic regressions. Trend analyses showed that participants in upper DASH diet adherence index quartiles were more likely older, female, non-Hispanic White, of normal weight, and had lower levels of fasting insulin than those in lower quartiles. Median values of HOMA-IR from lowest to highest DASH diet adherence index quartiles were 3.1 (interquartile range, 1.8–5.5), 2.9 (1.7–5.6), 2.1 (1.1–3.7), and 2.1 (1.3–3.5). Multivariable logistic analyses indicated that participants with the highest compared to the lowest DASH adherence showed 77.1% lower odds of having the highest level of insulin resistance (0.229, 95% confidence interval: 0.073–0.716; p = 0.017 for linear trend).ConclusionGood adherence to the DASH diet was associated with lower insulin resistance among community-dwelling HF patients. Heart healthy dietary patterns likely protect HF patients from developing type 2 diabetes.     

Reference values for resistance and compliance based on the single occlusion technique in healthy infants from Southeast China

Background

Respiratory disease is a major cause of morbidity and mortality in infants and has a large impact on health care. The aim of this study was to present the reference values of resistance and compliance by using a single occlusion technique (SOT) in healthy infants in Southeast China.

Methods

Respiratory compliance (Crs) and respiratory resistance (Rrs) were measured in healthy infants, aged 1–96 weeks, by using SOT in the Children’s Hospital of FuDan University (Shanghai, China). For comparison, the infants were grouped by age as follows: 1–24, 25–48, 49–72 and 73–96 weeks. Multiple regression analysis was performed using age, length, weight, and body mass index (BMI) as the independent variables to obtain predictive equations, separated according to sex.

Results

We measured 205 healthy infants from birth up to 96 weeks of age (112 boys, 93 girls). Height and weight increased significantly with age. The Rrs declined with length, whereas the Crs increased. The median Rrs was 5.04 kPa/L/sec (range, 3.73–6.82 kPa/L/sec), and the mean Crs was 119.52±60.47 mL/kPa. Regression equations for Rrs and Crs were obtained.

Conclusions

We obtained reference values for passive respiratory mechanics by using SOT in healthy infants from Southeast China. These data provide references for assessing the normality of SOT measurements in infants.     

261株鲍曼不动杆菌临床分布及耐药性分析

目的对本院2012年8月至2014年7月检出的261株鲍曼不动杆菌进行耐药性分析,为临床治疗鲍曼不动杆菌感染提供依据。方法按常规方法进行细菌培养,检测本院2012年8月至2014年7月间送检的各种临床标本(包括痰液、脓液、分泌物、尿液、血液和引流液等),应用VITEK-2 Compact全自动微生物分析系统对临床分离的病原菌进行鉴定和药敏试验,利用WHONT 5.6软件分析鲍曼不动杆菌的耐药性及其分布。结果共检出261株鲍曼不动杆菌,其中多重耐药菌141株(54.0%),83株多重耐药鲍曼不动杆菌分离自ICU和呼吸科。结论鲍曼不动杆菌多重耐药情况很严重,尤其是分离自ICU和呼吸科的标本,实验室应加强鲍曼不动杆菌耐药检测,临床医师应根据细菌的药物敏感性试验结果合理选用抗生素,同时应加强医院感染监测,做好隔离,防止医源性传播。     

Effect of chlorfenapyr on cypermethrin-resistant Culex pipiens pallens Coq mosquitoes

Chlorfenapyr is a promising pyrrole insecticide with a unique mechanism of action that does not confer cross-resistance to neurotoxic insecticides. The effect of chlorfenapyr on pyrethorid-resistant Culex pipiens pallens Coq (Diptera: Culicidae) has not been fully investigated under laboratory conditions. In this study, cypermethrin-resistant C. p. pallens exhibited 376.79-fold and 395.40-fold increase in resistance to cypermethrin compared with susceptible strains after exposure for 24 and 48 h, respectively. Larvae and adults were tested for susceptibility using dipping, topical, and impregnated paper methods as recommended by the WHO. No cross-resistance to chlorfenapyr was found. Increased mortality was apparent between 48 and 72 h, indicating a slow rate of toxic activity. Synergism experiments with piperonyl butoxide (PBO) showed an antagonistic effect on chlorfenapyr toxicity. Mixtures of chlorfenapyr and cypermethrin could therefore provide additional benefits over either insecticide used alone. Mixtures of 5 ng/ml chlorfenapyr and 500 ng/ml cypermethrin exhibited a slight synergistic effect on cypermethrin-resistant mosquitoes (3.33, 6.84 and 2.34% after 24, 48 and 72 h exposure, respectively. This activity was lost when the chlorfenapyr concentration was increased to 10 or 20 ng/ml. Chlorfenapyr showed quite good results for pyrethroid-resistant C. p. pallens, and could improve public health by reducing the occurrence of mosquito bites and subsequently protecting against transmission of lymphatic filariasis and Japanese encephalitis.     

Bacterial isolates from infected wounds and their antibiotic susceptibility pattern: some remarks about wound infection

Wound infection plays an important role in the development of chronicity, delaying wound healing. This study aimed to identify the bacterial pathogens present in infected wounds and characterise their resistance profile to the most common antibiotics used in therapy. Three hundred and twelve wound swab samples were collected from 213 patients and analysed for the identification of microorganisms and for the determination of their antibiotic susceptibility. Patients with diverse type of wounds were included in this retrospective study, carried out from March to September 2012. A total of 28 species were isolated from 217 infected wounds. The most common bacterial species detected was Staphylococcus aureus (37%), followed by Pseudomonas aeruginosa (17%), Proteus mirabilis (10%), Escherichia coli (6%) and Corynebacterium spp. (5%). Polymicrobial infection was found in 59 (27·1%) of the samples and was mainly constituted with two species. The most common association was S. aureus/P. aeruginosa. All Gram‐positives were susceptible to vancomycin and linezolid. Gram‐negatives showed quite high resistance to the majority of antibiotics, being amikacin the most active against these bacteria. This study is mostly oriented to health care practitioners who deal with wound management, making them aware about the importance of wound infection and helping them to choose the adequate treatment options to control microbial infection in wounds.     

不同糖耐量状态下胰岛素样生长因子-Ⅰ水平变化

目的：研究胰岛素样生长因子-Ⅰ（IGF-Ⅰ）在不同糖耐量状态下的水平变化。方法将212例受试者根据口服葡萄糖耐量实验结果分为正常对照组（NC 组）、糖耐量受损组（IGT 组）和2型糖尿病组（T2DM 组）,比较血糖与胰岛素之间的关系。将IGT 组和 T2DM 组根据胰岛素抵抗程度分为非胰岛素抵抗组和胰岛素抵抗组,比较胰岛素抵抗指数和空腹血清 IGF-Ⅰ水平的不同。结果 IGT 组和 T2DM 于 NC 组比较,血清 IGF-Ⅰ水平较低,T2DM 组血清 IGF-Ⅰ水平更低（P <0.05）。胰岛素抵抗组胰岛素抵抗指数高于非胰岛素抵抗组,血清 IGF-Ⅰ水平则低于非胰岛素抵抗组（P <0.05）。结论 IGF-Ⅰ可能参与胰岛素抵抗,与糖代谢密切相关。     

New Delhi Metallo-β-Lactamase-Mediated Carbapenem Resistance: Origin,Diagnosis, Treatment and Public Health Concern

Objective:To review the origin,diagnosis,treatment and public health concern of New Delhi metallo-β-lactamase (NDM)-producing bacteria.Data Sources:We searched database for studies published in English...