816株真菌感染分布及药敏分析

目的了解本院医院感染真菌分布的特点及对常用抗真菌药物的耐药情况。方法CHROMagar显色培养基及ATB真菌试剂盒进行鉴定;药敏试验采用纸片扩散K—B法。结果2008年1月至2009年6月我院临床共分离真菌816株,其中白色念珠菌（占53．2％）是引起真菌感染的最常见菌种,其次是热带念珠菌（21．6％）、光滑念珠菌（15．6％）、近平滑念珠菌（5．0％）和克柔念珠菌（2．3％）。药敏试验结果显示各种真菌对两性霉素B、制霉菌素的敏感性最高,分别达98％和99％,其次是氟康唑、伊曲康唑。结论真菌感染率呈逐年上升趋势,耐药率也逐渐增高。因此应及时对送检标本进行真菌培养和药敏试验,合理使用抗真菌药物,减少医院感染多重耐药和深部真菌感染的发生。     

95例COVID-19患者合并细菌及真菌感染的临床分析

目的:回顾性分析新型冠状病毒肺炎(COVID-19)患者合并细菌及真菌感染的临床特点和耐药情况。方法:收集同济医院2020年2月10日至3月31日血液、尿液、痰液和纤支镜冲洗液培养阳性的COVID-19患者的临床资料,采用WHONET5.6分析统计药敏数据。结果:共收集病原菌培养阳性COVID-19患者95例,非危重型...     

13例乳突根治术后术腔真菌感染临床分析

目的报道我科在中耳炎乳突根治术术后换药中处理13例真菌感染病。方法在耳显微镜下,先用镊子夹出真菌丝团块,用3%过氧化氢清洗术腔,生理盐水冲洗并吸干净,再用棉签蘸酮康唑乳膏涂术腔。结果 7~10天后所有病例外耳道及乳突腔清洁干燥,真菌镜检为阴性。结论 3%过氧化氢清洗术腔,配合酮康唑乳膏可有效控制乳突根治术后真菌感染。     

78例重型肝炎合并胆道感染的细菌分布及药敏分析

目的 了解我院近4年重型肝炎患者胆道感染的细菌分布及药敏情况,为临床合理用药提供依据.方法 对2004年1月～2007年12月我院收治的78例慢性重型肝炎合并胆道感染患者胆汁培养的病原菌分布和药敏情况进行统计分析.结果 培养分离的95株致病菌中,革兰氏阴性杆菌占40%,其中以大肠埃希菌(26.3%)和肺炎克雷伯菌(23.7%)为主;革兰氏阳性菌占35.8%,以肠球菌(26.5%)和凝固酶阴性葡萄球菌(23.5%)为主;真菌占24.2%,以白色念珠菌(39.1%)和热带念珠菌(39.1%)为主.革兰氏阴性杆菌对亚胺培南敏感率最高(97.1%),其次为阿米卡星(86.1%);革兰氏阳性菌时替考拉宁敏感率最高(97.1%),其次为万古霉素(95.1%);真菌对二性霉素敏感率最高(100~6),其次为氟康唑(95.7%).结论 重型肝炎合并胆道感染病原体仍以革兰氏阴性杆菌为主,但革兰氏阳性菌、真菌也占有较大比例.根据胆汁培养及药敏结果,合理应用抗菌素是治疗重型肝炎合并胆道感染的关键.     

对氨基糖甙类高水平耐药肠球菌的检测及药敏结果分析

目的：了解肠球菌对高水平庆大霉素的耐药情况及用于耐万古霉素肠球菌（VRE）治疗的氯霉素（C）、红霉素（E ）、四环素（TE）、利福平（RA）的耐药情况。方法：应用纸片扩散法药敏试验检测从临床标本中分离出的40株肠球菌。分析其药敏结果。结果：庆大霉素高水平耐药株（HLGR）16株（40.0%）、氯霉素耐药株17株（42.5%）、红霉素耐药株26株（65.0%）、四环素耐药株28株（70.0%）、利福平耐药株22株（55.0%），未检出对万古霉素耐药肠球菌。结论：治疗肠球菌感染时，应根据分离株的耐药特点选择不同的治疗方案。     

临床分离的4379株病原菌的分布特征及药敏结果分析

目的了解本院2008年临床分离的病原菌的分布特征及药敏结果,为合理使用抗菌药物提供依据。方法大多数细菌鉴定和药敏试验利用BD Phoenix仪,少数利用手工鉴定和K-B法药敏试验。念珠菌利用显色平板分离和鉴定,K-B法进行药敏试验。结果4379株细菌念珠菌中最常见的为大肠埃希菌（10.2%）、铜绿假单胞菌（9.4%）、金黄色葡萄球菌（7.7%）、鲍曼不动杆菌（7.7%）、白色念珠菌（7.0%）和肺炎克雷伯菌（6.2%）。大肠埃希菌和肺炎克雷伯菌产ESBLs比例分别为47.8%和41.3%。金黄色葡萄球菌、表皮葡萄球菌、溶血葡萄球菌和腐生葡萄球菌甲氧西林耐药率分别为58.1%、82.8%、83.6%和73.1%。G-杆菌中耐药率较低的为头孢哌酮/舒巴坦、亚胺培南、哌拉西林-他唑巴坦和阿米卡星。G＋球菌,万古霉素和替考拉宁的敏感率均为100.0%,其他抗菌药物耐药率较低的为氯霉素。念珠菌对两性霉素B和制霉菌素的耐药率均低于2.0%。结论本院临床分离大肠埃希菌和肺炎克雷伯菌产ESBLs水平、非发酵G-杆菌碳青霉烯类耐药率和葡萄球菌甲氧西林耐药率居高不下,应加强抗菌药物的合理使用,以降低耐药率。     

22例慢性重型肝炎合并真菌感染的临床分析

目的：探讨论慢性重型肝炎患并发真菌感染类型，临床表现特点和预后。方法：回顾性观察了我院近3年收治的慢性重型肝炎患合并真菌感染的情况。结果61例患中真感染22例(36．0％)、慢性重型肝炎并发真菌感染的病死率为72、73％。结论：慢性重型肝炎并发医院真菌感染并不少见，感染后预后差，主要防治措施是合理应用抗生素早期诊治真菌感染。     

214株临床分离菌的菌种分布及药敏分析

近年来由于抗菌药物的不合理使用，特别是三代头孢菌素的广泛应用，导致细菌耐药性和耐药机制发生了很大变化。由于细菌耐药机制的多样化，复杂化，体外药敏试验表现为敏感，但临床治疗往往无效。因此研究医院内临床分离细菌的分布及耐药性，对指导临床用药，减少耐药株产生具有重要价值。     

艾滋病合并呼吸道感染患者的病原菌分布及药敏分析

目的了解我院艾滋病合并呼吸道感染患者的病原菌分布及药敏情况,为临床治疗艾滋病合并呼吸道感染患者提供依据。方法收集2015年至2017年北京地坛医院住院的艾滋病合并呼吸道感染患者的合格痰液及支气管肺泡灌洗液(BALF)的细菌培养和药敏结果,回顾性分析病原菌的分离情况,采用Whonet 5.6软件对细菌进行药物敏感性分析。结果共检验1239例艾滋病合并呼吸道感染患者的合格痰液及肺泡灌洗液标本,去除同一患者的重复培养结果后,共培养阳性135例(痰液93例,肺泡灌洗液42例),阳性率10.89%。包括细菌121例(89.6%),酵母菌11例(8.1%)和双相真菌3例(2.2%)。其中细菌包括结核分枝杆菌31例(22.9%),非结核分支杆菌16例(11.85%),革兰氏阴性菌58例(43.0%),革兰式阳性菌16例(11.9%)。革兰氏阴性菌中排名前五位的是铜绿假单胞菌(11例),大肠埃希氏菌(10例),肺炎克雷伯菌(8例),鲍曼不动杆菌(7例),阴沟肠杆菌(6例)。大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率为0,但对氨苄西林的耐药率分别是100%和62.5%,铜绿假单胞菌对亚胺培南的耐药率为44.4%。然而,7例鲍曼不动杆菌全部为泛耐药菌株,除对多粘菌素B敏感外,对所有抗菌药耐药。真菌对多种抗真菌药物敏感。结论艾滋病合并呼吸道感染病原菌主要以革兰氏阴性菌为主,并且耐药现象明显,尤其鲍曼不动杆菌的耐药应当引起极度重视。     

Mycobacterium tuberculosis mixed infections and drug resistance in sub-Saharan Africa: a systematic review

BackgroundSub-Saharan Africa, is a region that records high rates of TB infection. Mycobacterium tuberculosis mixed strain infection, especially when the strains involved are of different susceptibilities, is an area of great interest because it is linked with an increased risk of treatment failure and transmission of resistant strains within the population. This paper reviewed original studies that reported MTB mixed infection and heteroresistance in the region between 2010 and 2020 to understand the extent of mixed strain infection and heteroresistance in the region. This information is very critical in the control of TB and ending the TB epidemic by 2035 as per the World Health Organization''s vision.Methodspubmed, Scopus, JSTOR, AJOL, and Google Scholar databases were searched through both key terms and subject headings. The literature was screened, assessed for the quality and evidence synthesized.ResultsEighteen original articles were included in this review after having met the inclusion criteria. The frequency of mixed strain infection reported in these studies varied between 2.8% and 21.1% while drug resistance range between 0.06% to 19% depending on the study design and the drug susceptibility screening technique utilized. The majority of the studies (50%) utilized Spoligotyping in conjunction with MIRU-VNTR typing in the detection of mixed infections.ConclusionDespite the scarcity of data on mixed infections and heteroresistance in sub-Saharan Africa, various studies have revealed that these conditions are frequent in the region than previously thought. Given the evidence of the effect of mixed infections on drug resistance and treatment outcome, we conclude that mixed infection is an unavoidable topic for future studies.     

Viral infections and drug hypersensitivity

Virus infections and T-cell-mediated drug hypersensitivity reactions (DHR) can influence each other. In most instances, systemic virus infections appear first. They may prime the reactivity to drugs in two ways: First, by virus-induced second signals: certain drugs like β-lactam antibiotics are haptens and covalently bind to various soluble and tissue proteins, thereby forming novel antigens. Under homeostatic conditions, these neo-antigens do not induce an immune reaction, probably because co-stimulation is missing. During a virus infection, the hapten-modified peptides are presented in an immune-stimulatory environment with co-stimulation. A drug-specific immune reaction may develop and manifest as exanthema. Second, by increased pharmacological interactions with immune receptors (p-i): drugs tend to bind to proteins and may even bind to immune receptors. Without viral infections, this low affine binding may be insufficient to elicit T-cell activation. During a viral infection, immune receptors are more abundantly expressed and allow more interactions to occur. This increases the overall avidity of p-i reactions and may even be sufficient for T-cell activation and symptoms. There is a situation where the virus-DHR sequence of events is inversed: in drug reaction with eosinophilia and systemic symptoms (DRESS), a severe DHR can precede reactivation and viremia of various herpes viruses. One could explain this phenomenon by the massive p-i mediated immune stimulation during acute DRESS, which coincidentally activates many herpes virus-specific T cells. Through p-i stimulation, they develop a cytotoxic activity by killing herpes peptide-expressing cells and releasing herpes viruses. These concepts could explain the often transient nature of DHR occurring during viral infections and the often asymptomatic herpes-virus viraemia after DRESS.     

鲍曼不动杆菌的临床分布及耐药性变迁

目的了解鲍曼不动杆菌在临床标本的分离率和病区分布及耐药性变化趋势。方法菌株鉴定采用法国梅里埃VITEK32细菌鉴定系统进行鉴定,药敏试验采用K-B法,药敏试验结果判定以CLSI/NCCLS标准进行。结果 2004-2010年共收到26670份标本,分离出阳性细菌7065株,其中鲍曼不动杆菌471株（6.67%）,分离率为1.77%（471/7065）。在471株鲍曼不动杆菌中,从痰液标本分离出最多有409株（86.83%）,分离率最高的是ICU,占49.3%。鲍曼不动杆菌对抗菌药物的耐药性普遍较高,且呈逐年升高趋势,部分表现出多重耐药特征。结论鲍曼不动杆菌的耐药状况日益严重,应重视临床鲍曼不动杆菌的感染与分离,谨防多重耐药鲍曼不动杆菌的院内感染及暴发流行。     

Nosocomial infections due to Acinetobacter species: Clinical findings, risk and prognostic factors

Purpose: Nosocomial infections caused by Acinetobacter species is of increasing concern in critically ill patients, and the risk factors for this infection are not well established. The present investigation was done to determine incidence of nosocomial Acinetobacter infections. Our study retrospectively attempts to find risk and prognostic factors for the nosocomial acquisition of Acinetobacter infection. Methods: The medical records of 43 patients with Acinetobacter infection during two-year period (Oct1998-Oct2000) were reviewed to find the factors involved in the nosocomial acquisition of Acinetobacter. Acinetobacter isolates that were obtained from these patients were phenotypically typed using carbon assimilation tests. Antimicrobial susceptibility testing results were noted from the microbiology records. Results: Acinetobacter baumannii accounted for 41.8% (n=18) of all the infections. By multivariate logistic regression analysis, only resistant antibiotype {(Ceftazidime- OR, 7.13 [95% CI, 1 to 46]; P= 0.044); (Cefotaxime- OR, 6.09 [CI, 0.87 to 30]; P = 0.045)} and mechanical ventilation (OR, 5.84 [CI, 0.83 to 31]; P = 0.05) were found to be potential independent risk factors for mortality. Overall mortality rate was 33%. Conclusions: Most of A. baumannii isolates were multidrug resistant in our set up and infections due to them were associated with high mortality. Prevention of Multiple drug resistant (MDR) A. baumannii infections was achieved after discontinuation of cefotaxime in ICU. Infection with resistant clones and mechanical ventilation were found to be potential independent risk factors for mortality.     

Clinical management of catheter-related infections

Central venous catheters represent a major source of nosocomial bloodstream infections, which cause considerable excess morbidity. It is currently unknown to what extent these infections contribute to mortality. Most catheter-related infections (CRIs) are caused by Gram-positive organisms (mainly coagulase-negative staphylococci). Definite diagnosis of CRI necessitates removal of the catheter in most cases. However, the recently described technique of differential time to positivity may allow diagnosis of CRI with the catheter left in place. Removal of the catheter has been standard clinical practice for the management of CRI in the past and is still recommended in many cases. In specific situations, such as infections of implanted catheters with coagulase-negative staphylococci, a trial of catheter salvage may be justified. In catheter-related bloodstream infection Staphylococcus aureus and Candida spp., the catheter should be removed immediately, due to the high risk of metastatic infection and increased mortality. A clinical work-up for the detection of additional foci (including transesophageal echocardiography in S. aureus infections) is advisable in these cases. All CRIs should be treated with antibiotics to which the causative agent has been shown to be susceptible. In addition to systemic antimicrobial therapy, antibiotic lock therapy may be applied, especially in patients with implanted long-term catheters if catheter salvage is attempted.     

2009—2011年某三甲医院鲍曼不动杆菌的耐药性分析

目的了解某三甲医院临床分离的鲍曼不动杆菌的分布及对各类抗菌药物的耐药性,以指导临床规范合理使用抗生素。方法收集常州市第一人民医院2009年1月至2011年12月临床分离的鲍曼不动杆菌,采用SPSS11．5统计软件统计分析鲍曼不动杆菌的检出率和耐药情况。结果2009—2011年共分离3360株鲍曼不动杆菌,均占全院分离病原菌的前三位。最常见的分离部位为下呼吸道,主要来源于ICU、呼吸内科、神经外科和神经内科,该菌对亚胺培南、美罗培南和哌拉西林-他唑巴坦的耐药率在2009年分别是55．52％、56．53％和70．01％,2011年分别上升至79．70％、77．61％和79．76％,差异有统计学意义。结论鲍曼不动杆菌对多种抗菌药物耐药率明显增高,泛耐药鲍曼不动杆菌比例明显增加。应加强耐药性监测,规范抗菌素的使用,防止鲍曼不动杆菌的暴发流行。     

医院内真菌感染的病原种类和耐药性分析

目的研究某教学医院侵袭性真菌感染的发病率、耐药性和病原分布特点,为临床医师合理用药提供科学依据。方法回顾分析2008-2010年住院患者真菌培养的检出率、标本来源、菌种分布及其对常见抗真菌药物的耐药性。结果医院内侵袭性真菌感染近3年的检出率19.32%,2008-2010年真菌检出率呈逐年上升的趋势,2008与2009年、2009与2010年差异有统计学意义（χ2=7.61、69.33,P〈0.05）;感染部位以呼吸道最多,其次为泌尿道;检出的真菌种类以假丝酵母菌属为主,约占99.78%,且白色假丝酵母菌居多,占49.04%。白假丝酵母菌和热带假丝酵母菌对三唑类药物敏感性仍较好,光滑假丝酵母菌及其他两种真菌则对三唑类药物耐药率较高,所有菌株对两性霉素B均较敏感。结论白色假丝酵母菌仍是医院内侵袭性真菌感染的主要病原菌,临床应根据药物敏感试验结果合理使用抗生素,防止侵袭性真菌的发生,延缓其耐药性的进一步发展。     

125例糖尿病足感染患者病原菌分布及耐药性分析

目的：分析糖尿病足部感染临床分离病原菌的分布及其抗菌药物敏感性特点,为临床医务工作者合理应用抗菌药物提供理论依据。方法：选取2011年1月至2014年9月,来本院治疗的糖尿病足合并感染患者125例,采集糖尿病足部溃疡分泌物,并保存培养分离出的病原菌,采用琼脂倍比稀释法进行药物敏感试验,药敏结果依据美国临床实验室标准化委员会2013年推荐的标准进行判读。结果：125例糖尿病足感染患者溃疡分泌物共培养分离出病原菌132株,其中,革兰阳性菌62株(47.0%),革兰阴性菌55株(41.7%),真菌15株(11.4%)。革兰阴性菌对碳青霉烯类抗菌药物和含β-内酰胺酶抑制剂的药物敏感性相对较高;革兰阳性菌对糖肽类抗菌药物、碳青霉烯类抗菌药物、氨基糖苷类药物的敏感性相对较高;真菌则对两性霉素B和卡泊芬净敏感度最高。结论：感染是糖尿病足患者病情加重的一个重要因素,对于糖尿病足部感染患者要尽早并多次进行分泌物的病原菌分离和药敏试验,以指导临床工作者筛选敏感的抗菌药物进行针对性治疗,减少耐药菌的产生。