中重度AECOPD感染铜绿假单胞菌的耐药表型及基因型分析

目的 探讨中重度慢性阻塞性肺疾病急性加重(AECOPD)感染铜绿假单胞菌耐药现状.方法 AECOPD患者105例,经呼吸道分泌物分离出铜绿假单胞菌21株,体外采用K-B法测定对14种抗生素的药敏结果.用PCR法检测14种耐药基因,分析铜绿假单胞菌的耐药表型和基因型.结果 21株铜绿假单胞菌对抗生素的耐药率:头孢曲松80.9％,头孢他啶76.2％,头孢吡肟66.7％,亚胺培南14.4％.21株铜绿假单胞菌中,blaTEM、blaSHV、blaOXA-10、blaPER、blaDHA阳性率分别为28.6％、21.4％、14.2％、42.8％、7.1％,而blaVEB、blaCTX-M、blaIMP、blaVIM、blaGIM、blaSPM均为阴性,oprD2基因缺失率为7.2％,ant(3″)Ⅰ,aac(6′)-Ⅱ阳性率分别为35.7％,36.8％.结论 中重度AECOPD分离的铜绿假单胞菌携带多种耐药基因,耐药基因主要与β-内酰胺类基因blaTEM、blaSHV、blaPER、blaOXA-10有关.     

慢性阻塞性肺病合并铜绿假单胞菌感染32例

近年来铜绿假单胞菌 (ｐｓｅｕｄｏｍｏｎｅｓａｅｒｕｇｉｎｏｓａ ,简称ＰＡ)肺部感染逐年增加 ,尤其高龄人群 ,由于机体免疫力低下 ,ＰＡ成为呼吸道感染的重要致病菌 ,且治疗较困难、预后差。我院 1996年 1月～ 1999年 5月共收治此类患者 3 2例 ,报道如下。1　临床资料1.1　一般资料　男 2 3例 ,女 9例。年龄 5 4～ 88岁 ,平均66.7岁。全部病例均为慢性阻塞性肺病 (ＣＯＰＤ) ,曾反复使用多种抗生素者 2 7例 ( 84.4% ) ,应用皮质激素者 12例 ( 3 7.5 % )。本组临床均有肺部感染的症状及体征 ,符合ＣＯＰＤ的诊断 ,胸部Ｘ线有炎症阴影 ,痰…     

老年COPD患者铜绿假单胞菌感染耐药分析

目的:分析老年COPD患者急性加重期铜绿假单胞菌感染的耐药状态.方法:采用常规方法分离、鉴定病原菌,选用13种常用抗生素对痰液中分离的铜绿假单胞菌进行体外MIC药敏试验.结果:铜绿假单胞菌对亚胺培南的耐药率最低,为8.5%,其次是头孢哌酮/舒巴坦和头孢他啶,均为10.6%;耐药率最高的是头孢噻肟(91.5%)和头孢曲松(83.0%).结论:铜绿假单胞菌是老年COPD患者急性加重期下呼吸道感染的主要致病菌,在临床治疗中应根据药敏结果选用抗生素.     

铜绿假单胞菌慢性肺部感染合并免疫低下大鼠模型的建立

目的：建立铜绿假单胞菌（Pseudomonas aeruginosa,PA）慢性肺部感染合并免疫低下大鼠模型,为相关模型建立与研究提供依据。方法：将实验大鼠分为空白对照组（A组）、肺部感染组（B组）、免疫低下组（C组）、肺部感染合并免疫低下组（D组）。以40 mg·kg^-1的剂量给予C、D 2组大鼠腹腔注射环磷酰胺（cyclophosphamide,CTX）,连续给药3 d,造模成功后以相同剂量每周注射一次;运用气管插管法,构建B、D组大鼠慢性肺部感染。在模型建立期间,以固定时间对大鼠肺载菌量、肺部病理学变化、免疫学指标变化、T细胞亚群等指标进行考察。结果：HE染色结果显示,B、D组大鼠在造模成功后肺部产生病理学病变,并有较明显的中性粒细胞聚集等现象。与A组相比,B组与D组大鼠外周血中性粒细胞有不同程度的增高,C组与D组白细胞数目有所下降,实验组大鼠CD₄⁺/CD₈⁺有显著增高。结论：通过该实验方法,成功建立PA慢性肺部感染合并免疫低下大鼠模型,成功率高、死亡率低,适于采取该方法进行相关研究。     

233例感染铜绿假单胞菌的老年患者耐药性分析

目的了解感染铜绿假单胞菌老年患者的耐药性特征,为临床预防及治疗提供理论依据。方法收集我院2013年1月至2014年7月感染铜绿假单胞菌的老年患者病例233例,采用Kirby-Bauer纸片扩散法和CLSI 2013年版判断标准进行耐药性监测,并用SPSS 19.0统计软件进行数据分析。结果阿米卡星耐药率最低,其他耐药率低于60%的包括庆大霉素、妥布霉素、复方新诺明、罗米沙星、左氧氟沙星、环丙沙星、美罗培南、亚胺培南、头孢吡肟、哌拉西林、哌拉西林/他唑巴坦、头孢他啶。结论老年患者中分离的铜绿假单胞菌呈现出多重耐药且耐药率不断上升的特点,建议根据药敏结果选择抗菌药物并联合用药。     

1例铜绿假单胞菌合并烟曲霉菌肺部感染患者的个体化治疗

摘要：本文报道临床药师通过全程参与1例铜绿假单胞菌合并烟曲霉菌肺部感染的临床治疗,通过患者进本情况与病情变化及时调整药物,并为患者制定个体化的抗感染治疗方案,取得了满意的临床疗效。在临床治疗中体现了临床药师的价值,提高了治疗的安全性和有效性。     

慢性阻塞性肺疾病合并铜绿假单胞菌感染的诊治分析

目的通过研究分析慢性阻塞性肺疾病合并铜绿假单胞感染的状况和耐药性,探讨治疗方案及早期预防措施。方法随机选取60例2015年3月到我院就诊的慢性阻塞性肺疾病合并铜绿假单胞菌感染患者,通过对这60例慢性阻塞性肺疾病患者采集痰标本,再将痰标本送去检验进行培养,最后分离出铜绿单胞菌进行药物测试和统计分析。结果通过鉴定和药物测试,这60株铜绿假单胞菌对阿莫西林的耐药性最高,达到了86.32%;对阿米卡星、西司他丁的耐药性较低,仅14.28%和17.43%;对其余的环丙沙星、头孢曲松等药物的耐药性在20%~60%。同时经过分析,大多数抗菌药物的耐药率逐年增高。结论铜绿假单胞菌对多种药物的耐药性较高,并且耐药性也逐年增高,这是慢性阻塞性肺疾病合并铜绿假单胞菌感染患者治疗时的重难点。医学工作者要重视对铜绿假单胞菌对多种药物的耐药性研究,合理使用抗菌药物,并加强慢性阻塞性肺疾病合并铜绿假单胞菌感染患者的感染控制。     

566株铜绿假单胞菌耐药性分析

目的:了解铜绿假单胞菌的耐药现状。方法:药敏试验用K-B法。结果:铜绿假单胞菌对多种抗生素的耐药率不断上升。结论:临床医生应根据实验室的试验结果合理、有效用药,减少、减缓耐药株的产生。     

Bioadhesive sulfacetamide sodium microspheres: Evaluation of their effectiveness in the treatment of bacterial keratitis caused by Staphylococcus aureus and Pseudomonas aeruginosa in a rabbit model

The aim of this study was to prepare bioadhesive sulfacetamide sodium (SA) microspheres to increase their residence time on the ocular surface and to enhance their treatment efficacy on ocular keratitis. Microspheres were fabricated by spray drying method using mixture of polymers such as pectin, polycarbophil and hydroxypropylmethyl cellulose (HPMC) at different ratios. The particle size and distribution, morphological characteristics, thermal behavior, encapsulation efficiency, mucoadhesion and in vitro drug release studies on formulations have been investigated. After optimisation studies, SA-loaded polycarbophil microsphere formulation with polymer:drug ratio of 2:1 was found to be the most suitable for ocular application and used in in vivo studies. In vivo studies were carried out on New Zealand male rabbit eyes with keratitis caused by Pseudomonas aeruginosa and Staphylococcus aureus. Sterile microsphere suspension in light mineral oil was applied to infected eyes twice a day. Plain SA suspension was used as a positive control. On 3rd and 6th days of the antimicrobial therapy, the eyes were examined in respect to clinical signs of infection (blepharitis, conjunctivitis, iritis, corneal oedema and corneal infiltrates) which are the main symptoms of bacterial keratitis and then cornea samples were counted microbiologically. The rabbit eyes treated with microspheres demonstrated significantly lower clinical scores than those treated with SA alone. A significant decrease in the number of viable bacteria in eyes treated with microspheres was observed in both infection models when compared to those treated with SA alone. In conclusion, in vitro and in vivo studies showed that SA-loaded microspheres were proven to be highly effective in the treatment of ocular keratitis.     

Dynamics of glutathione-S-transferases in Mytilus galloprovincialis exposed to toxic Microcystis aeruginosa cells, extracts and pure toxins

Molluscs and especially bivalves are able to accumulate dinoflagelates, diatoms and cyanobacteria toxins, and, being vectors for these toxins, transfer them along food chains. The data obtained from laboratory experiments showed that bivalve molluscs are resistant to cyanobacteria toxins. In this work, we wanted to test if Mytilus galloprovincialis organs react to microcystins and other cyanobacteria compounds by inducing or decreasing its GST activity. Acclimated mussels M. galloprovincialis were exposed to the toxic Microcystis aeruginosa M13 strain. Exposure of mussels to toxins was done in three ways: living Microcystis cells, crude Microcystis extracts and pure toxins. The measurement of soluble and microsomal GST activity in the different mussel organs was done by using the substrates 1-chloro-2,4-dinitrobenzene (CDNB) and 2,4-dichloro-1-nitrobenzene (DCNB). Analysis of the GST activity of the control mussels using CDNB as a substrate showed that cytosolic activity is much more significant than microsomal. Intact M. aeruginosa cells did not induce any significant response from the mussels, showing that these animals are quite resistant to the cyanobacteria if they are intact. On the other hand, cell extracts caused an important effect in the gut, in the gills and in the labial palps, although in different ways. There was an increase in GST activity in the gut and gills of mussels exposed to Microcystis extracts, showing a response of this detoxication pathway, but in the labial palps a severe reduction in GST activity occurred. Pure MC LR+YR induced an increase in GST activity in all organs but the labial palps. The results showed that other substances apart from microcystins may cause stress to mussels and affect detoxication enzymes such as GST.     

铜绿假单胞菌合并按蚊伊丽莎白菌肺部感染的病例分析

目的 探讨脑出血患者出现铜绿假单胞菌合并按蚊伊丽莎白菌感染的危险因素及抗菌药物治疗方案。方法 临床药师参与1例脑出血患者铜绿假单胞菌合并按蚊伊丽莎白菌肺部感染的治疗过程,通过查阅文献资料,并结合患者病情、病史、用药史及相关检查结果,分析按蚊伊丽莎白菌致病的危险因素并提出抗菌药治疗方案。结果 临床药师基于感染部位、混合细菌感染特点、抗菌药动学/药效学特性等,在抗感染方案调整为临床医师提出的用药建议后,患者全身感染得到有效控制。 结论 按蚊伊丽莎白菌为条件致病菌,毒力较低,不易感染健康人群。但当患者免疫力低时易转化为致病菌,需引起重视。     

Simulated microgravity alters growth and microcystin production in Microcystis aeruginosa (cyanophyta)

Recent researches indicated that microgravity can increase pathogenic bacteria virulence. We presumed that microgravity might affect the toxin production of toxic cyanobacteria too. Microcystis aeruginosa PCC7806 was chosen as the model organism to investigate the effects of simulated microgravity (SMG) on the growth and toxin production of toxic cyanobacteria. SMG could inhibit the growth of M. aeruginosa, which resulted in decreased cell number and lower specific growth rate after 20-day treatment. M. aeruginosa sensed the reduced gravity very quickly and immediately up-regulated its microcystin (MC) synthesis and exudation in 2 days. Subsequently, the intracellular MC content fell back since the 8^th day and was stable around the initial level in the following days, suggesting a quick adaptation to the reduced gravity. SMG had negative effects on the photochemical system and the absorption of phosphorus in most time. However, the photosynthetic pigment concentrations and nitrogen absorption used to be transitorily stimulated upwards by SMG. It was assumed that SMG inhibited cell growth by interfering its photosynthesis and phosphorus uptake, while the enhanced MC production was related with pigment and nitrogen metabolisms. This study reveals that SMG is a novel environmental signal which inhibits growth and enhances MC production of M. aeruginosa.     

Detection of point mutations associated with antibiotic resistance in Pseudomonas aeruginosa

Excessive use of broad-spectrum antibiotics in hospitals has led to the emergence of highly resistant strains of Pseudomonas aeruginosa. To reduce the selection pressure for resistance, it is important to determine the antibiotic susceptibility pattern of bacteria so that hospital patients can be treated with more narrow-spectrum and target-specific antibiotics. This study describes the development of a technique for detecting point muations in the fluoroquinolone resistance-determining region of the gyrA and parC genes as well as the efflux regulatory genes mexR, mexZ and mexOZ that are associated with fluoroquinolone and aminoglycoside resistance. The assay is based on a short DNA sequencing method using multiplex-fast polymerase chain reaction (PCR) and Pyrosequencing™ for amplification and sequencing of the selected genes. Fifty-nine clinical isolates of P. aeruginosa were examined for mutations in the abovementioned genes. Mutations related to antibiotic resistance were detected in codons 83 and 87 of gyrA and codon 126 of the mexR regulatory gene. Results of this study suggest Pyrosequencing™ as a substitute for traditional methods as it provides a rapid and reliable technique for determining the antibiotic resistance pattern of a given bacterial strain in <1 h.     

2014—2017年天津市儿童医院铜绿假单胞菌的分布及耐药性分析

目的 分析2014—2017年天津市儿童医院铜绿假单胞菌的分布和耐药性,为合理应用抗菌药物提供依据。方法 采用回顾性调查方法,对2014—2017年天津市儿童医院铜绿假单胞菌的分布及耐药性进行统计学分析。结果 共分离出铜绿假单胞菌572株,检出率为5.27%。以痰液为主要来源,构成比为56.1%。检出科室以呼吸科最高,占25.3%。铜绿假单胞菌对头孢哌酮/舒巴坦的耐药率最低,为3.32%;对头孢曲松、呋喃妥因和头孢呋辛酯的耐药率高,分别为100.0%、99.5%、98.8%。结论 天津市儿童医院铜绿假单胞菌的耐药性基本稳定,临床治疗时应根据药敏结果有针对性地合理选用抗菌药物,以提高疗效并减少耐药菌株产生。     

2016-2018年清镇市第一人民医院铜绿假单胞菌的分布及耐药性分析

目的 探讨2016-2018年清镇市第一人民医院铜绿假单胞菌感染的临床分布特征及耐药性变迁,为临床合理选用抗生素治疗提供参考。方法 收集2016-2018年清镇市第一人民医院临床标本中铜绿假单胞菌的检出情况、病区分布、标本来源及药敏结果等资料,并进行统计分析。结果 共分离出铜绿假单胞菌215株,以痰液标本来源为主,占84.2%,感染病区以呼吸内科、ICU和神经外科占前3位,分别占33.9%、18.1%、17.7%。铜绿假单胞菌对复方新诺明、氨苄西林、头孢唑林、氨苄西林/舒巴坦和头孢曲松的耐药率在90.0%以上,对阿米卡星的耐药率最低。与2016年相比较,2018年铜绿假单胞菌对哌拉西林、头孢他啶、哌拉西林/他唑巴坦、头孢吡肟的耐药率呈下降趋势,对庆大霉素、妥布霉素、阿米卡星、环丙沙星、左氧氟沙星、亚胺培南的耐药率呈上升趋势。结论 2016-2018年铜绿假单胞菌对多种抗生素耐药呈上升趋势,临床应加强铜绿假单胞菌感染监控及耐药性监测,密切关注耐药性变迁,合理选用抗生素治疗。     

2016-2018年中国医科大学附属盛京医院铜绿假单胞菌的分布及耐药性分析

目的 分析2016-2018年中国医科大学附属盛京医院铜绿假单胞菌的分布及耐药性,为临床合理使用抗菌药物提供参考。方法 收集中国医科大学附属盛京医院2016-2018年临床分离的1 465株铜绿假单胞菌,对其标本来源分布、科室分布和耐药性进行分析。结果 共分离出1 465株铜绿假单胞菌,痰液、尿液、引流液分别占53.9%、9.8%、9.1%;科室分布以ICU（23.3%）最多,其次为普外科（13.9%）、呼吸内科（13.4%）和新生儿呼吸内科（10.6%）。铜绿假单胞菌的耐药率2016-2018年变化不大,对头孢菌素类药物的耐药率较低,在12.75%~31.69%波动;对亚胺培南和美洛培南的耐药率分别为31.30%~33.46%、12.94%~29.11%,对阿米卡星的耐药率最低,为3.27%~4.54%。共分离出泛耐药铜绿假单胞菌37株,占2.5%。其中,2017年分离率最低,为1.39%。结论 应加强细菌耐药监测,采取有效措施控制耐药菌株传播,延缓泛耐药铜绿假单胞菌的出现和防止传播。     

In-vitro activities of various antibiotics, alone and in combination with amikacin against Pseudomonas aeruginosa

The in-vitro activities of various antibiotics, either alone or in combination with amikacin were assessed using clinical isolates of Pseudomonas aeruginosa. The minimum inhibitory concentrations (MIC) of these antibiotics were determined by microbroth dilution method against 50 clinical strains. The MIC values showed that 96, 94, and 74% of the isolates were susceptible or moderately susceptible to amikacin, meropenem and ceftazidime, respectively. The in vitro activities of ceftazidime and meropenem in combination with amikacin were determined by microbroth chequerboard technique and results were interpreted using the fractional inhibitory concentration (FIC) index. With a FIC index of ≤0.5 as borderline, synergistic interactions were more frequent with ceftazidime (70.8%) than with meropenem (40%). No antagonism was observed.     

2016—2018年南京市儿童医院铜绿假单胞菌的分布及耐药性分析

目的 回顾性分析2016—2018年南京市儿童医院铜绿假单胞菌的分布及其耐药特点。方法 对送检标本进行分离和培养,并对分离出的铜绿假单胞菌的分布及耐药性进行分析。结果 2016—2018年分离出铜绿假单胞菌分别为379、455和483株,检出率分别为4.17%、4.76%、5.15%,呈逐年递增。分离菌株数量最多的科室是普外科,共分离317株（24.07%）;标本来源以痰液为主,共737株（55.96%）。铜绿假单胞菌对大部分抗菌药物的耐药率较低,对环丙沙星、左氧氟沙星的耐药率仅为0.30%、0.53%;对亚胺培南、氨曲南、哌拉西林的耐药率较高,但也仅为20.88%、17.62%、11.62%,对其余抗菌药物的耐药率均小于10%。共检出158株多重耐药铜绿假单胞菌,平均检出率为12%,检出较多的科室为新生儿重症监护室。结论 铜绿假单胞菌是儿童医院感染的常见致病菌,易产生多重耐药性,了解其临床分布和耐药性变迁,以期为临床治疗提供最新的耐药性资料,以便更好地控制铜绿假单胞菌的感染。