目的 探讨不同年份CLSI文件中头孢吡肟折点变化对肠杆菌科细菌药敏结果的影响,辅助临床合理调整用药。方法 应用2013年(S23)与2014年(S24)CLSI文件中的头孢吡肟折点回顾性分析我院2014年肠杆菌科细菌的药敏变化情况。结果 与S23折点相比,肠杆菌科细菌中大肠埃希菌、肺炎克雷伯菌对头孢吡肟的耐药率分别上升了2.6%、2.8%,耐药率差异有统计学意义(P<0.05);产ESBLs大肠埃希菌、产ESBLs肺炎克雷伯菌以及非产ESBLs肺炎克雷伯菌对头孢吡肟的耐药率分别上升了3.8%、2.4%、2.0%,耐药率差异有统计学意义(P<0.05); 对于其它肠杆菌科细菌如非产ESBLs大肠埃希菌、阴沟肠杆菌等对头孢吡肟的耐药率变化无差异(P>0.05)。与S23相比,在S24中头孢吡肟MIC值分布在4 μg/mL、8 μg/mL、16 μg/mL时对细菌的药敏变化最为显著。结论 依照S24折点,肠杆菌科细菌对头孢吡肟的耐药率有不同程度的升高;尤其对产ESBLs菌株耐药率影响更大;临床应结合实验室报告合理调整用药。

Objective To investigate the change of the break point of the CLSI in different years on the drug sensitivity of Enterobacteriaceae bacteria. This is valuable for rational use of antibiotics. Methods To retrospective analyze 2014 Enterobacteriaceae bacteria susceptibility variation by CLSI file cefepime breakpoint of 2013(S23) and 2014(S24). Results Compared with breakpoint of S23, E. coli and Klebsiella pneumonia, cefepime resistant rate rose by 2.6% and 2.8% respectively, and the resistance difference was statistically significant (P<0.05); ESBLs-producing E. coli, ESBLs-producing Klebsiella pneumoniae and ESBLs non-producing Klebsiella pneumoniae toword cefepime resistant rate rose by 3.8%, 2.4% and 2.0% respectively, and the resistance difference was statistically significant (P<0.05); For other Enterobacteriaceae bacteria, such as ESBLs non-producing E. coli and Enterobacter cloacae with cefepime in drug resistance rate had no significant difference (P>0.05). Compared with S23, variety in drug susceptibility of bacteria was most significant in S24, during cefepime MIC of 4 μg/mL, 8 μg/mL, 16 μg/mL. Conclusion According to the S24 breakpoint, the drug resistance rates of the bacteria in the intestines of the bacteria is increasing, especially in ESBLs strain; antibiotics use should be following laboratory results.

目的 探讨妇女阴道健康状况及阴道分泌物清洁度、线索细胞及唾液酸酶法检测细菌性阴道病(BV)的相关性。方法 随机抽取2013年4月—2014年6月本院妇科疑似细菌性阴道病患者标本835例,分别采用生理盐水直接涂片及分泌物直接涂片进行革兰氏染色两者相结合检查清洁度、线索细胞;唾液酸酶法检测BV。结果 清洁度Ⅰ～Ⅱ占27.55%,BV阳性率为2.40%,线索细胞检出率1.32%;清洁度Ⅲ～Ⅳ占72.45%,病原菌阳性率为46.23%,其中BV阳性率为30.55%,线索细胞检出率为23.48%。结论 清洁度异常率比正常率偏高;清洁度正常不一定没有细菌性阴道病; BV的出现严重威胁妇女身体健康,正确的诊断有重要意义,唾液酸酶法检测BV虽有快速、操作简单、显色结果易判断,但温度、时间、取材问题等受多种因素影响。

Objective To explore the correlation between the health of women's vagina and vaginal cleanness, clue cells and bacterial vaginosis(BV)which is tested by the sialic acid enzymatic method. Methods Randomly select 835 suspected cases of bacterial vaginosis in our hospital gynecology department in April 2013-June 2014. Every case was respectively done saline direct smear and vaginal secretion direct smear gram staining to check vaginal cleanness and clue cells. BV is tested by sialic acid enzymatic method. Results The cleanness of I-II accounted for 27.55%, BV positive rate was 2.40%, the positive rate of clue cells was 1.32%;the cleanness of degree III-IV accounted for 72.45%, the positive rate of pathogenic bacteria was 46.23%, the positive rate of BV was 30.55%, the positive rate of clue cells leads to 23.48%. Conclusion The rate of abnormal vaginal cleanness is higher than the normal.The nomal vaginal cleaness does not show no bacterial vaginosis. The emergence of BV seriously affects women's health, so the correct diagnosis is of great importance. Although the of the saliva acid enzyme to test BV is fast, operates easily and the color results are easily to be judged, but it can be influenced by other factors such as temperature, time, materials issues.