目的 分析濮阳市人民医院肺炎克雷伯菌(Klebsiella pneumoniae,K. pneumoniae, KPN) 的临床分布、流行病学特点及耐药情况,以促进临床合理用药。方法 回顾性分析濮阳市人民医院2020年1—3月临床送检标本中分离出的209株肺炎克雷伯菌的分布及耐药情况。结果 临床标本中共分离出肺炎克雷伯菌209株,在肠杆菌科细菌中占比为68.30%;标本来源以痰液、血液和尿液为主,分别占75.11%、9.09%、5.74%;分离菌株数量较多的科室为ICU、神经外科一病区、EICU病区和胸外科病区,分别占比47.37%、 17.7%、3.35%和3.35%。产超广谱β-内酰胺酶(ESBLs)菌株检出率为11.48%,耐碳青霉烯肺炎克雷伯菌(CRKP)检出率为58.37%。不同来源KPN的耐药性具有显著差异, 综合ICU KPN的耐药率高于其他病区。结论 濮阳市人民医院临床分离KPN对常用抗菌药物有一定的耐药性,尤其以综合ICU分离菌株耐药严重,应加强监测KPN耐药情况,有针对性的选择抗菌药物,并增强院感防控,以减轻KPN的耐药情况。

Objective To analyze the characteristic of clinical distribution, epidemiological and drug resistance of Klebsiella pneumoniae (KPN) in the People's Hospital of Puyang City,and to provide evidence for rational use of antimicrobial drugs in clinical treatment. Methods A retrospectively analysis was conducted on 209 strains of KPN isolated from the clinical specimens in the People's Hospital of Puyang City from January 2020 to March 2020. Results A total of 209 strains of KPN were isolated from clinical specimens, accounting for 68.30% of enterobacteriaceae bacteria; the sources of specimen were mainly from sputum, blood and urine, accounting for 75.11%, 9.09% and 5.74% respectively; the departments with more isolated strains were ICU department, neurosurgery first department, EICU department, and thoracic surgery department, accounting for 47.37%, 17.7%, 3.35% and 3.35% respectively. Besides, the detection rate of extended spectrum β-lactamase(ESBLs) strains was 11.48%,and the detection rate of carbapenems-resistant klebsiella pneumoniae (CRKP) strains was 58.37%. The results showed that the drug resistance of KPN from different sources was with a significantly difference, and the drug resistance rate of KPN in comprehensive ICU was significantly higher than that of other departments. Conclusion The resistance of KPN isolated from the People's Hospital of Puyang City to common antibiotics is not optimistic. In particularly, the drug resistance of KPN isolated strains from the comprehensive ICU is more serious. Hence, the monitoring of KPN resistance should be strengthened and the effective prevention and control measures of hospital infection should be adopted. Furthermore, antibacterial drugs should be used rationally to reduce the generation of drug-resistant bacteria.

目的 探讨血培养分离菌的分布特点及耐药性,为临床科室诊治血流感染疾病和控制感染提供重要的参考依据。方法 收集某院2016—2020年血培养阳性样本,采用细菌鉴定和药敏分析系统检测,用WHONET 5.6软件进行病原菌分布特点及药敏结果的整理分析。结果 从血培养阳性标本分离出非重复菌3 424株,主要来自老年病科、危重症监护室、急诊留观室等。其中革兰阴性菌1 873株,常见有大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌等。近五年超广谱β-内酰胺酶革兰阴性耐药菌呈缓慢上升趋势,其余耐药菌变化趋势不大。革兰阴性菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、庆大霉素、妥布霉素、阿米卡星等总体耐药率均＜30%。革兰阳性菌1 328株,主要是葡萄球菌属,对达托霉素、替加环素均无耐药,对利奈唑胺、万古霉素、替考拉宁耐药率处于较低水平,对复方新诺明和克林霉素等的耐药率近五年呈缓慢下降趋势。结论 血流感染主要常见分离菌为肠杆菌属和葡萄球菌属,临床应重视早期规范血培养和药敏结果,科学合理规范使用抗菌药。

Objective To investigate the distribution characteristics and drug resistance of isolates from blood culture, and to provide important reference for the diagnosis and treatment of bloodstream infection and infection control in clinical practice. Methods Positive blood culture samples of a hospital from 2016 to 2020 were collected and detected by bacteria identification and drug sensitivity analysis system. The distribution characteristics of pathogenic bacteria and drug sensitivity results were analyzed by WHONET 5.6 software. Results A total of 3 424 non-repeating strains were isolated from positive blood culture specimens, which were mainly from geriatrics department, critical care unit, emergency observation room, etc.Among them, 1 873 strains of Gram-negative bacteria were found, including Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. In recent five years, the extended-spectrum beta-lactamases Gram-negative drug resistant bacteria was slowly increasing, while other drug resistant bacteria showed little change. The overall drug resistance rates of Gram-negative bacteria to cefoperazone/sulbactam, piperacillin/tazobactam, ceftazidime, cefepime, gentamicin, tobramycin and amicacin were all less than 30%. There were 1 328 Gram-positive strains, mainly Staphylococcus, showed no resistance to datoromycin and tegacycline, and the resistance rates to linezolid, vancomycin and teicolanin were at a low level, while the resistance rates to cotrimoxazole and clindamycin showed a slow declining trend in recent five years. Conclusion Enterobacteria and Staphylococcus were the most common isolates of bloodstream infection. In clinical practice, attention should be paid to the early blood culture and drug sensitivity results, and the antimicrobial drugs should be used scientifically and rationally.

目的 分析高龄呼吸道感染患者病原菌检测结果及耐药性情况,总结高龄呼吸道感染患者抗菌药物的合理用药经验。方法 对我院2018年1月—2020年12月收治的784例高龄呼吸道感染患者痰液标本进行病原菌培养及药敏试验,统计分析检测结果。结果 701株病原菌中,革兰阴性(G-)菌、革兰阳性(G+)菌和真菌分别检出497株、136株和68株,分别占70.90%、19.40%和9.70%。G-菌以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌和奇异变形杆菌为主,分别占21.97%(154株)、18.97%(133株)、14.98%(105株)和7.13%(50株),G+菌以金黄色葡萄球菌为主,占11.27%(79株)。G-菌耐药性前五位依次为氨苄西林、哌拉西林、复方磺胺甲噁唑、头孢唑啉和头孢他啶,耐药率依次为95.96%、85.11%、79.88%、77.06%和52.92%。G+菌耐药性前五位依次为青霉素、氨苄西林、红霉素、环丙沙星和复方磺胺甲噁唑,耐药率依次为95.59%、89.71%、84.56%、80.15%和75.00%。结论 高龄呼吸道感染患者病原菌构成以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、奇异变形杆菌和金黄色葡萄球菌为主,G-菌对氨苄西林、哌拉西林、复方磺胺甲噁唑、头孢唑啉和头孢他啶耐药最强,G+菌对青霉素、氨苄西林、红霉素、环丙沙星和复方磺胺甲噁唑最强,且呈多重耐药特征,加强临床耐药性监测有助于指导合理用药。

Objective To analyze the test results and drug resistance of pathogenic bacteria in elderly patients with respiratory tract infections, and summarize the rational use of antibiotics in elderly patients with respiratory tract infections. Methods The sputum samples of 784 elderly patients with respiratory tract infections admitted to our hospital from January 2018 to December 2020 were collected for pathogen culture and drug sensitivity test, and the test results were statistically analyzed. Results Among 701 strains of pathogenic bacteria, 497 strains were Gram-negative (G-) bacteria (70.90%), 136 strains were Gram-positive (G+) bacteria (19.40%) and 68 strains were fungi (9.70%). G-bacteria were mainly Klebsiellapneumoniae, Pseudomonas aeruginosa, Escherichia coli and Proteus mirabilis, accounting for 21.97% (154 strains), 18.97% (133 strains), 14.98% (105 strains) and 7.13% (50 strains). G+bacteria were mainly Staphylococcus aureus, accounting for 11.27% (79 strains). The top five antibiotics which G-bacteria resisted were ampicillin, piperacillin, compound sulfamethoxazole, cefazolin and ceftazidime.The resistance rates were 95.96%, 85.11%, 79.88%, 77.06% and 52.92%,respectively. The top five antibiotics which G+bacteria resisted were penicillin, ampicillin, erythromycin, ciprofloxacin and compound sulfamethoxazole, and the drug resistance rates were 95.59%, 89.71%, 84.56%, 80.15% and 75.00%, respectively. Conclusions The pathogenic bacteria in elderly patients with respiratory tract infections were mainly Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis and Staphylococcus aureus. G-bacteria resisted ampicillin, piperacillin,compound sulfamethoxazole, cefazolin and ceftazidime the most. G+bacteria were most resistant to penicillin, ampicillin, erythromycin, ciprofloxacin and compound sulfamethoxazole, and were characterized by multi-drug resistance.Enhancing bacterial resistance monitoring helps guiding the rational use of drugs.

目的 了解我院肺炎链球菌的临床分布及耐药情况,为临床合理应用抗菌药物提供依据。方法 采用WHONET 5.6软件对我院2012年—2016年培养、分离和鉴定出的肺炎链球菌的临床分布及药敏试验结果进行分析。结果 2012年—2016年共检出肺炎链球菌519株(不含重复菌株),每年秋冬和初春季节检出率最高。五年检出的肺炎链球菌对各类抗生素的耐药率变化不大。从8个科室和病区分离出此菌,以呼吸科为主,分离出313株,占60.3%。痰液中共分离出488株,占94.03%,其次从血液中分离出32株,占4.24%。对抗生素耐药率大于60%的有:复方新诺明、四环素、克林霉素和红霉素;未出现耐药的抗生素有厄他培南、莫西沙星、利奈唑胺和万古霉素;其余抗生素的耐药率均小于30%,其中肺炎链球菌对青霉素的耐药率为2%、中介率为20%。结论 青霉素仍可以作为治疗肺炎链球菌感染的首先药物;三代头孢菌素可用于青霉素非敏感的肺炎链球菌(PNSSP)治疗;未发现万古霉素非敏感菌株;红霉素、克林霉素的耐药率极高,不适合肺炎链球菌的治疗。临床应当根据培养药敏结果合理使用抗菌药物,减少细菌耐药率的发生。

目的 分析2011—2016年间铜绿假单胞菌分离株的耐药性及变迁情况, 为临床合理用药提供科学依据。方法 对2011年1月—2016年12月广州市第一人民院患者各类标本中分离到的铜绿假单胞菌2 257株进行细菌鉴定及药敏试验,并对耐药性变迁进行统计分析。结果 铜绿假单胞菌在痰液标本中的检出率最高为56.9％;6年铜绿假单胞菌平均耐药率以妥布霉素最低,为9.9%,对哌拉西林/他唑巴坦、头孢吡肟、头孢他啶、左氧氟沙星、环丙沙星、亚胺培南、庆大霉素等药物的耐药率均＜20%,在2013年耐药率最低,此后三年逐年上升。结论 铜绿假单胞菌对广州市第一人民院常用抗生素的耐药率在近3年呈逐年上升趋势, 临床医师应根据药敏结果合理选择抗菌药物, 以提高疗效和减缓耐药菌的产生。

Objective To analyze the changes of drug resistance of Pseudomonas aeruginosa (Pae) and to provide basis for the use of antibiotics in clinic. Methods 2 257 strains of Pae were cultured and isolated in the First People Hospitalof Guangzhou from 2011 to 2016, API bacterial identification system was applied to carry out bacterial identification and K-B method was used for drug sensitivity analysis. Results Most of the Pae (56.9％) were detected from the sputum specimen. It showed the highest sensitivity to tobramycin. The drug resistance of Pae to piperacillin/tazobactam, cefepime, ceftazidime, levofloxacin, ciprofloxacin, imipenem and gentamicin in 2013 was the lowest and has been increasing year by year. Conclusion Pseudomonas aeruginosa isolated in our hospital showed a rising trend of clinical drug resistance in the past three years. It was of the top priority for clinicians to use antibiotics rationally to retard the production of drug resistant strains.

目的 了解广东地区糖尿病足患者创面病原菌分布及耐药性变迁。方法 回顾性分析A组(2010年1月—2014年12月就诊的糖尿病足患者)和B组(2015年1月—2018年1月就诊的糖尿病足患者)研究者创面病原菌分布及耐药性变迁。结果 B组中创面G⁺菌及G^-菌均有下降趋势且G^-菌下降较快,细菌种类明显增加,真菌及混合感染明显上升,A组以金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌感染为主;B组以金黄色葡萄球菌、奇异变形杆菌、铜绿假单胞菌及真菌感染为主;B组相对于A组的细菌耐药性增加。结论 近年来糖尿病足患者病原菌种类明显增加且混合感染及真菌感染上升,且其耐药性增加,因此早期经验用药而后根据药敏选择抗菌药物治疗是糖尿病足感染治疗的关键。

Objective To investigate the distribution and drug resistance of pathogenic bacteria in diabetic foot wounds in Guangdong area. Methods Patients with diagnosis of diabetic foot between group A (from Jan 2010~Dec 2014 ) and group B (from Jan 2015 to Jan 2018) were retrospectively analyzed. We studied the bacteria distribution and drug resistance of pathogenic changes of group A and group B. Results In group B, both G+ and G- bacteria had a decreased trend while G- bacteria decreased rapidly, but the species of bacteria increased obviously just as fungi and mixed infection increased obviously. Bacteria infection in group A were mainly about Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli wihle group B were Staphylococcus aureus, Proteus mirabilis, Aeruginosa and Fungal infection; the resistance of group B to A was lower. Conclusion In recent years, kinds of pathogenic bacteria of diabetic foot were significantly increased and the mixed infection and increased fungal infection as well as its drug resistance increased, so the early experience of medication choice of antibiotics based on drug sensitivity and treatment are the key to the treatment of diabetic foot infection.

目的 了解龙川地区肺炎支原体耐药情况,以便临床合理运用抗生素。方法 收集2014年—2015年间疑似肺炎支原体感染住院小儿患者的咽分泌物标本2 666例,同时作Mp培养及IgM检查,同为阳性者共149例进行耐药性统计分析。结果 在2 666例疑似感染患者中,培养肺炎支原体阳性149例,阳性率为5.59%,学龄前儿童(≤3岁)患者阳性率2.06%,学龄儿童(4～15岁)阳性率9.79% ,学龄儿童感染肺炎支原体与学龄前儿童比较有显著差异(P<0.05)。其中红霉素、阿奇霉素、罗红霉素、克林霉素、依托红霉素、克拉霉素、乙酰螺旋霉、交沙霉素、加替沙星、莫西沙星、环丙沙星、左氧氟沙星、多西环素、米诺环素耐药率分别为2%、12.4%、4%、22% 、2%、1%、80%、44%、2%、15%、10%、1%、61%、44%。冬季感染与在其他季节比较有差异(P<0.05)。结论 阿奇霉素,红霉素为代表大环内脂类抗生素仍可以作为临床一线经验用药,乙酰螺旋霉、交沙霉素耐药率大于40%,不建议作为经验药物使用。喹诺酮类抗生素耐药率一般小于15%,可作为肺炎支原体治疗的第二选择。四环素类抗生素在本地区耐药性高,不建议作为经验药物使用。要加强预防冬季肺炎支原体感染。

目的 了解中山市7家医院金黄色葡萄球菌感染的临床分布,并对耐药基因进行检测,为临床经验治疗金黄色葡萄球菌感染提供用药及分子生物学依据。方法 收集2015年1月—2015年6月中山市7家医院分离到的金黄色葡萄球菌,使用ATB半自动细菌鉴定及药敏分析仪(法国梅里埃)对分离到的菌株进行鉴定及药敏试验,使用PCR技术对耐甲氧西林金黄色葡萄球菌(MRSA)的耐药基因进行检测。结果 7家医院共分离到89株金黄色葡萄球菌,其中MRSA检出33株,检出率为37.1%。金黄色葡萄球菌主要来源于呼吸内科(32株,36.0%)、骨科(20株,22.5%),主要分离自痰(41株,46.1%),伤口分泌物(16株,18%),对万古霉素、替考拉宁、奎奴普丁/达福普丁、复方新诺明、左氧氟沙星、诺氟沙星具有较高敏感性,MRSA对常用抗菌药物耐药率高于甲氧西林敏感金黄色葡萄球菌。共有32株MRSA检出bla_mecA基因,检出率为97%。结论 MRSA耐药情况较为严峻,临床科室应根据微生物培养报告合理使用抗菌药物。bla_mecA基因在MRSA检出较高,是MRSA主要的耐药机制。

Objective To analyze clinical distribution of Staphylococcus aureus infections from 7 hospitals in Zhongshan city, as well as to provide basis of empirical treatment and molecular biology for Staphylococcus aureus infections. Methods Staphylococcus aureus were collected from January 2015 to June 2015 in Zhongshan city, and then the strains were identified and tested antibiotic susceptibility by using ATB semiautomatic analyzer(Merieux). Resistance gene of methicillin-resistant Staphylococcus aureus(MRSA) was detected by polymerase chain reaction. Results 89 strains of Staphylococcus aureus were isolated from 7 hospitals and with prevalence of 33 strains of MRSA. Of all strains, 32(36.0%) were isolated from respiratory medicine and 20(22.5%) from orthopedics. 41(46.1%) strains of Staphylococcus aureus were isolated from sputum and 16(18.0%) from wound secretion. 89 strains of Staphylococcus aureus had highly susceptibility to vancomycin, teicoplanin, quinupristin/dalfopristin, cotrimoxazole, levofloxacin, norfloxacin. Resistance rates to commonly used antimicrobial drugs of MRSA were significantly higher than methicillin-sensitive. A total of 32 MRSA were detected carrying bla_mecA gene with the detection rate of 97%. Conclusion Clinical departments should be based on microbial culture report for rational use of antibiotics because of MRSA with more serious drug resistance. The gene of bla_mecA is the main mechanism of resistance for MRSA.

目的 对从淡水养殖鱼类、青蛙样品以及腹泻病人大便样品分离的菌株作临床常用抗生素的耐药性分析,为相关疾病的治疗提供实验依据。方法 获取临床腹泻病人的新鲜大便标本和在水产品市场采集淡水鱼和青蛙样品取肠道内含物分别涂布选择性培养基,选取疑似菌落进行生化鉴定和16S rRNA基因分子鉴定,确证为香港海鸥型菌的菌株采用纸片扩散法测定分离株对几类临床常见抗菌药物的敏感性。结果 本次检测的24株香港海鸥型菌分离株对八种常用的抗生素药物表现不同程度的耐药性。蛙源株对环丙沙星、阿米卡星、头孢他啶的耐药率高于鱼源株。其中分离的11株分离株(45.8%)对3个种类及以上抗生素表现耐药,为多重耐药株。结论 抗生素作为促生长剂和动物疾病防治被广泛加于动物饲料中,可能导致食源性细菌耐药性增加。人们有可能通过摄入含有香港海鸥型多重耐药株污染的食物而获得抗生素耐药性的潜在危险。

目的 研究鸟胞内分枝杆菌复合群(MAC)MAV3104基因编码蛋白与药物外排的关系。方法 以MAC标准株基因组为模板,扩增MAV3104基因,构建pMV261-MAV3104c重组质粒;测序正确后,转化重组质粒到大肠杆菌DH5并在MAC标准株中诱导表达, Western Blot鉴定MAV3104表达;按照CLSIM24-A2的操作要求检测MAC标准株对克拉霉素的敏感性及外排泵抑制试验。结果 经基因测序及Western Blot蛋白表达验证重组质粒构建成功;MAV3104过表达能提高鸟分枝杆菌对克拉霉素的MIC,且硫利达嗪能抑制该作用;MAV3104过表达也能提高胞内分枝杆菌对克拉霉素的MIC,但硫利达嗪对其没有抑制效应。结论 MAV3104转运蛋白介导的药物外排在鸟分枝杆菌耐克拉霉素中起重要作用。

Objective To investigate the association of the protein coded by Mycobacterium avium-Mycobacterium intracellulare complex in MAV3104 in drug efflux of Clarithromycin. Methods According to the Mycobacterium avium-Mycobacterium intracellulare complex standard strain, the MAV3104 gene was amplified by PCR and cloned into expression vector pMV261 to generate the recombinant plasmids. After verification by sequence analysis, the recombinant plasmids was transformed into E. coli DH5 andMycoba ctenum avium-Mycobacterium intracellulare complex standard strain. To identify the protein expression by western blotting and investigate the sensitivity of clarithromycin and efflux pump inhibition test in the light of CLSIM24-A2 protocol. Results It was verified by sequence analysis and western blotting that the recombinant plasmids were successfully constructed. Over expression of Mycobacterium avium MAV3104 gene could enhance clarithromycin MIC, which could be inhibited by thioridazine. Over expression of Mycobacterium intracellulare MAV3104 gene also could enhance clarithromycin MIC, but it could not inhibited by thioridazine. Conclusion This study demonstrates that efflux pumps mediated by MAV3104 protein play an important role in Mycobacterium avium resistance to clarithromycin.