目的 对546株常见病原菌进行耐药分析，为感染性疾病的临床治疗提供依据。 方法 对2012年4月－9月从临床标本中分离的546株常见病原菌进行耐药分析，菌种鉴定及药物敏感试验结果由法国生物梅里埃公司VITEK 2 COMPACT系统完成。 结果 在546株病原菌中，G−杆菌占82.8%，其前3位分别为大肠埃希菌（占22.2%），鲍曼/溶血不动杆菌（占16.5%），肺炎克雷伯菌（占15.4%）。在G−杆菌中，除嗜麦芽窄食单孢菌外，亚胺培南、厄它培南的耐药率最低，其次为丁胺卡那霉素和哌拉西林/他唑巴坦。鲍曼/溶血不动杆菌、肺炎克雷伯菌、铜绿假单孢对氨苄青霉素的耐药率均超过95%。金黄色葡萄球菌的耐药率较凝固酶阴性葡萄球菌低，耐甲氧西林金黄色葡萄球菌占22.00%；而耐甲氧西林凝固酶阴性葡萄球菌占94.44%。此外，金黄色葡萄球菌和凝固酶阴性葡萄球菌对万古霉素、利奈唑胺、替加环素、奎奴普丁/达福普丁、呋喃妥因的耐药率为0.00%。 结论 在该院新院区临床标本分离的常见病原菌中，仍以G−杆菌占优势。在G−杆菌中，除嗜麦芽窄食单孢菌外，亚胺培南、厄它培南的耐药率最低。金黄色葡萄球菌的耐药率较凝固酶阴性葡萄球菌低，且尚未发现对万古霉素耐药的葡萄球菌。
ObjectiveTo investigate the distribution and antimicrobial resistance of the clinical strains isolated from the First Affiliated Hospital of Xi’an Jiaotong University in 2019 and provide a basis for clinical rational use of antibiotics.MethodsAll the clinical samples which were collected from January 1st to December 31st in 2019 were employed to determine antimicrobial resistance retrospectively. Results were interpreted according to Clinical and Laboratory Standards Institute 2019 breakpoints and analyzed by WHONET 5.6 software.ResultsA total of 6 784 nonduplicate strains were isolated in 2019, including 2 865 (42.2%) strains of Gram-positive bacteria and 3 919 (57.8%) strains of Gram-negative bacteria. The top five pathogens with the highest detection rate were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, Pseudomonas aeruginosa, and Staphylococcus aureus. Methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase negative Staphylococcus accounted for 33.0% and 72.0%, respectively. The detection rate of vancomycin-resistant Enterococcus faecium was 1.0% and the detection rates of linezolid-resistant Enterococcus faecium and Enterococcus faecalis were 0.3% and 2.9%, respectively. As for the non-meningitis Streptococcus pneumoniae, the prevalence of penicillin-susceptible Streptococcus pneumoniae was 100% in the isolates from adults. Extended-spectrum β-lactamases-producing strains accounted for 58.2%, 33.6%, and 33.3% in Escherichia coli, Klebsiella spp., and Proteus mirabilis, respectively. The total detection rate of carbapenem-resistant Enterobacteriaceae was 7.8%, among which the detection rates of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae were 1.5% and 17.2%, respectively. The percentages of Pseudomonas aeruginosa strains resistant to imipenem and meropenem were 25.0% and 21.6%, respectively, and those of Acinetobacter baumannii were 73.8% and 74.2%, respectively.ConclusionsBacterial resistance is still serious in this hospital. It is necessary to strengthen rational drug use. At the same time, effective prevention and control measures should be taken to avoid cross-infection.
ObjectiveTo know the situation of nosocomial infection in 2014 in a western region hospital, in order to provide a scientific basis for hospital infection control and management. MethodWe selected the patients on August 14th in 2014 during the time from 00:00 to 24:00 as our study subjects. Bedside investigation and medical records investigation were combined to study the cross-sectional survey of nosocomial infection. We completed the questionnaire, and used statistical methods to count related data about nosocomial infections and community-acquired infections. ResultsA total of 1 908 patients were investigated. The nosocomial infection prevalence rate was 4.45%, and the community-acquired infection prevalence rate was 29.09%. The highest prevalence of nosocomial infection department was the Intensive Care Unit (38.10%); the top three surgical systems were Thoracic Surgery (18.67%), General Surgery (16.67%), and Neurosurgery (10.53%), and the top three medical systems were Endocrinology (11.11%), Neurology (6.67%), and Infectious Diseases Department (5.88%). The top three community-acquired infections occurred in Pediatrics Department (non-neonatal group) (95.37%), Burn surgery (92.31%), and Respiratory Medicine (86.46%). The main infection site for both nosocomial and community-acquired infection was lower respiratory tract (58.24%). Pathogens were mainly Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa. Hospital and community-acquired infection bacterial spectrum were consistent. And the rate of antibiotics use was 40.82%, in which 126 patients used for prevention (6.60%), and 599 patients used for treatment (31.39%). For patients using the drugs for treatment, bacterial culture submission rate was 80.71%, and the positive rate was 43.78%. ConclusionsThe prevalence of nosocomial infection is reliable, which provides a data support for nosocomial infection prevention and control.
Objective To analyze the clinical and etiological characteristics and bacterial susceptibility in patients with ventilator-associated pneumonia (VAP) in Guangzhou area.Methods A retrospective study was conducted on VAP patients in four hospital of Guangzhou from Jan 2004 to Oct 2005.Totally 157 patients were enrolled in this study，whose flora was identified and tested by Kirby Bauer disk diffusion susceptibility test.The univariate analysis method was used to analyze the prognostic parameters.Results The average onset time of VAP was 7.7 days after mechanical ventilation with a mortality rate of 38.2%.The proportion of Gram-negative bacilli，Gram-positive cocci and eumycete was 68.0%，23.4% and 8.7% respectively in 184 isolated strains.The most common pathogens were Pseudomonas aeruginosa (18.5%)，Stenotrophomonas maltophilia (14.1％)，Burkholderia cepacia (10.9%)，Staphylococcus aureus (10.3%) and Acinetobacter baumannii (8.7%).Pseudomonas aeruginosa，Stenotrophomonas maltophilia，and Acinetobacter baumannii were resistant to most common antibacterials such as cephalosporin and imipenem.18 strains oxacillin resistant Staphylococcus aureus，7 strains oxacillin resistant Staphylococcus simulans and one vancomycin resistant Staphylococcus aureus were isolated.Expect for vancomycin，teicoplanin and fusidic acid，the resistance of Gram-positive cocci were above 50% to other 9 antibacterials.Conclusions The antibiotic resistance situation of VAP in Guangzhou is very serious with high mortality.It is important to reinforce the prevention and guidance on the proper treatment of VAP.
ObjectiveTo explore the distribution and rule of pathogen strains in the third quarter and fourth quarter of 2012, and to provide the basis for clinical medication. MethodsTo retrospectively analyze the bacterial culture and drug susceptibility test results in the third quarter and the fourth quarter of 2012. ResultsThere were isolated 932 plants in the third quarter, and 915 plants isolated in the fourth quarter. Heavy drug resistance rates of detection of Pseudomonas aeruginosa decrease slightly. There was more multiple drug resistance of A. baumanii, Escherichia coli, Klebsiella pneumoniae, and methicillin-resistant Staphylococcus aureus in the fourth quarter than in the third one. ConclusionThe resistant strain increases in the fourth quarter. We should attach importance to the clinical examination, bacterial drug resistance monitoring, and rational use of antimicrobial agents.
ObjectiveTo provide the evidence for diagnosis and treatment of the complication by describing the distribution and drug sensitivity of pathogens in patients with prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA). MethodsBetween January 2003 and June 2013,65 cases (65 knees) with PJI after primary TKA were treated.There were 28 males and 37 females with an average age of 63.2 years (range,37-80 years).The median interval between PJI and primary TKA was 2.8 years (range,2 weeks to 11 years),including 29 left knees and 36 right knees.Prosthesis loosening could be found in 27 cases by X-ray examination.The average value of C-reactive protein and erythrocyte sedimentation rate was 37.4 mg/L (range,12.5-197.0 mg/L) and 63.2 mm/1 h (range,29.3-73.8 mm/1 h) respectively.Preoperative and intraoperative synovial fluid as well as intraoperative tissue samples should be submitted for aerobic and anaerobic culture.The four types of infections were made according to the Tsukayama et al.classification standards. ResultsThe patients were all diagnosed as having PJI.There were 5(7.69%) type I infections,4(6.15%) type ⅡA,8(12.31%) type ⅡB,3(4.62%) type Ⅲ,and 45(69.23%) type IV according to the Tsukayama et al.classification standard.Bacterial culture results were negative in 12 cases and positive in 53 cases,the main pathogen was Gram-positive cocci (39/53).The most common organism identified was Coagulase-negative Staphylococcus (24/53) followed by Staphylococcus Aureus (12/53).Resistant bacterium accounted for 61.11%(22/36) of Staphylococcus.These bacterium were all sensitive to vancomycin,linezolid,meropenem,and fluconazole;and highly resistant to erythrocin,penicillin,and cefoxitin.The main pathogenic bacteria of Coagulase-negative Staphylococcus and Staphylococcus aureus had highest resistant rate to penicillin. ConclusionGram-positive cocci is the main pathogen in patients with PJI after primary TKA,which is highly resistant to penicillin and macrolides.Antibiotic treatment of this complication should be based on the result of drug sensitivity test,vancomycin and linezolid may be used before the result of drug sensitivity test.It is important to pay attention to rare and multiple resistant bacteria.
The morbidity and mortality of pulmonary infection are high among infectious diseases worldwide. Rapid and accurate etiological diagnosis is the key to timely and effective treatment. Metagenomic next-generation sequencing (mNGS) technology has brokenthrough the limitations of traditional pathogenic microorganism detection methods and improved the detection rate of pathogens. In this paper, the application and advantages of mNGS technology in the diagnosis of bacteria, fungi, viruses and mixed infections in the lungs are analyzed, and the challenges and breakthroughs in RNA detection, wall breaking of firmicutes and host DNA clearance are described, in order to achieve targeted and accurate etiological diagnosis through mNGS, so as to effectively treat pulmonary infections.
Objective To investigate the characteristics of the pathogens isolated from the cerebrospinal fluid (CSF) and the prognosis of the adult patients with central venous system (CNS) infection, and to provide the basis for disease treatment. Methods The clinical data and findings of the laboratory examination of the patients, who were admitted to West China Hospital of Sichuan University from January 2014 to September 2016, and suffered from CNS infection with the positive results of CSF culture, were retrospectively analyzed. The species distribution and in-vitro susceptibility of the pathogens and hospital mortality were analyzed. Results A total of 157 cases, involving 87 (55.4%) community-acquired cases and 70 (44.6%) hospital-acquired cases, were included. One hundred and fifty-eight strains of the pathogens were isolated from the CSF specimens of these patients, including 73 isolates (46.2%) of gram negative bacteria, 64 isolates (40.5%) of fungus, and 21 isolates (13.3%) of gram positive bacteria. In terms of species distribution,Cryptococcus neoformans was the predominant (62/87, 71.3%) species isolated from the patient with community-acquired infection, whileAcinetobacter calcoaceticus-A. baumannii complex (31/71, 43.7%) was the predominant specie from the patients with hospital-acquired infection. Analysis of the resistance phenotypes showed that all theC. neoformans isolates were susceptible to the antifungal agents. More than 90% ofA. calcoaceticus- A. Baumannii complex isolates were resistant to the regular antibiotics. The resistant rates ofK. pneumoniae isolates to the regular antibiotics were no more than 25%. The hospital mortality of the groups infected by gram-negative bacteria, fungi, and gram-positive bacteria were 52.3% (38/72), 32.8% (21/64), and 19.0% (4/21), respectively. There was statistical difference for the hospital mortality among these groups (P=0.006). Conclusion In our hospital,C. neoformans are the common species isolated from CSF of the patients with community-acquired CNS infection. Gram negative bacilli are commonly isolated from CSF of the hospital-acquired cases. The mortality of patients with gram negative bacilli is high.
ObjectiveTo analyze the clinical characteristics and pathogenesis in patients with chronic obstructive pulmonary disease (COPD) with ventilator-associated pneumonia (VAP). MethodsNinety-two patients with VAP who underwent mechanical ventilation via tracheal incubation due to COPD and respiratory failure were recruited in the study.The clinical characteristics,bacterial culture and antibiotics sensitivity of specimen from tracheal secretion and bronchoalveolar lavage fluid were retrospectively analyzed. ResultsThe main pathogenic bacteria in the patients with COPD with VAP were as following,ie. Ainetobacter baumanii(24.1%),Pseudomonas aeruginosa (17.6%),Klebsiella spp (15.9%),Methicillin-resistant Staphylococcus aureus(14.7%),and Escherichia coli(10.6%) in which Gram negative bacteria were predominant. When compared with the patients who received antibiotics before mechanical ventilation,the mortality in the patients who did not receive antibiotics before mechanical ventilation was significantly lower (17.9% vs. 40.6%,P<0.01). The patients who received de-escalation antibiotics therapy had lower mortality than those who received escalation antibiotics therapy(19.3% vs. 57.1%,P<0.01). There was no significant difference in mortality between the patients who suffered from VAP less or more than 4 days after mechanical ventilation (54.8% vs. 45.2%,P>0.05). ConclusionsHigh drug resistant rate is observed in patients with COPD and VAP especially in those patients who using antibiotic before mechanical ventilation. De-escalation antibiotics therapy can lower the mortality. The mortality rate is not significant different between early-onset and late-onset VAP in patients with COPD.
目的 了解呼吸机相关性肺炎（VAP）患者病原菌情况，探讨其细菌耐药性及治疗策略。 方法 通过查阅2008年1月－2009年12月呼吸与危重症医学科收治的128例VAP患者的病历资料，分析其肺部感染病原菌分布特点及耐药率。 结果 VAP平均发病时间为机械通气后5.8 d，总病死率为35.1%（45/128）。共分离出病原菌262株，其中G?杆菌210株（占80.2%），G+球菌38株（占14.5%），真菌14株（占5.3%）。G?杆菌中占前3位的分别是鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷白杆菌，对青霉素类、头孢菌素类抗菌药物高度耐药，而对亚胺培南等耐药率相对较低；G+球菌主要是金黄色葡萄球菌，其中耐甲氧西林的金黄色葡萄球菌对多种常见抗菌药物高度耐药，而对万古霉素敏感。 结论 VAP的主要病原菌为G?杆菌，常为多重耐药的致病菌，应根据药敏结果选用合理的抗菌药物。