目的 了解2011年四川大学华西第二医院临床分离菌对常见抗菌药物的耐药性。 方法 采用法国生物梅里埃公司VITEK 2 COMPACT全自动细菌鉴定药敏仪，以及ATB 手工药敏条检测临床分离菌对各种常用抗菌药物的耐药性，参照CLSI 2011年版标准判定药敏试验结果，并用WHONET5.4软件统计分析。 结果 临床分离的1 692株细菌中，G+菌占28.0%（473/1 692），G?菌占72.0%（1 219/1 692）。分离的前5位病原菌分别为大肠埃希菌、流感嗜血杆菌、肺炎克雷伯菌、肺炎链球菌、金黄色葡萄球菌。耐甲氧西林金黄色葡萄球菌和耐甲氧西林的凝固酶阴性葡萄球菌分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的15.1%（22/146）和76.7%（46/60），未检出万古霉素、利奈唑胺耐药株。屎肠球菌对所测抗菌药物的耐药性显著高于粪肠球菌，对氨苄西林的耐药率分别为95.7%和13.3%，高水平氨基糖苷类抗生素耐药屎肠球菌和粪肠球菌的耐药率分别为82.6%和30.0%，检出1株对万古霉素耐药的屎肠球菌，未发现对利奈唑胺耐药菌株。青霉素耐药的肺炎链球菌占4.0%（6/151），肺炎链球菌对红霉素、克林霉素、四环素、复方磺胺的耐药率均高于90%。流感嗜血杆菌、副流感嗜血杆菌以及卡他布兰汉菌产β内酰胺酶的比例分别为58.1%（175/301）、70.0%（21/30）、75.9%（22/29）。肠杆菌细菌中产超广谱β内酰胺酶的大肠埃希菌和肺炎克雷伯菌检出率分别为59.9%和74.1%，耐药率最低的分别是3种碳青酶烯类抗生素和阿米卡星。不发酵糖G?杆菌在分离病原菌中所占比例较低，为12.1%（148/1 692），主要为鲍曼不动杆菌和铜绿假单胞，药敏结果显示，除铜绿假单胞对复方磺胺耐药率为93.5%和鲍曼不动杆菌对氨曲南耐药率为38.9%外，该两种细菌对所测抗生素敏感性高，均在80%以上，未检出泛耐药细菌。 结论 定期进行细菌耐药性监测有助于了解医院细菌耐药性变迁，对指导医院合理应用抗菌药物有重要意义。
【Abstract】ObjectiveTo establish adriamycin (ADM) resistant pancreatic cancer cell line SW1990/ADM and to investigate its drug resistance mechanism.MethodsADM-resistant pancreatic cancer cell line SW1990/ADM was obtained by culture of pancreatic cancer cell line SW1990 in vitro with intermittently increasing the concentration of ADM in the culture medium for ten months. After two months of drug free culture, its biological characteristics, drug sensitivity as well as the expression and function of multidrug resistant gene 1 (mdr1) were detected, respectively. ResultsCompared with the parental cell line, SW1990/ADM showed great changes in biological characteristics and developed a cross resistance to various chemotherapy drugs. The drug resistance indexes of cell line SW1990/ADM to ADM, mitomycin, fluorouracil and gemcitabine were 49.60, 7.25, 3.80 and 1.25, respectively. The level of mdr1 mRNA expression in cell line SW1990/ADM was much higher than that of the parental cell line（P＜0.01). ConclusionWe have established adriamycin resistant pancreatic cancer cell line SW1990/ADM with multidrug resistance phenotype, its multidrug resistance is positively relevant to the expression of mdr1.
【Abstract】Objective To review the advances in overcoming multidrug resistance of tumors caused by mdr1 gene.Methods Different ways of overcoming multidrug resistance of tumors caused by mdr1 gene in the literatures were reviewed. Results One of the important reasons causing multidrug resistance was due to the overexpression of mdr1 gene and its product Pglycoprotein. There were two ways to overcome multidrug resistance of tumors through mdr1 genes mRNA and its product Pglycoprotein effectively.Conclusion The clinical test of the unitary way to overcome multidrug resistance of tumors is unsatisfactory, combining different ways to overcome multidrug resistance of tumors will be the hot spot of tumors research in the future.
Objective To explore the clinical epidemiological characteristics of the lung infection after orthotopical liver transplantation. Methods The clinical data included infection morbidity, mortality, infectious times and relative factors, clinical manifestations, the bacterial strains and distributions of the pathogens, the bacterial resistances of the 53 liver transplantation recipients from 2003.3～2006.12 were summarized and analyzed retrospectively. Results Among 53 recipients, 33 developed lung infectious and 6 died .The mobidity was 62.3% and mortality was 18.2%, with a OR of 1.0. Lung infection predominantly occurred in the first month, especially in the first week after transplantation.There were many factors related to lung infections.Various pathogens, especially Klebsialla, Escherichia Coli and Staphylococus Hominis were isolated from sputum, airway suction drainages and throat swabs. Most of the G- bacteria were sensitive to aminoglycosides,β lactam and lactamase compounds and carbapenems while G+ bacteria were sensitive only to glycopeptides. All the bacteria were resistant to quinolones, β lactams of third and forth generation. Conclusions After liver transplantation, the morbidity and mortality of the lung infections are high.The infections develope at earlier stage, manifest nontypical clinical features.Many factors are revealed to be relevant to the lung infections,meanwhile, various drug-resistant pathogen strains are isolated.
Objective To investigate the antibiotic resistance and their genetic homology of stenotrophomonas maltophilia isolated from January 2005 to February 2006 at intensive care unit（ICU） of 6 hospitals in Bejing area.Methods The minimal inhibitory concentration（MIC） of 12 antibiotics against 82 strenotrophomonas maltophilia was determined by broth dilution method.PFGE was used to analyze the homology of 82 stenotrophomonas maltophilia.Results The drug sensitivity tests in vitro showed these strains were resistance to commonly-used antibiotics.Antibiotics with sensitive rate over 50% included Doxycycline, gatifloxacin,cefoperazone-sulbactam,levofloxacin,Compound sulfamethoxazole,Ceftazidime and ticarcillin- clavulanate. 7-18 DNA bands of different size were present in the gel and different homology was shown among the 82 strains.Four couples with homology over 85% were isolated from the same ICU.Three strain were same clones in PLA General Hospitals first hospital.2 couples from the different wards had homology of 80.6% and 79.6% of，respictively.Others strains had either poor or no homology.Conclusions No clonal outbreak is certified at ICU of 6 hospitals in Beijing area. There are only vertical dissemination of single clone in 6 ICU wards.PFGE is an effective approach for drug resistance test and epidemic analysis.
Objective To investigate the distribution and antibiotic resistance of pathogens isolated fromlower respiratory tract in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease ( AECOPD) . Methods The patients with AECOPD, who were hospitalized in RICU from January 2008 to November 2009, were divided into a community infection group and a nosocomial infection group. Lower respiratory tract isolates were collected by bronchoscopic protected specimen brush for bacterial identification and susceptibility test. Results 134 cases were enrolled in the study, with 75 cases in thecommunity infection group and 59 cases in the nosocomial infection group. The positive detection rate in the nosocomial infection group was significantly higher than that in the community infection group [ 81. 4%( 48/59) vs. 54. 7% ( 41/75) ] . In the community infection group, 49 strains were isolated, in which gramnegativebacteria, gram-positive bacteria, and fungi accounted for 55. 1% , 28. 6% , and 16. 3% , respectively.In the nosocomial infection group, 55 strains were isolated, in which gram-negative bacteria, gram-positive bacteria, and fungi accounted for 61. 8% , 21. 8% , and 16. 4%, respectively. There was no significant difference in the microbial distribution between the two groups ( P gt; 0. 05) . The detection rate of ESBLs producing strains in the nosocomial infection group was significantly higher than that in the community infection group ( 58. 8% vs. 37% ) . The resistance rates in the nosocomial groups were higher than those in the community infection group. Conclusions Antibiotic resistance is serious in mechanically ventilated patients with AECOPD, especially in the nosocomial infection patients. The increased fungi infection and drug resistance warrant clinicians to pay more attention to rational use of antibiotics, and take effective control measures.
Objective To investigate the drug resistance and homogeneous analysis of Acinetobacter baumanii in emergency intensive care unit ( EICU) . Methods Four multidrug-resistant Acinetobacter baumannii ( MDR-Ab) strains isolated fromnosocomial inpatients fromJuly 25 to September 7 in 2009 were collected and tested for drug sensitivity and MIC determination as well. The A. baumannii isolates were typed with pulsed-field gel electrophoresis ( PFGE) to determine whether they derived fromthe same clone.Results Four isolates from nosocomial inpatients were resistant to multiple antibiotics including carbapenem. The PFGE types identified from four isolates were A and B. The A. baumannii isolates did not derived from the same clone. Conclusion The prevalence of nosocomial infection is not due to transmission of the same strains among different individuals in EICU.
目的 了解本院病原菌分布及其耐药性趋势，为临床合理使用抗菌药物提供依据。 方法 对2011年1月－2012年1月门诊和住院患者送检的临床标本1 643份进行细菌培养及药物敏感性检测，并对其细菌耐药性进行分析。 结果 1 643份细菌培养标本中共检出致病菌750株，检出阳性率为45.6%；病原菌中，G+球菌242株，占32.3%，以金黄色葡萄球菌、凝固酶阴性葡萄球菌、肠球菌属为主。G−杆菌382株，占50.9%，以大肠埃希菌、铜绿假单胞菌、克雷伯菌属、肠杆菌属、鲍曼不动杆菌为主。耐甲氧西林金黄色葡萄球菌占金黄色葡萄球菌的59.0%。金黄色葡萄球菌对青霉素、头孢唑啉耐药率均为100.0%。肠球菌属中分离率最高的为粪肠球菌和屎肠球菌，粪肠球菌对青霉素的耐药率为35.3%。大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶检出率分别为77.6%和56.7%；非发酵菌以铜绿假单胞菌和鲍曼不动杆菌为主，耐碳青酶烯类鲍曼不动杆菌分离率占鲍曼不动杆菌37%。鲍曼不动杆菌、铜绿假单胞菌对亚胺培南的耐药率分别为46.3%、28.3%。 结论 本院细菌耐药性较高，应加强抗菌药物的合理应用，应谨慎使用第三代头孢菌素等β-内酰胺类抗菌药物，以减轻抗生素的选择性压力、防止耐药菌株在医院内播散。