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慢性阻塞性肺疾病院内下呼吸道肠球菌属感染及耐药分析

【摘要】 目的 调查和总结COPD 住院患者院内下呼吸道肠球菌属感染及耐药情况。方法 回顾性分析舟山市第三人民医院呼吸内科2004 年8 月至2010 年8 月院内发生下呼吸道肠球菌属感染的122 例COPD患者的临床资料和耐药情况。结果 从合格痰标本中共分离出肠球菌122 株, 其中粪肠球菌占72. 1% , 屎肠球菌占27. 9% 。对抗菌药物的耐药率普遍较高, 但所有菌株对利奈唑烷和万古霉素均敏感, 屎肠球菌的耐药率明显高于粪肠球菌。屎肠球菌和粪肠球菌对庆大霉素的耐药率均高于链霉素。高龄, 合并基底节脑梗死、肿瘤、肠道革兰阴性杆菌感染, 侵入性操作, 长期住院及持续应用抗菌药物均是COPD 患者院内感染肠球菌属的危险因素。结论 住院COPD 患者易发生院内肠球菌属感染, 临床治疗应合理应用抗菌药物、遵守侵入性操作的无菌原则及规范医务人员洗手。

紫色色杆菌眼内炎一例

洛菲不动杆菌性眼球内炎一例

Clinicopathologic study on fungal necrcotizing retinochoroiditis

Objective To investigate the clinical manifestation and histopathologic changes of the fungal necrotizing retinochoroiditis. Methods Collecting 7 cases of fungal retinochoroiditis with severe immunodepression and loss of visual acuity.Seven removed eyeballs were stained with HE,PAS and silver methenamine,and observed by light microscopy,and in addition,2 of them examined by electron microscopy.Also fungal cultures of blood and affected tissues were performed. Results The chief clinical macnifestation included ciliary injection of conjunctiva,opaque aqueous fluid and vitreous and diffuse hemorrhage and greyt white opacity with retinal detachment in severe cases.Pathologic changes included hemorrhage in the retina,chorioretinal tissue necrosis,hyphae in the blood vessels,affected tissue and vitreous.Fungal culture of blood was positive in three cases.Culture of affected tissues was positive in all cases. Conclusions Eedogenous fungal infection of choroid and retina may be due to the severe immunodepression of the sufferers and usually causes chorioretinal tissue destruction and blind. (Chin J Ocul Fundus Dis, 1999, 15: 235-237)

青光眼术后毛霉菌性眼内炎一例

Traditional laboratory detection methods and metagenomic next-generation sequencing in pulmonary fungal infection diagnosis

In recent years, due to the extensive usage of immunosuppressant and the rise of patients with cancers and organ transplantation, the incidence rate of invasive fungal infection, especially invasive pulmonary fungal infection, has increased. Besides the clinical manifestations, medical history and imaging, the diagnosis of pulmonary mycosis mainly depends on pathogen detection methods in clinical microbiology laboratory. However, due to the difficulty in fungi culturing and the low sensitivity of smear microscopy, better molecular biology methods are needed. To date, the emergence of metagenomic next-generation sequencing (mNGS) has improved the identification rate of pulmonary fungal infections. mNGS is significantly superior to traditional detection methods in rapid, accurate, and comprehensive determination of fungi from various clinical specimens, especially atypical fungi. However, some problems in mNGS method have to be addressed including sample collection, report interpretation, and its combination with traditional microbiology methods. With the in-depth discussion and solution of the above problems, mNGS will be indispensable to the etiological diagnosis of pulmonary invasive fungal infection.

Study on antimicrobial resistance profile and in vitro bactericidal assays of aztreonam combined with avibactam for carbapenem-resistant Enterobacter spp.

Objective To investigate antimicrobial resistance profiles of carbapenem-resistant Enterobacter spp. (CREn) and the bactericidal effects of aztreonam combined with avibactam. Methods The CREn strains isolated from the West China Hospital of Sichuan University between 2016 and 2021 were identified by gyrB gene amplification and subsequent sequencing. The drug sensitivity results, sample types and distribution of relevant patient departments of these strains were summarized. Colistin-resistant and -intermediate strains were selected to carry out the bactericidal test of colistin and aztreonam combined with avibactam. Results A total of 110 clinical strains of CREn were included. The most common strain was Enterobacter xiangfangensis (91 strains), the highest proportion was in the intensive care unit (27.27%), and the proportion of respiratory tract samples was more than 40%. The antimicrobial sensitivity results showed that CREns were all resistant to carbapenems, the resistance rate to colistin was 23.64%, and the resistance rate to aztreonam combined with avibactam was 0. Among other antimicrobial agents, the antimicrobial resistance rate of amikacin and tigecycline were less than 10%. The time-kill curve showed that for colistin-intermediate strains, colistin could achieve bactericidal effect in a shorter time than aztreonam combined with avibactam. However, whether the strain was resistant to colistin or not, the bactericidal rate of 2 μg/mL aztreonam combined with avibactam in 24 hours could exceed 99%. Conclusion CREn is resistant to most commonly used clinical antibacterial drugs, but remains sensitive to aztreonam combined with avibactam, and aztreonam combined with avibactam has bactericidal effect on it.