Objective To investigate the mutations of quinolone resistance determinational region ( QRDR) in fluoroquinolon-resistant Pseudomonas aeruginosa strains isolated from patients with nosocomial pneumonia. Methods Eight-four Pseudomonas aeruginosa strains isolated from patients with nosocomial pneumonia in Xinhua Hospital during January 2006 to December 2007, from whom fluoroquinolon-resistant resisitant ( case) and fluoroquinolon-susceptible ( control ) Pseudomona aeruginosa were identified. The mutation of QRDR was tested by restriction fragment length polymorphism ( RFLP) and gene sequencing.The relationship between QRDR mutations and clinical prescription was analyzed. Results Mutation in QRDR was found in 42 isolates among the 50 fluoroquinlon-resisitant isolates( 84. 0% ) , while no mutation was found in fluoroquinlon-susceptible isolates. The mutation in GyrB Ser464 was found in 34 isolates ( 68. 0% ) . There was statistical difference in the usage of β-lactams between the GyrB-Ser464-mutated group and the non-GyrB-Ser464-mutated group( OR = 11. 3, P = 0. 003 and OR = 3. 5, P = 0. 023) , also in the time of fluoroquinolon usage before isolated ( P = 0. 038) . Conclusions The mutation of QRDR is contributing to fluoroquindor-resisitance of Pseudomona aeruginosa, most of which lies in GyrB Ser464.Abuse of β-lactams and fluoroquinolon may be the risk factors of mutation in GyrB Ser464.
Objectives To retrospectively analyze the isolation rate and drug-resistance of pseudomonas aeruginosa in Fuwai Hospital of Chinese Academy of Medical Sciences from 2013 to 2016. Methods The specimens were collected and cultured. If the isolated bacteria were from the same part of the same patient, the first isolated strains were only counted. The isolated pathogens were identified and the drug-resistance were analyzed. Results A total of 1 404 pseudomonas aeruginosa were isolated. The majority of them were from postoperative recovery room of surgery department (62.1%) and ICU of internal medicine (22.3%). The specimen source were mainly from respiratory tract (75.7%), followed by blood (10.0%) and venous catheter (5.5%). The resistance rate of piperacillin and piperacillin/sulbactam to pseudomonas aeruginosa was 0.6% to 10.4%. The resistance rate of ceftazidime and cefepime was 0.3% to 11.7%. The resistance rate of imipenem and meropenem was 7.6% to 20.1%. The resistance rate of amikacin, gentamicin, and tobramycin was 0.3% to 3.2%. The resistance rate of ciprofloxacin and levofloxacin was 0.6% to 5.2%. Conclusions The isolates of pseudomonas aeruginosa are mainly from postoperative recovery room of surgery department and ICU of internal medicine . Imipenem and meropenem are not the best choices for pseudomonas aeruginosa infection. It has great value to combine piperacillin, piperacillin/sulbactam, ceftazidime and cefepime with aminoglycoside or quinolone antibiotics for the treatment of pseudomonas aeruginosa infection which will reduce drug resistance.
摘要:目的:探讨新生儿铜绿假单胞菌肺炎的临床特点及药敏特点,为合理治疗提供依据。方法:对我院新生儿科2006年8月到2008年7月收治新生儿肺炎痰标本进行培养分离鉴定,选择培养结果为铜绿假单胞菌者做药敏及临床分析。结果:铜绿假单胞菌对碳青霉烯类,如:亚胺培南,美洛培南敏感率达100%,对近几年在新生儿较少用的或不用的氨基糖甙类,环丙沙星敏感率为85%～100%,而对常用的氨苄西林+舒巴坦不敏感,对头孢他啶敏感率gt;70%,临床根据药敏结果选择敏感抗生素治疗,疗效满意。结论:近年新生儿铜绿假单胞菌肺炎有上升趋势,病死率极高,故应根据药敏试验结果选择敏感抗生素,以控制疾病发展,降低病死率。
Objective To establish a rat model of chronic pulmonary infection by inoculating Pseudomonas aeruginosa to Sprague-Dawley(SD) rats.Metods Sixty SD rats were divided into 2 groups,ie.the P.aeruginosa group and the control group. Silicone tube precoated with P.aeruginosa was placed into the main bronchus. For the control group, sterile silicon tube was intubated. Results P ． aeruginosa was detected from lung tissue of rats in infected groups.Bacterial number was higher than 103cfu ／ g 28 days after inoculation.The pathological study showed fibrinous proliferation and granulomas formation in the lungs of infected rats 28 days after inoculation.Microscopy examination showed a inflammation predominantly with lymphocyte infiltration.In control group, no bacterial and pathological changes could be detected. Conclusions The animal model with P.aeruginosa chronic pulmonary infection can be established successfully by silicone tubes precoated with P.aeruginosa intubated into the main bronchus.
摘要:目的:探讨老年耐亚胺培南铜绿假单胞菌(IRPA)感染的危险因素以指导临床救治。 方法:采用病例对照研究,选取四川省人民医院干部科2006年1月~2008年12月IRPA院内感染老年患者32例,并随机选择同时期敏感铜绿假单胞菌院内感染48例作为对照,采用单因素(t检验,χ2检验)及多因素Logistic回归进行分析。结果:IRPA分离率为34.8%,IRPA对抗生素的耐药性远远高于敏感铜绿假单胞菌组,但对阿米卡星敏感率达81.3%。单因素分析发现,下列因素与IRPA感染有关:高龄、住院时间≥4周、高急性生理和慢性健康状况(APACHEⅡ)评分、慢性肺部疾病(慢性阻塞性肺疾病COPD/支气管扩张)、分离出IRPA前2周用过亚胺培南/美罗培南、早期联用抗生素、院内获得性肺炎(HAP)。多因素Logistic回归分析表明:长程住院［比值比(OR)= 14.887］,APACHEⅡ评分≥16分(OR=38.908)以及分离出IRPA前2周用过亚胺培南/美罗培南(OR =12.945)是IRPA感染的独立危险因素。结论:长程住院、APACHEⅡ评分≥16分以及亚胺培南/美罗培南的使用是IRPA感染的危险因素。IRPA对阿米卡星敏感率相对较高,但治疗难度大。Abstract: Objective: To study the infection status and risk factors of nosocomial infection caused by imipenemresistant Pseudomonas aeruginosa (IRPA) in elderly patients. Methods: By a casecontrol study, the data of 32 cases of IRPA nosocomial infections were analyzed from Jan. 2006. to Dec. 2008 in cadres Ward of Sichuan Provincial People’s Hospital; 48 cases of Imipenemsensitive pseudomonas aeruginosa infection were randomized as control. Univariate analysis (T test and chisquare test )and multivariate logistic regression analysis were used for statistics. Results: The resistance to antibiotics of IRPA is much higher than the sensitive group.81.3％ of IRPA were sensitive to amikacin. According to univariate analysis,the factors associated with the infection caused by IRPA were age, length of stay in hospital more than 4 weeks, high score of APACHEⅡ, chronic pulmonary disease (COPD/bronchiectasis),imipenem/meropenem used 2 weeks before isolation of IRPA, early combination therapy of antibiotics and hospital acquired pneumonia (HAP). Multivariate logistic regression analysis identified three independent factors: Length of stay in hospital more than 4 weeks, APACHEⅡ score≥16 and imipenem/meropenem used 2 weeks before isolation of IRPA. Conclusion: Long length of stay in hospital, APACHEⅡ score ≥16 and previous imipenem/meropenem use were independent risk factors for IRPA infection. Although the sensitivity of IRPA to amikacin was relatively high, it was difficult to treat in clinical practice.
Objective To explore the overall outcome and its factors of patients with carbapenem-resistant Pseudomonas aeruginosa bloodstream infection (CRPA-BSI). Methods A single-center, retrospective cohort study was carried out. The demographic and clinical data of all emergency patients and inpatients in West China Hospital of Sichuan University from 2017 to 2021 were collected. Firstly, the prognosis of patients with CRPA-BSI was compared with those with carbapenem-sensitive Pseudomonas aeruginosa bloodstream infection (CSPA-BSI). Then Cox regression was used to analyze the factors affecting the prognosis of CRPA-BSI patients. Results A total of 53 patients with CRPA-BSI and 175 patients with CSPA-BSI were enrolled, and they were 1∶1 matched according to the age-adjusted Charlson Comorbidity Index (aCCI) to control for confounding factors. When aCCI was similar, the incidence of poor prognosis in CRPA-BSI patients was significantly higher than that in CSPA-BSI patients [41.5% vs. 18.9%; relative risk=2.20, 95% confidence interval (CI) (1.16, 4.19), P=0.011]. The median length of hospital stay in the CRPA-BSI group was 3 d longer than that in the CSPA-BSI group but the difference was not statistically significant (29 vs. 26 d, P=0.388). With regard to prognostic factors, univariate Cox regression analyses showed that the highest temperature ≤39℃ (P=0.014), hepatobiliary and pancreatic diseases (P=0.011), days of central venous catheterization (P=0.025), days of indwelling urinary catheters (P=0.037), adjustment of medication duration according to drug sensitivity results (P=0.015) and Pitt bacteremia score (P=0.007) were related to the poor prognosis of CRPA-BSI patients. Multiple Cox regression analysis showed that hepatobiliary and pancreatic disease [hazard ratio (HR)=3.434, 95%CI (1.271, 9.276), P=0.015] and Pitt bacteremia score [HR=1.264, 95%CI (1.057, 1.510), P=0.010] were independently associated with poor outcome in CRPA-BSI patients. Conclusions The prognosis of CRPA-BSI patients is worsen than that of CSPA-BSI patients. Hepatobiliary and pancreatic diseases significantly increase the risk of poor outcome in CRPA-BSI patients. Pitt bacteremia score is a predictor of prognosis in patients with CRPA-BSI.
Objective To investigate the predictors for carbapenem-resistant Acinetobacter baumannii, Enterobacteriaceae and Pseudomonas aeruginosa (CR-AEP) as the pathogens of bloodstream infection (BSI) for intensive care unit (ICU) patients. Methods A retrospective case-control study based on ICU- healthcare-associated infection (HAI) research database was carried out. The patients who have been admitted to the central ICU between 2015 and 2019 in the ICU-HAI research database of West China Hospital of Sichuan University were selected. The included patients were divided into two groups, of which the patients with ICU-acquired BSI due to CR-AEP were the case group and the patients with BSI due to the pathogens other than CR-AEP were the control group. The clinical features of the two groups of patients were compared. Logistic regression model was used to identify the predictors of BSI due to CR-AEP.ResultsA total of 197 patients with BSI were included, including 83 cases in the case group and 114 cases in the control group. A total of 214 strains of pathogenic bacteria were isolated from the 197 BSI cases, including 86 CR-AEP strains. The results of multivariate logistic regression analysis showed that previous use of tigecycline [odds ratio (OR)=2.490, 95% confidence interval (CI) (1.141, 5.436), P=0.022] was associated with higher possibility for CR-AEP as the pathogens of BSI in ICU patients with BSI, while previous use of antipseudomonal penicillin [OR=0.497, 95%CI (0.256, 0.964), P=0.039] was associated with lower possibility for that. Conclusion Previous use of tigecycline or antipseudomonal penicillin is the predictor for CR-AEP as the pathogens of BSI in ICU patients with BSI.
ObjectiveTo evaluate the safty of recurrent laryngeal nerve (RLN) and parathyroid if Pseudomonas aeruginosa injection (PAI) is used after total thyroidectomy and central neck dissection (CND).MethodsFrom Mar. 2016 to Oct. 2017, we recruited 113 patients with papillary thyroid cancer (PTC) who accepted total thyroidectomy and CND. During operation, 1 mL of PAI was applied in 58 patients (local spray group) and 55 not (control group). The hoarseness, hypoparathyroidism, chylous fistula, drainage volume, hospital stay, and incidence of complications were compared between the two groups.ResultsThe two groups embraced few difference in age, gender, BMI, tumor site, the diameter of tumor and the number of metastatic and the harvested lymph nodes (P>0.05). There were nobody who has suffered in hoarseness and permanent hypoparathyroidism in both groups at any time after operation. There was no significant differences of complication between the two groups. The drainage volume at 24 h after operation in the local spraying group was more than that in the control group, and the difference was statistically significant (P=0.023). There were 2 patients had chylous fistula after surgery in the control group but none in the local spray group. The total volumes of drainage, incidence of fever and incision infection, the mean stay in the hospital, and the postoperative pain score had no statistic significance in the both groups.ConclusionAfter total thyroidectomy and CND, local spraying of PAI in the wound cavity is safe and will not damage the recurrent laryngeal nerve.
Objective To explore the role of CD4+CD25+ Treg cells in chronic pulmonary infection caused by Pseudomonas aeruginosa(PA).Methods Sixty SD rats were randomly divided into a PA group and a control group(n=30 in each group).Chronic lung infection model was established by implantation of silicone tube precoated with PA into the main bronchus.Twenty-eight days later Treg cells in peripheral blood were measured by fluorescence-activated cell sorting（FACS）.Levels of IL-10 and TGF-β in serum were assayed by ELISA.The expression of Foxp3 mRNA in spleen was measured by RT-PCR.Pathological changes of lung tissue were studed by HE staining.Results Treg/CD4+ T cells in the PA group were significantly more than those in the control group[（19.79±6.45）% vs （5.15±0.47）%，Plt;0.05].The levels of IL-10 and TGF-β were (231.52±54.48)pg/mL and （121.05±7.98）pg/mL in the PA group respectively，which were significantly higher than those in the control group[（35.43±23.56）pg/mL and （36.02±8.94）pg/mL].The expression of Foxp3 mRNA in the PA group was significantly higher compared with the control group(0.80±0.044 vs 0.25±0.054，Plt;0.05）.HE staining revealed that PA caused a intensive inflammatory reaction with lymphocytes infiltration.Conclusion CD4+CD25+ Treg cell is up-regulated and plays an important role in chronic lung infection caused by Pseudomonas aeruginosa.
目的 探讨铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后淋巴漏的方法及效果。方法 笔者所在医院2012年4月至2012年7月期间共治疗甲状腺癌颈部淋巴结清扫术后顽固性淋巴漏患者4例，均采用铜绿假单胞菌注射液治疗。将铜绿假单胞菌注射液（1mL或2mL）通过引流管逆行注射到创腔，夹闭引流管1h后再开放引流管。结果 4例患者注射前1d24h引流量分别为200、350、540及810mL，其中2例患者为乳糜漏，引流时间分别为7d和15d；另2例患者为单纯淋巴漏，引流时间分别为13d和14d。注射1d后，引流量分别减少至20、45、120及255mL，4d后4例患者均顺利拔除引流管。4例患者治疗后均有不同程度的发热，经物理降温后体温恢复；均有不同程度的局部疼痛感，3例患者疼痛能耐受，另1例疼痛剧烈患者予以美洛昔康口服后缓解。结论 铜绿假单胞菌注射液治疗甲状腺癌颈部淋巴结清扫术后顽固性淋巴漏的疗效显著。