ObjectiveTo investigate the distribution and antibiotic resistance of pathogens isolated from children with primary nephrotic syndrome (PNS) complicated with urinary tract infection (UTI), so as to provide references for reasonable use of anti-infective agents in clinical practice. MethodsA total of 218 eligible patients who hospitalized in our department between January 2009 and December 2012 were included, and the data of distribution and antibiotic resistance of pathogens were analyzed retrospectively. ResultsIn this cohort, asymptomatic UTI in children with PNS accounted for 75.7% (165/218). And a total of 249 pathogenic strains were isolated and cultivated. The main pathogens of those subjects were G- bacilli, accounting for 64.3% (160/249), and 63.8% (102/160) of G- bacilli was Escherichia coli (E.coli); G+ cocci accounted for 31.7% (79/249), and 59.5% (47/79) of them was Enterococci faecalis; and fungi accounted for only 4.0%. Drug-susceptibility testing suggested that E.coli had a high resistance rate to hydroxyl ampicillin, cefazolin and ceftriaxone (>50%), but had lower resistance rate to cefoperazone/sulbactam and imipenem (<10%). Enterococci faecalis had a high resistance rate to rifampicin (74.6%), but had low resistance to vancomycin and linezolid (<10%). ConclusionAsymptomatic UTI is common in children with PNS. E.coli is the major pathogen and the proportion of enterococcus infection is also not low, and these pathogens have a high antibiotic resistance and most of them are multi-resistant.
【摘要】 目的 分析ICU患者院內下呼吸道感染的細菌分布情況,為臨床用藥提供依據。方法 對成都市第六人民醫院2006年1月—2009年6月566例ICU院內下呼吸道感染患者的痰培養標本結果進行回顧性調查分析。結果 共分離出371株病原菌,其中革蘭陰性桿菌235株,占63.34%;革蘭陽性球菌62株,占16.71%;真菌74株,占19.95%。藥敏結果顯示,對常規青霉素類基本耐藥,亞胺培南—西司他丁、美羅培南耐藥菌株少見,對萬古霉素耐藥菌株尚未出現。結論 加強ICU呼吸道感染的病原菌監測極為必要,對臨床抗生素的合理使用具有指導意義。
目的 總結腎移植術后肺部感染的臨床表現、病原學及救治措施，以提高其治愈率。 方法 對四川大學華西醫院50例次腎移植術后肺部感染住院患者的病歷資料進行回顧性分析。 結果 共收集42例（50例）次腎移植肺部感染患者，痰培養檢出病原體38例次（76%），未檢出12例次，其中細菌感染17例次（44.7%），真菌感染7例次（18.4%），巨細胞病毒感染19例次（38%），支原體感染6例次（12%），混合感染10例次（20%）。肺部感染發生在腎移植術后1個月以內者3例（7%），1～6個月者16例（38%），6個月以后者23例（55%）。50例次感染患者中48例次經積極治療搶救后好轉出院，有2例患者死亡。 結論 腎移植術后肺部感染患者的病原體與腎移植術后時間有一定的規律性。對于腎移植術后肺部感染，救治成功的關鍵是早期病原體及CT檢查，及時給予綜合治療措施，包括經驗性抗生素治療措施，及時調整免疫抑制劑方案，加強全身支持。
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.
Abstract: Objective To analyze the characteristics of pathogens isolated from patients with lung cancer after surgery, and provide instructions for the prevention and treatment of postoperative infection. Methods A retrospective investigation of the pathogenic microbiology data of 159 patients（142 males and 17 females with average age at 61.8±9.6 years) with lung cancer after surgery in West China Hospital from January 2009 to December 2011 was performed.We got the specimen from the patients by routine methods, identified the pathogens, and conducted drug susceptibility tests in vitro. Results The pathogens were mainly isolated from sputum of the patients （90.6%, 155/171）. Canidia albicans（25.7%, 44/171）, Klebsiella pneumonia（15.2%, 26/171）, Acinetobacter calcoaceticus-A. baumannii（13.4%, 23/171）and Pseudomonas aeruginosa（8.2%, 14/171） were the predominant species. Among A. calcoaceticus-A. baumannii isolates, 39.1%（9/23） of them were multidrug resistant strains. And 23.1%（6/26）of K. pneumonia isolates produced extended spectrum beta-lactamases. P. aeruginosa isolates showed high in vitro susceptibility to the antibacterial agents. Conclusion Pathogens are mainly isolated from sputum of patients after surgery for lung cancer. Canidia albicans and gram-negative bacilli are predominant isolates and should be the major targets for the prevention and treatment of postoperative infection.
目的 了解2011年1月－2012年12月臨床分離病原菌的分布和耐藥情況，為指導臨床合理用藥和醫院感染的控制提供依據。 方法 采用法國梅里埃API半自動微生物鑒定分析系統進行細菌鑒定和藥物敏感試驗，對所得數據用WHONET 5.4軟件完成統計分析。 結果 送檢的3 073份臨床標本中共分離出病原菌696株，陽性率22.1%。其中，G+菌占31.3%，G?菌占64.1%，主要為金黃色葡萄球菌（25.6%）、大腸埃希菌（17.8%）、肺炎克雷伯菌（16.4%）、銅綠假單胞菌（11.5%）。在葡萄球菌中，青霉素、紅霉素的耐藥率最高，分別是95.6%、78.5%；尚無耐萬古霉素菌株。腸道桿菌中，阿莫西林的耐藥率最高，為95.0%；替卡西林的耐藥率為91.0%；頭孢噻吩的耐藥率為72.0%；尚無耐亞胺培南菌株。多重耐藥的大腸埃希菌、肺炎克雷伯菌對亞胺培南具有良好的敏感性。 結論 該院臨床分離的致病菌耐藥情況不嚴重，對病原菌的分布和耐藥情況的研究較好地指導了臨床合理用藥和控制了醫院感染。
目的 了解綜合重癥監護病房（ICU）呼吸機相關性肺炎（VAP）感染率、危險因素、病原菌分布及其耐藥情況，探討有針對性的預防控制措施。 方法 2009年1月－12月綜合ICU共收治患者447例，采用主動監測方法，由ICU醫務人員和專職人員每日對綜合ICU病房住院時間≥48 h且撤停機械通氣后48 h內的患者進行VAP監測。 結果 447例患者中住院時間≥48 h的患者168例，96例患者使用呼吸機，使用呼吸機時間182 d，ICU住院總日數1 339 d，發生VAP 17例，呼吸機使用率13.59%，VAP感染率93.4例/1 000機械通氣日，根據平均病情嚴重程度（ASIS法）調整后的VAP感染率為2.38%。呼吸機使用方式與VAP發生有關聯。檢出病原菌18株，全部為Gˉ桿菌，其中鮑曼不動桿菌4株，對包括硫霉素、氨曲南在內的多種抗菌藥物耐藥。 結論 綜合ICU病房VAP感染率為2.38%，呼吸機使用不當是VAP的危險因素，VAP致病菌為Gˉ桿菌，其中鮑曼不動桿菌耐藥率達100%，并呈多重耐藥性；抗生素使用時間過長，預防性使用不當是致病菌產生多重耐藥的重要原因。
Objective To study the distribution and drugresistance of pathogens isolated from patients who suffered from lower respiratory infections after thoracotomy and provide basis for rational use of antibiotics in clinical practice. Methods A total of 118 patients suffered from lower respiratory infections after thoracotomy in Beijing Lung Cancer Center and the Thoracic Surgery Department of Xuanwu Hospital between January 1,2006 and December 31, 2009. We performed a retrospective study on pathogens from their lower respiratory tract. Of these patients, 89 are male and 29 are female with a mean age of 64.6 years. Sputum specimens were obtained by sterile sputum collectors or bronchofibroscopes, and then were sent to microorganism laboratory immediately. Cytological screening was carried out before specimen inoculation. Bacterial culture, identification and drug sensitivity test were performed with routine methods. Results A total of 201 strains of pathogens from the lower respiratory tract were identified. There were 126(62.7%) strains of gramnegative bacilli, 66(32.8%) strains of grampositive cocci, and 9(4.5%) strains fungi. The four prevalent gramnegative bacilli strains with the highest isolating rate between 2006 and 2009 included 34(27.0%) strains of acinetobacters, 28(22.2%) strains of verdigris Pseudomonas, 19(15.1%) strains of Klebsiellas and 19(15.1%) strains of Escherichia coli. Verdigris Pseudomonas ranked first in isolating rate among prevalent gramnegative bacilli strains from 2006 to 2008, but it was replaced by cinetobacters (9 strains, 40.9%) in 2009. The most prevalent strains of grampositive cocci were staphylococcus aureus (35 strains, 53%) from 2006 to 2009. Gramnegative bacilli were most sensitive to imipenem and no grampositive cocci were resistant to vancomycin. Conclusion Gramnegative bacilli are the most common pathogens in lower respiratory infections after thoracotomy and show extremely high drugresistance rate. Drugresistance monitoring of pathogens should be promoted. It may contribute to rational antimicrobial therapy and effective control of infections.
Objective To explore the distribution of bacteria among community acquired lower respiratory tract infection (LRTI) inpatients with underlying chronic respiratory tract diseases.Methods The clinical data，sputum culture and drug susceptibility results of 212 community acquired LRTI patients who were hospitalized during the period 2001-2005 were retrospectively analyzed.All patients had various underlying chronic respiratory tract diseases.Results A total of 229 strains of pathogens were detected，with the majority being gram negative bacteria.In pathogens of acute exacerbation of chronic obstructive pulmonary disease，gram negative bacteria occupied 73.9%.And Pseudomonas aeruginosa and Klebsiella pneumoniae were the most common pathogens，with each occupying 18.2% and 13.6% respectively.Gram positive bacteria occupied 23.8%，mainly Staphylococcus aureus (10.2%) and Streptococcus pneumoniae (9.1%).In patients with bronchiectasis exacerbated by bacterial infection，86.2% were caused by gram negative bacteria，the top three being，in descending order，Pseudomonas aeruginosa (27.5%)，Haemophilus parainfluenzae (13.7%)，and Haemophilus influenzae (11.8%).Bronchiectasis was the major risk factor of getting Pseudomonas aeruginosa infection (OR=5.590，95%CI 2.792~11.192).The risk factors of getting Acinetobacter baumanii infection were antacid usage within 1 month (OR=9.652，95%CI 2.792~11.192) and hypoalbuminemia (OR=2.679，95%CI 1.108~6.476).For enterobacters infections，including Klebsiella pneumoniae，Enterobacter cloacae and Escherichia coli，the risk factors were antibiotic usage within 1 month (OR=4.236，95%CI 1.982~9.057)，having renal diseases (OR=4.305，95%CI 1.090~17.008) and diabetes mellitus (OR=2.836，95%CI 1.339~6.009).Conclusions Gram negative bacteria were the main pathogens of community acquired LRTI in hospitalized patients with underlying chronic respiratory tract diseases.The pathogens were influenced by underlying diseases，severity of diseases and drug usage history of patients.