Pseudomonas aeruginosa （P. aeruginosa） is one of the leading pathogens involved in nosocomial pneumonia. In addition, P. aeruginosa infection is associated with significant morbidity and mortality. A major problem i...Pseudomonas aeruginosa （P. aeruginosa） is one of the leading pathogens involved in nosocomial pneumonia. In addition, P. aeruginosa infection is associated with significant morbidity and mortality. A major problem in P. aeruginosa infection is that this organism exhibits natural and acquired resistance to many structurally and functionally diverse antibiotics.展开更多
Background The incidence of vancomycin-resistant enterococci （VRE） appeared to be increasing in China, but very few nosocomial outbreaks have been reported. Our hospital had experienced an outbreak of VRE since Marc...Background The incidence of vancomycin-resistant enterococci （VRE） appeared to be increasing in China, but very few nosocomial outbreaks have been reported. Our hospital had experienced an outbreak of VRE since March 2008 to March 2009. The objective of this study was to analyze the molecular features of the isolates and the control measures used to eradicate a VRE outbreak in a tertiary institution in China.Methods We characterized VRE isolates from 21 infected and 11 colonized inpatients from a single hospital by pulsed field gel electrophoresis （PFGE）, multilocus sequence typing （MLST）, the analysis of Tn 1546-like elements and virulence genes detection. Infection control measures, including more environmental disinfection, screening for VRE colonization,contact precautions, education and strict antibiotic restriction, were implemented to control the outbreak.Results During the outbreak, a total of 32 VRE strains were obtained. There were 21 strains found in Emergency Intensive Care Unit （EICU）, 9 isolates from Geriatric Ward, and two from other units. All the isolates harbored the vanA gene, however,four of them exhibited the VanB phenotype. Meanwhile, MLST analysis revealed that all isolates belonged to clonal complex （CC） 17. With the infection-control measures, the epidemic was constrained in two units （EICU and Geriatric Ward）. After March 2009, no further case infected with VRE was detected in the following one-year period.Conclusion The outbreak was controlled by continuous implementation of the infection control programme, and more rigorous infection control policy is needed.展开更多
Background The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus （hVISA） is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of...Background The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus （hVISA） is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of hVISA is rare in China. This study summarizes the prevalence and clinical features associated with hVISA infections at our institution and the local impact they have on clinical outcome. Methods A total of 122 methicillin-resistant Staphylococcus aureus （MRSA） isolates which were of the causative pathogens were collected. One hundred and two patients for whom we had full information of MRSA pneumonia were included. Isolates of MRSA were collected using PCR to detect the mecA gene. Both Etest and macro Etest were performed to screen for hVISA. The Staphylococcal chromosome cassette mec （SCCmec） types were determined by multiplex PCR strategy. Logistic regression analysis was used to determine the risk factors. Results Among the 122 MRSA isolates collected, 25 （20.5%） strains were identified as hVISA. There were 119 （97.5%） SCCmec III isolates, two （1.6%） SCCmec II isolates, and one （0.8%） SCCmec V isolate. The 30-day mortality of MRSA-hospital acquired pneumonia （HAP） was 37.3%, and 62.5% for hVISA-HAP. Vancomycin treatment was the independent risk factor of hVISA. Factors independently associated with 30-day mortality in all patients were acute physiology and Chronic Health Evaluation （APACHE） II score 〉20, multiple lobe lesions, and creatinine clearance rate （CCR） 〈15 ml/min. Conclusions The prevalence of hVISA is 20.5% at our institution, hVISA-HAP patients had a poor clinical outcome. Vancomycin treatment was the independent predictors for hVISA infection. Factors independently associated with 30-day mortality in all patients were APACHE II score 〉20, multiple lobe lesions and CCR 〈15 ml/min.展开更多
文摘Pseudomonas aeruginosa （P. aeruginosa） is one of the leading pathogens involved in nosocomial pneumonia. In addition, P. aeruginosa infection is associated with significant morbidity and mortality. A major problem in P. aeruginosa infection is that this organism exhibits natural and acquired resistance to many structurally and functionally diverse antibiotics.
文摘Background The incidence of vancomycin-resistant enterococci （VRE） appeared to be increasing in China, but very few nosocomial outbreaks have been reported. Our hospital had experienced an outbreak of VRE since March 2008 to March 2009. The objective of this study was to analyze the molecular features of the isolates and the control measures used to eradicate a VRE outbreak in a tertiary institution in China.Methods We characterized VRE isolates from 21 infected and 11 colonized inpatients from a single hospital by pulsed field gel electrophoresis （PFGE）, multilocus sequence typing （MLST）, the analysis of Tn 1546-like elements and virulence genes detection. Infection control measures, including more environmental disinfection, screening for VRE colonization,contact precautions, education and strict antibiotic restriction, were implemented to control the outbreak.Results During the outbreak, a total of 32 VRE strains were obtained. There were 21 strains found in Emergency Intensive Care Unit （EICU）, 9 isolates from Geriatric Ward, and two from other units. All the isolates harbored the vanA gene, however,four of them exhibited the VanB phenotype. Meanwhile, MLST analysis revealed that all isolates belonged to clonal complex （CC） 17. With the infection-control measures, the epidemic was constrained in two units （EICU and Geriatric Ward）. After March 2009, no further case infected with VRE was detected in the following one-year period.Conclusion The outbreak was controlled by continuous implementation of the infection control programme, and more rigorous infection control policy is needed.
基金This research was supported by a grant from the National Natural Science Foundation of China
文摘Background The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus （hVISA） is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of hVISA is rare in China. This study summarizes the prevalence and clinical features associated with hVISA infections at our institution and the local impact they have on clinical outcome. Methods A total of 122 methicillin-resistant Staphylococcus aureus （MRSA） isolates which were of the causative pathogens were collected. One hundred and two patients for whom we had full information of MRSA pneumonia were included. Isolates of MRSA were collected using PCR to detect the mecA gene. Both Etest and macro Etest were performed to screen for hVISA. The Staphylococcal chromosome cassette mec （SCCmec） types were determined by multiplex PCR strategy. Logistic regression analysis was used to determine the risk factors. Results Among the 122 MRSA isolates collected, 25 （20.5%） strains were identified as hVISA. There were 119 （97.5%） SCCmec III isolates, two （1.6%） SCCmec II isolates, and one （0.8%） SCCmec V isolate. The 30-day mortality of MRSA-hospital acquired pneumonia （HAP） was 37.3%, and 62.5% for hVISA-HAP. Vancomycin treatment was the independent risk factor of hVISA. Factors independently associated with 30-day mortality in all patients were acute physiology and Chronic Health Evaluation （APACHE） II score 〉20, multiple lobe lesions, and creatinine clearance rate （CCR） 〈15 ml/min. Conclusions The prevalence of hVISA is 20.5% at our institution, hVISA-HAP patients had a poor clinical outcome. Vancomycin treatment was the independent predictors for hVISA infection. Factors independently associated with 30-day mortality in all patients were APACHE II score 〉20, multiple lobe lesions and CCR 〈15 ml/min.
