尿毒症血透患者感染溶血金葡萄球菌的药物治疗及护理

通过1例尿毒症溶血金葡萄球感染患者于中心静脉双腔管及静脉应用利福霉素，观察用药效果及不良反应，并进行护理措施的制定。

金葡菌感染211例临床分析

分析了１９９１￣１９９８年２１１例金葡菌感染的发病和转归，病例主要见于１儿、内、外科。其中耐甲西林金葡菌（ＭＲＳＡ）感染其３６．５％，金葡蓖败血症占５２．１％；Ｌ型金葡菌感染占１５．６５％，发生败血症占９３．９％。内、儿科系感染多见于免疫功能低下相关性疾病。尤其是老年、新生儿及早产儿等易感人群；外科则多见于烧伤创面感染、术后切口感染及留置静脉管道等。

早期发现皮肤烫伤改变的护理体会

近年来，由金色葡萄球菌（简称金葡萄菌）感染引起的皮肤烫伤样改变，对诊断金葡萄菌感染有重要意义，故被国内学者越来越重视。金葡萄菌感染，起病急，变化快并常伴有多器官的损害，病死率高，若能早诊断，及时治疗，对降低病死率有重大意义。限于目前基层医院的实验室无法进行早期快速检查，作为医护人员，当病人入院后，除应详细检查外，还应细致地观察病情，特别是对一些特异性表现的观察常有助于临床的早期诊断。近来我科经血培养确诊为金葡萄菌感染的11例患者中，有8例出现典型的皮肤烫伤样改变，现介绍如下。

Two bacterial infection models in tree shrew for evaluating the efficacy of antimicrobial agents

Animal models are essential for the development of new anti-infectious drugs.Although some bacterial infection models have been established in rodents,small primate models are rare.Here,we report on two bacterial infection models established in tree shrew（Tupaia belangeri chinensis）.A burnt skin infection model was induced by dropping 5×106 CFU of Staphylococcus aureus on the surface of a wound after a third degree burn.This dose of S.aureus caused persistent infection for 7 days and obvious inflammatory response was observed 4 days after inoculation.A Dacron graft infection model,2×106 CFU of Pseudomonas aeruginosa also caused persistent infection for 6 days,with large amounts of pus observed 3 days after inoculation.These models were used to evaluate the efficacy of levofloxacin（LEV） and cefoperazone（CPZ）,which reduced the viable bacteria in skin to 4log10 and 5log10 CFU/100 mg tissue,respectively.The number of bacteria in graft was significantly reduced by 4log10 CFU/mL treatment compared to the untreated group（P0.05）.These results suggest that two bacterial infection models were successfully established in tree shrew using P.aeruginosa and S.aureus.In addition,tree shrew was susceptible to P.aeruginosa and S.aureus,thus making it an ideal bacterial infection animal model for the evaluation of new antimicrobials.

A case of methicillin-resistant Staphylococcus aureus infection following bile duct stenting

AIM: To present a case of methicillin-resistant Staphylococcus aureus (MRSA) infection following bile duct stenting in a patient with malignant biliary obstruction.METHODS: A 78-year-old male patient was admitted to a community hospital with progredient painless jaundice lasting over two weeks, weight loss and sweating at night.Whether a stent should be implanted pre-operatively in jaundiced patients or whether these patients should directly undergo surgical resection, was discussed.RESULTS: ERC and a biopsy from the papilla of Vater revealed an adenocarcinoma. In addition, a 7-Ch plastic stent was placed into the common bile duct. Persistent abdominal pain, increasing jaundice, weakness and indigestion led to the transfer of the patient to our hospital.A pylorus-preserving pancreatoduodenectomy wasperformed. Intraoperatively, bile leaked out of the transected choledochus andthe stent was found to be dislocated in the duodenum. A smear of the bile revealed an infection with MRSA, leading to post-operative isolation of the patient.CONCLUSION:As biliary stents can cause severe infection of the bile, the need for pre-operative placement of biliary stents should be carefully evaluated in each individual case.

Anti-infectious efficacy of essential oil from Caoguo(Fructus Tsaoko)

OBJECTIVE: To evaluate the anti-infectious efficacy of essential oil extracted from Caoguo(Fructus Tsaoko).METHODS: Minimum inhibitory concentrations(MICs) against clinical isolates of three extracts andthe essential oil from Caoguo(Fructus Tsaoko) were determined by the agar dilution method. The anti-infectious efficacy of the essential oil was evaluated using a mouse peritonitis model which was infected with Staphylococcus aureus or Escherichia coli. The chemical components of the essential oil were identified.RESULTS: The results showed that the essential oil exhibited strong antibacterial activity in vitro, with MICs ranging from 22.49 to 1438.91 μg/m L. The results of in vivo anti-infectious efficacy showed that the Caoguo(Fructus Tsaoko) essential oil can protect the mice from Staphylococcus aureus or Escherichia coli infection. The compositions of the essential oil and relative component percentages were examined. A total of 32 compounds, were identified. The major compounds of essential oil were 1,8-cineole(25.92%) and geraniol(13.69%).CONCLUSION: Our findings suggest that Caoguo(Fructus Tsaoko) essential oil has broad-spectrum antibacterial properties. It warrants further investigation as an antibacterial agent targeting some bacterium with multi-drug resistance.

Selective inactivation of Gram-positive bacteria in vitro and in vivo through metabolic labelling

Bacterial infections are grave threats to human health,particularly those caused by the most common Grampositive bacteria.The massive administration of broad-spectrum antibiotics to treat various bacterial infections has led to the evolution and spread of drug resistance.As a universal antimicrobial technique unapt to induce drug resistance,photothermal therapy(PTT)is attracting extensive attention in recent years.However,its unspecific killing capability and side effects towards adjacent mammalian cells severely impede the practical applications.Herein,we proposed a metabolic engineering strategy to selectively inactivate Gram-positive bacteria by PTT.A bioorthogonal photothermal agent was prepared by the conjugation of IR-780 iodide and dibenzocyclooctyne(IR780-DBCO).Upon pre-metabolizing with 3-azido-D-alanine,Gram-positive bacteria rather than Gramnegative ones,such as Staphylococcus aureus and vancomycinresistant Enterococcus faecalis(VRE),could be specifically tied up by the explosive IR780-DBCO via copper-free click chemistry.Thereafter,they spontaneously detonated under 15 min near-infrared light irradiation and inactivated nearly 100% Gram-positive bacteria in vitro.Moreover,superbug VRE-induced infection was significantly inhibited by this approach in a mouse skin wound model.This metabolic labelling-based photothermal ablation strategy specific to Gram-positive microbes would stimulate the development of precise antibacterial candidates for preclinical applications.

A 61-year-old man with bloody purulent cerebrospinal fluid

Staphylococcus aureus meningitis(SAM)is a relatively uncommon but serious disease,accounting for only 1%–9%of cases of bacterial meningitis.In this report,we described a 61-year-old man,whose appearance of CSF was bloody and purulent.CSF test showed extremely elevated WBC count and protein quantification.Bacterial culture demonstrated SAM.Complications included septic shock,acute respiratory failure,and renal failure.Empiric antibiotic treatment was not effective for him.Therefore,we prescribed up to five types of antibiotics.We found that the clinical symptoms,CSF indicators,inflammatory markers,respiratory and renal function got better.The nerve function comparatively recovered well after 6 months of follow-up.