Threefold Increase in the Number of Drug Resistant TB Cases after Introduction of Universal Drug Susceptibility Testing: Experiences from Two South India Districts

Background: In India, tuberculosis (TB) is a major public health problem, and the advent of drug resistance TB (DR-TB) has worsened the situation. The Revised National TB Control Programme (RNTCP) has introduced universal drug susceptibility testing (UDST) for all diagnosed TB cases in 2018. We conducted this study to know the advantage of implementing UDST when compared to selective testing existent in 2017 on key diagnostic cascade parameters and to identify the challenges in the implementation of UDST. Methods: The study was conducted in two districts of Karnataka, India during January 2017-December 2018. The quantitative part consisted of before-and-after design and the qualitative part consisted of descriptive design. Results: In 2017 (during selective testing/“before” period) out of the 2440 TB patients, 80 (3%) were diagnosed with Isoniazid and Rifampicin resistance patients;in contrast in 2018 (during UDST/“after” period) of the 5129 TB patients 258 (5%) were diagnosed with Isoniazid and Rifampicin resistance. However, the proportion of eligible patients tested for rifampicin resistance during the “after” period was 60% when compared to 100% during the “before” period and median turnaround time for testing was also longer during the “after” period when compared to the “before” period (32.5 days vs 27.5 days). Major reasons for these two gaps were found to be difficulties in collecting sputum specimens and transportation. Conclusion: The rollout of UDST has led to a three-fold increase in a number of DR-TB cases detected in the region. There is a need for the programme to increase the proportion tested for DST by increasing the laboratory capacity and address the challenges in sputum collection and transportation.

Drug Susceptibility Test of Volatile Oil of Artemisiaargyi to Avian Pathogenic Escherichia coli

The volatile oil of Artemisia argyi was extracted by ultrasonic assisted extraction, and the extraction rate of volatile oil was 0.68%. Thevolatile oil of A. argyi was emulsified with 1% Tween-80, and drug susceptibility test was conducted with avian Escherichia coli. The results showedthat the volatile oil of A. argyi had antibacterial effect against avian E. coli, and the minimal inhibitory concentration was 50 mg/mL. Taking sixcommon antibiotics as the control, drug susceptibility test was conducted with volatile oil of A. argyi. The results showed that 10 strains of E. coliwere sensitive to the volatile oil of A. argyi, three of which had different degrees of resistance and one had the tendency of resistance.

Isolation and Identification of Four Strains of Salmonella and Drug Susceptibility Test

In order to isolate and identify the pathogenic bacteria causing dead chickens in a chicken farm in Qinhuangdao area, the liver, heart and other organs of dead chickens suspected of salmonella disease were collected aseptically, and streaked on SS agar medium and chromagar medium. Transparent colonies were observed on SS agar medium, and purple and transparent colonies on CAS medium. The isolate was conducted purification, staining microscopy, biochemical tests, and 16 S rRNA sequence analysis, and the results showed that four strains of the isolated bacte-ria were salmonella. The 16 S rRNA sequence analysis of four strains of salmonella showed that the isolates shared more than 99% homology. Drug susceptibility test was performed using paper method, and the results showed that most of the strains were resistant to tilmicosin, cefradine and sul-famethoxazole, but were sensitive to ceftriaxone.

Isolation, Identification and Drug Susceptibility Test of a Strain of Escherichia coli Causing Fox Pneumonia

[Objective] The paper was to determine the pathogen causing fox pneumonia in a breeding factory in Changli County.[Method]Through autopsy, a dominant strain was isolated from the lung of dead foxes, which was then performed Gram staining, 16 S rRNA sequence analysis and biochemical identification.[Result] The strain was negative in Gram staining, and was identified as E. coli through 16 S rRNA sequence analysis and biochemical identification. Drug susceptibility test was conducted using 15 kinds of drug susceptibility papers. The E. coli was sensitive to florfenicol, enrofloxacin, ceftriaxone, norfloxacin;intermediately sensitive to amikacin, gentamicin;and strongly resistant to penicillin, ampicillin,cefradine, sulfamethoxazole, lincomycin, streptomycin and amoxicillin.[Conclusion] It is difficult to treat E. coli causing fox pneumonia with traditional antibiotics clinically.

Antimicrobial Susceptibility Profiles among <i>Escherichia coli</i>Strains Isolated from Athi River Water in Machakos County, Kenya

Antimicrobial use in agriculture, livestock and human health has increased over the years leading to the increase in antimicrobial resistance that can also find its way to the aquatic environment. Rivers can act as reservoirs of highly resistant strains and facilitate the dissemination of multidrug resistant (MDR) strains to animals and humans using water. A total of 318 water samples were collected from six different sampling points along Athi River and E. coli isolates were subjected to Kirby-Bauer diffusion method for antimicrobial susceptibility testing. The total mean coliform count of the sampled sites was 2.7 × 104 (cfu/mL). E. coli isolates were most resistant to ampicillin (63.8%) and most susceptible to gentamicin (99.4%). MDR strains (resistance to ≥3 classes of antibiotics) accounted for 65.4% of all the isolates. The site recorded to have human industrial and agricultural zone activities had strains that were significantly more resistant to ampicillin, cefoxitin, amoxicillin/clavulanic acid (P ≤ 0.05) than isolates from the section of the river traversing virgin land and land with minimum human activities. This study indicates that E. coli strains isolated from Athi River were highly MDR and most resistant to some antimicrobial classes (ampicillin and cefoxitin) which constitute a potential risk to human and animal health.

2015-2021年CHINET尿液分离菌分布和耐药性变迁

目的了解2015-2021年CHINET细菌耐药监测网中尿液分离菌的分布和耐药性。方法收集CHINET细菌耐药监测网51家医疗机构2015-2021年所有尿液标本临床分离菌的耐药监测数据资料,采用WHONET 5.6软件进行统计分析。结果2012-2021年尿液标本共分离细菌261893株,其中革兰阳性菌62219株,占23.8%,革兰阴性菌199674株占76.2%。常见的分离菌依次为大肠埃希菌(46.7%)、屎肠球菌(10.4%)、肺炎克雷伯菌(9.8%)、粪肠球菌(8.7%)、奇异变形杆菌(3.5%)、铜绿假单胞菌(3.4%)、无乳链球菌(2.6%)和阴沟肠杆菌(2.1%)。上述细菌主要分离自住院患者,女性多见于男性,成人多见于儿童。大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌中产超广谱β内酰胺酶(ESBL)菌株分别占53.2%、52.8%和37.0%。耐碳青霉烯类的大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌中检出率分别为1.7%、18.5%、16.4%和40.3%。粪肠球菌对氨苄西林、呋喃妥因、利奈唑胺、万古霉素、替考拉宁和磷霉素的耐药率<10%,屎肠球菌对氨苄西林、左氧氟沙星、红霉素的耐药率>90%,对万古霉素、利奈唑胺和替考拉宁的耐药率<2%。ICU住院患者分离的大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌对大部分抗菌药物的耐药率明显高于门诊患者和非ICU住院患者。结论尿液标本临床分离菌主要以大肠埃希菌、肠球菌和肺炎克雷伯菌为主,不同人群尿液标本中分离的细菌种类和耐药性不尽相同,应重视细菌耐药监测,减少抗菌药物的不合理使用。

蜥蜴源黏质沙雷氏菌的分离鉴定与药敏试验

为弄清西北农林科技大学博览园1只观赏蜥蜴突发全身皮肤化脓溃烂、尾巴坏死脱落的病原,采集患病蜥蜴的坏死病灶及血液病料进行细菌分离纯化、生理生化试验、动物致病性试验、16S rRNA基因测序鉴定。结果显示,从病料中分离并纯化出1株菌株,该分离菌株的生理生化特性与黏质沙雷氏菌相符,且该菌对实验小鼠有致病性,其16S rRNA基因序列与NCBI中黏质沙雷氏菌的参考序列同源性为98%。结果表明,所分离到的菌株为黏质沙雷氏菌。药敏试验结果显示,分离菌株对诺氟沙星、丁胺卡那、头孢曲松、氧氟沙星、头孢噻肟等5种抗菌药物高度敏感,对复方新诺明中度敏感,对环丙沙星、头孢噻吩、庆大霉素、头孢氨苄、苯唑西林、多黏菌素B、林可霉素、四环素、氨苄西林等9种抗菌药物耐药。研究结果为筛选有效治疗药物提供了参考依据。

1株5型副猪格拉菌的分离鉴定及生物学特性研究

副猪格拉菌是猪的一种重要病原菌,给世界养猪业带来较大的危害和经济损失。开展副猪格拉菌的分离鉴定及特性分析研究工作,有助于为临床诊断治疗及预防提供依据。该试验对临床发病的仔猪病料进行细菌分离培养鉴定,采用革兰氏染色、生化鉴定、PCR扩增、测序比对、遗传进化分析、基因分型等方法对分离菌株进行鉴定分析,同时对其进行药敏试验及致病性研究。结果显示,分离得到副猪格拉菌,同源性分析结果显示该菌株与副猪格拉菌不同参考菌株之间的相似性介于92.3%~95.6%,基因分型显示分离株为基因型5型。分离菌株对多西环素、阿莫西林敏感,对新霉素、泰乐菌素、复方新诺明和头孢噻吩耐药。小鼠致病性试验显示其具有致病性。本试验相关结果为副猪格拉菌临床防控及治疗提供理论依据。

Performance of the microscopic observation drug susceptibility assay in pyrazinamide susceptibility testing for Mycobacterium tuberculosis

Background Drug susceptibility assay is very important in tuberculosis therapy. Pyrazinamide is a first line antituberculosis drug and diagnosis of its resistance in Mycobacterium tuberculosis （M. tuberculosis） is difficult and time consuming by conventional methods. In this study, we aimed to evaluate the performance of the microscopic observation drug susceptibility （MODS） assay in the detection of pyrazinamide resistance in M. tuberculosis relative to the conventional Wayne assay and Lowenstein-Jensen （L J） proportion method. Methods M. tuberculosis clinical isolates （n=132） were tested by the MODS and the Wayne assay： the results were compared with those obtained by the LJ proportion method. Mutations in the gene were identified by direct sequencing of the pncA genes of all isolates in which pyrazinamide resistance was detected by any of the three methods. Results Compared to the LJ results, the sensitivity and specificity of the MODS assay were 97.8% and 96.5% respectively; the sensitivity and specificity of the Wayne assay were 87.0% and 97.7% respectively. Mutations in the pncA gene were found in 41 of 46 strains that were pyrazinamide resistant （3 tests）, in 1 of the 4 strains （LJ only）, in 42 of 48 strains （at least I test）, but no mutations in 1 strain sensitive according to the MODS assay only. The MODS assay, Wayne assay and LJ proportion method provided results in a median time of 6, 7 and 26 days respectively. Conclusions MODS assay offers a rapid, simple and reliable method for the detection of pyrazinamide resistance in M. tuberculosis and is an optimal alternative method in resource limited countries.

某医院耐碳青霉烯类肠杆菌科细菌分布及耐药情况分析

目的:分析河池市人民医院耐碳青霉烯类肠杆菌科细菌(CRE)的分布及耐药情况。方法:选取2020年1月—2022年12月河池市人民医院收治的97例CRE感染者作为研究对象,收集感染者临床资料,采集标本分离培养,进行细菌鉴定和药敏试验,分析CRE分布及耐药情况。结果:CRE感染者主要来自手足外科(15.46%)和泌尿外科(14.43%)。CRE标本主要为尿液标本(38.14%),其次为呼吸道标本(27.84%)。CRE以肺炎克雷伯杆菌(34.02%)为主,其次为大肠埃希菌(30.93%)与阴沟肠杆菌(12.37%)。肺炎克雷伯杆菌对亚胺培南耐药率最高,大肠埃希菌对氨苄西林、哌拉西林/他唑巴坦、头孢呋辛、阿米卡星耐药率最高,阴沟肠杆菌对氨苄西林、氨苄西林/舒巴坦、氨曲南、复方新诺明耐药率最高。结论:河池市人民医院CRE在创伤骨科、手足外科、小儿外科及泌尿外科等科室中感染率较高,主要集中在泌尿生殖道及呼吸道,细菌类型以肺炎克雷伯杆菌为主,严重多重耐药。临床需重视CRE感染者,做好病原菌鉴定和病原菌培养工作,给予最佳药物治疗。

耐药结核病实验室诊断技术研究进展

结核病(TB)是严重危害公众健康的全球性公共卫生问题。耐药结核病(DR-TB)是TB防治的重点和难点。目前,常用的体外药物敏感性试验方法包括表型药物敏感性检测技术和分子药物敏感性检测技术。表型药物敏感性检测技术包括固体药物敏感性试验、液体药物敏感性试验、最低抑菌浓度法,分子药物敏感性检测技术包括GeneXpert MTB/RIF、线性探针技术、基因芯片技术、荧光聚合酶链反应(PCR)熔解曲线法、FluoroType MTBDR、Xpert MTB/XDR、核酸质谱分析、全基因组测序技术。文章就表型药物敏感性检测和分子药物敏感性检测对DR-TB实验室诊断技术的研究进展进行综述,旨在为DR-TB的早期诊断提供参考。

2018年~2021年河北省部分地区鸡源沙门菌的生物学特性及致病性研究

为调查河北地区鸡源沙门菌及其血清型的流行及分布情况,并分析其的致病性,本研究于2018年~2021年在河北省7个地区34个养鸡场共收集631份发病鸡肛拭子和62份病料样品共计693份,分别接种普通琼脂培养基分离细菌并纯化后经革兰氏染色镜检;将分离菌分别接种不同的培养基培养,并对分离菌经生化及16S r RNA基因的PCR及测序鉴定,随机选择32条测序序列经NCBI的BLAST比对,并采用DNAStar软件分析该基因的同源性。采用玻片凝集法鉴定分离菌的血清群及血清型并统计各血清群与血清型在河北不同地区的分布。结果显示,从693份病料样品中共分离到238株沙门菌,除3株未定群外,其余分离菌分属于A、B、C、D、E、F 6个血清群,其中D群最多达69.7%(166/238);238株沙门菌分属于7个不同的血清型和未定型,依次为鸡白痢沙门菌(91/38.2%)、甲型副伤寒沙门菌(43/18.0%)、鸡伤寒沙门菌(40/16.8%)、肠炎沙门菌(39/16.4%)等。血清群与血清型分布的统计结果显示,除张家口地区流行A群血清群外,其余地区流行的血清群均为D群;张家口地区流行鸡白痢沙门菌;秦皇岛地区有14种血清型,其中甲型副伤寒沙门菌为其流行血清型;石家庄、承德、唐山流行的均为鸡白痢沙门菌,邢台及保定地区分别流行肠炎沙门菌与鸡伤寒沙门菌。通过K-B药敏纸片法检测238株分离菌对7类共22种药物的敏感性;采用PCR检测分离菌的相关耐药基因并采用SPSS26.0软件中的Fisher确切概率法分析分离菌耐药表型与耐药基因之间的相关性。选取12株不同血清型的分离菌以0.2 m L/只(3×108cfu/mL)感染雏鸡,分析各分离菌对雏鸡的致病性。药敏试验结果显示,对苯唑西林、红霉素、青霉素、甲氧苄啶、氨苄西林、四环素耐药的菌株分别占97.5(232/238)、89.1%(212/238)、78.6%(187/238)、74.8%(178/238)、74.4%(177/238)、64.3%(153/238),对其它药物耐药的菌株均在32%以下,但均对头孢类药物敏感;且分离菌多呈多重耐药性(58.4%,139/238),耐6重药物的菌株(32.8%,78/238)与耐5重药物的菌株(11.8%,28/238)最多。耐药基因检测结果显示,对β-内酰胺类、磺胺类、大环内酯类、四环素类、氨基糖苷类药物的耐药基因tem、erm(B)a、tetA、strA-B的检出率分别为100%(238/238)、75.2%(178/238)、71%(169/238)、65.6%(156/238)及31.9%(76/238)。未检测到喹诺酮类和醛胺醇类耐药基因。经分析,氨基糖苷类、四环素类、磺胺类、β-内酰胺类、大环内酯类药物的耐药表型与其耐药基因的符合率分别为94.7%、98.1%、99.4%、97.5%、79.9%,相关性均较强。致病性试验结果显示,12株分离菌均能致感染鸡出现不同的临床症状及肝脏和肠道的剖检病变,且能对鸡造成不同程度的死亡,其中以致鸡死亡10只(100%)、7只(87%)为主,并从死亡鸡的肝脏再次分离到相应细菌。上述结果表明,本研究从河北不同地区分离的238株沙门菌血清群与血清型众多,大多数沙门菌的耐药性较强且多呈多重耐药性,其携带的5类药物的耐药基因与其相对应的耐药表型均呈较强的相关性,且分离菌对雏鸡呈不同的致病性。本研究为河北地区鸡源沙门菌的流行病学调查及其感染的防治提供参考依据。

新型冠状病毒感染疫情暴发前后复旦大学附属闵行医院多重耐药菌监测分析

目的统计分析新型冠状病毒感染疫情暴发前后复旦大学附属闵行医院多重耐药菌检出情况和耐药率变化。方法比较2017—2019年(疫情前)和2020—2022年(疫情后)两个阶段6种细菌的耐药性变化。使用WHONET 5.6软件统计细菌耐药监测数据。结果较疫情前,疫情后耐碳青霉烯类肺炎克雷伯菌检出率升高(40.1%对27.9%,P<0.01),耐碳青霉烯类大肠埃希菌检出率降低(1.9%对3.1%,P<0.05),其他耐碳青霉烯类的鲍曼不动杆菌、铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌和耐万古霉素肠球菌检出率无显著差异。疫情暴发前后,多重耐药菌均主要分离自呼吸道样本(78.4%对78.5%)。疫情后ICU多重耐药菌总检出率明显高于疫情前(53.1%对35.5%,P<0.01)。较疫情前,疫情后耐甲氧西林金黄色葡萄球菌对甲氧苄啶-磺胺甲唑的耐药率下降(3.5%对15.7%,P<0.01),粪肠球菌对青霉素G、氨苄西林和左氧氟沙星的耐药率均降低,屎肠球菌对高浓度庆大霉素的耐药率降低(39.2%对50.1%,P<0.01),大肠埃希菌对亚胺培南的耐药率降低(1.2%对2.7%,P<0.01)。铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯类抗生素的耐药率基本保持稳定,疫情暴发前后无显著差异(P>0.05)。结论新型冠状病毒感染疫情暴发后耐碳青霉烯类大肠埃希菌检出率明显下降,耐碳青霉烯类的鲍曼不动杆菌和铜绿假单胞菌、耐甲氧西林金黄色葡萄球菌有下降趋势,但耐碳青霉烯类肺炎克雷伯菌检出率和耐药率显著增加,仍需加强院感防控管理,控制多重耐药菌的传播。

内蒙古地区结核病的耐药现状及影响因素研究

目的了解内蒙古地区结核病的耐药现状及影响因素,为耐药结核精准防控提供参考依据。方法采用随机抽样法,分析内蒙古地区结核定点诊治医院就诊的符合纳入标准的结核患者的临床资料,对耐药菌株进行鉴定和表型药敏检测,计算耐药谱和耐药率,并采用Logistic回归模型分析结核病患者耐药的影响因素。结果一共纳入1321株结核患者,男性936例,女性385例,平均年龄(52.65±18.09)岁;单耐药、耐多药、多耐药及总耐药率分别为19.00%、11.58%、11.66%、42.24%,耐药率较高的是链霉素(7.27%)、异烟肼(4.69%)和异烟肼+链霉素(4.47%),耐药谱呈现多样性和复杂性;相较于女性,男性患者耐药比例较高(P<0.001);抗结核药物敏感患者比例随着年龄的增加而增加(P<0.05);20~40岁、40~60岁、60岁及以上耐多药患者比例均高于0~20岁(P<0.05),而20~40岁以及40~60岁耐多药患者比例高于60岁及以上(P<0.05);复治患者的耐多药、多耐药比例均高于初治患者(P<0.001);多因素Logistic回归分析显示,男性(OR=1.48,95%CI:1.02~2.14)、20~40岁(OR=2.64,95%CI:1.05~6.60)、复治(OR=2.34,95%CI:1.70~3.22)、门诊随访患者(OR=1.56,95%CI:1.05~2.33)是耐药结核发生的危险因素。结论内蒙古地区结核患者耐多药及总耐药率较高,耐药谱呈现多样性以及复杂性,男性、20~40岁、复治、门诊随访是结核耐药发生的独立危险因素。应当进一步完善临床诊疗工作,合理使用抗结核一线药物、注重个体化治疗,加强健康教育、完善医保制度和患者管理模式,以提高患者的依从性。

39味中药及其复方对鸡源禽致病性大肠杆菌体外抑菌试验研究

试验旨在筛选抑制鸡源禽致病性大肠杆菌(Avian Pathogenic Escherichia coli,APEC)O78地方流行株的有效中药。采用打孔法测定39味中药及其复方对APEC的抑菌效果,使用二倍稀释法测定其最小抑菌浓度(MIC)和最小杀菌浓度(MBC)。结果表明:39味中药中有9味中药对APEC有一定的抑菌效果,其中五味子、洛神花和黄柏对APEC高度敏感,MIC依次为31.25、31.25、500 mg/mL,MBC依次为62.5、125、500 mg/mL;蒲公英、红花和石榴皮中度敏感,MIC与MBC均大于或等于500 mg/mL;丹皮、何首乌和荷叶低度敏感;其余中药无抑菌效果。复方中五味子+洛神花配伍药效最好,MIC与MBC分别为31.25 mg/mL与125 mg/mL。说明在39味中药中五味子、黄柏、洛神花和复方五味子+洛神花(1∶1)对APEC有比较好的体外抑菌能力。

药物敏感性试验与全基因组测序检测抗结核药物耐药性的比较研究

目的通过药物敏感性试验(DST)和全基因组测序(WGS)检测结核分枝杆菌(MTB)的耐药情况,比较二者一致性,探讨全基因测序用于MTB耐药性检测的特点。方法选取2018-2020年留存于四川大学华西医院共71例MTB临床分离株,采用DST(氧化还原指示剂法)和WGS两种方法对菌株进行异烟肼(INH)、利福平(RIF)、链霉素(SM)、乙胺丁醇(EMB)、莫西沙星(MFX)、氧氟沙星(OFX)、左氧氟沙星(LFX)、卡那霉素(KAN)、阿米卡星(AMK)、卷曲霉素(CPM)、乙硫异烟胺(ETH)、利福布汀(RFB)、对氨基水杨酸(PAS)和氯法齐明(CLO)共14种药物的耐药性检测,并对结果进行Kappa检验分析。结果两种方法对RIF、RFB、SM、MFX、OFX和LFX 6种药物耐药性检测的符合率均超过90.00%,Kappa值均大于0.80,一致性较好;INH和EMB耐药性检测的符合率分别为84.51%,81.69%,Kappa值分别为0.68和0.54,一致性一般;AMK和KAN两种方法检测的耐药株未超过2株,耐药率小于3.00%;CPM、ETH、PAS、CLO耐药性检测的符合率范围为61.97%~91.55%,Kappa值均小于0.40,一致性较差。结论WGS检测不同抗结核药物耐药性的能力存在差异,其检测RIF、RFB、SM、MFX、OFX和LFX 6种药物耐药性效果较佳,而检测其他抗结核药物耐药性与DST相比较仍存在一定差异,需要进一步明确相关药物的详细耐药机制,并对WGS用于耐药性分析的标准化进行探索。

用E-test法对菌丝相马尔尼菲青霉进行体外药敏检测

用E test抗真菌药敏试条研究酮康唑、伊曲康唑、5 氟胞嘧啶、两性霉素B、氟康唑对马尔尼菲青霉(PM)菌丝相的敏感性 ,判定MIC值。结果5种抗真菌药对PM菌丝相均具良好敏感性 ,尤以伊曲康唑为优。马尔尼菲青霉的药敏试验为临床上选择有效药物具有一定的意义。

肺结核患者氟喹诺酮类耐药影响因素预测模型的构建与验证:基于LASSO-Logistic回归模型

背景利福平耐药/耐多药结核病(RR/MDR-TB)治疗困难,治愈率低,且传染性强,氟喹诺酮类(FQs)作为治疗RR/MDR-TB的核心药物,耐药趋势严峻,对FQs影响因素进行分析有助于提高RR/MDR-TB的治愈率,并控制准广泛耐药(pre-XDR)和广泛耐药结核病的发生。目的分析住院肺结核患者FQs耐药情况及影响因素,构建FQs耐药危险因素的列线图(Nomogram)预测模型并进行验证。方法回顾性选取于2021年1月—2022年2月在贵阳市公共卫生救治中心住院且有药物敏感试验结果的583例肺结核患者为研究对象。根据治疗史将患者分为初治组(296例)和复治组(287例);根据FQs耐药情况将患者分为FQs耐药组(63例)和FQs敏感组(520例)。分析患者对13种抗结核药物总耐药分布情况,比较FQs耐药组与FQs敏感组肺结核患者的基线特征。采用LASSO回归模型筛选特征变量后,行多因素Logistic回归分析FQs耐药的独立危险因素,并构建Nomogram预测模型;采用受试者工作特征(ROC)曲线下面积(AUC)、校准曲线对其进行验证。结果583例患者中FQs敏感520例,耐药63例,耐药率为10.81%,仅次于一线抗结核药异烟肼、利福平、链霉素、乙胺丁醇总耐药率(36.36%、32.76%、21.61%、12.86%)。复治组患者利福平、异烟肼、乙胺丁醇、链霉素、左氧氟沙星、莫西沙星、利福平耐药(RR)、耐多药(MDR)、pre-XDR耐药率高于初治组(P<0.05)。FQs耐药组患者其他民族、复治、艾滋病、吸毒史、空洞、咯血、不规则抗结核史、MDR占比高于FQs敏感组(P<0.05)。LASSO回归筛选出6个变量:民族、治疗史、艾滋病、吸毒史、咯血、MDR;多因素Logistic回归分析结果显示,其他民族(OR=2.313,95%CI=1.153~4.640,P=0.018)、复治(OR=1.892,95%CI=1.005~3.560,P=0.048)、咯血(OR=1.941,95%CI=1.087~3.465,P=0.025)、MDR(OR=3.342,95%CI=2.398~7.862,P<0.001)是肺结核患者FQs耐药的独立危险因素;Logistic回归方程Logit(P)=-3.571+0.838×民族+0.638×治疗史+0.663×咯血+1.468×MDR,基于此构建风险Nomogram预测模型,AUC为0.796(95%CI=0.717~0.876),Bootstrap法验证平均绝对误差为0.015,通过Hosmer-Lemeshow拟合优度检验,预测模型有较好的校准能力(χ^(2)=3.426,P=0.489)。结论肺结核患者FQs耐药率较高,其他民族、复治、咯血、MDR是肺结核患者FQs耐药的独立危险因素,构建Nomogram预测模型对于肺结核患者FQs耐药具有较好的预测价值,能够为临床诊断耐药结核病及为RR/MDR-TB制订合理治疗方案提供新思路。

某院2021~2022年住院患者抗菌药物使用分析

目的 分析我院2021~2022年抗菌药物的使用情况以及常见细菌的耐药现状,以期改善我院抗菌药物的使用情况,促进抗菌药物的合理使用。方法 通过医院信息系统(HIS)调取我院2021~2022年住院患者的抗菌药物使用数据,计算抗菌药物使用率、使用强度和使用频度(DDDs)。通过逸曜合理用药管理系统调取2021~2022年住院患者抗菌药物使用前药敏测试送检结果,计算出全年各科室药敏测试送检率和测试结果。结果 相比2021年,2022年的抗菌药物使用率无明显改变,但是大部分科室抗菌药物使用强度和DDDs明显增加。在DDDs排名前10的抗菌药物中,90%的药物DDDs升高,而抗菌药物的用药前送检率有所下降。药敏测试方面,除大肠埃希菌对常用抗菌药物耐药率变化不大外,粪肠球菌和无乳链球菌的耐药率均下降。结论 我院住院患者的抗菌药物使用基本合理,2022年较2021年住院患者的抗菌药物的使用强度和使用频度均升高,但用药前送检率下降。建议我院加强耐药监测和指导以及对抗菌药物使用人员的教育培训,促进抗菌药物的合理使用,减少细菌耐药性的发展。

秦皇岛地区鸡源大肠杆菌分离鉴定及药敏试验

试验旨在了解河北省秦皇岛地区养殖场鸡源大肠杆菌耐药情况,为该地区鸡大肠杆菌病的用药方案提供参考。采集秦皇岛市部分地区鸡场疑似感染大肠杆菌的病死鸡病料,采用细菌分离培养、革兰氏染色法和PCR鉴定对分离株进行鉴定,并进行药敏试验。结果显示:共检测出18株大肠杆菌,分离株对庆大霉素、丁胺卡那敏感;对哌拉西林、头孢哌酮、羧苄西林和头孢曲松呈中度耐药,耐药率为33.33%~50.00%;对青霉素、头孢他啶、苯唑西林、红霉素、头孢拉定和头孢氨苄高度耐药,耐药率为94.44%~100.00%。研究表明,应不定时检测当地鸡源大肠杆菌对常用抗生素药物的敏感性,以便及时快速地调整用药,避免造成耐药性。