Extensively drug-resistant bacteria are an independent predictive factor of mortality in 130 patients with spontaneous bacterial peritonitis or spontaneous bacteremia

AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis (SBP) and spontaneous bacteremia (SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases (68.5% males) with positive ascitic fluid and/or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBP had polymorphonuclear cell count in ascitic fluid > 250/mm3. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d period following diagnosis of the infection. The final outcome of the patients was recorded in the end of follow-up and comparison among 3 groups of patients according to the pattern of drug resistance was performed.RESULTS: Gram-positive-cocci (GPC) were found in half of the cases. The most prevalent organisms in a descending order were Escherichia coli (33), Enterococcus spp (30), Streptococcus spp (25), Klebsiella pneumonia (16), S. aureus (8), Pseudomanas aeruginosa (5), other Gram-negative-bacteria (GNB) (11) and anaerobes (2). Overall, 20.8% of isolates were multidrug-resistant (MDR) and 10% extensively drug-resistant (XDR). Health-care-associated (HCA) and/or nosocomial infections were present in 100% of MDR/XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA/nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium (E. faecium). All but one XDR were susceptible to colistin while all GPC (including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7% (69.2% for XDR and 34.2% for the rest of the patients) (log rank, P = 0.015). In multivariate analysis, factors adversely affecting outcome included XDR infection (HR = 2.263, 95%CI: 1.005-5.095, P = 0.049), creatinine (HR = 1.125, 95%CI: 1.024-1.236, P = 0.015) and INR (HR =1.553, 95%CI: 1.106-2.180, P = 0.011).CONCLUSION: XDR bacteria are an independent life-threatening factor in SBP/SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival.

雾化吸入阿米卡星联合静脉抗感染治疗多重耐药革兰阴性细菌感染的医院获得性肺炎临床分析

目的 探讨雾化吸入阿米卡星在多重耐药及泛耐药革兰阴性细菌感染的医院获得性肺炎（HAP）患者中的疗效及安全性。方法 选取确诊的多重耐药及泛耐菌细菌感染的HAP患者44例,按随机数字表法分为两组各22例,常规治疗基础上,治疗组予阿米卡星0.2~0.3 g＋沐舒坦15 mg bid雾化治疗,观察组予沐舒坦15 mg bid雾化治疗,疗程2周,监测患者血氧饱和度、血白细胞、临床肺部感染评分及细菌培养的变化,同时对患者治疗好转率、细菌培养阳性率及死亡率进行追踪和分析。结果 治疗组及观察组患者治疗好转率分别为77.27%及72.72%,差异无统计学意义（P〉0.05）,细菌培养阳性率分别为13.64%、45.46%,差异有统计学意义（P〈0.05）;治疗过程中有心率加快、氧饱和度降低等不良反应,仅1例患者出现声嘶,无严重不良事件。结论 雾化吸入阿米卡星可以作为临床上治疗多重耐药细菌感染的HAP患者的辅助治疗措施。

雾化吸入氨基糖苷类药物治疗MDR/XDR菌肺部感染的有效性与安全性的Meta分析

目的系统评价雾化吸入氨基糖苷类抗菌药物治疗多重/广泛耐药菌所致肺部感染的有效性与安全性。方法检索发表在PubMed、Embase、CNKI、万方及维普数据库中与雾化吸入氨基糖苷类药物治疗多重/广泛耐药菌所致呼吸机相关性肺炎或医院获得性肺炎相关的临床研究,按纳入排除标准提取文献数据资料并进行质量评价,采用Meta分析进行系统评价。结果共纳入13篇文献,包含976名患者。有效性方面:实验组(雾化组)的临床治愈率[OR=2.24,95%CI(1.35,3.71),P=0.002]和细菌清除率[OR=3.59,95%CI(2.53,5.08),P<0.0000l]都显著高于对照组(静脉或空白雾化),但死亡率[OR=0.90,95%CI(0.65,1.24),P=0.51]两组无显著性差异。安全性方面:雾化组的不良反应发生率显著低于对照组[OR=0.62,95%CI(0.47,0.82),P=0.0009]。结论雾化吸入氨基糖苷类药物治疗MDR/XDR菌所致肺部感染显示出较好的疗效且能降低患者的AEs发生率,但并不能降低死亡率。

西安市景观水体中产ESBLs菌的种属分布及其耐药特征

为了解城市景观水体中产超广谱β-内酰胺酶(extended-spectrum β-lactamases,ESBLs)细菌的种属分布和耐药特征,从西安市4处景观水体中分离出385株异养菌,利用双纸片协同试验筛选产ESBLs菌,并通过16S rDNA测序比对鉴定其种属.使用K-B纸片琼脂扩散法测定产ESBLs菌对氨苄西林、四环素、磺胺甲恶唑、环丙沙星和头孢唑肟的耐药表型.采用聚合酶链反应测定这些菌株是否携带β-内酰胺类耐药基因blaTEM、blaCTX-M和blaSHV以及Ⅰ类整合酶基因intI.结果表明:从城市景观水体中分离出19株产ESBLs菌,在异养菌中的占比为4.94%.这些产ESBLs菌株共计6属10种,主要为大肠埃希氏菌.它们对氨苄西林、四环素和磺胺甲恶唑普遍耐药,多重耐药菌占比为57.89%.这些产ESBLs菌株中Ⅰ类整合子检出率高达89.47%,但3种β-内酰胺酶耐药基因的检出率很低.