Direct and Residual Microbicidal Efficacy of Various Antiseptics against Multi-Drug Resistant Bacteria

Background: Infections in ICU’s patients are known to often originate from the colonization of wounds by the patient’s endogenous microbiota, and to eventually lead to secondary sepsis. Aim: to compare in vitro the direct and residual effects after different exposure times of 4% chlorhexidine, and of 0.1% and 0.04% polyhexanide (in gel and solution forms), on ATCC-microorganisms, and too, on bacterial strains obtained from ICU patients. Methods: We used wild multi-drug resistant strains recently obtained from the wounds of patients hospitalized at ICU and reference strains from the American Type Culture Collection (ATCC). Chlorhexidine 4% was studied as a reference solution. The direct and residual effects of the 0.1% and 0.04% polyhexanide, in gel and solution forms, were analyzed using cotton germ carriers. To evaluate the direct effect, we exposed the strains to the antiseptic. To assess the residual effect, the germ-carriers were impregnated with antiseptic and were allowed to dry before we contaminated them. We inoculated the germ carriers in a culture medium with an inhibitor of antiseptic effect to count the number of surviving microorganisms. Findings: 0.1% Polyhexanide solution proved a direct and residual efficacy after 24 hours equivalent to 4% chlorhexidine. Is very important to highlight that this great efficacy did not change according to whether they were ATCC or multidrug-resistant strains. Conclusions: 0.1% polyhexanide demonstrated a great direct and residual efficacy (like 4% chlorhexidine), against multi-drug resistant strains isolated from ICU’s patients. Moreover, due to its few cytotoxicity against keratinocytes and fibroblasts can be an optimal antiseptic for burns, wounds or ulcers.

<i>In Vitro</i>Antibacterial Activity of Flavonoid Extracts of Two Selected Libyan Algae against Multi-Drug Resistant Bacteria Isolated from Food Products

This study aimed to evaluate the antibacterial activity of flavonoids extracted from two Libyan brown algae namely Cystoseira compressa and Padina pavonica using microwave-assisted extraction method against pathogenic bacteria isolated from meat, meat products, milk and dairy products (Staphylococcus aureus subsp. aureus (5 isolates), Bacillus cereus (3 isolates), Bacillus pumilus (1 isolate), Salmonella enterica subsp. enteric (4 isolates) and Enterohaemor-rhagic Escherichia coli O157 (EHEC O157) (4 isolates)). All of these isolates were muti-drug resistant with high MAR index. The results showed that C. compressa extract exhibited better and stronger antibacterial activities against the seventeen tested isolates with inhibition zones diameter ranged from 14 - 22 mm compared to P. pavonica extract which showed positive effect against 9 isolates with low inhibition zone ranged from 11 - 16.5 mm. Flavonoids extracted from C. compressa also displayed the best spectrum of bactericidal effect with a ratio MBC/MIC ≤ 4 obtained on all susceptible tested bacterial strains. Flavonoids and proanthocyanidins significantly contributed to the antibacterial properties. The mode of action of these active extracts is under investigation.

Bacterial contamination of orally-consumed crude herbal remedies:A potential source for multi-drug resistant pathogens in man

Objective:The acceptability of herbal remedies for alleviating discomforts and ill-health has become very popular, on the account of the increasing cost of allopathic medicine for personal health maintenance.The observable non-adherence of herbalists to the established World Health Organization(WHO) / National Agency for Food and Drug Administration Control(NAFDAC) regulations for the quality control of herbal medicines is an issue for concern.In view of this,34 popular and widely consumed crude herbal remedies in southwestern,Nigeria were screened for compliance with standard limits for bacterial contamination,bacteria flora and their antibiotic susceptibility pattern.Methods:Isolates recovered from samples were identified using the cultural, morphological and biochemical characteristics.They were also tested for drug sensitivity using standard procedures. Results:A heavy bacteria load ranging from 3.00×10~3-9.58×10~5 CFU/ML and 1.20×10~5- 5.41×10~5 CFU/ML was observed for water and spirit extracted preparations respectively.The bacteria flora cum contaminants were:Staphylococcus aureus,Bacillus cereus,Bacillus subtilis,Pseudomonas aeruginosa, Micrococcus luteus,Lactobacillus plantarum,Klebsiella pneumoniae,Escherichia coli,streptococcus,Shigella, Neisseria,Arthrobacter,Kurthia and Clostridium species.All the isolates were multi-drug resistant(MDR) strains.Conclusion:The crude herbal preparations consumed in Nigeria failed to comply with the internationally recognized standards regarding bacteria load and flora.The presence of MDR pathogens is of greatest concern. It poses a great risk to consumers health and could be a source of introducing MDR organisms into the human population.There is the need for the enforcement of established guidelines to ensure the safety of these preparations.

Antimicrobial activity of green tea extract against isolates of methicillin-resistant Staphylococcus aureus and multi-drug resistant Pseudomonas aeruginosa

Objective:To evaluate antibacterial activity of the Indonesian water soluble green tea extract,Camellia sinensis,against clinical isolates of methicillin-resistantStaphylococcus aureus (S.aureus)(MRSA)and multi-drug resistant Pseudomonas aeruginosa(MDR-P.aeruginosa).Methods:Antimicrobial activity of green tea extract was determined by the disc diffusion method and the minimum inhibitory concentration(MIC)was determined by the twofold serial broth dilutions method.The tested bacteria using in this study were the standard strains and multi-drug resistant clinical isolates of S.aureus and P.aeruginosa,obtained from Laboratory of Clinical Microbiology,Faculty of Medicine,University of Indonesia.Results:The results showed that the inhibition zone diameter of green tea extracts forS.aureus ATCC 25923 and MRSA were(18.970依0.287)mm,and(19.130依0.250)mm respectively.While the inhibition zone diameter forP.aeruginosa ATCC 27853 and MDR-P.aeruginosawere(17.550依0.393)mm and(17.670依0.398)mm respectively.The MIC of green tea extracts againstS.aureus ATCC 25923 and MRSA were 400μg/mL and 400μg/mL,respectively,whereas the MIC for P.aeruginosa ATCC 27853 and MDR-P.aeruginosawere 800μg/mL,and 800μg/mL,respectively.Conclusions:Camellia sinensisleaves extract could be useful in combating emerging drug-resistance caused by MRSA andP.aeruginosa.

Management of Multi-Drug Resistant Methicillin Resistant <i>Staphylococcus aureus</i>Induced Pneumonia with New Antibiotic Adjuvant Entity: A Retrospective Study

Aim/Objective: Increase in incidences of pneumonia due to multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA) in both community and health care settings is of great concern globally. Present study aims to retrospectively analyze the efficacy of new fixed dose combination with antibiotic adjuvant entity (FDC) in comparison with vancomycin to treat patients with multi-drug resistant MRSA pneumonia. Materials and Methods: During this retrospective study, case sheets of patients who were treated for MRSA pneumonia with vancomycin or fixed dose combination of vancomycin + ceftriaxone + adjuvant (FDC) between 20 March 2010 to 20 October 2014 at tertiary care center, were analyzed. Various demographic features, antibiotic therapy, length of treatment duration and the resulting efficacy were evaluated. Microbiological success was measured in terms of bacterial eradication, while clinical success was monitored in terms of complete omission of systemic signs and symptoms. Results: Among 136 patients analyzed, 113 cases were having positive culture for MRSA, and hence were further analyzed. Out of these 113 patients, empirical treatment with vancomycin was given in 59 patients and 54 patients were treated with FDC empirically. After initial culture reports, 22 patients showing resistance to vancomycin were shifted to FDC. Amidst all the patients, 24 (64.86%) of 37 from vancomycin group and 62 (81.57%) of 76 from FDC group achieved clinical success. 9 patients out of these failure cases were cured with FDC + colistin combination therapy. Failure rates in FDC treated patients were significantly low (6.57%) as compared to vancomycin group (13.51%). Conclusion: For the treatment of different types of multi-drug resistant MRSA pneumonia, the empirical intravenous FDC therapy was safe and well tolerated with higher efficacy than vancomycin. Most of the vancomycin failure cases responded to FDC therapy and were cured. This retrospective study also concludes that an alternative option of FDC + colistin is safe and effective to treat the patients which fail to respond to FDC monotherapy.

Multiple Antibiotic Resistant Index of Gram-Negative Bacteria from Bird Droppings in Two Commercial Poultries in Enugu, Nigeria

Antimicrobial resistance refers to the ability of microorganisms to grow in the presence of an antimicrobial agent at a concentration that will normally kill or inhibit their growth. Antimicrobial resistance has become a major global threat making treatment of infections tougher especially with high cost of treatment in humans and animals. This study was done to determine the Multiple Antibiotic Resistant Index (MARI) of Gram-negative bacteria from bird droppings in two commercial poultries in Enugu. Forty (40) samples were collected from each of the poultries. Isolates were identified by standard microbiological methods. The isolates identified were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Citrobacter spp, Proteus spp. and, Enterobacter spp. Antibiotic susceptibility testing was carried out using disc diffusion technique. The organisms were tested against pefloxacin, augmentin (amoxicillin and clavulanic acid), ceftazidime, streptomycin, ciprofloxacin, gentamycin, cephalothin, neomycin and ofloxacin. The result of the susceptibility test showed that Proteus spp had the highest resistance and MARI value of 0.5 and 1.0 respectively. The other MARI values were Escherichia coli (0.9), Klebsiella pneumonia (0.9), Pseudomonas aeruginosa (0.8), Citrobacter spp (0.8) and Enterobacter spp (0.7). These results suggest that bacterial organisms from poultry source can contribute significantly to the spread of multi-antibiotic resistant organisms. This could arise from the indiscriminate use of antibiotics in bird feeds in poultries.

A New Evaluation Method for Antibiotic-Resistant Bacterial Groups in Environment

In the present manuscript it was presented whether spreading of antibiotic resistant bacterial groups in environment could be monitored by our newly developed method by enumerating antibiotic resistant bacterial groups in various biological wastes and composts. Although the numbers were not so high, diverse kinds of colistin resistant bacteria (25 mg·L-1) were included in row cattle feces (1.78 × 104 MPN g-1) and cattle feces manure (>3.84 × 104 MPN g-1). Compost originated from leftover food (>44.8 × 104 MPN g-1) and shochu lee (>320 × 104 MPN g-1) included higher numbers of chlortetracycline resistant Pseudomonas sp., (25 mg·L-1), and row cattle feces included higher numbers of chlortetracycline resistant Enterobacteriacea (15.7 × 104 MPN g-1), which mostly consisted from Pantoea sp. or Xenorhobdus doucetiae. Numbers of multi drug resistant bacteria, resistant to 25 mg·L-1 of ciprofloxacin, streptomycin, chloramphenicol, and ampicillin, were the highest in row cattle feces (>143.6 × 104 MPN g-1), followed by cattle feces manure (4.19 × 104 MPN g-1), and shochu lee (0.36 × 104 MPN g-1), which included diverse kinds of bacterial group. The present results indicated that higher numbers of multi drug resistant bacteria were typically found in row cattle feces, and the method was found suitable to enumerate and identify them. These results suggested that the method might become their environmental risk evaluation method.

Analysis on Distribution and Drug Resistance of Pathogenic Bacteria in ICU Patients with Nosocomial Infection from 2019 to 2021

Objective:To understand the pathogenic bacteria isolated from patients and their drug resistance changes in general ICU of the Affiliated Hospital of Hebei University,so as to provide reference for appropriate selection of antibiotics in clinical practice.Methods:A retrospective investigation was conducted to analyze the bacteriological distribution and drug resistance of nosocomial pathogens isolated from the specimens of hospitalized patients in the comprehensive ICU of the hospital from 2019 to 2021.The US technology BD Phoenix 100 automatic bacterial identification analyzer was used for bacterial identification of the pathogen samples,disk diffusion method was used for drug susceptibility test,and SPSS 22.0 software was used to analyze the trend of drug resistance.Results:A total of 970 strains of nosocomial pathogens were detected in the three years.The main pathogens were Acinetobacter baumannii(133 strains,13.71%),Klebsiella pneumoniae(106 strains,10.93%),Pseudomonas aeruginosa(83 strains,8.56%),Escherichia coli(76 strains,7.84%)and Enterococcus faecium(69 strains,7.11%).The resistance rate of Acinetobacter baumannii to antibiotics was high.Klebsiella pneumoniae,Pseudomonas aeruginosa and Escherichia coli had low resistance rates to carbapenems.The situation of bacterial drug resistance is still serious.Conclusion:The drug resistance of pathogenic bacteria collected from Class III Grade A Hospital’s patients to antibiotics was generally high.Therefore,clinical departments should strengthen the inspection of specimens of infection and drug sensitivity test in order to grasp the resistance mechanisms and drug resistance of pathogenic bacteria changes,and select appropriate antimicrobial agents according to the test results.Besides,the formation of drug-resistant strains also needs to be prevented,and the treatment of patients with severe infection needs to be improved.

Current concepts and future strategies in the antimicrobial therapy of emerging Gram-positive spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis(SBP) is the most common infection in end-stage liver disease patients.SBP is defined as an ascitic fluid infection with a polymorphonuclear leucocyte count ≥ 250/mm^3 without an evident intra-abdominal surgically treatable source.Several mechanisms contribute to SBP occurrence,including translocation of gut bacteria and their products,reduced intestinal motility provoking bacterial overgrowth,alteration of the gut's barrier function and local immune responses.Historically,Gram-negative enteric bacteria have been the main causative agents of SBP,thereby guiding the empirical therapeutic choice.However,over the last decade,a worryingly increasing prevalence of Gram-positive and multi-drug resistant(MDR) SBP has been seen.Recently,the microbiological spectrum of SBP seems to have changed in Europe due to a high prevalence of Gram-positive bacteria(48%-62%).The overall proportion of MDR bacteria is up to 22%-73% of cases.Consequently,empirical therapy based on thirdgeneration cephalosporins or amoxicillin/clavulanic acid,can no longer be considered the standard of care,as these drugs are associated with poor outcomes.Theaim of this review is to describe,with an epidemiological focus,the evidence behind this rise in Gram-positive and MDR SBP from 2000 to present,and illustrate potential targeted therapeutic strategies.An appropriate treatment protocol should include daptomycin plus ceftaroline and meropenem,with prompt stepdown to a narrower spectrum when cultures and sensitivity data are available in order to reduce both cost and potential antibiotic resistance development.

Unresolved issues in the prophylaxis of bacterial infections in patients with cirrhosis

Bacterial infections are highly prevalent and a frequent cause of hospitalization and short-term mortality in patients with cirrhosis. Due to their negative impact on survival, antibiotic prophylaxis for bacterial infections in high-risk subgroups of patients with cirrhosis has been the standard of care for decades. Patients with prophylaxis indications include those at risk for a first episode of spontaneous bacterial peritonitis(SBP) due to a low ascitic fluid protein count and impaired liver and kidney function, patients with a prior episode of SBP and those with an episode of gastrointestinal bleeding. Only prophylaxis due to gastrointestinal bleeding has a known and short-time duration. All other indications imply longlasting exposure to antibiotics-once the threshold requirement for initiating prophylaxis is met-without standardized criteria for re-assessing antibiotic interruption. Despite the fact that the benefit of antibiotic prophylaxis in reducing bacterial infections episodes and mortality has been thoroughly reported, the extended use of antibiotics in patients with cirrhosis has also had negative consequences, including the emergence of multi-drug resistant bacteria.Currently, it is not clear whether restricting the use of broad and fixed antibiotic regimens, tailoring the choice of antibiotics to local bacterial epidemiology or selecting non-antibiotic strategies will be the preferred antibiotic prophylaxis strategy for patients with cirrhosis in the future.

The Five Years Surveillance and Trends of Antibiotic Resistance in Some Common Gram Negative Bacteria at the Vietnam Military Hospital

The study is to identify trends and levels of antibiotic resistance of some common Gram-negative strains over time. The samples were collected from Vietnam Military Hospital 103 between 2014 and 2019. A total of 405 Acinetobacter baumannii., 528 Pseudomonas aeruginosa, 741 Escherichia coli, and 352 Klebsiella pneumoniae strains were identified and antimicrobial susceptibility was by Vitek system and Etest method. The multi-drug resistance (MDR) was major proportion of four common bacteria. In particular, there is a tendency to shift from MDR to Extended drug resistance (XDR) or possibly Pan drug resistant (pPDR). A. baumannii had the highest level of antibiotic resistance, namely, carbapenem (61.5% - 82.5%) and cephalosporin (72.7% - 88.7%). P. aeruginosa resisted most of commonly antibiotics, ranging from 50% to 70%. E. coli had a high resistance with antibiotics like ampicillin (87.2% - 97.6%) and the 3rd generation cephalosporins (up to 79.6%). K. pneumoniae resisted carbapenem from 14.7% to 44.4%, and other antibiotics with the higher rate of 40%. The collected data will be a prerequisite for further studies on mechanisms and factors related to antibiotic resistant bacteria, in order to find out a rational and effective using strategy of antibiotics.

Prevalence and Antimicrobial Resistance of Gram-Negative Bacteria Isolates in Shellfish Samples from Two River Estuaries in South-South Nigeria

Antibiotic resistant bacteria pathogens remain the leading cause of shellfish borne diseases and a major health threat to humans worldwide. The objectives of this study were to isolate, identify, and determine the antibiotic resistance patterns of Gram-negative bacteria from shellfish. We analyzed a total of 540 shellfish (117 clams, 88 oysters, and 136 periwinkles) samples collected from different vendors at Iko and Douglas Creeks in Akwa Ibom State, South-South Nigeria. Conventional cultural techniques, morphological, biochemical characteristics, and PCR amplification were used to identify the bacterial isolates. Antibiotic susceptibility tests (Kirby-Bauer disk diffusion method) and ESBL phenotype (disk) of the isolates were performed. One hundred and thirty-five (135) Gram-negative bacteria comprising 5 genera and 14 species were detected at a prevalence of: Alcaligenes faecalis TRB-7 38 (28.2%), Pseudomonas oryzihabitans strain KCB005 16 (11.9%), Paenalcaligenes retgerii strain B5 12 (8.9%) Pseudomonas aeruginosa JB2 10 (7.4%), Providencia stuartii DMC-28b 9 (6.7%), Alcaligenes species TLT151 8 (5.9%), Pseudomonas aeruginosa CIFRI DTSB1 7 (5.2%), Paenalcaligenes species UN24 7 (5.2%), Alcaligenes faecalis BT10 7 (5.2%), Vibrio species strain PrVy108 6 (4.4%), Pseudomonas xiamenensis C10-2 5 (3.7%), Providencia vemicola Bu15_38 4 (2.9%), Pseudomonas anguillisceptica 4029 3 (2.2%), and Pseudomonas aeruginosa N15-01092 3 (2.2%). All tested isolates showed various degrees of resistance to the thirteen antimicrobials evaluated. High levels of resistance (100%) to cefepime and imipenem were expressed by all isolates except the Providencia species. For the EBSL indicators, all isolates apart from Alcaligenes species were resistant (100%) to ceftriaxone. All Vibrio species were susceptible to norfloxacin, nalidixic acid, and ceftazidime. The identification of antibiotic resistant Gram-negative bacteria (GNARB) from shellfish in this study highlights the risk of disseminated multi-drug resistance—a serious public health concern.

2020—2022年自贡市第一人民医院细菌耐药性监测

目的了解自贡市第一人民医院临床分离菌对抗菌药物的耐药性,为临床合理使用抗菌药物提供依据。方法收集我院2020—2022年临床分离菌株,采用VITEK自动化鉴定及药敏系统、纸片扩散法及E-test方法进行细菌鉴定及药物敏感试验,以2022年美国临床和实验室标准化协会(CLSI)折点标准判断结果。结果共分离出临床菌株13324株,其中革兰阴性菌占69.6%,革兰阳性菌占30.4%。前五位分离菌为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌和流感嗜血杆菌。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为24.1%和73.0%。耐利奈唑胺屎肠球菌和粪肠球菌的检出率分别为2.1%和12.4%,分离出1株耐万古霉素的屎肠球菌。脑脊液中分离的4株肺炎链球菌均为青霉素非敏感菌株,未检出非脑脊液来源耐青霉素肺炎链球菌。耐碳青霉烯类阴沟肠杆菌的检出率为12.3%。而耐碳青霉烯类大肠埃希菌和肺炎克雷伯菌检出率低,分别为1.1%和2.9%。铜绿假单胞菌对哌拉西林/他唑巴坦、头孢吡肟和庆大霉素的耐药率逐年增加;鲍曼不动杆菌对常见抗菌药物耐药率明显高于铜绿假单胞菌,耐碳青霉烯类菌株检出率分别为41.9%和6.9%。未分离出耐头孢噻肟的流感嗜血杆菌和卡他莫拉菌。结论临床分离菌以革兰阴性菌为主,常见分离菌的耐药率呈现平稳或略有降低的特点。然而,耐利奈唑胺粪肠球菌和耐阿莫西林/克拉维酸流感嗜血杆菌检出率明显升高,应加强医院感染防控措施和抗菌药物的合理使用。

全院性医院感染防控文化活动作用评价

目的为评价全院性的感控文化建设在医院感染防控中的作用。方法回顾性分析2021—2023年某肿瘤专科医院举办的个人防护用品操作视频大赛、“手卫生之星”活动、“火眼金睛”——图说感控活动、感控微视频大赛等全院性感控文化相关活动,并统计2020—2023年各项院感监测指标变化情况,评价活动效果。结果2023年院感防控监测指标均较2021年有显著提升。其中,手卫生依从率从84.13%提高至94.46%,医院感染发生率由1.53%降低至0.70%,多重耐药菌感染率由0.21%降低至0.11%,多重耐药菌防控措施正确实施率由52.50%提高至88.19%,差异均有统计学意义(均P<0.05);个人防护用品穿脱考核通过3000余人次。结论适当举行全院性的感控宣传活动,能有效提高医院感染防控能力。

某院铜绿假单胞菌的临床分布及耐药性分析

目的统计大连市友谊医院近六年来铜绿假单胞菌感染的菌株来源与临床分布,分析11种临床常见抗菌药的耐药情况,为临床治疗铜绿假单胞菌感染及合理使用抗菌药物提供理论依据。方法回顾性分析我院2017年1月-2022年12月铜绿假单胞菌感染的临床送检标本1316株,进行细菌体外分离培养与药敏实验,应用Whonet 5.6软件分析药敏结果,Spss 23软件对6年内该菌耐药率的变化进行卡方检验。结果1316株铜绿假单胞菌中,主要来源于痰液907株(68.9%)和尿液167株(12.7%)。这些菌株主要分布于重症医学科513株(39.0%)和老年病科359株(27.3%)。在所统计的11种抗生素中,哌拉西林/他唑巴坦、头孢吡肟和氨曲南三种药物6年内耐药率变化显著,具有统计学意义(P<0.05);其间耐药率最高的是2021年左氧氟沙星(37.0%),耐药率最低的是2022年头孢吡肟(8.3%)。结论本院铜绿假单胞菌的碳青霉烯类和喹诺酮类耐药率较高,哌拉西林/他唑巴坦呈耐药率逐年上升;微生物室应加强耐药菌监测的同时,临床也要加强抗菌药物的管理。

儿科住院患儿多重耐药菌耐药性分析

目的探讨儿科住院患儿多重耐药菌感染的情况及对抗菌药的耐药性,为临床合理应用抗菌药提供理论依据。方法对2019年1月至2022年12月在海口市妇幼保健院儿科住院多重耐药菌感染的175例患儿临床资料进行回顾性分析。结果9376例患儿共分离病原菌1846株,检出多重耐药菌175株。175例患儿中,男102例,女73例,年龄1个月至5岁,<1岁56例,1~3岁107例,>3岁12例。175株多重耐药菌中,革兰氏阳性菌107株,占61.14%,革兰氏阳性菌中耐甲氧西林金黄色葡萄球菌97株(55.43%),其次是产超广谱β-内酰胺类酶(ESBLs)肺炎克雷伯菌和产ESBLs大肠埃希菌,分别为35株(20.00%)和27株(15.43%)。在标本的类型中,以痰液为主,为163株(93.15%),其次为大便9株(5.14%),药敏结果示耐甲氧西林金黄色葡萄球菌对青霉素、红霉素、头孢西丁、替加环素、苯唑西林、克林霉素耐药率100%,对万古霉素、利福平、利奈唑胺敏感率90%以上;表皮葡萄球菌对青霉素、红霉素、头孢西丁、苯唑西林、替加环素耐药率100%,对万古霉素、利福平、利奈唑胺敏感率80%以上。肺炎克雷伯菌对氨苄西林、氨苄西林/舒巴坦、头孢唑啉、头孢替坦、头孢他啶耐药率80%及以上,对亚胺培南和厄他培南敏感率70%以上;大肠埃希菌对氨苄西林、氨苄西林/舒巴坦、头孢曲松、头孢唑啉耐药率80%以上,对亚胺培南和厄他培南敏感。结论住院患儿多重耐药菌主要发生在1~3岁呼吸道感染的患儿,检测出的多重耐药菌耐药现象严重,应加强对此类患儿的管理及加强对多重耐药菌的检测和耐药性监测,合理使用抗菌药,预防多重耐药菌的产生。

医院多重耐药菌的消毒剂抗性研究进展及其消毒隔离防控

医院感染的病原体中多重耐药菌已逐渐成为医院感染的重要病原菌。多重耐药菌的感染不仅给患者带来痛苦和经济负担,增加医务人员的工作量和临床治疗的难度,还给医务人员及健康人群构成传播和感染风险,造成不良的社会影响。如何降低多重耐药菌的传播和感染风险成为医院感染管理的一大难题。多重耐药菌的防控主要措施包括抗菌药物管理、环境清洁消毒和物品消毒灭菌、规范诊疗等内容,但近年来研究显示,多重耐药菌对常用消毒剂产生了抗性,增加了消毒的难度。文章通过对医院多重耐药菌对消毒剂的抗性研究新进展,及其消毒隔离防控措施进行综述,为医院多重耐药菌的消毒隔离防控措施制定提供借鉴。

卫生部全国细菌耐药监测网(Mohnarin)2009年度报告:ICU来源细菌耐药监测

目的了解全国不同地区ICU病房分离细菌病原谱及其对常用抗菌药物的耐药性。方法全国114家医院ICU分离细菌,按照统一方案进行抗菌药物敏感性试验,并按照CLSI 2010版判断结果。结果 2009年度收集各医院ICU分离细菌共8931株,其中革兰阳性菌占26.4%,革兰阴性菌占73.6%。金黄色葡萄球菌和凝固酶阴性葡萄球菌中,甲氧西林耐药株的发生率分别为72.4%,95.4%。葡萄球菌属中,甲氧西林耐药株对β内酰胺类和其他抗菌药物的耐药率显著高于甲氧西林敏感株。对葡萄球菌属较为敏感的药物有磷霉素、复方磺胺、利福平和阿米卡星;未发现对万古霉素、替考拉宁和利奈唑胺耐药株。ICU分离的屎肠球菌(n=344)多于粪肠球菌(n=141),并且屎肠球菌对大多数抗菌药物的耐药率高于粪肠球菌。粪肠球菌对氨苄西林(26.1%)和呋喃妥因(17.2%)的耐药率较低;两者均出现了对万古霉素耐药菌株;未发现利奈唑胺耐药株。大肠埃希菌、肺炎克雷伯菌和产酸克雷伯菌中,产ESBLs酶菌株的发生率分别为73.8%,64.1%和63.6%;产ESBLs酶菌株对抗菌药物的耐药率均比非产ESBLs酶菌株高。肠杆菌科细菌中,已经出现了少数对碳青酶烯类耐药的菌株。铜绿假单胞菌对亚胺培南、美罗培南的耐药率分别为40.3%,35.2%;鲍曼不动杆菌对两者的耐药率分别为58.9%,59.5%。对鲍曼不动杆菌耐药率较低的抗生素为多粘菌素B(4.7%)、米诺环素(8.6%)和头孢哌酮/舒巴坦(29.0%)。嗜麦芽窄食单胞菌对复方磺胺、米诺环素和左氧氟沙星的敏感率均在80%左右及以上。鲍曼不动杆菌和铜绿假单胞菌中,均出现了对所有测试抗生素(除多粘菌素B外)均耐药的泛耐药株。结论 ICU分离细菌的耐药性较普通病房高,尤其是革兰阴性菌中的泛耐药株和肠球菌属中的万古霉素耐药肠球菌(VRE)有所增加。

滁州地区医院感染细菌监测与药敏试验结果分析

目的 分析滁州地区医院感染病原菌分布与耐药特点。方法 通过滁州市第一人民医院、滁州市儿童医院医院感染实时监控系统智能识别并实时上报2022年住院患者医院感染病例1152例次,进行细菌鉴定及药敏试验。结果 1152例次医院感染主要感染类型为下呼吸道感染(44.10%)、泌尿系统感染(18.75%)、血流感染(13.72%);共分离出病原菌1116株,其中革兰阴性菌占52.15%,检出率较高的是鲍曼不动杆菌(6.63%)、肺炎克雷伯菌(6.81%)、大肠埃希菌(7.71%)和铜绿假单胞菌(6.27%);革兰阳性菌占22.22%,检出率较高的是金黄色葡萄球菌(2.51%);真菌占25.63%,主要为假丝酵母(15.59%)。特殊耐药菌产超广谱β-内酰胺酶(ESBL)大肠埃希菌检出率51.16%、ESBL肺炎克雷伯菌检出率21.05%,耐甲氧西林金黄色葡萄球菌检出率28.57%。鲍曼不动杆菌对各种抗菌药物耐药率均超过50%;肺炎克雷伯菌对氨苄西林耐药率最高(100%),对氨苄西林/舒巴坦、头孢唑林、头孢呋辛耐药率均超过60%,对亚胺培南(34.21%)、妥布霉素(31.58%)、左氧氟沙星(10.53%)耐药率降低。大肠埃希菌对氨苄西林耐药率最高(90.70%),对呋喃妥因(4.65%)、亚胺培南(2.33%)、头孢替坦(2.33%)耐药率较低。铜绿假单胞菌对环丙沙星(2.86%)、庆大霉素(2.86%)、妥布霉素(2.86%)和左氧氟沙星(2.86%)耐药率最低。结论滁州地区医院感染细菌构成比主要以鲍曼不动杆菌、大肠埃希菌等为主,细菌耐药率较高。

2009年中国CHINET细菌耐药性监测

目的了解国内不同地区14所医院临床分离菌对常用抗菌药物的耐药性。方法国内不同地区14所教学医院(12所综合性医院、2所儿童医院)临床分离菌采用K-B法按统一方案进行细菌药物敏感试验。按CLSI 2009版判断结果。结果 2009年1月—12月收集各医院临床分离菌共43670株,其中革兰阳性菌占29%,革兰阴性菌占71%。金葡菌和凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA和MRCNS)平均为52.7%和71.7%。葡萄球菌属中甲氧西林耐药株对β内酰胺类抗生素和其他测试药的耐药率显著高于甲氧西林敏感株,但仍有72%和65% MRSA对磷霉素敏感;89.0%、66.0%和66.7%的MRCNS对利福平、磷霉素和氨苄西林-舒巴坦敏感,未发现万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中粪肠球菌对多数测试药物的耐药率低于屎肠球菌,两者中均有少数万古霉素耐药株,根据表型推测多数为VanA型耐药。本次监测首次出现少数耐利奈唑胺的粪肠球菌和屎肠球菌。非脑膜炎肺炎链球菌(SP)儿童株中PSSP较2008年减少,PISP和PRSP有所增多,在儿童株中首次出现少数喹诺酮类耐药株。大肠埃希菌、克雷伯菌属(肺炎克雷伯菌和产酸克雷伯菌)中产ESBLs株分别平均为56.5%和41.4%。肠杆菌科细菌中产ESBLs株对药物的耐药率均比非产ESBLs株高。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感,总耐药率<2%。铜绿假单胞菌对亚胺培南和美罗培南耐药率分别为30.5%和25.2%,不动杆菌属(鲍曼不动杆菌占86.8%)对两者的耐药率分别为50.0%和52.4%。与2008年相比肺炎克雷伯菌和鲍曼不动杆菌中的泛耐药株数量显著增多。新出现了5株泛耐药大肠埃希菌和6株泛耐药肠杆菌属细菌。结论细菌耐药性仍呈增长趋势,尤其泛耐药革兰阴性杆菌增多,对临床构成严重威胁。合理选用抗菌药,及早检测泛耐药菌,加强感染控制措施是当务之急。