Diarrheal Diseases: A Review on Gastroenteritis Bacteria Global Burden and Alternative Control of Multidrug-Resistant Strains

Diarrheal diseases represent a significant and pervasive health challenge for humanity. The aetiology of diarrheal diseases is typically associated with the presence of enteropathogens, including viruses, bacteria and parasites. The implementation of preventive measures, including the maintenance of good food hygiene, effective water sanitation, and the development of rotavirus vaccines, has resulted in a notable reduction in the prevalence of the disease. However, the emergence of bacterial multidrug resistance due to the past or present inappropriate use of antibiotics has rendered bacterial infections a significant challenge. The objective of this review is threefold: firstly, to provide an overview of diarrheal diseases associated with bacteria;secondly, to offer a concise analysis of bacterial multidrug resistance on a global scale;and thirdly, to present the potential of filamentous fungi as an alternative solution to the challenge posed by multidrug-resistant strains. Campylobacter spp. is the most dangerous bacteria, followed by Shigella spp. and Vibrio cholerae in all age groups combined. However, Shigella spp. was the deadliest in children under five years of age and, together with E. coli, are the most antibiotic-resistant bacteria. With their highly developed secondary metabolism, fungi are a reservoir of natural bioactive compounds.

Antibacterial activities of ethanol extracts of Philippine medicinal plants against multidrug-resistant bacteria

Objective: To investigate the antibacterial activities of crude ethanol extracts of 12 Philippine medicinal plants.Methods: Crude ethanol extracts from 12 Philippine medicinal plants were evaluated for their antibacterial activity against methicillin-resistant Staphylococcus aureus, vancomycinresistant Enterococcus, extended spectrum β-lactamase-producing, carbapenem-resistant Enterobacteriaceae and metallo-β-lactamase-producing Pseudomonas aeruginosa and Acinetobacter baumannii. Results: The leaf extracts of Psidium guajava, Phyllanthus niruri, Ehretia microphylla and Piper betle(P. betle) showed antibacterial activity against the Gram-positive methicillinresistant Staphylococcus aureus and vancomycin-resistant Enterococcus. P. betle showed the highest antibacterial activity for these bacteria in the disk diffusion(16-33 mm inhibition diameter), minimum inhibitory concentration(19-156 μg/m L) and minimum bactericidal concentration(312 μg/m L) assays. P. betle leaf extracts only showed remarkable antibacterial activity for all the Gram-negative multidrug-resistant bacteria(extended spectrum β-lactamaseproducing, carbapenem-resistant Enterobacteriaceae and metallo-β-lactamase-producing) in the disk diffusion(17-21 mm inhibition diameter), minimum inhibitory concentration(312-625 μg/m L) and minimum bactericidal concentration(312-625 μg/m L) assays. Conclusions: P. betle had the greatest potential value against both Gram-negative and Grampositive multidrug-resistant bacteria. Favorable antagonistic activities were also exhibited by the ethanol extracts of Psidium guajava, Phyllanthus niruri and Ehretia microphylla.

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.

Control of multidrug-resistant planktonic Acinetobacter baumannii:biocidal efficacy study by atmospheric-pressure air plasma

In this research,an atmospheric-pressure air plasma is used to inactivate the multidrug-resistant Acinetobacter baumannii in liquid.The efficacy of the air plasma on bacterial deactivation and the cytobiological variations after the plasma treatment are investigated.According to colony forming units,nearly all the bacteria（6-log） are inactivated after 10 min of air plasma treatment.However,7% of the bacteria enter a viable but non-culturable state detected by the resazurin based assay during the same period of plasma exposure.Meanwhile,86% of the bacteria lose their membrane integrity in the light of SYTO 9/PI staining assay.The morphological changes in the cells are examined by scanning electron microscopy and bacteria with morphological changes are rare after plasma exposure in the liquid.The concentrations of the long-living RS,such as H2O2,NO3^- and O3,in liquid induced by plasma treatment are measured,and they increase with plasma treatment time.The changes of the intracellular ROS may be related to cell death,which may be attributed to oxidative stress and other damage effects induced by RS plasma generated in liquid.The rapid and effective bacteria inactivation may stem from the RS in the liquid generated by plasma and air plasmas may become a valuable therapy in the treatment of infected wounds.

Synergistic Effect of Combined Antibiotics against Some Selected Multidrug Resistant Human Pathogenic Bacteria Isolated from Poultry Droppings in Akure, Nigeria

Antibiotic resistant bacteria pass between humans, between animals and between humans and animals in both directions, the use of antibiotics in poultry has contributed to multiple antibiotic resistant in pathogenic bacteria and use of two antibiotics might prevent the emergence of resistance to either. In this study, synergistic effect of combined antibiotics against multidrug resistant human pathogenic bacterial isolates from poultry droppings in Akure, Nigeria was examined. Collection of samples, isolation and identification of bacteria were carried out using standard microbiological method, antibiotic sensitivity test was performed by disc diffusion method and zone of inhibition was used to interpret the sensitivity test as resistant, susceptible or intermediate while combined effects of two antibiotics were investigated by macrobroth dilution and checkerboard assay methods while the synergetic effects of combined antibiotics were calculated using Fractional Inhibitory Concentration (FIC) and percentage synergistic interaction was calculated. All the ten (10) species of bacterial isolates were multidrug resistant and are less resistant to ofloxacin. The highest percentage synergistic interactions observed were Ofloxacin + Amoxicillin (90%), Ciprofloxacin + Amoxicillin (90%), Tetracycline + Amoxicillin (70%), Tetracycline + Augmentin (80%), Cotrimoxazol + Amoxicillin (50%), Cotrimoxazol + Augmentin (70%), Chloramphenicol + Amoxicillin (70%) and Chloramphenicol + Augmentin (80%). Poultry droppings is a potential source of human pathogenic bacteria, high frequency of multiple antibiotic resistance bacteria observed in this study is of great treat to man as this may cause the treatment of infection caused by these bacteria to be difficult. Combination of beta-lactam antibiotic with fluoroqunolones, tetracycline, Chloramphenicol and Cotrimoxazole was synergetic and this will reduce dose related toxicity and prevent resistance to single antibiotic.

Ventilator-associated pneumonia in patients with cancer: Impact of multidrug resistant bacteria

BACKGROUND Patients with cancer have several risk factors for developing respiratory failure requiring mechanical ventilation(MV).The emergence of multidrug resistant bacteria(MDRB)has become a public health problem,creating a new burden on medical care in hospitals,particularly for patients admitted to the intensive care unit(ICU).AIM To describe risk factors for ventilator-acquired pneumonia(VAP)in patients with cancer and to evaluate the impact of MDRB.METHODS A retrospective study was performed from January 2016 to December 2018 at a cancer referral center in Mexico City,which included all patients who were admitted to the ICU and required MV≥48 h.They were classified as those who developed VAP versus those who did not;pathogens isolated,including MDRB.Clinical evolution at 60-d was assessed.Descriptive analysis was carried out;comparison was performed between VAP vs non-VAP and MDRB vs non-MDRB.RESULTS Two hundred sixty-three patients were included in the study;mean age was 51.9 years;52.1%were male;68.4%had solid tumors.There were 32 episodes of VAP with a rate of 12.2%;11.5 episodes/1000 ventilation-days.The most frequent bacteria isolated were the following:Klebsiella spp.[n=9,four were Extended-Spectrum Beta-Lactamase(ESBL)producers,one was Carbapenem-resistant(CR)];Escherichia coli(n=5,one was ESBL),and Pseudomonas aeruginosa(n=8,two were CR).One Methicillin-susceptible Staphylococcus aureus was identified.In multivariate analysis,the sole risk factor associated for VAP was length of ICU stay(OR=1.1;95%CI:1.03-1.17;P=0.003).Sixty-day mortality was 53%in VAP and 43%without VAP(P=0.342).There was not higher mortality in those patients with MDRB.CONCLUSION This study highlights the high percentage of Gram-negative bacteria,which allows the initiation of empiric antibiotic coverage for these pathogens.In this retrospective,single center,observational study,MDRB VAP was not directly linked to increased mortality at 60 days.

耐药肺结核合并咽炎患者多重耐药α-溶血性链球菌分子流行病学调查及风险模型构建

目的探究耐药肺结核合并咽炎患者多重耐药α-溶血性链球菌分子流行病学调查并构建风险模型。方法选择2019年3月-2022年1月在我院接受治疗的耐药肺结核合并咽炎患者150例为研究对象。采用PhoenixTM-100全自动细菌检测分析系统进行药敏试验。依据脉冲场凝胶电泳(Pulsed field gel electrophoresis,PFGE)和多点位序列分析(Multilocus sequence type,MLST)技术对其中92例多重耐药草绿色链球菌(Viridans Group Streptococcus,VGS)感染患者进行分子流行病学调查。根据是否发生多重耐药感染将患者分为感染组(n=92)和非感染组(n=58),多因素Logistic分析多重耐药VGS感染的独立影响因素并构建简易评分模型划分感染风险等级并进行验证。结果药敏结果显示,VGS对亚胺培南、厄他培南的敏感性高,敏感率为100%;PFGE分型和MLST分型结果显示,92株多重耐药VGS菌株可分为5种PFGE克隆型和15种ST型;多因素Logistic分析结果表明,年龄、呕吐、腹泻、降钙素原、中性粒细胞、白细胞是导致耐药肺结核合并咽炎患者感染多重耐药VGS菌株的独立危险因素(P<0.05);年龄、白细胞、中性粒细胞和降钙素原与多重耐药VGS感染风险关联密切;简易评分模型结果显示其预测效能较好。结论年龄、降钙素原、中性粒细胞、白细胞是感染多重耐药VGS菌株关联最大的独立危险因素,为临床筛查和预防有多重耐药VGS感染风险的耐药肺结核合并咽炎患者提供了理论基础。

基于失效模式与效应分析法的管理在ICU患者多重耐药菌医院感染风险管理中的应用效果

目的:探讨基于失效模式与效应分析法(FMEA)的管理在重症监护室(ICU)患者多重耐药菌医院感染风险管理中的应用效果。方法:选取2022年6—12月盐城市中医院ICU住院患者120例与43名工作人员作为对照组(实施常规管理),选取2023年1—6月盐城市中医院ICU住院患者120例与43名工作人员作为观察组(实施基于FMEA的管理)。比较两组管理效果。结果:观察组手卫生依从率低、手卫生正确率低、个人防护执行不到位风险优先数(RPN)值低于对照组(P<0.001)。观察组多重耐药菌医院感染发生率为3.33%,低于对照组(P<0.05)。结论:基于FMEA的管理在ICU患者多重耐药菌医院感染风险管理中的应用效果显著,能提高工作人员工作质量,有效减少患者多重耐药菌医院感染风险。

煤矿井下冒顶事故致创伤性胫骨骨髓炎的致病菌培养及多重耐药菌感染风险因素分析

目的研究煤矿井下创伤性胫骨骨髓炎患者的骨组织和分泌物中致病菌的种类分布,以及多重耐药细菌(MDRO)感染的风险因素。方法本研究通过回顾性研究的方式,纳入2011年1月—2020年1月在华北医疗健康集团邢台总医院骨外科接受治疗的96名因煤矿井下冒顶事故所致创伤性胫骨骨髓炎男性患者的临床数据。研究对象根据手术后抗生素耐药菌株的感染情况被归为2个不同的类别:一组是由40例患者构成的感染组,另一组则是有56例未发生此类感染的非感染组。对所有患者进行骨组织和术后伤口分泌物的细菌培养和药物敏感性测试,研究致病菌的分布情况,并通过单变量和多变量Logistic回归分析来探讨MDRO感染的相关风险因素。结果在96例患者中,细菌培养共分离出152株致病菌,包括38株革兰阴性细菌(主要是大肠埃希菌和铜绿假单胞菌)和114株革兰阳性细菌(以金黄色葡萄球菌和表皮葡萄球菌为主)。单变量分析表明,医院感染、复发次数、感染性窦道形成、脓肿形成、住院次数、抗菌药物使用频次、更换抗菌药物种类数目以及联合使用抗菌药物种类数目等因素与MDRO感染风险增加相关(P<0.05)。手术清除病灶和局部冲洗引流被认为是预防MDRO感染的保护性因素(P<0.05)。多变量Logistic回归分析进一步确认,医院感染、感染性窦道形成、联合使用抗菌药物种类数目、更换抗菌药物种类数目和抗菌药物使用频次是MDRO感染的独立风险因素,而清除病灶则是MDRO感染的独立保护因素(P<0.05)。结论创伤性胫骨骨髓炎患者术后骨组织和伤口分泌物中以革兰阳性细菌为主,根据致病菌的种类合理使用抗菌药物,有效处理窦道感染、尽快清除感染病灶以及降低医院内部感染率是减少MDRO感染的关键措施;此外,矿井下工人早期的自救互助措施,如保护创面、预防性使用抗生素等对降低感染风险、减少预后不良起到至关重要的作用。因此,应大力倡导从灾难现场到院内康复“全链条”救治理念。

Aerosolized Amikacin as Adjunctive Therapy of Ventilator-associated Pneumonia Caused by Multidrug-resistant Gram-negative Bacteria： A Single-center Randomized Controlled Trial

Background： Aerosolized amikacin （AA） is a current option for the management of ventilator-associated pneumonia （VAP） caused by multidrug-resistant Gram-negative bacteria （MDR-GNB）, as it is reported that AA could increase the alveolar level of the drug without increasing systemic toxicity. This study aimed to evaluate the efficacy and safety of AA as an adjunctive therapy for VAP caused by MDR-GNB. Methods： In this single-center, double-blind study conducted in a 36-bed general Intensive Care Unit （ICU） in a tertiary hospital from June 2014 to June 2016, 52 ICU patients with confirmed MDR-GNB VAP were randomized to two groups （AA group, n - 27 and placebo group, n = 25）. Amikacin （400 rag, q8h） or saline placebo （4 ml, q8h） was aerosolized for 7 days. The attending physician determined the administration of systemic antibiotics for VAP. Patients were tbllowed up for 28 days. Bacteriological eradication, clinical pulmonary infection score （CP1S）, and serum creatinine were assessed on day 7 of therapy. New resistance to amikacin, cure rate of VAP, weaning rate, and mortality were assessed on day 28. Results： The baseline characteristics of patients in both groups were similar. At the end of the treatment, 13 of the 32 initially detected bacterial isolates were eradicated in AA group, compared to 4 of 28 in placebo group （41% vs. 14%, P - 0.024）. As for patients, 11 of 27 patients treated with AA and 4 of 25 patients treated with placebo have eradication （41% vs. 16%, P = 0.049）. The adjunction of AA reduced CPIS （4.2 ± 1.6 vs. 5.8 ± 2.1, P = 0.007）. New drug resistance to amikacin and the change in serum creatinine were not detected in AA group. No significant differences in the clinical cure rate in survivors （48% vs. 35%, P = 0.444）, weaning rate （48% vs. 32%, P = 0.236）, and mortality （22% vs. 32%, P = 0.427） were detected between the two groups on day 28. Conclusions： As an adjunctive therapy of MDR-GNB VAP, AA successfully eradicated existing MDR organisms without inducing new resistance to amikacin or change in serum creatinine. However, the improvement of mortality was not found.

Antibacterial efficacy of five medicinal plants against multidrug-resistant enteropathogenic bacteria infecting under-5 hospitalized children

OBJECTIVE： To evaluate in vitro antibacterial effectiveness of five medicinal plants used by an Indian aborigine, against 8 multidrug-resistant （MDR） enteropathogenic bacteria isolated from clinical samples of under-5 hospitalized children. METHODS： Antibiotic sensitivity patterns of eight clinically isolated strains of enteropathogenic bacteria, Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, Salmonella paratyphi, S. typhi, Shigella dysenteriae, S. sonnei and Vibrio cholerae were assessed by disc-diffusion method. Antibacterial activities of 8 solvent-extracts of leaves and bark of five medicinal plants were monitored by the agar-well diffusion method. The microbroth dilution method was used to assess minimum inhibitory concentration （MIC） and minimum bactericidal concentration （MBC）. Qualitative phytochemical analyses of active plant extracts were carried out. RESULTS： Ethanol, ethyl acetate and methanol extracts of Holarrhena antidysenterica leaf tissue were most effective against 8 MDR pathogens in vitro. Similarly, acetone, ethanol and methanol extracts of Terminalia alata leaf tissue; chloroform, ethyl acetate and methanol extracts of Terminalia aquna leaf tissue and ethyl acetate, ethanol and methanol extracts of Paederia foetida leaf tissue were most effective in inhibiting in vitro growth of the 8 MDR enteropathogens. Ethyl acetate and methanol extracts of H. antidysenterica bark tissue; acetone, ethanol and methanol extracts of T. alata bark tissue and acetone, ethanol and methanol extracts of T. arjuna bark tissue were most effective in controlling enteropathogen growth. The minimum inhibitory concentration and minimum bactericidal concentration values of the 3 most antimicrobial leaf and bark extracts from the five plants were in the range of 1.56 to 50 mg/mL. CONCLUSION： These 5 plants exhibited in vitro control over a cohort of 8 enteropathogenic bacteria strains isolated from clinical samples.

Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: A systematic review

To systematically review literature upon aetiology of nosocomial spontaneous bacterial peritonitis (N-SBP) given the rising importance of multidrug-resistant (MDR) bacteria. METHODSA literature search was performed on MEDLINE and Google Scholar databases from 2000 to 15th of November 2016, using the following search strategy: “spontaneous” AND “peritonitis”. RESULTSThe initial search through electronic databases retrieved 2556 records. After removing duplicates, 1958 records remained. One thousand seven hundred and thirty-five of them were excluded on the basis of the screening of titles and abstract, and the ensuing number of remaining articles was 223. Of these records, after careful evaluation, only 9 were included in the qualitative analysis. The overall proportion of MDR bacteria turned out to be from 22% to 73% of cases across the studies. CONCLUSIONN-SBP is caused, in a remarkable proportion, by MDR pathogens. This should prompt a careful re-assessment of guidelines addressing the treatment of this clinical entity.

Isolation and Identification of Multi-Drug Resistant Strains of Non-Lactose Fermenting Bacteria from Clinical Refuses in Major Hospitals of Khyber Pakhtunkhwa, Pakistan

Purpose: The present studied was performed in order to investigate the drug resistance of different non-lactose fermenting gram negative bacteria from clinical isolates. The bacteria were morphologically characterized through culturing and gram staining techniques were used for the identification of different bacterial strains. Methods: A total of 324 samples were collected from patients, after they were diagnosed by physicians at different hospitals at district Peshawar. Samples were morphologically identified by blood agar, MacConkey agar and Eosine Methylene Blue, identified by gram staining techniques. Modified Kirby-Bauer Disc diffusion method was used to test the in-vitro susceptibility of the identified isolates to different antibiotics. Results: The non-lactose fermenting gram negative bacteria were isolated from samples of blood (33.30%), pus/ wound (33.30%), urine (23.30%) and from ascetic/pleural fluids (10.20%). The study revealed that Pseudomonas aeroginosa showed high resistance against Gentamicin (74%) and Aztreonam (74%), followed by Ciprofloxacin (59.20%) and Amikacin (33.30). Tazocin was active as low resistance (18.50%) is shown. More resistance was seen in Morganella morganii against Aztreonam (77.7%) followed by Gentamicin (62.90%), Ciprofloxacin (40.70%). Tazocin show low resistance (3.70%). Multidrug resistant Proteus mirabillis was highly resistance to Gentamicin (66.60%), followed by Aztreonam (62.90%), Amikacin (55.50%), Ciprofloxacin (40.20%) and low resistance to Tazocin was (22.20%). Salmonella typhi demonstrated high resistance against Amikacin (62.90%), followed by Aztreonam (48.10%), Tazocin (40.70%). Gentamicin showed low resistance (29.60%), and hence it is more active against S. typhi. Conclusions: It can be concluded from the present study that different species of non-lactose fermenting gram negative bacteria have shown a different resistivity pattern. This study is a gate way for better and suitable management strategy for the infections caused by non-Lactose fermenting bacteria in the sampling region.

Phytochemical-encapsulated nanoplatform for ＂ondemand＂ synergistic treatment of multidrug-resistant bacteria

Though phytochemicals are a promising alternative to traditional antibiotics for combating resistant bacteria, the low water solubility and lack of selectivity seriously hinder their widespread applications. Herein, we constructed a hyaluronidase-activated ＂on-demand＂ delivery nanocarrier to encapsulate plant essential oils （PEOs） for the synergistic treatment of mulfidrug-resistant bacteria. The bioavailability and selectivity of PEOs was enhanced and the antibacterial effect was significantly improved by combining with the photothermal effect of the nanocarrier. This antibacterial system was successfully applied for healing methicillin-resistant Staphylococcus aureus-infected wound with negligible cytotoxicity and biotoxicity in mice. Given the increasing risk of antibiotic resistance, we believe that this phytochemical-encapsulated nanoplatform would provide a long-term solution and be a new powerful tool for skin-associated bacterial infections.

Isolation and Characterization of Multi-Drug Resistant Bacteria from Hospital Wastewater Sites around the City of Aizawl, Mizoram

A microbial study was conducted from wastewater soils of hospitals in Aizawl, Mizoram, India which were in existence for a longtime. The isolated bacteria from the wastewater soils were found to be mainly of Morganella morganii and Bacillus cereus and these isolated bacteria were found to be very resistant to a wide range of antibiotics and heavy metals. Antibiotics that were used for treating infections caused by these bacteria like chloramphenicol and ciprofloxacin were also found to be insensitive. The degree of resistance was also very high when compared to earlier reports of antibiotic resistance observed in the corresponding bacteria. Our results suggested that the high degree of resistance is probably conferred by the continued exposure to antibiotics from hospital waste leading to a selected population of highly antibiotics-resistant bacteria.

Isolation and Identification of Multi-Drug Resistant Strains of Non-Lactose Fermenting Bacteria from Clinical Isolates

Purpose: We studied the drug resistance of different microbes from clinical isolates. The morphological characteristics of bacteria were observed through culture characteristics and by carrying out gram staining techniques while the biochemical characteristics of bacteria were carried out by biochemical test. Methods: A total of 324 samples were collected from suspected patients visiting different hospitals at district Peshawar. For morphological identification, samples of clinical isolates were analyzed by blood agar, MacConkey agar and Eosine Methylene Blue, identified by gram staining and characterized by different biochemical tests. Antibiotic Sensitivity test by Modified Kirby-Bauer Disc diffusion method was used to test the in-vitro susceptibility of the identified isolates to different antibiotics such as Ceftazidime, Ceftazidime, Ceftriaxone, Cefepime and Imipenem. Results: These resistant non-lactose fermenting gram negative bacteria were isolated from samples of pus/wound (33.30%, n = 108/324), blood (33.30%, n = 108/324), urine (23.30%, n = 75/324) and from ascetic/pleural fluids (10.20%, n = 33/324). The study revealed that the percentage of non-fermenting bacterial infection was higher in females (53%) as compared to males (47%) along with higher infection observed in the age group of 11 - 30 years. Pseudomonas aeroginosa showed high resistance against Cefepime (88.80%), followed by Cefoperazone (55.50%), Ceftazidime (48.10%), Ceftriaxone (33.30%). Imipenem was active with low resistance (7.40%). More resistance was seen in Morganella morganii against Imipenem (66.70%) followed by Cefoperazone (55.50%), Ceftriaxone (55.50%). Cefepime showed low resistance (11%). Multi-drug resistant Proteus mirabillis was highly resistance to Ceftriaxone (74.07%), followed by Cefepime (59.20%), Cefoperazone (44.40%) and low resistance for Imipenem (25.90%). Salmonella typhi demonstrated high resistance against Imipenem (74.07%), followed by Ceftriaxone (40.70%), Ceftazidime (37.03%). Cefepime showed low resistance (3.70%), hence it is more active against S. typhi. Conclusions: The different species of non-lactose fermenting gram negative bacteria have shown a different resistivity pattern in the present study. Therefore identification of non-lactose fermenting gram negative bacteria and looking after their resistivity/susceptibility pattern are important for suitable management of the infections caused by them.

宣肺解毒方对多重耐药铜绿假单胞菌肺炎的作用机制探讨

目的探究宣肺解毒方对多重耐药铜绿假单胞菌肺炎的机理研究。方法除空白组外,其余组采用气管插管的方法建立MDR-PA(9×10^(8) CFU/mL,0.5 mL)肺炎大鼠模型,造模成功后随机分为模型组、宣肺解毒方低剂量组、宣肺解毒方中剂量组、宣肺解毒方高剂量组以及亚胺培南西司他丁组,每组12只;以上除空白组与模型组外,剩余给药组统称为干预治疗组。造模1 d后,宣肺解毒方低、中、高剂量组分别给予相应剂量的宣肺解毒方(Xuanfei Jiedu Formula,XFJDF)灌胃,亚胺培南西司他丁组给予亚胺培南西司他丁(imipenem,IPM)腹腔注射,空白组和模型组给予生理盐水灌胃,每天2次,持续7 d。观察大鼠的一般状态、体重变化、肺湿重/肺干重(W/D),采用苏木素-伊红(HE)染色法于光镜下观察大鼠肺组织病理学改变,采用酶免疫吸附测定法检测大鼠血清中IL-1β、TNF-α、TGF-β、IL-6炎症因子水平,采用比色法检测大鼠血清中GSH含量与MPO活性,采用TBA法检测大鼠血清中MDA含量,试剂盒法检测总抗氧化能力T-AOC;采用免疫组化法对肺组织中TLR4、Myd88、NF-κBp65蛋白进行定位与半定量观察,采用qPCR和Western Blot技术检测大鼠肺组织中TLR4、Myd88、NF-κBp65 mRNA和蛋白表达水平。结果与空白组比,模型组大鼠反应迟缓,呼吸频率加快、呼吸杂音增多且出现不同程度寒颤,饮食饮水减少,体重下降;肺W/D(P<0.01)显著升高,肺组织的肺泡腔以及肺支气管周围存有大量炎性细胞浸润,部分肺泡壁出现断裂融合形成气腔并伴有炎性渗出,肺间质增厚,局部可见肺纤维形成等;血清中IL-1β、TNF-α、TGF-β、IL-6水平明显升高(P<0.01),MDA含量增加、MPO活性增强、GSH含量与T-AOC能力降低(P<0.01),肺组织中TLR4、Myd88、NF-κBp65 mRNA和蛋白表达显著升高(P<0.01)。与模型组相比,干预治疗组均不同程度改善上述指标变化(P<0.05,P<0.01),以宣肺解毒方高剂量组以及亚胺培南西司他丁组最为显著(P<0.05,P<0.01)。结论宣肺解毒方能够显著改善MDR-PA大鼠的一般状态、体重、肺W/D以及肺病理,降低炎症与氧化应激反应,其作用机制可能与宣肺解毒方抑制肺组织中TLR4/Myd88/NF-κB通路表达有关。

扶正逐瘀汤治疗脓毒症合并多重耐药菌感染菌血症的临床疗效以及机制研究

目的采用网络药理学方法结合临床回顾性分析,探讨扶正逐瘀汤治疗脓毒症合并多重耐药菌感染菌血症的作用机制。方法回顾性队列研究方法分析2019年1月至2022年12月广西中医药大学第一附属医院仙葫院区重症医学科(ICU)的68例明确诊断脓毒症菌血症患者,并且药敏试验为多重耐药菌,根据是否使用扶正逐瘀汤分为观察组和对照组,观察组为菌血症多重耐药菌感染并使用扶正逐瘀汤的患者,对照组为菌血症多重耐药菌感染未使用扶正逐瘀汤的患者。所有的患者均进行了常规治疗。利用中药系统药理学数据库与分析平台(TCMSP)、Uniprot数据库检索扶正逐瘀汤的主要活性成分和作用靶点,利用OMIM和GeneCards数据库分别检索脓毒症、菌血症、多重耐药菌的靶点,绘制韦恩图。使用Cytoscape3.10.1软件、STRING数据库、DAVID数据库构建蛋白相互作用网络、基因本体(GO)和京都基因与基因组百科全书(KEGG)富集分析。结果治疗后两组SOFA评分、APACHEⅡ评分明显降低,且观察组明显低于对照组,差异具有统计学意义(P<0.001),观察组WBC计数、CRP水平、中医症候评分、症候疗效判定明显优于对照组,且差异具有统计学意义(P<0.05)。结论在治疗脓毒症菌血症多重耐药菌感染患者治疗中,加用扶正逐瘀汤的临床治疗效果明显优于常规治疗,且扶正逐瘀汤可以通过多组分、多靶点抑制常见多重耐药菌,值得推广应用。

规范ICU多重耐药菌感染病人接触隔离的循证护理实践

目的:提高重症监护病房(ICU)医护人员接触隔离管理水平及最佳证据执行能力,降低ICU多重耐药菌医院感染发生率。方法:运用循证护理方法获取最佳证据,制定多重耐药菌感染病人接触隔离管理审查指标并用于临床进行持续质量改进,比较证据应用前后ICU多重耐药菌医院感染发生率、医护人员对多重耐药菌感染病人接触隔离相关知识知晓情况及执行情况。结果:本研究形成21条质量审查指标,应用最佳证据后,ICU医护人员多重耐药菌接触隔离理论知识评分由(73.49±6.50)分提高到(92.88±6.27)分;接触隔离措施依从性大幅提升,13条审查指标执行率提升至88%以上,差异均有统计学意义(P<0.05),ICU多重耐药菌医院感染率从3.2%降低至1.9%。结论:将基于循证的最佳证据应用于临床,有助于推进ICU多重耐药菌感染病人接触隔离管控措施落实,提升医护人员理论知识及实践水平,降低ICU多重耐药菌医院感染发生率。

多重耐药菌感染的中医药治疗干预研究进展

随着多重耐药菌(MDRO)特别是革兰阴性耐药菌的广泛流行,临床抗感染治疗也面临着原有抗菌药物有效性下降的现状,细菌耐药性形势日益严峻,亟需建立多学科协作机制,共同应对MDRO感染。中医学学者也积极对中医药治疗MDRO感染开展研究。MDRO感染可归于现代医学感染性疾病范畴,现代中医学认为,MDRO感染病因病机为正、邪两方面的相互作用,临床治疗应根据中医辨证论治的特点,进行个体化分析。本文旨在从MDRO的中医病因病机、辨证分型及治则治法、中药、方剂及中成药应用等方面对MDRO的中医药治疗干预情况作一综述。