为探讨肛周脓肿病人大肠埃希菌药敏情况,指导临床合理选用抗生素,对303例肛周脓肿病人分离出的187例大肠埃希菌感染病例进行回顾性分析.结果表明,肛周脓肿病人临床使用抗生素需参考药敏分析结果及患者病情,选用合理安全的抗菌药物.

目的：探讨炎症性肠病（IBD）患者肠道菌群的变化，并分析其与炎性因子的相关性。方法选择IBD患者178例，其中活动期112例（活动组）、缓解期66例（缓解组），另选择82例健康查体者作为对照组。采集各组新鲜粪便，使用梯度稀释法定量培养分析肠道菌群；采集静脉血应用ELISA法检测血清IL-6、IL-17、IL-22、IL-33水平。结果与对照组、缓解组比较，活动组粪便中大肠杆菌、肠球菌数量升高，双歧杆菌、乳酸杆菌数量降低，血清IL-6、IL-17、IL-22和IL-33水平升高（P均＜0．05）。对照组、缓解组各观察指标比较均无统计学差异。大肠杆菌、肠球菌数量与IL-6、IL-17、IL-22和IL-33水平呈正相关，双歧杆菌、乳酸杆菌数量与IL-6、IL-17、IL-22、IL-33水平均呈负相关（ P均＜0．05）。结论 IBD活动期患者存在肠道菌群失衡，后者与炎症的发生密切相关。

Objective To estimate the effects of Pregabalin and Ibuprofen in the teatment of postherpetic neuralgia (PHN). Methods Seventy-two patients with PHN were randomly assigned to two groups: 36 cases in Pregabalin group, 36 cases in Ibuprofen group. Results In the whole 2 weeks therapeutic course,neuralgia and sleep were significantly improved in the two groups (P<0.05),and the improved score and rate in Pregabalin group is higher than in the Ibuprofen group(P<0.05). Conclusion Pregabalin had better effects in the treatment of neuralgia and sleep with PHN than Ibuprofen.

目的 评价不同术后镇痛方法对胃大部切除术患者血浆中细胞因子IL-6、IL-8、TNF-α、IL-10的影响,并与传统术后镇痛方法进行比较,观察术后充分镇痛对免疫功能的影响.方法 30例ASA Ⅰ～Ⅱ期,择期行胃大部切除手术患者随机分为对照组(C组),硬膜外自控镇痛组(PCEA组),静脉自控镇痛组(PCIA组).分别于麻醉前(T1),术后2 h(T2),术后8 h(T3),术后24 h(T4)及术后48 h(T5)抽取外周血.用ELISA法检测血浆IL-6、IL-8、TNF-a和IL-10水平.结果 (1)PCEA组和PCIA组的术后镇痛VAS评分效果在T2、T3、T4、T5各时间点显著好于C组(P＜0.05),PCEA组与PCIA组间差异无统计学意义(P＞0 05).(2)PCEA组和PCIA组术后各时间点的细胞因子IL-6、IL-8、TNF-α和IL-10低于C组(P＜0.05);与PCIA组比较,PCEA组的细胞因子IL-6、IL-8、TNF-α和IL-10显著降低(P＜0.05).结论 对胃大部切除术患者,PCEA组和PCIA组术后镇痛优于传统镇痛方法.PCEA组和PCIA组显著改善创伤后的免疫抑制,PCEA组更优于PCIA组.

OBJECTIVE To investigate distribution and drug resistance of pathogenic bacteria isolated from bile specimens obtained from the patients with biliary tract infections so as to provide basis for reasonable clinical use of antibiotics.METHODS The pathogenic bacteria,which were isolated from the bile specimens obtained from the patients who underwent biliary tract surgery from Mar 2010 to Feb 2012,were retrospectively analyzed,then the drug resistance was observed.RESULTS A total of 416 strains of pathogens were isolated,including 323(70.65%)strains of gram-negative bacilli,89(21.39%)strains of gram-positive cocci,and 4(0.96%)strains of fungi;the Escherichia coli(44.95%),Klebsiella pneumoniae(9.62%)and Pseudomonas aeruginosa(5.05%)ranked the top three species of gram-negative bacilli;the Enterococcus faecium(11.54%)and Enterococcus faecalis(6.97%)were the most common species of gram-positive cocci.The drug susceptibility rates of the E.coli and K.pneumoniaeto imipenem and meropenem were 100.0%;the drug susceptibility rate of the E.coli to cefoperazone-sulbactam was 99.47%,the K.pneumoniae 95.0%;the positive rate of ESBLs-producing E.coli was 63.64%,the ESBLs-producing K.pneumoniae 52.50%;the drug susceptibility rates of the P.aeruginosato amikacin and cefoperazone-sulbactam were 100.0%.The drug resistance rate of the Enterococcus faecalis was significantly lower than that of the Enterococcus faecium,and the drug susceptibility rates to linezolid and teicoplanin were 100.00% and 96.55%,respectively;no vancomycin-resistant Enterococci strains were detected.CONCLUSION The E.coli,Enterococci,and K.pneumoniae are the most common species of pathogens causing biliary tract infections;it is necessary for the hospital to reasonably use antibiotics based on the result of drug susceptibility testing so as to reduce the drug resistant strains and improve the cure rate.

Objective To investigate the distribution and antibiotic resistance of bacteria isolated from clinical samples and to guide reasonable clinical treatment of antibiotics.Methods 3 598 strains of bacteria with their drug sensitivity test results during May 2010 to Apr.2012 were review ed retrospectively.Results In 3 598 strains of pathogenic bacteria,2895(80.5%)strains were gram-negative bacilli which containedd 784(21.9%)strains of Escherichia coli, 703(19.6%)strains of Pseudomonas aeruginosa,462(12.8%)strains of Klebsiella pneumoniae,399(11.1%) strains of Acinetobacter baumannii.The positive rate of extended-spectrumβ-lactamases from Escherichia coli and Klebsiella pneumoniae were 55.5%and 31.0%,respectively.Both of them were 100%sensitive to imipenem and meropenem,highly sensitive to cefoperazone/sulbactam and amikacin.The sensitivity of Escherichia coli were 99.23% and 91.96%,and the sensitivity of Klebsiella pneumoniae were 98.92%and 92.21%.The sensitivity of pseudomonas aeruginosa to cefoperazone/sulbactam,amikacin and cefepime were 91.75%,90.18%and 89.47%,respectively. The sensitivity of Acinetobacter baumannii to cefoperazone/sulbactam,minocycline and ampicillin/sulbactam were 97.99%,93.48%and 84.71%,respectively.There were 556 strains of gram-positive cocci(15.5%)which contained 139 strains of Staphylococcus aureus(3.9%)、116 strains of coagulase-negative Staphylococci(3.2%),141 strains of Enterococcus faecalis(4.0%)and 101 strains of Enterococcus faecium(2.8%).The detection rate of MRSA and MRCNS were 21.6%and 56.0%,respectively.No strains of Staphylococcus and Enterococcus with resistance to vancomycin were detected.There were 147(4.1%)strains of fungi.Conclusion To understand the distribution of pathogen bacteria and monitor its drug resistance dynamically can guide the reasonable use of antibiotics as well as control and delay the emergence of drug resistant strains.

目的 分析胆道感染患者胆汁中病原菌的分布及耐药性,为临床合理使用抗菌药物提供依据.方法 回顾性分析2010年3月-2012年2月接受胆道手术治疗患者于术中所取胆汁标本分离的病原菌及耐药性.结果 共分离出416株病原菌,其中革兰阴性杆菌323株占77.65％,革兰阳性球菌89株占21.39％,真菌4株占0.96％,排名前3位的革兰阴性杆菌为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌,分别占44.95％、9.62％、5.05％;革兰阳性球菌中以粪肠球菌和屎肠球菌多见,分别占11.54％、6.97％;大肠埃希菌、肺炎克雷伯菌两者对亚胺培南、美罗培南的敏感率均为100.0％,对头孢哌酮/舒巴坦敏感率较高分别为99.47％、95.0％,产ESBLs酶的阳性率分别为63.64％和52.50％;铜绿假单胞菌对阿米卡星和头孢哌酮/舒巴坦敏感率为100.0％;革兰阳性球菌中粪肠球菌的耐药性明显低于屎肠球菌,对利奈唑胺和替考拉宁敏感率较高,分别为100.00％、96.55％,未发现耐万古霉素肠球菌.结论 胆道感染中以大肠埃希菌、肠球菌属、肺炎克雷伯菌最常见,临床治疗应依据药敏结果合理选用抗菌药物,降低或减缓耐药菌株的产生,提高治愈率.

目的 观察膝关节内注射生长抑素(SST)治疗膝关节骨关节炎(OA)的有效性以及它的耐受性和依从性.方法 OA患者233例(267膝),随机分成两组,观察组117例133膝,膝关节腔内注射SST 750 μg,每周1次,连续5周;对照组116例134膝,膝关节腔内注射玻璃酸钠2 mL,每周1次,连续5周.记录治疗前后疼痛缓解程度以及关节功能改善情况,并采用VAS疼痛评分和Legusne膝骨关节炎严重程度指数制定评定标准和评价治疗效果.结果 两组患者治疗后疼痛均有明显减轻,VAS评分与治疗前相比,差异有统计学意义(P<0.05).关节综合评分有效率显著提高.一个疗程后治疗组有效率为85.71%,1个月后效果最为明显,有效率为89.47%.停药后6个月时有效率仍为73.68%.结论 应用SST关节腔内注射治疗OA,能有效缓解关节疼痛,改善关节功能.与玻璃酸钠疗效相当,而且SST的作用时间更持久.患者对SST耐受性及依从性均较好.远期疗效尚需继续追踪.

随着广谱抗菌药物的广泛使用,细菌的耐药性日益成为医药界广泛关注的问题.非发酵革兰阴性杆菌是医院感染中一类很重要的病原菌,近年来在我国的感染率和分离率明显上升.为指导临床合理使用抗菌药物,我们对2008年7月-2010年1月山东大学齐鲁医院各类临床样本中分离到的565株非发酵菌的分布及耐药情况进行了总结分析,现报道如下.

目的 研制一种用于检测口腔常见无芽胞厌氧性细菌感染的基因芯片.方法 选择口腔感染中常见的无芽胞厌氧性细菌作为菌种,将16S rDNA作为靶基因.借助生物信息学方法,设计通用引物和特异性探针,选择与反义引物互补的核酸序列作为阳性质控探针;大肠杆菌16S rDNA基因序列为阴性质控探针,制备微阵列.进行厌氧性细菌DNA的提取、扩增、杂交、结果分析以及微阵列质量检测.结果 制备的用于检测口腔常见无芽胞厌氧菌感染的基因芯片特异性、灵敏度、重现性和稳定性均符合实验要求.结论 利用生物信息学方法设计的引物和探针合理,制备的芯片可用于口腔常见无芽胞厌氧性细菌感染的诊断.

[Objective]The 16S rDNA conservative sequences and 7 16S rDNA specific sequences' applying value was studied in diagnosing and identifying of oral anaerobic bacteria.[Methods]18 Clinical samples were collected from the outpatient who received medical treatment at the department of stomatology in Qilu hospital affiliated of Shandong University during Sep.2007 and Oct.2008;Oral Anaerobic bacteria 16S rDNA conservative sequences and 7 16S rDNA specific sequences were detected by PCR method and the standard anaerobic bacteria were detected by the same method simultaneously;PCR product was detected by Agarose Gel Electrophoresis.[Results]The same anaerobic bacteria detecting rate was acquired in standard anaerobic bacteria and oral infected samples,they were 100.0%(the standard anaerobic bacteria were 7/7,the anaerobic bacteria in oral infected samples were 18/18);The standard anaerobic bacteria's identifying rate was 7/7,the 7 16S rDNA specific sequences' detecting rate of the oral infected sample was 66.7%(12/18).[Conclusion]The 16S rDNA conservative sequences and the 7 specific sequences had higher value in detecting and identifying oral anaerobic bacteria's infection.

The Chinese Meropenem Surveillance Study (CMSS) programme was initiated in 2003 with the aim of monitoring the antimicrobial activity of broad-spectrum agents against nosocomial Gram-negative bacilli in China. From 2003 to 2008, a total of 3892 isolates were collected from 10 teaching hospitals. The minimum inhibitory concentrations (MICs) of 11 antimicrobial agents were determined by the agar dilution method. During the study period, a marked decrease in the susceptibility of Acinetobacter spp. to meropenem and imipenem was noticed, from 94.6% to 60.7% and from 92.5% to 62.1%, respectively. However, for Pseudomonas aeruginosa the susceptibility was relatively stable, with susceptibility rates of 86.2% to 76.0% for meropenem and 74.8% to 70.5% for imipenem. Meropenem and imipenem exhibited the highest activities against enterobacterial organisms, with ranges of MIC90 values (MIC for 90% of the organisms) from 0.064mg/L to 0.25mg/L and 0.25 to 4mg/L, respectively. Except for Acinetobacter spp., the next most active agent against the majority of isolates was amikacin, with susceptibility ranging from 78.8% to 93.3%, followed by piperacillin/tazobactam (73.7% to 98.2%), cefoperazone/sulbactam (63.9% to 99.1%), cefepime (67.0% to 95.4%) and ceftazidime (54.5% to 93.3%). The percentage of isolates positive for extended-spectrum β-lactamases among Escherichia coli, Klebsiella spp. and Proteus mirabilis ranged from 50.9% to 66.7%, 25.4% to 42.4% and 8.9% to 24.2%, respectively. These CMSS results have demonstrated increasing resistance of Acinetobacter spp. to carbapenems, resulting from the spread of highly resistant clones. Continued surveillance studies, including CMSS, as well as potent measures for controlling the spread of resistant clones are required.

Objective To investigate antimicrobial resistance situation of nosocomial gram-negative bacilli in China in 2008.Methods A total of 1,057 consecutive and non-repetitive gram-negative bacilli strains were isolated from 10 hospitals during September,2008 to December,2008 in China.All isolates were sent to the central laboratory for reidentification and susceptibility tests.The minimal inhibitory concentration(MICs)of meropenem and other antibacterial agents were determined by agar dilution method.Results The activity of antibacterial agents against Enterobacteriaceae was in the following order:meropenem(susceptible rate,99.4%)>imipenem(99.3%)>amikacin(90.4%).The most potent agents against E.coli and K.pneumoniae included meropenem,imipenem(97.9%～100%),piperacillin/tazobactam(87.2%～97.9%),and amikacin(82.3%～92.9%).The most potent agents against E.cloacae,E.aerogenes,and Citrobacter freundii included meropenem,imipenem(97.4%~100%),amikacin(87.2%~91.9%),and cefepime(82.4%~93.5%).The most potent agents against Pseudomonas aeruginosa were amikacin(77.4%),followed by meropenem (76%),piperacillin/tazobactam(70.5%),and imipenem(70.5%).The most potent agents against Acinetobacter baumannii were imipenem(58.6%),meropenem(57%),and cefoperazone/sulbactam(49.2%).The most potent agents against Burkholderia cepacia were ceftazidime(77.4%),meropenme(75.5%),and piperacillin/tazobactam(69.8%).Conclusion Carbapenems remains very potent against Enterobacteriaceae.A.baumanni and P.aeruginosa,especially A.baumanni,have increased resistance to carbapenems.

目的 探讨聚合酶链式反应(PCR)检测口腔厌氧茼的优势.方法 培养方法对口腔厌氧菌的培养与鉴定分析;PCR方法扩增口腔厌氧菌16S rDNA序列和七种厌氧菌特异性序列;同时采用厌氧菌标准菌株作对照.结果 PCR和培养方法具有相同的厌氧菌检出率,均为100%(标准菌株为5/5,标本为18/18);PCR和培养方法具有不同的鉴定准确率,标准菌株分别为100%(5/5)和40%(2/5);标本PCR为66.7%(12/18)培养方法不易界定;两种方法鉴定结果一致率低,只有5.6%(1/18).结论 PCR在口腔厌氧菌检出和鉴定方面明显优于培养方法.

Objective To investigate antimicrobial resistance situation of nosocomial gram-negative bacilli in China in 2008.Methods A total of 1,057 consecutive and non-repetitive gram-negative bacilli strains were isolated from 10 hospitals during September,2008 to December,2008 in China.All isolates were sent to the central laboratory for reidentification and susceptibility tests.The minimal inhibitory concentration(MICs)of meropenem and other antibacterial agents were determined by agar dilution method.Results The activity of antibacterial agents against Enterobacteriaceae was in the following order:meropenem(susceptible rate,99.4%)＞imipenem (99.3%)＞amikacin(90.4%).The most potent agents against E.coli and K.pneumoniae included meropenem,imipenem(97.9%～100%),piperacillin/tazobactam(87.2%～97.9%),and amikacin(82.3%～92.9%).The most potent agents against E.cloacae,E.aerogenes,and Citrobacter freundii included meropenem,imipenem (97.4%～100%),amikacin(87.2%～91.9%),and cefepime(82.4%～93.5%).The most potent agents against Pseudomonas aeruginosa were amikacin(77.4%),followed by meropenem(76%),piperacillin/tazobactam(70.5%),and imipenem(70.5%).The most potent agents against Acinetobacter baumannii were imipenem (58.6%),meropenem(57%),and cefoperazone/sulbactam(49.2%).The most potent agents against Burkholderia cepacia were ceftazidime(77.4%),meropenme(75.5%),and piperacillin/tazobactam(69.8%).Conclusion Carbapenems remains very potent against Enterobacteriaceae.A.baumanni and P.aeruginosa.especially A.baumanni,have increased resistance to carbapenems.

Objective To investigate antimicrobial resistance among nosocomial gram-negative bacilli in 2006.Methods About 987 consecutive and non-repetitive gram-negative bacilli were isolated from 10 teaching hospitals from Sep.to Dec.in 2006 in China.All of these isolates were sent to the central laboratory for reidentification and susceptibility testing.The minimal inhibitory concentration(MICs)of meropenem and other antibacterial agents were determined by agar dilution method.Results The activity of antibacterial agents against Enterobacteriaceae was as fol lows in descending order of susceptible rate: meropenem(susceptible rate 99.8%),imipenem(99.5%),piperacillin/tazobactam(91.3%),amikacin (89.3%),cefepime(83.8%),cefoperazone/sulbactam(79.7%),ceftazidime(74.7%),cefotaxime (57.7%),ceftriaxone(56.6%),ciprofloxacin(53.6%).The prevalence of extended-spectrum β-Iactamases(ESBL)was 59.0% in Escherichia coli,33.0%in Klebsiella pneumoniae and 8.0%in Proteus mirabilis.The most active agents against E.coli and K.pneumoniae were meropenem,imipenem(99.2%. 100%),piperacillin/tazobactam(90.8%-97.0%),and amikacin(83.8%-92.4%).Cefepime Was more active against K.pneumoniae than E.coli(85.4% vs.65.2%).Against E.cloacae,E.aerogenes and Citrobacter freundii,the most active agents were as follows in desecnding order:meropenem,imipenem (99.2%-100%),amikacin(85.2%-92.6%),cefepime(81.5%-85.9%),piperacillin/tazobactam (73.4%-87.2%),cefoperazone/sutbactam(65.6%-77.7%),and ciprofloxacin(53.1%-72.3%).The most active agents against Pseudomonas aeruginosa were amikacin(83.5%),followed by meropenem (79.1%),piperacillin/tazobactam(74.1%),and imipenem(70.9%).The most susceptible agents against Acinetobacter baumannii were imipenem(79.1%),meropenem(73.4%) and cefoperazone/ sulbaetam(54.7%).Mutiresistant A.baumannii increased up to 53.0%.The most active agents against Burkholderia cepacia were meropenem(73.3%),eeflazidime(73.3%),and piperacillin/tazobactam (62.2%).Conclusions Carbapenems remained very high activity against Enterobacteriaceae.Increasing resistance to 10 antimicrobials agents tested from A.baumanni and P.aeruginosa brought great concern.

AIM To evaluate the efficacy and safety of self-manufactured cefiizoxime for injection in the treatment of patients with acute moderate and severe respiratory tract infections.METHODS One hundred and thirty-eight patients with respiratory tract infection were enrolled in the multicenter randomized,controlled, single blind clinical trial and divided into trial and control groups,having administration of 2 g of ceftizoxime drop infusion within 30-60 min twice a day for 7-14 d as a course individually to both the trial group and the control group with self-manufactured and imported ceftizoxime,respectively.Evaluation of the efficacy and adverse reactions were carried out.RESULTS One hundred and thirty patients could be undertaken safety evaluation but only 125 of them provided the information for clinical efficacy evaluation,including 61 of trial group and 64 of control group.The efficacy rates were 92 %(56/61)and 89 %(57/64);the bacterial clearance rates were 94 %(48/51)and 93 %(50/54);whereas the incidences of adverse drug reactions were 5 %(3/65)and 6 %(4/65)for the trial group and the control group,respectively;with no statistical significant difference between the two groups(P0.05).CONCLUSION The self-manufactured ceftizoxime for injection is as effective and safe as those of imported ceftizoxime for the treatment of acute moderate and severe respiratory tract bacterial infections for injection.

副球菌属为革兰阴性非发酵型细菌,存在于海洋等外环境,共有15种,绝大多数的种与人的疾病无关[1].笔者从临床细菌检验中分离到1株伊氏副球菌,现报告如下.

近年来不动杆菌对碳青霉烯酶的耐药性不断增强,并且呈现多药耐药趋势.研究表明,不动杆菌对碳青霉烯的主要耐药机制是产生了质粒或染色体编码的碳青霉烯酶.为了解本地区鲍曼不动杆菌产碳青霉烯酶的类型,进行了研究.

对23例下呼吸道感染患者进行脑膜败血黄杆菌(FM)体外药敏试验,其中>60岁占82.6%,气管插管或切开占91.3%,合并多脏器衰竭占39.13%,病死率39.13%。体外药敏实验显示,FM对抗G-菌抗生素呈多重耐药,仅对氧哌嗪青霉素、环丙沙星有较好的敏感率,而对抗G+菌抗生素如万古霉素、克林霉素、阿奇霉素敏感。FM是老年、免疫力低下(特别是人工气道)患者下呼吸道感染的重要病原菌。