BackgroundConventional microbial testing (CMTs) for infectious pathogens faces challenges in rapid and comprehensive detection. Nanopore-targeted sequencing (NTS) is a novel approach for rapid identification of pathogens; however, clinical experience with the application of NTS is limited.MethodsWe evaluated the diagnostic value of NTS for detecting microbes in bronchoalveolar lavage fluid samples in patients with pulmonary infectious disease (PID, 137 cases), non-pulmonary infectious disease (NPID, 32 cases), or with an unknown etiology (11 cases). We performed a comparative analysis of the diagnostic efficacy of NTS and CMTs in identifying pulmonary infectious diseases and investigated the clinical utility of NTS as a diagnostic tool.ResultsNTS was significantly more sensitive than CMTs in detecting PID (86.13% vs 67.15%, P < 0.01), particularly for important specific pathogens. There were no significant differences between NTS and CMTs in terms of specificity, positive predictive value or negative predictive value. Moreover, NTS (not CMTs) detected 56 microorganisms consistent with clinical presentation, indicating that NTS can provide clinicians with additional support for infection diagnosis. Additionally, prior antibiotic exposure had no influence on the detection efficiency of NTS but significantly hindered that of CMTs. After antibiotic adjustments based on NTS findings, 87.76% of patients showed significant improvement, with a notable decrease in the level of inflammatory markers (CRP, NP, PCT, WBC) post-treatment. Furthermore, NTS can significantly shorten turnaround time and provide real-time results for rapid decision making.ConclusionsNTS is more efficient than CMTs in diagnosing pulmonary infectious diseases, particularly in detecting critical or specific pathogens, providing faster and more accurate clinical information even for patients with prior antibiotic exposure. Moreover, NTS can assist clinicians in formulating more effective anti-infection strategies.

BackgroundRapid and accurate diagnosis of the causative agents is essential for clinical management of bloodstream infections (BSIs) that might induce sepsis/septic shock. A considerable number of suspected sepsis patients initially enter the health-care system through an emergency department (ED), hence it is vital to establish an early strategy to recognize sepsis and initiate prompt care in ED. This study aimed to evaluate the diagnostic performance and clinical value of droplet digital PCR (ddPCR) assay in suspected sepsis patients in the ED.MethodsThis was a prospective single-centered observational study including patients admitted to the ED from 25 October 2022 to 3 June 2023 with suspected BSIs screened by Modified Shapiro Score (MSS) score. The comparison between ddPCR and blood culture (BC) was performed to evaluate the diagnostic performance of ddPCR for BSIs. Meanwhile, correlative analysis between ddPCR and the inflammatory and prognostic-related biomarkers were conducted to explore the relevance. Further, the health economic evaluation of the ddPCR was analyzed.Results258 samples from 228 patients, with BC and ddPCR performed simultaneously, were included in this study. We found that ddPCR results were positive in 48.13% (103 of 214) of episodes, with identification of 132 pathogens. In contrast, BC only detected 18 positives, 88.89% of which were identified by ddPCR. When considering culture-proven BSIs, ddPCR shows an overall sensitivity of 88.89% and specificity of 55.61%, the optimal diagnostic power for quantifying BSI through ddPCR is achieved with a copy cutoff of 155.5. We further found that ddPCR exhibited a high accuracy especially in liver abscess patients. Among all the identified virus by ddPCR, EBV has a substantially higher positive rate with a link to immunosuppression. Moreover, the copies of pathogens in ddPCR were positively correlated with various markers of inflammation, coagulation, immunity as well as prognosis. With high sensitivity and specificity, ddPCR facilitates precision antimicrobial stewardship and reduces health care costs.ConclusionsThe multiplexed ddPCR delivers precise and quantitative load data on the causal pathogen, offers the ability to monitor the patient’s condition and may serve as early warning of sepsis in time-urgent clinical situations as ED.ImportanceEarly detection and effective administration of antibiotics are essential to improve clinical outcomes for those with life-threatening infection in the emergency department. ddPCR, an emerging tool for rapid and sensitive pathogen identification used as a precise bedside test, has developed to address the current challenges of BSI diagnosis and precise treatment. It characterizes sensitivity, specificity, reproducibility, and absolute quantifications without a standard curve. ddPCR can detect causative pathogens and related resistance genes in patients with suspected BSIs within a span of three hours. In addition, it can identify polymicrobial BSIs and dynamically monitor changes in pathogenic microorganisms in the blood and can be used to evaluate antibiotic efficacy and survival prognosis. Moreover, the copies of pathogens in ddPCR were positively correlated with various markers of inflammation, coagulation, immunity. With high sensitivity and specificity, ddPCR facilitates precision antimicrobial stewardship and reduces health care costs.

随着检验医学实验室体系建设日臻标准化,检验技术手段不断更新,检验医学进入快速发展时期.目前,检验结果判读日趋复杂,临床医师在疾病的诊疗过程中对检验结果的依赖性也越来越强.在多学科交融发展的背景下,检验医师作为连接检验医学和临床医学的桥梁显得愈发重要.检验医师规范化培训在我国起步较晚,一直处于摸索前进阶段.临床微生物学属于检验医学的亚专业.近年来,该领域技术不断更新迭代,检测方式逐渐从传统形态学向基因诊断转换.由于该学科是针对微生物生命体的特殊学科,进而成为紧密联系临床的重要应用型学科.培养优秀的微生物检验医师成为当前检验医师规范化培训的重要任务.该专业规范化培训目的是培养具备丰富理论知识、掌握扎实的基本技能、沟通技能良好、适应感染性诊疗需求的微生物检验医师.该文将通过实际案例由点到面、由浅入深探讨如何利用病例教学引导和建立临床微生物检验医师的临床思维.

Background Urinary tract infections (UTIs) are some of the most common bacterial infections in the world. Nevertheless, as uncomplicated UTIs are treated empirically without culturing the urine, adequate knowledge of the resistance pattern of uropathogens is essential. Conventional urine culture and identification take at least 2 days. Here, we developed a platform based on LAMP and centrifugal disk system (LCD) to simultaneously detect the main pathogens and antibiotic resistant genes (ARGs) of urgent concern multidrug-resistant among UTIs. Methods We designed specific primers to detect the target genes above and evaluated their sensitivity and specificity. We also assessed the result of our preload LCD platform on 645 urine specimens with a conventional culturing method and Sanger sequencing. Results The results obtained with the 645 clinical samples indicated that the platform has high specificity (0.988–1) and sensitivity (0.904–1) for the studied pathogens and ARGs. Moreover, the kappa value of all pathogens was more than 0.75, revealing an excellent agreement between the LCD and culture method. Compared to phenotypic tests, the LCD platform is a practical and fast detection approach for methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Acinetobacter, carbapenem-resistant Pseudomonas aeruginosa (kappa value of all >0.75), and non-extended-spectrum β-lactamase producers. Conclusion We developed a detection platform that has high accuracy and that meets the need for rapid diagnosis, which can be completed within 1.5 h from specimen collection. It may be a powerful tool for evidence-based UTIs diagnosis, which has essential support for the rational use of antibiotics. More high-quality clinical studies are required to prove the effectiveness of our platform.

BACKGROUND:Mediastinitis and sternal osteitis are critical complications in cardiac surgery. Cases of these complications caused by Mycoplasma hominis are extremely rare.CASE PRESENTATION:We present a case of mediastinitis and sternal osteitis caused by M. hominis infection following ascending aortic replacement surgery. Whole gene sequencing analysis suggested the genitourinary tract as the most likely source of this M. hominis infection. Successful infection control was achieved through a regimen of moxifloxacin treatment. Additionally, a notable correlation was observed between serum levels of interleukin-6 and M. hominis infection.CONCLUSIONS:The significance of M. hominis as a potential cause of postoperative infection in cardiac surgery is still not fully recognized. Special attention should be paid to patients with bacteriologically negative infections, as M. hominis should not be disregarded, despite its rarity.

Klebsiella pneumoniae carbapenemase (KPC)-2, metallo-beta-lactamases (MBL), and oxacillinase (OXA)-48-like carbapenemases are considered the most important carbapenemases. In vitro studies have demonstrated that the carbapenemase activity of KPC-2 and MBL can be inhibited by 3-aminophenylboronic acid and ethylenediaminetetraacetic acid (EDTA), respectively. Understanding the carbapenemase types expressed in carbapenem-resistant Enterobacterales (CRE) is of great significance to clinical therapies. Liquid chromatography-coupled tandem mass spectrometry (LC–MS/MS) is fast, stable, and specific; and is considered the gold standard method for measuring small molecules. In this study, we developed carbapenemase inhibition tests combined with LC–MS/MS to rapidly identify carbapenemase types. A total of 295 clinical isolates were examined, including 212 KPC-2 producers, 29 MBL producers, 15 OXA-48-like producers, 3 KPC-2 + OXA-232 producers, and 36 carbapenem-sensitive strains. We used LC–MS/MS to determine the carbapenemase types by measuring the ratio of the hydrolyzed meropenem peak areas in the presence and absence of different inhibitors. The sensitivity and specificity of LC–MS/MS in detecting single KPC-2 producers were 97.64% and 100.00%, respectively, and 96.55% and 100.00% for MBL producers, respectively. In addition, the sensitivity and specificity of LC–MS/MS in detecting single OXA-48-like producers were both 100.00% when extending incubation time up to 2.5 h. LC–MS/MS showed excellent agreement in detecting carbapenemase types using the modified carbapenem inactivation (mCIM)/EDTA-carbapenem inactivation assay (eCIM) (kappa = 0.93 for serine carbapenemases and kappa = 0.98 for MBL carbapenemases). In this study, LC–MS/MS demonstrated excellent detection of different carbapenemase types, showing potential reliability in future clinical applications.

Background Carbapenem-resistant Enterobacteriaceae (CRE) infection constitutes a public health threat, which blaKPC was the major carbapenemases concerned in China. Timely and efficient diagnosis is of paramount importance for controlling the spread of drug-resistant bacteria. Here, we develop an approach based on loop-mediated isothermal amplification (LAMP) for rapid confirmation of blaKPC within 60 min from samples collected. Methods We designed primers specific to detect blaKPC and evaluated it for its sensitivity and specificity of detection using real-time monitoring. Five hundred forty-six clinical specimens were analyzed by the LAMP assay and compared with the phenotypic tests and PCR. The samples with inconsistent results were further verified by Sanger sequencing. Results The LAMP assay displayed a detection limit of 1 x 10(2) CFU/ml, which was 10-fold more sensitive than the PCR. No cross-reactivity was observed for strains that produced other types of beta-lactamase. Furthermore, we demonstrated concordant results (Kappa > 0.75) between the genotypic method and phenotypic tests for the 546 clinical samples. The data presented in this study suggested that the genotypic method is a reliable assay for identifying blaKPC-induced CRE in China. The results of the Sanger sequencing indicate that the developed method not only has high accuracy but also meets the need for rapid diagnosis, while the PCR method is prone to false negatives. Conclusions We successfully constructed a LAMP technique that can be used for auxiliary diagnosis of CRE, which is faster, cheaper, and more accurate than the PCR. It may therefore be routinely applied for detection of blaKPC producers in routine clinical laboratories.

Due to the highly contagious and spreads quickly of respiratory infectious diseases (ADR), the availability of rapid, sensitive, and reliable diagnostic methods is essential for disease control. Here, we develop an approach based on loop-mediated isothermal amplification (LAMP) for the detection of influenza A virus (Flu A), Flu A subtypes H1N1and H3N2, influenza B virus (Flu B), respiratory syncytial virus (RSV) subtypes A and B, human adenovirus (HAdV), parainfluenza virus (PIV) subtypes 1 and 3, and human rhinovirus (HRV) simultaneously. We designed primers specific to detect respiratory viruses above, optimized the RT-LAMP assay and evaluated it for its sensitivity and specificity of detection using real-time monitoring based on SYBR Green I. We also evaluated the result of our RT-LAMP assay on 638 nasopharyngeal swab specimens with the commercial RT-PCR by Cohen's Kappa. The inconsistent results were verified by Sanger sequencing furtherly. The developed RT-LAMP assay displayed a detection limit of 1 × 102 copies/ml RNA close to that of RT-PCR; no cross-reactivity was observed in the 10 kinds of viruses studied. The results obtained with 638 clinical samples indicate that the developed method has high specificity (0.988–1) and sensitivity (0.863–1) for viruses studied, and the Kappa value of all viruses was more than 0.85 revealed an excellent agreement between the two methods. We developed an RT-LAMP-based method and optimized for the detection of common respiratory viruses. It may be a powerful tool for rapid and reliable clinical diagnosis of ADR in primary hospitals.

检验医学科住院医师规范化培训(简称住培)是培养合格检验医师的必经途径,与临床其他专业相比,检验医学科专业培训的内容和目标有其自身的特点和要求.该文总结分析了同济大学附属东方医院检验科开展检验住培工作的探索与实践,围绕当前检验医学科专业住培目的,对轮转住院医师进行培训,探讨了在医学检验教育改革新形势下培养真正既懂临床又懂检验的检验医师亟需解决的问题,对进一步提升住院医师培训内涵质量具有重要的参考和借鉴意义.

目的 监测上海地区2019年三级甲等医院临床分离菌对抗菌药物的耐药性.方法 对上述医院临床分离菌采用纸片扩散法或自动化仪器法,按上海市细菌真菌耐药监测网技术方案进行抗菌药物敏感性试验.按2019年CLSI文件标准判断结果 .结果 收集2019年1-12月监测网内三级医院临床分离菌共119318株,其中革兰阳性菌占29.1％(34756/119318),革兰阴性菌占70.9％(84562/119318).金黄色葡萄球菌、表皮葡萄球菌和其他凝固酶阴性葡萄球菌中甲氧西林耐药株(MRSA、MRSE和其他MRCNS)的检出率分别为43.4％、83.2％和76.6％.甲氧西林耐药株(MRSA、MRSE和其他MRCNS)对绝大多数抗菌药物的耐药率均显著高于甲氧西林敏感株(MSSA、MSSE和其他MSCNS).MRSA对甲氧苄啶-磺胺甲(噁)唑和利福平的耐药率低,分别为5.2％和3.0％,MRSE对利福平耐药率低(7.6％),未发现万古霉素和利奈唑胺耐药株.肠球菌属中粪肠球菌对多数测试抗菌药物的耐药率均显著低于屎肠球菌;粪肠球菌中未发现万古霉素耐药株,但对利奈唑胺耐药率达1.7％;屎肠球菌对万古霉素和利奈唑胺耐药率分别为0.4％和0.2％.2019年儿童和成人中分离的肺炎链球菌中青霉素敏感株(PSSP)分别占96.8％和96.9％,检出率较2018年有所上升,中介和耐药株(PISP和PRSP)的检出率则有所下降.肠杆菌目细菌对碳青霉烯类抗生素仍较敏感,多数菌属的耐药率低于20.0％(除克雷伯菌属外).此外,不动杆菌属对亚胺培南和美罗培南的耐药率分别为63.4％和63.1％,铜绿假单胞菌对上述两药的耐药率分别为30.0％和26.1％.结论 临床分离菌对常见抗菌药物的耐药性仍呈增长趋势,尤其是碳青霉烯类耐药革兰阴性杆菌.上海市三级医院的耐药形势仍然严峻,需各相关部门协作以遏制耐药细菌流行播散.

目的 建立环介导等温扩增技术(loop-mediated isothermal amplification,LAMP)检测呼吸道感染患者痰液中肺炎克雷伯菌(Klebsiella pneumoniae,Kpn)的方法 并进行初步应用.方法 基于Kpn phoE基因设计4条特异性引物,对反应条件中的Mg2+和甜菜碱浓度进行优化,建立检测Kpn LAMP方法 并进行特异性和灵敏度试验;收集308例呼吸道感染患者痰液样本,进行细菌培养法、LAMP法、DNA测序技术检测,评估LAMP检测体系.结果 8 mmol/L、0.4 mmol/L确定为Mg2+和甜菜碱的最佳扩增浓度;该体系特异性强,与其他菌株无交叉反应,灵敏度为104 CFU/mL;临床样本中Kpn的LAMP检出率(53.89％)高于培养法(42.20％),差异有统计学意义(χ2=161.65,P<0.05);LAMP法与细菌培养法在Kpn阳性样本、无细菌生长样本、非Kpn其他细菌阳性样本中的一致率分别为96.15％、100％、65.25％,46例不一致样本经DNA测序验证,LAMP法与测序符合率为86.95％(40/46);LAMP法和DNA测序法对131例样本同时进行检测,经Kappa检验两者具有极好的一致性(Kappa系数=0.817).结论 与细菌培养法相比,LAMP法具有准确性高、灵敏度高、特异性强、反应省时等优势,可以作为肺炎克雷伯菌的快速检测方法 .

Objective To investigate the correlation between atlE gene and biofilm formation of Staphylococcus epidermidis . Methods 64 strains of clinically isolated Staphylococcus epidermidis in our hospital from June 2015 to June 2016 were collected . The biofilm formation test was used to detect bacterial biofilm .PCR was use to amplify atlE gene .Then the correlation between the atlE gene with biofilm formation was analyzed .Results 24 strains of biofilm positive bacterium were detected ,the detection rate was 37 .5% ;31 strains of atlE gene was detected ,the detection rate was 48 .4% ;atlE gene was significantly correlated to biofilm formation(P＜0 .05) .Conclusion Staphylococcus epidermidis has the ability to form biofilm ;atlE gene has a relation with biofilm formation of Staphylococcus epidermidis .

Objective To investigate the antimicrobial resistance proifle of clinical isolates in Shanghai hospitals during 2015. Methods Antimicobial susceptibility testing was carried out for the clinical isolates collected from 44 hospitals ( including 27 class A tertiary hospitals and 17 class B tertiary hospitals/class A secondary hospitals, of which 3 were children hospitals) according to a unified protocol using Kirby-Bauer method or automated systems. Results were analyzed according to CLSI 2015 breakpoints.Results Of the 107853 clinical isolates, gram positive cocci and gram negative bacilli accounted for 29.3 % and 70.7 %, respectively. The overall prevalence of MRSA in Staphylococcus aureus was 46.9 % and 74.2 % for MRCNS in coagulase-negative Staphylococcus. The average prevalence of MRSA and MRCNS was 53.6 % and 70.3 % in class B tertiary hospitals/class A secondary hospitals, 44.3 % and 75.6 % in class A tertiary hospitals. No strains were found resistant to vancomycin or linezolid. About 77.8 % of the 1021 strains of non-meningitis S. pneumoniae isolated from children were penicillin-susceptible (PSSP), 22.2 % were penicillin-nonsusceptible, including penicillin-intermediate (PISP, 13.3 %) and penicillin-resistant (PRSP, 8.9 %) strains. Of the 232 strains isolated from adults, 88.4 %, 5.2 % and 6.4 % were PSSP, PISP and PRSP, respectively. Overall, 51 strains of vacomycin-resistant E. feacium and 3 strains of vacomycin-resistant E. feacalis were identified. According to PCR results, most of these resistant strains werevan A type based on their phenotype. The overall prevalence of ESBLs-producing srains was 57.0 % in E. coli, 32.3 % in Klebsiella spp. (K. pneumoniae and K. oxytoca) and 41.5 % in P. mirabilis. Specifically, the prevalence of such strains was 58.0 %, 29.0 % and 45.5 % in class B tertiary hospitals/class A secondary hospitals, 56.5 %, 33.9 % and 40.2 % in class A tertiary hospitals, respectively.Enterobacteriaceae strains were still highly susceptible to carbapenem antibiotics. Overall, 7.4 % and 7.7 % of the Enterobacteriaceae strains were resistant to imipenem and meropenem, respectively. A few extensively drug-resistant strains were identified in A. baumannii,K. pneumoniae,P. aeruginosa, and E. coli. Conclusions It seems that antibicotic resistance is increasing in the clinical isolates. More attention should be paid to preventing the spread of drug resistant strains.

目的 分析临床分离表皮葡萄球菌对不同类型氨基糖苷类抗菌药物的耐药特征;分析icaADBC操纵子在临床分离的表皮葡萄球菌中的检出及与细菌耐药的关系.方法 收集2013年1～10月上海市东方医院临床分离的表皮葡萄球菌77株,采用纸片扩散法检测细菌4种氨基糖苷类抗菌药物(庆大霉素、链霉素、奈替米星和阿米卡星)药敏试验特征;构建icaADBC特异性引物,采用聚合酶链反应扩增技术检测77株细菌中icaADBC的分布状况.结果 结果77株表皮葡萄球菌对氨基糖苷类抗菌药物耐药率较高,分别为庆大霉素:62.3％,链霉素:61.0％,阿米卡星:22.1％,奈替米星:23.4％.icaADBC操纵子的检出率为20.8％,ica阳性菌株与阴性菌株对氨基糖苷类抗菌药物耐药性比较差异有统计学意义(P＜0.05).结论 临床分离的icaADBC操纵子阳性表皮葡萄球菌对氨基糖苷类抗菌药物耐药率较高.

Objective To investigate the formation of biofilm in clinical isolates of Staphylococcus epidermidis ,and to analyse the correlation between biofilm formation and antibacterial resistance of Staphylococcus epidermidis .Methods A total of 62 strains of Staphylococcus epidermidis isolated from blood specimens of inpatients with bloodstream infection ,from January 2014 to February 2015 ,were collected .The biofilm formation of Staphylococcus epidermidis was detected by using the semi‐quantitative adherence as‐say and polymerase chain reaction(PCR) amplification experiment .The antibacterial susceptibility test was carried out according to K‐B method .Results The positive rate of biofilm formation detected by using the semi‐quantitative adherence assay and PCR for icaA gene were 37 .1% (23 strains) and 43 .5% (27 strains) respectively ,and there was no statistically significant difference(P>0 .05) .There were 14 positive strains detected by both methods .The resistance rates of strains producing biofilm to antibacterial a‐gents were generally higher than those of non‐producing biofilm strains ,and there were statistically significant differences in resist‐ance rates of strains to gentamicin ,penicillin ,oxacillin ,levofloxacin and cefoxitin(P<0 .05) .All bacteria were sensitive to vancomy‐cin ,linezolid and quinupristin/dalfopristin .Conclusion There is no significant difference between the two methods in detecing bio‐film formation .The resistance rates of strains producing biofilm to antibacterial agents were generally higher than those of non‐pro‐ducing biofilm strains .

目的 分析转座子Tn4001和操纵子icaADBC与临床分离表皮葡萄球菌耐氨基糖苷类抗生素的关系.方法 收集表皮葡萄球菌临床分离株77株,利用纸片扩散法检测细菌4种氨基糖苷类抗生素(庆大霉素、链霉素、奈替米星和阿米卡星)药敏特征;构建Tn4001和icaADBC特异性引物,利用PCR扩增技术检测77株细菌Tn4001和icaADBC.结果 77株细菌对氨基糖苷类抗生素耐药率较高,分别为庆大霉素:62.3％;阿米卡星:22.1％;链霉素:61.0％;奈替米星:23.4％.Tn4001的检出率为58.4％,45株Tn4001阳性菌中,对庆大霉素、阿米卡星、链霉素、奈替米星耐药率分别为93.3％、33.3％、88.9％、37.8％.icaADBC的检出率为20.8％;16株阳性菌中,对庆大霉素耐药率为93.8％;对阿米卡星耐药率为62.5％;对链霉素耐药率为93.8％;对奈替米星耐药率为62.5％.结论 临床分离表皮葡萄球菌操纵子icaADBC阳性菌株中通常伴随有转座子Tn4001检出,携带icaADBC或Tn4001的菌株对氨基糖苷类抗生素耐药率较高.

Objective To investigate the infection status and drug suscepetibility of mycoplasma from 6 573 patients with non-gonococcal urethritis ,and to provide the scientific bases for the clinical application of antibiotics .Methods Mycoplasma detection kit was used to detect ureaplasma urealyticum (Uu) and mycoplasma hominis(Mh) and the drug susceptibility .All the patients were divided into two groups :Chinese group and foreigner group .Results Among 5 675 Chinese patients ,2 985 patients were infected by mycoplasma(52 .6% ) .The infection rate of Uu was 2 312(40 .7% ) .35 .2% patients were male ,and 61 .4% patients were female .In 898 foreign patients ,440 patients were infected by mycoplasma(49 .0% ) .The infection rate of Uu was 327(36 .4% ) .32 .2% pa-tients were male ,and 59 .5% patients were female .In Chinese patients infected by Uu ,the susceptibility rates to MIN ,DOX ,JOS and CLA were 96 .7% ,96 .2% ,93 .7% ,89 .7% ,respectively .In foreign patients ,the susceptibility rates to MIN ,DOX ,JOS ,and CLA were 98 .9% ,98 .4% ,95 .8% ,92 .1% .Conclusion The mycoplasma infection rate of Chinese patients is higher than foreign patients .In both groups ,Uu infection is the main type .Female patients are more than male patients .The drug sensitivity rate in for-eign group is higher than that in Chinese group .mycoplasma are sensitivity to MIN ,DOX ,JOS .

Objective To compare the selective power of anti-drug-resistant mutant of vancomycin , teicoplanin , linezolid and rifampicin to methicillin-resistant Staphylococcus aureus (MRSA) .Methods The minimum inhibitory concentration (MIC) to MRSA was determined by E-test method. Mutant prevention concentration (MPC) was measured by mix-bacterial method (the inoculated bacterial concentration1×1010CFU/mL) .Selection index (MPC/MIC) and the ratio of MPC to target maximum serum concentration (MPC/Cmax) of the four antibiotics were compared.Results MIC values of vancomycin , teicoplanin , linezolid and rifampin against MRSA were 0.5,1.0,0.5and≤0.5μg/mL; MPC values were 51.2, 25.6 , 9.6and 1024.0 μg/mL ; Selection indices were 102.4 , 25.6 , 19.2and2 048.0; MPC/Cmax were 1.28 , 0.57 , 0.64 and107.80 , respectively.Conclusion Linezolid and teicoplanin have narrower mutant selection window than vancomycin and rifampin , and they have obvious advantages in preventing bacterial antibiotic resistance.

Objective To investigate the quinolone-resistance of Shigella isolates and its relationship with the plamid-mediated qnr gene.Methods A total of 100 Shigella isolates were collected.50 isolates were Shigella flexneri,and 50 isolates were Shigella sonnei.The drug resistance was determined by disc diffusion method.The qnr gene was detected by polymerase chain reaction(PCR).The qnr gene segments were amplified and sequenced to analyze the correlation between quinolone-resistance and the presence of qnr gene.Results The qnr gene was identified in 9(9%)of the 100 Shigella isolates,2(4%)of the 50 Shigella flexneri and 7(14%) of the 50 Shigella sonnei.The resistance rate of ofloxacin in qnr positive isolates(11.1%) was higher than that in qnr negative isolates(5.5%),but there was no statistical significance.The median diameters of 5 quinolone inhibition zones of the isolates with qnr gene were smaller than those without qnr gene.Conclusions The plamid-mediated qnr gene in Shigella sonnei isolates is more than that in Shigella flexneri isolates.The plamid-mediated qnr gene of Shigella isolates can decrease the resistance rate of quinolone.