目的 了解2019年上海市二级医院临床分离菌对抗菌药物的耐药性.方法 对21所二级医院(包括6所三乙医院)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统一监测方案进行抗菌药物敏感性试验.按2019年美国临床和实验室标准化协会(CLSI)文件标准判断结果 .结果 收集2019年1-12月上述医院临床分离菌共48650株,其中革兰阳性菌12409株,占25.5％,革兰阴性菌36241株,占74.5％.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)的平均检出率分别为49.6％、78.4％和79.9％.MRSA和MRCNS对大多数测试药物的耐药率均显著高于甲氧西林敏感株(MSSA和MSCNS).葡萄球菌属中未见万古霉素耐药株.肠球菌属中粪肠球菌对多数受试抗菌药物的耐药率均显著低于屎肠球菌,粪肠球菌对利奈唑胺耐药率0.4％,屎肠球菌对万古霉素耐药率为0.3％.流感嗜血杆菌、肺炎链球菌和卡他莫拉菌检出率分别为2.5％(1235株)、0.4％(217株)和0.5％(238株),流感嗜血杆菌产β内酰胺酶率为51.3％.肺炎链球菌非脑脊液分离株中以成人分离株为多,占61.7％,成人中青霉素耐药肺炎链球菌(PRSP)检出率为4.5％(6/132),儿童中未发现PRSP菌株.肠杆菌目细菌对碳青霉烯类抗生素较敏感,多数菌属对美罗培南耐药率均低于4％,克雷伯菌属对亚胺培南和美罗培南的耐药率分别为23.6％和23.2％,沙雷菌属对两药耐药率分别为21.4％和16.0％.不动杆菌属细菌对上述两药的耐药率分别为52.1％和53.2％,铜绿假单胞菌对两药的耐药率分别为22.1％和20.5％.结论 2019年上海市二级医院细菌耐药性监测显示:其菌种的分布和耐药性与三级医院大致相仿,临床常见细菌的耐药率和MRSA、碳青霉烯类耐药的肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌等耐药菌株的检出率较高,面临细菌耐药增加的严重威胁,应引起足够重视;合理使用抗菌药物和规范治疗是当务之急.

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.

Cholylglycine is a much better marker than the traditional liver function tests. Testing of cholylglycine can provide important information for liver diseases’ diagnosis, treatment, and follow-up care. In addition to liver diseases, cholylglycine can also serve as marker for other diseases such as biliary disease and intrahepatic cholestasis of pregnancy. In this paper, cholylglycine metabolism and its significance on diagnosis of liver and other diseases were summarized. The potential applications of cholylglycine testing were also discussed.

Objective To investigate the resistance of clinical bacterial isolates to antibiotics in Shanghai hospitals from Jonuary through December in 2012.Methods Antimicobial susceptibility testing was carried out for the clinical isolates from 29 hospitals according to an agreed protocol using Kirby-Bauer (K-B)method.Results were analyzed according to CLSI 2012 breakpoints. Results Of the 76 407 clinical isolates,gram positive cocci and gram negative bacilli accounted for 26.6% and 73.4 %,respec-tively.The overall prevalence of MRSA in Staphylococcus aureus was 52.1% and 77.0% for MRCNS in coagulase-negative Staphylococcus.The average prevalence of MRSA and MRCNS was 67.3% and 82.9% in secondary hospitals,48.3% and 76.1% in tertiary hospitals.No strains were found resistant to vancomycin,teicoplanin or linezolid.About 72.7% of the 685 strains of non-meningitis S.pneumoniae isolated from children were penicillin-susceptible (PSSP),27.3% were penicillin-non-susceptible,including penicillin-intermediate (PISP,13.7%)and penicillin-resistant (PRSP,13.6%)strains.Of the 75 strains isolated from adults,92.0%,5.3% and 2.7% were PSSP,PISP and PRSP,respectively.Overall,26 strains of vaco-mycin-resistant E.feacium and 3 strains of vacomycin-resistant E.feacalis were identified.Most of these resistant strains were VanA type based on their phenotype.Two strains of vancomycin-resistant E.faecalis and 4 strains of vancomycin-resist-ant E.feacium were reported in the secondary hospitals for the first time.The overall prevalence of ESBLs-producing srains was 60.1% in E.coli,35.8% in Klebsiella spp.(K .pneumoniae and K .oxytoca)and 38.9% in P .mirabilis.Specifically, the prevalence of such strains was 65.6%,32.5% and 51.5% in secondary hospitals,58.7%,36.6% and 32.8% in tertiary hospitals,respectively.Enterobacteriaceae strains were still highly susceptible to carbapenem antibiotics.Overall,6.1% and 4.1% of the Enterobacteriaceae strains were resistant to imipenem and meropenem,respectively.Of the Acinetobacter spp. strains,50.6% and 55.1% were resistant to imipenem and meropenem,respectively.Of the P .aeruginosa strains,28.4%and 23.2% were resistant to imipenem and meropenem,respectively.A few pan-drug resistant strains were identified in E.co-li,K.pneumoniae,A.baumannii and P .aeruginosa.The strains of Enterococcus spp.and E.coli isolated from urine showed relatively lower resistance to fosfomycin.Conclusions It seems that antibicotic resistance is increasing in the clinical isolates, which poses a serious threat to the clinical practice.Special attention should be paid to the fact that the prevalence of resistant strains of some species in secondary hospitals is even higher than that in tertiary hospitals.

OBJECTIVE To study the molecular mechanism of antibiotic resistance in hospital acquired(Staphylococcus) epidermidis infection,so as to reduce the occurrence of drug resistance and infection(acquired) in hospital.METHODS DNA from 18 strains of S.epidermidis were extracted by the phenol-chloroform method,and mecA,gyrA and grlA were amplified by PCR,then the variation of gyrA and grlA was tested by Hinf Ⅰ-(digested)(analysis).RESULTS Fifteen from 18 S.epidermidis strains were resistant to meticillin,and all of them had mecA gene. Eleven from 18 S.epidermidis strains were resistant to meticillin,quinolones and other(antibiotics).And they all had a mutant in gyrA and/or grlA.The mutated spots were gyrA Ser84(TCA→TTA) and GrlA Ser80(TCC→TTC).CONCLUSIONS The majority of hospital acquired S.epidermidis strains are multi-resistant to meticillin,quinolones and other antibiotics,which are caused by acquirement of drug-resistance gene or(mutation) of drug-targeting genes.Medical institutions must strictly standardize the application of antibiotics to(reduce)(development) of drug resistance.

OBJECTIVE To identify the pop strain of Staphylococcus aureus hospital acquired infection by random amplification of polymorphic DNA(RAPD),and to study the molecular mechanism of antibiotic(resistance),so as to reduce the occurrence of drug resistance and infection acquired in hospital.METHODS 1.DNA from 21 strains of S.aureus were extracted by the phenol-chloroform method and analyzed by using arbitrary(primer) polymerase chain reaction(AP-PCR).2.Amplifying mecA,GyrA and GrlA by PCR,and testing the(variation) of these genes by using Hinf Ⅰ-digested analysis.RESULTS Twenty one S.aureus strains were divided into 3(genetic) types.Type Ⅰ is the pop strain in our hospital which including 12 strains.Fourteen from 17 clinical stains were resistant to meticillin and quinolones,of which 13 strains had mecA except isolate 13064.And they all had(variation) in(GyrA) and/or GrlA.CONCLUSIONS RAPD provides markers for the typing of clinical strains and is suitable for(molecular) epidemiologic studies with high type ability,powerful discrimination,simplicity and(rapidness). Type Ⅰ is the pop S.aureus strain in hospital-acquired infection of our hospital.The majority of these strains are multi-(resistant) to meticillin,quinolones and other antibiotics.

目的 了解目前细菌感染性疾病的病原学种类、耐药情况 ,提高临床经验性治疗的用药水平。方法 用K B法和MicroScan自动细菌鉴定系统测定各菌种的抑菌圈直径和MIC水平。结果 感染细菌占前八位的是大肠埃希氏菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌、粪肠球菌、阴沟肠杆菌和洛菲不动杆菌 ,GS- 杆菌以泰能最为敏感。GS+ 球菌以万古霉素和氧哌嗪青霉素 /Tazo最为敏感。结论 抗生素的选择应有针对性 ,在治疗前需做细菌培养 ,经验性治疗应根据鉴定结果即时调整用药