目的 分析2016年1月-2018年12月北京积水潭医院住院患者中段尿标本病原菌构成及耐药性,为临床合理使用抗菌药物提供依据.方法 采用VITEK 2 compact全自动细菌鉴定药敏仪进行细菌鉴定和药敏分析,应用WHONET 5.6软件进行数据分析.结果 3490株中段尿培养病原菌,其中革兰阴性菌2097株(60.1％),最常见的是大肠埃希菌(32.8％)、肺炎克雷伯菌(5.5％)、铜绿假单胞菌(5.4％)和奇异变形菌(3.4％);革兰阳性菌1323株(37.9％),最常见的是屎肠球菌(12.5％)、粪肠球菌(8.5％)、表皮葡萄球菌株(3.0％)和无乳链球菌(2.0％).女性患者大肠埃希菌检出率明显高于男性(45.8％对19.9％),但铜绿假单胞菌在男性患者中占比高于女性(7.6％对3.3％).大肠埃希菌和肺炎克雷伯菌产ESBLs的检出率为56.3％和58.5％;产ESBLs株对头孢菌素、喹诺酮类、四环素、磺胺类抗菌药物敏感率＜50.0％;肠杆菌科细菌对碳青霉烯类抗菌药物高度敏感,为88.5％～100.0％.非发酵菌群中铜绿假单胞菌对大部分抗菌药物敏感率＞70.0％.革兰阳性菌对万古霉素、替考拉宁和利奈唑胺高度敏感,为89.0％～100.0％.结论 大肠埃希菌和肠球菌是尿路感染主要病原菌,临床可依据病原菌分布特点及药物敏感性进行早期用药.

目的 采用多重PCR技术快速、高效检测耐碳青霉烯类肠杆菌科细菌(CRE)的耐药基因型,为 CRE的预防和控制提供依据.方法 收集北京积水潭医院住院患者分离得到的 58株 CRE 菌株.CRE 菌株表型检测采用改良 Hodge 试验和亚胺培南/亚胺培南联合 EDTA E-test 协同试验进行.CRE 菌株基因型检测采用多重PCR扩增反应体系 (包括 11对碳青霉烯酶基因引物:A组为blaIMP ,blaSPM ,blaVIM ,B组为blaBIC ,blaNDM ,blaKPC , blaOXA ,C组为blaAIM ,blaGIM ,blaSIM ,blaDIM ).对blaKPC阳性的肺炎克雷伯菌行全酶基因编码区PCR扩增及产物测序.结果 58株CRE菌株中52株为肺炎克雷伯菌,占 89.66%;3株为大肠埃希菌,占5.17%;2株为阴沟肠杆菌,占3.45%;1株为弗劳地枸橼酸杆菌,占1.72%.改良Hodge试验阳性52株(89.66%),亚胺培南/亚胺培南联合EDTA E-test协同试验阳性2株(3.45%).CRE中检出blaIMP基因型 1株(1.72%),为肺炎克雷伯菌;blaKPC基因 52株(89.66%),其中肺炎克雷伯菌为50株(86.21%),2株为大肠埃希菌(3.45%);bla NDM基因 1株(1.72%),为阴沟肠杆菌;11种基因检测全阴性为4株(6.90%),分别为肺炎克雷伯菌、阴沟肠杆菌、大肠埃希菌、弗劳地枸橼酸杆菌各 1株,基因检测阳性者均无重叠. blaKPC基因阳性的肺炎克雷伯菌全酶基因编码区测序结果为bla KPC-2亚型.结论 北京积水潭医院患者检出的 CRE中,以肺炎克雷伯菌为主.共检测出 3种基因型,其中bla KPC-2型是医院CRE的主要基因型,提示医院感控部门要加强对肺炎克雷伯菌耐药的监控,避免耐药率进一步上升.

目的 分析骨科患者血流感染的临床特点及病原菌耐药性,为临床诊断和抗感染治疗提供依据.方法 回顾性分析2012年1月-2017年12月北京积水潭医院骨科确诊血流感染患者的临床资料和病原学结果.结果 200例血流感染患者中男132例(66.0％),女68例(34.0％).开放性骨折是引起骨科血流感染常见诱因.本组患者中单发伤62例(31.0％),多发伤89例(44.5％).单一菌感染182例(91.0％),复数菌感染18例(9.0％);有基础疾病史患者55例(27.5％).共计分离出218株病原菌,其中革兰阴性菌108株(49.5％)、革兰阳性菌91株(41.7％)、厌氧菌10株(4.6％)、真菌9株(4.1％).前6位病原菌依次为凝固酶阴性葡萄球菌41株(18.8％)、大肠埃希菌27株(12.4％)、金黄色葡萄球菌23株(10.6％)、肺炎克雷伯菌19株(8.7％)、鲍曼不动杆菌14株(6.4％)及铜绿假单胞菌11株(5.0％).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)检出率分别为39.1％ (9/23)和78.0％ (32/41),未发现对万古霉素和利奈唑胺耐药的葡萄球菌.大肠埃希菌和肺炎克雷伯菌中超广谱β内酰胺酶(ESBL)的检出率分别为63.0％(17/27)和47.4％(9/19).肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感.鲍曼不动杆菌耐药性严重,对大多数抗菌药物耐药率大于80％.铜绿假单胞菌对氨曲南、阿米卡星、庆大霉素、环丙沙星和左氧氟沙星敏感率高,均≥80％.厌氧菌对哌拉西林-他唑巴坦和亚胺培南均敏感.念珠菌对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑和伏立康唑均敏感.结论 葡萄球菌和大肠埃希菌是骨科血流感染患者中最常见病原菌,应加强骨科病房感染防控措施,降低骨科血流感染的发生.

Objective To provide the reference of pathogenic diagnosis and clinical medication for 1 case with chronic osteomyelitis of femur.Methods Anaerobic,aerobic and microaerobic cultures and the identification of bacteria from fester and tissue specimens obtained during operation were performed by smear and microscopy. Thein vitro drug susceptibility test was performed by disk diffusion and E-test methods.Results Facultative anaerobicStreptococcus anginosus,obligate anaerobicVeillonella parvula and microaerophilic bacillusAeromonas foam were isolated from wound tissues. Thein vitro drug susceptibility test showed that they were highly sensitive to piperacillin-tazobactam,meropenem and vancomycin. Clinical medication program was as follows:preoperative and postoperative intravenous drip of piperacillin-tazobactam,medullary cavity with bone cement implantation of imipenem and vancomycin,artificial bone implantation with meropenem and vancomycin, and repair of muscle flap. The patient recovered after the above treatments.Conclusions Special attention should be paid to the patient with chronic osteomyelitis. All pathogens should be isolated,and drug susceptibility test should be performed. Individual medication program should be laid down and performed,which is a prerequisite fora thorough treatment of infection.

Objective To monitor the distribution and drug susceptibility of bacteria in infected wound from patients with hand injuries and provide evidence for selection of antibiotics.Methods Bacteria in the wound were identified by phenotype identification.Micro-dilution or/and Kirby-Bauer methods were adopted to measure the minimum inhibitory concentration of the antibiotics for drug susceptibility test.Results A total of 603 strains of 98 species of bacteria were isolated from wounds of 587 patients.Strains in top 10 species of pathogens accounted for 64.18％.Aerobic/facultative anaerobic gram-positive bacteria accounted for 38.97％.Aerobic/facultative anaerobic gram-negative bacteria accounted for 57,21％.Anaerobic bacteria accounted for 3.48％ There were 19.12％ of Methicillin-resistant strains among S.aureus (MRSA) and 73.77％ of those among S.epidermidis (MRSE).No Vancomycin (VA)-resistant and Linezolid (LZD)-resistant strains were found among MRSA and MRSE.SMZ-co had ＞ 90％ susceptible rates among MRSA.Rifampin had ＞ 90％ susceptible rates among MRSE.No VA-resistant strains were identified among E.faecalis,while there were 11.76％ of VA-resistant strains among E.faecium.E.faecalis had higher sensitivity to all antibiotics than E.faecium.All antibiotics used had ＞ 80％ susceptible rates among P.aeruginosa without Multi-Drug Resistant strains (MDR).Susceptible rates of antibiotics used are between 9.09 ％ and 56.52 ％ and Imipenem (IPM) had the highest susceptible rates among A.baumanii/calcoaceticus complex with 27.27％ of MDR.There were 58.06％ and 36.36％ of ESBLs-producing strains among E.coli and K.pneumoniae,respectively.Amikacin (AK),Cefepime,Levofloxacin and Piperacillin-tazobactam (TZP) were ＞ 80％ in susceptible rates among E.cloacae.No test for IPM-resistant or Meropenem (MEM)-resistant strains among E.coli,K.pneumoniae and E.cloacae and K.oxytoca was positive.Conclusion There are a variety of bacteria in hand injury wounds.They are mainly concentrated in the top 10 species.There were no VA-resistant and LZD-resistant strains among MRSA and MRSE.E.faecalis have higher sensitivity to all antibiotics than E.faecium.P.aeruginosa show high and A.cinetobacter present very low susceptibility to all antibiotics used.There were no IPM-resistant or MEM-resistant strains among E.coli,K.pneumoniae,E.cloacae and K.oxytoca.

多重耐药性细菌在综合性医院流行已引起人们普遍关注,它使抗感染治疗陷入困境.对医院细菌分布状况及其耐药特点进行监测,可为临床合理应用抗菌药物提供参考.

患者,男,25岁,因右手腕机器轧压后离断12 h入住本院. 手外科检查:右前臂自近腕横纹处离断,仅部分肌腱相连.右前臂自肘下肿胀,有压痛.触及皮下有空虚感,断手腕骨及附近组织消失,伤口损伤、污染严重.后行"右手腕清创,断腕再植术",术后抗感染支持治疗.术后24 h内肢体逐渐肿胀、变红,体温升高,换药时见伤口内大量恶臭分泌物及坏死组织.再植手肿胀明显,皮肤红、热、部分变黑,全身生命体征欠稳定,体温40℃.血常规:WBC 16.5×109/L;中性分叶粒细胞0.78;Hb 69.9 g/L.伤口分泌物涂片检查:见2种形态G+杆菌,一种为G+粗大杆菌,有荚膜;另一种为G+短粗杆菌,有芽孢.初步诊断:气性坏疽.