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.

Background The emergence of heteroresistant vancomycin-intermediate Staphylococcus aureus (hVISA) is increasingly challenging the methods for detection in diagnostic microbiology laboratories. However, the report of hVISA is rare in China. This study summarizes the prevalence and clinical features associated with hVISA infections at our institution and the local impact they have on clinical outcome. Methods A total of 122 methicillin-resistant Staphylococcus aureus (MRSA) isolates which were of the causative pathogens were collected. One hundred and two patients for whom we had full information of MRSA pneumonia were included. Isolates of MRSA were collected using PCR to detect the mecA gene. Both Etest and macro Etest were performed to screen for hVISA. The Staphylococcal chromosome cassette mec (SCCmec) types were determined by multiplex PCR strategy. Logistic regression analysis was used to determine the risk factors. Results Among the 122 MRSA isolates collected, 25 (20.5%) strains were identified as hVISA. There were 119 (97.5%) SCCmec III isolates, two (1.6%) SCCmec II isolates, and one (0.8%) SCCmec V isolate. The 30-day mortality of MRSAhospital acquired pneumonia (HAP) was 37.3%, and 62.5% for hVISA-HAP. Vancomycin treatment was the independent risk factor of hVISA. Factors independently associated with 30-day mortality in all patients were acute physiology and Chronic Health Evaluation (APACHE) II score >20, multiple lobe lesions, and creatinine clearance rate (CCR) <15 ml/min. Conclusions The prevalence of hVISA is 20.5% at our institution. hVISA-HAP patients had a poor clinical outcome. Vancomycin treatment was the independent predictors for hVISA infection. Factors independently associated with 30-day mortality in all patients were APACHE II score >20, multiple lobe lesions and CCR <15 ml/min.

Objective To monitor the distribution of pathogenic bacteria causing wound infection in trauma patients and their susceptibility to antibiotics in an effort to offer evidence for the rational clinical use of antibiotics.Methods Pathogens were identified by expressive type,but a very few was determined by the molecular methods.Micro-dilution or Kirby-Bauer method for minimum inhibitory concentration (MIC) was adopted for drug susceptibility test.Results A total of 121 species of pathogens numbering 1,257 bacterial strains were isolated from 1,066 patients.Strain number of the top 10 species accounted for 70.09％.Gram-positive cocci accounted for 48.93％ and Gram-negative bacilli for 49.72％.Among Staphylococcus aureus and epidermidis,methicillin-resistant bacterial strains accounted for 34.76％ and 71.08％ respectively,but none were resistant to vancomycin or linezolid.Enterococcus faecalis contained 6.06％ vancomycin-resistant enterococcal (VRE) and remained ＞ 90％ sensitive to teicoplanin,ampicilin and vancomycin.Enterococcus faecium contained 10.53％ VRE and remained ＞90％ sensitive to teicoplanin and ＞ 80％ sensitive to vancomycin.Baumanii contained 12.77％ multidrug resistant strains and remained ＞ 70％ sensitive to imipenem and meropenem.Baumanii/calcoaceticus complex contained 29.72％ multi-drug resistant strains and remained ＞ 50％ sensitive to imipenem and meropenem.Pseudomonas aeruginosa contained 3.73％ multi-drug resistant strains and remained ＞90％ sensitive to amikacin,meropenem,imipenem and piperacillin/tazobactam.No E.coli,klebsiella pneumoniae and enterobacter cloacae resistant to imipenem or meropenem were found.E.coli contained 69.51％ extended-spectrum β-lactamases (ESBLs)-producing strains and remained ＞ 90％ sensitive to piperacillin/tazobactam and ＞ 80％ sensitive to amikacin.Klebsiella pneumoniae contained 53.13％ ESBLs-producing strains and remained ＞ 80％ sensitive to amikacin.Conclusions Common bacteria are the leading cause of posttraumatic infection.Enterococcus faecalis and enterococcus faecium demonstrate higher susceptibility to teicoplanin; two kinds of acinetobacter demonstrate higher susceptibility to imipenem.

OBJECTIVE:To report a case of infection with methicillin resistant Staphyloccus aureus (MRSA) carrying Staphylococcal chromosome cassette mec (SCCmec) type V, and to identify the origin of the isolates.METHODS:A case of infection with MRSA carrying SCCmec type V was reported. The clinical characteristics of this patient were described. Screening for methicillin and other antibiotic resistant phenotypes by VITEK II compact was carried out. PCR was used to determine the MRSA mecA gene, and multiplex PCR assay was used for characterization of SCCmec.RESULTS:The 73-year old male patient was admitted to our hospital for exfoliative dermatitis, but the condition got worse with sepsis and hospital acquired pneumonia, and finally the patient died of septic shock. The isolated Staphyloccus aureus from peripheral blood and sputum showed resistance to beta-lactams alone, and susceptible to clindamycin, intermediate to moxifloxacin and gentamicin. The isolates were confirmed to be MRSA carrying SCCmec type V.CONCLUSION:A case of healthcare-acquired MRSA infection was identified, but the isolates also showed some characteristics of MRSA of the community origin.