目的 分析细菌感染住院患者后,在治疗过程中如再次分离细菌耐药性变化情况,为临床治疗和感控提供理论参考.方法 回顾性分析2014年至2020年我院大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌耐药性,并分析某菌首次感染及一周后的一个月内相同部位再次分离相同菌时耐药性变化情况.结果 细菌感染患者后,如在一周后再次分离时,对几乎所有监测抗生素耐药性均有所增高,但无明显统计学意义.再次分离时部分敏感株会转变为耐药株,转化率与本院细菌总耐药率呈正线性相关,最高为鲍曼不动杆菌对头孢他啶,一周后再次分离时37.04％敏感株转变为耐药株.结论 细菌感染患者后,在治疗过程中其耐药性可能会发生变化,所以即使首次分离为敏感株,也应做好临床感控管理预防其向耐药株转变,并同时做好耐药监测.

新型冠状病毒肺炎(COVID-19)疫情的防控工作目前进入常态化阶段,当前境外疫情持续蔓延和病毒变异影响,生物安全意识不容有丝毫松懈.该文从实习生实验室生物安全教育现状、实验室生物安全现状、生物安全培训和微生物检测和心理健康等方面思考临床微生物室实习带教生物安全的情况,不断提高CO-VID-19疫情下临床微生物室实习生的生物安全意识,使学生在毕业走向工作岗位时具备随时应对新一波疫情暴发、流行的防控能力.

患者,男,69岁,因反复咳嗽、咳痰8个月,加重伴咯血4d就诊.患者7年前曾患肺结核,抗痨治疗1年后治愈.就诊后第1次纤支镜灌洗液标本宏基因组二代测序检出结核分枝杆菌,血清和纤支镜灌洗液曲霉抗原半乳甘露聚糖试验阳性,第2次纤支镜灌洗液真菌培养出两种形态的烟曲霉(白色株和蓝绿色典型株),两株烟曲霉药敏试验结果相同且具有高度同源性.临床诊断继发肺结核合并侵袭性烟曲霉感染,予抗痨、伏立康唑抗真菌治疗,出院后继续抗痨,抗真菌治疗,定期随访复查胸部CT及痰涂片查抗酸杆菌.

目的 分析重庆市2011-2020年临床微生物项目室间质量评价运行情况,为提高该市临床微生物鉴定和药物灵敏度检测能力提供依据.方法 收集2011-2020年参加该市临床检验中心临床微生物项目室间质量评价实验室结果,对结果进行统计分析.结果 2011-2020年参加的实验室从93家发展至138家,合格率从61.3％ 到94.2％.10年共发放100株细菌,涉及35个菌属,55个菌种.细菌鉴定和药物灵敏度正确率逐年增高,少见菌鉴定和一些药物灵敏度检测仍存在一些问题.结论 通过临床微生物室间质量评价,发现实验室检测的不足,持续改进,提高实验室的检测能力,为临床诊疗提供可靠的依据.

目的 分析重庆市2019-2021年开展的真菌形态学室间质量评价结果,了解目前重庆市实验室微生物人员的真菌形态学读片水平,提高重庆市实验室真菌鉴定能力.方法 重庆市临床检验中心制备发放真菌形态学图片标本,收集参加实验室上报的数据,对结果进行统计分析.结果 重庆市参加真菌形态学室间质量评价的实验室主要是三级和二级医疗机构实验室.2019-2021年,参加的实验室由28家增加到53家,实验室合格率由53.6％上升到94.3％.实验室对常见真菌读片完全符合率高于少见真菌.结论 经过3年时间运行,重庆市实验室真菌形态学读片水平提高,推动了实验室微生物人员对真菌形态学的重视和学习,能为临床提供准确的检查结果.

目的 分析食酸代夫特菌(D.a)感染患者的临床特点和药敏结果.方法 回顾性分析D.a分离患者的临床资料,并对临床分离株进行体外药敏分析.结果 18例D.a分离患者,男性14例(77.8％).60岁以上14例(77.8％);患者合并高血压13例(72.2％)％,低蛋白血症12例(66.7％),器官功能衰竭11例(61.1％),慢性阻塞性肺疾病8例(44.4％),脑梗死8例(44.4％),冠心病7例(38.9％),肿瘤5例(27.8％),糖尿病5例(27.8％).17株细菌(94.4％)来自下呼吸道标本,1株来自血液标本.11例(61.1％)患者气管切开插管和呼吸机辅助通气,3例(16.7％)进行了中心静脉置管;9例(50.0％)患者肺部影像学检查提示肺部感染;9例(50.0％)患者分离该菌前使用了特殊使用级抗菌药物;7例(38.9％)患者死亡.D.a药敏结果:氨基糖苷类药物阿米卡星、庆大霉素和妥布霉素存在高达77.8％耐药率;喹诺酮类环丙沙星和左氧氟沙星的耐药率分别为55.6％和27.8％;碳青霉烯类亚胺培南和美罗培南敏感率分别为88.9％和100.0％;头孢曲松、头孢他啶和头孢吡肟的敏感率均为83.3％;甲氧苄啶-磺胺甲恶唑敏感率88.9％;哌拉西林/他唑巴坦敏感率为100.0％.结论 D.a分离多见于老年合并多种基础疾病进行侵袭性操作和使用特殊使用级抗菌药物患者,碳青霉烯类、第3,4代头孢和甲氧苄啶-磺胺甲恶唑敏感率较高.

目的 分析重庆市2017-2019年自制抗酸染色标本室间质量评价(EQA)结果 ,了解目前实验室人员的染色能力和读片能力,为提高该市抗酸染色显微镜检查质量寻找依据.方法 重庆市临床检验中心发放自制的抗酸染色标本,收集参加抗酸染色显微镜检查EQA的各实验室结果 ,对结果 进行统计分析.结果 2017-2019年参加重庆市抗酸染色显微镜检查EQA的实验室数从2017年的58家增加至2019年的88家,合格率从2017年的96.6％增加至2019年的97.7％.5次抗酸染色显微镜检查EQA,阴性标本符合率97.8％,阳性标本符合率98.1％,总体符合率97.9％.结论 通过自制标本开展抗酸染色显微镜检查EQA工作,实验室对抗酸染色显微镜检查质量控制越来越重视,抗酸染色显微镜检查质量有明显改进,推动了抗酸染色显微镜检查结果 的准确性、可比性,为临床诊疗提供快速可靠的依据.

目的 探讨下呼吸道嗜麦芽窄食假单胞菌感染对老年肺炎患者预后的影响.方法 对1837例老年肺炎患者进行分析.通过电子病历收集患者基础疾病、实验室检查、30 d预后等临床信息.分析影响老年肺炎患者30 d病死率的独立危险因素.结果 下呼吸道标本分离出嗜麦芽窄食假单胞菌患者30 d病死率明显高于未分离出嗜麦芽窄食假单胞菌患者(23.84％vs.11.51％,P<0.05).年龄≥85岁、合并肿瘤、清蛋白<30 mg/L、尿素氮≥7.14 mmol/L及嗜麦芽窄食假单胞菌感染是影响肺炎患者30 d病死率的独立危险因素(P<0.05).结论 嗜麦芽窄食假单胞菌感染与老年肺炎患者30 d病死率明显相关,可作为其短期预后的独立预测因子.

目的 分析2016-2019年重庆市细菌学涂片革兰染色项目室间质评结果,为提高重庆市微生物形态学显微镜检查质量提供依据.方法 收集2016-2019年参加重庆市临床检验中心细菌学涂片革兰染色项目实验室结果,对结果进行分析.结果 2016-2019年重庆市细菌学涂片革兰染色项目室间质评的医院数从2016年的52家增加至2019年的105家,合格率从2016年的84.6％增加到2019年的93.3％,参加细菌学涂片的实验室主要是综合性二、三级医院和中医院实验室.涂片革兰染色显微镜检查总体结果:革兰阳性球菌合格率为98.9％,革兰阴性杆菌合格率为95.0％,未发现细菌、真菌的革兰阴性球菌合格率为94.7％,革兰阳性杆菌合格率为94.8％,真菌合格率为95.0％,未发现细菌、真菌的阴性标本合格率稍低,为87.8％.结论 通过开展革兰染色室间质评工作,重庆市革兰染色显微镜检查质量有明显改进,保证了细菌学涂片显微镜检查结果的准确性、可比性.

Background The information on mortality after an acute stroke patient is still limited. Objectives The aim of this study was to investigate the prognostic potential of procalcitonin (PCT) serum levels in acute ischemic stroke. Methods A total of 748 patients were enrolled in this study. Prognostic potential of PCT was evaluated by Kaplan-Meier analysis and multivariable Cox hazard regression analyses. Results Procalcitonin levels were found to be significantly higher in acute ischemic stroke patients who died in 30 days than those who survived. Univariate logistic regression analysis showed that PCT was significantly associated with 30-day mortality, and Cox regression analysis revealed that PCT was a strong predictor of 30-day overall mortality. Kaplan-Meier analysis revealed that overall cumulative 30-day mortality was significantly higher in those with PCT levels >1.5 ng/mL when compared to those with PCT levels Procalcitonin is a significant independent prognostic marker of 30-day mortality after the one set of acute ischemic stroke.

目的 基于重庆市临床检验中心的平台,尝试利用脓肿分枝杆菌标准菌株A T CC 19977作为实验菌株,以期标准化制备稳定、均一的抗酸染色室间质量评价质控片.方法 通过比较不同的培养基、不同的消化液及其消化浓度,以及消化时间确保脓肿分枝杆菌在普通光学显微镜下获得最佳的菌体形态和抗酸染色背景,同时获得不同等级(+～++++)均一、稳定的抗酸染色室间质量评价质控片.结果 相较于改良罗氏培养基,血平板是脓肿分枝杆菌生长良好的培养基;浓痰理想的消化液是胰蛋白酶;最佳消化浓度是2％;最佳消化条件是37℃消化20 min.结论 在血平板上生长3 d的脓肿分枝杆菌,调菌悬液到0.50麦氏浓度,分别用消化后的痰液稀释200、100、50、10倍,取10μL制备成2 cm2菌膜可分别制备稳定、均一、不同等级的抗酸染色室间质量评价质控片.

目的 了解胆道产超广谱β内酰胺酶(ESBLs)细菌感染的现状及有关危险因素,便于指导临床治疗.方法 回顾性收集肝胆外科胆汁细菌培养所得101株大肠埃希菌、肺炎克雷伯菌和产酸克雷伯菌的药敏试验资料及相应患者的有关临床资料,进行单因素分析和多因数分析.结果 101株胆道细菌产ESBLs发生率为34.7％(35/101),其中大肠埃希菌产ESBLs发生率为54.2％(32/59).产ESBLs胆道细菌在总体上较敏感的抗生素包括氨基糖苷类(阿米卡星敏感率100.0％、妥布霉素敏感率82.9％、庆大霉素敏感率80.0％)和碳青霉烯类(厄他培南敏感率94.3％、亚胺培南敏感率88.6％),另外头孢替坦和哌拉西林/他唑巴坦敏感性也较高(88.6％、77.1％).单因素分析发现年龄(≥60岁)、高脂血症、入院前100 d内曾经使用抗生素、本次感染发作后使用抗生素≥7 d和胆道感染细菌种类与胆道细菌产ESBLs有关(P＜0.05).多因数分析发现年龄(≥60岁)、入院前100 d内曾经使用抗生素、本次感染发作后使用抗生素≥7 d和胆道感染细菌种类与胆道细菌ESBLs有关(P＜0.05).结论 胆道细菌产ESBLs发生率较高,对胆道产ESBLs细菌较敏感的抗生素包括阿米卡星、厄他培南、亚胺培南、头孢替坦和哌拉西林/他唑巴坦.胆道产ESBLs细菌感染的危险因素包括年龄(≥60岁)、入院前100 d内曾经使用抗生素、本次发作后使用抗生素≥7d、胆道感染细菌种类.

Objective To understand clinical distribution and antimicrobial resistance characteristics of Pseudomonas aeruginosa(P.aeruginosa)isolated from hospitalized patients, so as to provide reference for the empiric use of antimicrobial agents and control of healthcare-associated infection(HAI).Methods Clinical distribution and antimicrobial susceptibility testing results of P.aeruginosaisolated from patients in a hospital between 2012 and 2016 were analyzed retrospectively, statistical analysis were conducted based on different wards, specimen types and age groups.Results A total of 2 432 strains of P.aeruginosa were isolated from2012 to 2016, most of which were isolated from intensive care unit(ICU)(n=727, 29.89％), the main specimen was sputum(n=2 064, 84.87％). Resistance rates of P.aeruginosa to other antimicrobial agents except piperacillin/tazobactam in each year from 2012 to 2016 were significantly different(all P＜0.05).Resistance to piperacillin, ceftazidime, cefepime, imipenem, meropenem, levofloxacin, and ciprofloxacin decreased after peaked in2014;resistance rates to amikacin, gentamicin, and tobramycin were all low, showing decreased trend year by year(all P＜0.05).Except resistance rates to cefepime and tobramycin, resistance rates of P.aeruginosafrom sputum specimen were all higher than other specimens(all P＜0.05).Resistance rates of P.aeruginosaisolated from patients aged≥65 years to most antimicrobial agents were significantly higher than those isolated from patients aged＜65 years(all P＜0.05).Except resistance rates to gentamicin and tobramycin, resistance rates of P.aeruginosaisolated from ICU were higher than those isolated from other departments, which were 7.71％-66.02％.Resistance rate of P.aeruginosaisolated from department of surgery were relatively low, which were 1.69％-11.86％.Conclusion Clinical distribution of antimicrobial resistance of P.aeruginosais obviously heterogeneity, empiric antimicrobial use and formulation of HAI monitoring measures should be based on the data of antimicrobial resistance in different wards, different infection sites, and different age.

Objective To understand whether it had differences in bile culture and drug susceptibility test between patients with community-acquired acute cholecystitis and patients with community-acquired acute cholangitis at present.Methods 169 patients with community-acquired acute cholecystitis and the 97 patients with community-acquired acute cholangitis in our department were selected prospectively,in which 16 patients suffered from both community-acquired acute cholecystitis and community-acquired acute cholangitis.Bile sample was extracted in operations and delivered to perform aerobic culture and drug sensitivity test.The bile samples coming from cholecyst were divided into group A,while the bile samples coming from bile duct were divided into group B.Results The positive rates of bile culture in group A and group B were separately 24.9% and 64.9%(P<0.05).The result of the sample coming from cholecyst and the result of the sample coming from bile duct were not the same in 4 patients of the 16 patients who suffered from both community-acquired acute cholecystitis and community-acquired acute cholangitis simultaneously.The main bacteria of acute cholecystitis included Escherichia coli(28.0%),Klebsiella pneumonia(24.0%)and Enterococcus faecium(16.0%).The main bacteria of acute cholangitis included Escherichia coli(39.7%),Klebsiella pneumonia(19.2%)and Enterobacter cloacae(12.3%).The antibiotics which were lowly resistant to gram negative bacteria in the two groups(A and B) included amikacin(0%/0%),ertapenem(0%/0%),imipenem(0%/7.0%)and piperacillin/tazobactam(0%/7.0%).The antibiotics which had lower resistant rates to gram positive bacteria in the two groups included tigecycline(0%/0%)and linezolid(0%/0%).The proportions of the multidrug-resistant strains in the two groups were separately 24.0% and 35.6%(P>0.05).Conclusion Some difference exist in the results of bile culture between patients with community-acquired acutecholecystitis and patients with community-acquired acute cholangitis,but the main bacteria of the both two types of biliary tract infection are Escherichia coli and Klebsiella pneumonia.The drug resistance is serious in the both infections,and the most sensitive antibiotics to gram negative bacteria include amikacin,ertapenem,imipenem,piperacillin/tazobactam,and the most sensitive antibiotics to gram positive bacteria include tigecycline,linezolid in the both infections.

Cupriavidus gilardii was first identified as an aerobic, gram-negative, glucose-nonfermenting rod. C. gilardii has been characterized as an organism with low pathogenicity that causes opportunistic infections and few case reports of infection caused by this organism previously. We encountered the first case of bloodstream infection caused in China by C. gilardii in a 87-year old man without obvious immunodeficiency. The isolate were identified as C. gilardii by 16S rRNA sequencing. The infected patient was treated according to the laboratory's antibiogram of this strain. Similar to the case report in Japan, this is the second report of an infection caused by this organism without obvious immunodeficiency, suggesting that C. gilardii exerts its pathogenicity both in immunodeficient and immunocompetent hosts.

Objective To evaluate the anaerobic culture of bile specimens in 151 cases.Methods From September 2014 to January 2016,89 patients(group A)suffering from community-acquired acute biliary infection and 62 patients(group B) suffering from biliary tract disease without biliary infection were selected prospectively in our hospital.All bile samples were colleted for anaerobic culture.Results In group A,anaerobic bacteria were found only in 2 samples of the 54 samples collected from acute cholecystitis(the positive rate 3.7%),while anaerobic bacterium was found only in 1 sample of the 35 samples collected from acute cholangtitis.In group B,anaerobic bacterium was found only in 1 sample of the 54 samples collected from chronic cholecystitis(the positive rate 1.9%),while anaerobic bacterium was not found in the 8 samples collected from bile duct without acute bilary infection.The positive rate of bile anaerobic culture in group A and group B were separately 3.4% and 1.6%(P>0.05).Conclusion The positive rate of biliary anaerobes are lower in biliary tract infection,the technology and equipment need improvement.

Objective To analyze the current status of bacterial spectrum and drug resistance in community-acquired biliary tract infection to provide a basis for clinical medication .Methods The patients with community-acquired biliary tract infection (ex-periment group) and the patients with biliary tract diseases without biliary tract infection (control group) derived from the native ar-ea treated in this hospital from September 2014 to January 2016 were selected .The bile juice was intraoperatively extracted for con-ducting the bacterial culture and drug susceptibility test .Results Thirteen specieses (60 strains) of bacteria were isolated in the ex-periment group .The top 3 specieses were Escherichia coli (35 .0% ) ,Klebsiella pneumonia (21 .7% ) and Enterobacter cloacae (10 .0% ) .Eight specieses (13 strains) of bacteria were isolated in the control group .The top 3 specieses were Escherichia coli (30 .8% ) ,Klebsiella pneumonia(15 .4% ) and Lactococcus garvieae (15 .4% ) .The proportions of drug resistant strains in the two groups were 95 .0% and 84 .6% respectively (P>0 .05) .The proportions of multiple drug resistant strains in the two groups were 30 .0% and 7 .7% respectively(P>0 .05) .The occurrence rates of multiple drug resistance in the top 3 specieses of bacteria in the experiment group were 61 .9% ,7 .7% and 16 .7% respectively .Conclusion The bacterial spectra of community-acquired acute bili-ary tract infection in the native area are dominated by Gram negative bacteria .The total bacterial drug resistance is serious ,but the drug resistance situation in different bacteria pathogens is different .

Objective Biosafety means the comprehensive measures of avoiding risk factors from laboratory personnel exposuring and spreading outside.Methods In recent years,biosafety was lifted internationally to biosecurity protection,that is the security measures taken by some units and individuals in preventing the pathogen or toxin from losing,being stolen,abused,and transfered.Results After the the incident of SARS-CoV laboratory infection occurred in Taiwan and Beijing China,the laboratory biosafety had been put on the agenda.Conclusion In order to strengthen the management of laboratory biosafety,ensure the safe operation of laboratory,and protect the laboratory workers and public health,we constructed the biosafety management system that fit for our city.It would also provide some reference for the laboratory biosafety of our city.