Research progress on the effect of pH-sensitive drug delivery systems on oral microorganisms / 口腔疾病防治

@#Microorganisms are closely related to the occurrence and development of common oral diseases. Due to the unique physiological and anatomical characteristics of the oral cavity, locally introduced antibacterial drugs cannot be maintained in the effective concentration range under the effect of saliva erosion. Therefore, to enhance the retention and bioavailability of antibacterial drugs in biofilms, some scholars designed pH sensitive drug delivery systems with the fact that the pH value of oral biofilm is lower than the physiological pH value. This article reviews the research reports of a pH-sensitive drug delivery system in the oral cavity and elaborates its application in oral diseases such as dental caries, endodontic disease, periapical disease, peri-implant diseases, and oral candidiasis. Literature review Results show that the pH-sensitive drug delivery system loaded with antibacterial drugs could be used for the control of oral microorganisms with excellent pH sensitivity and antibacterial properties, especially in the application of acid-producing bacteria such as Streptococcus mutans for the prevention and treatment of dental caries. However, the research of pH-sensitive drug delivery systems in the oral cavity is still limited to basic research,and in clinical applications, it still faces many challenges, such as a complex design and synthesis, difficulties with lasting effects and eliminating drug-resistance and persistent bacteria. Further optimization of pH sensitive systems, as well as animal experiments and in vivo studies will be the focus of future research.

Design and application of ICU core control measures for multi- drug resistance bacteria / 中国实用护理杂志

Objective@#To design a record sheet of the core control measures for multi-drug resistant bacteria in ICU and apply it to clinical practice.@*Methods@#Through consulting the guidelines and literature, we designed the ICU core control measures to execute the record sheet and applied the record sheet to patients with multiple resistant bacteria infection. The implementation rate of the core control measures of medical personnel before and after the use of the record sheet(the awareness rate of medical personnel, the awareness rate of nursing staff, the compliance rate of hand hygiene, the implementation rate of isolation medical orders, the implementation rate of isolation marks, the implementation rate of single room isolation or bedside isolation, and the exclusive implementation rate of items), qualified rate of surface disinfection of articles, qualified rate of use of antimicrobial agents and incidence of multi-drug resistant bacteria infection were compared.@*Results@#After implementing the record sheet using the ICU multi-drug resistant bacteria core control measures, the implementation rate of medical personnel's core control measures, the conformity rate of surface disinfection of articles and the acceptance rate of antimicrobial drug use were all improved, the difference was statistically significant (χ2=2.85-432.18, P<0.05 or 0.01); incidence of multi-drug resistant bacteria infection from 15.7%(112/713) to 6.8%(51/748), the difference is statistically significant (χ2=28.22, P<0.05) .@*Conclusions@#The implementation of ICU multi-drug resistant core control measures can improve the rate of implementation of multi-drug resistant core control measures, reduce the incidence of multi-drug resistant infections, and standardize the operation of medical personnel against multiple drug resistant bacteria. The application of ICU multi-drug-resistant core control measures to the management of nosocomial infections in patients with multiple drug-resistant bacteria will help improve the quality of care and ensure the safety of patients.

Design and application of ICU core control measures for multi-drug resistance bacteria / 中国实用护理杂志

Objective To design a record sheet of the core control measures for multi-drug resistant bacteria in ICU and apply it to clinical practice. Methods Through consulting the guidelines and literature, we designed the ICU core control measures to execute the record sheet and applied the record sheet to patients with multiple resistant bacteria infection. The implementation rate of the core control measures of medical personnel before and after the use of the record sheet(the awareness rate of medical personnel, the awareness rate of nursing staff, the compliance rate of hand hygiene, the implementation rate of isolation medical orders, the implementation rate of isolation marks, the implementation rate of single room isolation or bedside isolation, and the exclusive implementation rate of items), qualified rate of surface disinfection of articles, qualified rate of use of antimicrobial agents and incidence of multi-drug resistant bacteria infection were compared. Results After implementing the record sheet using the ICU multi-drug resistant bacteria core control measures, the implementation rate of medical personnel's core control measures, the conformity rate of surface disinfection of articles and the acceptance rate of antimicrobial drug use were all improved, the difference was statistically significant (χ2=2.85-432.18, P<0.05 or 0.01); incidence of multi-drug resistant bacteria infection from 15.7%(112/713) to 6.8% (51/748), the difference is statistically significant (χ2=28.22, P<0.05). Conclusions The implementation of ICU multi-drug resistant core control measures can improve the rate of implementation of multi-drug resistant core control measures, reduce the incidence of multi-drug resistant infections, and standardize the operation of medical personnel against multiple drug resistant bacteria. The application of ICU multi-drug-resistant core control measures to the management of nosocomial infections in patients with multiple drug-resistant bacteria will help improve the quality of care and ensure the safety of patients.

The study of clinical distribution characteristics of multi-drug resistance bacteria isolated from thehospitalized patients in a hospital of Shenzhen City / 国际检验医学杂志

Objective To study the clinical characteristics of multi-drug resistance bacterias(MDROs) isolated from hospitalized patients in the Second People′s Hospital of Longgang District,to provide strategies for the prevention of MDROs infection.Methods The MDROs data of hospitalized patients from January 2015 to December 2016 were analyzed retrospectively.The multi-drug resistance incidence of each bacterias,each types of specimens and each clinical departments were analyzed and compared by SPSS16.0.Results A total of 104 strains of MDROs were isolated,and the top five bacteria were E.coli(32 strains,30.77%),coagulase negative staphylococcus(24 strains,23.08%),pseudomonas aeruginosa(16 strains,15.38%),staphylococcus aureus(10 strains,9.62%),kiebsiella pneumonia(10 strains,9.62%) respectively.There was significant difference in the multi-drug resistance incidence of each bacterias(χ2=20.62,P<0.05),the average incidence was 25.12%,and the top three incidence were E.coli(36.78%),pseudomonas aeruginosa(33.33%),coagulase negative staphylococcus(28.24%) respectively.There was significant difference in the multi-drug resistance positive rate of each types of specimens(χ2=43.68,P<0.05),the average positive rate was 5.84%,and the highest positive rate were wound secretion and pus(11.00%),followed by urine(8.25%).There was significant difference in the multi-drug resistance positive rate of each clinical departments(χ2=40.36,P<0.05),and the highest positive rate were in department of urinary surgery(12.63%),followed by department of gynaecology and obstetrics(11.16%).Conclusion E.coli coagulase negative staphylococcus and pseudomonas aeruginosa were mainly epidemic MDROs,and the MDROs are mainly distributed in urological surgery,obstetrics and gynecolog in this hospital.The occurrence of MDROs should be for the prevention and control strongly in the hospitalized patients with all kinds of trauma or diseases of urinary system and in the clinical department of urinary surgery,gynaecology and obstetrics.

Distribution and Drug Susceptibility Analysis of Pathogenic Bacteria in Patients with Cholesteatoma Otitis Media / 医药导报

Objective To explore the distribution and drug resistance of pathogens isolated from patients with cholesteatoma otitis media so as to provide guidance for clinical use of antibiotics.Methods This survey analyzed the spectrum of organisms causing cholesteatoma otitis media and their sensitivities to commonly antimicrobial agents from Hebei province eye hospital in 2014.Results There was 86 positive speciments were cultured from 89 samples,the positive rate was 96.6％.A total of 90 strains of pathogens have been isolated,including 52 strains of gram-positive coccus (57.8％),35 strains of gram-negative bacilli (38.9％),3 strains of gram-positive bacilli (3.3 ％),and 0 strain of fungi.Staphylococcus epidermidis,Staphylococcus aureus and Staphylococcus chromogenes ranked the top three species of pathogens,accounting for 20.0％,16.7％,and 12.2％,respectively.The gram-positive cocci were susceptible to vancomycin,rifampicin and amikacin,and showed higher drug-resistancerate to penicillin,amoxicillin and azithromycin.When applied to gram-negative bacilli,the drugs with best resistance were penicillin and cefazolin,and the drugs with the highest sensitivity were levofloxacin and pipercillin/ sulbactam.Conclusion Staphylococcus is the predominant pathogens of cholesteatoma otitis media in hospital,and the bacteria have a high antibiotic resistance.Enhanced monitoring on pathogenic bacteria distribution and drug resistance analysis of cholesteatoma otitis media could benefitthe guide of clinical rational use of antimicrobial agents.

Species and drug resistance of pathogens causing bloodstream infections in hospitalized patients / 中国基层医药

Objective To investigate the distribution and resistance of positive pathogens isolated from blood culture and guide the use of antibiotics for clinical treatment and prevention treatment of bacteremia.Methods Collected the blood samples from 201 4 to 201 5 and cultivate by Bact ALERT 3D,pathogenic bacteria identification and antimicrobial susceptibility testing was carried out by VITEK 2 compact.The bacterial data were analyzed by WHONET 5.6 software,according to the breakpoints of CLSI 2014.Results Among the 16 751 blood culture samples, 893 cases showed positive and the positive rate was 5.3%.Among the strains,the percentage of the gram -positive bacteria was 423,including coagulase -negative Staphylococcus (62.9%),S.aureus (8.6%),Enterococcus (1 3.8%);the percentage of the gram -negative bacteria was 41 9,including Escherichia coli(47.0%),Klebsiella pneumonia(1 6.5%),Pseudomonas aeruginosa(4.9%),Stenotrophomonas maltophilia(4.5%)and Brukhoderial. cepacia(3.8%);the percentage of fungi was 5.7%,including Candida albicans(76.5%)and candida parapsilosis (23.5%).The prevalence of ESBLs producing strains was 56.0% in E.coli and K.pneumoniae.The average prevalence of methicillin -resistant strains in S.aureus(MRSA)and coagulase -negative Staphylococcus(MRCNS) was 25.0% and 67.8% respectively.Enterobacteriaceae strains were still highly susceptible to the carbapenem drug. The rate of CRE was zero.The resistance to vancomycin,linezolid and quinupristin/Dafoe leptin was not found in Staphylococcus.VRE was not found.Conclusion There was a variety of pathogens leading to bloodstream infection which show a relative sensitive resistance to many antimicrobial agents.Meanwhile,the multi -drug resistant strains may have serious consequences,and the monitoring and rational use of antibiotics should be strengthened.

Infecção de corrente sanguínea em um hospital terciário / Bloodstream infection in a tertiary hospital

OBJETIVO: Determinar os microrganismos mais frequentes, o significado clínico e o perfil de sensibilidade aos antimicrobianos dos agentes isolados nas hemoculturas de um hospital escola. MÉTODOS: Trata-se de um estudo retrospectivo realizado por meio de levantamento das hemoculturas positivas de um hospital universitário no período de 2012 a 2014. RESULTADOS: Das 111 hemoculturas obtidas, os microrganismos mais isolados foram Staphylococcus epidermidis (27,4%), outros Staphylococcus coagulase-negativos (32,7%) e Staphylococcus aureus (13,3%). Aproximadamente metade das hemoculturas representou pseudobacteriemia, e Staphylococcus coagulase-negativo foi o contaminante em 89,1% dos casos. A maioria das cepas de S. aureus apresentou suscetibilidade para oxacilina (66,7%), enquanto as de Staphylococcus coagulase-negativo exibiram resistência. Nenhum Gram-positivo apresentou resistência à vancomicina. Escherichia coli, demais enterobactérias (exceto Klebsiella pneumoniae) e bacilos Gram-negativos não fermentadores apresentaram resistência para ampicilina + sulbactam, gentamicina e cefepime, respectivamente. CONCLUSÃO: Gram-positivos representaram a maior parte das bactérias isoladas, e todos foram sensíveis à vancomicina. O elevado número de contaminantes pôde ser atribuído à antissepsia inadequada na coleta, pois Staphylococcus coagulase-negativo, o contaminante mais frequente, está presente na microbiota da pele.

OBJECTIVE: To determine the most frequent microorganisms, the clinical significance and the susceptibility profile to antimicrobial agents obtained in blood cultures at a teaching hospital. METHODS: This was a retrospective study through the analysis of positive blood cultures at an university hospital in the period 2012 to 2014. RESULTS: Of the 111 blood cultures obtained, the most isolated microorganisms were Staphylococcus epidermidis (27.4%), other coagulase-negative Staphylococcus (32.7%) and Staphylococcus aureus (13.3%). Approximately half of blood cultures represented pseudobacteremia, and coagulasenegative Staphylococcus was the contaminant in 89.1% of cases. Most S. aureus strains showed susceptibility to oxacillin (66.7%), while coagulase-negative Staphylococcus showed resistance. No Gram-positive was resistant to vancomycin. Escherichia coli, other members of the Enterobacteriaceae (except Klebsiella pneumoniae) and Gram-negative bacilli non-fermenters were resistant to ampicillin + sulbactam, gentamicin and cefepime, respectively. CONCLUSION: Gram-positive bacteria accounted for most of the bacteria isolated and all were susceptible to vancomycin. The high number of contaminants can be attributed to inadequate antisepsis in the collection, as coagulase-negative Staphylococcus, the most frequent contaminant, is present in the skin microbiota.

The evaluation of Xpert MTB/RIF for the diagnosis of tuberculous meningitis / 中华检验医学杂志

Objective To evaluate the diagnostic performance of Xpert MTB/RIF for the diagnosis of tuberculous meningitis (TBM).Methods This was a prospective, single center clinical trial.A total of 116 consecutive patients with suspected meningitis who were admitted to Xijing Hospital from October 2013 to June 2015 were recruited.Mycobacterium tuberculosis ( MTB) and rifampicin ( RIF) resistance mutations in 1 ml cerebrospinal fluid ( CSF) were detected with Xpert MTB/RIF and the remaining sample was tested by Ziehl-Neelsen staining , MGIT960 liquid culture and other laboratory tests .And the enrolled patients were grouped according to the 2010 South African expert consensus .The diagnostic performance of Xpert MTB/RIF was evaluated by comparing against clinical score >5 points and MGIT960 liquid culture as reference standards respectively .The comparison was performed using a χ2 test or Fisher′s exact test for categorical variables and a nonparametric rank sum test for continuous variables .Results Among the enrolled 116 subjects, 23 subjects were diagnosed as definite-TBM by MGIT960 liquid culture, 16 subjects were classified as probable TBM , 27 subjects were classified as possible TBM , and 50 subjects were classified as non-TBM.When clinical score >5 points was used as a reference standard , the sensitivity of Xpert MTB/RIF (39.4%) was comparable with that of MGIT960 liquid culture (34.8%) (χ2 =0.292, P=0.589), and significantly better than that of Ziehl-Neelsen staining (9.9%) (χ2 =16.500, 12.771, P<0.001). No significant differences were found among the specificities of Xpert MTB /RIF, MGIT960 liquid culture and Ziehl-Neelsen staining ( 98.0%, 100.0% vs 98.0%, χ2 =1.014, P=0.602 ) .When tested against MGIT960 liquid culture as a reference standard , the sensitivity of Xpert MTB/RIF was 91.3%. Conclusions Xpert MTB/RIF is a rapid and specific method to detect MTB and RIF resistance in CSF .It exhibits a good rule in value for the diagnosis of TBM and a comparable sensitivity with MGIT 960 liquid culture, thus it can be used as the initial method for the diagnosis of tuberculous meningitis .

Analysis of the changes of bacterial infection and the correspondent measure in the department of neurology / 重庆医学

Objective To analyze the situation of infections of bacteria and multi-drug resistant bacteria in Department of Neurology of First Affiliated Hospital of Chongqing Medical University from January 2010 to December 2012.Methods Clinical data from 2010-2012 were obtained via Doctor Workstation system and Excel software was applied to analyze the bacteria subto-tals sites,classifications and drug resistance rates.Results The rate of hospital bacterial infection decreased from 4.99% in 2010 to 3.41% 2013,while the composition of the bacterial infection sites exhibits no significant change.Staphylococcus aureus accounts for the major gram-positive bacterial infections,while E.coli contribute to gram-negative bacteria infections.Moreover,the ranking in the three years did not change significantly.In addition,the rate of Acinetobacter baumannii and Pseudomonas aeruginosa increased. Conclusion Our department has achieved some success in the control of bacterial infection in the past three years,however the situ-ation remains to be difficult.

The distribution and drug resistance of respiratory tract infection pathogens isolated from patients of pediatric CICU / 国际检验医学杂志

Objective To analyze the common respiratory tract infection pathogens distribution and their drug resistance in pedi-atric cardiac intensive care unit(CICU),so as to provide reference for clinical rational use of antibiotics.Methods 1 350 cases of sputum specimens from lower respiratory tract infection patients of pediatric CICU in the medical center between January 2011 and December 2012 were cultivated and drug susceptibilities were tested.The results were retrospectively analyzed.Results 490 patho-genic strains were isolated from 1 350 cases of sputum specimens and identified,including Gram negative bacilli 288 strains (58.78%),Gram positive coccus 140 strains(28.57%),fungi 62 strains(12.65%,mainly Candida albicans ).Gram negative bacilli was given priority to with Klebsiella pneumoniae (62 strains,12.65%),followed by Branhamella catarhalis ,Pseudomonas aerugi-nosa and Escherichia coli .The rates of extended-spectrum beta-lactamases(ESBLs)-producing strains among Escherichia coli and Klebsiella pneumoniae were 73.33% and 66.13%,respectively.Gram positive coccus was given priority to with Staphylococcus aureus (65 strains,13.27%),followed by Streptococcus pneumoniae .Methicillin-resistant Staphylococcus aureus (MRSA)accounted for 24.62%.Conclusion Staphylococcus aureus ,Streptococcus pneumoniae and Klebsiella pneumoniae are main pathogens of re-spiratory tract infection in pediatric CICU.And there is multiple drug-resistant bacteria infection.Rational applicattion of antibiot-ics according to the test results of isolation and drug susceptibility is an effective way to control the infection of critical children and reduce the emergence of resistant strains.

Surveillance of bacterial antibiotic resistance in traumatic wound infection: a report of 1006 cases / 中华创伤杂志

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.

Changing pattern of microorganisms and antibiotic resistance rate of spontaneous bacterial peritonitis: A 12-year experience / 대한내과학회지

BACKGROUND/AIMS: Recently, the prognosis for spontaneous bacterial peritonitis (SBP) has improved; however, the causative microorganisms and antibiotic resistance rates are changing. We evaluated the changing pattern of causative agents and antibiotic resistance rates of SBP over a 12-year period. METHODS: We retrospectively analyzed 113 patients who were diagnosed with SBP and in whom ascites cultures were positive between 1996 and 2007. The 12-year period was subdivided into 6-year terms (period A, 1996~2001; and period B, 2002~2007). RESULTS: One hundred thirteen of 410 cases of SPB had positive ascites cultures. Thirty-seven cases were from period A and 76 cases were from period B. Hospital-acquired SBP was more common during period B. Gram negative microorganisms were isolated from 78% of SBP cases, and the most common microorganism was E.coli (60%). The resistance rates for ampicillin and ciprofloxacin were similar between the two periods, but resistance to cefotaxime was more frequent in period B (3% vs. 26%, p=0.002), and ESBL-producing E.coli was only cultured in period B (0% vs. 32%, p=0.002). Most of the initial antibiotics used were cefotaxime; carbapenem was used as a secondary antibiotic only in period B (0% vs. 55%, p=0.007). ESBL-producing microorganisms were the only predictor of in-hospital mortality based multivariate analysis (OR: 4.14, 95% CI: 1.09-15.07, p=0.037). CONCLUSIONS: No change in pattern of microorganisms in the ascites of patients with SBP was noted during the 12-year period under study, but there was a significant increase in the incidence of hospital-acquired SBP, resistance to cefotaxime, and ESBL-producing E.coli when comparing the outcomes of periods A and B. ESBL-producing microorganisms were the only predictor of in-hospital mortality.

Abdominal Infection of Rabbit due to Drug-resistant Bacteria:Establishment of Animal Model / 中华医院感染学杂志

OBJECTIVE To establish a simple and stable animal model with abdominal infection due to drug-resistant bacteria.METHODS Forty healthy rabbit were infected by Klebsiella pneumoniae ATCC700603,and divided into three test groups:A1(bacterial dose 8?109CFU/kg),A2(bacterial dose 16?109 CFU/kg) and A3(bacterial dose 24?109 CFU/kg).Normal control group B was established at the same time.Vital signs,white blood cell count(WBC),blood and abdominal irrigating solution cultures and strain identification were observed at 12,24,48,72 and 96h after infection.Patho-samples were obtained after being executed.RESULTS The body temperature,WBC,heart rate(HR) and respiratory rate(R) in group A3 were significantly higher than groups A1 and B,after rabbits having being infected 12-24 hours.And it continued for 96 hours(P