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Objective To investigate the epidemiological and etiological characteristics of gram-negative bacilli (GNB) isolated from patients with intra-abdominal infection (IAI). Methods The patients with abdominal infection were identified retrospectively during the period from 2011 to 2015. The clinical and microbiological data were analyzed by WHONET 5.6 and SPSS 20.0. Results A total of 478 cases of IAI [hospital-acquired (HA) 290 cases, community-acquired (CA) 188 cases] were included in this analysis. CA-IAI patients at low risk were associated with significantly better outcome, and lower acute physiology and chronic health evaluation (APACHE) Ⅱ score and sequential organ failure assessment (SOFA) score than the CA-IAI and HA-IAI patients at high risk. The most common gram-negative bacillus isolated from intra-abdominal infections was E. coli and K. pneumoniae. The prevalence of ESBLs-producing E. coli and K. pneumoniae isolates was 75.8％ and 35.8％, respectively. The E. coli isolates remained highly susceptible to amikacin, piperacillin-tazobactam, and carbapenems during the 5-year period, while the K. pneumoniae isolates showed poorer susceptibility to ampicillin-sulbactam. Conclusions The prevalence of ESBLs-producing GNB is increasing in the patients with IAI. Such isolates were resistant to commonly used antimicrobial agents, but generally susceptible to carbapenems. It is important to strengthen the monitoring of antimicrobial resistance in IAIs, and choose antimicrobial therapy rationally based on the results of antimicrobial susceptibility test.
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OBJECTIVE:To provide reference for rational use of antibiotics in the clinic of our hospital. METHODS:Drug re-sistance of Gram-negative bacillus in the inpatients of our hospital were analyzed retrospectively during May 2013-Dec. 2015 as well as the situation of producing metallo-β-lactamase(MBLs). RESTUTS:A total of 2089 strains of Gram-negative bacillus were detected in our hospital during 2013-2015,among which there were 1456 strains of enterobacteria (69.70%) and 633 strains of non-fermentative bacteria,mainly involving Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter bau-mannii and Enterobacter cloacae. A total of 406 strains of carbapenems-resistant bacteria were detected (19.44%),including 367 strains of non-fermentative bacteria and 39 strains of enterobacteria. The resistant rates of carbapenems-resistant strains to 16 antibi-otics were all higher than 50%,but those of non-carbapenems-resistant strains were in relative low level. Except for aztreonam,re-sistant rates of carbapenems-resistant strains to other 15 antbiotics were all higher than those of non-carbapenems-resistant strains, with statistical significance(P<0.05). A total of 36 strains of producing MBLs were detected(8.87%),including 13 strains of pro-ducing MBLs drug-resistant P. aeruginosa and 23 strains of producing MBLs drug-resistant A. baumannii;producing MBLs drug re-sistant enterobacteria had not been found. CONCLUSIONS:Gram-negative bacillus are mainly enterobacteria in our hospital;car-bapenems-resistant strains are mainly non-fermentative bacteria,resistant rate of them are commonly higher than that of non-drug-re-sistant strain. The situation of producing MBLs is serious,and enzyme producing strains are mainly non-fermentative bacteria. It is necessary to strengthen drug resistance of pathogen and enzyme producing strain monitoring,avoid the generation and spreading of drug-resistant strains due to irrational use of antibiotics.
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Objective To investigate the diagnostic value of combined detection of procalcitonin (PCT), C-reactive protein (CRP), white blood cell (WBC), and neutrophil percentage (NEU%) in bloodstream infection with gram-positive coccus(G+), gram-negative bacillus (G-)and fungus.Methods Detection results of positive blood culture of 389 patients in a hospital between January 2014 and December 2015 were analyzed retrospectively, according to the results of blood culture, patients were divided into G+ coccus, G-bacillus and fungal bloodstream infection groups, inflammatory indicators of different groups of patients were compared.Results Mann-Whitney U test revealed that PCT level of G-infection group was higher than that of G+ and fungal infection group (comparison between G-infection group and G+ infection group : Z=-2.68,P<0.01;comparison between G-infection group and fungal infection group: Z=-2.46,P<0.05).If PCT≥0.5 ng/mL, CRP≥5.0 mg/L, NEU%≥70% and WBC≥10×109/L were as the cut-off point, statistical analysis revealed the positive rate of PCT in G-infection group was higher than that in G+ and fungal infection group(comparison between G-infection group and G+ infection group:χ2=5.94,P<0.05;comparison between G-infection group and fungal infection group:χ2=7.721,P<0.01);the positive rate of CRP in G-infection group was higher than that in G+ infection group (χ2=5.03,P<0.05).Binary logistic regression was adopted to analyze the efficacy of four indicators for the differentiation of bloodstream infection caused by G+ coccus, G-bacillus, and fungus, only PCT had significant difference in the identification of bloodstream infection caused by G-bacillus, G+ coccus and fungus(P<0.01).Conclusion PCT has high accuracy in differentiating G-bacillus, G+ coccus, and fungus of blood culture, dynamic monitoring of PCT combined with detection results of CRP, WBC, and NEU%, patient's condition can be judged rapidly, and antimicrobial agents can be used rationally, so the mortality of patients with bloodstream infection can be reduced.
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OBJECTIVE:To provide reference for standardizing the clinical use of carbapenem antibiotics and controlling drug-resistant bacteria infection. METHODS:The detection of 3 kinds of carbapenems-resistant Gram-negative bacillus in our hospi-tal during 2011-2016 were analyzed retrospectively. The consumption,target cure rate and treatment course of carbapenem antibiot-ics were analyzed statistically. The correlation between detection rate of drug-resistant bacteria with the consumption of carbapenem antibiotics was investigated by Pearson test. RESULTS:During 2011-2016,1222 strains of carbapenems-resistant Acinetobacter bauman (CRAB),655 strains of carbapenems-resistant Pseudomonas aeruginosa (CRPA) and 53 strains of carbapenem-resistant Escherichia coli (CRE) were detected in our hospital. The detection rates increased from 23.88%,8.92%,0.09% in 2011 to 80.34%,35.74%,0.97% in 2016. The types of carbapenem antibiotics in our hospital were mainly imipenem and meropenem. The consumption of them increased from 4222,145 g in 2011 to 7218,4387 g in 2016. The both target cure rates were all lower than 60%,and the proportion of the patients with treatment course >14 d was more than 65%. The detection rates of CRAB,CR-PA and CRE were positively correlated with the consumption of carbapenem antibiotics (r>0.9,P<0.05). CONCLUSIONS:The detection rate of carbapenems-resistant Gram-negative bacillus and drug consumption increase year by year in our hospital,and they have certain correlation. The target cure rate of carbapenem antibiotics in our hospital is in low level,and there is a long treatment course. They are should be standardized in the clinic. The selection of carbapenem antibiotics should be strictly followed clinical in-dications so as to reduce the generation of drug-resistant strains.
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Objective To investigate the distribution and antimicrobial resistance of gram-negative bacilli isolated from wound specimens of orthopedic patients,and provide reference for the rational use of antimicrobial agents. Methods 682 isolates of gram-negative bacilli were collected from orthopedic department in a comprehensive hospi-tal between January 2011 and December 2013, antimicrobial susceptibility testing results were analyzed. Results The main gram-negative bacilli isolated from wound specimens of orthopedic patients were Pseudomonas aeruginosa (P .aeruginosa)(16.72%),Escherichia coli (E.coli)(15.40%),and Enterobacter cloacae (E.cloa-cae)(12.76%).The detection rates of extended-spectrum beta-lactamase-producing E.coli and Klebsialla pneu-moniae (K .pneumoniae)were 54.29%(57/105)and 31 .43% (22/70)respectively,and mainly distributed in the trauma orthopedic department,accounting for 49.12% and 45.45% respectively.The susceptibility rates of E.coli, K .pneumoniae ,and E.cloacae to meropenem and imipenem were all 100.00%.The susceptibility rates of E.coli and K .pneumoniae to amikacin,piperacillin-tazobactam and amoxicillin/clavulanic acid were all >80%.Suscepti-bility rate of E.cloacae to most antimicrobial agents were 71 .26% -100.00% except for piperacillin(64.37%). Susceptibility rates of P .aeruginosa to most antimicrobial agents were >85% except for cefepime (78.95%)and aztreonam (65.79%).Conclusion Gram-negative bacilli are the most common pathogens in wound infection of or-thopedics patients.In order to use antimicrobial agents rationally and improve clinical treatment effect,it is impor-tant to realize the distribution of pathogens and antimicrobial resistance.
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Objective To investigate the distribution and antibiotic resistance of gram-negative bacilli for better antimicrobial therapy in our hospital.Methods A retrospective analysis was conducted for the 1 060 strains of gram-negative bacilli isolated from clinical specimens during 2013.Results Of the 1 060 gram-negative bacterial strains isolated during 2013,E.coli,K . pneumoniae,P .aeruginosa and A.baumannii were the leading pathogens,accounting for 29.3%,22.8%,11.5% and 9.9%,respectively.The prevalence of extended spectrum-lactamases (ESBLs)positive strains was 63.7%,32.2% and 28.0% in E.coli,K .pneumoniae and P .mirabilis,respectively.The Enterobacteriaceae strains were highly sensitive to carbapenems.The percentage of the P .aeruginosa isolates resistant to meropenem,imipenem or amikacin was lower than 30%.The percentage of the Acinetobacter spp.(A.baumannii accounted for 70.9%)strains resistant to meropenem and imipenem were 25.0% and 26.2%.Conclusions Most of the gram-negative bacilli are resistant to multiple antimicrobial agents. We should strengthen the monitoring of the antibiotic resistance of gram-negative bacilli and optimize antimicrobial therapy.
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Objective To investigate the pathogen and incidence of ventilator-associated pneumonia (VAP) under different pH value of gastric juice,and to explore the endogenous pathogenesis of VAP.Methods Ninety-eight cases were admitted in our neonatal intensive care unit from Dec 2008 to Dec 2010.According to whether VAP happened,they were divided into VAP group (52 cases) and non-VAP group (46 cases).The relation between pH value of gastric juice and the species of pathogenic bacteria in stomach was analyzed.Results The incidence of VAP was 53.1％ (52/98).The pH value of gastric juice affected the species of pathogenic bacteria in stomach.When pH ≤ 4,the major species of pathogenic bacteria were Candida and Gram-positive bacillus; and pH ＞ 4,the major species were Gram-negative bacillus.The incidence of VAP was 34.5％ (10/29) when pH≤4;on the contrary,the incidence was 60.9％ (42/69) when pH ＞ 4.The incidence of VAP at the time of pH ＞ 4 was significantly higher than that of pH ≤4 ( x2 =5.71,P =0.017).Conclusion The pH value of gastric juice is an important factor of the species of pathogenic bacteria in stomach,especially for Gram-negative bacillus,including multi-drug resistant extended-spectrum β-lactamase-producing bacteria.The higher of pH value,the incidence of VAP is higher.
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87%. CONCLUSIONS The surveillance of overexpressing AmpC ?-lactamases in cefoxitin-resistant Gram-negative bacillus must be enhanced.The therapy of infections caused by related bacillus should make imipenem and meropenem a chief choice.DHA-1,CMY-2 and CMY-22 AmpC enzymes are found in Fuzhou.
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OBJECTIVE To investigate the distribution and resistance of clinical isolates to antimicrobial agents commonly used.Antimicrobial agents should be used rationally based on the results of susceptibility testing.METHODS The clinical isolates were identified with W/A-40 or VITEK-32.The results were analyzed by WHONET 5.3 software according to CLSI 2005.RESULTS A total of 2892 clinical isolates were collected in 2007.Gram-negative bacilli accounted for 68.2% and Gram-positive cocci accounted for 31.8%.The top eight pathogens were Pseudomonas aeruginosa,Escherichia coli,Klebsiella spp,Acinetobacter spp,coagulase-negative Staphylococcus,Enterobacter spp,Serratia spp and S.aureus.About 76.4% of S.aureus isolates were MRSA,81.6% of coagulase-negative Staphylococcus isolates were meticillin-resistant.Under 20.0% of Enterobacteriaceae strains were resistant to cefoperazone/sulbactam,imipenem and piperacillin/tazobactam.About 16.3% and 32.5% of P.aeruginosa isolates were resistant to cefoperazone/sulbactam and imipenem.CONCLUSIONS Gram-negative bacilli were dominant isolates in our hospital during 2007.P.aeruginosa is the most frequent pathogenwith severe antibiotic resistance.Enterobacteriaceae are susceptible to cefoperazone/sulbactam and imipenem.
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OBJECTIVE I understand all types of hospital clinical specimens sent from the main Gram-negative bacillus distribution and resistance,for clinical anti-infection treatment and provide the basis for the rational use of antibiotics.METHODS Clinical submitted the sputum,Blood,Urinary tract secretions,Wound secretions,Humoral etc all kinds of specimens from the conventional training,use Viekt-ATB auto-system,and K-B paper disk diffusion in accordance with NCCLS standards was employed for drug sensitivity tests.RESULTS July 2006 June 2007 Clinical specimens were isolated various major G-Bacillus 707,Habitat of the top three are:Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,16 kinds of antibiotics resistance in varying degrees.three major imipenem Enterobacteriaceae bacteria resistant rates are 0.0%,Highly resistant to ampicillin,to cefoperazone/sulbactam,piperacillin/tazobactam resistance rate of 3.3% to 34.0%.In non-fermented bacteria,In addition to Stenotrophomonas maltophilia Aeromonas natural resistance to imipenem,The remaining resistance to imipenem rate of