Characteristics of Gram-positive cocci infection and the therapeutic effect after liver transplantation / 中南大学学报(医学版)

OBJECTIVES@#Gram-positive cocci is the main pathogen responsible for early infection after liver transplantation (LT), posing a huge threat to the prognosis of liver transplant recipients. This study aims to analyze the distribution and drug resistance of Gram-positive cocci, the risk factors for infections and efficacy of antibiotics within 2 months after LT, and to guide the prevention and treatment of these infections.@*METHODS@#In this study, data of pathogenic bacteria distribution, drug resistance and therapeutic efficacy were collected from 39 Gram-positive cocci infections among 256 patients who received liver transplantation from donation after citizens' death in the Third Xiangya Hospital of Central South University from January 2019 to July 2022, and risk factors for Gram-positive cocci infection were analyzed.@*RESULTS@#Enterococcus faecium was the dominant pathogenic bacteria (33/51, 64.7%), followed by Enterococcus faecalis (11/51, 21.6%). The most common sites of infection were abdominal cavity/biliary tract (13/256, 5.1%) and urinary tract (10/256, 3.9%). Fifty (98%) of the 51 Gram-positive cocci infections occurred within 1 month after LT. The most sensitive drugs to Gram-positive cocci were teicoplanin, tigecycline, linezolid and vancomycin. Vancomycin was not used in all patients, considering its nephrotoxicity. Vancomycin was not administered to all patients in view of its nephrotoxicity.There was no significant difference between the efficacy of daptomycin and teicoplanin in the prevention of cocci infection (P>0.05). Univariate analysis indicated that preoperative Model for End-Stage Liver Disease (MELD) score >25 (P=0.005), intraoperative red blood cell infusion ≥12 U (P=0.013) and exposure to more than 2 intravenous antibiotics post-LT (P=0.003) were related to Gram-positive cocci infections. Multivariate logistic regression analysis revealed that preoperative MELD score >25 (OR=2.378, 95% CI 1.124 to 5.032, P=0.024) and intraoperative red blood cell transfusion ≥ 12 U (OR=2.757, 95% CI 1.227 to 6.195, P=0.014) were independent risk factors for Gram-positive cocci infections after LT. Postoperative Gram-positive cocci infections were reduced in LT recipients exposing to more than two intravenous antibiotics post-LT (OR=0.269, 95% CI 0.121 to 0.598, P=0.001).@*CONCLUSIONS@#Gram-positive cocci infections occurring early after liver transplantation were dominated by Enterococcus faecalis infections at the abdominal/biliary tract and urinary tract. Teicoplanin, tigecycline and linezolid were anti-cocci sensitive drugs. Daptomycin and teicoplanin were equally effective in preventing cocci infections due to Gram-positive cocci. Patients with high preoperative MELD score and massive intraoperative red blood cell transfusion were more likely to suffer Gram-positive cocci infection after surgery. Postoperative Gram-positive cocci infections were reduced in recipients exposing to more than two intravenous antibiotics post-LT.

ANTIBIOTICS RESISTANCE PATTERN AMONG GRAM POSITIVE COCCI ISOLATED FROM INTENSIVE CARE UNITS IN A TERTIARY CARE HOSPITAL

Multi drug resistant Gram positive cocci are implicated in life threatening infections, especially in critical care units. In the current study which was conducted from June 2018 to March 2019, the prevalence and antimicrobial resistance among gram positive cocci isolated from intensive care units of a tertiary care hospital has been detected . Various samples like urine, pus, body ?uids, sputum etc. were processed according to standard procedures. Total 81 gram positive cocci were isolated from 1650 samples. Maximum gram positive cocci were coagulase negative Staphylococcus followed by Staphylococcus aureus and enterococci. Coagulase negative Staphylococcus showed highest resistance to cotrimoxazole, erythromycin, ciprofioxacin, and penicillin and maximum sensitivity to gentamicin. Staphylococcus aureus showed maximum resistance to penicillin, tetracycline, co - trimoxazole and ciprofioxacin. All the isolates were sensitive to linezolid and vancomicin. Antimicrobial resistance among enterococci varied from 65% to 85%. Formation of antibiogram and strict adherence to hospital antibiotic policy is crucial to prevent spread of resistance among microorganisms.

Perfiles de resistencia a fluoroquinolonas en cocos Gram positivos de importancia clínica / Fluoroquinolone's resistance profiles in Gram-positive cocci of clinical importance

Para evaluar la resistencia a fluoroquinolonas en aislamientos clínicos de cocos grampositivos se revisaron los resultados de los cultivos procesados en el Centro de Referencia Bacteriológica del Servicio Autónomo Hospital Universitario de Maracaibo, durante el periodo enero 2011-diciembre 2015. Los datos fueron analizados mediante el software WHONETTM, (versión 5,6) y el IBM® SPSS® Statistics para Windows, (versión 25). Se encontró una frecuencia de 29,70% para los cocos grampositivos (9.292 cepas), correspondiendo el 76,18% de los aislamientos al género Staphylococcus (7.072); 15,30% a Enterococcus (1.422) y 8,59% a Streptococcus (798). Para Staphylococcus, la resistencia fue mayor en cepas resistentes a meticilina. Las tasas de resistencia más elevadas se detectaron en los enterococos, especialmente en Enterococcus faecium resistente a vancomicina. No se detectó resistencia a fluoroquinolonas en las cepas de Enterococcus faecalis resistentes a vancomicina. Los estreptococos, incluyendo Streptococcus pneumoniae, se mostraron, mayormente, sensibles a las fluoroquinolonas. La mayoría de las cepas de estafilococos y enterococos; presentó, resistencia cruzada a todas las fluoroquinolonas probadas. La distribución de la resistencia a las fluoroquinolonas por año de estudio en cada género bacteriano fue diferente. La resistencia a las fluoroquinolonas muestra una tendencia creciente en los tres géneros de cocos grampositivos evaluados

To evaluate the resistance to fluoroquinolones in clinical isolates of Gram-positive cocci records of processed culture al the Bacteriological Reference Center of the Autonomous Service University Hospital of Maracaibo during the period January 2011-December 2015, were reviewed. The data was analyzed using WHONETTM software (version 5.6) and IBM® SPSS® Statistics for Windows (version 25). A frequency of 29.70% was found for Gram-positive cocci (9,292 strains), with 76.18% of isolates corresponding to the genus Staphylococcus (7,072); 15.30% to Enterococcus (1422) and 8.59% to Streptococcus (798). For Staphylococcus, resistance was higher in methicillin-resistant strains. The highest resistance rates were detected in enterococci, especially vancomycin-resistant Enterococcus faecium. No resistance to fluoroquinolones was detected in vancomycin-resistant Enterococcus faecalis strains. Streptococci, including Streptococcus pneumoniae, were mostly sensitive to fluoroquinolones. Most strains of staphylococci and enterococci; presented cross resistance to all tested fluoroquinolones. The distribution of resistance to fluoroquinolones per year of study in each bacterial genus was different. Resistance to fluoroquinolones shows an increasing trend in the three genera of Gram-positive cocci evaluated

Distribution of pathogenic bacteria and analysis of drug sensitivity in acute dacryocystitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the pathogenic bacteria and drug resistance of acute dacryocystitis, and to provide a guide for rational clinical medication.<p>METHODS: Lacrimal sac pus samples from 80 acute dacryocystitis cases were collected for bacterial culture and drug sensitivity test in Hebei Provincial Eye Hospital from January 2014 to October 2019. The change of detection rate of pathogenic bacteria in different years, the species of pathogenic bacteria of acute dacryocystitis, the main pathogenic bacteria, drug sensitivity and drug resistance of acute dacryocystitis, and the average detection rate of pathogenic bacteria in acute dacryocystitis were analyze.<p>RESULTS:Totally 56 samples were positive for pathogenic bacteria, including 55 cases of bacteria and 1 case of fungi. The average detection rate was 70%. The detection rate of pathogenic bacteria strains was gradually decreasing year by year, and there were various types of pathogenic bacteria strains detected from samples. In addition, Gram-positive cocci was the main pathogenic bacteria of acute dacryocystitis, accounting for 68%(38 cases), of which, staphylococcus aureus accounted for 38%(21 cases). What's more, most Gram-positive cocci were sensitive to rifampin, levofloxacin, and chloramphenicol, and Gram-negative bacilli were more sensitive to tobramycin, levofloxacin, ciprofloxacin, and gentamicin. Fifty-five cases of bacterial samples were obviously resistant to the first and second generation cephalosporins.<p>CONCLUSION: Gram-positive cocci constitute the main pathogenic bacteria of acute dacryocystitis, and levofloxacin can be used as the first choice of topical antibiotics for the treatment of acute dacryocystitis.

Identifying gram-positive cocci in dermatoscopes and smartphone adapters using MALDI-TOF MS: a cross-sectional study

Abstract Background: The increasingly frequent use of dermoscopy makes us think about the possibility of transfer of microorganisms, through the dermatoscope, between doctor and patients. Objectives: To identify the most frequent gram-positive cocci in dermatoscopes and smartphone adapters, as well as the resistance profile, and to evaluate the factors associated with a higher risk of bacterial contamination of the dermatoscopes. Methods: A cross-sectional study was carried out with 118 dermatologists from Porto Alegre/Brazil between September 2017 and July 2018. Gram-positive cocci were identified by MALDI-TOF MS and habits of use of the dermatoscope were evaluated through an anonymous questionnaire. Results: Of the dermatoscopes analysed, 46.6% had growth of gram-positive cocci on the lens and 37.3% on the on/off button. The microorganisms most frequently found were S. epidermidis, S. hominis and S. warneri. Attending a hospital, using the dermatoscope at the hospital, with inpatients and in the intensive care unit were significantly associated with colonisation by gram-positive cocci. The highest resistance rates were observed for penicillin, erythromycin and sulfamethoxazole-trimethoprim. Study limitations: The non-search of gram-negative bacilli, fungi and viruses. Moreover, the small number of adapters did not make it possible to better define if the frequency differences were statistically significant. Conclusion: Coagulase-negative staphylococci were frequently identified. S. aureus was detected only on the lens.

Antibiotics sensitivity status and antibiogram patterns of aerobic bacterial isolates from surgical site infections

Background: Surgical Site Infections (SSIs) are the third most common nosocomial infections. Emergence and spread of drug resistant strains have been found to pose a serious challenge in the management of such infections. There is limited information on the epidemiology of such pathogens. The antibiotic sensitivity patterns of aerobic bacterial isolates from post-operative SSIs show wide variations that lead to difficulties in empirical selection of the right kind of drug for treatment. Properly planned studies about antibiotic sensitivities patterns of such isolates can help in judicious management of SSIs and cause reduction in morbidity and mortality.Methods: A total of 50 patients diagnosed by the surgeon and fulfilling the case definition of SSI, were studied for bacteriological analysis. All the clinical specimens were cultured and identified applying standard culture techniques. The aerobic bacterial isolates were subjected to antimicrobial susceptibility testing by Kirby Bauer Disc Diffusion method to arrive at the drug sensitivity patterns. Data were entered in MS Excel spread sheet and analysed using SSPP software version 21.00Results: A total of 32 patterns of sensitivity were observed. For Esch. coli, a total of nine patterns were observed. All strains of Esch. coli were found sensitive to tigecycline (100%) and colistin (100%). For Klebsiella spp. a total of 9 patterns were obtained with TIG-COL being the predominant pattern in 6 cases. For Acinetobacter spp. only colistin was found most effective drug. In case of Pseudomonas aeruginosa, except colistin (100% sensitivity), there were wide variations in sensitivity with imipenem (71%) as next most effective drug. In Proteus spp. - most of the in-use drugs were effective except cephalosporins. Among gram positive organisms, only three strains of Staphylococcus aureus were isolated, and these were MRSA (100%). Two strains of enterococcus were isolated, and these showed sensitivity to linezolid only.Conclusions: Wide variations in sensitivity status observed in the study are suggestive that antibiotic usage should be tailored to individual needs and proper selection of antibiotics for management of SSIs must be guided by laboratory antibiogram.

Identification of bacterial urinary tract pathogens from urine samples using conventional methods and matrix-assisted laser desorption ionization-time of flight mass spectrometry

Background: Early diagnosis of urinary tract infections (UTIs) is essential to avoid inadequate or unnecessary empirical antibiotic therapy. In this study, we evaluate the coincidence rate between conventional method for the diagnosis of UTIs (plate cultures and identification based on biochemical characteristics) and a fast method based on Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). In recent years, proteomic techniques have achieved a relevant role in the identification of microorganisms in the field of clinical microbiology. MALDI-TOF MS has been suggested as a fast and reliable method for bacterial identification.Methods: Around 50 midstream urine samples submitted to Microbiology laboratory for Gram staining and bacterial culture were analyzed. Samples were microscopically tested, characterized, and identified using different media such as blood agar and Mac Conkey agar and by applying suitable biochemical tests. Urine specimens showing a significant bacteriuria on culture and single morphological type by Gram staining were then processed by MALDI-TOF MS.Results: Of 50 specimens, colony growth was observed in 43(86%) specimens, and 38(88.3%) specimens had growth of single-colony morphological type in culture. 32(84.2%) of them had colony counts of >105 colony forming units (CFUs)/ml. 7(14%) samples were negative in culture, and all of them were also negative by MALDI-TOF MS. Microorganism identifications in this group were coincident at the species level in 28(87.5%) specimens. The most frequent microorganism identified was Escherichia coli, followed by Klebsiella species and Acinetobacter baumanii. MALDI-TOF MS identified Providencia stuartii in 3 samples and Pseudomonas putida in 1 of them; which were not in accordance with the conventional method used for identification.Conclusions: Present study results show that MALDI-TOF MS allows bacterial identification from infected urine in a short time, with high accuracy, and especially when uncommon uropathogens are involved.

Identification of Gram Positive and Negative Bacteria Microflora Isolated from Hot Water Spring in Bentong, Pahang / Jurnal Sains Kesihatan Malaysia

A study on the isolation and identification of bacterial flora from hot spring was carried out from Bentong hot springwater, Pahang. In general, many of the bacteria identified from the hot spring were from Bacillus sp. due to its abilityto adapt to high temperature mainly by forming endospore. The objective of this study was to identify bacteria otherthan Bacillus sp. that were able to survive this hot spring. Three hot spring pools were identified as A, B and C. Thetemperatures were ranging from 36°C to 52°C and their pH values were between 7.88-8.65. The result shows thattwo species of Gram positive cocci and three species of Gram negatives were isolated. The two Gram positives wereStreptococcus sp. and Staphylococcus sp. The three species of Gram negative rods were identified as Pseudomonas sp.,Klebsiella sp. and Proteus sp. In conclusion, non-sporulating species of bacteria other than Bacillus sp. have adaptedto survive in hot spring

Effect of sequential therapy of linezolid and teicoplanin for the treatment of the severe pneumonia induced by gram-positive coccus / 中国基层医药

Objective To investigate the effect of sequential therapy of linezolid and teicoplanin for the treatment of the severe pneumonia induced by gram-positive coccus.Methods From September 2014 to August 2017,0 cases of severe pneumonia patients in the Traditional Chinese Medicine Hospital of Zhoushan were gram positive coccus,tumbled to rina amine for patients treated with intravenous drip,the course of treatment was 7 days,and then intravenous drip their stead better treatment,treatment for 7 days,the clinical situation of patients before and after treatment respectively,the characteristics of signs and adverse reactions were analyzed.Results Among the 51 cases (63.75％),19 cases (23.75％),8 cases (10.00％),and 2 cases (2.5％),the total effective rate was 87.5 ％.In the distribution and clearance rate of pathogenic bacteria,the bacterial clearance rate of liniazolamide and the replacement of gram-positive coccus pneumoniae was 87.50％.There was no other adverse reaction.Conclusion Sequential therapy of linezolid and teicoplanin for the treatment of the severe pneumonia induced by gram-positive coccus has several good effects,high clearance rate of pathogenic bacteria,good security.

Distribution and drug resistance of pathogenic bacteria in children with blood stream infection in some area / 国际检验医学杂志

Objective To investigate the distribution and drug resistance of pathogenic bacteria in children with blood stream in-fection(BSI) in Beihai area .Methods The clinical data of children with blood stream infection from January 2013 to June 2016 were retrospectively analyzed .Results 95 .3% of BSI children patients were community acquired infection .The proportions of Gram-pos-itive cocci and Gram-negative bacilli were 53 .5% and 46 .5% respectively .The resistance rates of vancomycin and linezolid to Gram-positive cocci all were 0% ;which of piperacillin ,piperacillin/tazobactam ,cefepime and meropenem to Gram-negative bacilli were 9 .3% ,0 .0% ,9 .1% and 5 .0% respectively .Conclusion The proportion of Gram-positive cocci and Gram-negative bacilli is basical-ly consistent .Vancomycin and linezolid can be used as the empiric medication of Gram-positive cocci BSI ;piperacillin ,piperacillin/tazobactam ,cefepime and meropenem and can be used as the empiric medication of Gram-negative bacilli BSI .

Distribution and drug resistance of bacterial pathogens isolated from peritonsillar abscess during ;2010-2014 in Wenzhou / 中华临床感染病杂志

Objective To investigate the distribution and drug resistance of bacterial pathogens isolated from peritonsillar abscess .Methods Data on bacterial pathogens isolated from peritonsillar abscess in Wenzhou Central Hospital from January 2010 to December 2014 were retrospectively analyzed .Strains were identified with Vitek 32 identification system and the drug susceptibility test was performed with K-B method.Chi-square test for linear trend was performed to reveal the changes of distribution and drug resistance of the strains .Results A total of 2 864 bacterial strains were isolated in five years , in which 1 786 strains were Gram-negative bacilli (62.4%), and 1 078 (37.6%) strains were Gram-positive cocci. The positive rate of Gram-negative bacilli was on the rise during year 2010-2014 (χ2 =84.74, P<0.01), and the top three Gram-negative bacilli were Pseudomonas aeruginosa, Acinetobacter baumannii and Haemophilus influenzae, which accounted for 72.5%(1 295/1 786) of the total Gram-negative strains, and the positive rates of first two bacilli were on the rise (χ2 =83.75 and 24.74, P<0.01).Gram-positive cocci were mainly Staphylococcus aureus and Hemolytic streptococcus, which accounted for 83.2% ( 897/1 078) of the total Gram-positive strains.Resistance rates of Pseudomonas aeruginosa to ceftazidime, cefoperazone, piperacillin/tazobactam were on the rise (χ2 =16.17, 13.48 and 11.44, P<0.05), while resistance rates to gentamicin and amikacin were on the decline (χ2 =16.54 and 16.63, P <0.05). Resistance rates of Acinetobacter baumannii to ceftazidime, cefoperazone/sulbactam and piperacillin/tazobactam were on the rise (χ2 =12.52, 10.85 and 14.14, P<0.05).Resistance rates of Haemophilus influenzae to ampicillin were on the rise (χ2 =10.21, P<0.05), and the positive rate of β-lactamase producing strains was also on the rise (χ2 =10.38, P<0.05).Resistance rates of Staphylococcus aureus to cefazolin and methicillin were on the rise (χ2 =15.44 and 12.53, P<0.05), but no vancomycin resistant strain was found .Hemolytic streptococcus were sensitive to all commonly used antibiotics .Conclusions Peritonsillar abscess in Wenzhou Central Hospital is mainly induced by Gram-negative bacilli infection . Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus are the top three bacterial pathogens , and are highly resistant to most antibiotics .

La evolución de la resistencia bacteriana en México, 1973-2013 / Evolution of bacterial resistance to antibiotics in México, 1973-2013

Introducción. La resistencia bacteriana a los antibióticos es un problema de salud mundial. Las investigaciones relacionadas con este problema emergente son indispensables para reconocer y desarrollar programas para su vigilancia y control. Objetivo. Revisar y comentar las contribuciones de los investigadores mexicanos en el área de la resistencia bacteriana a los antibióticos. Materiales y métodos. Se realizó una búsqueda de la literatura científica relacionada con la resistencia bacteriana a los antibióticos producida por investigadores mexicanos y registrada en Medline-PubMed entre 1973 y julio de 2013. Resultados. En 66 publicaciones, las contribuciones de investigadores mexicanos incluyeron datos sobre la resistencia de agentes patógenos entéricos como Salmonella Typhi, múltiples contribuciones sobre la producción de betalactamasas de espectro extendido, de metalobetalactamasas y de carbapenemasas, los mecanismos de resistencia en Pseudomonas aeruginosa y la evolución de la resistencia en cocos Gram positivos como Streptococcus pneumoniae , Staphylococcus aureus y Enterococcus spp., entre otros. Conclusiones. Los datos publicados en los últimos 40 años son fuente adecuada para entender la evolución de la resistencia bacteriana a los antibióticos y desarrollar programas para su control.

Introduction: Bacterial resistance to antibiotics is a worldwide public health concern. Research priorities for the study and control of this emerging problem include country-wide surveillance. Objective: To review and comment on the contributions by Mexican investigators towards a greater understanding of the mechanisms of bacterial antibiotic resistance. Materials and methods: A comprehensive search of the medical literature on Medline/PubMed between 1973 and July 2013 was performed. Results: The contributions of Mexican investigators have included descriptions of resistance in enteric pathogens, such as Salmonella Typhi, publications on the production of extended spectrum beta-lactamases, metallo-beta-lactamases, and carbapenemases, resistance mechanisms of Pseudomonas aeruginosa , and the evolution of resistance in Gram-positive pathogens, including Streptococcus pneumoniae , Staphylococcus aureus , and Enterococcus spp. Conclusion: The Mexican literature on mechanisms of bacterial resistance is relevant for the development of plans to control the antibiotic resistance crisis.

Gram-positive bacteria associated nosocomial bloodstream infections: prognostic factors and drug resistance / 中华临床感染病杂志

Objective To investigate the risk factors of prognosis of gram-positive bacteria associated nosocomial bloodstream infections,and to investigate the drug resistance of the strains.Methods A total of 132 patients with gram-positive bacteria associated nosocomial bloodstream infections were collected from the First Affiliated Hospital of Zhejiang Chinese Medicine University during January 2010 and December 2012.Clinical data including demographic characteristics,underlying diseases,risk factors and use of antibacterial agents were retrospectively analyzed.According to 28-day prognosis,patients were divided into survival group (n =97) and death group (n =35).Binary logistic regression was used to identify the risk factors of 28-day fatality.Results Among 132 patients,49 (37.12％) were infected with coagulase-negative Staphylococcus,46 (34.85％) were infected with Staphylococcus aureus,37 (28.03％)were infected with Enterococcus.The rates of methicillin resistant coagulase negative Staphylococci (MRCNS) and methicillin-resistant Staphylococcus aureus (MRSA) were 77.55％ (38/49) and 54.35％ (25/46),respectively.The rate of linezolid resistant coagulase negative Staphylococci was 8.16％ (4/49) ; Four out of 37 strains (10.81％) of Enterococcus were both resistant to vancomycin and linezolid.Binary logistic regression showed that septic shock (OR =34.344,95％ CI:6.539-180.389,P =0.000),deep venous catheterization (OR =13.411,95％ CI:1.877-95.832,P =0.010),no catheter removal after infection (OR =8.759,95％ CI:2.197-34.911,P =0.002),parenteral nutrition (OR =3.684,95％ CI:1.072-12.663,P =0.038),inappropriate antibacterial therapy in early stage (OR =12.951,95％ CI:2.075-80.836,P =0.006) and Enterococcus associated bloodstream infections (OR =4.227,95％ CI:1.090-16.394,P =0.037) were independent risk factors of 28-day fatality in patients with gram-positive bacteria associated nosocomial bloodstream infections.Conclusions The predominant pathogens are coagulase-negative Staphylococcus,Staphylococcus aureus and Enterococcus in gram-positive bacteria associated nosocomial bloodstream infections.Patients with septic shock,deep venous catheterization,no catheter removal after infection,parenteral nutrition,inappropriate antibacterial therapy in early stage and Enterococcus associated bloodstream infections are likely to have high fatality rate.

Analysis on tigecycline and commonly used anti-bacterial agents resistance in Gram-positive cocci and Acinetobacter baumannii / 国际检验医学杂志

Objective To understand tigecycline and commonly used anti-bacterial agents resistance in Gram-positive cocci and Acinetobacter baumannii .Methods 445 strains of Gram-positive cocci and 83 strains of Acinetobacter baumannii were collected . VITEK 2 Compact automated bacterial identification and susceptibility analysis system was employed to identify Gram-positive coc-ci and Acinetobacter baumannii and their bacterial sensitivities toward tigecycline and commonly used anti-bacterial agents were de-tected by broth microdilution method for antimicrobial susceptibility testing (MIC assay) and Kirby-Bauer disk diffusion susceptibil-ity test(K-B) ,respectively .Results 155(34 .8% ) strains of Staphylococcus aureus ,78(17 .5% ) Enterococcus feces ,56(12 .6% ) Staphylococcus haemolyticus ,45(10 .1% ) Staphylococcus epidermidis ,43(9 .7% ) Enterococcus faecalis ,18(4 .1% ) human Staphy-lococcus ,16(3 .6% ) Wolfowitz Staphylococcus ,8(1 .8% ) birds Enterococci and 26(5 .8% )other strains were found in 445 cases of Gram-positive cocci .The rate of penicillin-resistant Staphylococci was 92 .4% and the rates of Staphylococci′s resistance to eryth-romycin ,clindamycin ,oxacillin and ciprofloxacin were all over 50% .Enterococci ,which was sensitive to linezolid and tigecycline ,was resistant naturally to many drugs .The tigecycline sensitive rate ,intermediate rate and resistance rate acquired by MIC assay for multi-drug resistant and pan-resistant Acinetobacter baumannii were 57 .1% (47/83) ,42 .9% (36/83) and 0 .0% (0/83) ,respec-tively ,while those by K-B methods were 2 .4% (2/83) ,40 .5% (34/83) and 57 .1% (47/83) ,respectively .Conclusion Tigecycline showes good antibacterial activity toward Gram -positive cocci and Acinetobacter baumannii .

Analysis of etiology and clinical features of hospital-acquired bloodstream infection in children / 中华传染病杂志

Objective To summarize the pathogenic spectrum and antimicrobial susceptibility of hospital-acquired bloodstream infections (HABSI) in children,and to provide evidence for clinical antiinfection treatment.Methods During January 2004 to December 2011,the clinical data and drug susceptibility results of 168 children who were diagnosed with HABSI based on positive results of pathogen tests were reviewed retrospectively in Yuying Children's Hospital affiliated to Wenzhou Medical College.Results A total of 171 strains were isolated from blood specimens of the 168 children.The majority of HABSI occurred in the intensive care unit (73.7 ％),followed by department of hematology (22.6％).Gram-positive bacteria,gram-negative bacteria and fungi accounted for 53.8％,34.5％ and 11.7％,respectively.The predominant pathogens were Stagphylococcus epidermidis (14.1％),followed by Klebsiella pneumonia (13.5 ％),Staphylococcus haemolyticus (7.6％),Staphylococcus aureus (6.4％),Enterococcus faecium (6.4％) and Escherichia coli (6.4 ％).Staphylococcus aureus and Staphylococcus epidermidis resistant to methicillin were detected in 9.1 ％ and 91.7 ％ of specimens,respectively.Staphylococcus and enterococcus which were resistant to vancomycin or linezolid were not detected.The isolation rates of Klebsiella pneumoniae and Escherichia coli with extended-spectrum beta-lactamases (ESBL) were 95.7％ and 72.7％,respectively.One hundred and sixty cases (95.2 ％) had underlying diseases including premature birth and low birth weight (60.7％).One hundred and twenty-six cases (75.0％) underwent invasive procedures.The peak incidence of HABSI occurred in children less than 3 months old (75.6％).Conclusions HABSI is most common in infants younger than 3 months old,with underlying diseases or undergone invasive procedures.The pathogens are mainly gram-positive bacteria.Very low birth weight infants can acquire unusual infection of Kodamaea ohmeri.Thus,it is essential to strengthen the prevention of hospital-acquired infection.

Analysis of antimicrobial resistancemonitor of gram-positive cocci in vitro / 中国综合临床

Objective To discuss the distributions and drug resistance of gram-positive cocci and provide scientific basis for reasonable use of antimicrobial drugs.Methods One hundred and twenty-five strains were isolated and cultured in our department from January 2009 to December 2011.The drug susceptibility was tested by K-B method and the results were judged by the criteria guideline of CLSI 2009.Results The main strains of separated cocci were Staphylococcus aureus (68,54.4％),Enterococcus faecium (22,17.6％),coagulase-negative staphylococcus (CNS) (20,16.0％),Enterococcus faecalis (6,4.8％),Staphylococcus haemolyticus(7,5.6％)and other gram-positive cocci (2,1.6％).Methicillin-resistant S.aureus (MRSA) and Methicillin-susceptible S.aureus (MSSA) detected were 40 and 28 strains(accounted for 58.8％ and 41.1％ of S.aureaus).The results of drug susceptibility tests showed that the drug resistant rate of MRSA to Gentamicin,Clidamycin,Erythromycin and Ciprofloxacin was up to 87.5％-95.0％,and the drug resistant rate of coagulasenegative staphylococcus to Penicillin,Erythromycin,Clidamycin and Gentamicin was up to 65.0％-95.0％,besides,the drug resistant rate of E.faecalis and E.faecium to Erythromycin,high level Gentamicin and Ciprofloxacin were 86.4％-100％ and 50.0％-66.7％,respectively.No strains with drug resistant to Vancomycin,Teicoplanin and Linezolid were detected.Conclusion S.aureus was the main strains of nosocomial infection of gram cocci.The resistance of gram-positive cocci is severe,so clinicians should attaches great importance to high drug resistance of gram-positive cocci.

Estudo bacteriológico do lavado broncoalveolar na gestão de antibióticos na pneumonia associada à ventilação mecânica de pacientes em unidades de terapia intensiva cirúrgica / Bacteriological study of bronchoalveolar lavage in the antibiotic management of suspected ventilator-associated pneumonia of patients in surgical intensive care units

OBJETIVO: determinar a correlação da coloração de Gram com o resultado final das culturas de LBA em pacientes cirúrgicos sob ventilação mecânica com PAV clínica. MÉTODOS: Estudo retrospectivo de 252 amostras de lavado broncoalveolar em pacientes com clínica de pneumonia associada à ventilação mecânica com trauma ou cuidados de pós-operatório. As amostras de coloração de Gram foram classificadas como cocos Gram-positivos e bacilos Gram-negativos, todos os outros resultados foram excluídos. Culturas de lavado broncoalveolar foram comparadas aos resultados da coloração de Gram. RESULTADOS: A correlação entre a coloração de Gram e a cultura do lavado broncoalveolar apresentou índice kappa de 0,27. A sensibilidade da coloração de Gram foi 53,9% e a especificidade de 80,6%. Considerando a identificação de cocos Gram-positivos comparada com os outros resultados (negativos e bacilos Gram-negativos), o valor preditivo negativo foi 94,8%. Na avaliação de bacilos Gram-negativos comparada com os outros resultados (negativos e cocos Gram-positivos), a sensibilidade foi 27,1% e a especificidade foi 95,4%. CONCLUSÃO: O valor preditivo negativo para cocos Gram-positivos parece ser aceitável, mas a sensibilidade da coloração de Gram na etiologia de pneumonia associada à ventilação mecânica não permite prever qual é o micro-organismo antes da cultura.

OBJECTIVE: To determine the correlation of Gram staining with the culture of bronchoalveolar lavage in patients with clinical features of ventilator-associated pneumonia from two adult trauma and surgical intensive care units. METHODS: We conducted a retrospective study of 252 samples of bronchoalveolar lavage from patients with clinical ventilator-associated pneumonia in trauma or surgical postoperative care. Gram staining samples were classified as Gram-positive cocci and Gram-negative bacilli, all other results being excluded. Cultures from bronchoalveolar lavage were compared with Gram staining results. RESULTS: The correlation between Gram staining and culture from the bronchoalveolar lavage showed a kappa index of 0.27. The sensitivity of Gram staining was 53.9% and the specificity, 80.6%. Considering the identification of Gram-positive cocci against other results (negative and Gram-negative bacilli), the negative predictive value was 94.8%. The evaluation of Gram-negative bacilli against other results (negative and Gram-positive cocci) rendered a sensitivity of 27.1% and a specificity of 95.4%. CONCLUSION: It appears that the negative predictive value for Gram-positive cocci is acceptable, but the sensitivity of Gram staining in the etiology of ventilator-associated pneumonia was not able to identify the microorganism before culture.

Identification of Bacterial Flora other than Bacillus sp. from Bentong Hot Spring in Pahang, Malaysia / Jurnal Sains Kesihatan Malaysia

A study on the isolation and identification of bacterial flora from hot spring was carried out using water from Bentong hot spring in Pahang. In general most of the bacteria identified from the hot springs were from Bacillus sp. This was due to its ability to adapt to high temperature mainly by forming endospore. The objective of this study was to identify bacteria other than Bacillus that were able to survive in hot springs. Three hot spring pools were identified (A,B and C) with temperatures ranging from 36°C to 52°C and pH values between 7.88-8.65. This study has succesfully isolated two species of Gram positive cocci and three species of Gram negative bacilli. The two Gram positives were Streptococcus sp. and Staphylococcus sp. The three species of Gram negative rods were unidentified and were denoted as X, XI and XII.

Pathogen and drug resistance of neonatal skin infection in Maternal-Neonatal Unit / 中华围产医学杂志

Objective To investigate the pathogens and their drug resistance of neonatal skin infection in Maternal-Neonatal Unit to provide evidence for rational selection of antibiotics.Methods Secretions of skin lesions from newborns with skin infections delivered in Maternal-Neonatal Unit,Department of Obstetrics of Beijing Daxing People's Hospital from Jan.2009 to Dec.2010 were collected,cultured and identified for bacterial serotype.Antibiotic resistances of pathogens were determined.Enumeration data was presented by frequency and rate.The difference between groups was compared with Chi-square test.Results Two hundred and six newborn skin infection cases were diagnosed,which accounted for 2.3％ of all newborns (n=9131) delivered in the hospital during the study period.Two types of skin infection were identified,impetigo (n=192,93.2％) and omphalitis (n=14,6.8％).Totally 154 pathogens were found,including 95 (61.7％) Gram-positive cocci and 59 (38.3 ％) Gram-negative bacilli.The major pathogens among Gram-positive cocci were Staphylococcus aureus (45/154, 29.2％), followed by Staphylococcus epidermidis and Staphylococcus haemolyticus.Staphylococcus was sensitive to Cefazolin,Amoxicillin/clavulanic acid and Piperacillin/tazobactam,while resistant to Penicillin,Ampicillin and Erythromycin.The major pathogens among Gram-negative bacilli were Enterobacter cloacae (19/154,12.3％),followed by Escherichia coli and Klebsiella pneumoniae.Drug resistance rate of Gram-negative bacilli was high in penicillin,aminoglycosides and cephalosporins,while they were sensitive to piperacillin/tazobactam,Ampicillin/sulbactam,carbapenems and Quinolones.Conclusions Gram-positive cocci are the main pathogens of neonatal skin infection in the Maternal-Neonatal Unit,and among which Staphylococcus aureus is the major pathogen.Multi-drug resistance is common in the identified pathogens.Attentions should be paid to use antibiotics reasonably according to drug sensitivity test.

Clinical features of sepsis caused by different types of pathogens in preterm infants / 中华围产医学杂志

Objective To investigate the clinical features of sepsis caused by gram negative or positive pathogens and funguses in preterm infants.Methods The clinical data of 140 premature infants with sepsis admitted to preterm neonatal intensive care unit of Bayi Children's Hospital from October 2008 to June 2011 were collected and analyzed retrospectively.The clinical features of sepsis caused by different types of pathogens in preterm infants were compared by SPSS 18.0 software.Comparison of measurement data was conducted by one way ANOVA,and comparison between groups was performed by LSD method.Rates among groups were compared by Chi-square test or Fisher's exact test.Results Of 140 preterm infants with sepsis,70 cases were caused by gramnegative bacteria,36 by gram positive bacteria,and 34 by funguses.The top three gram negative sepsis pathogens were Klebsiella pneumonia (55.7 ％,n =39),Escherichia coli (20.0 ％,n =14) and Acinetobacter baumannii (12.9％,n =9).The top three gram positive sepsis pathogens were Staphylococcus epidermidis (36.1％, n =13), Staphylococcus hominis (22.2％, n =8) and Staphylococcus haemolyticus (19.4％,n=7).The top four fungus sepsis pathogens were Candida parapsilosis (44.1％,n=15),Candida albicans (23.5％,n=8),Candida famata (8.8％,n=3)and Cryptococcus laurentii (8.8％,n=3).There were no significant differences in delivery mode,fetal distress, asphyxia, fetal growth restriction, meconium-stained amniotic fluid, maternal infection,hypertensive disorder complicating pregnancy,gestational diabetes mellitus,peripherally inserted central venous catheter,mechanical ventilation before infection,cortical hormon（e） (e)xposure,intraventricular hemorrhage, periventricular leukomalacia, peripheral blood immature-to-total neutrophil ratio,recovery time of platelet,the time of infection onset,fever and hypothermia among the three groups (P＞0.05).While there were differences in gestational age [(30.4 ± 2.3) weeks,(31.0±2.4) weeks and (29.5±1.8) weeks,F=4.317,P=0.015],birth weight [(1512.5±406.0) g,(1563.8±485.4) g and (1328.8±303.2) g,F=3.190,P=0.044],premature rupture of membranes rate [24.3％ (17/70),16.7％ (6/36) and 44.1％ (15/34),X2 =7.241,P=0.034],rate of surgery during neonatal period [12.9％ (9/70),38.9％ (14/36) and 11.8％ (4/34),X2 =10.430,P=0.005],the incidence of lowperfusion [64.3％ (45/70),30.6％ (11/36) and 50.0％ (17/34),X2 =10.922,P=0.004],rate of frequent apnea [67.1％ (47/70),36.1％ (13/36) and 55.9％ (19/34),X2=9.341,P=0.009],incidence of low white blood cell [21.4％ (15/70),8.3％ (3/36) and 32.4％ (11/34),X2=6.267,P=0.042],thrombocytopenia rate [64.3％ (45/70),16.7％ (6/36)and 67.6％ (23/34),X2 =25.576,P=0.000],white blood cell count [(19.9± 17.8) × 109/L,(19.9±14.3) ×109/L and (12.0±8.1)×109/L,F=3.553,P=0.031],platelet count [(159.1±169.1) ×109/L,(311.8±179.7) ×109/L and (121.4±123.4) ×109/L,F=14.140,P=0.000],C-reactive protein [(76.8±70.1) mg/L,(16.6±27.2) mg/L and (31.8±27.5) mg/L,F=17.248,P=0.000],incidence of central nervous system infections [1.4％ (1/70),2.8％ (1/36) and 11.8％(4/34),X2 =5.066,P=0.043],retinopathy rate of premature infants [38.6％ (27/70),50.0％(18/36) and 67.7％ (23/34),X2 =8.780,P=0.012],bronchopulmonary dysplasia rate [8.6％ (6/70),11.1％ (4/36) and 26.5％ (9/34),X2=5.837,P=0.044] and mortality [11.4％ (8/70),0.0％ (0/36) and 2.9％ (1/34),X2 =5.361,P =0.042] among the three groups.Conclusions There are significant differences among sepsis caused by different types of pathogens in risk factors (gestational age,birth weight,premature rupture of membranes and neonatal surgical procedures),clinical manifestations,infection indexes and prognosis in preterm infants.Sepsis caused by gram negative bacilli liked to present shock with obvious increasing of C-reactive protein; and the prognosis is the worst.Central nervous system infection is more common in fungal infection; and the rates of retinopathy of prematurity and bronchopulmonary dysplasia are higher.Sepsis caused by gram positive cocci have mild clinical manifestations and infection indexes variations and better prognosis.