Molecular epidemiology of clinical isolation of carbapenem-resistant Enterobacterales and application of carbapenemase inhibitor enhancement test / 中南大学学报(医学版)

OBJECTIVES@#The prevalence of carbapenem-resistant Enterobacterales (CRE) presents a significant challenge in clinical anti-infective treatment. This study aims to investigate drug resistance and the molecular epidemiological characteristics of CRE in our area. Additionally, we seek to evaluate practicality of utilizing carbapenemase inhibitor enhancement test in clinical laboratory.@*METHODS@#Non-repeated CREs isolated from clinical specimens at Xiangya Hospital, Central South University, were collected. Minimum inhibitory concentration (MIC) combined with Kirby-Bauer (KB) assay was used to detect the drug susceptibility of the strains, and 13 carbapenemase-producing genes were detected by PCR. The phenotype of 126 strains of carbapenemase-producing Enterobacterales identified by PCR was detected by the carbapenemase inhibitor enhancement test to understand the agreement between the method and the gold standard PCR results.@*RESULTS@#Among 704 CRE strains examined, we observed significant drug resistance in 501 strains dentified as carbapenemase-producing Enterobacterales (CPE). Klebsiella pneumoniae was the predominant CPE strain, followed by Enterobacter cloacae and Escherichia coli. A total of 9 carbapenemase types were detected, including Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), Verona integron- encoded metallo-β-lactamases (VIM), imipenemase (IMP), oxacillinase-48 (OXA-48), and rare imipenem-hydrolyzing β-lactamase (IMI), adelaide imipenemase (AIM), Bicêtre carbapenemase (BIC), and guiana extended-spectrum β-lactamase (GES). The detection rate of KPC serine carbapenemase was 61.7% (309/501). The carbapenemase inhibitor enhancement test exhibited a 100% consistency rate for the strains producing Class A serine carbapenemase and/or Class B metallo-β-lactamases.@*CONCLUSIONS@#CRE strains in Changsha, Hunan, China, are wide distribution and exhibit carbapenemase production. The main mechanism of carbapenem resistance in these bacterias is predominatly attributed to the production of KPC serine carbapenemase. The presence of GES and IMI genes carried by Enterobacterales has been detected for the first time in this region. The carbapenemase inhibitor enhancement test has been proven to be an accurate method for detecting CRE producing Class A serine carbapenemase and/or Class B metallo-β-lactamases. This method offers simpicity of operation and ease of results interpretation, making it weel-suited meeting the clinical microbiology laboratory's reguirements for the detection of serine carbapenemase and metallo-β-lactamases.

Extraction, identification and relative quantification of outer membrane vesicles of Klebsiella pneumoniae / 中华检验医学杂志

Objective:Based on the modified ultracentrifugation method, the outer membrane vesicles (OMV) secreted by Klebsiella pneumoniae were rapidly separated, identified and quantified. Methods:Standard strains of classic Klebsiella Pneumoniae (cKP) purchased from the Clinical Laboratory Center of the National Health Commission, and hypervirulent Klebsiella pneumoniae (hvKP) which was donated by Taiwan University were cultured in M9 basal media for 9 hours, and the OMV were extracted by modified ultracentrifugation. The shape and size of OMV were identified by transmission electron microscopy (TEM), relative quantification by Stewart phospholipids analysis method. Two groups were compared using independent samples t test. Results:It was observed under the TEM that most of the OMV secreted by cKP and hvKP showed spherical vesicle structure and a small part were irregular. The diameter of OMV ranged from 20 to 250 nm, multiple vesicles could be seen in clusters. Relative quantification found that the number of OMV secreted by hvKP were more than cKP ( P<0.05). Conclusions:This study successfully achieved the extraction, identification and quantification of OMV from Klebsiella pneumoniae through the modified ultracentrifugation method, which provided a foundation for further study about the function and mechanism of OMV, and also provided new ideas for the treatment of bacteria. Based on the ultracentrifugation method, the OMV secreted by Klebsiella pneumoniae were rapidly separated and extracted, then identified and quantified.

Effect of acupuncture on default mode network in patients with migraine based on functional Magnetic Resonance Imaging: a preliminary study / 中国针灸

OBJECTIVE@#To investigate the effect of acupuncture on default mode network (DMN) in migraine patients without aura based on functional Magnetic Resonance Imaging (fMRI).@*METHODS@#Fifteen patients with migraine were included and treated with acupuncture based on "root-knot" theory (Zuqiaoyin [GB 44] for @*RESULTS@#Compared before acupuncture, the functional connections of left parahippocampal cortex (PHC) and anterior medial prefrontal cortex (aMPFC), dorsal medial prefrontal cortex (dMPFC) and lateral temporal cortex (LTC) in DMN after acupuncture were weakened (@*CONCLUSION@#Acupuncture shows good clinical efficacy for migraine without aura, and could adjust the functional connection of DMN.

Application of pneumonia pre-ward in corona virus disease 2019 (COVID-19) / 医学研究生学报

Corona virus disease 2019 (COVID-19) is an emerging respiratory infectious disease first reported in Wuhan, China, with subsequent spread worldwide. Except for a professional medical team sending to the affected area, fever clinics, fever wards, as well as expert groups were set up by Jinling hospital at the first time. Meanwhile, a pneumonia pre-ward was established according to the needs of epidemic prevention and control. To date, a total of 22 pneumonia patients negative for COVID-19 nucleic acid test have been treated in this pneumonia pre-ward, of which 6 are still under treatment, 16 are cured and discharged, with the medical staff free from infection. This article discusses the application and value of pneumonia pre-ward in COVID-19 from aspects of ward setting and management, work flow, treated cases, experience in diagnosis and treatment, etc.

Research Advances in Interventions on Subjective Cognitive Decline / 中国医学科学院学报

Subjective cognitive decline(SCD),a clinical condition in the early stage of Alzheimer's disease,manifests as a continuous decrease in the individual's self-conscious cognitive function but with normal objective cognitive indicators. Research on SCD helps to identify individuals at high risk of senile dementia and explore the effective prevention and intervention strategies. This article reviews the recent research advances in SCD,with an attempt to provide evidence for early intervention in patients with SCD.

Nutritional status alters the mRNA expressions of galanin and its receptors in taste buds of rats / 生理学报

The nutritional and metabolic status alters the peripheral taste perception and food intake by participating in the modulation of taste information integration. The taste receptors and neuropeptides in the taste buds are the important targets of this modulation process. To explore the effects of nutritional status on the expressions of galanin and its receptors in the taste buds, we compared the mRNA levels of galanin and its specific receptor GalR2 in the taste buds among the high-fat diet induced obese rats (HF), chronically restricted diet rats (CR) and control rats. The high-fat diet, half of chow diet, and normal chow diet were given to HF, CR and control groups for 6 weeks, respectively. The body weight and some metabolic indexes, including blood glucose, triglyceride and cholesterol levels were detected. The mRNA expressions of galanin and its receptors in taste buds were determined using real-time PCR. Results showed that compared with control rats, the body weights, levels of blood glucose and triglyceride were significantly elevated in HF rats; while the mRNA expressions of galanin and GalR2 were dramatically decreased. However, galanin mRNA expression in CR rats was increased to 2.3 times of that in control group. Considering the results obtained from our previous studies, we conclude that the behavioral changes in tasting choice of HF rats may be related to the expressions of galanin and GalR2 in the taste buds. The changes of galanin and GalR2 in taste buds are involved in the peripheral mechanism of nutritional status regulating taste perception and feeding behavior in rats.

Observation on therapeutic effect of acupuncture at "experienced ten acupoints" for postprandial distress syndrome / 中国针灸

OBJECTIVE@#To observe the clinical effect of acupuncture at "experienced ten acupoints" for postprandial distress syndrome.@*METHODS@#A total of 62 patients with postprandial distress syndrome were randomly divided into an observation group (31 cases, 5 cases dropping off) and a control group (31 cases, 6 cases dropping off ). Acupuncture was applied at Baihui (GV 20), Zhongwan (CV 12), Qihai (CV 6), Tianshu (ST 25), Neiguan (PC 6), Zusanli (ST 36), Gongsun (SP 4), Danzhong (CV 17) in the observation group. In the control group, 6 non-acupoint points were intervened with shallow puncture. The treatment was given 20 min each time, once every other day, 3 times a week for a total of 4 weeks in the two groups. Symptom index of dyspepsia (SID) and Nepean dyspepsia index (NDI) scores were compared before and after treatment, and the efficacy was evaluated in the two groups.@*RESULTS@#The effective rate in the observation group was 76.9% (20/26), which was higher than 28.0% in the control group (7/25, <0.01). After treatment, the SID and NDI scores in the two groups were lower than those before treatment (<0.01, <0.05), and the SID and NDI scores in the observation group were lower than those in the control group (<0.01, <0.05).@*CONCLUSION@#Acupuncture at "experienced ten acupoints" can significantly reduce the symptoms of dyspepsia and improve the quality of life in patients with postprandial distress syndrome.

Pediatric projects funded by National Natural Science Foundation of China from 2009 to 2018: retrospect and prospects / 中国当代儿科杂志

OBJECTIVE@#To perform a review and data analysis of the pediatric projects funded by National Natural Science Foundation of China from 2009 to 2018, and to investigate the changes in key support areas, research interest, and research hotspots in pediatrics.@*METHODS@#The database of National Natural Science Foundation of China was searched to screen out pediatric research projects in 2009-2018, and the changes in funding intensity and research direction were analyzed.@*RESULTS@#From 2009 to 2018, a total of 1 017 pediatric projects were funded by National Natural Science Foundation of China, with 485 (47.69%) General Projects, 426 (41.89%) Youth Fund Projects, 73 (7.18%) Regional Research Programs, 16 (1.57%) Key Programs, 6 (0.59%) Outstanding Youth Fund Projects, 7 (0.69%) Overseas Programs, and 4 (0.39%) other programs. There was a seven-fold increase in the total amount of subsidies, which increased from 8.42 million yuan in 2009 to 66.25 million yuan in 2018. The projects with the Primary Discipline Code of reproductive system/perinatology/neonatology, nervous system and mental illness, or circulatory system received the highest amount of fund.@*CONCLUSIONS@#The support of pediatric projects by National Natural Science Foundation of China continues to increase in the past ten years, and the main types of projects are General Projects and Youth Fund Projects. Neonatology, nervous system/mental illness, and circulatory diseases are the main directions of funded projects.

Research Advances in Insomnia Disorder Based on Magnetic Resonance Imaging / 中国医学科学院学报

As the most common sleep disorder,insomnia decreases the quality of life and is the high risk for cardiovascular disease,neurological disease,and psychiatric disease. It has become a major public health problem. In recent years,magnetic resonance imaging technology has been widely used for research on the brain structure in patients with insomnia. This article summarizes recent research findings of the abnormal brain structure and the potential neural mechanism of insomnia,with an attempt to understand the mechanisms in abnormal brain regions and thus further identify the pathophysiology of insomnia.

Bloodstream infections with O16-ST131 and O25b-ST131: molecular epidemiology, phylogenetic analysis and antimicrobial resistance / 南方医科大学学报

OBJECTIVE@#To investigate the phylogenetics and prevalence of bloodstream infections with ST131, the antimicrobial resistance profiles of the pathogens, and the clinical features.@*METHODS@#Non-duplicate isolates were collected from 144 patients with bloodstream infections in our hospital between January and December, 2016.The phylogenetic groups of the isolates were analyzed using multiplex PCR, and O serotyping of ST131 strains was performed by allele-specific PCR.The clinical characteristics of the 144 patients were analyzed to define the differences in the clinical features between patients with ST131 infection and those with non-ST131 infection.Antibiotic susceptibility of the isolates was determined using the Vitek 2 compact system.@*RESULTS@#The phylogenetic group analysis showed a domination by group B2 (41.0%[59/144]), followed by group F, group B1 and group E, which accounted for 16.7%(24/144), 13.9%(20/144), and 13.2% (19/144), respectively.Nine strains (6.3%) of were identified to be ST131 strains, among which 8 were O25b-B2-ST131 strains and 1 was O16-B2-ST131 strain.Of the 9 cases of ST131 infection, 7(77.8%) were found to occur in a nosocomial setting.The demographic characteristics and clinical features of the ST131-infected patients were similar to those of non-ST131-infected patients.ST131 strains were sensitive to piperacillin/tazobactam, imipenem, ertapenem, and amikacin, but showed high resistance rates to cefazolin, ceftriaxone, ciprofloxacin, levofloxacin, gentamicin, and trimethoprim/ sulfamethoxazole (all over 50%).The positivity rate of ESBLs in the ST131 strains was 77.8%, and the multidrug resistance rate reached 88.9%, which was higher than that of non-ST131 isolates, but the difference was not statistically significant.@*CONCLUSIONS@#The most common phylogenetic groups of isolates from patients with bloodstream infections are group B2 and F, and the positivity rate of ST131 is low.We for the first time detected O16-ST131 in patients with blood-borne infections in China.The clinical features of ST131-infected patients are similar to those of non-ST131-infected patients.The positivity rate of ESBLs and the multidrug resistance rate are high in ST131 strains, which may raise concerns in the future.

Influencing factors for the psychological burden of depressive patients'caregivers / 预防医学

Objective To investigate the influencing factors for the psychological burden of depressive patients' caregivers. Methods We enrolled the chief caregivers of depressive patients who were hospitalized in Sir Run Run Shaw Hospital as our subjects. We investigated them by Caregiver Burden Inventory, Social Support Revalued Scale (SSRS) , Hamilton Depression Scale (HAMD) and Suicide Risk Assessment Scale, and learned influencing factors for the psychological burden of these caregivers by multiple linear regression analysis. Results We totally enrolled 101 subjects and collected 96 questionnaires (95.04%) . The 96 respondents scored (24.88±12.94) points in the psychological burden and 54 of which scored more than 20 points, accounted for 56.25%. The positive rate of mental pressure was 65.63%, which was the lowest; the positive rate of social burden was 93.75%, which was the highest. Multiple linear regression analysis showed that the objective support (β=-1.856, P=0.002), subjective support (β=0.526, P=0.008) and high suicidal score of depressive patients (β=0.290, P=0.048) were the influencing factors for the psychological burden of depressive patients' caregivers. Conclusion More than half of the caregivers have psychological burden, which is associated with objective support, subjective support and high suicidal score of depressive patients.

Distribution,antimicrobial resistance of pathogens from blood culture,and risk factors for death of children with leukemia / 中国感染控制杂志

Objective To observe distribution and antimicrobial resistance of pathogens from blood culture of chil-dren with leukemia,and study risk factors.Methods From September 2013 to November 2016,species and antimi-crobial resistance types of 131 strains of pathogens isolated from blood culture of 110 children in a pediatric hemato-logy ward were analyzed,childrens'clinical data were also analyzed statistically.Results 131 strains(5.23%)of pathogens were isolated from 2 505 blood culture specimens,gram-negative bacilli and gram-positive cocci accounted for 52.67% and 43.51% respectively,the top 3 pathogens were Escherichia coli(15.27%),Klebsiella pneumoniae (15.27%),and Staphylococcus hominis(12.98%). Gram-negative bacilli were highly resistant to ampicillin,ce-fazolin,ceftriaxone,and ampicillin/sulbactam,but sensitive to amikacin,cefoperazone/sulbactam,piperacillin/tazobactam,and carbapenems;gram-positive cocci had higher resistance to penicillin,oxacillin,erythromycin,and clindamycin,but were sensitive to tigecycline,linezolid,vancomycin,and quinupristin/dalfopristin. Univariate analysis showed that mixed infection,diarrhea,Pseudomonasaeruginosa infection,and Acinetobacterbaumannii in-fection were related to mortality due to bloodstream infection in children with leukemia.Conclusion Pathogens cau-sing bloodstream infection in children with leukemia is widely distributed,antimicrobial resistance rate is high,it is very im-portant to take active precaution and rational treatment according to antimicrobial susceptibility testing result.

The relationship between obstructive sleep apnea hypopnea syndrome and renal function in patients with type 2 diabetes mellitus / 中华内分泌代谢杂志

Objective To observe the effect of obstructive sleep apnea hypopnea syndrome (OSAHS) on the renal function in patients with type 2 diabetes mellitus (T2DM).Methods Sleep apnea hypopnea index (AHI), oxygen desaturation index (ODI), and nighttime lowest oxygen saturation (LSaO2) were evaluated in 298 patients with T2DM using a portable sleep apnea monitor.Patients were divided into T2DM without OSAHS group (n=120) and with OSAHS group (n=178) according to AHI90 ml·min-1·(1.73 m2)-1 (n=190), 90>eGFR>60 ml·min-1·(1.73 m2)-1 (n=84), eGFR<60 ml·min-1·(1.73 m2)-1 (n=24).The influencing factors of eGFR and AHI were analyzed by logistic regression analysis.Results There were significant differences in eGFR, uric acid (UA), high density lipoprotein-cholesterol (HDL-C), waist circumference, hip circumference, body mass index (BMI), and urinary albumin between T2DM without OSAHS and with OSAHS groups(all P<0.05).eGFR showed a significant correlation with AHI(r=-0.154, P=0.008), ODI(r=-0.236,P<0.01),and LSaO2(r=0.145, P=0.024).Logistic regression revealed that eGFR(OR=0.991, 95%CI 0.983~0.998, P=0.014), BMI(OR=1.107, 95%CI 1.028~1.193, P=0.008)were independent risk factors for AHI.There were significant differences in age, urinary albumin, AHI, ODI, LSaO2 among groups with various eGFR levels (P<0.05).Stepwise regression showed that age(β=-0.456, 95%CI-0.571~-0.346,P<0.01)and AHI(β=-0.119, 95%CI-0.226~-0.007,P=0.037) were independent risk factors for eGFR.Conclusions OSAHS is a risk factor for renal impairment in patients with T2DM.

Analysis for biofilm, quorum sensing related genes and drug resistance in clinical isolates of Pseudomonas aeruginosa / 临床检验杂志

Objective To study the relationship between biofilm-forming ability,distribution of quorum sensing related genes and antibiotic resistance in clinical isolates of Pseudomonas aeruginosa.Methods The biofilm-forming ability of 94 clinical isolates was analyzed semi-quantitatively by crystal violet staining.The antibiotic resistance of the isolates was determined by K-B method.Quorum sensing related genes,lasI,lasR,rhlR and rhlI,were detected by PCR.The diffe,rences of drug resistance of Pseudomonas aeruginosa with different biofilm-forming ability and the effects of quorum sensing related genes on biofilm-forming ability were analyzed.Results Of the 94 isolates,89(94.7％) showed biofilm-forming ability.The 89 isolates consisted of 22(23.4％) isolates with weakly positive biofilm-forming ability,44 (46.8 ％) with positive biofilm-forming ability and 23 (24.5 ％) with strongly positive biofilm-forming ability.The strains of Pseudomonas aeruginosa with different biofilm-forming ability showed different drug resistance rates to amikacin,tobramycin and gentamicin (P ＜ 0.05).The drug resistance rate of the strains with strong positive biofilm-forming ability to amikacin was higher than that of the strains with positive and weakly positive biofilm-forming ability(P ＜ 0.05),and the drug resistance rates to tobramycin and gentamicin were higher than those of the strains with weakly positive biofilm-forming ability(P ＜ 0.05).Of the 94 isolates,91 strains carried lasI,lasR,rhlI and rhlR gene and 2 strains only lost lasR gene,and 1 strain lost all the 4 genes.The strains with only lasR gene deficiency or all the lasI,lasR,rhlI and rhlR gene deficiencies showed negative biofilm-forming ability,and were sensitive to conventional antimicrobial agents.Conclusion Most of the clinical isolates of Pseudomonas aeruginosa in this study showed strong ability of biofilm-forming ability which may correlate positively to partial antibiotic resistance.The quorum sensing related genes may affect biofilm formation of Pseudomonas aeruginosa.

Drug resistant mechanism and homology analysis of carbapenem-resistant Klebsiella pneumoniae isolated from different sites of one patient / 临床检验杂志

Objective To investigate the drug resistant mechanism and homology of three strains of carbapenem-resistant Klebsiella pneumoniae (K.pneumoniae) isolated from different sites of one patient.Methods Three strains of carbapenem-resistant K.pneumoniae were isolated from femoral vein catheter tip,wound secretions and sputum of a patient with severe burns,respectively.Their carbapenemase,metallo-β-lactamase (MBL) and drug resistance genes were detected by modified Hodge test,double-disk synergy test and combination disk diffusion and PCR,respectively,and homology and biological typing were analyzed by enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) assay and multilocus sequence typing (MLST) technology,respectively.Results The carbapenemase and MBL of three strains of carbapenem-resistant K.pneumoniae were negative and positive,respectively.The blaNDM-1 gene was identified from the three strains,but other drug resistance genes such as blanC,blaGES,blaIMP,blaSPM,blaVIM,blaGIM and blaOXA-48 were not detected.ERIC-PCR showed that three isolates belonged to the same genotype,and MLST showed that they were type ST17.Conclusion Carring blaNDM-1 gene is the main cause leading to the drug resistance of three strains of carbapenem-resistant K.pneumoniae,and they belong to the same genotype.

Design of high-speed data acquisition system for very high frequency medical ultrasonic echo signals / 医疗卫生装备

Objective To develop a high-speed data acquisition system for very high frequency medical ultrasonic echo signals. Methods The chip LTC2285 with two integrated ADC channels was adopted to realize analog-to-digital conversion of ultrasonic echo signals. The sampling rate was 120 MHz. The converted digital signals were then input to the FPGA to realize parallel to serial conversion, and high-speed digital signals with a sampling rate of 240 MHz were obtained. Finally, the data were transferred through USB interface to the computer terminal to display. Results A timing simulation experiment, a resolution detection experiment, and an in vivo experiment of normal human eyes were carried out in this system. A preferable simulation result and real-time image were obtained. Conclusion The multi-channel and FPGA technology are used in the design of the system. Lastly, this technology simplifies the overall design of the system and improves the speed and reliability of the high speed data acquisition system.

In vitro analysis of the antibacterial activity of Micafungin against Pseudomonas aeruginosa / 中华检验医学杂志

Objectives Selecting and constructing the biofilm -model of Pseudomonas aeruginosa in vitro.Observing the antibacterial activity of using Micafungin alone , or combined with Meropenem against Pseudomonas aeruginosa ( plankton-grown and biofilm-grown ) . Methods Ten clinical isolates of Pseudomonas aeruginosa were collected in July 2012, constructing the biofilm-model by microwell plate from Xiangya Hospital, Central South University.The ability of biofilm-formation of these strains was estimated by crystal violet colorimetric method, and optical microscope was used to observe the shape of the biofilm .MICs of Micafungin and Meropenem against plankton -grown and biofilm-grown Pseudomonas aeruginosa were tested by broth microdilution method, and the changes of MICs were compared.Using broth microdilution method, and connecting with the crystal violet colorimetric method , to observe the antibacterial effect of using Micafungin alone, or combined with antibiotics in the inhibition of the biofilm formation and destruction of mature biofilm of Pseudomonas aeruginosa.SPSS18.0 and t-test were used in comparing the differences between both treatment group and control group.P <0.05 showed the difference was statistically significant . Results Ten strains of Pseudomonas aeruginosa were successful in forming biofilms.Comparing with their planktonic counterparts, biofilms became more resistant to Meropenem , with the MIC raised 4-128 times. However, MIC of Micafungin could not be measured.Micafungin can inhibit the formation of biofilm in 9 experimental strains (PA1-PA9), where the minimum effective concentration of Micafungin were 156.25, 625, 10 000, 2 500, 1 250, 2 500, 1 250, 625 and 10 000 mg/L respectively.The absorbance values of the minimum effective concentration group and its positive growth control group were 0.342 ±0.020 vs 0.491 ±0.027, 0.512 ±0.018 vs 0.627 ±0.043, 0.862 ±0.021 vs 1.155 ±0.027, 0.731 ±0.028 vs 0.863 ± 0.017, 0.311 ±0.003 vs 0.447 ±0.021, 0.435 ±0.021 vs 0.597 ±0.011, 0.520 ±0.012 vs 0.605 ± 0.027, 0.611 ±0.059 vs 0.734 ±0.017, 0.223 ±0.011 vs 0.343 ±0.037 respectively, where the P values were 0.02, 0.03, 0.00, 0.01, 0.01, 0.00, 0.03, 0.01 and 0.03 respectively.The differences are statistically significant.Micafungin can damage the mature biofilm of 7 strains (PA1, PA2, PA4 -PA8), where the minimum effective concentration of Micafungin were 2 500, 2 500, 5 000, 2 500, 5 000, 2 500, 5 000 mg/L respectively.The absorbance values of the minimum effective concentration group and its positive growth control group were 1.459 ±0.014 vs 1.534 ±0.020, 1.279 ±0.020 vs 1.431 ±0.007, 1.365 ±0.024 vs 1.467 ±0.065, 1.322 ±0.028 vs 1.530 ±0.090, 0.920 ±0.004 vs 1.047 ±0.013, 1.860 ±0.005 vs 1.953 ±0.055, 1.407 ±0.005 vs 1.553 ±0.045 respectively, where the P values were 0.01, 0.01, 0.02, 0.01, 0.00, 0.03, 0.02.The difference is statistically significant.Micafungin combined with Meropenem applied in multiple drug resistant strains , which can inhibit the formation of biofilm better.Conclusions Micafungin can inhibit the formation Pseudomonas aeruginosa biofilm and damage the mature biofilms.Micafungin combined with Meropenem can act on multiple drug resistant strain , which may get a higher inhibition rate of the biofilm.

Clinical distribution and antimicrobial resistance of 427 Serratia marces-cens isolates / 中国感染控制杂志

Objective To understand clinical distribution and antimicrobial resistance of clinically isolated Serratia marcescens(S .marcescens ),and provide basis for rational use of antimicrobial agents,as well as prevention and control of infection.Methods 427 S .marcescens strains isolated between January 1 ,2012 and December 31 ,2015 were analyzed,antimicrobial susceptibility testing were performed by disk diffusion method.Results 427 S . marcescens strains were mainly from respiratory tract (70.26%),among which the majority were from sputum (64.87%).S .marcescens were primarily from intensive care unit(ICU,19.44%),department of integrated tradi-tional Chinese and Western medicine(15.46%)as well as rehabilitation department (13.58%).The resistance rates of S .marcescens to cefoperazone/sulbactam,ertapenem,cefepime,ceftazidime,amikacin,imipenem,levofloxacin, and piperacillin/tazobactam were all<10%;resistance rates to ciprofloxacin,gentamicin,tobramycin,ceftriaxone, sulfamethoxazole/trimethoprim (SMZ/TMP),and aztreonam were 10%-30%.Difference in the resistance rates of S .marcescens to cefoperazone/sulbactam,ciprofloxacin,ceftriaxone,amikacin,aztreonam,and SMZ/TMP dur-ing 4 years were statistically significant (P <0.05).In 2012-2013,resistance rates of S .marcescens to cefopera-zone/sulbactam,ciprofloxacin,ceftriaxone,aztreonam,and SMZ/TMP increased obviously,then resistance rates tend to be stable,while resistance rates to cefoperazone/sulbactam decreased.Conclusion Susceptibility of S.marcescens to most antimicrobial agents are high,but resistance had increasing tendency;susceptible rates of S .marcescens to ertapenem,ceftazidime,levofloxacin,and piperacillin/tazobactam are all high,and can be used as the empirical medication for the treatment of related infection.

Distribution and changes in antimicrobial resistance of pathogens from blood culture in a tertiary first-class hospital in 2012-2015 / 中国感染控制杂志

Objective To investigate the distribution and change in antimicrobial resistance of pathogens causing blood-stream infection,so as to provide reference for rational antimicrobial use.Methods The isolation and antimicrobial resistance of major pathogens from blood culture specimens from a tertiary first-class hospital in 2012-2015 were analyzed statistically.Results A total of 4 780 isolates were detected,the top five species were Escherichia coli (n = 1 008, 21.09%),Klebsiella pneumoniae (n = 624,13.05%),Acinetobacter baumannii (n = 452,9.46%),Staphylococcus aureus (n=437,9.14%),and Pseudomonas aeruginosa (n=247,5.17%).The percentage of gram-negative bacilli, gram-positive cocci,fungi,and others were 62.05%,29.31%,7.76%,and 0.88% respectively.The resistance rates of Klebsiella pneumoniae to ertapenem and imipenem increased from 4.50% in 2012 to 46.79% and 33.94% in 2015(both P<0.01).The resistance rates of Acinetobacter baumannii to cefepime,ceftazidime,tobramycin,gentamicin,and imipenem were 86.50%,80.56%,78.10%,79.87%,and 84.29% respectively;resistance rates to amikacin in 2012-2015 were 0, 10.22%,39.85%,and 21.30% respectively(P<0.01);resistance rates to minocycline in four years were 0-7.52% (P<0.01 ).Conclusion The main pathogens causing bloodstream infection are gram-negative bacilli,Acinetobacter baumannii is highly resistant to cephalosporins and carbapenems,resistance rates of Klebsiella pneumoniae to carbapenems increased rapidly.Broad-spectrum antimicrobial agents must be used cautiously to reduce the selective pressure of antimicrobial agents.

An Outbreak of Infections Caused by a Klebsiella pneumoniae ST11 Clone Coproducing Klebsiella pneumoniae Carbapenemase-2 and RmtB in a Chinese Teaching Hospital / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae bacteria, which cause serious disease outbreaks worldwide, was rarely detected in Xiangya Hospital, prior to an outbreak that occurred from August 4, 2014, to March 17, 2015. The aim of this study was to analyze the epidemiology and molecular characteristics of the K. pneumoniae strains isolated during the outbreak.</p><p><b>METHODS</b>Nonduplicate carbapenem-resistant K. pneumoniae isolates were screened for blaKPC-2and multiple other resistance determinants using polymerase chain reaction. Subsequent studies included pulsed-field gel electrophoresis (PFGE), multilocus sequence typing, analysis of plasmids, and genetic organization of blaKPC-2locus.</p><p><b>RESULTS</b>Seventeen blaKPC-2-positive K. pneumoniae were identified. A wide range of resistant determinants was detected. Most isolates (88.2%) coharbored blaKPC-2and rmtB in addition to other resistance genes, including blaSHV-1, blaTEM-1, and aac(3)-IIa. The blaKPC-2and rmtB genes were located on the conjugative IncFIB-type plasmid. Genetic organization of blaKPC-2locusin most strains was consistent with that of the plasmid pKP048. Four types (A1, A2, A3, and B) were detected by PFGE, and Type A1, an ST11, was the predominant PFGE type. A novel K. pneumoniae sequence type (ST1883) related to ST11 was discovered.</p><p><b>CONCLUSIONS</b>These isolates in our study appeared to be clonal and ST11 K. pneumoniae was the predominant clone attributed to the outbreak. Coharbing of blaKPC-2and rmtB, which were located on a transferable plasmid, in clinical K. pneumoniae isolates may lead to the emergence of a new pattern of drug resistance.</p>