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Objective To investigate the molecular epidemiological characteristics of the Acinetobacter baumannii strains isolated from blood and sputum samples of patients with ventilator-associated pneumonia (VAP) in ICU.Methods The patients were analyzed in two groups:Group A,A.baumannii was isolated from both blood and sputum,and Group B,A.baumannii was isolated only from sputum.Clinical data of the patients were collected,including the results of antimicrobial susceptibility test.Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were performed for the strains.Results During the study period from June 2015 to December 2105,28 nonduplicate A.baumannii strains were collected from 14 patients in group A and 28 nonduplicate strains from 28 patients in group B.The 56 A.baumannii strains were multidrug-resistant (MDR).More than 80％ of the strains were resistant to carbapenem,third-generation cephalosporins or aminoglycoside,but highly sensitive to tigecycline.No significant difference was found for the resistance rates between group A and group B.The nonduplicate A.baumannii isolates from blood and sputum samples of the same patient in group A were all homologous strains confirmed by PFGE.Six pulsotypes were identified from the 28 strains in Group A and 9 pulsotypes in Group B.Five pulsotypes were shared between the two groups.MLST analysis showed that there were 9 ST types (ST195,ST208,ST229,ST369,ST373,ST457,ST836 and two new phenotypes ST N2,ST N5) in Group A and 8 ST types (ST195,ST208,ST381 and 5 new phenotypes ST N1,ST N2,ST N3,ST N4,ST N5) strains in group B.There was no significant difference in the proportion of the main ST types between the two groups.eBURST analysis indicated that ST195,ST208,ST457,ST369,ST N1,ST N2,ST N51 belonged to CC92 prevalent strain.Conclusions The antimicrobial susceptibility profile and genotype of A.baumannii isolates from blood and sputum samples are similar.There was CC92 prevalent strain in the ward.There is no direct relation between the risk factors for bloodstream infection in VAP patients and the genotype of A.baumannii strain.It is particularly important to reinforce infection control for prevention and treatment ofA.baumannii bloodstream infections.
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We report a case of cutaneous and subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei after renal transplantation in Guangdong. A 66-year-old man who had a renal transplantation 6 years ago was admitted in October 2011 for the presence of 16 nodules (0.5-1.5 cm) found on his right middle finger, wrist and forearm for 5 months. Microscopic examination of the purulent exudate showed segmented and branched brown mycelium, and tissue biopsy and PAS staining showed fungal hyphae. The isolate was processed for morphological identification and molecular sequence analysis. A black colony was found after culture of the isolate on SDA at 26 degrees Celsius;, and small culture identified the isolate as Exophiala jeanselmei. ITS sequence analysis of the isolate showed a 100% homology with Exophiala jeanselmei. E-test strip was used in drug sensitivity test, and the isolate was sensitive to amphotericin B, voriconazole, itraconazole and fluconazole, but resistant to 5-flucytosine and caspofungin. Good response was obtained with surgical intervention, local injection and systemic antifungal treatment.
Sujets)
Sujet âgé , Humains , Mâle , Exophiala , Virulence , Transplantation rénale , Phaeohyphomycose , Complications postopératoiresRésumé
Objective To study phylogenies, epidemiology and genetic environment of CTX-M type of ESBLs produced by Escherichia coli and Klebsiella pneumoniae isolated from nine hospitals in Guangzhou. Methods The phylogenies of CTX-M type of ESBLs were analyzed by PCR Genetic environment of CTX-M-15 encoding gene (bla_(CTX-M-15)) were investigated by conjugation test and plasmid analysis. The clonal relationship of strains producing CTX-M-15 was determined by enterobacterial repetitive intergenic consensus PCR (ERIC-PCR). Results A total of 361 ESBLs-producing isolates of Escherichia coli and Klebsiella pneumoniae were collected. 67.3% of ESBLs strains were detected to produce CTX-M-type ESBLs, and the commonest genotypes in Escherichia coli and Klebsiella pneumoniae were CTX-M-14 (35.4% and 28.3%), CTX-M-15(21.5% and 26.1%) EBIC-PCR products of all CTX-M-15-producing strains show 39 strains of Escherichia coli were classified into 27 genotypes while 43 strains of Klebsiella pneumoniae were divided into 30 genotypes. Furthermore, the genotypes of CTX-M-55, CTX-M-19, CTX-M-27, with ceftazidime-hydrelyzing activity, were detected in this study. The great majority of bla_(CTX-M-15) genes were found to locate on a 65 000 bp-conjugative plasmid, and there was no blaTEM-1, bla_(OXA-1), blaDSA-1 or aac (6')-Ib-cr gene coexisted on the plasmid, ISEcp1-like insertion sequences, relative to mobilization of bla_(CTX-M-15) gene, were detected in all bla_(CTX-M-15) positive strains, and the distances between the end of ISEcp1-like insertion sequences and the start cedon of bla_(CTX-M-15) were equal, with 48 base pairs. Conclusion CTX-M-14 is still the most common genotype of ESBLs in Guangzhou, but high prevalence of CTX-M-15 ESBLs hydrolyzing ceftazidime already appears in south China.
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Objective To analyze the incidence of the disease, clinical features, diagnostic criteria, therapy and prognosis of Penicilliosis marneffei found in Guangdong province. Methods To analyze patients data, clinical features, laboratory findings, response to therapy, and prognosis of 15 cases Penicilliosis marneffei found in Guangdong province of China. Results The male was predominant compared with the female (ratio 2 to 1) and without occupational preference, but the patients with AIDS as underlying disease were mostly drivers and the unemployed. Thirteen patients were immunocompromised such as AIDS, connective tissue disease, and kidney transplant. Clinical features showed different manifestations, such as high fever, loss of weight, skin lesion, and respiratory system symptoms. Biopsy of the skin lesion showed PAS stain positive yeast-like, or sausage-form spores. Four patients were localized infection of the skin, eleven patients were systemic infection. Nine patients died, five recovered, 1 patient refused to be treated. Fifteen isolates from different anatomic sites of the patients were identified to be Penicillium marneffei by morphology and dimorphism in the culture, and eleven isolates among these 15 isolates were also confirmed by DNA sequence analysis. Conclusion The incidence rate of Penicilliosis marneffei become higher in the recent years and many patients were accompanied with AIDS in Guangdong province. Attention should be paid to the disease.