Relationship of pks gene islands with virulence genes and biofilm formation in Klebsiella pneumoniae / 中华微生物学和免疫学杂志

Objective:To investigate the relationship of pks gene islands with virulence genes, capsular serotypes and biofilm formation in Klebsiella pneumoniae ( Kp). Methods:A total of 113 Kp clinical isolates were collected in the First Affiliated Hospital of Fujian Medical University and divided into two groups based on the presence of pks gene islands: pks+ and pks- groups. The hypermucoviscous (HM) phenotype was detected by string test. Five virulence genes ( peg-344, rmpA, rmpA2, iucA, iroB) and six common capsular serotypes (K1, K2, K5, K20, K54, K57) were detected by polymerase chain reaction (PCR). The biofilm formation ability was measured by crystal violet staining. Results:Among the 113 Kp isolates, 46 were pks+ strains and 67 were pks- strains. The detection rate of HM phenotype was higher in the pks+ group than in the pks- group [87.0% (40/46) vs 43.3% (29/67)]. The detection rates of virulence genes ( peg-344, rmpA, rmpA2, iucA, iroB) and K1 serotype in the pks+ group were also higher than those in the pks- group ( P<0.05). The biofilm formation ability of the pks+ strains was higher than the pks- strains ( P<0.05). Conclusions:Kp strains carrying pks gene islands were likely to display a HM phenotype and mainly belonged to the K1 serotype. Most of the pks+Kp strains carried the virulence genes of peg-344, rmpA, rmpA2, iucA and iroB, and had a greater ability to form biofilms.

Comparative evaluation of susceptibility testing methods for colistin and polymyxin B on isolates of Enterobacteriaceae / 中华检验医学杂志

Objective:To provide a promising and optimal laboratory susceptibility-testing method for the clinical usage of antibiotic (polymyxin), four susceptibility-testing methods were performed and the broth microdilution (BMD) was chosen as the gold standard.Methods:A total number of eighty-eight nonduplicate clinical Enterobacteriaceae specimes were collected from January to December of 2019 in the First Affiliated Hospital, Fujian Medical University. Among the clinical specimens, of which six strains were positive for mcr-1. The minimal inhibitory concentration (MIC) of polymyxin of the clinical specimens were examined by the following methods: (1) broth microdilution, (2) colistin broth disk elution, (3) Vitek-2?, (4)BD PhoenixTM,(5)commercial broth microdilution. With BMD as reference, essential agreement (EA), categorical agreement(CA), very major error(VME) and major error (ME) of polymyxins for different methods were analyzed. The Kappa-consistency testing, paired Chi-square testing and the Spearman-rank correlation testing were used to analyze the consistency between the four antimicrobial susceptibility testing methods and the gold standard.Results:Taking broth microdilution as reference, the EA of colistin broth disk elution, Vitek-2?, BD PhoenixTM, commercial broth microdilution were 94.32% (83/88), 92.05% (81/88), 90.90% (80/88), and 96.59%(85/88), respectively. The CA of all the four methods were 100% (88/88). No VME and ME were recorded for four methods. Moreover, the consistency between four susceptibility testing methods and the gold standard is acceptable (Kappa values=1, P<0.001, McNemar test P=1 and r>0.5, P<0.05). Conclusions:In the present work, four susceptibility testing methods all met the standards recommended jointly by the Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing, of which the performance of the commercial broth microdilution and CBDE fared relatively well. Thus, these four methods could be routinely used in clinical microbiology laboratory of our hospital for colistin and polymyxin B susceptibility testing.

Protection of medical data rights from the perspective of private law / 中华医院管理杂志

With the rapid development of " Internet+ healthcare" , medical data has gained an ever important role. How to determine the reasonable use boundary of medical data and leverage its supporting role, has grown an urgent problem to be solved. The authors analyzed the characteristics of medical data, and held that medical data is not equivalent to information, as it does not have the characteristics of legal objects in nature. In addition, it lacks originality. Therefore it is difficult to protect through the existing rights system. However, due to its property interest and personality, the authors tried to establish a new right for protection. In the construction of such medical data right, the authors claimed that patients should be the subject of the right, and medical institutions can appropriately restrict the freedom of patients′ through reasonable use rules and legal licensing system. In this way, we can not only promote medical data sharing and the development of social health, but also fully protect the legitimate rights and interests of patients.

Exploration and practice of student' clinical thinking ability in the courses of Medical Laboratory Technology / 中华医学教育探索杂志

This study was conducted to explore a proper training model of interns' clinical thinking ability under the construction of a new four-year system of medical laboratory technology courses, combined with the establishment of innovative standard whole process practice mode. Multi-teaching methods of clinical thinking, such as explanation of laboratory sheet, interactive teaching based on micro digital system, interdisciplinary multiple information system, combined PBL teaching and intern report, were applied and evaluated in the laboratory. Integrated application of these methods remarkably improved the intern's com-prehensive professional quality and their practice performance. All methods received high evaluation from both the interns and teachers.

Clinical distribution and drug resistance of 179 isolates of Streptococcus agalactia / 国际检验医学杂志

Objective To investigated the clinical distributions and antimicrobial susceptibility of Streptococcus agalactia strains isolated from the patients .Methods The identification and susceptibility of the strains were mainly measured by automatic VITEK‐Ⅱ system ,the K‐B disc diffusion tests were used for the resistance test of erythromycin ,meropenem ,and D‐test .Results The iso‐lates were mainly from urine (63 .1% ) ,genital tract(7 .8% ) and wound secretion(6 .7% ) .They were obtained from patients in dif‐ferent situations ,including 110 patients who were older than 50 years old (61 .5% ) ,113 female patients (63 .1% ) ,12 gravidas (6 .7% ) ,3 vertical transmitted newborns(1 .7% ) ,and 82 patients with cancer ,undergoing chemo radiotherapy ,with diabetes ,tuber‐culosis or after operations(45 .8% ) .The resistant rates of the isolated Streptococcus agalactia to erythromycin and clindamycin were 42 .9% -93 .3% and 41 .9% -80 .0% respectively .The positive rate of D‐test was 4 .1% .The strains were highly resistant to tet‐racycline(>80% ) ,while the resistance to penicillin was below 10% except in 2008 .All isolates were susceptible to vancomycin and meropenem .Only one strain was resistant to Quinupristin‐dalfopristin .Conclusion Streptococcus agalactia infection in adults most‐ly cause genitourinary tract ,skin and soft tissue infections .There were more females than males with Streptococcus agalactia infec‐tion .Penicillin andβ‐lactams are still the first choice for the treatment .Erythromycin ,clindamycin and tetracycline should be used with caution under the guidance of laboratory susceptibility test results .

Establishment and application of cubic and conductive teaching pattern in clinical microbiolog-ical analysis / 中华医学教育探索杂志

Cubic and conductive teaching pattern is based on standardized operation process of microbiological specimens. It uses multi-dimensional teaching methods including tests, question guid-ance, discussion, lectures, measurements and scientific researches to lead the undergraduate students to master the standardized inspection process and to train talents with good gifts and abilities in prac-tical application. The teaching pattern helps the trainees complete training in basic experiment skills, analysis and problem solving skills, scientific thinking and working methods. Then the corresponding practical quantification evaluation criteria has been established according to the standardized inspec-tion process to assess the interns' level of grasping various vocational skills and comprehensive appli-cation in the inspection process. This pattern reflects the teaching philosophy of modern laboratory medicine and can scientifically and objectively assess the talent cultivation quality and teaching quality. Since its implementation, these trainees have improved their overall vocational abilities, and made a good preparation for their practical work after school. Besides, it has enhanced the teaching level of microbiology laboratory practice and has been highly valued by interns. It is hoped that this practical experience will be a useful attempt to promote medical education development of modern laboratory medicine.

The value of galactomannan detection in bronchoalveolar lavage fluid in the diagnosis of invasive pulmonary aspergillosis in elderly patients with lung diseases / 中华老年医学杂志

ObjectiveTo evaluate the role of galactomannan (GM) detection in bronchoalveolar lavage fluid (BALF) in the diagnosis of invasive pulmonary aspergillosis (IPA) in elderly patients with lung diseases.MethodsThe elderly patients with lung diseases and suspected of having IPA were enrolled. BALF for culture and GM detection, and serum samples for GM detection were obtained from all participants.According to European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) with host factors, clinical criteria, mycological evidence and histological or cytopathological evidence, all patients were categorized into the proven, probable,possible and no IPA patients. The IPA patients were considered as IPA group while no IPA was considered as control group. ResultsAmong 76 enrolled elderly patients, 18 cases were diagnosed with IPA (1 proven, 11 probable and 6 possible), the remained 58 patients were as control group.Based on a GM index cutoff value of ≥0. 5, the sensitivity, specificity, positive predictive value and negative predictive value for BALF were 83.3％, 82. 8％, 60.0％ and 94.1％, respectively; these variables in serum were 55.60％ , 91.4 ％, 66.7 ％ and 86.9％ , respectively. Using a GM index cutoff value of ≥1.0, the specificity and positive predictive value of both BALF GM and serum GM reached 100％, but the sensitivity and negative predictive value of BALF GM were higher than serum GM (66.7％ vs. 22.2％, 90.60％ vs. 80.60％, respectively). Receiver operating characteristic curve analysis yielded a sensitivity of 83.4％ and a specificity of 96.6％ at a BALF GM index cutoff value of ≥0.725. ConclusionsGM detection in BALF seems to be a useful tool in the diagnosis of IPA in elderly patients with lung diseases,and could be widely used in future.