Point-of-care testing technology and experimental diagnosis of insect-borne diseases: applications and challenges / 中华检验医学杂志

Insect-borne infections are causing serious public health concerns worldwide. Point-of-care testing technology for insect-borne diseases can rapidly and accurately determine the pathogens, thus it plays an important role in the application of portable disease control measurements. This article provides an overview of the point-of-care testing technology for insect-borne infectious diseases regarding its application, advantages and limitations in experimental diagnoses, and its future trends.

Tetracycline-resistant Neisseria gonorrhoeae strains isolated in a GradeⅢhospital in eastern China:molecular characteristics and genetic diversity / 中华微生物学和免疫学杂志

Objective To analyze the genotypes of Neisseria gonorrhoeae ( N. gonorrhoeae) epi-demic strains in Wenzhou, eastern China, and to study the mechanism of tetracycline resistance in these strains. Methods A total of 77 N. gonorrhoeae strains were isolated from patients with gonorrhea. Antimi-crobial susceptibility of these strains to penicillin, tetracycline, ciprofloxacin, spectinomycin, ceftriaxone and azithromycin was analyzed using E-test. PCR and DNA sequencing were used to detect the genes associ-ated with tetracycline resistance, such as Tet-M, mtrR promoter region and mtrR coding region. N. gonor-rhoeae multi-antigen sequence typing ( NG-MAST) and multilocus sequence typing ( MLST) were used to determine the molecular characteristics of all clinical isolates and tetracycline-resistant isolates, respectively. Results Among the 77 N. gonorrhoeae isolates, 74 (96. 10％), 27 (35. 06％) ,70 (90. 91％) and 15 (19. 48％) were resistant to penicillin, tetracycline, ciprofloxacin and azithromycin, respectively. All tested isolates were susceptible to spectinomycin and ceftriaxone. Nineteen isolates were resistant to tetracycline and all of them carried Tet-M gene. Among them, 17 had one deletion mutation of base A in mtrR promoter region and three had G45D mutation in mtrR coding region. NG-MAST classified the 19 tetracycline-resistant isolates into 11 different sequence types (ST). ST14781, ST1766 and ST1866 each accounted for 15. 79％(three strains). Two ST (10. 52％, 2/19) found in the present study had not been reported previously in the NG-MAST database. MLST showed the 19 tetracycline-resistant isolates belonged to 12 different STs, in which ST10899 accounted for 26. 32％ (five strains) and ST1600 accounted for 15. 79％ (three strains). Conclusions Mutations in mtrR promoter region and carrying Tet-M gene were associated with tetracycline resistance in N. gonorrhoeae. Clinical strains isolated in Wenzhou showed considerable molecular diversity. Measures should be implemented to monitor the spread of NG-MAST ST1766 and MLST ST1600 N. gonor-rhoeae clones with high resistance to tetracycline in Wenzhou.

Detection of fusidic acid resistance in Staphylococcus aureus and analysis of molecular characteristics / 中华微生物学和免疫学杂志

Objective@#To investigate fusidic acid resistance in Staphylococcus aureus (S.aureus) strains and to analyze their molecular characteristics.@*Methods@#A total of 1 333 strains of S. aureus isolated in the First Affiliated Hospital of Wenzhou Medical University from October 2013 to March 2016 were collected. Fusidic acid resistance in these strains was detected by K-B method. Minimum inhibitory concentrations (MIC) of fusidic acid were measured by agar dilution method. Resistance genes of fusB, fusC and fusD and S. aureus A protein-coding gene (spa) were detected by PCR. Strains that did not carry fusB, fusC or fusD were detected for mutations in fusA by sequencing. Housekeeping genes were detected by PCR and analyzed by multilocus sequence typing (MLST).@*Results@#Among the 1 333 strains of S. aureus, 52 were resistant to fusidic acid, accounting for 3.90%. From 2013 to 2016, fusidic acid-resistant strains accounted for 5.3% (7/132), 3.5% (20/571), 4.1% (21/510) and 3.3% (4/120), respectively. The MIC values of fusidic acid against S. aureus were 2, 4, 8, 64 and >64 μg/ml, which inhibited the growth of 26.9% (14/52), 34.6% (18/52), 13.5% (7/52), 1.9% (1/52) and 23.1% (12/52) of strains, respectively. MLST revealed that there were 13 sequence types (STs), among which ST630 was the predominant type accounting for 50% (26/52), followed by ST5 accounting for 17.3% (9/52). There were 19 spa types, among which t4549 (11/52), t2460 (8/52), t377 (8/52) were the predominant types. Nine strains carried drug resistance genes accounting for 17.3% (9/52), including seven fusB-positive and two fusD-positive strains. No fusc-positive strains were detected. Mutations in fusA gene were detected in 11 strains (21.2%, 11/52) and the MIC values against them were all >64 μg/ml. The predominant type of the strains with fusA gene mutations was ST5-t2460.@*Conclusion@#Fusidic acid shows a good and relatively stable in vitro antibacterial activity against S. aureus. The mechanism of high resistance to fusidic acid is closely related to fusA gene mutation.

The study of genotype and plasmid transfer of carbapenem-resistant Enterobacteriaceae carrying blaNDM-1 with blaIMP-4 or blaKPC-2 / 中华传染病杂志

Objective To analyze the genotype and plasmid transfer of Enterobacteriaceae carring blaNDM‐1 with blaIMP‐4 or blaKPC‐2 .Methods From April 2012 to October 2014 ,a total of 33 non‐repeatitive carbapenem‐resistant Enterobacteriaceae ( including Imipenem‐resistant , meropenem‐resistant or Ertapenem‐resistant) were isolated from 5 hospitals in Wenzhou and Hangzhou . Identification and antimicrobial susceptibility test were performed using Vitek 2 Compact automatic microbiology analyzer . Phenotypes of carbapenemase were screened using modified Hodge test and ethylenediamine tetraacetic acid‐disk synergy test .Extended spectrum βlactamase test was determined by the double disk combination test which was recommended by Clinical and Laboratory Standards Institute .AmpC activity was tested by a three‐dimensional Cefoxitin method .Drug resistant genes including blaNDM‐1 and linkage of ISAba125‐NDM were detected by polymerase chain reaction (PCR) .The purified PCR products were cloned and sequenced .Plasmid conjugation experiment and elimination method were carried out to test partial bacterial strain and K . pneumoniae carrying blaNDM‐1 with blaIMP‐4 or blaKPC‐2 .Results Of the 33 non‐repeatitive carbapenem‐resistant Enterobacteriaceae ,28 were strains of K .pneumoniae ,1 strain of K . oxytoca,2strainsof Escherichiacoli,1strainof K.planticolaand1strainof E.cloacae.Thirteenstrains were isolated from Hospital of Sir Run Run Shaw of Zhejiang University ,thirteen from Wenzhou Hospital of Traditional Chinese Medicine ,one from Wenzhou People′s Hospital ,three from the First Affiliated Hospital of Wenzhou Medical University and three from Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine .Thirty‐one strains were confirmed as carbapenemase‐producing with 24 of blaKPC‐2 ,3 of blaNDM‐1 ,1 of blaNDM‐5 and 3 of blaIMP‐4 .Among them ,one strain carried blaNDM‐1 with blaIMP‐4 and one strain carried blaNDM‐1with blaKPC‐2 ,respectively .The plasmid transfer and conjugation experiment was performed between strains carrying blaNDM‐1 and Escherichia coli EC600 or K . pneumoniae ATCC13833 and genes of blaNDM‐1 and ISAba125‐NDM were obtained .Conclusions blaKPC‐2 gene is the popular carbapenemase genotype .blaNDM‐1 or blaNDM‐5 may be correlated with linkage gene of ISAba125‐N DM .Coexistence of blaNDM‐1 carrying blaIMP‐4 or blaKPC‐2 is detected in the same strain , respectively . Enough importance should be attached to the strains ,because most of them are multiple drug resistance with related genes located in the plasmid which is easily spread between strains .

Genetic analysis of a pedigree with hereditary coagulation factor Ⅶ deficiency / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify potential mutations in a family affected with inherited factor Ⅶ (FⅦ) deficiency.</p><p><b>METHODS</b>Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, FⅦ activity (FⅦ:C) and other coagulant parameters of the proband and 15 family members were measured. Potential mutations were screened in the pedigree by polymerase chain reaction and direct DNA sequencing.</p><p><b>RESULTS</b>The PT of the proband and his younger brother was significantly prolonged to 39.0 s and 30.1 s, respectively. FⅦ:C of the proband and his younger brother was obviously reduced to 2% and 3%, respectively. FⅦ:C of his grandmother, maternal grandmother, aunt, father, mother, maternal uncle and maternal aunt was all below the normal range (80%-108%), which measured 68%, 54%, 71%, 73%, 62%, 72% and 59%, respectively. The other coagulant parameters were in the normal range. Two heterozygous mutations, g.11349G>A and g.11482T>G, both reside in exon 8 of the F7 gene, have resulted in p.Arg304Gln and p.His348Gln substitutions, were identified in the proband. The same mutations were also found in the proband's younger brother. Four maternal members in this family (grandmother, mother, maternal uncle and maternal aunt of the proband) were heterozygous for the p.Arg304Gln mutation, while three paternal members (grandmother, aunt and father of the proband) were heterozygous for the p.His348Gln mutation.</p><p><b>CONCLUSION</b>The proband had inherited two independent mutations of the F7 gene including g.11349G>A and g.11482T>G from his mother and father, respectively. The compound heterozygous mutation probably explains the low FⅦ concentrations in this pedigree.</p>

Phenotype and genotype analysis for a consanguineous pedigree with combined coagulation factor VII and X deficiency / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify potential mutations and explore the molecular mechanism underlying combined inherited coagulation factors VII(FVII) and X(FX) deficiency for a family featuring consanguineous marriage between maternal cousins.</p><p><b>METHODS</b>Prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, FVII activity (FVII:C), FX activity (FX:C), FVII antigen (FVII:Ag), FX antigen (FX:Ag) and other coagulant parameters of the proband and 5 family members were measured. Potential mutations in exons, exon-intron boundaries and 5', 3' untranslated sequences of F7 and F10 genes were screened by polymerase chain reaction and direct sequencing. Suspected mutations were confirmed by sequencing the opposite strand.</p><p><b>RESULTS</b>PT and APTT of the proband were obviously prolonged to become 76.4 s and 60.2 s, respectively. FVII:C, FVII:Ag,FX:C and FX:Ag of the proband were obviously reduced to become 4%, 6%, 6% and 33%, respectively. Both PT and APTT of her grandmother, father, mother and daughter were slightly prolonged, which have measured 16.4 s, 15.8 s,16.9 s, 16.5 s, and 44.0 s, 42.1 s, 41.1 s, 43.5 s, respectively. And their FVII:C (34%, 39%, 31%, 40%, respectively), FX:C (50%, 58%, 47%, 42%, respectively) and FX:Ag (51%, 54%, 58%, 47%, respectively) were slightly reduced, while FVII:Ag was in the normal range. The coagulant parameters of her younger brother were within normal range. Two homozygous mutations, g.11267C to T in exon 8 of F7 gene, which resulted in an Arg277Cys substitution, and g.28139G to T in exon 8 of F10 gene which led to a Val384Phe substitution, were identified in the proband. The proband's grandmother, parents and daughter were heterozygous for both Arg277Cys and Val384Phe mutationss. Wild-type alleles of both F7 and F10 genes were also found in the younger brother.</p><p><b>CONCLUSION</b>A homozygous Arg277Cys mutation and a Val384Phe mutation have been respectively identified in the F7 and F10 genes, which can explain the low levels of FVII and FX in this family. The former has been inherited from the consanguineous parents.</p>

The expression of Panton-Valentine leukocidin gene and its correlation with agrA among different clinical isolates of Staphylococcus aureus / 中华检验医学杂志

Objective To investigate the correlation between expression of Panton-Valentine leukocidin gene and accessory gene regulator among different clinical isolates of Staphylococcus aureus.Methods All non-duplicate Staphylococcus aureus clinical isolates were isolated from various clinical specimens of the patients at 4 hospitals from January 2003 to December 2010.Panton-Valentine leukocidin genes among Staphylococcus aureus clinical isolates were detected by PCR and DNA sequencing.The expressions of lukS-PV and agrA were determined by real-time PCR.Results Ninty-six S.aureus isolates including 58 hospital-acquired and 28 community-acquired isolates were positive for PVL genes,among which 54 from blood,33 from pus and 9 from sputum.Ten isolates cannot be classified due to lack of information.Sixty-seven and 29 PVL-positive isolates were isolated from the specimens of adults and children.The median relative quantities of lukSmRNA of the isolates from pus and blood were 1.500 and 0.818.The quantity of lukSmRNA among the isolates from pus was significantly higher than that from blood (U =634,P =0.025).The median relative quantities of lukSmRNA of the isolates from children and adults were 1.292 and 0.540,respectively.The quantity of lukSmRNA among the isolates from children was significantly higher than that from adults (U =660,P =0.013).The median relative quantities of lukSmRNA among community-acquired and hospital-acquired isolates were 1.034 and 0.536,respectively.The quantity of lukSmRNA among community-acquired isolates was significantly higher than that from hospital-acquired isolates (U =338,P =0.012).The correlation coefficients between lukSmRNA and agrAmRNA of total isolates,pus isolates and blood isolates were 0.592 (P ＜ 0.01),0.810 (P ＜ 0.0l) and 0.543 (P ＜0.01),respectively.While the correlation coefficients of those among the isolates from children and adults were 0.804 (P ＜ 0.01) and 0.476 (P ＜ 0.01).The correlation coefficients of those among the isolates from community-acquired and hospital-acquired isolates were 0.767 (P ＜ 0.01) and 0.556 (P＜0.01).Conclusions The quantity of lukSmRNA of Staphylococcus aureus isolates from pus was significantly higher than that from blood.The agr may have positive regulation effect on the expression of lukS/F-PV,especially among the isolates from pus and children.(Chin J Lab Med,2013,36:313-317)

Molecular epidemiology and antimicrobial susceptibility of Salmonella isolates recovered from children with diarrhea / 中华检验医学杂志

Objective To investigate molecular epidemiology and antimicrobial susceptibility of Salmonella spp. isolates recovered from the stool samples of children with diarrhea. Methods Seventy-two isolates of Salmonella spp. were collected from children with diarrhea. The serum type of Salmonella spp.was determined by serology agglutinating method. Antimicrobial susceptibility was determined by K-B disk diffusion method and MICs of cefotaxime and ceftazidime were measured by agar dilution method for Salmonella spp. isolates. PCR and DNA sequencing were used for detecting ESBL, ISEcpl and AmpC genes; The transfer of cefotaxime resistance was determined by conjugation experiments. PFGE was performed for determining the homogeneity of the S. typhimurium isolates. Results A total of 72 isolates of Salmonella spp. were collected, among which S. typhimurium accounted for 86 % (62/72) and was the main serum type. S. typhimurium isolates and S. thompson isolates were often resistant to most of clinically used antimicrobial agents. Resistance of S. thompson isolates to ampicillin was the highest (90%, 56/62),followed by tetracycline (81%, 50/62), trimethoprim/sulfamethoxazole (74%, 46/62) and chloramphenicol (66%, 41/62). Seventeen S. typhimurium isolates (27%, 17/62) and two S. thompson isolates were resistant to cefotaxime. Forty-nine S. typhimurium isolates and two S. thompson isolates were positive for blaTEB-1b and resistant to ampicillin. Thirteen ESBL-producing S. typhimurium isolates (21%, 13/62) were positive for blaCTX-M (eight for blaCTX-M-14, three for blaCTX-M-15, one for blaCTX-M-55, one for both blaCTX-M-14 and blaCTX-M-55). All isolates harboring blaCTX-M genes were positive for upstream insert sequence ISEcpl. blaDHA-1was detected in a cefoxitin-resistant S. thompson isolate. Two main clones (PFGE type A and D) accounting for 19% (12/62) and 50% (31/62) respectively were found among 62 S. typhimurium isolates. Seven CTXM-producing isolates belonged to PFGE type D. Conclusions The multi-resistance to antimicrobial agents and high prevalence of blaCTX-M genes are found among S. typhimurium and S. thompson clinical isolates. blaCTX-M-55 is first found in S. typhimurium isolates and blaDHA-1 is found in S. thompson isolates. Clonal spread is responsible for the dissemination of S. typhimurium isolates.

The status of diagnosis and treatment on invasive fungal pulmonary infections / 中华临床感染病杂志

Objective To review the status of diagnosis and treatment for invasive fungal pulmonary infections(IFPI)in Lishui Central Hospital.Methods The clinical data of 79 patients with IFPI were retrospectively analyzed.Results The diagnostic status could be classified ills follows:6 eases had confirmed diagnosis,30 had clinical diagnosis,35 had suspected diagnosis and 8 misdiagnosed.The treatments were all effeetive in 6 COnfirmed cases;in 30 clinically diagnosed cases,6 were eriective.21 were inefiective and 3 died;in 35 suspected cases.3 were effective.25 were iHefieetive and 7 cflses did not receive antifungal treatment.Aspergillus and Cryptococcus pulmonary infections were predominant in confirmed cases.and the antifungal treatment lasted for 3 to 6 months.Conclusion Diagnosis and treatment for IFPI need to be improved.

The examination of qnr and aac(6')- Ⅰ b-cr genes of clinical isolates resistant to ciprofloxacin in Enterobacteriaceae / 中华微生物学和免疫学杂志

Objective To investigate the distribution of qnr and aac(6')- Ⅰ b-cr genes of clinical isolates resistant to ciprofloxacin in Enterobacteriaceae in Wenzhou. Methods From August 2005 to April 2008 a total of 461 clinical isolates resistant to ciprofloxacin in Enterobacteriaceae (370 isolates of Escherichia coli, 39 isolates of Enterobacter cloacae and 52 isolates of Klebsiella) were collected from the First Affiliated Hospital of Wenzhou Medical College. qnr and aac(6')- Ⅰ b genes were detected by PCR for all the clinical isolates, DNA sequencing was used for qnr and aac(6')-Ⅰ b-cr identification and conjugation experiment was proved to find ways of transmission of antimicrobial resistance. Results Fifteen qnr-positive isolates were detected among 461 Enterobacteriaceae isolates, including 5 qnrA-positive isolates (4 Enterobacter cloacae isolates and 1 Klebsiella ornithinolytica isolate), 4 qnrB-positive isolates( 2 Klebsiclla paeunoniae isolates and 2 Escherichia coli isolates), 6 qnrS-positive isolates(2 Klebsiella pneunoniae isolates and 4 Escherichia coli isolates). Fifty-two among 461 Enterobacteriaceae isolates harbored aac(6')- Ⅰ b-cr gene, including 42 Escherichia coil isolates, 4 Enterobacter cloacae isolates and 6 Klebsiella isolates. DNA sequencing for 15 qnr-positive isolates found they harbored aac(6')- Ⅰ b-cr gene simultaneously. Fifteen qnr-positive isolates were susceptible to imipenem but resistant to some other drugs. Conjugation experiments were successfully carried out in 7 of 15 isolates harbored qnr and aac(6')-Ⅰ b-cr genes, and their resistance to quinolones and aminoglycosides was partly transmitted to the recipient isolates. Conclusion The qnr genes are few in clinical isolates resistant to ciprofloxaein in Enterubacteriaceae in Wenzhou, however the aac(6')- Ⅰ b-cr gene is popular.

Molecular epidemiology and detection of clinical isolates of Klebsiella pneumoniae producing plasmid-mediated 16S rRNA methylases / 中华检验医学杂志

Objective To investigate the prevalence and molecular epidemiology of clinical isolates of plasmid-mediated 16S rRNA methylases-producing Klebsiella pneumoniae. Methods From January 2006 and September 2007, 337 non-replicate clinical isolates of Klebsiella pneumoniae were consecutively collected from inpatients in a teaching hospital in Wenzhou, China. All of the isolates were identified by the automated microbiology systems. MICs of amikacin, gentamicin and tobramycin were determined by agar dilution method. The isolates were investigated for the presence of ESBLs by the CLSI-recommended confirmatory tests. PCR was used to detect 16S rRNA methylase genes, ESBL genes and class Ⅰ integrase gene. The homology of these isolates was analyzed by pulse-field gel electrophoresis (PFGE). Results Sixty-four ( 19. 0% ), 28 ( 8. 3% ) and 55 ( 16. 3% ) of 337 isolates were resistant to gentamicin, amikacin and tobramycin, respectively. Twenty-one (6. 2% ) isolates carried 16S rRNA methylase genes (3 for armA, 13 for rmtB, 5 for both armA and rmtB) and high-level resistant to gentamicin, amikacin and tobramycin ( MICs ≥256 mg/L). Nineteen of 21 isolates with 16S rRNA methylase genes were ESBL producers, blaCTX-M-14-like, blaCTX-M-like and blaSHV-12-like were predominant genotypes of ESBLs. The plasmids of 13 isolates were transferred into the recipients E. co/iJ53. PCR and sequence analysis revealed that blaCTX-M-14-like,blaCTX-M-15-like and blaSHV-12-like were co-transferred with the armA or the rmtB to the recipients. All transconjugants harbored intll and blaTEN-1. Of the 21 isolates, 14 patterns were obtained by PFGE. Conclusion Both horizontal gene transfer and clonal spread were responsible for the dissemination of the rmtB or the armA gene in Klebsiella pneumoniae.

Prognostic value of cardiac troponin I and CRP in patients undergoing percutaneous coronary intervention / 中华检验医学杂志

Objective,This study was designed to evaluate the predictive value of pre-procedure Cardiac troponin I(cTnI)and CRP levels in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methotis cTnI and CRP were determined on admission in 335 consecutive patients with ACS who underwent primary PCI.Blood samples were obtained within 6-10 h after onset of symptom.The concentration of cTnI was determined by an automated chemiluminescence immunoassay.CRP was measured by immunoassay assay.According to the admission cTnI(＜0.1,0.1-0.5,＞0.5μg/L)and CRP(≤3,＞3 mg/L)divided into different groups.The pre-procedure cTnI and CRP status associated with 30 days cardiac mortality and major adverse cardiac events(MACE.including cardiac death.non-fatal recurrent MI.heart failure.readmission for any reason)were analyzed.The cardiac mortality at follow.uD period of 2 years were analyzed.Results Muhivariate logistic regression analyses revealed preoperative cTnI predicted 30 days cardiac mortality(OR=3.5,95%CI 2.2-5.3,P＜0.01),and recurrent MI rate(OR=1.5,95%CI 1.1-2.6,P＜0.05),independent of other known prognostic factors such as age,gender,hypertension,Hypercholestemlemia,diabetes and smoking.The pre-procedure CRP was independently related to 30 days cardiac mortality(OR=1.6,95%CI 1.1-2.3.P＜0.05),whereas there was no relationship to the MI rate.In ACS,levels of CBP≤3 mg/L,the three different risk groups (cTnI＜0.1,0.1-0.5,＞0.5μL)with corresponding 30 days MACE rates of 4.3%,11.7%,18.8%(X~2=4.829,P=0.028),CRP＞3 mg/L,the three groups mth corresponding 30 days MACE mtes of 5.5%,13.2%,21.1%(X~2=5.862,P=0.015),respectively.Patients were followed up for 2 years,Kaplan-Meier survival analysis demonstrated a significantly reduced survival at 2 years in patients witll a cTnI ＞0.5μg/L(80.0%versus 89.1%for a cTnI of 0.1-0.5μg/L and versus 92.2%flor cTnI＜0.1μg/L;X~2=7.571,P＜0.05 by log-rank).Conclusions The levels of CRP and cTnI in Acs of onset in 6-10 h provide an even better risk stratification after the PCI.and closely correlate with 30 days MACE.Elevated cTnI provides long-term prognostic information regarding cardiac mortality.Therefore.The combination of CRP and cTnI measurement should be taken into consideration for risk stratification to decide about the management strategies in ACS patients.

Prevalence of aac(6')-Ib-cr in clinical isolates of Klebsiella pneumoniae / 中华检验医学杂志

Objective To investigate the prevalence of aac(6')-Ib-cr in clinical isolates of Klebsiella pneumoniae.Methods A total of 337 isolates of Klebsiella pneumoniae were isolated from clinical specimens in our hospital from Jan,2006 to Sep,2007.Gentamycin,amikacin or tobramicin was used to screen the isolated with aac(6')-Ib-cr.aac(6')-Ib and class 1 interase gene(intl1)was determined by PcR All PCR products of aac(6')-Ib were sequenced for determination of aac(6')-Ib-cr. MICs of antibiotics were determined by agar dilution method.The ESBLs-producing isolates were determined by the CLSI-recommended confirmatory tests.Conjugation test was used to detect the transfer of plasmid.Results Of the 337 clinical isolates of Klebsiella pneumoniae,64(19.0%),28(8.3%)and 55(16.3%)isolates were resistant to gentamycin,amikacin and tobramycin,respectively.Among 64 gentamycin-resistant isolates,24(37.5%)were positive for aac(6')-Ib-cr,including 13 ciprofloxacin-resistant isolates and 11 ciprofloxacinsusceptible isolates.The prevalence of aac(6')-Ib-cr in ciprofloxacin-resistant and-susceptible isolates were 54.2%(13/24)and 27.5%(11/40).The positive rates of ESBLs and intl1 in the 24 isolates carrying aac(6')-Ib-cr were 79.2%(19/24)and 91.7%(22/24).Plasmids carrying aac(6')-Ib-cr of 13 isolates were successfully transferred to E.coli J53.Plasmids of all transconjugants were positive for aac(6')-Ib-cr and intl1.All transconjugants were ESBL producing strains.Conclusions aac(6')-Ib-cr exists widely in clinical isolates of Klebsiella pneumoniae.aac(6')-Ib-cr and ESBL gene usually coexist in a selftransmissible conjugative plasmid by class 1 integron.

Pathogenic Bacteria and Antimicrobial Resistance Analysis of Nosocomial Infections for 958 Diabetics in Hospital / 中华医院感染学杂志

50%).The resistance of Enterococcus avium and E.faecalis to ciprofloxacin was over 30%.CONCLUSIONS To Gram-negaive bacteria may use ?-lactamase inhibitors with antimicrobials and amikacin.To nonfermenters may use ciprofloxacin.To Gram-positive bacteria may use teicoplanin,nitrofurantoin,ampicillin/sulbactam and others.

Pathogens of Biliary Infection:A Surveillance / 中华医院感染学杂志

OBJECTIVE To find out the changes of pathogens and their sensitivity to antibiotics in bile samples of patients with biliary tract infection of our hospital during last six years. METHODS The data of 359 strains of microbes found in 371 patients with positive bile culture from Jan 2001 to Dec 2006 and their sensitivity to antibiotics were statistically analyzed. RESULTS There were 84 and 188 positive samples respectively in 140 samples during the first half of this study (2001-2003)and 231 ones during the second half (2004-2006) as well as 105 and 254 strains cultured. Respectively, Gram-negative bacteria accounted for 60.0%, and 50.8% and Gram-positive cocci 34.3%, and 40.2% and fungi 5.7%, and 9.0%; Escherichia coli was the major one and accounted for 36.2%, and 31.1%, with the increasing incidence of the positive rates of its ESBLs (34.2% vs 60.8%, P

Nosocomial Lung Infection by Chryseobacterium meningosepticum:Risk Factors and Drug-resistance / 中华医院感染学杂志

OBJECTIVE To analyze the risk factors and the drug-resistance of nosocomial acquired lung infection by Chryseobacterium meningosepticum.METHODS A retrospective investigation of the clinical correlative data and the drug sensitivity results of 60 cases with nosocomial acquired lung infection by C.meningosepticum from Jan 2004 to Jan 2006 was conducted in local hospital.RESULTS The patients were mainly distributed at ICU,respiration and neurosurgery wards.They had severe underlying diseases(100.0%),tracheal intubation(56.7%),central venous catheter(25.0%) and urine catheter(16.7%) treatments and applications of more than three antibiotics(68.3%).The drug-resistance of C.meningosepticum was serious.The antibiotic drugs which had higher susceptibility ratio were cefoperazone/sulbactam,fluoroquinolones,et al.CONCLUSIONS The main risk factors of nosocomial acquired lung infection by C.meningosepticum are severe underlying diseases,various invasive treatments,long-term hospitalization and inappropriate use of broad spectrum antibiotics.Clinical isolates are multi-drug resistant to many kinds of antibiotics.

PER-1 Type Extended-spectrum ?-Lactamases Produced by Gram-negative Bacilli / 中华医院感染学杂志

OBJECTIVE To investigate the prevalence of PER-1 type ESBLs-producing Enterobacteriaceae and their antimicrobial-resistance profile. METHODS Totally 167 strains of Escherichia coli, 154 strains of Klebsiella pneumoniae and 67 strains of Enterobacter cloacae were tested. All of them were isolated from all kinds of clinical specimens in four hospitals of Nanchang city from Aug 2003 to Jun 2004. Antimicrobial susceptibility test(AST) was determined by K-B disk diffusion test. double-disk test(CTX, CTX/CA and CAZ, CAZ/CA)and three- dimension extract test were used to determine ESBLs. PER-1 genes were amplified by PCR. The products of PCR were sequenced to identify its ?-lactamase encoding gene. RESULTS Sixteen isolates were PER-1 gene positive. The PER-1 gene positive rates of E. coli, K. pneumoniae and E. cloacae were 3.6%, 3.2% and 9.0% , respectively . The antimicrobial-resistant rates of isolates harboring blaPER-1 to cefotaxime, ceftaxidime, amikacin , cefoxitin , cefepime and imipenem were 100%,100%, 56%, 94%, 31% and 0%, respectively. CONCLUSIONS blaPER-1 is detected in E. coli, K. pneumoniae and E. cloacace, and has diffused in Enterobacteriaceae . Imipenem and amikacin may be used to treat the infection caused by bacteria harboring blaPER -1.

Pathogen of Infection in Emergency Intensive Care Unit:A Clinical Investigation and Nursing Measures / 中华医院感染学杂志

OBJECTIVE To investigate the profile of pathogen of infection in emergency intensive care unit(EICU). METHODS Pathogen of infection in EICU of our hospital from Jan to Apr 2005 were retrospectively investigated. RESULTS A total of 25 species from 119 pathogen strains were isolated from 45 cases. Among them, nonfermenters Gram-negative bacilli had great advantage, about 42.9% (51/119). Pseudomonas aerugionosa was the most one , counted for 16.8%. 65.9% of isolates were from sputum, 9.2%from blood. 81.4%(35/43) of cases were caused by multi-bacterial infection. CONCLUSIONS The pathogen of infection in EICU is mainly P. aeruginosa. The isolates are multi-resistant to biotics.

Primary preparation of 3-dimensional external distractor for zygomatic distraction osteogenesis / 中国组织工程研究

BACKGROUND: Distractor has decided the development of distraction osteogenesis since it was applied in oral and maxillofacial surgery. How to breach the limit of traditional distraction osteogenesis lies on designing three-dimensional (3-D) distractor.OBJECTIVE: To explore the design and manufacture of 3-D external distractor for zygomatic bone.SETTING: Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Anhui Medical University.DESIGN: An experiment of the external distraction system for 3-D distraction osteogenesis.MATERIALS: The distractor was made of biological material titanium with well histocompatibility, and consisted of three parts (support, expansion and direction-change) as well as some fittings such as titanium backup plate, spanner and rubber mat, etc.METHODS: Caprine of 10 months old were selected to separate the heads and prepare for isolated zygomatic models. Zygomatic bones were generally curve and made up of four-process-in-one, with the identical formation as human being. According to principle of mechanical movement,two support plates were designed to move relatively, which transferred randomly along with two perpendicular directions. It was done to change the direction and model 3-D distraction osteogenesis on zygomatic bone of the isolated caprine cranium.MAIN OUTCOME MEASURES: 3-D transference of expansion board and whole stabilization of distractor were observed in the process of distraction osteogenesis.RESULTS: The self-prepared 3-D external distractor was 30 g. The lengthener was built to provide 3-D suture expansion osteogenesis by changing the direction. The expansion bar could be moved about 2 cm in anteroposterior axes, 3.5 cm in perpendicular axes, 3 cm in coronal axes.CONCLUSION: The 3-D distractor is simple, accurate and practicable in experimental study, and lays a foundation for clinical study in the future.

Drug Resistance of Aminoglycoside-resistant Klebsiella pneumoniae / 中华医院感染学杂志

OBJECTIVE To investigate the antimicrobial-resistant profile of aminoglycosides-resistant Klebsiella pneumoniae isolated from Wenzhou.METHODS Between Jan 2006 and Sep 2007,non-replicate clinical isolates of K.pneumoniae were consecutively collected from inpatients in a teaching hospital in Wenzhou,China.Antibiotic susceptibility test was determined by the disc diffusion method recommended by CLSI.Sixty-four gentamicin-resistant isolates were investigated for the presence of ESBLs by the CLSI-recommended confirmatory tests.RESULTS Of the 64 gentamicin-resistant isolates,the resistant rates to ciprofloxacin,levofloxacin cefoxitin,tetracycline,trimethoprim/sulfamethoxazole,ceftazidime and cefotaxime were 7.5%,29.7%,39.1%,85.9%,76.6%,67.2%,and 73.4%,respectively.All isolates were susceptible to imipenem.73.4% of gentamicin-resistant isolates produced ESBLs.CONCLUSIONS Gentamicin-resistant K.pneumoniae is multi-resistant to antibiotics.