ObjectiveTo summarize the clinical features and experience of Methicillin-resistant Staphylococcus aureus (MRSA)-associated enteritis. MethodsClinical data of 21 patients with MRSA-associated enteritis who were treated in our hospital from Jan. 2003 to May. 2015 were analyzed retrospectively. ResultsAfter diagnosed or suspected of MRSA-associated enteritis, the 21 patients received a drug therapy with vancomycin instead of other antibiotic, 3 patients (14.3%) who failed to get satisfactory symptom relief received a plus therapy with biapenem; 13 patients (61.9%) received treatment which plus drugs such as Bacillus licheniformis capsules or combining Bifidobacterium to regulate intestinal microflora. Severe complications, such as intestinal fistula (8 patients, 38.1%）, toxic shock (16 patients, 76.2%）, organ system failure (14 patients, 66.7%) occurred in 17 patients (80.9%) of the 21 patients when 2-7 days (mean of 4.7 days) after diarrhea. Among 21 patients received therapy, 7 patients (33.3%) were cured and 2 patients (9.5%) were improved, whereas 11 patients died, with a total mortality of 52.4%, another 1 patient was lost to follow up (4.8%). There were 8 patients who were followed-up for 1-12 months (the median time was 3.1-month). During the followed-up period, 2 of them died and others stayed alive without occurrence. ConclusionAlthough uncommon, MRSA-associated enteritis progressed rapidly, with many complications and high mortality rate. Early diagnosis and timely targeted treatment restoring the balance of gastrointestinal microecology are the key to decrease its mortality.
摘要:目的: 金黄色葡萄球菌(金葡菌)的感染近年来已成为医院内的主要致病菌,而其耐药性也呈逐渐升高的趋势,为了解该菌在我院的感染和耐药情况,为临床合理使用抗生素提供科学依据。 方法 : 用经典生理生化鉴定方法,对各种临床标本主要来源于痰液和各种伤口脓液标本分离到的102株金葡菌进行生物学特性及药敏试验。 结果 : 从我们医院2007年5月至2009年8月所分离出来的102株金葡菌中青霉素耐药性8923%,氨苄青霉素耐药率为9385%,没有发现万古霉素耐药菌。 结论 : 除万古霉素外,耐药率较低的依次是利福平、苯唑青霉素、环丙沙星、呋喃妥因、阿米卡星、磺胺甲基异恶唑、红霉素,而青霉素G、氨苄青霉素、四环素耐药性情况非常严重,并且多重耐药,耐药性强,应引起临床的高度重视。Abstract: Objective: To analyze the bionomics and antimicrobial susceptibility of staphylococcus aureus, which was the main pathogenic bacterium with high drug tolerance in our hospital, in order to provide the rational use of antibiotics. Methods : Samples of one hundred and two staphylococcus aureus cases from sputamentum and pus were evaluated by classic physiology and biochemistry methods to test the bionomics and antimicrobial susceptibility. Results : The drug resistance rate to penicillin, penbritin and vancomycin was 8923%, 9385% and 0, separately. Conclusion : Besides vancomycin, the drug resistance rate of rifampicin, oxazocilline, ciprofloxacin, furadantin, amikacin, sulfamethoxazole and sulfamethoxazole increased one by one. The resistance to penicillin G, penbritin and tetracycline was serious, including multidrug resistant, which should be paid highly attention.
Objective To investigate the incidence rate, molecular epidemiology and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infection. Methods A total of 119 Staphylococcus aureus strains isolated from January 2016 to December 2020 in general surgery of this hospital were collected retrospectively and divided into MRSA group and methicillin-sensitive Staphylococcus aureus group according to whether or not resistant to oxacillin. The clinical data of all patients infected with Staphylococcus aureus and drug sensitivity of Staphylococcus aureus were collected. Molecular typing was performed by multilocus sequence typing (MLST), resistance gene, virulence gene and biofilm gene were detected by polymerase chain reaction (PCR) method, and a case-control study was used to identify risk factors for MRSA infection. ResultsThe detection rate of MRSA was 57.98% (69/119), mainly was from pus specimens (80.67%, 96/119). The results of MLST showed that the dominant clone types were ST88 (37.68%, 26/69), ST951 (27.54%, 19/69) and ST59 (18.84%, 13/69). The results of PCR showed that the detection rates of mecA, mecC, Aac (6′ )/Aph (2′ ′ ), Aph (3)-Ⅲ, ant (4′ )- Ⅰ a, tetM, qnrA, panton-valentine leukocidin, fibronectin-binding protein A, staphylococcal enterotoxin A, staphylococcal enterotoxin B, α-hemolysins, intracellular adhesion A, staphylococcal accessory regulators A, and fibronectin-binding protein B in 69 strains of MRSA were 100%, 0.00%, 27.54%, 34.78%, 18.84%, 14.49%, 1.45%, 8.70%, 98.55%, 11.59%, 91.30%, 94.20%, 92.75%, 97.10% and 86.96%, respectively. Multivariate analysis showed that hospital transfer, wound infection, catheter related infection, drainage tube and history of cephalosporin using were risk factors for MRSA infection. ConclusionsThe detection rate of MRSA in general surgery of this hospital is high. ST88 is the most common clone type. The carrying rates of resistant-, virulence- and biofilm-related genes are high. Hospital transfer, wound infection, drainage tube, history of cephalosporin using etc. are high risk factors for MRSA infection. It is advised that invasive operation should be reduced, antibiotics should be used rationally, hand hygiene should be paid attention to, environmental sanitation disinfection should be carried out regularly, and the monitoring of MRSA bacteria should be strengthened, so as to reduce and control the infection and spread of MRSA.
【摘要】 目的 通过总结耐甲氧西林金黄色葡萄球菌（meticillin-resistant staphylococcus aureus， MRSA）感染皮肤疾病患者的护理经验总结，探寻控制皮肤疾病感染的有效措施。 方法 对2009年1-10月收治的30例MRSA感染皮肤疾病患者的护理资料进行回顾分析。 结果 通过精心治疗、护理，30例患者皮损均治愈。 结论 采取严格的接触隔离措施，加强手卫生，对症选择敷料及换药，正确处理医用垃圾，加强与患者或家属的沟通交流，认真进行卫生宣教等，能有效的控制MRSA感染，提高临床痊愈率。【Abstract】 Objective To investigate the appropriate nursing for patients with skin disease due to methicillin-resistant staphylococcus aureus (MRSA) infection. Methods Careful nursing had been taken to 30 patients with skin disease due to MRSA infection from January to October in 2009. Results Skin lesions of 30 patients were cured through conscientious treatment and intensive nursing. Conclusion Strict contact isolation measures, strengthened hand hygiene, careful dressing, correct medical waste disposal, communication with patients or their families, and health education can effectively control the MRSA infection and improve the clinical cure rate.
Objective To investigate the effect ofstaphylococcal lipoteichoic acid (LTA-sa) on RAW264.7 cells differentiation into osteoclasts. Methods RAW264.7 cells were cultured with LTA-sa of 100 ng/mL (group A), LTA-sa of 200 ng/mL (group B), LTA-sa of 400 ng/mL (group C), receptor activator of nuclear factor κB (NF-κB) ligand (RANKL) of 100 ng/mL as positive control (group D), and equal volume of PBS as blank control (group E) respectively for 5 days. And then, tartrate resistant acid phosphatase staining (TRAP) was used to detect the formation of osteoclast-like cells, Image-Pro Plus 6.0 software to measure the areas of bone resorption pits in Corning Osteo Assay Surface (COAS) wells, and MTT assay to observe the proliferation activity of RAW264.7 cells in group A, B, C, and E. Results After cultured for 5 days, the formation of osteoclast-like cells and bone resorption pits were observed in all groups. The number of osteoclast-like cells and the area of bone resorption pits in groups A, B, C, and D were more than those in group E. And with the increased concentration of LTA-sa, the indexes in groups A, B, and C increased gradually, but were lower than those in group D, and differences were significant between groups (P<0.05). At 5 days after culture, there was no significant difference in absorbance value among the experimental groups (groups A, B, C, and E) (P>0.05). Conclusion LTA-sa has promoting effect on RAW264.7 cells differentiation into osteoclasts.
ObjectiveTo explore drug resistance, resistant mechanisms and resistant phenotypes of staphylococcus aureus (SA) isolated from wound secretion to macrolides-lincosamides-streptogramins (MLS). MethodsA retrospective design was used to collect clinical data and antimicrobial resistance profiles of SA in the First Affiliated Hospital and the Second Affiliated Hospital of Fujian Medical University and Anxi County Hospital from June, 2008 to October, 2015. SPSS 19.0 software was used for data analysis. ResultsA total of 127 isolates were included. The distribution of four resistant phenotypes of SA to MLS were all susceptibility(S) type (n=48, 37.8%), ML type (n=41, 32.3%), M/iCR+ type (n=22, 17.3%) and MLS type (n=16, 12.6%), respectively; There were three kinds of phenotypes caused by target changing including ML type, M/iCR+ type and MLS type, respectively. Moreover, no moxicaxin, linezolid or tigecyline resistant strain was detected, while quinolons and tetracyclines showed low-level resistant. ConclusionCompared with the different samples, the resistant phenotypes of SA isolated from wound secretion to MLS are few, and the total resistance ratio is low.
ObjectiveTo analyze the characteristics of distribution and drug resistance of clinical isolated staphylococci in the Whire Union Bacterial Resistance Surveillance Network across Sichuan from 2015 to 2018, so as to provide reference for clinical rational drug use and management of drug-resistant bacteria in Sichuan.MethodsA total of 18 023 strains of staphylococci were isolated from 9 hospitals of Whire Union Bacterial Resistance Surveillance Network for four years (2015-2018). Drug susceptibility test was carried out by disk diffusion method or automated instrument method. The data were statistically analyzed by WHONET 5.6 according to CLSI 2016 standard.ResultsThe 18 023 strains of staphylococci included 10 865 (60.28%) Staphylococcus aureus and 7 158 (39.72%) coagulase negative staphylococci. No strains resistant to vancomycin and linezolid were found. The detection rates of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative staphylococci were 25.10% (2 727/ 10 865) and 75.60% (5 411/7 158), respectively. The sensitivity of methicillin-resistant staphylococci to most antibiotics was significantly lower than that of methicillin-sensitive strains (P<0.05). The susceptibility rate of staphylococci to some antibiotics was significantly different from 2015 to 2018(P<0.05). The susceptibility rates of Staphylococcus aureus from different samples to rifampicin, moxifloxacin, ciprofloxacin, levofloxacin, oxacillin and erythromycin were significantly different (P<0.05). The susceptibility rates of Staphylococcus aureus from different departments in different samples of sulfamethoxazole, rifampicin, moxifloxacin, ciprofloxacin, levofloxacin, oxacillin, gentamicin, tetracycline, clindamycin and erythromycin were significantly different (P<0.05).ConclusionsThe susceptibility of strains isolated from different periods, different specimens and departments to the same antimicrobial agents varies greatly. For the infection of staphylococci, we should use drugs under the guidance of drug susceptibility according to the source of samples, which can avoid the abuse of beta-lactam drugs. Strengthening the monitoring and control of drug-resistant bacteria can prevent or reduce the spread of drug-resistant bacteria.