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.
Objective To systematically review the effectiveness and safety of linezolid versus teicoplanin in patients with MRSA pneumonia. Methods Such databases as CBM, CNKI, WanFang Data, VIP, Science Direct, PubMed, Ovid, SciFinder, The Cochrane Library (Issue 3, 2013) and EMbase were electronically searched for published articles (randomized controlled trials or non-randomized prospective trials with comparable baseline between groups) at home and abroad on the clinical effectiveness and safety of linezolid versus teicoplanin in patients with MRSA pneumonia from January 2003 to March 2013. Using the Cochrane methods, two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software in clinical cure rates, clinical effective rates, microbiologic eradication rates, and adverse reaction incidences. Results Finally, 7 studies were included involving 637 patients. The results of meta-analysis were clinical effective rates (RR=1.17, 95%CI 1.04 to 1.32, P=0.009), clinical cure rates (RR=1.06, 95%CI 0.94 to 1.19, P=0.37), bacterial clearance rates (RR=1.32, 95%CI 1.03 to 1.68, P=0.03), and adverse events rates (RR=1.24, 95%CI 0.78 to 1.97, P=0.37). The results of Begg test and Egger test were not significant (Pgt;0.05). Conclusion Current evidence shows that, in treating MRSA pneumonia, linezolid is better than teicoplanin in clinical effective rates and bacterial clearance rates. However, they are alike in clinical cure rates and bacterial clearance rates.
ObjectiveTo analyze the pathogenic bacteria distribution, structure and characteristics of drug resistance in patients with acute stroke complicated with pulmonary infection, in order to provide reference for the prevention of hospital infection and rational use of antimicrobial agents. MethodsA total of 864 clinical specimens of acute stroke complicated with pulmonary infection were chosen for study between January 2012 and December 2014. Separation and cultivation were done in accordance with the operation procedures regulated by the Ministry of Health. Drug sensitivity examination was done by Kirby-Bauer (k-b). Super-extensive spectrum β lactamase (ESBL) and methicillin resistant staphylococcus aureus (MRSA) were detected to analyze the bacterial species and resistance transition. ResultsA total of 864 samples were cultivated, in which G-bacteria accounted for 61.2%. The main pathogenic bacteria was Klebsiella pneumoniae bacteria, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumanmii and Staphylococcus aureus. Imipenem had high antimicrobial activity to G-bacilli, especially to Escherichia coli and Klebsiella pneumoniae bacteria. Linezolid, vancomycin and teicoplanin had high antibacterial activity to staphylococcus aureus. Vancomycin resistant Staphylococcus aureus was not found. Ciprofloxacin had high antibacterial activity to Pseudomonas aeruginosa, while imipenem had low antibacterial activity to Pseudomonas aeruginosa. Amikacin had high antibacterial activity to acinetobacter. ConclusionG-bacilli are predominant in acute stroke complicated with pulmonary infection. ESBLs and MRSA detection rate is high, and we should pay attention to the rational use of antibiotics to reduce drug resistance.
【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.
ObjectiveTo investigate the appropriate concentration of methicillin-resistant Staphylococcus aureus (MRSA) in establishing chronic femoral osteomyelitis model in rabbits.MethodsForty-eight adult New Zealand white rabbits were randomly divided into 6 groups with 8 rabbits in each group. Animals in groups B, C, D, E, and F were injected 1×109, 1×108, 1×107, 1×106, 1×105 CFU/mL MRSA on the location of 2 cm of the femoral supracondyle, respectively, and group A was injected with aseptic saline as a control. The general observation were performed at 4 weeks after operation, and the wound secretions were taken for bacteriological examination. The serum C-reactive protein content was detected at preoperation and 2 weeks and 4 weeks after operation. The X-ray, CT scan, and Norden imaging scoring were performed at 4 weeks after operation. At 4 weeks after operation, the animals were sacrificed, and the specimens were observed and evaluated by general scores; and the HE staining and histological score were also performed.ResultsFive rabbits died of severe infection in group B, 2 died in group C, and no rabbit died in groups D, E, and F. General observation showed that the incision healed without soft tissue swelling in group A; most animals had visible incision swelling and sinus formation, femoral thickening, bone destruction, and damage decreased with the decreasing of the concentration of liquid bacterial in groups B-D; the infection signs were seen in groups E and F, and the degree of infection were less than that of group D. Bacteriological examination showed that fistula formation animal in groups B, C, D, and E were cultured with positive results, and with the decrease of concentration, the number of animal fistula formation decreased gradually; and bacteriological culture did not be performed in group F because of no sinus formation. There was no significant difference in the content of C-reactive protein between groups before operation (P>0.05). The contents of C-reactive protein in groups B-F were significantly higher than those in group A at 2 and 4 weeks after operation (P<0.05). At 4 weeks after operation, the content of C-reactive protein was in the order of groups B, C, D, E, F, and A in turn from high to low, showing significant differences between groups (P<0.05). Imaging examination showed that there was no soft tissue swelling and bone destruction in group A; bone destruction, massive sequestrum formation, and soft tissue swelling were found in groups B and C; bone destruction was observed in groups D and E, and the degree of sequestrum formation was not as good as that in group C; and there was a small amount of bone infection in group F. The Norden scores in groups B-F were significantly higher than that in group A, and in groups B and C than those in groups D, E, and F, and in groups D and E than that in group F (P<0.05); there was no significant difference between groups B and C, and between groups D and E (P>0.05). The specimens general observation scores in groups B-F were significantly higher than that in group A, while in groups B and C than those in groups D, E, and F (P<0.05); there was no significant difference between groups D, E, and F (P>0.05). HE staining showed that the structure of bone trabecula in group A was clear and the structure was arranged neatly; in groups B-F, trabecular bone destruction and inflammatory cell infiltration were seen and the degree gradually decreased. The histological scores in groups B-F were significantly higher than that in group A, and in group B than those in groups C-F, in groups C and D than that in group F (P<0.05); there was no significant difference between groups C, D, and E, and between groups E and F (P>0.05).ConclusionThe optimal MRSA concentration of rabbit model of chronic osteomyelitis of femur is between 1×106 and 1×107 CFU/mL.
ObjectiveTo analyze the clinical distribution and changes of antimicrobial resistance profiles of Staphylococcus aureus (SA), as well as to provide the basis for the prevention and treatment of infection. MethodsThe clinical data and the antimicrobial resistance profiles of SA were collected from Jan, 2008 to Dec, 2014 in West China Hospital of Sichuan University. The WHONET 5.5 software was used to analyze the resistance data. ResultsA total of 5 698 SA isolates were included within 7 years. Of all strains, 2 721 (47.8%) were isolated from secretion, 1 638 (28.75%) were from respiratory tract specimens, 451 (7.9%) were from pus, and 362 (6.4%) were from blood. 811 (49.5%) SA isolates from respiratory tract specimens were Methicillin-resistant Staphylococcus aureus (MRSA), which was higher than those from secretion, pus and blood. 1052 (18.5%) SA strains were isolated from the dermatological department, 604 (10.6%) were from the orthopedics department, 472 (8.3%) were from the intensive care unit (ICU), 471 (8.3%) were from the department of burn, and the detection rate of MRSA from ICU (341, 72.2%) was the highest. During last 7 years, the total separation rate of SA was 8.2%, among them 1 858 (32.6%) MRSA were isolated, and the detection rate was 32.6%. The resistant rate of SA to erythromycin, clindamycin, tetracycline, gentamicin, rifampin, ciprofloxacin, levofloxacin and moxifloxacin had a statistically significant decrease from 2008 to 2014, while the resistant rate of SA to trimethoprim/sulfamethoxazole had increased. No vancomycin, linezolid, teicoplanin or tigecycline resistant strain was detected. The resistance rates of MRSA to common antibiotics such as penicillin G, erythromycin, clindamycin, tetracycline, gentamicin, rifampin and fluoroquinolones were higher than those of MSSA, while the resistance rate of MRSA to trimethoprim/sulfamethoxazole was lower than MSSA. ConclusionCompared with the monitoring data in China, the drug resistance of SA in West China Hospital is well controlled. However, experience-directed antibiotic treatment of MRSA infection is still limited. MRSA infection remains a serious problem in critically ill patients. The rational use of antibiotics and application of effective infection control measures are important to decrease the MRSA infection.