• 主题
高级搜索  >
历史搜索 清空历史
您现在的位置：首页> 中文期刊>临床医学>医药卫生>中国感染与化疗杂志

中国感染与化疗杂志

中国感染与化疗杂志

北大核心

CSCD

CSTPCD

Chinese Journal of Infection and Chemotherapy
本杂志由中华人民共和国卫生部主管，复旦大学医学院（原上海医科大学）主办，国内外公开发行的国家级医学学术期刊，双月刊，逢双月出版，主要刊载感染性疾病与抗感染化疗领域的最新科研成果、新技术、新方法及最新临床经验，主要读者对象为临床各科医师、医院药剂科工作人员、临床微生物检验人员及从事抗感染化疗的药理学、临床药理学、临床微生物学和临床药学研究的各级人员。
  • 发文量：2802
  • 被引量：2798
  • H指数：3
  • 开始收录时间：2001,1(1)
  • CNKI综合因子：2.91
  • 维普期刊影响因子： 2.3
  • 万方期刊影响因子：3.49
  • 创刊时间：2001
  • 国内刊号/CN：31-1965/R
    国际刊号/ISSN：1009-7708
  • 发行周期：双月刊
    邮发代号：4-686
  • 主管单位：中华人民共和国教育部
    主办单位：复旦大学附属华山医院
中国感染与化疗杂志-联系信息
  • 主编：张婴元
  • 电话：021-52888148
  • 邮箱：cjic@fudan.edu.cn
  • 地址：上海市乌鲁木齐中路12号
  • 邮编：200040
中国感染与化疗杂志-获奖情况
  • • 中国精品科技期刊
  • • 百种中国杰出学术期刊
  • • 中国高校百佳科技期刊
  • • 中国高校技术类优秀期刊
  • • 华东地区优秀期刊奖
  • • 上海市高校精品科技期刊奖
更多>
  • 收录汇总
  • 刊内文献检索
  • 投稿信息

刊期浏览

相关中文期刊

相关中文会议

相关外文期刊

相关外文会议

最新期刊

热门期刊

中国感染与化疗杂志 >2024年第5期
搜索

学科

年度

全选（0）
排序：
共4384条结果
  • 摘要：Objective To investigate the antibiotic resistance of Haemophilus influenzae isolates collected from the children with respiratory tract infection for rational use of antibiotics in clinical practice .Methods The H .influenzae strains were isolated from children and subjected to antimicrobial susceptibility testing by Kirby-Bauer method .Nitrocefin disc test was used to detect the production of beta-lactamases .WHONET 5 .6 software was used to analyze the susceptibility data .Results A totalof1256strainsof H.influenzaewereisolated.About37.8% ,65.5% and16.5% ofthe1256strainsof H.influenzae were resistant to ampicillin ,trimethoprim-sulfamethoxazole ,and ampicillin-sulbactam ,respectively .Less than 10 .0% of these strains were resistant to any other antibiotics tested .Beta-lactamase was produced in 33 .5% of the 1 256 strains of H . influenzae .Conclusions The H . influenzae strains in this study are mainly resistant ampicillin and trimethoprim-sulfamethoxazole .About 80 .0% of these H . influenzae strains were still susceptible to cefaclor ,ampicillin-sulbactam , cefixime ,ceftazidime ,azithromycin ,ciprofloxacin ,meropenem and rifampin .The primary mechanism of ampicillin resistance in Haemophilus is production of beta-lactamases .%目的：了解儿童呼吸道流感嗜血杆菌的临床分布特征和耐药特点，为指导临床合理用药提供科学依据。方法收集儿童痰液标本进行培养并分离出流感嗜血杆菌，用K-B纸片扩散法进行抗菌药物敏感试验，并对其进行β内酰胺酶测定；数据用WHONET5．6统计软件统计分析。结果从12374份痰液标本中共分离出1256株流感嗜血杆菌，分离率为10．2％；1256株流感嗜血杆菌对氨苄西林、甲氧苄啶-磺胺甲口恶唑和氨苄西林-舒巴坦的耐药率分别为37．8％、65．5％和16．5％，对其余测试的抗菌药物耐药率均＜10．0％；β内酰胺酶阳性率为33．5％。结论流感嗜血杆菌对氨苄西林和甲氧苄啶-磺胺甲口恶唑的耐药性较高；该菌对于头孢克洛、氨苄西林-舒巴坦、头孢他啶、头孢克肟、阿奇霉素、环丙沙星、美罗培南、利福平的敏感率均在80．0％以上。产β内酰胺酶是流感嗜血杆菌对氨苄西林的主要耐药机制。
  • 摘要：据报道,中国又有3例患者死于感染新发的H7N9禽流感病毒,死亡人数增至35例,而总的感染人数达到130例（加上中国台湾的1例）。在没有公布死亡详情的情况下,新华社报道在中国江西省发现了1例禽流感病毒H7N9感染病例,而世界卫生组织（WHO）宣称该病毒是全球致病性最强的禽流感病毒之一。本周一,新华社发言人引用卫生部门的数据重申,迄今为止尚未发现该病毒能在人与人之间传播的证据。值得注意的是,有57例感染该病毒的患者已经康复。
  • 摘要：Objective To investigate the distribution and antibiotic resistance of clinical Enterobacter isolates .Methods A total of 3 031 clinical strains of Enterobacter were collected from 15 hospitals from January 1 through December 31 , 2012 . Antimicrobial susceptibility testing was performed with Kirby-Bauer or minimum inhibitory concentration method .The results were analyzed according to CLSI 2012 breakpoints .Results Enterobacter cloacae and Enterobacter aerogenes accounted for 73 .0% (2 212/3 031) and 23 .9% (725/3 031) of all the Enterobacter strains .The isolates of other Enterobacter species accounted for 3 .1% (94/3 031 ) . The main source of the isolates was respiratory tract specimen , accounting for 53 .2% (1 612/3 031) .Most (> 89% ) of the Enterobacter strains were resistant to cefazolin and cefoxitin . Generally ,54 .4% ,47 .5% and 34 .3% of the strains were resistant to cefuroxime ,cefotaxime and cefazidime ,respectively . About 6 .6% to 26 .3% of the strains were resistant to amikacin ,gentamicin ,piperacillin-tazobactam ,cefepime ,cefoperazone-sulbactam ,ciprofloxacin and trimethoprim-sulfamethoxazole .Imipenem ,meropenem and ertapenem showed the highest activity , to which only 3 .5% ,3 .7% and 10 .3% of the strains were resistant ,respectively .About 8 .9% (269/3 031) of the strains were resistant to at least imipenem ,meropenem or ertapenem .Four Enterobacter strains were extensive-drug resistant (XDR) .Conclusions The prevalence of antibiotic resistance in Enterobacter isolates decreased slightly in 2012 compared to the data in 2011 ,but the situation is still very serious .We should continue to take effective measures to control the resistant strains .%目的：了解2012年中国不同地区15所医院临床分离肠杆菌属细菌的分布和耐药性现状。方法全国15所教学医院2012年1-12月临床分离的3031株肠杆菌属细菌，采用纸片扩散法或自动化仪器进行抗菌药物敏感性试验，结果以CLSI 2012年版标准判断。结果3031株肠杆菌属细菌中阴沟肠杆菌占73．0％（2212/3031），产气肠杆菌占23．9％（725/3031），其余肠杆菌属细菌占3．1％（94/3031）。主要分离自呼吸道标本，占53．2％（1612/3031）。肠杆菌属对头孢唑林和头孢西丁的耐药率高（＞89．0％），对头孢呋辛、头孢噻肟和头孢他啶的耐药率分别为54．4％、47．5％和34．3％，对阿米卡星、庆大霉素、哌拉西林-他唑巴坦、头孢吡肟、头孢哌酮-舒巴坦、环丙沙星和甲氧苄啶-磺胺甲口恶唑的耐药率较低（6．6％～26．3％），对亚胺培南、美罗培南和厄他培南的耐药率分别为3．5％、3．7％和10．3％。对亚胺培南、美罗培南和厄他培南中至少一种抗菌药物耐药的菌株占8．9％（269/3031）。共检出4株对所监测的抗菌药物均呈耐药的广泛耐药肠杆菌属细菌。结论2012年肠杆菌属细菌耐药性与2011年相比有所下降，但耐药情况仍很严重，应采取有效措施控制和降低耐药率。
  • 摘要：目的：了解血培养主要病原菌的分布及其耐药性。方法采用MicroScan WalkAway 96 PLUS及VITEK 2 compact全自动微生物鉴定及药敏系统对阳性分离菌进行鉴定及药敏试验。按CLSI 2013标准采用WHONET 5．6软件进行耐药性分析，IBM SPSS 20．0进行耐药率的比较。结果503株非重复分离菌中，革兰阳性菌占57．8％，革兰阴性菌占36．0％，真菌占6．2％。凝固酶阴性葡萄球菌（CNS）、大肠埃希菌、肠球菌属、金黄色葡萄球菌（金葡菌）和肺炎克雷伯菌是主要分离菌。耐甲氧西林金葡菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（ MRCNS ）的检出率分别为32．3％和71．7％。分离自ICU患者的CNS对多种抗菌药物的耐药率高于非ICU患者分离株（P＜0．05）。大肠埃希菌和肺炎克雷伯菌对常用头孢菌素类抗生素耐药率较高，但对哌拉西林-他唑巴坦、亚胺培南和阿米卡星耐药率低。鲍曼不动杆菌对常用抗菌药物的耐药率高。念珠菌属对抗真菌药物耐药率低。结论血培养阳性分离菌分布广泛，不同病原菌间耐药性亦不相同。应加强对血培养病原菌分布和耐药性的监测。%Objective To investigate the distribution and antibiotic resistance of the pathogens isolated from blood culture . Methods Identification and antimicrobial susceptibility testing were performed with MicroScan WalkAway 96 PLUS or VITEK 2 compact .WHONET 5 .6 software was used for analysis of the susceptibility data according to CLSI 2013 breakpoints .IBM SPSS 20 .0 was employed to compare the resistance rates between groups . Results Gram-positive bacteria , gram-negative bacteria and fungi accounted for 57 .8% ,36 .0% and 6 .2% of the 503 nonduplicate isolates ,respectively .The most common isolates included coagulase-negative Staphylococcus , Escherichia coli , Enterococcus spp ., Staphylococcus aureus and K lebsiella pneumoniae . The prevalence of methicillin-resistant S . aureus (MRSA ) and coagulase-negative Staphylococcus (MRSCN) was 32 .3% and 71 .7% respectively .The coagulase-negative Staphylococcus isolates from ICU patients showed higher resistance rates to many antibiotics than those non-ICU strains (P<0 .05) .E .coli and K .pneumoniae strains showed high percentage of resistance to cephalosporins , but relatively low resistance to piperacillin-tazobactam , imipenem and amikacin .A .baumannii isolates were highly resistant to most antimicrobial agents . Candida species were less resistant to antifungal agents .Conclusions The pathogens isolated from blood culture are diverse .The resistance profile is quite different among various pathogens .The distribution and antibiotic resistance should be actively monitored for the pathogens isolated from blood culture in order to facilitate the rational use of antimicrobial agents .
  • 摘要：万古霉素联合哌拉西林-他唑巴坦是重症感染的常用经验治疗方案,但这一联合对甲氧西林耐药金黄色葡萄球菌（金葡菌）（MRSA）和万古霉素中介金葡菌（VISA）抗菌活性的研究尚少。已有研究表明β内酰胺类药物联合万古霉素对MRSA及VISA具有协同作用。本研究旨在明确苯唑西林或哌拉西林-他唑巴坦联合万古霉素对VISA及MRSA的作用。
  • 摘要：本研究目的包括：1建立群体药动学（PPK）模型描述舒巴坦在人体内的代谢过程;2通过该药在不同MIC水平下达到药效学靶值概率（PTA）的分析,评价该药不同给药方案的有效性。研究方法：12名健康受试者分成2组,均接受舒巴坦1 g（100 mL生理盐水溶解）静脉滴注,组1滴注时间为1 h,组2为4 h。
  • 摘要：鲍曼不动杆菌（Acinetobacter baumannii）是医院感染的重要条件致病菌。鲍曼不动杆菌感染常发生在具有基础疾病的患者,如皮肤黏膜或呼吸道保护屏障受损的重症患者,正在接受侵袭性诊疗措施以及使用免疫抑制剂和广谱抗生素的患者。鲍曼不动杆菌常引起呼吸机相关肺炎、尿路感染、菌血症、皮肤软组织感染、腹腔和中枢神经系统感染,鲍曼不动杆菌也是战争相关伤口主要病原体之一。
  • 摘要：目的：了解2012年我国不同地区15所医院临床分离不动杆菌属细菌的构成、分布及其耐药性。方法共收集15所教学医院临床分离的8739株不动杆菌属，其中鲍曼不动杆菌7827株（89．6％）。按照统一方案，采用纸片扩散法或自动化仪器法进行药敏试验，结果按CLSI 2013年版标准判读，采用WHONET5．6软件进行数据分析。结果8739株不动杆菌属细菌主要分离自住院患者，占85．4％，门急诊患者占14．6％。26．4％不动杆菌属分离自IC U ，其次为内科病房（22．0％）。鲍曼不动杆菌对替加环素、米诺环素和头孢哌酮-舒巴坦的耐药率最低，分别为10．9％、35．2％和35．7％，其次为阿米卡星（43．4％）；对亚胺培南和美罗培南的耐药率分别为63．5％和68．2％。不同医院不动杆菌属细菌对抗菌药物的耐药率也有不同，不同科室分离株的耐药率也有不同，其中以IC U 分离株耐药率最高。出现较多多重耐药（45．0％，3521/7827）和泛耐药（20．0％，1567/7827）株。结论鲍曼不动杆菌是不动杆菌属中最常见的菌种，检出率呈逐年增长的趋势。该菌对于除米诺环素、阿米卡星和头孢哌酮-舒巴坦外的大多数抗菌药物的耐药率在60．0％以上，且耐药率有逐年增高的趋势。不同地区医院鲍曼不动杆菌的耐药率相差较大，不同科室菌株的耐药率也有很大差异。%Objective To investigate the antimicrobial resistance in the A cinetobacter baumannii strains in different parts of China during 2012 .Methods A total of 8 739 clinical isolates of Acinetobacter were collected from 13 general hospitals and two children’s hospitals ,of which most were A . baumannii (89 .6% , 7 827/8 739 ) . Antimicrobial susceptibility testing was carried out by means of Kirby-Bauer method according to the unified protocol . The susceptibility testing data were analyzed by WHONET 5 .6 software according to CLSI 2013 breakpoints .Results Majority (85 .4% ) of the Acinetobacter strains were isolated from inpatients .The remaining 14 .6% were from outpatients and emergency room patients .Of the 7 827 strains of A .baumannii , 10 .9% ,35 .2% ,35 .7% and 43 .4% were resistant to tigecycline ,minocycline ,cefoperazone-sulbactam and amikacin , respectively .The percentage of A .baumannii resistant to imipenem and meropenem was 63 .5% and 68 .2% ,respectively . The antimicrobial resistant pattern varied in different hospitals . The resistance of A . baumannii varied between different clinical departments .A number of pandrug resistant (PDR) (20 .0% ,1 567/7 827) and multidrug-resistant (MDR) (45 .0% , 3 521/7 827 ) A . baumannii were identified . Conclusions A . baumannii is the most popular pathogenic bacteria among Acinetobacter .The antibiotic resistance of A .baumannii is still increasing .Cefoperazone-sulbactam and minocycline has good in vitro antibacterial activity against A .baumannii .The antibiotic resistance of A .baumannii varies greatly with hospital and department .
  • 摘要：Objective To analyze the clinical characteristics of patients with L isteria septicemia for better clinical diagnosis and management of the disease .Methods A retrospective study was carried out in 13 patients with confirmed diagnosis of Listeria septicemia from July 2009 to November 2013 in West China Hospital of Sichuan University .The clinical features ,laboratory tests ,treatments and clinical outcomes were reviewed and analyzed . Results The vast majority of the 13 patients were immunocompromised or with critical organ dysfunction . The in vitro antimicrobial susceptibility testing indicated that penicillin ,ampicillin and levofloxacin were the most active agents against Listeria ,followed by imipenem ,erythromycin , ciprofloxacin and tetracycline .Only 33 .3% of the 13 Listeria isolates were sensitive to oxacillin .Eight patients were cured ,2 improved ,2 died after therapy .The remaining one patient gave up therapy .Conclusions The incidence of Listeria septicemia was associated with advanced age and presence of underlying diseases .Early etiology diagnosis and appropriate antibacterial therapy can improve the outcome of such patients .Actively treating underlying diseases helps reduce the mortality rate .%目的：分析总结李斯特菌败血症的临床特点，为临床诊治提供依据。方法回顾性分析四川大学华西医院2009年7月至2013年11月共13例经血培养确诊的李斯特菌败血症患者的临床表现、实验室检查、治疗方案和预后。结果13例患者中绝大多数有免疫功能低下或重要器官损害。体外药敏试验结果显示，李斯特菌对青霉素、氨苄西林、左氧氟沙星等抗菌药物的敏感率最高，为100％，其次为对亚胺培南、红霉素、环丙沙星、四环素；对苯唑西林的敏感率仅为33．3％。13例中8例治愈、2例好转出院，2例死亡，1例自动出院。结论李斯特菌感染患者多系高龄或有基础疾病，早期的病原微生物诊断及合理选用抗菌药物是改善预后的重要措施之一，积极治疗基础疾病也有利于降低病死率，提高治愈率。
  • 摘要：Objective To investigate the molecular epidemiology of Staphylococcus aureus in Yanbian area .Methods From March 2011 to June 2012 ,a total of 101 consecutive and non-duplicate strains of Staphylococcus aureus were collected from Yanbian Hospital .Genotypes of SCCmec ,spa,and multilocus sequence typing (MLST) were determined by PCR combined with DNA sequencing analysis .The pvl gene was detected by PCR .Results The most prevalent SCCmec type was type II (65 .0% ,39/60) ,followed by SCCmec type III (26 .7% ,16/60) .A total of 11 Spa types were identified for the MRSA strains ,including t2460 (55 .0% ,33/60) ,t030 (18 .3% ,11/60) ,t002 ,t324 ,and t632 (5 .0% ,3/60 each) .A total of 29 Spa types were identified for MSSA strains ,including t796 (14 .6% ,6/41) ,t309 (9 .8% ,4/41) ,and t126 (7 .3% ,3/41) . The pvl gene was identified in 5 stains .MRSA strains were classified into three types based on multilocus sequence typing (MLST) ,namely ST5 ,ST239 and ST72 .MLST-based MSSA types were more diverse ,including ST5 ,ST 25 ,ST 15 ,ST 59 ,ST 1 ,ST 7 ,ST 45 ,ST 22 ,and ST 188 .Conclusions ST5-MRSA-SCCmecII-t2460 and ST239-MRSA-SCCmecIII-t030 are the most prevalent MRSA clones in Yanbian area .Multiple prevalent MSSA clones are identified.%目的：研究我国延边地区金黄色葡萄球菌（金葡菌）的分子流行病学特点。方法收集2011年3月-2012年6月吉林省延边大学附属医院连续分离的金葡菌非重复株101株，通过PCR联合测序进行葡萄球菌染色体mec（SCC mec）分型、葡萄球菌A蛋白（spa）分型、多位点序列分型（MLST）并进行 pvl基因检测。结果 SCCmec分型：以Ⅱ型为主（39/60；65．0％），其次是Ⅲ型（16/60；26．7％）；spa分型：甲氧西林耐药金葡菌（MRSA）有11种，其中 t2460为33株（55．0％），t030为11株（18．3％），t002、t324、t632均为3株（5．0％）。甲氧西林敏感金葡菌（MSSA）共分出29种不同的型：t796为6株（14．6％）， t309为4株（9．8％），t126为3株（7．3％）；共检出 pvl基因阳性5株；MLST检测：MRSA共有3种分型，ST5，ST239，ST72。MSSA分型具有多样性：ST5，ST 25，ST 15，ST 59，ST 1，ST 7，ST 45，ST 22，ST 188。结论延边地区MRSA的主要克隆株为ST5-MRSA-SCCmecII-t2460和ST239-MRSA-SCCmecIII-t030，MSSA显示多克隆性。
  • 摘要：临床资料患者女,61岁,家庭妇女。有高血压病史2年,口服卡托普利25 mg,2次/d,平时血压维持在160/100 mmHg。患者于入院前2个月,在无明显诱因下出现间歇发热症状,体温最高时为38.6℃,伴厌食、乏力。当地医院给予依托必利分散片、抗感染治疗（具体用药不详）,效果不佳。患者体温逐渐升高至40℃,伴寒战、头痛。病程中,神志清,精神可。偶有头痛,无咳嗽咯痰,无夜间阵发性呼吸困难,无端坐呼吸。
  • 摘要：不动杆菌是引起医院感染的重要病原体之一,其中鲍曼不动杆菌是临床最常分离到的不动杆菌,其次为pittii不动杆菌（Acinetobacter pitti,A.pitti,即以前的不动杆菌基因种型3）和nosocomialis不动杆菌（Acinetobacter nosocomialis,A.nosocomialis,即以前的不动杆菌基因种型13TU）。这3种不动杆菌通常难以鉴别,统称为＂醋酸钙不动杆菌-鲍曼不动杆菌复合体＂（A.calcoaceticus-A.baumannii complex,Acb）。
  • 摘要：Objective To investigate the susceptibility and resistance of clinical isolates collected from hospitals in several regions of China . Methods Fourteen general hospitals and two children ’ s hospitals were involved in this program . Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated Systems .Results were analyzed according to CLSI 2013 breakpoints .Results A total of 84 572 clinical isolates were collected from January to December 2013 ,of which gram negative organisms and gram positive cocci accounted for 73 .0% and 27 .0%respectively .Methicillin-resistant strains in S .aureus (MRSA) and coagulase negative Staphylococcus (MRCNS) accounted for an average of 45 .2% and 73 .5% respectively .The resistance rates of methicillin-resistant strains to β-lactams and other antimicrobial agents were much higher than those of methicillin-susceptible strains .However ,92 .2% of MRSA strains were still susceptible to trimethoprim-sulfamethoxazole while 87 .4% of MRCNS strains were susceptible to rifampin . No staphylococcal strains were found resistant to vancomycin ,teicoplanin or linezolid .In Enterococcus spp .,the resistance rates of E . f aecalis strains to most tested drugs (except chloramphenicol) were much lower than those of E . f aecium .Some strains of both species were resistant to vancomycin .Vancomycin-resistant strains of E . f aecalis and E . f aecium were mainly VanA type based on their phenotype .Regarding non-meningitis S . pneumoniae strains ,the prevalence of penicillin-susceptible S . pneumoniae and penicillin-intermediate S . pneumoniae strains isolated from both adults and children were lower than those isolated in 2012 ,but the prevalence of penicillin-resistant S .pneumoniae strains increased .The prevalence of ESBLs producing strains was 54 .0% in E .coli ,31 .8% in Klebsiella spp .(K .pneumoniae and K .oxytoca) and 16 .5% in Proteus mirabilis isolates on average . ESBLs-producing Enterobacteriaceae strains were more resistant than non-ESBLs-producing strains in terms of antibiotic resistance rates .The strains of Enterobacteriaceae were still highly susceptible to carbapenems .Overall less than 7 .0% of these strains were resistant to carbapenems .About 62 .8% and 59 .4% of Acinetobacter spp .(A .baumannii accounts for 89 .2% ) strains were resistant to imipenem and meropenem ,respectively .Compared with the data of year 2012 , extensively-drug resistant strains in K . pneumoniae and A . baumannii decreased .Conclusions The antibiotic resistance of clinical bacterial isolates is growing in 2013 .The disseminated multi-drug or pan-drug resistant strains in a special region poses a serious threat to clinical practice and implies the importance of strengthening infection control .%目的：了解国内主要地区临床分离菌对常用抗菌药物的敏感性和耐药性。方法国内主要地区16所教学医院（14所综合性医院、2所儿童医院）临床分离菌采用纸片扩散法或自动化仪器法按统一方案进行药物敏感性试验。按CLSI 2013年版标准判断结果。结果2013年1-12月收集各医院临床分离菌共84572株，其中革兰阳性菌22863株，占27．0％，革兰阴性菌61709株，占73．0％。金黄色葡萄球菌（金葡菌）和凝固酶阴性葡萄球菌（CNS ）中甲氧西林耐药株的平均检出率分别为45．2％和73．5％。甲氧西林耐药株（MRSA和MRCNS）对β内酰胺类抗生素和其他测试药物的耐药率均显著高于甲氧西林敏感株（MSSA和MSCNS）。MRSA中有92．2％的菌株对甲氧苄啶-磺胺甲口恶唑敏感；MRCNS中有87．4％的菌株对利福平敏感。葡萄球菌属中均未发现对万古霉素、替考拉宁和利奈唑胺耐药株。肠球菌属中粪肠球菌对绝大多数所测试的抗菌药物（氯霉素除外）的耐药率均显著低于屎肠球菌，两者中均有少数万古霉素耐药株，根据表型推测多数为 v anA型或v anB型耐药。肺炎链球菌非脑膜炎株成人株和儿童株中青霉素敏感和中介株（PSSP和PISP）所占比例较2012年均略有降低，青霉素耐药肺炎链球菌（PRSP）的检出率有所升高。大肠埃希菌、克雷伯菌属（肺炎克雷伯菌和产酸克雷伯菌）和奇异变形杆菌中产ESBLs株分别平均为54．0％、31．8％和16．5％。肠杆菌科细菌中产ESBLs株对测试药物的耐药率均比非产ESBLs株高。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感，总耐药率≤7．0％。不动杆菌属（鲍曼不动杆菌占89．2％）对亚胺培南和美罗培南的耐药率分别为62．8％和59．4％。与2012年相比，肺炎克雷伯菌和鲍曼不动杆菌中广泛耐药株的检出率有所降低。结论细菌耐药性仍呈增长趋势，多重耐药和广泛耐药菌株在某些病区内的流行播散对临床构成严重威胁，应进行流行病学调查并采取有效的感控措施。
  • 摘要：目的：了解2012年中国CHINET耐药监测网所属15所医院临床分离的克雷伯菌属的耐药情况。方法采用自动化仪器和纸片扩散法（ K-B法）对临床分离株作药敏试验，并按CLSI 2012年标准判断药敏试验结果。结果共收集15所医院分离的肺炎克雷伯菌8772株、产酸克雷伯菌804株、肺炎克雷伯菌臭鼻亚种43株及其他克雷伯菌属2株。82．8％菌株（7963/9621）分离自住院患者，54．9％菌株（5285/9621）分离自呼吸道标本。儿童（17岁以下）来源的克雷伯菌属占16．3％（1564/9621）。药敏试验结果显示，克雷伯菌属对亚胺培南、美罗培南和厄他培南3种碳青霉烯类抗生素的耐药率分别为8．9％、10．8％和12．9％，对哌拉西林-他唑巴坦和头孢哌酮-舒巴坦的耐药率分别为14．1％和17．0％。所有15所医院均分离出对碳青霉烯类抗生素（亚胺培南或美罗培南或厄他培南）耐药菌株，其中肺炎克雷伯菌945株，产酸克雷伯菌45株。结论克雷伯菌属对碳青霉烯类抗生素、头孢哌酮-舒巴坦和哌拉西林-他唑巴坦仍保持较低耐药性，按CLSI 2012年新标准，对碳青霉烯类抗生素耐药菌株的分离率已达10．3％，且耐药株仍主要集中于华东地区，加强医院感染控制至关重要。%Objective To investigate the antimicrobial resistance of clinical strains of K lebsiella spp .isolated from 15 hospitals in China CHINET during 2012 .Methods Kirby-Bauer method and automatic microbiology analysis system were employed to study the antimicrobial resistance . WHONET 5 .6 software was applied for data analysis according to Clinical and Laboratory Standards Institute (CLSI) 2012 breakpoints .Results A total of 9 621 clinical K lebsiella isolates were analyzed ,including 8 772 strains of K . pneumoniae and 804 strains of K . oxytoca . About 54 .9% (5 285/9 621) of the K lebsiella strains were isolated from sputum ,and 16 .3% (1 564/9 621) were isolated from pediatric patients .Antimicrobial susceptibility testing showed that about 8 .9% ,10 .8% and 12 .9% of the strains were resistant to imipenem ,meropenem and ertapenem ,respectively .About 14 .1% and 17 .0% of the strains were resistant to piperacillin-tazobactam and cefoperazone-sulbactam , respectively . Carbapenem-resistant K lebsiella strains were identified from all the 15 hospitals ,including 945 strains of K .pneumoniae and 45 strains of K .oxytoca ,which were resistant to either imipenem ,meropenem or ertapenem .Conclusions The Klebsiella isolates collected from 15 hospitals in China during 2012 are relatively sensitive to carbapenems ,cefoperazone-sulbactam and piperacillin-tazobactam .The prevalence of carbapenem-resistant strains is still increasing in China ,about 10 .3% in 2012 ,and relatively higher in Eastern China .More efforts should be made to control the superbug .
  • 摘要：目的：分析组织胞浆菌病的临床特点、治疗和转归，加深对该病的认识。方法回顾性分析2001-2014年上海华山医院收治的7例组织胞浆菌病，并总结中国大陆同期发表的组织胞浆菌病文献共549例病例资料。结果播散型组织胞浆菌病的主要表现包括发热、肝脾肿大、浅表及深部淋巴结肿大、血细胞减少等，伴 HIV/AIDS者血细胞减少及皮肤黏膜表现突出。局灶性感染者缺乏系统性受累的症状或体征。组织学检查可见巨噬细胞内吞噬的荚膜组织胞浆菌。治疗多用两性霉素B，轻症患者予以伊曲康唑。结论组织胞浆菌病是由荚膜组织胞浆菌引起的深部真菌感染，病原菌培养阳性是诊断的金标准，需及时送检标本；治疗以两性霉素B为主，可辅以伊曲康唑。%Objective To describe the clinical feature ,therapeutic approach and prognosis of histoplasmosis for improving clinicians’ awareness of this disease .Methods The clinical data of 7 cases of histoplasmosis treated in Shanghai Huashan Hospital from 2001 to 2014 were reviewed retrospectively .Relevant reports about histoplasmosis from 2001 to 2014 in Chinese mainland were comprehensively reviewed .Results The major clinical manifestations of progressive disseminated histoplasmosis included fever ,hepatosplenomegaly ,lymphadenopathy ,and pancytopenia .Skin lesions and pancytopenia were more common in the patients complicated with HIV/AIDS .The patients with local infection were lack of systemic symptoms or signs . Histological examination found Histoplasmacapsulatum in macrophages in bone marrow or biopsy tissues .Amphotericin B was used most frequently to treat histoplasmosis .Itraconazole was appropriate in mild patients .Conclusions Histoplasmosis is caused by H .capsulatum .The golden standard of diagnosis is any culture positive for H .capsulatum .Antifungal treatments such as amphotericin B and itraconazole are very important .
  • 摘要：万古霉素广泛用于治疗耐甲氧西林金黄色葡萄球菌（MRSA）血流感染。近期的研究发现,β内酰胺类联合万古霉素对MRSA有协同作用。作者比较采用万古霉素联合β内酰胺类与万古霉素单独用对MRSA血流感染患者的细菌清除情况。MRSA细菌清除定义为治疗后（≥24 h）血培养转为阴性。本研究共纳入80例患者,其中万古霉素单药组30例,联合用药组50例,联合应用的β内酰胺类药物包括哌拉西林-他唑巴坦（68%）、头孢克肟（8%）、头孢曲松（6%）等。
  • 摘要：Gerber等发现3例存在肾功能不全接受同种异体造血干细胞移植的女性患者,在开始长疗程伏立康唑治疗后3~7.5个月后出现骨痛,影像学检查提示骨膜炎,骨扫描示局部摄取增高,血清碱性磷酸酶升高。停用伏立康唑后骨痛缓解。2例患者血清氟化物水平高于正常值10倍,停用药物3周后复查氟化物水平显著下降。
  • 摘要：革兰阳性菌所致皮肤软组织感染（SSSIs）、肺炎、败血症以及心内膜炎等感染性疾病的治疗在现代医学发达的今天仍然面临严峻挑战。以耐甲氧西林金葡菌（MRSA）为例,甲氧西林临床应用2年后即出现MRSA,此后50多年,该菌在世界各地医院中广泛传播。上世纪90年代初以来,社区获得性MRSA（CA-MRSA）出现并在全球播散,改变了MRSA感染仅发生在医院环境的旧观念。
  • 摘要：目的：了解2013年上海市细菌耐药性监测结果。方法采用纸片扩散法或自动化仪器法对上海市40所医院的临床分离菌进行药敏试验。其中包括28所三级医院和12所二级医院，采用CLSI 2013年版标准判断结果。结果总计98185株临床分离菌，革兰阳性菌26655株，占27．1％，革兰阴性菌71530株，占72．9％。耐甲氧西林金黄色葡萄球菌（金葡菌）（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为50．8％和77．6％。在二级医院和三级医院MRSA、M RCNS的平均检出率分别为55．1％、80．6％和49．8％、77．0％。葡萄球菌属中未发现万古霉素、替考拉宁和利奈唑胺耐药株。726株儿童肺炎链球菌非脑膜炎分离株中青霉素敏感、中介和耐药（PSSP、PISP和PRSP）的检出率分别为56．7％、15．6％和27．7％，107株成人分离株为91．6％、2．8％和5．6％。发现35株屎肠球菌和17株粪肠球菌对万古霉素耐药（VRE）。根据表型推测，多数VRE为V anA 基因型。大肠埃希菌、克雷伯菌属和奇异变形杆菌中产ESBLs菌株的检出率分别为61．3％、37．1％和39．5％。上述3种细菌中产ESBLs菌株的检出率在二级医院和三级医院的检出率分别为63．0％、31．6％、56．3％和60．7％、38．7％、33．5％。肠杆菌科细菌对碳青霉烯类抗生素仍高度敏感，对亚胺培南和美罗培南的总耐药率分别为5．8％和6．6％。铜绿假单胞菌和不动杆菌属对亚胺培南、美罗培南耐药率分别为25．3％、24．3％和52．6％、56．0％。大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌中有少数菌株为对所有测试药物耐药的广泛耐药株。分离自尿液标本中的肠球菌属和大肠埃希菌对磷霉素的耐药率低。结论细菌耐药性仍对临床抗感染治疗构成严重威胁，尤其是二级医院中某些细菌的耐药率高于三级医院，应引起高度关注。%Objective To investigate the resistance of clinical bacterial isolates to antibiotics in Shanghai hospitals from January through December in 2013 .Methods Antimicobial susceptibility testing was carried out for the clinical isolates from 40 hospitals (including 28 tertiary hospitals and 12 secondary hospitals) according to a unified protocol using Kirby‐Bauer (KB) method or automated systems .Results were analyzed according to CLSI 2013 breakpoints .Results Of the 98 185 clinical isolates ,gram positive cocci and gram negative bacilli accounted for 27 .1% (26 655/98 185) and 72 .9% (71 530/98 185) ,respectively .The overall prevalence of MRSA in Staphylococcus aureus was 50 .8% and 77 .6% for MRCNS in coagulase‐negative Staphylococcus .The average prevalence of MRSA and MRCNS was 55 .1% and 80 .6% in secondary hospitals ,49 .8% and 77 .0% in tertiary hospitals .No strains were found resistant to vancomycin ,teicoplanin or linezolid .About 56 .7% of the 726 strains of non‐meningitis S . pneumoniae isolated from children were penicillin‐susceptible (PSSP) ,43 .3% were penicillin‐nonsusceptible ,including penicillin‐intermediate (PISP ,15 .6% ) and penicillin‐resistant (PRSP ,27 .7% ) strains .Of the 107 strains isolated from adults ,91 .6% ,2 .8% and 5 .6% were PSSP ,PISP and PRSP ,respectively .Overall ,35 strains of vacomycin‐resistant E . feacium and 17 strains of vacomycin‐resistant E . feacalis were identified .Most of these resistant strains were VanA type based on their phenotype .The overall prevalence of ESBLs‐producing srains was 61 .3% in E .coli , 37 .1% in K lebsiella spp .and 39 .5% in P .mirabilis .Specifically ,the prevalence of such strains was 63 .0% ,31 .6% and 56 .3% in secondary hospitals ,60 .7% ,38 .7% and 33 .5% in tertiary hospitals ,respectively .Enterobacteriaceae strains were still highly susceptible to carbapenem antibiotics .Overall ,5 .8% and 6 .6% of the Enterobacteriaceae strains were resistant to imipenem and meropenem ,respectively .Of the P . aeruginosa strains ,25 .3% and 24 .3% were resistant to imipenem and meropenem ,respectively .Of the Acinetobacter spp .strains ,52 .6% and 56 .0% were resistant to imipenem and meropenem , respectively .A few extensively‐drug resistant strains were identified in E . coli , K . pneumoniae , A . baumannii and P . aeruginosa .The strains of Enterococcus spp .and E .coli isolated from urine showed relatively lower resistance to fosfomycin . Conclusions It seems that antibicotic resistance is increasing in the clinical isolates ,which poses a serious threat to the clinical practice .Special attention should be paid to the fact that the prevalence of resistant strains of some species in secondary hospitals is even higher than that in tertiary hospitals .
  • 摘要：Objective To investigate the antimicrobial resistance of clinical Stenotrophomonas maltophilia isolates from 15 hospitals in several regions of China during 2012 . Methods Fifteen representative general hospitals were involved in this program .Bacterial susceptibility testing was carried out by means of a unified protocol using Kirby‐Bauer method and minimum inhibitory concentration ( M IC ) determination .The results were analyzed according to the 2012 CLSI breakpoints .Results Most (97 .5% ) of the 2 156 clinical strains of S . maltophilia were isolated from inpatients .Only 2 .5% of the isolates were from outpatients . About 65 .4% (1 410/2 156) of the strains were isolated from old patients at least 60 years of age ,and only 5 .3% (115/2 156) were from patients of 18 years old or younger .Sputum and respiratory tract secretion were the most common specimen source , accounting for 82 .1% .And 3 .8% of the isolates were from blood ,abdominal fluid and other sterile body fluids .About 10 .0% ,10 .5 % ,3 .8 % and 24 .4% of the S . maltophilia strains were resistant to trimethoprim‐sulfamethoxazole , levofloxacin , minocycline , and cefoperazone‐sulbactam , respectively . Conclusions Majority of S . maltophilia strains are isolated from respiratory tract specimens of inpatients .Such strains are usually isolated from old patients at lease 60 years of age .The S . maltophilia strains are intrinsically resistant to most antibacterial agents , but still show low resistance to trimethoprim‐sulfamethoxazole ,levofloxacin and minocycline .Antimicrobial therapy for S .maltophiliastrains should be based on the results of antimicrobial susceptibility testing .%目的：了解国内不同地区15所医院2012年临床分离嗜麦芽窄食单胞菌对抗菌药物的耐药性。方法对国内主要地区15所医院2012年收集的临床非重复嗜麦芽窄食单胞菌菌株，按统一方案及材料、采用纸片扩散法或自动化仪器法进行细菌药敏试验，按照CLSI 2012年标准判读结果。结果全年共收集2156株嗜麦芽窄食单胞菌。其中住院患者分离2103株，占97．5％；门诊患者分离53株，占2．5％。60岁及以上的老年患者分离1410株，占65．4％，小于18岁的患者分离115株，占5．3％。分离自痰液等呼吸道分泌物标本1770株，占82．1％；分离自血液、胸腹水、关节腔液、脑脊液等无菌体液标本81株，占3．8％。该菌对甲氧苄啶‐磺胺甲口恶唑、左氧氟沙星和米诺环素的耐药率分别为10．0％、10．5％和3．8％，对头孢哌酮‐舒巴坦的耐药率为24．4％。结论嗜麦芽窄食单胞菌主要分离于住院患者及其痰液等呼吸道标本，且多见于60岁及以上的老年患者。该菌对大多数常用抗菌药物固有耐药，但对CLSI推荐的甲氧苄啶‐磺胺甲口恶唑、左氧氟沙星和米诺环素的耐药率低。头孢哌酮‐舒巴坦对该菌亦有较好抗菌活性。临床应以药敏试验结果合理选用治疗嗜麦芽窄食单胞菌的抗菌药物。
  • 摘要：目的：通过监测万古霉素血药浓度，分析血药浓度与疗效、药物不良反应的关系，指导万古霉素在耐甲氧西林葡萄球菌（M RS ）等革兰阳性球菌感染中的合理用药。方法在有指征应用万古霉素的M RS等革兰阳性球菌感染患者中进行该药药物浓度监测。留取血样时间为万古霉素给药至少4个剂量后，在给药前30 min内采血送检谷浓度，给药结束后30 min至1 h内采血送检峰浓度，采用荧光偏振免疫法测定万古霉素血药浓度，同时收集临床资料，进行统计分析。结果25例患者万古霉素血药谷浓度为3．22～50．79 mg／L ，谷浓度＜5 mg／L者3例，5～＜10 mg／L者11例，10～15 mg／L者3例，＞15 mg／L者8例；峰浓度为13．57～60．47 mg／L ，峰浓度＜25 mg／L者14例，25～40 mg／L者7例，＞40 mg／L者4例。感染患者临床好转率为80．0％（20／25）；细菌清除率为87．5％（21／24）。13例患者根据血药浓度监测结果调整用药剂量，其治疗好转率为92．3％（12／13）。4例患者出现肾功能损害。结论万古霉素血药浓度个体差异较大，通过监测血药浓度制定的万古霉素个体化给药方案用于治疗M RS等革兰阳性球菌感染可提高治愈率，减少药物不良反应。%Objective To analyze the relationship between plasma concentration and efficacy , adverse drug reactions by monitoring vancomycin serum concentrations for appropriately treating the infections caused by methicillin‐resistant Staphylococcus aureus or other gram‐positive cocci .Methods Vancomycin concentration was monitored in the patients with indications for vancomycin therapy .Blood sample was taken after vancomycin was administered for at least 4 doses .The blood sample collected within 30 minutes before dosing was used to determine the trough blood concentration .The samples were taken within 30 minutes to 1 hour after infusion of vancomycin were used to estimate the peak concentration by fluorescence polarization immunoassay .The clinical data were collected at the same time to analyze clinical efficacy and safety .Results Vancomycin trough concentration ranged from 3 .22 mg/L to 50 .79 mg/L in 25 patients ,specifically ,< 5 mg/L in 3 cases ,5‐<10 mg/L in 11 cases ,10‐15 mg/L in 3 cases ,and > 15 mg/L in 8 csaes .Peak concentration ranged from 13 .57 mg/L to 60 .47 mg/L ,specifically ,< 25 mg/L in 14 cases ,25‐40 mg/L in 7 cases ,and > 40 mg/L in 4 cases .The infection was cured in 80 .0% (20/25) of the patients .The gram‐positive cocci were eradicated in 87 .5% (21/24) of the patients .The dosage of vancomycin was adjusted in 13 patients according to the results of blood concentration monitoring .Majority of these patients (12/13 ,92 .3% ) were cured .Renal impairment was observed in 4 patients .Conclusions Vancomycin is safe and effective in treatment of methicillin‐resistant Staphylococcus aureus and other gram‐positive bacterial infections . Vacomycin concentration varies from person to person . Serum concentration monitoring is required to achieve best outcomes and the goal of individualized treatment of vancomycin.
  • 摘要：多中心回顾性观察研究评价达托霉素治疗粒细胞减少症患者革兰阳性菌感染的临床疗效。
  • 摘要：利奈唑胺（linezolid）是第1个用于临床的口恶唑烷酮类抗菌药物，对革兰阳性菌有良好的抗菌活性，是临床上抗甲氧西林耐药金黄色葡萄球菌（金葡菌）（MRSA）、万古霉素耐药肠球菌（VRE）等感染的重要药物。其主要通过抑制细菌蛋白质的合成发挥抗菌活性。与其他同样作用于核糖体抑制蛋白质合成的抗生素不同（例如氯霉素、林可霉素影响肽链合成），利奈唑胺在蛋白质合成的起始阶段发生作用［1］。
  • 摘要：2013年9月16日（路透社健康新闻）美国疾病预防与控制中心（CDC）报道，美国每年至少有200万例由一种或多种抗菌药物耐药细菌引起的严重感染，其中二三万例死于此类感染。
  • 摘要：Objective To compare the efficacy and safety of levofloxacin 750 mg for 5 days versus 500 mg for 7‐14 days intravenous (IV ) infusion in the treatment of community‐acquired pneumonia (CAP ) . Methods This study was a multi‐center , randomized , open‐label , non‐inferiority , controlled clinical trial .The CAP patients were randomized to receive levofloxacin 750 mg IV daily for 5 days or levofloxacin 500 mg IV daily for 7‐14 days .The clinical symptoms , laboratory tests , imaging results and microbiology data were collected and compared between the two treatment groups in terms of efficacy and safety .Results A total of 241 patients were enrolled in this clinical trial from 10 study centers .Among these patients ,223 were eligible for full analysis set (FAS) analysis ,including 111 in 750 mg group and 112 in 500 mg group .Of the 223 patients in FAS ,211 were eligible for per‐protocol set (PPS) analysis ,including 107 in 750 mg group and 104 in 500 mg group .Two hundred and forty‐one patients were included in safety set (SS) ,including 121 patients in 750 mg group and 120 in 500 mg group .The median treatment duration was 5 .0 days in 750 mg and 9 .0 days in 500 mg group .The median total dose was 3 750 mg in 750 mg group and 4 500 mg in 500 mg group .The overall efficacy rate was 86 .2% in 750 mg group and 84 .7% in 500 mg group in terms of FAS at visit 4 ,which suggested that the efficacy of 750 mg group was non‐inferior to 500 mg group .Of the 111 FAS patients in 750 mg group ,40 were bacteriological evaluable ,and 41 strains of pathogens were isolated .Forty‐nine of the 112 FAS patients in 500 mg group were bacteriological evaluable ,and 51 bacterial strains were obtained .The bacterial eradication rate was 100% in both groups .The clinical treatment efficacy rate for atypical pathogens was 100% in both groups .In 750 mg group ,the most common clinical adverse drug reactions (ADRs) were injection site adverse reactions including injection site pruritus ,pain and hyperemia .The other common ADRs were insomnia ,nausea ,skin rash .The most common drug‐related laboratory abnormalities were neutrophil percentage decreased , decreased white blood cell (WBC ) count , alanine aminotransferase (ALT) and aspartate aminotransferase (AST) elevation .Most of the ADRs were mild in severity and well‐tolerated .The safety profile of the two treatments was comparable in terms of the drug‐related treatment discontinuation and the incidence of ADRs .Conclusions The short‐course regimen of levofloxacin 750 mg IV for 5 days is at least as effective and well tolerated as the long‐course regimen of 500 mg IV for 7‐14 days in treatment of CAP .%目的：比较左氧氟沙星750 mg注射液5 d短程疗法与500 mg注射液7～14 d常规疗法治疗社区获得性肺炎（CAP）疗效和安全性差异。方法本临床试验为随机对照、开放、非劣效性多中心临床试验。CAP患者被随机分配到左氧氟沙星750 mg组治疗5 d或500 mg组治疗7～14 d ，两组均接受静脉给药治疗，观察其临床表现、实验室检查、影像学改变及微生物学检查等，比较两组安全性和疗效差异。结果10个研究中心共入选病例241例。其中全分析集（FAS ）223例，包括750 mg组111例，500 mg组112例。符合方案分析集（PPS）211例，包括750 mg组107例，500 mg组104例。安全性分析集（SS）241例，包括750 mg组121例，500 mg组120例。FAS 750 mg组疗程中位数为5．0 d ，500 mg组疗程中位数为9．0 d。750 mg组总剂量中位数为3750 mg ，500 mg组总剂量中位数为4500 mg。FAS第4次随访750 mg组有效率为86．2％，500 mg组有效率为84．7％，两组综合疗效评价相比为非劣效。FAS 750 mg组可进行微生物疗效评价者共40例，获病原菌41株，500 mg组可行微生物疗效评价者共49例，获病原菌51株，两组细菌清除率均为100％。另外，750 mg组和500 mg组的非典型病原体的临床有效率均为100％。对750 mg组安全性观察结果显示，临床不良反应最常见为注射部位瘙痒、疼痛和充血等，其次为失眠、恶心、皮疹等。较常见的实验室指标异常为中性粒细胞比率降低、白细胞总数降低、ALT升高、AST升高等。以上不良反应多属轻微，患者可耐受，与500 mg组相比，因药物中止试验和不良反应发生率差异无统计学意义，提示两组安全性相仿。结论左氧氟沙星750 mg注射液5 d短程疗法治疗CAP与左氧氟沙星500 mg注射液7～14 d常规疗程相比，其临床和微生物疗效相仿，不良反应发生率相仿，均较轻微，患者耐受性好。
  • 摘要：Objective To explore the characteristics of pathogenic bacteria and risk factors for stroke‐associated pneumonia (SAP) in senile patients in order to privide basis for early clinical intervention .Methods A retrospective study was carried out to review the clinical data of 689 SAP patients treated at a university hospital between January 1 ,2011 and December 12 ,2013 . The pathogens from sputum and their antibiotic resistance profiles were analyzed .Multivariate Logistic regression model was used to screen relevant factors for stroke‐associated pneumonia (SAP) in a case‐control analysis at 1∶1 ratio .Results Of the 684 bacterial strains isolated from sputum , 545 (79 .7% ) were gram‐negative bacteria . The top bacterial species were Pseudomonasaeruginosa,Klebsiellapneumoniae,Acinetobacterbaumannii,and Enterobacterspp.Gram‐negativebacteria were highly resistant to most of the antimicrobial agents . About 31 .8% of the Acinetobacter strains were resistant to imipenem .A total of 139 (20 .3% ) gram‐positive strains were isolated . Staphylococcus aureus was the most frequently isolated gram‐positive pathogen (51 .8% ) , of which 63 .9% were resistant to methicillin (MRSA) .Most gram‐positive bacteria were sensitive to vancomycin , teicoplanin and linezolid . Multivariate Logistic regression suggested that age ( OR = 5 .632 ) , NIH stroke scale (NIHSS) score (OR= 4 .126) ,dysphagia (OR= 3 .481) , totally bedridden (OR=3 .431) ,mechanical ventilation (OR=4 .214) ,hyperglycemia (OR=2 .076) ,hypoalbuminemia (OR=2 .008) ,and high serum cortisol (OR=1 .825) were the major risk factors for SAP in senile patients .Conclusions Multiple antibiotic‐resistant pathogens are usually identified in the senile SAP patients .Early intervention to control the risk factors of SAP is important for prevention of SAP in senile patients .%目的：探讨老年卒中相关性肺炎（SAP）的病原菌特点及其危险因素，为临床早期干预提供指导。方法采用回顾性研究，对2011年1月至2013年12月同济大学附属杨浦医院住院的689例SAP患者的痰液标本资料进行整理分析，了解老年SAP患者痰液病原菌构成情况及耐药性特点。对SAP患者给予1∶1配比对照组，分析老年SAP发生的相关危险因素。结果采集到的684株痰菌标本中，革兰阴性菌545株（79．7％），主要分离菌依次为铜绿假单胞菌、肺炎克雷伯菌、不动杆菌属和肠杆菌属。革兰阴性菌对多数抗菌药物有高耐药率，其中不动杆菌对亚胺培南的耐药率高达31．8％；革兰阳性菌139株（20．3％），以金黄色葡萄球菌（金葡菌）为主，占革兰阳性菌的51．8％，甲氧西林耐药金葡菌（M RSA ）占金葡菌63．9％。革兰阳性菌对万古霉素、替考拉宁和利奈唑胺敏感性较高。多因素Logistic回归分析显示，老年SAP发病的主要危险因素有：年龄（OR＝5．632），美国国立卫生院脑卒中量表（NIHSS）评分（OR＝4．126），吞咽困难（OR＝3．481），卧床（OR＝3．431），机械通气（OR＝4．214），合并高血糖（OR＝2．076）、低白蛋白血症（OR＝2．008）、高皮质醇水平（OR＝1．825）。结论老年SAP常合并多种耐药菌感染，其发生、发展有多种高危因素参与，临床需加强早期预防。
  • 摘要：Objective To understand the serotype distribution ,prevalence and antimicrobial susceptibility of Salmonella strains isolatd from diarrhea patients in Dongguan ,Guangdong Province .These data may be useful for disease control and prevention and clinical treatment .Methods From April to December in 2013 ,we collected 1 150 stool specimens from diarrhea patients . Salmonella strains were cultured by using Salmonella selenite brilliant green sulfa enrichment broth and selective chromogenic plates .Antimicrobial susceptibility was tested by ATB microbial identification and drug susceptibility system .Results A total of 72 strains of Salmonella were identified including 21 serotypes .The detection rate was 6 .3% (72/1 150) .Most of the strains were Salmonellatyphimurium (22/72 ,30 .5% )and Salmonellaenteritis (16/72 ,22 .2% ).Forty‐two (58 .3% )of the strains were isolated from the patients under one year of age ,12 (16 .7% ) strains from the patients of 3‐10 years of age ,and 18 (25 .0% ) strains from the patients of at least 20 years old .The results of antimicrobial susceptibility testing showed that 50 .0% of the strains were resistant to piperacillin and 48 .6% resistant to ticarcillin .Conclusions The prevalence of Salmonella typhimurium is the highest in local Salmonella‐associated diarrhea patients ,followed by Salmonella enteritis .Most of the Salmonella diarrhea occurred in the patients under one year of age .Clinicians should strengthen the monitoring of Salmonella in patients with diarrhea , especially in infants and young children , for early detection and treatment so as to reduce complications .%目的：了解广东东莞地区沙门菌血清型分布，腹泻患者沙门菌检出数量及药敏试验结果，为该省今后的疾病防控，药物治疗提供参考依据。方法收集东莞市人民医院2013年4—12月门诊及住院患者腹泻粪便标本1150份，用改良亚硒酸盐磺绿增菌肉汤和沙门菌显色平皿分离检测沙门菌；药敏试验采用法国生物梅里埃ATB微生物鉴定和药敏分析系统及其配套药敏试条。结果共检出沙门菌72株，检出率为6．3％，分出21个血清型，以鼠伤寒沙门菌检出数量最多，22株（30．5％），肠炎沙门菌16株（22．2％）。年龄分布1周岁以下42株（58．3％），3～10岁12株（16．7％），20岁以上18株（25．0％）。药敏试验结果耐药率较高的药物有哌拉西林（50．0％），替卡西林（48．6％）。结论本地区腹泻患者检出沙门菌属以鼠伤寒沙门菌检出率最高，肠炎沙门菌次之，年龄1周岁以下较多。临床医师应加强对腹泻患者沙门菌属监测，尤以婴幼儿为重点，早期发现早期治疗以减少并发症发生。
  • 摘要：尽管有正常的尿液流动、强大的生理屏障以及一系列的宿主防御系统，但是人类的泌尿道仍然是最常见的细菌感染部位［1］。大多数尿路感染最初的表现是膀胱炎，进而引起急性肾盂肾炎，在某些严重的情况下，细菌可以突破肾脏的上皮和内皮屏障进入血流，导致全身性感染和脓毒症［2］。
  • 摘要：Objective To investigate the distribution and antibiotic resistance of clinical isolates from blood culture in 15 hospitals across China in 2012 .Methods The susceptibilities of blood culture isolates to more than 20 antimicrobial agents were determined by Kirby‐Bauer method according to a unified protocol .Results A total of 8 490 strains were isolated from blood samples in 2012 ,of which gram positive cocci and gram negative bacilli accounted for 56 .0% and 44 .0% respectively .The top ten isolates were coagulase negative Staphylococcus (CNS ) (35 .5% ) , E . coli (16 .4% ) , K lebsiella spp . (9 .8% ) , Enterococcus spp .(7 .2% ) ,S .aureus (7 .2% ) ,Acinetobacter spp .(5 .9% ) ,S .viridans (4 .3% ) ,P .aeruginosa (3 .2% ) , Entrobacter spp .(2 .4% ) and Burkholderia spp .(1 .5% ) ,together accounting for 93 .5% of all the blood culture isolates . The prevalence of MRSA among S .aureus and MRCNS among CNS was 50 .8% and 61 .7% ,respectively .About 29 .0% and 10 .9% of the E . f aecalis isolates were resistant to high level gentamicin and ampicillin respectively ,significantly lower than thatofE.faecium.Penicillinresistancewasfoundin3.8% oftheS.viridansstrainsand31.2% oftheS.pneumoniae strains isolated from adults , and 34 .1% of the S . pneumoniae strains isolated from children . Vancomycin‐resistant Enterococcus was identified in 3 .5% of the E . f aecium isolates .No strains were found resistant to vancomycin or linezolid in Staphylococcus spp .,Streptococcus spp .,S .pneumoniae and E .faecalis .About 11 .2% to 19 .8% of the Klebsiella strains were resistant to carbapenems .For the other Enterobacteriaceae species ,less than 10 .0% of the isolates were resistant to carbapenems .Nonfermenters were highly resistant to carbapenems ,especially Acinetobacter spp .(71 .6% resistant) and P .aeruginosa (nearly 30 .0% resistant) .Conclusions Gram positive cocci still play an important role in blood stream infections in 2012 CHINET program ,but the proportion decreases compared to previous years .Resistance to the fist line antibiotics is common among the blood isolates ,especially the increase of carbapenem resistance in gram negative bacteria .Antimicrobial agents should be used appropriately to reduce the selection pressure . Hospital infection control measures should be strengthened to prevent the spread of resistant organisms .%目的了解2012年中国CHINET血培养分离菌的构成及耐药性。方法对中国CHINET 细菌耐药监测网2012年1月至12月所有血培养分离菌，按统一方案用K‐B纸片扩散法进行抗菌药物敏感试验。结果2012年自血标本中共获分离菌8490株，其中革兰阳性球菌占56．0％，革兰阴性杆菌占44．0％。居前10位的分离菌依次为凝固酶阴性葡萄球菌（CNS ）（35．5％）、大肠埃希菌（16．4％）、克雷伯菌属（9．8％）（其中91．1％为肺炎克雷伯菌）、肠球菌属（7．2％）、金黄色葡萄球菌（金葡菌）（7．2％）、不动杆菌属（5．9％）（其中93．8％为鲍曼不动杆菌）、草绿色链球菌（4．3％）、铜绿假单胞菌（3．2％）、肠杆菌属（2．4％）和洋葱伯克霍尔德菌（1．5％） ，占所有分离菌株的93．5％。甲氧西林耐药金葡菌（M RSA ）、甲氧西林耐药 CNS （MRCNS）分别占金葡菌和CNS的50．8％和61．7％。粪肠球菌对高浓度庆大霉素和氨苄西林的耐药率分别为29．0％和10． 9％，屎肠球菌对多数测试药物的耐药率显著高于粪肠球菌。草绿色链球菌对青霉素的耐药率为3．8％。儿童分离株中青霉素耐药肺炎链球菌株为31．2％，与成人分离株大致相仿（34．1％）。葡萄球菌属、肺炎链球菌、其他链球菌属和粪肠球菌中均未发现万古霉素和利奈唑胺耐药菌株，屎肠球菌对万古霉素的耐药率为3．5％。大肠埃希菌、肠杆菌属、沙雷菌属、变形菌属和枸橼酸菌属等肠杆菌科细菌对碳青霉烯类的耐药率均在10．0％以下，唯克雷伯菌属对碳青霉烯类耐药率为11．2％～19．8％。不发酵糖革兰阴性杆菌对碳青霉烯类耐药率较高，铜绿假单胞菌对碳青霉烯类的耐药率近30．0％，对不动杆菌属耐药率达70．0％以上。结论2012年中国CHINET监测资料显示，血培养分离菌仍以革兰阳性菌为主，但检出比例有所下降，革兰阴性菌有所上升。血培养分离株对常用抗菌药物耐药性仍严重，尤其革兰阴性菌对碳青霉烯类耐药率呈上升趋势。因此应合理应用抗菌药物，并加强医院感染控制措施抑制耐药菌传播。
  • 摘要：目的：探讨CD4＋ TCR四聚体‐流式分析和细胞爬片法检测分析外周血结核抗原特异性CD14＋单核细胞的应用价值。方法应用四聚体对肺结核患者（肺结核组）外周血进行染色，流式检测四聚体阳性CD14＋细胞的百分率，以非结核呼吸道感染患者（非结核呼吸道感染组）外周血及脐带血标本（脐带血组）作为研究对照。将肺结核组和对照组外周血制作成细胞爬片，用四聚体‐细胞爬片法原位染色，激光共聚焦倒置显微镜观察细胞爬片中四聚体与结核抗原双染阳性及四聚体与CD14双染阳性细胞的分布情况。结果应用CD4＋ Vα21‐J39／Vβ29‐D1‐J2 TCR四聚体检测肺结核组、非结核呼吸道感染组和脐带血组的四聚体阳性CD14＋细胞百分率中位数分别为1．32％、0．50％和0．26％，而CD4＋ Vα21‐J39／Vβ29‐D2‐J2 TCR四聚体则分别为1．05％、0．49％和0．19％。肺结核组外周血CD14＋单核细胞百分率显著高于各对照组。细胞爬片法可观察到肺结核组四聚体与CD14双染阳性及四聚体与结核抗原双染阳性的细胞，而对照组标本均为阴性。结论 CD4＋ TCR四聚体技术，结合细胞流式和细胞爬片原位染色方法，能在体外敏感地检测出结核抗原特异性CD14＋单核细胞，可以更准确地评价其在结核感染者体内的变化特征及临床意义。%Objective To evaluate the utility of CD4+ TCR tetramers‐based flow cytometric analysis and cell climbing slice assay in detecting antigen‐specific CD14+ monocytes in the blood of tuberculosis (TB) patients .Methods CD4+ TCR tetramers were used to detect tetramer‐positive CD14+ monocytes in the peripheral blood (PBL ) samples of inpatients with advanced pulmonary TB (PTB) by flow cytometric analysis .The PBL samples obtained from non‐TB patients and umbilical cords were used as controls .These tetramers were also used to examine tetramer‐bound CD14+ monocytes and Mycobacterium tuberculosis (MTB) antigen‐specific and tetramer‐bound cells by cell climbing slice in situ staining .Results The median percentage of tetramer‐bound CD14+ monocytes in PBL samples from PTB patients ,non‐TB patients and umbilical cords were 1 .32% , 0 .50% and 0 .26% respectively by using CD4+ Vα21‐J39/Vβ29‐D1‐J2 tetramer , while the medians were 1 .05% , 0 .49% and 0 .19% respectively by using CD4+ Vα21‐J39/Vβ29‐D2‐J2 tetramer . The percentage of tetramer‐bound CD14+ monocytes in PTB patients group was significantly higher than the other two control groups .In cell climbing slice in situ staining ,tetramer‐bound CD14+ monocytes ,and MTB antigen‐specific and tetramer‐bound cells were positive in PTB tissue compared with negative in control tissues . Conclusions CD4+ TCR tetramers‐based flow cytometric analysis and cell climbing slice assay could be used to sensitively detect M TB antigen‐specific CD14+ monocytes in the blood of TB patients ,and more accurately evaluate the changing profile and clinical significance of these cells in TB patients .

    中国感染与化疗杂志的期刊信息

    • 曾用名：中国抗感染化疗杂志
    • 创刊时间：2001
    • 地区：CN
    • 语言：中文
    • 热门主题：复旦大学附属华山医院
    • 学科分类： 临床医学;

      Medicine:Infectious Diseases;Microbiology (medical);Pharmacology (medical);

    中国感染与化疗杂志的获奖情况

    • • 中国精品科技期刊
    • • 百种中国杰出学术期刊
    • • 中国高校百佳科技期刊
    • • 中国高校技术类优秀期刊
    • • 华东地区优秀期刊奖
    • • 上海市高校精品科技期刊奖

    中国感染与化疗杂志的收录情况

    • 中国·北大核心期刊（2023版）
    • 中国·北大核心期刊（2020版）
    • 中国·北大核心期刊（2017版）
    • 中国·北大核心期刊（2014版）
    • 中国·北大核心期刊（2011版）
    • 中国·中国科技核心期刊
    • 中国·中国科学引文数据库-核心（2023-2024）
    • 中国·中国科学引文数据库-核心（2021-2022）
    • 中国·中国科学引文数据库-核心（2019-2020）
    • 中国·中国科学引文数据库-核心（2017-2018）
    • 中国·中国科学引文数据库-核心（2015-2016）
    • 中国·武大RCCSE核心期刊（2020）
    • 日本·日本科学技术振兴机构数据库
    • 荷兰·医学文摘
    • 美国·化学文摘（网络版）

    中国感染与化疗杂志的投稿信息

    • 投稿方式：在线投稿
    • 投稿须知：点击查看
    • 期刊官方网站：点击前往
    • 版面费：
    • 审稿费：元
    • 通讯地址：上海市乌鲁木齐中路12号
    • 邮编：200040
    • 联系电话：021-52888148
    • 邮箱：cjic@fudan.edu.cn
    • 期刊栏目：述评；论著；综述；临床研究；实验研究；临床经验；病例报告；合理用药；信息交流；讲座；国内外动态；作者·读者·编者等
    免费订阅本刊

    客服邮箱：kefu@zhangqiaokeyan.com

    京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有 出版物经营许可证

    • 客服微信

    • 服务号