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A Patient with autoimmune hepatitis and transverse myelitis presented with persistent Staphylococcus aureus bacteremia, the discrepancies in assessing susceptibility; VISA versus Non-VISA 1例自身免疫性肝炎合并横贯脊髓炎患者表现为持续性金黄色葡萄球菌菌血症,敏感性评估的差异签证与非签证
Pub Date : 2015-11-10 DOI: 10.3823/769
J. W. A. Ramahi, Abdelbadee Yacoub, Lamya Abu Shanab
Vancomycin-Intermediate Staphylococcus aureus (VISA) is still uncommon among MRSA isolates. In our region, we rarely encounter a case of VISA and/or GISA bacteremia. Here, we report a man who suffered from autoimmune hepatitis on immunosuppressive therapy and thoracic transverse myelitis suspected to be due to polyomavirus infection; he developed persistent MRSA blood stream infection, PVL-positive and MLST clonal complex 88 which is reported most commonly from Africa. A strain with Vancomycin susceptibility of 4 – 6 µg/ml (VISA) was initially identified, retested again elsewhere and showed MIC of 2µg/ml and Teicoplanin susceptibility of 4µg/ml. Treatment failure occurred while attaining higher serum vancomycin levels than recommended and died.
万古霉素-中间金黄色葡萄球菌(VISA)在MRSA分离株中仍不常见。在我们地区,我们很少遇到VISA和/或GISA菌血症病例。在这里,我们报告了一名接受免疫抑制治疗的自身免疫性肝炎患者和怀疑由多瘤病毒感染引起的胸横脊髓炎;他出现了持续性MRSA血流感染,pvl阳性和MLST克隆复合体88,最常见于非洲。初步鉴定出一株万古霉素敏感性为4 ~ 6µg/ml (VISA)的菌株,在其他地方再次检测,MIC为2µg/ml,替柯planin敏感性为4µg/ml。当血清万古霉素水平高于推荐水平时发生治疗失败并死亡。
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引用次数: 1
Genetic heterogeneity of CTX-M type extended-spectrum ß-lactamase producing Escherichia coli strains from diverse sources in Saudi Arabia 沙特阿拉伯不同来源产ß-内酰胺酶的CTX-M型大肠杆菌菌株的遗传异质性
Pub Date : 2015-10-21 DOI: 10.3823/768
S. Hassan, Y. Gherbawy, A. Altalhi
Background: The rise of CTX-M extended spectrum β-lactamase (ESBLs)-producing E. coli in non-human sources is a growing concern of public health. Understanding the extent of public health risk attributed to CTX-M type ESBLs-producing strains from different sources is critical for effective control. Objective: This study focuses on detection and molecular typing of CTX-M type ESBL-producing E. coli isolated from various sources in Taif, Western Saudi Arabia.  Material and Methods: A total of 24 E. coli ESBLs-producing isolates from multiple sources were assessed for the presence of CTX-M groups gene by PCR, and subsequently their clonal relatedness by random amplifid of polymorphic DNA (RAPD) analysis. Isolates were selected according to a resistance phenotype consistent with production of ESBL-type beta-lactamase using double disk diffusion method. Results: A CTX-M gene was detected in all 24 isolates. RAPD typing of E. coli isolates bearing CTX-M gene showed 24 patterns verifid into two major clusters (A, B) and three sub-clusters (A1 – A3). Phylogenetic analysis indicating a degree of similarity among clustering isolates from human, sheep and raw milk origins. Identical profie was observed between three isolates obtained from pet bird and chicken.
背景:在非人类来源产生CTX-M扩展谱β-内酰胺酶(ESBLs)的大肠杆菌的兴起是一个日益关注的公共卫生问题。了解来自不同来源的CTX-M型产生esbls的菌株造成的公共卫生风险程度对于有效控制至关重要。目的:研究沙特西部塔伊夫不同来源产esbl的CTX-M型大肠杆菌的检测及分子分型。材料与方法:采用PCR方法对24株产esbls的大肠杆菌分离株进行CTX-M群基因检测,并通过RAPD分析其克隆亲缘性。采用双盘扩散法,根据与生产esbl型β -内酰胺酶一致的抗性表型选择分离株。结果:24株分离株均检出CTX-M基因。对携带CTX-M基因的大肠杆菌进行RAPD分型,发现24种模式,分为A、B两大聚类和A1 ~ A3三个亚聚类。系统发育分析表明,来自人、羊和原料奶的聚类分离株具有一定程度的相似性。从家禽鸟和鸡中分离得到的三株分离株具有相同的特征。
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引用次数: 1
Usefulness of routine pairing of anaerobic with aerobic blood culture bottles and decision making on antimicrobial therapy 厌氧与好氧血培养瓶常规配对的有效性及抗菌治疗决策
Pub Date : 2015-10-11 DOI: 10.3823/767
J. W. A. Ramahi, Lamya Abu Shanab, Abdelbadee Yacoub, A. Diab, Dania Al Momani, Fawzi Hleil, Haifa Petro, Husam Farraj, Ghassan Wadi, Naheel Halloub, S. Abdulhadi, W. Issa
ObjectivesTo evaluate the growth concordance in paired aerobic/anaerobic sets, and the impact of the anaerobic growth on patients' antimicrobial management.MethodThis is a prospective multicenter study which was conducted in three hospitals, with total beds of 750 beds and 52 ICU beds. Prospectively, laboratory blood cultures logbooks were daily reviewed and patients from whom blood cultures were ordered were followed, their chart were reviewed. Entries on antimicrobial therapeutic changes were noted for all paired sets. Clinicians were blinded to the study, though they were informed about culture results via the usual work protocol in each hospital.ResultsCollected Blood culture sets totaled 2492; 172 single sets were excluded, and 1160 paired sets were analyzed. 1046 were concordant; 79 sets had bacterial growth and 967 sets had no bacterial growth. 114 sets were discordant; 97 in aerobic bottles, 13 in anaerobic, and 4 in both.The proportion of agreement for the concordant paired growth sets was 90.2%.  The composite proportion of agreement for sets with any growth (N = 193, composite proportion of agreement = 56%, 95% C.I., 34% - 48%). Cohen kappa composite agreement, measured for the total analyzed paired-sets (N = 1160, K = .52, SE = .038. 95% C.I., .447 - .595). The odds of modifying antimicrobial regimen were for total and subgroups intent to treat odds, based on paired sets showed that one modification took place in one anaerobic growth set (N = 1160, Odds = 0.0008), the odds for all sets with any growth (N = 193, odds = .005), and based on any anaerobic sets (79 concordant, 13 anaerobic, and 4 discordant) with bacterial growth (N = 96: odds = 0.010).ConclusionThe study demonstrates that the proportion of agreement among paired sets were high, and needless to include anaerobic sets in routine blood culture collection. Also the decision-making of anti-infective treatment on patients based on anaerobic blood culture growth was not evident.
目的评价好氧/厌氧配对组细菌的生长一致性,以及厌氧生长对患者抗菌药物管理的影响。方法采用前瞻性多中心研究,在3家医院共750张床位,52张ICU床位。前瞻性地,每天审查实验室血培养日志,并对要求进行血培养的患者进行随访,并审查其图表。记录了所有配对组的抗菌治疗变化条目。临床医生对这项研究是不知情的,尽管他们通过每家医院的常规工作协议被告知培养结果。结果共采集血培养物2492套;排除172个单组,分析1160个成对组。1046个是和谐的;细菌生长79组,无细菌生长967组。114组不一致;有氧瓶97瓶,无氧瓶13瓶,两瓶各4瓶。配对生长集的一致性比例为90.2%。任意生长的集合的一致性复合比例(N = 193,一致性复合比例= 56%,ci为95%,34% ~ 48%)。Cohen kappa复合一致性,测量了总分析配对集(N = 1160, K = 0.52, SE = 0.038)。95% c.i., 0.447 - 0.595)。修改抗菌方案的几率为总组和亚组意图治疗的几率,基于配对集显示,一个厌氧生长组发生了一次修改(N = 1160, odds = 0.0008),所有组的任何生长(N = 193, odds = 0.005),以及基于任何厌氧组(79个和谐组,13个厌氧组,4个不和谐组)的细菌生长(N = 96: odds = 0.010)。结论本研究表明,血常规培养标本的配对吻合率较高,不需要纳入厌氧标本。根据无氧血培养生长对患者进行抗感染治疗的决策也不明显。
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引用次数: 0
Molecular determinants of ß-lactamase producing Klebsiella pneumoniae in Mansoura University Neonatal Intensive Care Unit 曼苏拉大学新生儿重症监护室产ß-内酰胺酶肺炎克雷伯菌的分子决定因素
Pub Date : 2015-09-29 DOI: 10.3823/766
E. Hammad, Hamdia Askar, M. Saleh, B. Shouman
Background: The emergence of s-lactamase- producing Klebsiella pneumonia (K. pneumoniae), represents a significant diagnostic and therapeutic challenge to the management of infections caused by this organism. This prospective study aimed at studying the frequency of s-lactamase production by K. pneumoniae in neonatal intensive care unit (NICU) of Mansoura University Children’s Hospital.Methods: This prospective study was conducted over a period of thirty six months from September 2010 to August 2013, where 684 samples were collected from different body sites of neonates in the NICU. Microbial isolation, identification and antimicrobial susceptibility testing were carried out.  s-lactamase production by K. pneumoniae isolates was tested by phenotypic methods and PCR amplification of related genes using a six-gene panel for the amplification of the blaCMY-2, blaDHA, blaACC, blaSHV, blaTEM and blaCTX-M genes. In vitro transformation and conjugation were carried out to test for plasmid mediated AmpC s- lactamase resistance transmission to E. coli. Results: K. pneumoniae was isolated at a percentage of 12.6% and s-lactamase production was detected in 62.8% of the isolates.  The most commonly detected s-lactamase gene was blaSHV (51.9%), followed by BlaCMY-2 (16.67), blaDHA (12.96%), blaTEM (9.2%), blaCTX- M(7.4%) and lastly blaACC (1.85%). Additionally, some strains carried combinations of two or three genes. The plasmid carrying blaCMY-2 was 100% successfully transformed into the competent E. coli LE392 while conjugation with the E. coli ATCC 25922 was (77.8%) successful.Conclusion: K. pneumoniae is a common multidrug resistant isolate; the production of s-lactamases is the mechanism of resistance in a significant number of cases and represents a real risk for failure of many therapeutic options. This problem is highly complicated by the horizontal spread of resistance plasmids among microbial population.
背景:产生s-内酰胺酶的肺炎克雷伯菌(肺炎克雷伯菌)的出现,对由该菌引起的感染的管理提出了重大的诊断和治疗挑战。本前瞻性研究旨在研究曼苏拉大学儿童医院新生儿重症监护病房(NICU)肺炎克雷伯菌s-内酰胺酶产生频率。方法:本前瞻性研究于2010年9月至2013年8月为期36个月,在NICU新生儿不同身体部位采集样本684份。进行微生物分离鉴定和药敏试验。利用blaCMY-2、blacha、blaACC、blaSHV、blaTEM和blaCTX-M基因6基因板扩增相关基因,采用表型法和PCR扩增方法检测肺炎克雷伯菌分离株s-内酰胺酶产量。采用体外转化和偶联法检测质粒介导的AmpC s-内酰胺酶耐药性在大肠杆菌中的传播。结果:肺炎克雷伯菌分离率为12.6%,s-内酰胺酶产率为62.8%。s-内酰胺酶基因检出率最高的是blaSHV(51.9%),其次是BlaCMY-2(16.67%)、blaDHA(12.96%)、blaTEM(9.2%)、blaCTX- M(7.4%)和blaACC(1.85%)。此外,一些菌株携带两个或三个基因的组合。携带blaCMY-2的质粒100%成功转化到大肠杆菌LE392,与大肠杆菌ATCC 25922的结合成功率为77.8%。结论:肺炎克雷伯菌是常见的多药耐药分离株;在许多病例中,s-内酰胺酶的产生是耐药性的机制,并代表着许多治疗方案失败的真正风险。由于耐药质粒在微生物群体中的水平传播,这一问题变得高度复杂。
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引用次数: 1
Molecular characterization of staphylococcal cassette chromosome mec and virulence encoding genes in methicillin-resistant staphylococci at a medical center in Lebanon 黎巴嫩某医疗中心耐甲氧西林葡萄球菌卡式染色体mec和毒力编码基因的分子特征
Pub Date : 2015-08-03 DOI: 10.3823/765
Mirna Rajeh, A. Sabra, K. A. Kissoyan, Sukayna Fadlallah, G. Matar
Background: Methicillin-resistant staphylococci (MRS) are major human pathogens accounting for most hospital-acquired (HA) and community acquired (CA) infections worldwide. The recent increase in MRS in a medical center in Lebanon elicited the determination of SCCmec types, genotypes, and prevalence of Panton-Valentine leucociden (PVL) and toxic shock syndrome toxin-1 (TSST-1) among the MRS isolates.   Methods: Thirty-six MRS isolates collected between October 2010 and September 2011 at a medical center, Lebanon were typed using phenotypic and genotypic methods. Antimicrobial susceptibility was determined using the disk diffusion agar method. SCCmec typing was performed by multiplex PCR and sequence analysis. The prevalence of the genes encoding PVL and TSST-1 virulence factors and their transcription levels, were determined respectively by PCR and semi-quantitative real-time PCR. The genomic relatedness of the isolates was assessed by random amplified polymorphic DNA (RAPD) analysis.Results: Antimicrobial susceptibility revealed three distinct antibiotypes. The predominant SCCmec type found among the MRS isolates was type IVa (51%). Twenty-nine percent harbored SCCmec type III and 14% harbored SCCmec type II. One isolate harbored SCCmec type IVc, and another  harbored SCCmec type I. All methicillin-resistant Staphylococcus aureus (MRSA) isolates were negative for the gene encoding for PVL, and two were positive for the gene encoding for TSST-1. RAPD analysis demonstrated high genomic diversity among the MRS isolates.Conclusion: This study demonstrated the SCCmec types and the clonality of the MRS strains, allowing the differentiation between HA and CA-MRS strains. CA-MRS have  increased  in the hospital environment and rendered highly resistant to erythromycin and clindamycin.
背景:耐甲氧西林葡萄球菌(MRS)是世界上大多数医院获得性(HA)和社区获得性(CA)感染的主要人类病原体。黎巴嫩一家医疗中心最近MRS病例的增加,引发了对MRS分离株SCCmec型、基因型和潘通-瓦伦丁白血病(PVL)和中毒性休克综合征毒素-1 (TSST-1)患病率的测定。方法:2010年10月至2011年9月在黎巴嫩某医疗中心采集的36株MRS分离株采用表型和基因型方法进行分型。采用圆盘扩散琼脂法测定其药敏。采用多重PCR和序列分析进行SCCmec分型。采用实时荧光定量PCR和半定量PCR分别测定PVL和TSST-1毒力因子编码基因的流行率和转录水平。采用随机扩增多态性DNA (RAPD)分析鉴定分离株的基因组亲缘性。结果:药敏表现为3种不同的抗生素类型。MRS分离株中以IVa型SCCmec为主(51%)。29%为SCCmec III型,14%为SCCmec II型。1株为IVc型SCCmec, 1株为ⅰ型SCCmec。所有耐甲氧西林金黄色葡萄球菌(MRSA)分离株PVL基因编码阴性,2株为TSST-1基因编码阳性。RAPD分析显示MRS分离株具有较高的基因组多样性。结论:本研究证实了MRS菌株的scmec类型和克隆性,可以区分HA和CA-MRS菌株。CA-MRS在医院环境中增加,对红霉素和克林霉素产生高度耐药。
{"title":"Molecular characterization of staphylococcal cassette chromosome mec and virulence encoding genes in methicillin-resistant staphylococci at a medical center in Lebanon","authors":"Mirna Rajeh, A. Sabra, K. A. Kissoyan, Sukayna Fadlallah, G. Matar","doi":"10.3823/765","DOIUrl":"https://doi.org/10.3823/765","url":null,"abstract":"Background: Methicillin-resistant staphylococci (MRS) are major human pathogens accounting for most hospital-acquired (HA) and community acquired (CA) infections worldwide. The recent increase in MRS in a medical center in Lebanon elicited the determination of SCCmec types, genotypes, and prevalence of Panton-Valentine leucociden (PVL) and toxic shock syndrome toxin-1 (TSST-1) among the MRS isolates.   Methods: Thirty-six MRS isolates collected between October 2010 and September 2011 at a medical center, Lebanon were typed using phenotypic and genotypic methods. Antimicrobial susceptibility was determined using the disk diffusion agar method. SCCmec typing was performed by multiplex PCR and sequence analysis. The prevalence of the genes encoding PVL and TSST-1 virulence factors and their transcription levels, were determined respectively by PCR and semi-quantitative real-time PCR. The genomic relatedness of the isolates was assessed by random amplified polymorphic DNA (RAPD) analysis.Results: Antimicrobial susceptibility revealed three distinct antibiotypes. The predominant SCCmec type found among the MRS isolates was type IVa (51%). Twenty-nine percent harbored SCCmec type III and 14% harbored SCCmec type II. One isolate harbored SCCmec type IVc, and another  harbored SCCmec type I. All methicillin-resistant Staphylococcus aureus (MRSA) isolates were negative for the gene encoding for PVL, and two were positive for the gene encoding for TSST-1. RAPD analysis demonstrated high genomic diversity among the MRS isolates.Conclusion: This study demonstrated the SCCmec types and the clonality of the MRS strains, allowing the differentiation between HA and CA-MRS strains. CA-MRS have  increased  in the hospital environment and rendered highly resistant to erythromycin and clindamycin.","PeriodicalId":22518,"journal":{"name":"The International Arabic Journal of Antimicrobial Agents","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73864284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
The antimicrobial potential of Lactobacillus acidophilus on pathogenic bacteria causing diarrhea 嗜酸乳杆菌对引起腹泻的致病菌的抑菌潜力
Pub Date : 2015-07-18 DOI: 10.3823/764
R. Bassyouni, M. Nassar, Z. Ibrahim, Mohammed Saad Zaghloul Ahmed
Object: Lactobacillus acidophilus is a nonpathogenic member of gastrointestinal tract and it is widely used in fermented dairy products. This study aimed to assess the antimicrobial potential of two strains of L. acidophilus on some pathogenic bacteria frequently causing diarrhea or gastroenteritis. Methods: The antibacterial activity cell free supernatant (CFS) of two control standard strains of L. acidophilus (L. acidophilus-la5 and L. acidophilus against fie control standard strains of bacteria causing diarrhea; Enterotoxogenic Escherichia coli (ETEC), Enterohaemorrhagic E. coli O 157:H7(EHEC) Salmonella typhimurium Shigella flxeneri and Staphylococcus aureus were determined using agar well diffusion method. The sensitivity of the pathogenic bacteria to the CFS of each L. acidophilus in relation to time was determined by standard plate count .The antibiotic susceptibility tests of 20 antibiotics against tested organisms with and without CFS were assessed by disc diffusion method. The minimum inhibitory concentration (MIC) of ciproflxacin with and without CFS was determined by tube dilution method. Results: Both Lactobacilli strains decrease the colony count of tested strains by more than 90% after 60 min contact time. Both Lactobacilli strains signifiantly improve the antibacterial effect of tested antibiotics against ETEC, S. typhimurium and S. aureus, and S. flxeneri (P< 0.05). The MIC of ciproflxacin alone against all tested strains was 15.625 μg/ml, while when combined with both Lactobacilli CFSs, the MIC decreased signifiantly to 0.488 μg/ml for ETEC, S. typhimurium, and S. flxeneri and to 0.977 μg/ml for EHEC and S. aureus (P= 0.000). Conclusion : living L. acidophilus strains could be used in prevention and treatment of diarrhea caused by certain bacterial pathogens, either in fermented milk/ yoghurt or as mediations.
目的:嗜酸乳杆菌是胃肠道的非致病性成员,在发酵乳制品中有广泛的应用。本研究旨在评估两株嗜酸乳杆菌对腹泻或胃肠炎致病菌的抑菌潜力。方法:采用两种对照标准菌株(L. acidophilus-la5和L. acidophilus)的无细胞上清液(CFS)对5种腹泻菌对照标准菌株的抑菌活性;采用琼脂孔扩散法检测肠毒性大肠杆菌(ETEC)、肠出血性大肠杆菌o157:H7(EHEC)、鼠伤寒沙门菌、志贺菌和金黄色葡萄球菌。采用标准平板计数法测定各嗜酸乳杆菌对CFS的敏感性随时间的变化;采用圆盘扩散法评价20种抗生素对有无CFS的试验菌的药敏试验。用试管稀释法测定环丙沙星对CFS的最小抑制浓度(MIC)。结果:两株乳酸菌在接触60min后,使被试菌菌落计数减少90%以上。两株乳酸菌均显著提高了所试抗生素对ETEC、鼠伤寒沙门氏菌、金黄色葡萄球菌和氟克斯奈利葡萄球菌的抑菌效果(P< 0.05)。单用环丙沙星对所有菌株的MIC均为15.625 μg/ml,联用两种乳酸菌CFSs时,ETEC、鼠伤寒沙门氏菌和flxeneri的MIC均降至0.488 μg/ml, EHEC和金黄色葡萄球菌的MIC均降至0.977 μg/ml (P= 0.000)。结论:活的嗜酸乳杆菌菌株可用于预防和治疗某些细菌性致病菌引起的腹泻,既可用于发酵乳/酸奶中,也可作为培养基。
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引用次数: 3
Prevalence of Clostridium difficile infections among hospitalized patients in Amman, Jordan: A Multi-Center Study 约旦安曼住院患者中艰难梭菌感染的流行:一项多中心研究
Pub Date : 2015-06-30 DOI: 10.3823/763
J. Wadi, Ali Sameh Ayesh, Lamya Abu Shanab, Bilal Harara, Haifa Petro, A. Rumman, Mustafa Alaskar, Malek Maswadeh, M. Tadbir
Objective: To evaluate the prevalence of C. difficile infection (CDI) among hospitalized patients with toxin-positive stools. Methods: This study is a multicenter study held in Jordan and focused on the prevalence of in-patients with C. difficile toxin-positive diarrhea-stools. The study included three hospitals with approximately 750 beds. In-patients charts, laboratory logbooks for in-patients with diarrhea-stool specimens were reviewed. The participating hospitals used a rapid test, which detects fecal C. difficile toxins A and B. Results: 174 stool specimens were reviewed from March 2013 to October 2014, and 170 stool specimens from 168 patients were evaluated. The patients included 102 (60%) males, and 66 (40%) females including seven (10.6%) peripartum females. The patients were classified in the following age groups:neonates ≤ 28 days, infants 29 days - less than one year old (n = 4, 2.4%), 1 – 4 years (n = 3, 1.8%), and arbitrarily: 5 - 9 years (n = 3, 1.8%), 10 – 14 years (n = 3, 1.8%), 15 – 40 years (n = 33, 19.4%), 41- 64 years, (n = 53, 31.2%) and ≥ 65 years were (n = 71, 41.8%).Adults and older age groups make up the majority of all patients (92.4%). Comorbidities were highly prevalent among the patients: diabetic (n = 71, 41.8%), chronic lung diseases (n = 25, 14.7%), solid tumors other than colonic tumors (n = 12, 7.1%), immune-suppressive state (n = 15, 8.8%), and one patient had colonic tumor. The majority of the patients (n = 21) were on more than one class of broad-spectrum antimicrobials. The prevalence of C. difficile toxin-positive stools were 14.63/1000 discharged patients, 12.65% of patients (12.96% of stool specimens)
目的:了解难辨梭菌感染(CDI)在住院毒便患者中的流行情况。方法:本研究是在约旦进行的一项多中心研究,重点关注难辨梭菌毒素阳性腹泻-便的住院患者的患病率。该研究包括三家医院,共有约750张床位。回顾了住院患者腹泻-粪便标本的病历、实验室日志。结果:2013年3月至2014年10月共收集粪便标本174份,对168例患者的170份粪便标本进行评估。男性102例(60%),女性66例(40%),其中围产期女性7例(10.6%)。患者分为以下年龄组:新生儿≤28天、29天~ 1岁以下(n = 4, 2.4%)、1 ~ 4岁(n = 3, 1.8%),任意5 ~ 9岁(n = 3, 1.8%)、10 ~ 14岁(n = 3, 1.8%)、15 ~ 40岁(n = 33, 19.4%)、41 ~ 64岁(n = 53, 31.2%)和≥65岁(n = 71, 41.8%)。成人和老年群体占所有患者的大多数(92.4%)。合并症在患者中非常普遍:糖尿病(n = 71, 41.8%),慢性肺部疾病(n = 25, 14.7%),非结肠肿瘤实体瘤(n = 12, 7.1%),免疫抑制状态(n = 15, 8.8%), 1例有结肠肿瘤。大多数患者(n = 21)使用一种以上的广谱抗菌素。难辨梭菌毒素阳性粪便检出率为14.63/1000,占出院患者的12.65%(粪便标本的12.96%)。
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引用次数: 6
Value of phenotyic and genotypic identification of Acinetobacter baumannii isolates from two hospitals in Jordan 约旦两家医院鲍曼不动杆菌分离株表型和基因型鉴定的价值
Pub Date : 2015-05-27 DOI: 10.3823/762
M. Bustami, Nermen Dakkak, Lauy F. Abu-Qatouseh, R. Khalil, K. Matalka
Acinetobacter baumannii isolates have been recovered from hospitalized patients over the past few years from two hospitals in Jordan. Phenotypic and biochemical characterization in addition to disc susceptibility testing of all clinical isolates indicated that all of them were belonging to A. baumannii. A high degree of conservation of both the ITS length and the ITS sequence was observed, and their identities were further confirmed by amplified ribosomal DNA gene restriction analysis (ARDRA). The application of ARDRA for the identification of Acinetobacter species has several advantages over phenotypic identification. ARDRA considered rapid and reliable and universally applicable method for identification of most of the Acinetobacter genomic species, thus contribute to better understanding of the clinical importance and epidemiology of isolates.
过去几年中,从约旦两家医院的住院病人身上分离出鲍曼不动杆菌。所有临床分离菌株的表型和生化特征及药敏试验表明,它们均属于鲍曼不动杆菌。ITS长度和ITS序列高度保守,并通过扩增的核糖体DNA基因限制性分析(ARDRA)进一步证实了它们的身份。与表型鉴定相比,应用ARDRA技术鉴定不动杆菌种类具有许多优点。ARDRA为大多数不动杆菌基因组种的快速、可靠和普遍适用的鉴定方法,从而有助于更好地了解分离株的临床重要性和流行病学。
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引用次数: 1
Antibiotic Resistance and its Association with Biocides Susceptibilities among Microbial Isolates in an Egyptian Hospital 埃及一家医院微生物分离株抗生素耐药性及其与杀菌剂敏感性的关系
Pub Date : 2015-05-27 DOI: 10.3823/761
S. A. Daniel, M. Shawky, H. Abou-Shleib, M. El-Nakeeb
Background: Recently there has been a growing concern that the indiscriminate use of antimicrobial agents in the household, food industry and in hospitals may contribute to the emergence of bacteria resistant to antibiotics. Aim of the work: To detect any possible link between the susceptibility profiles of different clinical and environmental isolates to biocides and antibiotics in an Egyptian hospital. Methods: 66 different microbial isolates were isolated from different clinical specimens and different environmental samples obtained from a University Hospital in Alexandria. These isolates were screened for their susceptibility to 22 broad spectrum antibiotics using disc agar diffusion technique. Also the susceptibility of the isolates to 6 commonly used biocides was screened through MIC determination by agar dilution technique. Correlations between the obtained data were made through Spearman’s correlation using SPSS ® Statistical program. Results: 62% of the isolates were multidrug resistant (MDR); and 11% were extremely drug resistant (XDR). On the other hand, 34% of the tested isolates were multi-disinfectant reduced susceptibility (MDRS) isolates. The statistical analysis of the obtained data revealed a moderate positive correlation between antibiotic resistance and biocide tolerance (0.376≥ρ≥0.278, p<0.05). In addition, strong significant correlations (p<0.01) were also found between reduced susceptibilities to multiple biocides such as benzalkonium chloride (BK), cetrimide (CET), chlorhexidine (CHX), povidone-iodine (PVPI) and Dettol ® . Conclusion: Cross-resistance between biocides and antibiotics can aggravate the existing problem of antibiotic resistance in hospitals.
背景:最近,人们越来越担心,在家庭、食品工业和医院中不加选择地使用抗菌剂可能会导致耐抗生素细菌的出现。工作目的:检测埃及一家医院中不同临床和环境分离株对杀菌剂和抗生素的敏感性之间的任何可能联系。方法:从亚历山大市某大学医院不同临床标本和不同环境标本中分离出66株不同的微生物。采用圆盘琼脂扩散技术对22种广谱抗生素进行敏感性筛选。用琼脂稀释法进行MIC测定,筛选菌株对6种常用杀菌剂的敏感性。使用SPSS®统计程序对所得数据进行Spearman相关分析。结果:62%的分离株具有多重耐药(MDR);11%为极度耐药(XDR)。另一方面,34%的检测分离株为多重消毒液降低敏感性(MDRS)分离株。对所得数据进行统计分析,抗生素耐药性与杀菌剂耐受性呈中度正相关(0.376≥ρ≥0.278,p<0.05)。此外,对苯扎氯铵(BK)、西曲胺(CET)、氯己定(CHX)、聚维酮碘(PVPI)和Dettol®等多种杀菌剂的敏感性也显著降低(p<0.01)。结论:杀菌剂与抗生素交叉耐药会加重医院现有的抗生素耐药问题。
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引用次数: 5
Detection of Escherichia coli O157:H7 and O104:H4 in patients with diarrhea in Northern Lebanon and characterization of fecal E.coli producing ESBL and carbapenemase genes 黎巴嫩北部腹泻患者O157:H7和O104:H4大肠杆菌检测及产ESBL和碳青霉烯酶基因的鉴定
Pub Date : 2015-05-01 DOI: 10.3823/756
Sara Amrieh, M. Hamzé, H. Mallat, M. Achkar, F. Dabboussi
Background. While most strains of Escherichia coli (E. coli) are harmless, some are causing intestinal infections of varying severity. Then Shiga toxin-producing E. coli (STEC)/ enterohemorrhagic E. coli strains can be associated with fatal clinical manifestations. Of these E. coli Serotypes O157: H7 and O104: H4 were responsible for worldwide epidemics causing thousands of intestinal infections and dozens of deaths.The aim of this research is to investigate the prevalence of E. coli O157: H7 and O104: H4 in the diarrheal stools of 242 Lebanese patients.Materials and methods. This study includes 242 E. coli strains isolatedfrom fecal specimens of patients with diarrhea between February2013 and May 2014 in the microbiology department of Nini HospitalLaboratory in Tripoli - North Lebanon. All specimens were inoculatedon sorbitol MacConkey agar. Sorbitol negative strains were investigated for detection of stx1, stx2 and eae genes using real-time PCR. All carbapenem-resistant strains and ESBL producers were investigated by PCR for presence of KPC, IMI, NMC-A, EMS, GHG, VIM, NDM, IMP,OXA-48, blaTEM, blaCTX-M, blaSHV, blaOXA, blaGES and blaPER..Results. A total of 14 sorbitol negative strains were detected. The search for stx1, stx2 and eae genes showed the presence of a single positive strain for E. coli O157: H7. Out of 242 E.coli strains, 48 (19.8%) were ESBL-positive, 4 (1.6%) were resistant to ertapenem, and all were negative for stx2 genes, The blaCTX-M gene was the most frequentamong ESBL positive strains (85%), followed by the blaTEM gene (50%). One strain had the blaNDM-1 gene, another had the blaOXA-48 gene and 2 strains were probably resistant due to impermeability.Conclusion. The results of this study demonstrate rarely presence of enterohemorrhagic E. coli, but shows the frequent presence of multidrug resistant E.coli in the intestinal flra of North Lebanese patients. Therefore, it is important to search for MDR E.coli in the intestinal flra of patients who are going to be treated with major operations or those admitted to intensive care units
背景。虽然大多数大肠杆菌菌株是无害的,但有些菌株会引起不同程度的肠道感染。那么产志贺毒素大肠杆菌(STEC)/肠出血性大肠杆菌菌株可能与致命的临床表现有关。在这些大肠杆菌血清型中,O157: H7和O104: H4导致了世界范围内的流行病,造成数千人肠道感染和数十人死亡。本研究的目的是调查242名黎巴嫩患者腹泻便中大肠杆菌O157: H7和O104: H4的流行情况。材料和方法。本研究包括2013年2月至2014年5月在黎巴嫩北部黎波里尼尼医院实验室微生物科从腹泻患者粪便标本中分离的242株大肠杆菌。所有标本接种在山梨醇麦康基琼脂上。采用实时荧光定量PCR检测山梨醇阴性菌株stx1、stx2和eae基因。采用PCR方法对所有碳青霉烯耐药菌株和ESBL产生菌进行了KPC、IMI、NMC-A、EMS、GHG、VIM、NDM、IMP、OXA-48、blaTEM、blaCTX-M、blaSHV、blaOXA、blaGES和blaPER的检测。共检出14株山梨醇阴性菌株。对stx1、stx2和eae基因的搜索结果显示,存在一株O157: H7大肠杆菌阳性菌株。242株大肠杆菌ESBL阳性48株(19.8%),耐厄他培南4株(1.6%),stx2基因均阴性,ESBL阳性菌株中以blaCTX-M基因最多(85%),其次是blactem基因(50%)。1株含有blaNDM-1基因,1株含有blaOXA-48基因,2株可能因耐药而产生耐药性。本研究结果表明肠出血性大肠杆菌很少存在,但在北黎巴嫩患者的肠道菌群中却经常出现耐多药大肠杆菌。因此,在即将接受大手术治疗或入住重症监护病房的患者的肠道菌群中寻找耐多药大肠杆菌是很重要的
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引用次数: 4
期刊
The International Arabic Journal of Antimicrobial Agents
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