OBJECTIVE To investigate the genotype characteristics of extended-spectrum ?-lactamases(ESBLs) producing Escherichia coli and Klebsiella pneumoniae and drug resistance condition in Tianjin.METHODS A total of 218 strains of ESBLs-producing E.coli and K.pneumoniae were isolated from clinic.The drug-resistant CTX-M-1,CTX-M-2,CTX-M-8,CTX-M-9,TEM,SHV,OXA-1,OXA-2 and OXA-10 were tested by SYBR GREEN Ⅰ real-time fluorescent quantitative Polymerase chain reaction(PCR).RESULTS Among 109 strains of ESBLs-producing E.coli,the drug resistance of genotypes CTX-M-1,CTX-M-2,CTX-M-8,CTX-M-9,TEM,SHV and OXA-1 was 32.1%,0.9%,0.9%,33.9%,73.4%,27.5% and 15.6%,respectively.The strains with more than two genes were 66.1%.The positive rate of CTX-M-1,CTX-M-2,CTX-M-8,CTX-M-9,TEM,SHV,OXA-1 and OXA-10 was 49.5%,2.8%,1.8%,22.9%,78.9%,76.1%,33.0% and 0.9%,respectively.The strains with more than two genes were 82.2%.The strains were highly sensitive to imipenem.CONCLUSIONS Most of the genotypes of ESBLs-producing E.coli and K.pneumoniae in Tianjin are SHV,TEM,CTX-M-1 and CTX-M-9.The rate of OXA are increasing,and the drug resistance genes of K.pneumoniae from different hospitals are different.

OBJECTIVE To investigate the prevalence,antibiotic resistance and genotype of the extended-spectrum ?-lactamases(ESBLs)-producing clinical isolates of Klebsiella pneumoniae.METHODS A total of 104 isolates of K.pneumoniae were examined for the ESBLs production and the susceptibilities of the bacteria to 15 antimicrobial agents.PCR was performed to detect the genes encoding the ESBLs belonging to SHV and TEM families as well as CTX-M-1 and CTX-M-9 groups.RESULTS The ESBLs-producers of K.pneumoniae were 54.0% in the total of 104 isolates.Almost all of the ESBLs-producing isolates were resistant to the antibiotics commonly used,and only remained susceptible to carbapenems and the combination of cefoperazone with sulbactam.The genes of SHV,CTX-M-1 and TEM groups were detected in the ESBLs-producing isolates by 64.3%,46.4%,and 32.1%,respectively,and 35.7% and 8.9% of ESBLs-producing K.pneumoniae strains carried two and three genes.CONCLUSIONS The clinical isolates of K.pneumoniae in Tianjin Nankai Hospital are shown a high rate of ESBLs-producing and antibiotic resistance.SHV and CTX-M-1 groups of ESBLs are the dominant genotypes in the isolates of ESBLs-producing K.pneumoniae.

OBJECTIVETo observe the effect of sodium bicarbonate combined with ulinastatin on cholinesterase activity for patients with acute phoxim pesticide poisoning.

METHODSA total of 67 eligible patients with acute phoxim pesticide poisoning, Who were admitted to the emeryency department of hospital from March 2011 to February 2014, Acording to different treatments au patients were randomly divided into the conventional treatment group (n=34) and the sodium bicarbonate+ulinastatin group (n=35) . The conventional treatment group were given thorough gastric lavage with water, the sodium bicarbonate + ulinastatin group were given gastric lavage with 2% sodium bicarbonate solution. Both groups were given such treatments as catharsis, administration of oxygen, fluid infusion, diuresis, and antidotes such as atropine and pralidoxime methylchloride. On the basis of comprehensive treatment, people in the sodium bicarbonate+ulinastatin group were given 5% sodium bicarbonate injection and ulinastatin. The clinical effect of the two groups were compared.

RESULTSThe serum cholinesterase activity of the sodium bicarbonate+ulinastatin group was significantly higher than the conventional treatment group from the 5th day, and the difference was statistically significant (P<0.05) . The total atropine dosage, total pralidoxime methylchloride dosage and hospitalization days were better than the conventional treatment group, and the differences were statistically significant (P<0.05) . The difference in the time of atropinization between the two groups was not statistically significant (P>0.05) . The results of arterial blood pH, HCO3- of the sodium bicarbonate + ulinastatin group were higher than the conventional treatment group, and the difference of HCO3- at the 10th day was statistically significant (P<0.05) .

CONCLUSIONSSodium bicarbonate combined with ulinastatin can improve the therapeutic effect and reduce complications in the treatment of acute phoxim pesticide poisoning, and have beneficial effects on the recovery of cholinesterase activity.

Atropine ; therapeutic use ; Cholinesterases ; metabolism ; Glycoproteins ; therapeutic use ; Humans ; Organophosphate Poisoning ; drug therapy ; Organothiophosphorus Compounds ; poisoning ; Pesticides ; poisoning ; Pralidoxime Compounds ; therapeutic use ; Sodium Bicarbonate ; therapeutic use