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Antibiotic resistance of the Staphylococcus aureus strains isolated from sputum

Chinese Journal of Infection and Chemotherapy.2014;(3):245-246.

Objective A retrospective analysis was conducted to review the distribution and antibiotic resistance in the Staphy-lococcus aureus strains isolated from sputum and provide evidence for effective prevention and control of infections.Methods The 276 strains of S .aureus isolated during the period from January to September of 2009 were included in this analysis.The isolates were identified and tested for susceptibility using VITEK 2 Compact Automatic Culture and Identification System. Results The prevalence of methicillin-resistant S .aureus (MRSA)was 79.0% (218/276).The S .aureus strains were mainly isolated from Department of Neurology (27.5%,76/276),ICU (25.4%,70/276),Neurosurgery (18.1 %,50/276),and Re-spiratory Medicine (9.1 %,25/276).Vancomycin,teicoplanin and quinupristin-dalfopristin were the most active agents against these S .aureus .The resistant strains were less than 0.5%.MRSA showed lower resistance rate to trimethoprim-sulfamethox-azole than MSSA.MRSA strains were more resistant than MSSA to most other antibacterial agents.Conclusions The MRSA i-solates from sputum are highly prevalent and resistant to antibiotics.Antimicrobial agents should be selected appropriately ac-cording to the results of susceptibility testing.

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Mechanisms of gyrA,gyrB and efflux system jointly mediating quinolone resist-ance in clinical isolates of Pseudomonas aeruginosa

Guodong ZHANG ; Zhangrui ZENG ; Ying WANG ; Hongsheng ZHU

Chinese Journal of Infection and Chemotherapy.2014;(3):224-228.

Objective To investigate the mechanisms of both levofloxacin and ciprofloxacin resistance in clinical strains of Pseudomonas aeruginosa isolated from our hosptial.Methods Twenty P .aeruginosa isolates resistant to both levofloxacin and ciprofloxacin as tested by VITEK-2 Compact were collected.Agar dilution method was used to confirm their minimum inhibito-ry concentrations (MICs)of levofloxacin and ciprofloxacin.DNA gyrase (gyrA and gyrB )and topoisomerase IV (parC and parE)were analyzed by PCR amplification.The expression of efflux systems were analyzed by real-time RT-PCR.Results The MIC results were consistent between Agar dilution method and Vitek-2 Compact system.DNA gyrase (gyrA and gyrB )se-quencing analysis showed that the mutations were mainly frame-shifting mutation characteristic of base (C)insertion at position 941 in gyrA gene,deletion of base (A)at position 1588 in gyrB gene,and insertion of base (T)at position 1543 in gyrB gene.Insertion of base (C)at position 1895 in parE gene was identified in 3 strains.Overexpression of MexAB-OprM and MexCD-OprJ was detected by real-time RT-PCR.Conclusions The insertion and/or deletion of bases in DNA gyrase (gyrA and gyrB)genes and overproduction of MexAB-OprM and MexCD-OprJ efflux systems may contribute to the resistance to both ciprofloxacin and levofloxacin in clinical isolates of P .aeruginosa.

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Establishment and evaluation of hamster model of Clostridium difficile-associat-ed diarrhea

Shaohua XU ; Xiaolei SONG ; Fenfen ZHOU ; Shi WU ; Haihui HUANG

Chinese Journal of Infection and Chemotherapy.2014;(3):204-209.

Objective To explore a method for establishing the hamster model of Clostridium difficile-associated diarrhea (CDAD)and the indicators for its evaluation.Methods Clindamycin was administered to hamsters subcutaneously (day 1),and 24 h later infected with C.difficile clinical isolates KH1 (ribotype 027,106-108 CFU/mL)or SH9 (ribotype 001 ,108-1010 CFU/mL)by gavage.Animals were observed for CDAD symptoms such as diarrhea,weight loss and death.At the end of ob-servation period (day 7 or death),the cecum was collected from each animal for histological evaluation of inflammation.Results Following a single dose of 100 mg/kg clindamycin subcutaneously,all the animals challenged with KH1 (108 CFU/mL)devel-oped diarrhea and then died within 5 days.All the hamsters challenged with SH9 (1010 CFU/mL)developed diarrhea as well but only 66.7% died at the end of observation period.Among other groups,only one or none developed diarrhea and then died. The symptoms of hamsters with diarrhea included loose stool,wet tail and weight loss.On histological examination,conges-tion,hemorrhage and neutrophil infiltration of the mucosa were observed in the hamsters died of CDAD.Conclusions We have successfully established a hamster CDAD model that allows for future investigations.

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Report of 27 culture-positive fungal endophthalmitis

Mengyang LIU ; Zhongxin JIANG ; Shiying SUN

Chinese Journal of Infection and Chemotherapy.2014;(3):199-203.

Objective To report the clinical features and treatment outcomes of 27 patients with fungal endophthalmitis (27 eyes)over a five year period.Methods The authors retrospectively reviewed the etiology,direct smear examination,fungal cul-ture and treatments of 27 patients with culture-proven fungal endophthalmitis at the affiliated Hospital of Medical College Qing-dao University from 2007 to 2012.Results Exogenous infection was defined in 21 patients (77.8%),including 20 associated with penetrating wound,and 1 following cataract surgery.Endogenous infection was found in 6 patients (22.2%),including 3 associated with recent use of high-dose steroids,1 after abortion,1 following pelvic fracture,and 1 with long-term use of im-munosuppressive agents.Fungal hyphae were found in 17 smears of 27 samples (63.0%)by direct microscopic examination. The fungal strains cultured from 27 samples belonged to 8 genus and 12 species.The most common isolates were Aspergillus , Fusarium and Candida species.A.flavus (22.2%)and A.fumigatus (18.5%)were the predominant Aspergillus species. F .moniliforme (14.8%)and F .oxysporum (11 .1 %)were the most predominant Fusarium species.Two eyes were eviscer-ated immediately due to the serious condition.Among the other 25 eyes,22 (88.0%)got improvement after at least one of such treatments as intravitreal injection of antifungal agent,vitrectomy or penetrating keratoplasty (PK).Conclusions Exoge-nous fungal endophthalmitis is the most common type of fungal endophthalmitis in this hospital.Penetrating wound is the main cause of such infections.Microscopic examination of hyphae and fungal culture were effective for the diagnosis of fungal endophthalmitis.Aspergillus is the predominant pathogens, followed by Fusarium.Intravitreal injection of antifungal a-gent combined with vitrectomy is an effective treatment of fungal endophthalmitis.

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In vitro activity of fosfomycin tromethamine against Enterobacteriaceae isolates from urine

Jingyong SUN

Chinese Journal of Infection and Chemotherapy.2014;(2):153-156.

Objective To explore the in vitro activities of antimicrobial agents including fosfomycin tromethamine against Enter-obacteriaceae isolates from urine samples and provide evidence for reasonable use of antibiotics.Methods A total of 1 185 Enter-obacteriaceae isolates from midstream urine samples were identified by ATB system.Antimicrobial susceptibility and ESBLs production were tested by Kirby-Bauer method.The results were analyzed according to the breakpoints of CLSI 2012.WHO-NET 5.6 software was used to retrospectively analyze the distribution and antibiotic susceptibility of pathogenic bacteria.Re-sults Overall,about 90.8% of the 1 185 isolates tested were susceptible to fosfomycin tromethamine.The top three species of bacteria showing the highest suceptibility rate to fosfomycin tromethamine were Escherichia coli (93.1%),Klebsiella pneu-moniae (88.7%),and Proteus spp.(79.7%).The Enterobacteriaceae isolates from urine samples of inpatients were less sus-ceptibe to the antimicrobial agents tested compared to the isolates from outpatients (87.0% versus 92.7% susceptible).ESBLs were identified in 54.4% of Escherichia coli ,38.7% of Klebsiella pneumoniae and 23.2% of Proteus strains.The ESBL-pro-ducing E.coli (89.5%)and K.pneumoniae (87.5%)were highly susceptible to fosfomycin tromethamine.Conclusions Esch-erichia coli is the most popular Enterobacteriaceae isolated from urine samples.Fosfomycin tromethamine has good in vitro an-tibacterial activity against Enterobacteriaceae strains,including ESBLs-producing E.coli and K.pneumoniae.Fosfomycin tromethamine is a valuable therapeutic option for urinary tract infections.

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Pathogenic species and antibiotic sensitivity in 344 children with Salmonella enteritis

Xiaohua YANG ; Nan TAN ; Aixin LIN

Chinese Journal of Infection and Chemotherapy.2014;(2):149-152.

Objective To investigate the epidemiological characteristics and antibiotic sensitivity of Salmonella infection in children with diarrhea in Zhongshan City for rational use of antibiotics.Methods A total of 6 920 stool specimens were collected from children with diarrhea including outpatients and inpatients in Zhongshan Boai Hospital from September 2009 to April 2013.Salmonella strains (n = 344)were isolated and identified by enrichment culture.The overall infection rate was 5.0%(344/6 920).Antimicrobial susceptibility was tested by VITEK-2 Compact automicroscan.Results Of the 344 strains of Sal-monella,185 (53.8%)strains were Salmonella typhimurium ,43 (12.5%)were Salmonella stanley ,29 (8.4%)were Sal-monella enteritidis .The male-to-female ratio was 1.8∶1 for the children with diarrhea.The infection rate was 68.9% (237/344)in children under 1-year old.Susceptibility testing results indicated that majority (88.9%-98.0%)of these Salmonella strains were susceptible to levofloxacin,piperacillin-tazobactam,cefepime,ceftazidime,and ceftriaxone,but to ampicillin, 39.2% of the strains were susceptible.Conclusions Most Salmonella infections in Zhongshan City were caused by Salmonella typhimurium,followed by Salmonella stanley and Salmonella enteritidis .Such infections usually peak in summer and autumn seasons.The chidren under 1-year old were more susceptible to Salmonella infections.Higher incidence of infection is associat-ed with boys.Antibiotics should be chosen reasonably and prudently based on antimicrobial sensitivity testing.

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The change of serum IL-17 and Dectin-1 in non-neutropenic patients with invasive pulmonary aspergillosis

Fei CHEN ; Xiaoyong XU ; He SUN ; Chen CHEN ; Weiwei GAO ; Xin SU ; Yi SHI

Chinese Journal of Infection and Chemotherapy.2014;(3):240-244.

Objective To explore the changing levels of serumIL-17 and Dectin-1 and their implication in non-neutropenic pa-tients with invasive pulmonary aspergillosis (IPA).Methods The clinical data were reviewed for 23 non-neutropenic patients with clinical diagnosis of IPA (IPA group),31 patients with clinical diagnosis of pneumonia (pneumonia group)and 51 healthy subjects(control group).The peripheral serum was collected to analyze IL-17 level by ELISA.Serum Dectin-1 level was also determined at the same time.Serum G test,GM test,WBC and CRP level were also assayed for the patients in IPA group.Pa-tient outcome was followed up and analyzed in terms of serum IL-17.Results The serum IL-17 level of the patients in IPA group was significantly higher than that in the control group (P <0.05).The serum IL-17 level in the pneumonia group was not significantly different from that in the control group (P >0.05).The serum Dectin-1 level in IPA group was significantly higher than that in the control group (P <0.05).For the patients in IPA group,serum IL-17 level was positively correlated to serum Dectin-1 level (r=0.81 ,P <0.05),while serum IL-17 and Dectin-1 levels were not correlated to the results of G test, GM test, WBC,CRP or patient outcome (P > 0.05 ). Conclusions Dectin-1 may be produced and Th17 cell immunity activated in response to Aspergillus fumigatus in-fection in non-neutropenic patients.And,serum Dectin-1 level is correlated with Th17 response.

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Analysis of distribution and antimicrobial resistance of enteric pathogens among children

Fen PAN ; Jing KONG ; Chun WANG ; Xuebin XU ; Huihong QIN ; Yan SUN ; Hong ZHANG

Chinese Journal of Infection and Chemotherapy.2014;(3):235-239.

Objective To investigate the distribution,epidemiologic features and antibiotic resistance of the enteric pathogens i-solated from children with diarrhea.Methods Enteric pathogens were isolated from children’s stool samples.The children with diarrhea were treated in the outpatient and inpatient of Shanghai Children’s Hospital between 2008 and 2013.Antimicrobial susceptibility testing was conducted by disk diffusion method for Salmonella and Shigella with 6 antimicrobial agents.Results A total of 545 enteric pathogens were collected.Salmonella was the dominant pathogen,accounting for 67.2%,followed by Shigella (20.7%),S.aureus (4.6%),C.jejuni (3.7%),Aeromonas (2.4%),and enteropathogenic E.coli (0.9%).The main serotypes of Salmonella were S.typhimurium and S.enteritidis.Approximately 56.3% of the patients were boys.A-bout 72.7% of the patients were infants under 2 years.The prevalence of diarrhea peaked in summer and autumn (72.9%). The susceptibility of these isolates was only tested with seven antibiotics.Shigella showed higher level of resistance to ampicil-lin and trimethoprim-sulfamethoxazole than Salmonella (P<0.05).Significantly higher percentage of S.flexneri isolates were resistant to sulbactam-ampicillin,ceftriaxone,ciprofloxacin,and chloramphenicol than S.sonnei (P<0.001).Further-more,the prevalence of multidrug resistant strains in Shigella (68.3%)was much higher than that in Salmonella (44.7%,P<0.001).Conclusions A variety of diarrhea-causing enteric pathogens are isolated from the children in Shanghai Children’s Hospital.The isolates are predominantly Salmonella and Shigella species.The epidemiological features of Salmonella and Shigella species are different in terms of gender,age,season and geographical distribution.The resistance to antibiotics is a serious problem and varies with different types of pathogens. Intensive and ongoing surveillance of enteric pathogens and their changing resistant pattern is required to control diar-rhea in children.

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Pulmonary phaeohyphomycosis due to Exophiala jeanselmei：a case report and review of literature

Feng YE ; Lulu WU ; Danhong SU ; Qingsi ZENG ; Rongchang CHEN

Chinese Journal of Infection and Chemotherapy.2014;(3):229-234.

Objective To better understanding the clinical presentations of phaeohyphomycosis,and improve the diagnosis and management of the disease.Methods We reported a case of pulmonary phaeohyphomycosis caused by Exophiala jeanselmei at the First Affiliated Hospital of Guangzhou Medical University in 2008,and reviewed the relevant literature.The clinical,radio-logical and etiological features were summarized based on this case and the other 23 phaeohyphomycosis patients reported in China from January 1995 to August 2013.Results 24 Chinese cases of phaeohyphomycosis have been reported to date,including 15 males and 9 females.The age of these patients ranged from 4 to 76 (mean 40.0±21 .8)years old.Seventeen patients were otherwise healthy.The other 7 patients had complications.Clinical presentations of phaeohyphomycosis vary widely,including cutaneous and subcutaneous infection in 18 cases,pulmonary and central nervous system involvement in two cases each,para-nasal sinus and palpebral conjunctiva infection one case each.The diagnosis of 18 cases were confirmed both microbiologically and histologically.One case was confirmed histologically alone.Five cases were identified microbiologically alone.The samples for culture were collected from skin abscess (1/5 ),pulmonary tissue (2/5 ),and cervical spinal fluid (2/5 ),respectively. Twenty-two strains of causative organisms were identified,7 of which were Exophiala jeanselmei .Twenty-three patients received treatment.They were cured by antifungal agents alone (18)or in conjunction with surgical resection (4 ),or assisted with XD-635AB-based photodynamic laser therapy (1).Specifically,10 pa-tients were cured by itraconazole alone.Conclusions In China, most patients of phaeohyphomycosis have concurrent conditions or have previously received immunosuppressive agents and cor-ticosteroids.Cutaneous and subcutaneous infection were most common,located mainly on limbs,face,chest and abdominal skin.The most frequently isolated pathogen is Exophiala jeanselmei ,followed by Phialophora verrucosa and Exophiala spinifera .Itraconazole therapy would be very effective.Susceptibility testing is very useful in case of refractory infection.

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Role of lactoferrin and C-reactive protein in ascites of liver cirrhosis for diagnosis of spontaneous bacterial peritonitis

Li LIANG ; Yu LEI ; Daishu YIN ; Shan ZHONG ; Zhi ZHOU ; Hong REN

Chinese Journal of Infection and Chemotherapy.2014;(3):219-223.

Objective This study was to investigate the role of lactoferrin and C-reactive protein (CRP)assay in ascitic fluid for diagnosis of spontaneous bacterial peritonitis (SBP)in the patients with decompensated liver cirrhosis.Methods Ascites was collected from the inpatients with decompensated liver cirrhosis before and after treatment from May to December 2011 for anal-ysis of polymorphonuclear cells (PMN)and bacterial culture.The level of lactoferrin and C-reactive protein in the ascites were determined.Results A total of 117 ascites samples were collected from 66 patients.Twenty-six patients met the criteria of SBP with PMN ≥ 250×106/L in ascites,were assigned to SBP group.Of these patients,11 presented with fever 37.3℃ to 38℃, and 11 patients had elevated peripheral blood white cell count > 10 × 109/L.Eleven patients had neutrophil cell percentage >0.75.Only 8 patients in this group had positive bacterial culture.Another 12 patients met the criteria of suspected SBP,and assigned to suspected SBP group.The remaining 28 patients did not satisfy the criteria of SBP,and assigned to non-SBP group.The pretreatment lactoferrin level was (768.46 ± 611 .70)ng/mL and (98.28 ± 56.81 )ng/mL in SBP and non-SBP group,respectively.The pretreatment CRP level was (9.397 ±3.737 )mg/L and (1 .786 ±0.52 )mg/L in SBP and non-SBP group,respectively.The lactoferrin and CRP levels decreased sharply after antibacterial and support-ive treatment in SBP group,which were 657.05 ng/mL and 8.13 mg/L,respectively.The cut-off value of lactoferrin for diagnosis of SBP was 233 ng/mL with sensitivity 96.2% and spe-cificity 97.5%.The cut-off value of CRP for diagnosis of SBP was 4.390 mg/L with sensitivity 92.3% and specificity 92.5%. However,lactoferrin combined with CRP had a sensitivity of 99.70% and specificity of 90.18% for diagnosis of SBP.Conclu-sions Lactoferrin and CRP levels in the ascites of patients with liver cirrhosis are useful for diagnosis of SBP with high specifici-ty and sensitivity.

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