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Ｏｂｊｅｃｔｉｖｅ Ｔｏ ｉｎｖｅｓｔｉｇａｔｅ ｔｈｅ ｐｒｅｄｉｃｔｉｖｅ ｆａｃｔｏｒｓ ｆｏｒ ｔｈｉｒｄ － ｇｅｎｅｒａｔｉｏｎ ｃｅｐｈａｌｏｓｐｏｒｉｎ － ｒｅｓｉｓｔａｎｔ ｓｐｏｎｔａｎｅｏｕｓ ｂａｃｔｅｒｉａｌ ｐｅｒｉｔｏｎｉｔｉｓ （ＳＢＰ）． Ｍｅｔｈｏｄｓ Ａ ｒｅｔｒｏｓｐｅｃｔｉｖｅ ａｎａｌｙｓｉｓ ｗａｓ ｐｅｒｆｏｒｍｅｄ ｆｏｒ ｔｈｅ ｃｌｉｎｉｃａｌ ｄａｔａ ｏｆ ２０６ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｌｉｖｅｒ ｃｉｒｒｈｏｓｉｓ ｗｈｏ ｗｅｒｅ ｈｏｓｐｉｔａｌｉｚｅｄ ｉｎ ｔｈｅ Ｎｉｎｔｈ Ｈｏｓｐｉｔａｌ ｏｆ Ｎａｎｃｈａｎｇ ｆｒｏｍ Ｊａｎｕａｒｙ ２０１０ ｔｏ Ｄｅｃｅｍｂｅｒ ２０１８，ａｎｄ ａｌｌ ｐａｔｉｅｎｔｓ ｈａｄ ＳＢＰ ｗｉｔｈ ｐｏｓｉｔｉｖｅ ｂａｃｔｅｒｉａ ｂａｓｅｄ ｏｎ ａｓｃｉｔｅｓ ｃｕｌ ｔｕｒｅ． Ａｃｃｏｒｄｉｎｇ ｔｏ ｄｒｕｇ ｓｕｓｃｅｐｔｉｂｉｌｉｔｙ ｒｅｓｕｌｔｓ，ｔｈｅ ｐａｔｉｅｎｔｓ ｗｅｒｅ ｄｉｖｉｄｅｄ ｉｎｔｏ ｔｈｉｒｄ － ｇｅｎｅｒａｔｉｏｎ ｃｅｐｈａｌｏｓｐｏｒｉｎ － ｒｅｓｉｓｔａｎｔ ＳＢＰ ｇｒｏｕｐ （１０１ ｐａ ｔｉｅｎｔｓ ｗｉｔｈ ｔｈｉｒｄ － ｇｅｎｅｒａｔｉｏｎ ｃｅｐｈａｌｏｓｐｏｒｉｎ － ｒｅｓｉｓｔａｎｔ ｐａｔｈｏｇｅｎｉｃ ｂａｃｔｅｒｉａ ｉｎ ａｓｃｉｔｅｓ）ａｎｄ ｃｏｎｔｒｏｌ ｇｒｏｕｐ （１０５ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｐａｔｈｏｇｅｎｉｃ ｂａｃｔｅ ｒｉａ ｓｅｎｓｉｔｉｖｅ ｔｏ ｔｈｉｒｄ － ｇｅｎｅｒａｔｉｏｎ ｃｅｐｈａｌｏｓｐｏｒｉｎ）． Ｅｌｅｃｔｒｏｎｉｃ ｍｅｄｉｃａｌ ｒｅｃｏｒｄｓ ｗｅｒｅ ｒｅｖｉｅｗｅｄ ｔｏ ｃｏｌｌｅｃｔ ｒｅｌａｔｅｄ ｉｎｆｏｒｍａｔｉｏｎ． Ｔｈｅ ｔ － ｔｅｓｔ ｗａｓ ｕｓｅｄ ｆｏｒ ｃｏｍｐａｒｉｓｏｎ ｏｆ ｎｏｒｍａｌｌｙ ｄｉｓｔｒｉｂｕｔｅｄ ｃｏｎｔｉｎｕｏｕｓ ｄａｔａ ｂｅｔｗｅｅｎ ｇｒｏｕｐｓ，ａｎｄ ｔｈｅ Ｍａｎｎ － Ｗｈｉｔｎｅｙ Ｕ ｔｅｓｔ ｗａｓ ｕｓｅｄ ｆｏｒ ｃｏｍｐａｒｉｓｏｎ ｏｆ ｄａｔａ ｗｉｔｈ ｓｋｅｗｅｄ ｄｉｓｔｒｉｂｕｔｉｏｎ ｂｅｔｗｅｅｎ ｇｒｏｕｐｓ． Ｔｈｅ ｃｈｉ － ｓｑｕａｒｅ ｔｅｓｔ ｏｒ ｔｈｅ Ｆｉｓｈｅｒ’ｓ ｅｘａｃｔ ｔｅｓｔ ｗａｓ ｕｓｅｄ ｆｏｒ ｃｏｍｐａｒｉｓｏｎ ｏｆ ｃａｔｅｇｏｒｉｃａｌ ｄａｔａ ｂｅｔｗｅｅｎ ｇｒｏｕｐｓ． Ａ ｄｉｃｈｏｔｏｍｏｕｓ ｌｏｇｉｓｔｉｃ ｒｅｇｒｅｓｓｉｏｎ ａｎａｌｙｓｉｓ ｗａｓ ｕｓｅｄ ｆｏｒ ｍｕｌｔｉｖａｒｉａｔｅ ａｎａｌｙｓｉｓ，ａｎｄ ｔｈｅ Ｆｏｒｗａｒｄ：ＬＲ ｍｅｔｈｏｄ ｗａｓ ｕｓｅｄ ｆｏｒ ｔｈｅ ｓｃｒｅｅｎｉｎｇ ｏｆ ｉｎｄｅｐｅｎｄｅｎｔ ｖａｒｉａｂｌｅｓ． Ｒｅｓｕｌｔｓ Ｔｈｅｒｅ ｗａｓ ａ ｓｉｇｎｉｆｉｃａｎｔ ｄｉｆｆｅｒｅｎｃｅ ｉｎ ｔｈｅ ｃｏｍｐｏｓｉｔｉｏｎ ｏｆ ｐａｔｈｏｇｅｎｉｃ ｂａｃｔｅｒｉａ ｂｅｔｗｅｅｎ ｔｈｅ ｔｗｏ ｇｒｏｕｐｓ （Ｐ ＜ ０． ００１）． Ｔｈｅ ｕｎｉｖａｒｉａｔｅ ａｎａｌｙｓｉｓ ｓｈｏｗｅｄ ｔｈａｔ ａ ｈｉｓｔｏｒｙ ｏｆ ｂｒｏａｄ － ｓｐｅｃｔｒｕｍ ａｎｔｉｂｉｏｔｉｃ ｅｘｐｏｓｕｒｅ ｉｎ ｔｈｅ ｐａｓｔ ｔｈｒｅｅ ｍｏｎｔｈｓ （χ２ ＝ １２． ３５１，Ｐ ＜ ０ ００１），ｎｏｎ － ｆｉｒｓｔ － ｔｉｍｅ ｏｎｓｅｔ ｏｆ ＳＢＰ （χ２ ＝１４． ４２７，Ｐ ＜０． ００１），ｂｌｏｏｄ ｃｒｅａｔｉｎｉｎｅ （χ２ ＝ － ２． ５３７，Ｐ ＝ ０． ０１１），ａｎｄ ｂｌｏｏｄ ｂｉｃａｒｂｏｎａｔｅ （χ２ ＝ －４． ５９２，Ｐ ＜０． ００１）ｗｅｒｅ ｃａｎｄｉｄａｔｅ ｐｒｅｄｉｃｔｉｖｅ ｆａｃｔｏｒｓ ｗｉｔｈ ｓｔａｔｉｓｔｉｃａｌ ｓｉｇｎｉｆｉｃａｎｃｅ ｂｅｔｗｅｅｎ ｔｈｅ ｔｗｏ ｇｒｏｕｐｓ，ａｎｄ ｆｕｒｔｈｅｒ ｍｕｌｔｉｖａｒｉａｔｅ ａｎａｌｙｓｉｓ ｓｈｏｗｅｄ ｔｈａｔ ａ ｈｉｓｔｏｒｙ ｏｆ ｂｒｏａｄ － ｓｐｅｃｔｒｕｍ ａｎｔｉｂｉｏｔｉｃ ｅｘｐｏｓｕｒｅ ｉｎ ｔｈｅ ｐａｓｔ ｔｈｒｅｅ ｍｏｎｔｈｓ （ｏｄｄｓ ｒａｔｉｏ ［ＯＲ］＝２． ３７６，９５％ ｃｏｎｆｉｄｅｎｃｅ ｉｎｔｅｒｖａｌ ［ＣＩ］：１． ００９ －５． ５９８，Ｐ ＝ ０． ０４８），ｎｏｎ － ｆｉｒｓｔ － ｔｉｍｅ ｏｎｓｅｔ ｏｆ ＳＢＰ （ＯＲ ＝ ２． ８４１，９５％ ＣＩ：１． １３３ － ７． １２２，Ｐ ＝ ０． ０２６），ａｎｄ ｂｌｏｏｄ ｂｉｃａｒｂｏｎａｔｅ （ＯＲ ＝０． ８９２，９５％ ＣＩ：０． ８１８ －０． ９７３，Ｐ ＝０． ０１０）ｈａｄ ａｎ ｉｎｄｅｐｅｎｄｅｎｔ ｐｒｅｄｉｃｔｉｖｅ ｖａｌｕｅ ｆｏｒ ｔｈｉｒｄ － ｇｅｎｅｒａｔｉｏｎ ｃｅｐｈａｌｏ ｓｐｏｒｉｎ － ｒｅｓｉｓｔａｎｔ ＳＢＰ． Ｃｏｎｃｌｕｓｉｏｎ Ａ ｈｉｓｔｏｒｙ ｏｆ ｂｒｏａｄ － ｓｐｅｃｔｒｕｍ ａｎｔｉｂｉｏｔｉｃ ｅｘｐｏｓｕｒｅ ｉｎ ｔｈｅ ｐａｓｔ ｔｈｒｅｅ ｍｏｎｔｈｓ，ｎｏｎ － ｆｉｒｓｔ － ｔｉｍｅ ｏｎｓｅｔ ｏｆ ＳＢＰ，ａｎｄ ａ ｌｏｗ ｌｅｖｅｌ ｏｆ ｂｌｏｏｄ ｂｉｃａｒｂｏｎａｔｅ ａｒｅ ｉｎｄｅｐｅｎｄｅｎｔ ｐｒｅｄｉｃｔｉｖｅ ｆａｃｔｏｒｓ ｆｏｒ ｔｈｉｒｄ － ｇｅｎｅｒａｔｉｏｎ ｃｅｐｈａｌｏｓｐｏｒｉｎ － ｒｅｓｉｓｔａｎｔ ＳＢＰ，ａｎｄ ｔｈｉｒｄ － ｇｅｎｅｒａｔｉｏｎ ｃｅｐｈａｌｏｓｐｏｒｉｎｓ ｓｈｏｕｌｄ ｂｅ ｕｓｅｄ ｗｉｔｈ ｃａｕｔｉｏｎ ｉｎ ＳＢＰ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｔｈｅｓｅ ｆｅａｔｕｒｅｓ． [ABSTRACT FROM AUTHOR]

Objective: To investigate the mechanism of carbapenems resistance in Acinetobacter baumannii., Methods: WHONET-5 software was used to analyze the trend of carbapenem resistance in Acinetobacter baumannii collected from 1999 to 2001 at Peking Union Medical College Hospital. Analytical isoelectric focusing was used to measure the pI of the beta-lactamase. Conjugation experiment was used to study the transfer of carbapenem resistance and plasmid DNA was extracted and purified with Qiagen Plasmid Mini Kit. The homology of the isolates was determined by pulsed field gel electrophoresis (PFGE). Integrase genes and blaIMP-, blaVIM-, blaOXA- genes for resistant isolates were amplified and sequenced., Results: Imipenem resistance in A. baumannii was ranged from 1.8%-8.5%, but only 9 resistant isolates were viable. They were co-resistant to other carbapenems, ceftazidime, aztreonam, and gentamicin, and four isolates were resistant to ciprofloxacin. Impipenem resistance could not be transferred to susceptible strains. No plasmid was extracted. Each isolate produced TEM-1, AmpC, and two enzymes (pI 6.7, 6.0), which can not be inhibited by cloxacillin and clavulanic acid. Each isolate had class I intergase gene. Nine isolates were all negative for PCR of blaIMP- and blaVIM- genes, but positive for blaOXA-23 specific PCR. Sequencing found 100% homology with blaOXA-23. PFGE found 3 clones (A type: 5 isolates; B type: 3 isolates; C type: 1 isolate). Control isolates (imipenem-susceptible, but ceftazidime, ciprofloxacin, and gentamicin resistant) were also A clone., Conclusions: Production of OXA-23 carbapenemase in A. baumannii was one of the main mechanisms of carbapenems resistance at our hospital. It brings concern that imipenem-resistant clone has evoluted from nosocomial multiple-resistant strains.

Objective: In this article we investigated and analyzed the pathogenetic bacteria of burn infection and their drug resistance in recent 5 years from 1991., Methods: The patients are divided into 2 groups. The 1st group is from June 1986 to May 1991, and the 2nd group is from June 1991 to June 1996. Blood culture and burn wound bacteria culture were done, and bacteria and their drug sensitivity were analyzed., Results: In blood culture, Micrococcus had risen to rank the top (21.6%), while Staphylococcus aureus fell to rank the third. Among these G+ cocci comprised 56.5%, and G- bacilli 30.1%. In burn wound culture, Pseudomonas aeruginosa with rate of 18.1% was still in the 1st place. Enterobacter cloacae was in the 2nd place with the rate of 13.1%. Among these G- bacilli comprised 58.6%, G+ cocci 35.3%. Micrococcus enterobacter cloacae, Pseudomonas maltophilia, fecal Staphylococcus and candida albicans increased remarkably., Conclusion: The changes of pathogenetic bacteria of burn infection and bacteria drug resistance have certain relations with the wide usage of broad spectrum antibiotics such as cefazidime and imipenem.

Cefoperazone resistance gene (CPZr) has been cloned from plasmid pFC of E. coli HX88108 using the vector pMB9 (TCr, 5.3 kb). The plasmid pFC DNA was partially digested with Sau3A I, and its 1-2 kb fragments were ligated into BamH I site of vector plasmid pMB9. The recombinant DNA was then transformed into E. coli DH5 prepared using calcium chloride. CPZ resistant bacterial colonies were selected on the agar SOB plates containing CPZ (40 micrograms/ml). The resistance to CPZ could be stably reserved in generation after generation. The recombinant plasmids which encoded CPZ resistance were designated pFL11, pFL25, pFL33, pFL82, pFL86 and pFL102. Rapid small-scale preparation of plasmid and DNA restrication enzyme analysis were used for identification of bacterial colonies. Five plasmids DNA physical maps have been established. Comparison of recombinant plasmids maps with pFC map confirmed that the CPZr gene was oriented between nucleotide no. 3200 bp and no. 4800 + 40 bp of plasmid pFC total sequence. Its molecular weight was about 1.6 kb. There were EcoR I, Sma I and Pvu II sites within CPZr gene.

E. coli HX88108 was isolated from a patient and found to produce plasmid-encode beta-lactamases with conferring highly resistance to ceforperazone(CPZ). The beta-lactamases of the E. coli HX88108 and transformants pFC, pFT1, pFT2 and pFT3 were studied. The beta-lactamases stability test among 11 beta-lactam antibiotics showed that beta-lactamases from E. coli HX88108. pFC, pFT1, readily hydrolyzed penicillins, the first, second-generation cephalosporins and CPZ. beta-lactamases of pFT2 and pFT3 hydrolyzed penicillins more strongly than cephalosporins. On the other hand, experiments of inhibiting enzyme were carried out. The results indicated that beta-lactamases of HX88108, pTF1, pFT2 and pFT3 were inhibited by clavulanic acid(CA) and sulbactam (SBT). Enzyme of pFC was inhibited poorly by CA and SBT. Through isoelectric focusing technique, the PIs were as follows: HX88108 contained three beta-lactamases, of which the PIs were 5.25, 5.3 and 5.6 respectively; the PIs of beta-lactamases from pFT2, pFT3, were 5.3 and 5.6. pFC and pFT1 were different plasmids encoded beta-lactamases with the same PI 5.25. The results indicate that the beta-lactamases of E. coli HX88108 may be a new member in TEM farmily.

One hundred and eight strains of coagulase negative staphylococci (CNS) isolated from different clinical specimens (sputum, urine, blood, various catheters etc.) were classified into 9 species of CNS with biochemical technique. Staphylococcus epidermidis and staphylococcus saprophyticus accounted for the majority (66%). Drug susceptibility tests revealed that they were highly resistant to penicillin, oxacillin, erythromycin, chloramphenicol, compound sulfamethoxazole, tetracycline, cephazolin and ++ceftazidim but relatively sensitive to vancomycin, amikacin, gentamicin and rifapen. The MIC of oxacillin ranged from 0.125 mg/L to 128 mg/L. The MIC90 was 64 mg/L. It is suggested that vancomycin is the therapy of first choice in methicillin resistant CNS infection.

20 strains of Pseudomonas aeruginosa were isolated from burn patients of Xijing Hospital in Xi'an. These 20 strains which showed resistance to multiple antibiotics were selected to be studied regarding the location of multi-resistant gene. According to the sensitivity tests before and after plasmid removal, we found that in 70% of the bacteria resistance to multiple antibiotics was mediated by the plasmid. In 30% the bacteria remained resistant to antibiotics after plasmids were removed. Two explanations were postulated. (1) plasmids were not removed completely; (2) resistance gene was encoded by the chromosomes.