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Linezolid versus Teicoplanin for MRSA Pneumonia: A Meta-Analysis

Objective　To systematically review the effectiveness and safety of linezolid versus teicoplanin in patients with MRSA pneumonia. Methods　Such databases as CBM, CNKI, WanFang Data, VIP, Science Direct, PubMed, Ovid, SciFinder, The Cochrane Library (Issue 3, 2013) and EMbase were electronically searched for published articles (randomized controlled trials or non-randomized prospective trials with comparable baseline between groups) at home and abroad on the clinical effectiveness and safety of linezolid versus teicoplanin in patients with MRSA pneumonia from January 2003 to March 2013. Using the Cochrane methods, two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software in clinical cure rates, clinical effective rates, microbiologic eradication rates, and adverse reaction incidences. Results　Finally, 7 studies were included involving 637 patients. The results of meta-analysis were clinical effective rates (RR=1.17, 95%CI 1.04 to 1.32, P=0.009), clinical cure rates (RR=1.06, 95%CI 0.94 to 1.19, P=0.37), bacterial clearance rates (RR=1.32, 95%CI 1.03 to 1.68, P=0.03), and adverse events rates (RR=1.24, 95%CI 0.78 to 1.97, P=0.37). The results of Begg test and Egger test were not significant (Pgt;0.05). Conclusion　Current evidence shows that, in treating MRSA pneumonia, linezolid is better than teicoplanin in clinical effective rates and bacterial clearance rates. However, they are alike in clinical cure rates and bacterial clearance rates.

Surveillance of Bacterial Resistance in West China Second University Hospital of Sichuan University in 2011

目的　了解2011年四川大学华西第二医院临床分离菌对常见抗菌药物的耐药性。 方法　采用法国生物梅里埃公司VITEK 2 COMPACT全自动细菌鉴定药敏仪，以及ATB 手工药敏条检测临床分离菌对各种常用抗菌药物的耐药性，参照CLSI 2011年版标准判定药敏试验结果，并用WHONET5.4软件统计分析。 结果　临床分离的1 692株细菌中，G+菌占28.0%（473/1 692），G?菌占72.0%（1 219/1 692）。分离的前5位病原菌分别为大肠埃希菌、流感嗜血杆菌、肺炎克雷伯菌、肺炎链球菌、金黄色葡萄球菌。耐甲氧西林金黄色葡萄球菌和耐甲氧西林的凝固酶阴性葡萄球菌分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的15.1%（22/146）和76.7%（46/60），未检出万古霉素、利奈唑胺耐药株。屎肠球菌对所测抗菌药物的耐药性显著高于粪肠球菌，对氨苄西林的耐药率分别为95.7%和13.3%，高水平氨基糖苷类抗生素耐药屎肠球菌和粪肠球菌的耐药率分别为82.6%和30.0%，检出1株对万古霉素耐药的屎肠球菌，未发现对利奈唑胺耐药菌株。青霉素耐药的肺炎链球菌占4.0%（6/151），肺炎链球菌对红霉素、克林霉素、四环素、复方磺胺的耐药率均高于90%。流感嗜血杆菌、副流感嗜血杆菌以及卡他布兰汉菌产β内酰胺酶的比例分别为58.1%（175/301）、70.0%（21/30）、75.9%（22/29）。肠杆菌细菌中产超广谱β内酰胺酶的大肠埃希菌和肺炎克雷伯菌检出率分别为59.9%和74.1%，耐药率最低的分别是3种碳青酶烯类抗生素和阿米卡星。不发酵糖G?杆菌在分离病原菌中所占比例较低，为12.1%（148/1 692），主要为鲍曼不动杆菌和铜绿假单胞，药敏结果显示，除铜绿假单胞对复方磺胺耐药率为93.5%和鲍曼不动杆菌对氨曲南耐药率为38.9%外，该两种细菌对所测抗生素敏感性高，均在80%以上，未检出泛耐药细菌。 结论　定期进行细菌耐药性监测有助于了解医院细菌耐药性变迁，对指导医院合理应用抗菌药物有重要意义。

重症药疹伴耐甲氧西林金黄色葡萄球菌感染护理一例

Genetic Polymorphism of Methicillin Resistant Staphylococcus Aureus Isolated from Hospital Acquired Pneumonia

Objective To investigate the genetic polymorphism of methicillin resistant Staphylococcus aureus ( MRSA) isolated from hospital acquired pneumonia. Methods Seventy-four hospitalized patients were diagnosed as noscomial MRSA pneumonia from January 2007 to January 2008 in Xinhua Hospital, Shanghai Jiaotong Univesity. The genes of MRSA were amplified by random amplified polymorphic DNA typing ( RAPD) assay in 82 clinical isolates from these patients. Results Two to 15 amplified DNA fragments were observed in agarose gel and they were classified into 11 genotypes. Genotypes Ⅲ, Ⅵ and Ⅶ ( 32. 56% , 30. 23% and 13. 95% , respectively) were mainly isolated from the ICU. Both independent genotypes and overlapping genotpyes with those from ICU were identified in isolates from the departments of geriatrics, emergency and respiratory medicine. Outbreak or cluster cases ( 48. 65% ) were found in 36 of the 74 patients while all outbreak cases occurred in the ICU. Conclusions Noscomial MRSA pneumonia is easy to disseminate and small-scale outbreak may occur especially in ICU. RAPD is valuable for identification and prevention of the spread of MRSA in hospital.

社区获得性耐甲氧西林金黄色葡萄球菌坏死性肺炎伴血流感染一例

目的 通过对1 例社区获得性耐甲氧西林金黄色葡萄球菌( CA-MRSA) 坏死性肺炎伴血流感染、双侧脓气胸和支气管胸膜瘘病例的分析, 增强对CA-MRSA 感染的认识。方法 对上海交通大学附属第一人民医院呼吸科收治的1 例CA-MRSA 感染病例的临床资料进行回顾性分析, 评估治疗前后临床症状及实验室检查的变化。结果 患者出现了反复发作性皮肤软组织感染( SSTIs) 、坏死性肺炎、血流感染等典型的CA-MRSA 感染的临床表现, 致双侧脓气胸和支气管胸膜瘘, 接受利奈唑胺及万古霉素药物治疗, 联合胸腔穿刺引流及负压吸引, 治疗效果明显。结论 临床医生应当提高对CA-MRSA 的警惕, 对于CA-MRSA 感染患者, 早期、正确的药物应用及对症支持治疗能提高患者治愈率。

医院获得性耐甲氧西林金黄色葡萄球菌感染的分析与对策

目的　调查耐甲氧西林金黄色葡萄球菌（MRSA）医院感染人群的特点，了解有效控制措施，为临床提供依据。 方法　开展MRSA的医院感染目标监测，对我院2010年1月－2011年12月期间住院患者中发生MRSA医院感染的病例进行调查分析。 结果　研究期间共发现81 例MRSA医院感染病例，感染部位以下呼吸道为主共69例，占86.3%，高龄、有慢性基础疾病、免疫力低下是引起MRSA医院感染的高危因素。 结论　降低MRSA感染率的有效控制措施是实施接触隔离、建立监控及预警机制，加强宣教。

Analysis of Nursing for Skin Disease Due to Meticillin-resistant Staphylococcus Aureus Infection

【摘要】 目的 通过总结耐甲氧西林金黄色葡萄球菌（meticillin-resistant staphylococcus aureus， MRSA）感染皮肤疾病患者的护理经验总结，探寻控制皮肤疾病感染的有效措施。 方法 对2009年1-10月收治的30例MRSA感染皮肤疾病患者的护理资料进行回顾分析。 结果 通过精心治疗、护理，30例患者皮损均治愈。 结论 采取严格的接触隔离措施，加强手卫生，对症选择敷料及换药，正确处理医用垃圾，加强与患者或家属的沟通交流，认真进行卫生宣教等，能有效的控制MRSA感染，提高临床痊愈率。【Abstract】 Objective To investigate the appropriate nursing for patients with skin disease due to methicillin-resistant staphylococcus aureus (MRSA) infection. Methods Careful nursing had been taken to 30 patients with skin disease due to MRSA infection from January to October in 2009. Results Skin lesions of 30 patients were cured through conscientious treatment and intensive nursing. Conclusion Strict contact isolation measures, strengthened hand hygiene, careful dressing, correct medical waste disposal, communication with patients or their families, and health education can effectively control the MRSA infection and improve the clinical cure rate.

Treatment of MRSA Infection

重症监护病房呼吸道耐甲氧西林金黄色葡萄球菌感染概况及控制对策

目的探讨重症监护病房耐甲氧西林金黄色葡萄球菌（MRSA）感染的概况及控制对策。 方法对重症监护病房2012年1月－12月的23例呼吸道感染MRSA的患者进行回顾分析，并提出防控措施。 结果高龄、免疫低下、侵袭性操作频繁、住院时间长、使用广谱抗菌药物和抑酸剂使用量大且时间长是患者发生MRSA感染的危险因素。 结论应采取合理必要的防控措施防止院内交叉感染，并积极治疗和精心护理患者促进其康复，以控制MRSA在医院内的发生和流行。

Bacteria Distribution and Drug Resistance Analysis in Patients with Acute Stroke Complicated with Pulmonary Infection

ObjectiveTo analyze the pathogenic bacteria distribution, structure and characteristics of drug resistance in patients with acute stroke complicated with pulmonary infection, in order to provide reference for the prevention of hospital infection and rational use of antimicrobial agents. MethodsA total of 864 clinical specimens of acute stroke complicated with pulmonary infection were chosen for study between January 2012 and December 2014. Separation and cultivation were done in accordance with the operation procedures regulated by the Ministry of Health. Drug sensitivity examination was done by Kirby-Bauer (k-b). Super-extensive spectrum β lactamase (ESBL) and methicillin resistant staphylococcus aureus (MRSA) were detected to analyze the bacterial species and resistance transition. ResultsA total of 864 samples were cultivated, in which G-bacteria accounted for 61.2%. The main pathogenic bacteria was Klebsiella pneumoniae bacteria, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumanmii and Staphylococcus aureus. Imipenem had high antimicrobial activity to G-bacilli, especially to Escherichia coli and Klebsiella pneumoniae bacteria. Linezolid, vancomycin and teicoplanin had high antibacterial activity to staphylococcus aureus. Vancomycin resistant Staphylococcus aureus was not found. Ciprofloxacin had high antibacterial activity to Pseudomonas aeruginosa, while imipenem had low antibacterial activity to Pseudomonas aeruginosa. Amikacin had high antibacterial activity to acinetobacter. ConclusionG-bacilli are predominant in acute stroke complicated with pulmonary infection. ESBLs and MRSA detection rate is high, and we should pay attention to the rational use of antibiotics to reduce drug resistance.