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Objective: To investigate the clinical distribution and drug resistance of multidrug-resistant organism (MDRO) isolatedin our hospital, and to provide reference for clinical rational use of antibiotics. Methods: The pathogens isolated from the samples of inpatients in our hospital from January 2019 to December 2019 were retrospectively analyzed, and the distribution and drug resistance of MDRO were statistically analyzed. Results: 4399 strains of pathogens were isolated in our hospital, 459 strains of MDRO, the detection rate of MDRO was 10.43%. The top 5 MDRO were carbapenem resistant (CR-PAE, 125 strains, accounting for27.23%), carbapenem resistant Acinetobacter baumannii (CR-ABA, 123 strains, accounting for 26.80%), carbapenem resistant Klebsiella pneumoniate (CR-KPN, 118 strains, accounting for 25.71%), methicillin-resistant Staphylococcus aureus (MRSA, 74 strains, accounting for 16.12%) and carbapenem resistant Enterobacteriaceae (CRE, 13 strains, accounting for 2.83%). In terms of specimen types, MDRO accounted for 60.57% of all MDRO isolates in sputum, followed by urine, alveolar lavage fluid, secretions and blood samples. The top four departments of MDRO isolates were ICU, neurosurgery department, rehabilitation medicine department and cadre ward. In terms of drug resistance, CR-ABA and CR-KPN were the most serious drug-resistant strains in our hospital. CR-ABA showed high resistance to ceftazidime, ceftriaxone and cefepime, fluoroquinolones (ciprofloxacin), aminoglycosides (gentamicin and tobramycin), which was more than 85.00%. The drug resistance rate of carbapenem (imipenem) was more than 99.00%, and the sensitivity of tigecycline to the resistant bacteria was higher. CR-KPN to compound sulfamethoxazole, aztreonam, gentamycin, quinolone cefepime (ciprofloxacin and lev-ofloxacin), cephalosporins alkene (cefazolin, ceftriaxone, cefoxitin, cefepime, ceftazidime), β-lactam and enzyme inhibitors compounds(ampicillin/sulbactam, amoxicillin/clavulanic acid and piperacillin/tazobactam) and penicillium carbon alkene antimicrobial agents (ertapenem and imipenem) had drug resistance rates above 90.00%. Conclusion: The detection rate of MDRO in our hospital is high. We should strengthen the MDRO drug resistance monitoring, timely feedback to clinicians, establish a communication and cooperation mechanism, and promote the rational use of antibiotics to prevent the infection and spread of MDRO. [ABSTRACT FROM AUTHOR]

Objective: To study and analyze the drug resistance spectrum and molecular typing of Stenotrophomonas maltophilia in hospital infection, so as to provide basis for making reasonable infection control plan. Method: 42 strains of clinical isolates of Stenotrophomonas maltophilia were identified by mass spectrometer and their drug resistance phenotypes were analyzed. According to the different groups of drug sensitivity results of five antibiotics, ceftazidime, compound neoformamine, levofloxacin, minocycline and cefepime, the strains with the same drug sensitivity results were divided into one type and the strains with different drug sensitivity results were divided into another type; PFGE was used for molecular typing Analysis. Results: 42 strains of Stenotrophomonas maltophilia were divided into 6 types. 42 strains of Stenotrophomonas maltophilia were analyzed by PFGE and 4 genotypes of A-D were obtained. Conclusion: The characteristics of drug resistance spectrum and PFGE typing of Stenotrophomonas maltophilia are very useful for the selective treatment of antibiotics. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical features and risk factors of infections caused by cefepime- and ertapenem-heteroresistant Klebsiella pneumoniae (FEP-HR-KP and ETP-HR-KP, respectively). Methods We conducted a retrospective case-control study of 108 Klebsiella pneumoniae strains isolated from the body fluids of the inpatients in our hospital from January, 2014 to December, 2015. The heteroresistance of the isolated strains was detected using Kirby-Bauer disk diffusion test (K-B test) and E-test, and the results were further confirmed by population analysis profile (PAP) method. The risk factors for infections by FEP-HR-KP and ETP-HR-KP were analyzed using Chi-square test and logistic regression analysis. Results Of the total of 108 non-duplicate Klebsiella pneumoniae strains isolated, 41 (40.0%) were heteroresistant to cefepime, 63(58.3%) were heteroresistant to ertapenem, and 38 (35.2%) showed heteroresistance to both. The annual detection rate of FEP-HR-KP increased from 41.7% (20/48) in 2014 to 51.7% (31/60) in 2015, and that of ETP-HR-KP increased from 54.1% (26/48) in 2014 to 61.7% (37/60) in 2015. The strains were isolated mainly from blood specimens (25/66, 37.9%), and more than half (47/66, 71.2%) of the strains were isolated from the department of surgery. Multivariate logistic regression analysis revealed that soft tissue infection (OR=1.92, 95%CI: 0.91~3.91, P=0.049), mechanical ventilation (OR=2.45, 95%CI: 1.31~4.47, P=0.013), and use of cephalosporins (OR=2.10, 95%CI: 1.18~3.13, P=0.020) were independent risk factors for infections by FEP-HR-KP; use of cephalosporins (OR=2.08, 95%CI: 0.96~4.20, P=0.033), use of carbapenems (OR=2.52, 95%CI: 1.08~3.86, P=0.023) and drainage tube placement (OR=2.76, 95%CI: 1.49~4.90, P=0.018) were independent risk factors for ETP-HR-KP infections. Conclusion The Klebsiella pneumoniae strains isolated in our hospital show high rates of heteroresistance to cefepime and ertapenem. Avoiding unnecessary invasive operation and optimizing the use of antibiotics can help to reduce the generation of heteroresistant strains and improve the treatment efficacy for FEP-HR-KP and ETP-HR-KP infections.

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective :To screen antibacterials sensitive to drug-resistant Acinetobacter baumannii by establishing the model of Caenorhabditis elegans infected with drug-resistant A. baumannii. Methods : After C. elegans was infected with drug-resistant A. baumannii islolated from samples of clinical patients, 14 kinds of antibacterials such as piperacillin sodium, cefotaxime sodium, ampicillin sodium and sulbactam sodium, imipenem, ceftriaxone sodium, cefepime, meropenem, ceftazidime, cefoperazone sodium, amikacin, levofloxacin, ciprofloxacin, minocycline and amphotericin B were added to the cultures. Then, the survival of C. elegans was observed and recorded, after infection with drug-resistant A. baumannii. Results : Meropenem, imipenem, ampicillin sodium and sulbactam sodium and minocycline had obvious therapeutic effects on C. elegans infected with A. baumannii. Conclusion : The application of drug screening model of C. elegans infected with drug-resistant A. baumannii could provide reference for the selection of antibacterials in the treatment of drug-resistant A. baumannii infection. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Modern Laboratory Medicine is the property of Journal of Modern Laboratory Medicine Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To explore the drug resistance of Isolated From Blood Culture Escherichia coli ( E. coli ) in a hospital in Qinghai over the past seven years, to evaluate the ability of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) to analyze the homologous origin of E. coli , and to establish a protein fingerprint library to match with it, adjuvant clinical experience medication so as to provide the basis for the prevention and control of hospital-acquired infections. Methods: Retrospective analysis of blood cultures sent to hospitals from January 2016 to December 2022. Drug resistance and resistance changes in E. coli. A total of 1 841 E. coli strains were isolated from Qinghai Provincial People's Hospital from January 2016 to December 2022; all strains were identified by MALDI-TOF MS, and the VITEK2.0 drug sensitivity analyzer was applied for drug sensitivity analysis of the strains, and the mass spectrometry homology analysis and self-constructed protein fingerprint library were carried out by MALDI-Biotyper software; the protein fingerprint library was built by using WHONET5.6 software was used to statistically analyze the drug sensitivity results, SPSS23.0 software was used to analyze the relationship between fingerprint typing and drug sensitivity, and the χ 2 test was used for intergroup comparisons. Results: A total of 1 841 strains of E. coli from blood sources to piperacillin/tazobactam and ceftriaxone was on the rise, and it was slightly decreased to cefepime, amikacin, levofloxacin, and sulfamethoxazole, and there was not much change to the rest of the drugs; After MALDI-Biotyper clustering analysis, the 1841 E. coli from blood sources to piperacillin/tazobactam and ceftriaxone was on the rise, and it was slightly decreased to cefepime, amikacin, levofloxacin, and sulfamethoxazole, and there was not much change to the rest of the drugs; After MALDI-Biotyper clustering analysis, the 1841 E. coli strains from Isolated From Blood Culture were classified into two major clusters and five subtypes, of which type Ⅰa1 accounted for about 40%, type Ⅰa2 accounted for about 2.7%, type Ⅰb accounted for about 3.8, type Ⅱa accounted for about 46%, and type Ⅱb accounted for about 7.5%. The detection rate of type Ⅰa1 E. coli was higher in general surgery (50.45%) and emergency surgery (50.92%), and the detection rate of type Ⅰb E. coli to cefepime was 21.3% higher than that of the remaining four types, and the difference was statistically significant ( E. coli to cefepime was 21.3% higher than that of the remaining four types, and the difference was statistically significant ( χ 2 =37.74, P= 0.000); the resistance rate of type Ⅱ E. coli (>60%) to sulfamethoxazole was higher than that of type Ⅰ (<60%) as a whole, and the difference was statistically significant ( χ 2 =15.248, P= 0.004); and a preliminary database of homologous protein fingerprints of E. coli has been established E. coli homologous protein fingerprint library and validated. The drug susceptibility results of 1 288 E. coli isolated from a hospital in Qinghai province to piperacillin/Tazobactam, cefepime, amicacin and other antibiotics has changed greatly. A fingerprint database of P >0.05). Conclusion: In recent years, the resistance rate of E. coli isolated from a hospital in Qinghai province to piperacillin/Tazobactam, cefepime, amicacin and other antibiotics has changed greatly. A fingerprint database of E. coli homologous protein was established, and it was found that the drug sensitivity data of E. coli were different among different fingerprint types. According to drug sensitivity, drug use could assist clinical experience and provide evidence for prevention and control of hospital illness.

OBJECTIVE: To probe into the pharmaceutical practice for anti-infection treatment optimization in treatment of liver abscess by pharmacists. METHODS: Pharmacists participated in clinical ward rounds. After examining the ill condition of the patient with liver abscess, according to the pharmacodynamic characteristics of antimicrobial agents, the pharmacists suggested that the drug combination of cefepime, levofloxacin and metronidazole should be replaced by mezlocillin and sulbactam. The clinicians adopt the proposal. RESULTS: After the change of anti-infection treatment, the quality of medical care was assured, the adverse drug reactions were reduced, and the intensity of the antibacterial medicine also decreased. CONCLUSIONS: The clinical pharmacists participate into the clinical treatment, play their pharmaceutical specialty and provide pharmaceutical care can promote the improvement of medical quality. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into the pathogenesis and treatment regimen of antibiotic associated diarrhea (AAD), so as to provide reference for the clinical treatment and experience for the clinical pharmacists. METHODS: To introduce the treatment process of one significant case with AAD participated by the clinical pharmacists through summarizing and analyzing the essential clinical data and distinctive features of condition changes. RESULTS: After the adjustment of medication regimen, the patient's abdominal pain relieved, body temperature dropped and white cell counts recovered after only 24 hours. After treatment of 5 d, the routine blood leukocyte count was 11.87 ×109/L, ratio of neutrophile granulocyte was 73.91%. CONCLUSIONS: The clinic should identify AAD as early as possible and adjust treatment regimen timely, which can improve the quality of medical care; and the clinical emergency could turn the corner rapidly. It is suggested that the clinic should attach more importance to the anti-infective therapy. [ABSTRACT FROM AUTHOR]

Objective: To analyze the serotypes and antibiotic resistance phenotypes of non-typhi Salmonella strains in Henan province from 2011 to 2015. Methods: The stool samples were collected from diarrhea patients, and enriched with SBG enrichment broth and the pathogen isolation was conducted with CHROMAgar selective culture medium at 37 ℃ for 18-24 hours using KIA/MIU biochemical action and API20E biochemical system slab to identify Salmonella strains. The serotypes of all the positive strains were detected with SSI Salmonella typing sera. According to K-B drug susceptibility testing method published by USA clinical and Laboratory Standards Institute (CLSI), the antibiotics resistant phenotype of the positive strains were analyzed. Results: A total of 1 351 strains of non-typhi Salmonella were isolated, in which 811 were from males, 540 were from females. The ratio of men to women was 1.5∶1. Children and young adults were mainly affected. The pathogen isolation was mainly in May-October during a year. The 1 351 strains of non-typhi Salmonlla were divided into 58 serotypes. S. enteritidis, S. typhimurium, S. agona, S. derby, S. indiana, S. senftenberg and S. thompson ranked 1 st -7 th . The drug-resistance rate of the 1 351 strains was 46.1% to synthetic broad-spectrum penicillin ampicillin (AMP), 19.5% and 21.2% to the three generation cephalosporin ceftazidime (CAZ) and cefotaxime (CTX), 8.8% to the four generation cephalosporins cefepime (FEP), 58.7% to the one generation of quinolones nalidixic acid (NAL), 14.7% to the three generation fluoroquinolone ciprofloxacin (CIP) and norfloxacin (NOR), 25.0% and 35.6% to aminoglycoside antibiotic gentamicin (GEN) and streptomycin (STR), 35.4% to amphenicols (CHL), 31.7% to sulfonamide trimethoprim (TMP) and 37.8% to tetracycline (TET). Totally 879 strains were multidrug resistant (65.1%): 350 strains were resistant to 3-4 kinds of antibiotics (25.9%), 309 strains were resistant to 5-7 kinds of antibiotics (22.9%), 174 strains were resistant to 8-10 kinds of antibiotics (12.9%) and 48 strains were resistant to 11-12 kinds of antibiotics (3.6%). Conclusion: The serotypes of non-typhi Salmonella strains isolated from Henan province varied, some strains were resistant to 12 kinds of antibiotics commonly used in clinical treatment and the multidrug resistance has become serious.

Objective: To determine the drug resistance of Comamonas testosteroni (C. testosteroni) by the Kirby-Bauer (K-B) method without Clinical and Laboratory Standards Institute (CLSI) explanation or the minimum inhibitory concentration (MIC) method with the standard CLSI explanation to evaluate the sensitivity of K-B method in detection of C. testosteroni.
, Methods: K-B method and MIC method was used to determine the sensitivity of C. testosteroni to Piperacillin, Cefepime, Piperacillin/tazobactam, Imipenem, Meropenem, Amikacin, Gentamicin, Tobramycin, Ceftazidime and Ciprofloxacin. The interpretation standard for Pseudomonas aeruginosa was temporary used for the K-B method. The coincident rate was compared between the two methods.
, Results: The complete or partial coincident rate for K-B method and MIC method to detect Piperacillin and Cefepime was 97.4% or 2.6%; the complete coincidence rate to detect Piperacillin/tazobactam, Imipenem and Meropenem was 100%; the complete or partial coincident rate to detect Amikacin, Gentamicin and Tobramycin 94.7% or 5.3%; the complete or partial coincident rate to detect Ceftazidime was 97.4% or 2.6%; the complete or partial coincident rate to detect Ciprofloxacin 86.8% or 10.6%, and the full non-coincidence rate was 2.6%.
, Conclusion: The results of drug sensitive test from the two methods are highly consistent. We suggest that the microbiology labs do not report the interpretive results for C. testosteroni with K-B method but report the test results.

Objective: To study the distribution characteristics and drug resistance of non-fermenting bacterial infection in intensive care unit (ICU) at a tertiary hospital during seven consecutive years, and to provide evidence for rational use of antibiotics in ICU., Methods: A retrospective analysis was conducted. The related data about non-fermentative bacteria obtained from clinical specimens, collected from lower respiratory tract, blood, urine, bile and other secretions of ICU patients admitted to Binzhou Medical University Hospital from January 2009 to December 2015 were retrospectively analyzed. The distribution characteristics and drug resistance of non-fermentative bacteria, and isolation rate of multiple drug resistance (MDR) strains were analyzed., Results: 2 672 strains of nonfermentative bacteria were isolated during seven consecutive years, accounting for 57.9％ gram negative (G-) bacilli (2 672/4 613),and 35.2％ of all bacteria (2 672/7 587).The top five were Acinetobacter baumannii (38.4％),Pseudomonas aeruginosa (34.6％),Onion burkholderia cepacia (9.9％),Stenotrophomonas maltophilia (6.2％),and Pseudomonas fluorescens (5.6％).Non-fermentative bacteria were mainly isolated from the lower respiratory tract (60.9％).Isolation of the non-fermentative bacteria accounted for over 50％ of G-bacilli during seven consecutive years, and the isolation rate of the top five types of bacteria showed no obvious change, while positive rate of Acinetobacter baumannii showed a tendency to increase (obviously from 26.5％ in 2009 to 50.2％ in 2015),and a lowering trend of positive rate of Onion burkholderia cepacia,Stenotrophomonas maltophilia, and Pseudomonas fluorescens was obvious (from 15.6％,10.6％,13.0％ in 2009 to 5.6％,7.4％,1.4％ in 2015 respectively) was observed. The isolation rate of Pseudomonas aeruginosa was stable (about 30％) during seven consecutive years. The drug susceptibility results showed that the resistant rates of Acinetobacter baumannii against imipenem, meropenem, aminoglycosides and third-generation cephalmsporins were all higher than 70％,while its resistant rate to cefoperazone-sulbactam was relatively lower (40.2％-68.1％)with relatively higher sensitivity rate (23.6％-46.0％).In contrast, the resistant rates of Pseudomonas aeruginosa against antibiotics were low,while the sensitivity rate to fourth-generation cephalmsporins cefepime (58.3％-87.7％)and third-generation cephalmsporins was high (ceftazidime:55.6％-79.3％,piperacillin-tazobactam:62.5％-86.2％,cefoperazone-sulbactam:46.0％-89.8％).From 2009 to 2015,the incidence of MDR strains of Acinetobacter baumannii showed an obvious increasing tendency (from 68.0％ to 84.1％);in contrast, the incidence of MDR strains of Pseudomonas aeruginosa did not show an obviously increase in incidence from 2009 to 2012,on the other hand, it showed a decreasing tendency from a peak 68.6％ in 2012 to 23.5％ in 2015., Conclusions: The isolation rate of non-fermentative bacteria was high and the drug resistance situation was serious. Therefore,it is important to grasp the knowledge regarding distribution characteristics, drug resistance and variation of non-fermentative bacteria in ICU. It is not only beneficial for both rational use of antibiotics, improve efficacy but also helpful in reducing the emergence of drug resistance stains.

Objective: To investigate the drug tolerance and PFGE patterns of Salmonella(S.)paratyphi A strains isolated from sentinel hospitals in Dengfeng, Henan province, during 2009-2015., Methods: Venous blood samples were collected from paratyphoid patients and cultured in double phase blood culture bottle. Suspicious strains were identified and used for Salomonella. O antigen and H1/2 phase flagellum-induced serum agglutination test with API20E biochemical systems and SSI Salmonella typing sera. According to Salmonella molecular typing and K-B drug susceptibility testing method published by PulseNet China bacterial infectious disease monitoring network and USA Clinical and Laboratory Standards Institute, we analyzed the drug susceptibility and PFGE molecule characteristics of S. paratyphi A strains isolated from the patients., Results: A total of 126 strains of S. paratyphi A were isolated from 248 blood samples, the antigen modes of them were 1, 2, 12:a:-. The resistance rate of 126 strains of S. paratyphi A was 83.3% to ampicillin; 29.4% to ceftazidime, 31.2% to cefotaxime, 17.5% to cefepime; 62.6% to nalidixic acid; 19.3% to ciprofloxacin, 26.4% to norfloxacin; 22.8% to gentamicin, 47.9% to streptomycin; 19.2% to chloramphenicol, 24.2% to methicillin benzyl ammonium, 58.6% to compound sulfamethoxazole and 46.7% to tetracycline. The 126 strains of S. paratyphi A had different levels of resistance to 8 kinds of antibiotics, 109 strains were multidrug resistant(86.5%), 9 strains were resistant to 2-3 kinds of antibiotics(7.1%), 76 strains were resistant to 5-8 kinds of antibiotics(60.3%), 17 strains were resistant to 9-10 kinds of antibiotics(13.5%), 7 strains were resistant to 11-12 kinds of antibiotics(5.6%). The 126 strains of S. paratyphi A were divided into 14 molecular patterns by digestion with XbaⅠand pulsed field gel electrophoresis. The antibiotics resistance to third generation cephalosporin(CAZ, CTX), one generation and three generation of quinolones(NAL, CIP, NOR)and aminoglycosides antibiotics(STR)showed an upward trend. Each pattern contained 1-98 strains with similarity ranged from 64.10% to 100.00%. PTYA 1, 6, 9 and 10 were the main PFGE belt types., Conclusion: The drug resistance of clinical isolates of S. paratyphi A was serious in Dengfeng, Henan province, PFGE patterns showed a diversity, but predominant patterns could also be found. The PFGE patterns of some strains had clustering and were related with their antidrug spectrums.

Objective: To investigate the drug-resistance rate of community-acquired respiratory tract pathogens isolated from class B hospitals in China during 2013 and 2014., Methods: A total of 860 strains (S.pneumoniae 299, K. pneumoniae 221, H. influenzae 185, S. aureus 116, and M. catarrhalis 39) of non-duplicated community-acquired respiratory tract pathogens were isolated from 10 class B hospitals in 9 cities. The minimal inhibitory concentration (MIC) of antibacterial agents was determined by the broth microdilution method. The sensitive rates and MIC range of the antibiotics were analyzed by the WHONET-5.6 software., Results: Only 19.7%(59/299) S. pneumoniae was sensitive to oral penicillin. The sensitive rates of S. pneumoniae to second-generation cephalosporins(cefuroxime and cefaclor), amoxicillin with clavulanic acid, ceftriaxone, and macrolides (erythromycin, azithromycin and clarithromycin) were 25.6% (77/299), 33.4% (100/299), 63.5% (190/299), and 4.4% (13/299), respectively. About 93.5% (280/299)and 98.0% (293/299)of S. pneumoniae isolates were sensitive to levofloxacin and moxifloxacin.All of the K. pneumoniae isolates were sensitive to ertapenem and imipenem. The sensitive rates of K. pneumoniae to ceftriaxone, cefotaxime, ceftazidime, cefepime, and cefoxitin were about 85.0%, 93.2% (206/221), and 90.3% (200/221)of K. pneumoniae isolates were sensitive to levofloxacin and moxifloxacin.The mean prevalence of ESBL-producing K. pneumoniae was 8.1% (18/221). No S. aureus isolates resistant to vancomycin were detected in this study.The sensitive rates of S. aureus to levofloxacin, moxifloxacin, trimethoprim/sulfamethoxazole, and rifampin were 83.5% (97/116), 82.8% (96/116), 89.6% (104/116) and 83.5% (97/116), respectively. 37.4% (43/116) and 34.8% (40/116)of S. aureus isolates were sensitive to erythromycin and chloramphenicol.All of the H. influenzae and M. catarrhalis isolates were sensitive to amoxicillin with clavulanic acid, ceftriaxone, levofloxacin and moxifloxacin. The sensitive rates of H. influenza and M. catarrhalis to ampicillin, cefuroxime, cefaclor, erythromycin, azithromycin, and clarithromycin were from 80% to 100%., Conclusions: Penicillins, second-generation cephalosporins (cefuroxime and cefaclor) and amoxicillin with clavulanic acid showed low antimicrobial activity to S. pneumoniae, but a higher sensitive rate to ceftriaxone. The macrolides exhibited a high activity against H. influenza and M. catarrhalis, but low antimicrobial activity against S. pneumoniae and S. aureus. The antimicrobial activity of fluoroquinolones such as levofloxacin and moxifloxacin against most of the respiratory pathogens was high.

Objective: To explore the distribution and antibiotic resistance of pathogens in lesions of diabetic foot osteomyelitis (DFO) and analyze the risk factors causing osteomyelitis., Methods: A total of 372 patients with diabetic foot infections hospitalized between January 2011 and December 2014, including 203 with osteomyelitis (OM group) and 169 without osteomyelitis (non-OM group), were examined for the distribution and antibiotic resistance profile of the pathogens in the wounds. Logistic regression analysis was used to analyze the risk factors causing osteomyelitis., Results: Gram-negative bacteria were the predominant pathogens (53.7%) in the infected wounds in OM group, whereas Gram-positive bacteria were the most frequently found (56.7%) in non-OM group (P=0.001). Among the Gram-positive bacteria, Staphylococcus was the dominating flora (35.1%). The resistance rate to oxacillin and cefoxitin of the isolated bacteria in OM group (64.9% and 68.5%, respectively) was significantly higher than that in non-OM group (29.2% and 32.6%, respectively; P<0.05). Among the gram-negative bacteria, Enterobacteriaceae was the dominating flora (62.4%), with a higher resistance rate to Cefepime and Aztreonam in OM group (30.1% and 38.6%, respectively) than in non-OM group (15.1% and 22.2%, respectively; P<0.05). Logistic regression analysis indicated that the infection by multi-drug resistant bacteria and an wounds area >4 cm(2) were the risk factors for osteomyelitis in patients with diabetic foot infections (P<0.05)., Conclusion: In addition to an empirical anti-infection therapy, clinicians should choose specific antibiotics against Gram-negative bacteria according to the microbial spectrum and antibiotic resistance of pathogens in patients with DFO; patients with diabetic foot infections by multi-drug resistant bacteria and those with a wound area exceeding 4 cm(2) are exposed to an increased risk of osteomyelitis.

Objective: To investigate the spectrum and antimicrobial resistance of major pathogensthat causing nosocomial infections in China, 2013., Methods: Nosocomial cases as well as pathogens causing bloodstream infections (BSI), hospital-acquired pneumonia (HAP) and intra-abdominal infections (IAI) from 13 teaching hospital around China were collected. The minimum inhibitory concentrations (MICs) were determined by the agar dilution method. The CLSI M100-S23 criteria were used for interpretation., Results: Of all cases, 1 022 cases were from BSI, 683 from HAP and 674 from IAI.Escherichia coli and Klebsiella pneumoniae were the most prevalent pathogens causing BSI and IAI while Acinetobacter baumanii (34.6%) and Pseudomonas aeruginosa were dominated in HAP. Tigecycline, imipenem and meropenem exhibited high potency against Enterobacteriaceae and the susceptibilities rates were 95.6%, 94.2%and 95.2% respectively. Enterobacteriaceae demonstrated high resistance against cephalosporins (52.3%) and fluoroquinolones (38.9%) but were susceptible to β-lactam+inhibitor. Of all the Enterobacteriaceae, 30.5% were ESBLs positive and 4.3% were carbapenem resistant. Acinetobacter baumanii showed low susceptibilities to the microbial agents except for tigecycline (90.5%) and colistin (100%). The rate of carbapenem resistant Acinetobacter baumanii was 76.6%. Amikacin, ciprofloxacin, cefepime and piperacillin/tazobactam showed high antibacterial activity against Pseudomonas aeruginosa with susceptible rate 88.5%, 77.6%, 72.7% and 64.5% respectively. The resistant rate to imipenem and meropenem were 42.1% and 32.2%. All Staphylococcus aureus (166 strains) were susceptible to tigecycline, linezolid, daptomycin and glycopeptides. MRSA accounted for 46.9% of all the Staphylococcus aureus. The prevalence of MRSA in IAI (55.2%) and HAP (54.4%) were higher that that in BSI (35.0%). No Enterococcus strains were found resistant to tigecycline, linezolid and daptomycin. VRE was found in Enterococcus faecium, accounting for 1.9% of all Enterococcus faecium strains., Conclusions: Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa are the most common pathogens causing nosocomial infections. Nosocomial pathogens showed high susceptibilities against tigecycline. For ESBLs-producing Enterobacteriaceae strains, β-lactam+Inhibitor show high antibacterial activities. Vancomycin, teicoplanin and linezolid exhibit high potency to Staphylococcus aureus and Enterococcus.

Objective: To analyze the distribution and drug susceptibility of the pathogenic bacteria in the airway secretions in children with tracheobronchial foreign bodies so as to assist physicians in clinical prescription., Methods: Sputum specimens of 1 125 children with tracheobronchial foreign bodies were collected in removal of the foreign bodies by rigid bronchoscope, and the drug susceptibility test was performed., Results: Pathogenic bacteria were detected in 218 (19.4%) of 1 125 sputum specimens. Among the pathogenic bacteria, 126 (57.79%) strains were gram-negative bacilli, consisting of 76 (34.86%) strains of Haemophilus influenzae, 10 (4.59%) strains of Escherichia coli, 7 (3.21%) strains of Sewer enterobacter, 7 (3.21%) strains of Pseudomonas aeruginosa, and 6 (2.75%) strains of Klebsiella bacillus; and 92 (42.21%) strains were gram-positive bacilli, consisting of 80 (36.69%) strains of Streptococcus pneumonia and 10 (4.59%) strains of Escherichia coli. Most of detected gram-negative bacilli were highly sensitive to cefepime, ceftazidine, imipenem and amikacin, no strains were resistant to meropenem and ciprofloxacin. None of the detected gram-positive bacilli were resistant to cefepime, vancomycin, levofloxacin and teicoplanin., Conclusions: The Haemophilus influenzae of gram-negative bacilli and the Streptococcus pneumonia of gram-positive bacilli are the main pathogenic bacteria existing in the airway secretions of children with tracheobronchial foreign bodies. The Haemophilus influenzae were highly sensitive to cephalosporin, imipenem and amikacin, and the Streptococcus pneumonia to cefepime, vancomycin, levofloxacin and teicoplanin.

Objective: To study the biofilm-forming ability and the distribution of biofilm-related genes in Acinetobacter baumannii clinical isolates as well as antimicrobial resistance, to analyze their relationships with the bacterial resistance phenotype., Methods: A prospective study was conducted. Biofilm models of 70 strains Acinetobacter baumannii collected in Chengwu County People's Hospital from October 2012 to October 2013 were constructed using 96-well polystyrene plate. In order to analyze the biofilm-forming ability, a qualitative and quantitative analysis was conduct by crystal violet staining assay. And the antimicrobial resistance of different biofilm-forming ability strains was compared including imipenem, amikacin, meropenem, cefepime, sulbactam cefoperazone, trimethoprim, levofloxacin, gentamicin, ciprofloxacin, cefotaxime, ceftizoxime, aztreonam, piperacillin, ceftriaxone, cefuroxime. In addition, the expressions of biofilm-related gene Bap, bfs and intI1 were tested with polymerase chain reaction (PCR) assay., Results: Among 70 strains Acinetobacter baumannii, 40 strains were multi-drug resistant (57.14%) and 6 strains were pan-drug resistant (8.57%); 68 strains had biofilm-forming ability (97.14%), 14 of which were weakly positive, 20 were positive and 34 were strongly positive. The antimicrobial resistant rate of Acinetobacter baumannii to imipenem, amikacin, meropenem and cefepime was decreased, it was 30.00%, 32.86%, 38.57% and 41.43%, respectively. However, the antimicrobial resistant rates to other commonly used antibiotics were all higher than 50%. The drug resistance of Acinetobacter baumannii to levofloxacin (85.71%, 45.00%, 38.24%, χ² = 9.225, P=0.010), cefepime (71.43%, 45.00%, 29.41%, χ² = 7.222, P=0.027), gentamicin (78.57%, 55.00%, 38.24%, χ² = 6.601, P=0.037) was significantly decreased when biofilm-forming ability reinforced (weakly positive, positive, hadropositive). Bap gene positive rate of weakly positive, positive and strong positive biofilm-forming strains Acinetobacter baumannii was 50.00%, 65.00% and 79.41% (χ² = 4.244, P=0.120), respectively. Bfs gene positive rate was 35.71%, 65.00% and 88.24% , respectively (χ² = 13.602, P=0.001) and intI1 gene positive rate was 42.86%, 75.00% and 91.18%, respectively (χ² = 12.902, P=0.002). Moreover, the antimicrobial resistances of biofilm-related gene positive strains were higher than the negative, of which the drug resistance of intI1 positive group to amikacin was significantly higher than the negative group (40.38% vs. 11.11%, χ² = 5.194, P=0.023)., Conclusions: The Acinetobacter baumannii collected from the hospital had strong multi-drug resistance as well as strong biofilm-forming ability. The drug resistance of Acinetobacter baumannii decreased when biofilm-forming ability reinforced. In addition, genes, such as Bap, bfs, and intI1, contributed to biofilm formation.

Objective: To investigate the mechanism of drug resistance of carbapenems-resistant Acinetobacter baumannii (CRAB) in burn patients and the antimicrobial activity of a combination of drugs against this bacteria in vitro., Methods: A total of 135 strains of Acinetobacter baumannii (AB) from wound excretion, sputum, and venous catheter wall of patients hospitalized in our department from January 2011 to July 2013 were collected individually. Drug resistance of 135 strains of AB to 12 antibiotics commonly-used in clinic was detected using K-B paper diffusion method. Among the CRAB strains, double-disk synergy test was used to screen metallo-β-lactamase (MBL)-producing strains, and the drug resistance rates between MBL-producing strains and non-MBL-producing strains were compared. Minimal inhibitory concentration (MIC), 50% MIC (MIC50), and 90% MIC (MIC90) of cefoperazone/sulbactam, imipenem, cefepime, ampicillin/sulbactam, and amikacin used alone against MBL-producing CRAB were determined by broth microdilution method. MIC, MIC50, and MIC90 of amikacin respectively combined with imipenem, cefoperazone/sulbactam, cefepime, or ampicillin/sulbactam against MBL-producing CRAB were determined by checkerboard method with diluted agar. Fractional inhibitory concentration (FIC) index was calculated to determine the antibacterial effect of each combination of two antibiotics. Synergy with FIC lower than or equal to 0.5, or additivity with FIC higher than 0.5 and lower than or equal to 1.0 was regarded as effective, and indifference with FIC higher than 1.0 and lower than or equal to 2.0 or antagonism with FIC higher than 2.0 was regarded as ineffective. The effective rate was calculated. Data were processed with Chi-square test., Results: The resistant rates of the 135 strains of AB to imipenem, meropenem, and ceftazidime were high, and those of piperacillin/tazobactam and ampicillin/sulbactam were low. A total of 120 strains of CRAB was screened, accounting for 88.89%, among which the MBL-producing strains accounted for 78.33% (94/120). The resistant rates of MBL-producing strains to piperacillin/tazobactam, imipenem, meropenem, piperacillin, and cefepime were respectively 59.5%, 87.2%, 93.5%, 87.0%, 86.0%, and they were significantly higher than those of non-MBL-producing strains (respectively 43.0%, 81.3%, 87.5%, 78.4%, 64.0%, with χ(2) values from 4.571 to 8.260, P < 0.05 or P < 0.01). Among the inhibition concentrations of each of the 5 antibiotics used alone against MBL-producing strains, MIC, MIC50, and MIC90 of ampicillin/sulbactam were the lowest, respectively 4.00, 16, 64 µg/mL, while those of cefepime were high, respectively 32.00, 128, 512 µg/mL. MIC, MIC50, and MIC90 of amikacin combined with each of the other 4 antibiotics were decreased from 50.00% to 98.44% as compared with that of single administration of each antibiotic. Among the 94 strains of MBL-producing CRAB, the synergic, additive, indifferent, and antagonistic effects were respectively observed in 40, 33, 6, and 15 strains applied with combination of amikacin and ampicillin/sulbactam; 42, 30, 5, 17 strains applied with combination of amikacin and cefoperazone/sulbactam; 38, 15, 19, 22 strains applied with combination of amikacin and cefepime; 34, 2, 37, 21 strains applied with combination of amikacin and imipenem, among which the antibacterial effective rates decreased successively, respectively 77.7%, 76.6%, 56.4%, and 38.3%. The former two rates were respectively significantly higher than the latter two rates (with χ(2) values from 8.618 to 29.889, P values below 0.01)., Conclusions: Production of MBL is the main mechanism of resistance of the CRAB isolated from burn patients hospitalized in our department against carbapenems in about 3 years. The antibacterial effects of amikacin combined with each of the former-mentioned 4 agents are better than those of each of the five antibiotics used singly, and the effects are particularly obvious when combining amikacin with compound agent containing enzyme inhibitors.

Objective: To evaluate the change of extended spectrum beta-lactamase (ESBLs) Producing Klebsiella Pneumoniae (ESBLs-KPN) and Escherichia coli (ESBLs-ECO) causing nosocomial infection after antimicrobial intervention., Methods: We regularly monitored the data on the yearly consumption [defined as daily dose (DDD) per 1 000 patient-days] of frequently used antibiotics from Dec. 2004 to Dec. 2007. From Jan. 2005 to Dec. 2007, we monitored the resistance of frequently used antibiotics and the timely integrative antimicrobial intervention was based on the outcome of antimicrobial resistance. We also monitored the isolation rate of ESBLs-KPN and ESBLs-ECO causing nosocomial infection. The departments studied were the experimental group and other comparable medical departments were the control group(ICU was excluded)., Results: The isolation rate of ESBLs-KPN (43.90%) and ESBLs-ECO (45.83%) in the experimental group was higher than that in the control group (28.04% and 24.90%, respectively) before the intervention (P<0.05). The isolation rate of ESBLs-KPN decreased (from 26.47% to 17.65%) in the experimental group and that in the control group increased ( ESBLs-KPN: from 34.18% to 52.94%; ESBLs-ECO: from 47.13% to 63.78%) from 2005 to 2007 (P<0.05). The isolation rate of ESBLs-KPN and ESBLs-ECO in the experimental group was lower than that in the control group after the antimicrobial intervention (P<0.05). Usage of ceftazidime and cefoperazone/sulbactam and imipenem was reduced and the consumption of cefepime was increased in the experimental group (P<0.05). Consumption of ceftazidime and cefoperazone/sulbactam and cefepime was increased., Conclusion: The prevalence of ESBLs-KPN and ESBLs-ECO may be decreased after the integrative antimicrobial intervention.

Objective: To investigate the in vivo activities of ceftazidime and cefepime with susceptibility in vitro in rats with experimental pneumonia caused by extended-spectrum beta-lactamase-producing strain of Klebsiella pneumonia., Methods: With intratracheal instillation method, 3 Klebsiella pneumonia strains isolated from this hospital were used to produce 3 groups of experimental model of pneumonia in rats. All the 3 strains showed resistant to cefotaxime and susceptible to piperacillin-tazobactam in vitro. To ceftazidime and cefepime, strain 1 was both susceptible. Strain 2 was susceptible to ceftazidime and resistant to cefepime. Strain 3 was resistant to ceftazidime and susceptible to cefepime. The three groups of rats were randomly assigned to one of the following five groups: one control group and four treatment groups. The efficacies were evaluated 96 hours later by the survival rate and the viable bacterial counts of the lungs (lg CFU/g)., Results: Group 1: piperacillin-tazobactam, ceftazidime and cefepime significantly improved the survival rate (75.0%, 76.9%, 80.0%) and reduced the bacterial counts [(10.8 +/- 2.8), (11.1 +/- 3.2), (11.0 +/- 3.7) lg CFU/g] compared with cefotaxime and the control group [36.0%, 32.0%; (15.7 +/- 5.6), (16.0 +/- 5.5) lg CFU/g; P < 0.05]. Group 2: piperacillin-tazobactam, ceftazidime significantly improved the survival rate (79.2%, 73.1%) and reduced the bacterial counts [(10.7 +/- 2.3), (11.0 +/- 2.7) lg CFU/g] compared with cefotaxime and the control groups [42.3%, 33.3%; (15.5 +/- 5.4), (15.8 +/- 4.6) lg CFU/g; P < 0.05]. Group 3: the survival rate in piperacillin-tazobactam and cefepime groups (80.8%, 75.0%) were significantly higher and the bacterial counts in piperacillin-tazobactam [(10.4 +/- 2.4) lg CFU/g] were significantly lower compared with the cefotaxime and the control groups [37.5%, 34.6%; (14.2 +/- 5.6), (15.3 +/- 4.9) lg CFU/g; P < 0.05]., Conclusion: Cefepime and ceftazidime can reduce the mortality and the number of viable bacteria in rat pneumonia caused by some ESBL-producing Klebsiella pneumonia strains susceptible to either of them and their efficacies were similar to piperacillin-tazobactam.

Objective: To evaluate the therapeutic effects and safety of cefepime (Maxipime) and sulbactam/cefoperazone (sulperazone) on moderate and severe respiratory infection in children., Methods: Totally 100 children hospitalized for pneumonia were randomized equally into 2 groups, namely group A with maxipime treatment at the dose of 50 mg/kg given intravenously twice daily, and group B with sulperazone treatment at 50-100 mg/kg given intravenously twice a day. The therapeutic effects and safety of both medications were observed., Results: In maxipime group, 44 of the 50 cases were cured with complete elimination of the symptoms and signs, and obvious therapeutic effect was achieved in 5 cases with significant improvement or resolution of the majority of symptoms and signs. One case failed to respond favorably to the treatment, with the overall efficacy rate of 98% without incidence of adverse effects. In sulperazone group, 40 of the 50 cases were cured, 6 showed significant improvement, and 4 failed to respond to the treatment, with the rate of 92%. One patient complained of rashes during sulperazone treatment, which disappeared the next day without sulperazone withdrawal. Significant difference was not noted between the groups (chi(2)=2.43, P>0.05)., Conclusions: Both maxipime and sulperazon are effective and safe for application in children with moderate and severe respiratory infections.

Aim: To establish a sensitive and specific liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the determination of isomeric impurity in raw drug material of cefepime dihydrochloride., Methods: The HPLC separation experiments were performed on a reversed phase C18 column, with acetonitrile-10 mmol x L(-1) ammonium acetate (5:95) as mobile phase (a flow rate of 0.8 mL x min(-1)). The analytes were determined by electrospray ionization tandem mass spectrometry in positive mode. The chromatogram and mass spectra of cefepime dihydrocloride and its isomeric impurity were obtained by LC-MS/MS., Results: The method can be used for the separation and identification of cefepime dihychrocloride and its isomeric impurity, of which the retention times were 15.28 min and 9.18 min, respectively. Based on the MS/MS spectra of their molecular ions, the different fragmentation pathways of cefepime dihydrocloride and its isomeric impurity were compared and proposed., Conclusion: The method was rapid, sensitive and specific. It can be used for the identification of the isomeric purity in raw drug material of cefepime dihydrochloride.

Objective: To investigate the in vitro activities of cefepime and other 5 beta-lactam antimicrobial agents against 937 strains isolated from 10 teaching hospitals in different geographical areas in China during the early 1998., Methods: The MIC values of cefepime, ceftazidime, ceftriaxone, imipenem, cefoperazone/sulbactum, and piperacillin against 937 isolates were tested by a gradient concentration method (E-test((R)); AB Biodisk Co.)., Results: Quality control isolates were tested in all working processes. MIC values of 96.5% (829/859 times) of quality assurance tests were within expected ranges of NCCLS. Only imipenem and cefepime could inhibit 90% of enterobacter and citrobacter strains, Cefepime were significantly more active than 3rd Generation cephalosporins in enterobacter and citrobacter strains, and little better active than E. coli and Klebsiella spp. (98%, 95% susceptibility). All tested antimicrobial excluding ceftazidime had very high activity to oxacillin susceptible Staphylococci (95% approximately 100% susceptibility). cefepime, ceftazidime, imipenem, and cefoperazone/sulbactum had similar activity to Pseudomonas aeruginosa (83% approximately 79% susceptibility). Both imipenem and cefoperazone/ sulbactum were very active to Acinetobacter spp. (97%, 89% susceptibility)., Conclusion: The rank order of activity of the six tested agents is imipenem (97% Susceptible) > cefepime (89%) > cefoperazone/sulbactum (86%) > ceftazidime (76%) > ceftraixone (67%) > piperacillin (57%). The data are helpful to guide empiric therapy with beta-lactams in China.