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【Objective:】 To understand the real psychological feelings of cancer patients after withdrawing from drug clinical trials, and provide reference for clinical healthcare professionals to serve personalized care for patients in the transitional period after withdrawing from drug clinical trials. 【Methods:】 With the descriptive phenomenology method, 11 subjects who withdrew from drug clinical trials in the oncology department of a tertiary hospital in Shandong Province were selected by intentional sampling method to conduct semi-structured in-depth interviews. Colaizzi seven-step analysis method was used to analyze and sort out records, and refine themes. 【Results:】 The psychological experiences of cancer patients after withdrawing from drug clinical trials were summarized into four themes: benefits of participating in clinical trials, losses of withdrawing from clinical trials, attitudes towards future treatment, and expectations of receiving help. 【Conclusion:】 Cancer patients face great psychological pressure after withdrawing from drug clinical trials and require deep emotional support and humanistic care. Nursing staff should take personalized care measures to meet the special problems of patients’ psychological needs, so as to help patients smoothly pass through the withdrawal stage and enter subsequent treatment.
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Objective:To explore the cleansing effect of Nitric Oxide (NO) sustained-release silica nanoparticles (short for NO sustained-release agent) on endoscopic biofilm and its clinical application.Methods:A total of 160 clinical endoscopes were randomly divided into two groups: the cleansing agent group (80 pieces, disinfected with cleansing agents), NO group (80 pieces, disinfected with NO sustained-release agent). A biofilm model of Pseudomonas aeruginosa was constructed and used as the control for phosphate buffered solution (PBS) treatment. A biofilm model of Pseudomonas aeruginosa on the surface of endoscopic lumen was built first in vitro. Scanning electron microscopy was then used to observe the microstructure of biofilm after treatment with NO sustained-release agent. Viable counting method was used to evaluate the cleansing effect of NO sustained-release agent on biofilm. Finally, at the clinical level, the actual disinfection effect of NO sustained-release agent on clinical endoscopy was evaluated by detecting the protein residues, viable counting and adenosine triphosphate (ATP) biofluorescence detection. Results:The scanning electron microscopy showed that the biofilm was intact in the model group, but scattered bacteria were observed on the biofilm surface in the NO group and the detergent group. Compared with the model group [(4.86±2.67)×10 6(colony-forming units, CFU)/mL], the standard CFUs of the NO group [(1.37±0.61)×10 4CFU/mL] and the detergent group [(1.31±0.21)×10 5CFU/mL] were significantly lower (detergent group VS model group, P=0.009; NO group VS model group, P=0.008), and there was significant difference between the detergent group and the model group ( t=9.53, P=0.000 6). The levels of residual proteins in the endoscopic lumens before and after the treatment were 8.03±1.47 mg/mL and 0.50±0.37 mg/mL in the NO group, 8.01±1.51 mg/mL and 0.91±0.52 mg/mL in the detergent group with significant difference ( P<0.01), and the reduction effect of the NO group was more significant. The disinfection of NO group and cleaning agent group was within the qualifying range, but the ATP bioluminescence value, protein residue and colony count of NO group (78.56±42.59 RLU, 0.50±0.37 mg/mL, 7.55±4.56 CFU) were significantly lower than those of detergent agent group (120.80±54.00 RLU,0.91±0.52 mg/mL,11.50±4.75 CFU, P<0.01). Conclusion:NO sustained-release agent can effectively clear endoscopic biofilm and further improve the disinfection effect on endoscopes, which may be of great significance for improving the effects on treatment and prognosis of patients.
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OBJECTIVE@#To analyze the clinical characteristics of patients with emergency in-hospital cardiac arrest (IHCA) in Kashgar, Xinjiang Uygur Autonomous Region and the factors affecting the success rate of cardiopulmonary resuscitation.@*METHODS@#Retrospectively selected patients who had cardiac arrest and cardiopulmonary resuscitation in the emergency department of the People's Hospital of 6 counties and cities in Kashgar area from January 2019 to January 2022. The clinical data of all patients were collected, including gender, age, major underlying diseases, the beginning and duration of resuscitation, the number of electric defibrillation acute physiology and chronic health evaluation II (APACHE II). According to whether the resuscitation was successful, all patients were divided into successful resuscitation group and failed resuscitation group. The clinical characteristics of the two groups were compared. Then, the influencing factors of the success rate of cardiopulmonary resuscitation in IHCA patients were analyzed by binary Logistic regression.@*RESULTS@#A total of 1 376 patients were enrolled, including 1 117 cases of failed resuscitation and 259 cases of successful resuscitation. The success rate of resuscitation was 18.82%. Compared with the resuscitation failure group, the patients in the successful resuscitation group were younger (age: 49.10±20.99 vs. 58.44±18.32), the resuscitation start time was earlier [resuscitation start time ≤ 5 minutes: 76.45% (198/259) vs. 66.61% (744/1 117)], the proportion of cardiovascular and cerebrovascular diseases was lower [cardiovascular disease: 49.42% (128/259) vs. 58.19% (650/1 117), cerebrovascular disease: 17.37% (45/259) vs. 21.58% (241/1 117)], the number of electric defibrillation was lower [times: 0 (0, 2) vs. 1 (0, 1)], the proportion of endotracheal intubation was more [80.31% (208/259) vs. 55.60% (621/1 117)], APACHE II score was lower (13.75±8.03 vs. 17.90±4.63), and the difference was statistically significant (all P < 0.01). Binary Logistic regression analysis showed that age, start time of resuscitation, ventilation mode and APACHE II score were protective factors affecting the success rate of cardiopulmonary resuscitation in patients with emergency IHCA [age: odds ratio (OR) = 0.982, 95% confidence interval (95%CI) was 0.973-0.991, P < 0.001; resuscitation start time ≤ 5 minutes: OR = 0.629, 95%CI was 0.409-0.966, P = 0.034; tracheal intubation assisted ventilation: OR = 0.243, 95%CI was 0.149-0.397, P < 0.001; low APACHE II score: OR = 0.871, 95%CI was 0.836-0.907, P < 0.001], while underlying diseases (cardiovascular diseases) are a risk factor affecting the success rate of cardiopulmonary resuscitation (OR = 1.190, 95%CI was 1.015-1.395, P = 0.036).@*CONCLUSIONS@#Age, resuscitation start time, ventilation mode, APACHE II score and major underlying diseases (cardiovascular diseases) have a greater impact on the success rate of resuscitation in IHCA patients. The above factors are conducive to improving or formulating more effective rescue strategies for IHCA patients, so as to achieve the purpose of improving the success rate of clinical treatment.
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Humans , Adult , Middle Aged , Aged , Retrospective Studies , Cardiopulmonary Resuscitation , Heart Arrest/therapy , Electric Countershock , HospitalsABSTRACT
Objective To study and discuss the application effect of TCM characteristic nursing combined with individualized health education in vertigo multi_ specialty integrated diagnosis and treatment platform, and to provide reference basis for clinical research in the future. Methods From June 2016 to June 2017, 60 patients with vertigo treated by multi_professional integrated diagnosis and treatment platform in our hospital were studied. The subjects of both groups were treated with acupoint application, and were randomly divided into routine group and combined group. There were 30 cases in each group. The routine standardized nursing method was applied to the vertigo multi_specialty integrated diagnosis and treatment platform, and the combined group was applied to the platform based on the routine group, and the application effect of the two groups was compared. Results The total effective rate of nursing in the observation group was 96.67% (29/30), which was significantly higher than that in the routine group (86.67% (26/30), and the difference was statistically significant (χ2=4.172, P<0.05).There was no significant difference in the quality of life score before treatment between the two groups (t=0.178, P>0.05), but the score of the observation group was significantly higher than that of the routine group (t=4.237, P<0.05), and the quality of life score of the observation group was significantly higher than that of the routine group (t=4.237, P<0.05). At the same time, the scores of quality of life after treatment in the two groups were significantly higher than those before treatment (t=9.239, 5.217, P<0.05).The nursing satisfaction of the observation group was 96.67% (29/30), which was significantly better than that of the conventional group (83.33% (25/30), and the difference was statistically significant (x= 5.372, P<0.05). After one year of follow_up, the number of recurrences in the observation group was 2, the recurrence rate was 6.67%, the number of recurrences in the conventional group was 6, the recurrence rate was 20.00%, the observation group was superior to the normal group, and the difference was statistically significant (χ2=5.137, P<0.05). Conclusion In the integrated diagnosis and treatment platform of vertigo, the application of TCM nursing combined with individualized health education can improve the nursing effect, improve the patients' quality of life and nursing satisfaction, and reduce the recurrence rate. To provide new theoretical thinking and clinical methods for improving vertigo patients.
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Objective To investigate the distribution and drug resistance of carbapenem-resistant Enterobacteriaceae ( CRE) isolated from children in China. Methods CRE strains were collected in 10 ter-tiary children's hospitals of China from January 1, 2016 to December 31, 2017. Antimicrobial susceptibility of the clinical strains was detected with disk diffusion method ( KB method) and automated method. The re-sults were analyzed according to the Clinical and Laboratory Standards Institute ( CLSI) Standards published in 2017. WHONET 5. 6 software was used to retrospectively analyze the distribution characteristics and drug resistance of these strains. Results A total of 3065 CRE clinical strains were isolated from children with an overall prevalence of 7. 7％ and among them, 13. 5％ were isolated in neonatal group and 5. 8％ in non-neo-natal group. The detection rate of CRE in 2017 was higher than that in 2016 (9. 7％ vs 5. 7％). Among the 3065 CRE strains, there were 1912 strains of Klebsiella pneumoniae (62. 0％), 667 strains of Escherichia coli (22. 0％), 206 strains of Enterobacter cloacae (7. 0％), 56 strains of Klebsiella aerogenes (1. 8％) and 47 strains of Serratia marcescens (1. 5％). Most of the strains were isolate in neonatology departments including neonatal intensive care units (NICU) and intensive care units (ICU), accounting for 44. 8％ and 19. 7％, respectively. Respiratory tract (61. 8％), urine (19. 4％) and blood (5. 7％) specimens were the main sources of CRE isolates. Results of antimicrobial susceptibility test showed that the CRE strains were highly resistant to carbapenem antibiotics such as imipenem, meropenem and ertapenem, as well as penicillins and most cephalosporins (79. 6％-100％), especially those isolated in the neonatal group (P<0. 05). Children had relatively low resistance rates to aminoglycosides such as amikacin (19. 7％) and fos-fomycin (11. 9％), fluoroquinolones such as levofloxacin (37. 7％) and ciprofloxacin (43. 3％), and tige-cycline (3. 8％). Currently, no polymyxin B-resistant strains were isolated. Conclusions The prevalence of common CRE strains in children in 2017 was higher than that in 2016, especially in newborns. Drug re-sistance in CRE strains isolated from neonates to common antibiotics was more severe, suggesting that great attention should be paid to it and timely measures should also be taken.
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Objective@#To study and discuss the application effect of TCM characteristic nursing combined with individualized health education in vertigo multi-specialty integrated diagnosis and treatment platform, and to provide reference basis for clinical research in the future.@*Methods@#From June 2016 to June 2017, 60 patients with vertigo treated by multi-professional integrated diagnosis and treatment platform in our hospital were studied. The subjects of both groups were treated with acupoint application, and were randomly divided into routine group and combined group. There were 30 cases in each group. The routine standardized nursing method was applied to the vertigo multi-specialty integrated diagnosis and treatment platform, and the combined group was applied to the platform based on the routine group, and the application effect of the two groups was compared.@*Results@#The total effective rate of nursing in the observation group was 96.67% (29/30), which was significantly higher than that in the routine group (86.67% (26/30), and the difference was statistically significant (χ2= 4.172, P < 0.05).There was no significant difference in the quality of life score before treatment between the two groups (t = 0.178, P > 0.05), but the score of the observation group was significantly higher than that of the routine group (t = 4.237, P < 0.05), and the quality of life score of the observation group was significantly higher than that of the routine group (t = 4.237, P < 0.05). At the same time, the scores of quality of life after treatment in the two groups were significantly higher than those before treatment (t = 9.239, 5.217, P < 0.05).The nursing satisfaction of the observation group was 96.67% (29/30), which was significantly better than that of the conventional group (83.33% (25/30), and the difference was statistically significant (x = 5.372, P <0.05). After one year of follow-up, the number of recurrences in the observation group was 2, the recurrence rate was 6.67%, the number of recurrences in the conventional group was 6, the recurrence rate was 20.00%, the observation group was superior to the normal group, and the difference was statistically significant (χ2= 5.137, P<0.05).@*Conclusion@#In the integrated diagnosis and treatment platform of vertigo, the application of TCM nursing combined with individualized health education can improve the nursing effect, improve the patients' quality of life and nursing satisfaction, and reduce the recurrence rate. To provide new theoretical thinking and clinical methods for improving vertigo patients.
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Objective To explore the effect of medical and nursing integration notification on the truth knowing rate,anxiety,depression and quality of life in cancer patients undergoing chemotherapy. Meth-ods From February to March 2017,34 patients for the first time needing chemotherapy were included as control group,using normal disclosure.From June to July 2017,35 cases for the first time needing chemother-apy were included as the experimental group. The experimental group was informed of the medical and nurs-ing integration notification. The truth knowing rate,anxiety,depression and quality of life were compared be-fore and after three cycles of chemotherapy. Results After three cycles of chemotherapy,the truth knowing rate of patients in the experimental group (completely 57.14%,partly 34.29% and none 8.57%) was signifi-cantly different with the control group (completely 29.42%,partly 35.29% and none 35.29%,P＜0.01). The scores of anxiety and depression in the experimental group(39.43±4.60,41.86±5.23) were significantly low-er than those before chemotherapy(42.37±4.76,45.69±5.49,P＜0.01). The scores of anxiety and depression in the control group (45.74±5.20,49.74±5.42) were significantly higher than those before chemotherapy (42.77±5.62,45.56±6.27,P＜0.01).After three cycles of chemotherapy,the scores of anxiety and depression in the experimental group were lower than the control group (P＜0.01). After three cycles of chemotherapy, the total health status,body function,role function,emotional function,cognitive function,social function,fa-tigue,nausea and vomiting,and loss of appetite were statistically significant between the experimental group and control group (P＜0.05). Conclusion The medical and nursing integration notification has a positive effect on the truth knowing rate,anxiety,depression and quality of life in cancer patients undergoing chemo-therapy.
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Objective@#To describe the clinical characteristics of pneumococcal infections and drug resistance of Streptococcus pneumoniae isolates from children's hospitals, which would provide reference for preventing and treating pneumococcal diseases.@*Methods@#This was a prevalence survey. In this study, the age, specimen type, monthly distribution characteristics, and antimicrobial resistance of Streptococcus pneumoniae isolates from 9 children's hospitals in China were investigated between January 1, 2016 and December 31, 2016. The WHONET 5.6 software was used to analyze the antibiotic susceptibility of Streptococcus pneumoniae. The comparison of rates was performed by Chi-square test.@*Results@#A total of 6 200 isolates of streptococcus pneumoniae were obtained, namely, 95.1% (5 876/6 177) from the respiratory tract specimens, 2.2% (136/6 177) from blood specimens and 0.4% (24/6 177) from cerebrospinal fluid specimens. The isolates were mainly from children older than 1 and younger than 5 years (54.7%, 3 381/6 185) . Most of strains (33.2%, 1 184/3 563) were isolated in November, December and January. Streptococcus pneumoniae isolates were completely sensitive to vancomycin (100.0%, 6 189/6 189) , linezolid (100.0%, 6 030/6 030) , moxifloxacin (100.0%, 3 064/3 064) , highly sensitive to levofloxacin (99.8%, 5 528/5 540), ertapenem (98.8%, 3 024/3 061) and lowly sensitive to erythromycin (1.7%, 102/6 016), clindamycin (3.7%, 116/3 136), and tetracycline (5%, 244/4 877), respectively. According to the parenteral susceptibility breakpoints for non-meningitis isolates, the sensitivity of Streptocococus pneumoniae to penicillin from children's hospital of Chongqing Medical University (49.3%, 892/1 809) was significantly lower than those of other hospitals (χ2=1 268.161, P<0.05) .@*Conclusions@#Streptococcus pneumoniae is mainly isolated from respiratory tract, from children older than 1 and younger than 5 years and during November to January in tertiary children's hospital of China. The Streptococcus pneumoniae from children is highly sensitive to vancomycin, linezolid, moxifloxacin, levofloxacin. There are also significant differences in the sensitivity of penicillin for Streptococcus pneumoniae from different hospitals.
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Truth disclosure of cancer patients is becoming more and more recognized in the world.Truth disclosure is usually regarded as the doctor's responsibility.However,the nurse has become an active participant in the truth disclosure of cancer patients both intentionally and inadvertently.This article systematically reviewed the role of nurses at home and abroad in informing patients with cancer the truth so as to provide guidance for the clinical practice.In April 2017,we retrieved articles in Pubmed,Chinese CNKI,Wanfang database,VIP database,and retrieval time is not restricted.A total of 92 literatures were retrieved and 8 articles were retrieved by manual searching.Finally,23 articles were included.Through systematic review of the literature,nurses are found to play an important role in informing cancer patients the truth.Compared with physicians,nurses have a more positive attitude for truth disclosure.Nurses have the most contact with patients and family members,if the nurses have plans to communicate with the families on telling the truth to cancer patients,there will be a positive impact on the truth disclosure attitude of family members.It is necessary to explore the strategy of truth disclosure for cancer patients with integrated medical staff in the future.
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Truth disclosure of cancer patients is becoming more and more recognized in the world.Truth disclosure is usually regarded as the doctor's responsibility.However,the nurse has become an active participant in the truth disclosure of cancer patients both intentionally and inadvertently.This article systematically reviewed the role of nurses at home and abroad in informing patients with cancer the truth so as to provide guidance for the clinical practice.In April 2017,we retrieved articles in Pubmed,Chinese CNKI,Wanfang database,VIP database,and retrieval time is not restricted.A total of 92 literatures were retrieved and 8 articles were retrieved by manual searching.Finally,23 articles were included.Through systematic review of the literature,nurses are found to play an important role in informing cancer patients the truth.Compared with physicians,nurses have a more positive attitude for truth disclosure.Nurses have the most contact with patients and family members,if the nurses have plans to communicate with the families on telling the truth to cancer patients,there will be a positive impact on the truth disclosure attitude of family members.It is necessary to explore the strategy of truth disclosure for cancer patients with integrated medical staff in the future.
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Objective To investigate the current situation of healthcare-associated infection(HAI)in hospitals in Yunnan Province in 2015, and provide basis for formulating HAI control measures.Methods A cross-sectional survey on HAI prevalence rate , antimicrobial use,and pathogenic detection in 116 hospitals in Yunnan Province were conducted by combined methods of bed-side survey and medical record reviewing.Results A total of 64 386 hospitalized patients participated in the survey, the prevalence rate of HAI was 2.11%(n=1 357), and case prevalence rate was 2.29%(n=1 476).Difference in prevalence rates of HAI, antimicrobial usage rates, and pathogenic detection among hospitals of different beds were all significant(all P <0.01).The top 3 departments of HAI distribution were intensive care units(20.99%), burn departments(8.00%), and hematology departments (7.34%);the main infection site was lower respiratory tract(42.68%);HAI mainly caused by gram-negative bacteria(69.28%), the major were Escherichia coli , Klebsiella pneumoniae, and Pseudomonas aeruginosa.Antimicrobial usage rate at the survey day was 35.62 %, bacterial detection rate in patients receiving therapeutic antimicrobial use was 59.56%.Conclusion The cross-sectional survey on prevalence of HAI is helpful for understanding the current status of HAI, calculation of the percentile distribution of each index can promote self-evaluation for HAI-related work in each hospital.
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) was updated in 2014 on the basis of the version 2011. Inof the updated version, the evidence quality grade and GRADE were adopted for the evidence evaluation and recommendation grading in methodology, and the clinical feasibility was stressed. In text, the recognition of modern medicine was updated, the sta-ging treatment of acupuncture and moxibustion was emphasized, the inclusive articles were expanded and the important indexes of efficacy evaluation were increased and highlighted. The paper aims to provide the instruction for the application ofof the version 2014.
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Objective To construct prokaryotic expression systems of genes of intact rotavirus non -structural protein 4 (NSP4) and 86 to 175 amino acid peptide of NSP4 (NSP486-175) and to identify the bio-activities of the recombinant expression products .Methods Colloidal gold assay was used to screen group A rotavirus antibody-positive stools , from which the viral RNA was extracted and transcribed into cDNA .Then NSP4 gene and NSP486-175 gene were amplified by PCR and inserted into pET-28a(+) vector to construct the prokaryotic expression plasmids of pET-28a(+)-NSP4 and pET-28a(+)-NSP486-175 , which were transformed into E.coli BL21( DE3) and inducted by IPTG .The expressed NSP486-175 protein was purified by Ni-NTA af-finity chromatography and examined by Western blot .Fluo-3 AM ester was used to label intracellular free Ca2+( [ Ca2+] i) in Caco-2 cells and laser scanning confocal microscopy was performed to detect the effect of NSP486-175 protein on [Ca2+]i.Results DNA sequencing indicated that NSP4 gene and NSP486-175 gene were consistent with the corresponding sequences in NCBI .The intact NSP4 had difficulty in expressing in E.coli. NSP486-175 protein mainly existed in soluble form with a relative molecular weight of 10×103 .Fluorescence in-tensity and distribution were changed by exogenous addition of NSP 486-175 to cultured Caco-2 cells.Conclu-sion The expression vectors of pET-28a(+)-NSP4 and pET-28a(+)-NSP486-175 were successfully construc-ted and the target protein could induce [Ca2+]i imbalance.This phenomenon preliminarily indicates that the prokaryotic expressed NSP486-175 protein has biological activity and can be further used to elucidate rotavirus pathogenic mechanisms and perform vaccine research .
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Objective To investigate molecular epidemiology and antimicrobial susceptibility of carbapenem-resistant strains of Klebsiella pneumoniae isolated from children.Methods From July 2010 to June 2011,twelve non-replicate clinical isolates of carbapenem-resistant Klebsiella pneumoniae were consecutively collected from children inpatients in the Second Hospital of Wenzhou Medical Colloge.All of the isolates were identified by the automated microbiology systems.Modified Hodge test was used to screen strains producing carbapenemases.Pulsed field gel electrophoresis(PFGE) was performed to analyze the homogeneity of genomic DNA of Klebsiella pneumoniae.KPC,IMP,GIM,SPM,SME,OXA-10,bla(s),VIM gene and integrase gene were amplified by PCR and then sequenced to cofirm the genotypes;Plasmid conjugation experiment was used to study the transfer method of bacterial resistance.Plasmid-curing test were used to initally locate the resistant genes.Results One(8.3％),5(41.7％),7(58.3％),1(8.3％),1(8.3％) and4(33.3％) of12isolates were susceptible to gentamicin,tobramycin,amikacin,ciprofloxacin,levofloxacin and trimoxazole,respectively.All isolates carried KPC-2,TEM-1 and SHV genes(six for SHV-11-like,six for SHV-12-like).Eleven of twelve isolates with KPC-2 gene carried CTX-M genes(4 for CTX-M-14-like,6 for CTX-M-15-like).Two isolates carried OXA-10 genes,and one isolates carried PER-1 gene.None of NDM-1,GIM,SPM,SIM and VIM carbapenemase genes was detected in 12 isolates.All of 12 isolates carried Int 1 genes.The plasmids of 2 isolates were transgerred into the recipients E.coli EC600.PCR and sequence analysis revealed that blaTEM-1 and blaCTX-M-15-like were co-transferred with the KPC-2 gene to the recipients.Elimination of KPC-2-encoding plasmid from Kp7 and Kp12 resulted in imipenem susceptibility in the two isolates.Amplification revealed that KPC-2 gene was lost by the plasmid-curing test.Of the 12 isolates,5 patterns were obtained by PFGE.Pattern B and C were the main drug resistant clones.Conclusion KPC-2 gene are the major carbapenemase genes in Klebsiella pneumoniae isolated from children,including ESBLs and integrase.Some resistance genes can be disseminated by plasmids.
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ObjectiveTo investigate the prevalence and distribution of 16S rRNA methylase gene and research the relationship with drug resistant spectrum.And preliminary explore its role in molecular epidemiology analysis.MethodsCollected 69 clinical isolates of non repetitive ESBL-producing Klebsiella pneumoniae in our hospital from Mar to Sep 2010.Detection 16S rRNA methylation enzyme gene by PCR,and analyze ESBL genetype and integron gene of the positive strains.All PCR products were sequenced for determination.Plasmid conjugation test and plasmid elimination method to determine dissemination of 16S rRNA methylase gene.Then we used ERIC-PCR genotyping technology for the establishment of DNA fingerprinting.ResultsIn sixty-nine strains,twenty isolates were rmtB positive (28.9％),two isolates were armA positive,and two strains coproduce rmtB and armA.All positive isolates carried the CTX-M gene,detemined by sequencing,14 strains of CTX-M-14 gene,6 strains of CTX-M-15 gene,14 strains carried TEM1 gene,8 strains carried SHY gene,sequencing showed that 5 strains of SHV-12 gene,3 strains of SHV-11 gene,3 strains carried OXA-10 gene,3 strains carried VBE-1 gene.In addition,the intl gene was found in 12 isolates of 20 rmtB positive strains.All the intl gene positive strains were divided into five kinds gene cassettes,which contained drfA25,drfA1,drfA12,aadA1,aadA2,sat and blaVEB-1 genes.Respectivily,16S rRNA methylase gene positive strains were divided into five genetypes using ERIC-PCR technology.A genetype was the advantage popular clones.Conjugative plasmid and elimination test found that rmtB gene was located in a plasmid in KP5 and KP16 isolates with A genetype,and can disseminate by conjugation.ConclusionA high prevalence of 16S rRNA methylase gene-rmtB was found among clinical ESBL-producing K.pneumoniae isolates in our hospital,which could lead to resistant to almost all aminoglycoside at a high level.Both horizontal gene transfer and clonal spread were responsible for the dissemination of the rmtB gene.In addition,K.pneumoniae co-producing ESBLs,16S rRNA methylation enzymes and class Ⅰ integron existed and were spreading.
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OBJECTIVE To study the homology of the pandrug-resistant Acinetobactor baumannii(PRABA) by randomly amplificed polymorphic DNA(CRPD) to guide the control of the nosocomial infection and epidemology investigation.METHODS Eighteen strains of PRABA were collected from Jul 2008 to Mar 2009 in our hospital.The bacteria were examined by DADE BEHRING Microscan WalkAway 96SI;DNA extracted from all isolates was amplified by polymerase chain reaction using random primers.In addition epidemology investigation and antimicrobial susceptibility testing were also under taken.RESULTS Fifteen strains were divided into 6 RAPD profiles.There were two clonal strains derived,respectively,from two intensive care units.One strain was isolated from a patient in surgical ward who was transferred from ICU1,showing same homology with that in the ICU1.The homology was different from sensitive strains and drug-resistant strains obviously.CONCLUSIONS An outbreak of PRABA happens in intensive care unit.
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OBJECTIVE To establish a method of loop-mediated isothermal amplification(LAMP) for detecting Staphylococcus aureus in positive blood culture bottles.METHODS Genomic DNA in 293 positive blood culture bottles was extracted by guanidine hydrochloride and benzenemethanol,then genes ssa and mecA were amplified by LAMP to identify S.aureus.Finally,the results of LAMP were compared with the results of traditional method.RESULTS Twenty-two strains of S.aureus were detected in 293 positive blood culture bottles by LAMP method.Compared with traditional method,the sensitivity and specificity of LAMP method were both 100%,respectively,the detection could be finished in an hour.CONCLUSIONS The LAMP-based assay is simple,rapid,sensitive and specific which can be used to detect S.aureus in positive blood culture bottles rapidly.
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Objective To establish loop-mediated isothermal amplification(LAMP)method for detecting Streptococcus pneumoniae in clinical samples.Methods Four Streptococcus pneumoniae-specific LAMP primers were designed according to the published sequence of strain R6(GenBank accession number AE008540).Genomie DNA in positive blood cultures was extracted by nanidine hydrochloride and benzene-methanol.Then lytA was amplified by LAMP at 63℃ for 45 minutes.We observed the turbidity in thereaction tube.For further confirmation.The amplified products were also detected using electrophoresis in 2% agarose gels,followed by ethidium bromide staining.Resuits 16 strains of Streptococcus pneumoniae were detected in 196 positive blood cuhure bottles by LAMP.Compared with traditional method.It8 sensitivity and specificity were both 100%and the detection could be finished in an hour.The assay had a minimum detection limit of 102 CFU/m1.Conclusions This IJAMP-based assay is simple,rapid.Sensitive and specific.It can be used to detect trept OCOCCUS pneumoniae in clinical samples.
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Objective In order to choose a suitable method in detecting MRS,the detection rate,sensitivity and specificity of Vitek-32 auto microbacteria indentity system,oxacillin agar dilution test,cefoxitin disk diffusion test and PCR for mecA gene are evaluated.Methods MRSA and MRCNS are detected by the four methods metioned above in 175 staphylococci,then comparing the postive detection rate by Chi-square test and calculating sensitivity and specificity of the other three methods based on PCR for meeA gene as a gold standard.Results The detection rate of four methods have no difference in detecting MRSA,but the detection rate of Vitek-32 auto microbacteria indentity system and oxacillin agar dilution test is better than that of PCR for mecA gene in detecting MRCNS.Sensitivity and specificity of Vitek-32 auto microbacteria indentity system,oxacillin agar dilution test and cefoxitin disk diffusion test in detecting MRSA are 100%、96.3%、96.3% and 88.2%、100%、100% respectively,the sensitivity of detecting MRCNS are all 100%,the specificity of detecting MRCNS are 50%、46.1% and 65.4% respectively.Conclusions Both mecA gene and the determination for MIC of Oxacillin should be considered in final decision for MRS,Furthermore.the MRS mediated by mecA gene and the MRS mediated by non-mecA gene should be treated differentially.
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Objective To investigate mutation and deletion of genes mecR1 and mecI in clinical methicillin-resistant staphylococci isolates and study the mutation and deletion have effect on gene mecA expression and drug resistance phenotype.Metheods PCR was used to detecte gene mecA and the regulatory genes mecR1 and mecI in staphylococci which were separated from clinical specimen in 2006,then the sequence of gene mecI was determined and compared with the sequence obtains from pre-MRSA strain N315(GI:BA000018).Results Gene mecA was detected in 60 strains of Staphylococcus aureus,58 strains of Staphylococcus epidermidis and 37 strains of Staphylococcus heamolyticus,but gene mecA in 6 strains of Staphylococcus epidermidis and 4 strains of Staphylococcus heamolyticus were only amplified by primer mecA2-F/R and not by primer mecA1-F/R.The percentage of gene mecR1 exist in Staphylococcus aureus was higher than Staphylococcus epidermidis and Staphylococcus heamolyticus,but the percentage of gene mecR1 exist in Staphylococcus epidermidis was not higher than Staphylococcus heamolyticus.The mutation and deletion of gene mecI were often seen,the wild type mecI was only detected in 14 strains,the point mutation of nucleotice 202 was detected in 36 strains.Conclusions Gene mecA expression in Staphylococcus aureus could be chiefly induced by mecR1,but which in coagulase-ngeative staphylococci could be other factors.The mutation and deletion of mecI were universal phenomenon in clinical strains,there could be a mechanism for overcoming the repressing of resistance caused by mecI in staphylococci.