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2300 were adults, cerebrospinal fluid culture and drug resistance analysis of strains_3018

By Doris Ferguson,2014-10-30 08:22
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2300 were adults, cerebrospinal fluid culture and drug resistance analysis of strains_3018

    2300 were adults, cerebrospinal fluid culture and drug resistance analysis of strains

     Abstract Objective To summarize our hospital from January 2002 to June 2005 submission of the 2300 adults were CSF culture and drug sensitivity for the clinical diagnosis and treatment information. Methods used by the U.S. DADE Inc. Microscan Walkaway 40 automatic bacterial identification and antibiotic susceptibility analysis system for determination of bacterial identification and antimicrobial susceptibility.

    Results in 2300 were cerebrospinal fluid samples, 180 were detected in the number of positive (7.83%), including 144 bacteria (98 Gram-positive bacteria, Gram-negative bacteria

    46), 26 fungi, 10 strains of Mycobacterium tuberculosis.

    Streptococcus and Enterococcus sensitive to penicillin, vancomycin against Gram-positive cocci have a high

    antibacterial activity; Gram-negative bacteria to commonly

    used drugs cefotaxime and ceftriaxone in the sensitivity of poor, carbapenem, aztreonam against gram-negative bacteria

    have good antibacterial activity; part of the meningitis caused by Mycobacterium tuberculosis and fungi. Conclusion to nosocomial infection in this group mainly meningitis, suggesting that clinicians should be based on the

    characteristics of patients with meningitis, personalized medicine and rational use of antibiotics.

     Key words Cerebrospinal fluid drug-resistant pathogens

    reported

     Analyses on the pathogens and their resistance to antibiotics

     ABSTRACT Objective To analyze the pathogenic results and drug resistance of bacteria isolated from 2300 cerebrospinal fluild specimens of adults from 2002 to 2005 so as to provide evidence for clinical diagnosis and therapy of meningitis. Methods The bacteria identification and the

    antimicrobial susceptibility were assayed by automatic bacteria culture device Microscan Walkaway 40 from DADE Co. Results The positive rate of pathogens was 7.83% (180/2300) from 2300 cerebrospinal fluild specimens.There were 144 strains of bacteria which include 98 Gram positive bacteria and 46 Gram negative bacteria, 26 fungi, and 10 Mycobacterium tuberculosis. Streptococcus spp. and Enterococcus spp. were sensitive to penicillin, all the Gram positive cocci were sensitive to vancomycin; the Gram negative bacteria were

    resistant to routine antibiotics such as cefotaxime and ceftriaxone, while they have high percentage of susceptibility to aztreonam and carbapenems and some cases were infected with Mycobacterium tuberculosis and fungi. Conclusion It suggests

    that clinicians should pay more attention to personalized therapy based on the characteristic of meningitis so as to attain rational use of antibiotics.

     KEY WORDS Cerebrospinal fluild; Pathogen; Drug resistance

     Purulent meningitis pathogens, including bacteria usually caused by acute purulent meningitis, and Mycobacterium tuberculosis, deep fungal caused by chronic meningitis, very great harm to mankind, the highest mortality of infectious diseases in the world top ten [1]. The diagnosis of meningitis

    pathogens rely on examination of cerebrospinal fluid, cerebrospinal fluid bacterial culture and sensitivity results of the clinician's diagnosis, medication, efficacy plays an important role in determining [2]. With the social

    environment, medical means of changing pathogens of meningitis pathogens composition, drug sensitivity worth exploring. In this paper, West China Hospital of Sichuan University from January 2002 to June 2005 of cerebrospinal fluid culture results were analyzed 2300 reported as follows.

     1 Materials and methods

     1.1 The object of study

     West China Hospital of Sichuan University from January 2002 to June 2005 submission of the 2300 copies of cerebrospinal fluid specimens. 1.2 Specimen Collection

     To aseptic technology to collect cerebrospinal fluid 3 ~ 5ml, set sterile containers for immediate submission.

     1.3 Isolation and culture

     CSF will be sent for inspection immediately inoculated rabbit which has been pre-heating and non-vancomycin-blood

    agar plate of chocolate, as well as glucose broth by bacilli, the home 5% ~ 10% CO2 incubator box, culture 24h after the observation that if by bacilli in broth was cloudy or biofilm production, and then picked culture solution or membrane

    translocation kinds of bacteria in blood agar, the bacteria were isolated and cultured to identify the steps according to the "national clinical laboratory operating procedures" to. Experiments with rabbit blood agar, chocolate plate without

    vancomycin and glucose broth by bacilli are the West China Hospital clinical microbiology laboratory production, by the quality and pass the inspection before use.

     1.4 Identification and antimicrobial susceptibility of bacteria

     Experimenting with the use of instruments as the United States DADE Inc. Microscan Walkaway 40 automatic bacterial identification and antibiotic susceptibility analysis system (Dade MicroScan Inc., West Sacramento, CA, USA), according to the U.S. for Clinical Laboratory Standards Institute (CLSI /

NCCLS) (2004 year) documentation standards, micro-dilution MIC

    values measured interpretation of the results of bacterial susceptibility of sensitive (S), intermediate (I), resistance (R). Ceftazidime (30μg) and ceftazidime / clavulanic acid (30

    μg/10μg) and cefotaxime (30μg) and cefotaxime / clavulanic

    acid (30μg/10μg) is greater than the difference between the inhibition zone diameter of 5mm judged to be producing ESBLs strain.

     1.5 Quality control strains

     Escherichia coli ATCC25922, Staphylococcus aureus ATCC25923 and Pseudomonas aeruginosa ATCC27853 by the Ministry of Health clinical testing centers.

     2 Results

     2.1 In general

     In the 2300 cerebrospinal fluid specimens were adults, and the detection of 180 copies of the number of positive (7.83%), including 144 bacteria (98 Gram-positive bacteria,

    Gram-negative bacteria 46), fungal 26, Cryptococcus neoformans 22, like yeast-like fungi 4, 10 strains of Mycobacterium tuberculosis. Neurosurgery, Department of Infectious Diseases, Department of Neurology and other sections higher rate of positive separation (Tab.1, Tab.2). Reposted elsewhere in the paper for free download http://

     2.2 The sensitivity analysis of cerebrospinal fluid isolates

     Measured using micro-dilution method of MIC values of the results judged as sensitive, intermediate, resistant categories, Microscan Walkaway 40 system, the results of the sensitivity criterion and the United States for Clinical Laboratory Standards Institute (CLSI / NCCLS) document

    standards. Results (Tab.3) showed that isolated from the cerebrospinal fluid in the Bowman / hemolytic Acinetobacter to imipenem, aztreonam sensitivity is better, resistance rates were 0 and 35.71%; right Amiga Star (resistance rate 71.43%),

    compound I oxazole sulfamethoxazole (85.71%), ciprofloxacin (85.71%), gentamicin (85.71%), ceftriaxone (78.57%), cefotaxime (85.71 %) and tobramycin (71.43%), poor sensitivity. Escherichia coli isolated from seven in three producing ESBLs, imipenem and piperacillin / tazobactam sensitivity of good resistant rates were 0, to amikacin, cephalosporins West Ding, Tobramycin sensitivity are better.

     In the 180 positive culture in 98 Gram-positive bacteria,

    accounting for 54.44%. Tab.4 showed vancomycin remained higher against Gram-positive cocci of the antibacterial activity, sensitivity rate of 100%; rifampicin, gentamicin, mouth oxazole compound sulfamethoxazole, clindamycin against Gram-

    positive bacteria also have good antibacterial activity, Gram-

    positive cocci highly resistant to penicillin. In the 98-

    positive bacteria coagulase-negative staphylococci, 70 strains of Gram-positive bacteria accounted for 71.43%, are highly resistant to oxacillin, which Huang and other pairs of 14

    patients with bacterial meningitis isolated in cerebrospinal fluid susceptibility of coagulase-negative staphylococci were

    basically the same as [3]. 70 coagulase-negative

    staphylococcus bacteria Portugal Table 30, Table 25 has 23 Portuguese strains of MRSE, as high as 92.00%. Also in 98-

    positive bacteria, the Streptococcus genus of 12 (12.24%), Enterococcus 6 (6.12%), penicillin and vancomycin against streptococci and enterococci have good antibacterial activity [4] .

     2.3 Separation of cerebrospinal fluid specimens by

    Mycobacterium tuberculosis

     In 2300 the Chinese Communists were isolated from cerebrospinal fluid specimens of 10 strains of Mycobacterium tuberculosis, accounting for 5.56%, culture-positive.

     2.4 The fungi isolated from cerebrospinal fluid specimens

     In 2300 the Chinese Communists were isolated from cerebrospinal fluid specimens of 26 fungi, of which 22 strains of Cryptococcus neoformans, Candida tropicalis one, and another 4 like yeast-like fungi.

     3 Discussion

     Bacterial meningitis great harm to mankind, so early diagnosis and reasonable treatment is very important and should strive to give antibiotics before the CSF Gram stain of smears, cerebrospinal fluid culture and blood culture; a skin ecchymosis were local ecchymosis smears taken for bacteria. Culture results were positive for drug sensitivity test done. Begin as soon as possible the experience of antibacterial drugs in patients with life-saving treatment is essential.

    Physicians informed of bacterial culture and drug sensitivity test results, based on experience therapy and drug sensitivity test results to adjust medication. Such as the pathogenic diagnosis of clear, antibiotics should be adjusted as appropriate varieties, its dosage, course of treatment should

    be enough, use bactericidal drugs through blood-brain barrier,

    such as penicillin, second and third generation cephalosporins such as [2]. Because a small number of bacteria in cerebrospinal fluid of some bacteria such as Neisseria meningitidis resistance to the external environment is low, specimen collection and submission process is difficult to guarantee the survival of bacteria. Therefore, to enhance the detection rate of positive cerebrospinal fluid bacterial specimens should be as much as possible before the use of

    antimicrobial agents, timely submission and vaccination, and to prevent drying and to avoid direct sunlight, good insulation during cold weather work, if possible, preferably In the bed next to the inoculated samples [5,6].

     In this study, community-acquired meningitis caused by

    pathogenic bacteria Neisseria meningitidis in only 2 strains of Streptococcus pneumoniae 2, 4 strains of Staphylococcus aureus, non-separating out the Haemophilus influenzae; in a common cause of hospital acquired infection pathogens in

coagulase-negative staphylococci, 70 strains, 14

    Enterobacteriaceae, Acinetobacter spp 20, and Hussein [7], and Celal [8], etc. The results are different, this is a great source of patient relationship. Multi-hospital patient

    transfer from the primary hospital, most of them have a more serious impact on host defense function of underlying diseases, combined with immunosuppressive agents and the use of corticosteroids, anti-infection impaired immune function

    Ershi more invasive pathogens, and another account for sending Inspection number of 22.43% of neurosurgery patients with traumatic brain more invasive operation, and therefore the study of bacterial culture-positive patients with meningitis,

    mostly nosocomial infection, the majority of strains have different degrees of drug resistance [9,10]. 2300 specimens of Gram-positive cocci 98, in which a table, represented by the Portuguese strains of coagulase-negative staphylococci to

    penicillin sensitivity is poor, Streptococcus and Enterococcus

    sensitive to penicillin, vancomycin against Gram-positive

    cocci were a higher antimicrobial activity, rifampicin, gentamicin, sulfamethoxazole mouth oxazole compound against Gram-positive bacteria and has a good antimicrobial activity,

    suggesting that when the staphylococci resistant to oxacillin or vancomycin should choose when to go A vancomycin, rifampicin, where appropriate, joint [2,11]; streptococcus bacterial meningitis caused by routine use of penicillin or ampicillin, while resistant to penicillin, it can use third-

    generation cephalosporins, or vancomycin [2]; enterococcus bacterial meningitis caused by the use of conventional high-

    dose penicillin or ampicillin, penicillin-resistant or the

    patient when their allergy may use vancomycin and other

    glycopeptide antibiotics [4]. Gram-negative bacteria 46, to

    cefotaxime and ceftriaxone less sensitive, and often multi-

    drug resistant strains, imipenem, aztreonam against gram-

    negative bacteria is a good antibacterial activity, due to

    bacterial meningitis in patients with imipenem and easy to induce convulsions and other central nervous system adverse reactions, not recommended for patients with bacterial meningitis, such as the clinical do need to use the option of meropenem [2]. CSF bacterial culture and sensitivity test results are clinicians diagnosis and treatment of bacterial meningitis, rational use of antibiotics, improve efficacy, prevent the abuse of antibiotics, an important basis. In order to reduce nosocomial infection incidence of purulent

    meningitis, should be actively treated patients with primary

    disease and shorten the hospitalization time, do not abuse of antibiotics, to enhance the management of hospital disinfection, control of infection in brain surgery and lumbar

    puncture to improve immune function in patients with the control of local infection, such as the elderly and children, patients with low immunity should focus on monitoring, in order to reduce the chance of infection.

     References

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     [2] Wang Fu, Wu Yongpei, Zhang Yuan, et al. Antimicrobial agents of clinical application of the Guiding Principles [M]. Beijing, 2004:38

     [3] Huang CR, Lu CH, Wu JJ, et al. Coagulase negative

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     [6] Tang Yin, Xiu-Hua Xu. 160 copies of the anaerobic culture of cerebrospinal fluid and clinical analysis [J]. Hunan Medical University, 1992,17 (1): 43

     [7] Hussein As, Shafran S D. Acute bacterial meningitis in adults. A 12 yearreview [J]. Medicine, 2000,79 (6): 360

     [8] Celal A, Faruk GM, Salih H, et al. Characteristics of acute bacterial meningitis in Southeast Turkey [J]. Ind J Med Sci, 2004,58 (8): 327

     [9] CHEN Yi, Wang Xuelong, Ma Xuyang. Nosocomial infection in 42 cases of purulent meningitis in clinical analysis [J]. Chinese Journal of Epidemiology, 1999,17 (2): 137

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     [11] Pintado V, Meseguer MA, Fortun J, et al. Clinical study of 44 cases of Staphylococcus aureus meningitis [J]. Eur J Clin Microbiol Infect Dis, 2002,21 (12): 864 reposted elsewhere in the paper for free download http://

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