MRSA, methicillin-resistant Staphylococcus aureus

  • 文章类型: Journal Article
    对人类福祉和公共卫生的最大威胁之一是抗生素耐药性。如果允许不受控制地传播,它可能成为主要的健康风险,并引发另一场大流行。这证明有必要开发与抗生素耐药性相关的全球健康解决方案,并考虑到来自全球各地的微观数据。建立积极的社会规范,指导支持全球人类健康的个人和群体行为习惯,最终提高公众对采取此类行动的必要性的认识都可能产生积极影响。抗生素耐药性不仅是一个日益增长的临床问题,而且使治疗复杂化。使遵守当前指南管理抗生素耐药性极其困难。许多遗传成分与抗性的发展有关;其中一些成分在微生物之间具有复杂的转移路径。除此之外,随着支持抗生素耐药性发展的新机制被发现,抗生素耐药性在医学微生物学中变得越来越重要。除了遗传因素,误诊等行为,接触广谱抗生素,和延迟诊断有助于耐药性的发展。然而,生物信息学和DNA测序技术的进步彻底改变了诊断领域,能够实时识别抗生素耐药性的成分和原因。这些信息对于制定有效的控制和预防战略以应对威胁至关重要。
    One of the biggest threats to human well-being and public health is antibiotic resistance. If allowed to spread unchecked, it might become a major health risk and trigger another pandemic. This proves the need to develop antibiotic resistance-related global health solutions that take into consideration microdata from various global locations. Establishing positive social norms, guiding individual and group behavioral habits that support global human health, and ultimately raising public awareness of the need for such action could all have a positive impact. Antibiotic resistance is not just a growing clinical concern but also complicates therapy, making adherence to current guidelines for managing antibiotic resistance extremely difficult. Numerous genetic components have been connected to the development of resistance; some of these components have intricate paths of transfer between microorganisms. Beyond this, the subject of antibiotic resistance is becoming increasingly significant in medical microbiology as new mechanisms underpinning its development are identified. In addition to genetic factors, behaviors such as misdiagnosis, exposure to broad-spectrum antibiotics, and delayed diagnosis contribute to the development of resistance. However, advancements in bioinformatics and DNA sequencing technology have completely transformed the diagnostic sector, enabling real-time identification of the components and causes of antibiotic resistance. This information is crucial for developing effective control and prevention strategies to counter the threat.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    医院感染的高患病率与医疗插入装置如中心静脉导管(CVC)的使用有关。大多数引起医院感染的微生物是生物膜生产者,这种特性使它们能够粘附在非生物表面,并引起最初的导管感染,从而导致血液感染。本系统综述的主要目的是评估CVC相关感染中生物膜的患病率。特别是在重症监护病房(ICU)患者中,在应用不同的体外和体内方法的研究中。纳入截至2022年6月24日在PubMed和Scopus数据库中发表的所有报告导管相关医院感染患者临床分离株和生物膜评估的研究。25项研究符合资格标准,并纳入本系统评价进行分析。不同的方法被用于评估生物膜形成微生物,包括体外测定,体外导管感染,和体内小鼠模型。本研究表明,59%至100%的临床分离株能够形成生物膜,不同国家和地区的研究之间,生物膜形成的患病率差异很大。在我们研究集中收集的临床分离株中,各种各样的微生物,包括革兰氏阳性菌株,革兰氏阴性菌株,并发现了白色念珠菌。许多作者研究了与生物膜发育和表面粘附特性相关的抗性机制和基因。在某些情况下,研究还评估了使用各种导管涂层的生物膜抑制试验。
    The high prevalence of nosocomial infections is related to the use of medical insertion devices such as central venous catheters (CVCs). Most of the microorganisms causing nosocomial infections are biofilm producers, this characteristic allows them to adhere to abiotic surfaces and cause initial catheter infections that can lead to bloodstream infections. Our main goal in this systematic review was to evaluate the prevalence of biofilm among CVC-related infections, particularly among Intensive Care Unit (ICU) patients, in the studies applying different in vitro and in vivo methodologies. All studies reporting clinical isolates from patients with catheter-related nosocomial infections and biofilm evaluation published up to 24 June 2022 in the PubMed and Scopus databases were included. Twenty-five studies met the eligibility criteria and were included in this systematic review for analysis. Different methodologies were applied in the assessment of biofilm-forming microorganisms including in vitro assays, catheter-infected in vitro, and in vivo mouse models. The present study showed that between 59 and 100% of clinical isolates were able to form biofilms, and the prevalence rate of biofilm formation varied significantly between studies from different countries and regions. Among the clinical isolates collected in our study set, a wide variety of microorganisms including Gram-positive strains, Gram-negative strains, and Candida albicans were found. Many authors studied resistance mechanisms and genes related to biofilm development and surface adherence properties. In some cases, the studies also evaluated biofilm inhibition assays using various kinds of catheter coatings.
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  • 文章类型: Journal Article
    日益全球化,农业集约化,城市化,和气候变化导致了最近新出现的传染性人畜共患疾病的显着增加。人畜共患疾病变得越来越普遍,如此创新,有效,需要综合研究来更好地理解它们的传播,生态影响,以及野生动物-人类界面的动力学。高通量测序(HTS)方法在解开这些突发事件并提高我们的理解方面具有巨大的潜力,但是它们现在才开始在牲畜研究中实现。本研究调查了测序技术在牛等家畜病原体检测中的使用现状,狗(犬狼疮),绵羊(Ovisaries),猪(Susscrofa),马(Equuscaballus),鸡(家鸡),和鸭子(Anatidae)以及如何改善人畜共患感染的监测和检测。我们还描述了几种高通量测序方法,用于改进已知的检测,未知,和新出现的传染性病原体,从而更好地诊断传染病,以及人畜共患传染病的监测。在未来的几年里,测序技术的不断进步将改善牲畜研究,并加快各种新的农场动物基因组和技术研究的发展。
    Increasing globalization, agricultural intensification, urbanization, and climatic changes have resulted in a significant recent increase in emerging infectious zoonotic diseases. Zoonotic diseases are becoming more common, so innovative, effective, and integrative research is required to better understand their transmission, ecological implications, and dynamics at wildlife-human interfaces. High-throughput sequencing (HTS) methodologies have enormous potential for unraveling these contingencies and improving our understanding, but they are only now beginning to be realized in livestock research. This study investigates the current state of use of sequencing technologies in the detection of livestock pathogens such as bovine, dogs (Canis lupus familiaris), sheep (Ovis aries), pigs (Sus scrofa), horses (Equus caballus), chicken (Gallus gallus domesticus), and ducks (Anatidae) as well as how it can improve the monitoring and detection of zoonotic infections. We also described several high-throughput sequencing approaches for improved detection of known, unknown, and emerging infectious agents, resulting in better infectious disease diagnosis, as well as surveillance of zoonotic infectious diseases. In the coming years, the continued advancement of sequencing technologies will improve livestock research and hasten the development of various new genomic and technological studies on farm animals.
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  • 文章类型: Journal Article
    抗菌素耐药性的患病率正在增加,并且显然需要在临床诊断中开发快速检测方法。这篇综述探讨了利用质谱技术研究与碳青霉烯耐药性相关的分子表型的组学研究。虽然碳青霉烯耐药的具体机制是很好的表征,抗性表型知之甚少。了解抗性的获得如何通过分子表型分析影响细胞生理学和细胞代谢是通过诊断手段检测抗性的必要步骤。此外,本文探讨了质谱技术通过细菌分子谱分析鉴定耐药性生物标志物的潜力.质谱平台的发展正在扩大基于生物标志物的诊断领域。有针对性的措施,例如高分辨率质谱与色谱分离相结合,对于鉴定分子特征和开发用于检测碳青霉烯耐药性的快速诊断测定法显示出相当大的希望。
    Antimicrobial resistance is increasing in prevalence and there is a clear need for the development of rapid detection methods in clinical diagnostics. This review explores -omics studies utilising mass spectrometry to investigate the molecular phenotype associated with carbapenem resistance. Whilst the specific mechanisms of carbapenem resistance are well characterised, the resistant phenotype is poorly understood. Understanding how the acquisition of resistance affects cellular physiology and cell metabolism through molecular phenotyping is a necessary step towards detecting resistance by diagnostic means. In addition, this article examines the potential of mass spectrometry for the identification of resistance biomarkers through molecular profiling of bacteria. Developments in mass spectrometry platforms are expanding the biomarker-based diagnostic landscape. Targeted measures, such as high-resolution mass spectrometry coupled with chromatographic separation show considerable promise for the identification of molecular signatures and the development of a rapid diagnostic assay for the detection of carbapenem resistance.
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  • 文章类型: Journal Article
    如今,传染病作为全球危机持续存在,对世界各国的公共卫生和经济稳定造成重大破坏。尤其是由于多药耐药性(MDR)的流行和出现以及现有治疗选择的局限性,细菌感染仍然是最严重的问题。抗菌光动力疗法(APDT)是一种潜在的治疗方式,涉及光敏剂(PS)的系统给药,光,和分子氧(O2)用于应对细菌感染。尽管现有的卟啉和非卟啉PS在APDT中有效,溶解性差,对革兰氏阴性细菌的疗效有限,和非特异性分布阻碍了它们的临床应用。因此,为了提高传统PS的效率,各种聚合物驱动的改性和功能化策略已被采用来设计多功能混合光疗。这篇综述评估了为APDT应用开发的聚合物-PSs混合材料的最新进展和最新研究。Further,以下方面的关键研究成果被认为是深入的建设性讨论:i)通过各种分子相互作用的PSs集成/功能化聚合物复合材料;ii)PSs沉积在不同基材和设备上的涂层,以消除与医疗保健相关的感染;iii)PSs嵌入膜,脚手架,和用于再生医学应用的水凝胶。
    Nowadays, infectious diseases persist as a global crisis by causing significant destruction to public health and the economic stability of countries worldwide. Especially bacterial infections remain a most severe concern due to the prevalence and emergence of multi-drug resistance (MDR) and limitations with existing therapeutic options. Antibacterial photodynamic therapy (APDT) is a potential therapeutic modality that involves the systematic administration of photosensitizers (PSs), light, and molecular oxygen (O2) for coping with bacterial infections. Although the existing porphyrin and non-porphyrin PSs were effective in APDT, the poor solubility, limited efficacy against Gram-negative bacteria, and non-specific distribution hinder their clinical applications. Accordingly, to promote the efficiency of conventional PSs, various polymer-driven modification and functionalization strategies have been adopted to engineer multifunctional hybrid phototherapeutics. This review assesses recent advancements and state-of-the-art research in polymer-PSs hybrid materials developed for APDT applications. Further, the key research findings of the following aspects are considered in-depth with constructive discussions: i) PSs-integrated/functionalized polymeric composites through various molecular interactions; ii) PSs-deposited coatings on different substrates and devices to eliminate healthcare-associated infections; and iii) PSs-embedded films, scaffolds, and hydrogels for regenerative medicine applications.
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  • 文章类型: Journal Article
    对于传统的人工验证,第一次植入后需要大约三周的等待期,然后才能充分血管化。这个回顾性病例系列的目的是调查全层皮肤缺损,需要手术重建,可以通过植入碱性成纤维细胞生长因子(bFGF)浸渍的人工真皮并在较短的等待时间内进行二次皮肤移植来成功治疗。在2019年1月至2021年1月之间,使用bFGF浸渍的胶原蛋白-明胶海绵(CGS)进行了两阶段皮肤移植,治疗了14例患者(7例男性和7例女性)的19例皮肤缺损。所有这些都包含在这个案例系列中,还有植皮的等待期,植皮成功率,在等待期间感染,术后6~12个月对瘢痕质量进行回顾性调查。因此,所有植皮手术均成功进行,等待期为13.3±4.3天。在等待期间,在三个病变中观察到感染(15.8%);但是,所有感染都是可控的.术后瘢痕质量可接受(温哥华瘢痕评分范围,1-8).总之,与传统的人工验证相比,bFGF浸渍的CGSs有可能缩短等待期,而不会降低皮肤移植的成功率。需要进一步的研究来证实这一发现。
    For traditional artificial dermises, a waiting period of approximately three weeks is required after the first implantation before they are adequately vascularized. The objective of this retrospective case series was to investigate whether full-thickness skin defects, requiring surgical reconstruction, could be successfully treated by implantation of a basic fibroblast growth factor (bFGF)-impregnated artificial dermis and secondary skin grafting with a shorter waiting period. Between January 2019 and January 2021, 19 skin defects in 14 patients (7 male and 7 female) were treated with two-stage skin grafting using bFGF-impregnated collagen-gelatin sponge (CGS). All of them were included in this case series, and the waiting period for skin grafting, success rate of skin grafting, infection during the waiting period, and scar quality 6-12 months postoperatively were retrospectively investigated. As a result, all skin grafting surgeries were successfully performed with a waiting period of 13.3 ± 4.3 days. Infection during the waiting period was observed in three lesions (15.8%); however, all infections were controllable. Postoperative scar quality was acceptable (Vancouver Scar Scale score range, 1-8). In conclusion, compared to traditional artificial dermises, bFGF-impregnated CGSs have the potential to shorten the waiting period without decreasing the success rate of skin grafting. Further studies are required to confirm this finding.
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  • 文章类型: Journal Article
    未经批准:尽管在手术技术和管理方面取得了进步,手术部位感染(SSI)在心血管手术后仍然很重要。我们进行了调查,以确定术前鼻咽培养物(NCx)是否可以预测SSI及其微生物谱。
    UNASSIGNED:在2013年至2018年期间,对1226例接受NCx和正中胸骨切开术的心脏和胸主动脉手术的连续患者进行了回顾性审查,这些患者接受了标准SSI束的护理。对从NCx和SSI病原体中分离的微生物进行计数,以探索有和没有术后SSI的患者的微生物模式和相关变量。围手术期管理未因术前NCx的收集而改变。
    未经证实:有1281和127种微生物,包括最普遍的凝固酶阴性葡萄球菌,从784个鼻标本和111个咽标本中分离,分别。术后31例(2.47%)发生SSI,包括胸部,腹股沟,和腿SSI。未观察到SSI病原体与NCx微生物的显着重合。然而,有SSI的患者术前NCx阳性率明显高于无SSI的患者.NCx对SSI的敏感性/特异性为鼻部81%/37%,咽部45%/92%,分别。NCx对排除SSI的阴性预测值为鼻98.6%,咽部98.4%,分别。术后SSI的独立危险因素包括女性、糖尿病,术前NCx阳性,和术后使用PortexMini-Trach(SmithsMedical,明尼阿波利斯,Minn)或气管造口术进行多变量分析。
    UNASSIGNED:术前NCx可用于预测胸骨正中切开心脏直视手术后的SSI,以及耐甲氧西林金黄色葡萄球菌的筛查。
    UNASSIGNED: Despite advances in surgical techniques and management, surgical site infection (SSI) is still important after cardiovascular surgery. We investigated to determine whether or not preoperative nasopharyngeal cultures (NCx) can predict SSI and its microbial spectrum.
    UNASSIGNED: A retrospective review was done in 1226 consecutive patients undergoing NCx and cardiac and thoracic aortic surgery via median sternotomy who were cared for with the standard SSI bundle between 2013 and 2018. Microorganisms isolated from the NCx and SSI pathogens were counted to explore the microbial pattern and associated variables in patients with and without postoperative SSI. Perioperative management was not changed by collection of preoperative NCx.
    UNASSIGNED: There were 1281 and 127 microorganisms, including coagulase-negative Staphylococcus as the most prevalent, isolated from 784 nasal and 111 pharyngeal specimens, respectively. Postoperative SSI occurred in 31 patients (2.47%), including chest, groin, and leg SSI. Significant coincidence of the SSI pathogens with the NCx microorganisms was not observed. However, the patients with SSI showed significantly higher positive rates of preoperative NCx than those without SSI. The sensitivity/specificity of NCx for SSI were 81%/37% for nasal and 45%/92% for pharyngeal, respectively. The negative predictive value of NCx for ruling out SSI was 98.6% for nasal and 98.4% for pharyngeal, respectively. Independent risk factors for postoperative SSI included female sex, diabetes mellitus, positive preoperative NCx, and postoperative use of Portex Mini-Trach (Smiths Medical, Minneapolis, Minn) or tracheostomy on multivariate analysis.
    UNASSIGNED: Preoperative NCx may be useful to predict SSI after open heart surgery via median sternotomy, as well as screening for methicillin-resistant Staphylococcus aureus.
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  • 文章类型: Case Reports
    金黄色葡萄球菌感染性心内膜炎死亡率高,死亡的主要原因是心力衰竭,全身性栓塞,还有败血症.假性动脉瘤,这种感染的罕见并发症,通过适当的治疗并不总是致命的。一名以前健康的32岁男子被发现患有多发性脑梗塞,超声心动图诊断为有二尖瓣植被的感染性心内膜炎。因为耐甲氧西林金黄色葡萄球菌(MRSA)是从血液培养物中鉴定出来的,给予万古霉素。患者入院后第3天出现左侧颞枕叶大量脑出血,血肿通过手术完全切除.医院第7天右枕区又发现出血,导致病人深度昏迷.第10天的血培养对MRSA呈阴性;然而,影像学检查显示肠系膜上假性动脉瘤,肝,入院后3周,左动脉。由于患者仍处于昏迷状态,因此未对这些假性动脉瘤应用手术指征。入院后第78天,病人的血压突然下降,他死了。尸检显示肠系膜上动脉假性动脉瘤破裂引起的腹腔大出血。我们病人的临床过程是暴发性的,他的心内膜炎并发脑梗塞,颅内出血,入院3周内出现多个假性动脉瘤。回想起来,如果在入院的第一天或第二天进行了二尖瓣植被的紧急切除,则他可能幸存下来;但是,此类手术后的住院死亡率很高。
    Staphylococcus aureus infectious endocarditis has a high mortality, major causes of death being cardiac failure, systemic embolism, and sepsis. Pseudoaneurysms, a rare complication of this infection, are not invariably fatal with appropriate treatment. A previously healthy 32-year-old man was found to have multiple cerebral infarctions, and infectious endocarditis with mitral valve vegetation was diagnosed by echocardiography. Because methicillin-resistant Staphylococcus aureus (MRSA) was identified from blood cultures, vancomycin was administered. Massive intracerebral hemorrhage in the left temporo-occipital lobe occurred in the patient on the 3rd day after admission, and the hematoma was completely removed surgically. Another hemorrhage was identified in the right occipital region on the 7th hospital day, which led the patient deep coma. Blood cultures on the 10th day were negative for MRSA; however, imaging studies revealed pseudoaneurysms in the superior mesenteric, hepatic, and left popliteal arteries 3 weeks after admission. No surgical indication was applied to these pseudoaneurysms because the patient remained comatose. On the 78th day after admission, the patient\'s blood pressure suddenly dropped and he died. Autopsy demonstrated massive bleeding in the abdominal cavity caused by rupture of the superior mesenteric artery pseudoaneurysm. Our patient\'s clinical course was fulminant, his endocarditis being complicated by cerebral infarctions, intracranial hemorrhages, and multiple pseudoaneurysms within 3 weeks of admission. In retrospect, he may have survived if emergency resection of the mitral valve vegetation had been performed on the first or second day of admission; however, the in-hospital mortality rate after such surgery is high.
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  • 文章类型: Journal Article
    在全球范围内,抗菌药物耐药性的威胁日益增加,因此有必要对其他化疗策略进行研究以对抗感染。抗菌肽,或宿主防御肽,在这方面是一组有前途的治疗候选人。它们中的大多数引起膜透化,并且是针对病原体入侵的先天免疫应答的关键组分。还报道了肽自组装是控制这些肽候选物的杀微生物活性的驱动因素。虽然已经努力开发针对各种微生物的新型合成肽,这些肽的许多临床试验由于对宿主的毒性和溶血活性而失败。功能引导的合理肽工程,基于进化原理,AMP活性的理化性质和活性决定因素,有望帮助靶向特定的微生物。此外,重要的是要对AMP的进化有统一的认识,以便充分认识它们在宿主防御中的重要性。本文旨在探讨AMP的进化和AMP活性的物理化学决定因素。还回顾了驱动AMP自组装的特定相互作用,强调这种自组装对杀菌和免疫调节活性的影响。
    The burgeoning menace of antimicrobial resistance across the globe has necessitated investigations into other chemotherapeutic strategies to combat infections. Antimicrobial peptides, or host defense peptides, are a set of promising therapeutic candidates in this regard. Most of them cause membrane permeabilization and are a key component of the innate immune response to pathogenic invasion. It has also been reported that peptide self-assembly is a driving factor governing the microbicidal activity of these peptide candidates. While efforts have been made to develop novel synthetic peptides against various microbes, many clinical trials of such peptides have failed due to toxicity and hemolytic activity to the host. A function-guided rational peptide engineering, based on evolutionary principles, physicochemical properties and activity determinants of AMP activity, is expected to help in targeting specific microbes. Furthermore, it is important to develop a unified understanding of the evolution of AMPs in order to fully appreciate their importance in host defense. This review seeks to explore the evolution of AMPs and the physicochemical determinants of AMP activity. The specific interactions driving AMP self-assembly have also been reviewed, emphasizing implications of this self-assembly on microbicidal and immunomodulatory activity.
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