2011-2016年粪肠球菌和屎肠球菌耐药趋势分析

目的探讨临床来源的粪肠球菌和屎肠球菌2011-2016年6年间耐药趋势变化,为控制肠球菌感染及抗菌药物的选择提供参考。方法收集2011年1月-2016年12月医院门诊及住院患者送检标本中分离出的160株粪肠球菌与210株屎肠球菌,回顾性分析药物敏感试验结果。结果 6年间,粪肠球菌及屎肠球菌对万古霉素、替考拉宁、替加环素无耐药菌株出现;粪肠球菌对阿莫西林/克拉维酸、利奈唑胺、氨苄西林/舒巴坦、氨苄西林、哌拉西林/他唑巴坦的6年整体耐药率较低,对亚胺培南、呋喃妥因、青霉素G的6年整体耐药率在8.00%～25.00%之间,对氯霉素、环丙沙星、左氧氟沙星的6年整体耐药率为15.00%～50.00%之间,屎肠球菌对奎奴普丁/达福普汀6年整体耐药率<10%,2011-2016年连续分离出的粪肠球菌、屎肠球菌对临床抗菌药物的耐药率差异无统计学意义。屎肠球菌对阿莫西林/克拉维酸、氨苄西林、氨苄西林/舒巴坦、环丙沙星、红霉素、亚胺培南、左氧氟沙星、呋喃妥因、青霉素G、哌拉西林/他唑巴坦、利福平、利奈唑胺的2011-2016年整体耐药率高于粪肠球菌(P<0.001);屎肠球菌对氯霉素、高浓度庆大霉素、四环素、奎奴普丁/达福普汀的2011-2016年整体耐药率低于粪肠球菌(P<0.05)。结论临床分离的粪肠球菌和屎肠球菌对临床常用抗菌药物普遍表现为多药耐药,同一菌种对同一抗菌药物近6年的耐药率变化趋势并不明显,万古霉素、替考拉宁、替加环素仍是敏感药物。     

金黄色葡萄球菌和肠球菌属对17种抗菌药物敏感性分析

目的调查金黄色葡萄球菌和肠球菌属对17种抗菌药物的敏感性。方法收集医院2005—2006年临床分离的138株金黄色葡萄球菌和肠球菌属，琼脂稀释法检测17种抗菌药物对分离菌的最低抑菌浓度（MICs），数据分析采用wHONET5．3软件。结果耐甲氧西林金黄色葡萄球菌（MRsA）占金黄色葡萄球菌20．7％，MRSA对万古霉素和替考拉宁仍高度敏感（100．0％），MIC50和MIC90分别为0．5和1．0μg／ml，氟喹诺酮类、复方新诺明、红霉素和克林霉素对MRSA的抗菌活性均较差（敏感率0～33．3％）；粪肠球菌对万古霉素和替考拉宁最敏感（100．0％），其次哌拉西林／他唑巴坦、亚胺培南和氨苄西林（97．2％～100．0％）；屎肠球菌仅万古霉素和替考拉宁高度敏感（100．0％），MRSA、MSSA、粪肠球菌和屎肠球菌对氟喹诺酮类均存在明显的交叉耐药。结论医院MRSA和屎肠球菌对多种抗菌药物高度耐药，应加强病原菌耐药性的监测。     

249株肠球菌属对抗菌药物的敏感性分析

目的 了解全身感染和泌尿系感染粪肠球菌、屎肠球菌对抗菌药物的敏感性,为临床提供治疗依据.方法采用琼脂稀释法对249株来自临床送检的无菌体液、血液及尿液分离出的肠球菌属进行药敏试验,测定其MIC值.结果 249株肠球菌属中,粪肠球菌117株、屎肠球菌132株,粪肠球菌在尿中的分布68.4%高于屎肠球菌50.0%,而血液及其他无菌部位中分离的屎肠球菌(50.0%)高于粪肠球菌(31.6%);粪肠球菌对加替沙星、环丙沙星、青霉素G、氨苄西林、高浓度庆大霉素的敏感性均高于屎肠球菌,而屎肠球菌对米诺环素的敏感性(74.8%)明显高于粪肠球菌(23.7%);249株肠球菌属除1株粪肠球菌对万古霉素中度敏感外,对替考拉宁和利奈唑烷100.0%敏感;无论粪肠球菌还是屎肠球菌对红霉素几乎100.0%耐药;粪肠球菌对高浓度庆大霉素的敏感率39.5%高于屎肠球菌15.3%;血液中粪肠球菌对10种抗菌药物的敏感性高于尿液,血液中屎肠球菌对加替沙星、环丙沙星、青霉素G、氨苄西林和红霉素5种抗菌药物均100.0%耐药.结论粪肠球菌、屎肠球菌对不同的抗菌药物的敏感性差异有统计学意义,在治疗时,应根据耐药特点及菌种间的耐药性差异来选择相应的治疗方案,目前万古霉素、替考拉宁和利奈唑烷仍然是治疗肠球菌属引起感染的最好药物.     

2004—2014年尿标本分离粪肠球菌和屎肠球菌药物敏感性变迁

目的了解临床尿标本分离粪肠球菌和屎肠球菌药物敏感性状况及变迁,为临床抗感染治疗提供实验室依据。方法分析2004—2014年全国20所三级医院患者尿标本分离的粪肠球菌和屎肠球菌的药物敏感性,采用聚合酶链反应（PCR）检测万古霉素耐药肠球菌（VRE）的耐药基因。结果2004—2014年共分离菌株788株,其中粪肠球菌371株,屎肠球菌417株。粪肠球菌对氨苄西林、呋喃妥因、磷霉素、万古霉素和替考拉宁的敏感率均>90%,对利福平、米诺环素和红霉素的敏感率均<20%,2011年7月—2012年6月与2009年7月—2010年6月粪肠球菌对磷霉素敏感率比较,差异有统计学意义(P<0.0167)。屎肠球菌对万古霉素和替考拉宁的敏感率分别为96.9%和97.4%,对呋喃妥因、米诺环素和磷霉素的敏感率分别为41.7%、51.8%和78.2%,对氨苄西林、左氧氟沙星、利福平和红霉素的敏感率均<10%;屎肠球菌对呋喃妥因敏感率不同年份有降低趋势（任两组比较均P<0.0167）,2011年7月—2012年6月、2013年7月—2014年6月磷霉素敏感率较2009年7月—2010年6月有所降低（均P<0.0167）,其他药物不同年份药敏情况无显著变化。14株VRE均携带vanA耐药基因。结论尿标本分离的粪肠球菌对氨苄西林、呋喃妥因和磷霉素均较敏感,屎肠球菌对大部分抗菌药物敏感性相对较差;粪肠球菌和屎肠球菌对万古霉素和替考拉宁相对敏感,仅少数菌株耐药。     

Mohnarin2011年报告:西南地区细菌耐药监测

目的 了解2011年西南地区医院临床分离菌构成及对抗菌药物的耐药性,为临床用药提供参考依据.方法 西南地区5所医院的临床分离菌采用KB纸片扩散法或自动化仪器法进行抗菌药物敏感试验,按CLSI2011年标准(肠杆菌科细菌对碳青霉烯类抗菌药物敏感性的判断参照2010年标准),采用WHONET 5.6软件进行统计分析.结果 共分离细菌9154株,革兰阳性菌占25.8％,革兰阴性菌占74.2％;葡萄球菌属中MRSA和MRCNS检出率分别为56.9％和80.3％,未发现万古霉素、替考拉宁和利奈唑胺耐药株,肠球菌属中屎肠球菌的分离率、耐药性均高于粪肠球菌,屎肠球菌对万古霉素、替考拉宁和利奈唑胺的耐药率分别为1.9％、1.4％、0.6％,粪肠球菌分别为0.9％、0.8％、0.5％;肠杆菌科细菌对碳青霉烯类抗菌药物保持较好的敏感性,均＞93.6％,铜绿假单胞菌对阿米卡星耐药率最低为18.5％,对亚胺培南和美罗培南耐药率为24.1％和22.8％,鲍氏不动杆菌对头孢哌酮/舒巴坦的耐药率最低为38.6％,对亚胺培南和美罗培南耐药率为52.2％和65.6％.结论 西南地区医疗机构细菌耐药性呈增长趋势,定期进行耐药性监测有助于了解细菌耐药性,为临床用药提供参考.     

211株肠球菌属细菌对18种抗生素的耐药性特征

目的了解肠球菌属对18种抗菌药物的耐药性. 方法采用纸片扩散法进行药敏试验. 结果 65株屎肠球菌对青霉素、氨苄西林和阿莫西林/克拉维酸耐药率分别为89.2%、85.1%和78.5%;146株粪肠球菌对青霉素、氨苄西林和阿莫西林/克拉维酸耐药率分别为7.2%、3.8%和3.9%,粪肠球菌对磷霉素的耐药率为2.8%;粪肠球菌对高浓度链霉素耐药率(60.1%)比高浓度庆大霉素耐药率(45.3%)高药15%,与粪肠球菌相反屎肠球菌对高浓度链霉素耐药率和高浓度庆大霉素的耐药率分别为50%和80.6%;211株菌对万古霉素、替考拉宁全部敏感,值得注意的是粪肠球菌和屎肠球菌对红霉素耐药率高达78.8%和95.3%;屎肠球菌对青霉素类、呋喃妥因、喹诺酮类、高浓度庆大霉素、红霉素和利福平的耐药性明显高于粪肠球菌,而对四环素类抗菌药物、高浓度链霉素和氯霉素的耐药性低于粪肠球菌. 结论粪肠球菌对抑制细菌细胞壁合成的青霉素、氨苄西林、阿莫西林/克拉维酸、万古霉素、替考拉宁和磷霉素,作用于核酸合成的药物利福平、喹诺酮类的诺氟沙星、环丙沙星、左氧氟沙星以及作用于微生物酶系统的呋喃妥因较敏感;屎肠球菌对作用于蛋白质合成的抗菌药物(除红霉素外)四环素、多西环素和米诺环素及氯霉素较敏感.     

临床分离273株肠球菌属分析

目的 探讨2008年1-12月医院临床分离肠球菌属的易感因素及耐药情况,为临床用药提供证据.方法 按操作进行细菌的培养、分离及鉴定;运用VITEK-2分析仪进行菌株的鉴定及药敏检测;调查病历了解患者资料.结果 共分离出273株肠球菌属,其中粪肠球菌158株,屎肠球菌109株,其他肠球菌6株;其中耐高浓度氨基糖苷类肠球菌(HLAR)屎肠球菌10株,HLAR粪肠球菌80株,两者间分离率差异有统计学意义(P<0.05);屎肠球菌对氨苄西林、氨苄西林/舒巴坦、亚胺培南、红霉素、环丙沙星、莫西沙星的耐药率明显高于粪肠球菌,糖肽类抗菌药物(万古霉素和替考拉宁)和利奈唑烷对肠球菌属保持高度敏感性.结论 医院HLAR粪肠球菌产生率高,肠球菌属的耐药性较为严重;医院应加强抗菌药物使用的管理,严格掌握糖肽类抗菌药物的使用指针,降低细菌耐药率.     

Mohnarin2011年报告:西北地区细菌耐药监测

目的 了解2011年西北地区医院临床分离菌构成以及对常用抗菌药物的耐药性,为临床用药提供参考依据.方法 西北10所医院的临床分离菌采用K-B纸片扩散法或自动化仪器法进行抗菌药物敏感试验,按CLSI2011年标准(肠杆菌科细菌对碳青霉烯类抗菌药物敏感性的判断参照2010年标准),采用WHONET5.6软件进行统计分析.结果 共分离细菌13429株,革兰阳性菌占29.3％,革兰阴性菌占70.7％;葡萄球菌属中MRSA和MRCNS检出率分别为61.4％和84.0％,未发现万古霉素、替考拉宁和利奈唑胺耐药株,屎肠球菌的分离率、耐药性均高于粪肠球菌,屎肠球菌对万古霉素、替考拉宁和利奈唑胺的耐药率分别为2.9％、0.8％和0.7％,粪肠球菌分别为1.3％、0和0.5％;肠杆菌科细菌对碳青霉烯类抗菌药物保持较好的敏感性(＞95.4％),鲍氏不动杆菌对头孢哌酮/舒巴坦的耐药率最低为30.5％,对亚胺培南的耐药率为49.6％;铜绿假单胞菌对阿米卡星耐药率最低为11.2％,对亚胺培南的耐药率为20.6％.结论 西北地区医疗机构细菌耐药性呈增长趋势,定期进行耐药性监测有助于了解细菌耐药性,为临床用药提供参考.     

2007-2009年武汉地区儿童血培养中肠球菌属的分离现状及耐药分析

目的了解近3年来武汉地区儿童血培养中肠球菌属的分离现状及耐药性,指导临床合理使用抗菌药物。方法收集医院2007-2009年住院患儿血培养中分离的肠球菌属,按照CLSI推荐的方法和判断标准,用纸片扩散法进行药敏试验,资料用WHONET5.3软件进行统计分析。结果 29 614份血培养标本中分离出肠球菌属503株,3年平均分离率为1.69%,其中以粪肠球菌为主,占51.89%,其次为屎肠球菌,占21.47%;屎肠球菌在肠球菌属中的分离比例逐年上升,2007-2009年分别为13.33%、17.13%、27.13%;503株肠球菌属对万古霉素、替考拉宁全部敏感,粪肠球菌对青霉素G、氨苄西林敏感性高,屎肠球菌除对万古霉素、替考拉宁及利奈唑胺敏感外,对其他抗菌药物的耐药率均比粪肠球菌高。结论武汉地区儿童血培养中肠球菌属以粪肠球菌为主,屎肠球菌的分离率逐年升高,且其耐药率明显高于粪肠球菌,两者对除万古霉素、替考拉宁、利奈唑胺外的常用抗菌药物都产生了不同程度的耐药性;临床在治疗儿童血液中肠球菌属感染时,应根据药敏试验结果合理选择抗菌药物,以减少耐药菌株的产生。     

肠球菌属医院感染的耐药性分析

目的了解2007-2011年粪肠球菌和屎肠球菌在医院感染中的检出率及对常用抗菌药物的耐药性,指导临床合理用药。方法采用法国生物梅里埃公司全自动细菌鉴定系统VITEK-32型和VITEK Compact进行菌株鉴定,采用GPS110和GP535药敏卡测定其对11种抗菌药物的敏感性。结果 2007年4月-2011年4月医院感染标本中共检出粪肠球菌43株、屎肠球菌50株,50株屎肠球菌主要来自手术切口分泌物、尿液标本,分别占42.0%、16.0%;43株粪肠球菌同样主要来自手术切口分泌物、尿液标本,分别占39.5%、23.3%;屎肠球菌对环丙沙星、青霉素G、左氧氟沙星、氨苄西林耐药率均较高,分别为86.0%、90.0%、74.0%、84.0%,而粪肠球菌分别为53.5%、37.2%、44.2%、27.9%,屎肠球菌对上述抗菌药物的耐药率均高于粪肠球菌,差异有统计学意义(P<0.05);屎肠球菌对万古霉素、替考拉宁、利奈唑胺均敏感;粪肠球菌仅1株对替考拉宁耐药,对万古霉素和利奈唑胺均敏感;4年未检出耐万古霉素肠球菌属。结论粪肠球菌与屎肠球菌在医院感染中的耐药性明显不同,在治疗其引起的感染时应按药敏试验结果用药。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.