113株阴沟肠杆菌ESBLs和AmpC酶的携带率及耐药性分析

目的：了解两种超广谱β内酰胺酶(ESBLs和AmpC酶)在阴沟肠杆菌中的分布及其对常用抗菌药物的敏感性。方法:常规培养分离细菌，采用VITEK或API系统鉴定细菌。K-B纸片琼脂扩散法测定细菌对抗菌药物的敏感性；双纸片确认试验检测：ESBLs；三维试验确认法检测AmpC酶。结果:113株阴沟肠杆菌中产ESBLs和AmpC酶的阳性率分别为26．55％和42．48％；ESBLs和AmpC酶共同存在者为9．73％。阴沟肠杆菌对氨苄西林、头孢哌酮、阿米卡星、环丙沙星、头孢哌酮/舒巴坦、头孢吡肟和亚胺培南佰司他汀的耐药率分别为98．2％，66．4％，45．1％，23．0％，17．7％，9．7％和4．4％。产ESBLs菌株对头孢吡肟和亚胺培南/西司他汀的耐药率为6．7％和3．3％；产AmpC酶菌株对头孢吡肟和亚胺培南/西司他汀的耐药率为12．5％和2．1％；非产酶菌株对头孢吡肟和亚胺培南佰司他汀的敏感率为100．0％。结论：阴沟肠杆菌产EESBLs和AmpC酶的状况已十分突出，尤其是产AmpC酶的阴沟肠杆菌已逐渐成为引起医院感染的流行菌，应引起临床高度关注。临床应根据体外药敏试验合理选择抗菌药物，以减少阴沟肠杆菌耐药株的产生和流行。     

三种抗生素对细菌感染菌株药敏结果分析

目的 :比较头孢他啶 ,头孢哌酮 -舒巴坦与亚胺培南 -西拉司丁三种抗生素治疗细菌感染的效果。方法 :随机收集病房送检标本 10 0例 ,(其中 :痰液 3 0例 ,脓液 2 3例 ,分泌物 2 5例 ,组织液 2 2例 )进行细菌培养 ,菌种鉴定和药敏实验。结果 :共培养菌株 2 0 0株 ,其中以铜绿假单胞菌 (3 0 . 5 % )和金黄色葡萄球菌 (2 2 . 0 % )最为常见。所有革兰氏阴性杆菌对头孢他啶 ,头孢哌酮 -舒巴坦与亚胺培南 -西拉司丁的敏感率分别为 69. 0 % ,76. 0 %与 94. 0 % ,所有革兰氏阳性杆菌对头孢他啶 ,头孢哌酮 -舒巴坦与亚胺培南 -西拉司丁的敏感率分别为 68 .0 % ,70 . 0 %与 94. 0 %。结论 :细菌感染的治疗以亚胺培南 -西拉司丁最为敏感 ,亚胺培南-西拉司丁可作为治疗严重细菌感染的首选药物。     

心脑血管医院临床分离肠杆菌科细菌的分布与耐药性分析

目的 了解医院临床分离常见肠杆菌科细菌的分布及耐药性,为临床医师合理使用抗菌药物提供依据. 方法 对2005年3月-2008年12月临床分离的所有肠杆菌科细菌应用法国生物梅里埃公司VITEK-32微生物分析仪进行菌株鉴定,采用K-B法,按照美国NCCLS规定标准进行判断.结果 380株肠杆菌科细菌中,大肠埃希菌154株,肺炎克雷伯菌143株,阴沟肠杆菌38株;肺炎克雷伯菌对氨苄西林耐药率最高,占100.0%,对亚胺培南敏感率最高,占100.0%,大肠埃希菌对亚胺培南耐药率为0,对头孢哌酮/舒巴坦和哌拉西林/他唑巴坦敏感率分别为89.0%、76.0%;阴沟肠杆菌对阿米卡星耐药率仅为2.63%,对亚胺培南耐药率最低,为0. 结论 3种常见肠杆菌科细菌对抗菌药物的耐药性都呈上升趋势,合理使用抗菌药物,控制、降低耐药菌株的产生,加强医院病原菌耐药性的连续监测尤为重要,目前,亚胺培南仍是治疗肠杆菌科细菌最有效的抗菌药物之一.     

肠杆菌属的耐药调查及抗感染用药探讨

目的：了解肠杆菌属的耐药现状,为阴沟肠杆菌和产气肠杆菌引起的菌血症,肺炎和泌尿道等严重感染的治疗提供参考依据。方法：采用美国临床实验室标准化委员会（NCCLS）推荐的纸片扩散法,测定了5年中每个患者初次分离的892株阴沟肠杆菌,212株产气肠杆菌,42株阪崎肠杆菌和210株聚团肠杆菌对亚胺培南,环丙沙星,阿米卡星,头孢他啶等15种抗生素的药敏结果。结果：易产诱导型染色体Bush 1群β－内酰胺酶的阴沟肠杆菌,产气肠杆菌和阪崎肠杆菌对亚胺培南,阿米卡星,头孢他啶和环丙沙星的耐药率最低,分别为1－14％,6％－31％,13％－29％,10％－36％,亚胺培南,阿米卡星,庆大霉素,头孢他啶和环丙沙星对很少产生诱导型染色体Bush1群β-内酰胺酶的聚团肠杆菌有极好的活性,其耐药率为2％－9％,结论：亚胺培南,环丙沙星,阿米卡星和头孢他啶对所研究的肠杆菌属有较高的活性,系易产诱导型染色体Bush1群β－内酰胺阴沟杆菌和产气肠杆菌严重感染治疗最有效的抗生素。     

2013-2014年邵阳市中心医院常见革兰阴性杆菌的耐药分析

目的 监测2013-2014年邵阳市中心医院临床分离的常见革兰阴性杆菌的耐药性,为临床合理用药提供参考依据。 方法 对2013-2014年该院分离到的常见革兰阴性杆菌做药敏分析,使用WHONET5.6软件进行数据分析。 结果 连续两年该院分离到的常见革兰阴性杆菌前五位分别为大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和阴沟肠杆菌。肠杆菌科细菌对碳青霉烯类抗生素仍保持较高的敏感性,但阴沟肠杆菌的敏感性只有80%左右。对大肠埃希菌敏感性较高的抗生素有阿米卡星、亚胺培南、美罗培南和哌拉西林/他唑巴坦;对肺炎克雷伯菌和阴沟肠杆菌敏感性较高的抗生素有阿米卡星、亚胺培南、美罗培南和左氧氟沙星。铜绿假单胞菌和鲍曼不动杆菌对碳青霉烯类药物的敏感性均在50%以下。 结论 耐碳青霉烯类药物的肠杆菌科细菌逐年增多。鲍曼不动杆菌的耐药性较高。     

美罗培南治疗医院感染的临床研究

目的评价美罗培南治疗医院感染的临床疗效和安全性. 方法选择中、重度医院感染患者,治疗组给予美罗培南0.5 g,q8h,静脉滴注;对照组给予亚胺培南/西司他丁1.0 g,q8h,静脉滴注;两药疗程均为7～10 d. 结果美罗培南组和亚胺培南/西司他丁组的临床痊愈率分别为48.5%和54.8%;临床有效率分别为81.8%和87.1%;细菌清除率分别为90.0%和86.4%;不良反应发生率分别为9.1%和6.5%;以上指标差异均无显著性(P>0.05). 结论美罗培南治疗医院感染是有效和安全的,与亚胺培南/西司他丁相比差异无显著性.     

阴沟肠杆菌的临床分布与耐药性

目的 了解阴沟肠杆菌的临床分布状况及耐药性,为临床治疗阴沟肠杆菌的感染提供参考.方法 2006年6月-2009年6月住院患者标本中分离的细菌,用VITEK自动化细菌鉴定及药敏分析系统鉴定菌种并做药敏分析,对阴沟肠杆菌的分布状况及药敏结果做统计分析.结果 在191份检出有目的 菌的标本中,前3位标本分别为痰液(67.0%)、尿液(13.6%)、伤口分泌物(7.9%);痰液标本主要来自呼吸内科、神经外科以及老年内科,尿液标本主要来自泌尿内科,而伤口分泌物则主要来自外科病房;阴沟肠杆菌对阿莫西林、阿莫西林/克拉维酸、头孢噻吩、头孢西丁及头孢呋辛的敏感性差,其耐药率分别为73.3%～92.7%;对头孢吡肟、阿米卡星的敏感性则较好,其耐药率分别为29.3%、18.8%,未出现耐亚胺培南或美罗培南的菌株,对其余抗菌药物分别约有50.0%的耐药率,β-内酰胺酶抑制剂的抑菌效果不明显.结论 阴沟肠杆菌主要引起呼吸道、尿路和伤口感染,美罗培南、亚胺培南、阿米卡星、头孢吡肟为治疗阴沟肠杆菌感染的有效药物.     

亚胺培南联合磷霉素对多重耐药鲍曼不动杆菌的试验研究

目的 探索以亚胺培南为基础用药,对临床分离多重耐药鲍曼不动杆菌(MDR-AB)的体内外抗菌方法。方法 用微量肉汤稀释法及棋盘法测定7株临床分离的MDR-AB对亚胺培南、磷霉素、阿米卡星、替加环素、多粘菌素B 5种抗菌药物的最低抑菌浓度(MIC)及联合MIC,并计算部分抑菌浓度指数(FICI)。用时间杀菌曲线法判断亚胺培南联合磷霉素的杀菌效果。选取菌株AB6624、AB0153构建体外生物膜模型,结晶紫染色法半定量生物膜。激光共聚焦显微镜观察使用亚胺培南联合磷霉素对生物膜细菌的杀伤作用。流式细胞仪检测亚胺培南及磷霉素单药与联合用药对细菌活性氧(ROS)表达的影响。建立大蜡螟感染模型,记录亚胺培南及磷霉素单药与联合用药时大蜡螟存活率。结果 亚胺培南联合磷霉素对5株MDR-AB具有协同作用;亚胺培南联合磷霉素对菌株AB6624、AB0153分别在4、8 h的菌落数较单药组降低>2log₁₀ CFU/mL;亚胺培南联合磷霉素抑制菌株生物膜形成并对菌株AB0153生物膜结构具有破坏作用;亚胺培南联合磷霉素可以提高菌株AB0153胞内ROS水平,差异具有统计学意义(P&...     

新生儿阴沟肠杆菌败血症临床分析

目的探讨新生儿阴沟肠杆菌败血症的临床特点及药物敏感特点,为早期诊断和治疗提供临床依据。方法对我院新生儿科29例确诊为沟肠杆菌败血症的新生儿进行临床资料用药敏结果的回顾性分析。结果阴沟肠杆菌败血症常可引起多脏器功能受损。阴沟肠杆菌对亚胺培南、万古霉素及阿米卡星敏感率达100％;对常用头孢菌素均不敏感。及时使用敏感抗生素治疗阴沟肠杆菌收血症可获得满意疗效。结论阴沟肠杆菌败血症发病有增多趋势,且多为医院内感染,对一般常用搞生素不敏感。碳青霉烯类如亚胺培南及万古霉磁素是阴沟肠杆菌感染的首选用药。     

阴沟肠杆菌医院下呼吸道感染临床特点及耐药性监测

目的 调查阴沟肠杆菌医院下呼吸道感染的临床特点及其对抗菌药物的耐药性,为临床诊断及治疗提供依据.方法 回顾性分析2008年1月-2010年5月75例阴沟肠杆菌医院下呼吸道感染病例.结果 75例患者中年龄≥65岁59例,存在基础疾病的71例,使用抗菌药物56例,住院时间≥20 d的31例;除亚胺培南、阿米卡星、头孢呲肟和哌拉西林/他唑巴坦外,阴沟肠杆菌对其他抗菌药物的耐药率均≥46.7％.结论 阴沟肠杆菌医院下呼吸道感染与高龄、基础疾病、住院时间及免疫力低下等因素关系密切,临床表现及实验室检查缺乏特异性;阴沟肠杆菌对抗菌药物耐药性严重,亚胺培南可作为阴沟肠杆菌重症感染的首选抗菌药物.     

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 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.     

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.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

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.     

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.