金黄色葡萄球菌医院感染的临床及耐药性分析

目的探讨金黄色葡萄球菌所致医院感染的危险因素、临床特点及耐药情况,为临床治疗金黄色葡萄球菌医院感染提供指导。方法收集确诊为金黄色葡萄球菌医院感染病例的临床资料,分析发病的危险因素及临床特点,对分离到的菌株进行药物敏感性测定。结果共73例金黄色葡萄球菌医院感染患者,均存在着严重的基础疾病,82.19%的患者接受过侵入性操作,感染部位以肺部最多见;共分离出79株金黄色葡萄球菌,包括耐甲氧西林金黄色葡萄球菌（MRSA）66株（83.54%）和甲氧西林敏感金黄色葡萄球菌（MSSA）13株（16.46%）;金黄色葡萄球菌对多种抗菌药物呈普遍耐药,而MRSA的耐药性明显高于MSSA（P〈0.01）,未发现对耐万古霉素MRSA菌株。结论金黄色葡萄球菌医院感染常发生在有严重基础疾病、接受侵入性操作的患者,肺部感染最常见,MRSA表现为多药高度耐药,但糖肽类药物敏感性高。     

重症监护病房耐甲氧西林金黄色葡萄球菌感染调查

目的分析造成重症监护病房(ICU)耐甲氧西林金黄色葡萄球菌(MRSA)感染的原因,提出有效的预防与控制措施,进一步加强医院感染管理。方法对2005年12月-2006年2月初入住ICU患者,发生耐甲氧西林金黄色葡萄球菌感染进行前瞻性调查分析。结果9例患者发生下呼吸道医院感染,痰培养结果均为同一株MRSA所致;医护人员手、口咽、鼻腔培养出与患者同株MRSA。结论ICU为医院感染高发科室,患者病情危重、免疫低下、侵入性操作多、抗菌药物使用复杂且量大、耐药率高等都是导致医院感染的危险因素,所以提高医护人员医院感染控制理念,规范诊疗操作行为,树立合理使用抗菌药物的观念,是降低ICU发生MRSA感染的关键环节。     

头孢西丁和苯唑西林检测耐甲氧西林金黄色葡萄球菌的比较

目的比较头孢西丁和苯唑西林两种抗生素检测耐甲氧西林金黄色葡萄球菌(meticillin-resistant-Staphylococcus aureus, MRSA)的阳性率差异,并对91株MRSA进行临床调查,为临床诊断和控制该类菌引起感染的提供依据. 方法苯唑西林及头孢西丁分别采用K-B法和MIC法鉴定213株金黄色葡萄球菌中的MRSA阳性率. 结果 213株金黄色葡萄球菌中对苯唑西林耐药的有99株(46.5%);用头孢西丁纸片法和MIC法检测结果一致,耐药菌株有91株(42.7%);以头孢西丁检测方法作为标准,苯唑西林检测方法的假阳性率为8.1%,假阴性率为0%;MRSA的高发病区为重症监护病房(ICU)和呼吸科;MRSA对10种抗生素的耐药率高于MSSA. 结论检测MRSA头孢西丁法优于苯唑西林法;MRSA具有多重耐药的特性,应严格控制MRSA医院感染.     

ICU患者分离金黄色葡萄球菌的耐药性及分子流行病学特征

目的了解某院重症监护病房（ICU）金黄色葡萄球菌的耐药特点及分子流行病学特征。方法收集2014年1—12月该院ICU分离的金黄色葡萄球菌,进行细菌鉴定及药物敏感性试验,采用金黄色葡萄球菌A蛋白(spa)分型及多位点序列分型(MLST)方法进行分型。结果160株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌（MRSA）120株（占75.00%）。MRSA对红霉素、克林霉素、左氧氟沙星的耐药率均＞80%;MSSA对头孢唑林敏感,对红霉素、克林霉素、左氧氟沙星的耐药率分别为62.50%、35.00%、10.00%。spa分型和MLST结果显示,120株MRSA主要为ST239 t030、ST239 t037、ST5 t2460 3种型别,其中ST239 t030（105株,87.50%）为主要流行菌株,8个ICU均有检出;MSSA存在较多型别,ST59 t437仅在神经内科(8株)和消化科（2株）检出,ST6 t701、ST398 t3625、ST398 t1793和ST121 t2092分别仅在神经内科（7株）、麻醉科（5株）、神经外科（4株）和心外科（4株）检出。结论该院ICU MRSA分离率较高,以ST239 t030克隆株为主,存在医院内流行;不同型别MSSA在各科室内存在流行趋势。     

耐甲氧西林金黄色葡萄球菌医院感染现状及耐药性分析

目的监测耐甲氧西林金黄色葡萄球菌(MRSA)医院感染现状及耐药性,为临床医师合理选用抗菌药物提供参考。方法药敏试验及耐甲氧西林金黄色葡萄球菌检测均采用琼脂扩散法(K-B)法,操作及结果判断按照美国临床实验室标准化委员会(Nccls)进行。结果 67株金黄色葡萄球菌,其中耐甲氧西林金黄色葡萄球菌(MRSA)为48株,占71.6%;MRSA感染前均使用≥2种抗菌药物,(MSSA)为19株占28.4%。结论 MRSA检出率不断升高,严重的基础疾病、接受侵入性操作、长期应用广谱抗菌药物等可能是MRSA感染的危险因素;MRSA除对万古霉素外显示多重耐药。应加强与重视MRAS检测与报告,采取由效措施,预防与控制MRSA医院感染。     

152例金黄色葡萄球菌血流感染的临床特征及预后分析

探讨金黄色葡萄球菌血流感染的临床特征及影响预后的主要危险因素, 为临床预防和控制金黄色葡萄球菌血流感染提供参考依据。本研究回顾性分析广东省人民医院2019年1月至2021年12月诊治的152例金黄色葡萄球菌血流感染患者的临床资料, 包括基础疾病、临床特点、危险因素、细菌耐药性、治疗药物及预后等临床因素, 采用χ2检验、t检验等统计学方法对可能影响金黄色葡萄球菌和耐甲氧西林金黄色葡萄球菌(MRSA)血流感染患者临床特征及预后的相关危险因素进行单因素分析, 然后将单变量分析中P<0.05的变量纳入多因素logistic回归模型分析其预后不良的独立危险因素。结果显示, 152例金黄色葡萄球菌血流感染患者中, 检出MRSA 50例(32.89%), 甲氧西林敏感金黄色葡萄球菌(MSSA)检出102例(67.11%)。MRSA组留置导尿管、留置引流管、使用碳青霉烯类抗生素、使用β-内酰胺酶抑制剂比率明显高于MSSA组(χ2分别为8.272、11.972、4.998、4.776, P均<0.05)。MRSA组血流感染预后不良发生率高于MSSA组(34.00%vs 13.73%)(χ2=...     

157株葡萄球菌的耐药性分析

目的　监测葡萄球菌 (包括MRS和MSS株 )的耐药性 ,为临床合理选择抗生素提供依据。方法　药敏试验及耐甲氧西林葡萄球菌的检测均采用琼脂扩散法 (K -B法 ) ,操作及结果判断均按NCCLS标准执行。结果　金黄色葡萄球菌与凝固酶阴性葡萄球菌的分离率分别占 30 . 5 %和 6 9 .5 % ;MRSA和MRSCON株的检出率分别为 4 0 . 5 %和 6 7 .3% ;MRSA株对喹诺酮类的耐药性 (2 2 . 3%～ 5 8. 5 % )明显低于MRSCON株(80 . 7%～ 88 .5 % ) ;除万古霉素、呋喃妥因、阿米卡星和部分青霉素类外 ,MRSA和MRSCON株的耐药性显著高于MSSA和MSSCON株 (P <0 . 0 5 ) ;未发现VRS株。结论　由MRS菌株引起的严重感染首选万古霉素治疗 ,发现MRS株实验室要根据NCCLS的有关规定修订药敏报告 ,并且及时切断传播途径 ,降低细菌的耐药性和医院感染。     

耐甲氧西林金黄色葡萄球菌医院感染及社区感染的流行特点

目的了解住院患者中耐甲氧西林金黄色葡萄球菌(MRSA)医院感染及社区感染的流行特点,为积极预防和控制MRSA的感染与传播提供科学依据。方法 2008年7月1日-2010年12月31日,由专职人员每天根据细菌培养结果按照统一的方法到病房对患者进行前瞻性调查,2005年1月1日-2008年6月30日对金黄色葡萄球菌培养阳性住院患者进行回顾性调查。结果 MRSA医院感染率为0.10‰,入院患者中MRSA社区发病的感染率为1.40‰;医院感染中MRSA感染率为70.40%,显著高于社区感染感染率为46.04%(P<0.001);MRSA感染主要发生在重症监护病房(ICU)、内科及干部病房,呼吸系统的感染;MRSA感染率最高的是ICU和干部病房,>80.0%,呼吸系统和泌尿系统的感染。结论金黄色葡萄球菌耐药状况在医院内形势依然严峻,预防与控制MRSA感染重点在ICU、内科及干部病房,主要发生在呼吸系统的感染。     

213株金黄色葡萄球菌的分布及药敏分析

目的调查分析医院耐甲氧西林金黄色葡萄球菌的分布及药敏率。方法采用VITEK-2微生物鉴定仪及纸片扩散法K-B对2006-2010年收集到的213株金黄色葡萄球菌进行鉴定和药物敏感性试验分析。结果 213株金黄色葡萄球菌中,49.3%为耐甲氧西林金黄色葡萄球菌(MRSA),50.7%为甲氧西林敏感金黄色葡萄球菌(MSSA);在105株MRSA中ICU、普通外科、呼吸科、脑外科检出率较高,儿科检出率相对较低;所有MRSA均对青霉素耐药(100.0%),同时对测试的多种抗菌药物耐药;所有金黄色葡萄球菌对万古霉素敏感,敏感率100.0%。结论 MRSA的高检出率对多种药物的耐药性表明,应加强其监测,合理使用抗菌药物,防止MRSA医院感染暴发的流行。     

金黄色葡萄球菌277株的临床分布及耐药性分析

目的探讨金黄色葡萄球菌的临床分布及耐药性。方法应用药敏试验对277株金黄色葡萄球菌（SAU）进行检测,然后对其临床分布及耐药性进行分析。结果 277株SAU主要来自痰液（占35.74%）和脓液（占35.37%）。临床分布主要在ICU病房和骨科（分别占24.19%）。277株SAU中耐甲氧西林金黄色葡萄球菌（MRSA）201株,检出率为72.56%,其余为甲氧西林敏感金黄色葡萄球菌（MSSA）。16种抗生素药敏试验,MRSA对苯唑西林、青霉素、庆大霉素、左氧氟沙星、诺氟沙星、复方新诺明等6种的耐药率明显高于MSSA的耐药率,两者间差异有统计学意义（P〈0.05）。其余十种两者耐药率差异无统计学意义（P〉0.05）。结论 MRSA是医院感染的重要病原菌,对苯唑西林、青霉素、庆大霉素、左氧氟沙星、诺氟沙星、复方新诺明的耐药率比MSSA明显增高。     

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.