2008-2010年医院铜绿假单胞菌分布与耐药性变迁

目的 了解医院2008-2010年医院铜绿假单胞菌的临床分布及其耐药性,为临床合理使用抗菌药物提供依据.方法 回顾性调查2008年1月-2010年12月,医院住院患者分离的1124株铜绿假单胞菌临床分布及耐药性变迁.结果 3年中分离铜绿假单胞菌主要来源于呼吸道标本,主要分布于ICU、呼吸科、结核科、神经外科等病房;铜绿假单胞菌对抗菌药物的耐药率分别为哌拉西林/他唑巴坦32.7％、阿米卡星38.6％、头孢他啶44.1％、头孢吡肟48.1％;对亚胺培南耐药率为52.5％,且呈逐年上升趋势;铜绿假单胞菌对环丙沙星耐药率为64.4％,庆大霉素耐药率为67.1％,呈逐年上升趋势.结论 铜绿假单胞菌对抗菌药物保持较高耐药水平,并且耐药率逐年上升,应定期监测铜绿假单胞菌分布和耐药率,为临床合理使用抗菌药物提供依据.     

2008-2011年医院铜绿假单胞菌分布及耐药性变迁

目的 了解医院2008-2011年铜绿假单胞菌分布及耐药性变迁,为临床合理用药提供参考.方法 回顾性分析2008-2011年医院各类临床标本所分离的铜绿假单胞菌分布及药敏结果.结果 医院2008-2011年共分离出铜绿假单胞菌420株,分离率4.44％;标本来源以痰液为主,占79.00％,其次是分泌物,占7.85％;科室分布以神经外科最多,占22.38％,其次是呼吸内科和ICU,分别占20.95％和20.00％;铜绿假单胞菌的耐药性整体呈逐年上升趋势,耐药情况严重,除对亚胺培南耐药率较低外,对其他抗菌药物均产生了较严重的耐药性;对亚胺培南、美罗培南、头孢哌酮/舒巴坦、头孢他啶、阿米卡星、左氧氟沙星耐药率相对低,到2011年耐药率在37.06％～49.24％;对磺胺甲噁唑/甲氧苄啶、阿莫西林/克拉维酸、氨苄西林、庆大霉素、头孢西丁及除头孢他啶外的头孢菌素,均呈较高的耐药性,至2011年耐药性接近100.00％;氨曲南、头孢哌酮/舒巴坦,在2008年时耐药率低,分别为16.67％和17.24％,但从2009年开始耐药率逐年上升,至2011年耐药率分别为54.05％和42.35％;亚胺培南和美罗培南在2008年时耐药率低,分别为26.42％、28.3％,但从2009年开始逐年上升,至2011年耐药率分别为37.24％和45.18％.结论 铜绿假单胞菌的分离率和耐药性呈逐年上升趋势,多药耐药和泛耐药情况严重,应加强抗菌药物分级管理,临床科室应依据药敏结果合理应用抗菌药物,同时做好重点科室的医院感染控制,防止耐药菌株播散.     

基层医院铜绿假单胞菌的分布及耐药性分析

目的探讨基层医院培养的铜绿假单胞菌对常用抗菌药物的耐药性,为临床合理使用抗菌药物提供试验依据。方法采用K-B法对医院感染性标本中分离的234株铜绿假单胞菌进行14种抗菌药物的体外药敏试验结果两年来从临床各类标本中共分离出铜绿假单胞菌234株,其中尿液标本占43.2%,痰液标本占20.1%,脓液和分泌物标本占17.9%,穿刺液标本占12.0%;铜绿假单胞菌对常用抗菌药物的耐药率以亚胺培南和美罗培南为最低,分别为2.1%、1.7%;其他耐药率较低的还有头孢哌酮/舒巴坦(13.2%)、哌拉西林/他唑巴坦(13.2%)、阿米卡星(20.1%)等;而氨曲南、头孢噻肟、左氧氟沙星、环丙沙星耐药率均>50.0%。结论医院感染铜绿假单胞菌具有多药耐药性,需加强监测与控制。     

2007-2009年医院感染铜绿假单胞菌的耐药性分析

目的 了解医院铜绿假单胞菌对临床常用抗菌药物的耐药率,为临床经验性治疗及控制医院感染提供依据.方法 对2007-2009年1694株铜绿假单胞菌感染病例及耐药率进行回顾性调查与统计,采用常规方法对临床送检的标本进行细菌分离、培养、鉴定及药敏试验.结果 铜绿假单胞菌主要来源于痰液,占68.0％;3年间对16种抗菌药物耐药水平差异均有统计学意义(P＜0.05); 1694株铜绿假单胞菌对16种抗菌药物总耐药率为:环丙沙星26.9％、头孢哌酮/舒巴坦33.0％、美罗培南33.5％、头孢他啶33.7％、亚胺培南/西司他丁39.6％、氨曲南39.2％、头孢吡肟42.0％、左氧氟沙星42.8％、阿米卡星46.4％、哌拉西林/他唑巴坦48.4％、头孢哌酮50.7％、哌拉西林56.2％、庆大霉素59.8％、头孢曲松64.1％、替卡西林/克拉维酸64.6％、头孢噻肟69.3％.结论 铜绿假单胞菌对临床常用抗菌药物耐药现象严重,仅环丙沙星、头孢哌酮/舒巴坦、美罗培南、头孢他啶、氨曲南、亚胺培南/西司他丁保持相对高的抗菌活性.     

铜绿假单胞菌耐药性的变迁

目的分析临床分离的铜绿假单胞菌耐药性变迁,为铜绿假单胞菌感染的临床治疗提供依据。方法对2009-2012年共分离出412株铜绿假单胞菌采用纸片法测定对抗菌药物的敏感性,采用WHONET5.6软件统计分析。结果共分离出铜绿假单胞菌412株,标本主要为痰液和支气管灌洗液,占60.00%;铜绿假单胞菌感染主要发生在ICU、消化内科和神经科分离率明显增高;铜绿假单胞菌2009-2010年对多种抗菌药物的耐药性均呈上升趋势,对多黏菌素B耐药率为0,对阿米卡星耐药率约7.00%,其次头孢哌酮/舒巴坦4年中耐药率均<20.00%,对其他抗菌药物包括碳青霉烯类抗菌药物亚胺培南、美罗培南耐药率均>30.00%,4年头孢噻肟耐药率达到100.00%;经抗菌药物治理,2011-2012年耐药性均有所下降。结论铜绿假单胞菌是医院感染的重要致病菌,应加强对铜绿假单胞菌引起感染的管理,规范抗菌药物使用,减少耐药性发生。     

铜绿假单胞菌耐药性动态变化特征及分析

目的分析我院6年来铜绿假单胞菌耐药性的变化,为临床合理选用抗菌药物提供依据. 方法采用K-B纸片扩散法对临床标本分离的铜绿假单胞菌进行抗菌药物敏感性测定,数据输入WHONET4及SPSS 10.0软件进行对比统计分析. 结果对铜绿假单胞菌保持抗菌活性较强而耐药率＜30%的抗菌药物有阿米卡星、亚胺培南、头孢他啶、头孢哌酮/舒巴坦、头孢吡肟等,但6年来铜绿假单胞菌对常用抗菌药物的耐药率有普遍增高的趋势,其中对阿米卡星、庆大霉素、环丙沙星、亚胺培南、哌拉西林、替卡西林/克拉维酸、头孢噻肟、头孢曲松、头孢哌酮、头孢哌酮/舒巴坦等抗生素的耐药率变化显著(P<0.05). 结论铜绿假单胞菌对常用抗菌药物的耐药率高,多重耐药现象严重,根据药敏结果选择单一或联用抗菌药物,可有效控制和减缓细菌耐药性的增长.     

2011-2013年铜绿假单胞菌临床分离株的耐药性变迁分析

目的了解2011-2013年临床分离的铜绿假单胞菌对抗菌药物的耐药性变迁,为临床医师选择敏感抗菌药物治疗感染性疾病提供参考依据。方法调查统计医院2011-2013年临床分离的612株铜绿假单胞菌在各类感染性标本中的分布,以及铜绿假单胞菌对临床抗菌药物的耐药率,临床标本的正确采集运送、菌株分离培养及鉴定严格按照《临床微生物学操作技术流程》进行;药敏操作技术和数据界定采用K-B法及CLSI当年新的折点进行;数据采用WHONET5.5-5.6统计软件处理。结果 2011-2013年临床标本中共分离出铜绿假单胞菌612株,其中分离自呼吸道338株、泌尿道133株,分别占55.2%、21.7%;2011-2013年耐碳青霉烯类铜绿假单胞菌检出率分别为8.5%、10.2%、12.4%,泛耐药铜绿假单胞菌检出率分别为8.5%、8.7%、9.2%;2011-2013年耐药率上升幅度较大的抗菌药物为氨曲南、头孢他啶、环丙沙星;耐药率基本持平的抗菌药物为阿米卡星和庆大霉素;耐药率有所下降的抗菌药物为磺胺甲噁唑/甲氧苄啶、头孢哌酮/舒巴坦。结论 2011-2013年临床分离的铜绿假单胞菌对大多数抗菌药物耐药率表现出逐年上升趋势,因此,动态监测细菌耐药性已成为医院管理的重要项目,务必实施抗菌药物科学管理,力图扭转细菌耐药性非正常增长的不良趋势。     

铜绿假单胞菌的临床分布及耐药性分析

目的 了解医院2009年1月-2010年5月铜绿假单胞菌的临床分布及耐药性,为临床合理用药提供依据.方法 对医院各种感染标本中分离出的铜绿假单胞菌应用法国生物梅里埃全自动微生物鉴定仪进行鉴定,并做临床常用抗菌药物耐药性分析,用Whonet5.4软件进行统计分析.结果 187株铜绿假单胞菌主要来源于呼吸内科和ICU,分别占39.04％和20.86％;主要来源于痰液,共分离出152株,占81.28％;铜绿假单胞菌对亚胺培南、哌拉西林/他唑巴坦、美罗培南以及阿卡米星对铜绿假单胞菌有较好的抗菌活性,耐药率依次为9.2％、11.3％、16.2％和13.0％;对氨苄西林、氨苄西林/舒巴坦、头孢替坦、呋喃妥因和头孢唑林耐药率＞95.00％;对庆大霉素、氨曲南、头孢他啶和头孢吡肟等的耐药率＜50.00％.结论 医院临床分离的铜绿假单胞菌主要来源于呼吸道感染患者痰液标本中,耐药现象比较严重,加强耐药性检测,以指导临床合理用药控制医院感染.     

2011-2013年铜绿假单胞菌的耐药性变迁

目的了解2011-2013年铜绿假单胞菌(PAE)的感染及耐药性变迁,为临床合理选择抗菌药物提供科学依据。方法分析医院2011年1月-2013年12月临床标本中分离出1 053株铜绿假单胞菌,分离培养鉴定按照《全国临床检验操作规程》进行,药敏试验采用MIC法,数据采用SPSS 13.0软件进行统计分析。结果 2011-2013年共检出铜绿假单胞菌1 053株,其中从痰液中分离991株占94.11%;3年耐药率最高的抗菌药物为磺胺甲噁唑/甲氧苄啶、氯霉素和米诺环素,均为100.00%;3年耐药率均<20.00%的抗菌药物有氨曲南、哌拉西林/他唑巴坦、头孢吡肟、头孢哌酮/舒巴坦、多黏菌素B和黏菌素;耐药率增幅较大的抗菌药物为亚胺培南和美罗培南,分别由2011年的6.65%、8.82%上升至2013年的37.24%、21.62%。结论应加强铜绿假单胞菌耐药性监测,合理使用抗菌药物治疗,控制耐药菌株的产生。     

鲍氏不动杆菌及铜绿假单胞菌的分布与耐药性监测

目的 了解临床分离的鲍氏不动杆菌、铜绿假单胞菌的分布和耐药性,以指导临床合理使用抗菌药物.方法 K-B纸片扩散法测定临床分离菌株对常用抗菌药物的药物敏感性,按CLSI 2009年标准判读,用WHONET 5.4软件分析数据.结果 2011年浙江省人民医院共收集到非重复的鲍氏不动杆菌606株,分离自ICU 237株占39.1％,鲍氏不动杆菌对多黏菌素B敏感率为100.0％,对头孢哌酮/舒巴坦的敏感率为26.3％,哌拉西林/他唑巴坦为30.1％;对亚胺培南、美罗培南的敏感率分别为31.0％和40.8％,耐碳青霉烯类鲍氏不动杆菌(CRAB)为77.2％;2011年医院临床分离铜绿假单胞菌579株,164株分离自医院中心ICU(28.3％),铜绿假单胞菌对多黏菌素B敏感率最好为100.0％、妥布霉素为86.7％、左氧氟沙星为64.3％,对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的敏感率分别为63.8％、82.4％,对亚胺培南、美罗培南的敏感率分别为55.3％、64.7％;耐碳青霉烯类抗菌药物的铜绿假单胞菌(CRPA)检出率为44.6％.结论 临床分离的鲍氏不动杆菌、铜绿假单胞菌对常用抗菌药物敏感性低,CRPA、CRAB检出率高,应加强抗菌药物的合理使用和医院感染控制.     

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.     

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.     

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.     

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.