老年患者下呼吸道感染病原菌分布及耐药性分析

目的 探讨老年患者下呼吸道感染常见病原菌的感染现状及耐药性.方法采用天地人微生物分析系统对2008年1月至2011年5月在该院住院治疗的下呼吸道感染患者痰培养所分离的菌株进行鉴定分析.结果 985份痰液标本中共分离出病原菌296株(30.05%).其中革兰阴性(G-) 杆菌241株(81.42%),主要为肺炎克雷伯菌63株(21.28%)、大肠埃希菌57株(19.26%)、铜绿假单胞菌48株(16.22%)、鲍曼不动杆菌25株(8.45%)、阴沟肠杆菌19株(6.42%),其他G-杆菌29株(9.80%);革兰阳性(G+)球菌36株(12.16%),主要为金黄色葡萄球菌12株(4.05%)和表皮葡萄球菌11株(3.72%),其他G+球菌13株(4.39%);真菌19株(6.42%).63株肺炎克雷伯菌中ESBLs阳性菌15株,占23.81%;57株大肠埃希菌中ESBLs阳性菌12株,占21.05%.美洛培南对G-杆菌具高度敏感性.结论 该院老年患者下呼吸道感染病原菌以G-杆菌为主,对多种抗菌药物耐药率较高,应引起重视并合理选择抗菌药物.     

肿瘤患者下呼吸道感染常见病原菌的分布与耐药性研究

目的 研究肿瘤患者下呼吸道感染常见病原菌的分布与耐药现状,为临床合理使用抗菌药物提供科学依据.方法对2 037例下呼吸道感染肿瘤患者深部咳出的痰标本,按照<全国临床检验操作规程>进行病原菌分离、鉴定,药敏试验采用纸片扩散法(K-B法),并按 CLSI/NCCLS规定的标准进行.结果 病原菌的阳性检出率为70.3%,其中G-杆菌占40.9%,G+球菌占29.5%,真菌占28.7%;大肠埃希菌、凝固酶阴性葡萄球菌(CNS)和白色假丝酵母菌分别为G-杆菌、G+球菌和真菌的首位;大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs) 菌株分别为52.7%和30.8%,阴沟肠杆菌产AmpC酶菌株占16.9%,铜绿假单胞菌产金属β-内酰胺酶(MBL)菌株占9.8%;甲氧西林耐药株分别占金黄色葡萄球菌(SAU)和CNS的38.3%和70.5%,未发现万古霉素耐药的耐甲氧西林SAU(MRSA)和耐甲氧西林CNS(MRCNS);万古霉素、碳青霉烯类药物仍然分别是G+球菌和肠杆菌科细菌最敏感的药物.结论 本院肿瘤患者下呼吸道感染以白色假丝酵母菌位居第一,对伊曲康唑耐药性较严重;细菌耐药性以产ESBLs大肠埃希菌、肺炎克雷伯菌,产AmpC酶阴沟肠杆菌,产MBL铜绿假单胞菌,鲍曼不动杆菌,MRSA和MRCNS比较严重,其他细菌也分别存在不同程度的耐药情况.临床微生物实验室应继续加强耐药性检测,为临床合理选用抗菌药物提供科学依据.     

呼吸道病原菌分布及耐药性分析

目的：了解呼吸道感染患的病原菌分布及耐药性，指导临床合理用药。方法：从呼吸道分离出341株病原菌进行耐药性分析。产超广谱β内酰胺酶(ESBLs)细菌的检测及体外药敏试验均采用K-B法。结果：分离前5位的细菌依次为白念珠菌(占21％)、肺炎克雷伯菌(17％)、铜绿假单胞菌(13％)、大肠埃希菌(9％)和弗劳地柠檬酸杆菌(6％)。产ESBLs细菌的总检出率为16．8％。从呼吸道分离出的致病菌以革兰阴性杆菌为主，占72．7％；其次为真菌和革兰阳性球菌，分别占22．3％和4．7％。肺炎克雷伯菌和铜绿假单胞菌对亚胺培南、头孢哌酮-舒巴坦(头孢哌酮-舒巴坦对铜绿假单胞菌的敏感性高于亚胺培南)、头孢菌素类(铜绿假单胞菌只对头孢他啶、头孢哌酮敏感)、氨曲南、哌拉西林、呋喃妥因、喹诺酮类、氨基糖苷类的敏感性高。结论：革兰阴性杆菌为呼吸道感染的主要病原菌，真菌的感染不容忽视。临床应根据病原菌的种类(包括真菌)、药敏试验、耐药株的报告结果，正确选择药物。     

下呼吸道感染病原菌及其耐药性分析

目的：了解下呼吸道感染常见病原菌的感染现状及其耐药性。方法对1854例呼吸道感染患者痰标本进行病原菌鉴定及药敏试验检测,分析病原菌构成比及耐药性。结果下呼吸道感染病原菌以革兰阴性杆菌为主,占72.0%,革兰阳性球菌占23.1%,真菌占4.9%。革兰阴性杆菌以肺炎克雷伯菌(20.0%)、铜绿假单胞菌(18.7%)、鲍曼不动杆菌(15.6%)、大肠埃希菌(10.9%)为主;革兰阳性球菌以葡萄球菌属与链球菌属为主;真菌以白色念珠菌为主。革兰阳性球菌中的耐甲氧西林金黄色葡萄球菌耐药性较强,但未检出万古霉素耐药菌株。产超广谱β-内酰胺酶革兰阴性杆菌的耐药性明显高于非产酶菌株,但对亚胺培南、美罗培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率相对较低。结论下呼吸道感染病原菌种类较多,耐药性相差甚远,应根据药敏试验检测结果合理选择抗菌药物。     

下呼吸道感染病原菌分布及耐药性分析

目的分析下呼吸道感染常见病原菌分布及耐药性变迁情况,为临床合理使用抗菌药物提供依据。方法对临床送检痰标本进行分离培养,应用VITEK-2微生物分析仪进行菌种鉴定和药敏试验,采用WHONET5.4软件对数据进行统计分析。结果共分离病原菌3 050株,其中革兰阴性杆菌2 425株,占79.51%,革兰阳性球菌431株占14.13%,真菌194株占6.36%。革兰阴性杆菌中前4位的细菌分别为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌;其中鲍曼不动杆菌和铜绿假单胞菌对亚胺培南耐药率分别为75.0%和34.8%。大肠埃希菌、肺炎克雷伯菌ESBLs阳性率分别为81.4%、44.6%,且肺炎克雷伯菌对亚胺培南的耐药率达18.9%。革兰阳性球菌主要为金黄色葡萄球菌、肺炎链球菌;其中,耐甲氧西林金黄色葡萄球菌分离率达68.6%,未发现万古霉素耐药。结论本院下呼吸道感染病原菌以革兰阴性杆菌为主。非发酵菌最为常见且耐药问题较为严重。革兰阳性球菌未发现万古霉素耐药菌株。     

1253份痰标本的培养及药敏试验结果分析

目的 了解呼吸道感染的主要病原菌分布及耐药情况.方法 对1 253份痰标本进行培养和药敏试验.结果 1 253份痰标本检出病原菌393株,阳性率31.36%,检出率最高的菌株为肺炎克雷伯菌,共91株,占23.15%,金黄色葡萄球菌77株,占19.59%,大肠埃希菌72株,占18.32%,鲍曼不动杆菌45株,占11.45%,铜绿假单孢菌41株,占10.43%.革兰阴性杆菌仍是呼吸道感染的主要病原菌,碳青霉烯类药物对革兰阴性杆菌感染最敏感.金黄色葡萄球菌是引起呼吸道感染最主要的革兰阳性菌,本次实验的耐甲氧西林金黄色葡萄球菌检出率达到55.84%,未发现万古霉素耐药的菌株,万古霉素和利奈唑胺对金黄色葡萄球菌保持100%的敏感率.结论 临床应重视病原菌检测及药敏试验,合理使用抗生素,减少广谱抗生素的应用,杜绝盲目地使用多联抗生素的现象,预防细菌耐药性的增加和致命的二重感染.     

急性下呼吸道感染患儿痰培养联合药敏试验结果分析

目的分析急性下呼吸道感染患儿痰培养联合药敏试验的结果,探讨其对临床用药的影响。方法随机选取2015年3月至2017年4月急性下呼吸道感染患儿665例,均给予痰培养及药敏试验,应用细菌耐药性监测数据处理软件Whonet 5.3处理数据,分析下呼吸道感染病原菌及常见病原菌耐药情况。结果 665例急性下呼吸道感染患儿经痰培养,共分离出病原菌329株,占49.47%(329/665),其中革兰阳性菌87株(26.44%),革兰阴性菌233株(70.82%),其他菌9株(2.74%)。肺炎克雷伯菌、大肠埃希菌对氨苄西林均有较强耐药性,耐药率分别为91.03%、91.30%;鲍氏不动杆菌、金黄色葡萄球菌对氨苄西林耐药率分别为85.19%、17.07%。结论对急性下呼吸道感染患儿进行痰培养及药敏试验,可及时明确感染病原菌及其耐药情况,对合理选择敏感抗生素具有重要意义。     

重症监护病房下呼吸道感染病原菌分布及耐药性分析

目的了解重症监护病房(ICU)下呼吸道感染病原菌分布及耐药特征,为临床治疗提供参考。方法对2007年8月至2009年8月,ICU患者下呼吸道标本细菌分离培养鉴定及抗菌药物敏感试验进行回顾分析。结果203例下呼吸道标本中156例检出细菌,培养阳性率为76.8%,共分离到病原菌184株,其中革兰阴性杆菌(G-)130株,占70.7%,革兰阳性球菌(G+)23株,占12.5%,假丝酵母菌31株,占16.8%;分离前4位的病原菌依次是铜绿假单胞菌(PAE)、鲍曼不动杆菌(ABA)、白假丝酵母菌(SMA)、嗜麦芽寡养单胞菌;铜绿假单胞菌和鲍曼不动杆菌耐药情况严重,对多种抗菌药物的耐药率高达100%。结论ICU下呼吸道感染病原菌分布以非发酵菌为主,复合菌感染、非发酵菌合并真菌感染较为常见,病原菌多为泛耐药菌,显示监测细菌分布与耐性变化对指导抗菌药物合理使用、延缓泛耐药菌株形成最有重要意义。     

广州地区下呼吸道感染常见病原菌的分布与耐药性

目的 :探讨广州地区下呼吸道感染常见病原菌分布与耐药情况。方法 :收集广州地区 13所医院下呼吸道感染患者痰标本分离的 1778株病原菌 ,按美国国家临床实验室标准委员会 (NCCLS)标准进行药敏试验。结果 :主要菌群有铜绿假单胞菌 (2 2 .7% )、克雷伯菌属 (15 .8% )、不动杆菌属 (12 .5 % )和肠杆菌属 (10 .5 % )等。甲氧西林耐药株分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的 75 .7%和 92 .9% ,未发现万古霉素耐药株。大肠埃希菌和克雷伯菌属产超广谱 β内酰胺酶 (ESBLs)的发生率是 4 6 .8%和 37.0 % ,产ESBLs菌株对各种抗菌药物的耐药率明显高于不产ESBLs菌株。铜绿假单胞菌对头孢哌酮 舒巴坦、头孢他啶、头孢吡肟和亚胺培南的敏感率较高。结论 :广州地区下呼吸道感染主要病原菌是革兰阴性杆菌 ,其对常用抗菌药物耐药性较高 ,开展细菌耐药性监测十分重要。     

下呼吸道感染常见病原菌及药敏分析

目的回顾分析院内下呼吸道感染病原菌的分布及耐药情况,为临床选用抗菌药物提供参考依据。方法收集住院下呼吸道感染患者痰标本分离的病原菌,采用纸片扩散法行药敏试验。结果分离出819株病原菌,其中革兰阴性杆菌574株,占70.1%,革兰阳性球菌154株,占18.8%,真菌91株,占11.1%。革兰阴性杆菌中前3位依次为：铜绿假单胞菌308株,占53.7%,鲍曼不动杆菌140株,占24.4%,大肠埃希菌56株,占9.8%;革兰阳性球菌中前3位为：金黄色葡萄球菌84株,占54.5%,溶血葡萄球菌42株,占27.3%,表皮葡萄球菌21株,占13.6%。耐药性分析：铜绿假单胞菌对头孢曲松耐药率最高,对阿米卡星、头孢吡肟、亚胺培南、美洛培南、哌拉西林/三唑巴坦耐药率较低。鲍曼不动杆菌对头孢曲松耐药率高,对阿米卡星、亚胺培南、美洛培南、哌拉西林/三唑巴坦耐药率低。大肠埃希菌对环丙沙星耐药率高,对阿米卡星、氨苄西林/舒巴坦、头孢他啶、亚胺培南、美洛培南、哌拉西林/三唑巴坦耐药率较低。结论革兰阴性杆菌是下呼吸道感染的常见病原菌,最常见为铜绿假单胞菌;药敏结果表明细菌耐药性较高,应加强病原菌检测及耐药性监测,合理使用抗菌药物。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.