2007-2012年浙江萧山医院尿路感染患者的肠球菌分布及耐药性分析

目的 调查从尿路感染患者分离的肠球菌的菌种、临床分布及耐药性,为临床合理选用抗生素提供依据。方法 尿培养采用经典型浸片Uricult,ATB-Expression细菌分析系统进行鉴定和药敏试验;所有资料采用Whonet 5.6软件进行回顾性分析。结果 分离肠球菌238株,主要为粪肠球菌122株（51.3%）和屎肠球菌95株（39.9%）;菌株主要来源列前2位的是内科（38.2%）和泌尿外科（21.0%）;耐药率较高的是红霉素（86.5%）、利福平（75.7%）和四环素（66.4%）;较低的是呋喃妥因（19.7%）、万古霉素（9.6%）和利奈唑胺（0.0%）;粪肠球菌对利福平、红霉素、奎奴普丁/达福普汀和四环素的耐药率较高,均76.5%,万古霉素耐药率0.9%;屎肠球菌对氨苄西林等8种药物耐药率75.8%,万古霉素耐药率4.3%。粪肠球菌对所测试抗生素耐药率仅有四环素、奎奴普丁/达福普汀高于屎肠球菌,其余低于屎肠球菌;利福平、万古霉素和利奈唑胺耐药率在二者间差异无统计学意义。2007年与2012年相比,青霉素、氨苄西林等药物耐药率上升,而环丙沙星、四环素等下降。结论 肠球菌是引起尿路感染的重要病原菌,以粪肠球菌和屎肠球菌为主,不同种类肠球菌耐药率差别较大,加强细菌培养和定期分析其耐药性,有助于提高临床治愈率及合理用药水平。     

2009—2013年肠球菌属临床感染及耐药性分析

目的了解肠球菌属临床分布及耐药性特征,为临床合理使用抗菌药物提供依据。方法回顾性分析855株临床分离的肠球菌,采用VITEK2 Compact全自动微生物分析仪做细菌鉴定和药敏试验,K-B纸片法筛检高水平庆大霉素耐药株,数据统计分析用WHONET5.5软件。结果共检出465株屎肠球菌和347株粪肠球菌,主要分离自尿液、引流液和伤口分泌物。屎肠球菌总体耐药率较高,其对氨苄西林、环丙沙星、青霉素和左氧氟沙星耐药率≥71.4%,明显高于粪肠球菌对这4种抗菌药物的耐药率(≤37.2%);粪肠球菌对四环素、奎奴普丁-达福普汀的耐药率(分别为76.4%和72.6%)明显高于屎肠球菌对这两种抗菌药物的耐药率(分别为59.4%和5.6%);两种细菌对红霉素均显示较高的耐药率(≥76.9%),对万古霉素和替考拉宁耐药率较低(均≤2.2%)。812株屎肠球菌和粪肠球菌中共筛检出高水平庆大霉素耐药株537株,占66.1%(537/812)。结论肠球菌属感染以屎肠球菌、粪肠球菌为主;屎肠球菌对大多数抗菌药物耐药率高于粪肠球菌;已检出多株万古霉素耐药肠球菌;大部分肠球菌为高水平庆大霉素耐药株;临床治疗应根据病原菌药物敏感试验结果选择适当的治疗药物。     

肠球菌的临床分布特征及对利奈唑胺等新型抗菌药物的耐药性分析

目的:研究肠球菌属的分布特征及对利奈唑胺、奎奴普丁/达福普丁等新型抗菌药物的耐药性,为临床合理用药提供依据。方法:使用VITEK2-compact全自动微生物分析仪进行细菌鉴定。药敏实验采用最小抑菌浓度(MIC)法,运用统计学软件EpiInfor2000、WHONE5.4分析实验数据。结果:在所有170株受检肠球菌中,屎肠球菌、粪肠球菌、其他肠球菌分别占52.9%、41.2%和5.9%。检出肠球菌株数最多的标本是尿液,其余为胆汁和血液等。药敏结果表明,肠球菌属总体耐药水平较高,仅对万古霉素和利奈唑胺极度敏感,屎肠球菌除对氯霉素、四环素、奎奴普丁/达福普丁的耐药率低于粪肠球菌以外,对其他多数抗生素的耐药率均高于粪肠球菌。利奈唑胺对屎肠球菌和粪肠球菌的MIC值大多为1和2μg/L。72%粪肠球菌对奎奴普丁/达福普丁的MIC值大于2μg/L,而80%的屎肠球菌对其的MIC值则小于2 mg/L。结论:临床肠球菌属感染以屎肠球菌、粪肠球菌为主,屎肠球菌对大多数抗生素的耐药率均高于粪肠球菌。利奈唑胺对屎肠球菌和粪肠球菌均显示出了强大的抗菌活性,而奎奴普丁/达福普丁只对屎肠球菌有较好的抗菌活性。临床治疗应根据药敏试验合理应用抗菌药物,或选用利奈唑胺治疗耐万古霉素的肠球菌所引起的感染,同时密切关注抗菌药物的MIC值变化,以此延长药物的使用寿命。     

2010年中国CHINET肠球菌属细菌耐药性监测

目的了解2010年中国主要地区临床分离肠球菌属细菌对各类抗菌药物的耐药性。方法国内主要地区14所教学医院(12所综合性医院,2所儿童医院)按统一方案、采用统一的材料、方法(K-B法)和判断标准(CLSI 2010年版)进行肠球菌属细菌的耐药性监测。结果共分离到4 046株非重复肠球菌属细菌,最常见菌种为粪肠球菌1 829株(45.2%)、屎肠球菌1 817株(44.9%)、鹑鸡肠球菌78株(1.9%)、鸟肠球菌54株(1.3%)、铅黄肠球菌49株(1.2%)。肠球菌属对利奈唑胺、万古霉素、替考拉宁仍极敏感,耐药率<4%,万古霉素耐药粪肠球菌和屎肠球菌检出率分别为0.6%、3.6%。粪肠球菌对呋喃妥因、磷霉素和氨苄西林耐药率较低,分别为3.2%、5.7%和11.3%,对高浓度庆大霉素耐药率为44.0%;屎肠球菌耐药性明显高于粪肠球菌,对氨苄西林耐药率接近90%,对高浓度庆大霉素耐药率接近70%,对氯霉素耐药率仅为7.3%,儿童屎肠球菌分离株对磷霉素、呋喃妥因耐药率<10%。不同医院分离的肠球菌属细菌对抗菌药物的耐药率有一定差异。结论屎肠球菌的分离率有增加趋势,肠球菌属细菌对利奈唑胺、万古霉素、替考拉宁依然保持极高的敏感性。     

372例肠球菌对16种抗菌药物的药敏试验研究

目的探讨粪肠球菌和屎肠球菌对16种抗菌药物的耐药性。方法十堰市中医院2010年1月至2014年1月检出的372例肠球菌(280例粪肠球菌和92例屎肠球菌),对青霉素、红霉素、氯霉素、万古霉素、利奈唑胺等16种抗菌药物的药敏试验结果进行统计分析。结果粪肠球菌和屎肠球菌耐药率最高的均是红霉素,分别为86.07%和92.39%,差异无统计学意义(P0.05),耐药率最低的均是利奈唑胺,分别为0.36%和1.09%,差异无统计学意义(P0.05)。在青霉素、氨苄西林、他唑巴坦、奈替米星、环丙沙星和呋喃妥因等6种抗菌药物中,粪肠球菌的耐药率明显高于屎肠球菌,差异有统计学意义(P0.05),而在氯霉素和高浓度链霉素中,粪肠球菌的耐药率明显低于屎肠球菌,差异有统计学意义(P0.05)。结论粪肠球菌和屎肠球菌对16种抗菌药物有不同程度的耐药性,且耐药率有差异。     

2009～2012年重庆医科大学附属第一医院粪肠球菌和屎肠球菌耐药性监测

目的 了解2009~2012年重庆医科大学附属第一医院临床分离的粪肠球菌和屎肠球菌对各类抗菌药物的耐药性。方法 临床分离病原菌按统一方案进行细菌药物敏感试验,根据2012年版临床实验室标准化协会(CLSI)指导原则判读细菌的药物敏感试验结果,采用WHONET5.6软件对数据进行分析。结果 共分离到非重复粪肠球菌783株,屎肠球菌664株,二者对利奈唑胺和万古霉素非常敏感(耐药率均低于2.0%),粪肠球菌和屎肠球菌对万古霉素耐药率分别为0.1%和1.4%。粪肠球菌对青霉素、氨苄西林和呋喃妥因的耐药率较低,分别为5.7%、2.6%和2.2%;对庆大霉素的耐药率为32.9%。屎肠球菌对青霉素和氨苄西林的耐药率均在90.0%以上。结论 重庆医科大学附属第一医院肠球菌感染以粪肠球菌为主,监测其耐药情况对指导临床合理用药具有重要意义。     

粪肠球菌和屎肠球菌的临床分布及耐药监测研究

目的 研究临床感染患者中粪肠球菌和屎肠球菌的临床分布、对抗菌药物的敏感性以及耐药情况。方法北京积水潭医院2014年1月至2015年12月临床送检的感染标本,分离粪肠球菌和屎肠球菌进行鉴定和药敏分析。结果 分离出粪肠球菌184株,屎肠球菌109株。粪肠球菌药物敏感性从高到低依次为万古霉素、替考拉宁、氨苄西林、呋喃妥因、利奈唑胺、高浓度庆大霉素。屎肠球菌药物敏感性从高到低依次为替考拉宁、利奈唑胺、万古霉素、四环素、高浓度庆大霉素。检测出耐高浓度庆大霉素(HLGR)粪肠球菌75株,分离率为40.76%,HLGR屎肠球菌48株,分离率为44.04%。检测出2株耐万古霉素的粪肠球菌,分离率为1.09%,9株耐万古霉素霉素的屎肠球菌,分离率为8.26%。结论 肠球菌属的总体耐药率较高,且综合评价屎肠球菌的耐药性高于粪肠球菌,但肠球菌属对于万古霉素、利奈唑胺、替考拉宁等仍然保持较高的敏感性,临床上应选用合适的方法对肠球菌属进行耐药性检测,根据药敏结果选择适当的抗菌药物治疗。     

临床胆汁标本分离肠球菌的耐药性分析

摘要 目的 了解临床胆汁标本分离肠球菌的菌种分布及耐药趋势变化。方法 通过回顾性分析方法,对某医院住院患者送检胆汁标本分离出的856株肠球菌的分布及其耐药性进行分析。结果 856株胆汁来源肠球菌中,以粪肠球菌和屎肠球菌为主,构成比分别占46.5%和26.9%。屎肠球菌对红霉素、青霉素G和氨苄西林等抗菌药物耐药率均＞50%。粪肠球菌庆大霉素、青霉素G、氨苄西林和左氧氟沙星等抗菌药物比较敏感,耐药率均＜20%。6年间屎肠球菌对左氧氟沙星耐药率逐年下降(χ2=13.470,P=0.019),粪肠球菌对青霉素(χ2=14.269,P=0.014)、氨苄西林(χ2=20.906,P=0.001)耐药率逐年下降。粪肠球菌和屎肠球菌各检出耐万古霉素菌株4株和3株、耐利奈唑胺菌株26株和8株。结论 该医院临床胆汁标本分离的肠球菌以粪肠球菌和屎肠球菌为主,对常用抗菌药物的耐药率逐年下降,检出万古霉素、利奈唑胺耐药菌株。     

2015年重庆市粪肠球菌和屎肠球菌耐药性监测结果分析

目的 统计分析2015年重庆市细菌耐药监测网成员单位提交的粪肠球菌和屎肠球菌耐药性监测数据,为该市有效应用抗菌药物提供依据和参考.方法 各成员单位根据全国细菌耐药监测网技术方案要求,对目标细菌进行鉴定和药敏试验,并依据美国临床和实验室标准化协会(CLSI)2015版标准进行结果判读,使用WHONET5.6软件对药敏数据进行统计分析,耐药性差异采用SPSS21.0软件进行分析.结果 共分离到非重复粪肠球菌和屎肠球菌分别为1 811株和1 601株,共占所有阳性菌株的13.1%,两者对万古霉素的耐药性分别为0.5%和1.8%,对利奈唑胺的耐药率分别为2.5%和0.5%,均未发现对替加环素耐药的菌株.粪肠球菌对奎奴普丁/达福普汀的耐药性最高,为90.1%,对四环素的耐药率也高达78.8%,对高浓度庆大霉素的耐药率为43.0%,对青霉素、氨苄西林、呋喃妥因的耐药率均低于7.0%.除奎奴普丁/达福普汀和四环素外,屎肠球菌对其他药物的耐药率高于粪肠球菌(P<0.05).儿童和成人患者,以及重症监护病房(ICU)和非ICU患者分离株对部分药物的耐药率比较差异有统计学意义(P<0.05).结论 该市肠球菌感染主要病原菌是屎肠球菌和粪肠球菌,两者耐药性不同.做好耐药性监测有助于指导临床医生规范、有效使用抗菌药物.     

焦作某医院中段尿分离粪肠球菌与屎肠球菌耐药性分析

目的分析326株泌尿系感染粪肠球菌与屎肠球菌的耐药性,为临床合理使用抗生素提供依据。方法对医院2014年1月至2017年12月门诊及住院送检的中段尿培养分离的粪肠球菌与屎肠球菌进行回顾性分析,采用珠海黑马微生物鉴定产品进行细菌鉴定及药敏试验,使用WHONET 5.4软件对数据进行统计分析。结果 326株粪肠球菌与屎肠球菌,粪肠球菌占57.7%,屎肠球菌占42.3%,粪肠球菌分离率高于屎肠球菌;屎肠球菌对氨苄西林(92.8%)、红霉素(93.5%)、环丙沙星(88.4%)、高浓度庆大霉素(76.1%)、青霉素(93.5%)、左氧氟沙星(81.9%)、利福平(77.5%)表现出高度耐药率,粪肠球菌对红霉素(82.4%)、四环素(86.2%)、高浓度庆大霉素(68.6%)表现出高度耐药率,粪肠球菌与屎肠球菌分别检出利奈唑胺耐药1.1%、2.9%,未检出万古霉素与替考拉宁耐药菌株。结论粪肠球菌与屎肠球菌对抗菌药物耐药性差别较大,临床需依据细菌鉴定及药物结果合理使用抗生素,检出的利奈唑胺耐药粪肠球菌与屎肠球菌,应引起临床医生与感控人员的注意,加强细菌耐药性检测,从而减少耐药株的产生,防止细菌耐药性的增加。     

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.