新生儿葡萄球菌属感染及防治对策

目的探讨新生儿葡萄球菌属的感染及防治对策,为临床治疗和控制该菌感染提供指南。方法采用API微生物分析鉴定系统对葡萄球菌属进行鉴定,药物敏感试验采用K-B法。结果从送检标本中分离出葡萄球菌属165株,共检出耐甲氧西林葡萄球菌(MRS)112株,其中耐甲氧西林金黄色葡萄球菌(MRSA)37株,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)75株;MRS在血标本中的检出率高于分泌物和脓液及其他标本(P<0.01);112株MRS菌株对β-内酰胺类抗菌药物100%耐药,对万古霉素100%敏感,对庆大霉素、阿米卡星等常用抗菌药物存在不同程度的敏感性。结论MRS菌株已成新生儿感染的主要病原菌,一旦发现感染病例,应根据新生儿生理特点及药敏试验结果选用抗菌药物治疗。     

145株耐甲氧西林萄萄球菌的检测及药敏结果

目的了解我院耐甲氧西林葡萄球菌（MRS）的感染状况及其对临床常用抗生素的耐药特点，为临床医生正确选用抗菌药物提供参考依据。方法对常德市第二人民医院检验科微生物室2005—2007年收检的临床感染标本分离培养，将鉴定为耐甲氧西林葡萄球菌的病原学和药敏资料进行统计分析。结果（1）、三年来我院微生物室共分离出葡萄球菌255株，其中金黄色葡萄球菌98株，凝固酶阴性葡萄球菌157株。分离出耐甲氧西林金黄色葡萄球菌（MRsA）51株（52．04％），分离出耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）94株（59．87％）。（2）、MRS全部对万古霉素敏感，对利福平、复方新诺明耐药率较低，耐药率都小于25％，但对其它抗菌药物的耐药率较高，耐药率都大于70％。结论目前MRS分离率显著增高，加强MRS检测，指导临床合理使用抗菌药物非常重要。     

某医院内感染耐甲氧西林葡萄球菌的鉴定及耐药监测

目的对医院内感染耐甲氧西林葡萄球菌(MRS)进行分离鉴定及耐药监测,为采取控制措施提供依据。方法采用HX-21微生物分析系统和苯唑西林纸片法进行葡萄球菌的分离鉴定及MRS的筛选;采用K-B法对分离出的MRS进行药敏试验。结果716株葡萄球菌中共分离出MRS 306株,分离率为42.7%;痰液和尿液中MRS检出率分别为68.8%和59.0%,显著高于其它标本(P<0.01);MRS主要分布在重症监护室(占28.1%)、内科病房(占23.5%)及外科病房(占21.2%)。所有MRS对万古霉素敏感,对青霉素、红霉素耐药率>83.5%,对氯霉素、复方新诺明、利福平、阿米卡星的耐药率<57.1%;耐甲氧西林金黄色葡萄球菌对5种抗菌药物的耐药率显著高于耐甲氧西林凝固酶阴性葡萄球菌(P<0.01)。结论MRS在医院内感染严重,且呈多重耐药,应引起关注;临床上要根据药敏结果合理用药,MRS重症感染应首选万古霉素。     

感染性心内膜炎患者血培养病原菌及其耐药性分析

目的 了解安徽地区感染性心内膜炎的病原菌及其耐药性,为指导临床合理用药提供依据.方法 对心内科收治的27例感染性心内膜炎患者的血培养菌株种类和药物敏感试验结果进行回顾性分析,病原菌的鉴定和药敏通过MicroScan WalkAway-40自动微生物鉴定和药敏分析系统进行测定.结果 27株分离菌株中,酿脓链球菌占51.9%,葡萄球菌属占37.0%,其他细菌占10.1%;酿脓链球菌对四环素、红霉素的耐药率分别高达78.6%、42.9%;对氨苄西林的耐药率为14.3%、对青霉素、庆大霉素,氯霉素的耐药率为0;10株葡萄球菌属中,甲氧西林敏感葡萄球菌(MSS)6株,耐甲氧西林葡萄球菌(MRS)4株,MRS显示多药耐药,MSS的耐药率显著低于MRS;两种细菌对万古霉素的耐药率为0.结论 感染性心内膜炎的病原菌以酿脓链球菌和葡萄球菌属为主,酿脓链球菌对四环素、红霉素耐药显著,对青霉素等较为敏感,MRS多药耐药,未发现万古霉素耐药株.     

98株金黄色葡萄球菌分布及耐药性分析

目的分析近两年本院患者中分离的金黄色葡萄球菌的耐药情况,为临床合理使用抗菌药物提供依据。方法用湖南天地人公司TDR-200B微生物分析系统进行鉴定和药敏试验,WHONET5.3软件统计分析结果。结果 98株金黄色葡萄球菌中耐甲氧西林金黄色葡萄菌（MRSA）65株（66.3%）,主要来源于痰、伤口分泌物、脓等。检出的MRSA除对万古霉素和替考拉宁敏感,对米诺环素和氯霉素耐药率较小（24.6%和27.7%）,对利福平的耐药率为52.3%外,对其他抗菌药物耐药率均大于80.0%,且耐药率均高于甲氧西林敏感金黄色葡萄球菌。结论临床分离的金黄色葡萄球菌,MRSA对多种抗菌药物耐药率较高,许多MRSA菌株为多重耐药菌,实验室应加强对MRSA的耐药监测,以便合理使用抗菌药物。     

综合医院感染耐甲氧西林金黄色葡萄球菌耐药性监测

目的 调查医院临床分离耐甲氧西林金黄色葡萄球菌(MRSA)对抗菌药物的耐药现状,为临床治疗用药提供参考.方法 采用法国生物梅里埃公司ATB分析仪进行细菌鉴定,K-B法做体外药敏试验.结果 181株金黄色葡萄球菌中MRSA检出率为58.0%,MRSA检出率以老年病科最高(73.5%),其次是普外科(69.4%)及骨外科(61.9%);社区获得性感染MRSA检出率远低于住院患者;药敏结果显示,MRSA耐药率明显高于甲氧西林敏感金黄色葡萄球菌(MSSA),未检出对万古霉素及替考拉宁耐药菌株.结论 金黄色葡萄球隋耐药严重,MRSA的高检出率给临床治疗及控制医院感染带来较大困难;糖肽类抗菌药物可作为多药耐药金黄色葡萄球菌重症感染的首选抗菌药物.     

中医医院耐药葡萄球菌属检测分析

目的了解医院2008年10月-2010年4月门诊和住院患者耐药葡萄球菌属感染现状,为临床抗感染治疗提供依据。方法同步检测葡萄球菌属产β-内酰胺酶菌株、耐甲氧西林葡萄球菌菌株、红霉素诱导克林霉素耐药菌株等3种类型耐药菌的耐药表型。结果 141株葡萄球菌属中产β-内酰胺酶菌株阳性率95.7%;耐甲氧西林葡萄球菌(MRS)阳性率63.8%;红霉素诱导克林霉素耐药菌株阳性率(D试验阳性)39.0%;红霉素耐药率高达91.5%;克林霉素非诱导耐药率为41.1%,克林霉素总耐药率为80.0%;红霉素诱导克林霉素耐药菌株在MRS中为36.9%,甲氧西林敏感葡萄球菌(MSS)中为43.3%。结论注重葡萄球菌属多种耐药性检测,根据药敏结果合理应用抗菌药物。     

败血症患儿葡萄球菌属的分类与耐药性分析

目的 探讨医院2年来导致小儿败血症的葡萄球菌属分布及耐药情况,为临床治疗提供依据.方法 采用常规方法 对儿科送检的血培养标本进行分离培养,用美国德灵公司MicroScan auto SCAN4型细菌鉴定仪对分离的细菌进行鉴定及药敏试验.结果共分离出葡萄球菌属268株,其中金黄色葡萄球菌占第1位114株(42.5%),其他154株为凝固酶阴性葡萄球菌;114株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌(MRSA)占79株(69.3%);154株凝固酶阴性葡萄球菌中耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)占102株(66.2%);耐药率监测表明耐甲氧西林葡萄球菌(MRS)株对15种常用抗菌药物耐药率远远高于甲氧西林敏感葡萄球菌(MSS),且表现多药耐药,未发现耐万古霉素葡萄球菌.结论 患儿葡萄球菌属感染导致的败血症近年来日益增多,应引起足够重视,尤其应加强MRS的监测和报告,为临床医师提供可靠的诊断和治疗依据.     

葡萄球菌属医院感染的耐药现状调查分析

目的 了解葡萄球菌属医院感染和耐药现状,以采取有效措施'控制医院感染.方法 采集2006年1月-2008年12月医院感染患者临床各类标本中分离的葡萄球菌属129株,对其进行细菌鉴定、耐甲氧西林葡萄球菌(MRS)检测和K-B法药敏试验,并进行统计与分析.结果 129株葡萄球菌属分为6种,以金黄色葡萄球菌(SAU)分离率最高,为39.5%,其中耐甲氧西林金黄色葡萄球菌(MRSA)占29.4%,凝固酶阴性葡萄球菌(CNS)分离率为60.5%,其中耐甲氧西林药凝同酶阴性葡萄球菌(MRCNS)占32.1%;药敏结果显示甲氧西林敏感葡萄球菌(MSS)耐药率明显低于耐甲氧西林葡萄球菌株.结论 基层医院耐甲氧西林葡萄球菌医院感染比较严重,应采取有效措施,控制耐甲氧西林葡萄球菌医院感染.     

重症监护病房病原菌分布及耐药性分析

目的 了解医院近2年重症监护病房(ICU)病原菌分布及其耐药情况.方法 收集2007～2008年ICU送检的1013份标本,采用API鉴定系统进行菌株鉴定及药敏试验.结果 共分离出562株病原菌,阳性率55.5%,革兰阴性菌构成比明显高于革兰阳性菌,最常见的革兰阴性菌分别是铜绿假单胞菌(21.0%)、鲍氏不动杆菌(16.7%)、大肠埃希菌(8.2%)、产酸克雷伯菌(7.1%)、肺炎克雷伯菌(6.0 0A)、嗜麦芽寡养单胞菌(5.2%)与阴沟肠杆菌(4.6%);在革兰阳性菌中以葡萄球菌属和肠球菌属为主;主要革兰阴性杆菌对头孢哌酮/舒巴坦均敏感,而对其他多数常用抗菌药物耐药,肠杆菌科中产ESBLs菌株对青霉素类和头孢类抗菌药物耐药率明显高于非产ESBLs菌株,葡萄球菌属对万古霉素、替考拉宁等敏感;耐甲氧西林葡萄球菌(MRS)对常用抗菌药物耐药性均高于对甲氧西林敏感葡萄球菌(MSS),肠球菌属对多数常用抗菌药物耐药,仅对万古霉素与喹奴普汀/达福普汀敏感.结论 调查结果表明,ICU病原菌以革兰阴性菌为主,检出菌均存在严重耐药问题,及时监测病原菌变化及耐药趋势以指导临床用药至关重要.     

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.     

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.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

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.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.