骨科感染病原菌分布及耐药性分析

目的:主要分析骨科感染的病原菌分布及耐药性,为临床治疗感染合理用药及减少耐药菌产生提供科学依据。方法:采用回顾性分析方式,统计2016年5月~2017年5月门诊及病房送检细菌培养的伤口分泌物、血液、穿刺液、关节液、组织、尿液、痰等标本2749例,进行培养并对检出细菌进行鉴定及药敏分析。结果:共分析标本2749例,其中阳性1106例,阳性率40.23%,检出细菌1106株,革兰阳性菌占41.56%,其中金黄色葡萄球菌占27.68%,凝固酶阴性葡萄球菌19.08%,革兰阴性菌占38.55%,其中非发酵细菌占15.95%,肠杆菌科细菌占26.39%。真菌占0.72%。药敏结果显示细菌对不同的抗生素均有不同的耐药率,对G+球菌,万古霉素的敏感度最高;环丙沙星、复方新诺明、利福平的敏感度次之。亚胺培南、美罗培南对G-杆菌敏感度最高,头孢他啶、环丙沙星、阿米卡星对铜绿假单胞菌均有较好的敏感度。青霉素类、头孢霉素类和红霉素类对G+球菌或G-杆菌敏感性均不好。鲍曼不动杆菌对抗生素普遍耐药。结论:病人感染的病原菌分布广泛,主要以革兰氏阳性菌为主,临床治疗需结合药敏试验结果合理选择抗菌药物。对G+球菌可以选用万古霉素、喹诺酮类、复方新诺明和利福平等;对G-杆菌可以选用亚胺培南、美罗培南、头孢他啶、喹诺酮类和氨基糖甙类。喹诺酮类对于G+球菌和G-杆菌均有良好的敏感度。革兰阴性杆菌引起骨科感染的耐药也较严重,加强多重耐药菌监测,合理使用抗生素非常必要。     

新生儿重症监护病房呼吸机相关性肺炎病原菌分布及耐药性分析

目的:探讨新生儿呼吸机相关性肺炎(VAP)病原菌分布特点及耐药情况.方法:回顾性调查2007年1月～2012年12月江门市妇幼保健院NICU发生的68例呼吸机相关性肺炎,按时间顺序分两组,比较病原菌的变化,并对药敏情况进行分析.结果:68例VAP患儿的下呼吸道分泌物及气管导管末端培养中,共分离出病原菌株65株,其中G-杆菌34株(52.31％),G+球菌26株(40.00％),真菌5株(7.69％).两组比较,表皮葡萄球菌、金黄色葡萄球菌增多,溶血性葡萄球菌、嗜麦芽寡养单胞菌减少;耐药菌株呈上升趋势.主要的革兰氏阴性杆菌对亚胺培南、头孢哌酮/他唑巴坦、环丙沙星、左氧氟沙星敏感性高.嗜麦芽寡养单胞菌对亚胺培南100％耐药.革兰氏阳性球菌对万古霉素无耐药性,对利奈唑烷高度敏感,对其他抗生素广泛耐药.结论:VAP的病原菌谱近年来发生变化,存在明显的耐药现象,合理应用抗生素至关重要.     

医院病原菌分布及其耐药谱分析

目的 了解医院4年来临床病原菌的分布及其耐药谱趋势,以便为控制医院感染和医生合理选用抗感染药物提供依据与参考.方法 收集2004-2007年从住院和门诊患者中所提供的各种标本进行病原菌分离、鉴定与药物敏感试验,并经统计学方法分析.结果 4年中从送检标本中分离出3176株病原菌,革兰阳性(G+)球菌1369株(43.11%),其中β-溶血性链球菌、金黄色葡萄球菌、肺炎性链球菌、凝固酶阴性葡萄球菌和粪肠球菌分别占前5位;革兰阴性(G-)杆菌1275株(40.14%),依次为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌和黏膜炎莫拉菌;真菌(白色假丝酵母菌)532株(16.75%);G+球菌和G-杆菌几乎都有不同程度的耐药,G+球菌对万古霉素最为敏感,而G-杆菌则对亚胺培南很敏感.结论 加强临床病原菌及其耐药谱监测,对控制医院感染和治疗感染选用抗感染药物都有重要意义.     

癌症患者医院感染病原菌菌谱及耐药性分析

目的 探讨癌症患者医院感染病原菌的分布及其耐药状况.方法 回顾分析癌症患者医院感染1451例病例,采用WHONET-5软件进行统计处理.结果 1451株病原菌中革兰阴性(G-)杆菌492株,占33.9%,革兰阳性(G+)球菌411株,占28.3%,真菌548株,占37.8%;痰标本955株中G-杆菌为25.5%,G+球菌为31.2%,真菌为43.3%;大便标本284株中检出G-杆菌为64.4%,G+球菌为10.2%,真菌为25.5%;血液72株中检出G-杆菌为62.5%,G+球菌为30.5%,真菌为7.0%;咽拭子140株中检出G-杆菌为15.0%,G+球菌为43.0%,真菌为42.0%;药敏试验结果提示,G-杆菌对亚胺培南高度敏感对一代、二代头孢菌素、氨苄西林、哌拉西林等有较高耐药性,G+球菌对万古霉素高度敏感,对苯唑西林、青霉素、红霉素等耐药率很高,真菌对唑类抗菌药呈明显耐药.结论 由于产超广谱β-内酰胺酶菌(ESBLs)和耐甲氧西林葡萄球菌(MRS)检出率较高,临床用药应依据药敏试验结果选择和合理使用抗菌药物,控制病原菌的耐药性.     

2006-2007年呼吸病区下呼吸道感染病原菌耐药性监测

目的 分析医院呼吸病区下呼吸道感染病原菌的分布及其耐药情况,为临床合理选择抗菌药物提供参考依据.方法 收集2006-2007年下呼吸道感染患者晨痰或纤维支气管镜刷检分泌物,按NCCLS标准分离鉴定病原菌并进行药敏试验,统计检出阳性率、病原菌分布比例及敏感率.结果 病原菌检出阳性率为49.8%,其中G-杆菌占61.4%,真菌占27.9%,G+球菌占10.7%;前7位病原菌依次为:白色假丝酵母菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、流感嗜血菌、鲍氏不动杆菌和金黄色葡萄球菌;G-杆菌对亚胺培南的敏感率最高(>91%),G+球菌对万古霉素的敏感率最高(100%),真菌对两性霉素B敏感率最高(100%),真菌、肺炎克雷伯菌、大肠埃希菌和金黄色葡萄球菌对多数抗菌药物的敏感率显著下降.结论 定期监测医院常见病原菌的变迁及耐药情况的变化,对指导临床用药有重要的意义.     

烧伤病区常见病原菌及其耐药性调查

目的了解烧伤临床感染病原菌分布及耐药性情况。方法对2005年5月~2008年5月烧伤科送检的1216份标本的细菌培养和药敏结果进行回顾性分析。结果共检出627株病原菌,革兰阴性(G-)杆菌占33.8%,革兰阳性(G+)球菌占48.8%,真菌占17.4%;鲍氏不动杆菌占8.6%;铜绿假单胞菌占6.0%;金黄色葡萄球菌占G+球菌77.5%,其中耐甲氧西林金黄色葡萄球菌(MRSA)的分离率为金黄色葡萄球菌的94.9%;药物敏感试验显示,各检出菌具有多药耐药性,G+菌对万古霉素敏感,G-菌对亚胺培南敏感,但鲍氏不动杆菌仅对头孢哌酮/舒巴坦敏感。结论烧伤科细菌感染以G+球菌为主,G-杆菌次之,其中鲍氏不动杆菌检出率有增多趋势,临床应重视细菌的药物敏感性,合理使用抗菌药物。     

413例细菌性感染患者痰液病原菌分离及耐药性分析

目的了解细菌性感染患者痰液标本的病原菌检出情况及耐药性。方法收集我院门诊和住院患者痰液标本，按照《全国临床检验操作规范》进行常规微生物病原菌分离培养及药敏试验。结果从413例痰液标本中共分离出病原菌181株，阳性检出率为43.8％。其中：革兰氏阳性球菌34株，占病原菌总数的18．9％；革兰氏阴性杆菌139株，占病原菌总数的76．8％；真菌8株，占病原菌总数的4．4％。检出阳性率较高的病原菌依次为：肺炎克雷伯氏菌48株（26．5％）、金黄色葡萄球菌21株（11．6％）、铜绿假单胞菌19株（10．5％）、大肠埃希氏菌16株（8．8％）、凝固酶阴性葡萄球菌9株（5．0％）、阴沟杆菌8株（4．4％）、白色念珠菌6株（3．3％）。引起肺部感染的病原菌革兰氏阳性球菌中金黄色葡萄球菌和凝固酶阴性葡萄球菌对替考拉宁、万古霉素的耐药率最低，均为0。革兰氏阴性杆菌中肺炎克雷伯氏菌对亚胺培南，阿米卡星耐药率较低，分别为0、16．7％；铜绿假单胞菌对环丙沙星、亚胺培南耐药率较低，分别为15．8％、21．1％。大肠埃希氏菌对亚胺培南、阿米卡星耐药率较低，分别为0、12．5％。结论痰液分离培养病原菌结果以革兰氏阴性杆菌为主，占76．8％，革兰氏阳性球菌次之，占18．9％，真菌最少，占4．4％。革兰氏阴性杆菌对亚胺培南的耐药率最低；未发现耐万古霉素和替考拉宁的葡萄球菌；从总体的药敏结果来分析，病原菌多重耐药现象严重。因此，病原菌耐药性监测对指导临床合理使用抗菌药物非常重要。     

烧伤病房创面分泌物细菌学监测和耐药性分析

目的 为指导临床合理用药提供依据,提高疗效.方法 常规细菌培养,细菌的鉴定和药敏采用美国BD公司phoenix-100全自动细菌鉴定及药敏分析系统.结果 2005年6月-2008年6月在某医院烧伤科伤口分泌物中检出病原株301株,其中G-杆菌184株,G+球菌109株,真菌8株.G-杆菌对氨苄西林的耐药率最高(83.9%),其次为头孢噻吩(73.3%)和头孢唑啉(72.8%),耐药率最低的是亚胺培南(2.1%),其次是呋喃妥因(37.5%)和阿米卡星(44%).G+葡萄球菌除万古霉素外,对其他18种抗生素的耐药率,MRSA均高于MSSA.肠球菌对青霉素和红霉素耐药情况严重.结论 此医院烧伤病房创面分泌物细菌耐药率普遍较高,应加强耐药性监测.     

肺癌患者医院感染之菌谱及耐药性分析

目的探讨肺癌患者医院感染病原菌的分布及其耐药状况。方法回顾分析肺癌患者医院感染病例，采用WHONET-5软件进行统计处理。结果感染菌检出率：革兰阴性杆菌为54．8％，以铜绿假单胞菌为主；革兰阳性球菌为19．0％，以金黄色葡萄球菌为主；真菌为26．2％，以白色假丝酵母菌为主；药敏试验结果提示：G-杆菌对亚胺培南高度敏感，对一代、二代头孢菌素、氨苄西林、哌拉西林等有较高耐药性；G^ 球菌对万古霉素高度敏感，对苯唑西林、青霉素、红霉素等的耐药率很高；真菌对唑类抗菌药呈明显耐药。结论由于产超广谱β-内酰胺酶菌(ESBLs)和耐甲氧西林葡萄球菌(MRS)检出率很高，临床用药应根据药敏试验结果选择抗生素，同时应加强抗生素的合理使用，控制细菌的耐药性。     

对2503例临床分离细菌的药敏分析

目的了解常见临床分离菌株的药敏状况并为临床合理用药提供依据,以减少耐药菌的产生。方法使用VITEK AMS微生物自动鉴定系统,对住院和门急诊患者分离阳性标本进行细菌鉴定和药敏试验,并使用WHONET5.0进行统计分析。结果检出G-杆菌1703株,35属62种;G 球菌800株,5属28种,共计40属90种;G-杆菌对亚胺培南仍较为敏感;产ESBLs的大肠埃希菌占41%、肺炎克雷伯菌占35%。结论分离的G-杆菌对β-内酰胺类抗菌药物耐药主要是产ESBLs,而非发酵菌则为多重耐药,由此产生的细菌感染首选碳青酶烯类亚胺培南,对于非发酵菌则结合具体临床药敏试验结果联合用药,万古霉素仍是治疗葡萄球菌属感染的首选药物。     

企业职工高尿酸血症与血压、血脂、血糖的相关性研究

目的探讨企业职工高尿酸血症（HUA）与血压、血脂、血糖的相关性,为企业进行健康管理提供依据。方法以中国石油长庆油田公司各下属企业为抽样单位,整群随机抽取2个单位,每个单位中所有的HUA者作为HUA组,共720人;同时在尿酸水平正常者中随机选取620人为正常组。通过Logistic回归分析HUA与年龄、性别、血压、血脂、血糖的关系。结果HUA合并高血压、高血脂、空腹m糖受损任意一项、两项、三项的比例均远高于正常组（OR值分别为：4．036,2．562,4．174）。多因素Logistic回归发现：男性、收缩压、总胆固醇、三酰甘油、低密度脂蛋白胆固醇是HUA的危险因素（OR值分别为7．736,2．309,1．721,2．761,1．411）;高密度脂蛋白胆固醇为HUA的保护因素（OR值为0．211）。结论HUA存在性别差异,且与血压、血脂密切相关。企业对职工的健康管理应充分考虑多危险因素的综合作用,全面的进行健康教育及干预。     

Continuity and change in neighborhood disadvantage and adolescent depression and anxiety

We used data from the Fragile Families and Child Wellbeing Study which includes a sample of adolescents of age 15 at the most recent wave (between 2014 and 2017) from mainly low-income urban families in the United States, to examine the association between neighborhood poverty entries and exits and adolescent depression and anxiety. In addition, we examined whether these associations differed by gender. Adolescents who consistently lived in disadvantaged neighborhoods had the highest level of depression and anxiety. Those who entered poor neighborhoods were more depressed than those who never lived in poor neighborhoods. Those who exited poor neighborhoods showed no significant difference in depression and anxiety compared to those never lived in poor neighborhoods. Furthermore, these associations applied to adolescent girls only and were not statistically significant for boys. The results suggest that neighborhood poverty has cumulative negative impacts on adolescent mental health and disproportionally affects adolescent girls. Reducing neighborhood poverty would substantially improve the health of adolescents, especially girls, which would reduce health disparities.     

Enabling positive change: Progress and setbacks in HIV and sexual and reproductive health and rights

At a point in history when the future of sexual and reproductive health including HIV looks particularly uncertain, it is helpful to recognise that many of the challenges currently faced are neither new nor insurmountable. Reflecting on past achievements and lessons learned helps us to have confidence that positive change is feasible. This paper reflects on some of the changes observed in countries like India and Mozambique and identifies a range of factors which need to coalesce to enable these developments, along with specific contextual factors. It is the combination of these influences rather than any one of them alone that brought about the change in the three instances described – fostering a positive political response to HIV in its early years in India; bringing about policy reform on abortion in Mozambique; and increasing contraceptive prevalence and age at marriage in some districts in Bihar, India. Change is always fragile and susceptible to setbacks, but change-seekers can learn in the process and gain renewed hope that progress can and often does take place if they persevere.     

儿童青少年超重肥胖评价方法及SPSS和SAS实现

超重肥胖已成为世界各国儿童青少年面临的重大公共卫生问题之一。现行的儿童青少年超重肥胖筛查标准不统一,逐条评价或自行编写程序容易出错且效率较低。本研究以中国学龄儿童青少年超重与肥胖筛查标准为例,详细介绍了国际和中国共四种评价儿童青少年超重肥胖的方法和步骤,结合具体案例详细介绍其应用方法,同时编制SPSS和SAS程序包和解...     

初产妇与经产妇焦虑抑郁状态分析及干预

目的：分析初产妇、经产妇心理状态特点,以便采取更有效的干预措施。方法筛选2014年6月至2015年1月在咸阳市旬邑县妇幼保健院产科门诊产前检查的健康初产和经产妇各60名,孕周为28~40周。入组时用焦虑自评量表( SAS)、抑郁自评量表(SDS)对两组孕妇进行心理评定,并给1次支持性心理干预(40~60分钟),1周后再次用SAS、SDS对两组孕妇进行评定分析。结果经产妇干预前SAS(50.73±3.45)、SDS(49.13±3.86)评分明显高于初产妇SAS(42.45±2.08)、SDS(41.77±2.21),差异均有统计学意义(t值分别为-15.921、-12.817,均P<0.01);干预后两组SAS、SDS评分均比干预前明显降低,差异均有统计学意义(t值分别为14.999、15.413;15.724、15.832,均P<0.01);干预后经产妇 SAS(38.61±5.02)、SDS(39.10±3.03)评分明显高于初产妇SAS(34.88±3.31)、SDS(32.01±4.27),差异均有统计学意义(t值分别为-4.805、-10.489,均P<0.01)。结论初产妇和经产妇均伴有焦虑、抑郁情绪,干预前后经产妇抑郁、焦虑情绪均较初产妇明显,支持性心理干预能有效改善孕妇的不良情绪。     

骨钙素与儿童生长发育

骨钙素是成骨细胞分泌的骨蛋白 ,骨钙素水平与成骨细胞活性成正相关 ,是一项很好的反映骨形成与骨转化的生化指标。小儿骨生长发育有自身特点 ,骨钙素水平的改变类似儿童身高生长曲线 ,可以很好地应用于评价儿童生长发育及监测生长障碍患儿对治疗的反应     

癌缺氧病因及预防和治疗

目的 探讨癌及安阳林州市食管癌高发原因及癌病因预防和治疗措施.方法 对林州市食管癌等疾病现场进行调查,在进行10余年统计分析基础上,综合分析了全国156篇文献成果.结果 提出癌缺氧病因学说,使用制氧机、按摩器、饮用纯净水治疗恶性肿瘤,取得良好效果,改水能够大幅降低林州市居民食管癌发病率、死亡率.结论 癌可能是由于机体长...     

Recruitment and retention challenges and successes

Objective: Addressing health disparities requires well designed, culturally adapted research. However, recruiting/retaining minority participants has often been challenging. We present strategies used to successfully recruit and retain rural Hispanic women during a breastfeeding education intervention.

Design: This study involved a two-group repeated measures quasi-experimental design with assessments at seven intervals between enrollment and 6 months postpartum. Participants (Hispanic women?≥?15 years old) were recruited through a regional hospital.

Results: We successfully met our recruitment goals, most women contacted were enrolled (46 of 58), and 100% completed the study.

Discussion: Research staff with ties within the community helped establish trust. Using bilingual study materials, simple language, and an interpreter addressed language/literacy concerns. Phone assessments facilitated participation as transportation was an issue. Accommodating requests to deliver or mail study materials and providing incentives were important. Extra effort was needed to maintain contact when phone service was disrupted or participants moved. Keys to success were persistence, flexibility, and alleviating barriers to participation.     

Cholesterol and Egg Intakes with Cardiometabolic and All-Cause Mortality among Chinese and Low-Income Black and White Americans

We examined the associations of dietary cholesterol and egg intakes with cardiometabolic and all-cause mortality among Chinese and low-income Black and White Americans. Included were 47,789 Blacks, 20,360 Whites, and 134,280 Chinese aged 40–79 years at enrollment. Multivariable Cox models with restricted cubic splines were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality outcomes using intakes of 150 mg cholesterol/day and 1 egg/week as the references. Cholesterol intake showed a nonlinear association with increased all-cause mortality and a linear association with increased cardiometabolic mortality among Black Americans: HRs (95% CIs) associated with 300 and 600 mg/day vs. 150 mg/day were 1.07 (1.03–1.11) and 1.13 (1.05–1.21) for all-cause mortality (P-linearity = 0.04, P-nonlinearity = 0.002, and P-overall < 0.001) and 1.10 (1.03–1.16) and 1.21 (1.08–1.36) for cardiometabolic mortality (P-linearity = 0.007, P-nonlinearity = 0.07, and P-overall = 0.005). Null associations with all-cause or cardiometabolic mortality were noted for White Americans (P-linearity ≥ 0.13, P-nonlinearity ≥ 0.06, and P-overall ≥ 0.05 for both). Nonlinear inverse associations were observed among Chinese: HR (95% CI) for 300 vs. 150 mg/day was 0.94 (0.92–0.97) for all-cause mortality and 0.91 (0.87–0.95) for cardiometabolic mortality, but the inverse associations disappeared with cholesterol intake > 500 mg/day (P-linearity ≥ 0.12; P-nonlinearity ≤ 0.001; P-overall < 0.001 for both). Similarly, we observed a positive association of egg intake with all-cause mortality in Black Americans, but a null association in White Americans and a nonlinear inverse association in Chinese. In conclusion, the associations of cholesterol and egg intakes with cardiometabolic and all-cause mortality may differ across ethnicities who have different dietary patterns and cardiometabolic risk profiles. However, residual confounding remains possible.