铜绿假单胞菌β-内酰胺酶的检测及耐药性分析

目的：探讨铜绿假单胞菌的β-内酰胺酶检测及耐药性。方法：采用全自动微生物分析系统对我院2013年度院内感染铜绿假单胞菌130株对15种抗生素药敏谱的检测，同时采用双纸片协同试进行金属β-内酰胺酶的检测。结果：IPM耐药菌18株，占1385％；AMP、CZO、CTT、SAM的耐药率分别为99．23％、96．92％、95．38％、94．62％，均显著高于其他药物，具有高度统计意义（P〈0．05）。TOB、AMK、GEN、TZP的敏感率分别为93．08％、92．31％、9077％、88．46％；经协同试验，共检出MBL菌株7株，占5．38％，占IPM耐药菌的38．89％（7／18）。产MBL菌株对15种抗生素的耐药性均比较高；其中，TOB、AMK、GEN、TZP的耐药性分别为23．1％、23．1％、30．8％、30．8％。结论：分析铜绿假单胞菌的耐药性及检测β-内酰胺酶，能更好地指导临床用药，对控制耐药菌株的播散及流行具有重要的临床价值。     

社区与院内尿路感染的病原学比较及抗生素耐药性分析

目的为调查比较瑞金医院近期社区及院内尿路感染病原学构成特点及抗生素耐药情况. 方法回顾分析2004年1～6月,上海瑞金医院门诊与住院尿路感染患者中段尿培养及药敏试验结果. 结果社区与院内尿路感染的病原学分布以大肠埃希菌属、肠球菌属为主,但两菌所占比例明显不同;医院感染分离株耐药性普遍高于社区感染分离株;IMP、MEM、CAZ、FEP、TZP、CFS、CMZ治疗大肠埃希菌感染敏感性均>80%,而CIP、PIP、AMP、GEN均已产生>50%～80%耐药率;未检出耐VAN、TCL肠球菌菌株,AMP、NIT对肠球菌感染具有较高敏感性,而CIP、ERY已产生较高耐药性. 结论及时总结本地社区与院内尿路感染流行病学资料及耐药菌变迁规律,对指导临床正确选药意义重大.     

医院革兰阴性杆菌的分布和MIC法耐药性监测

目的 了解我院革兰阴性杆菌的分布及耐药性特征。方法 分离及鉴定来自各种临床标本中的G^-杆菌1031株,采用回顾归分析法测定其MIC。结果 分离率占前几位的G^-杆菌是大肠埃希菌（28．0％）、肺炎克雷伯菌（16．9％）、铜绿假单胞菌（13．1％）、醋酸钙不动杆菌（11．7％）、阴沟肠杆菌（9．4％）等;大肠埃希菌和肺炎克雷伯菌对头孢唑林、头孢呋辛、氨苄西林（氨苄肝霉素）、哌拉西林（氧哌嗪青霉素）和替卡西林的耐药率达41％－100％,MIC90（32－256）μg/ml,显示了较高的耐药性;铜绿假单胞菌对亚胺培南（亚胺硫霉素）的耐药率达36％,MIC5016μg／;对哌拉西林耐药率较低（12％）;82％的铜绿假单胞菌显示六重或以上耐药;阴沟肠杆菌和费劳地枸橼酸杆菌对头孢他啶、头孢曲松的耐药率达49％、67％,对其他所测抗生素药率量更高,达63％－100％,亚胺培南是对其有效的药物;不动杆菌、嗜麦芽食窄单胞菌、黄杆菌对所测抗生素广谱耐药,亚胺培南对不动杆菌较有效（耐药率8％）,对黄杆菌的耐药率达50％;嗜麦芽食窄单胞菌仅对磺胺的耐药率较低（20％）。结论 几种最常分离的G^-杆菌均有较高的耐药性;进行常规的耐药性监测,根据药物敏感试验合理应用抗生素十分重要。     

铜绿假单胞菌的血清分型及耐药分析

目的 了解铜绿假单胞菌（PAE）各血清型分布及其耐药状况。方法 按常规方法对临床各种标本进行细菌培养、分离，用VITEK-2全自动微生物鉴定仪进行鉴定，药物敏感试验采用K—B法，结果 按美国临床实验室标准化委员会（NCCLS）的标准进行判读；血清分型采用日本生研株氏会社分型血清；用SPSS 12．0软件对资料进行卡方分析。结果 405株PAE分型率为92．1％；以G、F、E、B、I型为主，共占76．8％；主要血清型PAE对临床常用的11种抗菌药物的耐药率分别是PIP 13．7％～66．7％、TIM 29．3％～68．3％、TZP 13．7％～61．7％、ATM 18．3％～43．1％、CAZ 8．3％～23．5％、FEP 10．0％～18．5％、IMP 8．3％～21．6％、GEN 19．6％～66．7％、CIP 13．7％～60．0％、AMK 9．8％～17．6％、SXT 90．2％～98．2％，经X^2检验，各主要血清型对ATM、CAZ、FEP、IMP、AMK、SXT的耐药性差异无统计学意义（P〉0．05），而对PIP、TIM、TZP、GEN、CIP的耐药性差异有统计学意义（P〈0．01）。结论 PAE血清型以G、F、E、B、I为主，不同血清型的PAE对临床常用的抗菌药物耐药严重且有差异，临床应合理谨慎应用抗菌药物以延缓耐药株的快速增加。     

医院感染病原菌分布与耐药性分析

目的 调查医院感染病原菌的分布和耐药性情况，为控制医院感染提供依据。方法 对医院2002年1月-2005年12月，培养分离出的1163株医院感染病原菌的分布和耐药性进行统计和分析。结果 发现G^＋球菌感染占32．3％，G杆菌占40．8％，其中G^-杆菌逐年增高；G^＋球菌以金黄色葡萄球菌为主，MRSA检出率平均达82．5％；G^-杆菌以大肠埃希菌（9．9％）、肺炎克雷伯菌（7．1％）、阴沟肠杆菌（5．4％）和铜绿假单胞菌（5．2％）为主；医院感染病原菌耐药率高并有继续增高趋势；2005年铜绿假单胞菌耐药性变化最大，对头孢他啶和亚胺培南耐药率从前3年的0增至48．9％。结论 医院感染菌中G^-杆菌呈逐年增高趋势，且对常用抗菌药物耐药性高，临床应根据病情及时作病原菌检测，结合药敏试验结果，正确合理使用抗菌药物。     

常见细菌耐药率调查

目的 为临床医师合理使用抗菌药物提供参考依据，减少耐药菌株的产生。方法 采用回顾性调查的方法，对某院2001年1～12月从临床送检标本中培养分离的1143株病原菌的种类、感染部位及对药物的敏感性进行汇总、分析。结果 G^ 菌245株，占21．43％；G^-菌730株，占63．87％；真菌168株，占14．70％。G^ 菌对苯唑西林、红霉素、阿米卡星、链霉素耐药率较高，G^-杆菌对阿莫西林耐药率高。结论 临床医师要根据药物敏感试验结果正确、合理使用抗菌药物。     

重症监护病房呼吸机相关肺炎病原学分析及临床研究

目的 研究医院重症监护病房(ICU)呼吸机相关肺炎(Ventilator Associated Pneumonia，VAP)病原菌的分布及耐药特点，指导临床合理用药。方法 分析某院ICU病房2002年2月～2003年8月发生VAP患的临床特征、病原菌谱及耐药性。结果42例VAP患共检出58株病原菌，革兰阴性(G^-)杆菌占79．31％，革兰阳性(G^ )球菌占13．79％，真菌占6．90％；G^-杆菌以铜绿假单胞菌(30．95％)为多，G^ 球菌主要为金黄色葡萄球菌(75．00％)，耐甲氧西林金黄色葡萄球菌(MRSA)占金黄色葡萄球菌的，50％。G^-杆菌对阿米卡星、哌拉西林／舒巴坦、头孢他啶、亚胺培南较敏感；产ESBLs菌对亚胺培南，MRSA对万古霉素均100％敏感。结论 ICU病房VAP病原菌以G^-杆菌为主，耐药率高，临床医师应根据药敏试验合理选择抗菌药物。     

呼吸机相关性肺炎的病原菌及耐药性研究

目的 探讨呼吸机相关性肺炎(VAP)的病原菌及其耐药性，为防治VAP提供科学依据。方法 对238例VAP患者的发病年龄、基础疾病、病原菌分布及革兰阴性杆菌耐药率进行调查分析。结果 老年VAP患者占84．9％；VAP病原菌以G^-杆菌为主，占菌株总数的76．5％，其中铜绿假单胞菌居首位；产超广谱β-内酰胺酶细菌分离率为35．1％，甲氧西林耐药金黄色葡萄球菌占金黄色葡萄球菌总数的45．8％；G^-杆菌对常用抗菌药物已表现出较高的耐药率。结论 提倡严密动态监测VAP病原菌，合理使用抗生素，以达到有效控制VAP的目的。     

某院临床标本细菌分布与耐药性分析

目的了解某院各种临床标本的细菌分布及其对常用抗菌药物的耐药性。方法统计分析该院1998—2003年门诊及住院患者送检标本中分离并经鉴定的细菌及其耐药情况。结果6年共检出细菌4632株，其中革兰阴性（G^-）杆菌2759株（59．56％），革兰阳性（G^＋）球菌1873株（40．44％）。G^-杆菌对亚胺培南耐药率（3．27％-25．20％）最低，对氨苄西林耐药率（71.57％～92.11％）最高；G^＋球菌对万古霉紊耐药率（0）最低，对青霉素G耐药率（77．96％～100％）最高。结论临床感染菌不断增多，耐药现象日趋严重，耐药性监测对指导临床用药具有重要意义。     

呼吸机相关性肺炎病原菌及耐药性调查

目的探讨呼吸机相关性肺炎（VAP）的病原菌及其耐药性，为防治VAP提供科学依据。方法对VAP的病原菌及耐药性进行调查，分析125例VAP患者的发病年龄、基础疾病、病原菌分布及革兰阴性杆菌耐药率等。结果VAP发生率29．9％，老患者占30．4％。VAP病原菌以G^-杆菌为主，占菌株总数的72．1％，其中鲍曼不动杆菌居首位；铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、嗜麦芽寡单胞菌及金黄色葡萄球菌是VAP的主要致病菌。产超广谱阻内酰胺酶细菌分离率为33．1％，G^-杆菌对常用抗药物已表现出较高的耐药率。结论对机械通气进行全面预防，提倡严密动态监测VAP病原菌，合理使用抗生素，以达到有效控制VAP的目的。     

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.     

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.     

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.     

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.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Hydrazine inhalation hepatotoxicity

Abstract Hydrazine is a hazardous chemical commonly used as a reactant in rocket and jet fuel cells. Animal studies have demonstrated hepatic changes after hydrazine inhalation. Human case reports of hydrazine inhalation hepatotoxicity are rare. We report a case of mild hepatotoxicity following brief hydrazine vapour inhalation in a healthy young man, which resolved completely on expectant management.     

Fitness standards in airline staff

Employers have a legal duty to manage safety and to meet this duty it is necessary to control risks arising from pre-existing medical conditions. Such conditions can be identified at the time of job placement, but there is little published information about the approach to fitness standards by most airlines. This review is therefore limited to the practice of one major airline. It is illustrated by reference to various occupations within the airline, with the associated rationale.