耐碳青霉烯类肺炎克雷伯菌碳青霉烯酶基因检测

目的 对耐碳青霉烯类肺炎克雷伯菌进行耐药性分析及碳青霉烯酶基因检测,为临床正确选择抗菌药物提供依据.方法 采用K-B法检测15株耐碳青霉烯类肺炎克雷伯菌对18种抗菌药物的耐药性,以WHONET5.5软件分析细菌耐药表型,改良Hodge试验检测碳青霉烯酶,以聚合酶链反应检测blaKPC、blaIMP、blaVIM、balNDM基因并进行测序.结果 2008年1月-2009年12月共分离到非重复耐碳青霉烯类肺炎克雷伯菌15株,改良Hodge试验检出14株含碳青霉烯酶,检出率为93.3％;PCR结果显示14株携带blaKPC,未检出blaIMP、blaVIM、blaNDM基因,与改良Hodge试验一致.结论 blaKPC是肺炎克雷伯菌耐碳青霉烯类药物主要原因,改良Hodge试验检测碳青霉烯酶具有很好的敏感性.     

耐碳青霉烯类肺炎克雷伯菌获得性耐药元件指标聚类分析

目的了解耐碳青霉烯类肺炎克雷伯菌(CRKP)对β-内酰胺类与氨基糖苷类药物的耐药相关基因与可移动遗传元件存在状况,以及获得性耐药相关基因与可移动遗传元件存在的相互关系。方法收集2014年1-12月住院患者标本中分离到的20株CRKP,用gyrA测序后BLASTn比对确认菌种,再采用聚合酶链反应(PCR)法分析40种β-内酰胺酶基因、6种氨基糖苷类修饰酶、6种16SrRNA甲基化酶、12种可移动遗传元件遗传标记和blaKPC型与ISKpn6连锁检测,并对检测结果作指标聚类分析。结果 20株CRKP对9种β-内酰胺类与氨基糖苷类均耐药;获得性耐药相关基因与可移动遗传元件标记每株均有阳性发现,共检出4种β-内酰胺酶基因(blaTEM、blaSHV、blaKPC、blaIMP),1种氨基糖苷类修饰酶基因(aac(3)-Ⅱ)、1种16SrRNA甲基化酶基因(rmtB),8种可移动遗传元件遗传标记(traA、trbC、tnp513、IS26、IS903、ISEcp1、ISKpn6、intⅠ1);5株CRKP blaKPC-ISKpn6连锁检测为阳性;指标聚类分析提示,β-内酰胺酶基因blaIMP与tnp513强关联;β-内酰胺酶基因blaKPC、blaSHV及16S rRNA甲基化酶基因rmtB与ISKpn6、ISEcp1、traA强关联;氨基糖苷类修饰酶基因aac(3)-Ⅱ与IS26、IS903、intⅠ1、trbC强关联。结论肺炎克雷伯菌耐药表型与基因型结果相符,对β-内酰胺类与氨基糖苷类药物的耐药与可移动遗传元件介导的blaTEM、blaSHV、blaKPC、blaIMP、aac(3)-Ⅱ、rmtB相关。     

天津海河流域抗生素抗性基因分布特征及与指示微生物的关系

目的研究海河流域抗生素抗性基因的时空间分布规律及与指示微生物的相关性。方法选取天津海河流域7个采样点连续采集水样12个月,分别对水样中7大类8种抗生素抗性基因、耐热大肠菌群和大肠埃希菌进行检测和分析。结果全年检出的8种抗生素抗性基因(检出率)分别为sul1(79.8%),aac(6’)-1b(76.2%),blaNDM-1(60.7%),gyrA(57.1%),tetA(56.0%),clmA(53.6%),ermB(51.2%)和ampC(47.6%)。磺胺类抗性基因sul1的最大拷贝数达到6.4×109copies/ml,为海河流域中的优势抗性基因。经统计学分析可知春、夏季抗性基因的检出率显著高于秋、冬季,而各采样点抗性基因的分布无显著差异。erm B、aac(6’)-1b、clm A基因分布与2种指示菌均具有显著相关性,其它5种抗性基因与指示菌之间未见相关性。结论抗性基因在海河中呈现春、夏季高于秋、冬季的规律,现有水中指示微生物指标对大部分抗性基因不具有指示作用。     

检测5种碳青霉烯酶基因的多重PCR方法的建立及临床应用

目的建立并评价一种多重降落PCR(Multiplex Touchdown PCR,MT-PCR)方法检测5种碳青霉烯酶基因。方法收集东部战区总医院保存的42株耐碳青霉烯类菌株和合成的带有OXA-48部分基因质粒,建立5种碳青霉烯酶基因的多重降落PCR方法,分析其特异性、敏感性,并收集东部战区总医院临床微生物实验室送检的临床无菌体液标本67份及其分离菌株36株进行临床应用评价。结果 MT-PCR可用于5种碳青霉烯酶基因的检测,对blaOXA-48、blaVIM和blaKPC检测限均为200 CFU/ml,而对blaIMP与blaNDM的检测限为2×10~3 CFU/ml。42株临床分离菌株的MT-PCR检测结果与单重PCR检测结果完全一致。以抗菌药物药敏试验为参考方法,67个无菌体液标本的MT-PCR结果与药敏试验结果差异无统计学意义(P=0.125),且敏感性和特异性分别为80.00%和100.00%。结论 MT-PCR方法能有效地用于临床分离物和无菌体液标本中的碳青霉烯酶基因检测。     

临床分离耐亚胺培南革兰阴性菌的耐药性研究

目的研究临床分离耐亚胺培南(IMP)革兰阴性菌的耐药性。方法琼脂稀释法测定最低抑菌浓度(MIC),应用泵抑制剂检测外排泵,鉴定β-内酰胺酶(Bla)表型和测定等电点(pI),PCR扩增检测耐药基因。结果 121株IMP耐药革兰阴性菌对常用抗菌药物耐药率为56.5%～100.0%,102株产6种、3种和4种不同pI的超广谱β-内酰胺酶(ESBLs)、头孢菌素酶(AmpC)和金属β-内酰胺酶(MBL),92株PCR扩增检出blaTEM、blaSHV、blaCTX-M、blaKPC、blaPER、blaOXA-23、blaDHA、blaampC、blaMIR、blaIMP、blaVIM等基因,75株外排泵阳性,98株菌膜蛋白基因缺失,108株存在≥2种耐药机制。结论临床耐IMP革兰阴性菌存在多药耐药性和多种耐药机制,应注意检测和监控。     

亚抑菌浓度抗生素对海水浴场来源肺炎克雷伯菌的接合及intI突变影响

目的探讨不同水环境介质及亚抑菌浓度抗生素对肺炎克雷伯菌的生长、耐药表型及抗性基因转移的影响。方法对海水浴场来源的肺炎克雷伯菌进行不同亚抑菌浓度的氧氟沙星、头孢他啶抗生素传代培养、运用DNAstar分析I类整合子(IntI)突变类型及突变位点,以耐药菌为供体菌,EC600为受体菌进行耐青霉素、氧氟沙星的质粒接合实验。结果经亚抑菌浓度抗生素研究发现2种抗生素亚抑菌浓度海水与生理盐水传代培养下的细菌生物量均有明显差异。但头孢他啶亚抑菌浓度下,海水介质比生理盐水介质的影响大。传代培养240 h后,细菌耐药能力增强。亚抑菌浓度抗生素作用下耐药菌的IntI突变类型主要集中于氨基酸的缺失与插入,突变位点集中在262～273。此外,4株耐青霉素耐药基因肺炎克雷伯菌成功接合,接合效率分别是2.6×10~(-6)、4.2×10~(-6)、6.0×10~(-6)、3.6×10~(-6),1株氧氟沙星1/16mic亚抑菌浓度刺激下的肺炎克雷伯菌成功接合,接合效率是6.4×10~(-6)。结论亚抑菌浓度抗生素对肺炎克雷伯菌传代培养存在差异,有诱导自发性突变的可能;证明了耐药基因可伴随接合型质粒转移。     

泛耐药肺炎克雷伯菌的耐药基因研究

目的 了解1株对临床常用18种抗菌药物(包括亚胺培南、美罗培南)均耐药的肺炎克雷伯菌(KPN)所携带的耐药基因状况.方法 对该株KPN进行了9类耐药基因的PCR法检测,包括β-内酰胺酶基因blaTEM、blaSHV、blaLEN、blaOKP、blaCTX-M-1、2、9群、blaOXA-1、2、10群、blaCARB、blaPER、blaVEB、blaGES、金属β-内酰胺酶基因blaIMP、blaVIM、blaKPC,AmpC酶基因blaDHA、blaACT/MIR、blaCMY/MOX、blaCMY/LAT,氨基糖苷修饰酶基因aac(3)-Ⅰ、aac(3)-Ⅱ、aac(6')-Ⅰ b、aac(6')-Ⅱ、ant(2")-Ⅰ、ant(3")-Ⅰ,喹诺酮类耐药基因qnrA、TMP耐药基因dfrA1、dfrA17,消毒剂磺胺耐药基因qacE△1-sul1,整合子遗传标记基因intⅠ1、intⅠ2、intⅠ3,转座子遗传标记基因tnpA、merA,共计36种.结果 KPN共检出7种耐药基因,分别为β-内酰胺酶基因blaTEM,blaSHV,金属β-内酰胺酶基因blaKPC-2,氨基糖苷修饰酶基因aac(3)-Ⅱ,ant(3")-Ⅰ,消毒剂磺胺耐药基因qacE△1-sull,整合子遗传标记基因intⅠ1.结论 在该株泛耐药KPN中发现了少见的blaKPC-2金属β-内酰胺酶基因,该菌对18种抗菌药物的耐药可能与其同时携带有多种耐药基因有关,临床应对此类菌株引起重视.     

ICU分离鲍氏不动杆菌对碳青霉烯类抗菌药物耐药机制研究

目的调查医院重症监护病房(ICU)分离鲍氏不动杆菌对碳青霉烯类抗菌药物的耐药机制,为ICU鲍氏不动杆菌感染治疗的抗菌药物选择提供理论依据。方法收集2010年1月-2014年1月ICU住院患者分离到的135株非重复鲍氏不动杆菌,采用VITEK-2Compact全自动微生物分析系统进行鉴定及药敏分析,采用PCR法检测blaVIM、blaNDM、blaOXA-23/24、blaIMP、blaKPC及blaOXA-51/58等碳青霉烯酶耐药基因,采用PCR检测ISAba1基因并与碳青霉烯酶基因连锁检测。结果 4年ICU分离出鲍氏不动杆菌135株,年龄60岁患者分离的鲍氏不动杆菌最多52株,占38.52%;ICU患者痰液标本中检出鲍氏不动杆菌最多79株占58.52%,其次为分泌物及尿液,分别占20.00%及11.11%;鲍氏不动杆菌对氨苄西林耐药率最高为94.81%,对美罗培南和亚胺培南的耐药率分别为32.95%和34.07%;对选取的46株碳青霉烯类耐药菌进行基因检测显示,46株均携带有blaOXA-51-like基因,46株菌携带ISAba1基因;40株携带blaOXA-23-like基因,对blaOXA-23-like基因测序,进行比对后确定为blaOXA-23基因,并同时检出ISAba1-blaOXA-23连锁基因;未检出blaKPC、blaIMP、blaVIM、blaOXA-58-like、blaOXA-24-like及blaNDM基因。结论 ICU患者分离的鲍氏不动杆菌耐药性严重,以老年患者居多,主要分离自痰液标本,其中碳青霉烯耐药株常携带有OXA-23型碳青霉烯酶基因,并与ISAba1连锁携带。     

2018—2021年武汉市3家医院不同科室病房空气环境中的耐药菌污染

目的 了解医院不同科室病房空气中耐药菌的污染情况。方法 于2018年11月至2021年6月采集武汉市3家医院部分科室病房空调回风口滤网积尘样本191份,对积尘中的耐药菌进行筛选、鉴定,选择19种常用抗生素对检出的金黄色葡萄球菌、鲍曼不动杆菌、肠杆菌科细菌等目标菌进行药敏试验。结果 119份积尘样本检出耐药菌,阳性率为62.30%,共筛选、鉴定出362株耐药菌,主要为不动杆菌属(28.73%)、芽胞杆菌属(24.31%)、假单胞菌属(22.10%)、葡萄球菌属(9.12%)等,不同科室积尘样本的阳性率由高到低依次为外科(68.29%)>重症监护室(59.62%)>内科(57.97%);其中检出72株目标菌,检出率为19.89%(72/362),不同目标菌的检出率由高至低依次为鲍曼不动杆菌(12.71%)>肠杆菌科细菌(4.42%)>金黄色葡萄球菌(2.76%)(P<0.05)。72株目标菌的药敏试验结果显示,41株为耐药菌,检出率为56.94%(41/72),包括耐碳青霉烯类鲍曼不动杆菌、耐甲氧西林金黄色葡萄球菌、耐碳青霉烯类肠杆菌科细菌等,其中24株为多重...     

某院耐碳青霉烯类肠杆菌科细菌耐药基因分析

目的研究某院耐碳青霉烯类肠杆菌科细菌(CRE)在细菌耐药方面的分子流行病学特征,为CRE的防控提供依据。方法收集某院2013—2017年细菌室保存的CRE,对其进行多位点序列分型(MLST)、药敏试验、全基因序列测定,选取部分CRE中携带的碳青霉烯耐药基因进行基因环境分析。结果共收集62株CRE,成功复活51株;其中耐碳青霉烯类肺炎克雷伯菌(CRKP)30株,耐碳青霉烯类大肠埃希菌(CREC)9株,耐碳青霉烯类阴沟肠杆菌(CRECL)6株,耐碳青霉烯类其他肠杆菌6株。CRKP MLST主要包括3株ST147、2株ST11;CREC MLST主要包括3株ST167;CRECL MLST主要包括3株ST93、2株ST88。51株CRE对氨苄西林、头孢噻肟的耐药率最高,均为100%。耐碳青霉烯类耐药基因分布:1株携带blaKPC-2,14株携带blaIMP-4,18株携带blaNDM-1,22株携带blaNDM-5,2株携带blaNDM-9,10株携带blaOXA-1,10株携带blaOXA-10,2株携带blaOXA-23,2株携带blaOXA-66。分析blaNDM-1、blaNDM-5、blaNDM-9、blaIMP-4不同菌种的基因环境,发现几种耐药基因各自的基因环境都与已报道的基因环境相似,无明显的菌种间差异性。结论耐药基因通过水平传播能稳定存在于不同的CRE菌株中,对医院感染防控造成一定的威胁。     

Trends in meningococcal disease in Italy in 1988

Meningococcal disease in Italy decreased 15% in 1988 from the previous year (290 vs. 342 cases). The decline was particularly evident in military cases (1.7/100,000 in 1988 vs. 5/100,000 in 1987) reflecting the full coverage of bivalent serogroup (A + C) meningococcal polysaccaride vaccine in army recruits, achieved since January 1988. The highest proportion of cases was seen in people older than 25 years of age (25%). Serogroup C constituted 60% of the isolates, while 19% belonged to serogroup B. The proportion of strains resistant to sulphonamides was 45%, while 15% were resistant to Minocycline and none to Rifampin. Out of the five military cases, only one (due to serogroup C) was attributable to the vaccine failure. A single coprimary case, but no secondary cases occurred among civilians. These findings are consistent with the trends reported in Italy in the previous years.     

Benzene in blood and phenol in urine in monitoring benzene exposure in industry

Determinations of benzene concentration in blood and of phenol in urine were made by head-space gas chromatography techniques on samples taken near the end of the work day from two groups of workers potentially exposed to low levels of benzene in the work-place atmosphere. Preliminary results suggest that benzene in blood is more reliable than phenol tests for assessing both exposure and uptake of benzene. Normal values of phenol in urine (10 mg/liter or less) were found in nearly all those cases in which benzene was detected in the blood.     

2015年郑州市饮用水放射性水平状况调查

目的了解郑州市不同地区、不同季节、不同水源类型的放射性水平。方法分别于丰水期和枯水期采集郑州市区黄河水源水、井水源水、丹江口水源水、出厂水和末梢水各一份;以县为单位,每单位采集出厂水、末梢水、水库水、河水、井水各1份,按《生活饮用水生活标准检验方法》(GB/T 5750.13-2006)检测饮用水中总α和总β放射性水平,依据《生活饮用水卫生标准》(GB 5749-2006)进行判定。结果丰水期、枯水期水体总α、总β放射性水平均低于国家标准限值。结论郑州市不同水源类型均处于正常的天然放射性本底水平。     

Occupational stress in nurses in psychiatric institutions in Taiwan

Nurses are known to be exposed to occupational stress. However, occupational stress is not well documented for nurses in psychiatric institutions in Taiwan. A cross-sectional study was conducted to explore the work-related stress and risk factors of nurses in psychiatric institutions in Taiwan. A structured questionnaire was distributed to nurses at five state-owned psychiatric hospitals in Taiwan in 2001. Demographic information, working environment, and personal health status were inquired. Occupational stress was assessed based on the Chinese version of Job Content Questionnaire (JCQ). General health status and mental health were evaluated by the International Quality of Life Assessment Short Form-36 (IQOLA SF-36). A total of 573 questionnaires were disseminated to nurses and 518 (90.4%) were satisfactorily completed by nurses, including 408 female full-time nurses who had been in their current work for more than 6 months. In the past one month, 17.2% of nurses reported being under significant stress often or always. Assault episodes were reported by 45.1% of nurses in the past 6 months. Among the nurses, 16.9%, 25.2%, 50.0%, and 7.8% belong to the "High strain", "Low strain", "Active", and "Passive" groups, respectively. Perceived occupational stress was associated with young age, widowed/divorced/separated marital status, high psychological demand, low workplace support, and threat of assault at work. Lower general health score was associated with low job control, high psychological demand, and perceived occupational stress. A lower mental health score was associated with low job control, high psychological demand, low workplace support, and perceived occupational stress. We concluded that nurses in psychiatric institutions are under significant stress related to work factors.     

Changes in nursing administration in supporting transplantation in Brazil

This historical and bibliographic study aimed to understand how Nursing was organized to support care in transplantation. The HISA, LILACS, BDENF, PERIENF and DEDALUS databases were consulted, and thirteen references were found, ten of which were scientific articles, two were master's dissertations and one was a doctoral thesis. The span of time chosen for study ranges from the date of the first kidney transplant in Brazil (1965), to the date of publication of the last scientific article found in the databases mentioned above (2003). After reading these articles, the ones that were similar in topic were grouped together, thus creating the thematic axis for the presentation of the results. The results showed that the Nursing profession has played an important and active role in transplants ever since the first procedure in 1965.     

2019年中国肿瘤流行病学研究进展

恶性肿瘤已成为中国居民的主要死因之一。近些年来,中国政府积极推进肿瘤预防和控制领域的研究工作,取得了很大的进步。本文简要汇总中国在肿瘤流行病学领域的研究进展,具体包括2019年的肿瘤负担、癌症危险因素及其干预、筛查和早期发现、癌症防治专项行动(2019-2022年)方案等方面,以期为我国肿瘤防治工作的有效开展提供技术支撑和理论依据。     

2012年绵阳市蔬菜中农药残留状况

目的 了解绵阳市2012年市售蔬菜中农药残留情况,为食用蔬菜监管提供依据.方法 全部样品均按照GB/T 5009-2003的方法进行农药的残留检测.依据GB 2763-2005《食品中农药最大残留限量》进行判定.结果 2012年共检测蔬菜165份,农药检出率和超标率分别为72.12％和23.64％.豆类、根茎类、叶菜类、瓜果菜类和食用菌类蔬菜检测农药残留超标率分别为8.00％、23.53％、36.00％、5.26％和27.03％,差异有统计学意义(x2=11.41,P＜0.01).不同种类农药超标率差异有统计学意义(x2 =62.42,P＜0.01).夏季和冬季蔬菜农药超标率差异无统计学意义(x2=3.44,P＞0.05).结论 绵阳市叶菜类蔬菜中农药残留情况较为严重,应采取有效措施,加强蔬菜的监督管理,从源头禁止高毒农药的使用,加大蔬菜种植、销售环节的监测,确保市民食用蔬菜的安全.