恶性肿瘤住院患者病原菌分布及耐药性分析

摘要:目的 了解恶性肿瘤住院患者的病原菌分布以及病原菌对常用抗菌药物的耐药情况。方法 对大型综合性三甲医院2010-2014年的恶性肿瘤(包括实体肿瘤与非实体肿瘤)住院患者的临床分离病原菌及其药敏结果采用回顾性分析。结果 临床分离病原菌共5 194株,其中革兰阴性菌4 569株,占87.97%,前三位依次为肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌,革兰阳性菌625株,占12.03%,前三位依为金黄色葡萄球菌、屎肠球菌、肺炎链球菌。革兰阴性菌对青霉素类、头孢菌素类、磺胺类、四环素类抗菌药物耐药率较高;革兰阳性菌对青霉素类、大环内酯类、喹诺酮类抗菌药物耐药率较高。结论 恶性肿瘤患者病原菌多为条件致病菌,而且对常用抗生素的耐药情况严峻。     

系统性红斑狼疮患者合并感染的病原菌及耐药性分析

目的了解系统性红斑狼疮(SLE)患者感染的病原菌分类及耐药性,为临床诊断及经验性使用抗菌药物提供参考。方法回顾性分析2011年11月-2014年3月,在本院就诊的SLE患者合并感染时的病原菌分类及耐药情况。结果632例SLE患者中210例合并感染,感染率为33.23%,例次感染率为46.20%;共分离出病原菌292株,其中革兰阴性菌119株(40.75%)、革兰阳性菌94株(32.19%)。革兰阴性菌对广谱青霉素、第一代及第二代头孢、磺胺类抗菌药物有较高的耐药率;对亚胺培南、美罗培南、阿米卡星较敏感,耐药率低。革兰阳性菌对普通青霉素、广谱青霉素耐药率极高;对第一代头孢、大环内酯类、喹诺酮类、氨基糖苷类等抗菌药物均具有较高的耐药率;而革兰阳性菌对万古霉素最敏感。结论 SLE合并感染者以革兰阴性菌为主,主要病原菌对抗菌药物的耐药率增高,监测病原菌及耐药性对合理选用抗菌药物具有重要的意义,同时不能忽视结核感染的可能。     

神经外科患者围手术期感染病原菌调查分析

目的了解神经外科患者围手术期感染病原菌的构成特点,为临床诊治及科学选药提供依据。方法回顾性统计分析2010年8月-2013年7月神经外科患者病原学标本中分离出的阳性病原菌和药敏监测资料,药敏试验采用K-B纸片法。结果神经外科患者围手术期感染病原菌标本来源以痰液和粪便标本为主,分别占59.49%和25.90%;共分离病原菌390株,其中革兰阴性菌199株占51.02%,革兰阳性菌65株占16.67%,真菌126株占32.31%;主要革兰阴性菌和革兰阳性菌对多数青霉素类、头孢菌素类、喹诺酮类的耐药率>70.00%,假丝酵母菌属对益康唑、伊曲康唑和酮康唑也有少数耐药现象。结论神经外科感染病原菌以革兰阴性菌为主,主要病原菌对常用抗菌药物均产生了较严重的耐药性,临床应针对感染的高危因素严格落实各项控制措施,根据药敏结果合理选择抗菌药物。     

老年患者下呼吸道感染的常见病原菌及耐药性分析

目的分析老年患者下呼吸道感染的常见病原菌分布情况及耐药性。方法选择2014年4月-2016年12月医院就诊48例老年急性下呼吸道感染患者,采用微生物半自动鉴定系统进行细菌分离及鉴定,通过K-B纸片扩散法进行药物敏感性试验,分析患者感染病原菌的分布情况及药敏试验结果。结果 48例老年急性下呼吸道感染患者痰培养标本中共分离出病原菌76株,其中革兰阴性菌46株,占60.5%;革兰阳性菌30株,占39.5%;老年急性下呼吸道感染患者分离的病原菌中革兰阴性菌对青霉素类,喹诺酮类,第三代以下头孢菌素,四环素类,部分氨基糖苷类等抗菌药物耐药性较高,部分可达100.0%,而对青霉素类+酶抑制剂、头孢菌素类+酶抑制剂、碳青霉烯类、阿米卡星等仍然较敏感,革兰阳性菌对青霉素类普遍耐药,但对部分头孢菌素类、万古霉素、替考拉宁、利福平、部分喹诺酮类等仍然较敏感。结论老年患者下呼吸道感染血培养分离的病原菌中以革兰阴性菌为主,且存在较严重的耐药现象,而部分氨基糖苷类,阿米卡星,青霉素类+酶抑制剂、头孢菌素类+酶抑制剂抗菌药物敏感性较高,应结合医院药敏试验结果针对性选用抗菌药物。     

新生儿重症监护病房患儿感染病原菌分布及耐药性分析

目的探讨新生儿重症监护病房(NICU)患儿感染病原菌分布及耐药性,为临床合理选择抗菌药物提供依据。方法选取2013年9月-2015年9月本院NICU感染患儿260例,采集患儿血液、痰液等标本进行病原菌培养、分离检测和药物敏感试验,分析病原菌分布及其耐药性。结果 260例患儿共分离病原菌274株,其中革兰阴性菌176株(64.2%),革兰阳性菌86株(31.4%),真菌12株(4.4%)。革兰阴性菌对第三代头孢菌素、喹诺酮、氨基糖苷类等抗菌药物耐药率较高,多数70%;耐药率较低的是亚胺培南、头孢哌酮/舒巴坦、哌拉西林/舒巴坦等;革兰阳性菌对青霉素、克林霉素、红霉素、氨苄西林和左氧氟沙星等抗菌药物耐药率较高,多数70%,未发现对万古霉素耐药菌;真菌的耐药率较低,均未表现出对伊曲康唑、制霉菌素和氟康唑等药物耐药。结论 NICU患儿感染病原菌以革兰阴性菌为主,耐药情况较为严重,临床用药应该避免经验性用药,及时做细菌培养和药敏试验,根据药敏结果进行针对性选择用药,避免抗菌药物的滥用。     

慢性阻塞性肺疾病患者急性发作期痰病原学分布特点与耐药性研究

目的探讨慢性阻塞性肺疾病急性发作期(AECOPD)患者痰病原菌培养结果及药物敏感性,为AECOPD下呼吸道感染的病原菌流行病学分析及抗菌药物选择提供借鉴。方法对2012年1月-2013年12月住院的813例AECOPD患者痰液病原菌培养及药敏结果进行统计分析。结果 813份痰标本中培养出病原菌168株,培养阳性率为20.66%;168株病原菌中,革兰阴性菌占78.57%、革兰阳性菌占8.33%、真菌占13.10%;革兰阴性菌除头孢他啶耐药率<32.79%外,对常用的第二、三代头孢菌素均出现明显耐药,耐药率在66.76%~100.00%,大肠埃希菌的耐药性更严重,耐药率均>87.50%,但革兰阴性菌对碳青霉烯类抗菌药物敏感性仍高,耐药率<24.59%;革兰阳性菌对第一、二代头孢及喹诺酮类抗菌药物敏感性仍高,耐药率<25.00%,万古霉素耐药率为0;白色假丝酵母菌对常用抗真菌药物敏感性高,耐药率<5.00%。结论 AECOPD患者感染的病原菌以革兰阴性菌为主,大肠埃希菌耐药严重,对病情重及反复住院患者,宜选用广谱β-内酰胺酶抑制剂的复合抗菌药物、氨基糖苷类。     

维持性血液透析患者静脉导管相关性感染的病原菌分布及药敏分析

目的分析维持性血液透析(MHD)患者静脉导管相关性感染的相关因素、病原菌分布及药敏性,为临床治疗提供依据。方法选取2013年1月-2015年12月医院收治100例MHD患者为研究对象,对患者进行血液/分泌物培养,分析患者发生导管相关性感染的相关因素、病原菌分布及药敏结果,数据采用SPSS16.0统计软件进行分析,计量资料用均数±标准差表示,计数资料用率和百分比表示行χ~2检验,感染发生的影响因素采用logistic多因素分析,P<0.05为差异有统计学意义。结果 100例MHD患者中,15例发生导管相关性感染,感染率15.00%;患者年龄及BMI(体质量指数)与感染的发生具有显著相关性,差异有统计学意义(P<0.05);感染患者共分离出46株病原菌,其中革兰阳性菌31株占67.39%,革兰阴性菌15株占32.61%;革兰阳性菌中金黄色葡萄球菌对苯唑西林、红霉素及克林霉素等耐药率较高,均>50.00%,表皮葡萄球菌对苯唑西林、磺胺甲噁唑/甲氧苄啶及庆大霉素等耐药率较高>30.00%,肠球菌属对苯唑西林、红霉素及环丙沙星等耐药率较高,均>60.00%,主要革兰阳性菌对万古霉素等耐药率均为0,革兰阴性菌对环丙沙星、左氧氟沙星、美罗培南及亚胺培南的耐药率为0,而对哌拉西林及头孢呋辛酯的耐药率较高。检出菌株中鲍氏不动杆菌对10类抗菌药物耐药,而铜绿假单胞菌对12类抗菌药物耐药。结论 MHD患者导管相关性感染的病原菌存在多药耐药现象,提示导管相关性感染的治疗需要以药敏检查结果为依据。     

尿毒症住院患者感染部位与病原菌分析

目的探讨尿毒症住院患者感染部位与病原菌分布,为预防和控制患者感染提供依据。方法选取2015年8月-2016年8月于医院血液净化科住院治疗,确诊为慢性肾功能不全尿毒症期并发感染的患者154例为研究对象,统计感染部位构成比,病原菌分布和药敏结果,采用SPSS22.0对数据进行分析。结果下呼吸道感染患者最多,占57.14%;分离出病原菌179株,其中,革兰阴性菌占43.01%,革兰阳性菌占45.81%,真菌占11.18%;革兰阴性菌和革兰阳性菌在不同部位的占比不同,下呼吸道两类细菌占比相似,腹膜和导管以革兰阳性菌为主,分别占62.07%和75.00%,泌尿系革兰阴性菌占70.83%;耐药性分析中,革兰阳性菌耐药率较高,溶血葡萄球菌对青霉素、亚胺培南、美罗培南、哌拉西林耐药率为100%,革兰阳性菌对替考拉宁、万古霉素、美满霉素、利奈唑胺耐药率低于10%;革兰阴性菌对哌拉西林、阿米卡星、美满霉素耐药率低于20%,大肠埃希菌对环丙沙星、左氧氟沙星、庆大霉素、磺胺甲噁唑/甲氧苄啶、四环素耐药率>50%;真菌耐药率均低于15%。结论尿毒症患者感染发生部位广泛,病原菌多为院内常见致病菌,耐药性高,应根据药敏结果合理应用抗菌药物。     

老年患者下呼吸道感染病原菌分布及耐药性分析

目的探讨老年患者下呼吸道感染病原菌的分布及其耐药性,为指导临床合理用药提供参考依据。方法选取2010年4月-2013年7月老年下呼吸道感染患者480例,采集所有患者痰液及支气管灌洗液标本进行病原菌检测,菌种鉴定采用法国生物梅里埃公司VITEK-60全自动细菌分析仪,药物敏感试验采用K-B纸片扩散法。结果 480例老年下呼吸道感染患者检出病原菌790株,其中革兰阴性菌463株占58.61%,革兰阳性菌259株占32.78%,真菌有68株占8.61%;革兰阴性菌对于喹诺酮类、氨基糖苷类、第三代头孢菌素等抗菌物耐药率较高,其中耐药率较高的是亚胺培南、头孢哌酮/舒巴坦、哌拉西林/唑巴坦,约100.00%;革兰阳性菌对克林霉素、左氧氟沙星、红霉素、青霉素有较高的耐药性;真菌的耐药率普遍较低。结论老年患者下呼吸道感染病原菌主要以革兰阴性菌为主,加强对病原菌分布以及耐药性监测,根据监测结果合理使用抗菌药物,以减少新耐药菌株的形成,降低医院感染的发生。     

人类免疫缺陷病毒感染及艾滋病患者合并神经梅毒的病原菌分布及耐药性分析

目的了解HIV/AIDS合并神经梅毒患者感染病原菌的分布及耐药情况,指导临床合理用药。方法回顾性分析243例2013年1月-2018年9月本院收治的诊断为HIV/AIDS合并神经梅毒患者感染病原菌的分布及耐药情况。结果分离出病原菌共176株,其中革兰阴性菌66株,占37. 50%;革兰阳性菌35株,占19. 89%;真菌60株,占34. 09%;结核分枝杆菌15株,占8. 52%。厄他培南、亚胺培南、头霉素类对肠杆菌科细菌的抗菌活性优异,头孢唑林、氨苄西林、复方新诺明对革兰阴性菌的整体抗菌活性均较差;凝固酶阴性葡萄球菌和金黄色葡萄球菌对青霉素G和红霉素耐药率较高,革兰阳性菌对万古霉素、利奈唑烷、呋喃妥因、替加环素的耐药率较低。结论 HIV/AIDS合并神经梅毒患者的感染病原菌以革兰阴性菌及真菌居多,结核分枝杆菌感染亦较高,细菌耐药情况较严重,临床应充分重视病原菌药敏的持续监测,合理选择抗菌药物。     

Female sterilization-acceptor characteristics

This article reports the findings of a study concerning the socioeconomic characteristics of women undergoing sterilization in India. Only 23% of India's 119 million couples use some form of contraception, but of these, 87% rely on male or female sterilization. It is estimated that some 20 million married women of reproductive age have been sterilized. This study examined the cases of 800 women who underwent sterilization at the Department of Obstetrics and Gynecology of the Kamla Nehru Hospital, Shimla from February 1986 to April 1987. In addition to investigating the socioeconomic characteristics of the women, the study also focused on the knowledge and practice of other contraceptive methods, the motivating factors, and the reasons for undergoing sterilization. The study found that 68% of the women were from rural areas and 32% from urban areas. 71% of the women belonged to lower social classes -- only 40% of the women were literate. 98% of the women were Hindus, the remaining 2% belonging to other religious groups. 72.9% of the women were between the ages of 20 and 33 years, the mean age at sterilization being 27.5 years. While 77.3% of the women has 2 or 3 living children, only 2.6% had only 1 living child. 71.2% of the women had both male and female children, and 9.2% had only female children. Concerning the use of contraception, only 22% of the women had practiced contraception prior to the operation. 70% of the women reported being self-motivated, while 26% said that they had been motivated by a family planning worker or hospital staff member. 96.5% of the women reported multiparity and/or socioeconomic reasons for undergoing the procedure, while 3.5% of the sterilizations were performed for therapeutic reasons.     

Placental characteristics and birthweight

Standard gross placental measures capture dimensions relevant to specific placental functions. Our objective was to determine their accountability independent of placental weight for variance in birthweight, an important proxy for intrauterine 'adequacy' in fetal origins studies. The sample consisted of 24 152 singleton liveborn children of the Collaborative Perinatal Project delivered from 34 to 42 completed weeks gestation, with complete data for six placental measures (placental disc shape, umbilical cord length, distance from cord insertion to nearest margin, large diameter, small diameter, placental thickness) and placental weight. Associations between birthweight and placental measures were examined using multiple linear regression. Placental weight alone accounted for 36.6% of birthweight variation; the six other placental measures accounted for 28.1%. Combined, all placental measures accounted for 39.1% of birthweight variation. Seven maternal characteristics (age, height, weight, parity, socio-economic status, cigarette use, and race) were investigated to determine whether their known associations with birthweight were mediated by placental markers. Analysis suggested that the impact of all maternal characteristics except smoking was consistent with mediation by placental characteristics.     

Patient characteristics and fairness

This study examines the fairness concept of health care professionals, and asks whether they are willing to use a patient’s age and other potential fairness characteristics rather than health benefits as relevant arguments in the allocation of health care resources? The patient characteristics in the health care professionals’ survey encompass age, productivity and lifestyle. The study is a replication of a much older study from the 1970s. The present study finds that the understanding of fairness among health care professionals differs from concepts of fairness in legislation. The status of various patient characteristics as rationing arguments has remained much the same, although nowadays health care professionals are expected to be more aware of moral dimensions and also legislation on patients’ rights. The fairness concept of health care professionals may lead to resource allocation decisions that deviate from the intention of such legislation.     

Lead attenuation characteristics models

Lead attenuation characteristic curves are often consulted in premises radiation shielding assessments employing the non-destructive testing (NDT) method. This study developed lead attenuation characteristics mathematical models for the radionuclide Co-57. These models take into account the statistical variation of the attenuation characteristics. The results are a set of equations that a NDT assessor can use to predict the range of transmission factors for the NDT measurement or, using the inverse functions, to gauge the lead equivalence (with the associated uncertainty) of a radiation barrier. This study showed that the combined effect of types of statistical variations can form an uncertainty region on the transmission characteristics such that the relative uncertainty decreases for values of lead mass per unit area up to approximately 20kg/m² and 15 kg/m² for the Ludlum 18 and Ludlum 2241–2 survey meters respectively but thereafter increases.     

氟喹诺酮类药物的药理特点

作为三、四代喹诺酮药物中的氟喹诺酮,因其本身的结构多了一种氟元素,因此使得该药物在药代动力学,临床使用方面以及疗效价格比等方面都取得长足的进步.近几年来,随着β-内酰胺类和氨基糖甙类药物的耐药菌株的不断增加,使得医院在临床工作中开始重视氟喹诺酮类药物.为了能够充分了解氟喹诺酮类药的药理特点,该文将从抗菌活性的广泛性、新奇的抗菌作用机制、氟喹诺酮类药的耐药机制及药物代谢的特点等方面逐一进行阐述.     

Cost characteristics of hospitals

Modern hospitals are complex multi-product organisations. The analysis of a hospital's production and/or cost structure should therefore use the appropriate techniques. Flexible functional forms based on the neo-classical theory of the firm seem to be most suitable. Using neo-classical cost functions implicitly assumes minimisation of (variable) costs given that input prices and outputs are exogenous. Local and global properties of flexible functional forms and short-run versus long-run equilibrium are further issues that require thorough investigation. In order to put the results based on econometric estimations of cost functions in the right perspective, it is important to keep these considerations in mind when using flexible functional forms. The more recent studies seem to agree that hospitals generally do not operate in their long-run equilibrium (they tend to over-invest in capital (capacity and equipment)) and that it is therefore appropriate to estimate a short-run variable cost function. However, few studies explicitly take into account the implicit assumptions and restrictions embedded in the models they use. An alternative method to explain differences in costs uses management accounting techniques to identify the cost drivers of overhead costs. Related issues such as cost-shifting and cost-adjusting behaviour of hospitals and the influence of market structure on competition, prices and costs are also discussed shortly.     

SARS的流行病学特征

本文对自SARS发生以来的有关文献资料进行了综述，介绍了全球SARS发生发展的过程和流行概况、流行环节、分布特征以及影响SARS流行的因素。对SARS潜伏期、传染性、超级传播现象、传播途径、人群易感性及“三间”分布特征进行了重点阐述。对SARS病人的预后及其影响因素也作了简要介绍。