重症医学科革兰阴性菌耐药性分析

目的了解重症医学科临床分离革兰阴性菌及细菌耐药性情况。方法对某院重症医学科2009年10月～2011年9月的所有分离革兰阴性菌株进行耐药分析。结果共分离革兰阴性杆菌795株细菌,最常见的革兰阴性菌依次为铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌和鲍曼不动杆菌。铜绿假单胞菌对多种抗菌药物耐药,对丁胺卡那的敏感率最高(77.8%);对亚胺培南敏感率仅为41.4%。ESBL(+)肺炎克雷伯菌、大肠埃希菌耐药率明显升高,对亚胺培南敏感率分别为96.2%和100%。鲍曼不动杆菌呈现多重耐药,对亚胺培南敏感率为61.3%。结论重症医学科革兰阴性菌对抗菌药物耐药率高。细菌耐药性监测对指导临床经验性用药及抗菌药物管理具有重要意义。     

福建闽江细菌种类及分布的调查

目的：了解福建闽江江水细菌的种类及分布情况。方法：采集闽江不同水域的水样,经增菌培养、细菌分离,进行细菌学鉴定。结果：从闽江中分离出细菌320株,其中肠杆菌科细菌189株（59.1%）,弧菌科细菌41株（12.8%）,非发酵菌35株（10.9%）,革兰阳性杆菌29株（9.1%）,革兰阳性球菌26株（8.1%）。结论：闽江细菌种类多、分布广泛,此项调查对于该水域细菌感染的防治具有重要意义。     

赛江水中肠杆菌科细菌分离及耐药性监测

目的:了解福建赛江水中肠杆菌科细菌的种类及其对抗菌药物的敏感性.方法:用水样采集器采集赛江水10个点,水样经增菌培养、细菌分离,进行细菌学鉴定和抗菌药物敏感性试验.结果:从赛江水中分离出肠杆菌科细菌123株,其中大肠埃希菌43株(35.0%)、变形杆菌属细菌25株(20.3%)、克雷伯菌属细菌24株(19.50%)、肠杆菌属细菌14株(11.4%)、枸橼酸杆菌属细菌9株(7.3%)和成团泛菌8株(6.5%).药敏试验结果显示,123株肠杆菌科细菌对头孢哌酮/舒巴坦和亚胺培南的敏感率为100.0%,对左氧氟沙星、阿米卡星、奈替米星、头孢哌酮、头孢他啶和头孢噻肟的敏感率为90.7%～100.0%,对复方磺胺甲恶唑、头孢呋辛、环丙沙星、哌拉西林和氨曲南的敏感率为60.5%～88.90k,,对氨苄西林和头孢唑啉的敏感率为4.2%～44.0%.结论:赛江水中肠杆菌科细菌种类多,对多种抗菌药物有一定耐药性,此项调查对于该水域细菌感染的防治具有一定的指导意义.     

晋江水中肠杆菌科细菌耐药性监测分析

目的:了解福建晋江水中肠杆菌科细菌的种类及其对抗菌药物的耐药性。方法:用采样器采集晋江江水10个点,水样经增菌培养和细菌分离,用常规方法和微生物分析仪进行细菌鉴定,药敏试验采用纸片琼脂扩散法。结果:从江水中分离出肠杆菌科细菌144株,其中大肠埃希菌47株(32.6%)、肠杆菌属细菌31株(21.5%)、奇异变形杆菌29株(20.1%)、克雷伯菌属细菌23株(16.0%)、沙雷菌属细菌8株(5.6%)、成团泛菌4株(2.8%)和弗劳地枸橼酸杆菌2株(1.4%)。药敏试验结果显示,130株肠杆菌科细菌对亚胺培南和头孢哌酮/舒巴坦的耐药率为0%,对左氧氟沙星、阿米卡星、奈替米星、头孢他啶和头孢噻肟的耐药率为3.2%~9.7%,对头孢呋辛、环丙沙星和氨曲南的耐药率为17.4%~38.7%,对氨苄西林和头孢唑啉的耐药率为51.6%~95.7%。结论:晋江水中肠杆菌科细菌对多种抗菌药物产生了一定的耐药性,开展江水细菌调查及耐药性监测,对于防治江水细菌感染和控制耐药菌株播散都具有重要意义。     

老年科感染病原菌分布及耐药性分析

目的分析医院2006～2008年老年科感染患者临床分离病原菌资料,了解老年科感染患者的病原菌分布及抗菌药物敏感性特征。方法采用API鉴定系统鉴定细菌及真菌;纸片扩散法测定细菌药物敏感性,Rosco纸片法测定真菌药物敏感性;WHONET5.4软件进行统计分析。结果医院老年科感染患者临床分离的2098株菌中,革兰阴性菌1534株(73.12%),革兰阳性菌268株(12.77%),真菌296株(14.11%);其中,检出率最高的病原菌是铜绿假单胞菌,共547株,占26.07%,其次是大肠埃希菌(12.77%)和克雷伯菌属(11.68%);耐药性分析结果显示,非发酵菌中,铜绿假单胞菌对大部分抗菌药物耐药率40.00%;不动杆菌属对美罗培南、亚胺培南和头孢哌酮/舒巴坦敏感性较高,75.00%;而肠杆菌科细菌对美罗培南、亚胺培南敏感性则90.00%,但其对多数头孢菌素类耐药率50.00%,当采用联合酶抑制剂后,其耐药性可有明显下降;葡萄球菌属未发现万古霉素耐药株,但对其他多种抗菌药物耐药。结论老年科感染病原菌对多种抗菌药物耐药率较高,应加强抗菌药物合理应用。     

福建江水细菌种类调查

目的 了解我国福建江水中细菌的种类及分布情况.方法 用水样采集器采集江水,水样经增菌培养和细菌分离,进行细菌学鉴定.结果 从80份水样中分离出细菌56种1 041株,其中肠杆菌科细菌608株(58.41%),弧菌科细菌158株(15.18%),非发酵菌116株(11.14%),革兰阳性杆菌82株(7.88%),革兰阳性球菌77株(7.39%).结论 福建江水细菌种类多、分布广,此项调查对于江水细菌感染的防治具有一定的意义.     

肝胆外科患者胆汁致病菌分离及药敏鉴定结果

目的了解胆汁致病菌分布及耐药状况。方法收集津市人民医院外科2000年1月-2008年4月送检胆汁标本中分离的致病菌及药敏鉴定结果,统计致病菌分布和抗菌药物的敏感率。结果分离到致病菌株441株,其中革兰阴性菌375株占85%,革兰阳性菌66株占15%。排名前五位的致病菌分别为:大肠埃希菌(29.3%)、不动杆菌属(13.6%)、变形杆菌属(10.9%)、铜绿假单胞菌(10.2%)、肠杆菌属(8.8%)。对革兰阴性菌的总体敏感率为亚胺培菌100%、阿米卡星79.9%、呱拉西林/他唑巴坦76.5%、磷霉素73.6%、美洛培南70.4%、头孢他啶66.4%,其余抗菌药物均<60%。结论胆汁中分离的细菌以革兰阴性为主。本研究结果将为胆道感染的预防和经验性抗菌药物治疗提供基本依据。     

2005-2007年呼吸科病房病原菌的分布及耐药性变迁

目的 分析医院呼吸科病房病原菌的分布及耐药性特点,为呼吸科临床合理使用抗菌药物提供依据.方法 回顾性分析2005-2007年呼吸科病房送检的所有标本细菌培养和药物敏感试验结果.结果 共分离菌株264株,革兰阳性菌68株(25.8%),革兰阴性菌165株(62.5%),真菌31株(11.7%);耐甲氧西林金黄色葡萄球菌(MRSA)检出77.1%,3年中呈增加趋势;未发现耐万古霉素金黄色葡萄球菌和肠球菌;肺炎链球菌对青霉索的耐药率为44.4%～66.7%;肠杆菌科细菌和鲍氏不动杆菌对亚胺培南高度敏感;铜绿假单胞菌敏感率＞70.0%的药物依次为头孢哌酮/舒巴坦、阿米卡星、庆大霉素、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、头孢哌酮、亚胺培南.结论 呼吸科病房临床分离菌符合近年来病原菌的变化趋势,病原菌以革兰阴性菌为主,病原菌的耐药日趋增高,对指导临床合理使用抗菌药物具有重要意义.     

九龙江水中肠杆菌科细菌分布及耐药性监测结果

目的 了解福建九龙江水中肠杆菌科细菌的种类及其对抗菌药物的耐药情况.方法 用采样器采集九龙江水10个点,水样经增菌培养和细菌分离,用常规方法及全自动微生物分析仪进行细菌学鉴定,抗菌药物敏感性试验殚采用纸片琼脂扩散法.结果 从九龙江水中分离出肠杆菌科细菌152株,其中大肠埃希菌48株(31.6%)、肠杆菌属细菌49株(32.2%)、克雷伯菌属细菌21株(13.8%)、变形杆菌属细菌19株(12.5%)、粘质沙雷菌8株(5.3%)、成团泛菌5株(3.3%)和异型枸橼酸杆菌2株(1.3%).对其中137株细菌进行药敏试验,结果显示亚胺培南和头孢哌酮/舒巴坦的耐药率为0%,对环丙沙星、氨曲南、左氧氟沙星、阿米卡星、奈替米星、头孢噻肟和头孢他啶的耐药率为4.1%～28.6%,对氨苄西林、头孢唑啉和头孢呋辛的耐药率为31.3%～95.2%.结论 九龙江水中肠杆菌科细菌对多种抗菌药物已产生耐药性,进行江水细菌耐药性监测,对于防治江水细菌感染具有一定的意义.     

医院2006-2008年革兰阴性菌分离及耐药性分析

目的 了解2006-2008年革兰阴性菌的分离和耐药情况,为临床治疗提供帮助.方法 细菌鉴定采用VITEK微生物分析仪,药物敏感性试验采用BIOMIC药敏测定仪,耐药性分析采用WHONET5.4软件.结果 3年医院分离细菌4982株,革兰阴性菌2922株,占58.7%,铜绿假单胞菌分离率最高(33.7%);连续3年革兰阴性菌对亚胺培南敏感性较好(79.8%～76.2%),其次是头孢他啶(71.1%～66.1%)和哌拉西林/他唑巴坦(67.6%～68.7%);3年假单胞菌属对头孢他啶、头孢吡肟、氨曲南的耐药率<40.0%,对头孢噻肟耐药率较高(63.0%～67.5%);埃希菌属对亚胺培南、阿米卡星、头孢他啶耐药率<30.0%,对磺胺甲噁唑/甲氧苄啶、环丙沙星、头孢呋辛的耐药率>50.0%;肠杆菌属对亚胺培南敏感性较好,对头孢呋辛耐药率较高(58.5%～76.5%);不动杆菌属对亚胺培南敏感性最好.结论 3年临床分离致病菌以革兰阴性菌为主,且非发酵菌分离率不断上升,细菌对抗菌药物耐药性也在不断增加.     

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.     

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.     

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.     

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.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

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.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.