急诊重症监护病房下呼吸道感染患者病原菌分布与耐药性的研究

目的探讨急诊重症监护病房下呼吸道感染患者的病原菌分布特征及其耐药性状况。方法对2005年8月至2006年2月间在我院急诊重症监护病房（EICU）收治的25例F呼吸道感染患者的临床资料进行分析。结果病原菌感染以革兰阴性菌为丰，占43．2％，其次为革兰阳性菌，占32．1％，真菌感染比例相对增多，占24．7％。革兰阴性菌以铜绿似单胞菌、奈瑟氏菌、鲍曼不动杆菌为主；革兰阳性菌以草绿色链球菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌为主；真菌以白色念珠菌、卵圆形芽生真菌孢子、热带念珠菌、光滑念珠菌为主。结论急诊重症监护病房（EICU）下呼吸道感染的病原学特征为革兰阴性菌感染较多，对指导临床经验性用药有指导意义。     

精神病住院患者医院感染情况调查与分析

目的：调查了解精神病住院患者医院感染发生情况及特点。方法：选择精神病住院患者307例，采用自制医院感染调查表，对医院感染发生率、发生部位、发生时间及病原菌等进行调查和分析。结果：307例中，发生医院感染29例，发生率9．4％。其中，呼吸道感染23例，占79．3％；其他部位感染6例，占20．7%。住院〈10天发生医院感染5例，占17．2％；10~30天8例，占27．6％；31~60天12例，占41．4%；〉60天4例，占13．8％。精神分裂症发生医院感染15例，占51．7％；双向情感障碍发生7例，占24．1％；神经症发生5例，占17．2％；其他精神病发生2例，占6．9％。发现病原微生物58株，其中革兰阴性菌43株，占74．1％；革兰阳性菌8株，占13．8％；真菌3株，占5．2％；其他4株，占6．9％。结论：医院感染以呼吸道感染为主，感染病原微生物以革兰阴性菌为主，应采取有效措施预防医院感染的发生。     

我院住院患者感染现患率调查分析

目的 了解和掌握我院医院感染实际发生率,感染特点,抗菌药物应用情况,为加强医院感染控制提供科学依据.方法 采用横断面调查,床旁调查和病例调查相结合的方法,对2016年5月17日0:00-24:00我院住院患者进行医院感染现患率调查.结果 调查的1435例患者中发生医院感染45例,51例次,感染率为3.14％,例次感染率3.55％.主要感染部位为呼吸道、手术切口和泌尿道感染.医院感染病原菌主要为鲍曼不动杆菌、肺炎克雷伯杆菌、大肠杆菌.结论 本次调查我院感染现患率较平时监测感染发生率高,抗菌药物使用率达国家规定标准,但较平时日常监测低.病原学送检率,手术切口感染仍是我院感染防控的重点.通过医院感染现患率调查,对掌握我院感染发生情况,强化医护人员感控意识,有效控制医院感染发生具有一定指导意义.     

军队干部病房医院感染危险因素及防治对策研究

目的了解军队干部病房医院感染危险因素,为制定切实可行控制措施,完善监控系统提供依据。方法采用描述性、分析性研究与定性访谈相结合的方法,对2005年军干病房医院感染危险因素进行单因素和多因素分析。结果军干病房医院感染率为9.91%。医院感染病人平均年龄78.09±7.49岁,平均住院日52天,呼吸道感染占81.41%。住院天数、肿瘤、肾功能不全、使用放疗和化疗、泌尿道插管、动静脉插管、气管插管和使用呼吸机、胃肠道插管、使用胃酸抑制剂、使用抗生素、报病危、手术等均能增加医院感染的危险性。结论军干病房医院感染的防控应进一步提高全员防感染意识,了解医院感染的危害性和防治方法,尽量缩短住院时间,加强病室环境管理;加强呼吸道、留置导尿、留置静脉导管等关键部位的管理;保护患者肾脏功能。     

脑血管疾病的相关因素及感染分析

目的：了解控制感染各种危险因素、疾病发生、感染及死亡率。方法：电脑随机抽取患脑血管疾病病历318份进行回顾性统计分析。结果：318份病历中高血压Ⅲ期占61．9％，高血压Ⅲ期＋糖尿病占38．1％，糠尿病占35．8％，冠状动脉硬化心脏病占19．2％，高血压心脏病占12．1％，侵袭性操作中吸痰占22．5％，置导尿管占38．0％，持续使用呼吸机占26．3％；感染率38．1％，其中上呼吸道感染占4．8％，下呼吸道感染占17．2％，尿道感染占13．1％，血液感染占0．9％，其他部位感染占1．1％；脑部手术23例，感染占24．0%；死亡率占21.1％；细菌分布主要为大肠埃希菌占34．5％，真菌占24．9％，铜绿假单胞菌占14．9％，多重菌占16．5％，EBSLs占12．0％，AMPC占8．7％，MRCNS占70．4％；零天住院死亡率占28．1％。结论：高血压Ⅲ期、糖尿病、冠状动脉硬化性心脏病、高血压是脑疾病的主要因素，主要引起肺部感染、尿路感染；对有家庭史的应早期检查、预防，对40～50岁人群应定期检查主动预防，对已患有高血压、冠状动脉硬化、糖尿病患者，应采取积极治疗，减少脑血管疾病的发生，加强对脑血管病患者的护理及呼吸道感染的预防，以减少死亡率。     

西藏高原金黄色葡萄球菌和表皮葡萄球菌分布的调查研究

目的：了解金黄色葡萄球菌和表皮葡萄球菌在西藏高原地区临床感染和环境中的分布情况。方法：按文献要求采集高原医院内和环境中空气、物表、水源和土壤等标本以及临床感染标本进行培养鉴定，部分资料来源本院文献报道。结果：临床金黄色葡萄球菌感染率为50．0％，表皮葡萄球感染率为14．0％，感染部位和标本不同检出率相差较大，并且葡萄球菌感染有逐年增加的趋势；环境中空气、皮肤和物体表面葡萄球菌检出率较高，水源和土壤葡萄球菌极少检出。结论：西藏高原金黄色葡萄球菌和表皮葡萄球菌是临床主要感染菌，对空气、物表和皮肤消毒处理是控制葡萄球菌感染的关键。     

医院感染现患率调查分析

目的：采用横断面调查全面监测医院感染的现状、日抗菌药物使用率及医院感染控制中存在的不足,为预防疾病感染控制提供有效依据及对策。方法各病房负责感染控制的医生对2014年5月15日00：00～24：00住院患者（含当日出院、转科和死亡的病例,排除当日入院病例）进行横断面研究,调查医院感染现患率并进行分析。结果调查患者为335人,抗菌药物联合用药情况为：一联为107人,占74.82％,二联为33人,占23.07％,三联为3人,占2.09％。使用抗菌药物过程中标本送检率为80.41％。结论通过医院感染现患率调查可见：医院感染发生率较低,感染主要部位为呼吸道,科室中存在有感染漏报及抗菌药物使用率过高等现象,标本送检率仍存在不足,导致抗菌药物使用不能根据药敏结果指导用药,存在不合理现象。     

2008-2010年度某医院感染现患率变化趋势观察

目的:观察分析我院2008-2010年度医院感染现患率及抗生素应用情况等变化趋势。方法:采用横断面调查方法,对2008、2009及2010年指定某一天的所有住院患者进行医院感染情况及抗生素应用情况调查,对调查结果进行比较分析。结果:3年共调查5237例。2010年现患率显著低于2008年及2009年(P<0.05);连续3年的调查中,感染部位均以下呼吸道感染居首位,其次为上呼吸道感染、手术部位感染;医院感染病原菌检出均以革兰阴性杆菌为主,各调查年度之间不同病原菌的构成比差异不显著(P>0.05);2008-2010年,抗菌药物使用率逐年显著或非常显著降低,病原学送检率逐年显著或非常显著增高(P<0.05,P<0.01);单联用药比例升高,三联及以上用药构成比非常显著逐年降低(P<0.01)。结论:近年来我院感染控制工作取得了良好成效,医院感染现患率呈逐年下降趋势,抗菌药物不合理应用情况有所减少,病原学送检意识逐渐增强。     

医院下呼吸道感染病原菌分布与耐药性分析

目的：了解医院下呼吸道感染病原菌分布及耐药情况。方法：对医院下呼吸道感染158例进行痰标本细菌培养，采取生物梅里埃API System鉴定和Vitek Am System微生物自动分析仪鉴定方法；抗生素耐药性分析采用K—B纸片法、按NccLs标准进行；真菌用20℃ AUX酵母菌法测定、按MIC评价其耐药性。结果：共分离出细菌161株，其中革兰阳性菌39株（24．2％），以表皮葡萄球菌、肺炎链球菌、类肠球菌为主；革兰阴性菌97株（60．3%），以铜绿假单胞菌，大肠埃希菌，终非不动杆菌为主；真菌25株（15．5%），以白色念珠菌为主。革兰阳性菌对青霉素类药物耐药率高；革兰阴性菌对第二代头孢类药物耐药率高。结论：医院下呼吸道感染以革兰阴性菌为主，且对常用抗生素有较高的耐药率。     

西安地区 58例病理妊娠 TORCH感染情况分析

目的：分析西安地区异常产妇TORCH感染情况。方法：用ELISA法检测58例异常妊娠妇女血清中TOX，RV，CMV，HSVI，HSVⅡ的IgM，结果：58例异常妊娠妇女TORCH 阳性率为65．52％，明显高于正常妊娠组（203例）的阳性率16．7％，二组有显著性差异（P＜0．01），异常妊娠妇女TORCH感染主要是CMV，RV感染，感染率分别为24．14％％和15．52％，而HSVI，HSVⅡ和TOX的感染率为8．62％，5．17％和12．07％，流产，习惯性流产，宫内发育迟缓RV感染率相近，结论：TORCH－IgM检测可用于孕妇产前筛，对缺陷儿进行产前干预及优生优良有重要意义。     

Risk factors for the development of hospital infections in the intensive care units

BACKGROUND: Patients admitted to intensive-care units (ICU) are at a high risk of nosocomial infections (NI) due to susceptibility associated with severity of their condition, but also the invasive medical procedures they undergo. AIM: To determine the frequency of NI at the ICU of the General Hospital Uzice, and to identify the risk factors for their development. METHODS: A prospective surveillance study of NI, conducted between June 27. and December 31 2001, included 914 patients who spent at least 24 hours in the ICU (total of 2 615 days). The surveillance of NI in the ICU was carried out daily. Follow-up period covered the time from the ICU admission to 48 hours after the ICU discharge. To assess risk factors for NI, we performed a case-control study. The variables measuring of extrinsic and intrinsic risk factors for NI were collected. RESULTS: In a six-month prospective surveillance study, the incidence of NI was 16.7% or 58.5 per 1,000 patient-day, respectively. The most frequent were the infections of the surgery wounds (32.6%), urinary tract infections (23.5%), and infections of the blood (7.1%). The identified independent risk factors for NI were: surgical intervention (OR = 5.74; CI = 2.01-16.41), endotracheal tubes (OR = 3.40; CI = 1.07-10.89), cystoscopy (OR = 2.35; CI = 1.38-4.02), obesity (OR = 1.98; CI = 1.27-3.11), and the duration of the infusion (OR = 1.34; CI = 1.23-1.46). CONCLUSIONS: The most important risk factors for NI at ICU were surgical interventions and endotracheal tubes.     

Nosocomial infections in the departments of orthopedics and traumatology

AIM: To determine the incidence and the localization of nosocomial infections (NI) in the departments of orthopedics and traumatology. METHODS: A prospective cohort study carried out between February 1 and July 31, 2002 included all of the surgical patients who were hospitalized longer than 48 hours, as well as 30 days after the discharge. The patients were examined and their diagnoses made according to the definition of NI, that was based on the clinical and/or laboratory findings. RESULTS: Out of 277 hospitalized patients, 78 had a total of 91 NIs. Sixty-seven (85.8%) of the patients had 1 registered NI each, 9 (11.6%) of the patient had 2 NIs each, while only the 2 (2.6%) were with 3 NIs. The incidence of the patients with HAI was 28.2% (95% IP = 22.9-33.5), while the incidence of HAI was 32.8%. The patients who developed a NI were hospitalized almost twice as long as the patients who did not (t test = 6.0, DF = 275, p < 0.001). In regard to the duration of hospitalization, the incidence of NI was 12.3 per 1000 patient-hospital days. The patients operated on most frequently had the surgical-site infections (69.2%). Of 63 infections of the surgical site, 3 patients (4.8%) were diagnosed as having the NI at that localization following the discharge, and then the urinary tract infections, 25.3% (23/91), and sepsis, 5.5% (5/91). CONCLUSION: Epidemiological surveillance was the first step towards the prevention and the eradication of NI. The results of this study could be of use in planning of the adequate measures for the prevention of NI in the departments of orthopedic surgery.     

自动毫安低剂量CT扫描对结肠病变的显示及其对图像质量的影响

目的 评估自动毫安低剂量CT扫描对结肠病变的图像质量及对辐射剂量的影响.方法 预实验采用猪结肠制备息肉模型,通过改变噪声指数(NI)调节毫安,对图像质量进行评价,得出可应用于临床病例组的NI值.病例组采用前瞻性研究的方法,搜集连续71例临床怀疑为结肠病变的患者,71例在CT扫描前均已行结肠镜检查.将第1组39例(2007年1月至2007年6月检查的患者)按照数字表法随机分为A、B、C 3个亚组,N1分别取10(15例)、13(13例)和16(11例),NI不随扫描体位而改变;第2组32例(2007年7月至2008年1月检杏的患者)NI随扫描体位而改变,NI分别取10(俯卧位)和20(仰卧位).以相同方法进行扫描获取横断面图像、CT虚拟结肠镜(CTVC)及透亮法显示(Raysum)的重组图像并进行图像质量评分.阳性病例均经肠镜活检或手术病理证实.将第1组中A、B、C 3个亚组间以及第2组中不同扫描体位所得平均CT剂量加权指数(CTDIw)与标准值(26.92 mGy)进行比较,第1组病例亚组间的图像评分以及第2组病例不同扫描体位的图像评分均采用等级资料的秩和检验进行比较.结果 第1组:NI=10时,横断面和重组图像平均评分分别为4.2和2.4分,平均CTDIw为17.51 mGy;NI=13时,上述平均评分分别为3.2和2.5分,平均CTDIw为12.90 mGy;NI=16时,上述平均评分分别为2.9和2.7分,平均CTDIw为5.94 mGy.当NI提高时,横断面图像质量评分降低,差异有统计学意义(H=20.01,P＜0.01);对于重组图像,图像质量评分不随NI加大而改变,差异无统计学意义(H=0.81,P＞0.05).第2组:NI=10时,横断面图像和重组图像的平均评分分别为3.6和2.3分;NI=20时,上述平均评分分别为2.2和2.3分,平均CTDIw为11.63 mGy.当NI由10提高到20时,横断面图像质量评分降低,差异有统计学意义(H=20.84,P＜0.01);重组图像评分不随NI的增加而降低(H=0.29,P＞0.05).第1组中NI分别为10、13和16时,CTDIw平均降低了35.O%、52.1%和77.9%;第2组中CTDIw平均降低了56.8%.结论 自动毫安低剂量CT扫描技术可以在明显降低辐射剂量的同时,兼顾图像质量.     

Suicidal admissions in the United States military

Suicide is currently the second leading cause of death in the U.S. military. Little recent research has been done on a well-defined cohort at high risk for death by suicide, which consist of military patients who attempt suicide or are admitted for suicidal ideation. As a pilot investigation based on a literature review of suicidal behavior in the U.S. military, 100 consecutive charts of suicidal patients at a tertiary military treatment facility were reviewed. The findings included the following: 94% were admitted with a depressed mood; 67% had a history of previous attempts or gestures; 49% had been treated with psychiatric medication prior to admission and 88% were treated with psychiatric medications while on the ward; 47% returned to a full duty status; 29% were recommended for administrative separation; and 18% were recommended for a medical board. Suggestions for future research are presented to help improve our suicide prevention programs.     

Optimization of Z-axis automatic exposure control for multidetector row CT evaluation of neck and comparison with fixed tube current technique for image quality and radiation dose

BACKGROUND AND PURPOSE: Z-axis automatic exposure control (AEC) technique automatically adjusts tube current based on size of body region scanned. The purpose of the current study was to compare diagnostic acceptability, noise, and radiation exposure of multidetector row CT (MDCT) of neck performed with z-axis AEC and with fixed current. MATERIALS AND METHODS: Two study groups of 26 patients each underwent MDCT of neck using z-axis AEC with 8 noise index (NI), 150-440 mA, and 10 NI, 75-440 mA, respectively. A control group consisting of another 26 patients underwent MDCT of neck with fixed-current technique (300 mA). Objective noise and mean tube current-time products (mA . s) were recorded. Two radiologists evaluated images for diagnostic acceptability and subjective noise on a 5-point scale. RESULTS: All CT examinations of study and control groups were diagnostically acceptable, though objective noise was significantly more with z-axis AEC (shoulder: NI 8, 20.6 +/- 6.2 HU; NI 10, 22.2 +/- 4.6 HU) than with fixed current (16.2 +/- 6 HU) (P = .01). There was no significant difference between AEC and fixed current in diagnostic acceptability and subjective noise (P = .22-.42). AEC resulted in significant radiation dose reduction (NI 8, 186.3 +/- 20.5 mA . s; NI 10, 158.1 +/- 21.2 mA x s), compared with fixed current (235 +/- 21.8 mA x s). CONCLUSION: Z-axis AEC resulted in similar subjective noise and diagnostic acceptability, with radiation dose reduction of 21% for NI of 8 and 33% for NI of 10, respectively, for MDCT evaluation of neck, compared with those of fixed current technique.     

Mission creep: an analysis of accident and emergency room activity in a military facility in Bosnia-Herzegovina

OBJECTIVE: To evaluate accident and emergency (A&E) room activity at a Role 3 Multinational Integrated Medical Unit (R3 MIMU) facility in Bosnia-Herzegovina. METHODS: Retrospective analysis of all patients attending the A&E room from 1st October 1999-30th September 2002. RESULTS: 1864 casualties are included in the analysis. 52.1% of casualties were Bosnian, 43.8% were military. Mean age of casualties was 35.5 years (SD 18.3), range 1-88 years. Traumatic injury was the leading cause of presentation (58.1%). Following treatment 66.7% of all cases were discharged or returned to unit, with 19.8% admitted to a ward area. During the 3 year period there was a 5 fold increase in the number of Bosnian nationals treated, this included 80 children (<13 years). CONCLUSION: There has been a dramatic increase in Methods A&E use during the period evaluated, Setting of study particularly by the local population. The increasing number of locals treated, both adult and child, has the potential to undermine the R3 MIMU mission and increase dependency within the Bosnian population. A balance is needed to ensure the staff and functions of a hospital are maintained whilst preserving the capability to deal with an influx of military casualties.     

Evaluation of dose reduction and image quality in chest CT using adaptive statistical iterative reconstruction with the same group of patients

Objectives The objective of this study was to compare the image quality and radiation dose of chest CT images reconstructed with a blend of adaptive statistical iterative reconstruction (ASIR) and filtered back-projection (FBP) with images generated using conventional FBP. Methods Patients with chest CT re-examinations were alternately assigned to two scanners with different reconstruction techniques. The study groups included noise index (NI) 11 with 30% ASIR (A30), NI 13 with 40% ASIR (A40), NI 15 with 50% ASIR (A50) and NI 17 with 60% ASIR (A60), sequentially changed every 2 months. The control images were obtained using FBP and NI 11. All acquisitions were performed with automatic dose modulation. Paired t-test and non-parameter test were applied to compare the difference. Results The radiation doses were significantly lower in the examinations that used ASIR (p<0.001). The mean dose reduction rate was 27.7%, 45.2%, 57.1% and 71.8% for Groups A30, A40, A50 and A60, respectively. The image quality of Groups A30-A50 was not inferior to that of the control examinations. The image noise of Group A60 was greater and subjective image quality was inferior to that of the control. Conclusions ASIR enabled the use of a higher NI with automatic dose modulation. With 50% ASIR and a NI of 15, the effective radiation dose was reduced by 57%, without compromising image quality.     

MR features of peripheral nerve sheath tumors: can a calculated index compete with radiologist's experience?

The aims of this study were, firstly, to provide a formula (neurogenic index) based on MR characteristics used in daily routine for predicting whether a soft tissue tumor is neurogenic or not, secondly, to test prospectively the performance of this formula, and thirdly, to compare this performance with that of radiologists experienced in MR imaging of soft tissue tumors. Retrospectively, MR images of 70 neurogenic and 70 non-neurogenic soft tissue tumors were evaluated in random order by two teams of two observers each. A neurogenic index (NI) was calculated based on those MR parameters that showed no or minor interobserver variability. Subsequently, three investigators in concert used the NI in a validation group of 15 neurogenic and 22 non-neurogenic soft tissue tumors. The same team, based on their own experience, tried to differentiate in the same validation group neurogenic from non-neurogenic soft tissue tumors. This was expressed in a subjective score (SS). Sensitivity, specificity, and predictive values were calculated. NI comprised spread (intra- or extracompartmental), distribution, fluid–fluid levels, homogeneity on T2-weighted images (WI), highest signal intensity (SI) on T1WI, lowest SI on T2WI, and delineation on T2WI. In the validation group, NI had a sensitivity of 88.6 %, a specificity of 52.0 %, a positive predictive value (PPV) of 54.1 %, and a negative predictive value (NPV) of 84.6 % for neurogenic tumors. The subjective score SS was superior and had a sensitivity of 93.3 %, a specificity of 77.2 %, a PPV of 73.7 %, and a NPV of 94.4 %. Our NI was less accurate than the SS; however, the low number of false-negative diagnoses for neurogenic tumors warrants continued efforts in development of neural networks. Received: 4 November 1999/Revised: 29 May 2000/Accepted: 30 May 2000     

Characteristics of sauna deaths in Korea in relation to different blood alcohol concentrations

Although the benefits of sauna bathing have been demonstrated in epidemiological studies, sauna deaths have been reported. The aim of this study was to determine the demographic and forensic characteristics associated with different blood alcohol concentrations (BACs) in sauna deaths in Korea. In this retrospective analysis, data were collected from a nationwide pool in Korea between January 2008 and December 2015 to determine the role of alcohol intoxication in sauna deaths based on the subjects’ BAC and to evaluate the demographic and forensic characteristics associated with different BACs. One hundred and three deaths were classified into 2 groups: the non-intoxication (NI) group (BAC,<0.08%; n =?27) and the intoxication (I) group (BAC,≥0.08%; n =?76). Demographic and forensic characteristics were compared between the groups using a multinomial logistic regression analysis. The proportions of decedents who were male (odds ratio: 17.4, 95.0% confidence interval: 3.8–79.8) and in a prone position at the scene of death (odds ratio: 11.3, 95.0% confidence interval: 2.1–60.1) were significantly higher (P <?0.001 and P <?0.05, retrospectively) in the I group than in the NI group. However, no significant differences were observed with respect to obesity, coronary artery narrowing, and liver pathology. Sauna deaths exhibited different characteristics according to BACs detected at autopsy. The differences in sauna deaths between the I and NI groups may have implications for the targeted prevention of sauna deaths associated with alcohol consumption.