县级医院尿路感染病原菌的耐药性调查

目的 调查县级医院尿路感染病原菌的分布情况及耐药性,为临床医师合理使用抗菌药物提供科学依据.方法 对医院2003-2007年336株尿路感染病原菌用常规方法进行鉴定,用纸片扩散法(K-B法)进行药物敏感性监测.结果 革兰阴性杆菌分离率为78.3%,革兰阳性球菌分离率为16.4%;大肠埃希菌分离率最高,占64.9%;除革兰阳性球菌对万古霉素100%敏感、革兰阴性杆菌对亚胺培南100.0%敏感外,所有病原菌对其他多种抗菌药物产生了不同程度的耐药性;大肠埃希菌和肺炎克雷伯菌中产超广谱p内酰胺酶(ESBLs)检出率分别为25.7%和28.0%.结论 医院尿路感染病原菌已产生了一定的耐药性,应采取有效措施进行预防与控制.     

糖尿病患者尿路感染病原菌的耐药性探讨

目的 探讨医院糖尿病(DM)患者尿路感染病原菌的种类分布及耐药性,为临床医师治疗尿路感染选择抗菌药物提供试验依据.方法 对医院199株糖尿病合并尿路感染患者的病原菌进行鉴定和药敏试验,细菌培养鉴定严格按照《全国临床检验操作规程》进行；药敏试验采用CLSI指定的K-B法进行操作和数据评价.结果 共分离出199株病原菌,其中大肠埃希菌122株占61.3％；肺炎克雷伯菌31株占15.6％；粪肠球菌18株占9.0％；凝固酶阴性葡萄球菌12株占6.0％；检出病原菌除革兰阴性杆菌对碳青霉烯类抗菌药物、革兰阳性球菌对糖肽类抗菌药物100.0％敏感以外,对其他临床常用抗菌药物均产生了较强的耐药性.结论 糖尿病患者尿路感染病原菌已表现出很强的耐药性,应以预防为主,避免因严重感染而影响患者的生存质量.     

尿路感染病原菌的分布及耐药性调查分析

目的 了解尿路感染病原菌的分布情况及耐药性,为临床医师合理选用抗菌药物提供依据.方法 采用常规方法对286株尿路感染病原菌进行菌株鉴定,采用K-B法进行药物敏感试验.结果 大肠埃希菌分离率居第1位,62.2%;药敏试验结果显示,尿路感染病原菌对多种抗菌药物均产生了不同程度的耐药性,但革兰阳性球菌对万古霉素、革兰阴性杆菌对亚胺培南敏感率为100.0%;产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌检出率分别是36.5%和40.9%;耐甲氧西林葡萄球菌(MRS)平均检出率为35.7%.结论 尿路感染病原菌的耐药性已十分严重,应采取有效措施控制耐药菌的流行趋势.     

产ESBLs大肠埃希菌与肺炎克雷伯菌医院感染及耐药性分析

目的 探讨产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌的临床分布及耐药性特征,为临床合理选用抗菌药物及预防与控制医院感染提供依据.方法 严格按照《全国临床检验操作规程》进行产ESBLs大肠埃希菌和肺炎克雷伯菌分离、鉴定;采用K-B法进行药敏试验,依据CLSI最新折点判读结果.结果 从132株阳性标本中检出产ESBLs菌33株,总检出率25.00％,其中产ESBLs大肠埃希菌27株、肺炎克雷伯菌6株,检出率分别为39.71％和9.38％,未检出泛耐药产ESBLs大肠埃希菌和肺炎克雷伯菌;检出率居首位的为痰液标本,占24.24％;产ESBLs大肠埃希菌和肺炎克雷伯菌对临床常用抗菌药物均产生了严重耐药性,对亚胺培南和美罗培南高度敏感.结论 肿瘤患者大肠埃希菌和肺炎克雷伯菌产ESBLs的检出率有明显增高趋势,应动态监测耐药性变迁,临床治疗中严格掌握抗菌药物应用指征,落实相关医院感染预防与控制措施,防止产ESBLs菌医院感染的暴发流行.     

糖尿病患者合并尿路感染病原菌分布及耐药性

目的研讨糖尿病(DM)患者继发尿路感染的病原菌分布及耐药性,为临床合理选药控制糖尿病尿路感染提供依据。方法回顾性调查分析288例医院糖尿病合并尿路感染患者的临床资料,标本接种和细菌计数严格按照《全国临床检验操作规程》进行,采用法国生物梅里埃公司生产的VITEK-32全自动细菌分析仪及配套鉴定盒进行菌种鉴定,药敏试验采用CLSI规定的纸片扩散法(K-B法),药敏数据运用WHONET 5.5软件处理。结果 288株尿路感染病原菌中,检出大肠埃希菌181株,占62.8%,居第1位;检出肠球菌属33株,占11.5%,居第2位;药敏结果显示,除了革兰阴性杆菌对碳青霉烯类抗菌药物亚胺培南、美罗培南100.0%敏感,革兰阳性球菌对糖肽类抗菌药物万古霉素、替考拉宁100.0%敏感以外,尿路感染病原菌对临床常用抗菌药物均产生了严重的抗药性;耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率为50.0%;产ESBLs大肠埃希菌和肺炎克雷伯菌检出率为48.5%。结论糖尿病患者尿路感染病原菌以肠道菌群为主,与其他病因尿路感染的病原菌无明显区别,且病原菌的耐药性已十分严重,医院应加强监管力度,扭转细菌耐药性快速增长的不良现象。     

小儿肺炎病原菌的分布及耐药性调查

目的 了解医院小儿肺炎的病原菌分布和耐药情况. 方法 对598例小儿肺炎患儿痰标本进行培养及药敏试验. 结果 598份标本中检出病原菌272株,分离率45.5%;其中革兰阴性杆菌201株(73.9%),以肺炎克雷伯菌和大肠埃希菌为主,肺炎克雷伯菌及大肠埃希菌中产超广谱β-内酰胺酶(ESBLs)检出率分别为52.9%、43.8%,对亚胺培南、美罗培南耐药性最低;革兰阳性球菌52株(19.1%),以金黄色葡萄球菌为主,对万古霉素和替考拉宁最敏感;真菌19株(7.0%). 结论 小儿肺炎病原菌以革兰阴性菌为主,不同菌种对抗菌药物耐药性存在很大差异,及时掌握病原菌分布及药敏动态对临床合理使用抗菌药物有重要意义.     

产超广谱β-内酰胺酶细菌的检测及耐药性分析

目的 了解产超广谱β-内酰胺酶( ESBLs)大肠埃希菌和肺炎克雷伯菌的检出率与耐药性,指导临床用药.方法 细菌鉴定、药物敏感试验(MIC法)和ESBLs的检测均采用法国生物梅里埃公司VITEK-2 Compact全自动细菌培养鉴定仪,统计方法采用Whonet 5.3软件.结果 大肠埃希菌的标本来源主要为尿液,占59.8％,肺炎克雷伯菌主要为痰液,占73.0％,产酸克雷伯菌主要为痰液,占75.0％; 714株病原菌中,产ESBLs细菌检出220株,检出率为30.8％,其中493株大肠埃希菌中产ESBLs 174株,检出率为35.3％,189株肺炎克雷伯菌中产ESBLs 36株,检出率为19.0％,32株产酸克雷伯菌中产ESBLs 10株,检出率为31.2％;产ESBLs大肠埃希菌与肺炎克雷伯菌对亚胺培南耐药率为0,对哌拉西林/他唑巴坦的耐药率＜4.2％,除亚胺培南外,产ESBLs菌株对其他抗菌药物的耐药率显著高于非产ESBLs菌株,差异有统计学意义(P＜0.05).结论 产ESBLs细菌的检出率和耐药率呈上升趋势,应加强细菌耐药性的监测.     

尿路感染病原菌的分布及耐药性分析

目的探讨尿路感染病原菌的分布和耐药性分析,为临床合理选用抗菌药物提供科学依据。方法对医院2007年5月-2009年5月,门诊及住院患者尿路感染尿培养分离的病原菌,采用MicroScan40/90全自动微生物分析仪进行细菌鉴定和药敏试验。结果 369株病原菌中,革兰阴性杆菌占81.03%,其中大肠埃希菌占56.91%,肺炎克雷伯菌占10.30%;革兰阳性球菌占14.09%;真菌占4.88%;大肠埃希菌和肺炎克雷伯菌产ESBLs的检出率分别为44.28%和36.84%,肠杆菌科对亚胺培南的敏感率为100.00%,葡萄球菌属、粪肠球菌和屎肠球菌对万古霉素的敏感率为100.00%。结论尿路感染病原菌以大肠埃希菌为主,多药耐药严重,临床应根据病原菌监测和药敏试验结果,合理选用抗菌药物,减少耐药菌株的产生。     

小儿下呼吸道感染病原菌分布与耐药性分析

目的 调查下呼吸道感染患儿的主要病原菌及其对常用抗菌药物的耐药性,为临床合理选择抗菌药物提供依据.方法 对3335例小儿下呼吸道感染患儿痰标本进行培养,采用美国MicroScan WalkAway 40型微生物分析仪,对细菌进行鉴定并做药敏试验,应用WHONET 5.4软件对数据进行分析.结果 3335份标本中检出病原菌1659株,分离率为49.7％,其中革兰阴性杆菌1423株占85.8％,以肺炎克雷伯菌、大肠埃希菌为主,肺炎克雷伯菌、大肠埃希菌中产ESBLs检出率分别为31.1％、43.0％,对亚胺培南的耐药率低;革兰阳性球菌218株占13.1％,以金黄色葡萄球菌为主,对万古霉素、利奈唑胺最敏感;真菌18株占1.1％.结论 小儿下呼吸道感染病原菌以革兰阴性菌为主,不同菌种对抗菌药物耐药性存在很大差异,临床在抗菌药物使用中应加强病原菌的检测,根据药敏结果科学选择,提高治疗效果,延缓细菌对抗菌药物耐药性的产生.     

普通外科患者感染的病原菌分布及耐药性分析

目的 实时监测和回顾性分析普外科患者感染细菌的种类和对抗菌药物的敏感率,以指导临床合理用药.方法 应用VITEK AMS系统对2006年1月-2010年12月医院普外病区患者病原菌进行分离、鉴定及药敏试验,并对资料进行统计分析.结果 5年共检出412株病原菌,以革兰阴性杆菌为主,占79.85％,革兰阳性球菌占20.15％,大肠埃希菌居首位,占35.92％;肺炎克雷伯菌次之,占13.59％,其后为奇异变形菌、丙二酸盐阴性柠檬酸杆菌、鲍氏不动杆菌、铜绿假单胞菌、溶血葡萄球菌、粪肠球菌、金黄色葡萄球菌及表皮葡萄球菌等;产ESBLs 大肠埃希菌检出69株,检出率为46.62％,产ESBLs肺炎克雷伯菌检出14株,检出率为25.00％;大肠埃希菌对8种抗菌药物敏感率＞50.00％.结论 长期监测普外科病区病原菌种类及对抗菌药物的药敏率的变化,从而指导临床合理选择应用抗菌药物是非常重要的.     

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.     

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.     

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.     

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.     

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.