产ESBLs肺炎克雷伯菌氨基糖苷类耐药性及其修饰酶基因型的研究

目的:了解产超广谱β-内酰胺酶(ESBLs)肺炎克雷伯菌对氨基糖苷类的耐药性,及其氨基糖苷类修饰酶(AMEs)基因型的流行状况。方法:采用K-B纸片法测定阿米卡星、庆大霉素、妥布霉素、奈替米星的敏感性,应用PCR方法扩增6种AMEs基因,并对PCR阳性产物进行测序以确定其基因型。结果:77株产ESBLs肺炎克雷伯菌对阿米卡星、庆大霉素、妥布霉素、奈替米星的耐药率分别为22.1%、59.7%、44.2%、42.9%,aac(3)-Ⅱ、aac(6’)-Ib、ant(3″)-I、ant(2″)-I基因检出率分别为49.4%、35.1%、22.1%、6.5%,未检出aac(3)-I和aac(6’)-Ⅱ基因。结论:产ESBLs肺炎克雷伯菌对氨基糖苷类高度耐药,其耐药性与AMEs密切相关,流行的AMEs基因型主要为aac(3)-Ⅱ、aac(6’)-Ib和ant(3″)-I。     

产ESBLs大肠埃希菌氨基糖苷类修饰酶基因的检测 FREE

目的了解某地区产超广谱β 内酰胺酶（ESBLs）大肠埃希菌氨基糖苷类修饰酶(AMEs)基因存在状况及耐药情况。方法对临床分离的75株大肠埃希菌用表型确证试验检测ESBLs, K B纸片扩散法对6种氨基糖苷类抗生素做药敏试验,并采用聚合酶链反应（PCR）检测AMEs基因。结果75株大肠埃希菌中共检出产ESBLs菌37株（49.33％）。产ESBLs菌对氨基糖苷类抗生素耐药率(包括中介株)：庆大霉素78.38%,链霉素75.68%,卡那霉素67.57%,妥布霉素64.86%,奈替米星24.32%,阿米卡星13.51%;共检出5种基因,其中以aac(3) Ⅱ（64.86%）和aac(6′) Ⅰ（45.95%）为主,其次为ant(3＂) Ⅰ（29.73%）、ant(2＂) Ⅰ（10.81%）、aac(3) Ⅰ（5.41%）,未检出aac(6′) Ⅱ;除ant(2＂) Ⅰ和aac(3) Ⅰ外,其余3种基因检出率均高于非产ESBLs菌株,且2个基因携带率也明显高于非产ESBLs菌株(P＜0.05)。结论该地区产ESBLs大肠埃希菌携带AMEs基因的比率较高,对氨基糖苷类抗生素的耐药率亦高,应加强监测与防控。     

产ESBLs大肠埃希菌氨基糖苷类修饰酶基因的检测

目的了解某地区产超广谱β-内酰胺酶(ESBLs)大肠埃希菌氨基糖苷类修饰酶(AMEs)基因存在状况及耐药情况。方法对临床分离的75株大肠埃希菌用表型确证试验检测ESBLs,K-B纸片扩散法对6种氨基糖苷类抗生素做药敏试验,并采用聚合酶链反应(PCR)检测AMEs基因。结果 75株大肠埃希菌中共检出产ES-BLs菌37株(49.33%)。产ESBLs菌对氨基糖苷类抗生素耐药率(包括中介株):庆大霉素78.38%,链霉素75.68%,卡那霉素67.57%,妥布霉素64.86%,奈替米星24.32%,阿米卡星13.51%;共检出5种基因,其中以aac(3)-Ⅱ(64.86%)和aac(6′)-Ⅰ(45.95%)为主,其次为ant(3″)-Ⅰ(29.73%)、ant(2″)-Ⅰ(10.81%)、aac(3)-Ⅰ(5.41%),未检出aac(6′)-Ⅱ;除ant(2″)-Ⅰ和aac(3)-Ⅰ外,其余3种基因检出率均高于非产ESBLs菌株,且2个基因携带率也明显高于非产ESBLs菌株(P0.05)。结论该地区产ESBLs大肠埃希菌携带AMEs基因的比率较高,对氨基糖苷类抗生素的耐药率亦高,应加强监测与防控。     

多药耐药鲍氏不动杆菌氨基糖苷类修饰酶基因分子类型分析

目的探索多药耐药鲍氏不动杆菌(MDR-ABA)氨基糖苷类药物修饰酶基因(AMEs)分子类型。方法采用K-B药敏法测定2007～2008年临床分离的MDR-ABA对庆大霉素、妥布霉素、阿米卡星的药敏表型,筛选出43株对氨基糖苷类药物耐药的菌株,以聚合酶链反应(PCR)的方法对7种AMEs进行检测和分析。结果 43株MDR-ABA对庆大霉素的耐药率为90.7%,对阿米卡星的耐药率为60.5%,对妥布霉素的耐药率为72.1%;7种AMEs检出率由高到低分别为:aac(3)-Ⅰ(65.1%)、aac(6′)-Ⅰ(60.5%),ant(3″)-Ⅰ(55.8%),aph(3′)-Ⅵ(51.2%),aac(3)-Ⅱ(34.9%),ant(2″)-Ⅰ(20.9%),aac(6′)-Ⅱ(18.6%),总检出率为90.7%。结论临床分离的MDR-ABA对氨基糖苷类抗菌药物耐药主要由AMEs引起。     

耐左氧氟沙星大肠埃希菌对氨基糖苷类药物的耐药性研究

目的探讨耐左氧氟沙星(LVX)大肠埃希菌对氨基糖苷类药物的耐药表型与基因型的相关性。方法用纸片扩散法测定75株大肠埃希菌对LVX和6种氨基糖苷类药物的耐药率,PCR法检测6种氨基糖苷类修饰酶基因。结果 49株(65.33%)对LVX耐药,耐LVX菌株对庆大霉素、卡那霉素、链霉素、妥布霉素、奈替米星、阿米卡星的耐药率分别为:73.47%、65.31%、61.22%、51.02%、16.33%、14.29%;与非耐LVX菌株比较,庆大霉素、卡那霉素、妥布霉素耐药率的差异均有统计学意义(P0.05);多药耐药表型的差异同样具有统计学意义(P0.05);耐LVX菌株aac(3)-Ⅱ、aac(6′)-Ⅰ、ant(3″)-Ⅰ、ant(2″)-Ⅰ、aac(3)-Ⅰ,aac(6′)-Ⅱ的检出率分别为:53.06%、46.94%、14.29%、8.16%、4.08%、0;与非耐LVX菌株比较aac(6′)-Ⅰ检出率的差异有统计学意义(P0.05)。结论耐LVX菌株多表现为同时对多种氨基糖苷类药物耐药,提示耐LVX大肠埃希菌对氨基糖苷类药物的耐药与氨基糖苷类修饰酶存在一定相关性,尤以AAC(6′)-Ⅰ为明显。     

鲍氏不动杆菌氨基糖苷类修饰酶基因的检测及分布

目的了解中山地区鲍氏不动杆菌(ABA)氨基糖苷类药物的耐药表型和基因分布及其相关性。方法用VITEK-2 Compact高级专家系统判定2010年1-9月405株鲍氏不动杆菌对氨基糖苷类药物的耐药表型,并对7-9月连续分离的18株多药耐药鲍氏不动杆菌(MDRAB)采用PCR的方法检测4种氨基糖苷类修饰酶基因。结果 405株ABA对氨基糖苷类药物的耐药表型模式:共11种,主要为表型RESISTANT(庆大霉素、奈替米星、阿米卡星、妥布霉素)+RESISTANT(庆大霉素、妥布霉素、阿米卡星),占41.5%;连续分离的18株MDRAB对氨基糖苷类药物的耐药表型模式:共有2种,表型RESISTANT(庆大霉素、奈替米星、阿米卡星、妥布霉素)+RESISTANT(庆大霉素、妥布霉素、阿米卡星)13株,占72.2%,表型RESISTANT(妥布霉素、庆大霉素、奈替米星)5株,占27.8%,检出阳性耐药基因2种:aac(6′)-Ⅰ和ant(3″)-Ⅰ分别为8、13株。结论临床分离的ABA氨基糖苷类药物耐药表型和基因型基本相符,推测该地区氨基糖苷类药物耐药的主要原因是氨基糖苷类修饰酶基因的存在导致。     

产ESBLs肺炎克雷伯菌氨基糖苷类修饰酶基因研究

目的了解产ESBLs肺炎克雷伯菌中氨基糖苷类修饰酶基因存在状况。方法对35株肺炎克雷伯菌,采用聚合酶链反应（PCR）检测aac（3）-Ⅰ、aac（3）-Ⅱ、aac（6′）-Ⅰ、aac（6′）-Ⅱ、ant（3″）-Ⅰ、ant（2″）-Ⅰ等6种氨基糖苷类修饰酶基因。结果35株肺炎克雷伯菌中,共有26株检出氨基糖苷类修饰酶基因（74.3%）。结论产ESBLs肺炎克雷伯菌氨基糖苷类修饰酶基因携带率高。     

铜绿假单胞菌氨基糖苷类修饰酶基因检测研究

目的了解医院铜绿假单胞菌中氨基糖苷类修饰酶编码基因的存在状况。方法对临床分离的59株铜绿假单胞菌中氨基糖苷类修饰酶(AMEs)基因进行PCR检测。结果共检出同时含aac(6′)-Ⅱ、ant(3″)-Ⅰ和ant(2″)-Ⅰ3种氨基糖苷类修饰酶基因的铜绿假单胞菌35株,且氨基糖苷类修饰酶基因对庆大霉素、阿米卡星的耐药表型有较高的阳性预测值>75%。结论铜绿假单胞菌对庆大霉素、阿米卡星耐药中氨基糖苷类修饰酶基因发挥着重要的作用。     

氨基糖苷类修饰酶基因在我院分离产超广谱β内酰胺酶肺炎克雷伯菌中的表达

目的 调查氨基糖苷类修饰酶（AMEs）基因在泰安中心医院院内分离的产超广谱β内酰胺酶（ESBL）肺炎克雷伯菌中的表达情况,为合理使用抗菌药物提供依据.方法 采用多聚酶链反应（PCR）方法,检测aac（3）-Ⅰ、aac（3）-Ⅱ、aac（3）-Ⅲ、aac（3）-Ⅳ、aac（6＇）-Ⅰ、ac（6＇）-Ⅱ、aph（3＇）-Ⅵ、ant（3＂）-Ⅰ和ant（2＂）-Ⅰ等9种AMEs,在42株院内分离的产ESBL肺炎克雷伯菌中的表达情况.结果 42株产ESBL肺炎克雷伯菌中,36株（85.7%）携带aac（3）-Ⅱ基因,25株（59.5%）携带ant（3＂）-Ⅰ基因,9株（21.4%）携带aac（6＇）-Ⅰ基因,4株（9.5%）携带aph（3＇）-Ⅵ基因,3株（7.1%）携带aac（3）-Ⅰ基因,AMEs携带率为90.5%（38/42）.结论 我院院内分离的产ESBL肺炎克雷伯菌的AMEs基因携带率很高,其对氨基糖苷类药物耐药可能与AMEs有关.     

肺炎克雷伯菌老年患者分离株氨基糖苷类药物耐药相关基因研究

目的了解肺炎克雷伯菌老年患者分离株16S rRNA甲基化酶、氨基糖苷类修饰酶基因的存在状况。方法自2006年1~10月住院患者标本中分离并筛选出20株多药耐药肺炎克雷伯菌,微量肉汤稀释法检测20种抗菌药物的敏感性;PCR法检测16S rRNA甲基化酶、氨基糖苷类修饰酶基因。结果20株多药耐药肺炎克雷伯菌16S rRNA甲基化酶(rmtA、rmtB、rmtC、rmtD、armA和npmA)基因均为阴性;氨基糖苷类修饰酶aac(3)-Ⅱ基因阳性15株、aac(6′)-Ⅰb基因阳性1株、ant(3″)-Ⅰ基因阳性16株、aph(3′)-Ⅰ基因阳性3株、ant(2″)-Ⅰ基因阳性1株。结论研究结果显示,肺炎克雷伯菌老年患者分离株对氨基糖苷类药物耐药的主要原因是aac(3)-Ⅱ、aac(6′)-Ⅰb、ant(3″)-Ⅰ、aph(3′)-Ⅰ和ant(2″)-Ⅰ5种氨基糖苷类修饰酶基因的存在;从肺炎克雷伯菌中检出aac(6′)-Ⅰb-Cr型和aph(3′)-Ⅰ均为国内首次。     

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.     

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.