2009-2011年肝胆外科ICU病原菌分布及多药耐药趋势分析

目的 研究医院肝胆外科ICU感染病原菌分布及多药耐药菌的变迁,以指导临床合理应用抗菌药物.方法 对2009年9月-2011年9月肝胆外科ICU感染患者送检2257份标本分离的病原菌进行鉴定及多药耐药菌分析.结果 共检出病原菌1576株,其中革兰阴性菌745株占47.27％,革兰阳性菌430株占27.29％,真菌401株占25.44％;标本主要来源于痰液、腹腔引流液、血液及胆汁;鲍氏不动杆菌、屎肠球菌、凝固酶阴性葡萄球菌的多药耐药菌检出率高居前3位,其中鲍氏不动杆菌及凝固酶阴性葡萄球菌的多药耐药率由67.44％、50.00％升至70.59％、61.7％,屎肠球菌多药耐药率则由58.82％降至46.00％;大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌产ESBLs检出率2009年9月-2010年9月分别为70.0％、48.08％及12.12％、2010年9月-2011年9月分别为45.61％、9.38％及0.结论 肝胆外科ICU患者感染的主要病原菌以革兰阴性菌为主,但革兰阳性菌及真菌感染率有上升趋势;加强病原菌及其耐药性的检测、指导合理应用抗菌药物,对降低细菌耐药率至关重要.     

254株鲍氏不动杆菌的分布及耐药性

目的 了解医院痰标本分离出鲍氏不动杆菌的科室分布及药敏结果,为临床合理用药提供参考.方法 收集医院2009年5月-2011年8月送检痰标本中分离出的254株鲍氏不动杆菌,并比较检出鲍氏不动杆菌科室的分布及药敏结果.结果 3455份痰标本共检出鲍氏不动杆菌254株,检出率为7.4％;鲍氏不动杆菌主要分布于ICU,占47.6％,其他依次为神经外科、呼吸内科、神经内科、肿瘤科,分别占18.1％、15.7％、11.8％、2.8％;鲍氏不动杆菌对15种常用抗菌药物中14种普遍耐药,平均耐药率高达79.6％,仅对头孢哌酮/舒巴坦表现出较敏感,敏感率为73.6％;ICU、神经外科、呼吸内科、神经内科的多药耐药、泛耐药菌株检出率显著高于其他科室(P＜0.05).结论 痰标本中鲍氏不动杆菌耐药率较高,其中多药耐药株、泛耐药株占有很高的比例,临床应引起高度重视;一旦发现感染耐药株,必须迅速采取控制措施,控制医院感染的蔓延.     

多药耐药菌感染目标性监测效果分析

目的 评价目标性监测对控制多药耐药菌感染的效果,为有效控制多药耐药药菌感染提供依据.方法 将开展目标性监测前的2010年1-6月和开展目标性监测后的2011年同期住院患者多药耐药菌检出结果进行分析和比较.结果 2010年1-6月检出多药耐药菌134株,占总检出细菌数的7.35％,2011年同期检出68株,占比下降为4.02％,两者间差异有统计学意义(x2=17.9125,P＜0.05);开展目标性监测前后,ICU检出多药耐药菌株数分别占该期间总耐药株数的52.24％和67.65％,目标性监测对非ICU科室降低多药耐药菌感染率的影响更大(x2 =4.3804,P＜0.05);约90.0％的多药耐药菌株分离自医院感染患者,约90.0％的多药耐药菌株分离自痰标本;部分革兰阴性菌的分布呈现明显的科室聚集性;主要检出细菌是多药耐药/泛耐药鲍氏不动杆菌.结论 目标性监测可明显降低多药耐药菌感染率,特别是非ICU科室的多药耐药菌感染率;对ICU重点感染菌多药耐药/泛耐药鲍氏不动杆菌应采取综合的控制措施.     

脑出血危重患者多药耐药鲍氏不动杆菌感染与耐药性研究

目的探讨脑出血危重患者多药耐药鲍氏不动杆菌感染与耐药性,为合理选择抗菌药提供参考依据。方法选取2011年1月-2014年12月医院收治的298例脑出血危重患者,对感染病原菌进行菌株鉴定及药敏分析;采用SPSS20.0软件对数据进行统计分析。结果 322份标本培养分离到病原菌468株,其中52株为多药耐药鲍氏不动杆菌,检出率为11.11%,以痰液和脑脊液检出为主,分别占48.08%和21.15%;2011-2014年分别检出多药耐药鲍氏不动杆菌7、11、15、19株,检出率分别为7.61%、10.38%、11.90%和13.19%;2011-2014年多药耐药鲍氏不动杆菌耐药率较高,多60.00%,且存在上升趋势;logistic回归分析显示,入住ICU时间、GCS评分、APACHEⅡ评分、呼吸机使用时间和气管插管或气管切开为多药耐药鲍氏不动杆菌感染的独立危险因素(P0.05)。结论多药耐药鲍氏不动杆菌的耐药率较高,临床上应根据药敏试验结果合理选择抗菌药物治疗,应积极预防控制多药耐药鲍氏不动杆菌的感染。     

住院患者多药耐药菌感染的监测分析

目的 调查住院患者多药耐药菌感染的情况,为预防控制医院感染提供依据.方法 对2009年1月-2010年12月检出的耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)、耐碳青霉烯类铜绿假单胞菌和泛耐药鲍氏不动杆菌进行统计分析.结果 多药耐药菌感染部位以呼吸系统为主,占73.1％；神经外科、ICU多药耐药菌感染较严重,分别占总感染数的30.0％、27.0％；MRSA、泛耐药鲍氏不动杆菌,已成为医院多药耐药菌感染的主要致病菌.结论 加强对多药耐药菌的监测,合理使用抗菌药物,做好消毒隔离及手卫生,可有效防止耐药菌株的流行和传播.     

127株不动杆菌属细菌的科室分布及药敏分析

目的 了解医院不动杆菌属细菌的科室分布及耐药性,指导临床合理使用抗菌药物.方法 对医院2008年2月-2010年10月痰标本分离出的127株不动杆菌属细菌进行药敏分析,并比较主要检出鲍氏不动杆菌在科室的分布及药敏结果.结果 2688份痰标本共检出鲍氏不动杆菌119株、鲁氏不动杆菌8株,检出率为4.4％、0.3％;鲍氏不动杆菌对14种常用的抗菌药物普遍耐药,平均耐药率高达80.9％,仅对头孢哌酮/舒巴坦表现出敏感,敏感率为65.5％、耐药率19.3％;而鲁氏不动杆菌耐药率较低,平均耐药率为22.1％;检出的119株鲍氏不动杆菌主要来自ICU、神经外科、神经内科和呼吸内科送检的痰液标本,占总株数的82.4％;多药耐药株、泛耐药株分别为73、24株,ICU、神经外科、神经内科和呼吸内科的多药耐药株、泛耐药株数显著高于其他科室(P＜0.01).结论 痰液标本中分离的不动杆菌属菌株主要以鲍氏不动杆菌为主,随着抗菌药物的广泛应用,对抗菌药物的敏感性发生了巨大变化,其中多药耐药株、泛耐药株占有很高的比例,加强鲍氏不动杆菌耐药机制的深入研究和新药的开发,控制医院感染的蔓延已刻不容缓.     

多药耐药鲍氏不动杆菌的临床分布特点及耐药性监测分析

目的观察多药耐药鲍氏不动杆菌的临床分布特点,并对其耐药性进行监测分析。方法选取2013年1月-2015年12月经细菌培养鉴定均存在鲍氏不动杆菌感染的临床标本1 771份,回顾性分析其标本来源和药敏试验结果。结果 1 771份标本共检出鲍氏不动杆菌1 771株,其中多药耐药鲍氏不动杆菌879株占49.6%;其中多药耐药鲍氏不动杆菌检出率2013年为46.8%,2014年为48.1%,2015年为53.1%;2013-2015年多药耐药鲍氏不动杆菌主要在痰标本中检出占>70.0%;多药耐药鲍氏不动杆菌以ICU检出率最高,达>30.0%;多药耐药鲍氏不动杆菌对氨苄西林、哌拉西林耐药率均>90.0%,对替加环素、阿米卡星、亚胺培南和美罗培南相对敏感,耐药率<40.0%,其中2013-2015年多药耐药鲍氏不动杆菌对替加环素、亚胺培南和美罗培南耐药率呈上升趋势。结论医院多药耐药鲍氏不动杆菌主要分离自痰液,以ICU分布居多,耐药现象较为严重,应引起临床重视。     

665株多药耐药菌的监测与分析

目的 了解医院感染多药耐药菌分布及耐药状况,促进合理用药及医院感染的预防控制.方法 对医院2009年1月—2010年12月发生的医院感染送检标本所分离的多药耐药菌株进行回顾性分析.结果 665株多药耐药菌株,其中产超广谱β-内酰胺酶(ESBLs)的细菌居第一位,占31.7％,耐甲氧西林凝固酶阴性葡萄球菌占29.6％,多药耐药鲍氏不动杆菌占14.6％ ;ICU共分离出126株多药耐药菌,其中多药耐药鲍氏不动杆菌居第一位,占38.9％％.结论 医院感染多药耐药菌株以产ESBLs的细菌为主,ICU感染以多药耐药鲍氏不动杆菌为主,医院感染预防控制压力大,应加强多药耐药菌医院感染控制工作,实施目标性监测,预防和控制多药耐药菌的传播,并加强抗菌药物的合理应用.     

ICU鲍氏不动杆菌医院感染耐药性分析

目的 探讨ICU鲍氏不动杆菌(ABA)医院感染的分布特征及耐药性,为指导临床合理选用抗菌药物提供依据.方法 对2010年1-12月ICU分离出的87株医院感染鲍氏不动杆菌分布及耐药性进行统计分析.结果 鲍氏不动杆菌在ICU的检出率较高,其中90.80％的标本来源于下呼吸道;该菌多药耐药现象严重,87株鲍氏不动杆菌耐药率最低的是多黏菌素为5.75％,对亚胺培南和美罗培南的耐药率达75.86％,对头孢三代、头孢四代、阿米卡星耐药率分别为87.36％、83.91％、80.46％,对哌拉西林/他唑巴坦、庆大霉素、替卡西林/克拉维酸、环丙沙星耐药率均＞90.0％;泛耐药鲍氏不动杆菌(PDRAB)检出17株,占19.54％.结论 ICU医院感染鲍氏不动杆菌耐药严重,医院应加强对ABA耐药性的监测,实施有效的预防控制措施,尽量减少和延缓耐药株和泛耐药株的产生,防止多药耐药ABA医院感染暴发流行.     

肿瘤患者鲍氏不动杆菌医院感染及耐药性分析

目的了解肿瘤患者鲍氏不动杆菌医院感染状况及耐药性特征,探索预防与控制鲍氏不动杆菌医院感染的监控措施,并为临床治疗提供依据。方法对2011年1-12月肿瘤患者发生医院感染分离出的鲍氏不动杆菌及其耐药性进行回顾性统计分析,采用美国临床实验室标准化委员会推荐的纸片扩散法进行测定初筛和确证试验,药敏试验为CLSI推荐的K-B法,采用WHONET最新版本进行数据统计分析。结果在检出的451株病原菌中检出鲍氏不动杆菌28株,检出率6.21%,其中多药/泛耐药鲍氏不动杆菌20株占71.43%;检出率居首位的为痰液标本占57.14%;临床分布主要在外科、ICU;鲍氏不动杆菌对常用抗菌药物均敏感,多药耐药鲍氏不动杆菌对除碳青霉烯类与多黏菌素E外的常用抗菌药物均耐药,泛耐药鲍氏不动杆菌仅对多黏菌素E敏感。结论肿瘤患者鲍氏不动杆菌,尤其是多药/泛耐药鲍氏不动杆菌医院感染情况日趋严重,应加强临床合理使用抗菌药物的管理,并对感染病例实施监控,防止多药/泛耐药鲍氏不动杆菌医院感染的暴发。     

Trends in meningococcal disease in Italy in 1988

Meningococcal disease in Italy decreased 15% in 1988 from the previous year (290 vs. 342 cases). The decline was particularly evident in military cases (1.7/100,000 in 1988 vs. 5/100,000 in 1987) reflecting the full coverage of bivalent serogroup (A + C) meningococcal polysaccaride vaccine in army recruits, achieved since January 1988. The highest proportion of cases was seen in people older than 25 years of age (25%). Serogroup C constituted 60% of the isolates, while 19% belonged to serogroup B. The proportion of strains resistant to sulphonamides was 45%, while 15% were resistant to Minocycline and none to Rifampin. Out of the five military cases, only one (due to serogroup C) was attributable to the vaccine failure. A single coprimary case, but no secondary cases occurred among civilians. These findings are consistent with the trends reported in Italy in the previous years.     

Benzene in blood and phenol in urine in monitoring benzene exposure in industry

Determinations of benzene concentration in blood and of phenol in urine were made by head-space gas chromatography techniques on samples taken near the end of the work day from two groups of workers potentially exposed to low levels of benzene in the work-place atmosphere. Preliminary results suggest that benzene in blood is more reliable than phenol tests for assessing both exposure and uptake of benzene. Normal values of phenol in urine (10 mg/liter or less) were found in nearly all those cases in which benzene was detected in the blood.     

Changes in immune function in asthma in the elderly

Asthma is an inflammatory disorder of the airway. The airway inflammation of asthma is typically an allergic inflammation characterized by cells and mediators described as a "Th2" inflammatory response. There is a growing body of evidence describing changes in the function of immune cells upon aging, a phenomenon referred to as "immunosenescence". Several studies utilizing animal models and human subjects with asthma have begun to explore age-related effects on the airway inflammation in asthma. This review explores the existing data on the presence and effects of immunosenescence or age-related changes in immune function in asthma.     

Changes in Fatty Acid Composition in Beef in Italy

Results from a study conducted in Italy concerning the updating of composition data of beef consumed in Italy are reported here. The study required a very wide sampling plan with regard to both animals and cuts to analyse. Data related to lipid composition of the most widely used type of beef consumed in Italy (young bull, 16–22 months old) show a reduction in total lipid content (which, according to the cuts, ranges between 1.8 and 10.2%) and a substantial change in fatty acid composition, with a high % of polyunsaturated fatty acids (mean 20% of total fatty acids). Such data have been confirmed by other studies conducted in Italy, and are in contrast with data reported in the tables of food composition from other countries, reporting a fatty acid composition characterized by a high fatty acid saturation degree. The occurrence of long-chain polyunsaturated fatty acid is probably due to the high ratio of phospholipids: triglycerides, occurring when the content in intramuscular lipid is very low; to the young age of animals; to the reduced activity of the rumen, where saturation of fatty acids occurs. It may be concluded that a fatty acid composition, which is particularly rich in polyunsaturated fatty acids, seems typical for Italian products.     

2015年郑州市饮用水放射性水平状况调查

目的了解郑州市不同地区、不同季节、不同水源类型的放射性水平。方法分别于丰水期和枯水期采集郑州市区黄河水源水、井水源水、丹江口水源水、出厂水和末梢水各一份;以县为单位,每单位采集出厂水、末梢水、水库水、河水、井水各1份,按《生活饮用水生活标准检验方法》(GB/T 5750.13-2006)检测饮用水中总α和总β放射性水平,依据《生活饮用水卫生标准》(GB 5749-2006)进行判定。结果丰水期、枯水期水体总α、总β放射性水平均低于国家标准限值。结论郑州市不同水源类型均处于正常的天然放射性本底水平。     

Occupational stress in nurses in psychiatric institutions in Taiwan

Nurses are known to be exposed to occupational stress. However, occupational stress is not well documented for nurses in psychiatric institutions in Taiwan. A cross-sectional study was conducted to explore the work-related stress and risk factors of nurses in psychiatric institutions in Taiwan. A structured questionnaire was distributed to nurses at five state-owned psychiatric hospitals in Taiwan in 2001. Demographic information, working environment, and personal health status were inquired. Occupational stress was assessed based on the Chinese version of Job Content Questionnaire (JCQ). General health status and mental health were evaluated by the International Quality of Life Assessment Short Form-36 (IQOLA SF-36). A total of 573 questionnaires were disseminated to nurses and 518 (90.4%) were satisfactorily completed by nurses, including 408 female full-time nurses who had been in their current work for more than 6 months. In the past one month, 17.2% of nurses reported being under significant stress often or always. Assault episodes were reported by 45.1% of nurses in the past 6 months. Among the nurses, 16.9%, 25.2%, 50.0%, and 7.8% belong to the "High strain", "Low strain", "Active", and "Passive" groups, respectively. Perceived occupational stress was associated with young age, widowed/divorced/separated marital status, high psychological demand, low workplace support, and threat of assault at work. Lower general health score was associated with low job control, high psychological demand, and perceived occupational stress. A lower mental health score was associated with low job control, high psychological demand, low workplace support, and perceived occupational stress. We concluded that nurses in psychiatric institutions are under significant stress related to work factors.     

Changes in nursing administration in supporting transplantation in Brazil

This historical and bibliographic study aimed to understand how Nursing was organized to support care in transplantation. The HISA, LILACS, BDENF, PERIENF and DEDALUS databases were consulted, and thirteen references were found, ten of which were scientific articles, two were master's dissertations and one was a doctoral thesis. The span of time chosen for study ranges from the date of the first kidney transplant in Brazil (1965), to the date of publication of the last scientific article found in the databases mentioned above (2003). After reading these articles, the ones that were similar in topic were grouped together, thus creating the thematic axis for the presentation of the results. The results showed that the Nursing profession has played an important and active role in transplants ever since the first procedure in 1965.