医院内细菌分布及药敏结果分析

据WHO统计，世界有5000万人携带耐药菌，耐甲氧西林金黄色葡萄球菌对青霉素和其它β-内酰胺类抗生素耐药，万古霉素是唯一治疗这种多重耐药金黄色葡萄球菌的抗生素，而万古霉素耐药的肠球菌近年来也逐渐增加；质粒介导的产超广谱β-内酰胺酶的菌株临床分离率在上升，且对所有的头孢菌素均耐药；除此之外还有产氨苄C酶和金属酶的菌株不断被分离到，使感染的治疗十分困难。因此临床微生物实验室应定期将细菌耐药性结果提供给临床。     

老年患者下呼吸道感染细菌谱监测分析

目的：监测老年下呼吸道感染细菌谱的变化。方法：老年下呼吸道感染154例，采用微量肉汤稀释法及双纸片法测定致病菌株。结果：检出革兰阳性菌34株，以凝固酶阴性葡萄球菌和金黄色葡萄球菌多见；革兰阴性菌120株，以克雷伯菌属和大肠埃希氏菌常见。结论：引发老年人下呼吸道感染的常见致病菌以革兰阴性菌比例较高，应强调临床合理使用抗生素。     

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。     

肺部革兰阳性球菌感染的诊治进展

近年来,革兰阳性球菌感染的发生率不断增高,不仅表现为医院和社区获得性感染的增加,而且耐药菌的比例也在增高.引起呼吸系统感染的常见阳性球菌包括葡萄球菌属、链球菌属和肠球菌属等.肺炎链球菌仍然是最常见的呼吸道感染致病菌,但目前对青霉素不敏感的菌株不断增多,给治疗带来困难.在金黄色葡萄球菌中,甲氧西林耐药金黄色葡萄球菌(MRSA)占引起院内感染菌株的比例接近60%,且这种趋势在向社区蔓延,但社区获得性MRSA(CA-MRSA)感染的特点与医院获得性MRSA(HA-MRSA)感染明显不同.本文主要对肺炎链球菌肺炎和金黄色葡萄球菌肺炎的诊治进展作一介绍.     

基层医院革兰阴性杆菌1309株的耐药性变迁

目的：分析革兰阴性杆菌的耐药变迁,避免临床抗生素的滥用。方法：回顾分析临床分离的1 309株革兰阴性杆菌的分布及耐药性变迁。结果：革兰阴性杆菌主要来源于伤口分泌物、中段尿液和呼吸道的痰液,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌为主,细菌对亚胺培南、头孢哌酮/舒巴坦、阿米卡星耐药率低,对氨苄青霉素、哌拉西林和一、二代头孢菌素类耐药率高,细菌耐药率呈逐年上升趋势。结论：革兰阴性杆菌对常用抗生素的耐药性呈上升趋势,医院应加强对其耐药性的监测,减少耐药菌株的产生。     

外科重症患者术后感染病原菌种类及药物敏感性分析

目的：探讨外科重症患者术后感染菌群分布和药物敏感性情况，为临床重症患者合理用药提供实验室依据。方法：采用回顾性研究方法，分析2004～2006年我院外科重症患者术后感染及药物敏感性情况。结果：外科重症术后以呼吸道感染最常见，送检标本以下呼吸道标本为主。排在前3位的科室分别为肝胆外科、神经外科和泌尿外科。前3位感染菌分别为大肠埃希菌、金黄色葡萄球菌和铜绿假单胞菌。大肠埃希菌产超广谱β-内酰胺酶菌株逐年增多，以亚胺培南最敏感（95．34％）；金黄色葡萄球菌以万古霉素最敏感（100％），未发现耐万古霉素菌株，耐苯唑西林菌株占54，62％，产β-内酰胺酶菌株约95％；铜绿假单胞菌以丁胺卡那霉素（78.61％）和亚胺培南（67．30％）最敏感，多重耐药性显著。结论：外科重症术后患者感染易出现，感染菌株耐药性高，不易控制，应定期、及时的按照细菌培养和药物敏感性检测结果慎重选用抗生素，防止多重耐药菌株的出现和爆发流行。     

呼吸科重症加强治疗病房肺癌病原菌分布及耐药性分析

目的了解近年来呼吸科重症加强治疗病房(RICU)肺癌患者院内下呼吸道感染病原菌分布及耐药情况。方法对2003年3月—2008年7月长海医院(RICU)366例住院肺癌患者下呼吸道感染痰细菌分离株及耐药监测情况进行回顾性分析。结果共分离细菌392株,病原菌革兰阴性占53.3%,以铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌为多见;革兰阳性菌占18.7%,主要是金黄色葡萄球菌;真菌占27.8%。致病菌对常用抗生素都不同程度地产生了耐药性,对青霉素、氨苄西林耐药率最高,对亚胺培南-西司他丁的耐药率最低,未发现对万古霉素耐药的金黄色葡萄球菌。结论RICU肺癌患者院内下呼吸道感染的主要病原菌为革兰阴性菌,细菌耐药性严重,并且具有多重耐药性。因RICU肺癌院内感染,患者预后相对较差,应早期采用有效的干预措施。     

呼吸道感染病原菌及其耐药性分析

目的　了解医院近年呼吸道感染常见病原菌的种类、分布及对 12种抗生素的耐药性。方法　对呼吸道感染患者的痰、咽拭子进行常规细菌培养 ,分离菌株 ,再用微量稀释法测定 398株致病菌 (真菌 15 3株除外 )对 12种抗生素的最低抑菌浓度 (MIC)。结果　 398株分离菌中以G-杆菌为主 ,占 5 8.3% ,真菌占 38.4 % ,G+ 球菌占 3.3%。对临床常用的 12种抗生素 ,抗菌作用最强的是丁胺卡那霉素 ,敏感率 6 9.4 % ;其次是复方新诺明 ,敏感率 2 4 .1% ;抗菌作用最差的是氨苄青霉素 ,敏感率 6 .1%。结论　呼吸道感染主要致病菌为G-杆菌 ,真菌感染的比例呈明显上升趋势 ,抗生素治疗应依据细菌学指导 ,选择敏感药物     

高原地区医院耐甲氧西林葡萄球菌感染及其耐药谱分析

目的：了解高原医院耐甲氧西林葡萄球菌感染及其耐药谱情况，为临床医生提供合理使用抗生素的依据。方法：将临床感染标本分离的金黄色和表皮葡萄球菌分别进行耐甲氧西林敏感性检测，采用K—B法分别对甲氧西林耐药和敏感的金黄色和表皮葡萄球菌进行27种抗生素的药敏比较试验。结果：葡萄球菌是高原医院主要感染菌，耐甲氧西林金黄色葡萄球菌感染率66．4％，而耐甲氧西林表皮葡萄球菌感染率68．9％，耐甲氧西林葡萄球菌耐药率大多明显高于甲氧西林敏感的葡萄球菌，去甲万古霉素敏感率最高而丁胺卡那霉素次之，所检测的感染葡萄球菌总能找出对其敏感的抗生素。结论：临床医生选择使用抗生素时以不易产生耐药性或耐药率相对较低的抗生素，临床检验工作者在实验工作中应增加药敏试验的抗生素品种，为临床医生提供更合适的敏感抗生素。     

高原地区217例医院感染菌及耐药性结果分析

目的了解高原地区医院感染的常见致病菌及其对常用抗生素的耐药情况。方法对217例患者采集标本，进行常规细菌分离鉴定及药物敏感试验。结果G^-杆菌（56．7％）高于G^＋球菌（43．3％）；医院感染的主要部位分布在呼吸道、胃肠道、泌尿道等处；金黄色葡萄球菌对青霉素的耐药率达94．3％，G^-杆菌对常用的抗G^-杆菌药物均显示出较高的耐药xin性，但头孢类抗生素对其有较高的敏感性。结论高原地区与低海拔地区相比，致病菌的分布情况及其耐药性并无明显差别。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.