抗感染督导疗法对烧伤脓毒症患者临床疗效的影响

目的探讨抗感染督导疗法对烧伤脓毒症患者临床结局的影响。方法选取医院2014年2月-2017年2月收治的烧伤脓毒症患者144例为研究对象,采用数字表法分为试验组和对照组,每组72例,对照组患者抗感染治疗依据临床常规抗感染治疗方法进行,试验组抗感染治疗依据《烧伤脓毒症抗感染督导疗法指导方针》进行,采集两组患者标本,检测病原菌,评价两组抗感染疗效和细菌清除率,记录两组抗菌药物使用时间、14d死亡率,治疗前后,采集患者静脉血,检测白介素2(IL-2)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)和C-反应蛋白(CRP)、可溶性肿瘤坏死因子受体I(sTNFR-I)和可溶性肿瘤坏死因子受体II(sTNFR-II)。结果试验组检出病原菌94株,其中革兰阴性菌49株,占52.13%,革兰阳性菌28株,占29.79%,真菌17株,占18.09%,对照组检出病原菌90株,其中革兰阴性菌45株,占50.00%,革兰阳性菌27株,占30.00%,真菌18株,占20.00%,两组病原菌构成差异无统计学意义;试验组细菌清除率、抗感染有效率均高于对照组(P0.05),抗菌药物使用时间短于对照组(P0.05),两组患者14d死亡率比较差异无统计学意义;治疗前,两组IL-2、IL-6、TNF-α、CRP、sTNFR-I和sTNFR-II水平差异均无统计学意义;治疗后,两组IL-2、IL-6、TNF-α、CRP、sTNFR-I均降低(P0.05),且试验组低于对照组(P0.05),sTNFR-II水平无变化。结论抗感染督导疗法可有效降低烧伤脓毒症患者炎性反应水平,提高抗感染疗效和细菌清除率,缩短抗菌药物使用时间,值得临床推荐。     

骨科患者医院感染病原学和耐药性分析

目的探索骨科患者抗菌药物应用及医院感染病原菌分布和耐药性。方法回顾性分析2015年2月-2018年2月于医院接受治疗的224例骨科伤口感染患者的临床资料,统计患者抗菌药物使用率、病原菌分布情况及占比、主要病原菌对不同抗菌药物耐药性。结果本次研究共224例骨科伤口感染患者,202例患者使用抗菌药物,患者抗菌药物使用率为90.18%。224例患者共检出246株病原菌,革兰阴性菌152株占61.79%,革兰阳性菌89株占36.18%。肺炎克雷伯菌对氨苄西林耐药性较高;铜绿假单胞菌对氨苄西林耐药性较高;金黄色葡萄球菌对青霉素耐药性较高;凝固酶阴性葡萄球菌对青霉素耐药性较高。结论骨科伤口感染患者抗菌药物使用率高,且大多数患者未经病原菌分析便滥用抗菌药物,伤口感染患者主要以革兰阴性菌为主,且革兰阴性菌及革兰阳性菌对多种抗菌药物产生耐药性,临床治疗时应该对患者伤口感染病原菌进行分析后用药。     

神经外科患者术后颅内医院感染的调查与抗菌药物使用分析

目的分析神经外科患者术后颅内医院感染情况、病菌原分布及其药敏性,以指导临床合理用药。方法选取2010年1月-2014年12月于医院行神经外科开颅手术的患者1 218例,术后对其脑脊液进行培养,观察术后颅内医院感染率、病原菌分布及其药敏性,并统计分析抗菌药物的使用情况;采用SPSS17.0软件对数据进行统计分析。结果 1 218例行神经外科开颅手术的患者中62例发生颅内感染,感染率为5.1%;共分离出病原菌78株,其中革兰阳性菌48株占61.5%,革兰阴性菌30株占38.5%;革兰阳性菌对万古霉素和利奈唑胺敏感率较高,革兰阴性菌对亚胺培南和美罗培南敏感率较高;抗菌药物使用方面,青霉素在预防性用药中所占比例最高,糖肽在经验性抗菌药物治疗中所占比例最高,而头孢菌素、糖肽等在目标性用药中所占比例较高。结论神经外科术后颅内医院感染以革兰阳性菌最为常见,临床用药时应以针对革兰阳性菌的抗菌药物为主,同时兼顾革兰阴性菌进行联合用药。     

烧伤创面病原菌感染的相关因素分析

目的探讨引起烧伤创面病原菌感染发生的相关因素及病原菌分布状况,为烧伤感染的预防及治疗提供参考。方法收集2012年1月-2015年12月在医院诊治的212例烧伤患者临床资料,回顾性分析创面病原菌培养结果及引起感染的相关因素。结果 212例患者发生创面感染者164例,感染率为77.36%;创面分泌物中培养出185株病原菌,其中革兰阴性菌131株占70.81%,革兰阳性菌49株占26.49%,真菌5株占2.70%,感染病原菌以铜绿假单胞菌、鲍曼复合醋酸钙不动杆菌、金黄色葡萄球菌为主,分别占18.38%、15.14%、11.89%;单因素及多因素logistic回归分析显示,烧伤面积越大、烧伤程度越深、预防使用抗菌药物种类越多感染率越高(P<0.05),入院后预防使用抗菌药物、合并休克、平时有自购抗菌药物滥用习惯、有长期服用糖皮质激素治疗疾病史等因素时感染率高(P<0.05)。结论烧伤发生后创面感染率极高,感染病原菌主要是革兰阴性菌,引起烧伤感染的因素较多,应针对性的进行干预以降低感染发生。     

2012年医院感染病原菌分布及耐药性分析

目的了解医院感染病原菌的分布及耐药性,为临床合理性用药提供参考依据。方法回顾性分析2012年医院15 874例住院患者分离的病原菌分布及耐药性,数据采用WHONET 5.4进行统计处理。结果共检出4178株病原菌,其中革兰阴性菌2 948株占70.56%,革兰阳性菌603株占14.43%,真菌227株占5.43%,其他400株占9.58%;主要肠杆菌属对常用抗菌药物的耐药率较高,但对亚胺培南完全敏感;葡萄球菌属对青霉素类药物有较高的耐药率均>95.00%,对多数抗菌药物敏感率低,未检出耐万古霉素菌株。结论了解主要病原菌对抗菌药物的耐药率,为临床合理使用抗菌药物提供依据,能有效预防与控制耐药菌在该地区的传播和医院感染。     

患儿下呼吸道感染病原菌的临床调查与耐药性分析

目的分析医院下呼吸道感染患儿分离出的病原菌耐药性,为临床合理用药和治疗提供参考。方法对2010年6月-2014年6月医院1 800例下呼吸道感染患儿的病原菌进行分离、培养、鉴定及耐药性分析,数据采用SPSS 20.0进行统计分析。结果患儿下呼吸道感染病原菌中革兰阳性菌942株,占52.3%,革兰阴性菌858株,占47.7%;革兰阳性菌及革兰阴性菌的耐药比例均较大,但革兰阳性菌对万古霉素敏感,革兰阴性菌对亚胺培南较敏感。结论患儿下呼吸道感染病原菌中革兰阳性菌和革兰阴性菌基本持平,对抗菌药物耐药性高,要加强临床监测。     

烧伤病房不同病种患者创面病原菌分布及耐药性对比研究

目的分析烧伤病房不同病种患者创面病原菌分布及耐药性,为临床合理选用抗菌药物提供依据。方法对2006年1月-2012年6月烧伤病房收治患者288份创面标本进行分析,采用K-B纸片扩散法对分离出的病原菌进行药物敏感试验,并对其耐药性进行研究。结果共分离出病原菌205株,检出率71.18%,包括革兰阳性菌91株占44.39%,革兰阴性菌113株占55.12%,真菌1株占0.49%;常见病原菌中金黄色葡萄球菌在烧伤难愈性创面多见,铜绿假单胞菌、鲍氏不动杆菌在非烧伤难愈性创面多见;革兰阳性菌对青霉素、红霉素、苯唑西林和克林霉素的耐药率>70.00%,革兰阴性菌对头孢唑林、头孢噻肟、阿莫西林/克拉维酸的耐药率>60.00%,3类创面的病原菌耐药率也有差异。结论不同病种创面的细菌分布和耐药性有差异,临床工作中需根据不同的创面采取不同的抗感染治疗措施。     

脑室-腹腔分流术患者反复感染的病原学分析与临床治疗研究

目的探讨脑室-腹腔分流术反复感染的病原菌与耐药性,以寻找最敏感的抗菌药物对症治疗,提高临床治疗水平。方法选取2007年1月-2013年1月130例脑室-腹腔分流术反复感染患者为研究对象,对所有患者进行病原菌与耐药性分析。结果分离出病原菌155株,其中革兰阴性菌占34.19%,革兰阳性菌占52.26%,真菌占13.55%;革兰阳性菌中耐药性较低的抗菌药物有亚胺培南、美罗培南,均为0,在革兰阴性菌中耐药性较低的抗菌药物为替考拉宁、万古霉素,也均为0;经过对症治疗后治愈103例,治愈率79.23%,17例放弃治疗,10例死亡,病死率7.69%。结论脑室-腹腔分流术反复感染以革兰阳性菌为常见病原菌,选择敏感抗菌药物联合手术等治疗后效果显著。     

颅脑外伤后肺部感染患者病原菌分布及耐药性分析

目的 探讨颅脑外伤患者发生肺部感染的病原菌分布及药敏结果,为临床合理使用抗菌药物提供依据.方法 对2002年1月-2012年8月收治的颅脑外伤合并肺部感染患者下呼吸道分离的病原菌进行培养,药敏试验采用纸片扩散法,按照美国临床实验室标准化委员会标准判断结果.结果 897例颅脑外伤患者有79例发生肺部感染,感染率为8.81％;分离79株病原菌,革兰阴性菌49株占62.03％,革兰阳性菌21株占26.58％,真菌9株占11.39％;多数病原菌对抗菌药物呈多药耐药性,对革兰阴性菌耐药率较低的有头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南,均＜40.00％,对革兰阳性菌耐药率较低的药物有万古霉素、替考拉宁,均＜5.00％.结论 引起颅脑损伤并发肺部感染患者的病原菌耐药性严重,对多种抗菌药物耐药,革兰阴性菌感染比例增高,临床应加强病原菌培养及药敏监测,合理使用抗菌药物,采取有效措施减少感染发生.     

烧伤病区抗菌药物使用强度变化的回顾性分析

目的 了解烧伤病区抗菌药物使用的情况及病原菌结构与耐药水平的现状,为临床合理用药提供参考.方法 计算烧伤病区2000-2011年度临床抗菌药物使用强度:DDDs/100人天,统计烧伤病区2000-2011年金黄色葡萄球菌对苯唑西林的耐药率以及鲍氏不动杆菌和铜绿假单胞菌对亚胺培南的耐药率;对抗菌药物的使用强度与3种病原菌的耐药率进行相关分析.结果 2011年三代头孢+酶抑制剂类、二代头孢、氨基糖苷类药物为使用强度最大的前3位药物,烧伤病区抗菌药物使用总强度达到52.78 DDDs/100人天;3种病原菌的耐药率变化均明显升高,一、二代头孢菌素的使用强度和抗菌药物使用总强度与3种病原菌耐药率的变化密切相关.结论 烧伤病区抗菌药物使用总强度和主要病原菌的耐药性均处于较高水平,降低病区抗菌药物使用的总强度,适当减少二代头孢菌素类抗菌药物的使用强度,可能会对降低病原菌耐药水平有一定的帮助.     

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.