ICU医院获得性肺炎多药耐药鲍氏不动杆菌对头孢哌酮/舒巴坦耐药的危险因素调查

目的 调查ICU医院获得性肺炎(HAP)患者多药耐药鲍氏不动杆菌对头孢哌酮/舒巴坦耐药的临床特征,分析头孢哌酮/舒巴坦耐药的危险因素.方法 对医院2009年1月-2011年1月ICU HAP患者多药耐药鲍氏不动杆菌引起的呼吸道感染50例,通过病例对照研究和多因素logistic回归分析ICU患者分离多药耐药鲍氏不动杆菌对头孢哌酮/舒巴坦耐药危险因素.结果 单因素分析结果表明,住院时间、纤维支气管镜灌洗、气管切开及机械通气、使用碳青霉烯类抗菌药物、三代头孢菌素、酶抑制剂、抗菌药物的应用种类均与多药耐药鲍氏不动杆菌对头孢哌酮/舒巴坦耐药显著相关(P＜0.01),logistic多因素回归分析结果表明,使用碳青霉烯类和酶抑制剂抗菌药物、支气管灌洗、机械通气是多药耐药鲍氏不动杆菌对头孢哌酮/舒巴坦耐药的独立危险因素.结论 使用碳青霉烯类和酶抑制剂抗菌药物、支气管灌洗、机械通气是ICU HAP患者多药耐药鲍氏不动杆菌对头孢哌酮/舒巴坦耐药的主要危险因素.     

耐碳青酶烯类鲍氏不动杆菌医院获得性肺炎临床分析

目的了解耐碳青酶烯类鲍氏不动杆菌医院获得性肺炎的特点,总结治疗经验。方法回顾性地分析12例鲍氏不动杆菌肺炎患者的临床表现、药敏及治疗方法。结果耐碳青酶烯类鲍氏不动杆菌肺炎均发生于有基础疾病的患者,胸片多表现为双侧斑片状渗出影;分离菌对亚胺培南及美罗培南均耐药,多黏菌素B敏感率为75%,对头孢哌酮/舒巴坦耐药率及中介率各为50%;使用头孢哌酮/舒巴坦治疗,10例好转,2例死亡。结论对于耐碳青酶烯类鲍氏不动杆菌医院获得性肺炎,头孢哌酮/舒巴坦有一定疗效。     

老年患者医院获得性鲍氏不动杆菌性肺炎临床特点及药敏分析

目的探讨老年患者医院获得性鲍氏不动杆菌性肺炎的临床特点以及对抗菌药物的敏感情况。方法回顾性地分析40例老年患者医院获得性鲍氏不动杆菌性肺炎的临床资料,包括一般情况、基础疾病、临床症状及体征、X线检查结果、实验室检查结果、机械通气实施情况、药敏结果及病情转归。结果老年患者由于自身免疫能力下降,患医院获得性鲍氏不动杆菌性肺炎后发热占65.0%,白细胞计数升高占32.5%,主要以中性粒细胞百分比升高为主(75.0%);对常规检测的抗菌药物均耐药的鲍氏不动杆菌占一定比例(25.6%),对抗菌药物敏感的鲍氏不动杆菌中其较敏感的抗菌药物依次为:亚胺培南35例(54.7%),阿米卡星34例(53.1%),左氧氟沙星31例(48.4%),多黏菌素B 26例(40.6%),头孢他啶26例(40.6%),环丙沙星26例(40.6%)。结论对于老年患者医院获得性鲍氏不动杆菌性肺炎,可联用碳青酶烯类(亚胺培南或美罗培南)和头孢哌酮/舒巴坦。     

老年重症肺部感染患者鲍氏不动杆菌分布特征与耐药性及对预后的影响研究

目的探讨医院呼吸内科老年重症肺部感染患者鲍氏不动杆菌的分布特征、耐药状况及预后影响因素。方法采用单中心回顾性研究,纳入2015年12月-2017年1月于医院呼吸内科住院治疗的126例经细菌培养出鲍氏不动杆菌的老年重症肺部感染患者。依据预后不同分为存活组和死亡组。详细记录患者一般临床特征、实验室资料、ICU住院时间等临床资料。分析鲍氏不动杆菌分布及耐药特征;分析两组患者临床特征及与患者预后可能相关的影响因素。结果 126例老年重症肺部感染患者中,好转90例,死亡36例,病死率28.57%;鲍氏不动杆菌分离率以呼吸道标本最高为85.71%,有22例占17.46%患者血与呼吸道标本同时分离到鲍氏不动杆菌;鲍氏不动杆菌对替加环素、阿米卡星、左氧氟沙星、头孢哌酮/舒巴坦耐药率较低,对氨苄西林/舒巴坦、头孢他啶、美罗培南和亚胺培南的耐药率较高;多因素Logistic回归分析结果显示,血清高水平PCT、接受机械通气和72h内液体出入量正平衡可能为鲍氏不动杆菌感染老年重症肺炎患者预后的影响因素。结论老年重症肺部感染患者鲍氏不动杆菌耐药率高,增加了抗菌药物选择难度;高水平血清PCT、接受机械通气及入院72h内累积液体出入量正平衡可作为患者预后的独立危险因素。     

多药耐药鲍氏不动杆菌耐药性分析

目的探讨住院患者感染多药耐药鲍氏不动杆菌的耐药性,以降低其感染率。方法分析2012年5月-2013年6月80例患者标本分离鲍氏不动杆菌耐药性及感染因素。结果耐药率最低为头孢哌酮/舒巴坦,占25.00%;敏感率由高到低依次为亚胺培南58.75%、头孢哌酮/舒巴坦48.75%、哌拉西林/他唑巴坦38.75%、左氧氟沙星36.25%、头孢他啶32.50%;感染多药耐药鲍氏不动杆菌患者药物治疗以碳青霉烯类抗菌药物为多,其中亚胺培南占65.00%,而头孢哌酮/舒巴坦占50.00%,氨基糖苷类占40.00%,且有20.00%患者给予头孢哌酮/舒巴坦联合氨基糖苷类治疗,联合治疗效果相比单药治疗较好;感染因素主要为机械通气、静脉插管、机械通气联合静脉插管以及抗菌药物的应用。结论对确诊感染多药耐药鲍氏不动杆菌患者应积极治疗原发病,尽量选择头孢哌酮/舒巴坦治疗以提高疗效。     

医院获得性肺炎预后及鲍氏不动杆菌感染危险因素分析

目的对医院患者感染鲍氏不动杆菌(AB)发生的医院获得性肺炎(HAP)的危险因素和HAP患者的预后进行回顾性分析,为预防和治疗医院获得性肺炎尤其是鲍氏不动杆菌感染的HAP提供依据。方法选取2014年1月-2015年12月医院HAP患者114例,通过多元logistic回归因素进行分析,评价HAP患者感染鲍氏不动杆菌的危险因素与HAP预后相关的危险因素。结果 114例HAP患者中发生呼吸机相关性肺炎15例,痰培养为鲍氏不动杆菌29例,患者病死率为43.0%;感染前30天内入住ICU、机械通气、使用碳青霉烯类抗菌药物为感染鲍氏不动杆菌的HAP独立危险因素;感染时APACHEII评分>18、合并ARDS、合并休克是HAP死亡的独立危险因素。结论对于ICU患者、有机械通气史患者要警惕鲍氏不动杆菌感染风险,尽量减少ICU住院日及机械通气时间;临床上滥用碳青霉烯类抗菌药物会增加住院患者感染鲍氏不动杆菌风险,HAP患者感染时APACHEⅡ评分可以预估患者的预后。     

耐碳青霉烯类鲍氏不动杆菌医院获得性肺炎危险因素分析

目的探讨耐碳青霉烯类鲍氏不动杆菌(CRAB)医院获得性肺炎的危险因素。方法采用病例对照研究,收集2005年1月-2010年12月鲍氏不动杆菌(ABA)引起的医院获得性肺炎92例,分为CRAB医院获得性肺炎组30例和碳青霉烯类敏感鲍氏不动杆菌(CSAB)医院获得性肺炎组62例;采用单因素分析及多因素logistic回归分析。结果单因素分析发现,APACHEⅡ评分≥16分、气管插管或气管切开、机械通气、分离出ABA前<2周曾应用过亚胺培南或美罗培南、≥2种抗菌药物联合应用与CRAB感染有关;多因素logistic回归分析发现,APACHEⅡ≥16分(OR=4.144,95%Cl1.346～12.761,P=0.013)及分离出CRAB前<2周曾应用过亚胺培南或美罗培南(OR=3.236,95%Cl1.128～9.282,P=0.029)是独立危险因素;CRAB组死亡11例,CSAB组死亡19例,2组死亡率差异无统计学意义。结论 APACHEⅡ≥16分及分离出CRAB前<2周曾应用过亚胺培南或美罗培南,是CRAB医院获得性肺炎的独立危险因素。     

耐亚胺培南鲍氏不动杆菌医院获得性肺部感染危险因素及耐药性分析

目的研究耐亚胺培南鲍氏不动杆菌(IRAB)医院获得性肺部感染(NP)发生的危险因素及其耐药性。方法对34例IRAB及68例亚胺培南敏感鲍氏不动杆菌(ISAB)NP作病例对照研究,采用平板稀释法测定常用抗菌药物对该菌株的最低抑菌浓度(MIC)。结果发生IRAB-NP的危险因素,在分离出鲍氏不动杆菌前15 d接受氟喹诺酮抗菌药物(OR=5.738)、碳青酶烯类抗菌药物治疗(OR=7.129),IRAB耐药率高,但对氨苄西林/舒巴坦及头孢哌酮/舒巴坦的耐药率<30%。结论碳青酶烯类抗菌药物及氟喹诺酮抗菌药物的应用是IRAB-NP的危险因素,IRAB仅对氨苄西林/舒巴坦及头孢哌酮/舒巴坦有相对较高的敏感性。     

头孢哌酮/舒巴坦使用剂量对鲍氏不动杆菌耐药性变迁的影响

目的 探讨头孢哌酮/舒巴坦使用剂量对鲍氏不动杆菌耐药性变迁的作用及与鲍氏不动杆菌对头孢吡肟、亚胺培南、左氧氟沙星、头孢哌酮/舒巴坦耐药性的影响.方法 对2009-2012年进行细菌培养的131 093例患者作为研究对象,并对其阳性标本进行分析,同时分析鲍氏不动杆菌对头孢哌酮/舒巴坦、氨苄西林/舒巴坦、头孢吡肟、亚胺培南、左氧氟沙星的耐药性.结果 调查131 093例患者送检标本中,阳性标本31 093例,检出鲍氏不动杆菌3093株,其中2009年893株、2010年876株、2011年765株、2012年559株;鲍氏不动杆菌的耐药率:2009年对头孢哌酮/舒巴坦、氨苄西林/舒巴坦、头孢吡肟、亚胺培南、左氧氟沙星分别为16.24％、68.65％、57.33％、61.03％、57.33％,2010年分别为26.37％、92.69％、64.27％、58.45％、51.83％,2011年分别为31.76％、93.20％、69.80％、59.35％、69.54％,2012年未对氨苄西林/舒巴坦进行检测,其他分别为23.61％、57.42％、61.36％、67.26％;鲍氏不动杆菌对5种抗菌药物的使用剂量与耐药的相关性分析,仅对头孢哌酮/舒巴坦与的耐药性有明显的正相关,头孢哌酮/舒巴坦使用剂量与左氧氟沙星、头孢吡肟的耐药性有相关性.结论 合理使用抗菌药物,可降低鲍氏不动杆菌的耐药性,继而提高临床疗效.     

老年呼吸机相关性肺炎鲍氏不动杆菌感染的耐药性分析

目的 研究老年呼吸机相关性肺炎(VAP)鲍氏不动杆(ABA)感染的耐药特征,提高临床对鲍氏不动杆菌防治水平.方法 对131例老年呼吸机相艾性肺炎(VAP)患者分离的69株鲍氏不动杆菌进行药敏试验,并对抗菌药物耐药结果进行回顾性分析.结果 69株鲍氏不动杆菌对头孢哌酮/舒巴坦的耐药率最低,为44.93％;其次为亚胺培南、美罗培南和哌拉西林/他唑巴坦均为47.83％,对其余11种抗菌药物的耐药率均为60.87～97.10％;共检出33株耐亚胺培南ABA,泛耐药株(PDR)2株.结论 鲍氏不动杆菌对常用抗菌药物呈多药耐药(MDR);在老年呼吸机相关性肺炎(VAP)感染已十分严重,其首选药物为头孢哌酮/舒巴坦、亚胺培南、美罗培南和哌拉西林/他唑巴坦;应加大对鲍氏不动杆菌耐药性的监测力度,强调根据药敏结果选择用药.     

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.     

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.     

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.     

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.