呼吸科病房病原菌分布及耐药性研究

目的 分析医院2011年呼吸科病房下呼吸道感染患者病原菌分布特点及其耐药性,为临床科学用药提供依据.方法 对下呼吸道感染住院患者送检的痰标本中分离出病原菌,用全自动细菌鉴定及药敏测定仪进行耐药性监测.结果 2822例下呼吸道感染住院患者中,共分离出革兰阴性菌326株占74.8％;革兰阳性菌110株占25.2％;检出率排前5位的病原菌依次为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球菌;肺炎克雷伯菌及大肠埃希菌中产ESBLs株分别占38.6％和58.4％,产ESBLs株对多种抗菌药物的耐药率均显著高于非产酶株;铜绿假单胞菌对阿米卡星、妥布霉素、哌拉西林、环丙沙星及亚胺培南的敏感率＞70.0％,鲍氏不动杆菌对临床常用抗菌药物耐药率较高,未检出耐万古霉素、利奈唑胺金黄色葡萄球菌.结论 对该地区病原菌进行监测,掌握常见病原菌分布及耐药特点,对合理选择抗菌药物非常重要.     

RICU呼吸机相关性肺炎病原学特点及耐药性分析

[目的]研究呼吸科重症监护病房(RICU)呼吸机相关性肺炎(VAP)病原菌的来源、分布特点及其耐药情况,探讨防治措施.[方法]对42例RICU呼吸机相关性肺炎的病原菌分布情况和耐药性等临床资料进行回顾性分析.[结果]共检出病原菌株124株,其中革兰阴性菌94株(75.8%),革兰阳性菌17株(13.7%),真菌13株(10.5%).大多数革兰阴性菌对常用的抗菌药物表现出较高的耐药性,金黄色葡萄球菌耐6性严重.[结论]VAP病原菌以革兰阴性菌为主,耐药情况比较严重,铜绿假单胞菌、鲍氏不动杆菌、肺炎克雷伯菌、金黄色葡萄球菌为RICU中VAP的主要致病菌,临床上应加强抗生素的合理使用.     

萍乡市某医院ICU收治的60例重症感染患者病原菌分布及耐药状况

目的了解萍乡市某医院重症感染患者病原菌分布及耐药性状况。方法选取2017年7月-2019年6月该院ICU收治的重症感染患者60例,对分离出的82株病原菌进行鉴定及药敏试验。结果 60例重症感染患者中,以下呼吸道、泌尿系统感染为主(共40例,占66.67%)。分离出的82株病原菌中,革兰阴性菌占75.61%,革兰阳性菌占24.39%。革兰阴性菌以铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌为主,革兰阳性菌以金黄色葡萄球菌、溶血葡萄球菌、肠球菌属为主。药敏试验显示,4种主要革兰阴性菌对阿米卡星、亚胺培南、头孢哌酮/舒巴坦敏感度较高,其中肺炎克雷伯菌、大肠埃希菌对亚胺培南未出现耐药性,铜绿假单胞菌、鲍曼不动杆菌对氨苄西林、头孢唑林耐药率均≥80%,铜绿假单胞菌对氨苄西林、头孢西丁耐药率均达100.00%。3种主要革兰阳性菌对万古霉素、利奈唑胺均敏感,金黄色葡萄球菌对利福平及左氧氟沙星敏感度较高,对青霉素耐药率均≥80%,溶血葡萄球菌、金黄色葡萄球菌对红霉素耐药率均>80%。结论该院重症感染患者病原菌主要以革兰阴性菌为主,多发于下呼吸道、泌尿系统;病原菌耐药性普遍较高,应加强抗菌药物的合理应用。     

2010-2013年老年病房下呼吸道感染病原菌分布及耐药性变迁

目的了解老年病房下呼吸道感染病原菌分布及耐药性变迁,为临床合理选用抗菌药物提供依据。方法回顾性分析某院老年病房2010—2013年下呼吸道感染患者分离的病原菌,并对其耐药性进行分析。结果 4年间,共分离病原菌2 398株,以革兰阴性菌为主(1 676株,占69.89%),最常见的革兰阴性菌分别为铜绿假单胞菌(25.94%)和大肠埃希菌(15.22%);其次为革兰阳性菌(323株,占13.47%),真菌中白假丝酵母菌达259株(占10.80%)。肠杆菌科细菌对碳青霉烯类抗生素的耐药率最低(1%),大肠埃希菌对头孢曲松和头孢噻肟耐药率较高(60%),肺炎克雷伯菌的耐药性普遍低于大肠埃希菌;铜绿假单胞菌对阿米卡星耐药率较低(11%),鲍曼不动杆菌对头孢哌酮/舒巴坦的耐药率相对较低,对亚胺培南、哌拉西林/他唑巴坦、头孢他啶等常见抗菌药物耐药率普遍40%。结论老年病房下呼吸道感染病原菌以革兰阴性菌为主,其中铜绿假单胞菌占首位,临床应根据药敏结果 ,合理使用抗菌药物。     

新生儿病房感染病原菌分布及耐药性分析

目的 了解2007-2009年新生儿病房医院感染的病原菌分布特点及其耐药性变化,为临床合理使用抗菌药物提供依据. 方法 对新生儿病房2007年6月-2009年7月所分离出的病原菌菌株及其耐药性进行回顾性调查分析. 结果 所有送检标本共检出病原菌124株,其中革兰阴性菌110株,占88.7%,革兰阳性菌12株,占9.7%,真菌2株,占1.6%,前4位病原菌依次为肺炎克雷伯菌、大肠埃希菌、凝固酶阴性葡萄球菌和铜绿假单胞菌;肺炎克雷伯菌和大肠埃希菌对常用抗菌药物耐药严重,且呈多药耐药,肺炎克雷伯菌ESBLs的检出率为94.1%,大肠埃希菌ESBLs的检出率为36.4%. 结论 进行病原学监测,了解病原菌株分布及其耐药趋势,对合理选择抗菌药物、降低新生儿感染发生率和死亡率以及减少耐药菌株产生均有重要价值.     

2016-2020年热带地区医院呼吸道感染病原菌及其耐药性

目的 明确热带地区呼吸道感染检出病原菌及耐药情况,为指导合理选择抗菌药物治疗医院呼吸道感染提供参考。方法 收集2016-2020年某医院发生呼吸道感染住院患者检出的病原菌,并对主要病原菌耐药性进行回顾性分析。结果 2 857例次医院呼吸道感染患者共分离出病原菌2 992株,其中革兰阴性菌1 839株占61.46%,以鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌为主;革兰阳性菌527株占17.61%,以金黄色葡萄球菌为主(其中耐甲氧西林金黄色葡萄球菌12株);真菌626株占20.92%,以白假丝酵母为主;近5年鲍氏不动杆菌、白假丝酵母和热带假丝酵母检出率显示下降趋势(P<0.05)。肺炎克雷伯菌、鲍氏不动杆菌和铜绿假单胞菌对亚胺培南耐药率分别为12.40%、77.90%和28.46%。结论 热带地区检出病原菌主要是革兰阴性菌,以鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和金黄色葡萄球菌为主;检出菌对广谱青霉素类抗菌药物的耐药性较高,对碳青霉烯类抗菌药物及β-内酰胺酶抑制剂的耐药率相对较低,近5年鲍氏不动杆菌对碳青霉烯类耐药趋势逐年下降,但仍处于较高状态,应加强呼吸道感染耐药菌...     

ICU下呼吸道感染者病原菌分布及耐药性分析

目的 探讨医院ICU下呼吸道感染者痰培养病原菌的分布及耐药性.方法 回顾性分析医院2008年1月-2010年12月ICU下呼吸道感染者1562份合格痰标本中培养的515株病原菌及耐药性.结果 515株病原菌中,革兰阴性菌325株,占63.1％,革兰阳性菌156株,占30.3％,真菌34株,占6.6％;革兰阴性菌中,鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌分别占18.6％、13.4％、7.0％、6.8％;革兰阳性菌中,金黄色葡萄球菌占l6.1％;鲍氏不动杆菌和铜绿假单胞菌的检出率呈逐年上升的趋势,耐药结果显示,大多数抗菌药物的耐药率逐年升高,多药耐药严重.结论 医院ICU的感染以革兰阴性菌为主;大部分病原菌呈现高耐药和多药耐药的特点,及时监测病原菌变化及耐药趋势以指导临床用药至关重要.     

急诊重症监护病房患者下呼吸道感染铜绿假单胞菌的研究

目的探讨急诊重症监护病房(EICU)下呼吸道感染患者铜绿假单胞菌分布特征及其耐药性。方法对2005年8月~2006年2月间,在医院EICU收治的25例下呼吸道感染患者的临床资料进行分析。结果在EICU的25例下呼吸道感染患者中,共分离出病原菌81株,革兰阳性菌32.1%,革兰阴性菌43.2%,真菌24.7%;其中铜绿假单胞菌占13.6%;铜绿假单胞菌药敏结果表明头孢噻肟、庆大霉素、复方新诺明、米诺环素、左氧氟沙星、加替沙星等抗菌药物耐药。结论铜绿假单胞菌感染与耐药是EICU中下呼吸道感染患者治疗中的重要问题,应引起重视。     

2010-2014年急诊重症监护病房病原菌变迁 及耐药性分析

摘要:目的　观察我院急诊重症监护病房（EICU）病原菌构成及耐药性变化,为临床合理使用抗菌药物提供理论依据。方法　回顾性分析2010-2014年我院EICU住院患者病原菌分布及耐药性变化。结果　2010-2014年我院ICU送检合格标本中共分离出病原菌2339株,其中革兰阳性菌626株、革兰阴性菌1522株、真菌191株。2010-2014年革兰阳性菌分别占22.18%、27.30%、25.00%、28.39%和28.06%,革兰阴性菌分别占73.59%、67.84%、68.20%、62.45%和60.52%,真菌分别占4.23%、4.86%、6.80%、9.16%和11.42%。EICU常见致病菌主要为鲍曼不动杆菌、肺炎克雷伯杆菌、铜绿假单胞菌和凝固酶阴性葡萄球菌。同时鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯杆菌对临床常用抗菌药物的耐药率总体均呈逐渐上升趋势。结论　EICU感染病原菌菌种较多,加强病原菌动态监测,合理使用抗菌药物已成为当务之急。     

下呼吸道感染患儿的病原菌分布及耐药性分析

目的分析下呼吸道感染患儿的病原菌分布及耐药性,为制订有效的临床治疗方案提供客观依据。方法选取2015年7月-2016年7月315例下呼吸道感染患儿作为研究对象,对患儿呼吸道分泌物中的病原菌分布及耐药性进行观察和分析。结果 315例下呼吸道感染患儿共分离出病原菌158株,其中革兰阴性菌、革兰阳性菌、真菌分别占70.9%、23.4%、5.7%,主要革兰阴性菌为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌,分别占21.5%、19%、13.3%,主要革兰阳性菌为肺炎链球菌、金黄色葡萄球菌、溶血葡萄球菌,分别占9.5%、8.2%和3.8%;铜绿假单胞菌对氨苄西林、四环素、头孢他啶、庆大霉素等耐药率较高,均>60.0%,大肠埃希菌对氨苄西林、头孢唑啉、头孢他啶、四环素、头孢呋辛等耐药率较高,均>80.0%,肺炎克雷伯菌对氨苄西林、呋喃妥因、头孢呋辛、头孢唑林、头孢他啶等耐药率较高,均>60.0%,3种主要革兰阴性菌对亚胺培南、阿米卡星、头孢哌酮/舒巴坦较为敏感,耐药率均<30.0%;三种主要革兰阳性菌中均未见对万古霉素、呋喃妥因耐药的菌株。结论患儿下呼吸道感染的病原菌分布和耐药性具一定特征性,临床医师应对其进行密切的监测,选择敏感性抗菌药物进行治疗。     

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.