荆州市多药耐药铜绿假单胞菌的耐药特性探讨

目的探讨医院感染多药耐药铜绿假单胞菌的耐药特性,为临床医师合理用药提供试验依据。方法严格按照《全国临床检验操作规程》进行细菌培养;采用法国生物梅里埃公司VITEK-32全自动微生物分析仪鉴定菌株;采用K-B法进行药敏试验。结果 287株多药耐药铜绿假单胞菌中检出24.4%的泛耐药株;对亚胺培南、美罗培南、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦已产生了24.4%~25.4%耐药率,对其他常用抗菌药物的耐药率均>40.0%,且耐药率呈逐年升高趋势。结论医院务必对多药耐药铜绿假单胞菌进行严密的监测,加强抗菌药物用药管理,遏制多药耐药细菌导致的医院感染暴发流行。     

泛耐药铜绿假单胞菌的目标性监测与分析

目的 了解临床泛耐药铜绿假单胞菌(PDRPA)的分离及耐药性,探索泛耐药铜绿假单胞菌感染病例的监控措施.方法 对2010年医院临床分离的病原菌进行目标性监测,统计出泛耐药铜绿假单胞菌的株数以及耐药性,并对临床泛耐药铜绿假单胞菌感染病例实施监控.结果 全年检测结果发现,共分离出铜绿假单胞菌1144株,泛耐药铜绿假单胞菌检出36株,检出率为3.15％;全院未发生泛耐药铜绿假单胞菌的暴发和流行.结论 泛耐药铜绿假单胞菌分离株数较多,应该加强临床合理使用抗菌药物的管理和对泛耐药铜绿假单胞菌感染病例实施监控,预防和减少多药耐药菌的产生,控制医院感染.     

多药耐药铜绿假单胞菌的医院感染现状及耐药性研究

目的 探讨多药耐药铜绿假单胞菌(PAE)的临床分布及耐药性特征,为预防和控制医院感染提供实验室依据.方法 PAE分离、鉴定严格按照《全国临床检验操作规程》进行;药敏试验采用K-B法,依据CLSI最新折点判读结果.结果 167株PAE在呼吸道标本中检出率居首位,占68.2％,在泌尿道标本居第2位,占12.6％;药敏结果表明,PAE对临床常用抗菌药物均产生了非常严重的耐药性,耐亚胺培南铜绿假单胞菌检出率为30.5％,PAE泛耐药菌株检出率为13.8％.结论 应重视PAE耐药性的监测工作,预防与控制多药耐药PAE医院感染的暴发流行.     

医院获得性铜绿假单胞菌感染的临床分布与耐药性分析

目的了解医院获得性铜绿假单胞菌感染的临床分布特点及耐药性,以指导临床合理使用抗菌药物提供依据。方法收集2010年1月-2012年12月住院患者标本中分离出的1 814株铜绿假单胞菌,按照《全国临床检验操作规程》进行菌株培养分离,并使用VITEK-2细菌鉴定及药敏分析系统,进行细菌鉴定和药敏试验,数据运用WHONET5.4和SPSS21.0软件进行统计分析。结果临床标本分离的病原菌中革兰阴性菌检出9 380株,其中铜绿假单胞菌检出1 814株,检出率为19.3%,检出多药耐药铜绿假单胞菌(MDRPA)312株,检出率为17.2%;铜绿假单胞菌主要分离自痰液占52.8%,其次为伤口分泌物及气管吸物,分别占18.0%、11.5%;ICU及呼吸内科检出的铜绿假单胞菌最多,分别占26.5%及21.1%;铜绿假单胞菌对哌拉西林/他唑巴坦、头孢吡肟、亚胺培南和美罗培南的耐药呈逐年下降趋势,差异有统计学意义(P<0.05)。结论医院获得性铜绿假单胞菌感染主要分布于侵入性操作多、抗菌药的应用广、住院周期长的临床科室,以呼吸道感染为主,且多药耐药菌检出率较高,严重感染可选β-内酰胺类与氨基糖苷类药物联合治疗。     

耐碳青霉烯类铜绿假单胞菌的耐药性分析

目的了解医院耐碳青霉烯类铜绿假单胞菌耐药性,指导临床合理使用抗菌药物。方法统计分析2010年1月-2011年1月30例耐碳青霉烯类铜绿假单胞感染患者感染部位、科室分布及耐药性;细菌鉴定采用VITEK-32细菌鉴定系统,药敏试验采用纸片扩散(K-B)法,采用WHO细菌耐药监测网提供的WHONET5.4软件进行统计分析。结果全年共分离出铜绿假单胞菌1 144株,其中耐碳青霉烯类铜绿假单胞菌30株,检出率为2.6%;30株耐碳青霉烯类铜绿假单胞菌以痰液检出率最高,占66.6%;科室分布以重症监护病房为主,其次是神经内科,分别占50.0%、26.7%;耐碳青霉烯类铜绿假单胞菌仅对多黏菌素B的耐药率为0,对阿米卡星耐药率为17.7%,对其他抗菌药物耐药率均>80.0%。结论耐碳青霉烯类铜绿假单胞菌临床分布比较集中,对常用抗菌药物呈高度耐药,给临床治疗带来严重挑战,提示临床加强抗菌药物的管理和对耐碳青霉烯类铜绿假单胞菌感染病例的实时监控,防止和减少此类耐药菌在医院内传播。     

197例铜绿假单胞菌临床分布和耐药分析

目的了解铜绿假单胞菌在医院不同科室的分布和构成比及其对抗生素的耐药性情况。方法分离医院感染患者各标本的细菌,采用法国梅里埃(API)公司的全自动细菌鉴定系统对细菌进行鉴定。药敏试验采用纸片扩散法。结果 197株铜绿假单胞菌主要分布在重症监护科62株,占31.50%和呼吸内科58株占29.40%,在样本中,痰液中检出铜绿假单胞菌最多141株,占71.60%,其次是咽拭子32株,占16.20%,尿液12株,占6.10%;铜绿假单胞菌中耐药率较高的是米诺环素91.88%、头孢噻肟85.79%,对妥布霉素70.56%、阿米卡星82.23%、多黏菌素B97.46%,保持较好的敏感性。结论铜绿假单胞菌对常用的抗菌药物耐药率较高,应根据临床药敏试验结果合理使用抗菌药物,预防耐药菌株的产生和扩散。     

某医院铜绿假单胞菌临床分布与耐药特征分析

探讨铜绿假单胞菌临床分布特点和耐药性特征,为临床治疗铜绿假单胞菌感染提供参考依据。收集2011年1月至2015年12月北京市昌平区医院就诊患者留取的临床样本进行细菌培养,对培养阳性的菌株采用Vitek2-Compact全自动细菌鉴定及药敏分析系统和Kirby-Bauer(K-B)纸片扩散法进行菌种鉴定和药敏试验,应用细菌耐药监测软件WHONET 5.6对数据进行统计分析。结果显示,2011-2015年,从临床样本中共分离出铜绿假单胞菌2 205株,占全部菌株的8.99%。来源于痰及咽分泌物样本中的铜绿假单胞菌最多(73.20%),其次为尿液(11.45%)。在科室分布中,分离自重症监护病房的菌株最多(38.82%),其次为呼吸科(20.32%)。铜绿假单胞菌对大多数抗菌药物的耐药率变化不大,2013-2015年亚胺培南、美罗培南和头孢哌酮/舒巴坦的耐药率较2011-2012年有所提高,对环丙沙星、庆大霉素、哌拉西林、替卡西林/克拉维酸的耐药率超过35%,对阿米卡星和头孢哌酮/舒巴坦的耐药率低于10%,未发现对多黏菌素B耐药的菌株,耐多药的铜绿假单胞菌具有逐年增加的趋势。铜绿假单胞菌感染以呼吸道为主,耐多药菌检出率逐渐增高,应加强铜绿假单胞菌流行和耐药性监测。     

重症监护病房铜绿假单胞菌耐药性分析及对策

目的分析医院重症监护病房铜绿假单胞菌的耐药情况,为降低铜绿假单胞菌耐药提供对策。方法采集2008年4月～2009年5月入住重症监护病房患者的各类标本进行细菌学培养、鉴定及药敏试验,选择抗菌药物,同时观察疗效。结果医院重症监护病房铜绿假单胞菌耐药情况严重,134株铜绿假单胞菌中多药耐药菌株占31.3%,泛耐药株占4.5%;经验用药有效率为57.5%,根据药敏试验结果选择抗菌药物,有效率为80.4%。结论铜绿假单胞菌易产生多药耐药,治疗比较困难,应以预防为主,加强耐药菌株监测,尽早进行药敏试验,合理使用抗菌药物,延缓其耐药菌株的产生,降低耐药菌株的感染率。     

医院感染铜绿假单胞菌耐药性分析

目的了解医院铜绿假单胞菌医院感染的分布及耐药性的变化趋势,指导临床合理使用抗菌药物。方法回顾性分析医院2007年1月-2009年12月临床分离出的219株铜绿假单胞菌的药敏结果进行统计分析。结果 219株铜绿假单胞菌主要分离自下呼吸道,其次是手术创面等部位;主要分布在ICU、呼吸内科、脑外科等科室,分别占34.2%、26.5%、21.5%;铜绿假单胞菌敏感率较高的抗菌药物是头孢哌酮/舒巴坦、美罗培南、亚胺培南,敏感率分别为98.2%、92.2%、91.8%;耐药率>50.0%的抗菌药物是庆大霉素、哌拉西林、妥布霉素,耐药率分别为87.2%、55.7%、52.5%。结论铜绿假单胞菌是医院感染的重要细菌,应加强对铜绿假单胞菌耐药性的监测,以减少多药耐药菌株的出现和医院感染的扩散。     

铜绿假单胞菌医院感染流行株的耐药性变迁分析

目的调查3年铜绿假单胞菌(PAE)医院感染流行株的感染部位及耐药性变迁趋势,为临床医师控制感染性疾病选择用药提供参考指南。方法采集2011年1月-2013年12月住院患者感染性标本,铜绿假单胞菌培养鉴定严格按照原卫生部制定的《临床微生物检验操作规范》进行;药敏试验采用CLSI指定的K-B法进行操作和结果读取;试验数据采用WHONET 5.5~5.6软件分析,微生物检验全过程进行室内质量控制。结果 3年共分离出589株铜绿假单胞菌,感染部位主要为呼吸道占54.7%、尿路占18.9%、皮肤黏膜创面占10.0%;铜绿假单胞菌对多数抗菌药物的耐药率呈逐年上升趋势,耐亚胺培南铜绿假单胞菌的阳性检出率分别是21.2%、22.4%、25.6%,泛耐药铜绿假单胞菌阳性检出率分别为7.9%、10.2%、12.8%。结论 3年铜绿假单胞菌医院感染流行株对临床抗菌药物的耐药性呈现逐年上升趋势,医院感染管理部门应加强监督职能和监控力度,力图改变细菌耐药率快速上升的不良倾向。     

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.     

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.