泛耐药肺炎克雷伯菌的耐药基因研究

目的 了解1株对临床常用18种抗菌药物(包括亚胺培南、美罗培南)均耐药的肺炎克雷伯菌(KPN)所携带的耐药基因状况.方法 对该株KPN进行了9类耐药基因的PCR法检测,包括β-内酰胺酶基因blaTEM、blaSHV、blaLEN、blaOKP、blaCTX-M-1、2、9群、blaOXA-1、2、10群、blaCARB、blaPER、blaVEB、blaGES、金属β-内酰胺酶基因blaIMP、blaVIM、blaKPC,AmpC酶基因blaDHA、blaACT/MIR、blaCMY/MOX、blaCMY/LAT,氨基糖苷修饰酶基因aac(3)-Ⅰ、aac(3)-Ⅱ、aac(6')-Ⅰ b、aac(6')-Ⅱ、ant(2")-Ⅰ、ant(3")-Ⅰ,喹诺酮类耐药基因qnrA、TMP耐药基因dfrA1、dfrA17,消毒剂磺胺耐药基因qacE△1-sul1,整合子遗传标记基因intⅠ1、intⅠ2、intⅠ3,转座子遗传标记基因tnpA、merA,共计36种.结果 KPN共检出7种耐药基因,分别为β-内酰胺酶基因blaTEM,blaSHV,金属β-内酰胺酶基因blaKPC-2,氨基糖苷修饰酶基因aac(3)-Ⅱ,ant(3")-Ⅰ,消毒剂磺胺耐药基因qacE△1-sull,整合子遗传标记基因intⅠ1.结论 在该株泛耐药KPN中发现了少见的blaKPC-2金属β-内酰胺酶基因,该菌对18种抗菌药物的耐药可能与其同时携带有多种耐药基因有关,临床应对此类菌株引起重视.     

全耐药菌10种耐药基因的研究

目的 研究全耐药菌氨基糖苷类修饰酶基因(AMEs)、消毒剂/磺胺耐药基因(qacE△1-sul1)、整合子(int)1、2、3等10种耐药基因的分布.方法 应用法国生物梅里埃公司的API鉴定条/PSE5.0药敏条和美国BD公司的Phoenix NMIC/ID-109鉴定/药敏板鉴定和细菌药敏试验,应用PCR法检测9株全耐药菌临床分离株6种A-MEs、qacE△1-sul、整合子(int)1、2、3等10种耐药基因,并分析其分布.结果 9株全耐药菌共检出8种耐药基因,其分布为aac(6')-Ⅱ、aac(3)-Ⅰ均1株,aac(3)-Ⅱ2株,ant(3")-Ⅰ、ant(2")-Ⅰ均3株,主要阳性耐药基因为aac(6')-Ⅰ b-Cr 4株,qacE△1-sul1、int Ⅰ 15株;int Ⅰ 2、int Ⅰ 3均为阴性;各有1株菌分别为2、3、5、6种基因阳性,2株菌为4种基因阳性;3株菌均为阴性.结论 全耐药菌菌种分布广;耐药机制多为多重机制,主要与A-MEs和Ⅰ类整合子有关,各种耐药基因的分布无特异性,部分菌需进一步研究.     

泛耐药鲍氏不动杆菌39种耐药相关基因的研究

目的 研究痰泛耐药鲍氏不动杆菌(PRBAB) 39种耐药相关基因.方法 应用法国生物梅里埃公司的API鉴定条/PSE5.0药敏条和美国BD公司的Phoenix NMIC/ID-109鉴定/药敏板进行细菌鉴定和药敏试验,应用PCR法检测1株分离于合格痰标本PRBAB临床分离株29种β-内酰胺酶相关基因(bla)、6种氨基糖苷类修饰酶基因(AMEs)、消毒剂/磺胺耐药基因(qacE△1-sul1)、3种整合子基因(intⅠ 1、2、3)等39种耐药相关基因,分析其分布情况.结果 该菌7种耐药相关基因阳性:bla基因(bla TEM、blaADC),AMEs基因[aac(6')-Ⅰb、aac(3)-Ⅰ、ant(3")-Ⅰ、qacE△1-sul1和Ⅰ类整合子基因(intⅠ1)];其他32种基因AMEs基因[aac(6')-Ⅱ、aac(3)-Ⅱ)、ant(2")-Ⅰ)等]均阴性.结论 泛耐药ABA耐药机制为多重机制,主要与7种耐药相关基因(bla TEM、blaADC、aac(6')-Ⅰb、aac(3)-Ⅰ、ant(3")-Ⅰ、qacE△1-sul1和Ⅰ类整合子)有关.     

22株多药耐药铜绿假单胞菌菌株亲缘性分析及耐药机制研究

目的 研究22株多药耐药铜绿假单胞菌(PAE)菌株的亲缘性.方法 采用聚合酶链反应(PCR)法检测22株多药耐药铜绿假单胞菌的β-内酰胺类耐药基因、氨基糖苷类修饰酶(AMEs)基因、喹诺酮类耐药基因、耐消毒剂基因(qacE△1-sul1)和整合酶基因,并以耐药基因为分子标志作聚类分析.结果 22株菌中aac(6')-Ⅰ b、blaCARB、gyrA、oprD2、ant(2')-Ⅰ和qacE△1-sul1基因的阳性率为100%,aac(3)-Ⅰ、aac(6')-Ⅱ、blaGES、blaGIM、blaOXA-10群、blaPER、blaSPM、blaSHV和blaDHA基因均阴性,blalMP-Ⅰ、blaTEM、blaVEB、aac(3)-Ⅱ、ant(3')-Ⅰ、int Ⅰ 1和blaVIM基因的阳性率分别为95.5%、77.3%、13.6%、4.5%、4.5%、4.5%和4.5%;经样本聚类分析显示存在严重的克隆传播.结论 22株铜绿假单胞菌β-内酰胺类、氨基糖苷类抗菌药物耐药与产β-内酰胺酶和氨基糖苷类修饰酶密切相关.医院感染铜绿假单胞菌可导致克隆传播医院感染,并引起暴发性流行.     

慢性重型肝炎患者痰泛耐药木糖氧化产碱菌木糖氧化亚种39种耐药基因的研究

目的 研究慢性重型肝炎患者痰泛耐药木糖氧化产碱菌木糖氧化亚种(AXXxx)39种耐药基因.方法 应用API鉴定条/PSE5.0药敏条和NMIC/ID-109鉴定/药敏板鉴定和细菌药敏试验,用PCR法检测分离于慢性重型肝炎患者合格痰标本1株泛耐药AXXxx临床分离株16S rRNA、29种β-内酰胺酶基因(bla)、6种氨基糖苷类修饰酶基因(AMEs)、1种消毒剂/磺胺耐药基因(qacE△1-sul1)、3种整合子基因(int Ⅰ1、2、3)等39种耐药基因,经测序和同源性分析证实并分析其分布情况.结果 该菌经16S rRNA测序和同源性分析,证实为AXXxx;经测序和同源性分析证实7种耐药基因阳性[两种bla基因(blaTEM-116、blaCARB-8)、3种AMEs基因aac(6′)-Ⅱ、aae(3)-Ⅱ、ant(3″)-Ⅰ、qacE△1-sul1和Ⅰ类整合子基因(int Ⅰ1)];其他27种bla基因、3种AMEs基因(aac (6′)-Ⅰ b、aac(3)-Ⅰ、ant(2″)-Ⅰ]和2种整合子基因(intⅠ 2、intⅠ 3)均为阴性.结论 该株泛耐菌耐药机制为多重机制,主要与7种耐药相关基因[blaTEM-116、blaCARB-8、aac(6′)-Ⅱ、aac(3)-Ⅱ、ant(3″)-Ⅰ、qacE△1-sul1和Ⅰ类整合子]有关.     

鲍氏不动杆菌流行株耐药基因及菌株亲缘性分析

目的 了解鲍氏不动杆菌(ABA)流行株耐药基因携带状况和菌株的亲缘性,为医院流行病学溯源提供依据.方法对39株ABA采用PCR检测19种耐药基因(TEM、SHV、PER、VEB、GES、CARB、CTX-M-1群、OXA-23群、OXA-24群、IMP、VIM、DHA、aac(3)-Ⅰ、aac(3)-Ⅱ、aac(6')-Ⅰ、aac(6')-Ⅱ、ant(3")-Ⅰ、ant(2")-Ⅰ、qacE△1-sull).结果 TEM阳性13株(33.3%)、OXA-23群阳性20株(51.3%)、aac(3)-Ⅰ阳性25株(64.1%)、aac(6')-Ⅰ阳性25株(64.1%)、ant(3")-Ⅰ阳性29株(74.4%)、qacE△1-sull阳性32株(82.1%),其余基因均阴性;聚类分析提示存在克隆传播现象.结论 ABA流行株β-内酰胺酶、氨基糖苷类修饰酶和消毒剂-磺胺耐药基因携带率高,存在克隆传播医院感染流行的危险.     

重型肝炎患者痰Burkholderia cenocepacia 39种耐药基因的研究

目的 研究重型肝炎患者痰中新洋葱伯克霍尔德菌(Burkholderia cenocepacia,BCE)39种耐药基因.方法 应用API鉴定条/PSE5.0药敏条和Phoenix NMIC/ID-109鉴定/药敏板鉴定和细菌药敏试验,应用PCR法检测分离于重型肝炎患者合格痰标本1株多药耐药BCE临床分离株16S rRNA、29种β-内酰胺酶相关基因(bla)、6种氨基糖苷类修饰酶基因(AMEs)、消毒剂/磺胺耐药基因(qacE△1-sull)、3种整合子基因(int Ⅰ1、2、3)等39种耐药基因,经测序和同源性分析证实并分析其分布情况.结果 该菌经16S rRNA测序和同源性分析证实为BCE;药敏试验,对头孢他啶、头孢吡肟、环丙沙星、左氧氟沙星和复方新诺明均敏感,对亚胺培南、美罗培南等均耐药;经测序和同源性分析证实6种耐药基因阳性[1种bla基因(blaTEM-116)、4种AMEs基因[aae(6′)-Ⅰb、aae(3)-Ⅰ、ant(2″)-Ⅰ、ant(3″)-Ⅰ)、和Ⅰ类整合子基因(intⅠ1)],blaTEM-116、aac(6′)-Ⅰ b、aae(3)-Ⅰ、ant(2″)-Ⅰ、ant(3′)-Ⅰ 5种耐药基因GenBank注册号分别为FJ887956、FJ609982、FJ609983、FJ887958、FJ644662;其他28种bla基因、2种AMEs基因(aac(6′)-Ⅱ、aae(3)-Ⅱ)、qacEA1-sull和2种整合子基因(intⅠ 2、intⅠ 3)均为阴性.结论 该株为多药耐药,其耐药机制为多重机制,主要与6种耐药基因[blaTEM-116、aac(6′)-Ⅰ b、aac(3)-Ⅰ、ant(2″)-Ⅰ、ant(3″)-Ⅰ和intⅠ 1]有关.     

多药耐药铜绿假单胞菌对β-内酰胺类、氨基糖苷类、消毒剂耐药相关基因研究

目的了解多药耐药铜绿假单胞菌(PAE)中β-内酰胺酶、oprD2基因、氨基糖苷类修饰酶及qacE△1基因存在状况。方法铜绿假单胞菌使用VITEK仪器鉴定,琼脂稀释法行MIC药敏试验,采用聚合酶链反应(PCR)技术检测TEMI、MP、VIM、oprD2、aac(3)-Ⅱ、aac(6′)-Ⅰa、ac(6′)-Ⅱ、ant(3″)-Ⅰ、ant(2″)-Ⅰ、qacE△1。结果TEM基因检出率分别为51.4%,IMP、VIM基因未检出,oprD2基因缺失率为60.0%;aac(3)-Ⅱ、aac(6′)-Ⅰ、aac(6′)-Ⅱ、ant(3″)-Ⅰ和ant(2″)-Ⅰ等5种氨基糖苷类修饰酶基因检出率分别为48.6%、40.0%、54.3%、45.7%、60.0%;qacE△1基因为94.3%。结论在35株多药耐药铜绿假单胞菌中,β-内酰胺酶、氨基糖苷类修饰酶基因检出率较高,耐消毒剂基因检出率很高,应该引起高度重视。     

产ESBLs大肠埃希菌获得性耐药元件指标聚类分析

目的探讨分析产ESBLs大肠埃希菌其水平获得性耐药基因和可移动遗传元件(MGEs)的携带状况,并分析各种水平获得性耐药基因与各种MGEs的相关性,为临床提供参考依据。方法收集医院2013年分离到的20株产ESBLs大肠埃希菌,检测了25种β-内酰胺类药物耐药相关的酶基因、12种氨基糖苷类药物耐药相关的酶基因、1种消毒剂与磺胺耐药重叠基因以及9种可移动遗传元件(MGEs)遗传标记,并用指标聚类分析法探讨水平获得性耐药基因和MGEs遗传标记的相关性。结果 20株产ESBLs大肠埃希菌共检出6种β-内酰胺酶基因、4种氨基糖苷类修饰酶基因、1种消毒剂与磺胺耐药重叠基因以及7种可移动遗传元件遗传标记;指标聚类分析(UPGMA法)提示β-内酰胺酶基因blaTEM、blaCTX-M-9 cluster,氨基糖苷类修饰酶基因aac(3)-Ⅱ、aac(6′)-Ⅰb、aadA5,消毒剂与磺胺耐药重叠基因qacE△1-sul1与可移动遗传元件intⅠ1、ISEcp1、IS26、IS903、traA、trbC可能存在关联,其中消毒剂与磺胺耐药重叠基因qacE△1-sul1与Ⅰ类整合子的整合酶基因intⅠ1存在高度关联。结论产ESBLs大肠埃希菌携带获得性耐药基因可导致对相关抗菌药物耐药,且可移动遗传元件的水平转移使细菌耐药性在同种细菌之间甚至不同种细菌菌株之间得以快速传播;指标聚类分析提示β-内酰胺酶基因blaTEM、blaCTX-M-9 cluster,氨基糖苷类修饰酶基因aac(3)-Ⅱ、aac(6′)-Ⅰb、aadA5,消毒剂与磺胺耐药重叠基因qacE△1-sul1为可移动遗传元件介导。     

从全耐嗜麦芽寡养单胞菌检出一种氨基糖苷类修饰酶aac(6′)-Ⅰb基因的新变型基因

目的 研究全耐嗜麦芽寡养单胞菌(SMA)耐药机制.方法 应用法国生物梅里埃公司的API鉴定条/PSE5.0药敏条和美国BD公司的Phoenix NMIC/ID-109鉴定/药敏板鉴定和细菌药敏试验,应用PCR法检测1株全耐SMA临床分离株6种氨基糖苷类修饰酶(AMEs)基因,并对阳性产物测序和同源性分析.结果 在该株菌,两种方法药敏结果均为全耐药;2种AMEs基因(aac(6')-Ⅰb、ant(2")-Ⅰ)PCR阳性,测序和同源性分析证实为2种AMEs基因;aac(6')-Ⅰb为新变型,GenBank注册号为EF 210035;ant(2")-Ⅰ GenBank注册号为EU255235.结论 该株全耐菌氨基糖苷类抗菌药物耐药机制主要与2种AMEs[aac(6')-Ⅰb、ant(2")-Ⅰ]有关;从全耐SMA检出一种AMEs基因aac(6')-Ⅰb的新变型基因,经检索中文生物医学期刊文献数据库(CMCC)和medline数据库,本研究是第1篇从SMA检出AMEs基因aac(6')-Ⅰb、ant(2")-Ⅰ及aac(6')-Ⅰb新变型耐药基因的报道.     

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.