重症监护病房鲍氏不动杆菌感染暴发的监控

目的 了解某重症监护病房(ICU)一周内发生的医院感染,与病房环境中的多药耐药鲍氏不动杆菌的耐药谱特征和同源性.方法 用K-B法检测17株鲍氏不动杆菌的耐药情况;用随机引物扩增多态DNA(RAPD)检测并进行同源性分析.结果 病房内环境分离出12株鲍氏不动杆菌,其中人携带分离出3株;ICU内物体表面分离出9株,其中11株为多药耐药菌,且耐药表型与患者的5株感染菌完全一致;RAPD分析患者感染菌3株、环境分离菌8株为同一基因型.结论 该病房存在着某一基因型鲍氏不动杆菌感染暴发流行.     

ICU耐碳青霉烯类鲍氏不动杆菌的分子流行病学及耐药基因研究

目的 了解医院ICU耐碳青酶烯类鲍氏不动杆菌的分子流行病学特征和耐药机制,为临床用药提供参考并有效控制医院感染的发生.方法 收集2012年1-6月梅州市人民医院ICU住院患者临床分离的耐碳青霉烯类鲍氏不动杆菌16株,采用K-B法检测其对14种抗菌药物的敏感性,采用随机扩增多态性DNA法检测基因型,进行分子流行病学分析;通过改良Hodge试验和EDTA协同试验对碳青酶烯酶进行表型分析,应用PCR法进一步确定碳青酶烯酶的基因型.结果 除大部分菌株对米诺环素敏感以及部分菌株对头孢哌酮/舒巴坦敏感外,菌株对所有药物均呈高水平耐药;16株耐碳青霉烯类鲍氏不动杆菌可分成9种基因型,以H型最为常见;苯唑西林酶OXA-23基因检出率为68.8％,金属酶检出率仅为6.3％.结论 产OXA-23型碳青霉烯酶是ICU鲍氏不动杆菌对碳青霉烯类耐药的主要耐药机制,菌株间存在克隆传播.     

ICU泛耐药鲍氏不动杆菌肺部感染暴发原因及控制

目的 分析ICU鲍氏不动杆菌感染暴发的原因与经过,为预防与控制感染提供依据.方法 对ICU2011年1月29日-2月15日陆续发生4例鲍氏不动杆菌肺部感染开展流行病学调查,查找感染源与传播途径,并采取干预措施控制感染.结果 从34份环境卫生学标本中分离出6株鲍氏不动杆菌,检出率为17.65％;对4例患者分离的4株泛耐药鲍氏不动杆菌进行随机扩增多态性DNA(RAPD)基因分型,结果显示,4株具有高度的同源性;采取综合性干预措施,泛耐药鲍氏不动杆菌感染患者集中隔离、加强医务人员手卫生、加强环境物体表面与医疗设备的清洁消毒等,有效控制了感染.结论 医院间传播、医护人员手卫生较差、环境与医疗设备物体表面污染严重是造成鲍氏不动杆菌感染暴发的原因.     

耐碳青霉烯类鲍氏不动杆菌的耐药机制及同源性分析

目的 调查医院ICU流行的耐碳青霉烯类鲍氏不动杆菌的耐药机制及其同源性,为临床有效防治提供依据.方法 收集北京市海淀医院2011年11月ICU住院患者痰标本分离出的耐碳青霉烯类鲍氏不动杆菌4株,按《全国检验技术操作规程》操作,用全自动微生物分析仪进行细菌鉴定及药敏试验,PCR扩增检测碳青霉烯酶基因,用脉冲场凝胶电泳(PFGE)进行分型,分析其同源性.结果 4株鲍氏不动杆菌中除对头孢哌酮/舒巴坦(2株敏感、2株中度敏感)、磺胺甲噁唑/甲氧苄啶(2株敏感、2株耐药)、阿米卡星(1株敏感、3株耐药)稍敏感外,对其他各种抗菌药物均耐药;4株菌株均携带blaOXA-23-like和blaOXA-51-like基因;PFGE电泳结果显示,4株鲍氏不动杆菌分为A(A1、A2、A3)和B型,其中A型为主要的流行株.结论 鲍氏不动杆菌为多药耐药菌株;产碳青霉烯酶OXA-23是该菌对碳青霉烯类抗菌药物耐药的主要机制;同一克隆株在同一病房内传播致交叉感染.     

鲍曼不动杆菌随机扩增多态性DNA的分子流行病学研究

目的:采用随机扩增多态性DNA(RAPD)基因分型方法监测鲍曼不动杆菌医院感染。方法:对临床分离的48株医院感染鲍曼不动杆菌进行RAPD基因分型,绘制亲缘关系树状图,分析菌株间的同源性,确证是否存在医院感染的院内流行。结果:48株鲍曼不动杆菌共分得10个型别,鲍曼不动杆菌存在医院感染的院内流行。结论:RAPD技术可对鲍曼不动杆菌进行分子流行病学研究。     

多药耐药鲍氏不动杆菌的同源性鉴定与控制

目的 通过对住院患者检出的多药耐药鲍氏不动杆菌进行同源性鉴定,确定医院内流行株,并采取措施有效控制其医院内流行.方法 收集医院1周内住院患者检出的多药耐药鲍氏不动杆菌,采用rep-PCR法对其同源性进行鉴定,根据鉴定结果,确定医院内流行株,强化控制措施后,再对住院患者检出的多药耐药鲍氏不动杆菌进行同源性鉴定,观察医院内流行株在医院的分布情况,评估控制效果.结果 1周内检出10株多药耐药鲍氏不动杆菌,其中9株为同源菌株,为院内流行株;强化控制措施后,1个月内共检出12株多药耐药鲍氏不动杆菌,其中与原流行株同源菌株2株,其他均为非同源菌株.结论 医院存在多药耐药鲍氏不动杆菌的流行,强化控制措施后,有效遏制了流行株的蔓延.     

多药耐药鲍氏不动杆菌基因同源性分析及流行病学调查

目的 了解重症监护病房(ICU)流行的多药耐药鲍氏不动杆菌(MDR-AB)耐药谱特征及其同源性,为临床防治提供依据.方法 MDR-AB分离自2007年5月,4株系住ICU肺部感染患者的痰标本,4株系病房物体表面;按<全国检验技术操作规程>要求操作,用全自动微生物分析仪进行细菌鉴定及药敏试验;用脉冲场凝胶电泳(PFGE)对8株鲍氏不动杆菌进行基因分型,明确其是否为同一菌株的克隆.结果 4株痰标本的鲍氏不动杆菌对包括碳青酶烯类在内的多种抗菌药物耐药,经DNA分型同为A型,另4株物体表面的鲍氏不动杆菌经DNA分型亦同为A型,8株有高度同源性,证实为同一克隆株.结论 鲍氏不动杆菌为多药耐药株,同一克隆株在不同感染个体间的相互传播导致了ICU内感染的流行;1号株可能是交叉感染的源头,医护人员标准预防未到位,尤其是手卫生问题是可能的传播途径.     

重症监护病房耐碳青霉烯鲍氏不动杆菌耐药性及基因同源性分析

目的研究绍兴市中心医院ICU住院患者临床分离的耐碳青霉烯类鲍氏不动杆菌的耐药性和基因分型。方法收集2016年绍兴市中心医院ICU住院患者临床分离的耐碳青霉烯类鲍氏不动杆菌60株。微量稀释法进行常规药敏试验。采用多重PCR技术检测菌株携带的耐药基因,PFGE分型技术对鲍氏不动杆菌进行基因同源性分析。结果抗菌药物敏感性试验显示所有菌株具有多药耐药性,对哌拉西林、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟耐药率>90%,对阿米卡星的敏感率较高为62.4%,其次为头孢哌酮/舒巴坦和左氧氟沙星;PCR检出60株鲍氏不动杆菌均为OXA-23型和OXA-51型。PFGE分型均为同一型别。结论绍兴市中心医院ICU分离的耐碳青霉烯鲍氏不动杆菌的耐药基因为OXA-23型和OXA-51型,为同一来源,考虑为医院感染所致,因此应采取有效措施来控制该耐药株的传播。     

多药耐药鲍氏不动杆菌外排泵耐药基因及同源性分析

目的分析临床多药耐药鲍氏不动杆菌外排泵耐药基因adeA、adeB、adeC及其调控基因adeR、adeS分布与抗菌药物耐药的关系,为ICU感染鲍氏不动杆菌的同源性有效应对医院感染。方法 2012年ICU检出鲍氏不动杆菌102株,采用K-B法进行药敏试验,PCR测定所有菌株的药物外排泵基因,并利用脉冲场凝胶电泳进行同源性分析。结果 94株耐药鲍氏不动杆菌对头孢唑林和呋喃妥因耐药率均为100.0%,对亚胺培南和氨苄西林/舒巴坦的耐药率为75.8%和95.0%,对其他抗菌药物耐药率均>85.0%;102株鲍氏不动杆菌中adeA、adeB、adeC、adeR、adeS基因型的阳性株分别为78、79、76、77、74株;5种基因均以阴性为主;敏感株中调控基因adeR、adeS表达率较低分别为37.5%和25.0%。结论 ICU分离的鲍氏不动杆菌中呈现严重的多药耐药,adeABC外排泵耐药基因相对于敏感株在耐药菌株中大量存在,外排泵基因的高表达与鲍氏不动杆菌的多药耐药存在相关性关系,而且其基因的播散主要通过克隆播散得以传播。     

重症监护病房下呼吸道医院感染鲍氏不动杆菌的耐药性分析

目的 调查重症监护病房(ICU)下呼吸道医院感染鲍氏不动杆菌的耐药情况,指导临床医师合理用药.方法 采用K-B法对109株ICU患者下呼吸道标本分离的鲍氏不动杆菌进行抗菌药物敏感性测定,依据美国临床实验室标准化研究所(CLSI)2007年标准判断结果,同时用标准菌株进行质量控制.结果 对鲍氏不动杆菌敏感率最高的是头孢哌酮/舒巴坦(77.1%),其次为亚胺培南(57.8%)和美罗培南(54.9%),其他抗菌药物敏感率<50.0%,耐药菌株存在较严重的交叉耐药现象,且ICU已检测出泛耐药菌株.结论 ICU下呼吸道医院感染的鲍氏不动杆菌耐药现象非常严重,应继续加强对该菌的监测与控制,严防耐药菌株在ICU暴发流行.     

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.