Microsporidial infections in immunocompromised hospitalized patients

Microsporidia Encephalitozoon cuniculi, obligate intracellular sporeforming protozoan parasite infecting a wide range of vertebrate and invertebrate host, has been described as opportunistic pathogen in severely immunocompromised human host. An antibody immune response to the presence of antibodies against Encephalitozoon cuniculi was investigated serologically using indirect immunofluorescence antibody test (IFAT). Of the total number of 113 sera from immunologically compromised patients examined, 5 were positive at the titre 1:32, 5 at the titre 1:64, and 6 at the titre 1:256. From total number of positive respondent patients were 12 children and 4 adults.     

Homicide in New Zealand: an increasing public health problem

Abstract: Injury purposely inflicted by other persons is a significant public health problem as well as a criminal problem. It accounts for approximately 3 per cent of all deaths from injury in New Zealand. National injury mortality data for the period 1978 to 1987, supplemented by reference to files of the Coroner's Court and the High Court, were used to identify the characteristics of victims of homicide, the nature of the injuries they sustained, and the circumstances in which the injuries were inflicted. The mortality rate from homicide for the 10-year period was 1.6 per 100 000 persons per year. A significant increase in the rate of homicide was identified. The rates for males were higher (2.0) than those for females (1.2), with those 20 to 24 years of age most at risk. Maori had higher rates than non-Maori. Homicides were most frequently committed with cutting and piercing instruments, and most commonly occurred in private homes. Homicides were most likely to occur on Fridays or Saturdays, between the hours of 6 p.m. and 6 a.m. In 55 per cent of homicides the victim and assailant were known to one another. Unemployment, membership of ethnic minority groups, availability of weapons, the private nature of interactions in the home, alcohol consumption, and stress in personal relationships were all identified as factors associated with homicide in the decade under study. The implications of these findings for the prevention of injury from assault are discussed.     

住院患者医院感染现患率调查

目的掌握医院住院患者医院感染和社区感染的实际情况,为提高医院感染管理和社区感染防治工作提供科学依据。方法调查2012年5月8日603例住院患者临床资料,包括出院、转科、死亡的患者,不包括新入院患者;调查人员由医院感染控制专职人员和各病区主治及以上医师组成,调查前统一培训,采取查阅病历和床旁调查相结合的方法,按要求填写个案和床旁调查表,按照标准区分医院感染和社区感染,医院感染网录入数据后进行数据统计。结果医院感染现患率为1.3%,社区感染现患率为61.9%;医院感染和社区感染的感染部位均以下呼吸道为主,分别占37.5%和64.5%;检出病原体医院感染以革兰阴性菌为主,社区感染以病毒感染为主;全院抗菌药物使用率为66.0%,下降幅度较为明显。结论该次调查资料准确,基本反映了医院医院感染和社区感染的实际情况,也暴露出一些问题,医院应加强医院感染预防控制措施及目标性检测,继续规范各类抗菌药物的使用。     

Tuberculosis: an increasing problem among minorities in the United States

Although the number of tuberculosis cases reported annually in the United States has decreased markedly during the past three and a half decades, the decrease among whites has been considerably greater than among nonwhites. As a result of this widening gap, nearly two-thirds of the cases reported in 1987 occurred in minority populations and, for the first time in history, the number of cases among blacks exceeded the number of cases among non-Hispanic whites. From 1985 to 1987, tuberculosis among blacks increased 6.3 percent and among Hispanics, by 12.7 percent, but it decreased 4.8 percent among non-Hispanic whites. Much of the increase appears attributable to tuberculosis occurring among persons infected with the human immunodeficiency virus (HIV). Although there are many obstacles to the elimination of the disease in minority populations, numerous strategies have been developed and are being implemented to address this situation.     

眼科住院患者血液传染性标志物检测结果分析

目的 了解眼科住院患者血液传染病的感染状况及在医院感染控制中的意义.方法 应用ELISA法对眼科住院患者进行乙型肝炎五项标志物(HBsAg、HBsAb、HBeAg、HBeAb、HBcAb)、丙型肝炎病毒抗体(Anti-HCV)、人类免疫缺陷病毒抗体(Anti-HIV)和苍白密螺旋体抗体(Anti-TP)4项血液传染性标志物检测,并同时检测丙氨酸氨基转移酶.结果 16551份住院患者中,乙型肝炎病毒感染及携带者为426例阳性率为2.58％,HBsAg+ HBeAb+ HBcAb阳性294例阳性率为1.78％,HBsAg+ HBeAg+ HBcAb阳性60例阳性率为0.36％,HBsAg+HBcAb阳性71例阳性率为0.42％,并同时有43例丙氨酸氨基转移酶升高;Anti-HCV阳性60例阳性率为0.36％;Anti-HIV初筛阳性3例阳性率为0.02％,送天津市疾病控制中心确诊3例;Anti-TP阳性11例阳性率为0.07％.结论 对住院患者进行血液传染性标志物检测分析,可有效地预防和避免医源性感染及交叉感染,对医院和患者均具有重要意义.     

408例住院患者医院感染现患率调查

目的 了解和掌握医院感染现状及抗菌药物使用,更好地预防与控制医院感染.方法 采用横断面调查方法,床旁调查和病历调查相结合,将调查日处于医院感染状态的病例进行统计分析.结果 应调查住院患者408例,实际调查405例,实查率为99.26％,医院感染22例,医院感染现患率为5.43％;神经内科感染率最高为16.00％,其次为肾病科感染率12.5％;医院感染部位居前3位的依次为下呼吸道、泌尿道、上呼吸道感染,分别占36.36％、27.27％、18.18％;共检出病原菌18株,分别为肺炎克雷伯菌9株,铜绿假单胞菌及大肠埃希菌各3株,白色假丝酵母菌2株,粪肠球菌1株;抗菌药物使用率为60.74％,其中治疗用药78.86％,预防用药17.89％,治疗十预防为3.25％;一联使用占74.79％,二联使用占23.98％,三联使用占1.22％.结论 加强重点科室医院感染管理,降低呼吸道感染,提高病原学送检率,规范化使用抗菌药物,降低医院感染现患率.     

1102例住院患者医院感染现患率调查与分析

目的 了解医院感染发生情况与影响因素,以改进预防控制措施,降低医院感染的发生.方法 以医院感染专职人员为主临床医院感染管理小组兼职人员协同,调查2011年10月22日0:00-24:00所有住院患者,床旁调查和查阅病历相结合,填写统一的床旁调查表和个案病史调查表,对调查结果进行统计分析.结果 应调查住院患者1121例,实际调查1102例,实查率为98.3％,感染19例,医院感染现患率为1.72％;感染部位以呼吸道居首8例,其次为表浅切口5例,泌尿道感染4例;抗菌药物使用率为20.5％,其中一联用药204例占90.3％,二联用药22例占9.7％,无≥三联联合用药;治疗性用药129例占57.1％,预防用药82例占36.3％,治疗加预防用药15例占6.6％;病原学检查103例,送检率为71.5％.结论 现患率调查可在短期内全面了解医院感染现状,根据结果提示有针对性地开展目标性监测,加强临床标本送检,规范抗菌药物合理使用,从而有效降低医院感染率.     

2050例住院患者医院感染现患率调查分析

目的 调查与分析医院感染的现患率,为临床更有效地预防医院感染提供依据.方法 采取床旁调查和查阅住院病历相结合的方法,对2010年3月24日的住院患者进行医院感染现患率调查.结果 应查2050例,实查2050例,实查率100.0％;发生医院感染75例,感染现患率为3.7％,高于平时连续性调查结果;医院感染部位以呼吸道感染居首位占62.7％;抗菌药物使用率为61.1％,其中一联用药率为70.9％;治疗用药病原菌送检率为54.4％;铜绿假单胞菌等革兰阴性菌为医院感染的主要病原菌,真菌感染也占有相当比例.结论 通过医院感染现患率调查,及时发现医院感染管理中存在的问题,有利于控制和预防医院感染.     

Inherited haemoglobin disorders: an increasing global health problem.

Despite major advances in our understanding of the molecular pathology, pathophysiology, and control and management of the inherited disorders of haemoglobin, thousands of infants and children with these diseases are dying through lack of appropriate medical care. This problem will undoubtedly increase over the next 20 years because, as the result of a reduction in childhood mortality due to infection and malnutrition, more babies with haemoglobin disorders will survive to present for treatment. Although WHO and various voluntary agencies have tried to disseminate information about these diseases, they are rarely mentioned as being sufficiently important to be included in setting health care priorities for the future. It takes considerable time to establish expertise in developing programmes for the control and management of these conditions, and the lessons learned in developed countries will need to be transmitted to those countries in which they occur at a high frequency.     

Enterococcal infections: host response, therapeutic, and prophylactic possibilities

The emergence of resistance against multiple antibiotics and the increasing frequency with which Enterococcus faecalis and Enterococcus faecium are isolated from hospitalized patients underscore the necessity for a better understanding of the virulence mechanisms of this pathogen and the development of alternatives to current antibiotic treatments. The genetic plasticity of enterococci and their ability to rapidly acquire and/or develop resistance against many clinically important antibiotics and to transfer these resistance determinants to other more pathogenic microorganisms makes the search for alternative treatment and preventive options even more important. A capsular polysaccharide antigen has recently been characterized that is the target of opsonic antibodies. A limited number of clinically relevant serotypes exist, and the development of an enterococcal vaccine based on capsular polysaccharides may improve our ability to prevent and treat these infections. Additional enterococcal surface antigens, including ABC transporter proteins and other virulence factors, such as aggregation substance (AS), may also be useful targets for therapeutic antibodies.     

发热伴血小板减少综合征的流行病学研究进展

目的调查苏州市丘陵山地风景区蜱的地理分布及其病原体携带感染率,旨在评估和预警该地区蜱传疾病的传播风险。方法利用人工布旗法和动物体表采集法采集游离蜱和寄生蜱,采用PCR方法检测蜱体内巴贝虫、斑点热群立克次体、伯氏疏螺旋体、蜱传脑炎病毒和发热伴血小板减少综合征布尼亚病毒(SFTSV)核酸。结果共捕蜱148只,隶属于1科3属4种,分别为长角血蜱(占47.3%)、中华血蜱(占49.3%)、血红扇头蜱(占2.0%)及微小牛蜱(占1.4%)。蜱标本中巴贝虫、伯氏疏螺旋体、蜱传脑炎和发热伴血小板减少综合征布尼亚病毒核酸检测均为阴性;斑点热群立克次体核酸检测阳性,最小感染率为2.8%。结论该地区蜱分布广泛,种类以长角血蜱和中华血蜱为主;部分蜱携带有斑点热群立克次体,应加强斑点热群立克次体的监控和研究。     

2008-2010年住院患者医院感染调查分析

目的 了解医院感染流行状况和病原菌的分布特点,为预防和控制医院感染提供科学依据.方法 采取前瞻性与回顾性调查相结合的方法,对医院2008-2010年住院患者发生医院感染的临床资料进行分析.结果 2008至2010年医院感染率为2.06％,医院感染发生率最高的科室为重症监护病房,最常见的感染部位为呼吸道感染,占80.14％;医院感染病原菌以革兰阴性杆菌为主,占71.88％.结论 针对流行规律采取相应预防措施,加强医院感染管理,降低医院感染率.     

Humans and animals: increasing contacts, increasing infections

Changes in the zoonotic infections that affect Americans stem primarily from shifting patterns of animal-human interaction, the crossover of species-specific organisms, and the importation or identification of new organisms. Although Lyme disease is not, strictly speaking, zoonotic, it leads off this review by virtue of its epidemic or near-epidemic prevalence in many areas.     

Injury from assault in New Zealand: an increasing public health problem

Abstract: Injury purposely inflicted by other persons is a significant public health problem accounting for approximately 4 per cent of all injury hospitalisations in New Zealand. National injury morbidity data for the years 1979–1988 were examined. These data were used to identify the characteristics of victims of assault who were hospitalised, the nature of the injuries they sustained, and the circumstances in which the injuries were inflicted. The incidence of hospitalisations in 1988 was 73.7 per 100 000 persons per year. A significant increase in the rate of hospitalisations over the decade 1979–1988 was identified. The rates for males were higher than those for females, with males 20–24 years of age most at risk. Maori had higher rates than non-Maori. Fights or brawls were the leading cause of hospitalisation. The most common place of occurrence was private homes, followed by streets and highways, and licensed premises. The findings with regard to age, sex, employment status and use of weapons were consistent with earlier studies. A higher proportion of incidents occurring in the home was attributed to differences in selection of cases between studies. An indication of underreporting by women was attributed to concealment of intentionality, possible owing to fear of reprisal. Standard hospital reporting procedures were proposed as a means of improving identification.     

心血管病住院患者肺部感染的原因分析

目的 分析心血管病患者住院期间并发肺部感染原因,提出防治对策,以期为降低心血管病住院患者医院感染的发生提供参考依据.方法 对432例心血管病患者临床资料进行回顾性分析,分析患者肺部感染发生情况.结果 432例患者住院期间发生肺部感染者64例,感染率为14.81％;患者高龄、合并有多种基础疾病、抗菌药物应用种类较多、抗菌药物应用时间较长、有侵入性操作、住院时间较长等是引起心血管病住院患者肺部感染发生的主要危险因素(P＜0.01);64例肺部感染患者痰培养共检出病原菌68株,其中革兰阳性菌45株占66.18％,革兰阴性菌21株占30.88％,真菌2株占2.94％,革兰阴性菌主要为肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌,分别占25.00％、17.65％、11.76％,革兰阳性菌主要为金黄色葡萄球菌、表皮葡萄球菌、溶血性链球菌,分别占11.76％、7.35％、4.41％,真菌主要为白色假丝酵母菌,占2.94％.结论 心血管病住院患者并发肺部感染的原因主要与高龄、合并有多种基础疾病、抗菌药物应用种类较多、抗菌药物应用时间较长、有侵入性操作、住院时间较长等原因有关,感染病原菌主要为革兰阴性菌,应针对以上高危因素进行干预,以降低医院感染发生率.     

住院患者医院感染现患率调查

目的了解住院患者医院感染现状,为有效预防和控制医院感染提供科学依据。方法于2012年5月23-25日采用横断面调查的方法,将床旁调查与病历调查相结合,逐一调查所有住院患者并填写统一的调查表,将调查结果输入医院感染网的办公系统,并参加2012全国医院感染横断面调查工作;采用SPSS13.0软件进行统计分析。结果应查住院患者1 362例,实查1 362例,实查率为100.00%;医院感染现患率为3.08%;医院感染部位以下呼吸道感染为主,占35.42%,其次为上呼吸道和口腔感染,分别占33.33%和6.25%;调查1 362例患者中751例患者应用抗菌药物,抗菌药物使用率为55.14%,其中治疗性应用抗菌药物比例占36.22%,预防性应用抗菌药物占32.89%,病原菌送检率为9.18%;共检出病原菌38株,其中革兰阳性菌为14株占36.84%,革兰阴性菌21株占55.27%,真菌3株占7.89%。结论现患率调查结果符合原卫生部医院感染现患率≤10.00%的要求,应进一步加强医院感染监测,合理使用抗菌药物,降低医院感染率。     

住院偏瘫康复治疗患者医院感染控制研究

目的调查住院偏瘫康复治疗患者医院感染状况,探讨感染的影响因素,以降低医院感染率。方法前瞻性调查2009年1月-2012年12月80例偏瘫康复治疗住院患者临床资料,使用SPSS17.0统计软件进行分析。结果发生感染共24例、28例次,感染率30.00%、例次感染率35.00%,以下呼吸道为主,占50.00%;年龄≥60岁、入院时间≤2周、侵入性操作≥10次、瘫痪肢体肌力0^Ⅱ级以及抗菌药物使用时间≥10d等患者的感染率分别为40.00%、60.86%、51.52%、60.86%、50.00%,与年龄<60岁13.33%、入院时间>2周17.54%、侵入性操作<10次的14.89%、瘫痪肢体肌力ⅢⅡ级以及抗菌药物使用时间≥10d等患者的感染率分别为40.00%、60.86%、51.52%、60.86%、50.00%,与年龄<60岁13.33%、入院时间>2周17.54%、侵入性操作<10次的14.89%、瘫痪肢体肌力Ⅲ^Ⅳ级的7.54%以及抗菌药物使用<10d16.67%相比,差异均有统计学意义(P<0.05);经多因素分析后,入院时间、侵入性操作次数、瘫痪肢体肌力以及抗菌药物使用时间等,均是患者发生感染的独立危险因素(P<0.05)。结论下呼吸道是住院偏瘫康复治疗患者发生感染的主要部位,而入院时间、侵入性操作次数、瘫痪肢体肌力以及抗菌药物使用时间等,是影响感染发生的危险因素。     

感染科住院患者医院感染的调查分析

目的 探讨感染科住院患者医院感染的临床特征及易感因素,旨在降低感染科医院感染的发生率.方法 回顾性分析2008年1月-2011年12月在感染科住院患者中发生医院感染的资料,观察医院感染发生率、相关基础疾病、感染发生部位及病原学特点等.结果 3447例住院患者中发生医院感染111例,感染率为3.22％,其中发生于结核病54例,占48.65％,其次为肝病45例占40.54％、艾滋病5例占4.50％、败血症4例占3.60％;感染部位以肺部为主,占39.64％,其次为消化系统和上呼吸道,分别占21.62％、15.32％;82份送检标本中,共检出病原体71株,检出率为86.59％,其中革兰阴性菌20株占28.17％,革兰阳性菌5株占7.04％,真菌44株占61.97％,病毒2株占2.82％.结论 感染科住院患者中以结核病患者发生医院感染比例最高,病原体以真菌为主,对感染科住院患者应给予密切关注,控制易感因素,规范抗菌药物的使用,从而降低医院感染发生率.