医院多重耐药菌的检测分析

目的:探讨沭阳仁慈医院多重耐药菌种类及分布特点,为加强抗菌药物临床管理、促进合理用药提供参考.方法:以2014年1月-2015年12月沭阳仁慈医院病区送检的3000例病原学标本为研究对象,全部标本均行病原菌检测和药敏试验,统计标本中多重耐药菌的检出率及构成比,观察耐药菌种类及病区分布.结果:3000例标本中,检出多重耐药菌株26株,占0.87%,其中以鲍曼不动杆菌构成比最高,为80.77%;检出MRS菌59株,占1.97%,其中以溶血葡萄球菌、表皮葡萄球菌构成比最高,均为32.20%;检出MRSA菌5株,占0.16%,以金黄色葡萄球菌构成比最高,为80.0%;检出HLAR菌4株,占0.13%,以其中以粪肠球菌构成比最高,为75.0%;检出产ESBL菌122株,占4.07%,其中以大肠埃希菌构成比最高,为76.23%.结论:沭阳仁慈医院多重耐药菌分离种类较多,涉及病区较广,今后需注重对多重耐药菌的生物监测,加强病区消毒隔离,进一步提高抗菌药物使用合理性,以有效防控多重耐药菌院内传播及感染,提高医疗安全.     

2021年甘肃省尿标本病原菌分布及耐药性

目的 分析2021年甘肃省医院临床尿标本分离病原菌的分布特点及耐药情况。 方法 收集甘肃省2021年细菌耐药监测网成员单位临床尿标本病原菌的耐药监测资料,根据临床实验室标准化协会(CLSI)2021版标准判断药物敏感性,应用WHONET 5.6软件进行数据统计分析。 结果 2021年尿标本中纳入分析的细菌共13 980株,革兰阴性菌占76.5%(10 692株),革兰阳性菌占23.5%(3 288株)。男性患者检出菌株占40.5%(5 656株),女性患者占59.5%(8 324株)。耐碳青霉烯类鲍曼不动杆菌的检出率较高,男性患者中＞30%。大肠埃希菌和奇异变形杆菌对氨苄西林的耐药率＞75%。铜绿假单胞菌对碳青霉烯类的耐药率＜10%。肠球菌对万古霉素、利奈唑胺和替考拉宁耐药率＜2%。粪肠球菌对氨苄西林的耐药率＜20%,屎肠球菌对氨苄西林的耐药率＞85%。 结论 不同性别患者尿标本检出病原菌分布及耐药率均有不同,临床可根据本地区耐药监测情况规范、合理使用抗菌药物。     

2015—2018年住院患者治疗性抗菌药物使用前分离菌株及药敏情况

目的 了解住院患者首次治疗性使用抗菌药物前分离菌株及药敏结果,为医院抗菌药物合理使用提供可靠的微生物依据。方法 基于某院抗菌药物临床决策支持系统后台相关节点数据及医院检验信息系统收集的住院患者分离菌株及药敏结果,收集2015—2018年患者入院后首次治疗性使用抗菌药物前临床分离菌株和住院期间送检标本所有临床分离菌株,比较抗菌药物使用前后菌株分布及其耐药情况。结果 2015—2018年住院患者所有送检标本共检出非重复菌株69 037株（包括细菌及真菌）,其中革兰阳性菌17 900株（占25.93%）,革兰阴性菌44 055株（占63.81%）,真菌7 082株（占10.26%）。住院患者入院后首次治疗性使用抗菌药物前采集标本中检出非重复菌株15 017株,其中革兰阳性菌4 661株（占31.04%）,革兰阴性菌9 451株（占62.93%）,真菌905株（占6.03%）。治疗用药前标本分离菌居前5位的依次是大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌和凝固酶阴性葡萄球菌,所有送检标本分离菌居前5位的分别为肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、假丝酵母菌属、大肠埃希菌,苛养菌如链球菌属、流感嗜血杆菌、卡他莫拉菌在所有送检标本中占比,较用药前低。临床常见分离菌包括金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌,抗菌治疗后送检标本分离菌株中耐药率更高。结论 研究首次报道大样本治疗性抗菌药物使用前临床送检标本分离的菌株及药敏情况,临床常见分离菌包括金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌,在抗菌治疗后标本中显示更高的耐药性。     

西北某三甲医院连续10年综合ICU医院感染目标性监测

目的 分析综合ICU连续10年医院感染相关特点及流行病学特征,为医院感染防控管理提供科学依据。 方法 采用前瞻性目标性监测方法,分析某三甲医院2013年1月—2022年12月综合ICU医院感染目标性监测资料。 结果 共监测患者15 189例,医院感染发病率为4.27%,例次发病率为4.73%。连续10年综合ICU医院感染发病率和例次发病率总体上处于下降趋势并趋于平稳,波动范围分别在2.73%~5.55%和2.83%~6.48%,且差异均有统计学意义(均P＜0.05)。医院感染部位以呼吸系统(71.34%)、血液系统(14.46%)和泌尿系统(11.96%)为主;发生器械相关感染543例,占比为75.52%。导尿管相关尿路感染(CAUTI)、血管导管相关血流感染(CRBSI)、呼吸机相关肺炎(VAP)发病率分别为1.198‰、0.603‰和9.266‰。连续10年综合ICU器械相关感染总发病率为3.531‰;2014年最高,为5.572‰;2022年最低,为2.226‰。649例医院感染患者共检出病原菌622株,以革兰阴性菌为主(77.82%),其中检出鲍曼不动杆菌居多(48.39%);共检出多重耐药菌365株,占比58.68%,其中以耐碳青霉烯类鲍曼不动杆菌居多(80.27%)。 结论 该院连续10年综合ICU医院感染相关的感染率处于较低水平,但器械相关感染和多重耐药菌管理仍是综合ICU医院感染防控管理的重点。     

重症下呼吸道感染患者多重耐药革兰阴性杆菌 培养分析

摘要:目的　分析医院重症下呼吸道感染患者多重耐药革兰阴性杆菌的耐药情况,为今后临床治疗方案的制定提供依据。方法　收集2013年1月-2014年6月之间,全院呼吸内科ICU收治的重症下呼吸道感染住院患者痰液标本388例进行培养,分析病原菌的检出情况及主要革兰阴性杆菌对常用抗菌药的耐药情况以及多重耐药的发生情况。结果　本次送检的388份痰液标本中,共分离出革兰阴性菌258株（66.49%）、革兰阳性菌87株（22.42%）、真菌43株（11.08%）。在本次检出的革兰阴性菌中,通过药敏实验,共分离出多重耐药革兰阴性菌55株,其中肺炎克雷伯菌11株（20.00%）,铜绿假单胞菌23株（41.82%）,大肠埃希菌21株（38.18%）。结论　在医院重症下呼吸道感染患者中,革兰阴性菌感染所占比例较高,多重耐药情况严重,临床治疗根据致病菌检验结果及药敏实验合理选择治疗用药、规范使用抗菌药物是提高治疗效果、遏制多重耐药发生的关键。     

某院2010—2019年常见肠杆菌目细菌临床分布及耐药性变迁

目的 了解某院常见肠杆菌目细菌的分布特征及耐药情况,为临床合理使用抗菌药物提供参考。 方法 收集2010—2019年某院临床标本中检出的所有肠杆菌目细菌非重复菌株,分析不同种类细菌检出情况、临床分布、标本分布及耐药情况等。 结果 共收集19 384株肠杆菌目细菌,其中大肠埃希菌占45.32%（8 784株）,肺炎克雷伯菌占25.11%（4 867株）,阴沟肠杆菌占5.67%（1 099株）,黏质沙雷菌占3.67%（711株）,产酸克雷伯菌占3.29%（638株）,其他肠杆菌目细菌占16.95%（3 285株）。大肠埃希菌以尿标本分离最多（占42.53%）,其次为呼吸道标本（21.63%）、全血标本（16.33%）等;肺炎克雷伯菌以呼吸道标本分离最多（占69.37%）,其次为尿（9.33%）、全血标本（8.73%）等。大肠埃希菌主要来源于泌尿外科（29.16%）,其次是儿内科（8.86%）等;肺炎克雷伯菌主要来源于神经外科（22.52%）,其次是儿内科（13.71%）等。2018—2019年肠杆菌目细菌对氨苄西林、哌拉西林、头孢唑林的耐药率较高,对亚胺培南和美罗培南的耐药率上升明显,耐碳青霉烯类肠杆菌目细菌检出率逐年上升,差异有统计学意义（P < 0.05）。 结论 肠杆菌目细菌耐药情况不容乐观,临床医生应当采取有效措施预防CRE的产生,同时预防与控制医院交叉感染也至关重要。     

贵州省某医院多重耐药菌目标监测结果分析

摘要:目的　了解医院多重耐药菌基本情况,为制定多重耐药菌的医院感染防控措施提供依据。方法　采用回顾性调查方法,对某医院2013和2014年多重耐药菌目标监测数据进行分析。结果　2013和2014年该院共检出多重耐药菌2433株,其中医院感染658株,占27.04%。菌种分布以产超广谱β-内酰胺酶（ESBLs）大肠埃希菌为主,占42.25%。将临床科室分为5个系统,其中外科系统检出多重耐药菌最多,五官系统最少。医院感染多重耐药菌以产ESBLs大肠埃希菌和CR-AB为主,并且外科系统医院感染多重耐药构成比最高,妇儿系统最低。另外,多重耐药菌医院感染标本来源以痰液为主。结论　加强多重耐药菌患者的管理,严格执行多重耐药菌消毒隔离措施,降低或避免造成多重耐药菌在院内的交叉感染风险,保障患者医疗安全。     

神经内科ICU耐碳青霉烯类肺炎克雷伯菌感染疑似暴发调查与控制

目的 调查神经内科重症监护病房(ICU)耐碳青霉烯类肺炎克雷伯菌(CRKP)感染暴发原因, 为有效控制多重耐药菌医院感染提供依据。 方法 对2021年6—7月某院神经内科ICU检出CRKP的患者进行现场流行病学调查和环境卫生学监测, 并采取控制措施, 评价防控效果。 结果 共发生CRKP医院感染7例, 罹患率为12.28%(7/57), 与2019、2020年同期罹患率相比, 差异有统计学意义(P＜0.05)。环境卫生学监测显示: 手标本CRKP检出率为6.67%(1/15), 为1名保洁员手; 环境物体表面CRKP检出率为5.45%(3/55), 分别为19床床头柜、19床输液泵、1号床手持电脑(PDA)。在采取集中隔离CRKP感染患者, 严格限制人员流动, 病区清洁与消毒, 加强手卫生监管等一系列针对性措施后, 此次事件得到有效控制。 结论 此次可判定为一起CRKP疑似医院感染暴发事件, 推测CRKP感染患者未采取集中隔离措施、环境消毒不彻底及手卫生执行不到位是此次暴发事件的主要原因。早期识别感染暴发, 调查原因, 及时采取有效的针对性措施是控制感染暴发的关键。     

烧伤患者创面感染病原菌耐药性调查分析

目的了解烧伤患者感染病原菌分布及耐药性。方法回顾性分析医院2011年1月-2016年12月6年烧伤病区送检的标本4742份,分析阳性标本来源,病原菌分布及药敏结果。结果 4742份标本中阳性标本为1960份,阳性率为41.33%,共检出2197株病原菌,主要来源为烧伤创面分泌物占72.19%;阳性标本中分离出革兰阴性菌占57.85%,革兰阳性菌占41.15%,真菌及其他占1.00%;金黄色葡萄球菌分离率最高,占分离病原菌的26.54%,而耐甲氧西林(MRSA)占金黄色葡萄球菌的74.27%;药敏试验显示,目前各检出菌的耐药性上升趋势严重。结论烧伤细菌感染以革兰阴性菌为主,对碳青霉烯类耐药率有上升的趋势,在检出率方面MRSA也有增高的趋势,临床应重视根据药敏试验用药,以延缓细菌耐药率。     

尿路感染患者病原菌分布及其耐药性分析

目的调查医院门诊及住院患者尿路感染病原菌分布及其耐药性,为临床治疗尿路感染及合理使用抗菌药物提供依据。方法收集医院2012年2-12月门诊及住院患者清洁中段尿标本中分离出的312株病原菌,对检出病原菌采用K-B纸片扩散法进行鉴定及药物敏感性监测,结果按CLSI标准判读,数据采用SPSS 17.0软件进行统计分析。结果门诊患者尿液标本中检出病原菌58株,革兰阴性菌52株占89.7%、革兰阳性菌4株占6.9%、真菌2株占3.4%,居前3位的为大肠埃希菌、铜绿假单胞菌、奇异变形菌,分别占70.7%、8.6%、5.2%;病房患者尿液标本中检出病原菌254株,革兰阴性菌190株占74.8%、革兰阳性菌41株占16.1%、真菌23株占9.1%,居前3位的为大肠埃希菌、肺炎克雷伯菌、粪肠球菌,分别占44.9%、9.1%、7.9%;革兰阴性菌对青霉素类及头孢菌素类耐药率普遍较高,均>50.0%,革兰阳性菌对青霉素耐药率>50.0%。结论医院尿路感染病原菌仍以革兰阴性菌为主,病原菌对常用抗菌药物耐药率呈上升趋势,规范合理使用抗菌药物对治疗尿路感染具有重要意义。     

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.