老年肺部感染住院患者多药耐药菌感染影响因素的回顾性调查

目的探讨引起老年肺部感染住院患者发生多药耐药菌(MDRO)感染影响因素,为老年肺部感染住院患者MDRO的防治提供参考。方法收集2016年1月-2017年12月期间住院的223例老年肺部感染患者临床资料,调查患者一般资料及肺部感染发生情况,对感染患者MDRO检测结果进行分析。结果共检出感染病原菌238株,其中87例为MDRO感染,感染率为39.01%,检出MDRO 92株,占总菌株的38.66%;MDRO中革兰阴性菌占72.83%,革兰阳性菌占27.17%,主要感染病原菌为铜绿假单胞菌、金黄色葡萄球菌、鲍氏不动杆菌、肺炎克雷伯菌、大肠埃希菌;患者年龄≥80岁、住院天数≥2周、合并心血管疾病、留置导尿管、机械通气、动静脉置管、抗菌药物使用种类≥2种、抗菌药物使用时间≥2周时MDRO感染率较高(P<0.05);Logistic回归分析结果显示住院时间长、合并心血管疾病、留置导尿管、机械通气、动静脉置管、抗菌药物使用种类≥2种、抗菌药物使用时间≥2周是老年肺部感染患者发生MDRO感染的独立影响因素(P<0.05)。结论老年肺部感染住院患者MDRO感染率较高,引起MDRO感染的影响因素较多,应根据相关危险因素积极进行预防以降低MDRO感染。     

心胸外科患者多重耐药菌感染及危险因素分析

目的 探讨心胸外科住院患者多重耐药菌(MDRO)感染的特征及其危险因素.方法 回顾性调查632例发生医院感染的心胸外科患者,根据其是否发生MDRO感染分为MDRO组和非MDRO组,计算MDRO感染率并分析多重耐药菌株分布,筛选影响心胸外科患者MDRO感染的相关危险因素.结果 心胸外科患者MDRO感染发生率为15.19％...     

多重耐药菌医院感染肺炎危险因素的多中心调查

目的:多中心调查分析多重耐药菌(MDRO)医院感染肺炎的危险因素。方法:选取本地区3所医院2013年3月-2015年3月收治的因5种MDRO及对应敏感菌导致的医院感染肺炎患者作为实验对象,其中出现5种MDRO医院感染肺炎患者为实验组(436例),出现对应5种敏感菌医院感染肺炎患者为对照组(425例),调查分析MDRO医院感染肺炎的危险因素,对比两组患者预后情况。结果:实验组出现耐药菌与敏感菌混合感染的有213例(48.85%),对照组201例(47.29%);发生MDRO医院感染肺炎的独立危险因素主要是入住重症监护室(ICU)、机械通气史、使用抗菌药物等等。结论:增加患者出现MDRO医院感染肺炎风险因素主要是入住ICU、实施各种侵入性操作及采用抗菌药物等等。     

骨科创伤患者术后多重耐药菌感染风险Nomogram模型构建与验证

目的 探讨骨科创伤患者术后多重耐药菌(MDRO)感染的危险因素及风险列线图(Nomogram)预测模型的构建。方法 回顾性分析2019年1月—2021年1月某院重症监护病房(ICU)的458例骨科创伤住院患者的临床资料,分别使用单因素和多因素lasso logistic回归分析骨科创伤住院患者术后MDRO感染的独立危险因素。最后纳入筛选出的独立危险因素建立Nomogram预测模型,另选取2021年2—10月224例骨科创伤患者建立验证组,对建模组数据进行验证。结果 458例创伤患者为建模组,其中创伤合并MDRO感染114例,感染率24.89%;非MDRO感染组患者344例。两组患者临床资料进行lasso logistic回归分析,APACHEⅡ评分≥20分(OR=2.567,95%CI:1.593～4.178)、发热日数≥3 d(OR=2.656,95%CI:1.631～4.361)、住院日数≥10 d(OR=3.563,95%CI:2.207～5.808)、使用抗菌药物(OR=2.314,95%CI:1.415～3.848)、联合使用抗菌药物日数≥7 d(OR=2.114,95%CI...     

人工气道患者耐碳青霉烯类抗菌药物铜绿假单胞菌肺部感染危险因素

目的分析重症医学科建立人工气道机械通气患者碳青霉烯类抗菌药物耐药铜绿假单胞菌(Carbapenem-resistant Pseudomonas aeruginosa,CRPA)肺部感染的危险因素及耐药性。方法选择2016年1月-2019年12月首都医科大学附属北京世纪坛医院重症医学科铜绿假单胞菌(Pseudomonas aeruginosa,PA)感染患者388例,其中CRPA肺部感染患者251例为研究组,碳青霉烯类抗菌药物敏感铜绿假单胞菌(Carbapenem-sensitive Pseudomonas aeruginosa,CSPA)肺部感染患者137例为对照组,比较两组患者年龄、合并基础疾病、抗菌药物使用及炎症因子指标等临床资料,分析人工气道机械通气患者CRPA肺部感染的危险因素,分析两组患者对常用抗菌药物的耐药性,并对PA常见耐药基因进行检测。结果两组患者年龄、APACHEⅡ评分、入院前卧床时间、炎症因子水平、合并慢性阻塞性肺病(COPD)、铜绿假单胞菌检出前使用碳青霉烯类抗菌药物、低蛋白血症比较差异有统计学意义(P0.05);其中合并COPD、机械通气时间10 d、铜绿假单胞菌检出前使用碳青霉烯类抗菌药物是人工气道患者CRPA感染的独立危险因素(P0.05);研究组对常用抗菌药物的耐药率均高于对照组;研究组除对阿米卡星耐药率为16.33%,头孢他啶25.50%外,其余耐药率均高于55.00%。碳青霉烯类抗菌药物耐药铜绿假单胞菌含有IMP、VIM、OXA-23、OXA-51等多种耐药基因。结论 CRPA肺部感染与合并COPD、铜绿假单胞菌检出前使用过碳青霉烯类抗菌药物、机械通气等多种因素相关,CRPA含有多种碳青霉烯类抗菌药物耐药基因,耐药率较高,预后差。     

糖尿病足溃疡病原菌分布及多重耐药菌感染的危险因素

目的了解糖尿病足溃疡患者病原菌分布及多重耐药菌(MDRO)感染相关危险因素,为临床有效防控糖尿病足溃疡MDRO感染提供参考依据。方法选取2011年1月—2016年9月某三甲综合医院内分泌科及骨科收治的糖尿病足溃疡患者。回顾性调查患者的糖尿病足感染情况,对MDRO感染的相关危险因素进行单因素及多因素logistic回归分析。结果共收集糖尿病足溃疡患者135例,检出病原菌122株,其中革兰阴性(G-)菌75株,占61.48%;革兰阳性(G+)菌42株,占34.43%;真菌5株,占4.10%。117株细菌中检出MDRO76株,MDRO检出率为64.96%,其中大肠埃希菌占22.37%,金黄色葡萄球菌占17.11%,铜绿假单胞菌占15.79%。单因素分析提示,既往使用过抗菌药物、抗菌药物使用疗程10 d、抗菌药物联合使用种类2种、因相同部位的伤口住院次数2次/年、合并骨髓炎、神经缺血性伤口和Wagner 3~5级7个因素为糖尿病足溃疡患者MDRO感染相关危险因素(P0.05)。多因素logistic回归分析结果显示,既往使用过抗菌药物、抗菌药物使用疗程10 d、因相同部位的伤口住院次数2次/年、合并骨髓炎、神经缺血性伤口和Wagner 3~5级是糖尿病足溃疡患者MDRO感染的独立危险因素(P0.05)。结论糖尿病足溃疡患者MDRO感染应以预防为主,在临床工作中应注意监测患者局部感染程度及病原菌变化,针对感染病原菌药敏结果合理使用抗菌药物,最大程度减少细菌耐药。     

神经外科呼吸机相关性肺炎患者多药耐药菌感染的影响因素分析

目的探讨神经外科呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)患者多药耐药菌(Multidrug-Resistant Organism,MDRO)感染现状与影响因素,为临床防控提供参考。方法回顾性调查收集2015年9月-2017年12月神经外科309例VAP患者的临床资料,分为MDRO感染组67例和非MDRO感染组242例。对两组间患者的性别、年龄、糖尿病史、意识状态、气管切开、住院时间等资料进行单因素分析,筛选出有统计学意义的作多因素Logistic分析,探讨神经外科VAP患者MDRO感染情况、病原菌分布及影响因素。结果 309例VAP患者发生MDRO感染67例,MDRO感染发生率为21.68%;共检出MDRO病原菌79株,以革兰阴性杆菌为主;多因素Logistic回归分析结果显示,意识障碍、血清白蛋白30g/L、抗菌药物疗程≥10d、抗菌药物联用疗程≥10d和机械通气时间≥7d为VAP患者MDRO感染的影响因素(P0.05)。结论应针对影响因素采取防控措施,科学合理用药,有效控制和减缓VAP患者MDRO感染。     

老年患者多重耐药菌肺部感染危险因素

目的探讨某院老年患者多重耐药菌(MDRO)肺部感染的危险因素,为其防治提供依据。方法采用回顾性调查方法,选取该院2010年8月—2012年12月发生肺部感染的老年患者188例,其中痰细菌培养结果为MDRO感染的患者作为病例组(95例),非MDRO感染患者作为对照组(93例),分析两组患者的病历资料。结果老年MDRO肺部感染患者共分离MDRO102株,居前3位的病原菌分别为鲍曼不动杆菌(31.37%),铜绿假单胞菌(25.49%)及耐甲氧西林金黄色葡萄球菌(15.69%)。单因素分析显示,脑血管病或痴呆病史、低蛋白血症、吞咽困难、长期卧床、重症监护病房(ICU)入住史、使用第三/四代头孢菌素、有创操作7项因素均是老年MDRO肺部感染的危险因素。多因素logistic回归分析显示,低蛋白血症(OR=6.02,95%CI:1.50~24.18)、有创操作(OR=6.55,95%CI:1.69~25.44)、长期卧床(OR=6.03,95%CI:1.92~18.91)均是老年患者发生MDRO肺部感染的独立危险因素。结论老年患者MDRO肺部感染是多种因素共同作用的结果,应针对其危险因素制定综合防治措施,预防和控制老年患者MRDO肺部感染的发生。     

医院多重耐药菌感染危险因素分析

目的探讨分析医院多重耐药菌感染的危险因素,为临床进一步有效控制医院多重耐药菌感染提供依据。方法在东莞市第三人民医院住院系统的医院感染监测数据库中选取2013年1月-2015年12月发生医院感染病例1 983例,其中医院感染多重耐药菌病例215例作为观察组,在余下的1 768例医院感染非多重耐药菌中随机抽取215例病例作为对照组,采用单因素χ2检验与logistic逐步回归分析医院多重耐药菌感染的可能危险因素。结果多重耐药菌感染的观察组感染前平均住院时间为(12. 74±55. 85) d,非多重耐药菌感染的对照组感染前平均住院时间为(25. 81±59. 35) d,两者差异有统计学意义(t=2. 352,P<0. 05)。气管插管、呼吸机使用、插导尿管、深静脉插管、插胃管在观察组和对照组的暴露比例差异有统计学意义(P<0. 05);抗菌药物使用数量在观察组和对照组的暴露比例差异有统计学意义(P<0. 05)。性别、年龄、基础疾病种类和数量在观察组和对照组暴露比例差异均无统计学意义(P>0. 05)。多因素分析表明侵袭性操作(OR=2. 452)和抗菌药物使用(OR=2. 077)是医院感染多重耐药菌的独立危险因素。结论侵袭性操作和抗菌药物使用是医院感染多重耐药菌的危险因素,医院尽量减少侵袭性操作,对于患者留置的管道进行严格的无菌操作,减少交叉感染的机会,同时应加强抗菌药物的合理使用。     

手术部位多重耐药菌感染的危险因素研究

目的 分析住院患者发生手术部位多重耐药菌感染的危险因素。 方法 对2012年5月-2015年4月玉溪某综合医院住院患者手术部位多重耐药菌感染进行回顾性调查,分析发生手术部位多重耐药菌感染的危险因素,比较多重耐药菌感染与敏感菌感染患者住院时间以及住院费用。 结果 3年间共实施手术39 433例,498例(1.26%)发生手术部位感染。在送检的样本中共166例患者检出感染病原菌,耐药菌感染87例(52.41%),敏感菌感染64例(38.55%),耐药菌与敏感菌混合感染15例(9.04%)。将15例混合感染患者分别计入耐药组(102例)与敏感组(79例)进行分析,Logistic回归模型进行多因素分析显示,患者有基础疾病(OR=2.78),频繁更换抗菌药物(OR=2.44)以及抗菌药物使用疗程≥5 d(OR=5.65)是发生手术部位多重耐药菌感染的独立危险因素。耐药组较敏感组住院时间平均延长 6.9 d,多重耐药菌感染患者住院总费用、药品费用、抗菌药物费用均高于敏感菌感染患者,差异均有统计学意义(Z=3.576、3.790、3.815,均P<0.001)。 结论 有基础疾病、频繁更换抗菌药物、抗菌药物使用疗程≥5 d均会增加患者手术部位发生多重耐药菌感染的风险。     

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.