重症监护病房获得性念珠菌感染的临床分布及耐药分析

目的对重症监护病房(ICU)院内念珠菌感染送检标本分离出的念珠菌,进行细菌分布及药敏结果分析,为临床用药提供依据.方法对我院ICU 2002年1月～2004年12月,181株念珠菌医院感染病例进行回顾性分析.结果ICU院内念珠菌感染老年患者居多;感染部位以泌尿道为主;基础疾病则为脑血管疾病的感染率最高;并与侵入性操作、抗菌药物和免疫抑制剂的使用、患者的机体免疫力有关;分离出的181株念珠菌中以热带念珠菌为多见,其次是白色念珠菌;药敏结果敏感率由高到低分别为:两性霉素B 96.1%、制霉菌素96.1%、5-氟胞嘧啶90.6%、酮康唑81.2%、咪康唑76.2%、益康唑75.1%、伊曲康唑75.0%、氟康唑64.9%.结论高龄、严重 基础疾病、侵入性操作、大量广谱抗菌药物的使用是ICU念珠菌感染的易感因素;ICU念珠菌感染以热带念珠菌最为多见,药物敏感性以两性霉素B、制霉菌素、5-氟胞嘧啶为高;对送检标本及时进行真菌培养和药敏试验,合理使用抗菌药物和抗真菌药,减少多重耐药和深部真菌感染的发生.     

医院内深部真菌感染的临床分布和药敏结果

目的对350株临床深部真菌感染的标本进行分离鉴定和药敏试验,了解患者真菌性医院感染现状,为临床感染性疾病提供病原学诊断和合理使用抗真菌药物的依据。方法按常规方法培养,采用念珠菌显色培养基进行鉴定,对于少见的念珠菌采用PCR技术鉴定;对真菌用棉蓝染色直接镜检和培养相结合的方法进行鉴定。采用纸片扩散法进行药敏试验。结果350株真菌标本中,念珠菌属329株,占94.00%;真菌(丝状菌)21株,占6.00%;分离菌株对药物的敏感性分别为氟康唑92.40%、两性霉素B 97.57%、伊曲康唑93.01%、5-氟胞嘧啶88.10%。结论院内真菌感染以念珠菌属最为多见,特别是白色念珠菌和热带念珠菌;药敏结果显示氟康唑、两性霉素B、伊曲康唑、氟胞嘧啶均有较高的抗菌活性,但氟康唑对克柔念珠菌和光滑念珠菌有较高的耐药性;对送检标本及时进行真菌培养和药敏实验,合理使用抗真菌药物,减少多重耐药和深部真菌感染的发生。     

2012-2014年医院内真菌感染的菌种分布 及耐药性变迁研究

摘要:目的　研究2012-2014年哈励逊国际和平医院临床标本中分离出的真菌分布及耐药性变迁,给临床用药提供依据。方法　采用法国梅里埃VITEK2-Compact微生物自动鉴定药敏仪进行真菌的鉴定和药敏实验。结果　2012-2014年共分离真菌菌株295株,白色念珠菌138株（占46.8%）,热带念珠菌104株（占35.3%）,光滑念珠菌37株（占12.5%）,克柔念珠菌13株（占4.4%）,其他真菌3株（占1%）。白色念珠菌、热带念珠菌及光滑念珠菌三种主要真菌对两性霉素B和伊曲康唑的耐药率均为0%,对5-氟胞嘧啶有较低的耐药率（≤13.3%）。白色念珠菌对酮康唑、氟康唑及5-氟胞嘧啶的耐药率有逐年增加趋势。结论　白色念珠菌是我院真菌感染中最常见的病原菌,感染率逐年上升,耐药率越来越严重,今后应加强抗真菌药物的应用管理。     

189株无菌部位白色念珠菌的药敏变迁分析

目的 回顾分析本院近5年分离自无菌部位的白色念珠菌的临床分布情况及其对5种常用抗真菌药物的敏感性变化。方法 收集本院2014年-2018年分离自尿液、分泌物、穿刺液等无菌部位的白色念珠菌,采用科玛嘉显色培养基和VITEK 2 Compact全自动细菌鉴定系统鉴定筛选出白色念珠菌,用ATB药敏板条进行药敏试验。结果 189株白色念珠菌株主要来自泌尿外科、ICU及神经内科,标本类型主要为尿液及分泌物。药敏检测最小抑菌浓度(MIC)发现,白色念珠菌对两性霉素B的5年敏感率均为100. 00%,3种唑类药物2015年-2017年其敏感率较高( 83. 00%),2017年均出现下降趋势(73. 00%～80. 00%)。另外,由于5-氟胞嘧啶无具体的药敏判定标准,在此次白色念珠菌药敏结果中,MIC值≤4 mg/L者187株,占98. 94%。结论 白色念珠菌对两性霉素B联合5-氟胞嘧啶敏感性最高,氟康唑及伏立康唑药物敏感性高于伊曲康唑。     

念珠菌性阴道炎菌种分布及耐药性

目的了解本地区妇女泌尿生殖道念珠菌感染情况及对常用药物的耐药性。方法收集我院普妇科、阴道炎科、阴道感染科的781例女性泌尿生殖道标本进行细菌及真菌培养,并就真菌阳性的标本进行药敏实验。结果 781例标本中,共检出念珠菌阳性120例,阳性率15.4%;耐药率由高到低依次为:伊曲康唑(16.7%)、氟康唑(12.5%)、咪康唑(5.8%)、5-氟胞嘧啶(3.3%)、酮康唑(2.5%)、两性霉素B(0)。结论妇科念珠菌感染以白色念珠菌为主,但非白色念珠菌感染比例有所上升。进行菌种鉴定和药敏实验有利于指导临床合理用药。     

呼吸科患者真菌感染分离鉴定及药敏试验分析

目的分析142例呼吸科真菌感染阳性标本分离鉴定及药敏试验结果,以探讨其预防及治疗措施.方法萨布罗培养基培养标本,用ID真菌鉴定板条进行鉴定分型,纸片扩散法进行药敏实验.结果142株真菌中,白色念珠菌感染率最高,占74.7%;分离的菌株对两性霉素B、氟康唑、伊曲康唑和酮康唑的敏感率较高,均为100%;对5-氟胞嘧啶的耐药率较高,白色念珠菌为1.9%,白吉利毛孢子菌为50%.结论对于加强对真菌感染的认识、及时进行真菌的鉴定和药敏实验、合理使用抗菌药物、减少真菌感染、特别是耐药菌株感染的发生有着重要的意义.     

436株酵母样真菌的分离鉴定及耐药性分析

目的探讨引起医院感染常见酵母样真菌种类及其耐药性特点,为临床感染性疾病提供病原学诊断和合理使用抗真菌药物的依据。方法采集2 680份患者标本分离培养,分离出酵母样真菌436株,API-20CAUX酵母样真菌鉴定试条进行鉴定,念珠菌药敏试条(ATB-Fungus)进行念珠菌药敏试验。结果436株酵母样真菌以念珠菌为主,其中白色念珠菌305株(69.9%),热带念珠菌81株(18.6%),克柔念珠菌27株(6.1%),光滑念珠菌11株(2.5%),其他12株(2.9%);念珠菌对两性霉素B(AMB)、5-氟胞嘧啶(5-FC)、制霉菌素(NYS)、酮康唑(KTC)、益康唑(ECO)、咪康唑(MTC)的耐药率分别为8.49%、14.91%、12.39%、46.56%、38.76%、30.73%。结论目前引起我院患者真菌感染的念珠菌仍以白色念珠菌为主,其次是热带念珠菌及克柔念珠菌,这些念珠菌对两性霉素B、5-氟胞嘧啶、氟康唑较敏感,对酮康唑、益康唑、咪康唑产生了较强的耐药性。     

435株真菌的临床分布及药敏分析

目的了解临床分离的真菌分布,分析其药敏性,为临床感染性疾病提供病原学诊断和合理使用抗真菌药物的依据。方法收集2010年1-12月中南大学湘雅三医院住院患者送检标本,经血培养基或沙保罗培养基培养后,挑取酵母样菌落,进行菌种鉴定和药敏试验。结果分离到435株真菌,居前三位者分别为白色念珠菌（54.9%）,近平滑念珠菌（20.5%）,葡萄牙念珠菌（11.3%）。这些真菌主要来自重症监护室（ICU）（32.6%）和痰标本中（74.8%）。药敏结果显示,分离的酵母样真菌对5-氟胞嘧啶、两性霉素B和酮康唑敏感性较高,分别为97.5%、96.8%和95.8%。对氟康唑、伊曲康唑和益康唑耐药性较高,分别为47.4%、43.0%和21.2%。结论真菌临床分离菌株以白色念珠菌和近平滑念珠菌为主,临床真菌对5-氟胞嘧啶、两性霉素B和酮康唑具有较高的敏感性。     

湖南湘西地区念珠菌的分离及耐药性分析

目的 了解本地区念珠菌的感染及耐药现状。对2003年5月～2005年2月本院门珍和住院病人的血液，痰液，尿液，阴道分泌物，粪便等标本中分离出的221株念珠菌进行鉴定，并用真菌药敏条的10种抗真菌药物作药敏试验，其结果结合临床综合分析。结果 痰液标本念珠菌检出率最高达66．7％，其次是阴道分泌物为18．1％。共分离出白色念珠菌161株，占72．8％，热带念珠菌30株占13．6％。以5-氟胞嘧啶，两性霉素B，氟康唑，制霉菌素敏感性较高；而对灰黄霉素耐药率高达81％。结论 临床标本中念珠菌分离以白色念珠菌为主；长期使用抗菌素及严重的基础病是病人感染真菌的主要原因；真菌药敏可为临床治疗其感染性疾病提供依据。     

糖尿病患者合并真菌感染的检测和药物敏感度分析

目的 分析糖尿病患者合并真菌感染的检测情况和药物敏感度,为临床诊治糖尿病患者合并真菌感染提供依据.方法 将临床诊断为糖尿病的患者送检标本937份,进行真菌分离,用API 20C AUX和VITEK YBC生化卡鉴定菌种.用ATB Fungus念珠菌药敏板检测部分真菌对两性霉素B、制霉菌素、氟胞嘧啶、益康唑、咪康唑、酮康唑6种抗真菌药物的敏感度.结果 糖尿病患者合并真菌感染以泌尿道和呼吸道多见.检出312株真菌中以念珠菌属为主,白色念珠菌的检出率最高.173株酵母样真菌药敏试验结果:两性霉素B、制霉菌素、氟胞嘧啶的敏感度高,益康唑的敏感度最低.结论 糖尿病合并真菌感染在临床较为多见,应重视真菌的检测和药敏试验,从而有效地诊断和治疗糖尿病合并真菌的感染.     

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.