泌尿系感染病原菌的分布及耐药性分析

目的分析泌尿系感染的菌群分布及耐药性特点,为临床选用抗菌药物提供依据。方法按照《全国临床检验操作规程》要求操作,用法国生物梅里埃公司的VITEK-60细菌鉴定仪鉴定菌种,采用K-B法做药敏试验,对临床分离的294株泌尿系感染病原菌进行鉴定及药物敏感试验。结果在分离的294株病原菌中,革兰阴性菌占75.9%、革兰阳性菌占24.1%;革兰阴性菌以大肠埃希菌为主,革兰阳性菌以肠球菌属为主;检出产超广谱β-内酰胺酶(ESBLs)菌63株,其中大肠埃希菌产ESBLs57株,占90.5%;肺炎克雷伯菌产ESBLs 6株,占9.5%;耐高单位庆大霉素肠球菌属21株,占肠球菌属43.7%。结论泌尿系感染的病原菌分布广泛,有些菌株产生多重耐药性;建议临床医生重视细菌学培养,用药敏结果指导临床合理用药,以减少ESBLs菌株的产生。     

胆道感染病原菌谱及其药敏分析

目的 分析胆道感染的菌群分布及耐药性特点,为临床选用抗菌药物提供依据.方法 按照<全国临床检验操作规程>要求操作,用法国生物梅里埃公司的VITEK-32细菌鉴定仪鉴定菌种,采用K-B法做药敏试验,对临床分离的253株胆道感染病原菌进行鉴定及药物敏感试验.结果 在分离的253株病原菌中,革兰阴性菌173株(68.4%),革兰阳性菌74株(29.2%),真菌6株(2.4%);革兰阴性菌以大肠埃希菌为主,革兰阳性菌以肠球菌属为主;检出产超广谱β-内酰胺酶(ESBLs)菌32株,其中大肠埃希菌产ESBLs 24株,占75.0%,肺炎克雷伯菌产ESBLs8株,占25.0%.结论 胆道系统感染的病原菌分布广泛,有些菌株产生多药耐药性;建议临床医师重视细菌学培养,用药敏结果 指导临床合理用药,以减少ESBLs菌株的产生.     

2008-2010年呼吸道感染病原菌分布及耐药性变迁

目的 了解医院2008-2010年呼吸道感染病原菌分布及其耐药性变迁.方法 采用VITEK系统或API系统鉴定细菌和真菌,应用WHONET5.0软件分析呼吸道感染病原菌的分布及药敏率.结果 2008-2010年医院呼吸道感染培养标本38657份,检出病原菌11593株,检出率为30.0％,以革兰阴性杆菌为主,占73.1％,革兰阳性菌占6.9％,真菌占20.0％;大肠埃希菌和肺炎克雷伯菌产ESBLs菌株及泛耐药铜绿假单胞菌和鲍氏不动杆菌,3年检出率变化不大,MRSA 3年检出率分别为25.3％、35.2％、54.3％.结论 呼吸道感染的主要病原菌是革兰阴性杆菌,定期监测和分析当地患者呼吸道感染病原菌种类及其耐药性变迁,对临床合理使用抗菌药物具有重要指导意义.     

低出生体重儿败血症病原菌分布及药物敏感性分析

目的了解低出生体重儿败血症的病原菌分布和耐药性,为临床低出生体重儿败血症的诊断和抗菌药物的合理使用提供参考。方法对2017年1月-2018年10月入住医院新生儿重症救护中心(NICU)的低出生体重儿(LBWI)血培养阳性结果进行回顾性分析。结果共分离出病原菌726株,革兰阴性菌461株占63.50%,革兰阳性菌252株占34.71%,真菌13株占1.79%。革兰阴性菌中肺炎克雷伯菌占30.80%,产ESBLs检出率为82.39%,耐碳青霉烯肺炎克雷伯菌检出率为2.81%;大肠埃希菌占24.95%,产ESBLs检出率为60.87%。铜绿假单胞菌占9.97%,耐碳青霉稀类铜绿假单胞菌检出率为8.70%。革兰阳性菌中以凝固酶阴性葡萄球菌为主(61.11%),其次为肠球菌(11.90%)、金黄色葡萄球菌(11.11%)和B群链球菌(8.33%),耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCoNS)的检出率分别为87.66%和89.29%。另检出真菌13株,均为白假丝酵母。结论 NICU病区LBWI败血症病原菌以革兰阴性菌为主,多重耐药菌检出率高,临床应引起重视,获得早期病原学诊断、规范抗菌药物的使用,是预防和治疗LBWI感染的关键。     

神经外科病房多药耐药菌感染流行趋势及控制措施

目的 分析神经外科病房感染病原菌分布及多药耐药菌耐药特征,探讨多药耐药菌感染预防和控制策略.方法 对2010年1月-2010年12月神经外科病房分离出的病原菌及其药敏结果进行分析.结果 2010年神经外科病房医院感染发生率为12.0％,感染病原菌以革兰阴性菌为主,占88.7％;革兰阳性菌占11.3％;耐甲氧西林金黄色葡萄球菌11株,凝固酶阴性葡萄球菌6株,未检出耐万古霉素金黄色葡萄球菌及耐万古霉素肠球菌;肠杆菌科中大肠埃希菌产ESBLs株检出8株、肺炎克雷伯菌检出9株;多药耐药鲍氏不动杆菌18株、铜绿假单胞菌10株,多药耐药菌株分离率呈上升趋势.结论 神经外科病房分离的多药耐药菌出现的频率增加,加强耐药性监测,合理应用抗菌药物,并落实及时有效的消毒隔离措施,避免多药耐药菌在医院的暴发流行.     

ICU血流感染的病原菌分布及耐药性分析

目的 了解ICU血培养分离病原菌的分布及耐药性.方法 回顾性调查2006年1月-2010年1月医院ICU临床血培养病原菌分布特点和耐药性.结果 结果血培养阳性率为18.3％,共获得临床分离病原菌217株,47.9％为革兰阴性杆菌,其中肠杆菌科细菌70株,占32.3％,革兰阳性菌占37.4％,真菌占14.7％;最常见的分离病原菌依次为大肠埃希菌、金黄色葡萄球菌和肺炎克雷伯菌,分别占15.6％、13.8％、9.7％;大肠埃希菌和肺炎克雷伯菌产ESBLs检出率分别为47.1％和42.8％,肠杆菌科细菌未发现碳青霉烯类耐药菌株,耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为73.3％和78.8％;未发现耐万古霉素葡萄球菌属和肠球菌属.结论 ICU血流感染以革兰阴性菌为主,真菌性感染呈上升趋势;血培养分离株耐药现象普遍.     

产超广谱β-内酰胺酶肠杆菌科细菌致急性前列腺感染的病原菌分析

目的 探讨产超广谱β-内酰胺酶(ESBLs)肠杆菌科细菌在急性前列腺感染中的检出率,并分析其药敏谱.方法 收集84株样本,用法国生物梅里埃公司ATB-Expression进行细菌鉴定,药敏试验采用ATB G-5药敏试剂条测试,表型确证试验检测ESBLs酶.结果 84例急性前列腺炎患者培养出56株病原菌,主要为革兰阴性杆菌,占67.8%,以肠杆菌科细菌为主,占革兰阴性杆菌的94.7%;革兰阳性菌占21.4%,以溶血葡萄球菌为主,占革兰阳性球菌的58.3%;14株大肠埃希菌中7株产ESBLs,占50.0%,13株肺炎克雷伯菌中3株产ESBLs,占23.1%;所有菌株均对亚胺培南和美罗培南敏感.结论 对产ESBLs肠杆菌科细菌致急性前列腺感染,按照药敏试验及时选择有效抗菌药物.     

2006-2011年老年患者医院感染流行病学及细菌耐药性变化

目的分析老年住院患者医院感染的细菌流行病学及其耐药变化,为医院合理用药提供参考。方法收集2006年1月-2011年12月年龄>60岁发生医院感染944例住院患者临床分离菌株,采用微量稀释法进行药敏试验。结果 6年平均细菌培养阳性率49.98%,低于全院61.00%;临床分离菌株中呼吸道标本为678株占71.8%,尿液标本223株占23.6%;检出革兰阴性菌637株占67.5%,革兰阳性菌307株占32.5%;产ESBLs大肠埃希菌占39.4%,产ESBLs肺炎克雷伯菌占25.2%,耐甲氧西林金黄色葡萄球菌占75.4%;2006-2011年革兰阴性菌中大肠埃希菌对碳青霉烯类保持高度敏感,其次为哌拉西林/他唑巴坦、头孢哌酮/舒巴坦;不发酵糖革兰阴性菌中铜绿假单胞菌、鲍氏不动杆菌对阿米卡星敏感性增强,对头孢哌酮/舒巴坦保持敏感,对碳青霉烯类耐药率有上升趋势;革兰阳性菌中葡萄球菌属和肠球菌属对抗菌药物的耐药性无明显变化。结论老年患者医院感染病原菌以革兰阴性菌为主,革兰阳性菌呈逐年上升趋势,病原菌也呈上升趋势;观察结果对于指导老年住院患者合并医院感染的经验性治疗有一定的参考价值。     

1126例痰培养病原菌分布及药敏分析

目的 调查医院住院患者呼吸道菌群分布及耐药性,为控制患者肺部感染提供试验数据,促进抗菌药物的合理使用.方法 对2010年7月--2011年6月住院患者痰标本进行常规培养和鉴定及药敏试验,收集阳性结果进行统计分析.结果 1126例痰液标本中,共检出病原菌803株,检出率为71.3％;革兰阴性杆菌553株占68.9％,其中克雷伯菌属190株占23.7％,大肠埃希菌93株占11.6％,铜绿假单胞菌92株占11.5％;检出主要革兰阴性杆菌对阿米卡星、左氧氟沙星、环丙沙星、哌拉西林/他唑巴坦的敏感度较高,无耐亚胺培南株,克雷伯菌属和大肠埃希菌产ESBLs酶的比率分别为31.1％和63.4％;共检出革兰阳性球菌149株占18.5％,其中金黄色葡萄球菌58株占7.2％,凝固酶阴性葡萄球菌37株占4.6％,肺炎链球菌36株占4.5％,耐苯唑西林的金黄色葡萄球菌和凝固酶阴性葡萄球菌分别为34.5％和67.6％;真菌以白色假丝酵母菌为主.结论 下呼吸道感染仍以革兰阴性杆菌为主,其中产ESBLs酶的大肠埃希菌和克雷伯菌属所占比例在增高,耐药现象严重;非发酵菌属检出比例也在增高;耐甲氧西林葡萄球菌的感染应引起重视;细菌耐药性监测与及时定期通报对临床正确应用抗菌药物具有重要的指导意义.     

医院感染病原菌分布特征及耐药性分析

目的 了解医院感染病原菌的来源分布及耐药性.方法 对2009-2010年医院感染病原菌的来源及药敏结果进行统计分析.结果 进行病原学送检的790例医院感染患者中分离出病原菌509株,以革兰阴性杆菌为主占63.5％,主要是肠杆菌科的大肠埃希菌、肺炎克雷伯菌及非发酵菌属的铜绿假单胞菌、鲍氏不动杆菌;产ESBLs大肠埃希菌检出率为82.3％,产ESBLs肺炎克雷伯菌检出率为73.9％,鲍氏不动杆菌耐药性较突出,亚胺培南耐药率为34.9％;革兰阳性球菌占21.8％,以表皮葡萄球菌和金黄色葡萄球菌为主,MRSE检出率为87.5％,MRSA检出率为29.4％,未检出耐万古霉素肠球菌.结论 为控制细菌的耐药性,须加强抗菌药物的合理使用;为减少耐药菌的传播,须加强耐药菌的监测和消毒隔离,规范洗手.     

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.