艾滋病患者感染菌群分布及耐药性分析

目的分析医院艾滋病患者感染病原菌的分布及耐药性,以指导临床医师合理用药。方法对医院2009年8月-2010年9月收治的艾滋病患者各类标本分离所得418株病原菌,采用自动微生物分析仪及配套试剂进行细菌鉴定与药敏试验。结果在418株分离的病原菌中,真菌感染占48.6%,革兰阴性杆菌占30.6%,革兰阳性菌占20.8%,病原菌以大肠埃希菌、新型隐球酵母菌、白色假丝酵母菌、马内菲青霉菌、肺炎克雷伯菌、肺炎链球菌、人葡萄球菌为主,同时,新型隐球酵母菌呈上升趋势,罕见马红球菌种日渐体现;两性霉素B及5-氟胞嘧啶对新型隐球酵母菌、白色假丝酵母菌敏感,伊曲康唑对马内菲青霉菌敏感,亚胺培南对各种肠杆菌科细菌有较强抗菌活性,大肠埃希菌对第二、三代头孢菌素敏感率仅为20.0%～35.0%;对头孢噻肟、左氧氟沙星、头孢唑林、磺胺甲噁唑/甲氧苄啶及氨苄西林高度耐药,肺炎链球菌对克林霉素、苯唑西林、红霉素及磺胺甲噁唑/甲氧苄啶耐用率高达80.0%～86.0%。结论艾滋病患者感染病原菌分布较复杂,病原菌的耐药形势严峻,加强耐药性连续监测,对临床合理使用抗菌药物、减少耐药菌产生有特别意义。     

儿童肺炎链球菌对青霉素耐药性分析

目的了解乐清地区儿童感染肺炎链球菌对青霉素及其他10种抗菌药物的耐药性。方法收集2007年1月-2009年12月,医院儿科门诊及入院首日患儿送检的呼吸道标本中分离出的201株肺炎链球菌药敏结果进行回顾性分析。结果 2007-2009年肺炎链球菌对青霉素的耐药率逐年升高,分别为71.0%、77.6%和83.8%,除青霉素外,对磺胺甲噁唑/甲氧苄啶、克林霉素、红霉素、四环素的耐药率高,分别为88.6%、93.0%、98.5%、94.5%,对万古霉素和左氧氟沙星均敏感;肺炎链球菌对青霉素敏感组与青霉素非敏感组的药物敏感性比较显示,两组对阿莫西林、头孢噻肟、磺胺甲噁唑/甲氧苄啶、克林霉素、红霉素和四环素的耐药性差异有统计学意义,特别是克林霉素、红霉素和四环霉素在两组的耐药率均>65.0%,且在青霉素非敏感组这种耐药性更加显著。结论乐清地区的儿童感染肺炎链球菌,青霉素的耐药逐年升高,磺胺甲噁唑/甲氧苄啶、克林霉素、红霉素、四环素的耐药率高,耐药情况严峻。     

痰培养及药敏检测在儿童急性下呼吸道感染中的应用

目的 检测分析急性下呼吸道感染患儿的病原菌分布及耐药性,为合理的临床用药提供参考依据.方法 对医院2009年3月-2011年3月收治的1108例急性下呼吸道感染患儿的痰标本进行细菌培养、菌株鉴定及药敏试验.结果 1108份痰标本中检出病原菌548株,革兰阴性杆菌389株占70.99％,革兰阳性球菌146株占26.64％,前5位病原菌为肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌及鲍氏不动杆菌,分别占23.72％、20.99％、12.41％、12.41％及8.21％;肺炎克雷伯菌对氨苄西林耐药率为90.77％,大肠埃希菌对氨苄西林耐药率为91.30％,铜绿假单胞菌对氨苄西林/舒巴坦、磺胺甲噁唑/甲氧苄啶的耐药率均为100.00％,金黄色葡萄球菌对青霉素、磺胺甲噁唑/甲氧苄啶耐药率均为91.18％,鲍氏不动杆菌对氨苄西林耐药率为91.11％.结论 急性下呼吸道感染的主要致病菌是革兰阴性杆菌,且呈多药耐药性,临床上应尽早做细菌学检测,合理选择抗菌药物.     

老年女性2型糖尿病患者尿路感染病原菌分布及药敏分析

目的 了解老年女性2型糖尿病(T2DM)患者合并尿路感染(UTI)的病原菌分布和药敏率,为临床合理使用抗菌药物提供指导.方法 对2006年8月-2010年7月106例老年女性T2DM患者送检标本进行尿培养病原学鉴定及药敏试验.结果 病原菌中革兰阴性菌占58.5％,以大肠埃希菌为主;革兰阳性菌占33.0％,以肠球菌属为主;真菌占8.5％;大肠埃希菌对氨苄西林、环丙沙星和磺胺甲噁唑/甲氧苄啶的耐药率＞65.0％;肠球菌属对磺胺甲噁唑/甲氧苄啶、红霉素和环丙沙星的耐药率＞ 80.0％,对万古霉素的耐药率达到9.1％.结论 老年女性T2DM患者UTI的病原菌以大肠埃希菌为主,但有下降趋势,肠球菌属和假丝酵母菌属的检出率在上升,病原菌对万古霉素耐药性的增加需高度重视,临床医师应根据药敏结果合理选择抗菌药物.     

感染性心内膜炎病原菌种类分布及耐药性分析

目的通过对感染性心内膜炎(IE)患者分离病原菌及其耐药率的分析,探讨IE病原菌的分布及临床抗菌药物的应用情况。方法对医院2007年1月-2010年12月收治的80例IE患者,分离的病原菌及抗菌药物耐药情况进行回顾性分析。结果统计的IE病原菌中,革兰阳性球菌65株占81.3%,其中酿脓链球菌55株占84.6%;革兰阴性杆菌11株占13.8%,其中嗜麦芽寡养单胞菌7株;真菌4株占5.0%,均为白色假丝酵母菌;体外药物敏感性试验发现,感染菌株中革兰阳性菌株对万古霉素、利奈唑胺的敏感性均为100.0%,而对苯唑西林、青霉素、红霉素等敏感性较低,而革兰阴性菌对左氧氟沙星、磺胺甲噁唑/甲氧苄啶的敏感性较高。结论酿脓链球菌仍然是IE的主要病原菌,对万古霉素、利奈唑胺耐药率较低;嗜麦芽寡养单胞菌感染为IE主要革兰阳性菌,其对左氧氟沙星、磺胺甲噁唑/甲氧苄啶耐药率较低;及时掌握其动态变化,做好抗菌药物的宏观管理,对遏制耐药菌的产生具有重要意义。     

多药耐药肺炎克雷伯菌对利福平及磺胺甲噁唑/甲氧苄啶耐药机制的研究

目的 研究多药耐药肺炎克雷伯菌对利福平及磺胺甲噁唑/甲氧苄啶的耐药机制.方法 收集2008年8月-2010年5月浙江省杭州市和湖州市6所医院共47株肺炎克雷伯菌,采用聚合酶链反应(PCR)的方法分析1种利福平耐药相关基因和5种磺胺甲噁唑/甲氧苄啶耐药相关基因.结果 该组肺炎克雷伯菌共检出1种利福平耐药相关基因和3种磺胺甲噁唑/甲氧苄啶耐药相关基因.结论 携带1种利福平耐药相关基因和3种磺胺甲噁唑/甲氧苄啶耐药相关基因是该组菌对利福平和磺胺甲噁唑/甲氧苄啶耐药的一个重要原因.     

晚期恶性实体瘤患者医院感染的病原学分析及治疗

目的 研究分析晚期恶性实体瘤患者并发感染的病原菌分布及耐药性,探讨临床治疗对策,以降低感染发生率.方法 回顾性分析2008年1月-2013年1月收治的晚期恶性实体瘤患者378例,采用法国生物梅里埃公司VITEK微生物全自动分析仪鉴定病原菌,采用纸片扩散法进行药敏试验,依据药敏结果提出临床诊治对策.结果 共送检标本592份,检出病原菌547株,检出率为92.4％;检出革兰阳性菌141株占25.7％,以金黄色葡萄球菌最多70株占12.8％;革兰阴性菌236株占43.1％,以大肠埃希菌最多76株占13.9％,真菌118株占30.7％,以白色假丝酵母菌最多77株占14.1％;革兰阳性菌对万古霉素与替考拉宁的耐药率为0,葡萄球菌属对青霉素、氨苄西林、磺胺甲噁唑/甲氧苄啶的耐药率均＞80.0％,链球菌属耐药率普遍在30.0％～50.0％,大肠埃希菌对氨苄西林的耐药率高达90.0％,对头孢唑林、头孢呋辛、环丙沙星、氨曲南的耐药率普遍＞50.0％,肺炎克雷伯菌仅对阿米卡星、头孢哌酮/舒巴坦、亚胺培南、美罗培南的耐药率在＜30.0％.结论 晚期恶性实体瘤患者并发感染主要为革兰阴性菌,且病原菌耐药现象严重,临床应依据药敏结果,采取针对性地抗菌药物治疗措施.     

小儿下呼吸道感染的病原菌分布及其耐药性分析

目的了解小儿下呼吸道感染(LRI)的常见病原菌分布及其耐药性分析,为临床合理用药提供参考依据。方法收集医院2012年1-12月1 525例因下呼吸道感染住院治疗患儿的痰标本,采用法国生物梅里埃公司VITEK-2全自动微生物分析仪进行细菌鉴定及药敏试验,流感嗜血菌的药敏试验采用ATB微生物药敏分析仪,采用Whonet 5.4软件对数据进行统计分析。结果 1 525例下呼吸道感染患儿痰标本中共分离出病原菌543株,分离率为35.6%,其中革兰阴性杆菌319株占58.75%,革兰阳性菌207株占38.12%,真菌17株占3.13%;检出前6位病原菌依次为肺炎链球菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌、流感嗜血菌,分别占24.49%、18.23%、12.52%、9.58%、7.18%、6.81%;前两位革兰阳性球菌对青霉素类及大环内酯类抗菌药物及克林霉素耐药率高,对万古霉素、利奈唑胺耐药率为0;前3位革兰阴性菌对阿米卡星、亚胺培南、β-内酰胺酶抑制剂类高度敏感;对青霉素类及头孢唑林、头孢曲松耐药率高;流感嗜血菌对第二、三代头孢菌素,氧氟沙星、利福平及阿莫西林/克拉维酸高度敏感,对氨苄西林及磺胺甲噁唑/甲氧苄啶耐药率高。结论肺炎链球菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌、流感嗜血菌是青岛地区小儿下呼吸道感染的常见病原菌,以肺炎链球菌最多见,不同菌种对抗菌药物的耐药率各有差异,临床应根据药敏试验结果合理选用抗菌药物。     

尿路感染常见病原菌的耐药性分析

目的分析医院尿路感染常见病原菌分布及其耐药性,为临床医师合理用药及医院感染控制提供依据。方法收集医院2012年1-12月尿液标本,采用法国生物梅里埃公司全自动细菌鉴定仪VITEK-2Compact进行病原菌分析,药敏试验采用K-B纸片扩散法进行,采用WHONET5.5软件进行数据统计分析。结果共检出病原菌573株,检出阳性率为30.62%,革兰阴性菌380株占66.32%,革兰阳性菌138株占24.08%,真菌55株占9.60%,其中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,真菌以白色假丝酵母菌为主;革兰阴性菌对氨苄西林、左氧氟沙星、磺胺甲噁唑/甲氧苄啶、庆大霉素耐药率较高,对碳青霉烯类抗菌药物较敏感,耐药率<6.0%;革兰阳性菌对万古霉素、利奈唑胺、呋喃妥因100.0%敏感,对左氧氟沙星、磺胺甲噁唑/甲氧苄啶、青霉素、庆大霉素的耐药率较高。结论大肠埃希菌和肠球菌属是泌尿系感染的主要病原菌,由于耐药性逐年增加,临床应在尿培养和药敏试验的基础上合理选用抗菌药物。     

新生儿细菌性感染病原菌分布与耐药性分析

目的探讨新生儿细菌感染性疾病的病原菌分布及耐药性。方法选择医院2016年1-12月细菌培养阳性患儿150例作为研究对象,分析患儿的细菌培养结果和药敏试验结果;采用法国生物梅里埃公司VITEK 32全自动微生物分析仪进行菌种鉴定和药敏试验。结果 150例细菌培养阳性患儿共分离出病原菌192株,标本来自于血液、痰液、咽拭子及脐分泌物等;其中革兰阳性菌93株占48.44%,以表皮葡萄球菌、金黄色葡萄球菌为主;革兰阴性菌99株占51.56%,以肺炎克雷伯菌和大肠埃希菌为主;表皮葡萄球菌对青霉素、红霉素、磺胺甲噁唑/甲氧苄啶的耐药率较高,耐药率分别为92.31%、84.62%、80.77%,对替考拉宁、万古霉素和利奈唑胺的耐药率均为0;金黄色葡萄球菌对青霉素、红霉素和克林霉素的耐药率高,耐药率分别为86.96%、78.26%、69.57%,对替考拉宁、万古霉素和利奈唑胺的耐药率均为0;肺炎克雷伯菌对头孢哌酮、头孢曲松、磺胺甲噁唑/甲氧苄啶的耐药率较高,耐药率分别为67.65%、61.76%、58.82%,对亚胺培南、阿米卡星的耐药率均为0;大肠埃希菌对头孢哌酮、磺胺甲噁唑/甲氧苄啶、头孢曲松的耐药率高,耐药率分别为80.00%、73.33%、63.33%,对阿米卡星的耐药率为0。结论新生儿细菌感染性疾病的病原菌主要为表皮葡萄球菌、金黄色葡萄球菌、肺炎克雷伯菌和大肠埃希菌,其中革兰阳性菌对青霉素类、大环内酯类、磺胺类药物,革兰阴性菌对临床常用的头孢三代、磺胺类药物的耐药性较高。     

Roads, railways, and childhood cancers

Study OBJECTIVES: To locate geographical sources of engine exhaust emissions in Great Britain and to link them with the birth addresses of children dying from cancer. To estimate the cancer initiating roles of nearby roads and railways and to measure effective ranges. DESIGN: Birth and death addresses of all children born between 1955 and 1980 in Great Britain, and dying from leukaemia or other cancer during those years, were linked to locations of railway stations, bus stations, ferry terminals, railways, roads, canals, and rivers. Nearest distances to births and deaths were measured, and migration data relating to children who had moved house were analysed. Excesses of close to hazard birth addresses, compared with close to hazard death addresses, indicate a high prenatal or early postnatal risk of cancer initiation. SETTING AND SUBJECTS: Child cancer birth and death addresses and their map references were extracted from an earlier inquiry. Map references of putative hazards were downloaded from the Ordnance Survey national digital map of Great Britain. These data are recorded to a precision of one metre and have ground accuracies around 20 metres. MAIN RESULTS: Significant birth excesses were found within short distances of bus stations, railway stations, ferries, railways, and A,B class roads, with a relative risk of 2.1 within 100 m, tapering to neutral after 3.0 km. About 24% of child cancers were attributable to these joint birth proximities. Roads exerted the major effect. CONCLUSIONS: Child cancer initiations are strongly determined by prenatal or early postnatal exposures to engine exhaust gases, probably through maternal inhalation and accumulation of carcinogens over many months. The main active substance is probably 1,3-butadiene.     

Reemergence and Autochthonous Transmission of Dengue Virus,Eastern China, 2014

In 2014, 20 dengue cases were reported in the cities of Wenzhou (5 cases) and Wuhan (15 cases), China, where dengue has rarely been reported. Dengue virus 1 was detected in 4 patients. Although most of these cases were likely imported, epidemiologic analysis provided evidence for autochthonous transmission.     

电感耦合等离子体发射光谱法测定奶及奶制品中锌、铁、钙、硒、铅、砷、铜

目的：研究测定奶及奶制品中锌、铁、钙、硒、铅、砷、铜电感耦合等离子体发射光谱法。方法：样品经硝酸消化完全后定容,上机测定,外标法定量。结果：锌、铁、钙、硒、铅、砷、铜检出限0.6、1.2、15、11、5、7、2μg/L,方法精密度RSD在0～20.7%之间,方法回收率在84.0%～110.0%之间。结论：本方法能够满足奶及奶制品中锌、铁、钙、硒、铅、砷、铜含量测定的要求。     

Epidemiology and Spatial Emergence of Anaplasmosis,New York,USA, 2010‒2018

Human granulocytic anaplasmosis, a tickborne disease caused by the bacterium Anaplasma phagocytophilum, was first identified during 1994 and is now an emerging public health threat in the United States. New York state (NYS) has experienced a recent increase in the incidence of anaplasmosis. We analyzed human case surveillance and tick surveillance data collected by the NYS Department of Health for spatiotemporal patterns of disease emergence. We describe the epidemiology and growing incidence of anaplasmosis cases reported during 2010–2018. Spatial analysis showed an expanding hot spot of anaplasmosis in the Capital Region, where incidence increased >8-fold. The prevalence of A. phagocytophilum increased greatly within tick populations in the Capital Region over the same period, and entomologic risk factors were correlated with disease incidence at a local level. These results indicate that anaplasmosis is rapidly emerging in a geographically focused area of NYS, likely driven by localized changes in exposure risk.     

Relationship of thyroid hormone levels to levels of polychlorinated biphenyls, lead, p,p'- DDE, and other toxicants in Akwesasne Mohawk youth

BACKGROUND: It is well documented that acute exposure to high levels of persistent organic pollutants, such as polychlorinated biphenyls (PCBs), p,p'-dichlorophenyldichloroethylene (p,p'-DDE), and hexachlorobenzene (HCB), can affect human health including thyroid function. Chronic exposure to multiple toxicants is common but difficult to analyze, and most prior studies have focused on adults or newborns, creating a gap in our understanding of multitoxicant effects among adolescents. OBJECTIVE: We investigated whether levels of PCBs, p,p'-DDE, HCB, mirex, lead, and mercury reflecting past chronic exposure are associated with alterations in levels of thyroid-stimulating hormone (TSH), triiodothyronine (T(3)), total thyroxine (TT(4)), and free thyroxine (FT(4)) among older children and adolescents. METHODS: The sample consists of youth from the Akwesasne Mohawk Nation (n=232) who reside in proximity to several industries that have contaminated the local environment. We used multiple regression analysis to examine the effect of PCB groupings, p,p'-DDE, HCB, lead, and mercury on thyroid hormones after adjusting for sociodemographic covariates and controlling for all other toxicants. RESULTS: Exposure to PCBs affects the thyroid hormone profile in adolescents. The group of persistent PCBs was positively associated with TSH but inversely related to FT(4). Nonpersistent PCBs were significantly and negatively related to FT(4) only. HCB was negatively associated with T(4), and lead was positively associated with T(3). Breast-fed adolescents had higher levels of persistent PCBs and p,p'-DDE but not of nonpersistent PCBs or any other toxicant when compared with non-breast-fed adolescents. Though having lower levels of persistent PCBs and p,p'-DDE, non-breast-fed adolescents exhibited significant relationships between persistent PCBs and TSH and FT(4), but breast-fed adolescents did not. It appears that PCBs from breast milk obscure the relationship between prenatal PCB exposure and thyroid function by adding random variation in PCB levels. CONCLUSION: Our results demonstrate a reduction in thyroid function in adolescents in relation to their current serum levels of PCBs. These observations are consistent with the hypothesis that pre-natal exposure to PCBs alters thyroid function in a long-lasting manner but does not exclude the possibility that postnatal exposure is influential also.     

Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students

Extensive attention has been paid over the past three decades to the stressors involved in training in the health professions. Although empirical studies have identified demographic subgroups of students most likely to become distressed during training, less research has been carried out to evaluate the impact of students' personality characteristics on their adjustment. Severe perfectionism is one such personality trait that has been shown to increase the risk for anxiety and depressive disorders in other populations. Another set of personality traits linked to increased psychological problems has been labelled the 'impostor phenomenon', which occurs when high achieving individuals chronically question their abilities and fear that others will discover them to be intellectual frauds. Both perfectionism and the impostor phenomenon would seem to be pertinent factors in the adjustment of health professional students; however, these character traits have not been empirically examined in this population. In the present study psychological distress, perfectionism and impostor feelings were assessed in 477 medical, dental, nursing and pharmacy students. Consistent with previous reports, the results showed that a higher than expected percentage of students (27.5%) were currently experiencing psychiatric levels of distress. Strong associations were found between current psychological distress, perfectionism and impostor feelings within each programme and these character traits were stronger predictors of psychological adjustment than most of the demographic variables associated previously with distress in health professional students. Implications for future research, limitations of this study and clinical recommendations are discussed.     

Isolation of Onchocerca lupi in Dogs and Black Flies,California, USA

In southern California, ocular infections caused by Onchocerca lupi were diagnosed in 3 dogs (1 in 2006, 2 in 2012). The infectious agent was confirmed through morphologic analysis of fixed parasites in tissues and by PCR and sequencing of amplicons derived from 2 mitochondrially encoded genes and 1 nuclear-encoded gene. A nested PCR based on the sequence of the cytochrome oxidase subunit 1 gene of the parasite was developed and used to screen Simulium black flies collected from southern California for O. lupi DNA. Six (2.8%; 95% CI 0.6%–5.0%) of 213 black flies contained O. lupi DNA. Partial mitochondrial16S rRNA gene sequences from the infected flies matched sequences derived from black fly larvae cytotaxonomically identified as Simulium tribulatum. These data implicate S. tribulatum flies as a putative vector for O. lupi in southern California.     

Clostridium difficile infection in outpatients, Maryland and Connecticut, USA, 2002-2007

Clostridium difficile, the most commonly recognized diarrheagenic pathogen among hospitalized persons, can cause outpatient diarrhea. Of 1,091 outpatients with diarrhea, we found 43 (3.9%) who were positive for C. difficile toxin. Only 7 had no recognized risk factors, and 3 had neither risk factors nor co-infection with another enteric pathogen.     

Population Structure and Antimicrobial Resistance of Invasive Serotype IV Group B Streptococcus,Toronto, Ontario,Canada

We recently showed that 37/600 (6.2%) invasive infections with group B Streptococcus (GBS) in Toronto, Ontario, Canada, were caused by serotype IV strains. We report a relatively high level of genetic diversity in 37 invasive strains of this emerging GBS serotype. Multilocus sequence typing identified 6 sequence types (STs) that belonged to 3 clonal complexes. Most isolates were ST-459 (19/37, 51%) and ST-452 (11/37, 30%), but we also identified ST-291, ST-3, ST-196, and a novel ST-682. We detected further diversity by performing whole-genome single-nucleotide polymorphism analysis and found evidence of recombination events contributing to variation in some serotype IV GBS strains. We also evaluated antimicrobial drug resistance and found that ST-459 strains were resistant to clindamycin and erythromycin, whereas strains of other STs were, for the most part, susceptible to these antimicrobial drugs.