重症监护病房感染病原菌分布及体外耐药性监测

目的 调查医院重症监护病房(ICU)患者临床感染病原菌的分布及耐药趋势.为临床合理选用抗菌药物提供依据.方法 对2005年1月-2006年12月ICU住院患者送检的各类标本中分离出的病原菌采用自动微生物分析仪ATB Expression及配套试剂进行细菌鉴定和药敏试验.结果 共分离病原菌1197株,以革兰阴性杆菌为主占64.2%,革兰阳性球菌和真菌比例较高,分别占19.6%和15.8%;革兰阴性杆菌中铜绿假单胞菌居于首位,非发酵菌所占比例较高,除大肠埃希菌(40.9%)外,褪色沙雷菌、肺炎克雷伯菌、鲍氏不动杆菌和阴沟肠杆菌产超广谱β-内酰胺酶(ESBLs)比率均＞70.0%;革兰阳性球菌以金黄色葡萄球菌为主,耐甲氧西林金黄色葡萄球菌(MRSA)占93.8%;各类对常用抗菌药物表现为严重耐药和多药耐药;真菌189株,主要为白色假丝酵母菌(4.9%)、光滑假丝酵母菌(4.5%)和热带假丝酵母菌(4.4%),对氟康唑、酮康唑及两性霉素B均敏感.结论 ICU患者感染及多药耐药严重,加强耐药性监测,合理使用抗菌药物十分重要.     

老干部病房医院获得性肺炎常见病原菌及其耐药性分析

目的 了解老干部病房医院获得性肺炎(HAP)常见病原菌及其耐药性.方法 对医院老干部病房2005年1月-2007年12月HAP患者痰标本中分离出的病原菌及其耐药性进行回顾性分析.结果 共分离出174株病原菌,前5种病原菌分别为铜绿假单胞菌(17.82%)、肺炎克雷伯菌(14.94%)、金黄色葡萄球菌(13.22%)、鲍氏不动杆菌(9.20%)和白色假丝酵母菌(8.62%);革兰阴性杆菌和革兰阳性球菌普遍呈现多药耐药性.结论 综合性医院老干部病房HAP发病率高,病原菌以革兰阴性菌为主,常呈多药耐药,及时掌握HAP的常见病原菌及药敏情况,有助于临床合理选用抗菌药物.     

1368份血培养的病原菌分布及耐药性分析

目的 了解血培养阳性致病菌菌谱以及药敏情况,为抗菌药物合理使用提供理论依据.方法 采用美国BD公司BACTEC9050型全自动血培养仪及其配套培养瓶,所有菌株按照常规操作流程进行鉴定,药敏试验采用K-B纸片扩散法,细菌菌谱及耐药性分析用WHONET5.5软件.结果 1368例血液培养标本中共分离出29种119株病原菌,检出率为8,7％;其中革兰阳性球菌63株,占52.9％,革兰阴性杆菌51株,占42.9％,真菌4株,占3.3％,革兰阳性杆菌1株,占0.8％;葡萄球菌属、链球菌属、肠球菌属耐药率各异,但均未发现万古霉素耐药菌株;革兰阴性杆菌中,各菌属对抗菌药物均有一定的耐药率;但均未发现亚胺培南和美罗培南耐药株;白色假丝酵母菌对多数抗真菌药物有一定程度的耐药,但耐药率均＜25.0％,仅对两性霉素B 100.0％敏感.结论 血液培养病原菌菌谱较广,以革兰阳性球菌为主,革兰阴性杆菌次之,且耐药情况普遍存在,因此应及时对血液细菌进行耐药性监测并指导临床合理使用抗菌药物.     

2009-2011年ICU菌群分布及耐药性分析

目的 了解2009-2011年医院ICU患者菌群分布情况及其耐药性,以指导ICU合理用药.方法 收集2009年1月-2011年12月入住医院ICU病原菌培养阳性患者2510例,用VITEK-2 Compact全自动细菌检定仪或API鉴定系统进行菌株鉴定及药敏分析,对致病菌株的分布构成及药敏结果进行分析.结果 共分离出病原菌2510株,其中革兰阴性杆菌1553株占61.87％,革兰阳性球菌434株占17.29％,真菌523株占20.84％;前4位病原菌依次为鲍氏不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌、白色假丝酵母菌,分别占16.73％、12.31％、10.60％、10.60％;菌株来源以痰液为主,1487株占59.2％,其次为血液标本,246株占9.8％;主要革兰阳性球菌对常用抗菌药物耐药率普遍较高,但对氯霉素较敏感,未发现对利奈唑胺、万古霉素、替考拉宁耐药菌株,除大肠埃希菌对美罗培南、哌拉西林/他唑巴坦100.0％敏感外,主要革兰阴性杆菌对常用抗菌药物均产生了较严重的耐药性.结论 近3年ICU感染仍以革兰阴性菌为主,但耐药率有上升趋势,其中鲍氏不动杆菌耐药现象严重,真菌感染有上升趋势,动态监测ICU病原菌分布和耐药性变化具有重要意义.     

ICU医院感染病原菌分布及耐药性分析

目的 分析ICU医院感染病原菌分布及耐药性,为临床危重患者抗感染治疗提供依据.方法 对2010年7月-2011年10月ICU所送标本的细菌培养及药敏试验结果进行回顾性分析.结果 共检出病原菌618例,其中革兰阴性杆菌400株,占64.7％,以鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌多见;革兰阳性球菌46株,占7.5％,以葡萄球菌属及肠球菌属为主;真菌172株,占27.8％,以白色假丝酵母为主;病原菌耐药现象较严重,常呈多药耐药.结论 ICU患者常呈多重感染,且对常用抗菌药物多药耐药,定期对ICU进行流行病学调查,临床医师应加强医院感染监测,根据药敏结果合理选用抗菌药物.     

中医院ICU医院感染常见病原菌耐药性监测

目的 了解中医院重症监护病房(ICU)患者医院感染常见病原菌的分布及抗菌药物敏感性,为临床医师合理使用抗菌药物提供参考依据.方法 细菌培养鉴定按照《全国临床检验操作规程》,采用常规方法进行;药敏试验采用CLSI推荐的K-B法,结果判断依据CLSI 2010-2011年标准进行,并制定医院感染预防控制措施.结果 分离出常见病原菌459株,以革兰阴性杆菌为主,占70.6％,其中铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌和肺炎克雷伯菌分离率最高,分别占25.1％、14.8％、10.5％和9.6％;革兰阳性球菌次之,占21.4％,其中分离率最高的为金黄色葡萄球菌、凝固酶阴性葡萄球菌和粪肠球菌,分别占8.9％、5.5％和3.9％;真菌占8.0％,主要为白色假丝酵母菌占6.3％;多数病原菌呈严重耐药和多药耐药,铜绿假单胞菌、鲍氏不动杆菌对碳青霉烯类亚胺培南、美罗培南已产生了22.6％～30.9％的耐药率;革兰阳性球菌对糖肽类抗菌药物100.0％敏感.结论 中医院ICU医院感染病原菌的耐药性已十分严重,应重视ICU病原菌耐药性监测,制定预防控制措施,以指导临床医师合理用药.     

血培养病原菌的临床分布及药物敏感性分析

目的:了解医院2006年1月-2009年6月血培养结果及病原菌的耐药状况,为血液感染性疾病的诊断、治疗提供依据。方法:回顾性分析我院导致血液感染的1345株病原菌的分布及其抗菌药物耐药状况。结果:从血液标本中培养分离病原菌1345株。其中革兰阴性菌550株,占40.8%,包括大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、鲍曼不动杆菌;革兰阳性菌468株,占34.9%,包括金黄色葡萄球菌、表皮葡萄球菌、人型葡萄球菌、溶血葡萄球菌、屎肠球菌、粪肠球菌、草绿色链球菌;酵母菌39株,占2.9%,包括热带假丝酵母菌、白色假丝酵母菌、近平滑假丝酵母菌。革兰阴性杆菌对亚胺培南、阿米卡星的敏感性较高,革兰阳性球菌对利奈唑胺、磷霉素、万古霉素、替考拉宁较为敏感,真菌对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑均敏感。结论:血液感染患者菌种复杂,革兰阴性杆菌为引起菌血症的主要病原茵,药敏结果提示检出菌株耐药性强且广谱耐药,应加强病原菌耐药性监测,合理使用抗菌药物。     

脑卒中患者医院获得性肺炎的病原学及耐药性分析

目的探讨脑卒中患者医院获得性肺炎（HAP）的病原菌分布特点及耐药性,为合理使用抗菌药物提供依据。方法对143例脑卒中合并HAP患者的痰培养及药敏结果进行回顾性分析。结果共分离出病原菌168株,其中革兰阴性菌占61．90％（104／168）,主要为肺炎克雷伯杆菌、铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌、阴沟肠杆菌等;革兰阳性菌占25．60％（43／168）,以金黄色葡萄球菌最多见,其次为凝固酶阴性葡萄球菌和粪肠球菌;真菌占12．50％（21／168）,主要为白色假丝酵母菌。致病菌对常用抗菌药物都产生了不同程度的耐药性。结论脑卒中患者HAP的主要病原菌是革兰阴性菌,耐药率普遍较高,应根据病原学分析,合理应用抗菌药物。     

医院病原菌的分布特点及耐药性分析

目的 监测住院患者常见病原菌的分布及耐药特征,指导临床合理应用抗菌药物.方法 采用MicroScan AutoScan-40半自动微生物鉴定仪和药敏系统及配套进行菌株鉴定与药物敏感性测定,并检测超广谱β-内酰胺酶(ESBLs)及耐甲氧西林金黄色葡萄球菌(MRSA),用WHONET5软件进行数据统计分析.结果 1439株临床分离菌株中革兰阴性杆菌965株占67.1％,主要为大肠埃希菌、克雷伯菌属、鲍氏不动杆菌、铜绿假单胞菌,大肠埃希菌和肺炎克雷伯菌产ESBLs分别为55.3％％和32.8％;革兰阴性杆菌对大多数抗菌药物耐药;革兰阳性球菌223株占15.5％,主要为金黄色葡萄球菌、凝固酶阴性葡萄球菌、肠球菌属,葡萄球菌属、肠球菌属耐药率较高,尚未检测到万古霉素耐药株;真菌251株占17.4％,其中以白色假丝酵母菌为主.结论 医院临床分离的病原菌种类多且耐药率高,以革兰阴性菌为主、革兰阳性球菌及真菌感染有增多趋势;临床应重视病原学检查及根据药敏结果合理应用抗菌药物,以减少病原菌耐药的发生.     

老年患者泌尿道感染病原菌分布与耐药性分析

目的 了解老年患者泌尿道感染病原菌的分布和耐药状况.方法对312例泌尿道感染的老年患者分离的406株病原菌进行常规细菌培养,用K-B法进行药敏分析.结果老年泌尿道感染患者的病原菌以革兰阴性杆菌为主,占67.0%,主要有大肠埃希菌、变形菌属、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、鲍氏不动杆菌;革兰阳性球菌占29.1%,主要有屎肠球菌、粪肠球菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌,同时还检出白色假丝酵母菌16株(4.0%);药敏结果显示,革兰阴性杆菌对亚胺培南、头孢哌酮/舒巴坦、阿米卡星较为敏感,革兰阳性球菌对万古霉素均敏感.结论老年患者泌尿道感染的病原菌耐药性严重,应定期监测病原菌的耐药趋势,以指导临床医生合理应用抗菌药物.     

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.