医院感染病原菌分布与耐药性分析

目的 调查医院感染病原菌的分布和耐药性情况，为控制医院感染提供依据。方法 对医院2002年1月-2005年12月，培养分离出的1163株医院感染病原菌的分布和耐药性进行统计和分析。结果 发现G^＋球菌感染占32．3％，G杆菌占40．8％，其中G^-杆菌逐年增高；G^＋球菌以金黄色葡萄球菌为主，MRSA检出率平均达82．5％；G^-杆菌以大肠埃希菌（9．9％）、肺炎克雷伯菌（7．1％）、阴沟肠杆菌（5．4％）和铜绿假单胞菌（5．2％）为主；医院感染病原菌耐药率高并有继续增高趋势；2005年铜绿假单胞菌耐药性变化最大，对头孢他啶和亚胺培南耐药率从前3年的0增至48．9％。结论 医院感染菌中G^-杆菌呈逐年增高趋势，且对常用抗菌药物耐药性高，临床应根据病情及时作病原菌检测，结合药敏试验结果，正确合理使用抗菌药物。     

某医院心脏外科监护病房医院感染情况调查

[目的]调查某医院接受心脏手术的患者在心脏外科监护病房医院感染的发生情况。[方法]对2004年10月至2005年10月接受心脏手术的患者进行医院感染发生部位和感染率调查。[结果]心脏外科监护病房共发生医院感染22例次，医院例次感染发生率为12．15％；其中下呼吸道感染8例，占36．36％；手术部位感染6例，占27．27％；上呼吸道6例，占27．27％；血液系统感染1例，占4．55％；其他部位感染1例，占4．55％。[结论]心脏手术后医院感染发生率高，应引起重视，需采取有效控制措施减少医院感染的发生。     

重症监护病房多器官功能障碍综合征患者医院感染病原菌分布及耐药分析

目的了解重症监护病房（ICU）多器官功能障碍综合征（MODS）患者感染病原菌的分布及耐药情况。方法对ICU40例MODS患者细菌培养结果及药物敏感试验进行回顾性分析。结果检出病原菌173株，G^-菌92株、G^＋菌60株、真菌21株，分别占53．18％、34．68％、12．14％；占前6位的病原菌分别为金黄色葡萄球菌23．70％（其中MRSA为13．87％）、铜绿假单胞菌14．45％、鲍氏不动杆菌11．56％、嗜麦芽寡养单胞菌8．67％、热带假丝酵母菌8．09％、屎肠球菌7．51％；万古霉素对金黄色葡萄球菌及肠球菌属的敏感率为100．00％，鲍氏不动杆菌及肺炎克雷伯菌对碳青酶烯类敏感率高；64．0％的患者发生复数菌感染，复数菌感染的发生与ICU停留时间长、发生呼吸衰竭及应用机械通气有关。结论ICU的MODS患者G^＋菌、真菌感染率及复数菌感染的发生率高，病原菌多为多药耐药，应加强医院感染的监测，合理应用抗菌药物。     

413例细菌性感染患者痰液病原菌分离及耐药性分析

目的了解细菌性感染患者痰液标本的病原菌检出情况及耐药性。方法收集我院门诊和住院患者痰液标本，按照《全国临床检验操作规范》进行常规微生物病原菌分离培养及药敏试验。结果从413例痰液标本中共分离出病原菌181株，阳性检出率为43.8％。其中：革兰氏阳性球菌34株，占病原菌总数的18．9％；革兰氏阴性杆菌139株，占病原菌总数的76．8％；真菌8株，占病原菌总数的4．4％。检出阳性率较高的病原菌依次为：肺炎克雷伯氏菌48株（26．5％）、金黄色葡萄球菌21株（11．6％）、铜绿假单胞菌19株（10．5％）、大肠埃希氏菌16株（8．8％）、凝固酶阴性葡萄球菌9株（5．0％）、阴沟杆菌8株（4．4％）、白色念珠菌6株（3．3％）。引起肺部感染的病原菌革兰氏阳性球菌中金黄色葡萄球菌和凝固酶阴性葡萄球菌对替考拉宁、万古霉素的耐药率最低，均为0。革兰氏阴性杆菌中肺炎克雷伯氏菌对亚胺培南，阿米卡星耐药率较低，分别为0、16．7％；铜绿假单胞菌对环丙沙星、亚胺培南耐药率较低，分别为15．8％、21．1％。大肠埃希氏菌对亚胺培南、阿米卡星耐药率较低，分别为0、12．5％。结论痰液分离培养病原菌结果以革兰氏阴性杆菌为主，占76．8％，革兰氏阳性球菌次之，占18．9％，真菌最少，占4．4％。革兰氏阴性杆菌对亚胺培南的耐药率最低；未发现耐万古霉素和替考拉宁的葡萄球菌；从总体的药敏结果来分析，病原菌多重耐药现象严重。因此，病原菌耐药性监测对指导临床合理使用抗菌药物非常重要。     

血液病患者医院感染的临床资料与病原菌回顾性调查分析

目的 探讨血液病患者医院感染好发部位、病原菌和危险因素,制定预防控制医院感染的干预措施.方法 对426例血液病医院感染患者的病历资料进行回顾性调查分析.结果 血液病患者医院感染的好发部位以呼吸道感染发病率最高占61.9％、其次是口腔感染占9.7％、其余依次为泌尿道感染占7.5％、消化道感染占6.0％、皮肤黏膜感染占6.0％、血液感染占5.2％、其他部位感染占3.7％;医院感染的危险因素是患者年龄、住院天数、白细胞减少、接受放化疗、免疫抑制剂、激素的应用等;医院感染病原菌均为多药耐药菌.结论 应制定有效的干预对策,预防与控制血液病患者医院感染.     

脑卒中患者医院感染研究分析

目的 通过对脑卒中患者医院感染情况的研究分析，探讨其发生医院感染的相关因素。方法 回顾性分析某院1996年1月～2002年12月收治的1265例脑卒中患者的临床资料。结果 1265例脑卒中患者的医院感染发生率为10．99％，脑出血、脑梗死患者的医院感染发生率分别为13．20％，9．93％；感染部位以呼吸道最常见(6．96％)，其次为泌尿道感染(4．35％)；感染病原菌以铜绿假单胞菌、大肠埃希菌和真菌最常见；感染的发生与年龄，有无意识障碍、糖尿病史、吸烟史、预防性应用抗菌药物、皮质激素的使用、侵袭性操作、鼻饲密切相关，而与性别、饮酒史无关。结论 脑卒中患者是医院感染的高发人群，应针对危险因素采取措施，降低其医院感染率。     

医院感染病原菌调查及耐药性分析

[目的] 对我院医院感染病原菌的检出及抗生素耐药性进行分析。为临床抗感染治疗提供参考依据。[方法] 细菌鉴定用传统细菌生化反应,必要时用ATBExpression鉴定．药敏试验用K-B法。[结果] 分离的阳性菌中凝固酶阴性葡萄球菌占10．6％、金黄色葡萄球菌占6．4％,阴性菌中铜绿假单胞菌占20．1％、大肠埃希菌占14．0％,肺炎克雷伯菌占12．6％、不动杆菌占7．0％。[结论] 我院医院感染病原菌以阴性杆菌为主,葡萄球菌和肠球菌为主要的阳性菌,且普遍存在多重耐药。     

重症监护病房医院感染流行病学调查

目的 探讨综合性医院ICU医院感染的流行病学、病原菌分布及耐药情况，为医院感染的防治提供依据。方法 对我院4个ICU于2001年4月-9月收治的796例患进行医院感染前瞻性调查。结果 感染发生率20．0％(159/796)，发生2例次以上感染占29．6％(47/159)；与留置尿管相关的泌尿道感染日发病率为9．9‰，与使用呼吸机相关的肺部感染日发病率为50．1‰，与气管切开相关的肺部感染日发病率为85．9‰；感染部位占前3位的是肺部感染50．0％(104/208)、胃肠道感染21．2％(44/208)和泌尿道感染16．3％(34/208)；分离出188株病原菌，以革兰阴性杆菌为主，占65．4％(123/188)，居前三位的是铜绿假单胞菌26．1％(49／188)，真菌13．8％(26／188)，不动杆菌12．2％(23/188)；革兰阴性杆菌对头孢哌酮／舒巴坦(舒普深)耐药率最低，为11．3％，铜绿假单胞菌、不动杆菌属、肠杆菌科对常用抗生素呈现多重耐药性。结论 ICU获得性感染发生率高，病原菌仍以革兰阴性菌为主，革兰阳性球菌及真菌有上升趋势，细菌耐药性升高，应合理使用抗菌药物。     

血液病患者医院感染调查分析

采用前瞻性调查方法，对某院2005年6月1日-2006年5月31日住院治疗的231例血液病患者进行医院感染监测。231例血液病患者发生医院感染48例（20．77％），57例次（24．68％）；医院感染的发生与患者的中性粒细胞值、年龄、住院时间、化学治疗及肾上腺糖皮质激素的应用密切相关（均P〈0．01）。共培养病原菌95株，其中革兰阳性球菌46株（48．42％），革兰阴性杆菌40株（42．11％），真菌9株（9．47％）。提示血液病患者医院感染率高，应重点监控，并采取有效的预防控制措施，降低其感染率。     

血液科医院感染部位及病原菌分析

目的 了解血液病患者医院感染部位分布、病原菌特点及耐药性,为临床合理选择抗菌药物和医院感染的控制提供参考.方法 对医院血液科2007-2010年住院患者临床分离的病原菌分布及耐药性进行分析.结果 共分离到455株病原菌,医院感染以革兰阴性菌为主,占66.4％,大肠埃希菌为主要病原菌,占20.9％,感染部位以呼吸道、血流和尿路感染为主,痰培养中居首位的病原菌为鲍氏不动杆菌,血和尿培养中居首位的病原菌是大肠埃希菌,大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶的检出率分别为61.1％和38.3％,耐甲氧西林金黄色葡萄球菌和耐甲氧西林表皮葡萄球菌检出率分别为70.4％和86.8％.结论 应针对医院感染高发部位及病原菌特点采取相应措施,以达到预防控制医院感染的目的.     

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.