肾结石患者经皮肾镜取石术后泌尿系感染的病原学特点及影响因素分析

目的探讨肾结石患者经皮肾镜取石术后泌尿系感染的病原学特征及影响因素分析,为降低感染提供依据。方法回顾性分析2014年6月-2017年6月医院泌尿外科收治的485例经皮肾镜取石术肾结石患者的临床资料,统计泌尿系感染患者病原菌分布及耐药性,单因素及多因素logistic回归分析发生医院感染的影响因素。结果 485例患者共发生泌尿系感染65例,感染率为13.40%。分离出88株病原菌,革兰阴性菌56株占63.64%、革兰阳性菌30株占34.09%、真菌2株占2.27%。主要革兰阴性菌大肠埃希菌对氨苄西林和甲氧苄啶耐药率均>70.00%,肺炎克雷伯菌对甲氧苄啶、头孢唑林、庆大霉素及四环素耐药率>60.00%,两种病原菌均未检出亚胺培南耐药菌株,主要革兰阳性菌屎肠球菌和粪肠球菌均对青霉素耐药率最高,分别为84.62%和90.91%,对万古霉素耐药率最低均为0.00%;多元Logistic回归分析显示,高龄、合并糖尿病,术前尿WBC满视野(+++)为PCNL术后发生泌尿系感染的独立影响因素。结论针对影响因素,加强监控,预防感染,对已发生感染患者,根据病原菌及药敏试验,合理应用抗菌药物。     

多发肾结石患者微创经皮肾镜取石术后感染耐药菌与药敏分析

目的探讨多发肾结石患者微创经皮肾镜取石术后感染病原菌与药物敏感性。方法回顾性分析2006年1月-2017年4月于医院就诊的多发肾结石患者1 400例的临床资料,均行微创经皮肾镜取石术治疗,根据术后感染情况分为感染组394例和未感染组1 006例;分析感染病原菌与药物敏感性及肌酐(Serum creatinine,Scr)、尿素氮(Blood urea nitrogen,BUN)、超氧化物歧化酶(Superoxide Dismutase,SOD)、丙二醛(Malondialdehyde,MDA),血清氧化应激因子和微量尿蛋白情况。结果多发肾结石患者微创经皮肾镜取石术后感染率为28.14%(394/1400);感染组患者Scr、BUN、微量尿蛋白与MDA分别为(123.15±8.94)μmol/L、(12.46±3.18)mmol/L、(29.81±4.12)mg/L、(33.81±6.15)mmol/L,高于非感染患者(P<0.001),而血清SOD为(401.23±15.79)U/L低于非感染组(P <0.05);氧化应激蛋白NOX2、NOX4、DUOX1分别为(0.61±0.12)mmol/L、(0.62±0.18)mmol/L、(0.59±0.20)mmol/L高于非感染组(P<0.001);394例感染患者共培养分离病原菌408株,其中革兰阳性菌176株占43.14%,以金黄色葡萄球菌、屎肠球菌为主;革兰阴性菌222株占54.41%,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌为主;真菌10株占2.45%;主要革兰阳性菌对万古霉素和利奈唑胺敏感,对青霉素耐药率较高;主要革兰阴性菌对青霉素类抗菌药物耐药率较高,对亚胺培南较敏感。结论多发肾结石患者微创经皮肾镜取石术后感染率较高,术后加强监管预防,可有效降低术后感染发生率,提升其预后效果,具有一定的临床意义。     

肿瘤患者血培养病原菌分布及耐药性分析

目的研究肿瘤患者血培养病原菌的分布及抗菌药物敏感性,为临床合理用药提供科学依据。方法对陕西省某肿瘤医院2014年2月-2016年2月送检的血培养标本进行回顾性统计分析。结果 1 137份血培养标本分离出病原菌123株,其中革兰阴性菌88株,占71.55%,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌较为常见;革兰阳性菌34株,占27.64%,以人葡萄球菌、肠球菌、溶血葡萄球菌较为常见。革兰阴性菌对亚胺培南、美洛培南、哌拉西林/他唑巴坦敏感性高;革兰阳性菌对万古霉素、替加环素、呋喃妥因敏感性高。结论肿瘤患者血培养阳性菌主要为革兰阴性菌,应做好细菌耐药性监测,有效指导临床用药。     

女性盆腔炎病原菌分布与耐药性分析

目的 了解引起女性盆腔炎感染的病原菌分布及耐药情况,为临床正确诊断、合理应用抗菌药物提供科学依据.方法 对分离的348株病原菌用K-B法进行药敏试验,对革兰阴性菌采用ESBLs确认试验检测ESBLs,头孢西丁三维试验检测AmpC酶.结果分离的348株病原菌中,革兰阴性菌215株,占61.78%,主要为大肠埃希菌、肺炎克雷伯菌、褪色沙雷菌;革兰阳性菌127株,占36.49%,以凝固酶阴性葡萄球菌、金黄色葡萄球菌居前2位,革兰阴性杆菌ESBLs、AmpC酶总检出率分别为38.1%、34.9%,单产ESBLs、单产AmpC、同产ESBLs+高产AmpC酶、ESBLs+诱导AmpC酶菌株依次占13.02%、9.77%、13.95%、11.16%,革兰阳性菌除对万古霉素、替考拉宁、喹奴普汀/达福普汀、利福平的耐药率较低外,其余抗菌药物的耐药率均>48.00%,革兰阴性菌对亚胺培南、美罗培南、头孢吡肟的耐药率分别为5.58%、3.72%、26.00%,产酶株较非产酶株具有较高的耐药率(P<0.05).结论 女性盆腔感染以凝固酶阴性葡萄球菌、金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌、褪色沙雷菌为主,万古霉素、替考拉宁对革兰阳性菌,亚胺培南、美罗培南、头孢吡肟对革兰阴性菌具有良好的抗菌活性.     

某三级综合医院2017年度细菌耐药性监测分析

目的了解2017年临床检出病原菌的耐药性,为指导临床合理使用抗菌药物提供理论依据。方法利用微生物分离鉴定系统及纸片扩散法(K-B法)等,对2017年医院门急诊和住院患者临床检出病原菌的分布情况及耐药性进行回顾性分析。结果 2017年共分离病原菌4 547株,其中革兰阴性菌3 163株占69.56%,革兰阳性菌983株占21.62%,真菌401株占8.82%。检出前五位的病原菌分别为大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、金黄色葡萄球菌和铜绿假单胞菌。大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗菌药物的耐药率分别<3.00%和10.00%。铜绿假单胞菌对亚胺培南和美罗培南的耐药率分别为14.67%和6.00%;鲍氏不动杆菌对亚胺培南和美罗培南的耐药率分别高达78.88%和79.37%。结论 2017年临床分离病原菌主要以革兰阴性菌为主,且革兰阴性菌的耐药形势非常严峻,合理选用抗菌药物具有重要意义。     

头孢哌酮/舒巴坦治疗肺部感染病原菌的抗菌活性研究

目的观察ICU患者肺部感染病原菌的分布及构成,研究头孢哌酮/舒巴坦对主要ICU肺部感染患者病原菌的抗菌活性,为临床治疗ICU肺部感染提供依据。方法选取医院2009-2012年ICU发生肺部感染病例152例,对送检标本进行细菌培养,选取主要病原菌对头孢哌酮/舒巴坦等10种抗菌药物进行药敏试验,药敏试验采用纸片扩散法;采用WHONET 5.5软件进行统计分析。结果共分离病原菌183株,其中革兰阴性菌120株占65.57%,革兰阳性菌45株占19.67%,真菌27株占14.75%;排前4位病原菌依次为鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌,分别占21.31%、17.49%、13.66%、10.38%;头孢哌酮/舒巴坦对鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌的敏感率分别为84.62%、90.32%、78.26%、89.47%,其中对鲍氏不动杆菌和铜绿假单胞菌的敏感性均明显高于其他9种抗菌药物,对于肺炎克雷伯菌和大肠埃希菌,仅次于亚胺培南和美罗培南。结论 ICU肺部感染以革兰阴性菌为主,头孢哌酮/舒巴坦为优选的治疗抗菌药物。     

感染性心内膜炎患者血培养病原菌及其耐药性分析

目的 分析感染性心内膜炎患者的病原菌的构成及其耐药性,以指导临床合理用药.方法 选取临床140例感染性心内膜炎患者经血液培养分离得到病原菌,并利用药敏试验对病原菌的耐药性进行分析.结果 病原菌中主要革兰阳性菌为酿脓链球菌72株占49.7％、金黄色葡萄球菌14株占9.7％、表皮葡萄球菌11株占7.6％、肠球菌属7株占4.8％、溶血性葡萄球菌6株占4.1％;主要革兰阴性菌为嗜麦芽寡养单胞菌16株占11.0％、大肠埃希菌11株占7.6％;革兰阳性菌对克拉霉素和利奈唑胺的耐药率较低,革兰阴性菌对亚胺培南、阿米卡星和美罗培南的耐药性较低.结论 感染性心内膜炎患者临床应依据病原菌的类型合理选择抗菌药物进行治疗,以减低耐药菌的产生.     

糖尿病泌尿系统感染的病原菌分布及耐药性分析

目的观察糖尿病泌尿系统感染的病原菌分布及耐药性。方法回顾性分析428例2型糖尿病患者,收集清洁中段尿标本,分离病原菌并做药敏试验。结果共有43例占10.0%发生泌尿系统感染,共分离出46株病原菌,3例复合真菌双重感染占6.5%;革兰阴性菌34株占73.9%,革兰阳性菌9株占19.6%,真菌3株占6.5%,分布最多的病原菌为大肠埃希菌占34.8%、鲍氏不动杆菌占17.4%、铜绿假单胞菌占10.9%和表皮葡萄球菌占10.9%;大肠埃希菌和鲍氏不动杆菌对头孢哌酮/舒巴坦、亚胺培南和美罗培南敏感性高。结论糖尿病患者并发泌尿系统感染率较高,且病原菌耐药性高,应根据药敏结果选择抗菌药物。     

儿童呼吸道感染革兰阴性菌的分布及药敏分析

目的了解该地区儿科呼吸道感染革兰阴性菌分布和耐药情况。方法对2009年1~6月入住医院儿科420例呼吸道感染患儿的痰液标本,做菌株分离培养鉴定和药敏试验,并进行分析。结果分离培养出病原菌212株,检出率50.5%,其中革兰阴性菌148株,占69.8%,大肠埃希菌、肺炎克雷伯菌、流感嗜血菌、铜绿假单胞菌分别占33.1%、26.4%、13.5%和8.1%,占革兰阴性菌的前4位;大肠埃希菌和肺炎克雷伯菌对亚胺培南、头孢吡肟和庆大霉素等敏感;嗜血菌属对头孢噻肟、头孢呋辛、阿莫西林/克拉维酸、氯霉素、环丙沙星和亚胺培南等敏感,对复方新诺明、氨苄西林耐药率高;铜绿假单胞菌对多种抗菌药物耐药,对亚胺培南敏感。结论该地区儿童呼吸道感染以革兰阴性菌感染为主,其中大肠埃希菌、肺炎克雷伯菌、流感嗜血菌、铜绿假单胞菌的感染率较高,临床治疗应根据药敏指导合理使用抗菌药物。     

血流感染病原菌分布与耐药性分析

目的了解血流感染患者病原菌分布及对常用抗菌药物的耐药性,为临床合理使用抗菌药物提供依据。方法对2012年1月-2013年6月临床送检的10 058份血培养标本中分离的菌株,采用纸片扩散法和MIC法进行药敏试验,用WHONET 5.6软件进行统计分析。结果 10 058份血培养标本共分离病原菌1 026株,其中革兰阳性菌395株占38.5%、革兰阴性菌571株占55.7%、厌氧菌26株占2.5%、真菌34株占3.3%;分离最多的为大肠埃希菌245株占23.9%,其次为凝固酶阴性葡萄球菌、肺炎克雷伯菌、肠球菌属及金黄色葡萄球菌分别占19.4%、13.9%、7.7%及4.7%;耐甲氧西林金黄色葡萄球菌和凝固酶阴性葡萄球菌的检出率分别为33.3%和74.9%,未发现耐万古霉素和利奈唑胺葡萄球菌;产ESBLs大肠埃希菌和肺炎克雷伯菌的检出率分别为64.9%和45.5%,大肠埃希菌和肺炎克雷伯菌对亚胺培南耐药率分别为0.4%和14.7%。结论血流感染病原菌以革兰阴性菌为主,大肠埃希菌居首;产ESBLs大肠埃希菌和肺炎克雷伯菌及耐甲氧西林葡萄球菌的检出率高,耐药性严重。     

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.     

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.     

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.     

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.     

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.     

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.