肾内科患者尿路感染病原菌分布与耐药性分析

目的分析肾内科患者尿路感染病原菌分布及耐药性,以指导临床合理用药。方法回顾性分析医院2012年1月-2013年12月肾内科302例尿路感染患者临床资料,统计分析其感染的病原菌种类分布及病原菌药敏试验结果,采用法国生物梅里埃公司生产的VITEK-32全自动细菌鉴定仪进行细菌鉴定及药敏试验。结果尿路感染患者标本中共分离出154株病原菌,其中革兰阴性菌110株占71.43%,以大肠埃希菌和铜绿假单胞菌为主,分别占20.78%和19.48%,革兰阳性菌28株占18.18%,以粪肠球菌为主占9.74%,真菌16株占10.39%,以白色假丝酵母菌为主占7.14%;大肠埃希菌和铜绿假单胞菌对亚胺培南的耐药率较低,分别为0、13.33%,粪肠球菌对磺胺甲噁唑/甲氧苄啶耐药率较低为20.00%。结论肾内科患者泌尿道感染病原菌以革兰阴性菌为主,其中大肠埃希菌为尿路感染的主要病原菌,其耐药性呈上升趋势,临床上应根据病原菌药敏结果合理使用抗菌药物。     

前列腺增生症患者尿路感染细菌分布特点与耐药性分析

目的探讨前列腺增生症患者尿路感染细菌分布特点及对临床常用抗菌药物的耐药性,为临床诊治前列腺增生症伴有尿路感染提供参考。方法选取2013年4-12月诊治的200例前列腺增生症伴有下尿路感染的患者,对中段尿进行细菌培养及药敏试验检测,分析其病原菌及耐药性,数据采用SPSS16.0软件进行统计分析。结果 84例患者尿液培养分离出病原菌,检出阳性率为42.00%,共分离出96株病原菌,以大肠埃希菌为主,共34株占35.42%;大肠埃希菌、肺炎克雷伯菌、奇异变形菌对庆大霉素、磺胺甲噁唑/甲氧苄啶耐药率均>50.00%;屎肠球菌、粪肠球菌对青霉素、氨苄西林、庆大霉素、左氧氟沙星、环丙沙星的耐药率>50.00%。结论引起前列腺增生症患者尿路感染革兰阴性菌以大肠埃希菌为主,革兰阳性菌以屎肠球菌及粪肠球菌为主,感染病原菌对青霉素类、头孢类、喹诺酮类等大多数抗菌药物有较高的耐药性。     

前列腺增生症患者尿路感染病原菌与耐药性分析

目的研究前列腺增生症患者尿路感染病原菌分布及耐药性,为临床合理用药提供参考。方法选择2011年2月-2015年9月于医院住院治疗的208例前列腺增生尿路感染患者为研究对象,分析患者感染病原菌分布及耐药性;采用SPSS17.0软件进行统计分析。结果共分离出病原菌242株,其中革兰阴性菌165株占68.18%,革兰阳性菌77株占31.82%;前4位病原菌依次为大肠埃希菌、屎肠球菌、粪肠球菌、肺炎克雷伯菌,分别占49.17%、11.57%、9.92%、8.68%;产超广谱β-内酰胺酶(ESBLs)大肠埃希菌对哌拉西林、头孢呋辛、头孢他啶、头孢曲松、氨曲南和左氧氟沙星等药物的耐药性显著高于非产ESBLs菌;产ESBLs肺炎克雷伯菌对哌拉西林、头孢西丁、氨曲南、左氧氟沙星和磺胺甲噁唑/甲氧苄啶等药物的耐药性显著高于非产ESBLs菌,差异有统计学意义(P0.05);屎肠球菌对庆大霉素、青霉素及红霉素的耐药率分别为89.29%、85.71%及82.14%,粪肠球菌对庆大霉素及氯霉素的耐药率分别为91.67%及62.50%。结论前列腺增生尿路感染者的大肠埃希菌、肺炎克雷伯菌及肠球菌属等病原菌存在较高的耐药率,在临床治疗时需综合尿培养及药敏试验结果,合理选择抗菌药物进行治疗。     

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。     

泌尿系感染的病原菌组成及耐药分析

目的 观察泌尿系感染患者病原菌菌群分布及药敏分析.方法 对某院473例尿路感染患者尿培养结果进行分析.结果 清洁中断尿培养阳性率为33.6％,尿路感染的病原菌以革兰阴性菌为主,占所有病原菌感染的59.1％,大肠埃希菌感染占革兰阴性菌58.5％.革兰阳性球菌引起的的感染占全部病原菌的28.9％,其中肠球菌引起的感染占阳性球菌的58.7％.真菌占12.7％.大肠埃希菌产ESBLs和大肠埃希菌不产ESBLs对亚胺培南和美罗培南没有耐药性;肠球菌对红霉素、克林霉素、青霉素和四环素的耐药率较高,对替考拉宁、利奈唑胺和万古霉素的耐药率较低.结论 在泌尿系感染中仍以革兰阴性杆菌为主,合理应用抗生素应以细菌培养和药敏试验为基础.     

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。     

疑似尿路感染患者中段尿样本培养的病原菌分布和耐药性分析

目的分析疑似尿路感染患者中段尿样本培养的病原菌分布和耐药性,为尿路感染的诊断和治疗工作提供研究依据。方法选取2014年5月-2018年5月医院检验科接收的2 852份疑似尿路感染患者中段尿样本,采用VITEK-2 compact全自动微生物鉴定系统进行病原菌鉴定,采用纸片扩散法(K-B法)进行药敏试验,对病原菌分布和耐药性进行回顾性分析。结果共908份样本检出病原菌,阳性率为31.84%;检出1 088株病原菌,其中,革兰阴性菌773株占71.05%,革兰阳性菌221株占20.31%,真菌94株占8.64%。检出病原菌的中段尿标本来源以泌尿外科、肾内科、重症监护病房为主,构成比分别为30.73%、16.30%和13.33%。主要革兰阴性菌对氨苄西林、哌拉西林、环丙沙星、左氧氟沙星、磺胺甲噁唑/甲氧苄啶、头孢噻肟的耐药率较高,对阿米卡星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的耐药率较低;革兰阳性菌对红霉素、四环素、庆大霉素、链霉素的耐药率较高,对呋喃妥因、替考拉宁、氯霉素的耐药率较低;耐甲氧西林金黄色葡萄球菌、产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌及肺炎克雷伯菌和奇异变形菌的检出率分别为50.00%、61.11%、53.13%、34.04%。结论疑似尿路感染患者中段尿样本中的病原菌以大肠埃希菌和铜绿假单胞菌等革兰阴性菌为主,病原菌的耐药性较强,临床医师应对中段尿样本中病原学检测结果给予高度的重视,根据药敏试验结果选用敏感性抗菌药物进行治疗,尽量减少病原菌耐药现象的出现。     

泌尿系统感染患者病原菌分布与耐药性研究

目的研究泌尿系统感染患者病原菌的临床分布及对抗菌药物的耐药性,为临床合理选用抗菌药物提供依据。方法采集2010年1月-2013年12月医院门诊及住院患者尿液标本,进行病原菌培养,尿路感染判断标准依据NCCLS标准,细菌鉴定和药敏试验利用BD Phoenix100仪器,数据分析采用WHONET5.4软件。结果 2010年1月-2013年12月泌尿系统感染患者共分离出病原菌2 995株,其中革兰阴性菌2 226株占74.3%、革兰阳性菌554株占18.5%、真菌215株占7.2%;尿液中最常见的病原菌为大肠埃希菌占44.8%、粪肠球菌占9.3%、肺炎克雷伯菌占8.8%、白色假丝酵母菌占6.7%、铜绿假单胞菌占5.2%;产ESBLs大肠埃希菌和肺炎克雷伯菌检出率分别为52.0%和37.1%,肺炎克雷伯菌对抗菌药物的耐药率普遍高于大肠埃希菌,对阿米卡星、呋喃妥因耐药率<21.6%;屎肠球菌对各种抗菌药物的耐药率明显高于粪肠球菌,未检出耐万古霉素、利奈唑胺菌株。结论应加强泌尿系统感染患者的病原菌检测,指导临床正确合理使用抗菌药物,以减少耐药菌株的产生。     

泌尿系感染患者病原菌分布及药敏特征分析

目的分析泌尿系统感染病原菌分布及耐药特征,为临床合理使用抗菌药物提供依据。方法对2011-2012年3 879例尿路感染患者尿培养中分离出的病原菌,采用法国生物梅里埃公司VITEK-2全自动细菌鉴定药敏仪和GN鉴定卡进行菌株鉴定,AST-GN16药敏卡进行药敏试验,并对产ESBLs耐药表型的菌株用双纸片法进行确证。结果 3 879份尿培养标本检出病原菌1 066株,检出率为27.5%;其中革兰阴性菌765株占71.8%,革兰阳性菌215株占20.2%,真菌86株占8.0%,检出率最高的前4位病原菌依次为大肠埃希菌、屎肠球菌、肺炎克雷伯菌和粪肠球菌,分别占51.3%、11.3%、7.6%和5.9%;大肠埃希菌和肺炎克雷伯菌产ESBLs检出率分别为64.4%、64.2%,产ESBLs大肠埃希菌和肺炎克雷伯菌对亚胺培南、美罗培南敏感率较高,>99.0%,对其余抗菌药物敏感率较低,<78.0%;肠球菌属耐药增长迅速。结论泌尿系统感染病原菌以革兰阴性菌为主,大肠埃希菌是主要病原菌,产ESBLs菌检出率较高且呈多药耐药特征,临床上应根据药敏结果合理用药。     

前列腺增生患者尿路感染病原菌分布及其耐药性

目的探讨前列腺增生患者尿路感染分离病原菌及耐药性情况,为临床诊断及合理使用抗菌药物提供依据。方法收集某院2012年2月8日—2013年10月12日171例前列腺增生合并尿路感染患者尿培养结果,对其进行回顾性分析。结果171例患者共分离病原菌192株,革兰阴性菌占79.17%,其中大肠埃希菌占37.50%,肺炎克雷伯菌占18.75%;革兰阳性菌占18.23%,假丝酵母菌占2.60%。大肠埃希菌和肺炎克雷伯菌中产超广谱β-内酰胺酶(ESBLs)细菌比率较高,分别为72.22%、63.89%,产ESBLs大肠埃希菌对抗菌药物(哌拉西林、头孢呋辛、头孢他啶、头孢曲松、氨曲南和左氧氟沙星)耐药率均高于非产ESBLs菌,产ESBLs肺炎克雷伯菌对抗菌药物(哌拉西林、头孢西丁、氨曲南、左氧氟沙星和复方磺胺甲口恶唑)耐药率均高于非产ESBLs菌。铜绿假单胞菌对亚胺培南、美罗培南耐药率均为50.00%;肠球菌对青霉素类、氨基糖苷类抗生素敏感率低,但未检出对利奈唑胺、万古霉素的耐药株。结论前列腺增生并尿路感染患者分离的菌株有较高耐药率,临床应根据其细菌分布特点及耐药性进行针对性治疗。     

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.