339例泌尿系感染患者菌群分布及耐药性分析

目的探讨分析泌尿系统感染患者病原菌分布及耐药性情况。方法对该院收治的339例泌尿系统感染患者进行细菌鉴定与药敏分析。结果革兰阴性菌(G-)、革兰阳性菌(G+)和真菌分别占59.6%、23.3%、17.1%。检出前几位的病原菌依次为大肠埃希菌、屎肠球菌、白色假丝酵母菌、铜绿假单胞菌、肺炎克雷伯菌、粪肠球菌;产ESBLs大肠埃希菌和肺炎克雷伯菌的检出率分别是65.2%和28.6%;未检出亚胺培南耐药的肠杆科菌株及耐万古霉素和耐利奈唑胺的肠球菌。结论泌尿系统感染患者存在病原菌的多样性以及病原菌耐药性的差异,根据药敏试验结果选择有效抗菌药物合理治疗,可达到理想的治疗效果及减少耐药菌株的产生。     

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。     

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。     

胆汁培养病原菌类型及耐药性分析

目的探讨胆汁培养分离的病原菌分布及耐药性,为临床医师针对性治疗胆道感染提供科学的实验室依据。方法选取2010年1月-2012年12月胆道感染患者409例,无菌手段抽取胆道感染患者的胆汁,采用临床微生物常规操作方法进行病原菌的分离培养和菌种类型鉴定;药敏试验采取WHO规定的纸片扩散法,药敏抑菌圈的量取、结果判断采用CLSI标准折点,应用WHONET5.5软件进行数据处理。结果留取的409份胆汁标本培养出病原菌227株,检出率为55.5%,其中革兰阴性菌151株占66.5%,革兰阳性菌49株占21.6%,真菌27株占11.9%,排名前3位病原菌依次为大肠埃希菌、粪肠球菌、肺炎克雷伯菌,分别占36.1%、14.5%、11.9%;胆道检出病原菌对临床抗感染常用抗菌药物出现了严重的耐药现象,革兰阴性菌对碳青霉烯类药物高度敏感,其中大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌对亚胺培南、美罗培南的耐药率为0,革兰阳性菌中肠球菌属对万古霉素、替考拉宁的耐药率为0;检出产ESBLs大肠埃希菌和肺炎克雷伯菌共55株,产ESBLs细菌检出率为50.5%。结论胆道感染致病菌多为肠道菌群,且耐药性呈上升趋势,医院应加快落实卫生部颁发的《抗菌药物临床应用管理办法》,增强临床医师病原学检测理念,提高胆道感染的临床治疗水平。     

尿路感染病原菌的分布及药物敏感分析

目的了解泌尿系感染的病原菌分布及药物敏感性,为临床正确诊断、合理应用抗菌药物提供科学依据。方法按照《全国临床检验操作规程》要求操作,用法国生物梅里埃公司的VITEK-32细菌鉴定仪鉴定菌种,对临床尿液标本中分离的966株泌尿系感染病原菌进行鉴定。结果在分离的966株病原菌中,共有49个种类,其中革兰阴性菌675株占69.9%、革兰阳性菌183株占18.9%、真菌108株占11.2%;革兰阴性菌以大肠埃希菌为主,革兰阳性菌以粪肠球菌属为主,真菌以白色念珠菌为主。分离数在前7位的病原菌依次为大肠埃希菌(49.0%)、粪肠球菌(9.6%)、肺炎克雷伯菌(7.0%)、白色念珠菌(6.8%)、奇异变形杆菌(3.9%)、铜绿假单胞菌(3.3%)、表皮葡萄球菌(3.0%)。大肠埃希菌产ESBLs检出率为47.3%,肺炎克雷伯菌产ESBLs检出率为33.8%,耐苯唑西林凝固酶阴性葡萄球菌的检出率为37.5%,MRSA的检出率为50.0%。大肠埃希菌对头孢吡肟、头孢他啶、哌拉西林/他唑巴坦、阿米卡星、亚胺培南敏感性较好(70.6%～100%)。结论引起泌尿系感染病原菌的分布广泛,大肠埃希菌为泌尿系感染的主要病原菌。临床医生应重视细菌学培养,结合药物敏感试验和特殊耐药菌株的报告,合理使用抗菌药物以减少、减缓耐药菌株的产生和医院感染的暴发流行。     

尿路感染病原菌的分布及耐药性分析

目的探讨尿路感染病原菌的分布和耐药性分析,为临床合理选用抗菌药物提供科学依据。方法对医院2007年5月-2009年5月,门诊及住院患者尿路感染尿培养分离的病原菌,采用MicroScan40/90全自动微生物分析仪进行细菌鉴定和药敏试验。结果 369株病原菌中,革兰阴性杆菌占81.03%,其中大肠埃希菌占56.91%,肺炎克雷伯菌占10.30%;革兰阳性球菌占14.09%;真菌占4.88%;大肠埃希菌和肺炎克雷伯菌产ESBLs的检出率分别为44.28%和36.84%,肠杆菌科对亚胺培南的敏感率为100.00%,葡萄球菌属、粪肠球菌和屎肠球菌对万古霉素的敏感率为100.00%。结论尿路感染病原菌以大肠埃希菌为主,多药耐药严重,临床应根据病原菌监测和药敏试验结果,合理选用抗菌药物,减少耐药菌株的产生。     

泌尿系感染病原菌的分布及耐药性分析

目的分析泌尿系感染的菌群分布及耐药性特点,为临床选用抗菌药物提供依据。方法按照《全国临床检验操作规程》要求操作,用法国生物梅里埃公司的VITEK-60细菌鉴定仪鉴定菌种,采用K-B法做药敏试验,对临床分离的294株泌尿系感染病原菌进行鉴定及药物敏感试验。结果在分离的294株病原菌中,革兰阴性菌占75.9%、革兰阳性菌占24.1%;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;检出产超广谱β-内酰胺酶(ESBLs)菌63株,其中大肠埃希菌产ESBLs57株,占90.5%;肺炎克雷伯菌产ESBLs 6株,占9.5%;耐高单位庆大霉素肠球菌属21株,占肠球菌属43.7%。结论泌尿系感染的病原菌分布广泛,有些菌株产生多重耐药性;建议临床医生重视细菌学培养,用药敏结果指导临床合理用药,以减少ESBLs菌株的产生。     

864株病原菌分布及耐药性分析

目的对病原菌的分布和抗生素耐药性进行分析,为临床抗感染治疗提供参考依据。方法采用美国DADE产病原菌分布MicroscanAutoscan-4型微生物分析仪对细菌进行鉴定并作药敏试验。结果2005年分离病原菌864株,其中革兰阳性菌557株;革兰阳性菌中凝固酶阴性葡萄球菌占74.85%,金黄色葡萄球菌占22.44%,肠球菌占2.7%;革兰阴性菌307株构成比例最大的前3种病原菌为大肠埃希氏菌、肺炎克雷伯菌和铜绿假单胞菌,分别占革兰阴性菌的35.83%,26.05%和14%;大肠埃希氏菌和肺炎克雷伯菌产超广谱酶(ESBLs),产酶率分别为39.1%和43.6%。结论我院主要感染病原菌为革兰阳性球菌;细菌耐药率普遍较高,且多重耐药占很大的比例,应引起临床和医院管理者的高度重视及合理使用抗生素。     

乌鲁木齐地区超广谱β-内酰胺酶菌株调查及耐药性分析

目的：了解产超广谱β-内酰胺酶（ESBLs）大肠埃希菌、肺炎克雷伯菌分布及不产ESBLs菌株的耐药性、耐药特点，指导临床合理用药。方法：采用VITEK-32自动微生物分析仪及GNI^ 卡鉴定到种，药敏卡GNS/506进行药敏及ESBLs检测。结果：分离革兰阴性杆菌715株。其中大肠埃希菌128株，产ESBLs占22%；肺炎克雷伯菌69株，产ESBLs占14.5%。分离的38株均为高耐三代头孢菌素的ESBLs；从痰标本中分离的肺炎克雷伯菌产ESBLs占14.5%，大肠埃希菌产ESBLs占7%；尿中分离以大肠埃希菌为主，其中产ESBLs占14.8%；耐药性显示38株产ESBLs菌除对亚胺培南100%敏感，对其他护一素耐药率在50%-100%。结论：不产ESBLs的大肠埃希菌和肺炎克雷伯菌对第三代头孢菌素和头孢西丁的耐药率相对较低。肺炎克雷伯菌对氮基糖苷类和喹诺酮类的敏感率明显高于大肠埃希菌，对产ESBLs菌株治疗以亚胺培南最佳 。     

1501份中段尿标本分离病原菌及其耐药性

目的了解某院中段尿标本分离病原菌及其对抗菌药物的耐药性,为临床抗菌治疗提供实验室参考依据。方法对该院2012年10月1日—2015年9月30日临床送检的中段尿标本分离病原菌进行鉴定和药敏试验,应用WHONET 5.6软件对药敏结果进行分析。结果 1 501份中段尿标本共检出病原菌658株,其中革兰阳性菌151株,占22.95%,以凝固酶阴性葡萄球菌和肠球菌为主;革兰阴性菌456株,占69.30%,其中大肠埃希菌占45.44%;真菌51株,占7.75%。病原菌对常用抗菌药物耐药性差异较大,其中大肠埃希菌、肺炎克雷伯菌和奇异变形杆菌中超广谱β-内酰胺酶(ESBLs)菌株的检出率分别为52.84%、41.67%和33.33%,ESBLs菌株的耐药性高于非产超广谱β-内酰胺酶菌株。结论该院中段尿标本分离的病原菌以大肠埃希菌为主,分离菌株对常用抗菌药物耐药严重。     

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.     

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.