产超广谱β-内酰胺酶大肠埃希菌和肺炎克雷伯菌的耐药性及其危险因素分析

目的调查分析产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌的耐药性及危险因素,为临床抗菌药物应用与控制产ESBLs耐药菌感染提供依据。方法检测2009-2013年临床分离的大肠埃希菌及肺炎克雷伯菌药物敏感性,多因素Logistic回归分析产ESBLs耐药菌感染的危险因素。结果 2009年1月-2013年12月,共分离大肠埃希菌2 307株,产ESBLs株1 015株(43.99%);肺炎克雷伯菌2 510株,产ESBLs株333株(13.26%)。除碳青霉烯类及酶抑制剂复合剂外,产ESBLs耐药菌对多种抗菌药物耐药。多因素分析,年龄≥60岁(OR=2.673,95%CI:1.548~4.615)、住院时间≥2周(OR=2.559,95%CI:1.296~5.054)、侵袭性操作(OR=3.022,95%CI:1.993~4.583)、接受广谱抗菌素治疗(OR=2.739,95%CI:1.584~4.738)是产ESBLs大肠埃希菌及肺炎克雷伯菌感染的危险因素。结论产ESBLs大肠埃希菌和肺炎克雷伯菌感染仍处于较高水平。缩短住院时间、重视无菌操作技术,合理应用抗菌药物是预防产ESBLs菌感染的重要措施。     

大肠埃希菌产超广谱β-内酰胺酶的耐药性分析

目的 分析大肠埃希菌(Escherichia coli,E.coli)产超广谱β-内酰胺酶(extended spectrumβ-lactamases,ESBLs)的耐药性.方法 选取2017年6月～2019年6月秦皇岛市第一医院收治的非重复大肠埃希菌感染80例患者作为研究对象,分别对其感染标本中的细菌进行检验、分离培...     

大肠埃希菌临床分离株耐药性的研究

目的 了解医院近两年大肠埃希菌临床标本分离株的耐药性.方法 采用K-B法检测435株大肠埃希菌对19种抗菌药物的耐药性,用三维试验检测AmpC酶和ESBLS.结果 宫颈分泌物、尿液、咽拭子和恶露是检出数最高的标本;大肠埃希菌对氨苄西林、氨曲南、复方新诺明和喹诺酮类药物的耐药率位居前列(49.23%～84.10%),第三、四代头孢菌素的耐药率也高达31.35%～46.80%;尚未发现对亚胺培南和美罗培南耐药株,头孢哌酮/舒巴坦仍有93.38%的敏感率;ESBLS检出率32.67%,AmpC酶检出率5.52%,其中有19株为同时产ESBLs和AmpC酶,单独产AmpC酶菌6株.结论 大肠埃希菌在临床标本中检出率和耐药率日趋严重,临床与实验室应共同采取应对措施,降低医院感染发生率,控制耐药菌的产生和播散.     

大肠埃希菌感染的临床分布与耐药性分析

目的:分析大肠埃希菌感染的临床分布与耐药性.方法:2012年4月19日至2016年9月19日期间收集2500份化验标本为实验对象,通过回顾性分析,发现500株大肠埃希菌感染,同时对其实施细菌鉴定和分离,最后分析各年份的产ESBLS菌株率和大肠埃希菌构成情况.结果:从大肠埃希菌构成情况角度分析,1.00%的大肠埃希菌来源于引流液,1.40%的大肠埃希菌来源于胸腹水,4.40%的大肠埃希菌来源于胆汁,6.40%的大肠埃希菌来源于分泌物,13.20%的大肠埃希菌来源于脓液,12.40%的大肠埃希菌来源于血液,28.00%的大肠埃希菌来源于痰液,31.20%的大肠埃希菌来源于尿液,2.00%的大肠埃希菌来源于其他液体;从产ESBLS菌株率角度分析,2012产ESBLS菌株率为46.66%,2013产ESBLS菌株率为56.32%,2014产ESBLS菌株率为57.54%,2015产ESBLS菌株率为56.63%,2016产ESBLS菌株率为62.18%.结论:大肠埃希菌存在较为严重的耐药情况,为了降低医院感染率和产生更多的耐药菌株,应加强病原菌分布检测和耐药性的检测.     

临床分离大肠埃希菌的科室分布及耐药性变迁

目的:了解温岭地区大肠埃希菌的耐药变迁,为临床治疗提供参考,为控制院内感染提供科学依据.方法:收集2000～2007年临床分离的613株大肠埃希菌,采用ATB微生物鉴定仪进行细菌鉴定和药敏试验.结果:大肠埃希菌主要分布在儿科(23.3%)、大内科(17.0%)、ICU(8.0%)、泌尿外科(7.0%)和脑外科(5.9%).613株大肠埃希菌对氨基糖苷类和喹诺酮类的耐药率出现先高后低现象,对哌拉西林达63.3%～90.7%、一代头孢菌素高达79.6%～88.5%、三代头孢呈逐年上升(6.7%～56.5%),对B一内酰胺类抗菌药物与酶抑制合剂的耐药率较低,对亚胺培南耐药率<1.0%.大肠埃希菌产ESBLS菌株在逐年增加(28.4%～77.1%).结论:大肠埃希菌产ESBLS和耐药性仍呈增长趋势,临床上在治疗大肠埃希菌感染时,应根据药敏试验结果选择敏感的抗菌药物,以提高疗效,减少医院感染.     

产ESBLs大肠埃希菌与肺炎克雷伯菌医院感染及耐药性分析

目的 探讨产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌的临床分布及耐药性特征,为临床合理选用抗菌药物及预防与控制医院感染提供依据.方法 严格按照《全国临床检验操作规程》进行产ESBLs大肠埃希菌和肺炎克雷伯菌分离、鉴定;采用K-B法进行药敏试验,依据CLSI最新折点判读结果.结果 从132株阳性标本中检出产ESBLs菌33株,总检出率25.00％,其中产ESBLs大肠埃希菌27株、肺炎克雷伯菌6株,检出率分别为39.71％和9.38％,未检出泛耐药产ESBLs大肠埃希菌和肺炎克雷伯菌;检出率居首位的为痰液标本,占24.24％;产ESBLs大肠埃希菌和肺炎克雷伯菌对临床常用抗菌药物均产生了严重耐药性,对亚胺培南和美罗培南高度敏感.结论 肿瘤患者大肠埃希菌和肺炎克雷伯菌产ESBLs的检出率有明显增高趋势,应动态监测耐药性变迁,临床治疗中严格掌握抗菌药物应用指征,落实相关医院感染预防与控制措施,防止产ESBLs菌医院感染的暴发流行.     

大肠埃希菌的耐药性及耐消毒剂基因研究

目的 了解大肠埃希菌的耐药性,同时了解产ESBLs大肠埃希菌耐消毒剂基因qacE△1-sul1的流行情况,揭示大肠埃希菌的耐药机制.方法 2007年1月-2011年11月医院分离的3688株大肠埃希菌用VITEK-32GNI+鉴定,GNS-448检测对氨基糖苷类、(p-)内酰胺类、喹诺酮类等15种抗菌药物的耐药性,并对其中36株产ESBLs大肠埃希菌用PCR法检测耐消毒剂基因qacE△1-sul1的流行状况.结果 3688株大肠埃希菌中共检出1660株产ESBLs菌株,检出率为45.0％;大肠埃希菌除对阿米卡星、亚胺培南、美罗培南、头孢西丁、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率较低外,对其他抗菌药物均产生了一定的耐药性,36株产ESBLs大肠埃希菌对氨苄西林、头孢唑林、头孢呋辛、庆大霉素全耐药,未检出亚胺培南、美罗培南耐药株;36株产ESBLs大肠埃希菌耐消毒剂基因qacE△1-sul1检测结果22株阳性,检出率为61.1％.结论 大肠埃希菌耐药性严重,但近几年基本稳定,产ESBLs大肠埃希菌存在多药耐药性;产ESBLs大肠埃希菌耐消毒剂基因qacE△1-sul1检出率较高,且与多药耐药关系密切.     

肛周脓肿术后切口感染大肠埃希菌的危险因素及其耐药基因和毒力因子

目的 分析肛周脓肿术后切口感染大肠埃希菌的危险因素及其耐药基因和毒力因子。方法 选取2017年8月-2021年8月焦作市人民医院收治的肛周脓肿术后切口感染大肠埃希菌患者32例作为研究组,选取同期单纯肛周脓肿术后未发生感染患者32例作为对照组;比较患者临床一般资料,归纳肛周脓肿患者术后感染大肠埃希菌的危险因素;采用最低抑菌浓度分析细菌的耐药性,实时荧光定量聚合酶链式反应(PCR)检出大肠埃希菌耐药基因和毒力基因。结果 合并糖尿病(OR=1.765,P=0.004)、术后使用抗菌药物(OR=1.627,P=0.017)和抗菌疗程(OR=1.654,P=0.027)是肛周脓肿术后切口感染大肠埃希菌的危险因素;大肠埃希菌对氨苄西林(75.00%)、左氧氟沙星(71.88%)、哌拉西林(71.88%)耐药率较高,对亚胺培南和美罗培南最敏感;32株大肠埃希菌中毒力基因fimH检出率为90.63%,traT检出率93.75%,Einv检出率59.38%;耐药基因GyrA检出率为96.88%,GyrB检出率96.88%,blaTEM检出率93.75%;不同毒力因子和耐药基因检出率之间差异有统计学意义(...     

临床标本中大肠埃希菌分布特征及耐药性分析

目的 分析临床分离大肠埃希菌的分布及药敏情况.方法 采集2010年1月至2011年7月临床各科送检细菌培养标本,进行大肠埃希菌的分离、培养,采用黑马微生物分析系统对大肠埃希菌进行筛选鉴定及药敏监测.结果 从临床标本分离出的大肠埃希菌486株,其中男297例,女189例,外科分泌物标本236株(占48.56％),呼吸内科的痰165株(占33.95％),泌尿外科的尿液39株(占8.02％)、其他样本46株(占9.47％).产ESBLs大肠埃希菌198株(占40.74％);产ESBLs大肠埃希菌株对19种抗生素的耐药性均高于大肠埃希菌株,产ESBLs大肠埃希菌对氨基糖苷类、喹诺酮类等抗菌药呈多重耐药,大肠埃希菌株均对亚胺培南敏感.结论 经手术、呼吸道、尿路产生的大肠埃希菌占有较大比重,而且耐药现象严重,根据大肠埃希菌药敏试验合理应用抗生素,尤其是产ESBLs大肠埃希菌株,要不断加强耐药性检测,为临床合理用药提供参考.     

新生儿大肠埃希菌败血症的药敏分析及ESBLs基因分型

目的 探讨医院新生儿大肠埃希菌败血症的耐药性,并对产ESBLs大肠埃希菌进行基因分型.方法 采用MicroScanWalkaway 96SI全自动微生物分析仪对45株新生儿败血症分离的大肠埃希菌进行鉴定及药敏试验,PCR检测大肠埃希菌的ESBLs基因分型,并采用SPSS13.O进行统计分析.结果 45株大肠埃希菌对亚胺培南敏感性最高,为100.O％,产ESBLs检出率高达57.8％,产ESBLs的大肠埃希菌对氨曲南、头孢菌素类几乎全部耐药,对含酶抑制剂类药物、碳青霉烯类和头霉素类抗菌药物敏感率较高(73.1％～92.3％);对26株产ESBLs菌株进行基因分型,发现11株携带有TEM基因,12株CTX-M- 14基因型,两株CTX-M-1基因型,5株SHV基因型,同时部分菌株携带有≥2种β内酰胺酶基因.结论 医院新生儿败血症分离大肠埃希菌耐药性严重,以产ESBLs株为主,其主要基因型为CTX-M基因,但也存在TEM、SHV等多种基因型.     

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.