术后颅内留置管道病原学监测及感染预防

目的　加强颅内留置管道的管理 ,防止医源性感染的发生。方法　对颅内留置管道的病人 ,拔管时、换药时进行细菌培养 ,如有其他并发症时也同时留取标本 ,进行监测。结果　留取标本 2 6 1份标本中2 0份阳性标本进行分析 ,G-杆菌 12株 (占 6 0 % ) ,G+ 球菌 5株 (占 2 5 % ) ,真菌 3株 (占 15 % ) ;在G-杆菌中铜绿假单孢菌 9株 ,肺炎克雷伯 2株 ,不动杆菌 1株 ,有 6例均属于医院感染。结论　医院感染管理人员必须要加强颅内留置管道的管理 ,特别是深部组织插管更应加强管理与指导 ,尽量减少感染 ,避免造成病人经济损失及精神损失。加强抗菌药物的合理应用 ,规范用药 ,才能将耐药菌株降低到最低限度。     

一起皮肤型炭疽疫情的调查报告

炭疽杆菌是需氧性芽胞杆菌属中唯一一种能引起人畜共患病的芽胞杆菌。人类的感染主要是通过接触病畜及其皮毛等病原。2002年夏天，我市许昌县和襄城县相邻的两个自然村在养殖和贩卖羊的农民中，发现了9例疑似皮肤型炭疽病人，经流行病学调查，临床治疗、实验室检验，最终确定为一起皮肤型炭疽爆发疫情。现将结果报告如下：     

青海省2006～2008年炭疽芽孢杆菌培养结果分析

[目的]总结查找炭疽芽孢杆菌检出率较低的原因. [方法]对2006～2008年疑似炭疽标本培养结果及送检标本质量进行描述性分析. [结果]3年来外环境标本检出率为0,生物标本检出率12.7%,将近85%的疑似病人标本送检前巳不同程度用药,12.2%的疑似病人标本无菌生长.[结论]对于疑似炭疽要早发现,早报告;病人标本要在用药前采集,提高外环境样本采集的质量;加强基层实验室检验能力建设.     

一起突发炭疽疫情中炭疽芽胞杆菌的分离及鉴定

目的：2007年8月在辽宁省北部某市JG镇两名村民在屠宰病死牛后怀疑感染了炭疽,采集了相应的样品分离炭疽芽胞杆菌。方法：对采集的一块牛肉及土壤标本分离培养炭疽芽胞杆菌,以生化试验,炭疽血清凝集试验,PCR试验鉴定。结果：从牛肉中分离出一株炭疽芽孢杆菌,经鉴定该分离菌株为炭疽芽胞杆菌。使用了三对引物包括两对质粒PXO1和PXO2上的基因片段及菌体基因进行PCR实验。结论：经PCR试验证实在923、1242、618 bp出现特征条带,为有毒性菌株。     

一起农民家庭屠宰病死羊引发皮肤炭疽疫情的调查和处置

目的 通过对一起家庭屠宰病死羊引发的皮肤炭疽疫情进行流行病学调查，分析其发病原因、病例诊断及报告情况，为炭疽疫情防控提供依据。方法 采用现场流行病学的方法对病例进行调查，对疫情发生后采取的措施进行分析，对疫情防控中存在的问题进行研究。结果 本次疫情为一起散发性人间皮肤炭疽疫情。病例于8月23日在自己家中没有采取任何防护措施的情况下宰杀病死羊，且在4天前左手大拇指关节处有约1～2 mm的小伤口，炭疽杆菌经过伤口感染发病。暴露后第3天伤口出现黑点，无痛感，黑点逐渐增大，第7天直径增至15 mm，颜色炭黑，第8天黑痂周围出现水肿，有痛感，先后就诊于村诊所和县医院骨外科，第9天（9月1日）就诊于乡镇卫生院并以“手指外伤”收治入院，入院后第3天卫生院院长怀疑炭疽并进行了报告。密切接触者和共同暴露者28人，均未感染。病例焦痂期2份黑痂周围水肿渗出液标本炭疽杆菌PCR检测阳性，病例急性期和恢复期双份血清抗炭疽特异性抗体出现阳转，采集27份外环境标本，进行炭疽杆菌PCR检测，其中7份阳性。结论 屠宰羊时应加强个人防护，以防感染；提高广大群众尤其是养殖户等重点人群对病、死畜危害的知晓率。应建立炭疽诊疗知...     

鲍曼不动杆菌医院感染的危险因素及基因分型研究

目的：了解鲍曼不动杆菌医院感染现状及危险因素，并证实医院内危重病人的监护病房（ICU）是否存在由鲍曼不动杆菌同源性菌株引起的感染。方法；对重庆市4所医院内由鲍曼不动杆菌引发的院内感染140例患者的危险因素进行1：1病例对照研究；同时将近期内某院ICU分离的鲍曼不动杆菌进行M13-PCR扩增分型。结果：研究表明与鲍曼不动杆菌医院感染相关的危险因素依次为病情（OR=8.691）、免疫抑制剂（OR=4.85）、机械通气（OR=3.68）、抗生素使用种类（OR=3.014）。基因分型结果显示从ICU分离的11株鲍曼不动杆菌，其中有5株的基因型完全相同。结论：病情、免疫抑制剂、机械通气和抗生素使用种类为鲍曼不动杆菌医院感染危险因素；院内ICU存在多重耐药鲍曼不动杆菌的感染，应加以控制。     

7 249例住院患者医院感染监测结果分析

目的 了解某院住院患者医院感染发病情况。方法 对全院7249例住院患者进行医院感染监测。结果 7249例住院患者中有303例发生医院感染，感染率为4．18％。感染部位以下呼吸道为主。标本送检率41．87％，阳性率61．87％；其中以革兰阴性杆菌为主，占56．04％，革兰阳性球菌占21．98％，真菌占20．88％。结论 加强医务人员感染知识培训，及时对各项监测资料进行分析、反馈，督促合理使用抗菌药物，可有效控制医院感染的发生。     

目标性监测在NSICU的风险分析与精准控制措施研究

目的通过对医院神经外科病房(NSICU)实施目标性监测,评估感染的风险因素,分析NSICU医院感染的现状,为预防和控制NSICU医院感染提供依据。方法根据卫生部2009年颁布的医院感染监测规范要求,对NSICU在2018年收治的325例患者进行了目标性监测和分析。结果 325例患者中,感染部位主要为呼吸道和泌尿道。医院感染45例,感染率13.85%,日感染率17.73‰。呼吸机相关性肺炎(VAP)发生率为15.22‰,导管相关性尿路感染(CAUTI)发生率为5.06‰,导管相关性血流感染(CLABSI)发生率为3.33‰。送检标本以痰液、尿液为主,检出革兰氏阴性杆菌211株,占92.95%,革兰氏阳性菌16株,占7.05%;前3位为肺炎克雷伯杆菌、铜绿假单胞菌和大肠埃希氏菌。结论 NSICU医院感染发病率为13.85%,感染部位以下呼吸道和泌尿道为主,器械相关感染占51.11%,主要病原菌为肺炎克雷伯杆菌、铜绿假单胞菌和大肠埃希氏菌。下呼吸道感染是NSICU精确控制的重点,同时,应加强对呼吸机和导管插管病人的管理和监测,制定有效、准确的控制措施,减少NSICU感染的发生。革兰阴性杆菌是NSICU医院感染的主要病原菌,建议临床治疗应选用革兰阴性杆菌覆盖的抗生素。     

我院医院感染菌的分布及耐药性分析

目的：了解引起医院感染的细菌分布及耐药趋势，为临床治疗及医院感染的控制提供参考。方法：对本院2000年2月－2001年2月从医院感染患者标本中分离出的主要致病菌，采用VITEK－AMS进行鉴定，按美国临床实验标准委员会1999年判断标准用纸片扩散法进行敏感试验。结果：从细菌的分布来看，感染部位主要以下呼吸道为主，全年共分离病原菌790株，革兰阳性菌208株，其中甲氧西林耐药株（MRS）分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的40％和66．2％；革兰阴性菌582株，主要以大肠埃希菌、不动杆菌、铜绿假单胞菌、克雷伯菌、嗜麦芽窄食单胞菌多见，其中产超广谱β－内酰胺酶的革兰阴性杆菌占11．9％，在监测中未发现万古霉素药的金黄色葡萄球菌，但发现1株耐万古霉素的肠球菌；革兰阴性杆菌对亚胺培南耐药率最低，对氨苄西林、哌拉西林、氟喹酮类耐药率较高。结论：医院感染的多重耐药问题相当严重，加强病原菌分布及耐药率监测，指导临床合理用药具有重大意义。     

三峡库区炭疽墓群的卫生清理及评价方法研究

目的探索一套完整炭疽坟墓群卫生清理及其评价方法,用于对奉节县安坪乡炭疽墓群的卫生清理.方法查清炭疽墓分布,通过物理(焚烧)和化学(漂白粉)的方法对炭疽坟墓进行卫生清理,以培养法、荧光PCR法检测炭疽芽孢杆菌和流行病学监测,评价清理效果.结果三峡库区奉节县安坪乡三沱村和东湾村19座(处)炭疽墓群实施了卫生清理,在卫生清理前,有2座检出炭疽芽孢杆菌;经对炭疽墓进行挖掘、泥土消毒、柴油浇注和火焰喷射器点火焚烧棺木与尸骨;墓穴和尸骨残核用漂白粉加强消毒;墓穴(掩埋地)回填夯实并对墓地周围5m范围消毒.消毒作用后1,2,3d、6个月各采样1次,均未检出炭疽芽孢杆菌.卫生清理人员和炭疽墓群地区人畜经18个月的监测,均未出现炭疽感染.结论物理燃烧和化学剂相结合的方法,清理炭疽墓能彻底杀灭炭疽芽孢杆菌.奉节县安坪乡炭疽墓群 的卫生清理方法及评价,为今后国内外清理炭疽坟墓提供可借鉴的技术.     

铁岭市一起皮肤炭疽疫情中炭疽芽胞杆菌的快速检测与分析

目的 对2015年7月铁岭市发生一起皮肤炭疽疫情中运用UPT上转发光免疫分析仪联合荧光定量PCR技术进行描述与分析,探讨可以快速现场检测炭疽芽胞杆菌的方法。方法 采集疑似皮肤炭疽患者的焦痂下涂抹样本10份和炭疽疫区外环境样本19份,运用上转发光免疫层析技术联合荧光定量PCR技术对标本进行检测,与此同时进行细菌分离培养。结果 10份患者的痂下涂抹物样本和2份病死牛血污染土壤样本在上转发光免疫层析技术和荧光定量PCR技术检测结果均呈现阳性。细菌分离培养技术仅分离到1株炭疽芽胞杆菌。结论 实验室检测结果充分证明此次疫情的病原体为炭疽芽胞杆菌的感染。上转发光免疫层析技术和荧光定量PCR方法的联合应用,能快速、特异、灵敏检测出炭疽芽胞杆菌,具有推广应用价值。     

一起皮肤炭疽疫情的病原学确诊及基因型溯源

目的 调查分析一起皮肤炭疽的感染来源,分离鉴定病原菌进行基因溯源,为控制炭疽疫情提供依据。方法 对患者进行流行病学调查,了解染疫病死畜的来源及去向,对病死牲畜饲养场所进行环境卫生学调查,采集患者皮肤炭疽病灶拭子标本,密切接触者血样,病死牲畜圈舍土壤、饲料,出售的病死畜样本。进行炭疽杆菌荧光定量PCR试验,分离培养炭疽杆菌及血清学检测。对分离到的病原菌进行canSNP分型及MLVA15基因分型。结果 本起皮肤炭疽患者多次多点购入16头牛饲养贩卖,在牛死亡后解剖病死牛而感染皮肤炭疽,密切接触者无发病。在病畜屠宰场所土壤及售出的牛皮中分离到2株炭疽杆菌。canSNP分型为A.Br.001/002型,MLVA15分型为MLVA15 - CHN51型,该基因型在国内首次发现。结论 流动牲畜贩运人员是炭疽高危人群,首次在国内报道炭疽基因型MLVA15 - CHN51型,丰富了我国炭疽杆菌的基因库。     

Airborne infection with Bacillus anthracis--from mills to mail

The lack of identified exposures in 2 of the 11 cases of bioterrorism-related inhalation anthrax in 2001 raised uncertainty about the infectious dose and transmission of Bacillus anthracis. We used the Wells-Riley mathematical model of airborne infection to estimate 1) the exposure concentrations in postal facilities where cases of inhalation anthrax occurred and 2) the risk for infection in various hypothetical scenarios of exposure to B. anthracis aerosolized from contaminated mail in residential settings. These models suggest that a small number of cases of inhalation anthrax can be expected when large numbers of persons are exposed to low concentrations of B. anthracis. The risk for inhalation anthrax is determined not only by bacillary virulence factors but also by infectious aerosol production and removal rates and by host factors.     

Environmental sampling for spores of Bacillus anthracis

On November 11, 2001, following the bioterrorism-related anthrax attacks, the U.S. Postal Service collected samples at the Southern Connecticut Processing and Distribution Center; all samples were negative for Bacillus anthracis. After a patient in Connecticut died from inhalational anthrax on November 19, the center was sampled again on November 21 and 25 by using dry and wet swabs. All samples were again negative for B. anthracis. On November 28, guided by information from epidemiologic investigation, we sampled the site extensively with wet wipes and surface vacuum sock samples (using HEPA vacuum). Of 212 samples, 6 (3%) were positive, including one from a highly contaminated sorter. Subsequently B. anthracis was also detected in mail-sorting bins used for the patient's carrier route. These results suggest cross-contaminated mail as a possible source of anthrax for the inhalational anthrax patient in Connecticut. In future such investigations, extensive sampling guided by epidemiologic data is imperative.     

Cross-contamination of clinical specimens with Bacillus anthracis during a laboratory proficiency test--Idaho, 2006

On July 18, 2006, the Utah Department of Health notified epidemiologists at the Idaho Department of Health and Welfare that Bacillus anthracis, the causative agent for anthrax, had been isolated from a patient. On the same day, the Idaho epidemiologists were notified by the Idaho Bureau of Laboratories of a specimen from a second patient received for anthrax testing. The two reports resulted briefly in alerts to the Federal Bureau of Investigation (FBI) and precautionary treatment of one of the patients for anthrax. Subsequent investigation revealed that, during July 2006, the Idaho Bureau of Laboratories had been conducting a sentinel laboratory proficiency testing exercise among Idaho's hospital laboratories. The exercise included specimens with the Sterne strain of B. anthracis, a nonvirulent strain. Subsequent laboratory testing of the two patient isolates detected the Sterne strain of B. anthracis; neither patient had signs or symptoms consistent with B. anthracis infection. Further investigation revealed that the Idaho hospital laboratories that tested the two specimens had been conducting the laboratory proficiency testing exercise simultaneously, but the Idaho epidemiologists were not aware of the exercise. The two specimens had become cross-contaminated with B. anthracis in the laboratories. The findings in this report underscore the need to follow proper laboratory practices to minimize cross-contamination. In addition, to guard against false reports of anthrax, public health epidemiologists who monitor reportable diseases should be notified of upcoming proficiency testing of high-priority bioterrorism agents.     

Anthrax vaccine and public health policy

The Centers for Disease Control and Prevention has classified Bacillus anthracis, the causative organism of anthrax, as a category A potential bioterrorism agent. There are critical shortcomings in the US anthrax vaccine program. Rather than depending on the private sector, the government must assume direct production of anthrax vaccine. The development of a capacity capable of preemptive immunization of the public against anthrax should be considered.     

Investigation of bioterrorism-related anthrax,United States, 2001: epidemiologic findings

In October 2001, the first inhalational anthrax case in the United States since 1976 was identified in a media company worker in Florida. A national investigation was initiated to identify additional cases and determine possible exposures to Bacillus anthracis. Surveillance was enhanced through health-care facilities, laboratories, and other means to identify cases, which were defined as clinically compatible illness with laboratory-confirmed B. anthracis infection. From October 4 to November 20, 2001, 22 cases of anthrax (11 inhalational, 11 cutaneous) were identified; 5 of the inhalational cases were fatal. Twenty (91%) case-patients were either mail handlers or were exposed to worksites where contaminated mail was processed or received. B. anthracis isolates from four powder-containing envelopes, 17 specimens from patients, and 106 environmental samples were indistinguishable by molecular subtyping. Illness and death occurred not only at targeted worksites, but also along the path of mail and in other settings. Continued vigilance for cases is needed among health-care providers and members of the public health and law enforcement communities.     

Passive transfer of protection against Bacillus anthracis infection in a murine model

Passive transfer of lymphocytes and sera from mice immunised using two different formulations containing recombinant protective antigen (rPA) have been used to further elucidate the mechanism of protection against Bacillus anthracis infection. The results demonstrated that an antibody response maybe important in protection against B. anthracis infection, under the conditions tested. The results provide further data for the development of an improved anthrax vaccine.     

Suspected cutaneous anthrax in a laboratory worker--Texas, 2002

On March 6, 2002, CDC's National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation from the director of Laboratory A to assist in the evaluation of a worker who had been diagnosed with cutaneous anthrax. Laboratory A, a provisionally approved Laboratory Response Network level B laboratory, had been processing environmental samples for Bacillus anthracis in support of CDC investigations of the bioterrorist attacks in the United States during fall 2001. Since March 7, CDC has interviewed the ill laboratory worker and other workers at the laboratory and conducted environmental assessments of the workplace. This report summarizes the epidemiologic and environmental investigation of this case, which indicates that the likely source of exposure was the surface of vials containing B. anthracis isolates that the worker placed in a freezer on March 1. Laboratory workers handling specimens of B. anthracis should follow recommended procedures to minimize the risk of B. anthracis transmission and anthrax.     

Efficacy and durability of Bacillus anthracis bacteriophages used against spores

Antibiotics and vaccines help fight anthrax disease, but there are no anthrax spore control methods suitable for use in environments where humans are present. The work reported in this article indicates that bacteriophages may help reduce risk from anthrax spores. Dose-response studies demonstrated that higher concentrations of mixed Bacillus anthracis bacteriophages (3.5 x 10(8) plaque-forming units per milliliter) inhibited subsequent growth of bacteria when sprayed on B. anthracis spores. Phages also were tested for durability under conditions designed to simulate environments possibly encountered during mass phage production, storage, and use against anthrax spores. They remained infectious at temperatures from -20 degrees C to 37 degrees C, under filtration, aerosolization, and treatments with perspiration and blood. Phages were sensitive to temperatures over 55 degrees C and to desiccation. Ultraviolet light reduced spore viability more than phage infectivity under similar conditions. The potential for personal or environmental decontamination of anthrax spores with phages is discussed.