血培养中病原菌的种类分布及耐药性分析

目的了解败血症患者病原菌分布及其常见病原菌耐药情况。方法败血症患者血培养标本经美国VersaTREK-240血培养仪培养,分离所得菌株用英国先德ARIS2X进行鉴定、药敏和K—B法药敏,比较排位前5位细菌耐特征。结果阳性率为17．0％,288株病原菌中,以表皮葡萄球菌、大肠埃希菌、人型葡萄球菌、金黄色葡萄球菌、肺炎克雷伯菌为主,病原菌对常用抗菌药物的耐药率较高,且医院感染菌的多药耐药率高于院外感染菌。结论病原菌以凝固酶阴性葡萄球菌为主,临床及时掌握败血症的细菌分布与其对抗菌药物的耐药现象和动态,对合理应用抗菌药物具有重要意义。     

综合型医院5382株医院感染病原菌的分布及耐药性分析

目的 了解5382株医院感染病原菌的临床分布及其对常用抗菌药物的耐药情况,指导临床合理应用抗菌药物.方法 收集医院2007年1-12月临床住院患者标本,进行病原微生物的分离、鉴定和药物敏感试验,同时对葡萄球菌属和革兰阴性杆菌分别进行MRSA、ESBLs的检测.结果 在12571份标本中共分离出医院感染病原微生物5382株,其中G-细菌3390株,占62.98%;G+细菌953株,占17.71%,真菌1039株,占19.31%;除真菌外的4343株病原菌中,位列前5位的细菌分别是铜绿假单胞菌(20.5%)、鲍氏不动杆菌(11.2%)、大肠埃希菌(10.8%)、肺炎克雷伯菌(8.6%)、金黄色葡萄球菌(8.3%);病原菌分离阳性率较高的临床科室依次为神经外科、呼吸内科、ICU、肝胆外科和儿科;病原菌耐药结果显示,金黄色葡萄球菌对克林霉素类、喹诺酮类、四环素类抗菌药物的耐药性较高,耐药率均约50.0%,但对万古霉素、替考拉宁、利奈唑烷的敏感度较高;G-菌对亚胺培南、美罗培南、阿奇霉素的耐药率较低,对其他常用抗菌药物的耐药率均30.0%.结论 医院感染病原菌主要为条件致病菌,仍以革兰阴性杆菌为主,病原菌耐药率普遍较高,真菌感染所占比例仍较高;因此,重视病原学检查及药敏监测,有助于临床合理选择和使用抗菌药物.     

早产儿医院感染病原菌分布与耐药性分析

目的对早产儿医院感染进行病原菌分布与耐药性分析,为临床减少医院感染提供理论依据。方法选取2011年1月-2014年6月医院出生的2 035例早产儿,对早产儿医院感染的病原菌分布与耐药性进行统计分析;采用法国生物梅里埃公司VITEK-32自动细菌鉴定药敏仪进行药敏试验,采用SPSS17.0软件进行统计分析。结果 2 035例早产儿中发生医院感染225例,感染率为11.06%;主要感染类型为肺部感染和败血症分别占43.11%和38.22%;共分离病原菌225株,其中革兰阴性菌131株占58.22%、革兰阳性菌61株占27.11%、真菌33株占14.67%;肺炎克雷伯菌对头孢曲松、头孢吡肟、头孢他啶的耐药率较高,>85.00%,鲍氏不动杆菌对头孢曲松、头孢吡肟、头孢他啶的耐药率较高,>73.00%,金黄色葡萄球菌耐药率高的抗菌药物主要有青霉素、头孢唑林,耐药率均为100.00%,表皮葡萄球菌耐药率高的抗菌药物主要有青霉素、头孢唑林、阿莫西林/克拉维酸,耐药率均为100.00%。结论早产儿医院感染率较高,对早产儿医院感染进行病原菌分布及耐药性分析,可指导临床合理使用抗菌药物,减少耐药菌的产生,有效降低医院感染的发生。     

糖尿病合并败血症病原菌分布及耐药情况分析

目的分析糖尿病合并败血症患者病原菌分布及对抗菌药物的耐药情况,为临床疾病判断与治疗提供依据。方法回顾分析113例糖尿病合并败血症住院患者的血培养资料,分析其病原菌特点及药敏情况。结果 113例患者中共分离出114株病原菌,其中革兰阳性球菌43株,占37.72%;革兰阴性杆菌70株,占61.40%;真菌1株,占0.88%。革兰阳性球菌以凝固酶阴性葡萄球菌和金黄色葡萄球菌为主。葡萄球菌对青霉素和氨苄西林的耐药率较高,对万古霉素100%敏感;革兰阴性菌以大肠埃希菌和肺炎克雷伯菌为主,二者对氨苄西林的耐药率为87.8%和100.0%,对亚胺培南100%敏感。结论加强对糖尿病合并败血症患者病原菌的鉴定和药敏分析非常必要,有利于临床早期选择敏感抗菌药物,并降低耐药菌株的扩散。     

2007-2009年临床病原菌分布及耐药趋势分析

目的分析2007-2009年医院临床分离病原菌的种类、分布及耐药趋势,为临床了解病原菌流行状况、合理使用抗菌药物、预防和控制医院感染发生提供依据。方法采用VITEK-32微生物鉴定药敏系统对分离病原菌进行鉴定和药敏试验。结果分离2694株病原菌中,革兰阴性菌1775株占65.9%、革兰阳性菌579株占21.5%、真菌340株占12.6%;细菌分布动态分析表明,近年来革兰阳性球菌感染比例呈下降趋势,而革兰阴性杆菌感染呈上升趋势;药敏结果显示,大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌等常见革兰阴性杆菌对氨苄西林耐药率最高,为87.2%~100.0%;对亚胺培南耐药率最低,为0~23.3%;肠球菌属、葡萄球菌属等革兰阳性球菌对青霉素耐药率较高,为54.7%~100.0%;对万古霉素耐药率最低,为0~16.7%。结论医院临床感染的病原菌以革兰阴性杆菌为主,常用抗菌药物的细菌耐药率有逐年增加的趋势,加强病原菌的检测和耐药性监测,合理使用抗菌药物,对控制细菌耐药性的发生和发展至关重要。     

耳鼻喉科患者病原菌分布与耐药性分析

目的调查耳鼻喉科住院患者病原菌分布和耐药性,为防治医院感染提供理论依据。方法回顾性分析医院耳鼻喉科2012年4月-2015年4月收治1 293例患者的临床资料,调查分析感染部位、病原菌分布与耐药性;采取法国生物梅里埃公司VITEK-2细菌鉴定仪进行菌株鉴定,采用SPSS19.0软件进行统计分析。结果 1 293例患者中发生医院感染98例,感染率为7.6%;共分离出病原菌84株,其中革兰阴性菌46株占54.8%,革兰阳性菌28株占33.3%,真菌10株占11.9%;铜绿假单胞菌对头孢唑林、头孢呋辛、氨苄西林和阿莫西林/克拉维酸等抗菌药物耐药率较高,70.0%,肺炎克雷伯菌对氨苄西林的耐药率为92.3%,金黄色葡萄球菌对红霉素和青霉素G高度耐药,耐药率为50.0%和91.7%,表皮葡萄球菌对红霉素、青霉素G和苯唑西林等抗菌药物高度耐药,耐药率≥80.0%。结论耳鼻喉科患者医院感染率高,感染病原菌以革兰阴性菌为主,临床应加强病原菌监测,根据药敏试验结果合理选择抗菌药物进行治疗。     

神经外科患者下呼吸道感染病原菌分布与耐药性分析

目的探讨神经外科患者下呼吸道感染的病原菌分布特点及对抗菌药物的耐药性,为神经外科预防医院感染及合理应用抗菌药物提供依据。方法收集医院2012年1月-2013年6月收治的972例神经外科下呼吸道感染患者的痰标本,对其进行病原菌检测及药敏试验,数据采用WHONET5.3软件进行统计分析。结果 972份痰培养标本检出病原菌286株,检出率为29.42%,其中革兰阴性菌173株占60.49%,革兰阳性菌82株占28.67%,真菌31株占10.84%,前4位病原菌依次为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌,分别占20.63%、14.33%、12.24%、9.79%;大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌对氨苄西林的耐药率为100.00%,肺炎克雷伯菌对亚胺培南的耐药率为0,革兰阳性菌对万古霉素、磺胺甲噁唑/甲氧苄啶耐药率较低,其中金黄色葡萄球菌和表皮葡萄球菌对万古霉素的耐药率为0,金黄色葡萄球菌对青霉素的耐药率为100.00%。结论神经外科住院患者下呼吸道感染病原菌主要为革兰阴性菌,主要病原菌的耐药形式较为严峻,应根据药敏试验结果严格使用抗菌药物,采取有效措施,控制医院感染的发生。     

骨科患者医院感染病原菌分布及耐药性变迁

目的分析骨科患者医院感染流行病学分布及耐药性,以指导临床合理选择抗菌药物。方法通过细菌分离培养和药敏试验方法,对某医院患者送检病原学标本进行检测和分析。结果 2015年-2017年骨科住院患者医院感染平均感染率为1. 61%,感染部位以皮肤软组织感染最多,占26. 88%;表浅切口感染占22. 11%;下呼吸道占17. 17%;以男性患者居多,革兰阴性菌检出1 199株,占51. 75%;其中以肺炎克雷伯菌最常检出(229株),占9. 88%;革兰阳性菌检出964株,占41. 61%,金黄色葡萄球菌检出329株,占14. 20%,真菌154株,占6. 65%;不同标本来源检出病原菌有所差异;病原菌对万古霉素无耐药菌检出,对青霉素类抗菌药物耐药率最高。结论骨科患者医院感染病原菌对抗菌药物的耐药性高,因此应严格按照细菌培养结果和耐药试验结果合理应用抗菌药物,降低骨科患者耐药率。     

2012-2014年医院感染主要病原菌耐药趋势分析

目的了解某院医院感染主要病原菌对不同类型抗菌药物的耐药性及其耐药趋势,为指导临床合理选用抗菌药物提供科学依据。方法采用美国BD PhoemixTM100全自动细菌鉴定/药敏分析仪对2012年1月-2014年12月医院感染患者所有送检标本进行细菌鉴定及药敏试验,WHONET5.6软件分析其耐药率,使用SPSS 13.0统计软件进一步分析其耐药变化趋势。结果 3年共检出医院感染病原菌1 202株,检出前5名依次为大肠埃希菌、白色假丝酵母菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌,其多药耐药菌所占比重较2013年有所上升;大肠埃希菌表现出对β-内酰胺类含酶抑制剂敏感性稍差,对哌拉西林/他唑巴坦的耐药率为10.10%~21.40%;肺炎克雷伯菌对阿莫西林/克拉维酸、氨曲南等22种抗菌药物耐药率维持在75.00%以下;金黄色葡萄球菌对氨苄西林、青霉素G耐药率维持较高水平,均>75.00%,2013年检出2株耐万古霉素金黄色葡萄球菌。结论医院感染主要病原菌耐药率总体维持在较高水平,需进一步加强对细菌耐药性监测,综合分析后合理选用抗菌药物。     

新生儿败血症的细菌分布和耐药率分析

目的了解湖北地区新生儿败血症的细菌分布和耐药率,为临床合理用药提供依据。方法对湖北省16所医院2000~2004年的新生儿血培养阳性数据资料进行分析。结果1 019株细菌中,革兰阳性菌948株(93%),革兰阴性菌71株(7%),主要的分离菌为凝固酶阴性葡萄球菌(CNS)(79.8%),其次是肠球菌属(7.0%)、金黄色葡萄球菌(SAU)(4.5%)、克雷伯菌属(1.7%)和嗜麦芽寡养单胞菌(1.2%);19.6%的SAU和71.3%的CNS为耐甲氧西林葡萄球菌(MRSA),肠球菌属46.5%耐氨苄西林,除1株鹑鸡肠球菌外,均对万古霉素敏感;56%大肠埃希菌和35%肺炎克雷伯菌ESBLs阳性;革兰阴性杆菌对亚胺培南、阿米卡星和氟喹诺酮类抗菌药物耐药率较低在0~15.6%之间,对头孢一~四代抗菌药物的耐药率在20%~70%之间。结论新生儿败血症的主要病原菌为革兰阳性球菌,根据药敏结果合理使用抗菌药物降低病死率,采取一切措施降低医院感染的发生更为重要。     

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.