恶性肿瘤患者下呼吸道感染病原菌分布及耐药性分析

目的探讨恶性肿瘤患者下呼吸道感染病原菌分布及其耐药性,指导临床合理用药。方法选取医院2006年5月-2011年9月收治的605例恶性肿瘤患者进行回顾性分析,使用法国生物梅里埃公司ATB1525Expression全自动细菌鉴定分析仪进行菌株鉴定,使用纸片扩散法探究菌株耐药性。结果共检出病原菌605株,其中革兰阴性菌322株占53.2%,革兰阳性菌113株占18.7%,真菌170株占28.1%,排前5位的病原菌依次为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、嗜麦芽寡养单胞菌,分别占15.2%、11.4%、10.6%、8.3%、4.5%;革兰阴性菌对亚胺培南/西司他丁、头孢哌酮/舒巴坦、阿米卡星及环丙沙星耐药率较低;革兰阳性菌对万古霉素耐药率最低,敏感率达100.0%,除万古霉素外,革兰阳性菌对其他抗菌药物耐药性均较高。结论恶性肿瘤患者下呼吸道感染的主要病原菌为革兰阴性菌,革兰阴性菌对亚胺培南/西司他丁耐药率较低,革兰阳性菌对万古霉素耐药率最低,对于出现感染的患者可根据其菌种选择适合的抗菌药物进行治疗。     

脑血管疾病患者医院感染的病原菌分布与耐药性分析

目的调查脑血管疾病患者医院感染的病原菌分布及其耐药性,指导临床合理使用抗菌药物。方法回顾性分析医院2010年1月-2014年1月122例脑血管疾病合并医院感染患者的临床资料,统计分析其感染病原菌种类及对常用抗菌药物的耐药率,数据采用SPSS13.0统计软件进行分析。结果 122例患者感染部位以下呼吸道感染最多47例、泌尿道25例、胃肠道感染21例,分别占38.5%、20.5%、17.2%;共分离出病原菌155株,其中革兰阴性菌81株占52.3%、革兰阳性菌59株占38.0%、真菌15株占9.7%;肺炎克雷伯菌对亚胺培南、阿米卡星和左氧氟沙星的耐药率较低,分别为0、11.1%和18.5%,金黄色葡萄球菌对万古霉素、美罗培南和庆大霉素的耐药率较低,分别为0、11.8%和17.6%,肠球菌属对万古霉素和美罗培南的耐药率较低,分别为0和7.1%。结论脑血管疾病患者医院感染的病原菌以革兰阴性菌为主,革兰阴性菌对亚胺培南和阿米卡星最敏感,革兰阳性菌对万古霉素和美罗培南最敏感,医院感染患者的治疗应参考病原菌药敏试验结果,合理选用抗菌药物,避免滥用广谱型抗菌药物,减少耐药菌株产生。     

抗甲状腺药物致粒细胞缺乏患者医院感染的研究

目的探讨抗甲状腺药物致粒细胞缺乏患者发生医院感染的病原菌分布及其耐药性,为临床选择敏感抗菌药物提供参考。方法选取2010年5月-2013年5月34例甲状腺药物致粒细胞缺乏发生医院感染患者为研究对象,分析感染病原菌的分布和对抗菌药物的耐药性,所有数据采用SPSS16.0软件进行统计分析。结果粒细胞缺乏症患者医院感染部位以呼吸道感染为主占41.18%,其次为泌尿系和皮肤软组织,分别占26.47%和11.76%;共分离病原菌42株,其中革兰阴性菌19株占45.24%、革兰阳性菌20株占47.62%、真菌3株占7.14%;革兰阳性菌中金黄色葡萄球菌对万古霉素和美罗培南耐药率最低,均为0;主要革兰阴性菌则对美罗培南、亚胺培南耐药率最低,均为0;对其他抗菌药物的耐药率均>20.00%。结论甲状腺药物致粒细胞缺乏合并医院感染以呼吸道常见,加强细菌培养、药敏试验,早期应用敏感抗菌药物至关重要。     

全髋关节置换患者术后感染的病原菌分布及耐药性研究

目的分析骨科全髋关节置换术后感染患者的常见病原菌分布及耐药性,为临床合理使用抗菌药物提供依据。方法对骨科2007年3月-2013年2月全髋关节置换后398例感染患者标本中分离出的120株病原菌进行菌种鉴定及耐药性分析,感染标本采集及菌种分离培养按照《全国临床检验操作规程》进行,菌种鉴定采用法国生物梅里埃公司全自动微生物系统进行,药敏试验采用K-B法。结果 398例全髋置换术后感染患者临床标本中共分离病原菌120株,检出率30.2%;120株病原菌中革兰阳性菌62株占51.7%,其中金黄色葡萄球菌检出最多占27.5%,革兰阴性菌58株占48.3%,其中铜绿假单胞菌检出最多占18.3%;革兰阳性菌的耐药率有上升趋势,但对糖肽类抗菌药物100.0%敏感,革兰阴性菌呈现不同程度耐药性。结论全髋关节置换术后感染患者的病原菌耐药问题非常严重,应加强病原菌耐药性监测,指导临床有针对性地使用抗菌药物,以便有效地预防与控制感染。     

医院感染与多重医院感染的病原菌分布及耐药对比分析

目的为探讨普通与多重医院感染病原菌的临床分布及对不同抗菌药物的耐药性,以指导临床合理选用抗菌药物。方法对2005年1月~2008年10月的住院患者中,普通与多重医院感染所分离到不同的病原菌,进行菌种分布和耐药性的回顾性统计比较分析。结果在普通医院感染所分离的1037株病原菌中,革兰阴性菌480株,占46.29%,革兰阳性菌351株,占33.85%,真菌206株,占19.86%;在多重医院感染所分离的284株病原菌中,革兰阴性菌139株,占48.94%,革兰阳性菌97株,占34.16%,真菌48株,占16.90%,两组病原菌分布革兰阳性菌均以葡萄球菌属为主,但革兰阴性菌两组明显不同;病原菌耐药显示,革兰阳性菌中普通医院感染较多重医院感染耐药率大多偏低,但已发现耐万古霉素、替考拉宁肠球菌菌株;革兰阴性菌中对美罗培南、亚胺培南耐药率较低外,妥布霉素、庆大霉素等对普通医院感染中的肺炎克雷伯菌、鲍氏不动杆菌均有较低的耐药率,且两组差异有统计学意义(P0.01)。结论两组医院感染的病原菌仍以革兰阴性菌为主,但分类中两组革兰阴性菌种类排序明显不同,两组对常用抗菌药物的耐药率也有所不同,对指导应用抗菌药物有一定的临床意义。     

重症监护病房医院感染病原菌分布及其耐药性分析

目的探讨重症监护病房(ICU)患者医院感染及耐药性,为临床合理选用抗菌药物提供依据。方法回顾性调查医院ICU 2009年6月-2010年5月感染患者分离的病原菌,检测其耐药性并进行统计分析。结果共分离出病原菌105株,医院获得性感染中仍以革兰阴性菌为主,占67.6%,其次革兰阳性菌,占29.5%,真菌占2.9%;革兰阴性菌以鲍氏不动杆菌、肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌为主;革兰阳性菌以金黄色葡萄球菌为主;革兰阴性杆菌对亚胺培南、美罗培南较敏感;革兰阳性球菌仍对万古霉素最为敏感,尚未发现耐药株。结论 ICU医院感染病原菌以革兰阴性杆菌为主,细菌对常用抗菌药物的耐药严重,且呈多药耐药;应加强ICU细菌耐药性检测,严格掌握抗菌药物使用原则。     

电视胸腔镜辅助微创肺癌根治术后患者切口感染病原菌分布及耐药性分析

目的分析电视胸腔镜辅助微创肺癌根治术后患者切口感染的临床特点并探究预防对策。方法选取医院2010年9月-2016年2月行电视胸腔镜辅助微创肺癌根治术患者1120例,分析患者术后切口感染率,并分析患者感染病原菌分布及耐药性。结果行电视胸腔镜辅助微创肺癌根治术患者术后感染76例,感染率为6.79%;76例感染患者共检出病原菌98株,病原菌主要为革兰阴性菌55株,占56.1%,革兰阳性菌43株,占43.9%;革兰阳性菌中金黄色葡萄球菌对青霉素耐药率最高为93.3%,对头孢他啶和万古霉素的耐药性为0,凝固酶阴性葡萄球菌对青霉素耐药率为100%。革兰阴性菌中大肠埃希菌及铜绿假单胞菌对左氧氟沙星耐药率最高分别为64.7%、100.0%。结论电视胸腔镜辅助微创肺癌根治术可降低患者术后切口感染率,但临床治疗中应重视术后切口感染病原菌的监测,依据切口感染病原菌的特点及耐药性,合理应用抗菌药物。     

2008-2009年肝胆外科病房病原菌分布及耐药性分析

目的调查肝胆外科医院近2年病原菌分布及耐药情况,为临床合理选择抗菌药物提供依据。方法对2008年1月-2009年12月医院肝胆外科患者各类送检标本的病原菌种类、分布和对25种抗菌药物的耐药性进行回顾性分析。结果共分离出病原菌594株,其中革兰阴性菌418株(70.4%),革兰阳性菌142株(23.9%),真菌34株(5.7%);革兰阴性菌以大肠埃希菌(19.9%)居多、革兰阳性菌以屎肠球菌(10.1%)居多,真菌主要为热带假丝酵母菌和白色假丝酵母菌;主要分离部位为腹腔引流液、痰液和胆汁;革兰阴性杆菌对碳青酶烯类以及含有酶抑制剂的药物耐药率较低,鲍氏不动杆菌对目前的抗菌药物耐药率高达81.7%～99.7%;耐甲氧西林金黄色葡萄球菌(MRSA)对常用抗菌药物耐药性高于甲氧西林敏感金黄色葡萄球菌(MSSA);没有检测到对万古霉素耐药的葡萄球菌属;肠球菌属对利奈唑胺和万古霉素的耐药率较低。结论肝胆外科患者医院感染主要病原菌以革兰阴性菌为主,定期监测病原菌并按照药敏结果选择药物治疗很有必要。     

2011-2012年医院获得性感染病原菌分布与耐药性变迁

目的探讨医院临床分离病原菌的分布特征及耐药变化,分析其耐药机制,为临床合理使用抗菌药物提供参考。方法回顾性分析医院2011年1月-2012年12月收治的14 827例患者临床资料,对其中发生感染患者的病原菌分布及其耐药性进行统计分析;使用世界卫生组织细菌耐药性监测网软件WHONET 5.6对数据进行统计分析。结果 14 827例患者中发生医院感染9 763例,感染率为65.85%;从12 798份感染标本中分离出病原菌11 519株,检出率为90.01%;其中革兰阴性菌7 128株占61.88%,革兰阳性菌3 716株占32.26%,真菌675株占5.86%;呼吸内科、ICU、神经内科、急症内科病原菌检出率较高;革兰阴性杆菌对亚胺培南和美罗培南100.00%敏感;革兰阳性菌对万古霉素、利奈唑胺100.00%敏感;耐甲氧西林金黄葡萄球菌、耐甲氧西林凝固酶阴性葡萄球菌对青霉素、头孢西丁100.00%耐药,而对万古霉素、利奈唑胺耐药率为0。结论医院感染以革兰阴性菌为主,耐药性严重,应加强对病原菌耐药性监测,合理选用抗菌药物,以防止病原菌耐药性的蔓延。     

创面感染病原菌分布及耐药性分析

目的分析创面感染病原菌分布及耐药性,为临床治疗提供参考。方法选取2016年1月-12月医院收治的手术病例8736例,分析病原菌分布及对常用抗菌药物敏感性。结果 8736例送检标本发生创面感染105例,占1.20%;105例患者标本共分离病原菌237株,其中革兰阴性菌140株,占59.1%,主要为大肠埃希菌、阴沟肠杆菌及铜绿假单胞菌;革兰阳性菌87株,占36.7%,主要为金黄色葡萄球菌、表皮葡萄球菌及屎肠球菌;药物敏感试验显示,主要革兰阴性菌对头孢哌酮/舒巴坦、亚胺培南、哌拉西林/他唑巴坦及美罗培南耐药率较低,主要革兰阳性菌对万古霉素、利奈唑胺及替考拉宁耐药率较低。结论临床上创面感染发生率较高,主要来源于骨外科,感染以创伤与手术切口为主,感染病原菌对常用抗菌药物具有较高耐药率,医师应合理选择抗菌药物,降低耐药菌发生,临床应加强对病原菌的培养及药敏监测。     

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.