耐碳青霉烯类革兰阴性菌分布特征及耐药性分析

目的了解临床分离的耐碳青霉烯类革兰阴性菌的分布特征及耐药特点,为临床合理使用抗菌药物提供理论依据。方法收集2016年1月-12月耐碳青霉烯类革兰阴性菌临床分离株,采用自动化仪器法和K-B纸片扩散法对上述菌株进行药物敏感性试验,药敏结果依据美国临床实验室标准化协会(CLSI)2016年版的要求进行判断。结果共收集耐碳青霉烯类革兰阴性菌722株,其中耐碳青霉烯类肠杆菌(CRE)52株,耐碳青霉烯类鲍氏不动杆菌(CRAB)492株,耐碳青霉烯类铜绿假单胞菌(CRPA)178株;痰标本检出耐碳青霉烯类病原菌最多,为560株占77.6%,主要来自重症监护病房,以60岁老年患者居多;CRE和CRAB对阿米卡星和替加环素敏感率较高(67.7%~86.5%),对头孢菌素类、喹诺酮类和加酶抑制剂类抗菌药物敏感率均≤23.1%;CRPA除对碳青霉烯类敏感率低外,对头孢菌素类、喹诺酮类和氨基糖苷类抗菌药物敏感率较高,均≥55.1%;CRE对阿米卡星、替加环素和亚胺培南的MIC值主要分布在≤2μg/ml(58%)、≤0.5μg/ml(52%)、≥16μg/ml(48%);CRAB对阿米卡星的MIC值主要分布在4μg/ml(24.4%)、8μg/ml(27.4%)和≥64μg/ml(28.9%),亚胺培南和替加环素的MIC值主要分布在≥16μg/ml(96.7%)、4μg/ml(47.4%);CRAB对阿米卡星、亚胺培南的MIC值集中在≤2μg/ml(53.4%)、≥16μg/ml(69.7%)。结论耐碳青霉烯类革兰阴性菌对常见抗菌药物敏感性较低,临床医生应根据实验室结果及MIC值合理使用抗菌药物,以减少或延缓耐碳青霉烯类细菌的产生。     

耐碳青霉烯类铜绿假单胞菌及鲍氏不动杆菌的耐药性分析

目的探讨耐碳青霉烯类铜绿假单胞菌(PAE)及鲍氏不动杆菌(ABA)的临床分布与耐药特性,为临床抗感染治疗和合理使用抗菌药物提供依据。方法采用微量肉汤稀释法测定12种抗菌药物的最低抑菌浓度(MIC)。结果两年共分离耐碳青霉烯类PAE和ABA分别为261、117株,两者>80.0%来源于呼吸道标本,41.0%耐碳青霉烯类PAE和64.9%耐碳青霉烯类ABA来自于重症监护病房,耐碳霉烯类ABA的多药耐药性比PAE更为严重,该菌株除头孢哌酮/舒巴坦耐药率在23.1%外,其他均>70.0%,亚胺培南和美罗培南耐药率分别为93.1%和96.6%,而耐碳青霉烯类PAE对亚胺培南和美罗培南耐药性却差异较大,16.0%菌株对亚胺培南耐药,而对美罗培南敏感,其中可能存在不同的耐药机制。结论耐碳青霉烯类PAE和ABA的耐药率在不断上升,特别是多药耐药和泛耐药株的增多,因此应慎重、合理地使用碳青霉烯类抗菌药物,密切关注PAE和ABA耐药的发展,采取有效的感染控制措施。     

耐亚胺培南铜绿假单胞菌耐药特征和碳青霉烯酶基因分析

目的研究耐亚胺培南铜绿假单胞菌对常用抗菌药物耐药性及其产碳青霉烯酶的基因特征。方法对耐亚胺培南铜绿假单胞菌的耐药性进行回顾性分析;Carba NP法进行碳青霉烯酶表型确证;PCR进行基因型检测。结果 640株耐亚胺培南铜绿假单胞菌对氨曲南耐药率最高,为58.8%;对3种氨基糖苷类耐药率最低,为19.2%~20.6%;对其他6种抗菌药物耐药率为40.0%~51.1%。检出72株耐亚胺培南铜绿假单胞菌产碳青霉烯酶,阳性率为11.3%。基因型检测3株为KPC-2型,占4.2%,26株为IMP型,占36.1%,43株为VIM型,占59.7%。结论耐亚胺培南铜绿假单胞菌对氨基糖苷类敏感性较好,但对其他抗菌药物耐药性严重;碳青霉烯酶主要以金属β-内酰胺酶为主。     

重症监护病房医院感染铜绿假单胞菌耐药性分析

目的探讨重症监护病房(ICU)医院感染铜绿假单胞菌(PAE)的耐药现状,为临床医师诊断与治疗提供科学依据。方法 PAE采用MicroScan AutoSCAN4自动微生物鉴定系统进行鉴定,用K-B法进行药物敏感试验并统计耐药率。结果 223株PAE对常用抗菌药物均产生了不同的耐药性,对碳青霉烯类抗菌药物亚胺培南和美罗培南耐药率分别为15.2%和14.3%。结论医院ICU PAE的耐药性已十分严重,必须重视耐药菌株的监测,预防与控制ICU医院感染的发生。     

美罗培南与米诺环素及头孢哌酮/舒巴坦对耐碳青霉烯类鲍氏不动杆菌的联合药敏研究

目的 评价美罗培南(MER)与米诺环素(MIN)及头孢哌酮/舒巴坦(CFS),用临床分离的耐碳青霉烯类鲍氏不动杆菌(CRAB)的体外联合抗菌效应.方法 采用棋盘法设计,微量肉汤稀释法测定,抗菌药物对60株临床分离的耐碳青霉烯类鲍氏不动杆菌的最低抑菌浓度(MIC),并计算抑菌指数(FIC)判断联合效应.结果 美罗培南与头孢哌酮/舒巴坦联用后,FIC≤0.5的占28.3％、0.5～1的占53.4％、1～2的占18.3％、FIC＞2的为0;美罗培南与米诺环素联用后,FIC≤0.5的占10.0％、0.5～1的占75.0％、1～2的占15.0％、FIC＞2的为0;上述药物组合联用后,各药的MIC50与MIC90明显降低,浓度-累积抑菌百分率曲线左移.结论 美罗培南与米诺环素及头孢哌酮/舒巴坦联用,对耐碳青霉烯类鲍氏不动杆菌体外联合抗菌效应主要表现为协同和相加作用.     

耐亚胺培南鲍氏不动杆菌的碳青霉烯酶研究

目的了解医院耐亚胺培南鲍氏不动杆菌碳青霉烯酶携带情况,对临床预防其感染及抗菌药物应用提供参考依据。方法收集2008年9月-2010年12月耐亚胺培南鲍氏不动杆菌65株,K-B纸片法测定其对抗菌药物的敏感性,琼脂稀释法测定其对多黏菌素B的MIC;改良Hodge试验检测碳青霉烯酶,EDTA纸片协同试验检测金属酶表型;PCR检测OXA-23、OXA-24、OXA-51、OXA-58、IMP、VIM编码基因。结果 65株鲍氏不动杆菌对米诺环素敏感率为19.0%,对其他11种抗菌药物敏感率均10.0%;对多黏菌素B的MIC均≤2μg/ml;改良Hodge阳性率为52.3%,所有菌株OXA-51均阳性,OXA-23阳性率为93.85%,OXA-24、OXA-58均阴性,未检测到金属酶基因。结论耐亚胺培南鲍氏不动杆菌主要携带OXA-23型碳青霉烯酶。     

医源性肺部感染患者耐碳青霉烯类铜绿假单胞菌及鲍氏不动杆菌的耐药机制分析

目的探讨耐碳青霉烯类铜绿假单胞菌(CRPA)及耐碳青霉烯类鲍氏不动杆菌(CRAB)的耐药机制,为指导临床合理选择抗菌药物提供治疗依据。方法回顾性调查2014年1月-2015年12月医院肺部感染住院患者送检的各类标本中检出病原菌577株,采用改良Hodge方法测定碳青霉烯酶表型,采用B-last方法测定超广谱β-内酰胺酶,分析CRPA及CRAB的耐药性及检出率的相关性。结果铜绿假单胞菌对亚胺培南、美罗培南的耐药率为32.95%和29.55%,而对阿米卡星的耐药率为5.11%,对磺胺甲恶唑/甲氧苄啶100.00%耐药;鲍氏不动杆菌对亚胺培南和美罗培南的耐药率均为47.75%,而对氨曲南100.00%耐药;176株PAE检出CRPA 31株,检出率17.61%,检出耐亚胺培南PAE 17株,检出率54.84%,检出耐美罗培南PAE 14株,检出率45.16%;178株ABA检出CRAB 39株,检出率21.91%,检出耐亚胺培南ABA 22株,检出率56.41%,检出耐美罗培南ABA 17株,检出率43.59%。结论医源性感染患者CRPA及CRAB的耐药率呈逐年增加,临床医师应根据细菌鉴定和药敏结果正确合理使用抗菌药物,以便提高疗效和减少耐药菌株的发生。     

医院感染铜绿假单胞菌的耐药性及控制对策

目的探讨医院感染铜绿假单胞菌(PAE)的耐药现状,制定医院感染控制对策。方法对医院感染患者标本,严格按照《全国临床检验操作规程》进行细菌培养鉴定;采用琼脂扩散法(K-B法)进行药物敏感试验,对病原菌耐药率进行分析。结果 PAE在痰液标本中分离率最高,检出率为48.5%,其次为脓液标本,占20.9%,尿液标本占18.9%;196株PAE中检出16株泛耐药菌株,检出率为8.2%;PAE对碳青霉烯类抗菌药物美罗培南、亚胺培南耐药率最低(7.1%、8.2%),其次对含酶抑制剂复合抗菌药物头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药率较低(19.9%、21.4%)。结论医院感染铜绿假单胞菌耐药性已非常严重,医疗机构应加大监测力度,加强合理使用抗菌药物管理,预防与控制多药耐药PAE导致的医院感染。     

大肠埃希菌耐药基因的聚合酶链反应分析

目的了解临床分离大肠埃希菌中碳青霉烯酶的携带及耐药基因分布,为临床合理应用抗菌药物提供科学依据。方法采用VITEK-2型全自动微生物检测系统鉴定细菌,用微量稀释法筛选耐碳青霉烯类大肠埃希菌30株,通过Hodge试验检测碳青霉烯酶,以EDTA/IMP、EDTA/CAZ复合纸片,亚胺培南和头孢他啶为底物,进行协同试验检测B类碳青霉烯酶(金属酶),用聚合酶链反应(PCR)扩增耐碳青霉烯类抗菌药物的基因,以确定基因的种类。结果 25株大肠埃希菌对头孢菌素、碳青霉烯类和喹诺酮类抗菌药物耐药,5株大肠埃希菌对阿米卡星敏感;通过Hodge试验对30株大肠埃希菌表型的筛选,阳性菌株共28株,阳性率为93.0%;通过PCR基因分析,30株大肠埃希菌中检出28株KPC基因,阳性率达到93.0%,30株大肠埃希菌中未发现VIM和IMP基因。结论耐碳青霉烯类抗菌药物的大肠埃希菌主要在ICU和呼吸科,耐药原因主要是KPC基因,但是不能排除VIM和IMP基因。     

11种联合方案对耐碳青霉烯类肠杆菌的体外联合药敏试验

目的 观察头孢他啶/阿维巴坦(CZA)联合氨曲南(ATM),亚胺培南(IPM)、美罗培南(MEM)分别联合头孢他啶(CAZ)、头孢哌酮/舒巴坦(SCF)、阿米卡星(AK)、左氧氟沙星(LEV)和磷霉素(FOS)对产KPC、NDM和IMP的耐碳青霉烯类肠杆菌(CRE)的体外联合药物敏感性。方法 选取从临床标本中分离的38株非重复CRE,采用微量肉汤稀释法测定抗菌药物对菌株的最低抑菌浓度(MIC),棋盘稀释法进行联合药敏试验,计算部分抑菌浓度指数(FIC)判定联合效果。结果 CZA对22株产KPC菌株的MIC均≤4μg/mL,对16株产B类金属酶NDM、IMP菌株的MIC均>128μg/mL,联合ATM后协同率为100%;IPM与MEM分别联合SCF协同率最强,分别为63.2%、68.4%,协同率与相加率之和为100%,IPM联合FOS的协同率与相加率之和最低,为40.5%。在肺炎克雷伯菌(KP)中,IPM与MEM联合SCF协同率均为68%,协同率与相加率之和均为100%,IPM联合FOS的协同率与相加率之和最低,为24%;大肠埃希菌(ECO)中,IPM与MEM联合SCF协同率分别为...     

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.