Mohnarin 2008年度全国细菌耐药监测

目的掌握我国细菌耐药状况与发展趋势,指导抗菌药物临床应用。方法监测2008年1月1日-12月31日全国89所医院临床分离细菌耐药状况,细菌敏感性测定采用标准纸片扩散法或自动化临床微生物测定方法 ,以Whonet5.4软件进行数据分析。结果 89所医院按照监测方案共获得临床分离157813株细菌敏感性结果 ,其中革兰阳性菌50856株,占31.7%,包括葡萄球菌属32378株,肠球菌属12127株和链球菌属5138株;革兰阴性菌106957株,占68.3%,其中大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌分别为26957、18347、16396株,耐甲氧西林金黄色葡萄球菌与表皮葡萄球菌的发生率分别为67.6%和83.2%;耐青霉素肺炎链球菌比率为3.8%;大肠埃希菌、肠杆菌属对大多数被测药物耐药率40.0%,其中大肠埃希菌对三代(包括头孢他啶)、四代头孢菌素耐药率60.0%,对喹诺酮类耐药率70.0%,产超广谱β-内酰胺酶比率为56.0%;非发酵菌对碳青酶烯类的耐药率24.8%～41.7%,鲍氏不动杆菌耐药率超过铜绿假单胞菌。结论我国临床分离细菌耐药现象较为普遍且耐药率仍呈上升趋势,特别是耐甲氧西林葡萄球菌、产超ESBLs肠杆菌科细菌、多药耐药非发酵菌等十分普遍。     

儿童细菌性肺炎的病原菌及耐药分析

目的了解医院临床儿童细菌性肺炎的病原菌分布、药敏率,为儿童细菌性肺炎的诊疗提供依据。方法应用K-B纸片扩散法测试细菌对抗菌药物的敏感性,产超广谱β-内酰胺酶(ESBLs)确证试验检测用双纸片扩散法,应用聚合酶链式反应(PCR)法检测铜绿假单胞菌的ESBLs基因亚型。结果分离的75株病原菌主要有:大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、金黄色葡萄球菌,检出革兰阴性菌62株,占82.7%,检出较高的为大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌,分别占28.0%、18.7%、14.7%、13.3%;检出革兰阳性菌13株,占17.3%,均为金黄色葡萄球菌;75株细菌对包括青霉素、氨苄西林、头孢唑林在内的多种抗菌药物耐药,对头孢他啶、头孢噻肟耐药率相对较低;ESBLs确证试验共检出24株产ESBLs细菌,检出率为32.0%;铜绿假单胞菌的ESBLs基因亚型为多药耐药CTX-M-14、TEM或CTX-M-14、CTX-M-3的菌株。结论医院临床分离儿童细菌性肺炎的病原菌均有耐药现象,产ESBLs菌有一定程度的流行。     

呼吸内科常见病原菌耐药性分析

目的了解两年间呼吸内科临床分离病原菌的分布及耐药性。方法回顾分析医院2014年1月-2015年12月呼吸内科住院患者临床分离病原菌的分布,药敏结果及多药耐药菌的检出情况。结果两年共分离病原菌435株,其中革兰阴性菌276株(63.4%),真菌102株(23.4%),革兰阳性菌32株(7.4%);检出最多的病原菌为铜绿假单胞菌79株(18.2%),鲍氏不动杆菌73株(16.8%)和白假丝酵母55株(12.6%);检出铜绿假单胞菌79株,其中多药耐药铜绿假单胞菌22株,占27.8%;鲍氏不动杆菌73株,其中多药耐药鲍氏不动杆菌57株,占78.1%;检出大肠埃希菌41株,其中产ESBLs大肠埃希菌19株,占46.3%;肺炎克雷伯菌38株,其中产ESBLs肺炎克雷伯菌14株,占36.8%;铜绿假单胞菌、鲍氏不动杆菌和肠杆菌科细菌对亚胺培南的耐药率分别为21.5%,75.3%,0;金黄色葡萄球菌和凝固酶阴性葡萄球菌对万古霉素、利奈唑胺的耐药率为0;肺炎链球菌对青霉素的耐药率为66.7%。结论呼吸内科临床分离病原菌以非发酵菌为主,鲍氏不动杆菌和金黄色葡萄球菌的耐药形势严峻,应根据药敏结果加强抗菌药物使用及多药耐药菌管理。     

2010年度卫生部全国细菌耐药监测报告:痰标本来源细菌耐药监测

目的 总结中国2010年度临床痰标本来源细菌的耐药性.方法 常规方法培养分离痰标本中的细菌,采用纸片法、MIC法或E-test法测定细菌对抗菌药物的敏感性,使用WHONET5.6对药物敏感性进行分析.结果 2010年度痰标本来源分离出细菌116 646株,前3位菌种为铜绿假单胞菌、鲍氏不动杆菌及肺炎克雷伯菌,分别占17.6％、17.1％及15.4％;青霉素不敏感的肺炎链球菌检出率为23.7％,耐甲氧西林金黄色葡萄球菌(MRSA)和凝固酶阴性葡萄球菌(MRCNS)的检出率分别为71.4％、92.5％;肺炎链球菌和葡萄球菌属对大环内酯类抗菌药物的耐药率＞70.0％;嗜血菌属对β-内酰胺类、大环内酯类和喹诺酮类的耐药率为15.0％～20.0％;肠杆菌科细菌对碳青霉烯类耐药率为3.0％～10.0％,铜绿假单胞菌和鲍氏不动杆菌对亚胺培南的耐药率为27.6％和53.4％.结论 铜绿假单胞菌、鲍氏不动杆菌和肺炎克雷伯菌为2010年度痰标本来源分离的前3位菌种;痰标本中肺炎链球菌和革兰阴性菌耐药率较高.     

2006—2007年MohnarinICU病原菌耐药性监测

目的 了解我国来源于ICU患者病原菌的分布及对抗菌药物的耐药状况.方法 采用纸片法、MIC法或E-test法测定病原菌药物敏感性,使用WHONET5.4软件进行分析,对卫生部全国细菌耐药性监测网(Mohnarin)所属84所三级甲等医院2006年6月1日-2007年5月31日上报数据中明确标明ICU来源的菌株进行分析.结果 共分离病原菌5746株,其中革兰阴性菌3811株(66.3%),革兰阳性菌1652株(28.8%),真菌283株(4.9%);前5位病原菌为铜绿假单胞菌、不动杆菌属、金黄色葡萄球菌、凝固酶阴性葡萄球菌、克雷伯菌属分别占14.7%、13.0%、11.1%、10.6%、8.7%,耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的检出率分别为86.8%和94.0%,未发现耐万古霉素金黄色葡萄球菌和耐万古霉素凝固酶阴性葡萄球菌,粪肠球菌和屎肠球菌中分别有5.3%和13.0%对万古霉素耐药,4.8%和11.4%对替考拉宁耐药;大肠埃希菌对头孢曲松和头孢噻肟的耐药率约70.0%,对喹诺酮类的耐药率＞70.0%;大肠埃希菌和肺炎克雷伯菌中ESBLs阳性率分别为40.3%和32.2%,高于同期整体监测水平;多药耐药铜绿假单胞菌的比例为14.0%,泛耐药铜绿假单胞菌的比例为6.9%,泛耐药不动杆菌属的比例为26.7%.结论 我国ICU病原菌的来源以非发酵菌、葡萄球菌属为主;病原菌的耐药突出,耐药率显著高于同期整体病原菌监测水平.     

2005～2008年临床常见细菌耐药性分析

[目的]了解临床分离出的细菌菌群及耐药情况,为细菌性感染的诊断和治疗提供依据.[方法]监测本院2005年7月1日～2008年6月30日临床分离细菌的耐药情况.细菌分离鉴定采用常规-TX-方法,细菌敏感性测定用浓度稀释法.[结果]3年来共分离鉴定出细菌2 962珠,其中革兰阳性菌1 054株,占35.28%,包括葡萄球菌属294株、肠球菌属168株、链球菌属210株;革兰阴性菌1 531株,占51.69%,包括大肠埃西菌345株、肺炎克雷伯菌219株、铜绿假单胞菌114株;耐甲氧西林金黄色葡萄球和表皮葡萄球菌的检出率分别为45.77%和52.63%;耐青霉索肺炎链球菌比率为60.14%;未检出耐万古霉素肠球菌;大肠埃西菌产超广谱β-内酰胺酶比率为46.09%,对氟喹诺酮、氨基糖苷类耐药率低;非发酵菌对常用抗菌药物耐药率较低.[结论]细菌耐药现象较普遍,细菌对β-内酰胺类抗菌药物耐药率偏高,革兰阳性菌对大环内酯类抗菌药物耐药率偏高,真菌耐药率偏高,细菌对氨基糖苷类、氟喹诺酮类抗菌药物耐药率较低.     

861株多药耐药菌耐药表型回顾性分析

目的 了解医院多药耐药菌(MDROs)的分布及流行情况.方法 收集医院2006年1月-2010年12月住院患者各类标本中分离出的非重复菌株资料,以WHONET5.4软件进行数据分析.结果 23 405份标本中检出病原菌6779株,检出阳性率为29.0％,其中革兰阳性菌704株占10.4％、革兰阴性菌4480株占66.1％、真菌1750株占25.8％;检出MDROs 861株,占12.7％,其中,产ESBLs细菌307株、耐碳青霉烯类肠杆菌科细菌(CRE)18株、耐甲氧西林凝固酶阴性葡萄球菌(MRCNS) 137株、耐甲氧西林金黄色葡萄球菌(MRSA) 127株、耐碳青霉烯类鲍氏不动杆菌(CRAB) 103株、多药耐药铜绿假单胞菌(MDRPA) 72株、泛耐药铜绿假单胞菌(PDRPA)19株及耐万古霉素肠球菌(VRE)2株;主要来源于下呼吸道457株占53.1％、尿液152株占17.7％、脓性分 泌物150株占17.4％、血液56株占6.5％,MDROs在ICU检出率最高占21.7％,其次为脑外科占10.7％、呼吸科占9.1％、肿瘤科占8.9％.结论 MDROs耐药表型中以产ESBLs细菌、MRCNS、MRSA为主;MDROs在下呼吸道、尿液、脓性分泌物标本中检出率较高,在ICU、脑外科、呼吸科、肿瘤科,MDROs流行情况严重.     

开腹手术患者术后多药耐药菌感染的病原学分析

目的分析开腹手术患者术后多药耐药菌(multidrug-resistant organism,MDROs)感染的临床特点及病原学,为合理使用抗菌药物、预防控制医院感染提供参考。方法回顾性分析2010年1月-2014年1月205例开腹手术术后检出病原菌阳性患者的资料,分析发生感染的多种MDROs临床特点及病原学分布。结果在送检的标本中共培养出205株病原菌,主要以革兰阴性菌为主139株占67.80%,其次为革兰阳性菌和真菌,分别占18.54%和13.66%;革兰阴性菌主要为产超广谱β-内酰胺酶大肠埃希菌、多药耐药鲍氏不动杆菌及多药耐药铜绿假单胞菌,检出革兰阳性菌主要为耐甲氧西林金黄色葡萄球菌(MRSA),真菌主要为白色假丝酵母菌;MDROs革兰阴性菌对亚胺培南、环丙沙星、左氧氟沙星的耐药率普遍较低,革兰阳性菌MRSA和耐万古霉素肠球菌对多种抗菌药物普遍耐药。结论开腹手术术后MDROs感染临床特点及病原学分析对临床合理使用抗菌药物具有重要的指导意义。     

中医院近3年常见细菌耐药监测分析

目的调查近3年医院临床分离的病原菌分布和对常用抗菌药物的耐药性,为临床合理选用抗菌药物提供依据。方法纸片扩散法测定抗菌药物的敏感性,数据用WHONET 5.4软件进行统计分析。结果 2007至2009年共分离出细菌14 435株,其中革兰阴性菌占85.8%,革兰阳性菌占14.2%;革兰阳性菌以金黄色葡萄球菌分离最多,其中耐甲氧西林金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌的连续3年检出率分别为44.6%、57.5%、68.8%和30.6%、31.8%、63.9%,无万古霉素耐药株;肠球菌中屎肠球菌对多数抗菌药物的耐药率>80.0%,粪肠球菌对多数抗菌药物敏感,仅对红霉素耐药率>70.0%,检出耐万古霉素的肠球菌属12株;肠杆菌科中分离率前2位的是大肠埃希菌、肺炎克雷伯菌,其中产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌检出率分别为65.9%和32.6%;非发酵菌中以铜绿假单胞菌、鲍氏不动杆菌最多,对多数抗菌药物的耐药率>90.0%,并检出多药耐药铜绿假单胞菌和泛耐药鲍氏不动杆菌。结论医院细菌耐药率呈逐年升高趋势,值得关注,加强细菌耐药性监测,合理使用抗菌药物。     

镇江市三所二级医院监测病原菌分布及耐药性分析

目的对镇江市3所二级医院临床标本细菌分离和耐药性进行监测分析,了解病原菌的分布、常见致病菌耐药性变化趋势。方法对2002~2004年从临床标本分离出1 661株细菌统计及常见细菌耐药率分析。结果1 661株细菌中革兰阳性细菌634株,占38.2%,其中以凝固酶阴性表皮葡萄球菌为首312株,其次凝固酶阳性金黄色葡萄球菌有148株;两种葡萄球菌的耐药率相似,对青霉素及苯唑西林的耐药率>85%,对红霉素>75%,对头孢菌素类和喹诺酮类>30%和35%,对万古霉素耐药率为零;革兰阴性细菌1 027株,占61.8%,前5位依次为肠杆菌属249株、克雷伯菌属226株、埃希菌属167株、铜绿假单胞菌136株、变形菌属62株;前5位革兰阴性细菌对常用抗菌药物的耐药性以半合成青霉素较明显,变形菌属的耐药率较突出。结论临床医师、实验人员、医院感染监测部门要高度重视细菌耐药性监测工作,掌握细菌变迁及细菌耐药性变化动向,提高抗菌药物合理使用水平。     

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.