2006-2008年血培养主要病原菌的分布与耐药性变迁

目的 了解医院2006-2008年血培养分离病原菌的构成比及耐药情况变迁的特点.方法 患者血培养标本经BacT/Alert 240血培养仪培养,分离所得菌株用法国生物梅里埃公司API系统进行鉴定,药敏用K-B法,用WHONET5.4软件对2006-2008年血培养结果进行回顾性统计分析.结果 革兰阴性菌是导致血行性感染的主要病原菌,其中大肠埃希菌稳居2006-2008年血行性感染病原菌的首位,肺炎克雷伯菌、铜绿假单胞菌及金黄色葡萄球菌也是导致血液感染的重要病原菌.表皮葡萄球菌、溶血葡萄球菌等凝固酶阴性葡萄球菌和铜绿假单胞菌血行性感染有上升趋势;亚胺培南和美罗培南对血行性感染大肠埃希菌和肺炎克雷伯菌的敏感率达100.0%,其次是阿米卡星和头孢西丁,且2008年的敏感率较之前2年有上升趋势;各类抗菌药物对血行感染铜绿假单胞菌的敏感率普遍较低,且此菌耐药性明显上升;血行感染鲍氏不动杆菌的耐药情况严重,除对亚胺培南和美罗培南的敏感率较高且有所上升(20.0%～69.2%)外,对其他药物的敏感率均低(0～41.7%),万古霉素、替考拉宁、喹奴普汀/达福普汀对血培养分离的金黄色葡萄球菌抗菌活性强,未出现耐药菌株.结论 血行性感染细菌种类及耐药性发生变化,加强血行性感染细菌的耐药性监测,对合理使用抗菌药物非常重要.     

肿瘤患者血培养病原菌分布及耐药性研究

目的 了解河南省肿瘤医院肿瘤患者血培养的病原菌分布和耐药性,为临床合理用药提供依据.方法 对医院2006年1月-2009年10月送检的血液或骨髓标本按常规方法进行分离、菌种鉴定和药敏试验.结果 4年血培养中革兰阴性菌,检出率分别为53.8%、46.9%,40.0%、53.3%,革兰阳性菌检出率分别为26.5%、35.0%、30.0%、23.7%,真菌检出率分别为19.7%、18.1%、30.0%、23.0%;最常见的病原菌依次为大肠埃希菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌、肺炎克雷伯菌、皱褶假丝酵母菌、近平滑假丝酵母菌;连续4年大肠埃希菌及肺炎克雷伯菌对亚胺培南、美罗培南敏感率100.0%;凝固酶阴性葡萄球菌及金黄色葡萄球菌对万古霉素和替考拉宁敏感率100.0%,均未发现耐药株.结论 2006-2009年医院肿瘤患者血液感染以革兰阴性菌尤其以大肠埃希菌为主,且具有多药耐药性,血培养分离菌中真菌所占比例增多明显,所以及时监测病原菌变化及耐药趋势,对指导临床用药至关重要.     

血培养病原菌的临床分布及药物敏感性分析

目的:了解医院2006年1月-2009年6月血培养结果及病原菌的耐药状况,为血液感染性疾病的诊断、治疗提供依据。方法:回顾性分析我院导致血液感染的1345株病原菌的分布及其抗菌药物耐药状况。结果:从血液标本中培养分离病原菌1345株。其中革兰阴性菌550株,占40.8%,包括大肠埃希菌、肺炎克雷伯菌、阴沟肠杆菌、铜绿假单胞菌、鲍曼不动杆菌;革兰阳性菌468株,占34.9%,包括金黄色葡萄球菌、表皮葡萄球菌、人型葡萄球菌、溶血葡萄球菌、屎肠球菌、粪肠球菌、草绿色链球菌;酵母菌39株,占2.9%,包括热带假丝酵母菌、白色假丝酵母菌、近平滑假丝酵母菌。革兰阴性杆菌对亚胺培南、阿米卡星的敏感性较高,革兰阳性球菌对利奈唑胺、磷霉素、万古霉素、替考拉宁较为敏感,真菌对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑均敏感。结论:血液感染患者菌种复杂,革兰阴性杆菌为引起菌血症的主要病原茵,药敏结果提示检出菌株耐药性强且广谱耐药,应加强病原菌耐药性监测,合理使用抗菌药物。     

慢性阻塞性肺病合并血液感染的病原菌分布及耐药性分析

[目的]了解我院慢性阻塞性肺病合并血液感染患者干2006～2008年9月血培养标本中分离菌的分布及耐药性,为临床治疗提供用药依据.[方法]血培养用BacT/ALERT120全自动血培养仪,阳性者再用MicroScan公司的autoSCAN-4全自动微生物分析系统进行细菌鉴定及药敏分析.[结果]2006～2008年9月呼吸病科血培养标本共1445例,分离菌株172株,总阳性率11.9%.常见分离菌中有凝固酶阴性葡萄球菌、金黄色葡萄球菌、肠球菌、大肠埃希氏菌、肺炎克雷伯菌及沙门菌属等.其中革兰阳性菌102株,分离率为7.1%,主要为凝固酶阴性葡萄球菌,占总病原菌的33.1%,其次是金黄色葡萄球菌,占总病原菌的13.4%;革兰阴性菌55株,分离率为3.8%,以大肠埃希菌检出率较高,占病原菌的14.5%;真菌4株,分离率为0.3%,其他菌11株,分离率为0.8%.血培养中葡萄球菌对万古霉素较为敏感;革兰阴性杆菌对亚胺培南、阿米卡星、哌啦西林/他唑巴坦较为敏感.[结论]COPD合并血液感染者应加强血培养中病原菌及其对抗菌药物的耐药性监测.     

2006-2011年某医院血培养病原菌分布及耐药性回顾性分析

目的回顾性分析2006-2011年江夏区第一人民医院感染患者血培养阳性标本(真菌除外)中的病原菌分布及耐药性,为临床抗感染治疗提供依据。方法血标本采用BD全自动血培养仪培养,用手和合肥恒星细菌鉴定仪鉴定细菌,药敏试验按照美国临床实验室标准研究所标准,采用K-B纸片扩散法;应用WHONET5.4软件分析血培养标本中所分离病原菌的分布和药敏结果。结果 2006-2011年血培养标本中,检出的阳性菌数量分别为39株、45株、62株、78株、98株、136株,检出率位居前五的菌分别是金黄色葡萄球菌、表皮葡萄球菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌,葡萄球菌属对万古霉素、替考拉林的敏感率为100%。结论血培养标本中,金黄色葡萄球菌是极为重要的致病菌,但对其它菌所引起的感染也不容忽视,血培养阳性标本检出病原菌种类复杂,耐药率高,临床医生应加强对疑似菌血症患者血液中病原菌的检测,以合理选用抗菌药物。     

血培养主要病原菌分布及耐药性分析

目的 分析医院2010年10月-2011年10月血培养中主要病原菌及其耐药性,为临床选择抗菌药物提供依据.方法 采集怀疑有血液感染的患者血标本,在BACETC 9120全自动血培养仪中培养,培养阳性者用传统方法对细菌进行鉴定,并用K-B法检测细菌的耐药性.结果 血培养共分离出细菌258株,革兰阳性菌139株,占53.88％;革兰阴性菌113株,占43.80％;真菌6株,占2.32％,所分离的病原菌中前3位分别为大肠埃希菌、表皮葡萄球菌和金黄色葡萄球菌,表皮葡萄球菌和金黄色葡萄球菌对青霉素、红霉素耐药,对万古霉素敏感;大肠埃希菌对氨苄西林耐药,对哌拉西林、头孢哌酮/舒巴坦和头孢他啶/克拉维酸敏感;真菌对5-氟胞嘧啶耐药,而对两性霉素B、氟康唑、伊曲康唑、酮康唑和制霉菌素敏感.结论 血培养中病原菌有较高的耐药率,为提高患者治愈率,应及时了解血培养结果以便临床合理用药.     

综合性医院6年血培养病原菌分布及耐药性变迁

目的 了解医院2003-2005年与2006-2008年两个时间段血培养中检出的病原菌分布及耐药性变迁. 方法 用WHONET 5.3软件对两个时间段血培养结果进行回顾性统计分析.结果 两个时间段所分离的病原菌以革兰阴性杆菌为主,主要变化表现为非发酵菌由5.1%上升至22.4%,而沙门菌属由26.9%下降至4.3%,肠球菌属由2.1%上升至6.9%,真菌由4.5%上升至8.2%,耐药率呈上升趋势. 结论 两个时间段引起血液感染的病原菌发生明显的变迁,应加强疑似败血症患者血液中病原菌的检测.     

2001-2010年血培养病原菌变迁及耐药性分析

目的 探讨同济医院2001 -2010年血培养病原菌的分布及耐药性变迁.方法 以全自动血培养仪进行血液培养；API或VITEK-2 Compact细菌鉴定系统进行细菌鉴定；抗菌药物敏感性试验采用K-B法.结果 医院血培养病原菌以革兰阳性菌为主,但其构成比显著下降,2001-2005年占63.7％,2006-2010年下降至58.0％；革兰阴性杆菌构成比由33.6％上升至36.3％；真菌由2.7％上升至5.7％；总体耐药率呈上升趋势.结论 2001-2010年医院血培养病原菌分布及耐药性发生明显变迁,病原菌对临床常用抗菌药物有较高的耐药性.     

血液需氧培养病原菌分布与耐药性分析

目的 回顾性分析3年血培养标本病原菌分布,了解病原菌耐药性变迁,为临床用药提供依据.方法 收集2009年1月-2011年12月住院患者送检血液需氧培养标本3380份,采用VERSATREK-48型全自动血液培养仪进行细菌培养,HX-21型微生物分析仪进行细菌鉴定和药敏分析,纸片扩散法(K-B法)对药敏试验进行补充.结果 3380份血培养标本中分离出病原菌505株,培养阳性率14.94％,其中革兰阴性菌244株占48.32％,革兰阳性菌237株占46.93％,真菌24株占4.75％；常见凝固酶阴性葡萄球菌、大肠埃希菌、金黄色葡萄球菌分别占24.75％、16.83％、10.89％;产ESBLs的大肠埃希菌和肺炎克雷伯菌检出率分别为55.29％和36.00％,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检出率分别为40.00％和76.80％；病原菌检出率最高的病区是神经内科155株占30.69％,其次是呼吸内科占21.39％、新生儿科占20.79％；革兰阴性菌对氨苄西林的耐药率＞90.00％,革兰阳性菌对万古霉素、利奈唑胺的耐药率为0；白色假丝酵母菌和热带假丝酵母菌对氟胞嘧啶的耐药率均为0；对氟康唑的耐药率分别为6.67％和20.00％.结论 血液培养中葡萄球菌属是主要致病菌,但革兰阴性菌所引起的感染也在逐渐升高,深部真菌的感染也不容忽视；只有做到合理使用抗菌药物,才能避免高耐药与多药耐药菌株的产生.     

血流感染病原菌分布及耐药性分析

目的了解医院血培养的病原菌分布以及耐药性,为临床合理使用抗菌药物提供科学依据。方法对2009年1月-2015年12月从血标本中分离的病原菌分布和药物敏感试验结果进行回顾性分析,数据采用WHONET5.6软件进行分析。结果 2009年1月-2015年12月医院35 368份血培养标本共分离病原菌2 375株,阳性率为6.72%,其中革兰阴性杆菌1 341株(56.46%),革兰阳性球菌905株(38.11%),真菌104株(4.38%);大肠埃希菌和肺炎克雷白菌出现耐亚胺培南菌株;葡萄球菌对利奈唑胺、万古霉素和喹奴普汀/达福普汀非常敏感;屎肠球菌整体耐药率较粪肠球菌高。结论医院血培养的病原菌以革兰阴性菌为主,肠杆菌科出现碳青霉烯耐药菌株,加强监测血培养病原菌变化及耐药趋势,对指导临床用药至关重要。     

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.     

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.     

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.     

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.     

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.