脑梗死老年患者肺部感染病原菌分布特点

目的研究脑梗死老年患者肺部感染病原菌分布特点及其耐药性,并探讨其防治措施,为治疗老年脑梗死肺部感染患者提供理论指导依据。方法选取2013年2月-2015年2月于医院脑梗死发生肺部感染82例老年患者作为研究对象,收集患者呼吸道深部痰液,培养分离病原菌,采用法国生物梅里埃公司VITEK-2系统对分离菌株进行鉴定和药物敏感性分析;采用SPSS19.0软件进行统计分析。结果 82例肺部感染老年患者送检标本分离出病原菌172株,其中革兰阴性菌114株占66.28%,革兰阳性菌58株占33.72%;革兰阴性菌对美罗培南的耐药率最低为5.26%,对环丙沙星、头孢吡肟、庆大霉素、左氧氟沙星耐药率较高,分别为91.23%、89.47%、83.33%、81.58%,革兰阳性菌对青霉素、左氧氟沙星、氯霉素、庆大霉素的耐药率均较高,分别为93.75%、84.38%、78.13%、78.13%,对万古霉素耐药率为0。结论脑梗死老年患者由于意识障碍,容易发生肺部感染,感染病原菌以革兰阴性菌为主,临床应根据病原菌培养结果及药敏试验合理选择的抗菌药物。     

老年脑卒中患者肺部感染病原菌分布与耐药性分析

目的探讨老年脑卒中患者肺部感染病原菌分布特点及其对抗菌药物的耐药性,为预防与控制医院感染提供依据。方法选择2012年12月-2013年12月76例老年脑卒中肺部感染患者,无菌方法收集痰液标本,依照临床微生物学检验方法对标本进行细菌培养及鉴定,并进行药敏试验,数据采用SPSS13.0软件进行统计分析。结果 76例脑卒中患者肺部感染标本中共分离出病原菌88株,其中革兰阴性菌67株占76.14%、革兰阳性菌16株占18.18%、真菌5株占5.68%;排前5位的病原菌为肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、嗜麦芽寡养单胞菌,分别占25.00%、19.32%、15.91%、10.23%、6.82%;肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌对亚胺培南、阿米卡星、美罗培南、头孢哌酮/舒巴坦耐药率均<25.00%,嗜麦芽寡养单胞菌对米诺环素、左氧氟沙星、磺胺甲噁唑/甲氧苄啶耐药率分别为10.75%、14.36%、17.98%,金黄色葡萄球菌对替考拉宁、万古霉素耐药率为0;铜绿假单胞菌和胞氏不动杆菌泛耐药菌株检出率为17.65%、14.29%,MRSA检出率为44.44%,产ESBLs菌检出率为42.05%。结论老年脑卒中患者肺部感染的病原菌主要为细菌,以革兰阴性菌为主,应根据病原菌培养鉴定及药敏试验结果,科学合理地应用抗菌药物。     

老年肺部感染患者病原菌耐药性分析及治疗策略

目的 分析老年肺部感染患者病原菌分布,探讨细菌耐药性及治疗策略,旨在为临床合理用药提供参考依据.方法 采集2010年12月-2011年12月在医院住院治疗的121例老年肺部感染患者痰标本,将其送细菌分离培养、鉴定,并做药物敏感试验.结果 121例老年肺部感染患者送取的痰标本检出149株病原菌,以鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌及大肠埃希菌为主,分别占21.48％、16.11％、14.77％及12.08％;33株革兰阳性菌对青霉素、红霉素、四环素、环丙沙星的耐药率分别为87.88％、84.85％、81.82％、75.76％,对阿奇霉素、阿莫西林/克拉维酸、头孢哌酮/舒巴坦、亚胺培南/西司他丁敏感,耐药率分别为6.06％、3.03％、3.03％、3.03％;114株革兰阴性菌对头孢唑林、头孢哌酮、环丙沙星、头孢他啶的耐药率分别为97.37％、88.60％、86.84％、69.30％,而对阿莫西林/克拉维酸、阿奇霉素、头孢哌酮/舒巴坦、亚胺培南/西司他丁敏感,耐药率分别为4.39％、3.51％、0.88％、0.88％.结论 老年肺部感染以革兰阴性杆菌为主,对阿莫西林/克拉维酸、头孢哌酮/舒巴坦及亚胺培南/西司他丁较敏感,在痰培养及药物敏感试验结果报告之前经验性的使用上述药物,可有效控制患者的临床症状、改善患者的预后.     

糖尿病并发获得性肺部感染患者病原菌分布及药物敏感性研究

目的探讨糖尿病并发获得性肺部感染患者的病原菌分布及药物敏感性,为临床治疗合理选择抗菌药物提供依据。方法选取2013年1月-2016年12月医院收治的136例2型糖尿病合并医院获得性肺炎患者,采集患者痰液标本,进行菌株鉴定和药敏试验。结果 136例糖尿病合并医院获得性肺炎患者中,检出病原菌158株,其中革兰阴性菌99株占62.66%,以肺炎克雷伯杆菌和铜绿假单胞菌为主;革兰阳性菌46株占29.11%,以金黄色葡萄球菌和肺炎链球菌为主;真菌13株占8.23%;肺炎克雷伯菌和铜绿假单胞菌对亚胺培南、美罗培南、氨曲南、左氧氟沙星、阿米卡星、氯霉素耐药率均<10.00%,金黄色葡萄球菌和肺炎链球菌对利奈唑胺、万古霉素、替考拉宁耐药率均<10.00%。结论革兰阴性菌是糖尿病合并医院获得性肺炎的主要致病菌,临床治疗时,根据药敏试验结果合理选择抗菌药物治疗。     

肺部感染患者多药耐药菌耐药性与转归

目的探讨肺部感染患者多药耐药菌(MDRO)耐药性与转归,为MDRO肺部感染的治疗提供参考。方法选取2017年1-12月医院收治的肺部感染患者200例为研究对象,采集痰液标本行细菌培养菌株鉴定及药物敏感试验,同时给予敏感抗菌药物治疗,观察患者治疗转归。结果178例患者痰液培养出病原菌,阳性率为89.00%,其中132例非MDRO感染、46例MDRO感染;46例MDRO患者中42例为单一病原菌感染,4例为多重病原菌感染。46例MDRO感染患者检出MDRO 50株,其中革兰阴性菌41株占82.00%,以鲍氏不动杆菌、肺炎克雷伯菌为主;革兰阳性菌9株占18.00%,均为金黄色葡萄球菌。MDRO金黄色葡萄球菌对青霉素、头孢唑林、苯唑青霉素、哌拉西林/他唑巴坦、红霉素完全耐药,对亚胺培南、环丙沙星、左氧氟沙星、庆大霉素、四环素耐药率均>70%,对万古霉素敏感;MDRO革兰阴性菌对一代头孢和青霉素类药物多数完全耐药,对亚胺培南耐药率相对低;MDRO感染患者恶化率为15.22%(7/46)高于非MDRO感染患者(P=0.013)。结论肺部感染患者MDRO感染率较高,主要以革兰阴性菌为主,对抗菌药物广泛耐药,MDRO感染患者不良转归率明显增高。     

肺部感染病原菌谱及耐药性分析

目的 了解医院肺部感染病原菌构成及耐药性,为临床治疗肺部感染合理选择抗菌药物提供指导.方法 采集医院172例肺部感染患者的痰标本,合格标本接种至血平板、巧克力平板、麦康凯平板进行细菌培养,细菌分离培养与鉴定参考《全国临床检验操作规程》进行,药敏试验采用纸片扩散法.结果 172例患者痰标本分离出148株病原菌,其中革兰阴性杆菌94株占63.51％,革兰阳性球菌32株占21.62％,真菌22株占14.87％;革兰阴性杆菌对氨苄西林耐药率最高,除嗜麦芽寡养单胞菌外,对亚胺培南敏感性最高;革兰阳性球菌对万古霉素的耐药率均为0.结论 革兰阴性菌为医院肺部感染的主要致病菌,且细菌的耐药性较严重,临床医师应根据药敏结果合理应用抗菌药物.     

老年心力衰竭患者肺部感染的病原菌分析及控制对策

目的 分析老年心力衰竭患者肺部感染的病原菌检测结果,提出控制对策,为老年心力衰竭患者肺部感染的控制提供参考。方法 选取2013年1月-2015年12月202例老年心力衰竭肺部感染患者,采集患者痰液标本送实验室进行病原菌培养及药物敏感试验,对结果进行评定及统计分析。结果 202份痰液标本培养阳性率为59.90%,共培养出病原菌154株,其中一种、两种、三种及以上病原菌感染分别占病原菌培养阳性患者的77.69%、18.18%、4.13%,病原菌中革兰阴性菌、革兰阳性菌、真菌构成比分别占59.74%、35.71%、4.55%,革兰阴性菌中肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌、阴沟肠杆菌为主要病原菌,分别占感染病原菌的15.58%、12.34%、11.04%、7.14%、5.19%,革兰阳性菌中金黄色葡萄球菌、肺炎链球菌、凝固酶阴性葡萄球菌、肠球菌属为主要感染病原菌,分别占11.04%、9.09%、6.49%、4.55%,真菌主要为白假丝酵母菌,占3.25%;革兰阴性菌和革兰阳性菌对多种抗菌药物耐药率均较高,肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌仅对亚胺培南耐药率<30.00%,金黄色葡萄球菌、肺炎链球菌、凝固酶阴性葡萄球菌仅对万古霉素耐药率<30.00%。结论 老年心力衰竭患者肺部感染的病原菌以革兰阴性菌为主,对常用抗菌药物耐药率较高,应针对老年心力衰竭患者自身特点采取多种措施降低肺部感染。     

老年急性脑卒中肺部医院感染患者痰标本分离病原菌及耐药性

目的了解老年急性脑卒中肺部医院感染患者痰标本分离病原菌及耐药情况,为临床抗菌药物合理应用提供依据。方法采用回顾性分析方法,对2011年3月—2013年9月某院干部病房年龄≥60岁的380例老年急性脑卒中患者进行医院感染的调查,对医院感染患者痰标本分离细菌进行鉴定和药敏检测。结果发生肺部医院感染54例,送检116份痰标本共分离病原菌80株,其中革兰阴性(G-)杆菌61株(76.25%),革兰阳性(G+)球菌7株(8.75%),真菌12株(15.00%),居前5位的病原菌依次是肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、白假丝酵母菌、大肠埃希菌。G-杆菌对美罗培南、亚胺培南、哌拉西林/他唑巴坦、阿米卡星等敏感率100%;G+球菌对万古霉素、利奈唑胺、替考拉宁敏感率100%;真菌对氟康唑、伊曲康唑等常用的抗真菌药敏感率100%。结论老年急性脑卒中肺部感染病原菌以G-杆菌为主,多重耐药菌株比例高,真菌感染呈上升趋势,临床上应加强病原菌监测,合理选用抗菌药物。     

老年患者下呼吸道感染病原菌分布及耐药性分析

目的探讨老年患者下呼吸道感染病原菌的分布及其耐药性,为指导临床合理用药提供参考依据。方法选取2010年4月-2013年7月老年下呼吸道感染患者480例,采集所有患者痰液及支气管灌洗液标本进行病原菌检测,菌种鉴定采用法国生物梅里埃公司VITEK-60全自动细菌分析仪,药物敏感试验采用K-B纸片扩散法。结果 480例老年下呼吸道感染患者检出病原菌790株,其中革兰阴性菌463株占58.61%,革兰阳性菌259株占32.78%,真菌有68株占8.61%;革兰阴性菌对于喹诺酮类、氨基糖苷类、第三代头孢菌素等抗菌物耐药率较高,其中耐药率较高的是亚胺培南、头孢哌酮/舒巴坦、哌拉西林/唑巴坦,约100.00%;革兰阳性菌对克林霉素、左氧氟沙星、红霉素、青霉素有较高的耐药性;真菌的耐药率普遍较低。结论老年患者下呼吸道感染病原菌主要以革兰阴性菌为主,加强对病原菌分布以及耐药性监测,根据监测结果合理使用抗菌药物,以减少新耐药菌株的形成,降低医院感染的发生。     

慢性心力衰竭患者肺部感染的病原菌分布及耐药性分析

目的探讨慢性心力衰竭并发肺部感染患者的病原菌分布及耐药性,为临床合理用药提供参考。方法采集2011年12月-2012年12月132例慢性心力衰竭并发肺部感染患者的痰液标本,进行细菌培养鉴定及药敏试验,细菌分离培养与鉴定按照《全国临床检验操作规程》实施,药敏结果判断标准参照CLSI 2009年标准,并对病原菌分布及耐药性进行分析。结果 132例患者痰标本共检出病原菌146株,其中革兰阴性菌104株占71.23%,以鲍氏不动杆菌、铜绿假单胞菌、大肠埃希菌为主,分别占23.28%、16.44%、12.33%;革兰阳性菌36株占24.66%,以金黄色葡萄球菌和表皮葡萄球菌为主,分别占16.44%和5.48%,真菌6株占4.11%;革兰阴性菌对头孢哌酮/舒巴坦、亚胺培南/西司他丁较敏感;革兰阳性菌对万古霉素和替考拉宁高度敏感,敏感率为100.00%。结论慢性心力衰竭并发肺部感染患者的病原菌以革兰阴性菌为主,选择合理抗菌药物,可降低病原菌的耐药率。     

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.