多药耐药鲍氏不动杆菌氨基糖苷类耐药相关基因研究

目的调查多药耐药鲍氏不动杆菌氨基糖苷类修饰酶基因(AMEs)、16S rRNA甲基化酶基因和抗菌药物外排泵基因adeB的存在情况。方法收集2008年1-12月医院住院患者痰标本中分离的多药耐药鲍氏不动杆菌共20株,采用聚合酶链反应(PCR)及序列分析的方法分析9种AMEs基因、2种16S rRNA甲基化酶基因和抗菌药物外排泵基因adeB。结果 20株鲍氏不动杆菌共检出4种AMEs基因:aac(3)-Ⅰ11株为55.0%、aac(6′)-Ⅰb 12株为60.0%、ant(3″)-Ⅰ15株为75.0%、aph(3′)-Ⅰ15株为75.0%,抗菌药物外排泵基因adeB 17株为85.0%,其余7种基因未检出。结论 20株多药耐药鲍氏不动杆菌菌株检出的4种氨基糖苷类修饰酶基因阳性率较高,2种16S rRNA甲基化酶基因未检出,抗菌药物外排泵基因adeB阳性率高;在氨基糖苷类耐药株中抗菌药物外排泵基因adeB检出率高。     

ICU与RICU患者分离的鲍氏不动杆菌耐药谱分析

目的分析医院ICU及RICU患者分离的鲍氏不动杆菌分布与耐药谱,以控制传播途径防止耐药菌的播散,指导临床抗菌药物的应用。方法收集2013年1月-2015年5月医院ICU患者分离的644株鲍氏不动杆菌及RICU患者分离的262株鲍氏不动杆菌,采用全自动微生物分析仪进行菌种鉴定和药物敏感试验,分析其分布及耐药谱的变化,数据采用SPSS 21.0软件进行统计分析。结果临床分离得到鲍氏不动杆菌主要源于痰液标本,ICU及RICU分别为92.70%及93.51%;ICU及RICU中检出的鲍氏不动杆菌均对氨曲南的耐药率最高,分别为99.82%及99.57%;其次为头孢菌素类、亚胺培南、环丙沙星等,耐药率最低均为磺胺甲噁唑/甲氧苄啶,ICU与RICU分别为59.59%及52.69%。结论 RICU患者分离的鲍氏不动杆菌对常用抗菌药物耐药率较ICU患者分离的菌株高,且对大多数种类的抗菌药物均有较高耐药性。     

泛耐药鲍氏不动杆菌外排泵系统与耐药机制的关系

目的探讨外排泵adeABC、IJK、FGH在医院泛耐药鲍氏不动杆菌(PDRAB)中的分布特点及其在耐药机制中的作用。方法收集医院2011年1月-2014年4月临床分离的PDRAB 67株(泛耐药组)及同期非多药耐药鲍氏不动杆菌68株(相对敏感组),用CCCP抑制试验对以上两组进行外排泵表型检测;同时PCR扩增外排泵基因adeABC、IJK、FGH,对产物进行测序,通过琼脂糖凝胶电泳观察结果,比较并分析两组间外排泵差异。结果两组共筛选出外排泵表型阳性菌88株,其中泛耐药组52株占77.6%,相对敏感组36株占52.9%;泛耐药组中adeB、adeG基因检出阳性率为100.0%,adeJ基因阳性率为92.5%;相对敏感组中adeB、adeJ、adeG基因检出阳性率分别为44.1%、75.0%、82.4%;泛耐药组检出阳性率均显著高于相对敏感组(P<0.01);泛耐药组中3种基因同时检出率显著高于相对敏感组(P<0.01)。结论外排泵阳性菌株在鲍氏不动杆菌临床分离株中广泛存在,PDRAB表达率显著增高,外排泵基因adeABC、IJK、FGH在PDRAB中均有高检出率,主动外排泵机制可能在PDRAB的耐药机制中起作用,且与3个基因的共同存在和共同表达有关。     

多药耐药鲍氏不动杆菌外排泵耐药基因及同源性分析

目的分析临床多药耐药鲍氏不动杆菌外排泵耐药基因adeA、adeB、adeC及其调控基因adeR、adeS分布与抗菌药物耐药的关系,为ICU感染鲍氏不动杆菌的同源性有效应对医院感染。方法 2012年ICU检出鲍氏不动杆菌102株,采用K-B法进行药敏试验,PCR测定所有菌株的药物外排泵基因,并利用脉冲场凝胶电泳进行同源性分析。结果 94株耐药鲍氏不动杆菌对头孢唑林和呋喃妥因耐药率均为100.0%,对亚胺培南和氨苄西林/舒巴坦的耐药率为75.8%和95.0%,对其他抗菌药物耐药率均>85.0%;102株鲍氏不动杆菌中adeA、adeB、adeC、adeR、adeS基因型的阳性株分别为78、79、76、77、74株;5种基因均以阴性为主;敏感株中调控基因adeR、adeS表达率较低分别为37.5%和25.0%。结论 ICU分离的鲍氏不动杆菌中呈现严重的多药耐药,adeABC外排泵耐药基因相对于敏感株在耐药菌株中大量存在,外排泵基因的高表达与鲍氏不动杆菌的多药耐药存在相关性关系,而且其基因的播散主要通过克隆播散得以传播。     

医院重症监护室环境分离鲍氏不动杆菌携带耐药相关基因研究

目的分析重症监护室(ICU)环境分离鲍氏不动杆菌株携带多种耐药基因的相关性,探索鲍氏不动杆菌耐药机制及传播耐药基因的途径。方法采用基因扩增技术与药敏试验微量稀释法进行研究。结果选取2013年1-12月ICU环境标本分离鲍氏不动杆菌109株,其中多药耐药的菌株47株占43.12%,对氨基糖苷类抗菌药物(阿米卡星)耐药率最高达62.39%;对碳青霉烯类抗菌药物(亚胺培南、美罗培南)的耐药率为53.21%~55.96%;对头孢菌素类的耐药率为53.21%~55.04%;所有菌株对多粘菌素B敏感;外排泵基因adeB基因的表达与A类、C类、D类β-内酰胺酶Tem基因、ADC基因、OXA-23群OXA-51,66群基因、膜孔蛋白CarO基因、氨基糖苷类基因aph(3′)-Ι具有相关性,qacE⊿1-sul1基因的表达与氨基糖苷类基因aph(3′)-Ι、C类β-内酰胺酶ADC具有相关性,CarO基因的表达与D类β-内酰胺酶OXA-23群基因、氨基糖苷类基因aph(3′)-Ι、aac(6′)-Ⅰb、回旋拓普酶gyrA基因具有相关性。结论环境分离鲍氏不动杆菌携带多药耐药基因相关性分析显示鲍氏不动杆菌多药耐药基因传播途径外排泵介导可对常用抗菌药物产生多药耐药性,产生耐消毒剂基因,膜孔蛋白CarO高表达,也加速多药耐药的积累和播散。提示加强病区环境消毒与管理,是有效阻断医院ICU多药耐药不动杆菌传播的重要措施。     

耐碳青霉烯类鲍氏不动杆菌基因检测与耐药性研究

目的研究耐碳青霉烯类鲍氏不动杆菌基因及其耐药性,为临床治疗与感染控制提供依据。方法收集医院2013年8-11月临床送检标本分离的非重复耐碳青霉烯类鲍氏不动杆菌26株,采用Phoenix100微生物全自动鉴定系统进行菌株鉴定及药敏试验;PCR方法扩增菌株的碳青霉烯酶B类和D类基因;阳性产物经ABI基因测序仪测序确认。结果 26株耐碳青霉烯类鲍氏不动杆菌对多黏菌素无耐药株,对四环素、阿米卡星、庆大霉素、磺胺甲噁唑/甲氧苄啶耐药率分别为11.5%、73.1%、92.4%、96.2%,对其余11种抗菌药物耐药率均为100.0%;26株鲍氏不动杆菌中检出blaOXA-64、blaOXA-51和blaOXA-23阳性率100.0%;blaIMP-1基因阳性率69.2%,未检出blaOXA-24、blaOXA-48、blaOXA-55、blaOXA-58、blaOXA-60、blaOXA-66、blaVIM-2和blaVIM-7基因。结论医院耐碳青霉烯类鲍氏不动杆菌主要碳青霉烯酶基因是blaOXA-23、blaOXA-51、blaOXA-64及blaIMP-1;blaOXA-64、blaIMP-1耐药基因共存同一菌株,是医院耐碳青霉烯类鲍氏不动杆菌的特点,与其他地区不同,医院鲍氏不动杆菌已呈现多药耐药应引起临床重视。     

鲍氏不动杆菌对碳青霉烯类抗菌药物的耐药机制研究

目的探讨临床分离的鲍氏不动杆菌对碳青霉烯类抗菌药物的耐药机制,为医院感染控制、临床合理用药提供依据。方法收集山西医学科学院(山西大医院)临床分离的鲍氏不动杆菌株共84株,其中亚胺培南耐药鲍氏不动杆菌(IRAB)63株,亚胺培南敏感鲍氏不动杆菌(ISAB)21株。用K-B纸片法检测以上细菌对常用抗菌药物的敏感性。PCR法分析10种β-内酰胺酶基因和carO、oprD膜孔道蛋白基因,adeB外排泵基因,并对扩增阳性的基因进行测序,同时应用DNASTAR软件对耐药和敏感菌株的carO、oprD序列进行对比分析。结果 63株亚胺培南耐药鲍氏不动杆菌对替加环素较敏感,对头孢哌酮/舒巴坦(28.6%)和米诺环素(30.2%)耐药率较低外,对其他抗菌药物耐药率均较高,而21株亚胺培南敏感鲍氏不动杆菌对多数抗菌药物较敏感;IRAB与ISAB检出TEM、OXA-23、adeB基因阳性率比较,差异有统计学意义(P<0.05),而ADC阳性率差异无统计学意义;84株细菌中carO、oprD和OXA-51均为阳性。亚胺培南耐药株carO编码基因序列与亚胺培南敏感株相比存在有意义突变。结论本研究中耐碳青霉烯类鲍氏不动杆菌耐药机制主要与β-内酰胺酶、adeB外排泵、carO孔道蛋白突变有关。     

2011-2013年鲍氏不动杆菌医院流行株耐药性变迁研究

目的统计分析医院分离的鲍氏不动杆菌(ABA)医院流行株耐药性变迁,为动态性耐药监测和临床合理选择用药提供参考依据。方法收集2011年1月-2013年12月医院感染住院患者送检标本分离出的186株鲍氏不动杆菌进行细菌培养与鉴定,按CLSI规定采用K-B法进行药敏试验,数据采用WHONET 5.5软件进行统计分析。结果 3年186株鲍氏不动杆菌中2011年检出55株检出率4.2%,2012年61株检出率4.7%,2013年70株检出率5.4%;鲍氏不动杆菌在感染性标本中检出率最高的是下呼吸道标本;3年鲍氏不动杆菌对临床常用抗菌药物耐药率总体呈逐年上升趋势,其中对米诺环素、亚胺培南、美罗培南、头孢哌酮/舒巴坦较为敏感,耐药率均<30.0%;对磺胺甲噁唑/甲氧苄啶、庆大霉素、环丙沙星、哌拉西林、头孢他啶耐药率较高,均>50.0%,尚未发现耐多黏菌素B鲍氏不动杆菌。结论鲍氏不动杆菌医院感染率呈逐年增加趋势,临床医师要关注多药耐药细菌的不断增长趋势,合理选择抗菌药物。     

多药耐药鲍氏不动杆菌获得性耐药相关基因与可移动遗传元件检测的指标聚类分析

目的 了解多药耐药鲍氏不动杆菌获得性耐药相关基因和可移动遗传元件携带状况,并分析两者的相关性.方法 收集2008年11月-2009年12月住院患者送检标本中分离的鲍氏不动杆菌共30株,采用聚合酶链反应(PCR)的方法,分析48种β-内酰胺类、氨基糖苷类、喹诺酮类获得性耐药相关基因和13种可移动遗传元件遗传标记,并对检测结果作指标聚类分析.结果 30株鲍氏不动杆菌共检出3种获得性β-内酰胺类耐药基因,5种获得性氨基糖苷类耐药基因,1种抗菌制剂外排泵基因,6种可移动遗传元件的遗传标记;其余46种基因未检出.结论 多药耐药鲍氏不动杆菌指标聚类分析显示,ADC型β-内酰胺酶基因和抗菌制剂外排泵基因adeB与tnpU、tnp513、IS26、ISaba9、intⅠ 1等可移动遗传元件遗传标记高度相关.     

耐碳青霉烯类鲍氏不动杆菌的耐药机制及同源性分析

目的 调查医院ICU流行的耐碳青霉烯类鲍氏不动杆菌的耐药机制及其同源性,为临床有效防治提供依据.方法 收集北京市海淀医院2011年11月ICU住院患者痰标本分离出的耐碳青霉烯类鲍氏不动杆菌4株,按《全国检验技术操作规程》操作,用全自动微生物分析仪进行细菌鉴定及药敏试验,PCR扩增检测碳青霉烯酶基因,用脉冲场凝胶电泳(PFGE)进行分型,分析其同源性.结果 4株鲍氏不动杆菌中除对头孢哌酮/舒巴坦(2株敏感、2株中度敏感)、磺胺甲噁唑/甲氧苄啶(2株敏感、2株耐药)、阿米卡星(1株敏感、3株耐药)稍敏感外,对其他各种抗菌药物均耐药;4株菌株均携带blaOXA-23-like和blaOXA-51-like基因;PFGE电泳结果显示,4株鲍氏不动杆菌分为A(A1、A2、A3)和B型,其中A型为主要的流行株.结论 鲍氏不动杆菌为多药耐药菌株;产碳青霉烯酶OXA-23是该菌对碳青霉烯类抗菌药物耐药的主要机制;同一克隆株在同一病房内传播致交叉感染.     

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.