内镜逆行胰胆管造影术后感染的病原菌及耐药性分析

目的研究内镜逆行胰胆管造影术后感染的病原菌种类分布,并对病原菌的耐药性进行分析,指导临床合理用药。方法选取医院2010年8月-2012年8月132例行内镜逆行胰胆管造影术后感染患者的标本,将分离培养的病原菌依据NCCLS指定的K-B琼脂法进行药敏试验,药敏试验结果判定严格按照按照NCCLS 2005年版。结果内镜逆行胰胆管造影术后感染患者病原菌来源分布中,胆汁38株占26.03%、胰液30株占20.55%、消化道23株占15.75%、尿液16株占10.96%;共分离出病原菌146株,其中革兰阳性菌64株占43.84%,革兰阴性菌82株占56.16%;革兰阳性菌对乙酰唑胺和林可霉素的耐药率较低,均<5.00%,革兰阴性菌对美罗培南和替考拉宁的耐药率较低,也均<5.00%。结论内镜逆行胰胆管造影术后感染患者病原菌对多数抗菌药物具有耐药性,当临床内镜逆行胰胆管造影术后感染发生时,应先分离培养病原菌,并进行药敏试验,选用耐药率低的抗菌药物进行及时的治疗。     

胆总管结石并发胆道感染患者病原菌与药敏分析

目的对胆总管结石伴胆道感染患者进行胆汁培养,对其病原菌分布及耐药性进行统计分析,为临床用药提供指导。方法选取医院2012年1月-2013年2月120例胆总管结石患者为研究对象,所有患者行内镜逆行胰胆管造影术(ERCP),术中抽取胆汁标本,进行细菌培养及药敏分析。结果 120例胆总管结石患者中96例检出病原菌,检出率为80.0%;共分离出病原菌107株,其中革兰阴性菌共检出75株占70.1%,革兰阳性菌30株占28.0%,真菌2株占1.9%;大肠埃希菌对亚胺培南、美罗培南及环丙沙星较敏感,耐药率<20.0%,肺炎克雷伯菌和铜绿假单胞菌对亚胺培南、美罗培南高度敏感,耐药率均为0;粪肠球菌对万古霉素、磷霉素及氯霉素较为敏感,耐药率<10.0%;真菌对酮康唑、伊曲康唑、制霉菌素及两性霉素较敏感。结论引起胆总管结石患者胆道感染的病原菌主要以革兰阴性菌为主,病原菌对常用抗菌药物表现出一定的耐药性,临床应根据药敏试验结果合理选用抗菌药物,避免盲目用药。     

胆道感染患者胆汁病原菌分布及耐药性分析

目的分析胆道感染患者胆汁病原菌分布及病原菌对抗菌药物敏感性,为临床合理使用抗菌药物提供参考。方法选取2015年1月-12月在医院肝胆脾胃科收治的胆道感染113例患者术中胆汁标本;采用法国生物梅里埃全自动微生物检测系统进行菌种鉴定,抗菌药物敏感性实验采用纸片扩散法(K-B)。结果 113例送检标本分离出病原菌128株,革兰阴性菌94株占73.44%,革兰阳性菌29株占22.66%,真菌5株占3.91%;对亚胺培南革兰阴性菌耐药率最低,革兰阳性菌对庆大霉素、万古霉素耐药率为0;真菌对氟康唑、伏立康唑等常用抗真菌药物耐药性均较低,使用后可得到良好效果,但对两性霉素B显示出较大抵抗性。结论胆道感染患者胆汁病原菌以革兰阴性菌为主,病原菌耐药性较为明显,院内应规范化执行《抗菌药物临床应用管理办法》,增强临床合理用药理念,延缓细菌耐药性快速提升态势。     

胆管结石合并胆道细菌感染患者胆汁病原菌及其预后影响因素

目的探究胆管结石合并胆道细菌感染患者内镜逆行胰胆管造影术(ERCP)术中及术后胆汁检出病原菌构成及药敏结果,并分析患者预后的影响因素。方法选择郴州市第一人民医院2017年3月-2020年3月收治的120例胆管结石伴胆道细菌感染患者作为研究对象,患者均行ERCP,术中与术后收集胆汁进行细菌培养及药敏试验,并分析患者预后影响因素。结果术中与术后患者胆汁细菌培养阳性率分别为73.33%与52.50%,差异比较有统计学意义(χ²=11.162,P<0.001);术中与术后患者共分离出病原菌分别为114株与82株,其中革兰阴性菌分别为76株(66.67%)和61株(74.39%),两组病原菌构成差异比较无统计学意义;胆汁革兰阴性菌中大肠埃希菌对头孢唑林耐药性较高,而对头孢吡肟、亚胺培南耐药性较低;铜绿假单胞菌对磺胺甲噁唑/甲氧苄啶耐药性较高,对亚胺培南耐药性较低;肺炎克雷伯菌对环丙沙星耐药性较高,对亚胺培南耐药性较低;革兰阳性菌粪肠球菌对莫西沙星、环丙沙星耐药性较高,而对利奈唑胺、亚胺培南、万古霉素耐药性较低;胆汁中金黄色葡萄球菌对环丙沙星、庆大霉素耐药性高,对替考拉宁、利奈唑胺、万古霉素耐药性较低;多元Logistic回归分析结果显示,结石大小、泥沙样与块状混合样结石、结石数量为患者预后的影响因素(P<0.05)。结论胆管结石合并胆道细菌感染患者ERCP术中及术后胆汁病原菌主要为革兰阴性菌,并对多种抗菌药物耐药,治疗时应该慎重选择抗菌药物,患者预后不良主要由结石大小以及性状导致,需要重点关注。     

胆结石患者胆道感染病原菌分布与药敏分析

目的分析胆结石合并胆道感染胆汁中病原菌的分布及药敏性,为临床合理用药提供参考。方法选取2009年3月-2014年3月收治的82例胆结石合并胆道感染患者,对患者利用内镜逆行胰胆管造影术进行检查,抽取胆汁样本进行病原菌的分布以及药敏分析,采用EpiData 3.1软件进行统计分析。结果 82例胆汁标本培养阳性的为78例,检出率为95.1%,共检出病原菌85株,其中革兰阴性菌59株占69.4%,革兰阳性菌18株占21.2%,真菌8株占9.4%;革兰阴性菌对亚胺培南的耐药率最低,其次为妥布霉素、哌拉西林/他唑巴坦、头孢吡肟及阿米卡星等,耐药率均<30.0%;革兰阳性菌对万古霉素的耐药率最低,其次为庆大霉素、链霉素、环丙沙星、利福平等,耐药率均<15.0%。结论胆结石合并胆道感染患者胆汁中病原菌的分布发生了新的变化,大肠埃希菌、肠球菌属及肺炎克雷伯菌等是其主要病原菌,在临床上,应根据患者胆汁药敏试验结果对抗菌药物进行合理选择。     

胆石症患者胆道感染的病原菌分布与耐药性分析

目的分析胆石症患者胆道感染的病原菌分布及耐药性,为临床合理用药提供参考依据。方法选取2013年254例胆石症患者,采集发生胆道感染患者静脉血和胆汁,对其病原菌分布及其耐药性进行筛查,采用SPSS13.0软件进行统计分析。结果 254例胆石症患者发生胆道感染164例,感染率为64.57%;血培养阳性90例,阳性率为35.43%,胆汁培养阳性164例,阳性率为64.57%,胆汁培养的阳性率明显高于血培养,差异有统计学意义(P<0.05);胆汁培养出病原菌164株,其中革兰阳性菌68株占41.46%,革兰阴性菌96株占58.54%;血液培养出病原菌90株,其中革兰阳性菌36株占40.00%,革兰阴性菌54例占60.00%,以大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌、粪肠球菌为主;革兰阳性菌对舒巴坦、红霉素的耐药率较高,>85.00%,对万古霉素、呋喃妥因敏感,耐药率为0;革兰阴性菌耐药性严重,对常用抗菌药物的耐药率均>50.00%,对氨苄西林的耐药率达100.00%,对亚胺培南敏感,耐药率<4.00%。结论胆石症合并胆道感染患者胆汁培养的阳性率较高,病原菌对常用抗菌药物均产生了较严重的耐药性,临床应根据药敏试验结果合理选用抗菌药物。     

抗甲状腺药物致粒细胞缺乏患者医院感染的研究

目的探讨抗甲状腺药物致粒细胞缺乏患者发生医院感染的病原菌分布及其耐药性,为临床选择敏感抗菌药物提供参考。方法选取2010年5月-2013年5月34例甲状腺药物致粒细胞缺乏发生医院感染患者为研究对象,分析感染病原菌的分布和对抗菌药物的耐药性,所有数据采用SPSS16.0软件进行统计分析。结果粒细胞缺乏症患者医院感染部位以呼吸道感染为主占41.18%,其次为泌尿系和皮肤软组织,分别占26.47%和11.76%;共分离病原菌42株,其中革兰阴性菌19株占45.24%、革兰阳性菌20株占47.62%、真菌3株占7.14%;革兰阳性菌中金黄色葡萄球菌对万古霉素和美罗培南耐药率最低,均为0;主要革兰阴性菌则对美罗培南、亚胺培南耐药率最低,均为0;对其他抗菌药物的耐药率均>20.00%。结论甲状腺药物致粒细胞缺乏合并医院感染以呼吸道常见,加强细菌培养、药敏试验,早期应用敏感抗菌药物至关重要。     

小儿下呼吸道感染病原菌分布及耐药性分析

目的探究常用抗菌药物对小儿下呼吸道感染病原菌的耐药性,为临床应用抗菌药物提供依据。方法对医院2009年9月-2012年3月收治的302例下呼吸道感染患儿进行回顾性分析,对其感染病原菌类型及常用抗菌药物敏感性进行探究。结果 302例患儿共检出病原菌149株,其中革兰阴性菌107株占71.8%,以流感嗜血菌和大肠埃希菌为主,革兰阳性菌34株占22.8%,以肺炎链球菌为主,真菌8株占5.4%;革兰阴性菌对阿米卡星、亚胺培南、美罗培南耐药率较低,均<20.0%,革兰阳性菌对呋喃妥因、万古霉素的耐药率均为0。结论小儿下呼吸道感染病原菌感染主要以细菌感染为主,革兰阴性菌分离率较高,而传统氨苄西林、第三代头孢等抗菌药物耐药率均明显升高,应按照病原菌药敏结果,合理选择抗菌药物,以有效清除病原菌,改善预后。     

脑血管疾病患者医院感染的病原菌分布与耐药性分析

目的调查脑血管疾病患者医院感染的病原菌分布及其耐药性,指导临床合理使用抗菌药物。方法回顾性分析医院2010年1月-2014年1月122例脑血管疾病合并医院感染患者的临床资料,统计分析其感染病原菌种类及对常用抗菌药物的耐药率,数据采用SPSS13.0统计软件进行分析。结果 122例患者感染部位以下呼吸道感染最多47例、泌尿道25例、胃肠道感染21例,分别占38.5%、20.5%、17.2%;共分离出病原菌155株,其中革兰阴性菌81株占52.3%、革兰阳性菌59株占38.0%、真菌15株占9.7%;肺炎克雷伯菌对亚胺培南、阿米卡星和左氧氟沙星的耐药率较低,分别为0、11.1%和18.5%,金黄色葡萄球菌对万古霉素、美罗培南和庆大霉素的耐药率较低,分别为0、11.8%和17.6%,肠球菌属对万古霉素和美罗培南的耐药率较低,分别为0和7.1%。结论脑血管疾病患者医院感染的病原菌以革兰阴性菌为主,革兰阴性菌对亚胺培南和阿米卡星最敏感,革兰阳性菌对万古霉素和美罗培南最敏感,医院感染患者的治疗应参考病原菌药敏试验结果,合理选用抗菌药物,避免滥用广谱型抗菌药物,减少耐药菌株产生。     

综合性医院胆汁细菌培养病原菌的分布及耐药性分析

目的分析胆汁细菌培养中病原菌的分布及耐药性,为临床合理选用抗菌药物控制胆道感染提供依据。方法调查医院从2013年1月-2015年12月各科室送检的胆汁中分离出病原菌的分布及耐药性,细菌的鉴定和药敏试验采用法国生物梅里埃公司VITEK 2 Compact全自动细菌鉴定药敏分析仪。结果共分离出270株病原菌,革兰阴性菌170株,革兰阳性菌82株,真菌18株,分别占63.0%、30.4%、6.7%;主要革兰阴性菌对多数抗菌药物产生了高度耐药,肺炎克雷伯菌对亚胺培南的耐药率达21.1%;主要革兰阳性菌中的屎肠球菌和粪肠球菌也有很高的耐药性,未发现耐万古霉素和利奈唑胺菌株。结论胆汁培养中的病原菌以革兰阴性菌为主,大肠埃希菌占第一位,且多为多重耐药菌,只有防止经验用药的不合理性,根据细菌和药敏结果选用抗菌药物,才能有效控制胆道感染。     

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.     

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.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

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.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

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.     

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.