目的 探讨影响本区肺结核发病的危险因素,为肺结核的防控提供参考依据。方法 采用频数匹配病例对照的研究方法,选自2012—2015年间,在本区居住的肺结核患者为病例组,按1∶1病例对照,在本区选择与病例组同性别、年龄相差<2 a的健康居民为对照组,用单因素Logistic分析及对多因素非条件Logistic 回归分析进行统计学分析。结果 肺结核发病的保护因素有文化程度的高低(OR=0.237,P<0.037),居住环境采光(OR=0.393,P<0.013),蔬菜水果类摄入(OR=0.748,P<0.021),蛋奶类摄入(OR=0.704,P<0.027)。肺结核的危险因素有工作环境是否接触粉尘(OR=2.984,P<0.001)是否吸烟(OR=1.537,P<0.020),是否饮酒(OR=1.110,P<0.041),结核病人接触史(OR=11.052,P<0.001),居住环境潮湿(OR=1.117,P<0.001)。最终被选入回归方程的因素为,文化程度、工作环境是否接触粉尘、结核病人接触史、居住环境潮湿、蔬菜水果类摄入,其OR值分别为0.471、8.945、17.652、14.268、0.234。结论 文化程度及蔬菜水果类的摄入为肺结核保护因素,工作环境接触粉尘、接触过结核病人及居住环境潮湿是肺结核的危险因素。

目的 分析我院2011—2015年我院儿科住院患者下呼吸道病原菌分布及其耐药性。方法 采用全自动生化鉴定仪对痰标本分离株进行鉴定,用全自动微生物药敏系统和纸片扩散法对病原菌的耐药性进行检测,并用头孢硝噻吩纸片法对β-内酰胺酶进行检测。结果 2011—2015年共分离得到下呼吸道病原菌518株,包括肺炎链球菌(21.62%)、金黄色葡萄球菌(16.99%)、流感嗜血杆菌(14.48%)、肺炎克雷伯菌(11.97%)、大肠埃希菌(8.11%)、卡他莫拉菌(5.41%)、鲍曼不动杆菌(3.86%)和铜绿假单胞菌(3.86%)等。药敏结果显示,肺炎链球菌对克林霉素(90.18%)、红霉素(92.86%)和复方新诺明(87.50%)的耐药率较高,金黄色葡萄球菌则对青霉素G(90.91%)和红霉素(68.18%)有较强耐药性,未发现对万古霉素或利奈唑胺耐药的革兰阳性球菌。流感嗜血杆菌对氨苄西林耐药率为32%,与其β-内酰胺酶阳性率较一致,肺炎克雷伯菌和大肠埃希菌对头孢类药物(17.33%~45.33%)和喹诺酮类药物(34.67%~50.67%)耐药性较高,并发现1株碳青霉烯耐药的肺炎克雷伯菌。结论 本院下呼吸道感染病原菌谱较广,主要包括多种革兰阳性球菌和革兰阴性杆菌,并对多种抗菌药物表现出较强耐药性,临床应注重合理应用相关抗生素,严格防控病原菌的医院感染及传播。

Objective To analyze the antimicrobial resistance and the profile of pathogens from lower respiratory tract infections in pediatric in patients. Methods Sputum bacterial isolates were identified by an automated biochemical identification system. Antimicrobial resistance was detected by an automated drug susceptibility detection system and the disc diffusion method. The β-lactamases was tested by the nitrocefin disc detection method. Results Five hundred and eighteen bacterial pathogens were isolated from sputum samples during 2011-2015, including streptococcus pneumoniae(21.62%), staphylococcus aureus(16.99%), haemophillus influenzae(14.48%), klebsiella pneumoniae(11.97%), escherichia coli(8.11%), moraxelle catarrhalis(3.8%), acinetobacter baumanii(3.86%) and pseudomonas aeruginosa(3.86%). High resistant rates were detected for S. pneumoniae to clindamycin(90.18%), erythromycin(92.86%) and sulfamethoxazole (85.50%), while S. aureus was highly resistant to penicillin G(90.91%) and erythromycin(68.18%). Resistance to vancomycin and linezolid was not detected for gram positive cocci. The resistant rate to ampicillin was 32% for H. influenzae, which was in concordance with the production of β-lactamases. Relatively high resistance was detected for K. pneumoniae and E. coli to cephalosporins and quinolones. A carbapenem-resistant K. pneumoniae isolate was also detected. Conclusion Multiple bacterial species were isolated from lower respiratory tract infections in our hospital, including different species of gram positive cocci and gram negative bacilli, and these isolates exhibited high resistance to antibiotics tested. The clinical use of antibiotics and hospital infection and transmission of these pathogens should be controlled.

肺动脉高压是一类发病率低,但常引起右心衰竭等最终导致患者死亡的严重肺血管疾病,其形成的主要病理改变是肺血管重构和肺血管收缩,多种细胞因子异常作用参与发病,对该作用机制的研究成为了治疗疾病,改善疾病预后的关键。

Pulmonary hypertension is a kind of low incidence, but it is often caused by right heart failure and other serious pulmonary vascular disease. The main pathological changes of pulmonary vascular include remodeling and pulmonary vascular contraction, and many kinds of cytokines are involved in the pathogenesis of disease, which is the key to improve the prognosis of the disease.

目的 研究探讨重症监护病房(ICU)病原菌的分布及耐药情况,为临床合理使用抗菌药物提供科学依据。方法 回顾性分析2015年ICU住院患者送检细菌分离培养及药敏试验结果。结果 ICU共送检标本1 326份,分离出病原菌554株,其中革兰阴性病原菌462株(83.4%),革兰阳性病原菌48株(8.7%),真菌44株(7.9%)。革兰阴性杆菌前5位依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、粘质沙雷菌和大肠埃希菌,且多耐药菌株比例较高。革兰阳性病原菌以金黄色葡萄球菌为主,32株(66.7%),MRSA检出率78.3%(25/32)。结论 加强重症监护病房的细菌及药敏监测,根据病原菌药敏结果指导临床合理使用抗菌药物,控制耐药菌株的产生,预防及控制院内感染及感染暴发。

Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria in intensive care unit(ICU) and provide scientific evidence for clinically reasonable use of antibiotics. Methods Specimens from hospitalized intensive care unit patients in 2015 were obtained for routine bacterial isolation and culture. Results A total of 554 bacterial strains were isolated from 1326 specimens, in which Gram-negative bacilli accounted for 462 stains (83.4%),Gram-positive cocci accounted for 48 stains (8.7%),and fungi accounted for 44 stains (7.9%). Gram-negative bacilli of the top five were Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae, Serratia marcescens and Escherichia coli,and the rate of multiple resistant bacteria was relatively high.Staphylococcus aureus were the main Gram-positive cocci, including MRSA accounted for 78.3%(25/32). Conclusion The monitoring of ICU clinical pathogens and their resistance should be strengthened. It is a great significance to use antibiotics rationally according to the results of susceptibility testing, in order to control the occurrence of resistant bacteria , prevent and control hospital infection and infection outbreak.

目的 探讨本中心引起儿童泌尿系统感染的常见病原菌的分布以及耐药情况,为临床合理选用抗菌药物提供参考。方法 回顾性分析本医疗中心2012年1月—2013年12月2463例泌尿系统感染患儿中段尿标本培养及药敏检测结果。结果 2463例患儿中段尿标本共培养病原菌479株,阳性率为19.45%。其中革兰阴性杆菌309株(64.51%),革兰阳性球菌138株(28.81%),真菌32株(6.68%,主要为白假丝酵母菌)。分离率前7位的病原菌依次为大肠埃希菌(36.53%)、肺炎克雷伯菌(12.73%)、粪肠球菌(D群)(12.32%)、屎肠球菌(D群)(10.23%)、真菌(6.68%)、铜绿假单胞菌(5.22%)、奇异变形菌(3.13%),革兰氏阴性杆菌以大肠埃希菌和肺炎克雷伯菌为主,其中产超广谱β‐内酰胺酶菌株125株,比例高达71.42%;革兰阳性球菌以肠球菌(D群)为主,金黄色葡萄球菌检出率为2.30%,其中耐甲氧西林株占27.27%。结论 大肠埃希菌仍为儿童泌尿系统感染的主要病原菌,且存在多重耐药菌感染情况,革兰氏阳性球菌有增多的趋势;明确病原菌种类及药敏结果,对临床合理应用抗菌药物治疗儿童泌尿系统感染有重要意义。

Objective To research the distribution of common pathogenic bacteria and drug resistance of urinary tract infection in the hospital for providing reference of antimicrobial drugs for clinical reference. Methods Pathogenic bacteria isolated from the germiculture positive specimens of midstream urine and the antimicrobial susceptibility test results from Jan 2012 to Dec 2013 in our hospital were retrospective summarized. Results 479 strains pathogenic bacteria were isolated from 2463 urine samples totally. The positive rate was 17.3％, with 309 strains of gram-negative bacilli (64.51％),138 strains of gram-positive coccus(28.81％),32 strains of fungi(6.68％).The top 7 isolation of pathogens were strains of escherichia coli(36.53％),strains of klebsiella pneumoniae(12.73％),strains of enterococcus faecalis D group(12.32％),strains of enterococcus faecium D group(10.23％),strains of fungi(6.68％),strains of pseudomonas aeruginosa(5.22％),strains of staphylococcus epidermidis(3.13％).125 strains of klebsiella pneumoniae produced ESBL were detected out with the rates of up to 71.42%. The strains of gram-negative bacteria were based on enterococcus faecalis (D group),yet staphylococcus aureus methicillin resistant strains accounted for 27.27%. Conclusion Escherichia coli is the main pathogenic bacteria of child urinary tract infection and the multidrug resistance of the pathogenic bacteria is in a very serious situation. And gram-positive cocci is going to be increasing. It is necessary to make clear pathogens and drug sensitivity results, which is important to guide clinic make use of antibacterial agents exactly to cure infection of urinary system in children.

目的 调查重症监护病房(ICU)医院感染的常见细菌分布及耐药性变化,为合理使用抗生素和医院感染的预防控制提供相关科学依据。方法 回顾性分析医院2007—2011年ICU收治的381医院感染患者感染菌株分布特点及耐药性情况。结果 ICU医院感染常见菌株主要来源于痰液标本,占78.2%,其次是血液。381 株临床分离菌中共检出革兰阴性杆菌262 株、革兰氏阳性球菌70例和真菌49例,分别占68. 8%、24.9%和占17.4%。革兰阴性杆菌中鲍氏不动杆菌(24.7%)、肺炎克雷伯氏杆菌(10.8%)、铜绿假单胞菌(9.2%)排前三位。其中除碳青霉烯类药物及抑酶制剂,鲍氏不动杆菌对其余抗菌药物耐药率均＞40%。革兰氏阳性球菌以金黄色葡萄球菌为主。对青霉素、庆大霉素、红霉素的耐药率均＞50%。结论 呼吸道仍是ICU最常见的感染部位。病原菌以革兰阴性杆菌为主,且对常用抗菌药物的耐药率逐渐升高,临床应加强抗菌药物规范使用,避免耐药菌株的产生。

Objective To investigate the distribution and drug resistance of pathogens in intensive care unit(ICU)causing nosocomial infections so as to provide scientific basis for antibiotic adoption and the prevention and control of nosocomial infections. Methods The specimen sources and the clinical distribution of the 381 pathogens isolated from 2007 to 2011 were retrospectively analyzed. The drug resistance was observed in ICU that causing nosocomial infections. Results The sputum was the major specimens source in ICU, accounting for 78.2%. Of the 381 pathogens causing nosocomial infections in ICU, the 262 gram-negative bacilli (68.8%), 70 gram-positive cocci (24.9%),and 49 fungi (17.4) were isolated, Among gram-negative bacilli the top three were acinetobacter baumannii (24.7%), klebsiella pneumonia(10.8%),and pseudomonas aeruginosa (9.2%). The drug resisitance rate of baumannii to antibiotics were more than 40%,beside carbapenem and B-Lactamaseinhibitors. The main gram-positive cocci of causing nosocomial infections was saphylococcus aureus in ICU. The drug resisitance rate of S. aureus to penicillin, erythromycin and gentamicin were higher than 50.0%. Conclusion The main distribution area of nosocomial infections was the respiratory tract and the gram-negative bacilli were the common pathogens in ICU. It was benefit to avoid presenting of drug resistant strain, and antibiotics should be reasonably used in clinic.

目的 分析基层医院ICU VAP的危险因素及病原学情况。方法 回顾性分析2013年1月—2014年12月本院ICU收治的机械通气>48 h 的118例患者,分VAP组和非VAP组,分析VAP的危险因素及病原学情况。结果 VAP组与非VAP组在紧急气管插管,机械通气时间,抗生素种类,糖皮质激素,PPI及镇静药物使用>7天,返流,MODS,ICU停留时间的项目,两组比较差异有统计学意义。紧急插管:52.2％ vs 31.9％,P＝0.029;机械通气时间:(9.8±3.5)vs(7.3±2.8)天,P＝0.038;抗生素种类>2种:52.2％ vs 26.4％,P＝0.005;使用糖皮质激素:56.5％ vs 27.0％,P＝0.001;PPI使用>7天:65.2％ vs 40.3％,P＝0.008;镇静药物使用>7天:58.7％ vs 38.9％,P＝0.035;返流:50％ vs 29.2％,P＝0.022;合并MODS:47.8％ vs 22.2％,P＝0.004;ICU停留时间:(13.6±6.6)vs(10.2±5.3)天,P＝0.023。使用糖皮质激素、机械通气时间、ICU停留时间是VAP的独立危险因素(多因素Logistic分析的OR值:2.481、1.234、1.075)。基层医院ICU VAP主要以革兰氏阴性菌(82.3%)为主。结论 使用激素、机械通气时间、ICU停留时间是基层医院ICU VAP的独立危险因素;而VAP病原菌感染以G-菌为主,可经验使用G-菌敏感的抗生素。

Objective To analyze pathogens and risk factors of VAP in a general ICU of a primary hospital. Methods Totally 112 patients(from 2013-01 to 2014-12) under mechanical ventilation over 48 h were retrospectively studied. The patients were assigned into VAP group and non-VAP group. The independent risk factors and pathogens of VAP were analyzed. Results There was significant difference between VAP group and non-VAP group in terms of emergent tracheal intubation, MV time, types of antibiotics used, the use of hormones,the use of PPI and sedative drugs for more than 7 days, regurgitation, MODS, ICU stay time. Emergent tracheal intubation:52.2％ vs 31.9％,P＝0.029;MV time:9.8±3.5day vs 7.3±2.8day,P＝0.038;types of antibiotics used > 2 kinds:52.2％ vs 26.4％,P＝0.005;the use of hormones:56.5％ vs 27.0％,P＝0.001;the use of PPI >7day:65.2％ vs 40.3％,P＝0.008;the use of sedative drugs >7day:58.7％ vs 38.9％,P＝0.035;regurgitation:50％ vs 29.2％,P＝0.022;MODS:47.8％ vs 22.2％,P＝0.004;ICU stay time:13.6±6.6day vs 10.2±5.3day,P＝0.023. The use of hormones,MV time, ICU stay time were the independent risk factors of VAP[odds ratio(OR) of multivariate logistic regression:2.481、1.234、1.075]. The main pathogens of VAP were gram-negative bacteria (82.3%). Conclusion The study shows that the use of hormones,MV time, ICU stay time are the independent risk factors of VAP; gram-negative bacteria are the main pathogens of VAP. Once VAP occurs, they can be treated with anti-gram-negative bacteria antibiotics.

目的 深入了解河源市某综合医院职业暴露的真实情况,评估健康风险,从而提出有效的控制措施,并提升医院员工的职业防护意识,以保障他们的健康和安全。方法 采用回顾性调查,从暴露类型、环节、病原体种类、职业类别、工龄等方面,对河源市某综合医院在2022—2023年所发生的职业暴露事件进行统计分析。结果 在2022—2023年期间,该综合医院共计发生了93例血源性病原体职业暴露事件,以锐器伤为主,共80例,占86.02%;职业暴露最多的是护理人员,共发生61例,占65.59%;工作人员中工龄≤2年的职业暴露比例最多,共有71例,占76.34%;职业暴露的发生环节主要集中在处理丢弃锐器物以及进行检查、治疗、护理操作的过程中,均为30例,占32.26%;发生职业暴露的原因主要是缺少防护,出现34例,占36.56%;职业暴露主要发生在普通病房,为37例,占39.78%;其次为门急诊,均为15例,占16.13%;职业暴露发生的暴露源传染病病原体种类以不明病原体为主,为36例,占38.70%;其次是乙型肝炎病毒,为32例,占34.40%;所有发生职业暴露的员工均接受了全面的暴露风险评估、合理的预防性用药措施以及定期的健康监测。结论 医院管理部门需加强职业安全培训,特别是针对护理人员和低年资员工,严格执行标准操作规程,提供充足防护用品,改进医疗设备设计,建立完善的监测报告和保障体系,并强化监督和管理,以降低职业暴露风险,保障员工职业安全。

Objective To gain a deep understanding of the actual situation of occupational exposure in a general hospital in Heyuan City, assess health risks, propose effective control measures,and enhance the awareness of occupational protection among hospital staff to safeguard their health and safety. Methods A retrospective study was conducted to statistically analyze the occupational exposure events that occurred in a general hospital in Heyuan City from 2022 to 2023, in terms of exposure types, links, types of pathogens, occupational categories, and years of service. Results During the period from 2022 to 2023, a total of 93 cases of occupational exposure to blood-borne pathogens occurred in the general hospital, with sharp instrument injuries being the most common, accounting for 80 cases（86. 02%）; nurses accounted for the majority of occupational exposures, with 61 cases（65. 59%）; among the staff, those with a service time ≤ two years had the highest proportion of occupational exposures, with 71 cases（76. 34%）; the main occurrence of occupational exposures was in the processes of disposing of discarded sharp instruments and conducting inspections, treatments, and nursing operations, both accounting for 30 cases（32. 26%）; the main reason for occupational exposures was lack of protection, with 34 cases（36. 56%）; occupational exposures occurred mainly in general wards, with 37 cases（39. 78%）, followed by outpatient and emergency departments, both with 15 cases（16. 13%）; the types of infectious pathogens exposed in occupational exposures were mainly unknown, with 36 cases（38. 70%）, followed by hepatitis B, with 32 cases（34. 40%）; all staff who experienced occupational exposures received comprehensive exposure risk assessments,reasonable preventive medication measures, and regular health monitoring. Conclusions Hospital management departments need to enhance occupational safety training, particularly for nursing staff and junior-level employees, strictly enforce standard operating procedures, provide adequate protective equipment, improve medical device design, establish a comprehensive monitoring and reporting system, strengthen supervision, and manage to reduce the risk of occupational exposure and ensure the occupational safety of employees.

       目的   分析重症烧伤患者血培养标本中检测出念珠菌的临床分布，探究重症烧伤患者血流念珠菌感染的病原学特征。方法   选取2012—2023年在广州市红十字会医院住院治疗的重症烧伤患者血培养标本1 148份，分析分离出念珠菌的非重复患者病死率、菌种分布、同时送检的其他类型标本念珠菌培养结果及患者念珠菌血流感染的检出时间与季节分布、抗菌药物使用情况及对常用抗真菌药物的耐药情况。结果  1 148份血培养标本中77份检出真菌，阳性率为6.71%。检出念珠菌感染的非重复患者27例，其中近平滑念珠菌13例，构成比为48.15%、白念珠菌8株，构成比为29.63%。血与静脉导管培养均检出念珠菌的有22例（81.48%）；血与伤口分泌物培养圴检出念珠菌的有10例（37.04%）；血、静脉导管、伤口分泌物培养圴检出念珠菌的有4例（14.81%）。静脉导管检出念珠菌高于其他类型标本。27例重症烧伤患者血流感染检出念珠菌的时间主要分布在入院后第2~3周、季节主要分布在春夏季。近平滑念珠菌、白念珠菌、热带念珠菌对氟康唑敏感率分别为83.33%、87.50%和75.00%。结论   重症烧伤患者血流近平滑念珠菌检出率最高，发生血流感染时间主要在春夏季及烧伤入院后第2~3周，静脉导管留置是增加重症烧伤患者念珠菌血流感染的因素。我院念珠菌对抗真菌药物具有较高敏感性。

      Objective  To retrospective analyze the clinical distribution of Candida species detected in blood cultures of patients with severe burns and to investigate the etiological characteristics of Candida bloodstream infections in these patients．Methods  A total of 1 148 blood culture specimens were collected from patients with severe burns hospitalized at an institution between 2012 and 2023．Patients data with Candida bloodstream infections isolated from 1 148 blood culture specimens were analyzed，including mortality rates，species distribution，Candida culture results from other simultaneously collected specimen types，and the timing and seasonal distribution of Candida bloodstream infections，the use of antibiotics and  resistance to commonly-used antifungal drugs．Results  A total of 1 148 blood culture samples，77 fungi were separated，resulting in a positive rate of 6.71%．Among the 27 patients with Candida infections，13 cases（48.15%）were caused by Candida parapsilosis and 8 cases（29.63%）by Candida albicans．Candida was isolated from both blood and intravenous catheter cultures in 22 cases，with a positivity  rate of 81.48%．Candida was isolated from both blood and wound secretion cultures in 10 cases（positivity rate of 37.04%），and 4 cases from blood，intravenous catheter and wound secretion cultures（positivity rate of 14.81%）．The detection rate of Candidafrom intravenous catheters was higher than that from other specimen types．Candida bloodstream infections were most commonly observed during the 2nd and 3rd week after admission，with a seasonal peak in spring and summer．The  susceptibility  rates of Candida parapsilosis、Candida albicans and Candida tropicalis to fluconazole were 83.33%、87.50% and 75.00%，respectively．Conclusions  The detection rate of Candida parapsilosis in bloodstream infections among patients with severe burns was the highest．These infections predominantly occur during the spring and summer and in the 2nd and 3rd week post-admission．The presence of intravenous catheters significantly contributes to Candida infections．The Candida in the hospital has high sensitivity to antifungal drugs．