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在医院感染监测过程中，有时会遇到少数感染病例由于在获得及发生感染的地点与时间上和人们熟知的医院感染定义在字面上不完全吻合，即发生在本医疗机构之外，而常被否定其医院感染的诊断，并被排斥在医院感染管理之外，直至引起暴发。几年来，我们经过仔细地调查，对被排除医院感染的病例进行了客观地分析，其中不乏应认定为输入性医院感染（Afferent nosocomial  infection）者。面对此种情况，为提升对医院感染的控制和管理水平，有必要复习与强调涉及输入性医院感染的几个问题。

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ObjectiveTo study the HIVbased lentiviral vector, pLenti6/V5SK, which contains the gene of interest , CXCintrakine (SDFKDEL), on the gene therapy of HIV1 infection. MethodsA pLentibased expression vector, pLenti6/V5DTOPO, was used to produce the lentiviral vector, which was cotransfected with the ViraPowerTM Packaging Mix (pLP1, pLP2, and pLP/VSVG) into 293FT cells to produce a replicationincompetent lentivius stock. After lentiviral stock had been titrated the by  HeLa cells, the expression of the  interest gene of  of SDF1  could be assayed by  indirect immunofluorescence in transduced HeLa cells.ResultsThe lentiviral expression vector, pLenti6/V5SK, was confirmed by restriction enzyme digestion and sequencing. The lentivirus stock was constructed in 293 FT cell line. The fluorescent protein was mainly scattered in cytoplasm and perinucleus in transduced HeLa cells. ConclusionThese findings demonstrated the ability of the lentiviral vector to transduce multiple genes into HeLa cells, and the potential therapeutic effect on the treatment of HIV1 infection. 

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1 Hunan Children's Hospital, Changsha 410007,China; 2 Hunan Institute of Animal and Veterinary Science, Changsha 410131, China

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ObjectiveTo apply a rapid and simple multiplex polymerase chain reaction(PCR) for detecting blaTEM，blaSHV and blaOXA-1 genes in Enterobacteriaceae. MethodsFrom October 2004 to July 2005,171 clinical strains of multiply drugresistant Enterobacteriaceae isolates were collected from three affiliated hospitals of Central South University in Hunan province. Extendedspectrum βlactamases (ESBLs)producing isolates were confirmed by means of phenotypic confirmatory tests as recommended by CLSI/NCCLS, multiplex PCR was used to determine blaTEM，blaSHV and blaOXA-1 genes. ResultsAmong 171 strains of multiply drugresistant Enterobacteriaceae,142 (83.04%) were ESBLs positive by phenotypic detection, 105 of 142 ESBLproducing Enterobacteriaceae isolates were confirmed to obtain positive results by multiplex PCR amplification. blaTEM DNA were detected in 85 isolates, blaSHV DNA in 26 isolates, blaOXA-1 DNA in 10 isolates, and 15 isolates carried  2 or more drugresistant genes.ConclusionMultiplex PCR is a suitable tool which allows the rapid genotypic detection of blaTEM, blaSHV or blaOXA1carrying bacteria from phenotypic ESBLsproducing Enterobacteriaceae.

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ObjectiveTo analyze the epidemic situation and risk factors of AIDS in 404 men who have sex with men (MSM) in Chongqing district, and provide a scientific basis for AIDS prevention and control.MethodsInvestigation was conducted by questionnaires,  the targets were surveyed by HIV screening and diagnosis test, and AIDS infection rates were calculated. ResultsAmong 404 MSM who have multisexual partners and the behaviors of unprotected sexual penetration, AIDS infection rate was 15.10%. The age of initial sexual behavior （χ2=16.61，P=0.001）, education background （χ2=28.68，P=0.000）and condom use frequency during sex behavior with female in the last six months （χ2=7.57，P=0.02） were different respectively, HIV infection rate was significantly different respectively.ConclusionThere is a high prevalence of HIV infection among MSM, effective measures to control AIDS in the MSM should be taken.

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ObjectiveTo study the characteristics and risk factors of infections in patients with earthquake injury. MethodsInfections from 140 patients who were injured in Wenchuan earthquake and admitted in a hospital from May 16 to August 20, 2008 were analyzed by prospective study. ResultsThe infection rate of 140 patients was 40.71% (57/140) and nosocomial infection rate was 28.57%(40/140) in patients with earthquake injury. Gramnegative bacilli were  the main pathogens among 88 strains of pathogens in infection, which accounting for 57.09%; 5 strains of anaerobic bacteria were isolated from wound.  Infection had a significant correlation with AISISS score, the higher  AIS-ISS score was, the higher rates of infections were. ConclusionInfection is a common complication of earthquake injury, it is necessary to analyze AISISS score for predicting the occurrence of nosocomial infection, and take effective measures to prevent and control traumatic infection. 

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ObjectiveTo analyze  clinical characteristics of 40 patients with AIDS in a hospital. MethodsClinical data of 40 HIVinfected patients who were admitted  between January  2003 and August 2004 were analyzed retrospectively. ResultsAll patients were in AIDS stage, CD4+T lymphocytes counts were (156.54±131.26)/μL(normal value were 800~1 200/μL).  The main clinical manifestations included fever, cough and expectoration, loss of weight, abdominal pain, diarrhea and  cervical  lymphadenectasis, some patients developed Kaposi’s sarcoma; The main opportunistic infections and complications  were hepatitis virus infection (30 cases,75.00%), pulmonary tuberculosis (15 cases, 37.50%).  HIV infections were  mainly through intravenous drug injection (32 cases,80.00%), and sex contact (4 cases,10.00%). Patients’ exposure to HIV time (intravenous drug injection, sex contact and blood transfusion) were 2~12 years, the average time were (7.31±1.30) years.ConclusionThe clinical manifestations of AIDS patients are various, and the main infection route is intravenous drug injection, multiple measures should be taken to prevent and control HIV transmission, patients should undergo effective untiviral treatment, monitor and followup, so as to control opportunistic infection and virus replication.

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ObjectiveTo investigate the characteristics of nosocomial infection (NI) in patients with lung cancer treated by chemotherapy. MethodsA retrospective analysis on clinical data of 2 067 patients with lung cancer from January, 2003 to December ,2007 was made. ResultsThe NI rate in patients with lung cancer treated by chemotherapy was 7.93%. Upper respiratory tract infection and  lower respiratory tract infection was 51.11% and 33.89% respectively. Patients’ characteristics, including average hospital stay, average chemotherapy cycles, the degree of leukopenia and application of granulocyte colony stimulating factors were not obviously different between patients  with  and without NI (all P>0.05). NI rate increased significantly in patients with grade Ⅲ or Ⅳ leukopenia (P=0.000), but there was no difference in NI rate between patients receiving and not receiving preventive antimicrobial agents (both P>0.05).ConclusionThe most common NI in patients with lung cancer during chemotherapy are upper respiratory tract infection and   lower respiratory tract infection. Taking antimicrobial agents as a preventive measure against infection seems to have no effect on decreasing  NI rate in patients with grade Ⅲ or Ⅳ leukopenia.

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ObjectiveTo study the risk factors for postcraniotomy intracranial infection in patients in department of neurosurgery, and provide reference for the prevention and control of intracranial infection. MethodsThirtyeight  patients with intracranial infection and 68 patients without intracranial infection from January to August  2006 were investigated through casecontrol study  of  patients’ general information, basic diseases, main diagnosis, operation, antimicrobial use, invasive procedure, length of hospitalization and operation medical personnel etc.ResultsUnivariate regression analysis showed  there were significant difference in main  diagnoses of patients, the craniotomy method, staying in ICU, duration of operation, length of hospitalization, indwelling ureter, use of H2 receptor antagonists (including proton pump inhibitor) and operation medical personnel between  two groups (P<0.05); multivariate Logistic regression analysis showed that duration of operation and operation medical personnel were independent factors for postcraniotomy intracranial infection.ConclusionPostcraniotomy intracranial infection in patients is related with duration of operation, operation skill and sterile awareness of operation medical personnel.

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ObjectiveTo investigate the distribution, antimicrobial susceptibility of Acinetobacter in lower respiratory infection and the association with lung underlying diseases. MethodsAcinetobacter isolated from sputum in patients  from January 2003 to December 2006 were analyzed retrospectively,clinical records were also reviewed and made statistical analysis. ResultsOne hundred and thirtytwo strains of  Acinetobacter strains were isolated, which accounting for 12.70% of total isolated bacteria and 15.02% of gramnegative bacilli, 79 of 132（59.85％）strains were  Acinetobacter baumanii，112(84.85%) strains  of Acinetobacter were isolated from patients with lung underlying diseases. Antimicrobial susceptibility results suggested that isolated Acinetobacter strains were sensitive to meropenem ，cefoperazone/ sulbactam and levofloxacin,  but resistant to aztreonam, mezlocillin and so on. Antimicrobial susceptibility between 79 strains of Acinetobacter baumanii and 53 strains of the other species of Acinetobacter was significantly different（P＜0.05 or P＜0.01）. The sensitive rates to cefoperazone and cefoperazone / sulbactam in 110 Acinetobacter isolates was 51.82% and 83.64% respectively, there was significant difference between  the two (χ2=25.47，P<0.01). Antimicrobial susceptibility test  results between  Acinetobacter isolated from  patients with  respirators and without respirators were also significantly different（P＜0.05 or P＜0.01）. Among 103 patients who were isolated Acinetobacter, 80 patients’ sputum sample delivery time were within 4 days after admission, 23 were 4 days later of admission, antimicrobial susceptibility between two groups was significantly different（t=3.84, P＜0.05）.ConclusionAcinetobacter is the main pathogen in lower respiratory  tract  infection, most of which  is Acinetobacter baumanii; drugresistance of Acinetobacter is serious and related to the use of respirator, time from admission to delivering sputum samples and lung underlying diseases. Acinetobacter is not only the main pathogen in nosocomial  infection, but also can cause  patients with lung underlying diseases develop  communityacquired pneumonia.

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ObjectiveTo study the  clinical and epidemiological characteristics of infants acute diarrhea caused by cluster A rotavirus（RV） in changsha. MethodsStool samples from infants with diarrhea in a hospital from May 2006 to April 2007 were detected by technique of colloidal gold and immunochromatography double antigen sandwich assay. Epidemiological data of infants were analyzed. ResultsAmong 1 724 detected stool samples, 342 (19.84%) cases were positive RV antigen, the positive rate of RV antigen  from May to June in the year of 2006 was 9.21%, while from November to December in 2006 and January to February in 2007 was 36.61% and 24.37% respectively, there were significant differences in the positive rates of RV antigen between the latter two periods and the other months (χ2=107.18, P＜0.001); The most susceptible age of the infection was 6 months ~ 1 years old, ~1.5  and ~2 years old, the positive rate was 26.57%, 31.48% and 29.55% respectively, there were significant differences in the positive rates of RV antigen between infants at age of 6 months ~2 years old and the other age groups (χ2=79.30, P<0.001); RV infection rate in male and female was 16.27% and 23.94% respectively, the former was obviously lower than the latter (χ2=15.87, P<0.005). ConclusionThe incidence peak of RV infection is from November to February of the next year, the susceptible age is 6 months to 2 years old. Infants with diarrhea should be detected RV antigen as soon as possible and given rational treatment, so as to prevent transmission.

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ObjectiveTo analyze the distribution and drug  resistance of pathogens isolated from patients in intensive care units( ICUs) and  nonICUs, so as to provide evidence for clinical antiinfective treatment. MethodsBacterial  strains from patients in clinical departments from May 2006 to May 2007 were isolated and identified,  pathogenic distribution and antimicrobial resistance  between ICUs and nonICUs were compared and analyzed.ResultsOne hundred and fifty strains were isolated from patients in ICUs, the constitutional ratio of nonfermentative bacteria was 40.67%(61/150); 495 strains were isolated from nonICUs, the constitutional ratio of nonfermentative bacteria  was 17.98%(89/495). The isolation rate of nonfermentative bacteria from ICUs was higher than that of nonICUs (χ2=33.20，P<0.01). The most common pathogens in ICUs were fungi（21.33％），Pseudomonas aeruginosa（17.33％） and Escherichia coli（12.67％）; The most common pathogens in nonICU were fungi (20.61%)，Escherichia coli (17.98%) and Staphylococcus aureus (10.30%). Antimicrobial resistance of Acinetobacter baumannii and Staphylococcus aureus isolated from ICUs were serious;  The resistance to the third generation cephalosporins for treating infection with gramnegative bacilli was quite different between ICUs and nonICUs.ConclusionThe isolation rate of nonfermentative bacteria in ICUs is high, and drug resistance is serious, which should be given strengthened management and surveillance.

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ObjectiveTo evaluate the detection results of transfusiontransmitted diseases (TTD) serum markers in blood recipients before transfusion.MethodsHBsAg, HBsAb, AntiHCV, Syphilis antibody (AntiTP) and AntiHIV were detected among 102 175 blood recipients by ELISA before transfusion.ResultsAmong 102 175 patients detected, the total positive rate  of  TTD serum markers was 15.63%. The positive rate of HBsAg, AntiHCV, AntiHIV and AntiTP was 12.95%,1.11%, 0.04%  and 1.53%, respectively. The positive rate of HBsAg, HBsAb and AntiHCV in blood recipients decreased gradually from 2001 to 2007(P=0.003 or P=0.000),but the positive rate of AntiHIV tended to increase (P=0.001). ConclusionSome blood recipients have TTD before transfusion, especially HBV infection. The serology detections in patients before transfusion not only help us to avoid the medical dispute and nosocomial infection resulted from the transfusion, but also provide useful information of spread of TTD in this area.

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ObjectiveTo investigate the distribution  and drugresistance of pathogens in  positive blood culture, so as to provide reference for the rational use of antimicrobial agents. MethodsFrom January 1, 2007 to December 31,2007, a total of 2 317 blood samples were cultured by  BACTEC9120 system, the isolates were identified by API system, drug sensitive tests were performed by KirbyBauer test, the data were analyzed by WHONET5.3 software.ResultsTwo hundred and twentythree patients in 55 clinical wards had 324 positive blood culture, the positive rate was 13.98%. The isolated strains include 26 species of bacteria and 3 species of fungi, there were 223 pathogenic strains in total. Grampositive cocci, gramnegative bacilli and Candida were 109(48.88%) strains, 106(47.53%) and 8(3.59%) respectively; The main  pathogenic bacteria were Coagulasenegative staphylococcus (67 strains), Escherichia coli (41), Klebsiella pneumoniae (20) and Staphylococcus aureus (15). The percentage of isolated bacteria in intensive care unit, emergency department and hematological department was 21.97%, 14.80% and 14.35% respectively. Methicillinresistant Coagulase negative staphylococcus (MRCNS) and methicillinresistant Staphylococcus aureus (MRSA) accounted for 73.13% and 40.00% respectively. The detection rate of extendedspectrum βlactams (ESBLs) of Escherichia coli and Klebsiella pneumoniae was  41.46% and 30.00% respectively; Drugresistant rate of MRCNS, MRSA and ESBLsproducing strains were all high.ConclusionThere are varieties of  pathogens isolated from  blood culture, and the drugresistance of pathogens are high, clinicians should pay attention to the culture  of blood  in patients suspected septicemia, so as  to use antimicrobial agents rationally.

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ObjectiveTo investigate the carrying condition and  antimicrobial  susceptibility of methicillinresistant Staphylococcus (MRS) on medical staff's hands.MethodsOne hundred and sixtyeight  medical staffs were selected randomly in a hospital, 336 swabs samples were collected from their hand skin before and after “sixstep” hand washing respectively. The samples were prepared for isolated culture of MRS as well as antimicrobial susceptibility tests. ResultsThe carrying rate of  MRS on medical staffs’ hands was 66.67% and  41.07% before and after hand washing respectively, there was significant difference between the two (χ2=22.14, P<0.01). All of MRS were methicillinresistant Coagulase negative staphylococcus (MRCNS), methicillinresistant Staphylococcus aureus (MRSA) wasn’t found. Except the relatively lower drugresistant rates to vancomycin and nitrofurantoin, drugresistance rates were all high  to  penicillin, ampicillin, amoxicillin/clavulanic acid，cefalotin and cefotaxime(70.37%～100.00%); the resistant rate to ciprofloxacin, erythromycin, clindamycin, trimethoprimsulfamethoxazole was 42.33%～80.42%; The drug resistance rate of MRS was obviously higher than that of methicillinsensitive Staphylococcus, and the multiply drug resistance was observed. ConclusionHigh carrying rates of MRS on medical staff’s hands should be paid more attention. Sixstep hand washing can  reduce the carrying rates of MRS as well as  the spread and prevalence of MRS among hospital.

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目的方法结果结论为了解张家界市永定区各级医疗机构消毒质量现状，于 2004—2007年按《消毒技术规范》要求，对辖区内2所区直医疗机构、25所乡镇（办事处）卫生院、105所村卫生室进行抽样检测。 结果显示，4年来该区医疗机构消毒合格率呈逐年上升趋势，由2004年的63.86%上升至2007年的76.99%（χ2＝45.63，P＜0.005）；区直医疗机构医疗用品消毒合格率为95.36%，明显高于乡镇（办事处）卫生院的79.16%和村卫生室的65.03%（χ2＝159.70，P＜0.005）。空气、物体表面、医护人员手、使用中消毒液、无菌医疗用品及器械消毒合格率分别为49.30%、56.81%、67.82%、91.46%、71.12%，经统计学分析，5类抽检样品消毒合格率差异有显著性（χ2＝353.01，P＜0.005）；5类抽检样品消毒合格率在年度间升高有统计学意义者为物体表面（χ2=59.18，P＜0.005）、无菌医疗用品及器械（χ2=15.49，P＜0.005）。提示该区医疗机构消毒管理工作未完全落实到位，应加强医护人员的消毒知识培训和技术指导，加大卫生监督力度。

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目的方法结果结论采用回顾性调查方法对某医院2008年5—6月出院的624例手术患者预防性使用抗菌药物情况进行调查分析。结果显示， 624例患者围手术期抗菌药物使用率达100.00% ，其中单一用药274例（43.91%），二联用药272例（43.59%），三联用药78例（12.50%）；围手术期抗菌药物使用时间平均为8.37 d；使用最多的抗菌药物为第三代头孢菌素类，其次为喹诺酮类。提示该院围手术期抗菌药物预防应用不规范，应加强管理。

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目的方法结果结论采用常规现场抽检采样和检测的方法对某院环境卫生学及消毒灭菌效果进行监测。2005年1月—2007年7月各监测项目总合格率分别为：室内空气97.71%，物体表面95.80%，医护人员手97.21%，使用中消毒液98.30%，无菌器械保存液96.60%，无菌物品100.00%，灭菌器97.05%，紫外线灯辐照强度99.82%，透析用水和透析液91.11%。2005—2007年各年度消毒监测总合格率分别为：98.72%、96.27%、97.88%，三者比较，差异有显著性（χ2=28.74，P＜0.05）。2005年消毒监测总合格率与2006年比较，差异有显著性（P＜0.05）；与2007年比较，差异无显著性（P＞0.05）。2006年消毒监测总合格率与2007年比较，差异有显著性（P＜0.05）。提示该院消毒灭菌质量整体较好，但存在消毒液质量和使用不规范等现象，应加大消毒管理和监督力度。

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目的方法结果结论采取到科内随机提问、观察和发放问卷表的形式对80名工勤人员进行医院感染知识掌握情况调查，发现大多数工勤人员缺乏自身防护意识，对从业的危险性认识不足，医院感染知识缺乏。提示必须加强工勤人员的医院感染知识培训。

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目的方法结果结论将7条纯棉浴巾代替以往使用的纯棉布大被套叠成30 cm×25 cm×25 cm的测试包进行BD试验，BD测试纸放于测试包中间，外用纯棉布包裹，封口用化学指示胶带固定。改进BD包后的BD试验合格率为93.00%，明显高于改进前的82.00%（χ2= 5.53，P＜0.05）。提示改用浴巾做BD包不失为一种价廉物美、行之有效的检测方法。

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慢性重型乙型肝炎，因其病情发展迅速、肝功能损害严重且并发症多而为一种难治性危重疾病。慢性重型乙型肝炎并发急性胰腺炎虽少见，但其病势凶险，且胰腺炎症状易被掩盖，预后差，病死率极高。早发现、早诊断、早治疗是提高此类患者生存率的重要措施。笔者对本科2007年4月—2008年4月收治的2例慢性重型乙型肝炎并发急性胰腺炎患者的病历资料总结报告如下。

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耐甲氧西林金黄色葡萄球菌（Methicillinresistant Staphylococcus aureus, MRSA）是医院感染的重要病原菌之一，自1961年在英国首次被报道以来，其感染率不断上升，目前医院正面临着MRSA感染日益严重和多重耐药的挑战。MRSA对包括甲氧西林在内的多种抗菌药物耐药，由它所致的感染易呈流行或暴发流行，治疗困难且病死率高，成为临床治疗的一大难题。医院感染MRSA（hospitalacquired, HAMRSA）一直受到人们的关注。近年发现，MRSA也可引起社区获得性感染，社区获得性MRSA（communityacquired, CAMRSA ）通常对非β内酰胺类抗生素敏感，在流行病学上不同种群中有其独特的感染谱，易见于皮肤脓肿、坏死性筋膜炎及坏死性肺炎。近20年，尤其是近3年，CAMRSA的播散已经成为一个全球性的问题。在CAMRSA分离率达到一定程度的国家，此种菌株所导致的感染近来逐渐受到国内外学者的关注，并采取相应的防治措施。本文就CAMRSA的流行病学、耐药特点、机制、传播机制及预防治疗对策作一综述。