Abstract:

近20年来，机会真菌所致侵袭性感染显著增高，同时其发病率和病死率也随之增高，主要的机会真菌感染为白假丝酵母菌、新生隐球菌和烟曲霉所致；但近年来，其他机会真菌亦日益重要，如非白假丝酵母菌、除烟曲霉外的其他曲霉、毛孢子菌属、红酵母属、接合菌属(根霉、毛霉等)、镰刀霉属、赛多孢菌属以及各种暗色真菌等［1］。

Abstract:

ObjectiveTo evaluate the inhibitory activities of deoxynojirimycin (DNJ) and its derivate Nbutyldeoxynojirimycin (NbutylDNJ) against hepatitis B virus(HBV) in vitro. MethodsHepG2 2.2.15 cell were treated with DNJ. At 3rd, 6th and 9th day after treatment, the supernatant was collected for HBsAg, HBeAg and HBV DNA quantitative assay. ResultsAt 9th day of incubation, 1 000 μg/mL DNJ and 100 μg/mL NbutylDNJ had obvious inhibitory effect on the replication of virus, there were significant differences compared with control group (both P＝0.001). ConclusionDNJ and its derivate have no obvious and direct cytotoxicity effect at the experimental concentration, 1 000 μg/mL DNJ and 100 μg/mL NbutylDNJ can inhibit the replication of HBV in HepG2 2.2.15 cell.

Abstract:

ObjectiveTo study the qacE△1sul1 gene in multiply drugresistant Pseudomonas aeruginosa. MethodsThe susceptibility of 30 strains of clinical isolated Pseudomonas aeruginosa to 15 antimicrobial agents was tested by KirbyBauer method，and qacE△1sul1 gene was analyzed by PCR.ResultsIn 30 strains of Pseudomonas aeruginosa, the positive rate of qacE△1sul1 gene was 43.33%(13/30).ConclusionThere is higher positive rate of qacE△1sul1 gene in Pseudomonas aeruginosa isolated from the inpatients, it is reported for the first time in Shandong provine.

Abstract:

ObjectiveTo investigate therapeutic effect of interventional injecting medicines through fiberbronchoscope on multidrug resistant cavernous pulmonary tuberculosis (MDRTB).MethodsEightsix patients (treatment group) with cavernous pulmonary MDRTB were treated with both injecting levofloxacin, amikacin, isoniazid, pyrazinamide through fiberbronchoscope catheter and routine chemotherapy, 94 cases in the control group were only given routine general chemotherapy. ResultsAfter 1,3,6 months treatment, the sputum negative conversion rate in treatment group was 17.44%, 65.11% and 87.21% respectively, which were significantly higher than those in control group（0.00%， 30.85% and 55.32%）respectively（P＜0.01）. After 3 months treatment, the effective rate in treatment group was 95.35%, cavity closure rate was 38.37%; which were significantly higher than those in control group (58.51% and 13.83%) respectively (P＜0.01）. ConclusionThe therapeutic effect of MDRTB treated with intervention injecting drugs in cavity by fiberbronchoscope and routine chemotherapy is superior to only routine chemotherapy.

Abstract:

ObjectiveTo investigate drug resistance of Mycobacterium tuberculosis (M. tuberculosis) isolated from inpatients with pulmonary tuberculosis in Shenyang Chest Hospital in recent 4 years.MethodsRetrospective analysis of drug susceptibility test of M. tuberculosis to isoniazid(INH), streptomycin(SM), ethambutol (EB) and rifampicin (RFP) was conducted, M. tuberculosis were isolated from new cases and retreated pulmonary tuberculosis patients with positive sputum culture in Shenyang Chest Hospital from January 1, 2003 to December 31, 2006. ResultsThe total drugresistant rate of M. tuberculosis was 39.11% (79/202), multidrugresistant rate was 10.89%(22/202). The initial drugresistant rate and acquired drugresistant rate was 35.11% and 46.48% respectively. The acquired multidrugresistant rate was 16.90%,which was obviously higher than that of initial multidrugresistant rate of 7.63%（χ2=4.08，P=0.049）. In 2004, the acquired multidrugresistant rate (36.36%) was obviously higher than that of initial multidrugresistant rate (5.66%)（χ2=5.95，P=0.02）. However in 2006, the two rates were the same(13.51%).The retreated patients showed a higher drug resistance to INH (47.89%), SM (46.48%) and RFP (36.62%). Multidrugresistant rate of retreated patients was 35.21%, single drugresistant rate and multidrugresistant rate of initial patients were both 16.03%.ConclusionThe results showed that the drug resistance and multidrug resistance of pulmonary tuberculosis are still serious, especially the initial drug resistance and multidrug resistance. So effective control of drug resistant tuberculosis is critical task currently.

Abstract:

ObjectiveTo evaluate the effect of hand hygiene in the prevention of ventilatorassociated pneumonia (VAP) in neonates. MethodsBy combination of retrospective and prospective methods, the occurrence of VAP of neonates in neonatal intensive care unit (NICU) was compared before and after the improvement of hand hygiene between 2004—2007. ResultsWhen the other conditions were not changed, the incidence of VAP reduced obviously from 30.00% (2004—2005) to 18.18%(2006—2007) after improving the hand washing method and facilities, there was significant difference between the two(χ2=9.44, P<0.01).ConclusionHand hygiene is an important process to prevent VAP, one of the key measures to reduce the occurrence of VAP are perfect hand washing methods and facilities and the compliance of health care workers.

Abstract:

ObjectiveTo evaluate the preliminary efficacy and safety of compound astragalus mongholicus granule in the 24week treatment of patients infected with HIV.MethodsTwentytwo patients infected with HIV received an oral administration of compound astragalus mongholicus granule for 24 weeks. HIV RNA were detected at week 0 and week 24; CD4+, CD8+ cell counts and levels of cytokines (IL2, IL4, IFNγ) were examined at week 0, week 8 and week 24. Clinic symptoms, blood routine examination, liver and renal function and adverse events were recorded at week 0, 8, 16 and 24, respectively. ResultsThe CD4+ cell counts increased 22 cell/μL (t=2.08，P＝0.03) when compared with the baseline. IL2 and IFNγ increased 7.29pg/mL and 3.82pg/mL respectively (t＝3.46，P＝0.00；t＝5.94，P＝0.00),while IL4 reduced 3.71pg/mL(t=8.18，P＝0.00); HIV RNA deceased 0.40 lg copy/mL(t=2.65，P＝0.02); 6 patients gained weight of more than 2 kg, 10 patients gained weight of no more than 2 kg. The results of blood routine examination, liver and renal function were normal. No obvious adverse events were observed. ConclusionCompound astragalus mongholicus granule can increase the number of CD4+ cells in patients infected with HIV, inhibit HIV replication and with immune regulation function to a certain extent. It can also improve HIV infection symptoms and gain the patients’ weight. No obvious side effects were observed in this clinical trial.

Abstract:

ObjectiveTo evaluate the infection rate and prognosis in intravenous drugaddicts. MethodsSerological markers and nucleic acid of hepatitis B virus ( HBV), hepatitis C ( HCV) and human immunodeficiency virus (HIV) were detected in 48 cases of intravenous drug addicts, and clinical analysis were made.ResultsAmong 48 cases of intravenous drug addicts, double infection of HBV and HCV was 31.25%, double infection of HBV and HIV was 4.17%, triple infection of HBV, HCV and HIV was 62.50%; Hepatitis gravis accounted for 70.83%, the hospitalization time of patients with hepatitis gravis was (48.67±19.25) days, which was obviously shorter than (65.32±31.49) days of nonintravenous drug addicts with hepatitis gravis (U=4.25, P<0.01). ConclusionSuperinfection in intravenous drug addicts is high, especially hepatitis gravis, but the prognosis is better than nonintravenous drug addicts.

Abstract:

ObjectiveTo study antimicrobial prophylactic usage in clean surgical operations during perioperative period, so as to strengthen the management of antimicrobial usage．MethodsPerioperative antimicrobial prophylactic use for 177 clean surgical operations were investigated retrospectively and statistically analyzed．ResultsAmong all cases，165 cases(93.22%) were given antimicrobial agents 0.5～2 hours before the operations;162 (91.53%) cases were administrated by intravenous drip. Among 56 patients whose duration of operation was longer than 3 hours, 3 patients(5.36%) received an additional intraoperative antimicrobial dose. Singledose antimicrobial prophylaxis was given in 25 cases（14.12%）; 67 cases（37.85%） received antimicrobial prophylaxis for 3~7 days after operations; 42 cases (23.73%) received antimicrobial prophylaxis for more than 7 days and 20 (11.30%) for more than 48 hours. 20 kinds of 7 categories of antimicrobial agents were used in the operations, 52.71% were cephalosporins (the majority were the first and second generation cephalosporins), followed by penicillins(28.08%). Drugs were used mainly in single dosage. ConclusionInappropriate usage was found in antimicrobial prophylaxis for clean surgical operations during perioperative period. Education about antimicrobial prophylaxis in perioperation to surgeons must be strengthened and management must be enhanced.

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ObjectiveTo evaluate HIV occupational exposure in health care workers(HCWs) in a hospital, and find the existing problems and aim directly at improving the management of occupational protection. MethodsAn event of HIV occupational exposure in HCWs occurred on March, 2007 was investigated retrospectively and the serological followup monitor was performed. ResultsThirtysix HCWs were involved in this occupational exposure event. Exposure rate to the intact skin, injury site and mucous membrane was 72.22% (26 persons), 25.00% (9 persons) and 2.78% (1 person) respectively. Only one person (2.78%) received emergent treatment. 12 months followup observation of HCWs showed that all the serological tests of HIV were negative. ConclusionHealth care workers are high risk population of HIV occupational exposure, there are potential problems in the occupational protection in this hospital, the education and training must be strengthened.

Abstract:

ObjectiveTo investigate the positive rate of class Ⅰ integrons and drugresistance of Stenotrophomonas maltophilia. MethodsSixty strains of Stenotrophomonas maltophilia were clinically isolated between July, 2006 and December，2007，the genes of intⅠ, qacE△1sul 1 of these strains were analyzed by PCR and antimicrobial susceptibility tests were performed by microbroth dilution method.ResultsThe positive rate of class Ⅰ integrons was 13.33% (8/60), only 80% Stenotrophomonas maltophilia were sensitive to minocycline，trimethoprimsulfamethoxazole and levofloxacin. ConclusionThe Stenotrophomonas maltophilia is an important pathogen in nosocomial infection, which has multipledrug resistance, and class Ⅰ integrons genes can promote the spread of bacterial resistance.

Abstract:

ObjectiveTo analyze the  data of antimicrobial resistance surveillance in a  hospital in 2007. MethodsBacterial isolates were identified by API system, antimicrobial  susceptibility  tests were performed by KirbyBauer method and  analyzed by WHONET5．4 software. ResultsA total of  3 107 clinical isolates were isolated in 2007，60.93% were gramnegative bacteria,27.78% were grampositive bacteria and 11.30％ were fungi. 60.58％of Staphylococcus aureus was methicillinresistant Staphylococcus aureus  (MRSA) and 77.35% of coagulase negative Staphylococcus was methicillinresistant coagulase negative Staphylococcus (MRCNS) respectively. The prevalence and drugresistance of Enterococcus faecium were higher than Enterococcus faecali (P<0.05), the prevalence of highlevel aminoglycosidesresistant Enterococcus was 59.44%. The prevalence of extendedspectrum  betalactamase of Escherichia coli and Klebsilla spp. was 59.50％and 55.98%, respectively. 63.97% of Pseudomonas aeruginosa were isolated from sputum, drugresistant rate  of Pseudomonas aeruginosa in sputum from patients in ICU, neurosurgical department, respiratory and emergency pediatric department, respiratory department was 21.05%, 15.99%,7.09% and 6.07% respectively .ConclusionPeriodical summarization of   antimicrobial resistance surveillance results  and  discovery of   drugresistance trends is great significant for guiding rational antimicrobial therapy.

Abstract:

ObjectiveTo evaluate the optimal standard for detecting coagulase test of Staphylococcus with slide method.MethodsSeventy strains of Staphylococcus spp. isolated  from clinic were studied, Staphylococcus coagulase gene were detected with PCR, Staphylococcus aureus were rapidly detected with latex agglutination test, Staphylococcus coagulase were detected with test tube and slide methods respectively. The species of bacteria were identified by VITEK-Ⅱautomatic analyzer. ResultsAmong 70 strains of Staphylococcus spp., 56 strains were  positive Staphylococcus coagulase gene with  PCR; the same 56 strains were also positive with latex agglutination test; 54 of which were positive with tube test method, 2 strains were false negative; strong positive were detected with slide method, all these 56 strains were identified as Staphylococcus aureus by VITEK-Ⅱ automatic analyzer (the same as PCR results). The other 14 strains were Staphylococcus haemolyticus. The judge of positive of coagulase test with slide method was according to coarse granule or apparent floccule agglutination, the accuracy rate was 80.00%, false positive rate was 20.00%. ConclusionThe optimal standard of  positive results with slide method are as follows: plasma appears apparent ball-like agglutination within 10 seconds, fluid in background should be clear, and there is no agglutination when bacteria strains are mixed in physiological saline.

Abstract:

ObjectiveTo study the drug resistance of extendedspectrum betalactamasesproducing and plasmidmediated AmpC betalactamasesproducing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) in a hospital. MethodsOne hundred and thirtynine strains of  E. coli and 102 strains of K. pneumoniae were collected from clinical specimens form November, 2006 to July,2007. ESBLs production was detected by the standard disk diffusion method, and AmpC production was detected by cefoxitin threedimensional test of enzymeextraction. Drug susceptibility was detected by KirbyBauer disk diffusion method, the result were analysed by American NCCLS Standard.ResultsAmong 139 strains of E.coli, ESBLsproducing, AmpC betalactamaseproducing, both ESBLs and AmpC betalactamaseproducing E.coli was 48.20%, 9.35% and 2.88% respectively; among 102 strains of K.pneumoniae, the isolation rate was 55.88%, 8.82% and 2.94% respectively. The resistant rate of ESBLsproducing strains to caphalosporins, aminoglycosides and monobactams was obviously higher than those of nonESBLsproducing strains (P<0.001~0.05), except carbapenem and ceftazime, plasmidmediated AmpC betalactamaseproducing strains revealed a high drug resistance to the second and third generation cephalosporins and quinolones (P<0.001~0.05). ConclusionProduction of ESBLs and AmpC  in bacteria are important factors in  drug resistance. More attention should be paid to the use of antimicrobial agents and control of nosocomial infection.

Abstract:

目的方法结果结论分析某院住院患儿血流感染病原菌分布及药敏特点。采用天地人微生物自动检测与分析系统对3 848份住院患儿血标本进行培养及细菌的分离、鉴定与药敏试验。 共分离病原菌262株（6.81%），其中革兰阳性（G+）菌占73.28%，革兰阴性（G-）菌占23.66%，假丝酵母菌属占3.05%；G+菌前3位依次是凝固酶阴性葡萄球菌（CNS）、肠球菌属和金黄色葡萄球菌，G-菌前3位依次是大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌。主要G+菌对万古霉素100%敏感，对青霉素86.41%耐药，对红霉素77.17%耐药；主要G-菌对常用抗菌药物已普遍耐药，仅对亚胺培南、环丙沙星、阿米卡星耐药率较低，分别为3.92%、15.59%、23.53%。G-菌中产超广谱β内酰胺酶（ESBLs）菌株较常见，其中大肠埃希菌产酶株检出率为77.78%，肺炎克雷伯菌为88.89%。

Abstract:

目的方法结果结论为了解某院嗜麦芽窄食单胞菌的临床分布及耐药情况，对2001—2006年间检出的158株嗜麦芽窄食单胞菌进行统计分析。结果显示，158株嗜麦芽窄食单胞菌主要分离自呼吸科（20.25%）和重症监护室（15.82%）送检标本； 标本分布以痰为主，占67.09%。该菌对复方磺胺甲口恶唑、左氧氟沙星和环丙沙星的耐药率较低，分别为19.61%、36.00％和47.71%；对氨苄西林、氨苄西林/舒巴坦、阿莫西林/克拉维酸、哌拉西林、头孢呋辛、头孢克洛、头孢噻肟、头孢曲松、氨曲南、头孢西丁、亚胺培南、美罗培南及四环素几乎完全耐药。提示嗜麦芽窄食单胞菌已成为医院感染的重要病原菌，其多重耐药现象严重，应加强对其耐药性的监测。

Abstract:

目的方法结果结论为了解门诊和住院部患者感染病原菌情况并比较其耐药性差异，对某院细菌实验室分离的病原菌资料进行统计分析。结果显示，门诊革兰阳性（G+）菌(20.56%)和革兰阴性（G-）菌(22.23%)的分离率均高于住院部(分别为9.73%与16.79%)，且差异有显著性（分别χ2=174.91，P=0.00；χ2=72.75，P=0.00）；门诊检出G+菌(48.02%)和G-菌(51.98%)的构成比与住院部(分别为36.70%、63.30%)差异亦有显著性（分别χ2=52.94，P＝0.00; χ2=160.56，P＝0.00）。大肠埃希菌、其他肠杆菌科细菌、金黄色葡萄球菌、粪肠球菌对部分常用抗菌药物的耐药率在门诊和住院部患者间差异有显著性（P＜0.05），大部分为住院部患者分离菌耐药率高于门诊患者。

Abstract:

目的方法结果结论了解某院2002—2006年间铜绿假单胞菌的分离情况及耐药性变化趋势。采用常规方法或MicroScan WalkAway 96微生物分析系统鉴定分离出的细菌，以KB纸片扩散法进行药敏试验，结果根据美国临床实验室标准化委员会/美国临床实验室标准化研究所（NCCLS/CLSI）标准进行判断。结果显示, 2002—2006年，铜绿假单胞菌每年在临床分离菌株中的构成比均上升,且2006年（22.86%）显著高于2002年（15.20%），两者比较，χ2=20.61，P=0.00。铜绿假单胞菌对第三、四代头孢菌素及氨曲南、头孢哌酮/舒巴坦和碳青霉烯类抗菌药物的敏感率每年均在下降，2006年的敏感率均明显低于2002年(均P=0.00)，同时对环丙沙星的敏感率也在下降，但对哌拉西林/他唑巴坦和阿米卡星的敏感率下降不明显。

Abstract:

目的方法结果结论为比较人工清洗消毒与自动清洗消毒机消毒的效果，于2006年10月—2007年8月对使用后的胃镜随机采用人工清洗消毒和自动清洗消毒机消毒，并现场采样，比较两组消毒效果。结果显示，人工清洗消毒胃镜435件，合格率97.93%；自动清洗消毒机消毒胃镜463件，合格率41.90%，远低于人工清洗消毒合格率（χ2=329.43，P=0.00）。提示对于胃镜的清洗消毒，人工清洗消毒方法优于自动清洗消毒机效果。

Abstract:

目的方法结果结论建立一种简易监测紫外线灯杀菌效果的方法。将金黄色葡萄球菌稀释后接种于血平皿，紫外线灯直接照射30 min；用相同条件房间空气作为对照，平皿开盖放置30 min。之后将两组培养皿置37℃培养箱中培养24～48 h，计菌落数，并计算杀菌率。重复试验变异系数值为6.86%，紫外线灯照射杀菌率为94.19% (80.14%～98.95%)。此方法简便易操作，可作为基层医院监测紫外线灯杀菌效果的替代方法。

Abstract:

人巨细胞病毒(human cytomegalovirus，HCMV)属β疱疹病毒亚科，广泛感染人类，是导致新生儿出生缺陷的头号感染性因素［1］，并严重威胁免疫力低下人群［2］。目前研究认为，HCMV能通过多种机制干扰宿主细胞正常生理过程，现将HCMV对宿主细胞周期调控因子影响的研究进展综述如下。

Abstract:

随着医疗技术的发展，大量侵入性操作的临床应用以及抗菌药物的广泛使用，医院感染率逐年上升。医护人员做好手卫生是控制医院感染的重要措施，而洗手被认为是非常必要的、最基本的、最简便易行的预防和控制病原体传播的手段之一［1］。正确的洗手可降低手部细菌量尤其是致病菌数量，从而降低通过手传播疾病的可能性，最终达到降低医院感染发生率的目的［2］。本文就近年来医护人员手卫生相关研究综述如下。