Abstract:

合理抗菌药物治疗社区肺炎（CAP）72 h内病情可以有所控制，但有些患者病情反而恶化，这首先要考虑其诊断是否准确，诊断准确者则可能由于宿主、病原菌及药物三方面问题导致治疗失败［1］。在判断为抗菌药物治疗失败前，首先要防止判断失误，要防止对病情已有进步而体温下降缓慢、血白细胞及胸片好转不明显，严重感染伴低体温或白细胞减少经有效的抗菌药物治疗后反有上升者的误判［2］。另外，还要注意排除退热剂及药物热对病情的医源性影响导致误判。

Abstract:

ObjectiveTo investigate the infection of methicillinresistant Staphylococcus aureus (MRSA) in patients in a hospital and environmental contamination of MRSA,and study  the possible sources and transmission routes with homology analysis of MRSA isolates collected from patients and environment. MethodsStaphylococcus aureus  were identified by Vitek2 system,MRSA were identified by cefoxitin  disk diffusion method and mecA PCR, homology of MRSA isolates was analysed with randomly amplified polymorphic DNA (RAPD) analysis.ResultsAmong all  isolates of Staphylococcus aureus, the isolation rate of MRSA from clinical and environmental samples was 58.54% (24/41)and 38.10%(16/24) respectively. The numbers of amplified DNA fragments by RAPD were 4～6, typing rate was 100%. Based on clustering analysis, 24 clinical strains were divided into 4 types,and the main type was type Ⅰ(14 strains); 16 environmental strains were divided into 3 types,and the main type was also type Ⅰ(13 strains).4 patients in burn unit and 4 patients in neurosurgical department and environment isolated homologous strains.ConclusionThe isolated rate of MRSA in patients and environment in this hospital was high,the dominant epidemic strain of MRSA was type Ⅰ and clone spread might exist. Extrinsic route  was the main source for nosocomial infection caused by MRSA.

Abstract:

ObjectiveTo understand and establish the normal reference values of peripheral blood CD3+, CD4+ and CD8+ T lymphocytes in healthy Miao ethnics in Hunan Province. MethodsThree hundred and sixty healthy  Miao ethnics were divided  into 5 age groups (10~19, 20~29, 30~39,40~49, 50~59), their  peripheral blood CD3+, CD4+ and CD8+ T lymphocytes were detected with FACSCalibur flowcytometry. ResultsThe mean absolute values of peripheral blood CD3+, CD4+, CD8+T lymphocytes and CD4+/CD8+ in healthy  Miao ethnics in 10～59 age groups were (1 426.71±462.92) cells/μL, (787.54±258.36) cells/μL, (589.86±242.91) cells/μL and 1.46±0.50 respectively, the mean absolute values of peripheral blood CD3+ and CD8+T lymphocytes in 10~19 age group were significantly higher than those in 30~59 age group (F=10.80,8.51, respectively, all P<0.05), CD4+T lymphocytes value was obviously higher than that in 50～59 age group (F=7.03, P＜0.05); There was on significant difference in above values between different genders (t=0.98, 0.80, 0.88, 0.16 respectively, all P＞0.05). ConclusionThe establishment of normal reference values of peripheral blood CD3+, CD4+ and CD8+T lymphocytes for healthy Miao ethnics will help to clinical diagnosis.

Abstract:

ObjectiveTo evaluate the requirement and identification of health care workers on responsibility of department   of hospital infection control (HIC) in general hospitals in China. MethodsRequirement and identification on responsibility of department of HIC were investigated among 453 health care workers, including hospital manager, director of department of HIC, clinical medical workers, all data were analyzed by SPSS 11.5 soft ware.ResultsIt is very similar that requirement and identification on responsibility of department of HIC among above persons in general hospitals. The requirement of HIC focus on the training for health care workers about  knowledge of hospital infection, surveillance, control and supervision of hospital infection, and personal protection, etc.ConclusionIt accords with the demand of development of infection control that requirement and identification on responsibility of department of HIC among different health care workers in general hospital in China.

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ObjectiveTo evaluate  the detection and antimicrobial susceptibility of imipenemresistant Pseudomonas aeruginosa (IRPA)  isolated from patients with nosocomial infection. MethodsData about IRPA of patients in 110 hospitals in Chinese Nosocomial Infection Surveillance System (CNISS) between July,1999 and June，2007 were analysed. ResultsAmong 5 490 strains of Pseudomonas aeruginosa, 3 090 strains were performed antimicrobial susceptibility test of impenem, 940 strains (30.42%) of which were IRPA. IRPA were mainly distributed in medical university (college)affiliated hospitals and general hospitals with more than 900 beds (847 strains, 90.11%); 2 years were as a stage, the detection rate of IRAP increased significantly with every stage (χ2=27.50, P=0.000); IRAP were mainly from lower respiratory tract, which accounting for 72.13%, the next were burn sites 7.87%. Antimicrobial resistant rate of IRAP to commonly used antimicrobial agents in clinic were >50%, the resistant rate to meropenem was up to 83.33%. ConclusionThe detection of IRAP is high, especially in large general hospitals, there is a tendency of increase and broad drugresistance

Abstract:

ObjectiveTo evaluate the distribution, phenotypes and resistance profiles of different kinds of βlactamasesproducing Escherichia coli (E. coli) isolated from clinic . MethodsE.coli isolated from a hospital  between July 2007 and July 2008 were collected, VITEK 2 Compact was used to identify and perform antimicrobial susceptibility test, phenotypes were determined by AESTM (Advanced Expert System) of VITEK 2 Compact. ResultsAmong 421 collected isolates, 249 (59.14%)  were extendedspectrum βlactamasesproducing (ESBLs) strains, including 67 CTXMproducing isolates; 120 (28.50%) were acquiredpenicillinaseproducing isolates; 8 (1.90%) were carbapenemaseproducing isolates; 47 (11.16%)   were wild type isolates. The total βlactamasesproducing rate was 88.84%(374/421). 174 (41.33%) isolates were from midportion urine,101(23.99%) were from  sputum; 39 (9.26%) isolates were from renal department, the other isolates were from the other departments.The resistant rates of various phenotypes of E.coli to most antimicrobial agents were quite different; The producing of ESBLs was the main cause of drugresistance of E.coli, the resistant rates of ESBLsproducing isolates were higher than acquiredpenicillinaseproducing isolates and wild type isolates (P<0.05) and were  highly resistant to most antimicrobial agents. Conclusionβlactamasesproducing rates of E.coli are high , and with various phenotypes, the most common phenotype is ESBLs; The multiply and cross drugresistance of ESBLsproducing isolates are serious, and the monitor should be paid attention, antimicrobial application should be used rationally, so as to control the emergence and spread of drugresistant strains.

Abstract:

ObjectiveTo evaluate the  measures for preventing and treating pulmonary infection in patients with  severe craniocerebral injury after tracheotomy. MethodsBy prospective and retrospective  analysis, clinical intervention measures (use of tracheal tube which can be rinsed, pay attention to the extraction of  tracheal tube, active bronchial lavage treatment through fiberbronchoscope, rational nutritional support and regulation of metabolism, sputum excretion by vibrative saliva ejector) were taken according to risk factors of  pulmonary infection after tracheotomy.ResultsIn observation group (clinical interventions were taken), pulmonary infection rate  in patients was 55.56%(35/63), the average time for controlling infection was (6.33±2.71)d; In control group (clinical interventions were not taken, retrospective  analysis), pulmonary infection was 72.31%(47/65), the average time for controlling infection was (8.44±3.14)d; There were significant difference in pulmonary infection rate and time for controlling infection between two groups (χ2=3.89, P<0.05; t=3.19，P<0.01, respectively). ConclusionAfter clinical interventions were taken, pulmonary infection in patients with  severe craniocerebral injury after tracheotomy reduced obviously, and time for controlling infection was also shortened.

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ObjectiveTo evaluate the incidence of catheterassociated nosocomial infection(NI)in intensive care unit (ICU) patients.MethodsPatients in ICU from November 2006 to October 2007 received targeted surveillance. The application of  respirators, arteriovenous catheters，  urinary catheters and associated NI were monitored and analyzed.ResultsA total of 224 patients received targeted surveillance, the incidence of NI was 36.16%(81cases). Daily NI rate was 69.53‰,  which was adjusted to be 20.82‰ by ASIS. The application rate of respirators, arteriovenous catheters and urinary catheters was 51.33%, 96.22% and 96.14% respectively,  the daily infection rate of ventilationassociated pneumonia, blood stream infection and  urinary tract infection was 45.15‰, 6.24‰ and 8.93‰ respectively. The common bacteria in  respiratory tract infection were Acinetobacter baumannii, Pseudomonas aeruginosa and methicillinresistant Staphylococcus aureus; The common bacteria in blood stream infection were Candida albicans, Staphylococcus haemolyticus and Pseudomonas aeruginosa; The common bacteria in urinary tract infection were Escherichia coli, Enterococcus and Candida albicans.ConclusionThe application of catheters are the leading factors causing NI in ICU patients. Appropriate preventive measures must be taken to reduce catheterassociated NI in ICU patients.

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ObjectiveTo evaluate the clinical characteristics, diagnosis and treatment of Rickettsia tsutsugamushi pneumonia.MethodsClinical data of 10 patients with Rickettsia tsutsugamushi pneumonia were analysed retrospectively. ResultsThe onset time of 10 patients with Rickettsia tsutsugamushi pneumonia were 2 in July, 6 in August and 2 in September; all patients were  bitten  by chigger and had symptoms of fever, chest distress,  dyspneic respiration, cough; eschar and ulcer were found at leg, scrotum,anus,axillary fossa,upper arm and neck;bacteria were not detected from blood and bone marrow culture, multiply antimicrobial agents were ineffective for treating Rickettsia tsutsugamushi pneumonia. All patients were given tetracycline and expectant and supporting treatment, 2 patients died of acute respiratory failure, the other patients recovered and discharged.ConclusionAs one of the causes of Rickettsia pneumonia, Rickettsia tsutsugamushi should be paid attention, pneumonia with unknown casuses should consider excluding tsutsugamushi. The key to rescue patients successfully is early diagnosis and treatment.

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ObjectiveTo evaluate the effect of  Pegylated interferon (PEG IFN)α2a on treating chronic hepatitis C. MethodsSixtyeight chronic hepatitis C cases were divided into observation and control group, 36 cases in observation group received  PEG IFN α2a plus ribavirin, 32 cases in control group received interferon  plus ribavirin, HCV RNA and serum alanine transaminase (ALT) were detected in two groups before treatment, during treatment, at the end of 48week treatment and 24week of followup, the treatment effect was compared between two groups. ResultsAt the end of 48week treatment, virological  response rate and  biochemical response rate were both 88.89%in  observation group, and it was 75.00% and 81.25% respectively in control group, there were no significant difference in the treatment effect at the end of treatment between two groups( both P> 0.05). The early virological response rate and sustained virological response  rate was 47.22% and 80.55% respectively in observation  group, which was significantly higher than  12.50% and 31.25% respectively in control group (χ2=9.57, P＜0.05；χ2=16.84, P＜0.05; respectively); The relapse rate was 8.33% in  observation group, which was significantly lower than 43.75% in control group (χ2=11.33，P＜0.05).  ConclusionThe effect of  PEG IFN α2a on treating chronic hepatitis C is superior to IFN α2a .

Abstract:

ObjectiveTo investigate the condition and characteristics of infection and coinfection of human immunodeficiency virus (HIV)，hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis before transfusion. Methods 9 694 cases of transfusing recipients in a hospital between October, 2007 and June, 2008 were detected; Serum HBV markers, antiHCV were detected by enzyme linked immunosorbent assay (ELISA); Serum antiHIV, antisyphilis  were detected by doublesandwich ELISA(DSELISA).ResultsAmong 9 694 transfusing recipients, the positive rate of HBV marker before receiving transfusion  was 15.98%(1 549 cases), the positive rate of antiHCV, antiHIV and  antisyphilis  was 0.61% (59 cases), 0.35% (34 cases) and  5.11% (495 cases) respectively. The coinfection rate of HBV  and HCV was 0.59%(57 cases), the coinfection rate of HBV and  syphilis was 0.97% (94 cases), the coinfection rate of HCV and  syphilis was 0.03% (3 cases); Among patients with HIV positive, the coinfection rate with HBV, HCV  and syphilis was 0.13%(13 cases), 0.10% (10 cases)  and 0.04% (4 cases) respectively; The coinfection rate of  HIV, HBV and HCV was 1.08%(2 cases), the coinfection rate of HIV, HBV and  syphilis was 1.08%(2 cases), coinfection rate of HIV, HBV, HCV and syphilis was 0.54%(1  case). ConclusionSome recipients have infection before transfusion, especially HBV and syphilis infection. The overall examination on recipients not only can avoid medical dispute, but also improve clinical therapy for patients and health care workers' occupation safety protection.

Abstract:

ObjectiveTo investigate an outbreak  of handfootmouth disease (HFMD) caused by EV71 virus in a kindergarten of Fangshan district in Beijing,  the cause of outbreak  and the effective preventive measures of HFMD were analysed and evaluated. MethodsAll cases were performed epidemiological investigation based on the “questionnaire of case for HFMD” made by the Ministry of Health, the data were analyzed by descriptive study. ResultsThe group of low age children (2~3 years old) accounted for 87.50%(14/16) of all cases in this epidemic outbreak, the peak  of incidence was on May 13 and May 14, 2008; 6 cases isolated EV71 virus. ConclusionThe HFMD can easily  cause  outbreak  among low age children in kindergarten,   timely and effective control measures can prevent the HFMD outbreak caused by EV71 virus.

Abstract:

ObjectiveTo investigate the clinical and bacteriological characteristics of the death of patients with septicemia.MethodsClinical and experimental data of 240  patients with septicemia （29 patients died from septicemia） in a hospital in 6 years were analysed retrospectively. ResultsSixtytwo species of pathogens were isolated from 240 patients, the main pathogens were Coagulase negative Staphylococcus (CNS), which accounting for 27.92%; among 29 patients died from septicemia, the majority were septicemia caused by gramnegative bacilli (41.38% were Escherichia coli), which accounting for 65.52%, the next were CNS (20.69%). Among patients died from septicemia, male patients were more than female patients （χ2=5.29, P<0.05）, age≥15 years old were more than age＜15 years old （χ2=5.59, P<0.05）, nosocomial infections were more than communityacquired infections （χ2=43.94, P<0.01）. ConclusionCNS are the main pathogens causing septicemia, but Escherichia coli of gramnegative bacilli is still the main pathogen. Among patients died from septicemia, the predominant are adults, male patients and patients with nosocomial infection.

Abstract:

目的方法结果结论依据《医院感染管理规范》和《河南省医疗机构消毒供应中心验收标准》对洛阳市40所二级及以上医院的消毒供应中心质量管理现状进行评审验收。检查内容包括组织管理、建筑布局与设备、质量管理三部分。40所医院评审合格率：市三级医院100.00%（2/2），市二级医院88.89%（24/27），县二级医院66.67%（6/9），市专科医院100.00％（2/2）。其中普遍存在消毒供应中心建筑面积小、布局欠合理、设备不完善、医疗器械清洗不彻底、灭菌方法不可靠等不足。提示该市医院消毒供应中心管理工作仍需加强，须促进消毒供应中心规范化管理。

Abstract:

目的方法结果结论为了解鲍曼不动杆菌感染分布及其耐药特征,对2005年1月—2007年12月住院患者临床标本分离的鲍曼不动杆菌资料进行统计分析。共分离鲍曼不动杆菌635株,其分离率 2005年为1.82%（163/8 932），2006年为2.27%（207/9 137），2007年为2.59%（265/10 228）；分离率呈逐年增高趋势（χ2=37.84，P＜0.05）。635株鲍曼不动杆菌分布于各科室，其中重症监护室最多，占 56.85%；标本来源以痰液为主，占64.88%；对常用抗菌药物的耐药率呈普遍上升趋势并多重耐药,耐药率最低的抗菌药物为亚胺培南（0.60%～6.77%）。

Abstract:

目的方法结果结论为了解某院外科Ⅰ类切口手术患者围手术期抗菌药物应用情况，对236例此类患者病历资料进行回顾性调查分析。236例患者全部使用了抗菌药物，预防用药率100％；在术前0．5～2 h用药者10例（4.24%），术前≥24 h用药者41例（17.37%），手术后用药者185例（78.39%）；手术后预防用药时间为1～21 d，其中用药时间≤3 d者55例（23.31%），≥4 d者181例（76.69%）；手术后单一和二联用抗菌药物率分别为85.17%、14.83％。该院Ⅰ类切口手术预防性应用抗菌药物存在明显不合理现象，应加强管理。

Abstract:

目的方法结果结论对某院2005年4月—2007年4月间的Ⅱ、Ⅲ类环境监测资料进行分析、比较。Ⅱ类环境空气监测合格率最低，为83.62%（439/525），其次为医护人员手87.59%（254/290），与Ⅲ类环境的93.39%（1 793/1 920）及93.95%（295/314）相比，差异有显著性（分别χ2=48.91，P＜0.01；χ2＝6.04，P＜0.05）。Ⅱ类环境无菌物品的合格率最高，为99.01%（500/505），Ⅲ类环境无菌物品的合格率最低，为86.01%（166/193），两者差异具有高度显著性（χ2 =53.77，P＜0.01）。无菌物品监测合格率，病房治疗室仅87.21%（150/172），急诊室仅75.00%（6/8），门诊注射室抽查2份，2份均不合格。提示须加强管理，提高消毒灭菌质量。

Abstract:

目的方法结果结论采用回顾性调查方法对15例血液病并发侵袭性肺部真菌感染患者的临床特点，痰培养、胸片、CT检查结果及治疗转归进行总结分析。15例发生侵袭性肺部真菌感染者均有发热（体温＞39℃），伴咳嗽(咳少量白痰),不同程度胸闷，其中10例肺部可闻及湿啰音；均送痰培养，连续2次培养出白假丝酵母菌者3例，曲霉菌者3例；均胸片示双肺呈斑点、云絮状改变，6例CT有结节样改变，4例CT有光晕征或新月形空气征样改变；临床诊断6例，拟诊9例；所有患者在抗感染治疗同时给予抗真菌治疗，其中9例（60.00%）死亡，6例症状改善。提示血液病并发侵袭性肺部真菌感染病死率高，在感染早期应结合宿主因素、临床表现和微生物检测，早诊断、早治疗，以改善预后。

Abstract:

目的方法结果结论对某省二、三级医院139名消毒员的现况进行调查。消毒员文化程度分别为小学、初中者占17.27%，高中33.09%，中专14.39%，大专31.65%，本科3.60%；持证上岗者38.85%；曾参加过相关培训者30.94%；认为培训受益者59.71%。对比不同文化程度消毒员专业知识掌握情况，差异无显著性(χ2=6.95，P＞0.05)。消毒员的专业素质亟待提高。

Abstract:

目的方法结果结论对某院收治的50名地震伤员进行医院感染目标性监测，有效地预防与控制医院感染的发生。通过分类安置伤员，专人目标监测，严格执行消毒隔离制度及手卫生、标准预防措施等，将医院感染发生率降至最低：仅1例重症挤压伤者发生医院感染，医院感染率为2.00%。

Abstract:

目的方法结果结论回顾性分析2006年8月—2008年4月间BD试验结果并进行评价。期间共做BD试验622次，合格610次，合格率98.07%。不合格原因为设备故障4次：真空系统故障、自控系统失灵、柜室封闭性受损、室内疏水阀锈蚀各1次；技术因素8次：BD测试包透气性能不良3次，标准测试包不标准2次，标准包测试包扎过紧、温度设定不正确、蒸汽过湿各1次。

Abstract:

近年来，临床革兰阳性（G+）菌的感染呈上升趋势，其中金黄色葡萄球菌(金葡菌)感染占很大比例，而金葡菌的耐药性也越来越普遍，特别是耐甲氧西林金葡菌(MRSA)对几乎所有抗菌药物均耐药，给治疗造成很大麻烦。在近来的研究中，又发现了一种新的与金葡菌多药耐药性有关的基因mgrA，它可从多个途径对耐药性进行调节。