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耐多药结核（multidrugresistant tuberculosis, MDRTB）是指结核分枝杆菌对至少2种一线抗结核药物耐药，其中至少包括同时对异烟肼和利福平耐药。MDRTB具有治疗费用高、治愈率低、死亡率高的特点，其发生率的增高以及广泛传播对结核病治疗及控制带来严峻挑战和威胁，令结核重新成为顽症。耐多药肺结核（MDRPTB）是MDRTB的主要组成部分。

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ObjectiveTo investigate the characteristics of circulating CD4+CD25+ regulatory T cells (Treg) in chronic hepatitis B (CHB) patients accepting peginterferon alfa2a and adefovir  therapy. MethodsPeripheral blood mononuclear cells (PBMC) of 35 patients with CHB were collected at baseline and week 12, 24 and 48 treatment. Eighteen patients were treated with peginterferon alfa2a (40 KD) (PEGASYS) and 17 patients were treated with adefovir dipivoxil (ADV). Twelve healthy volunteers with normal liver function and negative hepatitis virus markers were as controls. The proportion of CD4＋CD25＋Treg/PBMC were analyzed using flow cytometry. The correlation between Treg and serum alanine transaminase(ALT) or HBV DNA was also analyzed. ResultsThe proportion of Treg/PBMC in PEGASYStreatment group and ADVtreatment group before treatment were (3.72±1.15)% and (3.63±1.02)% respectively, which were significantly higher than that(2.47±0.90)%  in healthy controls (t=2.51, 2.48; both P<0.05). In PEGASYS group, the proportion of CD4＋CD25＋Treg at week 12, 24 and 48 treatment were (2.87±0.76)%, (2.75±0.72)% and (2.51±0.69)% respectively, which significantly decreased than that of baseline (t=2.41,2.58,2.95; P<0.05, <0.05, <0.01). No significant changes in CD4＋CD25＋Treg were found in ADVtreatment group before and after treatment(P>0.05). A strong correlation was observed between the change in ALT level and the proportion of CD4＋CD25＋Treg (r=0.52, P<0.01). No correlation was found between the change  in HBV DNA and CD4＋CD25＋Treg(r=0.25, P>0.05). ConclusionThe level of peripheral blood CD4＋CD25＋Treg in CHB patients is higher than that in healthy controls. PEGASYS antiviral treatment can decrease the proportion of CD4＋CD25＋Treg, while ADV antiviral treatment has no influence on CD4＋CD25＋Treg.

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ObjectiveTo explore HIVinfected people coinfected with HCV or TB in Hunan Province, and assess the incidence and related factors. MethodsHIV infected inpatients and outpatients in local hospitals in Hunan Province between 2006 and 2008 were surveyed by questionnaires, existing cases of HIV infected persons were performed detection of HCV and TB antibody; HIV and HCV or TB coinfection were analysed statistically  with SPSS software. ResultsA total of 978 cases were investigated, HIV and HCV coinfection rate was 33.95% (332 cases). The coinfecion rate of HIV and HCV in intravenous drug user, persons at the age of 30-44 and the jobless persons was  81.06% (321/396), 42.60%(262/615)and 61.89% (302/488) respectively; coinfection rate of HIV and HCV  in above three groups were  all higher than the other related groups （P＜0.0125，＜0.0125，＜0.0045）. Infection rate of HIV combined TB was 26.99% (264/978), coinfection rate in intravenous drug users(35.86%) was obviously higher that (19.65%)  in patients through sex（P＜0.0071）. Coinfection rate of HIV and TB in patients with CD4+T cell count ≤ 200/ μL was 41.59%, which was higher than that in other groups （both P＜0.0125）. ConclusionIt is the initial report on state and related factors of  HIV combined with  HCV or TB coinfection. Intravenous drug use is the most principal way for HIVinfected patients infect with HCV. Patients for HIV/HCV coinfection are concentrated on the age of 30-44 years old and the jobless. The incidence of tuberculosis in  HIV patients with CD4 + T cell count ≤200 / μL is higher than other HIV patients.

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ObjectiveTo evaluate antimicrobial resistance of bacteria in nosocomial infection (NI) and changing trend.MethodsAntimicrobial resistant results of bacteria reported to China  Nosocomial Infection Surveillance System (CNISS) by national wide hospitals between January, 1999 and December 2007 were analyzed statistically.ResultsAmong grampositive bacteria, Staphylococcus and Enterococcus were the most sensitive bacteria to vancomycin, sensitive rate was more than 96%; the detection rate of methicillinresistant Staphylococcus aureus, methicillinresistant Staphylococcus epidermidis, methicillinresistant Staphylococcus haemolyticus，penicillinresistant Streptococcus pneumoniae was 80.18%, 77.19%,  90.71%  and 43.84% respectively; the resistant rate of Enterococcus faecalis and Enterococcus faecium to ampicillin was 30.15% and 81.60% respectively. Among gramnegative bacilli, the common bacteria in Enterobacteriaceae were most sensitive to meropenem, which was more than 89%, the next was imipenem(88%); the resistant rates of nonfermentative bacteria including Pseudomonas spp., Acinetobacter spp., and Stenotrophomonas spp. to cefoperazone/sulbactam was the lowest, which was 28.86%,18.53% and 20.85% respectively, the resistant rate of Pseudomonas spp. and Acinetobacter spp. to imipenem was 33.81% and 22.86% respectively. Compared with resistant rate to piperacillin and cefoperazone, the resistant rate of common gramnegative bacteria  to piperacillin/tazobactam and cefoperazone/sulbactam decreased markedly (P<0.05). Comparison among drugresistant rates  from January, 2005-December, 2007 and January,1999-December, 2001 showed that drugresistant rates of bacteria increased 30% were as follows: Staphylococcus epidermidis to imipenem, Enterococcus faecalis to piperacillin, Enterococcus faecium to penicillin and amoxicillin/clavulanate, Escherichia coli to cefepime, Pseudomonas aeruginosa to ticarcillin/clavulanate, Acinetobacter baumannii to ampicillin/sulbactam, amoxicillin/clavulanate and imipenem, Stenotrophmonas maltophilia to ampicillin/sulbactam. Drugresistance increased most rapidly was Acinetobacter baumannii, and resistance to the third generation cephalosporins increased most rapidly.ConclusionDrugresistant rate in NI is high, and most are multiple drugresistance; antimicrobial agents with enzymeinhibitors are more sensitive than non enzymeinhibitors; the resistance has  tendency of increasing, especially Acinetobacter baumannii and the third generation cephalosporins.

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ObjectiveTo explore resistance of extendedspectrum βlactamase （ESBLs）and AmpCproducing Klebsiella pneumoniae (double positive K. pneumonia) to commonly used disinfectants, so as  to provide reference for the control of bacterial transmission. MethodsFour different disinfectants: 75% ethanol, 2% glutaraldehyde, 500 mg/L available chlorine solution and compound iodine solution were used to test their efficacy on K. pneumoniae with suspension quantitative germicidal test and biofilm germicidal test, the killing rates of each disinfectant was calculated. ResultsIn  suspension quantitative germicidal test, the killing rate of 4 kinds of disinfectants to the double positive strains  was 5.0%-10.0%, 0.5%-3.5% lower than the double negative strains  with a 1min and 3 min contact time respectively, the killing rates were all ≥99% with a 5min and 10 min contact time.The killing rate of 4 kinds of disinfectants to double positive strains in biofilm germicidal test was 10.0%-15.0%, 5.5%-19.0% and  0.1%-5.5% lower than that in suspension quantitative germicidal test with a 1 min, 5min and 10 min contact time respectively,the killing rates were all ≥99% with a 30 min contact time. ConclusionWhen contact time is short, the resistance of ESBLs and AmpCproducing K.pneumoniae to disinfectants are stronger than nonESBLs and nonAmpCproducing K.pneumoniae; when contact time is prolonged, commonly used disinfectants can kill ESBLs and AmpCproducing K. pneumoniae.

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ObjectiveTo realize direct economic cost of surgical site infection(SSI) of postthoracotomy incision. MethodsA retrospective study was conducted,1:1 match case control method was adopted to analyze direct economic cost of SSI of postthoracotomy incision in patients with SSI (case group) and without SSI (control group).  ResultsThe median of cost of hospitalization stay were 25 911.70 and 19 899.75 RMB in  case and control group respectively, the former was significantly higher than that of the latter (t=5.67, P=0.00).The median of length of  hospital stay were 32.50 and 19.50 days in case and  control group respectively,excess hospital stay were 13 days, there was significant difference between the two groups（t=10.02, P=0.00）. ConclusionSSI significantly increase medical cost and prolong length of hospital stay. Effect on infection control should be enhanced to reduce SSI rates.

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ObjectiveTo realize isolation state and drug resistance of Escherichia coli (E.coli) from  hospital environment, clinical samples and health care workers(HCWs). MethodsProspective investigation was performed. From May 1, 2008 to October 31,2008, E.coli were isolated from samples of environment of  intensive care unit (ICU), ICU HCWs and nonICU HCWs at a large general hospital. Data of E.coli isolated from patients were from clinical microbial laboratory during the same period. Drug resistance of E.coli were analyzed statistically.ResultsA total of 376 samples were collected  from general  ICU environment, 69(18.35%) strains of E. coli were isolated. The isolation rate of E.coli from handwashing facilities, sputum aspirators and respirators was 29.17%, 28.07% and 21.74% respectively. The isolation rate of E.coli from 177 HCWs’ anal swabs was 45.76%(81/177). 73 strains of E.coli were isolated from clinical samples of patients, most from stool (21 strains, 28.76%) and urine (18 strains, 24.66%) samples. Except resistant rate of clinical samples to cefoperazone/sulbactam (13.70%) was lower than 30.43% of environmental samples (χ2=5.82, P<0.05), the differences in drug resistance  to the other antimicrobial agents were not significant (χ2=0.56-2.89, P>0.05); There were no significant difference in drug resistant rates of E. coli from HCWs, clinical  and environmental samples to gentamycin, nitrofurantoin and ceftriaxone (χ2=1.34-3.12,P>0.05), but resistant rates of  E. coli from environmental and clinical samples were higher than  that of  HCWs (χ2=10.59-215.28, P<0.05); the difference in drug resistant rates of E. coli from HCWs in ICU and nonICU was not significant (χ2=0.18-2.36,P>0.05). ConclusionDrug resistance of E. coli from environment is closely related with patients, E. coli from environment and  patients’ samples has little effect on drug resistance of intestinal E. coli from HCWs.

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ObjectiveTo establish the concept of “monitor during preventive process” as well as  the feasibility of surveillance and control method, and apply the method on the control of indwelling urinary catheterassociated urinary tract infection(UTI). Methods155 inpatients who received indwelling urinary catheter in a neurology department between January and July, 2007 were as control group, 141  inpatients who received indwelling urinary catheter between August, 2007 and February, 2008 were as trial group; Control group received routine nursing for indwelling catheter, trial group received monitor during preventive process (such as evaluation, supervision and education) in addition to routine nursing.ResultsIndwelling urinary catheterassociated UTI in trial group and control group was 4.26% and 16.13%, the former was significantly lower than the latter (χ2=11.10, P<0.01); In trial group, the duration of catheterization in 70% patients was within 13.10 days, which was significantly lower than 18 days in control group; When duration of catheterization were 11-30 days,>30 days, urinary catheterassociated UTI in  trial group was 6.67% and 16.67% respectively, which was obviously lower than 30.77% and 57.89% in control group(χ2=8.27, P<0.01; χ2=5.13, P<0.05).ConclusionMonitor during  preventive process can prevent nosocomial infection effectively.

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ObjectiveTo investigate the health care workers’ （HCWs） knowledge about  nosocomial infection(NI) during “nosocomial infection prevention week” (NIPW). MethodsSurvey on HCWs was carried out by comparing statistics from questionnaires before and after NIPW.  ResultsThe recognizing rate of NI before and after NIPW was 60.13% and 65.66% respectively, the latter was  significantly higher than the former (χ2=91.08, P<0.01),  HCWs’ recognizing rate on hand hygiene achieved the  highest, which was up to 98.86%. Recognizing rate of prevention of occupational exposure after NIPW（60.29%）was considerably higher than that (45.93%) before NIPW (χ2=28.95, P＜0.01）.ConclusionThe recognizing rate of NI of HCWs went up remarkably in NIPW, and should be widely promoted.

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ObjectiveTo analyze the species and  antimicrobial resistance of pathogens isolated from stool of patients with diarrhea in Tangdu Hospital,  Fourth Military Medical University in Xi'an between 2004 and 2008. MethodsMicroscan WalkAway40 system was used to identify  bacteria and analyze  antimicrobial susceptibility. Antimicrobial susceptibility tests were performed with KirbyBauer method, results were judged according to the standard of Clinical and Laboratory Standards Institute (CLSI) in 2006. ResultsPositive rate of stool culture was 36.63%. Among 496 isolated  bacteria strains, 163 (32.86%) were grampositive bacteria, 299 (60.28%) were gramnegative bacteria, and 34 (6.85%)were fungus. The main grampositive bacteria were Enterococci (154 strains, 94.48%), the main gramnegative bacteria were Shigella (136 strains, 45.48%). Enterococci were highly susceptible to linezolid and vancomycin, which was 96.10% to 100.00%;  while Shigella were highly susceptible to imipenem, cefoperazone, ceftriaxone and gentamycin, which was 81.62% to 100.00%.  ConclusionIt is of great importance to understand the distribution characteristics and antimicrobial resistance of bacteria in stool for  controlling infection and  emergence of antimicrobialresistant strains.

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ObjectiveTo investigate infections with double and multiple drugresistant bacteria in hospitalized patients, and to put forward control measures. MethodsMedical histry of patients who were hospitalized between January, 2007 and December, 2008 were analysed retrospectively. ResultsAmong 55 084 patients, 1 436 (2.61%)  developed infections with  double and multiple drugresistant bacteria, 959 (1.74%) of which were communityacquired infections, 477(0.87%) were nosocomial infections, there was significant difference between the two (χ2=323.571, P=0.000). Infection with double and multiple drugresistant bacteria accounted for 25.74% (1 853 cases) of  patients with nosocomial infection. Infection mainly occurred in patients in intensive care unit (16.98%), department of neurosurgery (14.67%), burn unit(14.25%) and department of neurology (14.04%). The main infection sites were respiratory tract (824 cases, 51.92%). 75.97% (1 091 cases) of patients  received antimicrobial agents before developing infection.ConclusionInfections with double and multiple bacteria are mainly communityacquired infection. Rational appplication of antimicrobial agents are the main strategies for controlling and reducing infection with double and multiple bacteria

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ObjectiveTo analyse the pathogens in nosocomial infection (NI) in surgical intensive care unit (SICU), so as to guide clinicians to use  antimicrobial agents properly. MethodsMedical records  of  patients with NI in SICU at a hospital in 2006 were analysed retrospectively. ResultsNI rate in SICU patients was 11.67%(70/600), 42 cases(60.00%) were simple bacterial infection, 2 (2.86%) were fungi infection, 13 (18.57%) were mixed infection (bacteria and  fungi), 13 (18.57%) were negative  for microbial culture. The first five common bacteria in infection were Enterococcus faecium (18.49%), methicillinresistant staphylococcus aureus(17.65%)，methicillinresistant coagulase negative Staphylococcus(17.65%)，Pseudomonas aeruginosa（9.24%） and Escherichia coli（7.56%）; grampositive cocci was 52.90%. The first three  common fungi were Aspergillus spp.（31.58%）, Candida albicans （26.32%） and Candida glabrata（21.05%）. The length of  ICU stay was prolonged in patients with fungi infection (P<0.05), and mortality in patients with fungi infection was 46.67%(7/15).ConclusionNI rate in patients  in SICU  is high, the most common infection are bacteria infection, mixed infection are the second. The most common bacteria is grampositive cocci;  The common fungi are Aspergillus spp., Candida albicans and Candida glabrata, successively. The length of  ICU stay is prolonged and the prognosis is poor in patients with fungi infection.

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ObjectiveTo investigate the antimicrobial resistance of extendedspectrum βlactamases(ESBLs) of Escherichia coli (E. coli) isolated from the First People’s Hospital of Kunming.Methods293 strains of E. coli were  isolated between January and December, 2006, ESBLs of E. coli were confirmed by phenotype confirmatory test, antimicrobial  susceptibility were detected by KirbyBauer method. Results168 of 293 (57.34%) strains of E. coli were ESBLsproducing strains. The main specimens isolated   ESBLsproducing strains was sputum (64.71%), the next were blood (62.50%) and pus (57.14%); Among departments, intensive care unit had the highest isolation rate of ESBLsproducing E. coli(65.22%), the next were department of endocrinology(65.00%) and oncology(63.33%). Except  imipenem and amikacin, the resistant rates  of ESBLsproducing strains against the other 14 antimicrobial agents  were significantly higher than nonESBLsproducing strains (all P<0.01); ESBLsproducing strains were resistant to penicillins,cephalosporins, aztreonam, quinolones, aminoglycosides and sulfonamides, the resistant rate to imipenem and amikacin was both <5%, which was 0.00% and 3.30% respectively. ConclusionThe prevalence of ESBLs is  high  among clinical E.coli isolates in  the First People’s Hospital of Kunming; ESBLsproducing strains are highly resistant to multiple antimicrobial agents, clinicians should choose antimicrobial agents rationally.

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目的方法结果结论为有效提高医务人员手卫生的依从性，降低医院感染率。某院于2008年8月—2009年6月，采取了一系列手卫生干预促进措施：全员手卫生知识培训、ISO9001质量体系文件管理、洗手前后手部细菌连续监测对照、统计各科洗手液使用情况、制作洗手宣传图片等。经干预后，医务人员在接触患者前后的洗手率（均为95.05%）、手卫生监测合格率（98.10%）等均高于干预前（分别为75.10%、90.00%、73.06% ），两两比较，差异均有高度显著性（均P＜0.01）。提示采取积极有效的手卫生促进策略，能有效提高医务人员手卫生的依从性。

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目的方法结果结论了解某地区泌尿生殖道感染与不孕症患者的支原体感染及药敏情况，为临床诊断及治疗提供实验数据。采用支原体鉴定、药敏试剂盒对683例患者的标本进行检测，并用WHONET5.4软件作统计分析。683份标本中共检出支原体阳性353份，阳性率51.68%。其中，解脲支原体(Uu)阳性率38.07%，人型支原体(Mh)阳性率1.17%，Uu与Mh共同感染的阳性率为12.45%；男性标本的阳性率为24.53%，女性标本的阳性率为63.91%,后者明显高于前者(χ2=90.78，P<0.005)。在药敏结果中，Uu对强力霉素、交沙霉素、美满霉素的敏感率较高,分别为91.15%、90.38%、90.38%；而Uu与Mh混合感染对上述3种抗菌药物的敏感率分别为68.24%、56.47%、65.88%。提示在生殖道支原体感染中,女性明显高于男性；支原体中Uu单项感染率高,单项Uu感染对抗菌药物的敏感性比Uu+Mh混合感染高。

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目的方法结果结论为了解建筑改建对烧伤手术室空气污染状况及改建后首次使用多功能空气层流净化杀菌机的有效消毒时间，对改建后烧伤手术室分别于消毒前及多功能空气层流净化杀菌机消毒2、4 h，3组均以空气自然沉降法采样，分别培养24、48 h，计数每立方米菌落数（CFU/m3）。经24 h培养，3组样本仅少量细菌生长。 经48 h培养，消毒前组的空气平均菌落数为(534.29±154.98) CFU/m3，空气合格率53.57%；经空气消毒机消毒2 h及4 h后的空气平均菌落数分别为(277.91±68.45) CFU/m3和(101.99±31.58) CFU/m3，合格率分别提高到71.43%和92.86%。提示改建后手术室的空气污染严重，首次应用多功能空气层流净化杀菌机对空气消毒应达4 h以上。

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目的方法结果结论调查流动采血车医务人员手细菌及乙型肝炎病毒（HBV）污染状况。对流动采血车医务人员手消毒后工作状态下未戴手套及戴手套的手指采样，进行细菌培养和乙型肝炎表面抗原（HBsAg）检测（酶联免疫吸附试验）。结果显示，未戴手套操作时，采血人员、检验人员、后勤人员、体检人员的手平均菌落数分别为4.20、7.30、8.60、10.50 CFU/cm2，手合格率分别为82.72%、64.17%、52.26%、45.33%；HBsAg阳性检出率分别为0.00%、2.08%、0.00%、0.00%。采血人员和检验人员戴手套操作时手（于手套上采样）平均菌落数分别上升至6.80 CFU/cm2和12.60 CFU/cm2，检验人员手HBsAg污染率上升至9.38%。提示流动采血车医务人员手细菌污染严重，戴手套操作时手消毒不规范增加了微生物污染的危险性。

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目的方法结果结论回顾性分析67例恶性血液病患者并发感染及治疗情况。2007年1月—2008年10月收治的67例恶性血液病患者并发感染40例（59.70%),其中急性白血病并发感染30例（81.08%），有明显感染灶者38例（95.00%）。感染部位以呼吸道为主（60.00%），其次为胃肠道（15.00%）、皮肤与肛门（13.33%）；病原学培养阳性13例，其中咽拭子、痰标本培养革兰阴性（G-）菌6例（46.15%）；脑脊液、咽拭子培养真菌3例（23.08%）；肛门、鼻腔分泌物培养革兰阳性（G+）菌2例（15.38%）；血培养阳性2例，为金黄色葡萄球菌、表皮葡萄球菌。治疗好转与缓解32例（80.00%）。提示恶性血液病尤其是急性白血病患者是并发感染的高危人群，应积极预防与控制。

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目的方法结果结论回顾分析某生殖专科医院2005—2007年3年的法定传染病报告资料，调查其报告质量。3年共检测65 482例患者，发现法定传染病3 133例； 2005—2007年分别报告642例、835例、1 656例，不合格（迟报、错报、表格填写不完善）率分别为1.56%、0.60%、0.12%，各年份不合格率差异有高度显著性（χ2=17.48，P＜0.01）。该生殖专科医院法定传染病报告准确性呈逐年上升趋势。

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目的方法结果结论2008年4月3日—23日，对某市辖区16所基层医院的医院感染管理工作进行督查，发现存在不同程度问题：组织机构不健全，领导不重视；管理力量薄弱，医院感染难以控制；医务人员对医院感染认识不足，相关知识欠缺；基础设施陈旧，环境简陋；消毒剂应用不合理；紫外线消毒灯管安装及监测不规范；一次性医疗用品购进管理不规范；医疗废物管理混乱；医务人员手卫生意识差等。提示应强化医院感染意识，重视医院感染管理工作。

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目的方法结果结论探讨轴节类手术器械有效的润滑保养方法。将回收的1 263件轴节类手术器械随机分为机器上油组（615件）和手工上油组（648件）。机器上油组经全自动清洗消毒机p1程序清洗消毒以及机器上油保养；手工上油组经全自动清洗消毒机p2程序清洗消毒后手工上油保养。使用后锈蚀器械数：机器上油组67件（10.89%），手工上油组9件（1.39%），两组差异有显著性（χ2=5.02，P<0.05）；两组器械锈斑发生的主要部位都在轴节、咬合、缝隙处。采用手工上油能使手术器械的轴节、缝隙、咬合处等部位彻底润滑，防止器械氧化锈蚀。

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