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ObjectiveTo investigate the epidemiological characteristics of nosocomial infection (NI) outbreak incidents in recent 30 years .MethodsNI outbreak occurred between January, 1980 and December, 2009 were surveyed retrospectively through literature index survey .ResultsThere were 352 cases of NI outbreak in China in recent 30 years, 7 656 persons were infected, and 341 died． The major pathogens of infection were bacteria and virus（91.48%）, the main spread routes were contact(44.32%) and iatrogenic infection(43.18%); the peak season of NI outbreak was summer(35.51%, 125/352); the major population of cases were infants (43.99%), the mortality of infants was 84.58% (192/227); general hospitals (provincial,city,countylevel) were the high area of outbreak(73.58%, 259/352); the major infection sites were intestinal tract (32.07%), lower respiratory tract (26.19%), and blood stream(14.07%); The main causes of outbreak were cross infection of health care workers’ hands, contamination of blood product, insufficient disinfection and isolation, incorrect manipulation, et al ．ConclusionThe outbreak of NI had certain regulation, preventive measures should be drawn up based on epidemiological characteristics, so as to control the outbreak of NI effectively.

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ObjectiveTo study the pathogens in an infection outbreak after cesarean section in a hospital of Shantou, and analyze antimicrobial susceptibility of pathogens.MethodsFrom December 2009 to March 2010, 32 specimens (including focal tissue, secretion of incision and pus) were taken from 20 cesarean section patients infected with Mycobacterium abscess, and specimens were performed bacterial culture and gram staining and acidfast staining, The isolates were identified and determined the drug susceptibility on the bases of rapid growing Mycobacterium.ResultsOf 20 patients, 11 patients isolated 14 strains of rapid growing Mycobacterium , all were Mycobacterium abscess. All strains were sensitive to erythromycin, clarithromycin, azithromycin and amikacin, medium sensitive to imipenem, linezolid and gentamycin, but resistant to the other antimicrobials.ConclusionThe postoperative infection is caused by Mycobacterium abscess. Management and surveillance of nosocomial infection should be intensified to prevent the occurrence of such incident.

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ObjectiveTo investigate fungal infection and drug resistance of fungi in ICU patients with external intubation.Methods161 specimens of intubator used by 84 ICU patients in a hospital were collected, and specimens were inoculated on Candidal chromogenic medium , all strains were identified by API 20C AUX Kit,and drug sensitivity test were performed by ATB FUN3 Kit.ResultsNinetyeight (60.87%) fungus strains were isolated from 161 specimens, most of which were Candida albicans (52, 53.06%), the next were Candida tropicalis (14, 14.29%), Candida glabrata (11, 11.22%), Candida parapsilosis (9, 9.18%) , and Candida krusei (12, 12.25%). Sixty strains (61.22%) were isolated from respiratory intubator, 25(25.51%) from urethral catheter and 13(13.27%) from venous cannula. Drugresistant rate of isolated strains to 5fluorocytosine, amphotericin B, and voriconazole were all <10% , resistant rate to itraconazloe was 12.24%;resistant rate of Candida glabrata, Candida parapsilosis and Candida krusei to fluconazol were all >45%.ConclusionCandida albicans is the main fungi in infection caused by external intubation; fungal infection rate in patients undergoing respiratory intubation is high than patients undergoing the other external intubation ; All kinds of Candida have low drugresistance to 5fluorouracil, amphotericin B and fluconazole and have high drugresistance to fluconazole.

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ObjectiveTo observe the adverse drug reactions of ganciclovir in treating infants with cytomegalovirus (CMV) hepatitis, and to analyse the influencing factors. MethodsInformation of the infants who suffered from CMV hepatitis and administered with ganciclovir from January,2005 to December, 2009 was collected, and the incidence of adverse reactions was calculated. The SPSS statistical software was used to analyse the influencing factors.ResultsThe total incidence of adverse reactions during the treatment of ganciclovir was 29.46%（71/241, 95%CI: 23.70%-35.21%）,the incidence of bone marrow suppression was 22.08%（51/231，95%CI: 16.73%-27.43%）, and the incidence of liver damage was 9.71 % (20/206, 95%CI: 5.67%-13.75%). Among 71 infants with adverse reaction , 46(64.79%)had effective treatment of ganciclovir; among 170 infants without adverse reaction, 120(70.59%) had effective treatment of ganciclovir, there was no significant difference in effective rate between two groups (χ2=0.79, P=0.38). There was no correlation between adverse reaction and infants’ genders, jaundice, premature delivery, cesarean section,and infection (all P>0.05).ConclusionGanciclovir can induce the bone supression and liver damage, but the treatment effect is not affected, there is no correlated influencing factor with adverse reaction.

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ObjectiveTo investigate status of infectious diseases among public practitioners in Changping District of Peijing.MethodsPublic health information management system was adopted to analyze statistically on physical examination results of public practitioners in Changping District of Beijing in 2009.ResultsAmong 76 654 practitioners, the positive rate of HBsAg was 1.83%, employees in food and public places was 1.51% (920/61 032) and 3.09% (482/15 622) respectively; local employees and employees from the other towns was 0.74%(139/18 749) and 2.18% (1 263/57 905) respectively; male and female was 2.25%(729/32 397) and 1.52%(673/44 257) respectively; The difference in each group was statistically significant(both P＜0.01). The detection rate of active pulmonary tuberculosis was 0.12%, local employees and employees from the other towns was 0.05%(9/18 749) and 0.15% (86/57 905) respectively, the difference was statistically significant(P＜0.01). HCV and HEV antibody positive rate was 0.02% and 0.01% respectively; Suppurative or exudative skin diseases detection rate was 0.03%; typhoid/ dysentery was not found. ConclusionAmong all monitored infectious diseases ,the detection rate of HBsAg was the highest, the detection rate of pulmonary tuberculosis, purulent and exudative skin diseases were relatively low. Public practitioners should adhere to annual physical examination , the management of practitioners from the other towns should be intensified and receive vaccination .

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ObjectiveTo study resistant mechanisms of two clinical strains of Enterobacter aerogenes (Ea293 and Ea2880)to ertapenem. MethodsThe minimum inhibitory concentrations (MICs) of antimicrobial agents were determined by microbroth dilution method, drug resistance of strains to imipenem，meropenem，and ertapenem were determined by KB test; carbapenemase was confirmed by modified Hodge test, carbapenemase genes（KPC，IMP1 group，IMP2 group，VIM）, broadspectrum and extendedspectrum βlactamases genes（TEM，SHV，CTXM1 group，CTXM2 group，CTXM9 group） were amplified by polymerase chain reaction (PCR), and sequences were analysed; Outer membrane protein (Omp) was analyzed by sodium dodecylsulfatepolyacrylamide gel electrophoresis (SDSPAGE) and the coding gene OmpE36 was amplified by PCR. ResultsAntimicrobial susceptibility test showed that Ea293 and Ea2880 were all resistant to ertapenem. Among amplified 4 carbapenemase genes and 5 broadspectrum and extendedspectrum genes, only  blaSHV and blaCTXM9 group ESBLs in Ea2880 were positive, BlaSHV DNA sequence was SHV11 type. SDSPAGE showed that compared with ertapenemsensitive isolate Ea1885, ertapenemresistant isolate Ea293 and Ea2880 lacked the protein band with 42kD which might be the outer membrane protein gene OmpE36. OmpE36 was amplified by PCR, Ea2880 appeared the excepted bands, but Ea293 didn’t. The similarity of DNA and amino acid sequences of OmpE36 of Ea2880 with the standard Enterobacter aerogenes ATCC13048 from GenBank were both 87%.ConclusionThe resistance of clinical strains of Enterobacter aerogenes Ea293 and Ea2880 to ertapenem might be associated with the loss of outer membrane protein gene OmpE36. Furthermore，Ea2880 might be associated with production of CTXM9 group ESBLs.

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ObjectiveTo report the clinical and laboratory detection data of 4 cases of rare deep infections caused by Sporothrix schenckii, Fusarium moniliforme, Penicillium marneffei and Scedosporum apiospermum. MethodsSecretion and blood specimens from patients' infected sites were taken for direct smear and culture , fungi were identified according to colony features and appearance under microscope. ResultsFour strains of filamentous fungi isolated from the wound secretion and blood specimens were Sporothrix schenckii, Fusarium moniliforme, Penicillium marneffei and Scedosporum apiospermum .ConclusionInfection caused by Sporothrix schenckii, Fusarium moniliforme, Penicillium marneffei and Scedosporum apiospermum in clinic are very rare, and the detection is also difficult. The knowledge and laboratory detection on the rare fungi infection should be strengthened to improve the level of diagnosis and therapy.

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 ObjectiveTo study the influence of different load patterns on pressure steam sterilization parameters of autoclave.MethodsThermologgers was used to measure the temperature distribution of sterilization chamber without load, the temperature time variation at the center and on the upper layer of the tested package, as well as the pressure time variation of different load patterns. The influence of different load patterns on the temperature and air expelling level inside the tested package was analyzed.ResultsLoad pattern directly acts on the temperature and air expelling level inside sterilization package. Extremely heavy load pattern may lead to the temperature inside package being lower than required sterilization temperature and remain air inside package.ConclusionLoad pattern of autoclave can influence sterilization efficacy, it is necessary to standardize the load pattern of autoclave.

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ObjectiveTo investigate the characteristics of the distribution and drugresistance of Acinetobacter spp. in a cardiovascular special hospital.MethodsThe distribution and drugresistant rates of Acinetobacter spp. which isolated from clinical specimens from January,2006 to December,2009 were analysed retrospectively.Results409 Acinetobacter spp. were mainly isolated from sputum(75.79%),followed by blood(8.56%), the rest from others(urine,venous catheter,secretions) and accounted for 15.65%; department distribution : Acinetobacter spp. were mainly isolated from surgical ICU and accounted for 40.59%,followed by medical ICU and accounted for 37.41%,other departments(including surgery and internal medicine) was 22.00%;bacteria distribution: Acinetobacter spp. consisted of Acinetobacter baumannii(80.20%),followed by Acinetobacter lwoffii(16.87%)and Acinetobacter haemolyticus(2.93%). Acinetobacter spp. had low drugresistant rates to cefoperazone/sulbactam, piperacillin/tazobactam, ceftazidime,cefepime,gentamycin,amikacin and ciprofloxacin, drugresistant rate was 2.69%,14.18%,19.56%,15.16%,15.65%, 9.29%,and 14.18%, respectively. The percentage of drugresistant rate to imipenem and meropenem was 3.67% and 5.87% respectively, while it was over 57% to the other antimicrobial agents .ConclusionAcinetobacter spp. is one of nonfermentative bacteria in nosocomial infection, the main infection is respiratory tract infection , and shows serious drugresistance. Cefoperazone/sulbactam and carbapenems are effective antibiotics for treating infections caused by Acinetobacter spp..

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ObjectiveTo investigate the state and risk factors for nosocomial infection (NI) in a general intensive care unit(ICU) .MethodsPatients who were hospitalized in ICU for >48 hours between JanuaryDecember, 2007 were investigated by targeted monitor methods.ResultsA total of 214 patients were surveyed, 51 patients developed 67 cases of NI, NI rate was 23.83%, NI case rate was 31.31%. The main infection sites were lung (71.64%) and urinary tract (11.94%). 217 strains of pathogens were isolated, 116(53.46%) of which were gramnegative bacilli, 82(37.79%) were grampositive cocci, 19(8.76%) were fungi. The top 4 pathogens were Staphylococcus aureus (26.73%), Acinetobacter baumannii(10.06%), Enterococci spp.(10.60%), and Pseudomonas aeruginosa(9.68%). The risk factors for NI were age≥58 years old, dysfunctin of organs, use of respirator, long length of staying in ICU.ConclusionNI is high in ICU patients, the major pathogen is gramnegative bacilli, prevention should be carried out according to the related risk factors and commonly occurred NI.

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ObjectiveTo investigate the effect of strict management of prophylactic use of antimicrobials in patients during perioperative period. MethodsCrosssectional study was carried out on the rationality of antimicrobial application in patients at general surgery and orthopedics surgery departments in March, 2006 (before intensifying management of antimicrobials) and April, 2009(after intensifying management of antimicrobials) . ResultsPerioperative antimicrobial prophylactic application rate in patients undergoing aseptic operation decreased from 91.16% in March, 2006 to 82.39% in April, 2009(χ2=5.24,P<0.05); Rational application rate increased from 35.07% to 57.93% (χ2=14.61,P<0.05). The main problems of irrational application were the incorrect choice of medicine and long term use .ConclusionProphylactic use of antimicrobials in perioperative patients exist unreasonable factors. Reinforcing management of antimicrobials can improve rationality of prophylactic use.

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ObjectiveTo summarize and analyze the incidence of occupational exposure to bloodborne pathogens among medical personnel, so as to provide strategies of prevention. MethodsA total of 48 cases of occupational exposure were analyzed retrospectively from 2003 to 2008.ResultsOf 48 occupational exposure cases, 19 were human immunodeficiency virus exposure, 18 were hepatitis B virus, 6 were hepatitis C virus, and 5 were Treponema pallidum exposure. Twentynine exposure were in medical personnel in operating room, 16 were in nonoperating room, 3 were in the other departments. Sharp injuries during operation were the most common route of exposure (16 cases). Most exposures were among doctors(24 cases, 4 of whom were interns), followed by nursing staff (21 cases, 8 of whom were probationer nurses), laboratorians(2 cases),and midwife (1 case). Intervention was carried out promptly among medical personnel after exposure , and no one was infected by these pathogens.ConclusionOccupational safety awareness should be emphasized，intervention should be taken promptly to reduce the risk of infection from postoccupational exposure.

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ObjectiveTo realize the condition of nosocomial infection (NI) in Fujian Provincial Hospital, so as to prevent and control NI effectively. MethodsAccording to the survey project of prevalence rate of nationwide NI established by ministry of health, the prevalence rate of NI at a given day between October, 2007 and October, 2009 were conducted.ResultsThe prevalence rate of NI was 5.67%, 6.97% and 4.57% (χ2=8.970, P=0.011), respectively, NI case rate was 6.26%,7.45% and 5.11% (χ2=7.846, P=0.020), respectively, the highest was in 2008，there was significant difference among 3 years. Respiratory tract infection was the most common infection, which accounting for 65.69% , followed by urinary tract (11.11%) and surgical site infetion(5.56%); The departments with high rate of NI were general intensive care unit (30.50%), hematology (24.66%), neurosurgery (17.10%) and neurology （11.31%）; The main pathogen in NI were gramnegative bacilli, which accounting for 66.18% of all pathogens, Acinetobacter baumannii infection showed a rising trend, the constitutional ratio was 18.31%, 20.00% and 21.43% respectively in 2007-2009.ConclusionThe monitor and intervention of key departments and key sites of NI should be strengthened, the enhancement of consciousness of NI among medical staff plays an important role in reducing the occurrence of NI.

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目的提高平战状况下医院感染、传染病疫情及生物武器防控水平。方法以Delphi和NET为开发工具，C/S+B/S架构，结合Java Script+ASP+XML+web Service等技术，建立功能强大的医院感染监控及疫情预警指挥系统。结果该系统科学的预警设置，完善的系统功能，使平时、战时医院感染、传染病疫情动态监控得到了实现。结论该系统的研发可提高医院感染及疫情监控效率，提升突发公共卫生事件的应对能力。

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目的探讨口腔科综合治疗台用水管路消毒效果，为其用水污染控制提供依据。方法对口腔科6台新安装的牙科综合治疗台用水管道，于消毒前和用含氯消毒剂消毒后进行采样，作细菌学监测。结果消毒前冲洗水含菌量为2 520～9 000 CFU/mL, 平均6 347 CFU/ mL；手机喷水含菌量为4 530～10 000 CFU/mL，平均7 164 CFU /mL；两者合格率均为0.00%。消毒后冲洗水含菌量为0～570 CFU / mL，平均84 CFU / mL，合格率94.00%；手机喷水管道含菌量为0～208 CFU / mL, 平均71 CFU / mL，合格率98.00%。冲洗水、手机喷水合格率，消毒前与消毒后比较，差异均有高度显著性（χ2分别为88.68、96.08，均P＜0.01）。结论采用含氯消毒剂对口腔科综合治疗台用水管路进行消毒，能有效改善其用水管路污染状况。

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目的探讨提高基层医院医务人员医院感染知识的培训方法。方法先进行问卷调查，了解基层医院医务人员医院感染知识知晓情况；再分管理组、医生组、护理组，分别对95名学员进行医院感染知识培训，包括理论和现场培训2部分。培训结束后，进行效果评估。结果经过上述培训方法培训后，全部学员培训成绩均合格，其中29人为优秀（考核成绩＞85分）；培训后的医院感染知识正确回答率显著高于培训前（P＜0.01），其中医院感染基本概念、重点环境的感染控制要求和布局知识点提高明显。结论通过理论与实践相结合的培训，可以有效提高基层医院医务人员医院感染控制知识。

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目的调查精神病专科医院住院患者的抗菌药物使用情况，分析其抗菌药物使用中存在的问题。方法选取2005年1月1日—2007年12月31日3 281份出院病历进行回顾性调查，对其中810例次抗菌药物使用的种类、指征、途径及联合用药情况等进行统计分析。结果3年3 281例出院患者中，使用抗菌药物810例次，抗菌药物例次使用率24.69%。其中，治疗用药613例次（75.68%），预防用药197例次（24.32%）；口服用药422例次（52.10%），静脉用药388例次（47.90%）；单一用药585例次（72.22%），联合用药225例次（27.78%）；使用抗菌药物前病原体送检67例次,病原学送检率10.93%；行辅助检查（病原学检查、血常规、胸片、尿常规等）399例次（49.26%）。结论精神病专科医院住院患者抗菌药物例次使用率在合理范围； 抗菌药物使用存在用药指征不严，给药途径不规范，联合用药不合理，辅助检查率低，病原学送检率低等问题，须加大对临床抗菌药物使用的管理力度和对医务人员用药知识的培训，以促进抗菌药物的合理应用。

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目的研究水垢性质、除水垢剂温度、浸泡时间因素对医疗器械水垢去除效果的影响。方法收集某院沉积有肉眼可见水垢的器械，分别按照水垢性质、不同除水垢剂温度、不同浸泡时间分组进行水垢去除试验，记录试验结果并进行统计学分析。结果在相同的除垢条件下，水垢的去除难度为：金黄色水垢＞混合水垢＞白色水垢；当其他条件相同时，在除水垢剂中浸泡时间越长，水垢去除效果越好；当其他条件相同时，除水垢剂的温度越高，水垢的去除效果越好。结论水垢特性、除水垢剂温度及浸泡时间是医疗器械水垢去除工作中的重要因素，只有掌握好这些因素，才能更有效地去除水垢，保证医疗器械的清洁。

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 目的通过现患率调查，了解医院感染的实际情况，发现医院感染管理中存在的问题，为制定医院感染防控措施提供依据。方法统一培训调查人员。采用床旁逐个调查和查阅在架病历相结合的方法，填写统一的个案调查表和床旁调查表，对调查日处于医院感染状态的病例进行统计分析。结果本次调查住院患者1 110例，发现医院感染61例，64例次，医院感染现患率为5.50%，例次现患率为5.77%。感染高发部位依次为下呼吸道（43.75%）、皮肤软组织（12.50%）、上呼吸道（9.38%）、浅表切口（9.38%）、泌尿道（6.25%）、深部切口（6.25%）；在医院感染部位构成比中，此次调查与以往前瞻性医院感染监测相比，上呼吸道、胃肠道、浅表切口、深部切口和皮肤软组织差异有统计学意义（均P＜0.05）。当日抗菌药物使用率为42.07%，治疗性用药病原学送检率为37.72%。结论长期住院、反复感染的患者会显著增加现患感染率；需加强重点科室、重点部位的感染管理，合理、规范使用抗菌药物。

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   近年来，由于抗菌药物的广泛应用，导致肠道菌群失调病例时有发生［1］，其主要表现为抗菌药物治疗无效的腹泻。我们应用大便直接涂片、革兰染色镜检法判定菌群失调性腹泻，采用健康儿童大便悬液灌肠法治愈2例严重肠道菌群失调患者，现报告如下。

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     丙型肝炎病毒（hepatitis C virus，HCV）是丙型肝炎的病原体。目前全世界约有1.2亿～1.8亿慢性HCV感染者，是世界范围内导致慢性肝炎、肝硬化、肝细胞癌的主要病因之一［1］。传统的感染细胞模型HCV复制效率非常低，缺乏合适的体外细胞培养模型及小动物感染模型,使得HCV各方面的研究进展缓慢。HCV复制子细胞培养体系的出现，解决了长期以来缺乏适合HCV体外复制的细胞培养体系的问题，被认为是HCV研究具有里程碑意义的突破。HCV复制子细胞培养体系极大地方便了HCV完整生命周期、HCV与宿主细胞的相互作用、抗病毒药物筛选及HCV对抗病毒药物耐药机制等方面的研究。而HCV复制子细胞培养体系本身也不断被改进、完善，在HCV研究中发挥越来越大的作用。本文综述了HCV复制子细胞培养体系的发展及其在HCV研究领域的应用。

Abstract:

      近年来，第三代头孢菌素和氨曲南等氧亚氨基β内酰胺类抗生素被广泛用于临床抗感染治疗，使耐药形势日趋严重，而导致细菌对此类药物耐药的最主要原因是产生超广谱β内酰胺酶（extendedspectrum βlactamases， ESBLs）。特别是1983年德国首次从臭鼻克雷伯菌发现产ESBLs株以来，产ESBLs的菌株在世界各地被广泛报道。最常见的质粒介导的ESBLs有：TEM型、SHV型、CTXM型。至今已报道了91种OXA型酶，命名为OXA1～89及AmpS和LCR1。随着OXA型ESBLs的型别数量逐渐增多，对该酶的研究逐渐成为热点。