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ObjectiveTo investigate an outbreak of nosocomial infection(NI) with multidrugresistant(MDR) Acinetobacter baumannii (A.baumannii) in an intensive care unit (ICU). MethodsNine strains isolated from patients and 24 strains isolated from   ICU environment during NI outbreak with MDR A.baumannii were typed by repetitive extragenic palindromicpolymerase chain reaction (repPCR) and antimicrobial susceptibility  was tested by KirbyBauer method. ResultsNine strains isolated from patients were    divided into 4 genotypes by repPCR,  type E1 and E2 had 4 and 3 strains respectively, both type E3 and E4 had 1 strain. 24 strains of  A .baumannii  were  isolated from the environmental samples, 17 of which belonged to type E1. Antimicrobial sensitivity test results showed that all clinical isolates and 19  environmental isolates  were  multidrugresistant strains.ConclusionThe MDR A.baumannii outbreak in ICU   was caused by transmission of E1 and E2 genotype A.baumannii among patients， and environment was also contaminated.

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ObjectiveTo explore the risk factors for nosocomial infection （NI）of Acinetobacter baummanii (A. baumannii) in patients in the internal medicine intensive care units (ICUs).MethodsA 1：2 matched casecontrol study was carried out in ICUs in a hospital between January 1,2007 and December 31,2008. Cases were patients with A. baumannii infections and controls were those without NI. Conditional Logistic regression analysis was performed to identify independent risk factors.ResultsThe independent risk factors were the number of the underlying diseases（OR=4.03）, duration of nasal feeding tube（OR=11.37）, using respirators（OR=9.83）and acute physiology and chronic health evaluation Ⅱ score system（OR=1.20）;  the protective factor was using vitamin（OR=0.05）.ConclusionImproving patients’ body state and immunity and reducing invasive procedures are helpful for the control and prevention of NI with A. baumannii in  patients in ICUs.
［Key words］intensive care unit；Acinetobacter baumannii；nosocomial infection；risk factors；casecontrol study

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Antimicrobial resistance and gene typing of extendedspectrum βlactamasesproducing Klebsiella pneumoniaeLIU Xiaochun,WANG Guoqing,WANG Rong, LIU Yunde (Department of Laboratory Medicine, Tianjin Medical University, Tianjin 300203, China)［Abstract］ObjectiveTo investigate antimicrobial resistance and genotypes of extendedspectrum βlactamases(ESBLs)producing Klebsiella pneumoniae(K. pneumoniae) isolated from clinic in a hospital . MethodsK. pneumoniae were collected, ESBLs preliminary screen and phenotype confirmatory tests were carried out according to the NCCLS guidelines; antimicrobial susceptibility tests were determined by KirbyBauer test; gene types of βlactamases were performed with PCR . ResultsThe detection rate of ESBLsproducing K. pneumoniae was 62.22%(56/90). ESBLsproducing strains were only sensitive to the combination of the third generation cephalosporins with βlactamases inhibitor and carbapenems. The detection rate of genes of SHV, CTXM1, TEM and CTXM9 was 69.64%, 51.79%, 37.50% and 0.00% respectively. 35.71% and 14.28% of ESBLproducing K. pneumoniae carried two or three genes respectively. ConclusionAntimicrobial resistance of K. pneumoniae is serious, the main gene types are SHV and CTXM1

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Immune response of T lymphocytes in patients with pulmonary tuberculosis combined with chronic hepatitis B GUO Haoyu1, LIU Hongbo2, ZHANG Chengguo1 (1 Changsha Central Hospital, Changsha 410004, China; 2 Xiangya Hospital, Central South University, Changsha 410008, China )［Abstract］ObjectiveTo study the serum levels of Th1 lymphocyte factor and the expression pattern of Th1 and Th2 in patients with pulmonary tuberculosis (PT)combined with chronic hepatitis B (CHB)．MethodsSerum levels of tumor necrosis factorα(TNFα),interferonγ(IFNγ),interleukin12 (IL12) in 21 patients with PT combined with positive HBsAg, 30 simple PT patients and 30 healthy controls were detected with enzymelinked immunosorbent assay (ELISA) ;and the expression pattern of CD4+T lymphocytes,Th1 and Th2 cells in peripheral blood were detected by flow cytometry．ResultsThe serum levels of TNFα in patients with simple PT and PT coinfected with CHB were both higher than that in healthy group (both P<0.01)；the serum levels of IFNγ and IL12 in patients with simple PT were both lower than that in healthy group (both P<0.05)；the serum levels of IFNγ and IL12 in patients with PT coinfected with CHB were both lower than that in simple PT patients (both P<0.01).The expression of CD4+ T lymphocytes and Th1 cells in simple PT patients were significantly lower than that in healthy group (P<0.05，P<0.01)；The expression of Th2 cells in simple PT patients was significantly higher than that in healthy group (P<0.05)；The expression of CD4+ T lymphocytes and Th1 cells in PT coinfected with CHB patients were significantly lower than that in simple PT patients (P<0.05，P<0.01).ConclusionPatients with PT showed lower expression of Th1 and higher expression of Th2; patients with PT coinfected with CHB showed further lower expression of Th1 and higher expression of Th2.

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Detection and clinical significance  of HIV1 antibody in urineGUO Jingjing1, XU Dan2, WANG Min2, XIE Weiwei3, LIU Wenen1(1 Xiangya Hospital, Central South University, Changsha 410008, China; 2 Infectious Disease Hospital of Changsha,  Changsha 410011, China; 3 Department of Medical Laboratory of Xiangya School of Medicine,  Central South University, Changsha 410013, China)［Abstract］ObjectiveTo evaluate the clinical significance of detecting antiHIV1 antibody in urine samples.  MethodsAntiHIV1 antibody was  tested in serum and urine samples from 59 HIVinfected persons diagnosed by Provincial Center for Disease Control and Prevention and 30 healthy controls with  ELISA； Taking the results of the counterpart serum samples tested as standard, the sensitivity and specificity of  antiHIV1 antibody in urine samples were calculated.ResultsAmong 59 HIVinfected cases, antiHIV1 antibody positive results of serum test were observed in all cases, while 53 urine samples showed positive and 6 ones were negative. None of the serum samples showed antiHIV1 antibody positive in the control group, but 1 urine sample was positive, which was determined to be negative by serum enzymelinked immunosorbent assay and electroselenium assay. The sensitivity and specificity for the urine ELISA were 89.83% and 96.67% respectively. ConclusionThe results indicate that urine antiHIV1 antibody can be tested to screen HIV infection in high risk population, if serum samples are unavailable.

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To explore the clinical significance of mean platelet components (MPC)  in children with sepsis.MethodsIntravenous blood of 93 children with sepsis within 24 hours of admission were collected, platelet count (PC) and MPC were analysed  by  ADVIA 2120 hematocyte system, and results were compared with healthy  control; severe and mild group of children with sepsis was compared.ResultsThe levels of PC and MPC of all children with sepsis were (101.00±49.00)×109/ L and (225.00±20.00) g/L respectively, which  were significantly lower than (212.00±72.00)×109/ L and (267.00±22.00) g/L in healthy group respectively (both P<0.05). The levels of PC and MPC of 40 children with severe sepsis  were (86.00±35.00)×109/ L and (213.00±13.00) g/L respectively, which  were significantly lower than (141.00±40.00)×109/L and  (235.00±18.00) g/L in mild sepsis group respectively (both P<0.05). When the critical value of PC and MPC were 100.00×109/L  and 267.00 g/L, among 53 children with mild sepsis, PC values of 20 children and MPC values of 51 children were all decreased, the sensitivity was 37.74% and 96.23% respectively. ConclusionThe routine detection of PC and MPC,  especially MPC at  the early stage, can be considered as a quick and reliable guide in the assessment of the extent of  sepsis.

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To evaluate the clinical efficacy and safety of high dosage levofloxacin injection in the treatment of hospitalacquired pneumonia(HAP) in intensive care unit (ICU).MethodsEightyfour  patients with HAP  in ICU from September ,2007 to December, 2008 were randomly divided into high dosage (HD group, n=50 ) and routine dosage levofloxacin injection treated group (control group, n=34), HD and control group both received  intravenous drip of levofloxacin 500mg, once per 16 hours and once per 24 hours respectively, therapeutic efficacy and adverse reactions in both groups were observed.ResultsThe total efficacy rate of HD and control group  was 88.00% and 76.47% respectively, there was  no significant difference between the two (χ2=1.94, P>0.05);  The effective time were (4.18±2.62)d and (5.64±2.72)d, the course of treatment  were (7.87±3.66)d and (9.64±3.52)d, bacterial eradication rate was 86.00% and 64.71%, respectively, there were  significant difference between  two groups (t=2.47, P<0.01; t=2.19, P<0.05; χ2=4.10, P<0.05); adverse reactions were observed in 12.00% and 8.82% of patients in  two groups respectively, there was  no statistical significance (χ2=0.01, P>0.05). ConclusionHigh dosage levofloxacin is effective and safe for HAP in patients in ICU,  and can save time for saving life, maybe widespread used.

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To evaluate the establishment and effectiveness of information monitoring  procedure of trocarassociated blood stream  infection, and test the stability, effectiveness and convenience of software.MethodsAccording to hospital information system (HIS), using the database oracle10.0 and programming tool powerbiuld 9.0, based on inserted catheter and project, the objective monitoring sofeware of nosocomial infection were explored and developed.Peripheral venous blood stream infection was included in monitoring system. 2 318 patients with  peripheral vein trocar between September and November, 2008 were studied. The distribution of departments and diseases, complications and retention time, the relationship between hypertonic and general liquids resulting in  complications were analysed.ResultsThe use of HIS realized  the data sharing,comprehensive data about retention trocar were captured from database quickly for  providing basic information  about  infection monitor.The results showed that trocars had been  widely used in patients receiving infusion at different departments and with different diseases; complications were related with retention time (P=0.000); there was significant difference in complications resulted from infusion of hypertonic and general liquid (P=0.000); there was no blood stream infection in this surveillance.ConclusionThis procedure can fully and quickly capture the information about indwelling peripheral vein, provide a basis for judging catheterrelated  infection, and guide  proper retention, strengthen infection control and reduce the incidence of complications.

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To explore  the effective intervention measures  to raise the curative effect of bacterial infections by promoting  the pathogenic detection.MethodsPathogenic delivering rates, curative or improving rates, and average hospitalization days before and after performing intervention measures on pathogenic detection were compared and analysed.ResultsThe rate of sample delivering, positive rates, and the coincident rate of positive results and clinical manifestations increased from 44.23%, 43.48% and 72.50% before  interposing to 58.82%, 55.79% and 89.74% after interposing respectively,  the curative or improving rate increased form 93.27% to 97.48%, and the average hospitalization  days shortened from 9.94d to 8.97d.ConclusionScientific and effective administrative and technical intervention measures is help for raising pathogenic delivering rate, promoting curative effect of antiinfection and shortening hospitalization days.

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To evaluate in vitro activity of linezolid and other antimicrobial agents against Enterococci spp. isolated from clinic.MethodsIdentification and  antimicrobial sensitivity test of Enterococci spp. was carried out by Microscan WalkAway40 system.ResultsNo  linezolidresistant strain was detected in 117 Enterococci spp. strains. Resistant rate of Enterococcus faecium and Enterococcus faecalis against vancomycin was 4.41% and 5.71% respectively, the resistant rates to  penicillin, ampicillin, erythromycin, high concentration  gentamycin, levofloxacin  and ciprofloxacin were all above 70%.ConclusionLinezolid has  high activity against Enterococci spp., especially the control of infections caused by multidrugresistant  isolates.

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To evaluate the antifungal activities of amphotericin B (AMB) combination with  azithromycin (AZI) and other antifungal agents  against 30 strains of Aspergillums fumigatus in vitro, so as to guide rational use of antifungals against invasive aspergillosis. MethodsThe M38A method recommended by Clinical and Laboratory Standards Institute was used to detect  antifungal activity of the combination application of antifungal drugs. ResultsThe minimum inhibitory concentration(MIC) of voriconazole(VRC), caspofungin(CBF), itraconazole(ICZ) and AMB against Asperillus fumigatus was 0.29 μg/mL,  0.45 μg/mL, 0.52 μg/mL and 0.55 μg/mL, respectively. Asperillus fumigatus were all resistant to terbinafine, fluorocytosin 5 (5FC),  fluconazole(FCZ) and AZI. The total percentages of synergistic activity for AMB+ICZ, AMB+VRC, AMB+CBF, and AMB+5FC was 96.67%, 90.00%, 83.33% and 50.00% respectively. ConclusionAspergillus fumigatus were highly sensitive to AMB, ICZ, VRC and CBF, but resistant to AZI and FCZ; The combination of AMB+ICZ, AMB+VRC, AMB+CBF and AMB+5FC  displayed a  synergistic activity. The combination of AMB and other antifungals  can be chosen for invasive aspergillosis.

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To investigate the change in  drugresistance of Pseudomonas aeruginosa (P. aeruginosa) to βlactam antibiotics in a hospital, so as to provide reference for treatment of P. aeruginosa infection.MethodsDrug sensitivity tests of 2 127 strains of P. aeruginosa isolated fom clinic between 1999—2007 to 18 kinds of antibiotics were analysed.ResultsResistance of P. aeruginosa to 18 kinds of βlactam antibiotics  increased year by year during  the past 9 years, there was significant difference between each year (P<0.05 or P<0.01). The total resistant rates to meropenem, imipenem and ceftazidime were below 30%. ConclusionP. aeruginosa was resistant to many kinds of βlactam antibiotics, and resistant rate increased year by year, in order to control and slow down the emergence of the resistant strains , the use of third generation cephalosporins and carbapenems should be properly controlled .

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To study the distrubution and drugresistance of Escherichia coli (E. coli) and Klebsiella pneumonia (K. pneumonia) which  produced extendedspectrum betalactamases(ESBLs) in a hospital.MethodsThe doubledisk synergy test was performed to detect ESBLsproducing strains and antimicrobial susceptibility was determined by disk diffusion test in specimens collected from  patients from October， 2007 to September， 2008.Results443 of  766(57.83%) E. coli strains produced ESBLs； 355 of 632 (56.17%) K. pneumonia strains produced ESBLs. Most ESBLsproducing strains were isolated from  sputum (557 strains, 69.80%) and urine (149 strains,18.67%). ESBLsproducing strains were susceptible to imipenem／cilastatin, meropenem and cefoperazone/sulbactam, but resistant to almost all the first to third generation cephalosporins, and had cross resistance among  quinolones and aminoglycosides.ConclusionInfections caused by ESBLsproducing strains are serious, majority are lower respiratory tract infection, the next is urinary tract infection; drugresistance is high, imipenem/cilastatin, meropenem and cefoperazone/sulbactam have high antimicrobial activity on ESBLsproducing strains.

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realize the detection and drug resistance of nonfermentative bacteria from clinical samples between January and December, 2008, so as to provide evidence for rational use of antimicrobial agents in clinic. MethodsBacteria were identified by ATB identification system, antimicrobial susceptibility tests were performed by KirbyBauer method. Results215 strains of nonfermentative bacteria were isolated from 3 555 samples, the isolation rate was 6.05%, which accounting for 19.15% (215/1 123) of total isolated bacteria; the most common isolated bacteria was Pseudomonas aeruginosa, which accounting for 41.86% of total nonfermentative bacteria, the next was Acinetobacter baumannii and Burkholderia cepacia, the constitutional ratio was 29.30% and 16.74% respectively. The isolation rates of nonfermentative bacteria varied with different infection sites, the isolation rates were high in  samples of sputum and throat swabs, and excretion of subcutaneous tissue, which was 15.32% and 9.17% respectively. Pseudomonas aeruginosa, Acinetobacter baumannii, Burkholderia cepacia and Stenotrophomona maltophilia were all had obvious drug resistance. ConclusionThe isolation rate of nonfermentative bacteria in clinical infected patients are high, and drugresistance is strong. In order to control nonfermentative bacteria infection and  emergence of drug resistant strain, antimicrobial agents for treatment of infection should be chosen according to antimicrobial susceptibility test results.

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目的探讨某院下呼吸道感染患者病原菌种类及耐药状况，为临床治疗提供参考。方法对2005—2006年下呼吸道感染住院患者送检的痰及下呼吸道分泌物标本进行普通细菌培养、鉴定，并采用KB纸片琼脂扩散法进行药敏试验。结果分离217株病原菌，以革兰阴性杆菌为主，共145株，占总菌株数的66.82％，其中肺炎克雷伯菌、铜绿假单胞菌分别占29.03％、13.37％，产超广谱β内酰胺酶（ESBLs）的肺炎克雷伯菌和大肠埃希菌检出率分别为30.16％和25.00％；革兰阳性球菌中耐甲氧西林凝固酶阴性葡萄球菌占59.09％，耐甲氧西林金黄色葡萄球菌占46.67％。结论该院下呼吸道感染病原菌以革兰阴性杆菌为主，且耐药性日益严重，应不断进行监测，合理使用抗菌药物。

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目的探讨地震伤员创面感染特点，提高救治成功率。方法伤员入院后行床旁X线、腹部B超检查，血液生化及血、尿、大便常规检查，创面感染的伤口连续3 d行床旁采样，做细菌、真菌及厌氧菌培养，根据药敏结果调整抗菌药物。择期手术者预防应用抗菌药物。疑似泌尿系统或肺部感染者行尿和痰培养。结果地震伤员多为复合伤，创面为混合细菌或霉菌感染。14例开放性骨折及骨筋膜室综合征切开减压术后伤员中，10例发生创面感染，感染率71.43%。初次分离的15株细菌中，7株为多重耐药株，提示开放性伤口的感染与医院感染相关。结论应重视地震创伤感染创面的病原菌检测，尽早清创处理，并根据药敏结果调整抗菌药物，预防控制医院感染。

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目的总结某院在抗震救治特殊环境中的医院感染防控工作。 方法采用回顾性方法对该院诊治地震伤员的医院感染控制工作进行经验总结。结果通过建立工作流程，使感染管理工作有章可循；感染管理工作前移，保证医院感染控制措施的落实；积极开展对伤口的目标性监测；深入临床一线，参与危重患者救治等措施的实施，确保了医疗质量和患者安全，未发生气性坏疽二代感染，多重耐药菌感染患者经过治疗，多数痊愈出院，部分病情较重患者病情得到控制。结论抗震救治的特殊环境中，医院感染防控技术和措施的贯彻落实是确保医疗质量、患者安全的重要环节。

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目的评析42例剖宫产病例不合理应用抗菌药物情况。方法采用回顾性方法调查某基层医院符合病例选择条件的剖宫产术患者病历资料。结果216例行剖宫产者中，97例符合病例选择条件，其中不合理用药42例（43.30％）。不合理用药表现为：抗菌药物选择不当, 联合用药不合理,给药次数与剂量不正确, 给药时间过长等。结论该医院应加强预防性应用抗菌药物的管理。

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目的了解中医门诊治疗室之间空气细菌菌落数差异及引起该差异的原因。方法将中医门诊4间治疗室按其作用功能分为A、B两组，A组1、2号系针灸治疗室（设为A1、A2），B组3、4号系推拿、按摩治疗室（设为B1、B2）。下午治疗结束后进行空气采样培养，比较组内和组间细菌菌落数。结果各治疗室细菌数：A1为(231.83±66.80)CFU/m3，A2为(236.17±53.07)CFU/m3，B1为(546.00±78.19)CFU/m3，B2为(528.67±71.38)CFU/m3；A、B两组组内两间治疗室细菌菌落总数差异均无显著性（t分别为0.25、0.80，均P＞0.05），而A、B两组间细菌菌落总数差异有高度显著性（t＝14.93，P＜0.01）。结论针灸治疗室空气未经消毒时的细菌数符合卫生学标准，与针灸时药艾条熏烧有关，建议可免除空气紫外线、化学消毒剂消毒。

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肺炎球菌肺炎是一种常见病，近年由于抗菌药物的广泛应用，临床上以轻型或不典型者较常见，多数预后良好。科学地无偿献血不会导致该病的发生，就所查文献，也未见类似报道。但是，如果对献血前的咨询不严格，献血后的服务不重视，就有可能成为该病发生的一个间接诱因。本例病例虽属个案，但其发生的意义不容忽视。

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高迁移率族蛋白B1 (high mobility group box1 protein, HMGB1，NP_002119)是35年前发现的存在于真核细胞核内的非组蛋白染色体结合蛋白，因其在聚丙烯酰胺凝胶电泳(PAGE)中迁移速度快而得名。HMGB1是一个含有215个氨基酸残基的单链多肽，高度保守，N端富含带正电荷的赖氨酸，C末端富含带负电荷的天门冬氨酸和谷氨酸，又称酸性尾巴，分子量约为24 894 Da。从氨基端到羧基端的结构依次为9—79氨基酸残基的A box，95—163氨基酸残基的B box和186—215仅含谷氨酸和天门冬氨酸残基的受体结合模体。结构功能分析显示，HMGB1的B box是发挥炎症的功能区域，A box是B box的拮抗位点。A box和B box都能够与DNA结合，并参与DNA双链的折迭与扭曲。

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随着抗菌药物、免疫抑制剂及皮质类固醇激素的应用，器官移植、侵入性操作的广泛开展，临床上真菌感染逐年增多，尤其在免疫力低下和危重患者中，侵袭性真菌感染已成为主要并发症，其发病率和死亡率居高不下，严重威胁着患者的生命［1］。通常侵袭性真菌感染的早期诊断比较困难，一方面因为真菌感染早期无特异的临床表现；另外，目前临床常用的培养鉴定方法难以满足早期诊断的要求。因此，建立非培养的快速真菌感染诊断方法成为研究热点，这类方法主要包括血清学、免疫学和分子生物学等。本文就此方面的研究综述如下。

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不动杆菌属细菌（Acinetobacter spp.）是一种机会致病菌，世界范围内的医疗保健机构几乎都暴发过不动杆菌肺炎。1992—1997年，美国的呼吸机相关性肺炎（VAP）中有6%是由不动杆菌属细菌引起。美国国家医院感染监测资料显示，1986年其重症监护室（ICU）中医院感染性肺炎仅有4%为不动杆菌属细菌感染所致，而2003年则上升到了7%。某些高危人群也可发生社区获得性不动杆菌肺炎。此外，不动杆菌属临床分离株的耐药性也在不断增加。因此，目前对该菌感染的关注不断增加。