Abstract:

     著名医学杂志《柳叶刀感染病分册》2010年第9期载文称［1］，在印度、巴基斯坦、英国出现一种新的抗生素耐药机制，即上述地域分离的部分大肠埃希菌和肺炎克雷伯菌能产生一种新的新德里金属β内酰胺酶（简称为NDM1），此酶能破坏目前所有的β内酰胺类抗生素，包括美罗培南和亚胺培南在内的碳青霉烯类抗生素。该细菌仅对个别新的或临床少用的抗生素（如替甲环素和多粘菌素）部分敏感。NDM1是NDM1基因的产物，NDM1基因存在于这些细菌携带的质粒中，并可通过质粒在细菌间传播。同时该文还报道，在印度Hayana地区分离的肺炎克雷伯菌呈克隆分布；其他产NDM1的细菌还有阴沟肠杆菌、变形杆菌属、弗劳地柠檬酸杆菌、产酸克雷伯菌、摩根摩根菌、普罗威登菌等，这些细菌主要引起尿路、血流、伤口、肺部和导管相关感染等，既有医院感染也有社区感染。多个国家和地区随后在该刊的第11期和12期分别报道分离到产NDM1细菌。

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  ObjectiveTo study the effect of γ interferoninducible protein 10 (IP10) on pulmonary pathological changes in mice infected with influenza virus (IV) or respiratory syncytial virus(RSV).MethodsPulmonary pathological changes in mice infected with IV or RSV after being administered IP10 were compared with mice infected with IV or RSV alone, normal control and only IP10 administration mice were set up.Results The mice infected with IV or RSV after receiving IP10 developed severe pulmonary inflammation, mice infected with IV or RSV alone also developed interstitial pneumonia, but less serious than the mice infected with IV or RSV receiving IP10, there were significant difference between the two respectively (t=-12.56;t=-5.60, both P<0.01). After being administered IP10, mice infected with IV was more serious than the mice infected with RSV, there was significant difference in pathological scores of interstitial pneumonia(t=7.73, P<0.01).ConclusionIP10 is an important chemokine which has great effect on the severity of pneumonia caused by IV or RSV.

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    ObjectiveTo evaluate the difference in the configuration and quantity of biofilms in dental unit water lines (DUWL) before and after disinfected with sodium hypochlorite solution. MethodsThe samples of biofilms from DUWL supplied with 10 separate water sources were collected and the microorganisms were quantified after incubated for 48h, and the configuration of biofilms were observed with confocal laser scanning microscope (CLSM) and scanning electronic microscope (SEM). The sodium hypochlorite at concentration of 525 mg/L was used for disinfection of DUWL. ResultsThe number of bacteria in biofilms at the baseline was 1.7×103CFU/cm2 before disinfection and 0 CFU/cm2 after disinfection with sodium hypochlorite solution, there was significant difference between the two (t=12.03,P=0.02) . CLSM and SEM showed that before disinfection, biofilm existed in the inner wall of DUWL,and bacilli and cocci distributed in the matrix; after disinfection, the configuration of biofilms, particularly fencelike structures were destroyed, but matrix was still existed. ConclusionDUWL has been contaminated heavily with a number of microbes, and the inner walls of DUWL is covered with biofilm, which is composed of millions of bacteria. The high concentration of microbes in DUWL is bringing the high risk of cross infection to both dental professionals and patients. Sodium hypochlorite at the concentration of 525 mg/L may be used as a disinfection solution for DUWL with separate water source.

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ObjectiveTo explore the influence of adefovir dipivoxil (ADV) therapy on the cellular immunity by observing the levels of interferonγ(IFNγ), interleukin4 (IL4) and their relationship with HBV DNA loads in patients with HBeAgpositive chronic hepatitis B at different time before and after treatment. MethodsSera of 30 patients before ADV therapy and 16 weeks ,52 weeks and 132 weeks after ADV therapy respectively were collected in this study. There were 14 complete response cases(group A),16 incomplete response cases(group B). Sera of 10 healthy people were chosen as control group(group C). Levels of IFNγ and IL4 were detected with enzymelinked immunosorbent assay; HBV DNA loads were detected by ROCHE COBAS AMPLICOR HBV MONITOR, lower limit was 103 copy/mL.ResultsThe average IFNγ level in group A was significantly higher than that of group B（P<0.05）and C（P<0.05）, there was no significant difference between group B and C(P>0.05);The level of IL4 of group A decreased after treatment while group B didn’t. HBV DNA loads of all groups had no significant correlation with IFNγ and IL4 levels before treatment, but dropped obviously at 16th week after treatment; and the increased level of IFNγ in group A was significantly higher than that of group B(P<0.05); IL4 levels in group A decreased gradually, but didn’t decreased obviously in group B.ConclusionCellular immune response of patients with hepatitis B was resumed to some extent after ADV treatment. The resumption level was positively related with the decreased level of HBV DNA load.

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ObjectiveTo observe the effects of a traditional Chinese medicine Jiayijian on the matrix metalloproteinase2 (MMP2) and transforming growth factorbeta1 (TGFβ1) expression in experimental hepatic fibrosis rats.MethodsSixty male Wister rats were randomly divided into normal control group and liver fibrosis model group. Dimethylnitrosamine(DMN) was administered to induce liver fibrosis in the model group, and rats in model group were randomly divided into model control group and Jiayijian treatment groups with high concentration (22g/［kg·d］)and low concentration (5.5g/［kg·d］) 4 weeks after liver fibrosis had been induced. All rats were killed after 4 weeks intragastric administration of Jiayijian. The expression of MMP2 and TGFβ1 of rat liver tissue were detected by immunohistochemical method.ResultsThe expression of TGFβ1 in high and low concentrations of Jiayijian treatment groups was significantly lower than that in the model control group (P<0.05), and the expression of TGFβ1 in the high concentration of Jiayijian treatment group was significantly lower than the low concentration of Jiayijian treatment group (P<0.05), but there was no significant difference in the expression of MMP2 between high and low concentrations of Jiayijian treatment groups and the model control group (P>0.05).ConclusionJiayijian can downregulate the expression of TGFβ1 of experimental hepatic fibrosis model rat’s liver tissue, which is the one of the mechanisms of antiliverfibrosis.

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ObjectiveTo realize the efficacy of practicing of preventive intervention measures of catheterassociated nosocomial infection（NI）in intensive care units (ICUs).MethodsTargeted surveillance was adopted to monitor the occurrence of NI in patients admitted in ICUs between January 2006- December 2007 and January 2008- December 2009 , corresponding intervention measures on NI were undertaken, NI rates were adjusted with average severity of illness score (ASIS) method . ResultsAfter adjusted with ASIS method ,the daily NI rate decreased from 5.77 ‰ between 2006-2007 to 3.63 ‰ between 2008-2009 ; catheterassociated infection rates decreased with different degree, ventilatorassociated pneumonia in surgical ICU decreased mostly， from 10.53 ‰ between 2006-2007 to 4.79‰ between 2008-2009.ConclusionCarrying out preventive intervention measures in ICUs can decrease NI rates obviously．

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ObjectiveTo investigate the clinical diagnostic value of sandwich cup collecting bacteria and smear method (sandwich cup method) in the detection of acidfast bacilli.MethodsFrom July to December 2008 ， 1 782 sputum samples (including 642 morning sputum and 1 140 random sputum) were collected from people who were suspected to have pulmonary tuberculosis at tuberculosis prevention and treatment departments in 4 counties （cities） of Hunan Province. Each sample was dealt with sandwich cup method and improved Lowenstein Jensen(LJ) culture, respectively, the results were analyzed.ResultsThe positive rate of LJ culture and sandwich cup method was 26.64%(171/642) and 23.52% (151/642) in morning sputum, respectively, there was significant difference between the two(χ2=4.56,P=0.04); The positive rate of LJ culture and sandwich cup method was 23.33%(266/1 140) and 18.07% (206/1 140) in random sputum respectively , there was significant difference between the two(χ2=34.60,P=0.00). The positive rate of sandwich cup method in morning sputum was significantly higher than that in random sputum(χ2=7.62, P=0.01), while the positive rate of LJ culture in morning and random sputum showed no statistical difference (χ2=2.42, P=0.12).ConclusionThe positive rate of sandwich cup method is lower than LJ culture in detecting acidfast bacilli, but the former is simple, timesaving and easy to carry out quality control, and is worth popularizing in clinic. The positive rate of sandwich cup method in morning sputum is high, so morning sputum should be kept to detect acidfast bacilli clinically.

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ObjectiveTo evaluate targeted surveillance in reducing ventilatorassociated pneumonia (VAP) in patients in surgical intensive care unit(SICU).MethodsMonitor on SICU patients with respirators were conducted by infection control practitioners and SICU personnel responsible for SICU infection control . Based on the detected results, control measures were modified and strictly carried out , detection process was emphasized.ResultsSince the targeted surveillance has been carried out for more than one year, the incidence of VAP reduced from 31.93‰ on AprilDecember 2008 to 21.48‰ on JanuaryDecember 2009, there was significant difference between the two(χ2=17.81,P=0.00).ConclusionTargeted surveillance can reduce the occurrence of VAP.

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To evaluate the clinical significance of serum procalcitonin (PCT) in acute infectious diseases. MethodsNinetyeight emergency patients with fever were studied prospectively, then blood samples were taken to test PCT, Creactive protein (CRP) and blood routine. Etiology or serum immunological tests were performed for diagnosis, the value of all test results for diagnosis of bacterial infection were compared. ResultsWhite blood cell, neutrophil ratio, PCT, and CRP in bacterial infection group were all higher than those of nonbacterial infection group (P<0.01). The sensitivity and specificity of PCT was 91.30% and 82.76% respectively, and it had a higher diagnostic value than the other indicators in fever patients with bacterial infection.ConclusionPCT tests are helpful to identify bacterial infection in patients with fever, it has good sensitivity and specificity.

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To decrease the incidence of nosocomial respiratory infectious diseases in the nonisolation wards during H1N1 epidemic period by setting up comprehensive disinfection and prevention measures.MethodsDigestive department 2 was as group A which enforced comprehensive disinfection and prevention measures:scientific education ; new relatives' visiting and assisting system; intensifying standardized ward ventilation and disinfection. Digestive department 1 was as group B (control group), the measures were: reducing visiting, disinfecting the wards with ozone once a week .The knowledge about prevention and control of H1N1 among inpatients , assisting persons , visitors and healthcare workers before and after conducting education , as well as the bacterial count and the occurrence of nosocomial infection (NI) were compared.ResultsAfter conducting scientific education, the knowledge about prevention and control of H1N1 improved obviously , the average score increased from 43.85 before education to 94.55 after education (P<0.0001); the number of visitors decreased from 12 532 before education to 4 385 after education , the number of bacteria in group A were (21.63±12.94)CFU/m3 , which was significantly lower than (903.46±241.73)CFU/m3 of group B (P<0.0001); NI rate and upper respiratory tract infection rate was 0.48% and 0.00% respectively , which were obviously lower than 3.36% and 1.92% before education respectively (both P<0.05). No H1N1 case occurred.ConclusionDuring H1N1 outbreak and epidemic period , the enforcement of strict and comprehensive disinfection and prevention measures and education can enhance the knowledge of patients, patients’ relatives and healthcare workers, which is important for the reducing of NI and upper respiratory tract infection.

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ObjectiveTo evaluate the bacteria load and disinfectant efficacy after the opening of rapid hand disinfectant , so as to provide reference for the effective use of rapid hand disinfectant in clinic. MethodsThree bottles of rapid hand disinfectant in the same department and at the same time were opened for using, 15 samples of these disinfectant were randomly taken at the 1st,10th,20th, 30th, and 40th day of opening for bacterial culture, and hand samples disinfected with disinfectant were also taken for bacterial culture. Results At the 1st day of the opening , the highest bacterial count in disinfectant and disinfected hands were 11 CFU/mL and 6 CFU/cm2 respectively, but with the prolonged duration of opening of disinfectant , bacterial count in disinfectant and hands increased obviously, which were up to 93.1 CFU/mL and 9.45 CFU/ cm2 respectively.ConclusionRapid hand disinfectant should be used within 30 days after opening; for the department without enough staffs, smallpackaged rapid hand disinfectant is suggested to avoid waste and contamination.

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ObjectiveTo explore the method to improve hygienic hand disinfection compliance among healthcare workers.MethodsA series of measures were drawn up by applying total quality management (TQM) theory and method to improve hygienic hand disinfection compliance among healthcare workers, investigated data of June,2008 was as basic information, 2009-2010 was intervention enforcement stage, and data was summarized in 2010 .ResultsThree investigations between June,2008 to June,2010 were carried out, the hygienic hand disinfection compliance rate rose from 35.23% (315/894) in 2008 to 53.11%(563/1 060) in 2010, there was significant difference between the two (χ2＝62.65，P＜0.01).ConclusionTQM can enhance effectively the compliance to hygienic hand disinfection among healthcare workers.

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ObjectiveTo investigate the distribution and drug resistance of pathogens isolated from blood in recent 4 years in a hospital, so as to provide a basis for rational use of antimicrobial agents in clinic.MethodsBlood specimens collected from outpatients and inpatients during 2006-2009 were cultured, and drug sensitivity tests were conducted. The distribution and drug resistance of pathogens were studied and analyzed.ResultsAmong all blood samples in the past four years, 633 strains of pathogens were isolated, the positive isolation rate was 10.32%(633/6 135), 240 strains (37.92%) of which were gramnegative bacteria; 354 (55.92%) were grampositive bacteria; 39 (6.16%) were Candida. Staphylococcus aureus, Escherichia coli and Staphylococcus epidermidis were three dominant pathogens, which accounting for 18.17%,17.22%, and 15.64% respectively. Gramnegative bacteria had the most sensitive rate to imipenem, the resistant rate was only 1.67%. Compared with 2006, the resistant rates of gramnegative bacteria to ampicillin, piperacillin/tazobactam, cefoperazone/sulbactam,and aztreonam increased significantly in 2009 (P<0.05)；Among grampositive bacteria, there were only two vancomycinresistant Enterococci strains, the resistant rates of grampositive bacteria to penicillin,cefotaxime,levofloxacin,clindamycin, and azithromycin increased continuously; Compared with 2006, the resistant rates of grampositive bacteria to these antimicrobial agents in 2009 increased significantly(P<0.05).ConclusionStaphylococcus aureus and Escherichia coli are the most common pathogens in grampositive bacteria and gramnegative bacteria, respectively, drug resistance of isolated pathogens increases year by year; Monitoring on pathogens and trends of drug resistance is important for rational use of antimicrobial agents.

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ObjectiveTo investigate the distribution and drugresistance of Burkholderia cepacia isolated from an intensive care unit (ICU) in a hospital.MethodsBurkholderia cepacia isolated from ICU in a hospital between January 2008 and December 2009 were analysed retrospectively .Results166 strains of Burkholderia cepacia were isolated,which accounting for 23.82% (166/697) of the total isolated strain, 153 of which were isolated from sputum and throat swabs, 9 from urine, 2 from fluid in blood catheter,2 from drainage fluid. Antimicrobial susceptibility test showed that Burkholderia cepacia had high resistance to antimicrobial agents including cefazolin, imipenem, ampicillin/sulbactam,gentamicin,tobramycin, and amikacin, which were up to 98.19%-100.00%; and Burkholderia cepacia had low resistant rate (11.45%) to the thirdgeneration cephalosporins (ceftazidime).The lowest resistant rate (10.84%) was to piperacillin/tazobactam. ConclusionThe isolation of Burkholderia cepacia is high in ICU in this hospital , and resistance to commonly used antimicrobial agents is high , clinicians should perform pathogenic detection, and use antimicrobial agents rationally.

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ObjectiveTo analyze the distribution and drug resistance of pathogens in type 2 diabetes mellitus patients combined with urinary system infection, so as to provide reference for rational use of antimicrobial agents. MethodsPathogens were isolated by routine method, and identified with VITEK32 system , drug susceptibility test was carried out by KirbyBauer method, and yeastlike fungi were identified by chromagar.ResultsA total of 256 pathogens were isolated, 150 (58.59%) of which were gramnegative bacilli, 71 (27.74%) were grampositive cocci, 35 (13.67%) were yeastlike fungi. 42.86% of Escherichia coli and 37.78% of Klebsiella pneumoniae were extendedspectrum βlactamaseproducing strains, but sensitive to imipenem, meropenem, piperacillintazobactam, amikacin, cefoxitin and cefepime were still high, the resistant rate was between 0.00%-29.41%. The isolated coagulase negative Staphylococcus, Staphylococcus aureus and Enterococcus were sensitive to vancomycin, linezolid, and chloramphenicol, the resistant rate was between 0.00%-20.00%.ConclusionThe main pathogens in type 2 diabetes mellitus patients combined with urinary system infection is gramnegative bacilli , infection with fungi has a rising tendency. Pathogenic detection and drug susceptibility test should be paid attention.

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目的预防和控制儿科病房鼠伤寒沙门菌感染聚集性发生。方法对一起小儿鼠伤寒沙门菌感染聚集性发生事件进行调查分析。结果5例腹泻患儿粪便均培养出鼠伤寒沙门菌，其中3例为社区感染，2例为医院感染。医院感染系通过共用卫生间水池及生活接触传播，经及时、有效的控制措施，无续发病例。5例患儿全部治愈。结论此次鼠伤寒沙门菌感染聚集性发生，主要为使用后尿布处理不彻底、病房消毒隔离制度执行不够及手卫生落实不到位所致。对免疫功能低下的患儿应加强监测，做到早发现、早隔离、早治疗。

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目的了解某院神经外科重症监护室(NICU)医院感染病原菌分布特点。方法回顾性分析该院NICU 2008年1—12月分离的病原菌感染部位及种类。结果72例医院感染患者送检的267份标本中共分离病原菌169株，感染部位以呼吸道（79.88%）为主，其他依次为泌尿道（8.29%）、脑脊液（4.73%）、深静脉置管（2.96%）、血流（2.96%）、皮肤切口（1.18%）。革兰阴性（G-）杆菌占55.62%，革兰阳性（G+）球菌占36.10%，真菌占8.28%。G-杆菌以铜绿假单胞菌为主，占总菌株数的18.34%； G+球菌以金黄色葡萄球菌为主，占总菌株数的11.84%；真菌以白假丝酵母菌为主，占总菌株数的4.73%。结论NICU住院患者感染的病原菌主要来源于呼吸道，以G-杆菌为主；应制订相应的对策，加强NICU患者医院感染的风险评估和风险控制。

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目的探讨血液透析（血透）患者肺部感染的危险因素及预防措施。方法回顾性分析70例维持性血透患者的病历资料，对肺部感染组及非感染组患者年龄、血红蛋白、血清清蛋白、尿素下降率及血透频率进行统计分析。结果肺部感染组与非感染组患者年龄无明显差异（P＞0.05）；血红蛋白、血清清蛋白、尿素下降率,肺部感染组均显著低于非感染组（均P＜0.01）；患者原发病、血透频率与肺部感染有关，透析频率低者肺部感染率低于透析频率高者（P<0.05）。结论积极改善贫血及营养状况，充分透析，控制原发病，加强血透室环境管理，是减少血透患者肺部感染的有效方法。

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目的应用简便、省时、有效的手卫生方法，提高门诊医务人员手卫生执行度。方法随机抽取162名门诊医务人员分为2组，一组采用六步洗手法于流动水下洗手，另一组采用卫生手消毒法（速干手消毒凝胶）免水揉搓双手，比较2组手卫生前后手采样细菌数、合格率和手卫生消耗的总时间。结果六步洗手法组与卫生手消毒法组医务人员执行手卫生后，手的菌落总数分别为（2.40±1.28）CFU/cm2、（2.37±1.31）CFU /cm2,均达到手卫生目的（P>0.05），合格率分别为97.50%、93.90%，差异无显著性（P>0.05）；采用卫生手消毒法每进行手卫生100次较六步洗手法洗手可平均节省时间（3.60±0.30）h。结论卫生手消毒法可节省手卫生时间，效果好，提高了工作效率，在手部无明显污染时可替代六步洗手法广泛应用于门诊医务人员操作后的手卫生。

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目的了解鼻咽癌患者在住院放射治疗（放疗）期间真菌感染现状，并探讨其相关因素及干预措施。方法对106例鼻咽癌放疗期间发生真菌感染患者的病历资料进行回顾性分析。结果106例病例发生真菌感染117例次，其中白假丝酵母菌感染84例次（71.80%），热带假丝酵母菌感染7例次（5.98%），未分类酵母菌感染26例次（22.22%）；感染部位以口腔黏膜居多，共78例次（66.67%），其次为肺部感染32例次（27.35%），泌尿道感染5例次（4.27%），胃肠道感染2例次（1.71%）。真菌感染的发生与患者免疫力低下、鼻咽癌的病因、损伤性放疗、不规范的操作等因素有关。结论控制感染的危险因素，合理选择放疗视野和剂量，加强营养，提高患者自身免疫力，进行有效和针对性的健康教育，是预防鼻咽癌放疗期间医院真菌感染的主要措施。

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目的调查某医院医院感染现患率，了解医院感染发生的特点及管理存在的问题，改进预防控制措施。方法采用床旁调查和病历调查相结合的方法，对2009年9月4日的住院患者进行医院感染现患率调查。结果共调查住院患者1 536例，医院感染现患率为5.27%，例次现患率为5.60％；现患率较高的科室为：综合重症监护室（ICU）40.00%，神经外科（包括其ICU）19.67%，肾内科15.38%，血液病科11.90%，新生儿监护室10.81%；主要感染部位依次为：下呼吸道41.86%，上呼吸道23.26%，泌尿道8.14%，血液系统5.81%；分离病原菌43株,以革兰阴性菌为主，占69.77%；气管切开和呼吸机使用相关感染率分别高达20.69%和7.41%；调查日抗菌药物使用率为56.52%，治疗用药病原学送检率41.60%。结论该院医院感染现患率较高的科室为综合ICU和神经外科，需重点监控；感染部位以呼吸道为主；病原菌以革兰阴性菌为主；抗菌药物使用率较高，病原学送检率较低，需加强合理使用抗菌药物的管理。

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目的预防控制传染病医院感染，保证医务人员职业安全及患者医疗安全，指导二、三级综合医院做好感染性疾病科门诊建设。方法采用现场查看、询问核实和查阅相关材料的方法进行调查并填写调查表。结果42所二、三级综合医院的感染性疾病科门诊中，规章制度及工作流程合格率最高，为61.90%；布局设置合格率最低，为30.95%；医疗设备及消毒设施的配置、防护用品标准、医护人员配备合格率分别为42.86%、57.14%、47.62%。二级综合医院感染性疾病科门诊各项调查内容合格率除布局设置外，均明显低于三级综合医院（P≤0.01）。结论 二、三级综合医院感染性疾病科门诊的建设是传染病防控工作中的重要任务，应加大经费投入，完善各项规章制度，合理配备医疗设备、消毒设施与防护用品，同时对医务人员进行相关培训，加强管理和技术指导，保证工作质量。

Abstract:

传染病是当今世界范围内引起人类死亡的重要原因，人类正面临着与传染病斗争的新形势。新传染病的出现、老传染病的复燃、病原体对抗菌药物耐药性的增加，构成了对人类健康的巨大威胁，使临床工作和高等医学教学面临新的挑战，已引起国际医学界的极大关注。2003年发生在我国及东南亚各国的严重急性呼吸综合征（SARS）暴发流行，近年来引起全球恐慌的禽流感疫情及2009年全球暴发的甲型H1N1新型流感流行再次警示人们应高度重视“新”传染病的出现和“老”传染病的死灰复燃。

Abstract:

铜绿假单胞菌（Pseudomonas aeruginosa，PA）是常见的医院感染致病菌，其严重的耐药性与产生细菌生物膜（bacterial biofilm，BF）密切相关。藻酸盐是PA生物膜的主要组成成分。研究发现，抗菌药物等可对BF及其主要成分藻酸盐产生抑制作用。本文综述了近年来PA生物膜及其抑制药物的研究进展。

Abstract:

重患者静脉给药的有效途径，在疾病治疗中起着非常重要的作用。按照美国疾病预防控制中心（CDC） 1996年和2002年《预防血管内导管相关血流感染指南》对导管的分型，中心静脉导管包括非隧道式导管、隧道式导管、皮下埋置式输液管、经外周穿刺中心静脉导管、血液透析导管等。血管内导管已成为一种临床应用非常广泛的医疗用品，同时也引起了并非少见的各种机械性、血栓性或感染性的并发症。在这些并发症中，血流感染是最致命的。在危重症患者中，若并发血流感染，则归因死亡率可能高达35％［1］。
美国CDC认可洗必泰是中心静脉导管穿刺时的首选皮肤消毒剂［2］。同时国内近年来对洗必泰的临床使用也给予了高度关注，但对其作用特点、安全性能和临床应用的研究介绍较少，本文就此对洗必泰消毒剂作如下综述。