Abstract:

ObjectiveTo investigate whether gas chromatographic wholecell fatty acid analysis can be applied to analyze the homology of Pseudomonas aeruginosa. MethodsTwentysix multidrugresistant Pseudomonas aeruginosa（MDRPA） strains isolated from sputum samples of intensive care unit (ICU) patients were collected from January to December 2008. Pulsedfield gel electrophoresis (PFGE) and gas chromatographic wholecell fatty acid analysis were performed to analyze the homology. ResultsPFGE analysis revealed that 26 isolates had 6 clones; gas chromatographic wholecell fatty acid analysis showed that 26 strains had 4 clones, and consistent rate was only 26.92%（7/26）.ConclusionGas chromatographic wholecell fatty acid analysis is not identical with PFGE in analyzing homology of Pseudomonas aeruginosa.

Abstract:

ObjectiveTo investigate the differences in distribution and characteristics of the class 1 integron (IntⅠ) between multidrug resistant (MDR) and susceptible Pseudomonas aeruginosa (PA), and to evaluate whether IntⅠ was associated with the formation of MDR of PA.MethodsPositive rate of IntⅠ in 67 MDR and 62 susceptible isolates from clinical samples were detected by polymerase chain reaction(PCR), and integrated gene cassettes in IntⅠ positive strains were also identified by PCR.Results32(47.76%) isolates with MDR phenotype were IntⅠ positive but only 1(1.61%) isolate with susceptible phenotype was IntⅠpositive, the distribution of IntⅠin MDR isolates was significantly higher than susceptible ones(χ2=36.02,P<0.05). The gene cassettes in MDR group carried large fragments, but the susceptible isolates carried an empty one.ConclusionPositive rate of IntⅠ in MDRPA is high and may be related with MDR of PA.

Abstract:

ObjectiveTo assess the effect of healthcareassociated infection (HAI) on hospitalization expense in intensive care unit (ICU) patients.MethodsHospitalization expense of 1 597 ICU patients in a teaching hospital were analyzed, and multiple stepwise regression analysis was used to analyze the meaningful variables, multiple regression equation was established based on the main impact factors of hospitalization expense in ICU patients.ResultsThe average hospitalization expense were 111 116.47 yuan in patients with HAI and 40 383.06 yuan in patients without HAI （Z=-15.477，P=0.000）. According to the stratification of HAI sites,the calculated average hospitalization expense ranged from 56 052.87 to 218 709.77 yuan (χ2=245.872，P=0.000);according to the stratification of primary diseases, the calculated average hospitalization expense ranged from 31 978.79 to 51 125.10 yuan (χ2=63.871，P=0.000). Multiple regression model showed R2=0.538, after multiple stepwise regression analysis, hospitalization expense in patients with HAI increased by 49 812.76 yuan.ConclusionHAI can increase hospitalization expense in ICU patients. Effective measures can prevent and control the occurrence of HAI, and reduce hospitalization expense.

Abstract:

ObjectiveTo analyze the epidemiological trends of the secondary and latent syphilis among women of childbearing age （15-49 years old） in Guangdong Province of China from 2005 to 2010.MethodsData collected from China Information System for Diseases Control and Prevention were analyzed statistically.Results(1) Epidemiological trend: The incidence of latent syphilis among women of childbearing age  in Guangdong Province of China increased  from 17.37/100 000 (3 300 patients) in 2005 to 49.79/100 000 (10 100 patients)  in 2010, with an average annual increase rate of 24.55% (χ2=4.85, P=0.028);the epidemiological trend of secondary syphilis slightly declined with an average annual increase rate of -2.42% (χ2=3.31, P=0.069).  (2) Age distribution: A higher incidence was found among women aged 25-35 years old, which was up to 85.45/100 000 -98.75/100 000. (3) Proportions of reports by different medical institutions: General hospitals accounted for 60.86%, followed by maternal and children health hospitals (14.26%), institutes of skin disease prevention (10.32%), and primary care institutes including hygiene stations and community health service centers (1.66%). ConclusionSlightly decreased incidence of secondary syphilis and rapid increase in latent syphilis among women of childbearing ages called for greater efforts in screening syphilis and raised capacity of screening at primary care institutes. Such endeavors will contribute to the control of the increasing incidence of syphilis among those women and mothertochild transmission of syphilis.

Abstract:

ObjectiveTo analyze the data and related risk factors of occupational exposure to bloodborne pathogens in a hospital in 2010.MethodsAfter encountering occupational exposure to bloodborne pathogens, health care workers (HCWs)  filled out the designed forms, and submitted them to the department of healthcareassociated infection prevention and control.ResultsA total of  227 HCWs encountered  230  occupational exposure in 2010, 193 of whom  reported 196 sharp injuries, and 34 of whom reported 34 of blood/body fluid exposures; occupational exposure distributed in 48 departments, which top 5 as follows: operating room (34 times), orthopedics department (18), liver and blood vessel surgical department (18), nephrology department (11), and anesthesia department(10).Among occupation distribution, doctors and nurses accounted for 85.46%; 63.48% were longterm HCWs in this hospital, and 36.52%  were interns and HCWs for advanced study. 73.57% of persons worked less than 5 years.  Syringe and suture needles were the main devices for stabbing, using and disposal of the needles were the main procedures leading to stabbing; 70.59% of persons didn’t wear  personal protective equipment when they exposed to  blood/ body fluid, 26.53% of the occurrence persons didn’t wear gloves.ConclusionAnalysis of the occurrence of occupational exposure to bloodborne pathogens can help to identify the key departments, the target population and the risk factors, and to take appropriate intervention.

Abstract:

ObjectiveTo investigate the clinical characteristics and prognosis of methicillinresistant Staphylococcus aureus (MRSA) infection in the special group and the normal group of children.MethodsBacterial isolation and identification were performed by routine methods, antimicrobial susceptibility testing was performed by KirbyBauer method. Sick children were grouped according to the source of children and Healthcareassociated Infection Diagnostic Criteria authorized by the Ministry of Health.ResultsSixtysix children with MRSA infection were admitted to the hospital in 2010, 30 of whom were the abandoned sick babies cured in Shanghai Municipal Welfare Home for Children(SMWHC). Communityassociated infection(CAI) group were neonates and contact infected children; infectionrelated factors in SMWHC group included severe malnutrition, surgical site infection, previous hospitalization, longterm bedridden/local compression; healthcareassociated infection (HAI) group was associated with chemotherapy after operation of malignant tumor, longterm nasal feeding, recent operation, tracheal intubation/mechanical ventilation. Average length of hospitalization was 40 days. The prognosis were as follows: All patients in CAI group were improved and discharged; 2 patients in SMWHC group died, mortality was 6.67%; 3 patients in HAI group died, mortality was 50%.ConclusionCharacteristics of MRSA infection in different groups varied significantly, the isolation treatment for the special children in the singleroom ward can reduce the cross infection between the CAMRSA and HAMRSA, as well as to reduce HAI.

Abstract:

ObjectiveTo investigate independent risk factors and pathogens of tracheotomyassociated pulmonary infection(PI). MethodsClinical data of 132 patients with tracheotomy were analyzed retrospectively, and related risk factors were analyzed with unconditional multivariate Logistic regression analysis.Results A total of 84 cases of PI developed in 132 patients (63.64%). Unconditional multivariate Lgistic regression analysis showed that the related risk factors were age<14 years or>65 years, blood transfusion, late tracheotomy, smoking in the past 5 years, disturbance of consciousness, and use of antacids. A total of 178 pathogenic isolates were isolated, and the most common were gramnegative bacteria (141 isolates, 79.21%). Among 14 Staphylococcus aureus isolates, 12(85.71%) were methicillinresistant strains.ConclusionThe morbidity of tracheotomyassociated PI is high, and the main pathogens are gramnegative bacteria. Effective measures should be taken to control the related risk factors.

Abstract:

ObjectiveTo evaluate the clinical significance of procalcitonin (PCT) for the diagnosis and prognosis of infections in patients.MethodsPCT and blood culture data of patients in a hospital from September 2009 to December 2010 were analyzed retrospectively.ResultsAmong 570 detected samples, the positive rate of PCT and blood culture was 46.49% (265/570) and 30.18% (172/570) respectively; when PCT=0.50ng/mL was used as the cutoff value of diagnosis, the sensitivity and specificity of PCT was 90.53%（516/570）and 64.74%（369/570） respectively, the positive and negative predictive value of PCT was 44.53%（118/265）and 82.30%(251/305) respectively.ConclusionQuantitative PCT has important guiding significance for the early diagnosis and prognosis evaluation of infections in patients, it can provide evidence for clinical decisionmaking by continuously monitoring infections in patients.

Abstract:

ObjectiveTo evaluate the relationship between the pathogen distribution and  nationalities as well as   classification of chronic suppurative otitis media (CSOM) and cholesteatoma in Xinjiang region.MethodsMiddle ear secretion  were collected from  151  inpatients and outpatients   with otitis media, and all samples were  performed  microbial culture as well as antimicrobial susceptibility testing, the  isolation rates and types of microbials were gained and analyzed.ResultsAmong 164 ears, 58（35.37%） and 106（64.63%）were cholesteatoma and CSOM respectively; the major pathogens were Staphylococcus aureus（37.04%）, Proteus spp.（21.30%）, Pseudomonas aeruginosa（17.59%） and coagulasenegative staphylococci（14.81%）.The isolation rate of pathogens in different nationalities was varied, the top isolated pathogen from Weiwuer nationality was Staphylococcus aureus (40.79%), the next was Proteus spp.(25.00%); all kinds of pathogens were  isolated from Han nationality; the major pathogen isolated from Hasake nationality was Staphylococcus aureus (35.30%),but only 5.88% Proteus spp.  was isolated, no fungus was isolated  (0.00%).  The distribution  of Staphylococcus aureus, Proteus spp.， Pseudomonas aeruginosa and coagulasenegative staphylococci was not significantly different among different nationalities（P>0.05）；isolation rate of fungi from patients with cholesteatoma was significantly higher than that from patients with CSOM (18.96% vs 0.00%,χ2=20.812，P<0.01); isolation rate of other pathogens  from patients with cholesteatoma was significantly lower than that from patients with CSOM (15.52% vs 43.40%,χ2=13.072，P<0.01).ConclusionIsolation rates and species of pathogens, as well as types of otitis media in patients of different nationalities in Xinjiang is different from the other area of China  and other countries,fungal infection is commonly found in cholesteatoma.

Abstract:

ObjectiveTo investigate the occurrence of occupational exposure to bloodborne pathogens, and put forward preventive measures.Methods135 cases of occupational exposure to bloodborne pathogens among  healthcare workers (HCWs) in two hospitals from January 2008 to December 2010 were investigated and analyzed.ResultsThe top 3 exposure rates were observed among nurses (54.81%), doctors (25.19%) and housekeeping staff (16.30%); sharp injuries were the most common causes (91.11%), which occurred frequently during needlewithdrawing and suturing; among bloodborne pathogens, hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and Treponema pallidum accounted for 20.18%,  2.63%,  2.63% and 6.14% respectively. None of HCWs was infected after taking proper preventive measures following exposure.ConclusionStrengthening occupational safety education, carrying out standard prevention, standardizing manipulation, local treating for injured site correctly, and reporting the occurrence of injury timely following exposure can  reduce the risk of occupational infection with bloodborne pathogens.

Abstract:

ObjectiveTo investigate whether antimicrobial use before endoscopic retrograde cholangiopancreatography (ERCP) can decrease postERCP cholangitis rate.Methods138 patients with hilar cholangiocarcinoma were randomly grouped into experimental group (67 cases) and control group(71 cases). Patients in experimental group accepted intravenous injection of cefoperazone sodium 1.0 g 30 min before ERCP, control group were treated routinely and without using antimicrobial agents.ResultsThere was no significant difference in general clinical data between two groups(P>0.05). After receiving ERCP, cholangitis rate in experimental group and contro group was 34.33%（23/67） and 26.76%（19/71）respectively, there was no significant difference between two groups (χ2=0.360, P=0.152).ConclusionPreERCP antimicrobial use is not ideal for decreasing postERCP cholangitis rate.

Abstract:

ObjectiveTo study the effect of  monitoringtrainingplanning(MTP) intervention approach on perioperative prophylactic antimicrobial use in classⅠ incision surgery. MethodsIn accordance with the Clinical Antimicrobial Application Supervision  Scheme in China in 2011 and rational drug selection indicators of  World Health Organization ,  the case histories of patients receiving classⅠ incision operation in department of general surgery in the first  quarter of  2011 were selected  as the baseline, and MTP  intervention was then carried out，during the next three quarters, investigated  indicators were analyzed . In this way, three cycles of MTP intervention investigation were implemented.ResultsAfter three cycles of interventions, rate of perioperative prophylactic antimicrobial use , average drug exposure days , and rate of combination of antimicrobial agents  decreased  from 100.00%, (1.65±0.80) days and 15.00% to 26.32%, (0.26±0.46) days and 0.00% (All P<0.05) respectively; preoperative antimicrobial use rate (0.5-2 h before operation) and  rational drug selection rate both reached 100.00%. ConclusionMTP intervention mode is feasible and effective in promoting the rational use of antimicrobial agents for perioperative prophylaxis in classⅠ incision surgery.

Abstract:

ObjectiveTo compare the effect of manual and ultrasonic cleaning methods on small dental instruments, so as to provide reference for selecting the best cleaning method on dental instruments.MethodsContaminated small dental instruments were cleaned by manual (group A) and ultrasonic cleaning method (group B) respectively. The cleaning effect were determined by naked eye observation, adenosine triphosphate (ATP), and residual protein before and after cleaning.ResultsNaked eye observation: the cleaning qualified rate in group A and B was 100.00%(26/26) and 65.38%(17/26) respectively, there was significant different between two groups (χ2=20.61, P<0.001); ATP testing: relative light unit in group A and B was 156±50 and 1 089±663 respectively,there was significant difference between two groups(t=4.84, P<0.01);residual protein testing:the cleaning qualified rate in group A and B was 92.31%(24/26) and 96.15%(25/26) respectively, there was no significant difference between two groups(χ2=0.13, P>0.05).ConclusionBoth manual and ultrasonic cleaning methods can achieve ideal effect on cleaning of small dental instruments,but manual cleaning is superior to ultrasonic cleaning method.

Abstract:

ObjectiveTo investigate the characteristics of measles epidemic in Taizhou City in the first half  year of 2011.MethodsDescriptive epidemiological method was used to analyze measles prevalence.ResultsA total of 313 suspected measles cases were reported in the first half year of 2011, 106 (17.99/1 000 000) of which were confirmed cases,the confirmed cases increased by 39.47% compared with 76 cases of 2010, showing a high incidence level. Peak incidence occurred earlier than in 2010. The ratio of male to female patients was 1.79:1, age concentrated on children ≤1 year and adults ≥ 25 years; with unknown or without history of measles vaccination; 45.28% of measles cases were healthcareassociated infection.ConclusionThe incidence of measles in the first half year of 2011 was higher than that during the same period of 2010, it is necessary to strengthen routine immunization (Expanded Programme on Immunization) and supplementary immunization for small age children and adults over 25 years old.

Abstract:

ObjectiveTo investigate the distribution and antimicrobial resistance of pathogenic bacteria in a pediatric intensive care unit (PICU), and provide reference for preventing and controlling healthcareassociated infection and rational use of antimicrobial agents. MethodsIsolation rate and distribution of pathogenic bacteria isolated from PICU patients from June 2010 to May 2011were analyzed statistically. Results A total of 245 pathogenic bacterial strains were isolated, 73.88%, 22.86% and 3.26% were gramnegative bacteria, grampositive bacteria and fungi, respectively. The isolation rate of Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, Streptococcus pneumoniae and Staphylococcus aureus was 18.78%, 14.29%, 11.43%, 8.16%, 5.31% and 4.90%, respectively. The percentage of extendedspectrum βlactamaseproducing Klebsiella pneumoniae and Escherichia coli was 11.63% and 8.85%, respectively; detection rate of methicillinresistant Staphylococcus aureus was 16.67%. Most gramnegative bacteria were sensitive to carbapenems and cefoperazone / sulbactam, and relatively resistant to other antimicrobial agents. Acinetobacter baumannii was highly resistant to carbapenems(75.00%). Streptococcus pneumoniae and Staphylococcus aureus were highly sensitive to ceftriaxone, cefazolin and cefepime(0.00%-7.69%); no bacterial strain was found to be resistant to vancomycin. ConclusionGramnegative bacteria is the main pathogenic bacteria in PICU patients, most isolates are highly drugresistant. Analysis of pathogenic bacteria and drugresistance surveillance are of vital importance to guide treatments for critically ill children and reduce drugresistant bacterial strains.

Abstract:

ObjectiveTo investigate risk factors for general surgical site infection (SSI), so as to adopt preventive and control measures to reduce infection rate.MethodsSSI infection in patients with general surgical operation from January to December  2010 were monitored with  prospective investigation method.Results914 patients were monitored, 15 cases of SSI occurred, SSI rate was 1.64%; risk factors  for SSI were patients’ age, as well as types,duration, category and  modes of operation. There was significant difference in SSI rate between 2010 and 2009 (1.64% vs 3.45%［19/550］, χ2=4.98,P=0.03).ConclusionTargeted monitor and management of risk factors  can reduce SSI rate in general surgical operation.

Abstract:

目的探讨某院神经外科病房病原菌检出情况及其耐药性，为临床合理使用抗菌药物、预防和控制感染提供依据。方法对2009年6月—2011年6月某院神经外科病房送检的各类标本进行细菌培养、鉴定及药敏试验，对分离出的病原菌及其耐药情况进行统计分析。结果共分离病原菌762株，以革兰阴性（G-）杆菌（511株，67.06%）为主，其次是革兰阳性（G+）球菌（212株，27.82%）、真菌（33株，4.33%）及其他菌种（6株，0.79%）。主要病原菌依次是鲍曼不动杆菌（131株）、肺炎克雷伯菌（120株）、铜绿假单胞菌（112株）、金黄色葡萄球菌（66株）、阴沟肠杆菌（43株）、大肠埃希菌（32株）、表皮葡萄球菌（32株）等。肠杆菌科细菌仅对头孢哌酮/舒巴坦、美罗培南和亚胺培南等敏感，非发酵菌仅对头孢哌酮/舒巴坦敏感。金黄色葡萄球菌中，耐甲氧西林株（MRSA）检出率为69.70%。未检出耐万古霉素葡萄球菌和屎肠球菌。结论该院神经外科病房病原菌检出以G-杆菌为主，主要病原菌对抗菌药物耐药严重。应动态监测神经外科病房病原菌的流行和耐药情况，规范、合理使用抗菌药物，预防和减少耐药菌株的产生。

Abstract:

目的分析某儿童医院临床送检血标本分离的侵袭性肺炎链球菌耐药特点，指导临床合理用药。方法回顾性分析该院2007年4月—2011年6月临床分离的63株侵袭性肺炎链球菌的药敏资料。结果63株肺炎链球菌对青霉素的敏感率为22.22%，对红霉素和复方磺胺甲口恶唑的敏感率低，分别为8.93%和28.57%；对阿莫西林、头孢曲松和头孢噻肟的敏感率较高，分别为85.71%、80.96%、85.71%；未检出万古霉素或利奈唑胺不敏感菌株。结论侵袭性肺炎链球菌耐药率高，应做好对其的耐药性监测，以指导临床合理用药，积极有效地治疗侵袭性肺炎链球菌疾病。

Abstract:

目的了解某院2008—2010年医院感染现患率，为改进医院感染监测方法与修订医院感染控制措施提供依据。方法对2008—2010年医院感染现患率调查资料进行回顾性分析。结果2008—2010年医院感染现患率分别为4.79%（24/501）、4.99%（31/621）、2.81%（19/676）；3年医院感染部位均以下呼吸道为主，构成比分别为44.00%、69.70%、39.13%；分别检出病原体24、24、30株，其中革兰阳性(G+)菌分别为12株（50.00%）、10株（41.67%）、5株（16.67%），革兰阴性(G-)菌分别为11株（45.83%）、13株（54.16%）、24株（80.00%）,真菌分别为1株（4.17%）、1株（4.17%）、1株（3.33%）；抗菌药物使用率分别为50.10%、44.77%、39.20%，以治疗为目的的病原学送检率分别为 57.14%、69.36%、82.45%。结论医院感染现患率调查有助于了解医院感染发病情况及流行特点，以便针对性地开展目标性监测并采取防控措施降低医院感染发病率。

Abstract:

本地区从事畜牧业工作的人员少,布鲁杆菌不易查出，在患者感染后，因为用药与普通细菌感染的菌血症有区别，而未得到正规有效的治疗方案。总结该病例诊疗经验，以提醒本地区医务人员在布鲁杆菌感染的预防和治疗方面有所警惕，及时、有效地诊断治疗，控制病情和防止耐药菌株的产生。

Abstract:

鲍曼不动杆菌广泛分布于自然界和医院环境中,能在潮湿和干燥的表面生存,也可存在于健康人的皮肤和上呼吸道, 为条件致病菌。但近年来鲍曼不动杆菌已成为医院感染的重要病原菌，在非发酵菌中, 其临床标本分离率仅次于铜绿假单胞菌［1］。由于高度的多重耐药性或泛耐药性, 鲍曼不动杆菌对亚胺培南的耐药性日益升高，已经导致了世界范围内的暴发流行［2-4］。鲍曼不动杆菌的生物膜感染是其致病性的重要方式，因此阐明鲍曼不动杆菌的生物膜形成机制将为防治其所致的感染提供有效的方法。

Abstract:

医院感染是指住院患者在医院内获得的感染。  医院感染在全世界（无论是发达国家还是资源贫乏的国家）各个医院都有发生。世界卫生组织（WHO）对来自欧洲、东地中海、东南亚和太平洋地区14个国家的55所医院所进行的调查显示，住院患者中平均有8.7%发生医院感染；在每一个时刻，全球有140万人患有医院感染［1］。虽然医疗机构可以采取多项措施（包括手卫生、隔离防护措施等）保护病患和工作人员不发生医院感染，但有效地进行表面清洁消毒仍然是消除细菌、减少交叉污染和控制医院感染的关键步骤之一。应重视对整个医疗机构环境表面的清洁消毒， 特别是那些易被病原微生物污染的“常接触”表面。