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ObjectiveTo detect the expression of CD81 and low density lipoprotein receptor (LDLR) mRNA in cultured human trophoblast cells from different placental villi, and to explore HCV entry mechanisms.MethodsCD81 and LDLR mRNA expression in trophoblast cells from human placental villi was detected by RTPCR, and expression of CD81 and LDLR was also detected during different pregnancy stages by immunofluorescene method.ResultsCD 81 and LDLR were found in different placental villi and their expression has shown an increasing trend during different stages of gestation by immunofluorescene. ConclusionThe localization and expressions of HCV entryrelated receptor CD 81 and LDLR are found in cultured human trophoblast cells, which lay the foundation for further exploring the molecular mechanism of HCV infection transmission by CLEC4M.

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ObjectiveTo investigate the status of tuberculosis (TB)infection control in healthcare facilities.MethodsAccording to Monitoring and evaluation form of tuberculosis infection control in healthcare facilities, 22 healthcare facilities in Beijing, Shanghai and Inner Mongolia were surveyed, and data about TB infection control were collected and analyzed.ResultsOf 22 surveyed healthcare facilities, 20 developed TB infection control system, but only 7 regularly carried out monitoring and evaluation of TB infection control; most facilities isolated patients with infectious diseases from patients with other diseases, but only 5 isolated cough patients from other patients;18 facilities regularly maintained ultraviolet lamps, however, the layout of waiting areas and outpatient department were not very well; 14 facilities provided medical protective masks for health care workers, but only 5 carried out fitness tests of medical protective masks and relevant trainings.ConclusionSome achievements about TB infection control in healthcare facilities have been obtained, TB infection control monitor and evaluation screen still need to be strengthened, triage, isolation, layout and personal protection in healthcare facilities should be reinforced to reduce the risk of TB.

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ObjectiveTo investigate the risk factors of transmission of suspected acute hemorrhagic conjunctivitis(AHC) in the S hospital of Shenzhen city, and provide a scientific basis for timely control of the epidemic.MethodsCases were searched according to the definition of AHC, and distribution of space,time and population were described; hypothesis were put forward based on field epidemiological investigation; casecontrol study was adopted to compare the difference in the possible risk factors between case and control groups.ResultsFrom June 7 to June 15, 2011, 11 AHC cases were found in W inpatient department of the S hospital. The attack rate was 6.01%(11/183)， and the major clinical manifestations were conjunctival congestion(100.00%), tingling(81.82%), and foreign body sensation(72.73%). The median of disease course was 6 days (3-11days). No complication was found.The attack rate of patients living in corridor beds was significantly higher than that of patients living inside the ward room (13.24% ［9 / 68］ vs 2.70% ［2 / 74］, χ2=5.50，P=0.02). Using a public toilet (OR=12.21,95% CI:1.28-288.33), using a public lavatory (OR=12.21,95% CI:1.28-288.33) and rubbing eyes (OR=6.22, 95% CI:1.08-39.96) were risk factors; analysis on habit of rubbing the eyes “often or sometimes”, “occasionally”, “never” showed that the risk of developing AHC increased with increasing frequency of rubbing eyes（Liner trend χ2=5.54，P=0.02）.ConclusionClinical manifestations and epidemiological data suggest that this is an outbreak of AHC. S hospital is suggested to strengthen disinfection of the public toilets, faucets and other public places, and patients are suggested not to rub eyes directly by hand; government are suggested to increase investment in the beds construction of medical and health institutions.

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ObjectiveTo observe in vitro inhibitory activity of the metabolites of Pseudomonas aeruginosa (P. aeruginosa) against Candida spp. . MethodsIn vitro inhibitory activity of P. aeruginosa against 54 Candida spp. isolates was detected by crossstreak assay. Results The metabolites of P. aeruginosa had the strongest inhibitory activity on Candida albicans (C. albicans) and Candida glabratas (C. glabratas), and produced the widest zone of inhibition. The inhibition rate of aquamarine pigmentproducing No.6 P. aeruginosas against C. albicans and Candida tropicalis (C. tropicalis) were both 100%, and the inhibition rate of yellow green pigmentproducing No. 8 P. aeruginosas against C. albican,C.tropicalis and Candida krusei (C. krusei) were all 100%,too. The pigmented strains were found to have stronger antifungal activity than the unpigmented strains. ConclusionThe metabolites of P. aeruginosa has strong antifungal activity against C. albicans and C. glabrata.

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ObjectiveTo investigate the control efficacy of hospitalacquired multidrugresistant organism infections (MDROHAIs) through carrying out bundle measures in a surgical intensive care unit(SICU).MethodsSICU patients with positive cultures of methicillinresistant Staphylococcus aureus(MRSA), vancomycinresistant Enterococcus(VRE), extendedspectrum βlactamase positive Escherichia coli (ESBLE. coli), ESBL positive Klebsiella pneumoniae (ESBLKp), and multidrugresistant Acinetobacter baumannii(MDRAb) between January 1, 2007 and December 31, 2010 were selected for investigation. From July 1, 2008 to December 31, 2010,patients were investigated prospectively and bundle measures (such as hand hygiene, single room isolation, gloves, and isolation gowns) for patients with MDRO infection or colonization were carried out. From January 1, 2007 to June 30, 2008, medical records of patients (without performing bundle measures) with above 5 pathogens were surveyed retrospectively, and efficacy of bundle measures was analyzed.ResultsFrom January 1, 2007 to December 31, 2010, a total of 3 526 patients were admitted to this SICU, there were 11 207 bed days, and there were totally 104 episodes of MDRO infections including 65(62.50%) cases of ICUassociated infections (ICUAI) and 39(37.50%) nonICUassociated infections. ICUAI,especially MRSA and MDRAb infection, decreased significantly（18.75%）along with the carrying out of bundle measures.ConclusionMDRO infections in SICU are serious, which can be controlled effectively through bundle measures.

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ObjectiveTo investigate the Klebsiella pneumoniae carbapenemase (KPC) production in clinical isolates of Enterobacteriaceae in a hospital.Methods1 801 clinical Enterobacteriaceae isolates were collected from this hospital from 2009 to 2010. Highly drugresistant strains were screened by antimicrobial susceptibility testing, KPCtype carbapenemase was detected with the modified Hodge testing and polymerase chain reaction (PCR), and DNA sequencing was performed to confirm carbapenemase genotypes.ResultsOf 1 801 Enterobacteriaceae isolates, 783(43.48%) were resistant to the third cephalosporins, 4 of which were also resistant to carbapenem; 2 isolates were screened as drugresistant strains by Hodge testing, and blaKPC2 gene was identified in this 2 isolates by PCR.ConclusionKPC2 Enterobacteriaceae strains with carbapenemaseproducing drugresistant gene have emerged in this hospital, monitor and control should be strengthened.

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ObjectiveTo investigate the DNA homology of MRSA isolated from patients in a surgical intensive care unit (SICU) and SICU environment, so as to provide reference for the control of MRSA spread in hospital.MethodsMRSA were isolated from SICU patients and environment from August to October 2010． RepPCR based DiversiLab microbial typing system was applied to analyze the homology of MRSA．ResultsOf 124 samples, 12 MRSA were isolated, with 9 of 10 MRSA isolates from patients and 3 MRSA isolates from environment. They were highly homologous.ConclusionMRSA isolated from SICU patients are highly homologous to those from SICU environment. MRSA transmission in this SICU is serious.

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ObjectiveTo study the value of procalcitonin (PCT) and highsensitivity Creactive protein (HsCRP) detection in the diagnosis of fever of unknown origin （FUO） in children.MethodsElectrochemiluminescence and immunoturbidimetry method were adopted to detect serum PCT and HsCRP levels, and the values were evaluated according to the final diagnosis.ResultsOf 244 children with FUO, infectious diseases (152 cases, 62.30%),connective tissue diseases (34 cases, 13.93%) and the tumor diseases (20 cases, 8.20%) were the main causes of FUO. Serum PCT, HsCRP levels in children with infectious diseases were (31.65±7.26)μg/L and (17.52±6.43)mg/L respectively, which was significantly higher than those of the normal control group(［0.31±0.28］μg/L and ［1.87±0.31］mg/L respectively, both P<0.01); serum PCT and HsCRP level in children with noninfectious diseases was (0.52±0.51)μg/L and (1.96±0.45)mg/L respectively, there were no significant difference compared with the normal control group(both P<0.05). Of all infectious diseases, serum PCT and HsCRP levels were the highest in patients with bacterial infection(［43.24±8.34］μg/L,［26.74±7.05］mg/L, respectively), the next was in patients with Mycoplasma/Chlamydia infection(［6.72±1.65］μg/L, ［15.05±2.79］mg/L, respectively), virus infection didn’t change obviously(［0.34±0.26］μg/L, ［1.89±0.66］mg/L, respectively)；positive diagnosis rate of simultaneous detection of PCT and HsCRP (92.63%) was significantly higher than that of PCT (84.21%) or HsCRP(68.42%) alone (both P<0.01).ConclusionCombination detection of serum PCT and HsCRP can improve the early diagnosis of FUO, distinguish infectious fever from noninfectious fever, bacterial from viral infection，which is beneficial to timely diagnosis and treatment of FUO in children.

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ObjectiveTo evaluate the risk factors and effective prevention and control measures on healthcareassociated infection (HAI) in neonates in a neonatal intensive care unit (NICU) through the targeted monitor.MethodsAll neonates who admitted to NICU from January to September 2010 were monitored prospectively according to the Standard for healthcareassociated infection surveillance, control measures were taken, and risk factors were analyzed.ResultsA total of 638 neonates were surveyed, 67 neonates (10.50%) developed 69 times (10.82%) infection, infection rate per day was 8.29‰. Lower respiratory tract infection accounted for 63.77%, 56.82% of which was ventilatorassociated pneumonia; bloodstream infection accounted for 21.74%. Gramnegative bacteria, grampositive bacteria and fungi accounted for 65.08%(41 isolates), 33.33%(21), and 1.59%(1) respectively; Enterobacteriaceae accounted for 63.49% (40/63), multidrugresistant organisms accounted for 66.67%(42/63). Risk factors were birth weight ≤1 500g, endotracheal intubation mechanical ventilation and continuous time ≥ 3d, prophylactic use of antimicrobial drugs and duration time ≥ 5d; no use of antimicrobial agents was beneficial factor.ConclusionTargeted monitoring on HAI can get detailed information on HAI status and related risk factors of patients, and is helpful to reduce HAI rate through proper measures according to related risk factors.

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ObjectiveTo evaluate the status and influencing factors of surgical site infection(SSI) in colorectal cancer patients.MethodsA retrospective investigation was conducted to analyze the medical records of 420 colorectal cancer patients who were hospitalized between January 2007 and December 2011.ResultsSSI rate in 420 patients was 20.24 % (85/420); 75.29%(64/85) were superficial incisional infections, 22.35%(19/85) were deep incisional infections, 2.35%(2/85) were organ space infections. A total of 98 pathogenic strains were isolated, 56.13% (55 isolates) were Escherichia coli. The incidence of SSI increased significantly in patients with overweight or obesity (BMI≥23), diabetes mellitus, operative duration more than 3.5 h and high Dukes stage (all P<0.05).ConclusionSSI rate in colorectal cancer patients is high. Overweight or obesity, diabetes mellitus, long operative duration and the high Dukes stage are important factors for SSI in colorectal cancer patients．

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ObjectiveTo investigate healthcareassociated infection(HAI) and related risk factors in premature infants.MethodsMedical records of 476 premature infants who were hospitalized in a neonatal intensive care unit(NICU) from January 2009 to December 2010 were surveyed retrospectively.ResultsOf 476 premature infants,73 developed 79 episodes of HAI(15.34%),case infection rate was 16.60%; Respiratory tract was the major infection site(65.82%), followed by skin soft tissue (12.66%) and gastrointestinal tract (7.60%); 53.95% of pathogens were gramnegative bacteria, the major pathogens were Klebsiella pneumonia, Escherichia coli and Pseudomonas aeruginosa;38.16% of pathogens were grampositive bacteria,the main pathogens were Staphylococcus epidermidis,Streptococcus pneumonia and Staphylococcus aureus;7.89% of all pathogens were fungi,the main fungi was Candida albicans. HAI rate was high in premature infants with low birth weight, invasive operation, long length of stay in ICU, long time use of antimicrobial agents, and use of glucocorticoid(P<0.01).ConclusionHAI rate is high in premature infants, the major infection site is respiratory tract, the major pathogen is gramnegative bacteria, the related risk factors for HAI are low birth weight, invasive operation, long hospitalization time, long time use of antimicrobial agents and use of glucocorticoid.

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ObjectiveTo investigate the current status of multidrugresistant organism (MDRO) infection in a hospital, and evaluate intervention strategies in prevention and control of MDRO infection.MethodsMonitor on MDRD infection was conducted, infectionrelated factors were analyzed, administration strategies were put forward, and intervention was implemented.ResultsFrom July 2010 to November 2011, 17 240 patients were admitted in this hospital, 213(1.23%) cases of MDRO infection developed, the major infection sites were respiratory tract (108 cases, 50.70%) and urinary tract (53 cases, 24.88%). MDRO infection rate dropped from 1.49% (93/6 256) before intervention (JulyDecember, 2010) to 1.09%(120/10 984) after intervention (JanuaryNovember, 2011) (χ2=5.07, P=0.02), and constituent ratio of multidrugresistant Pseudomonas aeruginosa dropped from 22.58% to 10.83%; constituent ratio of respiratory tract infection dropped from 59.14% to 44.17%; MDRO infection rate in intensive care unit and tumor internal medicine department dropped significantly (49.02% vs 28.44%, χ2=6.47, P=0.01; 3.72% vs 1.21%, χ2=5.04, P=0.03).ConclusionEffective prevention and control of MDRO infection can be achieved through accurate and timely obtaining information, improving hand hygiene compliance, strengthening training on MDRO infection knowledge, implementing strict disinfection and isolation measures, strengthening nursing care, and using antimicrobial agents rationally.

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ObjectiveTo investigate the prevalence rate of healthcareassociated infection(HAI) in a hospital, and evaluate the reliability and accuracy of routine HAI surveillance data. MethodsHAI prevalence rate survey was conducted among all inpatients from 0∶00 to 24∶00 on investigation day with crosssectional survey, uniform questionnaires were filled out,and data were analyzed.ResultsOn June 9, 2010 and April 8, 2011, 1 196 inpatients were investigated, the actual investigation rate was 97.04% and 97.58% respectively; HAI prevalence rate was 6.27% and 6.11% respectively, which was slightly higher than HAI of the respective month (5.01% and 5.54% respectively). The main infection site was lower respiratory tract(66.27%), followed by urinary tract(13.25%) and upper respiratory tract(7.23%). ConclusionPrevalence survey can benefit to realize the current status of HAI, improve routine surveillance quality, and take proper measures to reduce HAI rate through the intervention in departments with high HAI.

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ObjectiveTo investigate Clostridium difficile (C. difficile) infection in hospitalized patients with diarrhea by screening C.difficile in stool specimens and comparing detection rate in different periods.Methods106 stool specimens of inpatients with diarrhea between FebruaryDecember 2009 and AprilJuly 2011 were collected, anaerobic culture and API identification were performed, C.difficile isolates were detected toxin A,toxin B and binary toxin gene by polymerase chain reaction(PCR);enzymelinked fluorescence immunoassay was used for toxin A/B detection.ResultsOf 106 specimens, 16(15.09%) were positive for C.difficile. PCR amplification of toxin A/B were both positive, binary toxin was negative. The positive rate was 12.26% (13/106)by direct detection of toxin A/B,there was no significant difference compared with positive rate of anaerobic culture(χ2=0.16,P>0.05).Positive rate of anaerobic culture was 22.81%（13/57）in February December 2009 and 6.12%（3/49）in AprilJuly 2011, the difference was statistically significant (χ2=5.73,P<0.05);the detection rate of toxin A and B was 17.54%(10/57) and 6.12%(3/49) respectively, there was no significant difference(χ2=3.18,P>0.05). Patients with C. difficile infection used one or more antimicrobial agents,such as cephalosporins, quinolones, carbapenems, broadspectrum penicillin and clindamycin during hospitalization period.ConclusionC. diffilileassociated diarrhea is serious in this hospital, antimicrobial use is an important factor for inducing C.difficile infection.

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ObjectiveTo investigate species and drugresistance of pathogens in neonatal septicemia, and provide the basis for clinical treatment.MethodsAnalysis was made on positive blood culture and antimicrobial susceptibility testing results of pathogens from 158 neonates with septicemia who were admitted in a hospital from January 2007 to December 2010.ResultsThe top 3 bacteria in blood culture were coagulasenegative Staphylococcus(CoNS, 77 isolates,48.73%), Staphylococcus aureus (S. aureus,44 isolates,27.84%) and Escherichia coli (E. coli,19 isolates,12.03%); S.aureus and CoNS had high resistant rates to penicillin and erythromycin, but had no resistance to vancomycin and teicoplanin; E.coli had high resistance to ciprofloxacin, cefotaxime,trimethoprim/sulfamethoxazole, but had low resistance to tetracycline, cefoperazone/sulbactam, all were sensitive to imipenem and meropenem.ConclusionStaphylococcus spp. and E. coli are the major pathogens in neonatal septicemia, detection of antimicrobial resistance and choice of rational antimicrobial agents for treatment should be stressed.

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目的了解小儿血液科住院患儿医院感染情况及相关因素和防治措施。方法采用回顾性调查方法，对某院小儿血液科2009年1月—2010年12月间住院的482例血液病患儿病历资料进行调查分析。结果482例患儿发生医院感染68例，80例次，医院感染率为14.11%，感染例次率为16.60%。医院感染部位构成比前５位分别为：上呼吸道43.75%，下呼吸道16.25%，胃肠道15.00%，皮肤软组织10.00%，血管相关性6.25%。住院时间长、贫血程度高、白细胞计数低和患白细胞疾病者医院感染率高。结论小儿血液科住院患儿医院感染率较高，应严格控制易感因素，并针对其危险因素重点监控。

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目的探讨集束化策略预防呼吸机相关性肺炎（VAP）的效果。方法对某院2009年8月—2010年7月间395例住重症监护室（ICU）机械通气的患者采取集束化干预（采取头高位、密闭式吸痰、加强气道管理、避免使用质子泵抑制剂等）措施，并与该ICU2008年8月—2009年7月间未进行集束化干预的387例机械通气患者VAP发生率进行比较，评价集束化干预方案预防VAP的有效性。结果采取集束化干预措施前VAP发病率为28.42%（110/387）,干预后下降为7.85%(31/395)，两者比较，差异有统计学意义（χ2 =55.99，P＜0.05）；患者住院时间，采取集束化干预前为（15.06±4.51）d,干预后为（10.86±2.37）d，明显缩短（t=17.14,P＜0.05）。结论集束化策略预防VAP有效。

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目的探讨多方位全程干预措施在重症监护室（ICU）感染控制中的应用效果。方法选取某院2010年6月ICU投入使用以来采用多方位全程护理干预的600例重症患者(观察组)及2010年6月前（ICU未投入使用，未采用多方位全程护理干预）的315例重症患者(对照组)为研究对象，比较两组的感染率、护理质量合格率、医患矛盾冲突发生率及患者满意率。结果观察组的感染率、护理质量合格率、医患矛盾冲突发生率及患者满意率分别为3.00%、91.17%、1.67%、93.00%，显著高于对照组的12.06%、74.92%、9.52%、74.92%（均P＜0.05），即采用多方位全程护理干预的观察组护理效果明显优于对照组。结论多方位全程干预措施在ICU感染控制中的应用可有效降低感染率，提高医疗护理质量，确保患者住院安全，减少医疗纠纷。

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目的评价手术室-供应室一体化污染器械流程化管理预处理后防锈效果。方法设观察组(2011年1—4月)与实验组(2011年5—9月)。 观察组手术室白班作息时间为8∶00—12∶00、15∶00—18∶00，手术结束后污染器械用自来水冲洗后湿式保存，消毒供应中心于每日8∶00、15∶00到手术室收集手术器械；实验组手术室白班作息时间为8∶00—15∶00，手术结束后白班污染器械用自来水冲洗后湿式保存，夜班污染器械用自来水冲洗后以酶液保存，消毒供应中心于每日8∶00、11∶30、15∶00收集手术器械。消毒供应中心人员将回收的器械初步清洗后目测，统计器械的生锈和报损情况。结果观察组白班器械、夜班器械生锈率分别为2.38%（935/39 283）、23.60%（8 889/37 670），实验组分别为0.25%（208/84 255）、0.39%（81/20 734）；观察组和实验组的器械报损率分别为0.13%（98/76 953）、0.001%（1/104 989），两组比较，差异均有统计学意义（均P＜0.01）。实验组手术器械的生锈率及报损率均显著下降。结论改进的手术室-供应室一体化污染器械流程化管理，即增加回收器械次数，白班、夜班污染器械的预处理分别用自来水冲洗后湿式保存、酶液保存，防锈效果理想。

Abstract:

目的了解某院消毒供应中心对外来手术器械的管理现状，实施规范化管理，保证手术安全。方法对该院消毒供应中心外来手术器械管理现状进行调查分析，并提出相应对策。结果该院外来手术器械使用中的风险因素：（1）管理制度不完善；（2）清洗质量不佳；（3）消毒供应中心工作人员对外来手术器械的结构和功能不熟悉。结论该院外来手术器械管理存在较大安全隐患，需规范管理。

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［摘要］目的了解某院消毒供应中心手工清洗集中处理呼吸机管路的效果。方法对250件呼吸机管路进行手工清洗、消毒、干燥及包装，采用目测法及采样细菌学检测进行效果评价。结果250件呼吸机管路进行集中清洗消毒处理后，经目测及采样细菌学检测，均符合要求（细菌菌落总数≤20 CFU/g或100 cm2）。结论消毒供应中心对呼吸机管路实施集中处理，能够确保清洗消毒质量，避免医院感染，确保医疗安全。

Abstract:

目的调查某院内科住院患者抗菌药物应用现状，通过综合管理措施促进抗菌药物的合理应用。方法医院采取分级管理、宏观调控、知识培训、信息反馈等综合管理措施促进抗菌药物合理应用。 2007—2010年随机抽取10%内科出院病历，分析抗菌药物的使用率、联合用药情况和病原学送检率。结果2007—2010年连续4年内科住院患者抗菌药物使用率分别为89.86%、74.79%、61.05%、58.98%，呈逐年下降（χ2=263.771，P=0.000）；二联用药率分别为44.30%、37.02%、33.39%、32.65%，有所下降，但χ2趋势检验差异无统计学意义（χ2=1.203，P=0.273）；病原学送检率分别为40.32%、55.56%、73.81%、76.00%，呈逐年上升（χ2=17.767，P=0.000）。结论该院抗菌药物综合管理收效明显，抗菌药物应用日趋合理。

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白假丝酵母菌败血症是真菌败血症的一种，一般发生于存在严重基础疾病、免疫功能低下及使用大量广谱抗菌药物、长期留置导管等危险因素的患者，且通常为医院获得性感染。而免疫功能正常的成年患者发生社区获得性真菌败血症少见，现报告1例，以便临床医生了解其临床特点及处理。

Abstract:

链球菌致热外毒素B（Streptococcal exotoxin B，SpeB）是A群链球菌(group A Streptococcus，GAS)以酶原形式分泌到胞外后形成的活性巯基蛋白酶。其能降解宿主胞外基质、免疫球蛋白和补体成分以及GAS自身表面黏附素M蛋白、F1蛋白、C5a肽酶和其他一些分泌蛋白，破坏宿主防御系统，帮助细菌逃避免疫清除，协助GAS最初感染部位的扩散和入侵宿主深层组织［1］。因此，SpeB被认为是GAS的重要致病因子，在GAS引起的严重侵袭性感染过程中起重要作用。本文就SpeB结构与表达调控、免疫逃逸和致病性等方面的研究进展作一介绍，以期为临床诊断治疗和研究A群链球菌感染提供一定的参考。