Abstract:

ObjectiveTo study the risk factors of Pseudomonas aeruginosa （PA） infection and homology of PA isolated from nasopharyngeal carcinoma patients undergoing  radiotherapy, and prevent and control the spread of infection.MethodsBacteria isolated from clinical specimens were identified by BD Phoenix automated microbiology system. Gene homology were analyzed with randomly amplified polymorphic DNA (RAPD) technique.ResultsFortynine strains of PA were mainly isolated from 43 nasopharyngeal carcinoma patients, the major specimens were nasopharyngeal swab (46.94%), sputum(32.65%), and oral secretion (10.20%).All these strains were amplified 46 electrophoresis diagrams, and 19 genotypes were identified. The highly homologous genotypes of type H and J strains were mainly isolated from patients in the second section (57.14%,4/7） and fourth section (60.00%,3/5） of radiotherapy department respectively.  ConclusionLocalized epidemic of highly homologous PA exists in different sections of ward, transfer of patients between different sections is the risk factor for homology PA infection/colonization. Genotyping technique  such as RAPD for analyzing the homology of pathogenic bacteria in healthcareassociated infection has important value in preventing and control Ling infection  spread.

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ObjectiveTo realize antimicrobial resistance rate of Pseudomonas aeruginosa(P. aeruginosa) and it’s correlation with antimicrobial use density(AUD), and to provide reference for control of healthcareassociated infection.MethodsFrom July 2011 to December 2013, antimicrobial resistance rate of P. aeruginosa isolated from hospitalized patients and AUD of patients were monitored, and the correlation between them was analyzed.ResultsAUD of patients decreased from 73.61 in the third and fourth quarters of 2011 to 41.33 in the same quarters of 2013. Correlation coefficient of AUD and antimicrobial resistance rate of P. aeruginosa was -0.32~0.88, correlation coefficient of resistance rate of P. aeruginosa to aztreonam and aztreonam use density was 0.88,there was statistical significance. ConclusionAUD of hospitalized patients revealed a decreasing tendency, suggesting antimicrobial selective resistance should be considered in clinic.

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ObjectiveTo investigate colonization status and risk factors of multidrugresistant organisms(MDROs) in a surgical intensive care unit (SICU),and provide a basis for active clinical screening of MDROs.  MethodsFrom June 1,2013 to August 31,2013, patients who admitted to SICU≥24 hours were performed active screening, the colnization status of methicillinresistant Staphylococcus aureus (MRSA) and extendedspectrum βlactamaseproducing Escherichia coli/Klebsiella pneumoniae (ESBLE.coli/Kp) among patients were detected, related risk factors were analyzed. ResultsWhen patients who admitted to SICU≤48 hours, the detection rate of MRSA and ESBLE.coli/Kp was 11.00％ and 73.00％ respectively；when admitted to SICU > 7 days,the increased detection rate of MRSA and ESBLE.coli/Kp was 16.67% and 44.44% respectively. Patients stayed in hospital >7 days before admitting to SICU (OR95%CI：4.48［1.21-16.65］) was  an independent risk factor of carrying MRSA when admitting to SICU, APACHE Ⅱ score ≥16 (OR95%CI：6.36［1.47-27.54］) was an independent risk factor of carrying MRSA 48 hours after admitting to SICU. ConclusionWhen patients admitted to SICU, the carrying rate of MDROs is high, isolation rate rises with prolonged length of SICU stay. Hospitals should carry out MDRO colonization screening project among patients and implement effective isolation control measures to reduce the incidence of healthcareassociated infection.

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ObjectiveTo investigate antimicrobial  use in 33 township central hospitals, and improve the rational use of antimicrobial agents. MethodsThirtythree township central  hospitals in 11 counties were randomly selected,  7 920  outpatient prescriptions, medical records of 465 nonsurgery patients and 213 surgery patients were investigated and analyzed. ResultsOf 33 hospitals, antimicrobial  usage rate in outpatients and inpatients was  56.60% and 89.68% respectively，combined antimicrobial  usage rate was 24.16% and 43.58% respectively. Antimicrobial use density in inpatients was 147.25DDDs. Antimicrobial usage rate  in surgery patients was 97.18%, combined antimicrobial  usage rate was 59.90%，the percentage of one drug, twodrug combination and threedrug combination was 40.10%, 47.82%, and 12.08%  respectively.  The percentage of antimicrobial use in patients of type Ⅰ,Ⅱ,and Ⅲincision was 97.56%（40/41）, 96.93%（158/163） and 100.00%（9/9）respectively，combined antimicrobial usage rate was 30.00%,67.72%, and 44.44% respectively.ConclusionThe overuse of antimicrobial agents exists in 33 township central hospitals, antimicrobial usage rate, combined usage rate, antimicrobial use density and antimicrobial prophylaxis in typeⅠincision operations are all high.

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ObjectiveTo explore the effect of bundle hand hygiene intervention in controlling  healthcareassociated infection(HAI) in a primary comprehensive hospital, so as to improve hand hygiene compliance and correct rate,  and reduce AHI rate. MethodsIn JanuaryJune 2014, bundle hand hygiene intervention among health care workers (HCWs) in a hospital was performed, hand hygiene knowledge awareness rate, hand hygiene compliance and correct rate, hand sanitizer usage and HAI rate before and after intervention were compared. ResultsAfter performing intervention for six months, the awareness rate of hand hygiene knowledge(concept, significance, indications, methods, sanitizer use) of HCWs improved compared with before intervention (P＜0.05);hand hygiene compliance and correct rate were significantly higher than before intervention (77.92% vs 49.78%; 76.47% vs 37.72%) (P＜0.05). Hand sanitizer usage increased from  2.14mL/ bedday to 4.63 mL/ bedday , HAI rate decreased from 1.97% to 1.54% (P＜0.05).ConclusionBundle hand hygiene intervention can improve HCWs’ knowledge awareness, compliance and execution rate of hand hygiene, and effectively reduce HAI rate.

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ObjectiveTo study the risk factors for healthcareassociated infection (HAI) in neurosurgical patients with  hypertensive intracerebral hemorrhage, and provide the basis for prevention and control of HAI. MethodsClinical data of 380 hospitalized patients with hypertensive intracerebral hemorrhage from January to December 2013 were analyzed.ResultsOf 380 patients, 36 (9.47%) had HAI. The top three sites of infection were lower respiratory tract (50.00%), surgical  incision (16.67%) and urinary tract(11.11%). A total of  51 pathogens were isolated, among which gramnegative bacilli and grampositive cocci accounted for 64.71%(n=33)  and 35.29% (n=18) respectively. The top three pathogens included Staphylococcus aureus (19.61%), Klebsiella pneumoniae (17.65%） and Escherichia coli (13.73%). Risk factors for HAI in hypertensive intracerebral hemorrhage patients were combined underlying diseases, invasive procedures, use of respirator, prolonged use of antimicrobial agents and long length of hospitalization(P<0.05).  ConclusionHAI rate is high in neurosurgical patients with  hypertensive intracerebral hemorrhage, surveillance should be intensified,  and effective preventive and control measures against risk factors  should be taken.

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ObjectiveTo explore risk factors for surgical site infection(SSI) in orthopaedic surgery, and propose the intervention measures.Methods1 082 patients who received orthopaedic surgery in a hospital from January 2012 to December 2013 were monitored, SSI were surveyed by healthcareassociated infection control professionals  based on  medical records reviewing, onsite examination of surgical incision and postdischarged following up call. ResultsOf 1 082 patients, 8(0.74%) developed SSI. Univariate analysis revealed that SSI were related to  patients’ age, associated diabetes mellitus, emergency operation, incision numbers, types of incisions, duration of operation,and  implant (P<0.05); Logistic regression analysis revealed that independent risk factors for SSI were age, diabetes mellitus, emergency operation, incision numbers, incision types, and duration of operation (P<0.05). ConclusionMultiple factors contribute to SSI in orthopaedic surgery. It is necessary to take comprehensive prevention measures to reduce the incidence of SSI.

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ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens causing diabetic foot ulcer(DFU).  MethodsSecretion specimens of DFU in patients at several hospitals in Qingdao were collected and performed bacterial culture and antimicrobial susceptibility testing.  ResultsA total of 216 pathogens were obtained from 137 patients with DFU. Isolation rate of gramnegative bacilli, grampositive cocci and fungi was 58.80% (n=127), 39.81% (n=86) and 1.39%(n=3) respectively. 76 （55.47%）patients were infected with single pathogen, 61 （44.53%）were infected with mixed pathogens；the top five detected pathogens were Pseudomonas aeruginosa（n=37）, Staphylococcus aureus (n=35), Escherichia coli (n=26), Staphylococcus epidermidis(n=24), and Acinetobacter baumannii(n=22). The resistance of Enterobacteriaceae to amikacin, amoxicillin / clavulanic acid, cefoxitin, imipenem, piperacillin / tazobactam, ticarcillin / clavulanic acid were 0-16.67%；the resistance of Pseudomonas aeruginosa to  imipenem, tobramycin, amikacin, cefepime, gentamicin, and quinolones were 2.70%-18.92%；the resistance of Acinetobacter baumannii to imipenem and levofloxacin were low，but to the other antimicrobial agents were all above 30%. ConclusionThe major pathogens from DFU were gramnegative bacilli, the next were grampositive cocci, antimicrobial resistance patterns of each species are quite different, clinicians should choose antimicrobial agents according to antimicrobial susceptibility testing results.

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ObjectiveTo evaluate the efficacy of topical and systemic antimicrobial application on reducing conjunctival sac bacterial flora. Methods82 cataract patients (164 eyes) were randomly selected for studying, nonsurgical eye of the same patient was as control eye. Surgical eyes received 3day preoperative 0.5% levofloxacin eye drops, all patients received systemic antimicrobial agents 30 minutes before surgery. Specimens from conjunctival sac were collected at the following time points：admission (T0); 3 days after receiving 0.5% levofloxacin eye drops before surgery (T1); 30 minutes after all patients received systemic antimicrobial agents (T2),all specimens were performed bacterial culture. ResultsThe percentage of positive cultures for surgical and control eyes was 42.68%（35/82） and 43.90% （36/82） at T0,  0 （0/82）and 8.54% （7/82）at T1, 0（0/82） and 0 （0/82）at T2,respectively. ConclusionTopical and systemic antimicrobial application can reduce conjunctival sac bacteria. Because of the side effects of systemic antimicrobial agents, preoperative routine systemic antimicrobial use is not suggested.

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ObjectiveTo study the effectiveness of alkaline electrolyzed water (AEW) in the cleaning of medical instruments and its corrosive effect on metal. MethodsMedical instruments of solid smooth, solid with gear or tube were cleaned with AEW adding ultrasonic washing, cleaning efficacy were compared with conventional method, AEW without pulsing ultrasonic washing and control group,   corrosive effect of AEW on metal  immersed in AEW was tested. ResultsCleaning efficacy of solid smooth, solid with gear or tube instruments were significantly different among four groups（F=10.868, 14.268, 6.146，respectively,all P＜0.05）. For solid smooth instruments, cleaning with AEW adding ultrasonic and cleaning without ultrasonic had a better effect than  conventional cleaning (both P＜0.005）； For solid with gear instruments, AEW adding ultrasonic cleaning obviously had a better effect than conventional cleaning and AEW without ultrasonic cleaning(both P＜0.001）； For tube instruments, cleaning efficacy of three cleaning methods were not significantly different (all P>0.05）. AEW had no corrosive effect on stainless steel and copper. ConclusionThe cleaning efficacy of AEW on solid smooth, solid with gear instruments is superior to conventional cleaning method, and can  achieve better effectiveness  if  ultrasonic cleaning is added.

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ObjectiveTo investigate the status of disinfection and sterilization quality of different levels of medical institutes in Xi’an, and improve the management level of disinfection and sterilization of medical institutes. MethodsDisinfection and sterilization efficacy of 69 medical institutes were monitored and evaluated according to Standardization for Disinfection Techniques (2002 edition) and Sanitary Standards for Hospital Disinfection (GB15982-1995). ResultsFrom 2011 to 2013, 2 224 specimens were tested, 1 766 (79.41%) were qualified．The qualified rate of tertiary medical institutes was higher than second and below medical institutes （83.67％ vs 77.50％,P=0.001）， the qualified rate between public medical institutes and private medical institutes was not statistically different （79.64％ vs 78.20％, P=0.532）, the qualified rate of comprehensive medical institutes was higher than specialized medical institutes （80.18％ vs 74.92％,P=0.030）. Of different detected specimens, the qualified rates of disinfectant in use and pressure steam sterilizers （including test pack and process challenge device） were higher （98.46%,100.00%,and 98.06% respectively），while the hands of health care workers (HCWs) and glutaraldehyde were lower（58.48% and 43.28% respectively）．ConclusionDisinfection and sterilization quality in different medical institutes in Xi’an is different, and different disinfected and sterilized objects are also varied ．It is necessary to intensify the management of hand hygiene of HCWs and concentration of glutaraldehyde.

Abstract:

目的调查分析某院临床应用抗菌药物的现状、存在的问题及对策，为医院对抗菌药物的管理提供依据。方法随机抽取该院临床18个科室2013年7—9月份的出院病历1 450份，采用回顾性调查方法对其中的抗菌药物使用情况进行统计分析。结果1 450例住院患者中，使用抗菌药物者1 028例（70.90%），其中治疗用药556例（54.08%），预防用药394例（38.33%），治疗+预防用药78例（7.59%）；治疗用抗菌药物者病原学送检率仅为25.71%。结论该院抗菌药物使用率较高，存在用药不合理、不规范现象，需加强监管。

Abstract:

目的调查某院重症监护室（ICU）一起泛耐药鲍曼不动杆菌（XDRAB）感染暴发的原因。方法调查2014年1月30日—2月9日入住该院ICU发生肺部感染的患者，对其周围环境进行流行病学采样；观察医务人员无菌操作及手卫生执行情况。结果5例肺部感染患者痰液中均检出XDRAB，且XDRAB耐药谱一致，均仅对多粘菌素E敏感，对其他抗菌药物全部耐药。环境细菌学调查结果显示，病房台面、心电监护仪、吸引装置、工作人员手、设备塔台面菌落数超标，总阳性率为88.00%（44/50）；共检出鲍曼不动杆菌12株，其中XDRAB 9株。经实施一系列控制措施后，2月10日—3月10日，ICU再无新发XDRAB医院感染病例。结论ICU环境消毒不彻底、医务人员手卫生依从性差、无菌操作不规范是此次医院感染暴发的主要因素。

Abstract:

目的了解2013年内蒙古自治区医院医院感染、抗菌药物使用及病原菌检出情况。方法对全区91所医院采取床旁调查与查阅住院病历相结合的方法进行医院感染现患率调查。结果91所医院，实际监测患者31 504例，发生医院感染573例、614例次，医院感染现患率为1.82%、例次现患率为1.95%。医院感染部位以下呼吸道为主（49.35%）； 抗菌药物使用率为32.95%，其中单一、二联、三联、四联及以上用药率分别为75.35%、23.28%、1.22%和0.15%；治疗、预防、治疗+预防用药率分别为59.13%、30.55%和10.32%；病原学送检率为27.38%（1 974/7 210）。结论长期、系统的医院感染现患率调查有助于医院感染管理者了解医院感染状况，及时发现存在的问题，制定有效的预防控制措施，开展医院感染目标性监测工作。

Abstract:

目的分析某院临床标本分离的大肠埃希菌和肺炎克雷伯菌的耐药特点,为临床合理用药提供依据。方法对该院2010—2012年临床送检痰液、血液与胸腹腔积液标本分离的大肠埃希菌和肺炎克雷伯菌资料进行统计分析。结果3年分离大肠埃希菌359株，其中产超广谱β内酰胺酶（ESBLs） 菌株175株，占48.75%；分离肺炎克雷伯菌296株，其中产ESBLs菌116株，占39.19%。产ESBLs 菌株对亚胺培南、美罗培南耐药率（2.29%～3.45%）低，对头孢替坦、哌拉西林／他唑巴坦耐药率（4.31%～8.57%）也较低，对其他抗菌药物的耐药率均较高。产ESBLs菌株的耐药率高于非产ESBLs菌株。结论大肠埃希菌和肺炎克雷伯菌对多种抗菌药物具有较高的耐药性。 ESBLs检出率，大肠埃希菌高于肺炎克雷伯菌。临床治疗该类菌感染时应根据药敏结果与ESBLs检测结果合理选择抗菌药物。

Abstract:

艾滋病（获得性免疫缺陷综合征，AIDS）患者，由于免疫功能缺陷，容易合并各种机会性感染。尸检结果表明，90％ AIDS患者死于机会性感染［1］。但同一名艾滋病患者同时合并结核、梅毒和马尔尼菲青霉菌（Penicillium marneffei,PM）感染鲜有报道，本院收治此类患者1例，现将其诊断情况报告如下

Abstract:

丙型肝炎病毒（hepatitis C virus，HCV）感染是一个重要的全球健康问题，起病隐匿，慢性化程度高，是导致肝硬化和肝癌的最主要病因。直接抗病毒药物（directacting antiviral agents, DAAs）较聚乙二醇干扰素α（pegylated interferon, pegIFN）联合利巴韦林（ribavirin, RBV）治疗方案可获得更高的持续病毒学应答（sustained virological response, SVR）率，并可缩短治疗时间，前景良好。DAAs 新药开发将成为未来抗HCV治疗研究的趋势。2009年，欧洲药物管理局（European Medicines Agency，EMA）颁布的《慢性丙型肝炎直接抗病毒药物治疗的临床评价指南》和2013年10月美国食品药品监督管理局（Food and Drug Administration，FDA）新发布的《抗丙型肝炎病毒的直接抗病毒药物临床药物研究指南》为DAAs临床试验的有效性和安全性研究提供了指导性建议，如人群纳入、研究方案、研究设计、研究终点、药物安全性等，另外还对肝功能失代偿者、肝移植患者、人免疫缺陷病毒（HIV）/HCV共同感染者等特殊人群的药物研究提出了特别要求，这些内容有助于指导DAAs临床试验设计