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ObjectiveTo understand the distribution of PCR ribotyps and toxin gene polymorphism of Clostridium difficile (C. difficile) in some areas of China, provide the reference sequences for the establishment of appropriate molecular detection and typing methods, and support clinical decision for the complex C.difficile infections.MethodsSixtyfour C.difficile isolates collected from 3 cities(Beijing,Guangzhou,Jinan) were performed PCRribotyping analysis. Among them, tcdA and tcdB of 26 representative strains were amplified and sequenced.ResultsAmong 64 C.difficile isolates, 45(70.31%) were type A+B+,19(29.69%) were type A-B+. Nine different PCR ribotypes were obtained. The top 3 ribotypes were 017(21 isolates,32.81%), 001(13 isolates,20.31%), and 012(11 isolates,17.19%). Among A-B+ strains, 14（73.68%）were ribotype 017, 1 was ribotype 001. Toxin gene sequences showed polymorphism, there were 7 TSTA, 6 TSTB, and 8 TSTG.ConclusionThe dominant Chinese ribotype may be 017, and toxin genes show certain polymorphism among strains, there is a corresponding relationship between PCR ribotypes and toxin gene polymorphism. Further study will be performed with expanding strains, so as to find appropriate molecular detection and molecular typing method, and help hospitals to prevent and control C. difficile infection.

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ObjectiveTo investigate point prevalence of healthcareassociated infection(HAI) and communityassociated infection(CAI) in hospitals with different scales.MethodsAccording to the unified arrangement of National HAI Surveillance System, crosssectional survey was adopted to investigate daily HAI and CAI rate, antimicrobial use, and specimen detection rate in hospitals participated in the survey in 2012. ResultsOn the survey day, a total of 786 028 patients in 1 313 hospitals were investigated, of whom 25 273 (3.22%) had HAI, and 177 009(22.52%) had CAI, 301 770 (38.39%) were prescribed antimicrobial agents. Among patients prescribed antimicrobial agents for therapy, 40.16% had their specimens sent to the laboratory for bacterial culture. Among hospitals with＜300,300-599,600-899, and ≥900 beds,prevalence rate of HAI (HAIR) and bacterial culture rate(BCR) had a “stepbystep” rise (HAIR：2.11%，2.52%，3.49%，3.91%; BCR: 23.43%,33.97%,45.38%, 49.05%, the difference was statistically significant);prevalence rate of CAI (CAIR) and antimicrobial use rate(AUR) had a “stepbystep” decrease (CAIR：28.99%，25.43%，21.97%，18.72%；AUR： 46.58%，41.14%，37.23%，34.64%,the difference was statistically significant). The top five departments with highest prevalence rate were intensive care unit (ICU,27.76%), hematology (10.13%), burn (9.64%),neurosurgery（9.00%）,and neonatology division of pediatric department（5.34%）. A total of 12 447 pathogens were isolated from patients with HAI, the top five bacteria were Pseudomonas aeruginosa（1 825 isolates）, Escherichia coli（1 750 isolates）, Klebsiella pneumoniae（1 437 isolates）, Acinetobacter baumannii（1 321 isolates）, and Staphylococcus aureus（1 112 isolates）.ConclusionPoint prevalence rate of HAI has decreased compared with previous, ICU has the highest HAI prevalence rate; gramnegative bacteria are main pathogens of HAI; AUR is lower than before, and the BCR increased obviously.

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ObjectiveTo evaluate whether APACHEⅡ score and arterial blood gas (ABG) analysis parameter of elderly patients with severe pneumonia can be improved if low molecular weight heparin (LMWH) was added to conventional therapy.MethodsFrom October 2009 to September 2011, 43 inpatients with severe pneumonia were randomly divided into treatment (n=23) and control (n=20) group. Control group received conventional treatment, and treatment group received conventional treatment plus the LMWH treatment (4 000U q.d.) for 7 days. APACHEⅡ score, and arterial blood gas analysis (pH of blood, partial pressure of oxygen［PaO2］,partial pressure of carbon dioxide［PaCO2］,lactate［Lac］) were compared at 24 h, day 3 and day 7 of treatment.ResultsThe basic data and APACHEⅡ score in two groups were not significantly different before treatment (P>0.05); the difference in incidence of hemorrhage was not significantly different during treatment (P>0.05); At 24 h and day 3 treatment, APACHEⅡ score in two groups was not significantly different (P>0.05),but at day 7,the APACHEⅡ score of treatment group was significantly lower than control group (［13.71±3.65］ vs ［16.95±4.70］, t=2.47, P=0.02). At 24 h, day 3 and day 7, the PH,PaCO2,Lac were not significantly different (P>0.05); at 24 h and day 3, PaO2 was not significantly different (P>0.05),but at day 7, the PaO2 of treatment group was significantly higher than control group(［106.8±32.7］ vs ［88.6±22.2］, t=-2.15,P=0.04).ConclusionLMWH plus conventional treatment for elderly patients with severe pneumonia can improve the oxygenation of patients, and reduce APACHEⅡ score.

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ObjectiveTo evaluate the effect of external fixation of balloon urethral catheter on preventing urinary tract infection in male patients. MethodsTwo hundred tumor male patients were randomly divided into observation group (100 cases) and control group (100 cases). Control group only applied balloon catheter to perform fixation of catheter inside bladder after the success of catheterization; observation group applied the external fixation of balloon catheter on the basis of inner fixation of catheter, urinary tract infection (UTI) on the 3rd, 5th and 7th day of catheterization in two groups of patients were observed and compared. ResultsOn day 3,5,and 7 in observation group, asymptomatic bacteriuria rate was 1.00%，4.00%，and 9.00% respectively, UTI rate was 0.00%，2.00%，and 3.00% respectively;in control group, asymptomatic bacteriuria rate was 7.00%, 13.00%, and 21.00% respectively, UTI rate was 3.00%，7.00%，and 13.00% respectively, asymptomatic bacteriuria rate and UTI in observation group was lower than control group respectively（P＜0.01）. ConclusionApplication of external fixation of balloon catheter for male patients with catheterization can avoid the moving of catheter, and reduce the occurrence of UTI.

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ObjectiveTo investigate the awareness of tuberculosis(TB)related knowledge and the status of occupational protection among health care workers (HCWs) in a general hospital.MethodsQuestionnaires were used to investigate the awareness of TBrelated knowledge and the status of occupational protection among HCWs.ResultsA total of 333 HCWs were enrolled in the investigation, correct response rate in the TBrelated knowledge was 62.84%-93.09%; correct response rate in national TBrelated policy was 59.52%-77.27%.The implementation rate of protective measures was not significantly different between the awareness group and the unawareness group (［10.74%-79.34%］ vs ［10.38%-82.55%］,P>0.05), but implementation rate of regular medical examination in awareness group was significantly higher than unawareness group（92.56% vs 79.25%， P＜0.05）.ConclusionThe knowledge about tuberculosis and occupational protection training should be strengthened among HCWs in general hospitals.

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ObjectiveTo evaluate the effect of fast detection on occupational blood exposure with unidentified bloodborne infection status. MethodsData of 45 cases of occupational blood exposure with unidentified bloodborne infection status between January and December 2011 were analyzed retrospectively.ResultsBefore fast detection,10(22.22%) source patients were with identified infection status,3(6.67%) exposed healthcare workers (HCWs)were with positive HBsAb; after fast detection,35 (77.78%) source patients were identified the infection status, the identified rate increased by 55.56%,23 HCWs were detected positive HBsAb, 22 HCWs needn’t to be detected, the identified rate was 51.11%, the identified rate increased by 44.44%. Postexposure preventive measures were taken, and no HCWs was found to be infected due to the occupational exposure.ConclusionPostexposure preventive measures according to the result of fast detection can effectively reduce the occurrence of infection due to occupational blood exposure.

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ObjectiveTo realize the contamination of reusable dialyzer housing and efficacy of two different disinfection methods on dialyzer housing.Methods300 pieces of used dialyzers were cleaned, checked and disinfected by automatic disinfection machine, then divided evenly into three groups before stored in the cabinet, and specimens were taken from dialyzer housings without being disinfected, wiped with disinfectant containing 500mg/L available chlorine,and immersed with the same disinfectant, respectively.ResultsThe average colony count of dialyzer housings of three groups was as follows: nondisinfection group was （15.52±3.81）CFU/cm2,qualified rate was 87%； wiping disinfection group was （3.22±0.71） CFU/cm2，qualified rate was 100%； qualified rate of immersing disinfection group (immersion time was 10 minutes) was 100%,qualified rate between two disinfection groups and nondisinfection group was different statistically（χ2=7.89，P＜0.05）.ConclusionWiping and 10minute immersion of dialyzer housings with disinfectant containing 500 mg/L available chlorine can both achieve disinfection efficacy, but the latter is better.

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ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens from bile specimens from patients with biliary tract infection, and provide reference for clinical antimicrobial use.MethodsBile specimens collected from May 2011 to May 2013 were cultured, identification and antimicrobial susceptibility testing of the isolated bacteria were performed by VITEK2 COMPACT automatic system, antimicrobial susceptibility data were analyzed using the WHONET 5.3 software.ResultsOf 445 cultured bile specimens, 254 (57.08%) were positive for bacterial culture. A total of 306 pathogenic isolates were obtained, 231 (75.49%) of which were gramnegative strains，58 (18.95%) were grampositive strains, and 17(5.56%) were fungi. The most common gramnegative pathogens in biliary tract infection were Escherichia coli(21.89%), Klebsiella pneumoniae(18.30%)，and Pseudomonas aeruginosa (13.40%); the most common grampositive pathogens were Enterococcus faecalis (5.56％)，coagulase negative Stahylococcus (3.59％),and Enterococcus faecium (3.59％)．Antimicrobial resistant rate of gramnegative bacteria to imipenem and ertapenem was the lowest, followed by cefotetan, amikacin, and piperacillin /tazobactam;the resistant rates to quinolones,penicillins,and cephalosporins were high. Antimicrobial resistant rate of grampositive bacteria to vancomycin was the lowest, followed by linezolid, the resistant rates to other antimicrobial agents were 30%-90%.ConclusionThe major pathogens in biliary tract infection are gramnegative bacilli, regular monitor on antimicrobial resistance is important for the treatment.

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ObjectiveTo analyze the distribution and antimicrobial resistance of common pathogens isolated from a hospital，and provide reference for rational antimicrobial use.MethodsData of 2 208 pathogens from clinical specimens from January 2011 to December 2012 were analyzed retrospectively by WHONET5.5 software.ResultsA total of 2 208 pathogens were isolated，pathogens were mainly isolated from sputum (50.63%, 1 118/2 208）and urine (22.69%, 501/2 208). 1 418(64.22%) isolates were gramnegative bacteria, Escherichia coli was the most common gramnegative bacillus (15.72%), followed by Klebsiella pneumoniae(11.96%), Acinetobacter baumannii(10.64%), and Pseudomonas aeruginosa(9.83%); 577(26.13%) isolates were grampositive bacteria, 11.23% of which were Staphylococcus aureus; 213(9.65%) isolates were fungi.Gramnegative bacilli were sensitive to imipenem,but resistance of Acinetobacter baumannii was serious（resistant rate was 55.74%-74.04%）.The percentage of methicillinresistant Staphylococcus aureus and methicillinresistant coagulase negative Staphylococcus was 69.76% and 87.56% respectively, no Staphylococcus spp. isolates was found to be resistant to vancomycin.ConclusionThe main infection site of patients in this hospital is respiratory tract; antimicrobial resistance of pathogens is serious, intensified surveillance on antimicrobial resistance is important to guide rational use of antimicrobial agents and reduce multidrug resistant strain.

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ObjectiveTo realize the species and antimicrobial resistance of pathogens isolated from blood culture in recent 3 years at a hospital, and provide reference for the rational use of antimicrobial agents.MethodsBlood culture results of 3 880 clinical specimens detected from January 2009 to December 2011 were analyzed using WHONET 5.5 software.ResultsOf all blood specimens, 410(10.57%) were isolated bacteria, gramnegative bacilli, grampositive cocci, grampositive bacilli, anaerobic bacteria and fungi were 210 isolates（50.48%），128（30.77%），15（3.60%），17（4.09%） and 46（11.05%）,respectively. The top five pathogens were Escherichia coli (88 isolates, 21.15%), Staphylococcus aureus(36,8.66%),Staphylococcus epidermidis(28, 6.73%), Klebsiella pneumoniae (26, 6.25%)， and Candida parapsilosis(27,6.49%). The positive rate of extendedspectrum βlactamaseproducing Escherichia coli and Klebsiella pneumoniae was 60.70% and 28.60% respectively, all strains were sensitive to imipenem and meropenem; the positive rate of methicillinresistant Staphylococcus aureus and methicillinresistant Staphylococcus epidermidis was 25.00% and 100.00% respectively; the sensitive rates of Candida parapsilosis to 5fluorocytosine, amphotericin B, fluconazole and itraconazole were all 100%.ConclusionEnterobacteriaceae are the main pathogens in blood culture in this hospital, the next is Staphylococcus spp., infection rate of fungus is also high; the change in pathogen in blood culture and antimicrobial resistance should be paid attention, and healthcareassociated bloodstream infection should be prevented and controlled.

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ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens isolated from blood culture from a hospital.MethodsData of pathogens isolated from blood specimens between 2008 and 2011 were analyzed retrospectively.ResultsA total of 285 pathogenic isolates were obtained from 1 780 specimens, positive rate was 16.01%. The number of grampositive cocci were 155 isolates（54.39%）,the major were Staphylococcus aureus （84 isolates，29.48%）and coagulase negative Staphylococcus （38 isolates，12.28%）; the number of gramnegative bacilli were 103 isolates(36.14%),the major were Escherichia coli（43 isolates，15.09%）,Pseudomonas aeruginosa（19 isolates，6.67%）,and Klebsiella pneumoniae（13 isolates，4.56%）;the number of fungi was 27 isolates (9.47%),the major was Candida albicans(13 isolates,4.56%).The resistant rate of grampositive cocci was high, but all strains were sensitive to vancomycin and teicoplanin, 40.48% of Staphylococcus aureus and 57.14% of coagulase negative Staphylococcus were methicillinresistant. Gramnegative bacilli were sensitive to imipenem, meropenem,and enzyme inhibitorcontaining antimicrobial drugs; 31 extendedspectrum βlactamaseproducing isolates were detected, 25（58.14%） of which were Escherichia coli， 6（46.15%）were Klebsiella pneumoniae.ConclusionThe major pathogens isolated from blood culture from this hospital are grampositive bacteria, and antimicrobial resistance is high, clinicians should choose antimicrobial agents according to antimicrobial susceptibility testing results, so as to reduce the emergence of resistant strains.

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ObjectiveTo realize the clinical distribution and antimicrobial resistance of common nonfermentative bacteria from a hospital.MethodsData of nonfermentative bacteria isolated between January 1, 2012 and December 31,2012 were analyzed retrospectively.ResultsA total of 427 （9.37%）isolates of nonfermentative bacteria were isolated from 4 559 specimens，405 (94.85%,405/427) isolates of which were Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia, these strains were mainly isolated from sputum specimens（75.89%-78.79%） and with high antimicrobial resistance, but the resistant rate of Pseudomonas aeruginosa to amikacin, meropenem, and polymyxin B was low(14.54%,11.89%, and 14.98% respectively), the resistant rate of Acinetobacter baumannii to amikacin, meropenem, and polymyxin B was low(6.25%,6.25%, and 8.04% respectively), the resistant rate of Stenotrophomonas maltophilia to compound sulfamethoxazole and polymyxin B was low(3.03% and 13.64% respectively).ConclusionNonfermentative bacteria in this hospital are mainly isolated from lower respiratory tract specimens, and antimicrobial resistance is high, antimicrobial agents should be used according to antimicrobial susceptibility testing result, and spread of infection should be prevented.

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ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens causing communityassociated pneumonia(CAP) in children，and provide basis for rational treatment.MethodsData of pathogens isolated from sputum of 242 children with CAP in a hospital between January 2011 and February 2012 were analyzed.ResultsThe top 5 pathogens isolated from VAP children were Streptococcus pneumoniae（102 isolates）, Haemophilus influenzae（48 isolates）, Moraxella catarrhalis（30 isolates）, Staphyloccocus aureus （19 isolates）, and Escherichia coli（14 isolates）. Pathogens were slightly different in children of different ages, Staphyloccocus aureus and Escherichia coli were mainly isolated from infants. The resistant rates of the top 5 pathogens to penicillin were higher, the resistant rates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis to the third and fourth generation cephalosporins were slightly lower; the resistant rate of Staphyloccocus aureus to vancomycin was 0.00%; the resistant rates of Escherichia coli to cefoxitin and carbapenems were 0.00%. ConclusionThe realizing of the distribution of pathogens causing CAP is beneficial to the correct empirical antimicrobial application in children with CAP.

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目的了解冬季外出灭菌的医疗用品包裹湿包的原因，以采取防范措施，有效降低湿包发生率。方法对2012年11—12月送至外院灭菌的医疗用品包裹发生湿包的情况进行统计分析，并针对性采取改进措施，比较采取措施前后的湿包率。结果采取改进措施前，外出灭菌包的湿包率为10.00%（99/990）；采取改进措施后，外出灭菌包的湿包率降至1.90%（19/998），差异有统计学意义（χ2=58.35, P=0.00）。结论冬季灭菌医疗用品包裹送至外院灭菌，发生湿包的主要原因为冷凝水，经过增加干燥与降温时间，改进运输过程中的包装，较好解决了湿包问题。

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目的探讨污染分装皮肤消毒剂的因素，优化分装皮肤消毒剂的管理。方法采用现场观察、询问的方法调查改进管理方法前后的皮肤消毒剂及其盛装容器使用情况，并采集全院使用中的皮肤消毒剂进行细菌培养。结果使用频率＜11次/d的皮肤消毒剂合格率为91.67%，11～19 次/d为38.46%，＞19次/d为35.71%，细菌培养合格率随暴露次数增加而降低（χ2=7.99，P＜0.05）。改进前,住院部的皮肤消毒剂细菌培养合格率为42.31%，门诊为76.92%，改进后分别提高至89.33%（χ2=24.28，P=0.00）和91.43%。改进前，皮肤消毒剂盛装容器使用时间＜3 d、3～7 d及＞7 d的细菌培养合格率分别为58.33%、60.00%及20.00%；改进后不再有使用时间＞7 d的皮肤消毒剂，而使用时间＜3 d、3～7 d的皮肤消毒剂合格率分别为86.79%、92.98%，与改进前比较，均显著提高（χ2分别为7.46、24.81，均P＜0.01）。结论分装皮肤消毒剂暴露频率高是造成污染的重要因素；加强管理，对减少使用中皮肤消毒剂细菌数超标情况有效。

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本院于2012年8月自神经内科监护室一患者脑脊液引流液标本中培养分离出1株放射根瘤菌（Rhizobium radiobacter），现将该病例临床资料分析报告如下。

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体外PK/PD模型是指一类借助体外装置来模拟药物在体内的药代动力学过程和药效动力学的研究方法。与传统的抗菌药物药效学研究方法相比，该模型能够直接体现体内抗菌药物动态变化过程中与细菌的相互作用，且不受实验动物的限制，因此近年来被国外学者广泛用于抗菌药物药效学研究的各个方面，如抗菌药物的研究开发、PK/PD参数的确定、细菌的耐药性研究及抗菌药物给药方案的优化等。本文主要介绍体外PK/PD模型的发展及近年来利用该模型进行抗菌药物给药方案优化的相关研究。