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ObjectiveTo investigate molecular epidemiological characteristics and antimicrobial resistance mechanism of PERtype extendedspectrum βlactamases (ESBLs)producing Acinetobacter baumannii(A. baumannii). Methods129 A.baumannii clinical strains isolated from a hospital between January and May 2009 were performed antimicrobial susceptibility testing by KirbyBauer disk diffusion method, PER gene was amplified by polymerase chain reaction (PCR),PCR amplified products of PER gene were sequenced, genotypes were identified by enterobacterial repetitive intergenic consensusPCR (ERICPCR).ResultsPER1 gene was detected in 78 of 129 clinical isolates, positive rate was 60.47%（78/129）. The resistance rates of PER1positive strains to imipenem, meropenem, ampicillin/sulbactam, minocycline and cefoperazone/sulbactam was 46.15%, 44.87%, 38.46%, 10.26% and 8.97% respectively,the resistance rates to the other 10 kinds of antimicrobial agents were all >60%; The resistance rates of PER1positive strains to ceftazidime, cefotaxime, cefepime, ciprofloxacin, and levofloxacin were significantly higher than PER1negative strains (all P<0.05). 78 PER1positive strains were divided into 7 types, including type A(1), B(1), C(55), D(18), E(1), F(1), and G(1), of which the main clones were type C and D.ConclusionType C and D PER1positive A.baumannii are the main epidemic strains in this hospital. PER1type ESBLproducing A.baumannii strains are multidrug resistant, minocycline and cefoperazone/sulbactam are optimal antimicrobial agents for treating A. baumannii infection in this hospital.

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ObjectiveTo evaluate the effect of herbal tanreqing injection on adjuvant therapy for Acinetobacter baumannii (A. baumannii) pulmonary infection，and provide reference for more effective treatment for pulmonary infection caused by A. baumannii.MethodsFiftytwo intensive care unit patients with A. baumannii pulmonary infection between January 2012 and March 2013 were selected and randomly divided into conventional therapy group(29 cases)and tanreqing adjuvant therapy group(23 cases).Conventional therapy group were treated with antimicrobial agents according to pathogenic microbiological culture and antimicrobial susceptibility testing results; tanreqing adjuvant therapy group were treated with conventional therapy plus tanreqing injection, therapeutic effect of two groups was compared.ResultsAcute physiology and chronic health evaluationⅡ(APACHEⅡ) score and sequential organ failure assessment (SOFA) score of tanreqing adjuvant therapy group decreased more significantly than the conventional therapy group；the ICU length of stay, antimicrobial days within 28 days, mechanical ventilation days were all significantly lower than conventional therapy group（P＜0.05）. Mortality within 28 and 90 days was not significantly different between two groups(P＞0.05).ConclusionTanreqing injection and antimicrobial agents has a synergistic antimicrobial effect, and has certain therapeutic effect on A.baumannii pulmonary infection.

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ObjectiveTo evaluate in vitro activity of antimicrobial agents against multidrugresistant Acinetobacter baumannii (MDR A.baumannii).Methods224 MDR A.baumannii strains isolated from specimens of clinical departments in a hospital between January and May 2013 were identified and performed antimicrobial susceptibility testing.Results224 MDR A.baumannii strains were mainly isolated from respiratory disease department(21.43%), neurosurgical department(16.07%), neurosurgical intensive care unit(12.50%), and neurology department(12.50%). The major specimens of A.baumannii was sputum(57.14%),the next were tracheal intubation(16.52%) and drainage fluid(9.82%). MDR A.baumannii strains were sensitive to tigecycline, the resistant rate to minocycline was 7.14%,to the other eight antimicrobial agents were all ≥75%, resistant rate to cefotetan was up to 98.21%.ConclusionTigecycline is highly effective against MDR A.baumannii in this hospital.

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ObjectiveTo investigate antimicrobial resistance of commonly isolated pathogenic bacteria in a hospital between January and December 2012, and compared with report of Ministry of Health National Antimicrobial Resistance Investigation Net(Mohnarin),so as to provide reference for the rational use of antimicrobial agents．MethodsClinical specimens were cultured, minimal inhibitory concentration(MIC) of pathogenic bacteria were detected and compared with the absolute difference in drug resistance rate of Mohnarin report,the overall difference in antimicrobial resistance rates was compared respectively by χ2 test.ResultsIn 2012, the total resistance of four kinds of gramnegative bacteria (Acinetobacter baumannii，Escherichia coli，Klebsiella pneumoniae, Pseudomonas aeruginosa) were slightly higher than Mohnarin report; resistance rate of Staphylococcus aureus was lower than average level of Mohnarin report (P<0.01),detection rate of methicillinresistant Staphylococcus aureus was 19.25%,which was lower than 46.1% of average level of Mohnarin report, vancomycinresistant bacterial strain was not found. Extendedspectrum βlactamaseproducing Escherichia coli and Klebsiella pneumoniae was higher than average level of Mohnarin report respectively(37.54% vs 26.2%; 21.33% vs 16.2%,respectively); multidrugresistant Acinetobacter baumannii and Pseudomonas aeruginosa was 9.2% and 1.5% respectively, which approximating to the detection rate of average level of Mohnarin report.ConclusionAntimicrobial resistance of pathogenic bacteria is stable in this hospital, monitor on bacterial antimicrobial resistance is significant for the rational clinical use of antimicrobial agents.

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ObjectiveTo study epidemiological characteristics of sexually transmitted diseases(STDs) in Zhuhai, and provide a scientific basis for the formulating of STD prevention and control measures.MethodsThe epidemic reporting data (2005—2012) of four zones(towns) in seven administrative districts of Zhuhai were analyzed by stratified cluster sampling method.ResultsIn 2005-2012, 3 566 STD cases were reported, the average annual incidence rate was 116.64/100,000. The occurrence of STDs increased year by year, the average annual incidence per 100,000 population was 14.63,19.64,16.89,78.03,56.91,160.27,232.99, and 245.63, respectively. The incidence of syphilis, acquired immunodeficiency syndrome, gonorrhea, genital herpes, Chlamydia trachomatis genital infection and pointed condyloma was 15.90, 2.00, 17.83, 16.58, 37.09, and 27.25 per 100,000 population, respectively. Reported cases mainly concentrated on population aged 20-39 years (80%). The incidence of syphilis in population aged ＞60 years was higher than those aged 20-39 years (25.92/100,000 vs 19.06/100,000）; the incidence of pointed condyloma in 15-19 age group was higher than the average annual incidence （32.82/100,000 vs 27.25/100,000）; there was an increased trend in the development of STDs in housework and unemployed persons.ConclusionIncidence of STDs tends to increase in this city, there is a greater increase in certain STDs, and there is a growing trend in the incidence among general population, indicating the prevention effort on STDs should go deep into all kinds of people, especially in communities and schools.

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ObjectiveTo investigate the efficacy of ATP bioluminescence assay on improving the compliance and qualifying rate of hand hygiene of rotating doctors in an intensive care unit.MethodsBaseline status of hand hygiene of doctors were investigated firstly,then the frequency and methods of monitor according to the results were made, hand hygiene were monitored by ATP bioluminescence assay, results were performed feedback, the status of hand hygiene after intervention were investigated.ResultsA total of 120 doctors participated in the baseline investigation, the total qualified rate of hand hygiene was 73.33%, hand hygiene compliance rate was only 14.17%. After field detection by ATP and feedback intervention, the qualified rate of hand hygiene increased to 82.24%（χ2=13.68，P=0.008）; handwashing compliance rate increased most during the intervention process (69.44%).ConclusionATP bioluminescence assay on the field detection and timely feedback of doctors’ hand hygiene status can improve the hand hygiene compliance and qualified rate.

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ObjectiveTo analyze the epidemiological and clinical characteristics of measles cases, and compare the differences between adult and infant measles. MethodsClinical data of 165 measles patients hospitalized between January 2006 and June 2013 were analyzed retrospectively, epidemiological and clinical characteristics between infant and adult measles were compared.ResultsExcept December, measles occurred all the year round, and mostly occurred between February and August (157 cases, 95.15%).The occurrence of high fever（n=68，82.93%）,Koplik’s spot（n=78，95.12%）,gastrointestinal symptoms（n=43， 52.44%）,eye symptoms（n=61， 74.39%）in adult group were higher than infant group(［n=39， 55.71%］,［n=47， 67.14%］,［n=23， 32.86%］,［n=41， 58.57%］,respectively), duration of Koplik’s spot in adult group was longer than infant group(［5.99±1.57］d vs［3.12±1.41］d)，(all P<0.05）, incidence of abnormal liver function in adult group was significantly higher than infant group(［n=64， 78.05%］vs［n=7， 10.00%］）,while incidence of bronchopneumonia in infant group was higher than adult group（［n=29， 41.43%］ vs ［n=12， 14.63%］）(both P＜0.05）.Of 32 adults who were performed detection of lymphocyte count on the second day of admission, 30(93.75%) were had decrease of absolute CD4+T lymphocyte count (［122.10±96.20］cells/μL)，repeated detection after oneweek treatment showed an elevated CD4+T lymphocyte count （［445.10±187.20］cells/μL） in 26 adults（P＜0.01）.ConclusionAdult measles is more likely to appear high fever, gastrointestinal symptoms, eye symptoms and liver injury, systemic symptoms are serious; while infant measles is more likely to appear bronchopneumonia.

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(CRP) for detecting healthcareassociated infection(HAI) in hospitalized patients without localizing signs of infection.Methods150 patients with suspected HAI were conducted prospective study,diagnostic value of PCT and CRP in the detection of HAI were evaluated.ResultsThe sensitivity, specificity, positive predictive value and negative predictive value of PCT and CRP were (57.14% vs 76.19%）,（89.15% vs 48.06%）,（46.15% vs 19.28%）,and （92.74% vs 92.54%）,respectively. Positive likelihood ratio of PCT was higher than CRP （5.26 vs 1.46）. The area under the curve(AUC）was 0.80 (95% CI： 0.68-0.91) for PCT and 0.73 (95% CI： 0.63-0.82) for CRP;the optimal cutoff value was 7.49 ng/mL for PCT and 39.01 mg/L for CRP.ConclusionPCT and CRP are valuable for diagnosing HAI, the specificity and positive predictive value of PCT are higher than CRP.

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ObjectiveTo evaluate the changes and clinical significance of platelet and blood coagulation function in elderly patients with bacteremia in an intensive care unit (ICU).MethodsTwentyfour elderly patients with bacteremia were detected platelet count (PLT) and blood coagulation function before and after bacteremia occurred, PLT and blood coagulation function were compared among different pathogen infection groups (grampositive coccus, gramnegative bacillus and fungus) and between survival and death group.ResultsAfter bacteremia occurred, PLT count was(144.50±84.10）×109/L, activated partial thromboplastin time(APTT) was (47.04±14.60)s，prothrombin time (PT) was (18.63±8.92)s, and fibrinogen (FIB) was （4.20±0.98）g/L, compared with baseline values (［233．18±78.20］×109/L, ［33.98±7.36］s, ［12.83±2.17］s, ［3.16±0.79］g/L,respectively),the differences were significant （P<0.05）,but thrombin time (TT) was not significant(P>0.05). PLT and blood coagulation function were not significantly different among different pathogen infection groups(P>0.05). PLT in death group was much lower than survival group(［89.60±36.42］×109/L vs ［213.13±76.06］×109/L)（P<0.05）, APTT was higher than survival group(［54.55±13.21］s vs［35.93±7.03］s)（P＜0.05）, both FIB and PT were not significantly different between death and survival group(P>0.05).ConclusionPlatelet and partial blood coagulation function indexes can be used as auxiliary diagnosis of bacteremia in elderly patients, and to some extent, it can judge prognosis.

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ObjectiveTo investigate the application of quinolones, so as to promote the rational use of antimicrobial agents.Methods Four hospitals in Dongguan area were randomly selected, 1 085 prescriptions and related medical records of outpatients from April to May 2013 were analyzed retrospectively.ResultsA total of 6 kinds of quinolones were used, three most frequently used quinolones were levofloxacin（48.01%）, ciprofloxacin（28.52%） and ofloxacin（13.90%）; 85.53% of prescriptions were intravenous drip (928 cases, 654 were only intravenous drip,274 were intravenous drip plus oral administration), quinolones were commonly used in the treatment of urinary tract infection（358 cases，33.00%）, digestive system infection（305 cases，28.11%）, and lower respiratory tract infection（211 cases，19.45%）; 166 prescriptions were 2drug combination, 3drug and more combination use was not found; irrational combination drug use existed, including combination of oral administration of quinolones and H2 receptor blocking agents， H+ pump inhibitors, magnesium and aluminiumcontaining antiacids.ConclusionThe prescriptions of quinolones for outpatients in this area are basically rational, but the choice of indications, combination use, dosage form, and dosage administration need to be improved.

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ObjectiveTo compare the cleaning efficacy of gynecological and obstetrical surgical instruments by different cleaning methods, so as to find out the effective cleaning method.MethodsSixty sets of artificial abortion instruments used in an outpatient department of gynecology and obstetrics were randomly divided into 3 groups(A,B,C, 20 for each), group A adopted multienzyme immersion in combination with manual clean, group B adopted multienzyme immersion combined with machine wash, and group C adopted ultrasonic clean with machine wash, cleaning efficacy of three groups were compared. ResultsAssessment by visual inspection and magnifying glass showed that the qualified rate of cleaning of group C was significantly higher than group A and B(99.78% vs 73.48%; 99.78% vs 78.70%; both＜0.0125）;group A and B was not significantly different (P＞0.0125). The qualified rate of cleaning of nonlumen instruments in group A and B were both significantly higher than lumen instruments (both P<0.05). Occult blood test result showed that the qualified rate of group C was significantly higher than group A and B (99.16% vs 75.00%; 99.16% vs 80.61%; both P＜0.0125）; group A and B was not significantly different (P＞0.0125). The qualified rate of cleaning between lumen and nonlumen instruments of three groups was not significantly different respectively (all P>0.05).ConclusionOn the basis of immersion in multienzyme,ultrasonic clean in combination with machine wash can improve the cleaning quality of intricate and lumen instruments and ensure the sterilization efficacy.

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目的调查某院神经外科病区黏质沙雷菌感染发生的原因及危险因素，采取有效干预措施，最大限度地减少医院感染的发生。方法通过现场调查和查阅病历相结合的方法，对2012年5月—2013年5月神经外科病区发生的6例黏质沙雷菌感染进行流行病学调查，同时进行环境微生物学检测。采取综合性防控措施进行干预。结果6例患者均为手术后感染黏质沙雷菌。环境微生物学检测结果显示，负责理发备皮的护工手部及理发的刀架上均分离出黏质沙雷菌。强调医务人员手卫生的重要性和无菌操作，重视环境及物体表面的消毒后，未再出现此类感染病例。结论医院感染危及患者的医疗安全，应用流行病学方法及环境微生物学检测手段可以有效促进医院感染的防控；加强医务人员手卫生的管理及重视环境、物体表面的消毒，可以准确控制、有效预防医院感染的发生。

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目的探讨医院感染防控措施对降低新生儿病房轮状病毒（RV）肠炎医院感染的效果。方法观察组：某院2012年1—12月新生儿病房收治的2 032例新生儿，同期采取一系列RV肠炎医院感染防控措施；对照组：该院2011年1—12月新生儿病房收治的2 007例新生儿，执行一般诊疗护理常规。比较两组新生儿RV肠炎医院感染情况。 结果观察组发生RV医院感染12例，发病率为0.59%；对照组发生RV医院感染36例，发病率为1.79%，观察组新生儿RV医院感染发病率显著低于对照组（χ2＝12.45，P＜0.01）。新生儿RV肠炎医院感染以冬春季多发，医院感染病例主要集中在1、2和12月，3～5月少量散发，6～11月无RV肠炎医院感染发生。结论通过采取主动筛查、提高工作人员手卫生依从性、严格执行消毒隔离制度等一系列医院感染防控措施，能有效降低新生儿病房RV肠炎医院感染发病率，避免医院感染的暴发流行。

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目的在集中式管理模式下，利用原有的人力资源，持续改进消毒供应质量。方法各区域设立区域责任人，并由责任人担任质量控制小组成员，全面流程化运作下实行区域责任制。选取分责前后各项数据进行组间比较。结果分责前后各项数据组间比较结果显示，质量管理及物资管理合格率在分责后均明显上升，差异均有统计学意义（P＜0.05）；分责后临床科室满意度由76.00%提升至96.00%，差异有统计学意义（P＜0.05）。结论消毒供应中心实行区域责任制，提高了集中消毒供应质量。

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目的了解开展医院感染知识培训对提高医务人员感染控制知识水平及手卫生依从性的作用。方法 2012年8月—2013年2月，对某院医务人员开展医院感染知识培训（采取讲课、现场指导和情景模拟相结合的方式），比较培训前后医务人员医院感染知识掌握情况和手卫生执行情况。结果培训前医务人员医院感染知识掌握合格率（46.08%,229/497）与培训后（95.77%，476/497）比较，差异有统计学意义（χ2=297.6，P＜0.001）。培训后医务人员无菌操作考试合格率显著高于培训前［（96.88%，62/64）vs（39.06%，25/64）；χ2=42.9，P＜0.001］；手卫生依从率显著高于培训前［（73.75%，177/240）vs（29.17%，70/240）；χ2=19.89，P＜0.01］，各洗手指征手卫生执行情况均显著提高（均P＜0.01）。结论理论培训结合现场指导和情景模拟的方式可以提高医务人员感染控制知识水平及手卫生依从性。

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目的了解某院住院患者医院和社区感染现状，为有效预防和控制医院感染提供依据。方法采取床旁调查与查阅病历相结合的方法，对该院2011年6月9日和2012年6月19日0∶00—24∶00的住院患者进行调查。结果2011、2012年分别调查住院患者899例、1 107例，医院感染率分别为3.23%、3.79%，两者比较，差异无统计学意义（χ2=0.47，P＞0.05）；2011年社区感染率(15.57%)显著高于2012年（9.94%；χ2=14.45，P＜0.01）。医院和社区感染的感染部位均以下呼吸道为主。2012年抗菌药物使用率(33.33%,369例）显著低于2011年（48.83%，439例；χ2=49.54，P＜0.01）;治疗性使用抗菌药物占抗菌用药的比例(81.30%,300例)和病原学送检率(50.33%,151例）显著高于2011年［分别为58.54%（257例)、36.96%（95例）；均P＜0.01］。 2011和2012年医院感染病原学送检率分别为56.76%（21例）、77.78%（35例）；均以检出鲍曼不动杆菌为主，分别占18.18%（6/33）、28.57%（8/28）。结论现患率调查有助于了解医院感染情况，为抗菌药物的合理应用、制定医院感染预防控制措施提供依据。

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［摘要］目的了解某院腹股沟疝修补术围手术期抗菌药物使用情况。方法采用回顾性调查方法，对该院2011年138例腹股沟疝修补术患者病历资料进行分析。结果抗菌药物使用率为94.93%（131/138），联合用药率达39.69%（52/131）。共使用8大类抗菌药物，居前3位的是哌拉西林/他唑巴坦（29例次）、依替米星（26例次）和头孢呋辛（23例次）。二联用药46例，三联用药6例，以依替米星+哌拉西林/他唑巴坦（6例次）和依替米星+头孢曲松/他唑巴坦（6例次）为主。平均抗菌药物费用为1 002.68元，占药费的41.69%。结论该院腹股沟疝修补术围手术期抗菌药物使用存在用药起点高、时间长、无指征用药等不合理现象，需引起医院相关部门的重视，采取措施，规范抗菌药物的使用。

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目的了解基层医院综合性重症监护室（ICU）住院患者医院感染发病情况，为制定医院感染预防控制措施提供依据。方法按照《医院感染监测规范》中目标性监测方法，对某院2012年7月—2013年6月间的综合ICU住院患者进行监测。结果共监测537例患者，发生医院感染37例，感染率为6.89%，例次感染率为7.26%，日感染率为15.20‰，调整日感染率为5.05‰；医院感染部位以下呼吸道为主，占89.74%。呼吸机相关日感染率为35.14‰；导尿管相关日感染率为0.98‰；中心静脉插管相关日感染率为0。共分离病原菌49株，其中革兰阴性菌33株（67.35%），革兰阳性菌4株（8.16%），真菌12株（24.49%）。结论基层医院综合ICU医院感染控制重点是下呼吸道感染，以革兰阴性菌为主。感染管理涉及多个部门、多个环节，需要多部门、多学科加强合作。

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目的探讨某院新生儿重症监护室（NICU）极低出生体重儿(VLBWI)医院感染病原体分布及耐药性。方法对该院NICU 2007年1月—2013年1月收治的127例VLBWI病历资料进行回顾性分析。结果发生医院感染46例次，例次感染率为36.22%；共分离病原体46株，其中革兰阴性（G-）菌27株（58.70％），革兰阳性（G+）菌16株（34.78％），真菌3株（6.52％）；常见病原体为大肠埃希菌(13株，28.26％)、肺炎克雷伯菌(10株，21.74％)、凝固酶阴性葡萄球菌(9株，19.57％)和金黄色葡萄球菌(5株，10.87％)。大肠埃希菌对氨苄西林的耐药率最高（84.62%），除头孢哌酮/舒巴坦和头孢他啶外，对其他头孢类抗生素的耐药率均＞69%；肺炎克雷伯菌对氨苄西林的耐药率达90.00%，对阿莫西林/克拉维酸、环丙沙星和庆大霉素的耐药率为40.00%，除头孢哌酮/舒巴坦外，对其他头孢类抗生素的耐药率均＞60%。G+菌对青霉素、苯唑西林耐药率＞60%；对头孢唑林和头孢西丁的耐药率也＞40%。结论该院NICU住院的VLBWI医院感染病原菌对常用抗菌药物普遍耐药；进行病原体监测，有助于了解其流行趋势及耐药特点，以便合理用药，预防医院感染。

Abstract:

目的了解某院淋病奈瑟菌感染患者流行病学特征，为相关单位控制其感染提供依据和对策。方法对2012年该院皮肤性病科101例就诊患者进行调查，对其送检的生殖道分泌物标本进行淋病奈瑟菌的分离鉴定。结果检出淋病奈瑟菌65例，检出率为64.36%，均为男性患者。患者年龄主要分布在17～24岁和47～65岁组，分别占47.70%（31例）、46.15%（30例），其他仅占6.15%（4例）。学生和社会青年所占比率高达53.85%（35/65），其次为农民24.62%（16例）；所有患者均有不洁性生活史。结论淋病奈瑟菌感染人群向年轻化、老年化发展，农民患者数量上升。应引起相关部门重视，加强宣传，控制感染。