Abstract:

ObjectiveTo study the relationship between Notch ligand Deltalike 1 (Dll1)，MHC class I molecule (MHCⅠ) in mice pulmonary alveolar macrophages (PAM) and cellular immunity response based on cytotoxic Tlymphocytes(CTLs) ,and provide  theoretical basis for the preparation of vaccine against influenza virus. MethodsMice were randomly divided into 3 groups：heterosubtypic immune group(immunized with recombinant virus  vaccine  rLH5 ), homosubtypic immune group ( immunized with  A/H1N1 influenza virus vaccine), and viral infection group(immunized with PBS). Mice immunized with different vaccines were all infected with A/H1N1 influenza virus. mRNA expression of NotchDll1 and MHCⅠ among 3 groups were compared, levels of IFNγ and T cells in  3 groups were studied.  ResultsAt day 4,7 of postinfection, in heterosubtypic immune group, mRNA expression of NotchDll1( ［0.01460±0.00125］),［0.01750±0.00196］) and MHCⅠ (［0.03050±0.0029］,［0.0495±0.0024］) were both higher than those before infection (［0.00045±0.00004］ , ［0.0120±0.0018］) , in viral infection group, mRNA expression of NotchDll1(［0.01010±0.00107］,［0.01320±0.00143］) and MHCⅠ (［0.0219±0.0024］,［0.0248±0.0022］)were both higher than those before infection( ［0.00032±0.00007］ ,［0.0090±0.0013］)；At day 4,7 of postinfection , mRNA expression of NotchDll1 and MHCⅠ in heterosubtypic immune  group were both higher than those in homosubtypic immune group (NotchDll1 ［0.00089±0.00018］,［0.00143±0.00096］ ； MHCⅠ ［0.0038±0.0008］,［0.0008±0.0002 ］) and viral infection group，the difference was statistically significant(all P<0.05). At day 7 of postinfection, the percentage of IFNγ and CD8+T cells in heterosubtypic immune  group was（3.31±0.34）% , which was significantly higher than homosubtypic immune group （［0.38±0.06］%）and viral infection group (［1.58±0.27］%) ; At day 5 of postinfection , viral load of heterosubtypic immune group （［6.26×105±3.7×105 ］copies/μL) was  lower than that of viral infection group （［6.85×107±2×107］ copies/μL)，but higher than that of homosubtypic immune group（［400±250 ］copies/μL ) (all P<0.05).  ConclusionNotchDll1 and MHCⅠ in mice PAM may play active roles by promoting CTL differentiation during heterosubtypic immune  against influenza virus.

Abstract:

ObjectiveTo investigate transmission routes of healthcareassociated infection(HAI) caused by methicillinresistant Staphylococcus aureus (MRSA), and make effective measures for preventing and controlling the occurrence and epidemic of HAI caused by multidrugresistance bacteria.MethodsFrom February 24 to March 29,2012, 12 MRSAinfected patients were performed epidemiological study, these patients underwent  bronchoscopy because of tracheal stenosis, strains were identified by amplifying the sequences of 16S rRNA, femA and mecA with  realtime quantitative polymerase chain reaction （PCR）， homology analysis of strains were performed by Spa genotyping. ResultsAll 12 MRSAinfected patients were susceptible to multidrugresistance bacterial infection, 5 cases of MRSA infection  occurred during this hospitalization. Detection of specimens from health care workers and environment were all negative; Spa gene of all 12 MRSA isolates was type t 030,  which was the main epidemic strain in Asia; Spa gene of Staphylococcus aureus isolated from nurses’ noses was type t1425.ConclusionThe assumption of MRSA spread among health care workers aren’t supported by the epidemiological investigation results, genotypes of 12 MRSA isolates are identical, but the result of gene typing can’t be as the evidence of homology of infection ; patients at high risk for MRSA infection should be screened as early as possible, early contact isolation should be performed, so as to prevent and control the occurrence of HAI.

Abstract:

ObjectiveTo realize the incidence of healthcareassociated infection (HAI),the rate of invasive procedure and related infection rate, use of antimicrobial agents and distribution of pathogens in gereral intensive care units (GICUs) of hospitals in China. MethodsHAI crosssectional investigation data  of GICUs reported to China HAI Surveillance Network were summarized and analyzed.ResultsOf 1 313 hospitals, 621（47.30%）had GICUs；a total of 5 887 patients were surveyed, 1 634 patients developed 1 962 times of infection，HAI prevalence rate and case rate was 27.76% and 33.33% respectively. The main infection sites were lower respiratory tract（70.39%），urinary tract （12.79%） and blood（2.86%）.The application rate of urinary catheter, arteriovenous catheter and ventilator was 53.52%（n=3 151）,37.05%（n=2 181）and 35.62%（n=2 097）respectively，and related prevalence of urinary tract infection, pneumonia and blood stream infection was 4.67%,20.41%, and 0.60%，respectively，which accounting for 58.57%,30.99%, and 23.21% of urinary tract infection, pneumonia and blood stream infection respectively, the overall prevalence of above invasive procedurerelated infection accounted for 29.97%（588/1 962）of the overall HAI prevalence.A total of 1 795 isolated pathogens causing HAI were detected，the top three were Pseudomonas aeruginosa（20.78%）, Acinetobacter baumannii (17.99%) and Klebsiella pneumoniae (11.64%). The usage rate of antimicrobial agents was 71.58%（n=4 214），rate of specimens delivered for detection  was up to 75.27%（2 553/3 392）.ConclusionPrevalence and antimicrobial use in patients in GICUs are all high, all kinds of invasive procedure are frequent, 30% of HAI are related to invasive procedure; infection caused by nonfermentative bacteria is serious, pathogen detection is well performed.

Abstract:

ObjectiveTo investigate risk factors for healthcareassociated infection(HAI) in patients with craniocerebral operation, and provide reference for the  prevention and control of HAI.MethodsA total of 4 246 cases of craniocerebral surgery in a neurosurgery department  from January  2010 to December 2012 were enrolled in the study,  the risk factors for HAI were analyzed.ResultsOf 4 246 cases of craniocerebral surgery, 393 patients developed 446 times of postoperative HAI,HAI incidence rate was 9.26%, case infection rate was  10.50%, which were higher than  incidence (2.02%) and case infection rate (3.02%) of HAI of all hospital during the same period,the difference was statistically significant (χ2=811.06, 629.30,respectively, P<0.001). The major infection site was  central nervous system (56.50%), followed by respiratory system (27.36%). Unconditional univariate logistic regression analysis showed that sex, age, communityacquired infection, primary disease, operative time, length of stay in intensive care unit (ICU) before infection,  the number of surgery, invasive procedures and nasogastric tube, the difference was statistically significant (all P<0.05). Multivariate logistic regression analysis showed that sex, elderly patients, congenital brain diseases, stay in ICU>7 d, antimicrobial use >7 d, central venous and urinary tract catheterization, invasive ventilator were risk factors for HAI in patients with craniocerebral operation.ConclusionThe incidence of HAI in patients with craniocerebral operation is high,effective preventive and control measures according to risk factors  should be strengthened to reduce the incidence of HAI.

Abstract:

ObjectiveTo investigate healthcareassociated infection(HAI) prevalence and antimicrobial use in a hospital. MethodsHAI prevalence rate, antimicrobial use and pathogen detection in all inpatients on August 21, 2013 were investigated with crosssectional survey method.  ResultsA total of 2 238 inpatients were investigated, 104 patients developed 126 times of HAI, HAI prevalence rate and case rate was 4.65% and 5.63% respectively; the top four sites for HAI were lower respiratory tract (28.57%), upper respiratory tract(18.25%), urinary tract(7.94%) and gastrointestinal tract(4.76%).Rate of specimens delivered for detection was 91.35%(95/104), the main specimen was sputum (26.32%),followed by blood (25.26%) and urine (10.53%). Antimicrobial usage rate was 24.58%, therapeutic, prophylactic plus therapeutic, and prophylactic use accounted for 36.55%, 45.09%, and 18.36% respectively; the usage rate of single, combination of 2, and 3 antimicrobial agents accounted for 75.82%,20.91% and 3.27% respectively. Risk factors of HAI were age (<15 or >60 years), all kinds of invasive procedures (tracheotomy, mechanical ventilation, urinary catheterization, arteriovenous  intubation, hemodialysis), and antitumor chemotherapy.  ConclusionSurvey on HIA prevalence helps to know the occurrence of HAI and usage of antimicrobial agents, as well as risk factors and highrisk departments of the occurrence of HAI, it also provides basis for subsequent targeted monitor on HAI.

Abstract:

ObjectiveTo study the risk factors for catheterrelated bloodstream infection (CRBSI) in an intensive care unit （ICU）, and provide scientific evidence for CRBSI prevention and control. Methods1 677 ICU patients with central venous catheterization (CVC) for>48 hours between January 2008 and December 2012 were divided into CRBSI group and nonCRBSI group, risk factors  for CRBSI were analyzed. ResultsThe utilization rate of CVC was 92.88% (21 041 d); 86 (5.13%) patients developed CRBSI, the incidence of CRBSI per 1 000 catheterizationday was 4.02, the mortality of CRBSI group was significantly higher than nonCRBSI group (58.14% ［50/86］ vs 36.83%［586/1 591］)（χ2=15.74，P＜0.01）.Multivariate logistic regression analysis showed that the risk factors for CRBSI included length of stay in ICU>5 days, CVC>5 days, the episode of CVC>1 (P<0.01). ConclusionRealizing the occurrence status and risk factors of CRBSI in ICU patients can provide reference for further targeted monitor and implementation of zero tolerance goal of the CRBSI.

Abstract:ObjectiveTo investigate the occurrence of healthcareassociated infection(HAI) and catheterrelated infection in a general intensive care unit(GICU) ,so as to strengthen the management. MethodsTargeted monitor method was adopted, monitor scheme was established , personal monitor contents and forms were designed, hospitalized GICU patients were investigated prospectively between May 2012 and May 2013, and surveyed data were analyzed.ResultsA total of 868 patients were investigated, 65 times (7.49%) of HAI occurred; infection rate per day was 21.49‰, adjust infection rate per day was 7.26‰. Infection rate of ventilatorassociated pneumonia , catheterassociated urinary tract infection ,and central venous catheterrelated bloodstream infection per day was 23.91‰, 3.46‰, and 6.12‰, respectively; the main infection site was respiratory tract ( 67.69%). Sixtyfive isolates of pathogens were detected, 81.54%（n=53）of pathogens were gramnegative bacilli, and with multidrug resistance.ConclusionHAI rate is high in GICU , the use of various types of catheters is an important factor for HAI in GICU patients. Targeted monitoring on ICU is a scientific and effective method , it can timely reflect the weak links of infection control practice and promote HAI control .

Abstract:

ObjectiveTo investigate the economic losses in kidney transplant patients with healthcareassociated lower respiratory tract infection(LRTI). MethodsAll transplant patients in a hospital from 2008 to 2012 were investigated, patients with LRTI were in infection group(n=45) , and patients without LRTI were in control group(n=266) , hospitalization expenses and hospitalization days between two groups were compared. ResultsA total of 383 kidney transplant patients were included in the study, the incidence of LRTI was 11.75% (n=45), median expense of infection group and control group was  ￥79 291.82 and  ￥72 185.14 respectively, the difference was not statistically significant (P>0.05). The largest increased expense in patients with LRTI was medicine ( increased by ￥5 429.82) , medicine and examination expense in infection group were significantly higher than control group (￥39 123.17 vs ￥33 693.35; ￥702.52 vs  ￥593.73; P<0.05).The median  hospitalization days in infection group and control group was  28.38 days and 21.47 days respectively，there was significant difference between two groups（P＜0.05）.  ConclusionKidney transplant patients with LRTI suffer from a heavy financial burden, and their hospitalization days are prolonged, so measures should be taken to prevent the occurrence of LRTI and save limited medical resources.

Abstract:

ObjectiveTo evaluate the clinical significance of serum procalcitonin (PCT) in early diagnosis of pulmonary tuberculosis (PTB) complicated with pulmonary infection. MethodsClinical data of active PTB patients admitted to a hospital between August and December 2013 were collected, patients were divided into bacterial infection group(n=104), fungal infection group(n=37) and control group (n=95) according to whether patients were associated with bacterial infection, fungal infection, and without infection, serum PCT concentrations in three groups were compared, receiver operating characteristic (ROC) curve analysis was conducted. ResultsThe median PCT concentrations in bacterial infection and fungal infection group was 0.44ng/mL and 0.30ng/mL respectively，which was significantly higher than 0.16ng/mL of control group（Z=9.49，3.51 respectively，both P<0.001）. The area under curve (AUC) was 0.89（0.84-0.93）and 0.69（0.61-0.77）respectively; cutoff point was 0.31 ng/mL and 0.27 ng/mL respectively; sensitivity was 79.81%（70.57%-86.80%）and 59.46%（42.19%-74.80%） respectively; specificity was 83.16%（73.79%-89.78%） and 73.68%（63.48%-81.95%）respectively.ConclusionPCT level is a valuable predictor for early diagnosis of PTB complicated with pulmonary infection, and can provide reference for the rational use of antimicrobial agents.

Abstract:

ObjectiveTo investigate the change in distribution and antimicrobial resistance of pathogens from blood culture of children，and provide a basis for treatment of bloodstream infection. MethodsPathogens isolated from blood culture of hospitalized children between January 2009 and December 2013 were divided into group 2009—2011 and 2012—2013. Distribution and antimicrobial susceptibility of pathogens were analyzed. ResultsFrom 2009 to 2013, a total of 48 455 blood specimens were taken for culture, 2 730 pathogenic bacteria were isolated, positive rate was 5.63%. The positive rate of blood culture decreased yearbyyear (χ2=415.30，P＜0.01).Of 2 730 isolates of pathogenic bacteria，grampositive bacteria, gramnegative bacteria, and fungi accounted for 80.37% (n=2 194），18.68%（n=510），and 0.95%（n=26）respectively. The difference between two groups of pathogenic bacteria was significant（χ2=180.334，P＜0.001）. Susceptibility rates of grampositive cocci to vancomycin, linezolid and teicoplanin were all  100%, resistance rates of coagulasenegative Staphylococcus and Staphylococcus aureus to ciprofloxacin, compound sulfamethoxazole and tetracycline all decreased. Susceptibility rates of gramnegative bacilli to imipenem,meropenem and amikacin were all≥97.50%, susceptibility rate of Klebsiella pneumoniae to levofloxacin was 100%; Of cephalosporins, Escherichia coli and Klebsiella pneumoniae had high resistance except ceftazidime  and  cefepime.   ConclusionDistribution of pathogens from blood culture of children in 20092013 changed significantly, pathogens have high resistance to commonly used antimicrobial agents,more attention should be paid to the monitor of pathogens from blood culture and pathogenic antimicrobial resistance.

Abstract:

ObjectiveTo investigate the activities associated with nurses’ occupational exposure to bloodborne pathogens and the source patients’infection status during blood collection process, so as to provide a basis for developing occupational exposure prevention strategies.MethodsData about occupational exposure to bloodborne pathogens during blood collection process in a hospital from August 2011 to September 2013 were monitored. ResultsA total of 89 times of bloodborne exposure occurred among HCWs, including 75 times of arterial blood collection and 14 venous blood collection. The top three procedures of occupational exposures were rebounding of needles after needles were pulled out (28.09%,n=25)， concentrated cleaning up of rubbish at the end of blood collection  (20.22%,n=18)，and  touching blood and body fluids by skin and mucous membrane （14.61%,n=13）. 48.31% (n=43) source patients infected with at least hepatitis B virus， hepatitis C virus , hepatitis E virus， Treponema pallidum，and human immunodeficiency virus , 51.69%(n=46）source patients were not infected ,after proper handling, none of nurses were infected during blood collection . ConclusionDeveloping safe bloodwithdraw needle，putting sharp instrument into sharp instrument container，wearing gloves, and intensifying training of  standard and occupational precaution are important strategies for the reducing of the occurrence of bloodborne exposure of clinical nurses during  blood collection process .

Abstract:

目的 探讨通过开展目标性监测和采取综合干预措施，对肿瘤患者经外周置入中心静脉导管（PICC）导管相关血流感染（CRBSI）率的影响。方法对某院2012年7月—2013年6月入住肿瘤科的164例PICC患者进行目标性监测和综合干预（作为观察组），以2011年7月—2012年6月入住肿瘤科的122例PICC患者作为对照组，比较两组患者医院感染及CRBSI发生情况。结果观察组患者评估资料完整率为98.17%（161/164），显著高于对照组的81.97%（100/122），差异具有统计学意义（χ2=23.03，P＜0.001）。观察组发生医院感染5例，医院感染率3.05%；对照组发生医院感染10例，医院感染率8.20%，两组比较，差异具有统计学意义（χ2=4.145，P＜0.05）。观察组患者CRBSI发生率为0.61%，明显低于对照组的4.10%（χ2=3.371，P＜0.05）。结论对肿瘤科PICC患者进行目标性监测，采取综合干预措施，能有效预防和控制PICC患者CRBSI的发生，确保患者置管及留置的安全。

Abstract:

目的了解某院住院患者医院感染现状，为制定目标监测方案及完善预防控制措施提供依据。方法采用床旁调查与病历调查相结合的方法进行医院感染现患率调查。根据《医院感染诊断标准（试行）》对医院感染病例进行诊断。结果实查住院患者2 511例，发生医院感染198例，219例次，医院感染现患率为7.89%，例次现患率为8.72%。医院感染现患率最高的科室为重症监护室（45.00%，9/20）。医院感染部位以下呼吸道（46.58%，102/219）居首位。共检出病原菌269株，其中细菌226株（84.01%），以革兰阴性菌为主；真菌43株（15.99%）。调查日抗菌药物使用率为31.38%（788/2 511），治疗用药病原学送检率为54.69%（373/682）。结论通过此次调查，了解了该院医院感染的真实情况，为目标监测的开展和干预措施的完善提供了可靠依据。

Abstract:

目的了解某院医院感染现状，为有效预防和控制医院感染提供依据。方法对该院2010—2012年收治的住院患者进行医院感染监测回顾性分析。 结果3年实查住院患者174 966例，发生医院感染3 025例次，医院感染例次发病率为1.73%。其中2010年医院感染例次发病率为2.15%（1 204例次），2011年为1.63%（971例次），2012年为1.43%（850例次），2010—2012年医院感染发病率逐年下降。医院感染发病率最高的科室为心胸外科（14.12%），其次为肝病科（5.44%）、神经外科（4.43%）等；感染部位按感染率由高至低排列依次为下呼吸道（39.97%）、上呼吸道（28.99%）、胃肠道（9.12%）、泌尿道（5.29%）等。感染病原菌主要为大肠埃希菌（20.21%），其次为铜绿假单胞菌（15.66%）、肺炎克雷伯菌（12.38%）等。 结论应针对医院感染的高发科室、高发部位及检出率较高的病原菌，重点开展目标性监测，尤其要加强对呼吸道感染的预防控制及医务人员的持续培训，增强无菌操作意识，提高手卫生依从性，以有效预防和控制感染的发生。

Abstract:

目的了解某院医院感染现状、抗菌药物使用情况及医院感染管理中存在的问题，为进一步提高医院感染监控质量提供科学依据。方法采用床旁调查和查阅在架病历相结合的方法对该院2012年8月20日0∶00—24∶00间的所有住院患者进行医院感染现患率调查。结果共调查290例住院患者，发现医院感染病例10例，10例次，医院感染现患率和例次现患率均为3.45%；社区感染109例，112例次，社区感染现患率为37.59%，例次现患率为38.62%。调查日抗菌药物使用率为65.52%（190/290）。治疗性使用抗菌药物者病原送检率为28.32%（32/113）；分离病原菌14株，阳性检出率43.75%（14/32）。医院感染高发部位为下呼吸道（占40.00%），其次为浅表手术切口（占30.00%）。结论该院应加强重点部门、重点部位的监督管理，加强抗菌药物合理应用管理，提高病原学送检率。

Abstract:

目的了解采取手卫生管理策略对提高医护人员手卫生依从性的效果。方法对某院临床科室手卫生设施配备情况和医护人员手卫生执行情况进行督查，比较2012年4月和2013年4月（干预前后）医护人员手卫生的依从性。结果2013年4月，抗菌洗手液和干手物品配备合格率分别为88.89%、66.67%，明显高于2012年4月的18.18%和0；医护人员洗手方法合格率（96.43%）和手卫生依从率（81.15%）亦显著高于2012年4月（分别为63.64%、51.40%），差异有统计学意义（均P＜0.05）；医护人员接触患者前后和接触患者物品后手卫生依从性均显著高于2012年4月（均P＜0.05）。结论采取有效的手卫生管理策略，可提高医护人员手卫生依从性，保障医疗安全。

Abstract:

呼吸机相关性肺炎(ventilatorassociated pneumonia,VAP)是机械通气患者常见的并发症之一,也是引起重症监护室（ICU）住院患者感染的常见原因。目前临床上VAP的发生率及病死率仍居高不下，探寻更为有效的防治措施任重道远。众多研究表明，免疫调理在治