Abstract:

ObjectiveTo investigate the spatiotemporal distribution characteristics of syphilis epidemic in Mainland China in 2005-2011.MethodsGeographic information system was established based on the data of syphilis epidemic and demographic information from online reporting system of 31 provinces, municipalities and autonomous regions of Mainland China from 2005 to 2011, global indication of spatial autocorrelation(GISA), local indication of spatial autocorrelation (LISA), and spatialtemporal cluster analysis were conducted by GeoDa 0.95i and SaTScan 9.1.1 software, high risk areas of spatialtemporal distribution of syphilis were determined. ResultsThe number of syphilis in Mainland China in 2005-2011 were 1 841 217 cases, annual incidence was 20.07/100 000, suggesting a sign of obvious cluster distribution. Except 2011, GISA coefficient Moran’s I were statistically different. According to LISA analysis, Jiangsu, Shanghai, Zhejiang and Fujian lay in highhigh region in 2005-2009, Chongqing lay in highlow region in 2006-2008, and in 2011, no area was found in highhigh region. Spatiotemporal cluster analysis showed that the most likely cluster was in Shanghai and Zhejiang (2009-2011); the secondary cluster distributed in five areas, including Guangdong, Guangxi and Hainan (2009-2011), Xinjiang (2009-2011), Liaoning and Jilin (2010-2011), Gansu, Ningxia, Shaanxi, Sichuan, Chongqing, Shanxi and Inner Mongolia (2011), Beijing and Tianjin (2008-2010).ConclusionSignificant spatiotemporal cluster pattern is found for the distribution of syphilis in mainland China, which can be meaningful for pertinent control.

Abstract:

ObjectiveTo evaluate the influence of perioperative antimicrobial prophylaxis in surgical site infection (SSI) following thyroid surgery.MethodsApplication of antimicrobial agents, healing status of surgical wound, and occurrence of healthcareassociated infection (HAI) in thyroid surgery patients before and after performing antimicrobial stewardship program were surveyed and compared. ResultsAntimicrobial use prevalence was 99.53%（211/212） in 2011 (from April to August, before stewardship intervention) and 10.89% （22/202）in 2012 (from April to August, after stewardship intervention), difference was statistically different（χ2=334.23，P＜0.001）. HAI rate was 3.77% (8/212) in 2011 and 2.97%(6/202) in 2012, and SSI rate was 1.42% (3/212) and 0.99% (2/202) respectively. There was no statistical difference in HAI and SSI rate between two groups(P>0.05).ConclusionRational perioperative antimicrobial prophylaxis enhanced significantly after antimicrobial stewardship program was performed, the reducing of perioperative antimicrobial use does not result in the increase of SSI and HAI rate.

Abstract:

ObjectiveTo investigate the species and drug resistance of pathogens causing bloodstream infections in hospitalized patients,and provide scientific evidence for antimicrobial use and control of healthcareassociated bloodstream infection.MethodsFrom January 1 to December 31,2012, 16 428 blood specimens were performed blood culture,pathogens were isolated and performed antimicrobial susceptibility testing.ResultsOf 16 428 blood specimens from 5 546 patients, 384 (6.92%) were positive for blood culture, 398 pathogenic isolates were detected, of which grampositive bacteria, gramnegative bacteria, and fungi accounted for 23.62% (n=94),68.34% (n=272), and 8.04% (n=32) respectively, positive rate of blood culture were highest in 61-80 age group(8.26%), the top five departments of positive rate of blood culture were departments of burn, traditional Chinese medicine, cardiac intensive care unit, transplantation and traumatology; grampositive cocci were highly susceptible to vancomycin, teicoplanin and linezolid, one Enterococcus faecium strain was found to be resistant to vancomycin; Among gramnegative bacilli, Enterobacteriaceae were highly susceptible to amikacin and carbapenems; drug resistance rates of Acinetobacter baumannii and Pseudomonas aeruginosa to carbapenems was70.97% and 35.90% respectively. ConclusionGramnegative bacteria are the major pathogens causing bloodstream infection, positive rate of blood culture of elderly people is high. It is necessary to conduct regular surveillance on distribution and drug resistance of pathogens.

Abstract:

ObjectiveTo evaluate the correlation between serum procalcitonin concentration and systemic inflammatory response syndrome (SIRS) score in patients with bacterial bloodstream infection.MethodsIn JanuaryDecember, 2012, 96 patients with bacterial bloodstream infection in a hospital were selected as trial group, and these patients were divided into three groups(group A,B and C) according to SIRS score; 84 patients without bacterial infection was as control group, PCT concentration of all patients were detected, and the correlation between PCT concentration and SIRS score was analyzed. ResultsAmong 96 patients with bacterial bloodstream infection,7 （7.29%）died (4 were in group B and 3 in group C); there was no death case in control group. PCT concentration in control group, group A,B and C of trial group were （0.28±0.09）ng/mL,（0.63±0.13）ng/mL,（3.68±1.01）ng/mL, and（7.45±1.53）ng/mL，respectively, the difference between each group was significant（P＜0.01）. Pairwise comparison of four groups showed statistical difference (P＜0.001）.Spearman correlation analysis on PCT concentration and SIRS score was conducted, correlation coefficient r=0.874（P＜0.001）suggested positive correlation between serum PCT concentration and SIRS score.ConclusionPCT concentration in patients with bacterial bloodstream infection and SIRS score is positively correlated, PCT concentration and SIRS score can be used as two markers for assessing the extent and prognosis of bacterial bloodstream infection.

Abstract:

ObjectiveTo evaluate the clinical value of plasma procalcitonin and Ddimer measurements in estimating the prognosis of patients with sepsis. MethodsAccording to prognosis,68 patients with sepsis were divided into survival group and death group，levels of procalcitonin and Ddimer, and acute physiology and chronic health evaluation II (APACHE II) of two groups of patients were compared, predictive value of above markers in estimating the prognosis of patients with sepsis were evaluated.ResultsOf 68 patients with sepsis, 28 survived and 40 died,mortality was 58.82%. There were significant differences in levels of procalcitonin and Ddimer,as well as APACHE II between two groups(both P<0.05), death group were all higher than survival group.Procalcitonin and Ddimer level were positively correlated with APACHE II score（P＜0.05）.ConclusionProcalcitonin, Ddimer level and APACHE II score can be used to evaluate condition of patients with sepsis as well as the prognosis of disease.

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ObjectiveTo evaluate the role of procalcitonin (PCT)in the early diagnosis for hand, foot and mouth disease (HFMD) with bacterial infection.MethodsClinical data of 234 HFMD children who were hospitalized  between January and July 2012 were analyzed retrospectively, according to discharge diagnosis, data  were divided into simple viral infection group (n=178）and viral associated with bacterial infection group (n=56）,and data of 20 healthy children were selected as the control group. Serum PCT, Creactive protein (CRP) and peripheral white blood cell  (WBC) count were compared. ResultsThere was significant difference in the level of PCT, CRP and WBC among three groups (F=381.94,24.18,and 26.46，respectively,all P＜0.05）.The positive rate of PCT,CRP and WBC among three groups was significantly different（χ2=178.25,38.98, and 71.21，all P＜0.05）， PCT,CRP and WBC in bacterial infection group(92.86%［52/56］,85.71%［48/56］, and 87.50%［49/56］respectively) were significantly higher than those of simple viral infection group (3.93%［7/178］,62.36%［111/178］,and 30.90%［55/178］respectively) and healthy control group (5.00%［1/20］,10.00%［2/20］, and 5.00%［1/20］respectively). The sensitivity rate of PCT,CRP and WBC was 92.86%,85.71%, and 87.50% respectively，specificity rate was 95.00%,90.00%,and 95.00% respectively.ConclusionThe level of PCT has important value for the early diagnosis of HFMD with bacterial infection, and its accuracy rate and sensitivity are better than CRP and WBC levels.

Abstract:

ObjectiveTo explore the clinical effect of intravenous immunoglobulin（IVIG）on chronic obstructive pulmonary disease(COPD) and fungal infection. MethodsSeventytwo COPD patients with fungal infection were randomly and equally divided into conventional and intervention group. Patients in conventional group were treated with common schedule for COPD plus antifungal agents; patients in intervention group received 10 g/d IVIG besides routine therapy. Length of hospital stay and prognosis were recorded, and therapeutic effectiveness were evaluated. ResultsThe effectiveness rate of intervention group was significantly higher than that of conventional group (［88.89%,32/36］ vs ［66.67%,24/36］);the average length of hospital stay was significantly shorter than conventional group (［12.62±7.51］ d vs ［20.81±6.92］ d), and mortality was lower than conventional group (［5.56%,2/36］ vs ［22.22%,8/36］), the differences were statistically significant (P<0.05). ConclusionIVIG for treating COPD with invasive pulmonary fungal infection can improve therapeutic efficacy, shorten length of hospital stay and decrease mortality rate.

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ObjectiveTo analyze the status of healthcareassociated infection(HAI) and characteristics of pathogens in patients with traumatic brain injury and cerebrovascular diseases, and evaluate prevention and control measures.MethodsClinical data of 236 patients with traumatic brain injury and cerebrovascular diseases in a hospital from 2008 to 2010 were analyzed retrospectively.ResultsA total of 29 patients developed 50 times of HAI, HAI rate was 12.29%, HAI case rate was 21.19%, HAI case rate of respiratory system, urinary system, oral cavity, gastrointestinal tract,skin and soft tissue, and other sites was 46.00%（n=23），30.00%（n=15），8.00%（n=4），6.00%（n=3），4.00%（n=2），and 6.00%（n=3）respectively. A total of 69 pathogenic strains were detected，percentage of gramnegative bacteria was 65.22%（n=45），the major were Pseudomonas aeruginosa（n=17）, Klebsiella pneumoniae（n=12）, Escherichia coli（n=10）, and Acinetobacter baumannii（n=4）；percentage of grampositive bacteria was 30.43%（n=21），the major were Staphylococcus aureus（n=11）, Staphylococcus epidermidis （n=7）,Streptococcus spp.（n=2）；percentage of fungi was 4.35%（n=3）.ConclusionHAI in patients with traumatic brain injury and cerebrovascular diseases is high, the main infection site is respiratory system, the main pathogens are gramnegative bacteria. Preventive and control measures should be taken accordingly.

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ObjectiveTo assess clinical efficacy and safety of linezolid in treating postoperative intracranial infection after neurosurgery operation, and provide clinical basis for the treatment of postoperative intracranial infection.MethodsFrom January 2011 to December 2012,clinical data of 51 neurosurgery patients receiving linezolid for treating postoperative intracranial infection were collected, changes in symptoms, temperature, cerebrospinal fluid (CSF) bacterial culture, as well as white blood cell (WBC) count, protein and glucose in CSF before and after therapy were compared, clinical efficacy and safety of linezolid in the treatment of postoperative intracranial infection were assessed based on the diagnostic criteria for intracranial infection.ResultsAfter linezolid treatment, 30 cases of postoperative intracranial infection were cured, and linezolid was effective in 12 cases, improved in 5 cases, and ineffective in 4 cases, total effective rate was 92.16%. Of 47 cases with effective therapy, the mean therapy day were 12.5 d (2-27 d）, 11 of whom isolated grampositive bacteria from CSF before therapy, and CSF culture were all negative after linezolid therapy. ConclusionLinezolid is effective for treating intracranial infection caused by Staphylococci, Enterococci and other grampositive bacteria which failed to response to vancomycin therapy.

Abstract:

ObjectiveTo explore feasible methods of hand hygiene intervention, and improve the compliance with hand hygiene among health care workers (HCWs).MethodsHand hygiene promotion activities were carried out in 20 medical institutes of Wuhan city, questionnaires and field observation were used to evaluate the change before and after the intervention.ResultsAfter intervention, hand hygiene knowledge among HCWs increased significantly, the compliance rate of hand hygiene rose from 60.59% （143/236）to 84.08%（243/289）(χ2=36.82,P＜0.001) before direct contact with patients; healthcareassociated infection (HAI) in patients in intervened department decreased from 39.33% (118/300）to 31.20%（83/266）（χ2=4.07,P=0.04）, the difference was statistically significant (P＜0.05）.ConclusionTaking positive and effective hand hygiene promotion activities can obviously enhance hand hygiene compliance of HCWs,and reduce the incidence of HAIs.

Abstract:

ObjectiveTo explore the effective measures to improve hand hygiene compliance among health care workers(HCWs) in a hospital.MethodsIn 2012,comprehensive management measures were taken to intervene hand hygiene compliance among HCWs in a hospital.ResultsA total of 72 times of inspection of hand hygiene among HCWs in the whole hospital were conducted, 86 nonhandtouching water taps were transformed, 420 posters pictures and hand washing flow charts were put up. Hand hygiene compliance rate in 2012 was higher than in 2011(60.48% vs 34.50%)（χ2=458.70，P＜0.05）；qualified rate of hand hygiene was higher than in 2011 (82.13% vs 60.04%)(χ2=188.41，P＜0.05）.The consumption of fastacting hand disinfectant of whole hospital and intensive care unit was significantly higher than in 2011(3.15mL /bed/day vs 0.39mL/bed/day,t=2.59; 21.82 mL/bed/day vs 17.81mL/bed/day,t=2.76，both P＜0.05）.ConclusionComprehensive management measures can effectively improve hand hygiene compliance among HCWs.

Abstract:

目的了解某院临床科室医务人员手卫生依从性，分析存在的问题，为提高医务人员手卫生依从性提出对策。方法对该院2013年8月临床科室在岗医务人员手卫生执行情况进行调查，并对结果进行分析。结果共调查医务人员2 189人次，手卫生依从率为62.13%。在所设计的6种情况下，医务人员手卫生依从率为54.46%～92.00%，其中摘手套后手卫生依从率（92.00%）最高，其次为无菌操作前(74.03%)、接触体液等后(72.43%)、接触患者环境后(66.23%)、接触患者后(61.03%)和接触患者前(54.46%)。不同岗位医务人员手卫生依从性差异有统计学意义（χ2=12.807，P=0.002）；医生手卫生依从率为67.70%，明显高于护士的59.92%（χ2=10.903，P=0.001），医生在无菌操作前、接触患者后和接触体液等后手卫生依从性明显高于护士，差异具有统计学意义（均P＜0.01）。结论该院手卫生管理体系已初具模型；完善手卫生管理制度，对有效干预手卫生、提高手卫生依从性具有重要意义。

Abstract:

目的通过调查护工的手卫生现状并分析其影响因素，予以手卫生培训等干预措施，提高护工的手卫生依从性。方法利用床旁视频对某院综合重症监护室（ICU）内10名护工进行手卫生现状调查，医院感染管理兼职护士利用讲课和现场操作等方法对其进行手卫生的行为干预，并比较干预前后的手卫生依从性。结果干预前观察的护工手卫生依从率为28.01%（142/507），干预后提高至63.09%（306/485），差异有统计学意义（χ2=121.79，P＜0.001）。结论医院感染管理兼职护士对护工进行行为干预，提高了护工的手卫生意识及手卫生依从性。

Abstract:

目的评价临床药师参与感染性疾病和疑似感染性疾病会诊的作用及效果。方法临床药师参与1例感染性疾病和1例疑似感染性疾病会诊，分析患者治疗方案调整及疾病转归情况。结果通过会诊，临床药师为临床医生提供了合理性建议，2例患者均痊愈。结论临床药师参与会诊，对感染性疾病的治疗有一定的作用，是医院诊疗活动的一个重要组成部分。

Abstract:

目的调查某院多重耐药铜绿假单胞菌（MDRPa）肺部感染的传染源和传播途径，控制医院感染的发生。方法对该院MDRPa感染患者及其医疗环境、操作流程等进行流行病学调查。结果7例MDRPa感染患者均为男性，患者的症状、感染部位、护理操作相同，痰培养结果及耐药情况均与已消毒的超声雾化管分离出的菌株高度一致。通过采取一系列防控措施，MDRPa医院感染得到有效控制。结论 此次医院感染是由于超声雾化管的清洗消毒不合格引起，医院应加强多重耐药菌感染的管理，做好相应隔离措施，确保医疗器械的消毒灭菌效果，有效防止医院感染的暴发流行。

Abstract:

目的探讨康复医院痰培养分离病原菌的分布特点及耐药性，为临床合理选用抗菌药物提供依据。方法回顾性分析某康复医院2012年4月—2013年3月住院患者送检的1 087份痰培养标本资料。结果共分离病原菌686株，其中革兰阴性菌661株（96.36％），革兰阳性菌25株（3.64％）；分离率居前4位的病原菌依次为铜绿假单胞菌（338株，49.27%）、肺炎克雷伯菌（69株，10.06%）、奇异变形杆菌（57株，8.31%）和大肠埃希菌（47株，6.85%）。铜绿假单胞菌对常用抗菌药物表现较高的耐药性，羧苄西林、氧氟沙星的耐药率均>70％；对亚胺培南、美罗培南的耐药率分别为31.66%、38.17%；对阿米卡星、头孢他啶、妥布霉素的耐药率较低，分别为14.79%、18.64%、19.23%。结论铜绿假单胞菌是该康复医院住院患者呼吸道感染的主要病原菌，临床医生应合理选用抗菌药物。

Abstract:

目的分析某中西医结合医院2010—2012年临床住院患者分离的肠球菌标本来源及其耐药性。方法对该院2010年1月1日—2012年12月31日临床住院患者分离的283株肠球菌进行分析。结果283株肠球菌中，粪肠球菌居首位（176株，62.19%），其次为屎肠球菌（97株，34.28%），其他肠球菌（10株，3.53%；包括棉子糖肠球菌5株，鹑鸡肠球菌2株，鸟肠球菌、坚韧肠球菌、铅黄肠球菌各1株）。粪肠球菌对奎奴普丁/达福普汀（93.75%）、红霉素（86.36%）和四环素（76.14%）的耐药率较高；屎肠球菌对环丙沙星、红霉素、左氧氟沙星、青霉素和氨苄西林的耐药率均＞90%。共检出7株耐万古霉素肠球菌，其中4株粪肠球菌，3株屎肠球菌；耐利奈唑胺的粪肠球菌和屎肠球菌各4株。结论医院应加强对治疗肠球菌感染的抗菌药物，特别是万古霉素和利奈唑胺的监管，防止新的耐药菌株的产生和蔓延。

Abstract:

目的对某院BD试验失败的原因进行分析，制定相应对策。方法对该院2010年1月— 2012年12月间1 401次BD试验结果进行分析。结果2010—2012年共做BD试验1 401锅次，合格次数1 190次，合格率为84.94%。BD试验失败原因包括操作技术和设备因素,其中设备因素占94.79%。通过完善设备的维护保养、加强工作人员的规范操作,BD试验合格率逐年上升，由2010年的72.98%提高至2012年的97.90%，差异有统计学意义(χ2＝10.37，P＜0.001)。结论该院BD试验失败的原因以设备因素为主。医院通过加强管理，能提高BD试验的合格率。

Abstract:

本院于2012年8月收治1例子宫切除术后2年迟发性腹壁切口脓肿患者，切口脓肿由多重耐药大肠埃希菌感染所致。现将该病例的临床资料分析报告如下。

Abstract:

产科实施母婴同室能有效提升母乳喂养率［1］，使母子关系密切。但是，新生儿各器官系统发育不完善，免疫力低，抵抗力差，对很多微生物高度易感，是医院感染的高危人群。而母婴同室为开放式的管理模式，新生儿日常照顾由产妇及陪护完成，其感染防控意识较淡薄，防控知识欠缺，而且陪护及探视者流动性大，规范管理较困难，增加了新生儿感染的概率。为规范母婴同室区新生儿医院感染管理，有效防控新生儿医院感染，本文对母婴同室区新生儿医院感染的研究进展综述如下。