Abstract:

ObjectiveTo investigate antimicrobial resistance characteristics and  mechanisms of imipenemresistant Pseudomonas aeruginosa (P. aeruginosa) isolated from clinical specimens.MethodsBacterial strains were identified by BD Phoenix 100 automatic microbial analysis system, antimicrobial susceptibility testing  was performed by KirbyBauer method; Carbapenemase genes (IMP, VIM, OXA,GES) and outer  membrane protein gene oprD2  were detected by polymerase chain reaction.ResultsResistant rates of imipenemresistant P. aeruginosa strains to amikacin was the lowest (8.33%); resistant rates to gentamicin and tobramycin were<20%； resistant rates to the third and fourth generation  cephalosporins,aztreonam, meropenem,compound sulfamethoxazole and minocycline were all>60%, and all strains were resistant to ampicillin /sulbactam.The positive rate of OXA17 gene was 2.78%（n=1）， deletion rate of oprD2 was 38.89%,the other drugresistant genes were not detected. ConclusionExcept aminoglycosides, resistance of imipenemresistant P. aeruginosa to other antimicrobial agents is serious; resistance of P. aeruginosa to imipenem may be due to  lacking of OprD2 and production of carbapenemases.

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ObjectiveTo investigate antimicrobial susceptibility of Klebsiella pneumoniae (K. pneumoniae) to aminoglycosides and detection of  16S rRNA methylase genes in K. pneumoniae.MethodsNinetysix nonrepetitive clinical K.pneumoniae isolates were collected from Xiangya hospital of Central South University from January to July 2009, minimal inhibitory concentrations (MICs) of gentamycin, amikacin and tobramycin were determined by agar dilution method ;  genotype of 16S rRNA methylase genes (armA,rmtA,rmtB,rmtC,rmtD,npmA）were detected by polymerase chain reaction(PCR). ResultsMIC50 of amikacin, gentamycin and tobramycin was 256μg/mL, 512μg/mL and  512μg/mL respectively; and MIC90 were all>512μg/mL; antimicrobial resistance rate was 21.88%，63.54%，and 41,67% respectively. 68 isolates （70.83%）were resistant to at least one kind of antimicrobial agent，21 isolates（21.88%）were resistant to three  kinds of antimicrobial agents.22 isolates（22.92%） carried armA, but rmtA,rmtB,rmtC,rmtD and npmA were not detected; of 22 isolates harboring armA 16S rRNA methylase genes, 17(77.27%) were highly resistant to gentamicin, amikacin and tobramycin，the homology of armA positive isolate and armA (FJ410928.1) was 100%. ConclusionarmA 16S rRNA methylase gene harbored in K. pneumoniae plays an important role in aminoglycoside resistance. 

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ObjectiveTo analyze effect of the syphilis prevention and control work among female sex workers（FSWs）,and provide reference data for target intervention in Guangdong province.MethodsSyphilis prevalence among FSWs from 2009 to 2013 were analyzed statistically based on the data from Guangdong Provincial highrisk groups in sexually transmitted infection（STI） control program. ResultsA total of 34 338 FSWs were detected, including 23 816（69.36%）FSWs at the hightier venues, 8 811（25.66%） middletier, and 1 711（4.98%）low tier. The syphilis prevalence of  FSWs at high, middle, and lowtier venues in 2009 was 2.60%, 7.36%, and 10.54% respectively，and in 2013 was 1.45%,2.75%,and 21.88% respectively. Chisquare test showed a downward trend in the prevalence of syphilis among the high and middle tier FSWs  in 20092013(χ2=12.807,52.333 respectively, both P<0.001), and  remained high among FSWs at lowtier venues(χ2=0.027,P=0.87). The difference in syphilis prevalence in 2013 among FSWs from different types of venues was statistically significant  (χ2=190.64,P<0.001). No significant difference in syphilis prevalence was found among  FSWs from Pearl River Delta, eastern, western and northern Guangdong（χ2=5.24,P=0.07）. ConclusionSignificant difference is found in prevalence of syphilis among FSWs from different types of settings. FSWs from lowtier settings have a relatively lower syphilis testing rate but with higher infection rate.

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ObjectiveTo evaluate the effect of selective oral decontamination (SOD) on reducing incidence of ventilatorassociated pneumonia (VAP).MethodsSixty patients hospitalized in an intensive care unit (ICU)for >72 hours and with mechanical ventilation for >48 hours from January to June 2102 were selected for study,patients were randomly divided into trial group(n=30) and control group(n=30).All patients received cefotaxime intravenous drip for 4 days, then trial group received oropharyngeal application of tobramycin during the whole process of mechanical ventilation, control group topically received saline solution, the incidence and onset time of VAP, duration of mechanical ventilation, length of stay in ICU, and mortality of two groups were compared. Sputum in the trachea was taken periodically for bacterial culture.ResultsThe incidence of VAP in trial group was lower than control group (30.00% vs 63.33%)；the onset time of VAP was later than control group (［9.37±6.62］d vs ［5.17±4.72］d)；Overall duration of mechanical ventilation was less than control group (［7.63±6.91］d vs ［12.26±9.36］d)；length of stay in ICU was shorter than control group(［13.56±7.22］d vs ［16.79±11.16］d)(all P<0.05). There were no significant difference in mortality between two groups(P>0.05).ConclusionSOD is effective for preventing and treating VAP,it can reduce the incidence of VAP, delay onset time of VAP, shorten mechanical ventilation,and reduce length of stay in ICU.

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ObjectiveTo explore the investigation and control  method  for the  epidemic of surgical site infection(SSI)in a hospital. MethodsData of orthopedics patients receiving clean wound orthopedics operation were analyzed retrospectively, and effective measures were taken to control the epidemic of HAI. Results From June to August 2012, a total of 312 patients received clean wound  orthopedics operation,7 (2.24%) SSI cases occurred. SSI rates during the same period from 2009 to 2012 were significantly different(P<0.05), and was the highest in 2012. HAI management staff reviewed patients’ medical records,communicated  with staff in orthopedics department, and put forward  advice for SSI control; orthopedics department worked out and implemented detailed infection control measures. The subsequent surveillance showed that the prevalence of SSI in orthopedics ward decreased to 0.38%，infection outbreak  was effectively controlled. ConclusionHAI management department played an important role in the finding and control of HAI outbreak. Scientific analysis on monitored data and proper measures adopted by HAI management department and clinical department can effectively control HAI outbreak.

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ObjectiveTo evaluate the effect of special rectification of clinical antimicrobial use in a hospital.MethodsMedical records of patients receiving inguinal hernia repair before (in 2011) and after (in 2012) the performance of special rectification  were reviewed, and the rationality of perioperative antimicrobial prophylaxis was compared. ResultsProphylactic antimicrobial usage rate in patients receiving  inguinal hernia repair decreased from 53.90%(76/114) in 2011 to 5.59%(10/179) in 2012, the difference was significant   (χ2=93.68，P＜0.05) ; average expense of antimicrobial use per patient decreased by  86.95% (from ￥ 624.73  in 2011 to ￥ 81.52  in 2012)；Combination use and single use was 93.42% and 80. 00% respectively.Surgical site infection did not occur in both groups. ConclusionThrough the special rectification activities of the clinical antimicrobial use, perioperative antimicrobial prophylaxis  and expense of antimicrobial agents in patients receiving inguinal hernia repair is effectively reduced.

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ObjectiveTo explore the clinical significance of procalcitonin(PCT) in guiding the optimizing antimicrobial treatment strategy in ventilatorassociated pneumonia(VAP). MethodsSixty patients  receiving mechanism ventilation for ≥48 hours in an intensive care unit between November 2011 and  April 2013 were randomly divided into control group (n=29) and trail group (n=31), patients in control group stopped antimicrobial use according to guideline, patients in trail group stopped antimicrobial use according to serum procalcitonin level, duration of antimicrobial use and  mechanical ventilation between two groups were compared. ResultsDays of mechanical ventilation,length of ICU stay, mortality rates between two groups were not significantly different(all P>0.05); antimicrobial days  in trail group was significantly less than control group（［10.70±3.78］ d vs ［13.93±3.03］ d)（t=4.484；P＜0.001）. ConclusionSerum procalcitonin level plays an important  role in the rational use of antimicrobial agents in patient with VAP.

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ObjectiveTo analyze the etiology and clinical characteristics of infectious mononucleosislike syndrome(IMLS).MethodsEightyseven children with IMLS in a hospital from January 2006 to September 2013 were performed pathogenic detection, then clinical features were summarized and analyzed. ResultsThe top 5 pathogens in IMLS were Mycoplasma pneumoniae (MP, n=20 ), cytomegalovirus (CMV, n=13), simplex herpes virus(HSV,n=11), Chlamydia (CP,n=11),and parvovirus B19 (Hpv B19,n=9 ), clinical manifestations of all kinds of diseases were similar, but the occurrence rates were slightly different. MP infection were mainly fever, hepatosplenomegaly, and lymphadenopathy, and most were associated with respiratory complications(including laryngitis,bronchitis,and pneumonia), CMV infection were also showed fever and hepatosplenomegaly, but the latter was more obvious; rubella patients didn’t appear skin rash, but the other symptoms were obvious. ConclusionEtiologies of infectious mononucleosislike syndrome are varied, MP infection is most common, the next is CMV. Pathogens should be ascertained to provide theoretical basis of treatment.

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ObjectiveTo evaluate distribution and antimicrobial resistance of pathogens in  neonatal infectious pneumonia.MethodsSputum specimens and ends of tracheal intubation of neonates at neonatal intensive care unit and pediatric intensive care unit between January  2010 and  December 2013 were cultured,and isolated pathogens were identified and performed antimicrobial susceptibility testing.ResultsA total of  3 278 pathogenic isolates were isolated, 1 391(42.43%) were grampositive cocci, 1 884(57.47%) were gramnegative bacilli，and 3(0.09%) were fungi. The top five  pathogens were Staphylococcus aureus(22.82%)，Klebsiella pneumoniae(20.01%)，Escherichia coli(17.33%), Staphylococcus epidermidis(6.96%), and Staphylococcus haemolyticus(4.94%). The detection rate of extendedspectrum βlactamaseproducing  Klebsiella pneumoniae and Escherichia coli was 66.46% and 66.55%,respectively.Susceptibility rate of Klebsiella pneumoniae  and Escherichia coli    to piperacillin / tazobactam,cefepime and cefotetan were>84, susceptibility rates of  Staphylococcus aureus and Staphylococcus epidermidis to ampicillin / sulbactam，fosfomycin and linezolid were all 100%.  ConclusionMonitoring on pathogens in neonatal infectious pneumonia is helpful for realizing the epidemiological trend and drug resistance  characteristics, and can promote the rational use of antimicrobial agents for  the treatment of neonatal infectious pneumonia.

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ObjectiveTo investigate the possible causes of surgical site infection（SSI）in neurosurgical patients in a hospital during a short period of time. MethodsMedical data of 135 neurosurgical operative patients from February 1 to March 15, 2013 were reviewed,the possible risk factors for SSI  were analyzed retrospectively with casecontrol study. ResultsOf 135 operative neurosurgical patients, 5 (3.70%) developed SSI. Casecontrol study showed that the ratio of the run of the fifth operating room and undergoing of secondary  operation was 4.07 (95%CI: 0.52-36.65) and 18.00（95%CI：2.00-180.00）respectively. The difference between each surgeon special SSI rate and the average SSI rate in 2012 （2.54%［17/669］） was not significantly different (P>0.05). Bacterial detection of environmental specimens of the fifth operating room showed that except anesthetic cuff exceeded standard, the others were met the national requirements, and the isolated bacteria from anesthetic cuff was coagulase negative Staphylococcus, which was not related with pathogens in infection. Conclusion“The secondary surgery” is the key risk factor for SSI of neurosurgical patients.

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ObjectiveTo monitor the quality of inuse disinfectant,evaluate the causes of exceeding of bacterial content standard, and put forward  the corresponding management measures.  MethodsAccording to the different management methods, disinfectant specimens were divided into experimental group(n=210, from August 2012 to July 2013) and control group (n=190, from August 2011 to July 2012); inuse disinfectant in experimental group was contained with groundglass stoppered bottles, inuse disinfectant in control group was contained with stainless bottles and groundglass stoppered bottles, biological monitor results of two groups were compared. ResultsQualified rate of biological monitor result in experimental group was 100.00%（201/201）,and in control group was 90.00%（171/190）, there was significant difference between two groups（χ2=21.13，P＜0.05）.ConclusionImproving management method can increase the qualified rate of biological monitoring result of inuse disinfectant, and ensure the safety and effectiveness of disinfection.

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ObjectiveTo analyze the present medical teaching textbooks and practice skill guidelines, and explore the profound causes of poor hand hygiene idea among doctors. MethodsThree sets of unified textbook series used for domestic medical colleges and universities and two sets of manipulation skill guidelines were studies. Statistical method was conducted to analyze whether concepts and methods of hand hygiene, handwashing and antiseptic handrubbing were included in these teaching textbooks; as to eight aseptic manipulation skills, coverage of knowledge, steps of handwashing and antiseptic handrubbing in manipulation skill guidelines were also analyzed. ResultsThe mentioning rate of hand hygiene, handwashing and antiseptic handrubbing in 8year and 5year program teaching textbooks were both 0, in nursing teaching textbooks was 100%; as to 8 aseptic manipulation in 2 sets of skill practice guidelines, mentioning rate of  hand washing was 37.50%, and method and steps of antiseptic handrubbing were both 0. ConclusionSchool teaching and skill assessment are the basis, it is difficult to form the right idea by only relying on continuing education without basic education. Hand hygiene should be stressed in the written of teaching textbooks, guidelines should be written following the newest progress, so as to form the correct idea of hand hygiene among doctors.

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ObjectiveTo evaluate the effect of FOCUSPDCA program(find, organize, clarify, understand, select, plan, do, check, act )  on the prevention and control of  catheterrelated blood stream infection (CRBSI) in an intensive care unit(ICU). MethodsProcess of  central venous catheterization and nursing care were analyzed by using FOCUSPDCA program, and the causes for CRBSI were found out ; a continuous quality improvement  (CQI) team was established to provide training for ICU nurses, and the process was improved and supervised, virtuous circle was created. ResultsIncidence of CRBSI decreased from 8.29‰ before FOCUSPDCA intervention(JanuaryDecember,2010) to 3.20‰ after FOCUSPDCA intervention(January 2011—December 2012),the difference was significant (χ2=14.6，P＜0.001）.  ConclusionFOCUSPDCA program is effective for controlling the incidence of CRBSI.

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ObjectiveTo study direct economic loss of healthcareassociated infection (HAI) in hospitalized children with acute respiratory infection (ARI), and  the influence in satisfaction  degree of children’ relatives. MethodsClinical data of 1 039 children with ARI in a pediatrics ward between April 1,2012 to March 31,2013 were analyzed retrospectively. 50 patients with HAI were in case group and 50 patients without HAI were in control group. The difference in medical cost and the degree of satisfaction of children’s relatives were compared between two groups. ResultsMedical cost of patients in case group was significantly  higher than  control group（［P25- P75：￥3 095.54-￥4 779.48］ vs ［P25-P75：￥1 744.14-￥2 382.07］,Z=5.89, P＜0.01). The expenses  in medicine，laboratory  examination，diagnosis and treatment，and  nursing in  case group were all higher than control group, there were significant differences between two groups（all P＜0.01）; Hospitalization day of case group was significantly longer than control group (［P25-P75： 9 d-15 d］vs［P25-P75：6 d-8 d］, Z=5.79, P＜0.01）. Satisfaction degree of patients’ relatives in case group was significantly lower than control group (Z=8.22, P＜0.01). ConclusionHAI occurred in ARI children can increase medical cost, prolong length of hospital stay and decrease satisfaction degree of patients’ relatives.

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ObjectiveTo study the reporting status of notifiable infectious diseases in a general  hospital, grasp epidemiological characteristics and patterns, and  provide scientific basis for the preventive measures of infectious diseases.MethodsEpidemic data of notifiable infectious diseases reported by a hospital in 2007-2011 were analyzed statistically. ResultsReporting rate of  notifiable infectious diseases was 0.40%(15 386 /3 852 327）in 2007-2011, and were statistically different among each year (χ2=94.93，P＜0.01）, the major age of reported cases were 14-45 years(46.70%), the main transmission routes were blood and sex (60.68%), followed by respiratory tract (33.06%).The reporting rates among different months were statistically different（χ2=487.60，P＜0.01）， April ranked first for five consecutive years（0.53%）,followed by December（0.51%） and May（0.48%）. The main reported infectious diseases included viral hepatitis（42.82%）, varicella（20.06%）, syphilis（16.96%）, rubella（5.41%）, and pulmonary tuberculosis（3.75%）. ConclusionBloodborne diseases,sexually transmitted diseases, and  infectious respiratory diseases are the stress in the prevention and control of infectious disease, management should be intensified.

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目的探讨老年住院患者导尿管相关尿路感染的危险因素。方法采用回顾性调查方法，对2012年1月—2013年12月某院干部病房102例留置导尿管老年患者（年龄≥60岁）的临床资料进行统计分析。结果102例留置导尿管的老年患者，发生尿路感染27例，感染率为26.47%。单因素分析结果显示，年龄≥70岁、留置导尿管时间≥14 d、使用抗菌药物是导尿管相关尿路感染的危险因素（均P＜0.05）；共检出病原体68株，以大肠埃希菌为主（22株，32.35%），其次为肠球菌属（11株，16.18%）、白假丝酵母菌（6株，8.83%）等。 结论老年患者导尿管相关尿路感染发生率高，应注意避免留置导尿管时间过长，并合理使用抗菌药物，以降低导尿管相关尿路感染发生率。

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目的调查某院产妇产后发生医院感染的情况与特点。 方法对该院2010年1月—2012年12月出院的30 940例产妇的病历资料进行回顾性分析。结果30 940例产妇产后发生医院感染720例（2.33%），771例次（2.49%）；3年间，产妇产后发生的医院感染率在2.10%～2.58%。感染部位以生殖道（67.96%，524/771）为主，其次为会阴切口（13.49%，104/771）和呼吸系统（8.17%，63/771）等；不同分娩方式中，阴道手术产后医院感染发生率（5.08%，23/453）最高。结论该院产妇产后医院感染率处于稳定水平。减少不必要的侵入性操作，提高操作技能，操作时严格执行无菌技术操作，是降低医院感染发生率的重要手段。

Abstract:

目的了解并掌握住院患者医院感染现状及存在的问题，为医院感染的预防与控制提供依据。方法采用横断面调查方法，对某院2012年12月11日0∶00—24∶00所有住院患者进行医院感染现患率调查。结果住院患者182例，实查179 例，实查率98.35%；医院感染7例，医院感染现患率3.91%；感染部位为下呼吸道（4例）和上呼吸道（3例）。重症监护室（ICU）医院感染率最高，达20.00%。调查当日使用抗菌药物患者85例，日抗菌药物使用率47.49%，其中治疗用药47例（55.29%），预防用药37例（43.53%），预防+治疗用药1例（1.18%）；单一用药35例（41.18%），二联用药42例（49.41%），三联用药8例（9.41%）；48例治疗用药者中，仅1例送病原学检查，病原送检率为2.08％。结论该院抗菌药物的联合使用比例较高，病原送检率低，存在不合理用药现象，医院管理部门应加强对临床医生的培训和监督。

Abstract:

类丹毒是由猪红斑丹毒丝菌引起的,主要表现为丹毒样皮肤损害的一种急性感染性疾病。现将1例类丹毒败血症误诊患者的诊疗情况报告如下。

Abstract:

消毒剂的历史已逾百年，特别是在医疗感染预防及控制上的应用目前仍无可替代。虽然医疗技术及条件得到不断完善，时至今日，世界范围内仍面临医疗感染的严峻挑战。这一问题的产生有多种原因，而细菌对消毒剂敏感性的下降无疑是其中重要的一点。该情况也引起学者们的广泛关注与诸多报道。本文主要阐述细菌对消毒剂的抗性机制，并以全球公共卫生系统中重要的病原菌—金黄色葡萄球菌为例，详细介绍细菌对消毒剂抗性在流行病学领域中的研究热点及趋势，以期为今后在细菌抗消毒剂方面的研究提供参考借鉴。