Abstract:

ObjectiveTo assess the risk factors of multidrugresistant organism(MDRO) healthcareassociated pneumonia(HCAP). MethodsThe casecontrol study was conducted in patients admitted to 22 hospitals in 4 cities  between April 1, 2013 and December 31, 2013,patients with  HCAP  caused by MDRO (MRSA,MDRPA,MDRAB,ESBL KP, ESBL E.coli）(drugresistant group )and drugsensitive organisms （MSSA, PA,AB,KP,E.coli）(drugsensitive group )were surveyed  . Univariate and multivariate statistical analysis methods were used to evaluate the risk factors for MDRO HCAP. The prognosis, cost and length of hospital stay between drugresistant group and drugsensitive group were compared . ResultsA total of 1 656 patients were included in the study ,including 43 patients （2.60%）with mixed infection caused by both drugresistant and drugsensitive organisms ;there were 927 cases （55.98%）in drugresistant group and 772 cases（46.62%）in drugsensitive group . Logistic regression model revealed that admission to ICUs (OR 95%CI：1.55［1.14-2.11］), mechanical ventilation (OR 95%CI：1.45［1.15-1.84］), arteriovenous catheterization (OR 95%CI：1.29［1.02-1.63］）, fiberbronchoscopy (OR 95%CI：1.46［1.02-2.09］）, antimicrobial use(OR 95%CI：1.63［1.20-2.22］） , chronic lung diseases (OR 95%CI：1.54［1.13-2.10］）, and chronic cardiovascular and cerebrovascular diseases (OR 95%CI：1.42［1.15-1.74］）were independent risk factors for MDRO HCAP .Compared with drugsensitive group , drugresistant group prolonged length of hospital stay by an average of 5.89 days, increased hospitalization and  antimicrobial expense by ￥40 739.30 and ￥2 805.80 respectively; prognoses was worse, risk factor was 1.66fold of drugsensitive group（OR 95%CI：1.16-2.35）.ConclusionAdmission to ICUs, invasive operations, antimicrobial use, chronic lung diseases and chronic cardiovascular and cerebrovascular diseases can increase the risk of MDRO HCAP .

Abstract:

ObjectiveTo evaluate the relationship between cytotoxinassociated geneA (CagA) seropositive  of Helicobacter pylori (H. pylori )infection and risk of atherosclerotic cerebral infarction(ACI). MethodsRelated literatures were researched through literature retrieval , literatures were obtained  by uniformed  criteria of inclusion and exclusion, and Meta analysis was performed with RevMan 4.2 software.ResultsA total of 10 literatures which met the inclusion criteria were retrieved, all were casecontrol study, case group  included 907 studied subjects, and control group included 966 subjects; the included population were divided into   Chinese subgroup and European Caucasian subgroup. Meta analysis of CagA seropositive  of H. pylori infection and risk of ACI  revealed that OR of the overall population,Chinese subgroup,and European Caucasian subgroup was  2.66( 2.17-3.26),2.60(1.93-3.49), and 2.71( 2.05-3.59) respectively; Meta analysis of CagA seronegative  of H. pylori infection and risk of ACI  revealed that OR of the overall population, Chinese subgroup, and European Caucasian subgroup was 0.74（0.49-1.10）,0.81（0.45-1.48）, and 0.64（0.37-1.09）respectively. The funnel plot and failsafe number showed that there was no significant publication bias, the result was stable  and reliable.ConclusionChronic infection caused by CagA seropositive strains of H.pylori may be one of the risk factors of CAI, whether the eradication treatment of seropositive strains of H.pylori influences the process of atherosclerotic diseases like CAI needs to be further studied.

Abstract:

ObjectiveTo study antimicrobial resistance of clinically isolated Escherichia coli(E.coli), the prevalence of integrons in E.coli,and relation of integron with antimicrobial resistance of E.coli. MethodsE.coli isolated from three hospitals of Guangdong Province  from 2010 to 2012 were collected, and antimicrobial susceptibility testing was performed by KirbyBauer method; integrons were detected by polymerase chain reaction (PCR), and gene cassette was analyzed by sequencing. ResultsA total of 156 E.coli isolates were collected, antimicrobial susceptibility testing showed that resistance rate of E.coli to most penicillins, cephalosporins, fluoroquinolones, aminoglycosides and sulfonamides were over 50%; the resistance rate to antimicrobials <10% included cefoperazone/sulbactam（0）,imipenem（3.85%）,cefotetan（4.35%）,ertapenem（7.69%） and piperacillin /tazobactam （8.97%）; The positive rate of class I integron was 57.69%(90/156); the positive rate of class I integron in multidrugresistant and nonmultidrugresistant E.coli was 66.00% (66/100) and 64.71% (22/34) respectively, the difference was not statistically different (P>0.05),but compared with sensitive E.coli （9.09%，2/22）,  the difference was statistically different (P<0.01).There were nine types of integrondrug resistant gene cassettes in the variable regions, most of which contained  aadA and dfrA. ConclusionAntimicrobial resistance of E.coli is serious; high incidence of class I integrons are widely found in E.coli, and is closely related with drug resistance of E.coli， class I integrons mainly mediated aminoglycosides,sulfonamides and betalactams resistance.

Abstract:

ObjectiveTo explore the risk factors for methicillinresistant Staphylococcus aureus (MRSA) infection of refractory wound, and provide reference for clinical prevention and control.  MethodsClinical data of patients who were isolated Staphylococcus aureus (SA) from wound at the burn ward in a hospital from January 2006 to December 2013 were analyzed, patients were divided into four groups according to whether the isolated SA were MRSA and whether  SA  were from refractory wound or from nonrefractory wound. Risk factors for MRSA infection of refractory wound were analyzed.ResultsA total of 112 isolates of SA were isolated from wound, statistical differences existed in the length of hospital stay, recent invasive operation, and recent antimicrobial use between patients in refractory wound MRSA group and refractory wound methicillinsensitive SA (MSSA) group (all P<0.05); nonconditional logistic regression analysis revealed that length of hospital stay>30 days (OR 95% CI：1.14-30.69) and recent invasive operation (OR 95% CI：1.41-17.84)were independent risk factors for refractory wound MRSA infection. There were statistically differences in previous MRSA infection, burn depth, recent operation and recent antimicrobial use between refractory wound MRSA group and nonrefractory wound MRSA group(all P<0.05) ; nonconditional logistic regression analysis revealed that recent antimicrobial use (OR 95% CI：2.080-26.800） was independent risk factor for the persistence of MRSA infection  of refractory wound. ConclusionShortening the length of hospital stay, reducing invasive operation, and using antimicrobial agents rationally are helpful for the prevention and control of MRSA infection of refractory wound.

Abstract:

ObjectiveTo evaluate risk factors for multidrugresistant Acinetobacter baumannii (MDRAB) infection, so as to provide reference  for making preventive and control measures of MDRAB infection.MethodsClinical data of patients with Acinetobacter baumannii (A. baumannii ) infection in a hospital between April 2011 and  September 2012 were surveyed, distribution and specimen sources of A. baumannii  and MDRAB were analyzed, and risk factors of MDRAB were assessed.ResultsOf 236 isolates of A. baumannii, 74 (31.36%) were MDRAB . The isolation rate of MDRAB in intensive care unit and neurosurgery department was up to 60.00%（27/45）and 58.06%（18/31）respectively; MDRAB were mainly isolated from wound （45.45%）, respiratory tract （34.27%）, and urinary tract（17.65%）.Univariate analysis revealed that difference in length of hospital stay, use of serum albumin, fiberbronchoscopy, coma days, tracheotomy, use of ventilator, incisional drainage, urinary catheterization, use of carbapenems, and antimicrobial days in different groups were statistically different (P<0.05). Multivariate logistic regression analysis revealed that  tracheotomy（OR95%CI：1.152-7.187）, use of ventilator（OR95%CI：1.263-7.664）were independent risk factors for MDRAB infection. ConclusionTracheotomy and use of ventilator play an important role in the producing and spreading of MDRAB , management on drugresistant bacteria is important in reducing MDRAB infection.

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ObjectiveTo evaluate the risk factors for healthcareassociated infection(HAI) in senile dementia patients, so as to adopt effective nursing measures to reduce the incidence of HAI. MethodsClinical data of 82 senile dementia patients aged≥60 years and hospitalized between January 2011 and June 2013 were analyzed retrospectively. ResultsOf 82 patients, 28 (34.15%) developed HAI. The main infection site was lower respiratory tract（n=15，53.57%）, followed by urinary tract(n=6，21.43%）. Univariate analysis revealed that risk factors for HAI in senile dementia patients were bedridden, long length of hospital stay , dysphagia,  indwelling urinary catheter, irrational use of antimicrobial agents, combined with tumor, and  hypoproteinemia (all P<0.05). The main isolated bacteria were gramnegative bacilli(n=40,62.50%) , the top three pathogens were Klebsiella pneumoniae（n=12，18.75%）, Escherichia coli（n=10，15.63%）, and Pseudomonas aeruginosa （n=8，12.50%）. ConclusionRealizing the risk factors and common pathogens of HAI in senile dementia patients is helpful for taking effective measures to prevent and control the incidence of HAI .

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ObjectiveTo compare the bacteriostasis effect of two disinfectants on frequently touched object surfaces in laminar flow general intensive care unit (GICU), and investigate bacterial contamination on the object surfaces, so as to provide reference for proper disinfection method and control of infection. MethodsSpecimens from surfaces of bed rails and bedside tables were taken for bacterial culture before being disinfected. Then object surfaces around bed units were disinfected with disinfectant containing 500 mg/L of available chloride (routing group) and GammaTM disinfecting wet wipes (control group)respectively, bacteriostasis rate and qualified rate of bacterial count on object surfaces between two kinds of disinfection methods were compared. ResultsBefore routine disinfection, a total of 87  pathogens were isolated from 200 specimens of object surfaces,bacterial contamination rate was 43.50%. Detection rate of  grampositive bacteria was 78.16%% (n=68),the major were Corynebacterium (26.47%,n=18), Staphylococcus aureus (23.53%,n=16) and  Staphylococcus epidermidis (23.53%,n=16）; detection rate of  gramnegative bacteria was 21.84%(n=19),the major was Acinetobacter baumannii (63.16%,n=12）. After a 10minute disinfection on surfaces, bacteriostasis rate of routine group and control group was （94.89±7.72）% and（96.33±12.88）% respectively，there was  no significant difference between two groups(P>0.05); qualified rates of bacterial count of object surfaces of two groups were both 100%. ConclusionRegular disinfection of object surfaces around bed units, standardization of the manipulation  and hand hygiene compliance of  medical personnels are simple and effective method of cutting off bacteria dissemination and preventing healthcareassociated infection.

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ObjectiveTo investigate the prevalence rate of healthcareassociated infection(HAI) in a hospital, so as to provide reference for making HAI control measures. MethodsThe crosssectional survey on HAI was carried out among all hospitalized patients on May 26, 2010, December 12, 2012 and December 4, 2013, respectively, surveyed data were analyzed. ResultsThe prevalence rate was 6.66%(n=116）, 6.67%（n=113） and 6.33%（n=120）in 2010,2012 and 2013 respectively, and case rate was  7.29%（n=127）,7.38%（n=125）and 6.97%（n=132） respectively,  intensive care unit( ICU ) had the highest infection rate, internal medicine ICU was up to 71.43%. The main infection site was lower respiratory tract（44.53%）,  followed by surgical site infection (9.11%) and urinary tract infection (9.11%). The isolation rate of gramnegative bacteria,  grampositive bacteria and fungi was 60.81%, 20.38% and 18.81% respectively. Usage rate of antimicrobial agents in three years was 32.95%,29.87% and 25.59% respectively （χ2=13.16，P＜0.01）.ConclusionPrevalence rate of HAI in this hospital is high , the main pathogen is gramnegative bacteria, the main infection site is  lower respiratory tract , antimicrobial use  decreased year by year. Monitor on high risk departments, main sites and pathogens should be intensified.

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ObjectiveTo investigate the incidence  of sharp injury (SI) among health care workers(HCWs) in different levels of hospitals in Gansu Province, so as to improve HCWs’ precaution awareness, standardize behavior, and provide guide for making occupational precaution measures. MethodsFrom January to December 2012, HCWs in 38 medical institutes in Gansu Province were selected with stratified random sampling, HCWs were surveyed through questionnaires and interview.    ResultsA total of 11 358 questionnaires were received, the incidence of SI was 9.87%(n=1 121), case rate was 12.60%(n=1 431), the frequency of SI was 1.05 times/ (person·month). SI rates of different genders, positions and years of working were statistically different (all P<0.05). The main medical devices causing SI were syringe needle, venous transfusion scalp needle and surgical suture . SI caused by known sources  were 1 099 times (76.80%); 980 times (68.48%) of  SI  were induced by contaminated sources, 474 (48.37%) of which were bloodborne diseases, bloodborne disease exposure accounted for 33.12%. Among bloodborne disease exposure, hepatitis B virus  accounted for 74.25%, Treponema pallidun 13.10%，hepatitis C virus 12.01% ,and human immunodeficiency virus 0.64%.   ConclusionThere is a high incidence rate of SI among HCWs in Gansu Province, it is a very important public health problem which needs to be solved.

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ObjectiveTo realize hand hygiene status and effect of handdrying measures on handwashing of health care workers(HCWs) in an intensive care unit(ICU). MethodsFrom February to April 2013, 210 HCWs in an ICU were selected and randomly divided into three groups， group A dried hands with paper towel， group B with hand drier，and group C with personal towel，specimens from hands before handwashing, after handwashing, and after handdrying were taken and performed detection.ResultsHand microorganism count in group A,B and C before washing hands after contacting patients was (29.10±15.08)CFU/cm2,(31.42±14.76)CFU/cm2 and (30.36±15.52)CFU/cm2 respectively, the difference was not statistically different（F=0.048，P＞0.05）； After sixstep handwashing, hand microorganism count before hand drying in group A,B and C was (3.26±0.61)CFU/cm2, (2.98±0.59)CFU/cm2  and (3.87±0.67)CFU/cm2 respectively,compared with hand microorganism count before handwashing,  the difference was statistically different(all P<0.01）. After adopting different  handdrying methods, microorganism count in three groups was statistically different（F=1.892，P＜0.05）, group A (［1.29±0.58］CFU/cm2 )was significantly lower than group B and C, group B (［9.51±0.73］CFU/cm2 )was significantly lower than group C(［22.76±4.11］CFU/cm2); the qualified rate in group A （90.00%）was significantly higher than group B and C, group B （68.57%）was significantly higher than group C （47.14%）.The top 5 pathogens isolated from HCWs’ hands were Pseudomonas aeruginosa， Acinetobacter baumannii， Klebsiella pneumoniae，Escherichia coli，and  Coagulase negative Staphylococcus, these strains were highly consistent with the top 5 multidrugresistant organisms (MDROs) isolated from ICU patients in this hospital in 2013. ConclusionHCWs’ hands  are seriously contaminated after all kinds of medical performance; if hands are improperly dried，secondary contamination may occur; pathogens isolated from HCWs’ hands are highly consistent with MOROs from patients,timely and correct handwashing and  handdrying is the key link to ensure the quality of hand hygiene，and  is of great significance to reduce the occurrence of MDROs infection in ICU patients.

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ObjectiveTo investigate the current situation of healthcareassociated infection(HAI) management in grassroots medical institutes in a province. MethodsFortysix grassroots medical institutes in 13 cities of the province were selected randomly for the survey, questionnaires about the current situation of HAI management in grassroots medical institutes were filled out, and related data were analyzed. ResultsFortyfour  qualified  questionnaires were adopted for analysis,and 2 unqualified questionnaires from public hospitals were excluded. HAI management in 44 medical institutes (100.00%) was in the charge of major leaders in medical institutes. Only 2 institutes（4.55%）set up independent HAI management departments, and 10 institutes（22.73%）established basic regulations and position responsibilities of HAI management, 38.67% of medical institutes established regulations of HAI prevention and control in key departments and responsibilities for key positions. The score for the establishment of basic regulations and position responsibilities of HAI management in village clinics was lower than the other medical institutes (F=5.762，P＜0.01). Except aseptic technique, the core regulations of HAI management weren’t implemented well in village clinics compared with the other institutes(P＜0.05). ConclusionOrganizational settings, HAI management of key departments, and core regulations of HAI management are not performed well in grassroots medical institutes in this province. Village clinics perform the worst in HAI management among all types of grassroots medical institutes. More measures, including education and surveillance, should be taken to improve HAI management in grassroots medical institutes.

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ObjectiveTo explore the distribution and drug resistance of pathogens causing bloodstream infection in patients in a general intensive care unit (GICU), and provide reference for the prevention of bloodstream infection and rational use of antimicrobial agents. MethodsFrom January 2011 to December 2013, clinical data of patients who were diagnosed with bloodstream infection were reviewed retrospectively, detected pathogens and drug resistance were analyzed statistically. ResultsThe major pathogens isolated from 385 patients with positive blood culture were  gramnegative bacilli, which accounting for 62.34%; isolation rate of  grampositive cocci and  fungi  was  27.01% and  10.65% respectively. The top five pathogens were Escherichia coli (18.18%), Pseudomonas aeruginosa(16.10%), Staphylococcus aureus (15.59%), Acinetobacter baumannii (13.25%), and Klebsiella pneumoniae (9.09%).The detection rate of methicillinresistant Staphylococcus aureus and methicillinresistant coagulase negative Staphylococcus was 72.55% and 68.34% respectively. Gramnegative bacilli was most sensitive to imipenem and amikacin (resistant rate was 0-35.65%）.ConclusionGramnegative bacilli are the main pathogens in blood culture from GICU in this hospital, and drugresistant rates are high. It’s important to strengthen blood culture of patients with suspected septicemia,  use antimicrobial agents rationally and control infection effectively.

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目的了解某中医院医院感染分布特点，为预防与控制医院感染提供科学依据。方法采用回顾性与前瞻性调查的方法，对该院2010—2013年间住院患者的医院感染监测数据进行统计分析，了解干预效果。结果4年共调查住院患者164 796例，发生医院感染2 973例（1.80%），3 351例次（2.03%）。2010年医院感染高发的科室为综合重症监护室（ICU，57.14%）、血液科（15.46%）、老年科（13.44%），2011年起对上述科室开展目标性监测和综合干预，感染率呈逐年下降趋势，至2013年，综合ICU、血液科、老年科医院感染率分别降至29.63%、10.76%和7.32%，差异均有统计学意义（P＜0.01）。医院感染部位以下呼吸道（45.66%）为主，其次是泌尿道（15.16%）和血液（13.31%）；4年共分离病原菌2 069株，以革兰阴性菌为主（64.81%），分离较多的是大肠埃希菌（304株）、铜绿假单胞菌（279株）、肺炎克雷伯菌（236株）、鲍曼不动杆菌（212株）、白假丝酵母菌（173株）、嗜麦芽窄食单胞菌（136株）和金黄色葡萄球菌（134株）。 结论开展综合性监测有利于发现医院感染的高危科室和重点部位，针对性地进行监测及干预；可明显降低医院感染发生率，是控制医院感染的有效手段。

Abstract:

目的调查某中医院重点科室医务人员手卫生知识掌握情况及影响手卫生执行的因素。 方法随机抽查该院重点科室的医务人员，进行问卷调查。 结果共发放问卷142份，其中有效问卷130份，有效率91.55%。医务人员手卫生知识平均得分为（18.97±1.44）分（总分21分），不同年龄、性别、工龄、学历、职业、职称、工作科室医务人员手卫生知识得分差异无统计学意义（P＞0.05）；影响医务人员执行手卫生的因素主要有：清洁剂、消毒剂刺激皮肤（74.62%）, 洗手池旁未配备干手用具（55.38%），无足够清洁剂（45.38%）等。 结论该院医务人员对手卫生的认知水平较高；改善手卫生用品及设施，加强管理，多措并举，可切实提高医务人员手卫生水平。

Abstract:

非结核分枝杆菌(nontuberculous mycobacteria，NTM)是指结核分枝杆菌、牛分枝杆菌与麻风分枝杆菌以外的分枝杆菌。NTM是自然界中广泛存在的条件致病菌，存在于水、土壤和气溶胶中，可以导致免疫力低下的患者发生感染［1］。2013年2月，本院心胸外科医生报告1例手术切口迁延不愈的病例，医院感染管理部（院感部）接到报告后根据临床症状及微生物实验室检验结果，确认为NTM（快速生长型）感染病例。遂结合文献，对感染的原因开展现场与流行病学调查，现报告如下。

Abstract:

生物被膜(biofilm，BF)是指细菌黏附于植入的医疗器械或受损组织，将其自身包裹在含水的多糖基质和蛋白质中，形成黏质状态，显微镜下观察可见通过胞外聚合物结合的细菌密集的聚集物［1］。BF的形成过程包括5个阶段，分别为黏附期、种植期、生长期、成熟期和播散期。种植期的细菌黏附是不可逆的，多形成微菌落。研究［2］发现，成熟的BF通常由内层、中层和外层3层结构组成，内层是调节膜，该结构未完全覆盖生物或非生物体表面，而是形成网格样结构；中层是紧密的微生物基底膜；外层是漂浮的表面膜，为浮游生物的聚居地，浮游生物可自由漂浮，扩散到其他区域引起急性感染或形成新的BF。早在1676年，Antonie van Leeuwenhoek便从牙菌斑中观察到细菌BF；但直到1978年，Costerton等才首次提出BF的相关理论，并在1982年证明了细菌在异物上具有黏附性，其黏附性与异物结合的牢固程度取决于细菌表面的生化特性及惰性表面的物理化学性质。1987年，Costerton又提出BF致病性问题［3］。医院感染与BF黏附的生物材料（如中心静脉导管、导尿管、心脏瓣膜修补以及骨科植入假体等）有关。尽管患者感染的微生物及感染部位不同，但均具有相似特征，即被膜中的细菌能够逃避宿主的免疫防御，并抵制抗菌药物的作用。预防及抑制BF的生长成为控制医院感染的重要措施，现将相关研究总结如下。