Abstract:

近一个世纪以来，抗菌药物在人类战胜各种感染性疾病的过程中发挥了关键作用，但日益突出的多重耐药菌问题已给临床抗感染治疗带来了严峻挑战。如何有效减缓多重耐药菌的产生，阻断多重耐药菌传播，已引起医学界、政府与社会的广泛关注。为加强多重耐药菌的医院感染管理，有效预防和控制多重耐药菌在医院内的产生和传播，保障患者的安全，由中国感染控制杂志组织，58位国内知名专家共同发起,邀请全国165位专家参与,历时10个月,召开了9场专题讨论会,在充分收集意见和讨论的基础上,最终形成了《多重耐药菌医院感染预防与控制中国专家共识》。共识荟萃了国内外多重耐药菌医院感染防控的最新进展,总结了我国大多数权威专家防控方面的宝贵经验,旨在规范和指导我国多重耐药菌医院感染的防控，提高我国多重耐药菌感染防控水平。

Abstract:

ObjectiveTo investigate genotypes and antimicrobial susceptibility of Rhizobium radiobacter (R. radiobacter) isolated from pediatric patients with bacteremia.MethodsR. radiobacter strains from blood cultures of pediatric patients with bacteremia from February 2013 through February 2014 were collected. 16S rDNA fragment was amplified by polymerase chain reaction(PCR), bacterial genotypes were identified by pulsedfield gel electrophoresis (PFGE), antimicrobial susceptibility testing were performed by KirbyBauer disk diffusion method. Results13 isolates of R.radiobacter were isolated from 12 children with positive blood culture, which including 3 genotypes, the homology of 16S rDNA fragment and R.radiobacter IFM 10623 was up to 99%. According to CLSI 2003 standard, these 13 R.radiobacter were resistant to ceftazidime, piperacillin, ticarcillin, piperacillin / tazobactam, ticarcillin / clavulanic acid, aztreonam and polymyxin B, but sensitive to cefepime, doripenem, imipenem, meropenem, tobramycin,  netilmicin, ciprofloxacin, levofloxacin, and norfloxacin.  In addition, cefotaxime and ceftriaxone showed larger inhibition zone.ConclusionTherapy of R.radiobacter infection should be based on antimicrobial susceptibility testing results;  cefotaxime and ceftriaxone are better selection for the therapy of R.radiobacter infection in pediatric patients.

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ObjectiveTo evaluate the comprehensive medical goal appraisal system on hand hygiene compliance rate of health care workers(HCWs). MethodsComprehensive medical goal appraisal system was adopted to intervene hand hygiene compliance rate of HCWs  in a comprehensive hospital , hand hygiene compliance rates of HCWs and consumption of instant hand sanitizer per bedday before (December 2012) and after intervention (January 2013-June 2014) were compared. ResultsHand hygiene compliance rate after intervention was higher than before intervention (85.17% ［18 208/21 379］vs 39.92%［853/2 137］)，hand hygiene compliance rate enhanced by 113.35%（χ2=2 590.81，P＜0.001）.Hand hygiene compliance rates of HCWs of different departments, different occupations and different hand hygiene moments were all higher than before intervention (all P＜0.001）; after intervention , hand hygiene compliance rate revealed a increased tendency, and has maintained high since October 2013 (>90%), consumption of instant hand sanitizer before and after intervention was 7.24 mL/ bedday（4 200 L/579 841 bedday） and 10.54 mL/bedday（9 323.5L/884 489 bedday）respectively, the consumption after intervention increased by 45.58% compared with that before intervention.  ConclusionComprehensive medical goal appraisal can effectively enhance hand hygiene compliance rate , and maintains at a high level; the measure can affect hand hygiene behavior of HCWs by hawthorne effect, and is an effective and longterm measure to improve hand hygiene compliance of HCWs.

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ObjectiveTo study the effect of disinfectant resistance gene qacEΔ1 on the drug resistance of commonly isolated gramnegative bacteria.MethodsGramnegative bacteria isolated from neonates in a neonatal intensive care unit(NICU) in JulyDecember 2013 were detected and performed antimicrobial susceptibility testing,qacEΔ1 gene were detected by polymerase chain reaction. ResultsA total of 608 gramnegative bacteria were collected, the major isolates were Klebsiella pneumoniae (n=216), followed by Escherichia coli (n=128), Enterobacter cloacae (n=77), Acinetobacter baumannii (n=62),and Pseudomonas aeruginosa (n=19). The positive rate of  qacEΔ1 gene in above five bacteria was 62.75%(315/502), Acinetobacter baumannii was the highest (87.10%). qacEΔ1positive  and negative strains showed statistical difference in the resistance rates to piperacillin,  cefepime, aztreonam, imipenem, and compound sulfamethoxazole （all P≤0.05）.The resistance rate of five strains to piperacillin, ceftazidime, cefepime, and aztreonam  were all high.ConclusionThe positive rates of qacEΔ1 in five major gramnegative bacteria from neonates in  NICU are all high, qacEΔ1positive strains have even higher resistance rates to piperacillin, cefepime, aztreonam, imipenem, and compound sulfamethoxazole.

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ObjectiveTo compare the disinfection efficacy of different disinfectants on dental unit waterlines (DUWLs). Methods18 sets of DUWLs were randomly divided into 4 groups, and disinfected or treated with  hydrogen peroxide (H2O2) disinfectant, sodium hypochlorite  (NaClO) disinfectant, hydrogen peroxide silver ion disinfectant(Sanosil),and  distilled water (DW) respectively. Water specimens from triple syringes and highspeed handpieces were taken, bacterial count before and after disinfection were compared. ResultsBefore disinfection,no significant differences in bacterial counts were found among four groups (all P>0.05), bacterial counts of DUWLs of all groups severely exceeded the standard(all＞3 000 CFU/mL）. After disinfection,except DW group, bacterial counts of DUWLs of the other groups declined dramatically  (all ＜100 CFU/mL）, bacterial count after disinfection were all obviously lower than  before disinfection （all P＜0.001).One week after disinfection, bacterial counts among three disinfectant groups in different time periods were statistically different (triple syringes: Day1—Day5,all P<0.05; highspeed handpieces:  Day2,Day3 and Day5，all P＜0.05). Day3 after disinfection of triple syringes by H2O2 and  NaClO, Day4 after disinfection of highspeed handpieces by H2O2 and  NaClO, and Day5 of triple syringes and highspeed handpieces by Sanosil all exceeded the standard of  Center for Disease Control and Prevention of America. One week after disinfection, bacterial counts of three disinfection groups all exceeded or approximated to that before disinfection. ConclusionThree types of disinfectants can all effectively reduce bacterial load in DUWLs. Compared with  other disinfectants, Sanosil has advantage of inhibiting bacterial growth after disinfection.

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ObjectiveTo understand the impact of methicillinresistant Staphylococcus aureus (MRSA) bloodstream infection on the length of hospital stay, hospital mortality, and poor prognosis of patients.  Methods357 patients with Staphylococcus aureus (S.aureus) bacteremia  in a hospital between January 1,2009 and December 31,2013 were surveyed and analyzed retrospectively.   ResultsOf 357 patients, 91 were infected with MRSA and 266 with methicillinsusceptible S.aureus (MSSA).  The length of hospital stay was statistically different between MRSA and MSSA group(29 d vs 23 d, P＜0.01）; before infection, length of hospital stay of MRSA group was longer than MSSA group（P＜0.01）; after infection, length of hospital stay was not statistically different between two groups（17 d vs 16.5 d, P=0.92）. Mortality of MRSA group and MSSA group was not statistically different（13.19％ vs 9.02％, χ2=1.28，P=0.26）. The incidence of poor prognosis of MRSA group was higher than  MSSA group(29.67％ vs 16.92％, χ2=6.85，P=0.01）. Multivariate analysis results showed that  MRSA infection was independent risk factor for poor prognosis (P＜0.01). ConclusionMRSA infection doesn’t contribute to the prolongation of hospital stay, but MRSA bloodstream infection is a risk factor for poor prognosis of patients.

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ObjectiveTo explore the risk factors for urosepsis  after minimally invasive percutaneous nephrolithotomy(mPCNL). MethodsClinical data of 1 022 patients undergoing mPCNL were collected, risk factors for urosepsis  after mPCNL were analyzed．ResultsOf 1 022 patients, 62 (6.07%) developed urosepsis. All patients recovered and discharged after early diagnosis and active treatment. Logistic regression analysis showed that age（OR95%CI：1.25-3.92）,blood routine examination （OR95%CI：1.25-14.00）,urine routine examination（OR95%CI：2.67-10.02）and  volume of  intraoperative fluid perfusion（OR95%CI： 1.37-4.18）were closely related to urosepsis following mPCNL. ConclusionAge（≥60 years）and  intraoperative perfusion fluid volume (≥30L）during operation are the risk factors for urosepsis following mPCNL, The recognition of the related risk factors is helpful for the prevention and timely treatment of urosepsis following mPCNL.

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ObjectiveTo explore the risk factors for infection following percutaneous nephrolithotomy(PCNL),and provide the basis for prevention of postoperative infection.Methods96 patients who were performed PCNL in a hospital between August 2010 and August 2013 were chosen, clinical data of patients were retrospectively analyzed, the occurrence of postoperative infection, risk factors and isolated pathogens were analyzed.Results35 patients (36.46%［35/96］）developed infection following PCNL.  Univariate analysis revealed that risk factors for postoperative infection were the size and shape of stone, duration of operation, and intraoperative perfusion (all P<0.05). 96 patients before operation and 18 patients after operation were performed bacterial culture for urine, a total of 39 strains were isolated, the main isolated pathogens was  Escherichia coli (n=12),   followed by Pseudomonas aeruginosa (n=8),  Streptococcus viridans (n=5), Klebsiella pneumoniae (n=4) and Enterobacter cloacae (n=3). ConclusionInfection rate following PCNL is high, duration of operation and intraoperative perfusion should be reduced, antimicrobial agents should be used rationally.

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ObjectiveTo explore the efficacy and adverse reactions of diminishing scheme of cefaclor sustained release tablets in the treatment of recurrent urinary tract infection(RUTI). Methods60  RUTI patients in a hospital were divided into treatment group(n=30) and control group (n=30), patients in treatment group were treated with diminishing scheme of cefaclor sustained release tablets, patients in control group were treated with diminishing scheme of levofloxacin tablets, clinical therapeutic efficacy and adverse reactions of  two groups  were observed. ResultsThe curative rate in treatment group was higher than control group （［80.00%,n=24］vs ［53.33%,n=16］） (χ2=4.80，P=0.028）. The incidence of RUTI in treatment group was lower than control group (［6.67%，n=2］ vs ［26.67%，n=8］)（χ2=4.32，P=0.038）. Incidence of adverse reactions in treatment group was lower than control group (16.67% vs 50.00%)（χ2=7.50，P=0.006）. ConclusionThe diminishing scheme of cefaclor sustained release tablets in the treatment of RUTI has good curative efficacy, low recurrence rate, fewer adverse reactions, and can be used for the treatment of recurrence of RUTI.

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ObjectiveTo analyze the clinical distribution and antimicrobial resistance of Acinetobacter baumannii (A.baumannii) from a hospital, so as to guide the rational use of antimicrobial agents and provide scientific basis for the prevention and control of healthcareassociated infection(HAI). MethodsDistribution and antimicrobial susceptibility testing results of A.baumannii isolated from patients between January  2011 and December 2013 were analyzed retrospectively. ResultsA total of 339 A. baumannii isolates were isolated within three years, 291 isolates (85.84%) were from sputum, followed by urine (n=29,8.55%）, secretion(n=12,3.54%) and blood (n=3, 0.89%). The main distribution departments were intensive care unit(ICU, n=149,43.95%), department of respiratory medicine (n=46,13.57%）, department of pediatrics (n=32,9.44%） and oncology (n=22, 6.49%）. The resistant rate of A.baumannii to tobramycin and  imipenem were 11.11%49.47%, the resistant rates to the other antimicrobial agents were relatively high; antimicrobial resistant rate of 2012 and 2013 were obviously lower than 2011. ConclusionA. baumannii  from this hospital are mainly from sputum specimens, and mainly distribute in ICU and department of respiratory medicine, antimicrobial resistant rate is high, but there is a decreasing tendency in recent years.

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ObjectiveTo investigate healthcareassociated infection (HAI) in neonatal intensive care unit(NICU), and provide reference for controlling HAI in newborns. MethodsTargeted surveillance on HAI in all newborns in NICU of a hospital from January 2011 to December 2013 was performed by  prospective investigation method.  ResultsA total of  5 365 newborns were monitored, 128 newborns developed 133 times of HAI,HAI rate and HAI case rate was 2.39% and 2.48% respectively. The major infection sites were conjunctiva (33.08%), upper respiratory tract (23.31%) and  skin soft tissue (17.29%). The daily infection rate was 3.32‰(128/38 528), vascular catheter usage rate and respirator usage rate was 1.75%（676/38 528）and 1.09%（420/38 528）respectively. The difference in vascular catheter usage rate and respirator usage rate in newborns with different body weight had statistical difference (χ2=3 075.22; 442.46, both P＜0.01）. HAI in newborns with body weight of ≤1 000 g, 1 001-1 500 g, 1 501-2 500 g, and ＞2 500 g was 16.67%,12.26%,4.15% and 1.06% respectively. None newborns developed catheterrelated bloodstream infection(CRBSI), the incidence of ventilator-associated pneumonia (VAP) was only 4.76‰（2/420）. A total of 51 specimens were sent for detection, 27 pathogens were isolated, the major were grampositive bacteria（55.56%）.ConclusionThe incidence of HAI in newborns is high,  the main infection sites are eye, upper respiratory tract, and skin and soft tissue.

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ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens isolated from surgical patients with infection. MethodsDistribution and antimicrobial resistance of 1 208 pathogens isolated from surgical patients with infection from January 2013 to January 2014 were analyzed retrospectively. ResultsOf 1 208 pathogenic isolates, gramnegative bacteria, grampositive bacteria and fungi accounted for 64.57%（n=780），24.92%（n=301） and 10.51%（n=127） respectively. The main specimens were sputum (44.78%), urine (21.11%),blood(11. 51%), and pus（10.26%）.Antimicrobial suscept ibility testing results showed that the producing rate of extendedspectrum βlactamases (ESBLs)  of Escherichia coli and Klebsiella pneumoniae was 62.60% and 33.61% respectively, resistant rate to imipenem was 0.76% and 15.57%, respectively. The resistant rate of Pseudomonas aeruginosa and Acinetobacter baumannii to imipenem was 38.93% and 75.80% respectively. Methicillinresistant Staphylococcus aureus and methicillinresistant coagulase negative Staphylococcus was 71.68% and 87.93% respectively. ConclusionThe major pathogens isolated from surgical patients with infection are gramnegative bacteria, the main infection sites are respiratory tract and urinary tract in this hospital; multidrug resistance is serious, especially carbapenem resistance, which should be paid attention.

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ObjectiveTo understand the occurrence and risk factors for surgical site infections (SSIs) following appendectomy, so as to provide reference for taking effective prevention measures.  MethodsThrough monitoring on surgical site, SSIs in patients undergoing appendectomy in a hospital from July 1,2011 to July 1,2013 were investigated. ResultsA total of 817 appendectomy surgery patients were investigated, 37 (4.53%) of whom had SSIs, 36 of which were superficial wound infection, and 1 was deep wound infection. Univariate  analysis  showed that SSIs were related with  duration of operation, anesthesia mode,  ASA score, blood sugar, whether perioperative antimicrobials were used, and operative risk index score（all P＜0.05）. Multivariate logistic regression analysis revealed that blood sugar （OR 95% CI: 1.07-4.72）, whether perioperative antimicrobials  were used（OR 95% CI: 1.14-7.10）, and  risk index score （OR 95% CI: 5.90-43.28）were independent  risk factors for SSIs following appendectomy (all P<0.05).ConclusionSurgical site monitoring is helpful for the understanding of SSIs following appendectomy; proper intervention measures should be adopted in clinic to prevent SSIs following appendectomy.

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ObjectiveTo explore intervention efficacy of clinical application of antimicrobial agents in internal medicine departments of a hospital. Methods1 880 medical records from internal medicine and pediatrics departments this hospital in JulyDecember 2010 were randomly selected as control group (before intervention), and  2 207 medical records in JulyDecember 2011 were as trial group (after intervention), antimicrobial use of two groups was compared. ResultsThe overall usage rate of antimicrobial agents after intervention was lower than before  intervention (48.12% vs  58.62%, χ2=44.45，P＜0.001）. Except endocrinology, pediatrics  and  hematology departments, the usage rates of antimicrobial agents in the other departments after intervention were all obviously lower than before  intervention（all P＜0.05）. The usage rate of antimicrobial agents in endocrinology and  hematology departments were both low（＜40%）, which met the requirements of Ministry of Health.ConclusionComprehensive intervention in clinical use of antimicrobial agents reduced the usage rate of antimicrobial agents in internal medicine and pediatrics departments in this hospital.

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ObjectiveTo investigate the causes and treatment measures of an outbreak of  Norwegian scabies occurred  in a hospital.  MethodsIn May 2013, an outbreak  of  Norwegian scabies among health care workers(HCWs) occurred because of the misdiagnosis of a patient with Norwegian scabies, epidemiological investigation was carried out by healthcareassociated infection(HAI) control  department, medical intervention and disinfection and isolation measures were performed. ResultsA total of 27 HCWs and patients’ relatives developed Norwegian scabies. After active medical treatment, patients’ condition improved; all appliances used by patients were cleaned and disinfected after being wrapped and sealed with plastic bags for one week. Epidemic trend of infection was under control and no new case was found. ConclusionWith highly contagious, Norwegian scabies can be spread in local area, it is necessary to improve HCWs’ diagnostic ability to this disease and take effective measures to prevent the epidemic once HAI occur.

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ObjectiveTo understand the distribution and antimicrobial resistance of pathogens isolated from bone and joint infection sites  of  orthopedic patients, so as to provide reference for  prevention and therapy of bone and joint infection. Methods114 specimens from bone and joint infection sites of orthopedic patients between June 2010 and October 2013 were surveyed, pathogens and antimicrobial susceptibility of pathogens were analyzed.ResultsA total of 145 pathogenic isolates were obtained, 62.07%(n=90) of which were gramnegative bacteria,34.48%(n=50) were grampositive bacteria, 2.07%(n=3) were Candida spp., and 1.38%(n=2) were anaerobic bacteria. The top 4 pathogens were Pseudomonas aeruginosa (20.69%), Staphylococcus aureus (12.41%), Escherichia coli (11.03 %), and Enterobacter cloacae (9.65%).These pathogens presented remarkable resistance. The resistant rate of Pseudomonas aeruginosa to ceftazidime was up to 40.00%; the resistant rates of Escherichia coli to compound sulfamethoxazole, ciprofloxacin and levofloxacin were all 100.00%.ConclusionGramnegative bacteria are the major pathogens in orthopedic ward, the isolated strains are resistant to multiple antimicrobial agents.

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ObjectiveTo understand healthcareassociated urinary tract infection (HAUTI) and pathogens causing HAUTI in intensive care unit (ICU) patients, so as to provide scientific basis for the prevention and control of HAUTI. MethodsTargeted surveillance data about HAUTI  in 32 hospitals in 2013 were analyzed. ResultsA total of  23 680 ICU patients were monitored, 157 cases of HAUTI occurred,  HAUTI rate was 0.66%; the usage rate of urinary tract catheter was 80.83%，catheterassociated UTI was 1.25‰.  A total of 162 pathogenic strains were detected, the percentage of fungi, gramnegative bacteria, and grampositive bacteria was 40.74% (n=66)； 31.48 % (n=51), and 27.78% (n=45) respectively. ConclusionThe main pathogens causing HAIURI are fungi, comprehensive intervention measures should be taken to control HAUTI in ICU patients.

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ObjectiveTo investigate the occurrence of intraoperative occupational exposure to blood among surgeons in a hospital, so as to make effective precaution measures. MethodsCombined with questionnaires, the monitoring data of  occupational  exposure to blood among surgeons from June 2011 to June 2013 were analyzed statistically. ResultsA total of 49 surgeons sustained  115 times of occupational exposure to blood, including  42 times (36.52%) in general surgery surgeons, 36 (31.30%) in orthopedic surgeons,31 (26.96%) in obstetrics and gynecology surgeons, and 6(5.22%) in urinary surgery surgeons. The main occupational exposure were sharp injuries (n=71, 61.74%), blood and body fluid splashing were 44 times (38.26%); the top two exposed sites were hands (49.57%)  and faces (17.39%). 88.70% of exposed cases were given emergent treatment, and 55.65% of  exposed cases were reported. The followup found no surgeons were infected after the prompt and correct treatment.ConclusionSurgeons are at high risk of occupational exposure. Occupational precaution should be strengthened, occupational awareness and ability of HCWs should be enhanced, and postexposure treatment should be improved.

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目的了解某院尿路感染患者病原菌分布及耐药情况，为临床尿路感染的预防及经验用药提供依据。方法回顾性分析该院2013年1月—2014年5月尿路感染患者中段尿培养的临床资料，对其病原菌检出及耐药情况进行统计分析。结果712例患者中段尿经培养分离后共得到阳性菌株342株，培养阳性率为48.03%。排列前3位的菌株分别为大肠埃希菌（57.89%）、屎肠球菌（8.19%）、粪肠球菌（5.85%）。呋喃妥因的耐药率：大肠埃希菌(2.02%)、屎肠球菌(7.12%)、粪肠球菌(0.00%)、弗氏柠檬酸杆菌(0.00%)。结论大肠埃希菌是尿路感染主要病原菌，可根据药敏结果选择抗菌药物。

Abstract:

霍乱弧菌是导致急性霍乱性腹泻的病原体，O1群和O139群霍乱弧菌是导致霍乱大流行的血清群。抗菌药物与补液疗法联合使用，对治疗霍乱弧菌引起的感染性腹泻具有协同作用，利于缩短病程，控制霍乱疫情蔓延。本文就霍乱弧菌的抗菌治疗现状及耐药机制作一综述。