Abstract:

ObjectiveTo investigate the epidemiological characteristics of healthcareassociated infection (HAI) in neonatal intensive care units(NICUs) of tertiary firstclass hospitals in China, and provide scientific evidence for the prevention and control of neonatal HAI.  Methods17 hospitals in 9 provinces were selected for multicenter study, HAI occurred in neonates at NICUs from October 2013 to September 2014 were surveyed prospectively according to the uniform diagnostic criteria and methods. ResultsA total of 12 998 neonates were monitored, 436 (3.35%) HAI cases occurred, the total patientdays were 126 125 days, incidence of infection  was 3.46/1 000 patientdays. HAI cases rate decreased with the increase of birth weight (χ2=291.55, P＜0.001). The difference of HAI rate in neonates at different sizes of ICUs were significantly different(χ2=49.77, P＜0.001), infection case rate and infection incidence per 1 000 patientdays were both highest in NICUs with ＞30 beds; HAI case rate was highest in southwest region(10.36%), infection rate per 1 000 patientdays was the highest in southern China(10.52‰). Lower respiratory tract and bloodstream were the main infection sites; the major pathogens for infection were  Klebsiella pneumoniae, Escherichia coli, and  Acinetobacter baumannii.ConclusionThe incidences of HAI in NICUs are different among neonates of different birth weight, at different sizes of ICUs, and at ICUs of different regions, surveillance should be strengthened, prevention and control measures should implemented according to infection characteristics.

Abstract:

ObjectiveTo compare the differences between two statistical methods for evaluating nonsensitivity of pathogenic bacteria to antimicrobial agents, and explore effect of nonconsideration of clinical background on evaluating extent of bacterial resistance.MethodsData of Staphylococcus aureus and Acinetobacter spp. in a hospital in the first half year of 2008, 2010 and 2013 were collected and conducted statistical analysis with two methods (method 1: based on all clinically isolated bacteria; method 2 : based on infectionrelated nonrepetitive bacteria), two methods for evaluating bacterial nonsensitive  rates to antimicrobial agents were compared.ResultsThe nonsensitive rates of Acinetobacter spp. to various antimicrobial agents : statistical results by using method 1 were generally higher than those using method 2， absolute difference between two statistical methods was 10.46%-33.77%; the nonsensitive rates of Staphylococcus aureus to various antimicrobial agents : except compound sulfamethoxazole in 2010 and 2013(difference were 6.17% and 10.21% respectively), penicillin G (difference was 3.86%), erythromycin (difference was 2.71%), and azithromycin in 2013 (difference was 2.43%), statistical results by using method 1 were generally higher than those using method 2， absolute difference between two statistical methods was 0-18.04%.ConclusionThere are deviation in the nonsensitive rates of bacterial strains to antimicrobial agents by using two different statistical methods, deviation is larger in Acinetobacter spp.. The resistance level might be incorrectly higher when evaluating the resistance status without considering clinical background of bacteria.

Abstract:

ObjectiveTo investigate prevalence of resistance genes for βlactams in clinically isolated multidrugresistant Acinetobacter baumannii (MDRAB) in a hospital.Methods22 clinically isolated MDRAB strains were performed antimicrobial susceptibility testing, resistance genes for βlactams (TEM, SHV,  CTXM,  PER, DHA,  IMP, VIM, SIM, OXA23, OXA24, and OXA58) in these strains were detected with polymerase chain reaction.ResultsThe resistant rates of 22 isolates of MDRAB to ceftazidime，cefotaxime，cefepime， gentamycin， amikacin，ciprofloxacin，and compound sulfamethoxazole were all 100.00%;to imipenem, meropenem,and cefoperazone / sulbactam were 50.00%,40.91%, and 31.82% respectively, intermediated rates were 31.82%,36.36%, and 31.82% respectively. The carriage rates of OXA23, TEM, IMP, and PER were 100.00% (n=22), 72.73 % (n=16), 54.55% (n=12), and 18.18%(n=4) respectively.Detection results of SHV,CTXM,DHA,VIM,SIM,  OXA24,and OXA58 were all negative.ConclusionCarriage of IMP, TEM, PER, and OXA23 resistance genes are the major resistance mechanisms of MDRAB to βlactamase antimicrobial agents in this hospital.

Abstract:

ObjectiveTo develop a multiplex touchdown PCR for simultaneous detection of extendedspectrum βlactamases (ESBLs)producing Enterobacteriaceae and methicillinresistant Staphylococcus aureus (MRSA).MethodsBlood culture positive specimens from 102 hospitalized patients were collected between March 2013 and  September 2014, four pairs of specific primers were designed based on SHV,TEM, and OXA genes of ESBLsproducing Enterobacteriaceae and MecA gene of MRSA,  drugresistant genes were amplified with single touchdown PCR and multiplex touchdown PCR, the results were compared with KirbyBauer disk diffusion method.ResultsEach single PCR amplified a specific band， four drugresistant genes were also detected by multiplex touchdown PCR；the lower detection limits of multiplex touchdown PCR for DNA of  MecA,SHV, TEM, and  OXA were 4.37 ng, 2.19 ng, 4.53 ng, and 3.59 ng, respectively. Compared with KirbyBauer disk diffusion method, the overall sensitivity and  specificity of multiplex touchdown PCR were 100.00% and 88.24% respectively, for ESBLs were 100.00％ and  87.23％ respectively，for  MRSA were both 100.00％.ConclusionA higher sensitivity and specificity multiple touchdown PCR assay has been developed, and it can be used in the rapid diagnosis and epidemiology investigation of  bloodstream infection caused by ESBLsproducing Enterobacteriaceae and  MRSA, and is helpful for guiding antimicrobial use in clinic.

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ObjectiveTo explore the risk factors and prognosis of hospitalized patients with bloodstream infection due to carbapenemresistant Acinetobacter baumannii(CRAB).Methods163 patients with CRAB bloodstream infection from 2010 to 2013 were conducted retrospective casecontrol study, 68 patients with bloodstream infection due to carbapenemsusceptible Acinetobacter baumannii(CSAB) during the same period were as control group.ResultsThe independent risk factors for CRAB bloodstream infection were stay in intensive care unit(ICU) (OR,1.27［95%CI,5.55-22.89］) and emergency department(OR,3.57 ［95%CI,1.67-7.62］) before infection. Patients with CRAB bloodstream infection had lower 28day survival rate than those with CSAB bloodstream infection(66.17% vs 96.95%，χ2=15.71,P＜0.001). The independent risk factors for influencing prognosis of Acinetobacter baumannii bloodstream infection were infection of CRAB (HR 95% CI,3.01-67.28), blood disease(HR 95%CI, 3.77-25.97), cardiac insufficiency(HR 95%CI,2.10-20.41), stay in ICU(HR 95%CI, 1.01-5.28),and age(HR 95%CI,1.01-1.04).ConclusionThe independent risk factors for CRAB bloodstream infection are stay in ICU and emergency department before infection, CRAB bloodstream infection is risk factor for influencing prognosis of patients.

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ObjectiveTo investigate the status of invasive fungal infection(IFI) associated with hematopathy, and evaluate drug resistance and risk factors of fungal infection. Methods1 246 cases of infection occurred in patients in a hospital from 2006 to 2010 were analyzed retrospectively， pathogenic features and risk factors of IFI were analyzed.ResultsThere were 281 cases of fungal infection， and 162 fungal isolates were isolated, the main infection site was respiratory tract(134 isolates,82.72%). Four major Candida were Candida albicans, Candida tropicalis，Candida glabrata, and Candida krusei; in 20062009, the main fungi were Candida albicans, while in 2010, the majority were nonCandida albicans.The resistant rates of four isolated Candida to fluconazole and itraconazole were 5.15% and 4.41% respectively, 6 isolated Candida krusei strains were all resistant to both fluconazole and itraconazole, voriconazoleresistant strain was not found. The independent risk factors for fungal infection were diabetes and duration time of agranulocytosis＞14 days.ConclusionThe proportion of infection caused by nonCandida albicans increased obviously, fluconazole and itraconazoleresistant nonCandida albicans strains have emerged, comprehensive measures should be adopted to prevent IFI actively and treat patients early.

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ObjectiveTo investigate current status of healthcareassociated  infection(HAI) and communityassociated infection(CAI) of different levels of hospitals in Xinjiang.MethodsInfection, antimicrobial use and pathogen detection in patients in secondclass   and above hospitals in Xinjiang on March 20,2014 were performed crosssectional survey by  bedside visiting  and medical record reviewing methods.ResultsA total of 66 208 patients in 132 hospitals were investigated, HAI prevalence rate and case prevalence rate was 1.83% and 2.02% respectively;  CAI prevalence rate and case prevalence rate was 24.53% and 24.83% respectively. HAI prevalence rate in thirdclass hospitals was higher than secondclass hospitals (2.58% vs 1.44%, P＜0.001）,while CAI prevalence rate was lower than secondclass  hospitals (17.84% vs 28.01%, P＜0.001）.HAI prevalence rate was highest in intensive care unit (14.91%),  CAI was  highest in pediatric department. The common infection sites were respiratory tract, surgical site and urinary tract. Antimicrobial usage rate was 31.27%，antimicrobial usage rate in secondclass hospitals was higher than that of the thirdclass hospitals(［35.95%, n=15 642］ vs ［22.32%,n=5 064］,χ2=1 288.974,P＜0.001),pathogen detection rate  in thirdclass hospitals was higher than that of the secondclass hospitals(［59.40%, n=2 224］ vs ［53.59%,n=6 436］,χ2=38.964,P＜0.001) Gramnegative bacilli were main isolated pathogens, the top 3 pathogens were Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii.ConclusionThe crosssectional survey can reflect infection status of different levels of  hospitals, surveillance of targeted microbial detection and rational antimicrobial use should be strengthened, management of infection in high risk population and key sites should be paid close attention.

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ObjectiveTo analyze pathogen spectrum of intraabdominal infection in patients in an intensive care unit（ICU）.MethodsIntraabdominal infections and pathogens of 1 330 patients who admitted to ICU from January 2012 to March 2013 were analyzed retrospectively.Results283 patients developed intraabdominal infection, incidence of infection was 21.28%;  133 （47.00%）patients were detected 186 isolates of pathogens, the proportion of gramnegative bacilli, grampositive cocci, and fungi were 68.82%(n=128),28.49%(n= 53), and 2.69%(n=5) respectively. The major gramnegative bacilli were Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumoniae, the major grampositive cocci were Enterococcus faecium,Staphylococcus aureus, and Enterococcus faecalis. The detection rates of pathogens after patients stayed in ICU for ≤2, 3-7, 8-14,and＞14　days were 70.43%（n=131）, 12.90%（n=24）, 10.22%（n=19）, and 6.45%（n=12）respectively; Escherichia coli(n=51) and Enterococcus faecium (n=21)were the main pathogens when patients stayed in  ICU for ≤48 hours, Acinetobacter baumannii was the main pathogen when patients stayed in ICU for ＞48 hours. Most  intraabdominal infection occurred after intestinal tract(53.23%) and hepatobiliary system operation(24.19%). 39 (29.32%) patients isolated at least two kinds of pathogens, 29 of whom isolated 2 kinds of pathogens.ConclusionMost pathogens of intraabdominal infection in ICU patients are detected following  intestinal tract and hepatobiliary  operation, and mixed pathogens are common, predominantly gramnegative bacilli. Escherichia coli and Enterococcus faecium are the main pathogens when patients stayed in ICU for ≤48 hours, opportunistic pathogens are the main pathogens when patients stay in ICU for ＞48 hours.

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ObjectiveTo analyze the epidemiological characteristics of epidemic mumps in Chongqing Wanzhou district, and provide scientific basis for taking effective prevention and control measures. MethodsEpidemic data of mumps in Wanzhou district from January 2011 to December 2014 were investigated retrospectively.ResultsA total of  2 785 cases of epidemic mumps were reported, there was no death case, the incidence of mumps was 44.02/100 000. Incidence of mumps in population under 15 years old was the highest, accounting for 84.45% (2 352/2 785). Mumps mainly occurred among students (1 674 cases,60.11%).The peaks were from April to July and October to December,  the number of mumps increased significantly from October to December in 2013. Difference in incidence among each year of 2011-2014  was statistically different（χ2=40.52，P＜0.01）. Incidence of mumps was statistically  different between the city streets and villages/ towns（63.99/100 000  vs 32.13/100 000, χ2=20.168，P＜0.01）.Incidence was statistically  different between the city streets and villages/ towns each year of 2011-2014 (all P＜0.01）, except  2012, the incidence of mumps of  city streets was significantly higher than  villages/ towns.ConclusionIt is important to conduct “Five early” for the prevention and treatment of infectious diseases,  strengthen the vaccination of measlesmumpsrubella (MMR) vaccine or vaccine against epidemic mumps, especially the vaccination for students and children in nurseries, popularize the knowledge about prevention and control of mumps, improve diagnosis and treatment level, and strengthen the epidemic monitoring.

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ObjectiveTo investigate the current situation of healthcareassociated infection (HAI) management in basic level  private medical institutions.Methods118 basic level  private medical institutions in a district of Chengdu were investigated  through visiting and questionnaire.ResultsOf 118 medical institutions,only 2 had HAI management personnel,  4 had HAI  management system.  22.03% had hand washing   facilities in therapeutic rooms and consulting rooms，37.29% of institutions stored  aseptic items in accordance with the requirements，55.93% of institutions  disposed medical waste at disposal center；99.15% handled reusable items  by users.ConclusionHAI management status is worried, health administrative department should strengthen support and supervision，especially intensified the supervision of private dental clinics.

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ObjectiveTo investigate the relationship between occurrence of healthcareassociated infection (HAI)  and seasonal change， so as to  provide the basis for seasonal HAI prevention and control.MethodsThe occurrence of HAI among inpatients in a hospital between 2010 and 2013 was analyzed retrospectively.ResultsOf 303 371 patients, 10 376  developed 12 919 cases of HAI, the incidence of HAI was 3.42%， infection case incidence was 4.26%. The highest incidence of HAI occurred in the fourth quarter（3.76%）and lowest in the second quarter （3.20%）(P ＜0.01); the main HAI site was lower respiratory tract (39.79%), followed by upper respiratory tract (13.17%), blood stream (10.39%), surgical site (8.60%)， and urinary tract (7.91%). Patients in the following departments were with HAI rates of ＞5%: intensive care unit（ICU, 24.61%）,hematology（17.47%）,rehabilitation（13.16%）,neurosurgery（9.27%）, infectious diseases （9.17%）, cardiothoracic surgery（7.67%）, and hepatobiliary surgery（5.13%）,the main HAI sites in patients in ICU, department of neurosurgery were lower respiratory tract, blood stream, and urinary tract.ConclusionThe occurrence of HAI is closely related with  seasonal change, appropriate control measures should be taken according to  seasonal change and sites of high HAI rates, so as to reduce the occurrence of HAI.

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ObjectiveTo investigate the prevalence rates of healthcareassociated infection (HAI) and antimicrobial use in a hospital in 2011-2013, and provide scientific basis for prevention and control of HAI.MethodsHAI prevalence rates and antimicrobial use in a hospital in 2011-2013 were investigated by combination of bedside visiting and medical records reviewing.ResultsA total of 3 011 patients were investigated during three years, the prevalence rates were 3.49%, 2.87% and 3.98% respectively, difference of prevalence rates during three years were not significantly different (χ2=2.105，P=0.356). Among  HAI sites, lower respiratory tract ranked first, the major pathogens were gramnegative bacilli, constituent ratios of different pathogens were not significantly different among three years（χ2=1.003，P=0.972）；antimicrobial usage rates and specimen detection rates among 3 years were both significantly different(χ2=12.569，P＜0.01;χ2=6.758，P＜0.01, respectively)，antimicrobial usage rate was highest in 2011(63.40%), and specimen detection rate was highest in 2012(62.14%).ConclusionPoint prevalence rate in this hospital is at average national level，antimicrobial usage rate decreased， the consciousness of  pathogenic detection gradually enhanced，clinical application management of antimicrobial agents  still needs to be strengthened continuously.

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ObjectiveTo analyze the distribution and antimicrobial resistance of pathogenic strains in wound infection，and provide scientific evidence for rational use of antimicrobial agents in  treatment of wound infection as well as  reducing the emergence of drugresistant organisms.MethodsData about pathogenic strains isolated from wound specimens of patients with wound infection in a hospital between June 2011 and April 2014 were analyzed retrospectively.  ResultsA total of 965 pathogenic strains were isolated from wound specimens，the main infection sites were limbs（50.47%）；infected  patients mainly distributed in department of orthopaedic surgery（44.97%）；trauma  and incisional wound infection were the major infection types(47.98%, 36.48%, respectively). Among isolated pathogens, grampositive bacteria， gramnegative bacteria, and fungi accounted for 37.20%, 59.59%, and 3.21% respectively. The main grampositive bacteria were highly susceptible to vancomycin, teicoplanin，and linezolid，the main gramnegative bacteria were highly resistant to most commonly used antimicrobial agents except cefoperazone / sulbactam, piperacillin / tazobactam， imipenem, and meropenem.ConclusionPatients with wound infection are mainly distributed in department of orthopedics，  the main infection types are trauma and surgical site infection,  antimicrobial resistant rates of the major grampositive and gramnegative bacteria are both high. Surgeons, especially orthopedics surgeons, should pay attention to the culture of pathogens and monitoring of antimicrobial susceptibility, use antimicrobial agents rationally，and strengthen the prevention and control of surgical site infection，so as to reduce the infection incidence and occurrence of drugresistant organisms.

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ObjectiveTo evaluate risk factors for multidrugresistant organisms(MDRO)  pulmonary infection in elderly patients in a hospital, and provide scientific basis for prevention and control of MDRO infection.Methods188 elderly patients who developed pulmonary infection between August 2010 and December 2012 were divided into MDR group (n=95) and nonMDR group (n=93) according to sputum bacterial culture results, clinical data of two groups of patients were analyzed.Results102 strains of  MDROs were isolated from patients with MDRO pulmonary infection, the top three were Acinetobacter baumannii (31.37%), Pseudomonas aeruginosa (25.49%), and methicillinresistant Staphylococcus aureus (15.69%). Univariate analysis showed that 7 risk factors for MDRO  pulmonary infection in elderly patients were  history of cerebrovascular disease or dementia, hypoproteinemia, dysphagia, bedridden, history of ICU hospitalization, recent application of 3,4generation cephalosporins, and invasive procedures. Multivariate logistic  regression analysis showed that hypoproteinemia (OR,6.02［95%CI,1.50-24.18］)，invasive procedures (OR,6.55 ［95%CI,1.69-25.44］), and bedridden (OR,6.03 ［95%CI,1.92-18.91］) were independent risk factors for MDRO  pulmonary infection in elderly patients.ConclusionMultiple factors contribute to MDRO pulmonary infection in elderly patients, comprehensive prevention and control measures should be taken against the risk factors, so as to prevent and control MRDO pulmonary infection in elderly patients.

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ObjectiveTo investigate healthcareassociated infection(HAI) in patients in a cancer hospital,  provide reference for controlling HAI in cancer patients, and guide rational use of antimicrobial agents.MethodsClinical data of patients in a cancer hospital between August 2006 and July 2012 were analyzed retrospectively.ResultsThe incidence of  HAI case was 1.53% (2 060/134 389), and annual incidence  showed a downward trend. The main infection site was lower respiratory tract (46.46%, n=957),followed by bloodstream (15.63%, n=322), abdominal and pelvic (14.03%, n=289). The main pathogens were Pseudomonas aeruginosa (16.16%, n=350), Staphylococcus aureus (9.97%, n=216), Klebsiella pneumoniae (9.79%, n=212), Escherichia coli (9.65%, n=209), and Candida albicans (6.51%, n=141). Gramnegative bacilli, including Klebsiella pneumoniae and Escherichia coli, were sensitive to carbapenems and βlactamase inhibitors.ConclusionLower respiratory tract is the major HAI site in patients with cancer, and gramnegative bacteria are the main pathogens. Carbapenems and βlactamase inhibitors are recommended for the empirical treatment of HAI in cancer patients.

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ObjectiveTo investigate the incidence of healthcareassociated  infection (HAI) in patients in a respiratory intensive care unit (RICU)  of a teaching hospital, and provide reference for HAI prevention and control.MethodsAll  patients admitted to this RICU from January to December 2014 were surveyed with prospective targeted monitoring  method, surveyed data were analyzed statistically.ResultsA total of  561 patients were surveyed, 43 patients developed 44 times HAI, HAI rate and HAI case rate were 7.66% and 7.84% respectively, incidence of  HAI and adjusted incidence of HAI per 1 000 patientdays were 6.26‰ and 1.79‰ respectively. The main infection site was urinary tract (45.46%, n=20). Incidence of ventilatorassociated pneumonia (VAP), catheterrelated bloodstream infection （CRBSI）,and catheterassociated urinary tract infection (CAUTI) per 1 000 catheterdays were 2.73‰(n=13),1.57‰(n=2), and 3.78‰(n=18) respectively. Incidence of HAI per 1 000 patientdays between the first and second half year of 2014 was significantly different（4.59‰ vs 7.89‰；u=-1.75，P=0.04）. A total of 47  pathogenic strains were isolated, the main pathogens were gramnegative bacteria(n=26,55.32%).ConclusionThe major HAI in RICU is deviceassociated infection, it is necessary to strengthen the management of invasive procedures; targeted monitoring can find the weak links of infection control practice and helpful for taking effective prevention and control measures to reduce the incidence of HAI in ICU.

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目的探讨两种脐部护理方法对减少新生儿脐部感染和败血症的效果。方法分别对2012年1—6月（改进前）、2012年7—12月（改进后）入住某院产科及新生儿科的新生儿采取两种不同的脐部护理方法，比较两组新生儿脐部感染和败血症发生情况。结果脐部护理方法改进前后新生儿脐部感染发病率分别为1.12%、0.35%，两者比较差异有统计学意义（χ2=4.75，P=0.029），新生儿败血症发生情况差异无统计学意义（P=0.251）。结论加强对新生儿感染监测及其家属的健康宣教，改进护理方法，可有效降低新生儿感染的发生。

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目的探讨品管圈在呼吸机冷凝水管理中的应用效果。方法严格按照品管圈的各个步骤，对冷凝水管理进行干预，品管圈活动实施前后对冷凝水管理情况及细菌培养结果进行评价。结果品管圈活动实施前冷凝水管理的合格率为62.28%，实施后合格率为85.33%，活动前后比较，差异具有统计学意义(t=12.68，P＜0.001)；活动后不同监测项目、不同监测时段冷凝水管理合格率均高于活动前，差异均具有统计学意义(均P＜0.001)。品管圈活动实施前冷凝水细菌培养中位数为200 CFU/mL，四分位间距为235 CFU/mL；实施后中位数为10 CFU/mL，四分位间距为130 CFU/mL，活动前后比较，差异具有统计学意义(Z=-2.22，P=0.03)。结论品管圈活动可以提高呼吸机冷凝水管理水平，降低冷凝水内细菌含量。

Abstract:

麻疹（measles）是由麻疹病毒（measles virus）引起的，经呼吸道飞沫传播的病毒性传染病。在麻疹黏膜斑（Koplik’s spots，科氏斑）出现之前，与其他病毒性感冒相比，并无特征性表现，容易误诊。本院2014年5月收治1例因误诊而导致误治病例，现将其诊断与治疗情况总结分析如下。

Abstract:

2013年3月在我国首次发现的新型人感染H7N9禽流感已导致数百人丧生，病死率高达38%，目前对此种疾病的认识仍有限［1］。急性呼吸窘迫综合征（ARDS）是感染H7N9禽流感患者的主要并发症。抗病毒与免疫调节治疗是治疗H7N9禽流感的关键措施，目前尚无标准化的抗病毒和免疫调节治疗方案可用于H7N9禽流感病毒感染者的临床治疗，许多患者的病情迅速进展为ARDS和多器官功能衰竭（MOF）［14］。
由于当前公共卫生领域缺乏相关资料，从H7N9禽流感病毒感染者收集到的资料缺乏一致性，仅依据H7N9禽流感病毒感染者的临床报告制订建议存在诸多问题，本文综述了近年来H7N9禽流感治疗方面使用抗病毒与免疫调节药物的进展。