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ObjectiveTo study the resistance to commonly used antimicrobial agents and ampicillin resistance mechanism of Haemophilus influenzae (H. influenzae). MethodsAntimicrobial resistance and βlactamase of H. influenzae isolated from inpatients and outpatients in a hospital from January 1 to December 31, 2012 were detected by BauerKirby disc diffusion method and nitrocefinbased test, TEM and ROB βlactamase genes were amplified by polymerase chain reaction (PCR). ResultsOf 100 patients infected with H. influenzae, 61.00% were aged 1-10 years. The resistance rate to ampicillin was 35.00%(n=35)，resistance to sulphamethoxazole/trimethoprim was up to 64.65%；susceptibility rate to levofloxacin, azithromycin, ciprofloxacin, cefotaxime, chloramphenicol, cefuroxime, ampicillin / sulbactam   was 97.96%, 96.84%,96.91%, 92.78%,85.71%,77.89% and 74.75% respectively. Of 100 H.influenzae isolates, 21 were  βlactamase positive strains, and all were resistant to ampicillin. 35 ampicillinresistant strains were performed TEM and ROB genes detection, of which 22 were TEM positive, ROB positive strain was not found. ConclusionH.influenzae is sensitive to most antimicrobial agents except sulphamethoxazole/trimethoprim. Producing of TEM βlactamase is the major mechanism of ampcillin resistance in H.influenzae.

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ObjectiveTo understand the status of intensive care unitacquired lower respiratory tract infection (ICULRTI), and the distribution characteristics of pathogens, so as to provide the basis for taking preventive and control measures, and scientific diagnosis and treatment for patients.  MethodsTargeted monitoring data on healthcareassociated infection (HAI) in ICUs of 32 hospitals in a province in 2013 were investigated retrospectively. ResultsThe incidence of ICULRTI was 5.79%, ventilator usage rate  was 31.25%, incidence of ventilatorassociated pneumonia(VAP) was 26.93‰;There was no linear correlation between ventilator usage rate and incidence of VAP（r=0.160，P=0.380）. A total of 1 593 pathogens causing LRTI were detected, the major were gramnegative bacteria （75.77 %,n=1 207）, followed by grampositive bacteria（18.21%,n=290），fungi（5.90%,n=94），Mycoplasma pneumonia and other pathogens（0.12 %, n=1 for each）.The top five detected pathogens causing LRTI were Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli, accounting for 25.49%, 15.26%, 14.63%, 13.37% and 5.09% respectively.ConclusionTargeted monitoring on ICU is helpful for realizing healthcareassociated  LRTI, each hospital should conduct targeted monitor to find out the causes of HAI, as well as improve the awareness of VAP among ICU health care workers.

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ObjectiveTo evaluate diagnostic method and infection factors for catheterrelated bloodstream infection(CRBSI) due to Rhizobium radiobacter (R. radiobacter) in pediatric patients. MethodsClinical data of 1 014 pediatric patients with central venous catheter(CVC)related treatment in a hospital from February 2012 to February 2014 were collected, semiquantitative  culturing  of catheter, colony forming unit (CFU) ratio of catheter to venous blood, difference in culture time between venous blood and catheter were detected among patients with R.radiobacter infection；factors for R. radiobacter infection were analyzed.ResultsOf 1 014 pediatric patients who used CVC, 32 were detected R. radiobacter from catheter blood, 28 were detected from venous blood, 27 were detected from both catheter and venous blood. Catheter semiquantitative  culture of 27 patients were ≥15 CFU, 5 were＜15 CFU; CFU ratio of catheter to venous blood of 22 patients were ≥5:1, 6 were＜5:1; difference in culture time between venous blood and catheter of 26 patients were ≥2 hours, 2 were＜2 hours. Risk factor analysis revealed that child’s age, catheter indwelling time of each group were significantly different  (both P＜0.05). ConclusionCatheter semiquantitative culture, CFU ratio of catheter to venous blood，and difference in  culture time between venous and catheter blood are important diagnostic  basis for confirming  R.radiobacter bloodstream infection; patients aged <2 years, catheter indwelling time >5 days are risk factors for R.radiobacter bloodstream infection.

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ObjectiveTo analyze clinical distribution and change in drug resistance of Acinetobacter baumannii (A. baumannii) in 2009-2013, guide clinical rational antimicrobial  use， and reduce healthcareassociated infection rate. Methods919 A. baumannii isolates were isolated from inpatients and outpatients in a hospital between January 2009 and December 2013, specimen and department sources, as well as change in drug resistance of A. baumannii were analyzed. ResultsA total of 10 273 pathogens were isolated from 2009  to  2013,  the constituent ratio of A. baumannii in each year was 7.98%（n=93）,11.31%（n=155）,10.22%（n=185）,7.73%（n=217）, and 8.62%（n=269）respectively；the constituent ratio of imipenemresistant A. baumannii was 24.73%,38.06%,71.89%,64.52%, and 86.99% respectively；the main specimen source was sputum (83.68%); the major department sources were intensive care unit(ICU, 39.28%),  department of neurology (20.78%）， and department of respiratory  medicine（8.60%）. The resistant rate of A. baumannii to most antimicrobial agents increased, the resistant rates to imipenem and piperacillin / tazobactam  increased from 24.73% and 4.44% in 2009 to 86.99% and 86.25% in 2013 respectively; resistant rate to sulphamethoxazole/trimethoprim decreased from 91.30% in 2009 to 27.14% in 2013; in 2013, except resistant rates to amikacin and sulphamethoxazole/trimethoprim were low (20.82% and 27.14% respectively), resistant rates to the other 11 kinds of antimicrobial agents were all ＞83.64%.  ConclusionThe isolation rate of A. baumannii  is high in this hospital, the main specimen source is sputum, the main department source is ICU; antimicrobial resistant rate of A. baumannii is high, prevention and control of infection and transmission of A. baumannii should be strengthened.

Abstract:

ObjectiveTo understand the distribution and antimicrobial resistance of pathogens from sputum specimens of patients with respiratory tract infection in a hospital in recent 5 years, so as to provide basis for infection control and rational use of antimicrobial agents. MethodsBacteria were isolated with routine method, and  were identified  by VITEK 2 and Phoenix100 automated bacterial identification system, antimicrobial susceptibility testing was performed by KirbyBauer  disk diffusion method according to the Clinical and Laboratory Standards Institute standards. ResultsA total of 1 829 pathogenic bacterial strains were isolated from patients in respiratory department between 2009 and 2013, of which gramnegative bacilli and grampositive cocci accounted for 78.84% (n=1 442) and 21.16% (n=387) respectively. The major gramnegative bacilli were Acinetobacter baumannii(A. baumannii 21.76%), Pseudomonas aeruginosa(P. aeruginosa 18.70%), Klebsiella pneumoniae (K. pneumoniae 11.70%) and Escherichia coli(E. coli 7.16%); the major grampositive cocci were Staphylococcus aureus (S. aureus 11.76%) and Enterococcus faecium (E. faecium 4.70%). The average detection rate of extendedspectrum βlactamase (ESBL)producing E. coli and K. pneumoniae was  61.83% and 34.45% respectively. The resistant rates of A. baumannii to amikacin,imipenem and meropenem were all  ＞70%;  the resistant rate of P. aeruginosa to cefepime and  ceftazidime was 22.22% and 51.46% respectively, the resistant rate to imipenem and meropenem was 49.71% and 49.42% respectively.Linezolidresistant S. aureus  strains were found, the resistant rate  of S. aureus to nitrofurantoin was ＜6.0%, the average detection rate of methicillinresistant S. aureus (MRSA) was 88.37%;  the resistant rates of Enterococcus spp. to linezolid and teicoplanin were both 4.35%, the resistant rate to vancomycin was 8.70%. ConclusionThe main pathogens  causing  respiratory tract infection are A.baumannii, P. aeruginosa, K. pneumoniae, E. coli and S. aureus，which have high and multiple resistance to antimicrobial agents.

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ObjectiveTo explore the clinical and epidemiological characteristics of severe measles in infants. MethodsClinical data of 62 infants with severe measles were analyzed retrospectively. ResultsOf 62 infants with severe measles, 42 (67.74%) were aged < 9 months, of whom 37（88.10%）were not vaccinated against measles. The onset months were FebruaryMay, 41 cases (66.13%) were found in MarchApril.  All patients had fever and skin rash, the rates of other symptoms and complications were as follows : oral leukoplakia 80.65%（n=50）, Catarrh symptom 77.42%（n=48）, conjunctivitis 79.03%（n=49）, history of choked water cough 75.81%（n=47）, pneumonia 95.16%（n=59）, acute laryngitis 35.48% (n=22), electrolyte disorder  20.97%（n=13）, acute respiratory distress syndrome 9.68%（n=6）, liver function damage 9.68%（n=6）, pneumothorax 8.06% （n=5）,myocardial damage 4.84% （n=3）, respiratory failure 3.23% （n=2）, toxic encephalopathy 3.23%（n=2）, measles encephalitis 1.61% （n=1）, and pleural effusion  1.61%（n=1）. Of all cases, 41 cases were cured, 19 cases improved, 1 case died, and 1 case gave up treatment.  ConclusionThese severe measles cases occurred mainly in infants aged<9 months and were not vaccinated against measles; infants had history of choked water cough; the main onset months were MarchApril ; pneumonia was still a predominant complication of infant measles.

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ObjectiveTo study the changes and clinical value of platelet(PLT) parameters and coagulation indicators in children with severe pneumonia. Methods97 children were divided into severe pneumonia group Ⅰ and severe pneumonia group Ⅱ according to whether children were associated with other diseases besides severe pneumonia, and 30 healthy children were in control group. The levels of PLT count, mean platelet volume(MPV), prothrombin time(PT), activated partial thromboplastin time(APTT), fibrinogen(FIB), antithrombinⅢ(ATⅢ), and Ddimer(DD) among three groups were compared. ResultsThe differences of PLT,MPV,DD and ATⅢ activities were all significant  among  three groups (all P<0.05). PLT, MPV and DD levels in group Ⅰwere all significantly higher than those of control group (［454.00±157.00］×109/L vs ［300.00±63.00］×109/L ; ［9.66±1.24］fL vs ［8.90±0.37］ fL; ［0.47±0.37］ mg/L vs ［0.27±0.06］ mg/L, respectively); ATⅢ activity in groupⅠ was lower than control group(［79.91±20.34］% vs［107.03±8.11］%) (both P<0.05). ATⅢ activity and  PLT level in group Ⅱwas (66.11±11.12)% and (279.00±185.00)×109/L  respectively, which were both significantly lower than  group Ⅰ, MPV and DD level was （10.37±1.51）fL and （0.70±0.46） mg/L respectively, which were both higher than groupⅠ (both P<0.05). ConclusionThere is obvious coagulation dysfunction in children with severe pneumonia. The changes in PLT,MPV, ATⅢ and DD levels are associated with the severity of pneumonia.

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ObjectiveTo investigate the effect of new comprehensive treatment scheme on the treatment of central airconditioning circulating water, and compared with the original treatment scheme, so as to take more effective measures to prevent and control the source of healthcareassociated infection.MethodsAfter the implementation of two water treatment schemes, biofilm dynamic trend, microorganisms, and corrosion rate were detected by online microbial analyzer and biofilm detection kit. ResultsAfter the implementation of original scheme, biofilm trend value of central airconditioning circulating water was continuously high, maintaining at 200-500; pathogens (Pseudomonas aeruginosa) existed in the circulating cooling water; corrosion testing showed that corrosion coupons were severely corroded. After the implementation of new scheme, biofilm trend value declined continuously, and finally stably maintained below 20; pathogens were not detected after 6 days, which was corresponded to biofilm trend value; corrosion coupons were slightly corroded，corrosion rate was＜0.075 mm/a. ConclusionNew comprehensive treatment scheme is definitely effective for reducing and controlling the growth of pathogens, biofilm and corrosion.

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ObjectiveTo evaluate the effect of chlorhexidine gargle on respiratory tract infection (RTI) in patients following general anesthesia. MethodsFrom January 2012 to June 2013，94 patients who received general anesthesia for removal of vertebral disc were randomly divided into two groups, with 47 cases in each group，control group gargled with normal saline，observation group accepted 2% chlorhexidine gargle. The occurrence of RTI and detection of pharynx pathogens of two groups were compared. ResultsThe incidence of RTI in observation group and control group was 8.51%（n=4）and 23.40%（n=11） respectively（χ2= 12.95，P＜0.05）. 4 patients in observation group were detected 4 isolates of pathogens, 11 patients in control group were detected 26 isolates of pathogens, the detection rate of pharynx pathogens of observation group was lower than  control group （χ2=3.89，P＜0.05）. The main isolated pathogens were Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae and Escherichia coli.  ConclusionChlorhexidine gargling can effectively reduce RTI following general anesthesia，it is worthy of clinical application.

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ObjectiveTo understand the occurrence of surgical site infection (SSI) following class I incision operation in a tumor hospital, explore the continuous surveillance and improve effectiveness, so as to provide reference for further intervention.MethodsTargeted surveillance on thyroid surgery patients undergoing class Ⅰ incision operations in a hospital in JanuaryJune 2013 were performed by medical record review, bedside observation,  dressing change observation  and patient followup, the surveillance result was compared with that of the same period of 2010. ResultsThere was one case of SSI in JanuaryJune 2013 and  JanuaryJune 2010 respectively, SSI rate was 0.20% and 0.18% respectively，there was no significant difference（P=1.000）. In JanuaryJune 2013, prophylactic perioperative antimicrobial usage rate was 0.20%，which was lower than 27.21% of 2010; the coincident rate of indication for antimicrobial use was 100%, which was higher than 6.67% of 2010, the difference was statistically different(all P＜0.001）. ConclusionTargeted surveillance on SSI is helpful for the rational perioperative use of antimicrobial agents, the reducing of antimicrobial prophylactic use doesn’t lead to the increase of class Ⅰ incision SSI.

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ObjectiveTo understand the incidence and related risk factors of healthcareassociated infection(HAI) in neurological patients with cerebrovascular diseases. MethodsThe occurrence and risk factors of HAI in patients with cerebrovascular diseases in a hospital between Jan and December 2013 were investigated and analyzed.  ResultsOf 3 573  investigated patients，214 had HAI, the incidence of HAI was 5.99%；the main infection site was respiratory tract （54.67%）, followed by urinary tract (25.23%). Univariate analysis revealed that age，length of hospitalization，disturbance of consciousness,   chronic obstructive pulmonary disease, diabetes mellitus, invasive procedures, application of antacids, and antimicrobial prophylaxis were all related to the occurrence of HAI (P<0.05). Multivariate logistic regression analysis revealed that disturbance of consciousness, old age, invasive procedures, chronic obstructive pulmonary disease, and diabetes mellitus  were independent risk factors for the occurrence of HAI (all P＜0.05). ConclusionThe incidence of HAI is high in hospitalized patients of the neurology department，there are multiple risk factors associated with HAI， it is necessary to take corresponding interventions for reducing the incidence of HAI.

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Objective To explore the effect of implementation of prevention and control measures on reducing the incidence of multidrugresistant organisms(MDROs) healthcareassociated infection(HAI) rate. MethodsImplementation of prevention and control measures on MDROs were strengthened in a hospital in 2012, the relationship between implementation status and change in MDROs infection in the whole hospital were analyzed statistically.ResultsThrough continuous monitoring and tracking, the implementation of prevention and control measures on MDROs continued to be improved, MDRO HAI rate of the second half year was significantly lower than the first half year (［0.29%，119/41 579］ vs［0.49%，186/38 252］）（χ2=20.95，P＜0.01）. ConclusionContinuous monitoring and tracking of MDROs is helpful for implementing the prevention and control measures on MDROs infection, as well as reducing the incidence of HAI caused by MDROs .

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ObjectiveTo realize the bacterial contamination on uniforms of health care workers(HCWs)  in a general hospital,  and  put forward the corresponding management measures.   MethodsIn MayOctober 2012, a total of 360 specimens of 120 uniforms of HCWs in departments of respiratory internal medicine, general surgery, gynecology, and pediatrics were taken on the first, third and seventh day of wearing, bacterial counts on uniforms were monitored, compared and analyzed.  ResultsBacterial counts of uniforms at different wearing time were statistically different. The longer time of uniforms were worn, the more bacteria could be detected. Bacterial contamination of nurses’ uniforms was more serious than doctors （［0.65±3.38］CFU/cm2  vs ［7.68±2.99］ CFU/cm2）, contamination of uniforms of HCWs in surgical departments was more serious than nonsurgical departments（［10.43±4.12 ］ CFU/cm2  vs ［8.60±3.01］ CFU/cm2) (U=5.06, 2.78，respectively, both P＜0.01）, over standard rate of different  sites of  HCWs’  uniforms were significantly different（χ2=33.12, P＜0.01）); over standard rates of bacteria on the cuffs, abdomen and chest sites was 73.33%, 58.33% and 36.67% respectively. ConclusionThe management of cleaning system of HCWs’ uniforms needs to be strengthened, the change cycle of uniforms is suggested twice a week, and the frequency needs to be increased in high contamination departments.

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ObjectiveTo investigate the current status of compliance with hand hygiene  among health care workers (HCWs) in a comprehensive hospital in Xi’an. MethodsStatus of hand hygiene among HCWs in 73 clinical departments was observed directly.Results404 moments for hand hygiene of 404 HCWs were observed,  255 times of hand hygiene were implemented, 181 times of hand hygiene were correct, the total compliance rate was 63.12%, and correct rate was 44.80%. Compliance  rate and correct rate of hand hygiene of HCWs in intensive care unit were both  higher than general wards (91.89% vs 60.22%,χ2=14.485，P＜0.001; 81.08% vs  41.14%, χ2=5.671，P=0.017）. Among HCWs of different occupations, compliance rate and correct rate of  hand hygiene of nurses were both the highest （73.76% and 60.18% respectively）, while auxiliary persons were both the lowest （40.90% and 10.20% respectively）；among five moments for hand hygiene,  compliance rate was highest  after body fluid and blood exposure (80.00%),  correct rate was highest before aseptic procedure  (62.96%). ConclusionThere is a high compliance rate and low correct rate of hand hygiene among HCWs in this hospital. Compliance rate and  correct rate of hand hygiene among HCWs in different departments, different occupations and different hand hygiene moments are varied,  compliance with hand hygiene among HCWs should be paid extensive attention.

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ObjectiveTo investigate the management status of loaner surgical instruments, and evaluate the effect of plandocheckact cycle (PDCA) quality control on loaner surgical instrument management. MethodsFrom July 2011 to June 2012, 8 965 pieces of  loaner surgical instruments before adopting PDCA quality control management was as control group; from July 2012 to June 2013, 8 564 pieces of loaner surgical instruments adopting PDCA quality control was as observation group. The defects of loaner surgical instruments during application process and effect of PDCA quality control on loaner surgical instrument management were analyzed. ResultsThere were many problems in checkingtracking，cleaning quality and company personnel of loaner surgical instruments. The qualified rate of observation group was higher than that of control group(99.36% vs 96.27%)（χ2=194.74，P＜0.01）.The main causes for unqualification of observation group were unqualified cleaning （n=21 ，38.18%） and incomplete function of  instruments（n=8，14.55%）；while the main causes for unqualification of control group were the loss of instruments（n=81，24.25%），lack of monitor and record （n=71，21.26%），unqualified cleaning（n=55，16.47%）and the soaking of package（n=54，16.17%）. ConclusionPDCA quality control is an effective method for loaner surgical instruments management，it is helpful for  building longterm effective quality control system for loaner surgical instruments, and make  loaner surgical instrument management more scientific， systematic, and standard.

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目的了解某院综合ICU医院感染、各侵入性导管使用及相关感染的情况。方法2013年1—12月对该院综合ICU患者进行医院感染目标性监测。结果2013年1—12月共监测ICU住院患者395例，发生医院感染61例、98例次，感染率为15.44%、例次感染率为24.81%；住院总日数为5 684 d，日感染率为10.73‰。呼吸机相关肺炎（VAP）感染率为15.13‰（59例），血管导管相关血流感染率为2.29‰（2例），导尿管相关泌尿道感染率为3.70‰（17例）。VAP患者分离病原菌居前3位的是铜绿假单胞菌（27株）、鲍曼不动杆菌（15株）和肺炎克雷伯菌（11株）。结论综合ICU患者医院感染率高，侵入性导管相关感染以VAP为主，需重点加强并落实相关感染防控措施。

Abstract:

目的探讨提高护理人员手卫生依从性的有效方法。 方法某院开展“感染控制宣传周”干预活动，对干预前后该院当班护理人员进行手卫生现状调查，比较干预前后护理人员手卫生依从性。 结果干预后，护理人员手卫生知识知晓率为79.50%，高于干预前的54.00%，两组比较，差异有统计学意义（χ2=29.30，P＜0.05）。干预后，护理人员的手卫生依从率、正确率、细菌检测合格率分别为66.97%、96.50%、95.00%，均高于干预前（分别为36.56%、79.00%、62.50%），各组比较，差异均有统计学意义（均P＜0.05）。结论开展“感染控制宣传周”干预活动可提高护理人员手卫生依从率。

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目的了解老年病房下呼吸道感染病原菌分布及耐药性变迁，为临床合理选用抗菌药物提供依据。方法回顾性分析某院老年病房2010—2013年下呼吸道感染患者分离的病原菌，并对其耐药性进行分析。结果4年间，共分离病原菌2 398株，以革兰阴性菌为主（1 676株，占69.89%），最常见的革兰阴性菌分别为铜绿假单胞菌（25.94%）和大肠埃希菌（15.22%）；其次为革兰阳性菌（323株，占13.47%），真菌中白假丝酵母菌达259株（占10.80%）。肠杆菌科细菌对碳青霉烯类抗生素的耐药率最低（＜1%），大肠埃希菌对头孢曲松和头孢噻肟耐药率较高（＞60%），肺炎克雷伯菌的耐药性普遍低于大肠埃希菌；铜绿假单胞菌对阿米卡星耐药率较低（<11%），鲍曼不动杆菌对头孢哌酮/舒巴坦的耐药率相对较低，对亚胺培南、哌拉西林/他唑巴坦、头孢他啶等常见抗菌药物耐药率普遍＞40%。结论老年病房下呼吸道感染病原菌以革兰阴性菌为主，其中铜绿假单胞菌占首位，临床应根据药敏结果，合理使用抗菌药物。

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细菌性肝脓肿（pyogenic liver abscess, PLA)是化脓性细菌侵入肝脏而形成的肝内化脓性感染病灶，其病死率较高［1］，主要死亡原因为脓毒症或感染性休克。笔者现将1例骨髓增生异常综合征（myelodysplastic syndrome,MDS）合并PLA病例的诊疗情况并文献分析报告如下。

Abstract:

肝硬化是一种或多种原因引起的，以肝组织弥漫性纤维化、假小叶和再生结节为组织学特征的进行性慢性肝病，是我国常见疾病和主要死亡病因之一。引起肝硬化的病因很多，我国以病毒性肝炎所致的肝硬化为主，而国外以酒精性肝硬化多见。当机体发生肝硬化时，由于肠道细菌过度生长、肠道黏膜通透性增高、内毒素灭活功能减退等原因导致肠道的细菌及其相关产物（如内毒素）突破肠道屏障，从肠道转移到肠系膜淋巴结及其他肠外器官，从而形成细菌移位及肠源性内毒素血症；进入循环系统的内毒素又可以进一步加重肝细胞损害，促进门静脉高压形成，如此反复，形成恶性循环。    1肝硬化导致肠源性内毒素血症的发生机制