Abstract:

ObjectiveTo investigate the detection of IMP and VIM metalloβlactamases (MβLs) genes in clinically isolated gramnegative bacteria as well as  bacterial resistance to  βlactam antimicrobial  agents.  Methods113 clinically isolated  bacteria were performed antimicrobial susceptibility testing by KirbyBauer method , drugresistant genes IMP and VIM were detected by polymerase chain reaction (PCR) , PCR products were sequenced  and aligned with BLAST software.  ResultsVIM gene was detected in 1 Pseudomonas fluorescens strain , IMP gene was detected in 15 strains , they were Klebsiella pneumoniae (n=6) ， Acinetobacter baumannii (n=3)， Escherichia coli (n=2)， Ralstonia pickettii (n=1)， Pseudomonas aeruginosa (n=1)， Citrobacter amalonaticua (n=1)，and Enterobacter cloacae (n=1).  BLAST results showed that VIM gene was VIM2 subtype, similarity with gene bank was 99%; all IMP genes were IMP1 subtype，which were highly homologous , similarity was 98%-99%.  Resistant rates of IMP positive strains to  ceftriaxone，cefotaxime,   cefoxitin，aztreonam and imipenem  were all significantly higher than negative strains (all P<0.05). ConclusionIMP genes of different strains are highly homologous, all are IMP1 type, indicating that  IMP genes are highly transmissible and can spread among different species of bacteria. IMP genes are related with resistance of β-lactam antimicrobial agents.

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ObjectiveTo evaluate the features of disinfectantresistant genes in methicillinresistant Staphylococcus aureus (MRSA) in China through Metaanalysis.MethodsLiteratures about features of disinfectantresistant genes in MRSA were searched from  China National Knowledge Infrastructure（CNKI）, Wanfang Med Online, PubMed, and Excerpta  Medica Database (EMbase) through  computerized   retrieval system, literatures were selected according to standard inclusion and exclusion criteria, Metaanalysis was performed using R3.1.1 software and RevMan 5.3 software.ResultsA total of 42 literatures were included, involving disinfectantresistant genes of 2 671 strains of MRSA from 16 provinces (municipalities) in China. The overall detection rate of qacA/B, qacC, qacJ and norA was 28.03%(95%CI: 20.03%-36.48%), 8.94%(95%CI: 1.27%-22.49%), 17.74%(95%CI: 2.25%-43.39%), and 17.90%(95%CI: 0.00%-76.38%) respectively. The detection rates of qacEΔ1, qacG, and qacH were 0.00%. The overall detection rate of qacA/B of the southern and northern China areas was 27.12% (95%CI: 19.03%-36.06%) and 30.14% (95%CI: 13.11%-50.63%) respectively, there was no statistical difference between two areas (Z=0.59, P>0.05). The overall detection rate of qacA/B in the eastern, central and western economic region was 29.95% (95%CI: 21.85%-38.73%), 22.65% (95%CI: 10.08%-38.47%), and 26.94% (95%CI: 3.78%-60.95%) respectively, there was no statistical difference among these regions (P>0.05). The detection rates of qacA/B in hospitalacquired (HA)MRSA and communityacquired (CA)MRSA were not statistically different (OR and 95%CI=0.69［0.14-3.31］, P=0.64). The detection rate of qacA/B in MRSA was  higher than those in methicillinsensitive Staphylococcus aureus (MSSA) (OR and 95%CI=4.99［3.53-7.06］，P＜0.01）. ConclusionDetection rate of disinfectantresistant genes in MRSA is high in China, which is common and serious , monitoring on disinfectantresistant genes  should be enhanced, disinfectants should be used rationally.

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ObjectiveTo investigate the isolation and drug resistance change trend of pathogens isolated from cerebrospinal fluid (CSF) of neurosurgical patients in Beijing Tian Tan Hospital. MethodsPathogens and antimicrobial susceptibility of pathogens from CSF specimens of neurosurgical patients from August 1997 to August 2013 were analyzed. ResultsA total of 2 732 isolates of pathogens were detected,grampositive  and gramnegative  bacteria accounted for 71.23%(n=1 946 ) and 28.77%(n=786 ) respectively. The top three isolated bacteria were Staphylococcus spp. (n=1 751,64.09%), Acinetobacter spp. (n=254, 9.30%), and Enterococcus spp. (n= 172, 6.30%). Grampositive bacteria were the major isolated pathogens, detection rate of methicillinresistant Staphylococcus aureus (MRSA) and methicillinresistant coagulasenegative Staphylococcus (MRCNS) was 74.34% and 80.73% respectively; gramnegative bacteria increased gradually in recent years. All Staphylococcus spp.  isolates were highly sensitive to vancomycin and linezolid（＞90%） . The overall antimicrobial susceptibility rate of gramnegative bacteria decreased, susceptibility rates of Acinetobacter spp. to imipenem and meropenem was 51% and  44% respectively. ConclusionThe major pathogens causing intracranial infection in neurosurgical patients are grampositive bacteria, the detection rates of MRSA and MRCNS are high; gramnegative bacteria, especially extensively drugresistant Acinetobacter spp. shows an increasing tendency in recent years.

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ObjectiveTo investigate the detection of respiratory tract virus from throat swabs of patients with lower respiratory tract infection(LRTI) in a hospital, so as to provide reference for clinical diagnosis and treatment. MethodsThroat swabs of hospitalized children with LRTI between May 2103 and April 2014 were detected by direct immunofluorescence assay, infection/carriage of respiratory syncytial virus(RSV), adenovirus(ADV), influenza virus A(IVA), IVB, parainfluenza virus 1(PIV1), PIV2,  and  PIV3 in children were surveyed. ResultsOf 8 425 throat swab specimens of hospitalized patients, 1 879 were detected virus, the total detection rate was 22.30%, detection rate of RSV was the highest (11.31%), followed by PIV3(4.37%). There was no significant difference in the total detection rate of respiratory tract virus between children of different genders (P=0.051). Of all age groups, detection rate of RSV  in infants and young children  was the highest, the detection rates of 7 kinds of  virus from preschool children were approximate,  detection rate of ADV from primary school children was the highest (37.50%). In spring and winter, children mainly infected with RSA, accounting for 62.82% and 69.88% respectively; in summer， PIV3 was the predominant virus, accounting for 41.47%, in autumn, there was little difference in the percentage of each virus.  ConclusionThe detection rate of 7 kinds of virus isolated from throat swabs of hospitalized children with LRTI is related to age and season;  the detection rate of 7 kinds of virus from infants and young children is high, RSA is the main virus.

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ObjectiveTo investigate antimicrobial resistance of Escherichia coli (E.coli) isolated from patients with bloodstream infection, and provide evidence for rational use of antimicrobial agents in clinical practice.MethodsBacT/Alert automated blood culture system and VITEK 2 automated identification system were used for bacterial culture and identification. Antimicrobial susceptibility testing and detection of extendedspectrum βlactamases (ESBLs)producing strains were performed by KirbyBauer method. ResultsFrom 2009 to 2011, a total of 235 strains of E.coli were isolated from patients with bloodstream infection, 90 (38.30%) of which were ESBLs positive strains. The resistant rates of ESBLsproducing strains to ampicillin, cefotaxime and ceftriaxone were all 100%, but susceptibility rate to imipenem/cilastatin and meropenem were all 100%, to cefmetazole and amikacin were >90%. The resistant rate of nonESBLsproducing strains to ampicillin was the highest (70.63%), susceptibility rate to imipenem/cilastatin and meropenem were both 100%, to amikacin, cefotaxime, and cefmetazole were all >95%. The resistant rate of ESBLsproducing strains was significantly higher than that of the nonESBLsproducing strains. Of βlactamase inhibitor, only susceptibility rate of ESBLsproducing E.coli to cefoperazone/sulbactam was>90%,  susceptibility rates to piperacillin / tazobactam and ticarcillin/clavulanate were both<80%. ConclusionAntimicrobial resistant rate of ESBLsproducing strains causing bloodstream infection is high, individualized treatment strategies should be made according to antimicrobial resistance of bacteria causing infection in patients.

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ObjectiveTo compare the colonization/infection of methicillinresistant Staphylococcus aureus (MRSA) in patients in intensive care unit (ICU), respiratory ICU (RICU) and neurosurgical ICU（NSICU）, so as to find out the risk factors for MRSA colonization/infection in patients. MethodsA prospective method was used for this study, data of all patients admitted to three ICUs between May 1 and July 31, 2013 were collected, specimens of nasal swabs of patients and health care workers (HCWs), as well as specimens of patients’ surroundings were taken and performed MRSA detection.ResultsThe average colonization rate of MRSA in 197 patients at  three ICUs was 11.17%, 22 MRSA strains were isolated, the colonization rate in ICU, RICU and NSICU patients was 4.00%, 11.90% and 15.87% respectively, no significant difference was found among different ICU groups (χ2=4.04, P=0.133). The detection rate of MRSA from patients was 2.03% （4/197）, colonization rate of MRSA in  HCWs’ nasal vestibule was 1.72%（2/116）. Detection rate of MRSA from surroundings of patients with MRSA colonization was higher than that  without MRSA colonization (22.73%［5/22］ vs 4.00%［7/175］,χ2=8.93， P=0.003）. Multivariate logistic regression analysis indicated that patients aged ≥60 years, invasive procedures, long length of ICU stay,and recent antimicrobial use were independent  risk factors for MRSA colonization/infection.ConclusionPatients in ICU should be screened for MRSA colonization, effective measures should be taken to avoid MRSA transmission between hospital and patients; invasive procedures should be minimized, length of ICU stay should be shortened, antimicrobial agents should be used rationally, so as to reduce MRSA colonization and infection in ICU patients.

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ObjectiveTo analyze the effect of hand hygiene compliance on the incidence of ventilatorassociated pneumonia(VAP) in children,  and explore the role of hand hygiene in the prevention and control of VAP. MethodsHand hygiene compliance among HCWs in a pediatric intensive care unit  (PICU) was intervened, hand hygiene compliance rate of HCWs and incidence of VAP in children with mechanical ventilation from March 1, to October 31, 2012  (before intervention)  and from January 1, to August 31,2013  (after intervention) were compared.  ResultsHand hygiene compliance rate after intervention was higher than before intervention( 37.31%［97/260］ vs 24.17% ［58/240］) （χ2=10.08，P＜0.01）;  the consumption of hand washing liquid and alcoholbased handrub enhanced from 3.48mL /bed day before intervention to 4.49 mL/bed day after intervention,which  increasing by 29.02%. The incidence of VAP after intervention was lower than before intervention (2.21‰［5/2 261］ vs 6.50‰［13/2 001］）（χ2=4.67，P＜0.05）. ConclusionImplementation of comprehensive measures and improvement of HCWs’ hand hygiene compliance can reduce the incidence of VAP in children.

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ObjectiveTo investigate the occurrence of central venous catheterrelated bloodstream infection(CRBSI) in mass severe burn patients, evaluate related risk factors for infection, and effectiveness of prevention and control measures. MethodsIn August 2014, 9 cases of severe burn patients were rescued in a hospital, all patients received CVC, infection prevention and control intervention measures were performed during the whole process of catheterization. ResultsAll  patients received 30 episodes of CVC，total CVCdays were 227 days， bacterial culture for threecavity catheters of femoral veins in 2 patients were positive, incidence of CRBSI was 8.81‰；1 patient was isolated Enterococcus faecium,1 isolated both Acinetobacter baumannii and  Stenotrophomonas maltophilia. 2 CRBSI patients received femoral vein catheterization, catheterization site was trauma surface, duration of catheterization were both ≥7 days, both used threecavity catheters, and third degree burns  were ≥60%, both patients were cured after timely removal of catheters and receiving of antimicrobial agents.  ConclusionCVC is helpful for long term, safe and effective fluid infusion, but it can cause CRBSI; infection prevention and control intervention for patients receiving CVC  during the whole process of catheterization can reduce the occurrence of CRBSI.

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ObjectiveTo evaluate  the efficacy of ganglioside on treatment of severe handfootmouth disease (HFMD) in children, and effect on serum neuronspecific enolase (NSE) as well as plasma S100 β protein levels.MethodsOne hundred and forty cases of severe HFMD patients in a hospital from April 2011 to June 2014 were  randomly divided into routine therapy group and trial group, and 30 healthy children who received physical examination in outpatient department during the same period were selected as control.  Children in routine therapy group were given antiviral and intracranial decompression therapy; trial group were administered ganglioside in addition to routine therapy , levels of NSE and S100 β protein levels of 3 groups, as well as clinical efficacy between  routine therapy group and trial group were compared. ResultsTotal efficacy rate of trial group was significantly higher than routine therapy group ( 91.43%［64/70］ vs  78.57%［55/70］，χ2=4.54，P＜0.05). The levels of NSE and S100 β protein in children with severe HFMD were significantly higher than control group (［17.63±4.21）μg/L vs ［8.79±2.12］μg/L; ［492.05±119.33］ng/L vs ［296.35±91.02］ng/L，both P＜0.01) . NSE and S100 β protein levels of routine therapy group and trial group before treatment were not significantly different(both P>0.05); after 10day treatment, NSE and S100 β protein levels of both groups were lower than before treatment (both P＜0.01),  the decreasing level of NSE and S100 β protein in trial group were both higher than routine therapy group（［10.18±2.36］ μg/L vs ［5.87±3.03］μg/L; ［247.55±64.64］ng/L vs ［113.97±43.44］ng/L ) (both P＜0.01). ConclusionGanglioside has obvious therapeutic efficacy on severe HFMD in children, and can effectively reduce brain damage markers NSE and S100 β protein.

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ObjectiveTo reduce infection risk in hemodialysis patients through analyzing the  causes of over standard colony forming unit(CFU) and conducting bacteriological detection of  hemodialysis concentrated B solution. MethodsAccording to microbial monitoring results of hemodialysis concentrate B solution  in a hospital between November 2011 and May 2012, disinfection frequency of B solution was changed and dispensing container was covered during the process of using, four groups were divided according to different measures (group A disinfected  twice a week, covered during the process of using; group B  twice a week; group C once a week; group D once every two weeks), monthly bacteriological detection of B solution was conducted, condition before and after disinfection of four groups were compared. ResultsBacterial count in group A, B  ,C and D was（25.41±15.08）,（28.24±28.04）,（68.58±22.58）,and （75.25±26.63）CFU/mL, respectively (F=79.00，P<0.01）; bacterial count of group A, B, and C after intervention were all lower than group D before intervention  (all P<0.01)，bacterial count of group A and B was the lowest. The qualified rate of group A was 100.00%， the unqualified rate of group B,C, and D was 13.95%,24.24%, and 35.94% respectively（χ2=28.70，P<0.01），the unqualified  rates of group A, B, and C after intervention were all lower than group D. ConclusionHemodialysis concentrated B solution  should be  used within 24 hours after preparing,  disinfected twice a week, and  covered during the process of using , so as to control B solution colony number within the standard level.

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ObjectiveTo evaluate the application value of  highrisk  human papillomavirus (HRHPV) DNA detection and ThinPrep liquidbased cytology testing（TCT）in cervical disease screening.  MethodsCervical specimens of women with cervical lesions in a hospital between October 2012 and December 2013 were taken and performed human papillomavirus DNA genotyping (HPV DNA) and ThinPrep liquidbased cytology testing(TCT). Positive patients were performed colposcopy pathological detection. HPV DNA positive rates among different TCT groups, and different cervical lesion groups were compared, the sensitivity and specificity of TCT and HPV DNA detection, as well as differences between  separate  and joint detection were also compared. ResultsThe positive rate of HPV DNA was 28.07% (1 045/3 723), most were HRHPV (21.57%, n=803), the major HRHPV genotypes were HPV 16,58,52,and 18 type. HRHPV positive rates were statistically different among different age groups（χ2=31.74，P＜0.001） , positive rate was highest in 20-30 year old age group . Positive rate of TCT was 13.46% (n=501), a total of 971 patients were performed pathological detection, 293 were positive. Patients were divided according to different TCT and different lesion type, χ2 testing of HRHPV DNA positive rate showed that positive rate of HRHPV had a increasing tendency with the increase in severity of diseases(all P<0.01). Pathological detection was as a gold standard , the sensitivity of HRHPV DNA and TCT  was 90.44％(265/293) and 85.32％(250/293)  respectively, the sensitivity of joint HRHPV DNA detection and TCT  was 95.90％. In positive pathological group, the detection rate of TCT and HRHPV DNA was 85.32％ and 90.44%, respectively, joint detection rate was 95.90％, the difference among three groups was significant (χ2=18.185，P<0.001）. Joint detection rate was higher than separate detection rate of TCT or HPV DNA. ConclusionHPV DNA detection is a useful supplement for cervical cancer screening, HPV DNA detection combined with TCT can reduce the misdiagnosis rate.

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ObjectiveTo explore the effect of comprehensive intervention measure on antimicrobial use and incidence of healthcareassociated infection(HAI)  in patients in  sports medicine department. MethodsAntimicrobial use and incidence of HAI in hospitalized patients in the surgical departments (sports medicine department and other surgical departments) of a hospital between January 2006 and  December 2010 were analyzed retrospectively(before intervention),from January 2011, comprehensive intervention based on clinicalcentered multidepartment cooperation was adopted by sports medicine department, the other surgical departments over the same period were not comprehensively intervened; antimicrobial use and incidence of HAI in patients in surgical departments between January 2012 and  December 2013 were monitored prospectively (after intervention ), effectiveness of intervention was evaluated. ResultsAntimicrobial use and incidence of HAI in patients in sports medicine department after intervention were both lower than before intervention ( 55.75% vs  95.26%, χ2 =753.42;  0.10% vs 0.32% , χ2 =15.13, both P＜0.01). Antimicrobial use in patients in other surgical departments after intervention was lower than that before intervention（65.63% vs 73.79% , χ2=251.57, P＜0.01）; incidence of HAI was higher than that before intervention（0.55% vs 0.42% , χ2=19.04, P＜0.01）.  ConclusionComprehensive intervention measure based on clinicalcentered multidepartment cooperation is safe and  effective, it can reduce antimicrobial use and incidence of HAI  in patients in sports medicine department.

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ObjectiveTo evaluate the drill method to prepare for healthcareassociated infection (HAI) outbreak, and strengthen the control of HAI outbreak. MethodsAccording to two cases of surgical site infection (SSI) reported by a neurosurgical department on January 16,2014,  HAI  outbreak emergency drill was started, SSI occurred from January 2012 to January 2014 were analyzed,  specimens of air, object surface and hands of health care workers(HCWs) in the SSIrelated operating room and neurosurgical intensive care unit(NSICU) were taken and analyzed. ResultsIn July 2013, 3 cases of SSI occurred in neurosurgical department  ( 1 case was suspected of SSI, and didn’t perform cerebrospinal fluid culture), SSI didn’t exceed 2 cases in the other months, and SSI outbreak couldn’t be confirmed. 16 specimens of air, object surface and hands of HCWs in operating room were taken, microbial detection results were all qualified. 13 specimens of air, object surface and hands of HCWs in NSICU were taken, qualified rate was 61.54%; and mould was detected from 2 air specimens. 24 disposable objects of neurosurgical department were performed bacterial culture, 3 were positive, and all were qualified after repeated detection. ConclusionHAI outbreak drill is helpful for HAI  management professional personnel to grasp the method of HAI outbreak investigation method, improve the correct hand washing of surgeons and nurses, strengthen the standard operating procedure, and ensure the safety of patients.

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ObjectiveTo investigate the application of antimicrobial agents in a tertiary firstclass hospital before and after implementing special rectification activity on clinical antimicrobial use. MethodsData about antimicrobial use in a hospital in Sichuan Province between  January 2011 and December 2013 were collected and analyzed retrospectively, data included antimicrobial varieties, the ratio of antimicrobial prescription in outpatient department to emergency department, percentage of antimicrobial application expense in the total hospitalization expense,  antimicrobial use rate and use density,  antimicrobial use rate and use density of special use antimicrobial agents, microbial detection for patients receiving restricted and special antimicrobials.ResultsBefore implementing rectification of antimicrobial use, there were 88 kinds of antimicrobial agents in hospital, after implementing rectification, there were 50 kinds of antimicrobial agents. The ratio of antimicrobial prescription in outpatient department to emergency department,  and the percentage of antimicrobial expense in the total hospitalization expense were both lower than before rectification (both P<0.05）. Antimicrobial use rate and antimicrobial use rate of special use  antimicrobial agents before and after rectification were all statistically different（all P<0.05）.Compared with before rectification, microbial detection rate of specimens from patients receiving restricted and special use antimicrobial agents improved significantly (both P<0.05). Perioperative antimicrobial prophylactic use rate in patients with class Ⅰincisional operation after rectification was lower than before rectification, while percentage of antimicrobials used 30 min 2 h before operation was higher than before rectification (both P<0.05).ConclusionAfter three year special rectification, antimicrobial use become more rational, but management still needs further and continuous improvement.

Abstract:

目的某院发生一起医院内疥疮暴发，探讨医院内疥疮暴发的确认与处理方法。方法结合流行病学特征和临床症状提示，对出现不明皮疹患者做皮屑镜检，采取反复刮片法检查，寻找疥螨、虫卵，或在矿物油制备的刮片标本中找螨粪。结果经查实，入院时皮肤有不明皮疹患者为此次疥疮暴发的输入性疥疮感染者，继发感染的1名护工和1名护士为医院获得性疥疮感染者。结论当出现群发性不明皮疹患者时，应考虑疥疮感染的可能，并采取有效的消毒隔离措施，预防感染暴发。

Abstract:

目的了解某院医院感染发病情况及抗菌药物使用情况。方法采取横断面调查的方法，调查2012年10月23—24日时间段内某一日0∶00—24∶00所有住院患者，判断有无感染、感染类型、抗菌药物使用情况及病原学送检情况。结果共调查住院患者903例，发生医院感染30例，30例次，医院感染现患率为3.32%；医院感染现患率最高的科室为重症监护室（33.33%），感染部位以下呼吸道（占63.34%）为主；抗菌药物使用率为54.60%；治疗性使用抗菌药物细菌培养送检率为27.32%，医院感染的主要病原菌为革兰阴性菌。结论医院感染现患率调查有助于了解全院医院感染发生及抗菌药物使用情况，便于医院感染管理及临床医务人员针对相关科室采取预防与控制措施，减少医院感染的发生。

Abstract:

目的根据藏医院的具体情况，以环境卫生学监测作为切入点，了解医院环境卫生状况及存在的问题，采取有效的控制措施进行改进，提高医院感染控制效果。方法2010—2012年对该院手术室、妇产科、外科等科室的空气、医务人员手、物体表面、消毒剂、无菌物品进行采样监测。结果各科室环境卫生学监测合格率由2010年的70.00%上升至2012年的87.34%，差异有统计学意义（χ2=14.694，P=0.001），尤以医务人员手（χ2=9.344，P=0.002）及物体表面（χ2=7.047，P=0.008）合格率上升显著。结论通过系列整改，该院预防控制医院感染工作基本符合卫生部相关要求，医务人员的感控意识不断增强。

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诺卡菌在自然界分布广泛，多为腐生寄生菌［1］。诺卡菌病是由诺卡菌引起的一种急性或慢性化脓性或肉芽肿性病变［2］，多由呼吸道吸入病原菌或经外伤感染引起，常见于免疫缺陷患者。与人类疾病密切相关的是星形诺卡菌和巴西诺卡菌［3］。笔者就本例巴西诺卡菌感染患者的临床资料,结合近年来诺卡菌报道相关文献进行分析，对诺卡菌的实验室鉴定、诊断及治疗总结如下。

Abstract:

随着医疗器械技术的快速发展，越来越多高科技手术器械被用于外科手术。而这些手术器械因价格昂贵、更新快和使用率低等原因，通常由生产厂商以租借或免费的方式提供给医院使用，此类器械被称为外来手术器械。外来手术器械不属于医院固定资产，其保管和维护的责任由生产厂家或经销商承担。这给外来手术器械管理带来了许多问题，特别是清洗灭菌的质量管理。2009年国家卫生部规定外来手术器械的清洗、消毒、灭菌统一由消毒供应中心（central sterile supply department,  CSSD）负责。由于外来手术器械结构复杂、技术精密，CSSD对其清洁和灭菌存在盲区，故需生产厂家提供明确的产品介绍和经认证的清洗灭菌流程说明书，以帮助CSSD有效保障外来手术器械的清洗灭菌质量。本综述将主要介绍外来手术器械清洗灭菌的国内外现状，并阐述医疗机构向外来器械生产商索要清洗灭菌说明书的必要性。