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ObjectiveTo study the homology of carbapenemresistant Acinetobacter baumannii (CRAB) isolated from patients with bloodstream infection in an intensive care unit(ICU).MethodsCRAB isolated from bloodstream， lower respiratory tract， and venous catheter tips of patients with bloodstream infection in JanuaryDecember 2012 were collected and performed antimicrobial susceptibility testing, homology of isolates were identified by pulsedfield gel electrophoresis (PFGE).Results50 CRAB strains were isolated from patients’ bloodstream(n=26), lower respiratory tract (n=20), and venous catheters  (n=4); the resistant rates of CRAB to piperacillin, piperacillin / tazobactam, ampicillin / sulbactam, ceftriaxone, cefotaxime, cefepime, imipenem, meropenem, and ciprofloxacin were all 100%. 36 CRAB isolates from patients’ bloodstream (n=26),  respiratory tract (n=6), and venous catheter tips(n=4) were performed PFGE, 7 major PFGE genotypes(AG) were identified,  including clone A (n=5 )，B(n=2)，C(n=3)，D(n=4)，E(n=3)，F(n=8)，and G(n=3); the other 8 isolates were sporadic strains. This ICU was divided into section Ⅰand Ⅱ,  clone A, B, and F all  existed in both sections. CRAB isolated from different sites of 3 patients were of the same clone,  2 of these patients isolated the same clone of CRAB from bloodstream, lower respiratory tract, and venous catheter tips, 1 isolated the same clone of CRAB from bloodstream and lower respiratory tract. PFGE genotyping of CRAB from 6 patients’ lower respiratory tract revealed that 3 strains were clone D.Venous catheter tips of 12 patients were performed culture， 4 were positive for CRAB, and CRAB was of the same clone as that from patient’s respective bloodstream.ConclusionCRAB bloodstream infection prevail in ICU, cross transmission among patients is the main mode of hospital epidemic.

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ObjectiveTo study transmission characteristics of Acinetobacter baumannii (A. baumannii ) clone and clinical features of infected patients in a respiratory intensive care unit (RICU)，so as to guide the effective prevention and control  of A. baumannii transmission.Methods40 A.baumannii strains isolated from RICU patients were performed homology analysis by pulsedfield gel electrophoresis (PFGE) and cluster analysis，relationship of strains was determined，antimicrobial resistance and clinical data were analyzed. Results40 A.baumannii strains were divided into 11 genotypes(AK)，the main epidemic strains were type A, B and E. The resistant rate to imipenem was the lowest(70.00%)，the next was levofloxacin (77.50%). The average age of 40 infected patients was 67 years old, the average length of hospital stay was 41 days, 12 patients died because of invalid treatment. There was overlapping hospitalization among patients infected with type A and E strains; among patients infected with type B strain,  there was no overlapping hospitalization among the last 6 and first 6 infected patients.  ConclusionThe main epidemic strains of  A.baumannii were type A, B and E，antimicrobial resistant rate is high; the infected patients are with high average age and long length of hospital stay. It is important to reduce the transmission of A.baumannii through rational use of antimicrobial agents, strict aseptic operation, and intensified disinfection and sterilization of hospital environment and medical devices.

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ObjectiveTo evaluate the effect of selective decontamination of digestive tract(SDD) on preventing ventilatorassociated pneumonia by Metaanalysis based on theory and method of evidencebased medicine. MethodsSix medical databases ( PubMed， Excerpta Medica Database ［EMBASE］, China Biology Medicine disc［CBMdisc］， China National Knowledge Infrastructure［CNKI］, VIP database, from 1995 to 2014,  and Cochrane Library of issue 12,2014) were searched， literatures were selected, data were extracted, Metaanalysis was performed by using RevMan 5.3 software. Results13 literatures were included (2 676 patients were involved), Metaanalysis revealed that the incidence of VAP in treatment and control group was 20.68% and 35.99% respectively (OR and 95%CI,0.40 ［0.28，0.56］, P<0.001)，the mortality rate of patients with mechanical ventilation in treatment group and control group were 20.60% and 20.03% respectively (OR and 95%CI，0.99 ［0.81，1.20］，P=0.91). ConclusionSDD can  reduce the incidence of VAP in patients with mechanical ventilation, but can’t reduce mortality rate.

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ObjectiveTo investigate the influencing factors for postdischarge treatment compliance of patients with multidrugresistant tuberculosis (MDRTB). MethodsMDRTB patients who were hospitalized in a tuberculosis hospital between November 2011 and January 2013 were chosen， postdischarge followup was conducted regularly through telephone call. Medicinetaking  and reexamination of patients was inquired， factors influencing patients’ treatment compliance were analyzed.Results299 patients were included in the study，the total treatment compliance rate was 81.94% (n=245)； 249（83.28%）patients regularly took medicine，50（16.72%） didn’t regularly take medicine； 254（84.95%）were reexamined on time，45（15.05%）were not reexamined on time； 37（12.37%）discontinued treatment，  260（86.96%） continuously treated till the survey deadline.Univariate analysis revealed that treatment compliance (including regular medication rate, timely reexamination rate, interrupted treatment rate， and total compliance rate）was significantly different among MDRTB patients of different  ages, education levels, treatment time, and with or without adverse reactions（all P＜0.05）.Logistic regression analysis revealed that treatment compliance of MDRTB patients was negatively correlated with treatment time（β=-1.47，Wald χ2=24.28，P＜0.05） and adverse reactions（β=-2.02，Waldχ2=24.24，P＜0.05）,while positively correlated with education levels（β=0.79，Wald χ2=6.50，p＜0.05）.ConclusionProlonged treatment time and adverse reactions can reduce the treatment compliance of MDRTB patients, the higher education levels of MDRTB patients have, the better treatment compliance they implement.

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ObjectiveTo evaluate the  effect of azithromycin on class Ⅰ integronintegrase gene (intI1) mRNA expression in biofilmforming (BF) Pseudomonas aeruginosa(PA)．MethodsintI1 of 10 PA strains isolated from a hospital were detected, 1 strain with positive BF+intI1 was selected for culture, blank control group and three azithromycin trial groups (divided according to 3 concentrations:16 mg/L, 32 mg/L, and 64 mg/L) were set, experiments were repeated 5 times, expression of intI1 mRNA were detected by RTPCR． ResultsRelative expression of intI1 mRNA in azithromycin groups of 16 mg/L, 32 mg/L,  64 mg/L, and control group were （1.15±0.04）,（12.47±3.10）,（19.71±0.78）, and （1.00±0.00），respectively, there were significant difference among four groups（F=163.82，P＜0.001）；intI1 mRNA expression between 16mg/L azithromycin group and control group was not significantly different (P＞0.05), but among other groups were significantly different (P<0.05), intI1 mRNA expression in azithromycin groups increased with the enhancing concentration of azithromycin in culture solution .ConclusionExpression of intI1 gene mRNA in BF PA can be upregulated by the present of azithromycin，which may improve the probability of drugresistant genes, and promote drugresistant gene recombination.

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ObjectiveTo study the early diagnostic value of procalcitonin（PCT）, highsensitivity Creactive protein（hsCRP） and interleukin6（IL6） in catheterrelated bloodstream infection (CRBSI)  in patients in intensive care unit(ICU).Methods78 ICU patients with suspected CRBSI between April 2013 and April 2015 were selected, blood specimens of patients on the first day of admission and being suspected CRBSI were taken, blood and venous catheter tips were performed culture, patients were divided into CRBSI group and nonCRBSI group according to culture results of blood and venous catheter tips, diagnostic values of PCT, hsCRP, and IL6 were compared.  Results28  patients were diagnosed CRBSI. On the day of  being suspected with CRBSI, levels of PCT, hsCRP,  IL6, and white blood cell(WBC)  in CRBSI group were significantly higher than nonCRBSI group respectively(［3.35±1.52］μg/L vs ［1.22±0.44］μg/L; ［32.90±11.10］mg/L vs ［23.50±6.00］mg/L; ［423.20±171.70］ng/L vs ［257.90±81.40］ng/L; ［12.70±2.70］×109/L vs ［11.20±1.90］×109/L］，P＜0.05 ). The receiver operating characteristic curve(ROC)  analysis showed that area under the curve (AUC)  and  95% CI of  PCT, hsCRP,  IL6, and WBC were 0.92（0.85，0.99）,0.75（0.62, 0.88）,0.80（0.67, 0.92）, and 0.64（0.50, 0.72）respectively；sensitivity were 0.82,0.64,0.71, and 0.46 respectively；specificity were 0.92,0.94, 0.92,and 0.88 respectively.  ConclusionPCT and IL6 have high effectiveness for early diagnosis of CRBSI in ICU patients, and have certain predictive value for early diagnosis of CRBSI.

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ObjectiveTo explore clinical therapeutic effect of cattle encephalon glycoside and ignotin (EGI) on adjunctive therapy of severe handfootandmouth disease (HFMD). Methods94 children with severe HFMD in a hospital were selected and divided into two groups according to the parity of patients’  admission numbers， 46 children in control group were given conventional therapy; 48 children in trial group were given EGI adjunctive therapy based on conventional therapy, therapeutic effect of two groups was compared. ResultsThe total therapeutic effective rate in trial group was significantly higher than that of control group (95.83% vs 76.09%， χ2=16.81,P＜0.001）. Neurological function score was not significantly different between two groups before therapy(P＞0.05）; after therapy, neurological function score in trial group was significantly lower than control group (［4.07±0.13］ vs ［5.59±0.18］, χ2=18.19,P＜0.05）. The recovery time of temperature, heart rate, blood pressure, and breathing，as well as  length of stay in hospital in trial group were all significantly shorter than control group（P＜0.05）；incidence of complications in trial group was lower than control group (4.17%［n=2］ vs 21.74%［n=10］,χ2=10.08, P＜0.001）. The proportion of turning into critically ill cases in trial group was significantly lower than control group (2.08% ［n=1］vs 13.04%［n=6］, χ2=8.94, P＜0.001）.ConclusionEGI has remarkable efficacy in adjunctive therapy of severe HFMD, which can effectively improve clinical symptoms, and  is worthy to be  popularized and applied.

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ObjectiveTo evaluate the effect of wound protector on preventing incisional wound infection following class ⅢⅣincision abdominal operation. MethodsPatients who had undergone class ⅢⅣincision abdominal operation from January 2013 to December 2014 were divided into  trial group and  control group according to whether they had used wound protector ,  incidence of postoperative incisional wound infection between two groups were compared. ResultsA total of 310 patients were monitored, 150 cases in  trial group, and 160 cases in control group. Incidence of incisional wound infection in trial group was significantly lower than control group (4.00% ［n=6］ vs  11.88%［n=19］,χ2＝6.48，P＜0.05）. The average operation time and length of hospital stay in trial group were both shorter than control group （［42.10±3.30］ min vs ［58.30±4.10］ min,  P＜0.05; ［7.00±2.20］d vs ［10.00±3.50］d , P＜0.05）, score of pain assessment of incision in trial group was lower than control group（［2.00±1.70］vs ［3.00±1.80］, P＜0.05）. ConclusionWound protector can effectively reduce the incidence of incisional wound infection following class ⅢⅣincision abdominal operation.

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ObjectiveTo analyze the difference in constituent  and antimicrobial resistance of pathogens in communityassociated urinary tract infection(CAUTI)  and  healthcareassociated UTI(HAUTI) .  MethodsClinical data and microbial detection of urine specimens of 960 patients with UTI in a hospital between January 2013  and June 2014 were investigated retrospectively, difference in constituent  and antimicrobial resistance of pathogens were analyzed. Results403 cases were CAUTI, and 557 were HAUTI; pathogens in both CAUTI and  HAUTI were gramnegative bacteria, accounting for 78.16% and 66.97% respectively. Constituent of pathogens in CAUTI and HAUTI were significantly different（χ2 =21.68,P＜0.001）. Resistant rates of Escherichia coli to piperacillin / tazobactam, cefazolin, cefoperazone / sulbactam, aztreonam, meropenem, ertapenem, gentamicin, and compound sulfamethoxazole were all significantly different between CAUTI and HAUTI (all P<0.05); Except aztreonam, resistant rates of Escherichia coli in HAUTI to the other antimicrobial agents were all higher than CAUTI. Resistant rates of Enterococcus faecium in HAUTI to penicillin, ampicillin,  gentamicin, levofloxacin, ciprofloxacin, and moxifloxacin were all higher than CAUTI(all P<0.05). ConclusionConstituent and antimicrobial resistance of pathogens in CAUTI and HAUTI are different, proper antimicrobial agents should be chosen according to constituent features of pathogens and change in antimicrobial resistance, so as to prevent and reduce the emergence of drugresistant strains, and improve therapeutic effectiveness

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ObjectiveTo compare sputum smear  and culture results in children with lower respiratory infection，realize the laboratory diagnostic value of sputum smear, and analyze the distribution and antimicrobial resistance of cultured pathogens in infection, so as to guide rational antimicrobial use in clinic.MethodsQualified sputum specimens collected from hospitalized children with lower respiratory tract infection from March to May 2014 were conducted gramstaining after smeared, meanwhile, bacterial culture, identification and antimicrobial susceptibility testing of sputum specimens were performed, gramstaining microscopic examination and culture results were compared.ResultsThe overall coincidence rate of sputum smear and culture results was 67.43%(n=617), positive rate of sputum culture was 65.90%(n=603); 730 pathogenic strains were isolated， the top 3 isolated pathogens were Haemophilus parainfluenzae(36.17%), Streptococcus pneumoniae(24.38%), and Moraxella catarrhalis(13.29%).βlactamaseproducing rates of Haemophilus parainfluenzae, Haemophilus influenzae, and Moraxella catarrhalis were 44.70%（118/264）,45.83%（11/24）,and  93.81%（91/97）respectively. Streptococcus pneumoniae were susceptible to most antimicrobial agents, while resistant rates to erythromycin, tetracycline, and compound sulfamethoxazole were high， vancomycin,  linezolid, and/or moxifloxacinresistant strains were not found.ConclusionSputum smear has certain laboratory diagnostic value, gramstaining is recommended  while sputum culture is performed, antimicrobial agents should be used rationally according to antimicrobial susceptibility testing results， so as to reduce the emergence of antimicrobialresistant organisms.

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ObjectiveTo analyze the clinical features of fungal septicemia  in premature infants in a hospital， and  provide reference for clinical diagnosis and treatment. MethodsClinical data of 18 premature infants with fungal septicemia in a hospital between January 2011 and  December 2013  were analyzed retrospectively. ResultsGestational ages of 18 premature infants were 2736 weeks, birth weights were 1 050 g-3 100 g， 8 of whom were very low birth weight  infants(VLBWI);all premature infants were treated with broadspectrum antimicrobial agents， and were given longterm parenteral nutrition before infection, 10 with mechanical ventilation，2 with peripherally inserted central catheters（PICC）. The main clinical manifestations were apnoea, twitch,  feeding difficulty, and poor reaction; manifestations appeared 3 hours52 days after birth. 13(72.22%) premature infants had abnormal white blood cell count，12(66.67%)  had thrombocytopenia (<100×109/L)，18(100.00%) had elevated Creactive protein (CRP), the average CRP level was (41.90±26.77) mg/L. The main pathogens were Candida spp.(n= 17, 94.44%），including Candida parapsilosis (n=7)， Candida albicans(n=5)， biovariety of Candida albicans(n=4)，and Candida famata (n=1)；premature infants were treated with fluconazol and  amphotericin B，15 (83.33%) were cured，2 (11.11%) improved， and 1(5.56%) died. ConclusionFungal septicemia  in premature infants are mainly caused by Candida, there is no specific clinical manifestations， clinical symptoms in premature infants with  high risk factors should be closely observed， blood routine and CRP should be detected periodically,  timely treatment with antifungal agents should be given, which are beneficial to achieve good therapeutic effect.

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ObjectiveTo explore strategies and measures to improve hand hygiene (HH) compliance and correctness of health care workers (HCWs) in a large hospital.MethodsThe WHO multimodal hand hygiene improvement strategy was adopted by healthcareassociated infection(HAI) management department of a hospital, measures consisted of five key components, including: system change, education and training, evaluation and feedback, reminders in the workplace, and institutional safety climate. HH compliance and correctness of HCWs were observed by infection control practitioners, HH compliance and correctness in JanuaryJune of 2012 (preintervention) and JanuaryJune of 2014 (postintervention) were compared, effectiveness of intervention strategies were evaluated.ResultsHH compliance rate and correctness rate of postintervention were both higher than preintervention (75.92%［8 369/11 023］ vs 53.67%［5 127/9 553］, P＜0.001;   94.11%［7 782/8 269］ vs 83.88%［3 642/4 342］, P＜0.001）. Of different occupations, HH compliance rates of doctors and nurses were significantly different before and after intervention (both P＜0.001）, while workers and staff of other occupations before and after intervention were not significantly different(both P>0.05）. Except ‘after body fluid exposure’, HH compliance rates of the other four indications for HH before and after intervention were significantly different(all P＜0.001）.ConclusionHH compliance and correctness of HCWs can be improved after adopting WHO multimodal hand hygiene improvement strategy.

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ObjectiveTo investigate antimicrobial resistance of Acinetobacter baumannii (A. baumannii)  causing hospitalacquired pneumonia (HAP)， so as to guide rational use of antimicrobial agents and reduce antimicrobial resistant rate.MethodsClinical data of patients with A. baumannii HAP in a hospital between 2009 and 2012 were collected and analyzed retrospectively. Antimicrobial resistance data were summarized and analyzed statistically according to uniformed methods.ResultsA total of 284 patients developed A.baumannii HAP， patients mainly distributed in intensive care unit（45.07%）,  department of respiratory diseases（19.01%）, neurosurgery （9.15%）, and  neurology（5.99%）. The incidences of A. baumannii  HAP，multidrugresistant A. baumannii (MDRAB) HAP， and extensively drugresistant A. baumannii (XDRAB) HAP increased year by year.  The total resistant rates of A. baumannii to cefoperazone/sulbactam (9.51%) and minocycline(9.86%) were low,  to levofloxacin(43.66%) and ciprofloxacin(45.42%) were relatively higher; resistant rates to imipenem and  meropenem were 16.20% and 20.42% respectively. The resistant rates to meropenem, imipenem, cefoperazone/sulbactam,  and ampicillin/sulbactam increased year by year (all P<0.05).ConclusionAntimicrobial resistance of A. baumannii is serious, it is essential to strengthen the monitoring of antimicrobial resistance of A.baumannii, and  prevent the spread in hospital.

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ObjectiveTo explore the current status of  healthcareassociated infection (HAI) and antimicrobial use in a children’s hospital.  MethodsPrevalence rates of HAI and antimicrobial use among hospitalized patients at 0∶00—24∶00 of May 1, 2014 were investigated by combination of bedside visiting and medical record reviewing. ResultsA total of 1 027 patients were investigated, 8 patients developed 10 times of infection, prevalence rate of HAI was 0.78%, prevalence case rate was 0.97%. HAI mainly occurred in patients in blood center (n=4),  the main infection site was respiratory tract（upper respiratory tract, n=2; lower respiratory tract，n=2）, antimicrobial usage rate was 62.12%. Antimicrobial usage rate， purpose of antimicrobial use， and combination use of antimicrobial agents among different departments were all significantly different(all P<0.05).The departments with top 3 antimicrobial usage rates were neonatal center（89.69%）, emergency center（76.00%）, and comprehensive department（73.91%）；except department of ophthalmologyotorhinolaryngologystomatology (preventive antimicrobial use accounted for 57.89%) and department of surgery(therapeutic antimicrobial use accounted for 26.32%), the other departments mainly used therapeutic antimicrobial agents; department of ophthalmologyotorhinolaryngologystomatology, heart center, and neurological rehabilitation center mainly adopted single medication treatment （all ＞95%），twodrug combination rate in neonatal center accounted for 48.28%, threedrug combination rate in blood center accounted for  30.30%. ConclusionRoutine surveillance on departments and sites of high HAI incidence should be intensified in children’s hospitals, training on knowledge of HAI among health care workers should be strengthened， and antimicrobial should be used rationally.

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ObjectiveTo investigate occupational exposure among health care workers (HCWs) in a tertiary comprehensive hospital, and analyze the causes and preventive measures of occupational exposure. Methods134 cases of occupational exposure among HCWs in a hospital from January 2010 to December 2013 were analyzed. ResultsOf  HCWs sustained occupational exposure, doctors， nurses, and technicians accounted for 59.70%， 19.40%, and  9.70% respectively. The main cause for occupational exposure was nonstandardized management of the sharps  （46.27%，n=62）,followed by unexpected operation（42.54%，n=57）and inadequate protective measures ( 11.19%， n=15);The main exposure mode was sharp injury(94.78%，n=127), mucosal exposure accounted for 5.22% (n= 7); 42.54% of exposure sources were not clear， 57.46% of exposure sources were  clear， 35.82%, 12.69%, 3.73%, and 2.24% of  which were hepatitis B virus(HBV)， hepatitis C virus(HCV)， Treponema pallidum(TP), and human immunodeficiency virus(HIV); 2.24%(n=3）of exposure sources were coinfection of HBV and HCV；0.74%(n=1) was coinfection of  HIV, HBV,HCV, and TP.  95.52% of occupational exposures were treated correctly. ConclusionThe highrisk population for occupational exposure are nurses, standard occupational precautions and management of the sharps can reduce the occurrence of occupational exposure among HCWs.

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ObjectiveTo investigate the awareness of knowledge, attitude and behavior about disinfection and sterilization among clinical health care workers (HCWs). Methods200 clinical HCWs were investigated randomly by using questionnaires.ResultsThe average awareness rates of knowledge, attitude and behavior about disinfection and sterilization among HCWs were 71.49%, 63.79%, and 86.45% respectively.  The awareness rates of knowledge about the expiration dates of sterilized articles, classification of infectious diseases, and biological monitoring were 49.43%，42.53%，  and  23.56%, respectively； HCWs’ attitude towards disinfection and sterilization：awareness rate of whether they paid attention to the new technology in specialty of central sterile supply was the lowest (26.44%) ; 86.45% of HCWs thought they could master the aseptic operation technique, correct application method for sterile apparatus and related items，but easily ignored to check the integrity of aseptic packages and indicators before operation (67.24%).ConclusionThe knowledge, attitude and behavior about disinfection and sterilization among HCWs still need to be improved，training on knowledge about disinfection and sterilization among HCWs should be strengthened.

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目的评估品管圈（QCC）对提升某医疗机构医疗废物正确分类处置的效果。方法成立QCC小组，运用QCC管理模式对科室医疗废物分类处置、职业暴露发生情况进行现场调查，对QCC活动前后数据进行对照分析。结果QCC活动前后科室医疗废物分类处置正确率分别为53.03%和83.33%，差异有统计学意义（χ2=27.94，P＜0.001）；职业暴露率分别为0.15例次/人月和0.03例次/人月。QCC活动后由处置医疗废物导致的职业暴露为0.00例次/人月。结论开展QCC活动能够显著提高医疗废物分类处置正确率，可以减少医务人员因处置医疗废物导致的职业暴露。

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多重耐药菌即1种微生物对3类（比如氨基糖苷类、红霉素、β内酰胺类）或3类以上抗菌药物同时耐药。随着抗菌药物应用日益广泛，细菌耐药性已成为国际、国内医院感染和社区感染普遍存在的问题。对于难治性（多重耐药菌感染）创口的治疗，某中医院普通外科采取中医特色自制黄连纱条对难治性感染创口进行治疗。2010—2014年共治疗25例难治性创口感染患者，均已进行分泌物细菌培养及检测确诊，其中创面超过3 cm×4 cm 9例，形成窦道伴有渗出8例，采取传统抗菌药物换药无效果11例，采用黄连纱条治疗后所有患者均在30 d内出院，其中完全愈合18例（72.00%），基本愈合7例（28.00%），均取得较满意疗效。现将2例典型的难治性感染创口病例报告如下。

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近年来，由于抗菌药物的不合理使用，碳青霉烯耐药肠杆菌科细菌(carbapenemresistant Enterobacteriaceae，CRE)日益增多，临床不能再以碳青霉烯类抗生素作为治疗肠杆菌科细菌感染的最后防线。CRE的出现严重威胁人类健康，研究细菌对碳青霉烯类耐药机制是解决其耐药性并指导临床用药的重要途径，本文旨在对肠杆菌科细菌耐碳青霉烯类药物的机制及合理有效的临床治疗方案作一综述。