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ObjectiveTo understand the distribution of serotypes and virulence genes of Klebsiella pneumoniae(KPN) isolated from feces specimens, and provide basis for clinical treatment. MethodsKPN isolated from feces specimens of healthy physical examination people and hospitalized patients without diarrhea in a hospital between November 2013 and June 2014 were collected. Mucoid phenotype, 6 kinds of capsule serotypes（K1, K2, K3, K5, K54, and K57), and 6 kinds of virulence genes （rmpA, fimH, Aero, mrkA, wabG, and ironB）were detected, distribution of capsule serotypes and virulence genes in KPN of different mucoid phenotypes and from different populations were analyzed. ResultsA total of 510 feces specimens were collected, 92 were from healthy physical examination people and 418 from hospitalized patients without diarrhea, 107 strains of KPN were isolated ( 19 from healthy physical examination people, and 88 from hospitalized patients without diarrhea),the total isolation rate of KPN from feces specimens was 20.98%, 24 isolates were hypermucoviscous phenotype KPN (HMVKP) stains, and 83 were nonHMVKP strains. 6 kinds of capsule serotypes and 6 kinds of virulence genes were all detected among KPN, the major were K1, K2, K57, and K54 serotypes(48.60%)；the detection rates of virulence genes mrkA and wabG were the highest (90.65% and 83.18% respectively), simultaneous detection of rmpA+fimH+Aero +mrkA +wabG gene was most common (30.84%), which mainly distributed in K1,K2,K57,and K54 serotypes. rmpA and Aero virulence genes were mainly detected in K1,K2,K57,and K54 serotypes. Among healthy physical examination people, the main serotype of KPN was K1 type（26.32%），while K3 and K57 types were not detected; 6 kinds of capsule serotypes were all  detected from hospitalized patients without diarrhea, the major types were K1, K2, K57, and K54. HMVKP strains carrying 4 kinds of virulence genes was higher than nonHMVKP strains (83.33%［20/24］ vs 32.53%［27/83］, χ2=19.51，P＜0.01). The total detection rate of K1, K2, K57, and K54 serotypes in HMVKP strains were higher than nonHMVKP strains (91.67%［22/24］ vs 36.14%［30/83］）； the detection rates of rmpA and Aero genes were both 95.83%, which were higher than those in nonHMVKP strains (31.32% and 30.12% respectively)( both P＜0.05）. ConclusionHypervirulence capsular serotypes and multiple virulence genes are detected in KPN from feces, especially HMVKP strains and strains from hospitalized patients, which should be paid attention.

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ObjectiveTo understand the psychological state, healthrelated quality of life (HRQOL) score, and the influencing factors of HRQOL score in patients with genital herpes. MethodsFrom January 2014 to August 2015, patients with genital herpes in dermatology outpatient clinic of Daping Hospital were investigated, and their psychological status was assessed by selfrating depression scale(SDS), HRQOL score was measured with the 36item short form health survey (SF36), correlation between HRQOL and SDS score,as well as influencing factors of HRQOL score were analyzed. ResultsA total of 145 patients with genital herpes were investigated, HRQOL and SDS scores were (479.46±92.45) and (62.2±14.1) respectively. Mild, moderate, and severe depression were 46 (31.73%)，28（19.31%），and 17（11.73%）cases respectively. Pearson correlation analysis showed that HRQOL score of the subjects was negatively correlated with SDS score (R=-0.37, P<0.001). Multiple linear stepwise regression analysis suggested that the factors related to HRQOL score from large to small were as follows: receive treatment, aware of genital herpes prevention knowledge, drinking, age, SDS score, sleep time, and exercise (all P＜0.05). HRQOL score was negatively related with age,drinking, and SDS score（all P＜0.05），but was positively related with treatment, exercise, aware of genital herpes prevention knowledge, and sleep time（all P＜0.05）. ConclusionMost patients with genital herpes suffer from depression, and with poor HRQOL, more attention must be paid to patients of old age and with depression, psychological intervention needs to be performed.

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ObjectiveTo understand the distribution characteristics and antimicrobial resistance of Salmonella isolated from feces of children. MethodsSalmonella were isolated from fecal specimens of children in a hospital between January 2012 and October 2015, serotypes and susceptibility of Salmonella to commonly used antimicrobial agents were analyzed. ResultsA total of 7 047 children’s fecal specimens were detected, 459  (6.51%) children were isolated  Salmonella, the ratio of male to female was 2.4∶1, 352 (76.69%)  children were less than 3 years old; 374 strains (81.48%） were isolated from May to October, the numbers of stains isolated in July, August, and September were 72, 84, and 78 respectively. Salmonella group B and group D were the most common serotypes, accounting for 69.06% and 19.39% respectively, most were serotypes of Salmonella typhimurium (S. typhimurium) and Salmonella enteritidis (S. enteritidis). No imipenem or ertapenemresistant strains were found, susceptibility of Salmonella to piperacillin/tazobactam, cefepime, ceftazidime, aztreonam, and ceftriaxone were all>70%, susceptibility rate of S. enteritidis to cephalosporins was lower than S. typhimurium, but to compound sulfamethoxazole was higher than S. typhimurium. ConclusionSalmonella are mainly isolated from children less than 3 years old in this hospital, summer and autumn are peak seasons, the main serotypes were S. typhimurium and S. enteritidis, antimicrobial therapy should be carefully selected in combination with serotypes and antimicrobial susceptibility testing result.

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ObjectiveTo evaluate the basic situation of healthcareassociated infection（HAI）in hospitals in different regions of Guizhou Province, so as to provide basis for making HAI prevention and control measures.MethodsFrom January 1 to September 30, 2014, 118 secondary or above level medical institutions in 9 regions of Guizhou Province were investigated through the use of questionnaires, data about prevalence rate of HAI, antimicrobial use, surgical site infection(SSI), and deviceassociated infection were summarized and analyzed.ResultsA total of 52 531 patients were surveyed, 1 175 cases of HAI occurred, prevalence rate of HAI was 2.24%, antimicrobial usage rate in 51 735 patients was 39.02%, microbiology specimen submission rate in patients receiving therapeutic antimicrobial agents was 38.81%. Postoperative pulmonary infection and SSI rates among 8 119 patients were 0.71% and 2.50%  respectively. Targeted monitoring data showed the rates of catheterassociated urinary tract infection, ventilatorassociated pneumonia, and central venous catheterrelated bloodstream infection were 2.56 ‰, 7.62 ‰,and 1.12 ‰ respectively. Differences in specimen submission rate in patients receiving therapeutic antimicrobial agents, postoperative pulmonary infection rate, and SSI rate among different regions were statistically significant (χ2 =1 128.459, 16.086, 31.360，respectively, all P<0.05).ConclusionThere remain some differences in postoperative pulmonary infection, SSI, deviceassociated infection, and specimen submission rates among different regions. HAI monitoring, prevention, and control measures should be developed for all levels of medical institutions.

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ObjectiveTo construct a good reliability and validity of questionnaire for patients participating in hand hygiene (HH) promotion in medical institutions. MethodsQuestionnaires for patients participating in HH promotion in medical institutions were constructed by research group, 195 hospitalized patients and 207 health care workers(HCWs) in two medical institutions of Xi’an city were randomly selected and investigated, questionnaire items were analyzed with critical ratio, correlation coefficient, and factor analysis method. ResultsOriginal questionnaires included questionnaires for patients and HCWs, each had 3 dimensions and 20 items. The revised formal questionnaires for patients and HCWs had 17 items respectively, questionnaires for patients included 8 items in cognitive dimension, 7 items in willingness dimension, all were closed problems; 2 items for participation ways, both were openended questions. Questionnaires for HCWs included 9 items in cognitive dimension, 5 items in willingness dimension, 1 item for participation status, all were closed problems; 2 items for participation ways, both were openended questions.ConclusionThe questionnaires for patients participating in HH promotion in medical institution are further optimized though analyzing and revising the items based the investigated data.

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ObjectiveTo establish the risk assessment scoring system for urinary tract infection(UTI)  in patients in urology department,  and provide reference for the prevention of UTI. Methods470 patients admitted to the urology department of a hospital from May 2011 to May 2014 were enrolled in the study, logistic regression model was constructed to analyze influencing factors, risk assessment scoring system was established, effect of model prediction was assessed with ROC curve. Results31 cases of UTI occurred among 470 patients (6.60%). Logistic regression analysis showed that age, combined underlying diseases, length of hospital stay, duration of indwelling catheter, and combination use of antimicrobial agents were independent risk factors for UTI. The risk assessment scoring system was as follows: aged≥60 scored 2 points,  with complications 1 point, length of hospital stay≥10 days 3 points, duration of indwelling catheter≥5 days 6 points, used ≥2 kinds of antimicrobial agents 2 points. Patients with the risk assessment score ≥11 points were the population at high risk of UTI. The area under ROC curve(AUC) of the scoring system in model group was 0.89， sensitivity and specificity were 84.9% and 81.6% respectively; AUC in validation group was 0.69， sensitivity and specificity were 77.2% and 62.4% respectively.  ConclusionRisk assessment scoring system of UTI in patients of urology department has been established and validated，it is helpful for monitoring high risk patients, and reducing the occurrence of infection.

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ObjectiveTo investigate clinical manifestations and epidemiological characteristics of patients with atypical pneumonia of unknown cause. MethodsClinical data and therapeutic effect of 11 cases of concentrated outbreak of atypical pneumonia with unknown cause were retrospectively analyzed.Results11 patients（3 males and 8 females，age 2232 years, average age 26.3 years）were admitted in the hospital, they worked at the same institution and occurred atypical pneumonia during the same period, the main clinical manifestations were fever, cough, expectoration, chest distress, but without difficulty in breathing. Computed tomography (CT) findings were as follows: increased bilateral lung markings, patchy and nodular shadows at single or multiple lobes, with blurred edge, small nodule shadow at mediastinum, no free liquid density shadow in the thoracic cavity; white blood cell count in peripheral blood was normal or decreased, detection results of common atypical pneumonia pathogens were negative. All hospitalized patients were isolated and given treatment, and were cured and discharged after receiving antiinfection treatment. ConclusionThis group of patients are with unknown etiology, atypical pneumonia occurs in an aggregated population, lung is characterized by patchy shadow, clinical symptoms are mild, prognosis is good after antiinfection treatment, and is in accordance with the characteristics of atypical pneumonia.

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ObjectiveTo investigate health care workers’ (HCWs) understanding on knowledge about central lineassociated bloodstream infection (CLABSI) in intensive care units (ICUs) and operation of CLABSI monitoring system module, so as to provide corresponding basis for evaluation of the monitoring system. MethodsAnonymous selfcompletion questionnaires were used to investigate 54 HCWs who were responsible for the monitoring of CLABSI in the ICUs of 28 hospitals in Beijing.ResultsA total of 54 questionnaires were retrieved, and all were available.  The average working experience of HCWs responsible for CLABSI monitoring was 3 years, 83.33%（n=45）of  HCWs knew the definitions of CLABSI and catheterrelated bloodstream infection（CRBSI）, there were still 14.81% (n=8) of HCWs didn’t know the contents and the difference between CLABSI and CRBSI. 61.11%（n=33）of HCWs still used paper form for recording monitoring data, 33.33%（n=18） adopted spreadsheet+ manual input. 51（94.45%）HCWs understood CLABSI diagnostic criteria, 85% of HCWs knew other symptoms/signs of CLABSI besides high fever and chill. Awareness of CLABSI infection control measurerelated knowledge (intubation technique, standard manipulation, pipeline maintenance, reducing catheterization time, and effective skin disinfection) was 94.45%-100.00%. ConclusionThe CLABSIrelated knowledge and system operation ability of the monitoring personnel should be improved, CLABSI monitoring system module needs to be further evaluated.

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ObjectiveTo study the effect of different skin disinfectant on the prevention of catheterrelated bloodstream infection (CRBSI). MethodsClinical control study was used to compare the difference in incidences of CRBSI in patients who used compound skin disinfectant and 2% chlorhexidine gluconate (CHG) alcohol skin disinfectant before central venous catheterization in the intensive care unit of a tertiary first class hospital between December 2011 and May 2014. ResultsAmong patients who used 2% CHG alcohol skin disinfectant, 2 had CRBSI, one was gramnegative bacterial infection (Pseudomonas aeruginosa), and the other was grampositive bacterial infection (Staphylococcus aureus)，incidence of CRBSI was 0.44‰(2/4 546）; among patients who used compound skin disinfectant, 22 had CRBSI, 13 were gramnegative bacterial infection, 7 were grampositive bacterial infection, and 2 were fungal infection, incidence of CRBSI was 4.11‰(22/5 349), incidence of CRBSI between two groups of patients was significantly different (χ2=15.640，P<0.01). Conclusion2% CHG alcohol skin disinfectant has a better effect on the skin disinfection before central venous catheterization, which can effectively reduce the incidence of CRBSI in ICU patients, and is worthy of priority clinical application.

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ObjectiveTo study the incidences and risk factors of ventilatorassociated pneumonia (VAP)，and provide basis for prevention and control of VAP. MethodsPatients who used ventilators in two tertiary firstclass general hospitals from January 2006 to December 2011 were performed prospective monitoring; patients with VAP were  selected as VAP group, and without VAP were in nonVAP group (1∶1 ratio), risk factors for VAP were analyzed. ResultsA total of 2 550 patients who used ventilators were monitored, 475 cases of VAP occurred, the total number of ventilation days were 32 623, incidence rate of VAP was 14.56‰. Univariate analysis showed that risk factors for VAP were history of recurrent respiratory tract infection, use of broad spectrum antimicrobial agents within one month, multiple hospitalization, coma, hypoproteinemia, intubation again after failure in ventilator weaning, use of glucocorticoid, mechanical ventilation for >5 days, regurgitation, and poor oral hygiene. Multivariate logistic regression analysis showed that independent risk factors for the occurrence of VAP were  coma (OR 95% CI：1.38-2.93), hypoproteinemia (OR 95% CI：1.12-2.10), use of glucocorticoid (OR 95% CI：1.10-2.24), intubation again after failure in ventilator weaning (OR 95% CI：2.14-4.74), mechanical ventilation＞5 days (OR 95% CI：2.55-4.83), regurgitation (OR 95% CI：1.24-2.77), and poor oral hygiene (OR 95% CI：1.72-3.74). ConclusionIncidence of VAP is high, and risk factors are multiple, comprehensive intervention measures (proper oral hygiene, headofbed elevation, timely assessment of withdrawal of respirator, and improving nutritional status) should be taken, so as to reduce the incidence of VAP.

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ObjectiveTo evaluate the combined detection value of lactic acid(LA)  and Creactive protein (CRP)in the diagnosis of severe pneumonia.MethodsSerum LA and CRP levels in 40 patients who were diagnosed with ordinary pneumonia, 40 with severe pneumonia, and 30 healthy physical examination subjects (control group) were detected, diagnostic value in severe pneumonia was evaluated.ResultsSerum LA and CRP levels in patients with severe pneumonia were (9.90+1.30)mmol/L and (80.10+12.30)mg/L  respectively, which were higher than those in ordinary pneumonia (［4.90+0.50］mmol/L，［30.20+5.70］mg/L, respectively) and healthy control group (［1.20+0.10］mmol/L，［5.01+0.50］mg/L, respectively)，difference were both significant（both P<0.05）.  The sensitivity of separately detected LA and CRP were 75.0% and 60.0% respectively, specificity were 90.0% and 70.0% respectively， sensitivity and specificity of combined detection of LA and CRP were 90.0% and 85.7% respectively, sensitivity of combined detection was higher than that of separate detection(P<0.05); specificity of each group was not significantly different (P>0.05).ConclusionThe diagnostic value of serum LA level in severe pneumonia is better than that of CRP, combined detection of LA and CRP can improve the sensitivity, but will not decrease specificity.

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ObjectiveTo understand the effect of quality control circle (QCC) on improving hand hygiene(HH) compliance of health care workers(HCWs) in department of neurology. MethodsQCC activity group was established, activity plan was formulated, and selfdesigned questionnaire was adopted to investigate HH of 62 HCWs in the neurology department of a hospital, the implementation of HH was observed, causes and countermeasures were analyzed, and a 6month continuous quality improvement was conducted. ResultsThe compliance rate and correct rate of HH among HCWs after QCC activities were both higher than that before QCC activities (80.00% vs 44.41%, χ2 =63.652, P＜0.01; 81.55% vs 46.46%, χ2 =39.940, P＜0.01）. The compliance rate and correct rate of HH among doctors and nurses improved from 42.68% and 48.41% before QCC to 85.54% and 78.38% respectively after QCC. The lowest compliance rates of HH moment before QCC activities were as follows: doctors were before contacting with the patients（18.18%），nurses were before performing cleaning/aseptic operation（28.00%）, which improved to 63.16% and 60.00% respectively after QCC activities. Goal achievement rate after QCC activity was 138.43%, improvement rate was 80.14%, ability of circle members improved greatly in the activities. ConclusionQCC activities can fully mobilize the enthusiasm of everyone, develop the team spirit of HCWs, and improve HH compliance of HCWs.

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ObjectiveTo understand the characteristics and risk factors of healthcareassociated infection(HAI) in hospitalized children in a children’s hospital, so as to provide reference for prevention and control of HAI. MethodsClinical data of all hospitalized children in this hospital between January 1 and December 31, 2013 were analyzed retrospectively. ResultsA total of 22 458 hospitalized children were investigated, 14 494（64.54%）were male children，and 7 964（35.46%）were female children；294 cases of HAI occurred, HAI rate was 1.31%(male 1.16%， female 1.58%)；the top three underlying diseases in children with infection were leukemia（5.78%）, other malignant tumors（4.01%）, and urinary system diseases（3.40%）; the major infection sites were upper respiratory tract (33.22%), gastrointestinal tract (24.67%),  and lower respiratory tract (23.03%). Univariate analysis showed that risk factors for HAI in male and female children were age ≤3 years old, length of hospital stay >7 days, stay in intensive care unit/ neonatal intensive care unit, being rescued, and antimicrobial use (all P<0.01). Multivariate nonconditional logistic regression analysis showed that independent risk factors for HAI in male children were length of hospital stay>7 days, onset of disease in spring and winter season, being rescued, and antimicrobial use; independent risk factors for HAI in female children were age≤3 years old, length of hospital stay＞7 days, underwent surgery / invasive operation, and antimicrobial use. ConclusionHAI rate in the children’s hospital is low, and there are gender differences, HAI control system can be established according to the different clinical features of children.

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ObjectiveTo analyze microbiology specimen submission in patients who received therapeutic antimicrobial use in a hospital for consecutive two years, and evaluate the clinical effect.MethodsPatients discharged from a hospital in 2014 and 2015 were as the studied subjects, microbiology specimen submission rates, days of antimicrobial use,  detection of sterilesite specimens and so on in patients receiving therapeutic antimicrobial use were compared.ResultsMicrobiology specimen submission rate in patients receiving therapeutic antimicrobial agents in 2015 was higher than that of 2014 (51.81% vs 45.55%; χ2=308.31，P＜0.01）；the quartile of antimicrobial use in patients receiving therapeutic antimicrobial agents in 2015 was shorter than that of 2014(7［4，12］d vs 8［5，12］d; Z=-5.89，P＜0.01）；The percentage of sterilesite specimen submission in 2015 was higher than that of 2014 (37.69%［20 190/53 574］ vs 31.56%［17 050/54 025］; χ2=446.15，P＜0.05）.Constituent ratios of infection of respiratory system, urinary system, bloodstream, and central nervous system were 58.75%, 10.54%, 7.02%, and 0.58% respectively; among all detected specimens, constituent ratios of sputum, blood, urine and cerebrospinal fluid were 53.01%, 15.55%, 9.58%, and 1.64% respectively. ConclusionThe enhancement of microbiology specimen submission rate can shorten duration of antimicrobial use, clinical effect is obvious.
infection

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ObjectiveTo understand the population distribution characteristics and risk links of sharp injuries among health care workers(HCWs) in a hospital,  and provide basis for making effective protection measures.MethodsOccupational exposure of HCWs in a tertiary first class hospital between January and December 2014 were retrospectively surveyed. Occupations of HCWs sustained sharp injuries, exposure locations and links, exposure sources and so on were analyzed.ResultsA total of 2 643 HCWs were monitored in JanuaryDecember 2014,  61 cases of sharp injuries occurred, 43(70.49%）sharp injuries occurred in nurses, 13（21.31%）in doctors. Sharp injuries mainly occurred in HCWs in department of orthopedics(n=9, 14.75%), the major device causing sharp injuries was transfusion needles(n=33, 54.10%), the main manipulation was pulling out the needles (n=21, 34.43%), the main exposure source was hepatitis B virus(n=36, 59.01%); 34（55.74%）HCWs with sharp injuries didn’t wear gloves during manipulation. 54（88.52%）HCWs performed local treatment following sharp injuries, only 18（29.51%）HCWs  received medication(including preventive medication), 43(70.49%) HCWs with occupational exposure were followed up and didn’t develop infection.ConclusionHospital should establish comprehensive monitoring system for occupational exposure injuries, strengthen the training of sharp injuries among high risk population, improve standard prevention, monitor and intervene risk links,  so as to effectively reduce the incidence of sharp injuries among HCWs

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ObjectiveTo evaluate the effect of quality control circle(QCC) on improving compliance to ventilatorassociated pneumonia(VAP) control measures. Methods100 patients who were admitted to an intensive care unit(ICU) and with mechanical ventilation in JanuaryDecember 2014 (control group) and 100 patients with mechanical ventilation in JanuaryDecember 2015 (trial group) were selected with convenient sampling method. Trial group implemented QCC management method，compliance to VAP control measures and hand hygiene (HH) among HCWs before and after implementing QCC was compared respectively. ResultsDifference in compliance to each VAP control measure between HCWs in trial group and control group was significant（all P＜0.001）；compliance rate to all control measures in control group and trial group were 32.00% and 74.00% respectively（P＜0.001）. Compliance rate and qualified rate of HH among HCWs in control group were 29.14% and 42.50% respectively, trial group were 83.64% and 82.50% respectively， incidence of VAP in patients in control group and trial group were 10.00% and 2.00% respectively ( all P＜0.001). ConclusionQCC management has remarkable effect on improving bundle prevention strategy of VAP and HH compliance of HCWs, and can effectively reduce the incidence of VAP.
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ObjectiveTo investigate the application effect of fluorescence labeling on quality assessment of hospital environmental cleanliness, and provide basis for establishing rational and effective assessment strategy. MethodsFrom October 2014 to February 2015, frequently touched object surface in the wards of a tertiary firstclass general hospital were randomly selected and labelled, after cleaning staff completed the cleaning, effectiveness of hospital environmental cleanliness quality was assessed by fluorescence labeling and microbial culture method (golden standard). Results216 frequently touched sites in the wards were detected, the qualified rates detected by fluorescence labeling method and microbial culture method were 43.06% and 49.54% respectively, the sensitivity and specificity of fluorescence labeling for assessing environmental cleanliness quality were 82.24% and 94.50% respectively, kappa value was 0.88, positive and negative predictive values were 93.61% and 84.43% respectively. Cost of fluorescence labeling method for each sampling point detection was ￥0.15, while microbial culture method was ￥8.20. ConclusionFluorescence labeling can be applied in assessing the quality of hospital environmental cleanliness, it is reliable, economical, and practicable.

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目的了解荧光标记法在临床环境清洁效果评价及干预中的应用效果。方法随机选取某院20间病房，对病房高频接触物体表面做荧光标记，清洁后4 h内进行荧光标记复核，未见荧光标记为清除，见到荧光标记或部分荧光标记均为未清除，计算荧光标记的清除率。持续干预半年：每月向保洁员反馈监测结果，并进行规范化培训，评价干预效果。结果干预前（第1个月）、干预后（第2个月）重症监护病房（ICU）高频接触物体表面荧光标记清除率分别为58.33%(84/144）、85.90%(134/156），均高于普通病房［分别为15.31%(30/196）、52.94%(108/204）］；干预后普通病房和ICU高频接触物体表面荧光标记清除率均高于干预前（均P＜0.001）。持续干预半年，高频接触物体表面荧光标记清除率：普通病房由第1个月的15.31%提高至第6个月的85.18%，ICU由第1个月的58.33%提高至第6个月的96.26%，差异均有统计学意义（χ2值分别为93.89、28.46，均P＜0.001）。结论荧光标记法简捷有效、成本低廉,临床上容易普遍开展，适用于环境清洁效果的快速评价，有助于环境清洁效果的持续改进。

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目的评价科室兼职感染控制人员（兼职人员）进行手卫生依从性目标性监测的可靠性。方法2014年12月某院医院感染管理科专职人员（专职人员）及兼职人员均采取隐蔽性观察方法进行手卫生依从率调查，前者在上午临床查房、治疗及护理操作高峰时段观察，后者在日常工作中进行观察，比较两种方法调查的数据。结果专职人员调查的医务人员手卫生依从率为36.67%（110/300）,低于兼职人员调查的61.90%（533/861）；不同科室、不同手卫生时刻，专职人员调查的手卫生依从率均低于兼职人员调查的数据（均P＜0.01）。专职人员与兼职人员的调查结果均显示，血液透析室、重症监护室病房（ICU）的手卫生依从率较高；清洁/无菌操作前、血液/体液暴露后、接触患者后手卫生依从率较高。 结论兼职人员调查的手卫生依从率偏高，但不同时刻手卫生依从率的高低与专职人员调查一致，有一定的可取之处。

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目的了解某院成人心脏术后患者分离的类酵母菌及其耐药性，为临床治疗提供参考。方法对2012年1月1日—2015年12月31日阜外心血管病医院成人心脏术后患者分离的类酵母菌进行鉴定和药敏试验。结果共分离类酵母菌166株，其中白假丝酵母菌103株，其次为热带假丝酵母菌(25株)、近平滑假丝酵母菌(19株)等；标本来源以痰为主，占77.11%（128株），其次为深静脉导管及血。主要类酵母菌对氟康唑、两性霉素B、5-氟胞嘧啶敏感率较高，为84.21%～100.00%；对伊曲康唑敏感率相对较低，为52.00%～85.44%。结论成人心脏术后患者分离的类酵母菌以白假丝酵母菌为主，标本来源以呼吸道为主，氟康唑仍为类酵母菌治疗的首选药物。

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20世纪80年代以来，结核病（tuberculosis，TB）疫情呈全球性回升趋势，我国作为全球最大的发展中国家，同时也是全球TB疫情最严重的国家之一［1］。随着全球耐药结核病（drugresistant tuberculosis，DRTB）的出现和传播，特别是耐多药结核病（multidrugresistant TB，MDRTB）、广泛耐药结核病（extensively drugresistant TB，XDRTB）,以及全耐药结核病（totally drugresistant TB，TDRTB）发生率的增高，全球TB的有效治疗和控制受到严重威胁。深入研究结核分枝杆菌（Mycobacterium tuberculosis，MTB）的耐药分子机制，发现基因突变是MTB产生耐药的重要原因。现就各抗结核药物的耐药表型与耐药基因型的相关性研究进行综述。

Abstract:

感染性肺炎（infectious pneumonia）指人体受病原微生物感染而发生的肺炎，病原体主要包括细菌、肺炎支原体、真菌和病毒等。每年有数以万计的人患病，且无季节特征，一年四季均可发生，病情严重程度无明显特征，各年龄段人群均可感染，尤其以老年人和儿童患者易感，重症者甚至可导致死亡［12］。社区获得性肺炎（communityacquired pneumonia，CAP)患者中3.3%～40%是由肺炎支原体感染引起，其中大约25%的肺炎支原体感染者合并肺外并发症，引起其他器官的损伤。肺炎支原体感染者临床症状多样，肺部体征一般较轻，有时甚至无任何肺部症状，仅以肺外并发症为首要症状。根据患者的流行病史、临床症状、胸片等相关检查，难以将其与一般病毒或其他细菌感染引起的呼吸道疾病相鉴别，所以在肺炎支原体感染的诊断中病原学检查具有重要作用。目前，越来越多的报道提示肺炎支原体感染与支气管炎急性发作、慢性阻塞性肺病、急性呼吸窘迫综合征、急性感染性多发性神经炎（格林-巴利综合征）、中风、冠心病、多发关节炎，以及人类免疫缺陷病毒（HIV）阳性者感染肺炎支原体导致血清阳性率升高有一定的关联［3］，因此，呼吸道感染性疾病和非呼吸道感染性疾病均可能是由于肺炎支原体感染引起。临床治疗过程中需要针对不同的病原体而合理使用抗菌药物，因此，早期检测出肺炎支原体对指导治疗非常重要。在头孢类不过敏的人群中，头孢类药物用药安全指数较高，价格较便宜，抗菌效果较好，临床使用经验较多，患者接受性较强，所以临床医生通常首先选择头孢类药物治疗非病毒性感染疾病。因肺炎支原体无细胞壁，所以头孢类药物对肺炎支原体通常无效，鉴于上述原因支原体感染治疗面临的最大问题就是如何尽快选择合理有效的抗菌药物。目前，临床上部分医生一般先给予患者头孢类抗生素，治疗一段时间无效后再换用大环内酯类抗生素；部分基层医院儿科医生在尚未诊断为肺炎支原体感染，即开始给予大环内酯类抗生素治疗，上述做法均不是治疗感染的有效措施，也不能预防抗菌药物耐药。因此，早期、准确检测肺炎支原体，可及时指导临床治疗，进而预防可能发生的流行和并发症，减少抗菌药物的滥用，减轻患者的病痛与负担。

Abstract:

脓毒症（sepsis）是危急重症患者常见的死亡原因之一，病情危重，发展迅速，死亡率较高，在临床诊疗过程中缺乏强有力的检测指标，使得脓毒症的阶段性诊疗颇为棘手，而炎性标记物是贯穿脓毒症发生发展过程中最活跃的炎性因子。在脓毒症的不同阶段，多种炎性标记物呈阶段性分泌的特点，在某一阶段能够反映脓毒症患者的病情及预后。本文通过综述炎性标记物超敏C反应蛋白（highsensitivity Creactive protein，hsCRP）在脓毒症诊疗过程中的应用，为脓毒症更合理的治疗提供新思路与策略。脓毒症是（sepsis）由细菌、病毒、真菌等多种病原体感染机体后引起的全身严重炎症反应综合征的简称［1］。脓毒症发病机制复杂，既往针对抗炎与抑炎的单一治疗并不能降低脓毒症患者病死率［2］，抗菌药物的应用虽可降低脓毒症患者的死亡，但大部分脓毒症患者早期得不到及时有效的抗感染治疗［3］，而后期长时间的抗菌药物治疗又造成医疗资源的浪费。对脓毒症的病情发展缺乏有力的检测，因此，深入研究hsCRP在脓毒症诊断、治疗及病情预后中的表达，有助于为脓毒症早期合理治疗及阶段性抗菌药物合理应用提供参考。