Abstract:

ObjectiveTo evaluate the value of amplification and sequencing of 16S rRNA gene in the identification of clinical rare pathogenic bacteria, and guide the diagnosis and treatment for related clinical infection.Methods12 bacterial isolates that were difficult, or unable to be identified with conventional laboratory methods, or with special phenotypes were collected. The 16S rRNA gene was amplified by polymerase chain reaction (PCR), then  sequenced for identifying bacterial species through BLAST comparison, clinical characteristics of related infection were analyzed. Results12 clinical isolates were all positive for PCR amplification (about 1 500 bp), species were all identified  (similarity  ≥99%), the identified strains were Listeria monocytogenes(n=2), Brucella melitensis(n=2), Fusobacterium mortiferum(n=1), Rothia aeria(n=1), Nocardia farcinica(n=1), Staphylococcus saccharolyticus(n=1), Rhizobium radiobacter(n=1), Prevotella bivia(n=1), Ralstonia mannitolilytica(n=1), and Atopobium vaginae(n=1). The sensitivity of 16S rRNA gene amplification was high, and the minimum detection limit of Escherichia coli ATCC 25922 was 1.5×101 CFU/mL. Clinical data of 12 patients revealed that these strains can cause multisites and multitypes of infection,after patients received targeted antimicrobial therapy, 11 improved, and 1 died.ConclusionSequencing for 16S rRNA gene can rapidly and accurately identify rare, anaerobic, and difficult cultured bacteria, provide laboratory evidence for etiological diagnosis and treatment of different types of infection.

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ObjectiveTo investigate the incidence of recurrence and occurrence rate of recurrence of handfootandmouth disease (HFMD) in Jiangbei  District of Ningbo City between 2012 and 2014, analyze the influencing factors, and provide a scientific basis for the prevention and control of HFMD.MethodsData of HFMD in Jiangbei in 2012-2014 were collected from China Disease Surveillance Information System, immunization data were from Immunization Programme Information System of Ningbo City, the recurrent infectious cases were selected and analyzed by descriptive epidemiological methods.ResultsThe occurrence rate of recurrent HFMD in Jiangbei in 2012-2014 was 5.40%, the median month of patients with single occurrence and recurrence of HFMD were 33.77（20.03，47.83）and 38.26（22.05，54.75）months respectively, median month of patients with the initial occurrence were 23.93（15.87，36.87）months, median of time interval of recurrent HFMD was 10.27（5.23，16.06）months. The occurrence rate of recurrence was the highest in 3 years old group（χ2=37.51，P＜0.001）. Most were scattered children and children in childcare center. Female was a protective factor of recurrence of HFMD (OR,0.73［95%CI, 0.57-0.92］), while children in childcare center was a risk factor (OR,1.46［95%CI,1.16-1.84］). The median attack rate of recurrence in HFMD group and control group in blocks within 7 days were 10.36（9.29,11.44）/100 000 and 8.95(8.16,9.74)/ 100 000 respectively, there was significant difference（Z=-2.68，P＜0.001）. Inoculation frequency between recurrent HFMD group and control group was not significantly different （Z=-1.38，P=0.17）.ConclusionThe epidemic of recurrence of HFMD was serious in Jiangbei District of Ningbo City between 2012 and 2014, boys and children in childcare center should be paid attention, contacts with patients should be reduced, and targeted prevention and control measures should be carried out.

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ObjectiveTo investigate perioperative antimicrobial prophylaxis in arthroscopic surgery in a hospital before and after intervention, evaluate intervention efficacy, and provide evidence for the rational clinical antimicrobial application.MethodsFrom August 2012, measures were taken to intervene perioperative antimicrobial use, perioperative antimicrobial use and surgical site infection(SSI) in 312 patients undergoing arthroscopic surgery between September 2011 and August 2013 were retrospectively surveyed.ResultsA total of 312 patients were investigated, preand postintervention were 150 and 162 cases respectively, SSI rates were both 0 before and after intervention. Antimicrobial usage rate after intervention was lower than before intervention (26.54% vs 100.00%， χ2=1.781,P＜0.001). Irrational antimicrobial use dropped obviously；average expense of antimicrobial agents dropped from (1 165.69±756.33) yuan (RMB) before intervention to (32.71 ±119.29)yuan (RMB) after intervention (t=3.330, P＜0.001).ConclusionPerioperative antimicrobial usage rate in arthroscopic surgery at this hospital decreased significantly after intervention, rational use of antimicrobial agents has improved, SSI rate still remains zero.

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ObjectiveTo investigate the prevalence of healthcareassociated  infection(HAI)  in a children’s specialty hospital in Guangzhou in 2014.MethodsA crosssectional survey was undertaken to investigate the prevalence of HAI among all hospitalized patients on September 17, 2014.ResultsA total of 997 patients were investigated, 30 patients developed 32 times of  HAI, HAI rate and HAI case rate were 3.01% and 3.21% respectively. The main infection sites were upper respiratory tract（n=11，34.38%）；the departments with higher HAI prevalence rates were intensive care unit(ICU, 3.99%) and  pediatric internal medicine department（3.60%）; the rate of etiological examination in patients with HAI accounted for 93.33%, a total of 24 strains of pathogens were isolated, 6 of which were virus (25.00%), 6 were fungi (25.00%), 11 were bacteria (45.83%), and 1 was Chlamydia (4.17%). The main bacteria were Staphylococcus aureus (n=3, 27.27%) and Staphylococcus epidermidis (n=3, 27.27%); a total of 451 (45.24%) patients received antimicrobial agents on the investigation day,  67.41% of whom received therapeutic use of antimicrobial agents，19.73% received prophylactic use, and 12.86% received both therapeutic and prophylactic use; monodrug application accounted for 82.26%, the percentage of bacterial detection among patients with therapeutic antimicrobial use (including  combination of therapeutic and prophylactic use) was 82.60%.ConclusionManagement of key departments and key sites of HAI should be strengthened in children’s specialty hospital, antimicrobial agents should be used rationally, so as to protect the safety of children.

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ObjectiveTo evaluate the effect of Lean Six Sigma （LSS） on intervening in medical waste management in a hospital, and evaluate the intervention effect.MethodsMedical waste disposal in  inpatient departments and operating rooms in a tertiary firstclass hospital were investigated, 13 inpatient departments  were randomly chosen for study. December 2014March 2015 was preintervention  stage, baseline data of medical waste management were surveyed,  AprilJuly 2015 was postintervention stage, LSS DMAIC (define, measure, analyze, improve, control) process was used to standardize process of the classification and disposal of medical waste, management effect was evaluated.ResultsAnalysis on factors influencing the cost of medical waste disposal revealed that there were 7 influencing factors, and that presenting 4 progressive structures, undefined responsibility of administration department was the root cause, which led to the different standards for medical waste classification, and eventually influenced the cost of medical waste disposal. The qualified rates of medical waste classification in inpatient departments and operating rooms increased from 69.22% and 71.88% before intervention to 80.42% and 81.00% after intervention respectively，difference were both significant（both P＜0.01）; medical waste weight in inpatient departments decreased from (1.11±0.14) kg/bedday to (0.91±0.18) kg/bedday, and that in operating room decreased from (10.77±0.33)kg/bedday to (7.26±1.04) kg/bedday(both P<0.05). The benefitcost ratio was 6.09, that is, 1yuan investment could save 6.09 yuan.ConclusionLSS management method can effectively reduce medical waste weight and cost of every hospitalization day,  and it has certain health economic value.

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ObjectiveTo evaluate the incidence and risk factors of urinary tract infection(UTI)  following ureteroscopy.MethodsPatients undergoing ureteroscopy examination or ureteroscopic lithotripsy in a hospital between 2002 and  2011 were analyzed retrospectively, clinical data of patients were collected and analyzed, including age, sex, history, complication ,  urine routine test, urine culture, blood routine test, urethral catheterization, ureteral stent placing and antimicrobial use.ResultsIncidence of UTI  following ureteroscopy was 3.77%（20/531），UTI  following ureteroscopy examination was higher than ureteroscopic lithotripsy (5.84%［9/154］ vs 2.92%［11/377］). Pyelonephritis was the main infection type(n=15), the main pathogen was Escherichia coli(n=6),  there was no statistical difference in UTI among patients receiving different types of antimicrobial prophylaxis (P=0.185).Patients with bacteriuria, hydronephrosis, urethral catheterization, without ureteral stent placing, and  without receiving antimicrobial prophylaxis had higher incidence of URI(all P<0.05).ConclusionBacteriuria, hydronephrosis, urethral catheterization, without postoperative ureteral stent placing, ureteroscopy examination, and  without receiving antimicrobial prophylaxis are risk factors of UTI following ureteroscopy.

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ObjectiveTo evaluate the effect of class 10 000 laminar flow ward on the incidence of healthcareassociated infection (HAI) in patients with initial occurrence of  acute leukemia during induction chemotherapy period.MethodsPatients with initial occurrence of acute leukemia admitted to a hematological department of a hospital between October 2013 and June 2014 were investigated retrospectively,  patients in class 10 000 laminar flow ward was as trial group, in general ward was as control group. All patients received standard induction chemotherapy and the same nursing measures, the incidence of HAI between two groups of patients, and ward air cleanliness were compared.ResultsA total of 79 patients with initial acute leukemia were received (trial group, n=39; control group, n=40). The average  air cleanliness value in rooms and  corridors of laminar flow wards were both significantly different with general ward (3.57×106/m3 vs 149.36×106/m3, t=45.80, P＜0.001; 24.46×106/m3 vs 15 854.38×106/m3, t=108.70， P＜0.001）. Incidence of HAI between trial group and control group was significantly different  (23.08%［9/39］ vs 45.00%［18/40］, χ2=4.219，P=0.040）.  The main infection site in trial group was gastrointestinal tract (n=5), in control group was lower respiratory tract (n=8). The duration of fever, duration and cost of antimicrobial use in trial group were （6.20±2.10）d,（9.35±2.12）d, and （27 113.79±1 559.03）yuan respectively, in control group were (10.20±2.90）d，（14.15±3.14）d, and （58 566.29±2 217.54）yuan respectively, difference in duration of fever and cost of antimicrobial use between two groups were all significant（t=1.021,1 377.45，both P＜0.05）.ConclusionLaminar flow ward can reduce the incidence of HAI in patients with initial occurrence of acute leukemia,  and decrease cost of antimicrobial use.

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ObjectiveTo understand drug resistance in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV /AIDS) after antiretroviral therapy(ART).MethodsArticles about drug resistance in HIV /AIDS patients after ART were retrieved from Wangfang data, China National Knowledge Infrastructure(CNKI)，and PubMed. Meta analysis were performed.Results15 articles （1 English and 14 Chinese）were extracted, quality score of 3,4,and 8 articles was 6,7, and 8 respectively.  Heterogeneity of the included studies showed the difference was significant (Q=45.98,P<0.001), there was heterogeneity, randomeffects models was conducted for Meta analysis,which revealed that the overall drug resistance rate in HIV/ AIDS patients in China was 4% (4%-5%); Begg’s test showed that P=0.012, there was publication bias. After articles were excluded through sensitivity analysis, the combined effect was still 4%(4%-5%).ConclusionThe overall drug resistance rate  in Chinese HIV/ AIDS patients  after ART  is not high.

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ObjectiveTo investigate compliance and influencing factors of hand hygiene (HH) among health care workers(HCWs).MethodsFrom November 2014 to February 2015, implementation of HH among HCWs in 15 clinical departments in a hospital was investigated through questionnaires, the effect of HH purpose on HH behavior of HCWs was analyzed with multivariate logistic regression method.ResultsA total of 364 HCWs were investigated, 245 (67.31%）of whom implemented  HH  well. Univariate analysis revealed that implementation of  HH among HCWs of different occupations, education levels, and HH purpose were all significantly different (all P<0.05). Multivariate logistic regression analysis showed that HH purpose as well as HH compliance were both significantly different (P=0.042）. Compared with HH purpose of selfprotection among HCWs, HCWs with HH purpose of crossinfection prevention had better HH behavior (OR,2.17［95%CI, 1.29-3.65］).The top five objective factors influencing HCWs’  HH implementation were as follows: lack of warm water in winter (70.73%), heavy workload,had no time (61.38%), skin irritation caused by disinfectant or hand sanitizer (54.88%), without hand dryer (47.56%), and use disposable gloves (45.12%).ConclusionOn the basis of improving HH facilities, changing HCWs’ awareness of HH only for selfprotection may be an another way to improve HH compliance among HCWs.

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ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens causing pneumonia in acute stroke patients, and guide clinical antimicrobial use.Methods Patients with strokeassociated pneumonia(SAP) admitted to a tertiary firstclass hospital from 2008 to 2013 were investigated retrospectively, distribution and antimicrobial susceptibility testing results of pathogens from sputum were analyzed.ResultsA total of 98 patients with SAP were investigated, 124 stains were isolated from sputum specimens, 75 strains (60.48%) were gramnegative bacteria, 44 (35.49%) were grampositive bacteria, and 5 (4.03%) were fungi. There were 21 cases of mixed infection (21.43%), bacterial alterations during treatment process existed among 23 cases（23.47%）.The top 4 isolated pathogens were Staphylococcus aureus（S. aureus,n=43，34.68%）, Klebsiella pneumoniae（K. pneumoniae, n=19，15.32%）, Pseudomonas aeruginosa（P. aeruginosa, n=18，14.52%）, and Acinetobacter baumannii（A. baumannii, n=18，14.52%）. Antimicrobial resistance rates of K. pneumoniae were all ＜32%，and susceptibility rates to ceftazidime, piperacillin /tazobactam, imipenem, ciprofloxacin, levofloxacin, amikacin, and tobramycin were all 100%. Both A.baumannii and P.aeruginosa showed severe multidrug resistance. Resistance rates of A.baumannii to ceftazidime was >80%, resistance rates of P.aeruginosa to imipenem was 33.33%. No resistant strains were detected among fungi.ConclusionThe main pathogens causing SAP in this hospital are S.aureus, K.pneumoniae, A.baumannii, and P.aeruginosa, except K.pneumoniae, the other strains are severely resistant to antimicrobial agents, clinicians should choose antimicrobial agents according to the distribution characteristics and antimicrobial susceptibility testing results.

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ObjectiveTo evaluate effect of care bundle on preventing neonatal ventilatorassociated pneumonia(VAP).MethodsEighty neonates who met the inclusion criteria were selected and randomly divided into trial group and control group, two groups of neonates were both given routine nursing care, trial group were implemented care bundle to prevent VAP on the basis of routine nursing care. Incidence of VAP, average length of neonatal intensive care unit (NICU) stay, and average hospitalization expense were compared between two groups of neonates.ResultsA total of 80 neonates were monitored, trial group and control group were both 40 cases. Incidence of VAP in trial group and control group were 21.21‰ and 35.04‰ respectively(P＜0.05); average length of NICU stay in trial group and control group were (17.84±4.03) d and (23.50±4.81) d respectively(P＜0.05); average hospitalization expense in trial group and control group were（26 200.71±389.45）yuan and （38 506.36±582.13）yuan respectively(P＜0.05).ConclusionCare bundle can effectively prevent the occurrence of VAP, reduce the length of NICU stay, decrease hospitalization expense, and improve nursing quality and satisfaction.

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ObjectiveTo evaluate effectiveness of clinical pharmacists’ intervention in perioperative antimicrobial use in type I incisional surgery.MethodsClinical data of 1 398 patients undergoing type I incisional surgery in a hospital between January and December 2014 were analyzed retrospectively, 633 patients who underwent surgery between January and June were as preintervention group, 765 patients who underwent surgery between July and December were as postintervention group (clinical pharmacists were assigned to strengthen the management and control of rational antimicrobial use), antimicrobial prophylaxis between preintervention group and postintervention group were compared.ResultsIn pre and postintervention groups, antimicrobial prophylaxis were 56.71% and 28.37% respectively（χ2=113.26，P＜0.05). Rational selection rates of antimicrobial types were 60.45% and 89.86% respectively, rational rates of administration time were 49.58% and 82.49% respectively, the rates of antimicrobial prophylaxis course≤24 hours were 11.42% and 29.95% respectively，＞24 hours were 88.58% and 70.05% respectively，combination antimicrobial use were 10.31% and 0 respectively，the differences between before and after intervention were all statistically significant (all P＜0.05). Incidence of surgical site infection in preand postintervention groups were 0.79%（5/633）and 0.26%（2/765）respectively（P=0.255）.ConclusionThrough clinical pharmacists’ intervention in perioperative antimicrobial prophylaxis in type I incisional surgery, antimicrobial prophylaxis rate decreased dramatically, antimicrobial management is more standardized, scientific and systematic.

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ObjectiveTo analyze characteristics of pathogenic microbiology and antimicrobial susceptibility of Vibrio vulnificus (V.vulnificus) causing infection in patients at a hospital in Shantou City.MethodsFour patients with V.vulnificus infection admitted to a hospital between June 2013 and June 2014  were analyzed  retrospectively,  blood specimens of patients were collected for culture, blister fluid  and wound secretion were taken and inoculated on blood agar plates,  MacConkey agar plates, and thiosulfate citrate bile salts sucrose (TCBS) plates, isolated strains were  identified and performed antimicrobial susceptibility testing.ResultsAmong 4 patients with V.vulnificus infection, 3 died, 1 was cured; patients developed primary septicemia and lower extremity infection because of eating pickled crab，steamed scallop， or  contacting with seafood products after trauma. Blister fluid  from patients A and B,  wound secretion from patient C, and blood from patient D were all isolated  oxidasepositive gramnegative bacteria  which produced green colonies on TCBS plate, these strains were identified as V.vulnificus, which were resistant or intermediate to cefazolin, intermediate to cefotetan, and 1 strain was resistant to cefepime. ConclusionFour patients infected with V.vulnificus have high mortality rate （3/4）, positive rates of blister fluid  and wound secretion are higher than blood;  timely medical consultation, early antimicrobial therapy, and active debridement will help to cure the disease.

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目的了解常见革兰阴性（G-）菌菌群分布及耐药性变化，为临床合理使用抗菌药物提供可靠依据。方法采用回顾性调查方法，分析某院2009—2013年临床标本分离的主要G-菌及其耐药性。结果临床分离的主要G-菌数由2009年的1 189株增加至2013年的2 364株，常见居前4位的G-菌依次为大肠埃希菌3 331株（37.38%）、肺炎克雷伯菌1 623株（18.22%）、铜绿假单胞菌1 566株（17.58%）、鲍曼不动杆菌1 057株（11.86%）。2009—2013年产超广谱β内酰胺酶（ESBLs）大肠埃希菌检出率分别为47.84%（144/301）、56.90%（301/529）、59.49%（395/664）、55.05%（469/852）、52.49%（517/985）；产ESBLs肺炎克雷伯菌检出率分别为35.68%（76/213)、41.00%（139/339）、36.75%（122/332）、41.78%（155/371）、36.96%（136/368）。产ESBLs大肠埃希菌耐药率较高，对大多数抗菌药物的耐药率＞50%；产ESBLs肺炎克雷伯菌对亚胺培南、阿米卡星、哌拉西林/他唑巴坦较敏感。铜绿假单胞菌对氨基糖苷类、喹诺酮类、头孢吡肟、头孢他啶、亚胺培南、哌拉西林/他唑巴坦保持较强的抗菌活性，耐药率＜20%；鲍曼不动杆菌对喹诺酮类、氨基糖苷类、头孢吡肟耐药率均＞40%，5年间耐药趋势变化不大。结论该院G-杆菌耐药性强且多重耐药，必须加强合理使用抗菌药物，预防感染。

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目的了解肠球菌属细菌菌种分布及耐药谱特点，为临床用药提供依据。方法对某院2013年1—12月各临床科室送检标本分离的441株肠球菌属细菌作回顾性分析。结果441株肠球菌属细菌，包括8个菌种，以屎肠球菌为主（占51.02%，225/441）, 粪肠球菌次之（38.55%、170/441)，其余菌种所占比率均＜3%。标本分布以体液为主（46.26%，204/441），其次为尿（32.88%，145/441）、痰（14.06%，62/441）。分离居前3位的科室依次为普通外科（107株，占24.26%），重症医学科（78株，占17.69%）和儿内科（31株，7.03%）。除四环素外，屎肠球菌对青霉素、氨苄西林、环丙沙星、左氧氟沙星、莫西沙星、红霉素、呋南妥因的耐药率均高粪肠球菌，差异均有统计学意义（均P＜0.01)。未发现耐万古霉素、利奈唑胺和替加环素的屎肠球菌和粪肠球菌。粪肠球菌对青霉素、氨苄西林、环丙沙星、左氧氟沙星、莫西沙星、呋南妥因耐药率均＜30%。除对奎奴普丁/达福普汀和呋南妥因的耐药率＜20%，屎肠球菌对其他抗菌药物的耐药率较高。结论不同种肠球菌属细菌对抗菌药物的耐药性存在差异，且多重耐药现象严重，应定期监测其细菌变迁和耐药性变化，指导临床合理用药。

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寨卡病毒（Zika virus,ZIKV）是一种新发现的病毒，该病毒最早于1947年通过黄热病监测网络偶然在乌干达维多利亚湖畔寨卡丛林的恒河猴身上发现，随后于1952年在乌干达和坦桑尼亚人群中发现［1］。2014年2月份开始，美洲共有18个国家和地区确认存在寨卡病毒的传播，包括巴西、巴巴多斯、哥伦比亚、厄瓜多尔、萨尔瓦多、法属圭亚那、危地马拉、圭亚那、海地、洪都拉斯、马提尼克岛、墨西哥、巴拿马、巴拉圭、波多黎各、圣马丁、苏里南和委内瑞拉，传播范围还有继续扩大趋势。