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ObjectiveTo investigate the molecular epidemiological characteristics and homology of Staphylococcus aureus (S. aureus) isolated from patients in intensive care units (ICUs) of a hospital,  so as to provide laboratory basis for the effective control of healthcareassociated infection(HAI). Methods62 S. aureus strains isolated from various specimens from ICU patients with infection in MarchAugust 2013 were collected, 7 housekeeping genes were amplified with polymerase chain reaction (PCR), the amplified products were sequenced, ST typing of strains was performed by multilocus sequence typing (MLST)， phylogenetic analysis of ST typing was conducted. Results62 S. aureus strains were amplified specific product of 7 housekeeping genes; there were 10 ST genotypes, in which 2 ST genotypes（STn1and STn2） were first discovered，1 ST genotype（ST675） was first discovered domestically. ST239 was the main ST type of S. aureus from ICU patients in this hospital, accounting for 74.20%，which distributed in 6 ICUs， ST5 distributed in 3 ICUs. 62 strains formed 7 main branches in the phylogenetic tree, 55 (88.71%) MRSA strains were detected. ConclusionS. aureus isolated from hospital ICUs has some homology, and the small number of types showed the trend of concentrated distribution.

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ObjectiveTo investigate infection status and antimicrobial resistance mechanism of methicillinresistant Staphylococcus aureus(MRSA)，and provide reference for the rational antimicrobial use in clinic. MethodsStaphylococcus aureus (SA) isolated from various specimens in Xuzhou area in 2012-2015 were collected, MRSA strains were preliminarily screened by cefoxitin disk diffusion method, and confirmed by amplification of mecA gene, antimicrobial resistance of MRSA was determined by KirbyBauer method, minimal inhibitory concentration (MIC) was measured by Etest method, genotypes of staphylococcal chromosomal cassette mec(SCCmec) were determined by multiplex PCR. ResultsA total of 116 strains of MRSA were identified among 210 SA strains in 2012-2015，114 of which were positive for mecA gene, the total detection rate of MRSA was 55.24%. Susceptibility rates of MRSA to vancomycin， quinupristin/ dalfopristin, and linezolid were all 100%， resistance rates of MRSA to chloramphenicol and furantoin were both low, which were 15.52% and 1.72% respectively, resistance rates of MRSA to 10 kinds of antimicrobial agents were all>80%; resistance rates of MRSA to penicillins, aminoglycosides, macrolides, quinolones, sulfanilamide, rifampicin, tetracycline, and clindamycin were all higher than methicillinsensitive Staphylococcus aureus(MSSA). MICs of vancomycin to MRSA in 2012-2015 were all 1.0 μg/mL，MIC90 were all 1.5 μg/mL， one MRSA isolate was with a vancomycin MIC of 2.0 μg/mL in 2015. MRSA typing results of 116 MRSA isolates showed that SCCmec II,  SCCmec III， and SCCmec IV accounted for 9.48%(n=11), 73.28%(n=85)，and 1.72%(Iva, n=2; IVb, n=2) respectively, 13.79%(n=16) of MRSA isolates were nontypeable, SCCmec I and SCCmec V type strains were not found. ConclusionMRSA is seriously multidrugresistant，the drift has not been discovered in MIC value of vancomycin against MRSA, the major SCCmec genotype of MRSA is SCCmec III， infection control measures should be taken to control MRSA infection.

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ObjectiveTo understand the carriage of NDM1 and other carbapenemases in carbapenemresistant Acinetobacter baumannii(CRAB) in Jiangxi area, and provide laboratory basis for the prevention and control of healthcareassociated infection (HAI). MethodsSixtyfour strains of CRAB isolated from clinical specimens from 3 tertiary firstclass hospitals in Jiangxi area from January 2015 to June 2016 were collected, susceptibility to commonly used antimicrobial agents were detected with KirbyBauer method. Carbapenemases and metalloenzyme in CRAB were screened with modified Hodge test and EDTAdisk synergy test respectively, carbapenems gene was detected by polymerase chain reaction (PCR)， NDM1producing Acinetobacter baumannii (A. baumannii) were performed conjugation test.ResultsThe resistance rates of CRAB  to ampicillin/sulbactam, ciprofloxacin, gentamicin, and levofloxacin were up to 95.31%, 98.44%, 90.63%, and 54.69% respectively. The positive rates of modified Hodge test and EDTAdisk synergy test were 76.56% and 96.88% respectively. PCR amplification result showed that 87.50%（n=56） of CRAB carried OXA23 and VIM1 genes，18.75%（n=12）carried SIM， 3.13%(n=2）carried OXA-24，and 26.56%（n=17) carried NDM1. CRAB carrying NDM1 gene were all from The First Affiliated Hospital of Nanchang University, 64.70%（11/17）of which were pandrugresistant strains. Conjugation test result showed that NDM1producing strains could transfer NDM1 gene to recipient strain Escherichia coli J53, then acquired resistance to imipenem. ConclusionAntimicrobial resistance rates of clinically isolated CRAB in this area are high, OXA23 and VIM1 genes are the main carbapenemase genes, NDM1 gene positive CRAB is detected, and there may be a clonal spread of NDM1 gene in hospital, effective measures should be taken as soon as possible to prevent and control the spread of NDM1 positive CRAB.

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ObjectiveTo systematically evaluate risk factors for healthcareassociated infection(HAI) with multidrugresistant Acinetobacter baumannii (MDRAB), so as to provide scientific basis for formulating MDRAB prevention and intervention strategies. MethodsLiteratures at home and abroad were searched, RevMan 5.3 statistical software was used for meta analysis of the included literature data. ResultsA total of 21 papers were included, 8 in English and 13 in Chinese, 35 risk factors were analyzed, 20 of which were significantly different（all P＜0.05），which included in 4 categories: ① Related factors for antimicrobial use：use of antimicrobial agents prior to isolation of MDRAB（OR, 12.87 ［95%CI, 5.14-32.21］）, duration of antimicrobial use（MD, 6.99 ［95%CI， 2.21-11.78］）, types of used antimicrobial agents (MD, 1.07 ［95%CI, 0.60-1.54］）, combined use of antimicrobial agents（OR, 4.16 ［95%CI, 2.63-6.57］）,carbapenems use（OR, 3.95 ［95%CI， 2.54-6.13］）, use of third and above generation cephalosporins（OR, 2.48 ［95%CI， 1.90-3.24］）; ② Related factors for invasive procedures：mechanical ventilation（OR, 4.30 ［95%CI, 3.03- 6.10］）, endotracheal intubation/tracheotomy（OR, 4.17 ［95%CI, 2.41-7.22］）, urinary catheterization（OR, 2.35 ［95%CI, 1.42-3.88］）, deep venous puncture（OR, 2.18 ［95%CI, 1.14-4.16］）, drainage catheterization（OR, 2.06 ［95%CI, 1.19-3.58］）; ③Related factors for intensive care unit (ICU): ICU admission（OR, 5.60 ［95%CI, 2.73-11.48］）, length of ICU stay（MD, 4.21 ［95%CI, 0.72-7.71］); ④ Other factors：heart disease（OR, 0.71 ［95%CI, 0.55-0.93］）, tumor（OR, 0.67 ［95%CI,0.48-0.95］）, pancreatitis（OR, 2.04 ［95% CI，1.11-3.76］）, mixed infection（OR, 2.57 ［95%CI, 1.78-3.71］）, length of hospital stay（MD, 5.92 ［95%CI, 3.61-8.23］）, APACHE II score（MD, 4.56 ［95%CI, 1.94-7.18］）, use of glucocorticoid（OR, 2.18 ［95%CI, 1.21-3.90］）. ConclusionAntimicrobial use, invasive operation, ICUrelated factors are the main risk factors for MDRAB HAI, the relevant treatment and nursing intervention strategies should be formulated based on risk factors to prevent and reduce MDRAB infection.

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ObjectiveTo understand  antimicrobial resistance of Enterobacteriaceae strains and distribution characteristics of carbapenemaseresistant Enterobacteriaceae(CRE)  in Xijing Hospital in 2015,  so as to provide basis for rational use of antimicrobial agents in clinic. MethodsSpecimens from infected inpatients and outpatients in Xijing Hospital in JanuaryDecember 2015 were performed pathogenic culture, isolation and identification. Antimicrobial susceptibility testing was performed with KirbyBauer method, carbapenemase confirmatory test was conducted with modified Hodge test, antimicrobial resistance of Enterobacteriaceae was statistically analyzed. ResultsA total of 4 166 pathogenic strains were isolated in 2015, 1 554 (37.30%) of which were Enterobacteriaceae strains, the top 5 isolated pathogens were Escherichia coli(E. coli), Klebsiella pneumoniae(K. pneumoniae), Enterobacter cloacae (E. cloacae), Proteus mirabilis, and Enterobacter aerogenes. Of 787 E. coli strains, 581(73.82%) were extendedspectrum βlactamases(ESBLs)producing strains；of 367 K. pneumoniae strains, 182(49.59%) were ESBLsproducing strains. E. coli and K. pneumoniae had the highest resistance rates to cefazolin, which were 93.14% and 78.48% respectively. A total of 81 (5.21%) CRE were detected, K. pneumoniae, E. cloacae, and E. coli were 41, 27, and 13 strains respectively; strains were mainly isolated from patients in departments of neurosurgery(n=42),  gastroenterology(n=9)， and neurology(n=8) . 1.02%（8/787) of E. coli and  3.27% (12/367) of K. pneumoniae were multidrugresistant. ConclusionEnterobacteriaceae accounted for a higher proportion of pathogenic bacteria causing HAI, the detection rate of ESBLsproducing strains remains high, the isolation rate of carbapenemresistant Enterobacteriaceae is higher than that of last year, especially K. pneumoniae.

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ObjectiveTo understand the effect of improving compliance rate to multidrugresistant organism (MDRO) prevention and control measures on reducing MDRO transmission in the intensive care unit (ICU). MethodsAll  patients in 5 ICUs of a hospital in MarchJune 2014 were chosen, March 1April 30, 2014 was baseline survey stage, May 1June 30, 2014 was intervention stage (comprehensive intervention measures were taken), the implementation of patients contact isolation measures, as well as awareness of MDROrelated knowledge among health care workers(HCWs) in 5 ICUs before and after intervention were compared respectively. ResultsHCWs’ awareness rates of MDRO transmission modes, contact isolation measures, and informing of department transfer after intervention were all higher than before intervention(100.00% vs 67.22%, 98.89% vs 61.11%, 93.33% vs 45.56%, respectively）; except singleroom isolation，compliance rates to other prevention and control measures(including doctor’s advice on isolation, bedside isolation, wearing isolation gowns, adding isolation logo) were all higher than before intervention(>70% vs <50%, all P＜0.01). Detection rate of MDROs after intervention was lower than before intervention (7.16%［90/1 257］ vs 9.65%［117/1 212］, χ2=5.00，P=0.03). ConclusionComprehensive intervention measures can improve HCWs’ compliance to prevention and control measures on MDROs, and reduce the transmission of MDROs.

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ObjectiveTo analyze drug resistance phenotypes and clinical distribution characteristics of clinically isolated carbapenemresistant Klebsiella pneumoniae(CRKP), and provide evidence for rational use of antimicrobial agents and control of healthcareassociated infection(HAI). MethodsCRKP isolated from inpatients in a hospital in 2013-2015 were collected, sources of specimens and homology of antimicrobial susceptibility of pathogens were analyzed. ResultsOf 949 nonrepetitive strains of Klebsiella pneumoniae, 75(7.90%) were CRKP strains. The detection rates of CRKP from 2013 to 2015 were 1.35%, 7.77%, and 17.04% respectively, which showed an upward trend year by year, difference was statistically significant（P＜0.01）. The main infection sites of CRKP were respiratory tract and urinary tract, CRKP mainly distributed in intensive care unit(ICU), geriatrics and emergency departments. Susceptibility rates of CRKP to amikacin and trimethoprim / sulfamethoxazole were 57.33% and 48.00% respectively. 22 (29.33%) cases of CRKP infection were communityacquired and 53 (70.67%) were healthcareassociated infection. 18 （24.00%）cases died among 75 CRKP infected patients. According to drug resistance phenotype analysis, there were 5 clones of CRKP strains, mainly distributed in ICU, geriatrics and emergency departments.ConclusionThe proportion of CRKP infection is increasing year by year, clinical monitoring on CRKP should be strengthened, intensive infection control measures should be tarken, so as to prevent and control the spread and prevalence of CRKP.

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ObjectiveTo investigate the efficacy of bundle care under the supervision of professionals in preventing ventilatorassociated pneumonia(VAP). MethodsPatients who received mechanical ventilation between July 2013 and June 2014 in the intensive care unit(ICU) of a hospital were selected, JulyDecember 2013 was as control group (n=150), patients received bundle care, but without special supervision； JanuaryJune 2014 was as special supervision group (n=177), patients received bundle care under the supervision of professionals, incidence of VAP, duration of mechanical ventilation, and length of ICU stay were compared between two groups. ResultsIn special supervision group, 141 patients received invasive mechanical ventilation, mechanical ventilation day were 1 937 days, 9 patients developed VAP, incidence of VAP was 4.65‰; in control group, 127 patients received invasive mechanical ventilation, mechanical ventilation day were 1 965 days, 21 patients developed VAP, incidence of VAP was 10.69‰, difference was statistically significant between two groups（χ2=5.68，P=0.042）. In special supervision group, overall compliance rate of bundle management strategies, duration of average invasive mechanical ventilation， and length of ICU stay were 94.92%,（11.11±2.57）days, and（15.11±2.88）days respectively，in control group were 48.67%,（14.67±4.35）days, and（19.33±5.81）days respectively，difference was statistically significant between two groups (all P＜0.05）. ConclusionBundle care strategies supervised by professionals can effectively prevent the occurrence of VAP, the implementation of bundle care strategies should be set up according to the clinical practice.

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ObjectiveTo understand serological detection results of syphilis among hospitalized patients in a general hospital, and provide new ideas for further prevention and treatment of syphilis. MethodsClinical data of inpatients with abnormal serological detection results for syphilis in a hospital from January 2012 to December 2013 were analyzed. ResultsA total of 164 442 patients were admitted to a hospital from January 2012 to December 2013, 112 576 of whom were performed syphilis serological screening, 2 048 cases were with abnormal results of serological detection for syphilis. The abnormal serological detection results were mainly in patients of 31～ and 41～ years  （39.06%），followed by patients of 51～, 61～ years （34.42%）, and≥71 years （15.63%）；unemployed people（34.08%）, farmers（23.05%）, and retirees(19.19%) were the main population with abnormal results. The abnormal serological detection results distributed in all 36 departments, the main departments were departments of respiratory medicine（9.86%）, gynaecology（7.13%）, and cardiovascular internal medicine（6.88%）. Nonmarital sex is the main route of transmission（56.79%）; the main syphilis serological detection results were both positive for Treponema pallidum particle agglutination (TPPA)assay and rapid plasma reagin (RPR) （46.14%）, as well as TPPA positive and RPR negative （43.31%）. 860 (41.99%) patients were with latent syphilis. ConclusionThe current status of patients with abnormal serological detection results of syphilis is not optimistic, mainly concentrated in patients of 31-50 years. It is necessary to strengthen publicity and education on prevention and treatment of syphilis, implement syphilis prevention and treatment policy, intensity syphilis screening， so as to prevent the epidemic and spread of syphilis.

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ObjectiveTo investigate the homology of methicillinresistant Stphylococcus aureus(MRSA) from the neonatal intensive care unit(NICU) of a children’s hospital, and evaluate routes and preventive strategies of MRSA healthcareassociated infection(HAI). MethodsMRSA strains from neonates and environment of NICU between October and December 2014 were collected, and strains were identified by VITEK2 microbial analysis system and cefoxitin KirbyBauer method, homology of MRSA was analyzed by pulsedfield gel electrophoresis (PFGE). ResultsA total of 6 MRSA strains were isolated from NICU between October and December 2014, 3 of which (bed58, 70, and 100) were detected MRSA from specimens, MRSA were isolated from neonatal incubator and nurse (nasal swabs and hands) who cared for neonate at bed 58. 5 of 6 MRSA strains were homology, antimicrobial susceptibility testing result showed that No. 1-5 strains were resistant to clindamycin and amoxicillin/clavulanic acid, No. 6 strain was slightly different from No. 1-5 strains, No. 6 strain was susceptible to both clindamycin and amoxicillin/clavulanic acid. PFGE results showed that No. 1-5 strains were of the same type, No. 6 strain was a different type. ConclusionThe main route of this MRSA transmission is contact transmission, especially through the hands of health care workers, identification and analysis of epidemic strains by PFGE technique is an effective measures to prevent HAI outbreak and perform epidemiological study

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Nocardia is a genus of grampositive, weakly acidfast, filamentous aerobic actinomycetes, which mainly causes infection in immunocompromised persons. We reported a successfully treated fatal case of severe pneumonia caused by Nocardia farcinica in a hospital, then reviewed 25 domestic and abroad case reports about nocardiosis combined with severe pneumonia occurred since 2006, so as to improve health care workers’ cognition on clinical manifestations, image features, pathogenic characteristics, and diagnostic and treatment schemes of severe pneumonia caused by Nocardia farcinica.

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ObjectiveTo understand characteristics and research status of literatures related to surgical site infection(SSI) in China.MethodsLiteratures about SSI published between January 2000 and March 2016 were retrieved from China National Knowledge Infrastructure(CNKI), VIP database, Vanfang Database, and China Biology Medicine(CBM) database. Bibliometric method was adopted to analyze external and internal characteristics of literatures.ResultsA total of 1 036 articles in Chinese were included, 40（3.86%）, 189（18.24%）,and 807（77.90%）were published in 2000-2005，2006-2010，and the first quarter of 2011-2016 respectively.  Articles were mainly published in Chinese Journal of Nosocomiology（n=226, 21.81%）, Chinese Journal of Infection Control(n=53，5.12%）, and Chinese Journal of Disinfection（n=27, 2.61%）. The research fields included risk factors(n=277, 26.74%), infection rates (n=261, 25.19%)， antimicrobial application (n=208, 20.08%), and pathogens (n=153, 14.77%); the infection rates were higher in general surgery and neurosurgery, the main pathogens were Escherichia coli，Staphylococcus aureus, and Pseudomonas aeruginosa, risk factors mainly included the types of incision，duration of surgery, diabetes, age, and body mass index.ConclusionIn recent years，articles about SSI research increases significantly，research in etiology and epidemiology has gained substantial achievement, but in the intervention and economics is still weak, suggesting that SSI research in economics，risk management，and behavioral aspects should be strengthened.

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ObjectiveTo analyze factors affecting quality of life(QOL) in patients with chronic hepatitis B(CHB), and provide reference for improving QOL of patients. MethodsThe MOS 36item short form health survey (SF36) was adopted to survey QOL of patients with CHB, Morisky medication adherence scale was used to measure patients’ adherence to medication, factors affecting QOL of patients with CHB were analyzed. ResultsOf 357 CHB patients, 271(75.91%) were married, 107(29.97%) received college or above education, 163(45.66%) patients’ average household monthly income were ￥2 000-￥5 000, 138（38.66%）patients’ family members were also with CHB, 198 (55.46%) patients smoked, 150 (42.02%) drank. The average score of CHB patients’ adherence to medication was (2.15±1.29). Factors affecting QOL in patients with CHB were age, education level, duration of disease, whether or not hospitalized, whether or not drink, as well as adherence to medication. Age, drink, and duration of hepatitis B, and previous hospitalization were negative factors affecting QOL in patients with CHB, education level and adherence to medication were positive factors affecting QOL in patients with CHB. ConclusionStrengthening CHB patients’ understanding on disease and improving their medication adherence can help them to improve QOL.

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ObjectiveTo evaluate the change and clinical significance of serum procalcitonin（PCT）and Creactive protein（CRP）in patients with septic shock. MethodsPatients with severe infection in the intensive care unit (ICU) of a hospital between January 2013 and June 2015 were selected. According to the extent of infection, patients were divided into septic shock group (n=66, subdivided into survival group ［n=50］ and death group［n=16］ according to 1month survival) and severe sepsis group (n=62), control group were patients without septic shock during the same hospitalization period, serum PCT, CRP, and WBC levels in each group at different times before and after treatment were compared. ResultsIn septic shock group, serum PCT，CRP and WBC levels before treatment, after 1, 3, and 7 days of treatment were all significantly higher than control group; in severe septic shock group, serum PCT and CRP levels after 1, 3, and 7 days of treatment were all significantly higher than control group; in death group, serum PCT levels after 1, 3, and 7 days of treatment were all significantly higher than survival group, CRP levels after 3 and 7 days of treatment were both significantly higher than survival group（all P<0.05）. Receiver operating characteristic (ROC) curves showed that area under the curve （AUC） and 95%CI of PCT，CRP, and WBC were 0.786（0.703-0.864），0.754（0.691-0.827），and 0.603（0.542-0.679） respectively. Spearman correlation analysis showed that serum PCT and CRP in patients with septic shock before treatment，after 7 days of treatment were positively correlated（［r=0.596，P=0.004］, ［r=0.523，P=0.012］, respectively）, and after 7 days of treatment, serum PCT was positively correlated with WBC（r=0.604，P=0.001）. ConclusionPCT can be used as a indicator in early diagnosis of patients with septic shock，and dynamic observation of PCT and CRP has important significance in evaluating patients’severity and prognosis.

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ObjectiveTo evaluate the efficacy of hydrocolloid dressings on preventing mechanical phlebitis induced by peripherally inserted central catheter (PICC) in cancer patients. Methods100 cancer patients with PICC were divided into observation group (n=50) and control group (n=50). Hydrocolloid dressing was used in observation group and hotwet compress was used in control group. Incidence of mechanical phlebitis, comfort degree, and implementation time between two groups were compared.ResultsThe incidence of mechanical phlebitis in observation group and control group were 4.0%（2/50）and 22.0%（11/50）respectively, grade of mechanical phlebitis in observation group was significantly lower than control group（P＜0.05）. The rates of skin irritation, activity limitation, and body exposure in observation group were all significantly lower than control group(0 vs 10.0%, 2.0% vs 14.0%, 0 vs 16.0%, respectively, all P<0.05）, the implementation time of observation group and control group were （2.8±1.1）and (35.2±7.4) minutes respectively, difference was statistically significant（P＜0.05）. ConclusionHydrocolloid dressing can significantly reduce the mechanical phlebitis induced by PICC, enhance patients’ comfort degree, and reduce nurses’ workload.

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ObjectiveTo understand the current situation of multidrugresistant organism (MDRO) infection in hospitalized patients in a tertiary firstclass hospital, as well as efficacy of bundle intervention measures on prevention and control of infection. MethodsHospitalized patients who were infected with MDROs in this hospital during 2012-2014 were monitored and conducted bundle intervention. ResultsIn 2012-2014, a total of 1 909 MDRO strains were isolated. The isolation rates of MDROs in 2012-2014 were 30.69%, 31.04%, and 29.40% respectively，bedside intervention rates were 81.02%, 92.05%, and 94.23% respectively，implementation rates of clinical isolation were 69.97%, 82.98%, and 93.04% respectively; MDRO isolation rates during 2012-2014 were not significantly different（P＞0.05）；bedside intervention rates and implementation rates of clinical isolation were both significantly different（both P＜0.05）. The top 3 isolated MDROs in 2012-2014 were extendedspectrum βlactamases(ESBLs)producing Escherichia coli, multidrugresistant Acinetobacter baumannii, and ESBLsproducing Klebsiella pneumoniae. ConclusionBundle intervention measures, such as multidepartment collaboration and strengthened onsite supervision, can promote more standardized management of healthcareassociated infection, enhance the implementation rate of clinical isolation, and effectively prevent and control the spread of MDRO in hospital.

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ObjectiveTo investigate the distribution of pathogens and positive alarming time of blood culture, and provide basis for laboratory diagnosis and clinical treatment. MethodsBlood specimens from clinical departments in a hospital in MayNovember 2015 were collected, positive alarming time of blood culture was recorded, species of pathogens were identified. ResultsA total of 157 pathogenic strains were isolated from blood culture specimens, grampositive cocci, gramnegative bacilli, and fungi accounted for 31.85%, 57.32%, and 10.83% respectively. The median positive alarming time were as follows: Enterobacteriaceae 0.50 day, nonfermenting bacteria 0.63 day, Enterococcus spp. 0.60 day, Streptococcus spp. 0.80 day, Staphylococcus spp. 1.01 days, and fungi 1.44 days, respectively. ConclusionPositive alarming time of blood culture specimens from early to late are as follows: Enterobacteriaceae, Enterococcus, nonfermentative bacteria, Streptococcus spp., Staphylococcus spp., and fungus. Positive alarming time of pathogens causing bloodstream infection are all within 4 days, and most of them are within 1 day.

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目的了解某院职业暴露发生的特点，针对薄弱环节制定防控措施。方法采用回顾性调查对该院2013年1月—2015年12月140例次职业暴露的类型、原因以及暴露源、处置随访等方面进行分析。结果暴露者中护士居多，占40.72%；其中暴露类型以锐器伤为主，占84.29%。发生暴露的主要原因在于操作者本人未能执行标准操作流程，暴露源病原体以乙型肝炎病毒（HBV）最多见（41.45%），暴露者能正确处置者占94.29%。结论了解职业暴露特点和薄弱环节的管理，有利于制订医务人员职业安全措施。

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目的了解某传染病医院医务人员人类免疫缺陷病毒（HIV）职业暴露情况。方法收集2011年1月—2014年12月该传染病医院发生HIV职业暴露的医务人员信息，分析医务人员HIV职业暴露环节、方式等情况。结果4年共发生49例HIV职业暴露，其中护士37例，医生7例，医技人员4例，保洁员1例；职业暴露人员中工龄≤5年者占75.51%。暴露方式以手术中器械、注射器针头、输液器针头等造成的锐器伤为主（36例，占73.47%）；暴露环节以注射穿刺及有创术中操作为主（28例，57.14%）；职业暴露中手术室发生22例（44.90%）、病房17例（34.69%）、检验科4例、产房3例、急诊2例、消毒供应中心1例。发生职业暴露后无1例感染HIV病毒。结论护士为HIV职业暴露的高发群体，针刺伤为暴露的主要方式。

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重症颅脑损伤是指颅内血肿、脑干损伤或者广泛脑挫裂伤，是神经外科常见的急危重症［1］。其诊断标准是：（1）广泛颅底骨折、脑挫裂、脑干损伤或颅内血肿;（2）深昏迷12 h以上，意识障碍逐渐加重或出现再昏迷;（3）有明显的神经阳性体征;（4）生命体征有明显的改变［23］。由于本病在救治过程中极易引起医院感染，且多见肺部感染［1］。重症颅脑损伤并发肺部感染的诊断标准依据卫生部2001年颁布的感染诊断标准。严重的肺部感染易诱发患者呼吸功能降低、全身感染、加重基础疾病，最终结局不良［4］。因此，降低肺部感染的发生率，可明显提高患者的抢救成功率。

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利福霉素为袢霉素类家族成员，可用于治疗多种感染，如结核病、耐甲氧西林金黄色葡萄球菌感染、艰难梭菌引起的艰难梭菌相关性腹泻（Clostridium difficileassociated diarrhea, CDAD）、衣原体的持续感染［1］、旅行者腹泻［2］等。然而，利福霉素广泛用于临床感染治疗的同时，细菌耐药问题却使该杀菌“利器”变得“钝化”。结核分枝杆菌极易对利福平（rifampin, RIF）耐药，约有3.6%新增结核病和20.2%复治结核病为耐多药结核病［3］。CDAD是成人医院获得性腹泻的主要原因［4］，利福霉素类中利福昔明因其口服不易被吸收，用于治疗复发性CDAD［5］，然而艰难梭菌对利福霉素耐药率高达11%［6］。如何在正常发挥药物抗菌作用的同时减少细菌耐药的产生，关系临床抗感染治疗的成败。本文在介绍RIF抗菌机制的基础上，对细菌耐RIF的机制予以综述，为临床开发新的细菌转录抑制剂类药物提供帮助，以便更加有效的治疗感染。

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