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ObjectiveTo study plasmidmediated transfer, plasmid replicon typing, and genetic environment of blaNDM1 gene in Enterobacter aerogenes(E. aerogenes).MethodsE. aerogenes HNNDM0711 was used as the subject of this research, the transferable properties of plasmid were analyzed by conjugation testing, conjugant was performed stability testing, plasmid type was determined by PCRbased replicon typing (PBRT), downstream and upstream of blaNDM1 were sequenced using chromosome walking method, genetic context was analyzed by BLASTN and BALSTP, as well as annotated using Vector NTI 11.5.1 software, sequence pipeline graph was made, the sequence was submitted to Genbank through software Banklt.ResultsThe conjugation testing of E. aerogenes pHNNDM0711 was positive, after positive conjugant was conducted 4day passage, minimal inhibitory concentrations (MICs) of imipenem and meropenem to all the cloned strains didn’t change, blaNDM1 were all positive. The replicon type was IncA/C; blaNDM1 gene was localized between ISAba14 and IS91, at upstream of the blaNDM1, class 1 integron and Tn3 transposon were identified, class 1 integron contained a new mosaic structure of a drugresistant resistance gene cassette.ConclusionE. aerogenes pHNNDM0711, bearing blaNDM1 gene in IncA/C plasmid, derived from gene recombination under different antimicrobial selection pressure. Antimicrobial use in clinical, industrial and agricultural area should be strictly controlled, so as to reduce the emergence of such bacteria.

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ObjectiveTo investigate the current status of healthcareassociated infection(HAI) management professionals  in county and above levels of traditional Chinese medicine(TCM) institutions in a province.MethodsThe uniform questionnaires were adopted to investigate the basic status of HAI professionals in county and above levels of TCM institutions in a province.ResultsThere were 117 county and above levels of TCM institutions in this province, 85 TCM  institutions participated the investigation, there were  a total of 128 professionals, including 82 professionals in 65 secondary hospitals, and 46 in 20 tertiary hospitals. Among the investigated  TCM hospitals, 83 (97.65%) set up HAI management committees, 77 (90.59%) set up independent HAI management departments, 55 (64.71%) assigned HAI professionals that met The Requirements of HAI Surveillance Guideline, 27（31.76%）exclusively engaged in management of HAI, 58（68.24%）were also responsible for other management besides HAI management. Among investigated professionals, 91.41% were nursing staff, 55.47% received undergraduate course or above, 54.69% had intermediate professional titles, 61.72% were at the age of 41-50, 45.31% engaged in HAI management for 1-3 years, 115 professionals had management certificates.ConclusionThe infection management in provincial traditional Chinese medicine institutions are understaffed, professional structure is unitary, professional quality is low, leaders in different levels of TCM institutions should enhance HAI management awareness,  strengthen the construction of professional quality, and cultivate multidisciplinary talents as soon as possible.

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ObjectiveTo investigate prognosis and related factors of infectious pancreatic necrosis(IPN) caused by multidrugresistant organisms(MDROs).MethodsClinical data of 53 IPN patients admitted to a hospital between October 2010 and March 2016 were analyzed retrospectively, patients were divided into MDRO infection group and common bacterial infection group according to antimicrobial resistance of pathogens isolated from peripancreatic drainge fluid, prognosis and related factors of two groups were compared.ResultsAmong 53 IPN patients with confirmed evidence for pathogenicity, 33（62.3%）were in MDRO infection group, and 20（37.7%）were in common bacterial infection group, the most common MDROs isolated from peripancreatic drainage was multidrugresistant Acinetobacter baumannii (MDROAB)（37.5%，18/48）. The mortality of IPN patients was 30.2% (16/53), mortality of MDRO infection group was higher than common bacterial infection group（39.4%［13/33］ vs15.0%［3/20］, P<0.05）; the severity score, length of intensive care unit (ICU) stay, and hospitalization expenses in MDRO infection group were all higher than common bacterial infection group(all P<0.05). The mortality of IPN patients were closely associated with MDRO infection and severity score of acute pancreatitis(all P<0.05).ConclusionPrognosis of patients with MDRO infection is poor, treatment is difficult, MDRO infection has become one of the most important challenge to the treatment of severe acute pancreatitis.

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ObjectiveTo analyze the risk factors for healthcareassociated pneumonia (HAP) in patients with orthopedic injury, provide the basis for making prevention and control measures. MethodsHAP occurred in patients with orthopedic injury and admitted to the department of orthopedics of a hospital from June 2011 to May 2015 were investigated retrospectively, risk factors were analyzed by univariate and multivariate logistic regression methods. ResultsA total of 2 578 patients with orthopedic injury were investigated, 92 patients developed HAI, incidence of HAP was 3.57%. 107 strains of pathogens were detected, the major were Klebsiella pneumoniae（n=22, 20.56%）, Escherichia coli (n=14, 13.08%）, and Acinetobacter baumannii(n=13, 12.15%). Risk factors for HAP in patients with orthopedic injury were length of hospital stay≥15 days, smoking history≥3 years, bedridden≥7 days, associated with underlying diseases, complications, indwelling catheter≥7 days, surgical operation, mechanical ventilation, admitted to intensive care unit, open injury, blood sugar≥11 mmol/L, plasma albumin＜30 g/L, hemoglobin concentration＜90 g/L, and use of glucocorticoid≥4 days (all P＜0.05）. Multivariate logistic regression analysis showed that smoking, bedridden, surgery, mechanical ventilation, glucocorticoid use, and anaemia were independent risk factors for HAP in patients with orthopedic injury. ConclusionThe occurrence of HAP in patients with orthopedic injury is related with multiple factors, the major are surgical operation, mechanical ventilation, glucocorticoid use, long term smoking, bedridden, and anaemia.

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ObjectiveTo survey the point prevalence of healthcareassociated infection(HAI) in 13 tertiary hospitals in Dongguan, understand the occurrence of HAI in tertiary hospitals, so as to provide guidance for the prevention and control of HAI. MethodsThrough bedside investigation and medical record reviewing, HAI among inpatients in 13 tertiary hospitals in Dongguan at 0：00-24：00 of September 24, 2014 were investigated. ResultsA total of 11 344 patients were investigated, 379 patients developed 404 times of HAI, HAI rate was 3.34%, HAI case rate was 3.56%. Incidence of HAI in the intensive care unit was highest (12.82%). The main infection site was respiratory tract（n=173, 42.48%）. The usage rate of antimicrobial agents was 30.50%, most were for therapeutic use (including therapeutic+ prophylaxis) （n=2 545, 73.55%）and single use （n=2 689, 77.72%），pathogenic microorganism detection of specimens from patients receiving therapeutic antimicrobial use was 53.79%. A total of 299 strains of pathogenic orgamisms were detected from infected patients, the major were Escherichia coli (n=56, 18.73%), Pseudomonas aeruginosa (n=54, 18.06%), and Klebsiella pneumoniae (n=35, 11.71%), 92 strains of multidrugresistant organisms(MDROs) were isolated, accounting for 30.77% of total isolated pathogens. ConclusionThe basic characteristics of HAI in tertiary hospitals in this city were preliminarily investigated, identification of high risk departments, high risk population, and high risk links should be strengthened, HAI prevention and control measures should be implemented.

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ObjectiveTo analyze antimicrobial resistance of clinically isolated Burkholderia cepacia(B. cepacia), and provide evidence for clinical rational antimicrobial use.MethodsB. cepacia isolated from clinical specimens between January 2013 and December 2014 were analyzed retrospectively, antimicrobial susceptibility results were statistically analyzed.ResultsA total of 98 isolates of B. cepacia between January 2013 and December 2014 were isolated, the main specimen was sputum(n=86, 87.76%）, the main department distribution was intensive care unit（n=46, 46.94%），resistance rate of B. cepacia to ticarcillin / clavulanic acid was highest(73.47%), resistance rates to piperacillin / tazobactam and cefoperazone / sulbactam were both 16.33%，resistance rate to minocycline was the lowest(5.10%).ConclusionInfection caused by B. cepacia is high, prevention and control of healthcareassociated infection should be strengthened, early etiological examination should be performed, antimicrobial treatment should be combined with antimicrobial susceptibility results.

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ObjectiveTo evaluate risk factors for surgical site infection(SSI) in patients with thoracolumbar fracture, and provide basis for making prevention and control measures.MethodsPatients with thoracolumbar fractures operation in the department of spinal surgery of a hospital between January 2010 and March 2015 were monitored through information monitoring system, onsite visit, and telephone followup, incidence of SSI was investigated, risk factors were performed univariate analysis.ResultsA total of 326 patients undergoing thoracolumbar fracture operation were monitored, 15(4.60% ) had SSI. SSI were high in patients≥60 years old, underwent operation at nonlaminar air flow operation room, didn’t receive antimicrobial prophylaxis 30 minutes prior to operation, preoperative hospital stay >3 days, operation duration >3 hours, as well as with diabetes mellitus and chronic respiratory disease （all P＜0.01）.ConclusionRisk factors for SSI in patients undergoing thoracolumbar fractures operation were patients with older age, receive operation at nonlaminar air flow operation room, didn’t receive antimicrobial prophylaxis, long length of preoperative hospital stay and operation duration, as well as combined with diabetes mellitus and chronic respiratory disease, preventive measures should be taken to reduce the incidence of infection.

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ObjectiveTo understand the distribution and antimicrobial resistance of pathogens isolated from blood culture in a hospital in Sanya city.MethodsBlood culture specimens and antimicrobial susceptibility testing results in this hospital from January 2013 to December 2015 were analyzed retrospectively.ResultsA total of 356 isolates of pathogenic bacteria were isolated from 3 195 blood culture specimens, the positive rate was 11.14%，including 215（60.39%）gramnegative bacterial strains, 122(34.27%) grampositive bacterial strains, and 19(5.34%) fungi strains. The top 3 gramnegative bacteria were Escherichia coli(n=90, 25.28%), Klebsiella pneumoniae(n=60, 16.85%), and Burkholderia pseudomallei(n=24, 6.74%); the most common grampositive bacteria were Staphylococcus aureus(n=42, 11.80%), coagulasenegative staphylococcus(n=38, 10.67%), and Streptococcus spp.(n=33, 9.27%). Resistance rates of Escherichia coli and Klebsiella pneumoniae to cefoperazone/sulbactam，amikacin, and carbapenems were all lower than 10.00%； resistance rates of Burkholderia pseudomallei to most antimicrobial agents were lower than 10.00%. There were no strains of main grampositive bacteria that were found to be resistant to linezolid and vancomycin.ConclusionGramnegative bacteria are the main pathogens causing bloodstream infection in this hospital in recent years, especially the isolation rate of Burkholderia pseudomallei is higher, which should arouse more attention in clinic.

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ObjectiveTo understand the clinical distribution characteristics and antimicrobial resistance of pathogens causing healthcareassociated infection(HAI) in a comprehensive hospital. MethodsClinical data of patients with HAI in this hospital between  May 2012 and May 2015 were collected, the distribution and antimicrobial resistance of pathogens isolated from patients were analyzed.ResultsA total of 6 563 cases of HAI occurred among 183 850 patients, incidence of HAI was 3.57%, 445 patients were isolated at least two kinds of pathogens, 375（84.27%） patients were isolated two kinds of pathogens, 132 of whom were infected with both gramnegative bacilli. 4 478 specimens were sent for pathogenic detection, 2 503 (55.90%) of which were isolated pathogens; a total of 2 755 pathogens were isolated, including 1 713(62.18%) strains of gramnegative bacilli, 732(26.57%) grampositive cocci, 304(11.03%) yeastlike fungi, and 6(0.22%) anaerobic bacteria. 524(19.02%）strains were mainly from patients in department of neurology. The main specimen was sputum (n=1 340, 48.64%). The isolation rates of carbapenemresistant Escherichia coli(CREC), Klebsiella pneumoniae (CRKP), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa(CRPA) were 0.39%（2/510）, 1.66%（3/181）, 59.14%（207/350）, and 5.29%（11/208）respectively；isolation rate of methicillinresistant Staphylococcus aureus (MRSA) was 21.55%（25/116）. ConclusionMultidrugresistant organisms causing HAI are various, it is necessary to understand distribution characteristics and prevalence of pathogens, monitor multidrugresistant organisms, and implement contact isolation measures, so as to prevent the outbreak of HAI.

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ObjectiveTo investigate the sources and transmission routes of clustered cases of healthcareassociated infection（HAI） caused by multidrugresistant Acinetobacter baumannii (MDRAB) in the intensive care unit (ICU) of a hospital, and provide evidence for the prevention and control of HAI.MethodsClustered cases of MDRAB HAI in ICU were investigated, specimens of patients and environment were collected and cultured, the isolated strains were performed antimicrobial susceptibility testing.ResultsFive strains of pathogenic bacteria were isolated from sputum of patients with HAI, 5 infected patients were at adjacent beds from the same ICU; the onset time was on January 2-7, 2016. A total of 21 strains of pathogenic bacteria were isolated from environmental specimens during the same period, these strains were from quilt, bedside cabinet, treatment trolley, faucet, bedrail, breathing tube, and hands of health care worker(HCWs). Antimicrobial susceptibility testing results showed that strains from patients and environment were all MDRAB, and had the similar antimicrobial resistance pattern.ConclusionThe occurrence of clustered HAI cases is due to contamination of HCWs’ hands and hospital environment by MDRAB.

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ObjectiveTo understand the occurrence and risk factors of healthcareassociated infection(HAI) in a neonatal intensive care unit(NICU). MethodsNeonates who were admitted to the NICU of a hospital from January 2012 to December 2014 were investigated retrospectively, risk factors for HAI were performed univariate analysis. ResultsA total of 760 neonates were included in the investigation, 198 neonates developed 259 times of HAI, incidence of HAI was 26.05%，case incidence of HAI was 34.08%，incidence of HAI per 1 000 patient days was 9.50‰； the main infection site was lower respiratory tract （n=92, 35.52%）； among 259 cases of HAI, 172 strains of pathogenic bacteria were isolated, the major pathogen was Acinetobacter spp.(n=40, 23.26%）; incidence of HAI was high in neonates with gestational age ≤32 weeks, birth weight≤1 500 g, length of hospital stay≥10 days, duration of antimicrobial use≥10 days, mechanical ventilation, deep venous catheterization, and feeding intolerance, difference was statistically significant (all P<0.001). ConclusionIncidence of HAI in NICU is high, effective prevention and control measures should be formulated according to its risk factors, so as to reduce the occurrence of HAI in neonates.

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ObjectiveTo compare postoperative pulmonary infection in patients undergoing surgical operation at different surgical opportunities. MethodsPatients who underwent surgical operation in a hospital from January to December 2014 were surveyed retrospectively, patients’ data were reviewed, patients with postoperative pulmonary infection were compared. ResultsA total of 20 343 surgical patients were investigated, 227(1.12%) had postoperative pulmonary infection. Postoperative pulmonary infection rate in patients undergoing emergency operation was higher than that of selective operation (5.13% vs 0.70%, χ2=307.49，P＜0.001）. Postoperative pulmonary infection rates in patients undergoing emergency neurosurgical, general surgical, and cardiothoracic surgical operation were all higher than selective operation(all P<0.001). Among patients with pulmonary infection following emergency operation, the proportion of those who aged <60 years, with preoperative irrational antimicrobial use, cardiovascular disease, hypertension, and tracheotomy were all higher than those who received selective operation(all P<0.05); the proportion of patients with cancer is lower than that of elective surgery patients（P＜0.05）. ConclusionPostoperative pulmonary infection rate in patients undergoing emergency operation is higher than selective operation, postoperative pulmonary infection rates in patients undergoing emergency neurosurgical, general surgical, and cardiothoracic surgical operation are high. Patients with cardiovascular disease and hypertension are the focus of protection; for elective surgery, cancer patients are the focus of protection.

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ObjectiveTo observe air disinfection efficacy of ultraviolet ray, ozone disinfector, and circulating air disinfector in outpatient blood collection room.MethodsAir in outpatient blood collection room was disinfected by ultraviolet ray, ozone disinfector, and circulating air disinfector, air specimen was taken before and after air disinfection, as well as after 1, 2, 3, and 4 hour working condition of staff, efficacy of 3 disinfection methods were compared.ResultsUnder static condition, there was no significant difference in average colony forming unit(CFU)  among 3 disinfection methods（P=0.317），the average CFU in air which disinfected by ultraviolet ray and ozone disinfector increased rapidly after the entry of personnel, the number of air colony did not meet the requirements of category Ⅲ environmental sanitation standard after staff worked for 2 hours; circulating air disinfector could continuously disinfect after the entry of personnel, the average CFU met the requirement of category Ⅲ environmental sanitation standard after staff worked for 1, 2, 3, and 4 hours; there were significant difference in the CFU among different disinfection methods（F=211.00，P＜0.001），there were significant difference in CFU at different sampling time（F=272.95，P＜0.001）.ConclusionCirculating air disinfector can meet the requirements of category Ⅲ environmental sanitation standard during the working condition of staff, and is suitable for air disinfection in outpatient blood collection room.

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ObjectiveTo investigate the applicability of autoregressive integrated moving average (ARIMA) model in predicting healthcareassociated infection(HAI) in children. MethodsThe ARIMA model was constructed according to the incidence of HAI in a hospital from January 2011 to December 2014. With the use of information criterion, optimal model was determined; HAI data in 2015 was as test samples, the feasibility of the model was evaluated. ResultsARIMA (0,1,1) was the optimal prediction model for HAI rate, the Akaike Information Criterion（AIC）and Bayesian Information Criterion(BIC）of the ARIMA(0,1,1) were 66.61 and 70.76, respectively. The LjungBox statistics value Q= 14.14 was not significantly different (P= 0.658), suggesting a white noise sequence of residuals with a good model fitting. The mean absolute percent error(MAPE) between actual and fitting value of HAI was 22.4, the actual values were within the 95% confidence interval. ConclusionARIMA model fits the time series data, and can achieve satisfactory effect on predicting the incidence of HAI in hospitalized children.

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ObjectiveTo understand the current situation of pressure steam sterilization in medical institutions in Xi’an city, and provide reference for the monitoring and quality control of pressure steam sterilization. MethodsCentral sterile supply departments（CSSDs） in medical institutions in Xi’an in 2012-2014 were investigated. Physical, chemical, and biological monitoring methods were used to evaluate the pressure steam sterilizers. ResultsA total of 135 medical institutions in Xi’an were monitored, including 40 tertiary medical institutions and 95 secondary and below medical institutions. A total of 540 specimens were collected, 454 were qualified, overall qualified rate was 84.07%. Qualified rate of monitoring result of pressure steam sterilization of tertiary medical institutions was higher than secondary and below medical institutions（93.13% vs 80.26%, χ2=13.91，P＜0.01）. Qualified rates of chemical PCD and biological test pack of tertiary as well as secondary and below medical institutions were 100% and ＞90% respectively. The qualified rate of  recoded temperature in secondary and below medical institutions was 88.42%, but actually measured temperature was 38.95%，which was significantly lower than 72.50% of tertiary medical institutions（χ2=12.68，P＜0.01）. The rates of the measured temperature>134℃ of pressure steam sterilizer in each year were all low, but measured temperature＜132℃ was about 50.00%, difference between actually measured temperature and recorded temperature was -4℃-1℃，difference between -2.5℃-0.5℃ accounted for 80.00%，the main unqualified temperature was 130℃-131℃，accounting for 82.61%. ConclusionEfficacy of pressure steam sterilization is different in different levels of medical institutions in Xi’an, physical monitoring measures are not standardized, the supervision of physical parameters in key sectors should be strengthened to ensure the sterilization quality of medical institutions and reduce the occurrence of iatrogenic infection.

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ObjectiveTo investigate the characteristics and risk factors of occupational exposure to bloodborne pathogens among health care workers(HCWs), and evaluate prevention and treatment countermeasures. MethodsRecord Form for Occupational Exposure to Bloodborne Pathogens Among Health Care Workers was used for retrospective survey on the occurrence of occupational exposure to bloodborne pathogens in a hospital between January 1, 2013 and December 31, 2015. ResultsA total of 246 cases of blood/body fluid occupational exposure occurred. The main occupational exposure population were nurses (n=95, 38.62%); occupational exposure mainly occurred in wards(n=148, 60.16%); the main mode of occupational exposure was sharp injury(n=219, 89.02%）；the main opportunity of occupational exposure of HCWs was surgical accident（n=69, 28.05%）；the main exposure source was hepatitis B virus(n=123, 50.00%）；none of HCWs developed infection after local treatment and prophylactic medication. ConclusionMedical institutions should strengthen the training for HCWs about occupational exposure to bloodborne pathogens, enhance protection awareness, standardize operation procedures, and improve working environment, so as to minimize the occurrence of occupational exposure.

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ObjectiveTo evaluate the cleanliness of frequently touched object surfaces in a hospital and efficacy of intervention measures.MethodsCompliance to cleaning of frequently touched object surfaces before and after intervention was surveyed by fluorescence labeling method, SPSS 17.0 statistical software was used to analyze data.ResultsBefore and after intervention, 6 800 items in 400 wards were investigated, compliance rates to cleaning of hospital object surfaces before and after intervention were 14.71% and 54.76% respectively（P＜0.001）; differences in compliance rates to cleaning of object surfaces in common wards and special wards before and after intervention were both statistically significant（both P＜0.001）；after intervention, compliance rates to cleaning of object surfaces in wards and toilets increased significantly compared with before intervention, which increased by 41.57% and 33.00% respectively，differences were statistically significant (both P＜0.001）; after intervention, compliance rates to cleaning of different object surfaces increased by 21.50%-52.00% (all P＜0.001）.ConclusionScientific and effective intervention measures can improve the cleaning effectiveness of frequently touched object surfaces, which can improve the environmental quality of hospital.

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ObjectiveTo evaluate the accuracy and feasibility of timeresolved immunofluorometric assay (TRIFA) for detection of HBsAg based on Abbott automated chemiluminescence immunoassay(CMIA), so as to carry out this project in primary hospitals, and provide reference for individual antiviral strategy and prediction of therapeutic effect. MethodsSerum of 157 patients infected with hepatitis B virus were detected with CMIA and TRIFA, specimens with HBsAg titers exceeding the detection limit were firstly diluted, then performed quantitative analysis. HBsAg levels were divided into 4 groups: ≤100 IU/mL, 101-1 000 IU/mL, 1 001-20 000 IU/mL, and ＞20 000 IU/mL， quantitative correlation between two methods was analyzed. ResultsThe linear regression equation of two methods was Y=2.323X-896.3, correlation coefficent r=0.943, P<0.001. CMIA was as a reference, 4 groups were divided for analysis, results showed that when detected specimens was at low concentration of HBsAg, TRIFA value was low compared with CMIA method, while detected specimens was at high concentration of HBsAg, CMIA value was high, two reagents had good consistency in the detection of different concentrations of HBsAg(both P<0.05), when concentration was at 1 001-20 000 IU/mL, consistency was the best. ConclusionThe accuracy of two reagents in the quantitative detection of HBsAg is similar, and the best correlation of detection value is 1 000-20 000 IU/mL. TRIFA assay has wide application for its lowcost and easy to be operated, which is especially suitable for primary hospitals.

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ObjectiveTo compare the efficacy of vidarabine monophosphate and ribavirin for treating handfootmouth disease (HFMD) in children.Methods120 children with HFMD and admitted to a hospital from April 2013 to April 2015 were randomly divided into observation group and control group, 60 cases in each group， observation group treated with vidarabine monophosphate, control group treated with ribavirin, the therapeutic efficacy between two groups were compared.ResultsAfter treatment, the negative conversion rate of intestinal virus EV and EV71, as well as Coxsackie virus A16（CA16） in observation group were 87.0%, 85.7%, and 93.1% respectively, in control group were 64.0%, 69.8%, and 78.6% respectively, difference between two groups was statistically significant (all P<0.05). The average length of hospital stay in observation group was shorter than control group (［4.5 ± 1.3］ days vs ［6.2 ± 1.2］ days, P<0.05), symptom(fever, stomatitis, skin rash) control time in observation group were all shorter than control group(all P<0.05). Whether patients with or without complication, therapeutic effect of the observation group was better than that of control group; myocardial enzyme data, C reactive protein(CRP), and white blood cell(WBC) in observation group were all lower than control group(all P<0.05).ConclusionEfficacy of vidarabine monophosphate for treating children with HFMD is better than ribavirin, but it needs further study.

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目的了解某院住院患者医院感染和社区感染现状，为更好地预防和控制医院感染提供依据。方法采用床旁调查和查阅病历相结合的方法，对某院2014年9月11日0：00—24：00所有住院患者进行医院感染横断面调查。结果本次调查应查住院患者2 470例，实查住院患者2 470例，实查率为100.00%；发生医院感染89例（93例次），医院感染现患率为3.60%（例次现患率为3.77%）；发生社区感染574例（617例次），社区感染现患率为23.24%（例次现患率为24.98%）。医院感染和社区感染部位均以下呼吸道为主，分别占50.53%和46.19%。医院感染现患率居前5位的科室依次为重症医学科、急诊（创伤）外科、神经外科、胃肠外科、心胸外科；社区感染现患率居前5位的科室依次为儿科、呼吸内科、急诊内科、血液内科及风湿免疫科。医院感染和社区感染病原体均以革兰阴性菌为主，分别占78.38%和49.54%。抗菌药物使用率为31.09%，以治疗用药为主（82.29%）；抗菌药物联合用药以一联为主（94.66%）；治疗性使用抗菌药物病原体送检率为65.19%。结论医院感染和社区感染横断面调查有助于了解医院感染和社区感染现状；有利于加强对重点科室、重点部位医院感染管理。

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目的了解某院金黄色葡萄球菌(SAU)耐药性和克林霉素诱导型耐药情况，指导临床医生合理使用抗菌药物。方法回顾性分析该院2011—2014年临床分离的233株SAU标本分布与药敏结果，并进行克林霉素诱导耐药试验(D试验)。 结果共分离233株SAU，标本来源以痰为主，其次是伤口分泌物；科室以重症监护病房（ICU）和呼吸内科为主。药敏结果显示233株SAU对青霉素和氨苄西林的耐药率最高，分别为95.71%、90.99%；对红霉素、克林霉素、环丙沙星、庆大霉素的耐药率分别为83.26%、67.81%、47.21%、43.78%，均＞40%；对四环素、头孢唑林、复方磺胺甲口恶唑的耐药率分别为33.48%、27.04%、26.18%；对万古霉素100%敏感。233株SAU 中MRSA检出率为30.47%，2011—2014年MRSA检出率分别为39.78%、34.43%、17.95%、15.00%；D试验阳性菌株13株，占总菌株的5.58%。结论加强细菌耐药性监测，利用D试验检测克林霉素诱导型耐药，对指导临床医生合理使用抗菌药物具有重要意义。

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粉螨种类繁多，分布广泛，多栖息繁衍于人类居室内储藏物中，危害储粮及人类健康。本研究发现1例婴幼患儿尿液中发现粉螨，国内外相关报道罕见，且病因独特，危害极大，特报告如下。

Abstract:

骨科内置物主要包括骨折内固定装置和人工假体，患者一旦感染，若不能进行及时有效的治疗，可能会发展为慢性骨髓炎。内置物相关性骨髓炎是关节置换和骨折固定的一个严重并发症。在很多情况下，导致感染的细菌是人体永久或暂时性的菌群。内置物相关骨髓炎仅与皮肤上少数细菌菌种有关，最常见的细菌是金黄色葡萄球菌，其导致急性感染的特点是发热、局部肿胀和骨溶解。骨折内固定材料主要为暂时性使用，骨折愈合后可以去除。人工关节主要替代不可逆的关节损害，用于治疗骨关节炎或炎症性关节炎［1］。内置物植入体内，机体容易发生细菌、真菌感染。骨折内固定术后手术部位感染可致残或导致病死率增加［2］。不同的骨折类型（闭合性或不同类型的开放骨折）骨折内固定术后感染风险为0.4%～16.1%［3］。在过去的几十年中，很多新方法用于预防、诊断和治疗假体周围感染，但是随着人工关节置换数量的增加，以及抗菌药物耐药，假体周围感染有增加的趋势［4］。假体周围感染的经济负担增加，原因是人工关节置换增加，其次是由于假体的存在，有可能发生血源性感染［5］。假体周围感染的快速诊断非常重要，延迟诊断可能导致人工假体不能保留［6］。本文将从危险因素、分类、临床表现、诊断和内置物相关感染的治疗进行综述。

Abstract:

艰难梭状芽孢杆菌（Clostridium difficile, CD）简称艰难梭菌，属于厌氧芽孢梭菌属，革兰染色阳性，粗大形杆菌（长3.0～16.9 μm，宽0.5～1.9 μm），有鞭毛，能形成芽孢［1］。CD于1935年由Hall和O’Toole第一次从婴儿的粪便中分离得到。1978年George第一次报道CD与人类假膜型结肠炎相关，患者在使用抗菌药物后发生由CD导致的假膜型结肠炎。二十世纪九十年代起艰难梭菌感染（Clostridium difficile infection, CDI）成为重要的医源性感染之一，2003年北美洲及欧洲曾发生多起严重医院内CDI暴发，病死率显著升高。CDI发生率增加及暴发流行的原因可能与高毒力菌株NAP1/027/BI（限制性内切酶分型BI，脉冲场凝胶电泳分型NAP1，PCR核糖体分型027）有关［2］。目前，该亚型在世界范围内广泛流行。本文将对CDI的发病机制，临床症状及国内外分子流行病学的研究现状进行综述。

Abstract: