• Volume 17,Issue 7,2018 Table of Contents
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    • 论著
    • Value of 18F-FDG PET/CT in the early diagnosis of secondary infection of severe acute pancreatitis

      2018, 17(7):553-559. DOI: 10.3969/j.issn.1671-9638.2018.07.001

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      ObjectiveTo evaluate the value of 18FFDG PET/CT in the early diagnosis of secondary infection of severe acute pancreatitis (SAP).MethodsInfection group models of SAP SD rats were constructed with two types of bacteria (ATCC 25922 and ATCC 25923), control group model was constructed with saline solution. Complete blood cell count and serum amylase were measured at hour 0, 1, and 3  after modeling. After modeling for 3 hours,18FFDG PET/CT imaging was performed, then biological distribution, HE staining, and gram staining were performed to verify the results of PET imaging.Results18FFDG PET/CT imaging showed that rat models of two types of bacteria infection groups both showed radioactivity concentration in pancreas; target(pancreas) and nontarget (muscle) ratios(SUV) of Escherichia coli group, Staphylococcus aureus group, and saline group were 4.22+0.61,4.32+1.21,and 2.26+0.35 respectively. There was no statistical difference in the SUV of model animals between two types of bacteria infection group (P>0.05). The model of Escherichia coli infection group was statistically different from that of the control group model (P<0.01). Biological distribution was consistent with the result of PET imaging.Conclusion18FFDG PET/CT can be used as a detection method for early diagnosis of secondary infection of SAP.

    • Comparison of molecular detection and routine culture in pathogenic diagnosis of moderate and severe skin and soft tissue infection

      2018, 17(7):560-565. DOI: 10.3969/j.issn.1671-9638.2018.07.002

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      ObjectiveTo explore the feasibility of molecular detection technique in the pathogenic diagnosis of moderate and severe skin and soft tissue infection (SSTI).MethodsFifty moderate and severe SSTI cases in the department of burn reconstruction and plastic surgery in Peking University First Hospital between January and October 2016 were studied, deep tissue of wound were taken for bacterial culture and bacterial smear; DNA in each specimen was extracted, conserved regions of 9 common bacterial genomes were used as target sequences, specific primers were designed for performing polymerase chain reaction (PCR) membrane hybridization of bacteria; results of molecular detection, routine culture, and smear were compared.Results38 cases were positive for routine culture, 28 cases were positive for molecular detection, and only 8 cases of bacterial smear were positive, complete coincidence rate between molecular detection results and routine culture results of 9 detected bacteria was 82.1%(32/39), molecular detection results presented multiple species of bacteria, 7.7% (3/39) of bacterial culture result showed single bacteria.ConclusionMolecular detection technology can detect and identify common pathogenic bacteria causing moderate and severe SSTI, it has more advantage in the detection of pathogens of mixed bacterial infection.

    • Homology analysis on human and animalderived Escherichia coli

      2018, 17(7):566-570. DOI: 10.3969/j.issn.1671-9638.2018.07.003

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      ObjectiveTo study the homology of Escherichia coli(E. coli) isolated from a large scale farm and patients in a hospital. MethodsFour strains of polymyxinresistant E. coli were isolated from a large scale farm in Tai’an, 12 strains of carbapenemresistant E. coli were isolated from patients in Tai’an Central Hospital; target strains were performed resistance gene sequencing, homology detection was performed by multilocus sequence typing (MLST) and pulsedfield gel electrophoresis (PFGE), homology between E. coli from human and duck were analyzed. ResultsThere were 16 strains of E. coli, 2 of 4 duckderived strains were ST5912; 5 of 12 humanderived strains were ST167, 3 were ST405; 1 duckderived strain and 1 humanderived strain was of the same ST, both were ST10, but PFGE showed that their similarity was 64.7%. ConclusionHomology between humanderived and duckderived E. coli strains in Tai’an area is not very high.

    • Effect of hepatitis B virus X protein on promoting hepatocellular senescence

      2018, 17(7):571-576. DOI: 10.3969/j.issn.1671-9638.2018.07.004

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      ObjectiveTo evaluate effect of hepatitis B virus (HBV) on hepatocyte senescence through HBV X protein (HBx). MethodsHepG2.2.15 cells, HepG2.2.15  cells treated by HBx siRNA (HepG2.2.15HBxsi), and HepG2 cells with overexpressed HBx (HepG2HBx) were performed βgalactosidase staining, hepatocyte senescenceassociated protein was detected by Western Blot; effect of HBx on hepatocyte senescence was compared. ResultsThe proportions of positive cells for βgalactosidase staining in each group were as follows: (0.480±0.096) in HepG2.2.15 group, (0.016±0.005) in HepG2 group, difference between two groups was statistically significant (P<0.001); (0.278±0.065) in HepG2.2.15HBxsi group, (0.329±0.044) in its’ control group(HepG2.2.15HBxnc group), difference between two groups was not statistically significant(P=0.092); (0.319±0.033) in HepG2HBx group, (0.064±0.012) in it’s control group(HepG2HBxcon group), difference between two groups was statistically significant(P<0.001). Western Blot showed that the expression of hepatocyte senescenceassociated protein p53 and p21 in HepG2.2.15 group and HepG2HBx group were significantly higher than those of control group, while p53 and p21 in HepG2.2.15HBxsi group were significantly lower than that of HepG2.2.15HBxnc group. ConclusionHBV can promote hepatocellular senescence through HBx protein.

    • Influencing factors for surgical site infection following neuroendoscopic transsphenoidal pituitary adenoma resection

      2018, 17(7):577-580. DOI: 10.3969/j.issn.1671-9638.2018.07.005

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      ObjectiveTo analyze the risk factors for surgical site infection (SSI) following neuroendoscopic transsphenoidal pituitary adenoma resection(NTPAR), provide theoretical basis for prevention and control of SSI. MethodsGeneral data and occurrence of SSI of patients who underwent NTPAR in a hospital from April 2015 to April 2017 were analyzed retrospectively, data were analyzed by SPSS 21.0 software. ResultsA total of 252 subjects were included in the study, 15 SSI cases occurred, incidence was 5.95%. Univariate analysis results showed that preoperative diabetes mellitus, long length of operation time, large amount of intraoperative bleeding, blood transfusion, postoperative cerebrospinal fluid leakage were influencing factors for SSI in patients undergoing NTPAR (all P<0.05); multivariate logistic analysis results showed that cerebrospinal fluid leakage(OR=21.758,95%CI:4.132-114.567), preoperative diabetes mellitus(OR=10.025,95%CI:2.267-44.335), length of operation time≥3 hours(OR=11.622,95%CI:2.783-48.533)were independent risk factors for SSI in patients undergoing NTPAR. ConclusionThere are many factors that influence SSI following NTPAR, postoperative cerebrospinal fluid leakage, preoperative diabetes mellitus, and length of operation time≥3 hours are independent risk factors for SSI, effective prevention and control measures should be taken against the risk factors.

    • Infection characteristics and antimicrobial resistance of Burkholderia cepacia from two hospitals in Hainan Province

      2018, 17(7):581-584. DOI: 10.3969/j.issn.1671-9638.2018.07.006

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      ObjectiveTo explore infection characteristics and antimicrobial resistance of Burkholderia cepacia(BC) from two hospitals in Hainan Province, and compare their resistance to BC. Methods59 infected hospitalized patients who isolated BC in two hospitals between January 2012 and December 2016 were analyzed retrospectively, basic characteristics of infection, antimicrobial susceptibility results and difference in resistance of strains were analyzed. ResultsThe detection rates of BC from sputum specimen (55.94%) and intensive care unit (18.65%) were the highest. In both hospitals, most patients with BC infection were with underlying cardiovascular diseases, which were 11 cases and 13 cases respectively; BC from one hospital had higher susceptibility rates to ceftazidime, levofloxacin, and compound sulfamethoxazole, all were>90%, while BC from the other hospital had resistance rate of>50% except for levofloxacin (resistance rate 34.62%, intermediate resistance rate 15.38%), difference in susceptibility rates of BC to ceftazidime, levofloxacin, and compound sulfamethoxazole were all statistically significant between two hospitals(all P<0.05). ConclusionMost patients with BC infection are accompanied by underlying diseases; antimicrobial resistance of BC in different hospitals is different.

    • Investigation and related suggestions on the use of mercury thermometer, mercury sphygmomanometer, and their substitutes in 126 medical institutions in 7 provinces (districts)

      2018, 17(7):585-590. DOI: 10.3969/j.issn.1671-9638.2018.07.007

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      ObjectiveTo investigate the application status of mercury thermometer, mercury sphygmomanometer, and their corresponding substitutes in 126 medical institutions in 7 provinces (districts), provide reference for making performance policy of The Minamata Convention on Mercury. MethodsA total of 126 tertiary, secondary, and township medical institutions in 7 provinces (districts) in the eastern, central, and western regions were selected; mercury thermometer, mercury sphygmomanometer, and their substitutes used in 2013-2016 were investigated. ResultsUp to March 1, 2016, 156 088 mercury thermometers were used by 126 medical institutions, utilization rate was 100.00%, the daily use of each bed was 0.11 piece; 13 576 mercury sphygmomanometers were used, utilization rate was 100.00%, daily use of each bed was 0.010 piece. 10 510 mercuryfree thermometers were being used, 40(31.75%), 50(39.68%), and 52(41.27%) medical institutions used mercuryfree thermometers in 2013, 2014, and 2015 respectively. 8 266 mercuryfree sphygmomanometers were being used, 85(67.46%), 83(65.87%), and 87(69.05%) medical institutions used mercuryfree sphygmomanometers in 2013, 2014, and 2015 respectively. ConclusionSome medical institutions have started to use a small amount of mercuryfree thermometer and mercuryfree sphygmomanometer; the performance policy of The Minamata Convention on Mercury should pay attention to raising awareness of the use of mercuryfree alternatives as well as providing policy and financial support.

    • Survey on management status of surgical instruments and dressings in 187 hospitals in 14 provinces of China

      2018, 17(7):591-596. DOI: 10.3969/j.issn.1671-9638.2018.07.008

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      ObjectiveTo investigate management status of surgical instruments and dressings in hospitals in China, understand centralized management of central sterile supply department (CSSD), management of loaner medical instruments and implants, laparoscopy processing method, as well as material and current washing status of surgical drapes and surgical clothes.Methods187 second level and above hospitals in 14 provinces in China were selected, a questionnaire survey proved by experts in healthcareassociated infection control and operating departments (rooms) was adopted, survey was conducted through email to the surveyed hospitals.ResultsA total of 108 tertiary and 79 secondary hospitals were investigated. 52.94% of hospitals performed centralized management for surgical instruments and dressings in CSSD. 90.27% and 96.76% of hospitals cleaned and sterilized loaner medical instruments in CSSD respectively. 89.19% of hospitals used pressure steam sterilization to sterilize implants. 49.46% and 57.61% of hospitals cleaned and sterilized laparoscopy in CSSD. More than 70% of hospitals adopted cotton cloth for surgical drapes and surgical clothes materials. About 60% of tertiary hospitals entrusted laundry agencies to wash surgical drapes and clothes, 80% of second hospitals washed surgical drapes and clothes in hospital laundries.ConclusionCentralized management of CSSD needs to be further implemented, management of loaner medical instruments and implants, and processing of laparoscopy has improved, but there is still room for further standardization. Cotton is still the main material for surgical drapes and clothes throughout the country, laundry agency and hospital laundry should strictly compliance with The technical specification for washing and disinfection of medical fabrics in hospitals, so as to ensure the safety of patients.

    • Visualization analysis on research literatures about catheterrelated bloodstream infection in China

      2018, 17(7):597-605. DOI: 10.3969/j.issn.1671-9638.2018.07.009

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      ObjectiveTo analyze the current research status of catheterrelated bloodstream infection (CRBSI) in China. MethodsOn October 2017, literatures about CRBSI from China National Knowledge Infrastructure(CNKI), Wanfang Database, China Biomedical Literature Database(CBM), PubMed, and Cochrane Library were searched and screened. Frequency diagrams of funds, periodicals, and issuing agencies were constructed by using Excel, visualized collinear network diagram of authors, issuing agencies, research area, and key words were generated by Ucinet software, BICOMB software, and Netdraw software. ResultsA total of 1 451 effective literatures were retrieved. In the research field of CRBSI, cooperation among authors and close cooperation among agencies were frequent. Distribution of issuing agencies revealed that The West China Hospital of Sichuan University ranked first (28 articles), followed by the Chinese PLA General Hospital (16 articles) and Xiangya Hospital of Central South University (15 articles); funds were mainly supported by provincial, municipal, and autonomous regional projects; literatures were published mainly in Chinese Journal of Nosocomiology, and the links between provinces and cities were relatively close, mainly in East China, North China, and Central China. The high frequency key words were "central venous catheterization", "ICU", "healthcareassociated infection", "bundle intervention", "nursing", "target monitoring", and "risk factor", which revealed the hot topics in the field of research. ConclusionAt present, CRBSI has attracted wide attention of domestic scholars, cooperation between regional institutions, individuals, and research groups needs to be strengthened, research in this field needs to be focused, and quality of research needs to be improved.

    • Therapeutic effect of extract of Polygonum paleaceum Wall on influenza A H1N1 virus infection in Balb/c mice

      2018, 17(7):606-609. DOI: 10.3969/j.issn.1671-9638.2018.07.010

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      ObjectiveTo assess therapeutic effect of extract of Polygonum paleaceum Wall(PPW) on influenza A H1N1 virus infection in Balb/c mice. MethodsMice model of influenza A H1N1 virus infection was established by intranasal method, different doses of PPW were given by gavage, positive control group was given oseltamivir, and mice without giving oseltamivir were in virus control group. Life status of mice within 14 days was observed, lung index of mice was calculated, relative amount of viral nucleic acid and virus titer in lung tissue were detected. ResultsThe median lethal dose of influenza A H1N1 virus to mice was 10-6. Survival rates of mice in positive control group, high PPW dose group, and middle PPW dose group were all 100%, the average survival time was 14 days, survival rate and average survival time of mice in low PPW dose group were 42.86% and 9.14 days respectively, while in virus control group were 0 and 3.57 days respectively. The average survival days of mice in different groups were statistically significant (F=8.53, P=0.02); average survival days of mice in positive control group, high PPW dose group, middle PPW dose group, and low PPW dose group were all higher than those of virus control group (P<0.05). Lung index of positive control group, high PPW dose group, middle PPW dose group, low PPW dose group, and virus control group were (0.84±0.07)%, (0.81±0.07)%, (0.84±0.10)%, (0.84±0.10)%, and (1.42±0.12)% respectively, difference was statistically significant(P=0.03); relative amount of viral nucleic acid were 0.37±0.11, 0.42±0.06, 0.42±0.06, 0.65±0.19, and 1.00±0.06 respectively, difference was statistically significant(P=0.04); titer of virus were 2.49±0.12, 2.35±0.29, 2.43±0.15, 2.46±0.12, and 2.80±0.16 respectively, difference was statistically significant(P=0.04). Lung index, relative amount of influenza virus nucleic acid and virus titer in lung tissue of positive control group and different PPW dose groups were all lower than that of virus control group (P<0.05); but the above indexes in positive control group were not statistically significant compared with different PPW dose groups (P>0.05).ConclusionExtract of PPW has inhibitory effect on influenza A H1N1 virus in vivo, it can decrease lung tissue lesions and reduce the mortality of mice infected with influenza A H1N1 virus.

    • Clinical characteristics of 22 patients with acquired immunodeficiency syndrome and Talaromyces marneffei infection

      2018, 17(7):610-614. DOI: 10.3969/j.issn.1671-9638.2018.07.011

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      ObjectiveTo analyze clinical characteristics of patients with acquired immunodeficiency syndrome (AIDS) and Talaromyces marneffei (T. marneffei) infection. Methods22 patients with AIDS and T. marneffei infection were admitted to The First Hospital of Changsha between January and December 2016, clinical data were collected, clinical manifestations, auxiliary examination results, treatment course, and prognosis of disease of patients were analyzed retrospectively.ResultsOf 22 patients, 15 were males and 7 were females, aged 18-57 years. They all presented with respiratory symptoms, 20 had fever with varying degrees, 12 had rash, 7 had splenomegaly, 15 were accompanied by emaciation, oral leukoplakia, and lymphadenectasis. Blood routine examination showed a decrease in leukocyte and lymphocyte, accompanied by anemia and thrombocytopenia; CD4+ counts reduced with varying degrees, all were<50 cells/μL; serum adenosine deaminase increased with varying degrees in 21 patients; chest imaging findings of infected patients were usually presented flaky or spotted infiltrating shadow, followed by nodule shadow and ground glasslike change. Amphotericin B and itraconazole were effective in the treatment of T. marneffei infection. 16 patients were controlled after active antifungal therapy, 5 patients were transferred to the local area for continuing treatment, only 1 patient died of severe multiple organ failure during hospitalization.ConclusionClinical manifestations of AIDS complicated with T. marneffei infection are complicated and diversity, serum adenosine deaminase can be used as an auxiliary diagnostic index, AIDS patients all present with obvious immunodeficiency.

    • Clinical and laboratory characteristics of 5 cases of neurobrucellosis

      2018, 17(7):615-618. DOI: 10.3969/j.issn.1671-9638.2018.07.012

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      ObjectiveTo improve clinical and laboratory diagnosis of neurobrucellosis through analysis on clinical data of 5 cases of neurobrucellosis.MethodsClinical and laboratory data of 5 patients with neurobrucellosis in a hospital from January 2015 to June 2017 were analyzed retrospectively.ResultsAll 5 patients had history of cattle and sheep contact or history of eating cattle and sheep products, recurrent fever accompanied by headache was the main symptom. Routine cerebrospinal fluid(CSF) test showed that all patients were positive for pandy test and with leukocytosis (mainly mononuclear cells); biochemical analysis of CSF revealed that protein increased and chloride decreased in all patients, glucose decreased in 3 patients; immunoglobulin IgA and IgG in CSF were several times higher than the normal value; 5 patients were cultured Brucella melitensis, 4 patients showed abnormal brain imaging. Blood routine test showed that white blood cell count(WBC) was slightly higher in 3 patients, liver function (alanine aminotransferase, aspartate aminotransferase, γglutamyltranspeptidase) was normal in 5 patients, highsensitivity Creactive protein(hsCRP) was normal in 4 patients, Brucella antibody tube agglutination test was positive in 1 patient. After 2week treatment with doxycycline combined with rifampin or rifamycin, 5 patients’ body temperature all returned to normal, symptoms of headache and dizziness all relieved; WBC count and protein in CSF all decreased.ConclusionNo characteristic changes in hsCRP and blood routine WBC count are found in the diagnosis of neurobrucellosis. Clinical manifestations of neurobrucellosis are diversity, it is easy to cause missed diagnosis and misdiagnosis, health care workers should improve the understanding of the disease.

    • Economic loss due to surgical site infection in neurosurgery department

      2018, 17(7):619-622. DOI: 10.3969/j.issn.1671-9638.2018.07.013

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      ObjectiveTo analyze the direct and indirect economic loss due to surgical site infection(SSI) in neurosurgery department.MethodsA 1:1 matched casecontrol study was used to investigate patients who underwent neurosurgical operation in a hospital from January 2014 to December 2015, the median was used for description, Wilcoxon ranksum test was used for comparison.ResultsA total of 24 patients with SSI and 24 patients without SSI were included in the study. The total hospitalization expense in infection group was significantly different from that in control group (79 066.66 yuan vs 36 139.03 yuan, Z=-3.650, P<0.001). Compared with control group, the average expense of Western medicine in infection group increased by 21 409.11 yuan per case (expense of antimicrobial agents was 12 049.90 yuan), accounting for 49.87% of the total increased expense in each case. The indirect economic loss of hospital due to prolongation of average length of hospital stay resulting from SSI was 2 569.58 yuan, indirect loss of patient’s charge for loss of working time was 752.05 yuan, the total economic loss caused by SSI was 46 249.26 yuan per case.ConclusionSSI following neurosurgical operation prolongs length of hospital stay of patients, bring economic losses to both hospitals and patients.

    • Status of healthcareassociated infection management in 276 township hospitals in Mianyang City

      2018, 17(7):623-626. DOI: 10.3969/j.issn.1671-9638.2018.07.014

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      ObjectiveTo understand current status of healthcareassociated infection(HAI) management in township hospitals in a city, analyze the existing problems, and put forward the preliminary improvement measures. MethodsA questionnaire survey was adopted to investigate HAI management in 276 township hospitals in a city.Results201(72.83%), 274 (99.28%), and 166(60.14%) hospitals established HAI management committee, HAI management department, and HAI management group respectively. 128 (46.38%) hospitals carried out HAIrelated monitoring; 39 (14.13%) hospitals carried out point surveillance survey; 68 (24.64%) hospitals carried out monitoring of hand hygiene compliance; 254 (92.03%) hospitals carried out training on HAI knowledge; 181 (65.58%), 162 (58.70%), and 137 (49.64%) hospitals established occupational protection system, disposal process after occupational exposure, and educational guidance respectively.ConclusionThere are many problems in HAI management in township hospitals in this city, such as imperfect organization, shortage of personnel, imperfect system, poor implementation of disinfection and sterilization, and no monitoring system, HAI management work in township hospitals needs to be further strengthened.

    • Bacterial contamination of dressing change trolley before and after dressing change

      2018, 17(7):627-630. DOI: 10.3969/j.issn.1671-9638.2018.07.015

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      ObjectiveTo investigate bacterial contamination of dressing change trolley before and after dressing change. MethodsOnsite survey method was adopted, a dressing change trolley in the plastic and burn ward in a hospital was taken specimens from March 23, 2016 to June 26, 2016 and from August 8, 2017 to September 13, 2017, respectively. The handle, the drawer handle and the top layer of dressing change trolley were taken specimens before and after dressing change trolley was used, as well as when it was at a resting state for 3 hours after disinfection. Specimens were performed bacterial culture, number of bacterial colonies per unit area was calculated, difference in the number of colonies at different specimen taken opportunities was compared. ResultsA total of 303 specimens were collected, including 90 specimens before dressing change, 123 specimens after dressing change, and 90 specimens at a resting state for 3 hours after disinfection. There was a significant difference in the number of bacterial colonies on the top layer of dressing change trolley at different specimen taken opportunities (P=0.003);group comparison showed that the number of bacterial colonies on the top layer increased after dressing change than before dressing change and at a resting state for 3 hours after disinfection (both P<0.05). There was no significant difference in the number of bacterial colonies on the handle and drawer handle of dressing change trolley at different dressing change opportunities (all P>0.05). There was no significant difference in the number of bacterial colonies among different parts of dressing change trolley at the same specimen taken opportunities (all P>0.05). The qualified rates of three parts of dressing change trolley were all 100.00%, qualified detection rates of handle, drawer handle, and top layer of dressing change trolley were 100.00%, 97.56%, and 97.56% respectively,qualified detection rates of three parts at a resting state for 3 hours after disinfection were all 100.00%. ConclusionSurface disinfection can meet the hygienic standard for disinfection for class II surface health standards in hospitals in China, it is basically safe to use the dressing change trolley within 3 hours after disinfection.

    • Concealed field observation on hand hygiene compliance among health care workers in organ transplant department

      2018, 17(7):631-634. DOI: 10.3969/j.issn.1671-9638.2018.07.016

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      ObjectiveTo investigate status of hand hygiene(HH) compliance among healthcare care workers(HCWs) in an organ transplant department.MethodsHH compliance among HCWs in an organ transplant department was investigated with concealed field observation once a week from January to June 2017, unified WHO HH observation forms were filled out, and SPSS 18.0 software was used for statistical analysis.ResultsA total of 37 HCWs were investigated, 380 times of HH should be implemented during observation, 86 times of actual implementation of HH was observed, compliance rate and correct rate of HH were 22.63% and 53.49% respectively. Difference in HH compliance rate among HCWs of different occupations was not significant(χ2=1.003,P=0.80). Difference in HH correct rate among HCWs of different occupations was significant(χ2=8.411,P=0.038);doctors had the highest correct rate of HH (88.89%), patient care workers had the lowest correct rate of HH(0). Among HH with different professional titles, correct rate of HH among associated chief doctors and attending doctors was highest(100%). There was a significant difference in HH compliance rate under different HH indications(χ2=15.082,P=0.005);compliance rate of HH after exposure to blood and body fluid was highest(27.27%), compliance rate before aseptic manipulation was lowest(9.91%). There was no significant difference in the correct rate of HH under different indications (χ2=7.150,P=0.128). There was no significant difference in HH compliance rate and correct rate among HCWs during different periods (both P>0.05). The main reason for the disqualification of HH of HCWs was inadequate time for rubbing (19 times, 47.50%) and the wrong method of rubbing (21 times, 52.50%).ConclusionCompliance of HH among HCWs in organ transplant department is low, compliance rate and correct rate of HH among HCWs of different occupations is significantly different, compliance of HH among HCWs needs to be improved, and corresponding effective intervention measures should be taken.

    • 病例报告
    • Blocking of transmission of vancomycinresistant Enterococcus faecium incisional infection in a hospital: one case report

      2018, 17(7):635-637. DOI: 10.3969/j.issn.1671-9638.2018.07.017

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      肠球菌广泛分布在自然界,常定植于人和动物的肠道和女性泌尿生殖系统,是人类的正常菌群之一。随着抗菌药物的广泛应用,肠球菌耐药株日益增多,氨基糖苷类高水平耐药肠球菌(highlevel aminoglycosideresistant Enterococcus, HLARE)和耐万古霉素肠球菌(vancomycinresistant Enterococcus, VRE)分离率更是快速增长[1]。文献[2]报道,VRE的耐药基因可通过质粒转移给其他肠球菌属或其他种类的细菌如金黄色葡萄球菌,因此,做好医院感染监测,控制VRE的传播,防止致病性更强的耐万古霉素金黄色葡萄球菌(VRSA)出现是医院感染监控不可忽视的任务。VRE的流行病学资料显示,自20世纪80年代英国首次报道VRE以 来,VRE在欧美国家的分离率快速增长,已成为导致欧美国家医院感染的第三大病原菌[3]。VRE已在美国、澳大利亚、挪威、南非、日本、法国等许多国家和地区造成了医院感染暴发流行,1998年上半年在美国就有16起医院感染暴发流行的报道[4]。在我国, VRE感染的发病率也呈逐年上升趋势,是医院感染的重点监测病原菌之一[5]。根据卫生部全国细菌耐药监测网(Mohnarin)数据显示:2007—2008年在344株肠球菌中,仅发现2株对糖肽类耐药的VanA型屎肠球菌和5株对万古霉素中介的其他肠球菌[6]。2010年后各地区有上升趋势,其中西北地区检出率为1.0%[7],华东地区检出率为0.7%[8],东北地区则为0[9]。而广东地区细菌耐药监测数据显示,2011年1 007株屎肠球菌中耐万古霉素有16株,耐药率为1.6%[10]。以上数据说明我国VRE检出率虽然整体上处于较低水平,但VRE检出率有上升趋势。广东某三级综合中医院于2010年开始实施多重耐药菌监测项目,其中VRE属于重点监测菌种之一。根据监测结果显示该院2010年1月—2013年10月共检出肠球菌542株,未检出VRE。本次检验科上报一株VRE,属于该院罕见菌株,为此,研究者对该院该例VRE感染病例进行调查,并采取相应的防控措施,有效阻止了该菌株在该院播散,现将有关经验分享如下。

    • 综述
    • Application of Saccharomyces boulardii in the treatment of Helicobacter pylori infection

      2018, 17(7):638-641. DOI: 10.3969/j.issn.1671-9638.2018.07.018

      Abstract (173) HTML (0) PDF 882.00 Byte (627) Comment (0) Favorites

      Abstract:

      幽门螺杆菌(Helicobacter pylori, Hp)的致病作用已经让越来越多的人认识,目前已明确Hp感染是引起慢性胃炎、消化性溃疡、胃黏膜相关淋巴组织淋巴瘤和胃癌的重要致病因子,属于I类致癌原。Hp感染不仅可以造成胃十二指肠的疾病,其中高毒力株Hp还有可能导致动脉粥样硬化性脑梗死发病风险增高[1]。人们对根治Hp越来越重视,但由于抗菌药物的滥用和不规范的Hp根治过程,Hp的耐药现象越来越严峻。在耐药与抗耐药的交锋中,医务工作者在不断尝试新的办法,延长疗程、增加剂量、通过Hp培养和药敏试验选用更敏感的抗菌药物、应用铋剂以及选用更强的抑酸药物,与之伴随的往往是不断增加的药物安全风险和不够理想的根除率,如何更安全更有效地根除Hp往往成为临床医生面临的棘手问题。近年来,一种真菌类益生菌-布拉氏酵母菌被应用于根除Hp治疗中,取得一定的效果。但也有研究表明,布拉氏酵母菌虽然可以有效减少根除Hp治疗时的不良反应,但其对Hp根除率的作用尚有待进一步研究。现就布拉氏酵母菌在Hp根除治疗中的应用现状及存在问题作一综述。

    • 标准.规范.指南
    • Diagnosis for pulmonary tuberculosis

      2018, 17(7):642-652. DOI: 10.3969/j.issn.1671-9638.2018.07.019

      Abstract (248) HTML (0) PDF 986.00 Byte (748) Comment (0) Favorites

      Abstract:

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