Abstract:Objective To investigate the distribution and drug resistance of pathogens isolated from blood culture in elderly patients in a hospital in Wuxi City, and provide evidence for rational empiric antimicrobial therapy for bloodstream infection(BSI). Methods Blood culture result and clinical data of outpatients, emergency and hospita-lized patients aged ≥ 65 years in a hospital from 2012 to 2016 were collected, WHONET 5.4 software was used to analyze the data. Results A total of 734 strains of pathogens were isolated from 15 102 blood specimens, 56.13%, 37.74%, and 6.13% of which were gram-negative bacteria, gram-positive bacteria, and fungi respectively. The top three species of pathogens were Escherichia coli, Klebsiella pneumoniae, and Staphylococcus epidermidis, accounting for 20.16%, 10.90%, and 7.90% respectively; positive strains of blood culture mainly came from intensive care unit (n=187, 25.48%). Resistance rates of Escherichia coli and Klebsiella pneumoniae to imipenem were 0 and 7.50% respectively, to amikacin were both<5%; resistance rates of Acinetobacter baumannii to commonly used antimicrobial agents were ≥ 50%, resistance rate to imipenem was 69.05%. Isolation rate of methicillin-resis-tant Staphylococcus aureus (MRSA) was 34.38%, which was lower than that of methicillin-resistant Staphylococcus epidermidis and methicillin-resistant Staphylococcus hemolyticus (91.38% and 100.00% respectively), no Staphylococcus spp. were found to be resistant to vancomycin and linezolid, resistance rates of Enterococcus faecium to vancomycin and linezolid were 3.03% and 6.06% respectively. Conclusion Gram-negative bacteria are the main pathogens isolated from blood culture of elderly patients, Escherichia coli and Klebsiella pneumoniae are the dominant pathogens, which are sensitive to imipenem and amikacin. Isolation rate of methicillin-resistant coagulase-negative Staphylococcus (MRCNS) is higher than that of MRSA, resistance rates of Enterococcus faecium to linezolid is higher than resistance rates to vancomycin.

Abstract:Objective To understand clinical features and homology of Acinetobacter pittii (A. pittii) and Acinetobacter nosocomialis (A. nosocomialis) infection in a hospital. Methods A total of 335 non-duplicate clinical isolates of Acinetobacter calcoaceticus-Acinetobacter baumannii complex (ACB) were collected from a hospital between January 2016 and December 2016, species were identified by 16S-23S rRNA gene spacer sequence analysis, clinical data and laboratory detection results of A. pittii, A. nosocomialis and A. baumannii were compared, OXA-51 gene of three kinds of bacteria was detected by polymerase chain reaction(PCR), homology between A. pittii and A. nosocomialis was analyzed by randomly amplified polymorphic DNA (RAPD). Results Among 335 ACB strains, 18, 23, 284, and 10 were A. pittii, A. nosocomialis, A. baumannii, and other Acinetobacter respectively. There were significant differences in admission rate of intensive care unit(ICU), invasive operation, pulmonary infection rate, and mortality during hospitalization period between patients with infection of A. baumannii and A. nosocomialis (all P<0.05). Resistance rates of A. pittii and A. nosocomialis to most antimicrobial agents were lower than those of A. baumannii. No positive amplification of OXA-51 gene was found in A. pittii and A. nosocomialis, PCR detection was positive in OXA-51 gene of 284 strains of A. baumannii. A. pittii and A. nosocomialis were divided into four different clones by RAPD detection, homology analysis showed that clone A and clone F were epidemic strains of A. pittii and A. nosocomialis respectively. Conclusion A. pittii and A. nosocomialis should be considered as different clinical strains from A. baumannii, amplification of OXA-51 gene can be used as a simple and rapid molecular biological technique for rapid identification of A. pittii and A. nosocomialis. Surveillance of A. pittii and A. nosocomialis should be strengthened.

Abstract:Objective To explore the value of CatBoost model in predicting severe hand-foot-mouth disease (HFMD) by the machine learning algorithm. Methods A total of 2 983 children with HFMD diagnosed and treated in a hospital in Zhengzhou from January 2014 to June 2017 were collected, data were analyzed with R 3.4.3 software, CatBoost model and other common models were constructed, prediction performance of CatBoost model was evaluated. Results The predictive accuracy of the finally constructed CatBoost model was 87.6%, artificial neural network model ranked second (83.8%), other models (decision tree, support vector machine, logistic regression, Bayesian network) had predictive accuracy less than 80%. The area under receiver operating characteristic (ROC) curve, sensitivity, and specificity of CatBoost algorithm model were all high (0.866, 80.80% and 92.33% respectively), the top three predictive variables were vomiting, limb jitter, and pathogenic results. Conclusion CatBoost model can be used to predict severe HFMD, which has higher accuracy and diagnostic value than other traditional algorithms.

Abstract:Objective To understand the incidence of healthcare-associated infection(HAI), device usage rate, and incidence of related infection in patients in different types of intensive care units(ICUs). Methods Prospective targeted surveillance data of HAI in patients in 6 different types of ICUs from July 1, 2015 to June 30, 2018 in a tertiary first-class teaching hospital were collected and analyzed statistically. Results A total of 21 485 patients in all different ICUs were monitored for three consecutive years,incidence and case incidence of HAI were 5.77% and 7.33% respectively, there were significant differences in incidence and case incidence of HAI among three years(all P<0.05). After adjusting average severity of illness score(ASIS), the adjusted incidence and adjusted case incidence per 1 000 bed-day in patients in general ICU were the highest. The utilization rates of central vascular catheter, urinary catheter, and ventilator in all different ICUs were 31.65%, 77.07%, and 26.08% respectively; incidences of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and ventilator-associated pneumonia (VAP) were 2.90‰, 2.08‰, and 5.37‰ respectively. Incidence of CLABSI was highest in respiratory ICU(4.85‰), incidence of CAUTI was highest in pediatric ICU(5.53‰), incidence of VAP was highest in neurosurgical ICU(9.33‰). The top 3 HAI sites were lower respiratory tract (36.00%), blood (17.52%), and gastrointestinal tract (13.08%);the top 3 pathogens of HAI were Acinetobacter baumannii (27.74%), Klebsiella pneumoniae (13.18%), and Pseudomonas aeruginosa (7.76%). Conclusion Corresponding preventive and control measures should be formulated according to the characteristics of HAI in different types of ICUs, so as to reduce the incidence of HAI in ICUs.

Abstract:Objective To understand the current situation and changing trend of healthcare-associated infection(HAI) in a hospital of Qinghai Province from 2010 to 2017. Methods Medical record review and bedside survey was adopted to investigate the occurrence of HAI, antimicrobial use, pathogens causing HAI, and bacterial culture(therapeutic antimicrobial use) of all inpatients in one day of each year from 2010 to 2017. Results A total of 12 446 inpatients were investigated in 8 cross-sectional surveys, 488 patients had 555 cases of HAI. HAI rate and HAI case rate were 3.92% and 4.46% respectively. Prevalence of HAI in each year were 2.93%-5.70%. The highest prevalence of HAI was found in ICU (58.72%), and the main site of HAI was lower respiratory tract (n=279). There was a significant difference in the usage rate of antimicrobial agents in each year (χ²=135.98,P<0.01), decreased from 55.56% in 2010 to 16.05% in 2017. The use of antimicrobial agents were mainly therapeutic (65.74%), proportion of therapeutic antimicrobial use gradually declined; 91.52% were antimicrobial monotherapy, proportion of combined use of at least three antimicrobial agents was 0 in 2011-2017. There was a significant difference in pathogenic detection of therapeutic antimicrobial use among each year (χ²=57.48,P<0.05). A total of 203 pathogens were isolated, the main pathogens were gram-negative bacteria (n=138, 67.98%) and gram-positive bacteria (n=52, 25.62%), followed by fungi and other pathogens. Conclusion The prevalence of HAI in this hospital is generally stable, antimicrobial use and pathogenic detection of therapeutic antimicrobial use are gradually standardized, close attention should be paid to the management of HAI in ICU, departments of neurosurgery and hematology.

Abstract:Objective To measure the spattering range of spatter produced by dental handpiece used for simulating dental preparation in dental clinic, so as to determine the safe hygienic distance, reasonable location of barrier and safe height of dental unit. Methods Dental preparation was simulated in a dental clinic of a tertiary general hospital, 5% methylene blue solution was used as indicator agent of spattering dyeing, horizontal and vertical spatter produced during dental diagnosis and treatment was collected with glass slides, spattering range was determined by common optical microscope observation. Results When dental handpiece used for simulating dental preparation, the farthest spattering distance in horizontal direction was 1 600 mm, vertical spattering height was up to 1 800 mm away from 1 000 mm of diagnosis and treatment manipulation. Conclusion The best safe distance between two dental units without physical barrier should be more than 1 600 mm, the minimum height of physical barrier between two dental units should be no less than 1 800 mm.

Abstract:Objective To establish a multi-index linear discriminant model for the diagnosis of bacterial meningitis after neurosurgery operation. Methods A retrospective analysis was performed on 14 laboratory examinations of bacterial meningitis (n=226) and aseptic meningitis (n=255) in patients in a hospital from 2012 to 2016. Receiver operating characteristic (ROC) curve for significant variables was drawn, items with area under the curve (AUC)>0.7 were conducted linear regression fitting, and a linear discriminant model for combined multi-index diagnosis was established, data of 26 patients with meningitis were selected to verify the discriminant capacity of the discriminant model. Results There were significant differences in 11 indexes between two groups of patients with meningitis (all P<0.05). AUC of cerebrospinal fluid(CSF) white blood cell count (C-WBC), CSF glucose concentration (C-Glu), blood glucose concentration (B-Glu), CSF blood glucose ratio (C/B-Glu) and CSF lactic acid (C-Lac) were all>0.7. The discriminant model was obtained by linear fitting:Y=-0.268×C-Glu+0.127×B-Glu+0.24×C-Lac-0.722×C/B-Glu+0.00000638×C-WBC-0.866, AUC of ROC curve of five indexes for diagnosis of bacterial meningitis was 0.907, sensitivity, specificity, positive predictive value, and negative predictive value were all>80.0%. Data of 26 patients with meningitis validated the discriminant capacity of discriminant model, the accuracy and specificity discriminated by the model were high (90.0%, 81.2%), consistency rate was 84.6%. Conclusion The combined diagnosis of multiple indexes can effectively distinguish bacterial meningitis from aseptic meningitis, and promote the diagnosis of bacterial meningitis.

Abstract:Objective To evaluate the secretion level of interleukin-10 (IL-10) in Han and Uyghur nationality patients with anti-tuberculosis drug-induced liver injury(ATDLI), and compare the difference between two nationalities. Methods Patients who were diagnosed with ATDLI in Chest Hospital of Xinjiang Uyghur Autonomous Region and the First Affiliated Hospital of Medical College of Shihezi University were selected. Secretion level of IL-10 in patients was detected by double antibody sandwich ELISA. Expression level of serum IL-10 in patients of two nationalities, different genders, and different extent of liver injury of two nationalities were compared. Results A total of 100 ATDLI Han and 135 Uyghur nationality patients were collected. The secretion level of IL-10 in Uyghur nationality ATDLI patients was higher than that in Han nationality patients ([56.30±17.24]pg/mL VS[45.81±11.04]pg/mL, P<0.0001). Serum levels of IL-10 in patients with mild, moderate, and severe liver injury in Han nationality patients were (44.73±9.10)pg/mL, (47.39±10.58) pg/mL, and(49.52±13.21)pg/mL, respectively; in Uyghur nationality patients were (52.30±15.24)pg/mL, (56.84±13.71)pg/mL, and (58.62±14.38)pg/mL, respectively. Group comparison showed that the secretion level of serum IL-10 of patients with moderate and severe liver injury in Han and Uyghur nationalities were both higher than that in patients with mild liver injury (both P<0.05). Conclusion Secretion level of IL-10 in patients with ATDLI increases with the severity of liver injury. Secretion level of IL-10 in Uyghur nationality ATDLI patients is higher than that in Han nationality ATDLI patients.

Abstract:Objective To evaluate the relationship between serum procalcitonin (PCT) elevation and clinical characteristics and prognosis of patients with acute attack of chronic heart failure(CHF) but without clear evidence of bacterial infection. Methods Patients with acute attack of CHF and hospitalized in Handan Central Hospital from February 2015 to December 2017 were studied prospectively. According to PCT level, patients were divided into elevated PCT group and normal PCT group, basic clinical characteristics of two groups of patients were compared, causes of PCT elevation were analyzed by logistic regression; efficacy of standard treatment 48 hours after admission and the incidence of all-cause death/readmission within 30 days were compared. Results A total of 593 patients with acute attack of CHF were enrolled, including 521 patients with normal PCT and 72 patients with elevated PCT. Logistic regression analysis showed that the increase of heart rate, pulmonary edema, white blood cell count(WBC) and blood urea nitrogen (BUN) were positively correlated with the elevation of PCT, especially WBC (OR, 2.19[95% CI, 1.76-2.73], P<0.001); hemoglobin and serum albumin were negatively correlated with PCT elevation. After 48 hours of standardized treatment, symptoms of 67.9% of patients in normal PCT group significantly improved, which was higher than 55.6% in elevated PCT group (P=0.037). The 30-day all-cause mortality/readmission rate in patients in elevated PCT group was higher than that in normal PCT group (30.6% VS 18.8%), difference was statistically significant (P=0.02). Conclusion Although the degree of heart failure is the same, patients with acute attack of CHF and elevated serum PCT level have poor therapeutic effect and poor prognosis, suggesting that there may be undiagnosis or potential bacterial infection.

Abstract:Objective To explore syphilis infection and its influencing factors among older female sex workers (OFSWs) in Guigang City, provide scientific theoretical basis for making effective measures and strategies for prevention and control of syphilis among this population. Methods In 2010-2016, a sentinel sampling survey among female sex workers (FSWs) in Guigang City was performed according to the "National AIDS Sentinel Surveillance Program", a face-to-face anonymous survey on subjects was conducted by trained investigators using "Questionnaire of National AIDS Sentinel Surveillance on FSWs", and blood specimens were taken to detect syphilis and other infections. Results A total of 2 851 OFSWs in Guigang City were investigated, the main sources of OFSWs were marriage/cohabitation, household registration in other provinces, Han nationality, primary education, and low-grade locations, the median age was 41 years old (interquartile range:38-45). Among 2 851 OFSWs, the positive rates of syphilis, HIV, and HCV were 17.33%, 2.84%, and 1.89% respectively; 5.02% of OFSWs were diagnosed with sexually transmitted diseases (STDs) during the last year, 88.46% used condoms in the latest commercial sexual intercourse, and 57.42% used condoms every time during the latest month commercial sexual intercourse. 87.93% and 34.86% of OFSWs respectively received condom publicity and distribution/AIDS counseling and detection as well as peer education intervention services. Multivariate analysis showed that low grade locations, Zhuang nationality, illiteracy, age ≥ 35 years, without receiving condom publicity and distribution/AIDS counseling and detection intervention services, as well as positive for HIV and HCV antibody detection were independent risk factors for syphilis infection in OFSWs. Conclusion Infection status of syphilis among OFSWs in Guigang City is severe, low grade locations, Zhuang nationality, illiteracy, age ≥ 35 years, without receiving condom publicity and distribution/AIDS counseling and detection intervention services, positive for HIV and HCV antibody detection are high risks for syphilis infection in OFSWs. It is necessary to strengthen intervention services such as condom publicity and distribution, increase condom use among OFSWs, and adopt comprehensive prevention and control measures against sexually transmitted diseases such as syphilis, HIV and HCV.

Abstract:Objective To systematically evaluate the risk factors for death in patients with healthcare-associated infection(HAI) caused by multidrug-resistant Acinetobacter baumannii (MDR-AB), and provide evidence for formulating prevention and control strategies. Methods Case-control studies on risk factors for death in patients with MDR-AB HAI were searched in computer database, patients died of MDR-AB HAI was in death group, those with MDR-AB HAI but survived was in survival group, Meta-analysis was carried out with RevMan 5.3 software after selecting literature, extracting data, and evaluating quality according to inclusion and exclusion criteria. Results A total of 1 204 patients with MDR-AB HAI in 11 studies were enrolled, 474 cases were in death group and 730 cases in survival group. Meta-analysis showed that old age (MD=3.99), hypoproteinemia (OR=2.1), mechanical ventilation (OR=4.23), tracheal intubation/tracheotomy (OR=2.5), deep venous catheterization (OR=2.21), post-transplantation (OR=3.12), and high APACHE Ⅱ score on admission (MD=2.33) were risk factors for death in MDR-AB patients (all P<0.05). Conclusion Risk factors for death in patients with MDR-AB HAI are complex, corresponding preventive measures should be taken.

Abstract:Objective To establish an early warning model of healthcare-associated infection(HAI) in the department of neurology, predict the risk of HAI in patients in department of neurology, and provide basis for early prevention and control. Methods Data on incidence of HAI in neurology ward of a tertiary first-class hospital in Guizhou Province were collected, the ARIMA(p,d,q)×(P,D,Q)s model was constructed, parameter estimation and model diagnosis were performed for the established model, and the optimal prediction model was selected. The best constructed model was used to predict the incidence of HAI in the department of neurology, and the prediction efficacy was evaluated. Results The data of monthly incidence of HAI in department of neurology in this hospital from 2014 to 2017 was as training specimens, the optimal prediction model ARIMA(2,1,2)×(1,1,1)₄ was obtained. Data of January-May 2018 was as validation sample for model prediction, the results showed that the dyna-mic trend of predicted value of model was basically consistent with the actual condition, the actual incidence was within the 95% confidence interval of the predicted value. This model was used to predict the incidence of HAI in department of neurology from June to December 2018, the predicted results showed that the predicted values were within 95% confidence interval. Conclusion The ARIMA(2,1,2)×(1,1,1)₄ model can better simulate the trend of HAI rate in the department of neurology, and it has preferable prediction effect.

Abstract:Objective To evaluate the effect of renal function on serum procalcitonin in patients with bacterial bloodstream infection (BSI). Methods Patients with double positive blood culture from May 2014 to November 2017 and detected serum procalcitonin(PCT) 12 hours before and after blood culture were analyzed retrospectively. They were grouped according to gram-staining result of pathogens from blood culture and renal function, four groups were gram-positive bacteria with normal renal function group(G⁺/NRF group), gram-positive bacteria with impaired renal function group (including severely impaired) (G⁺/IRF group), gram-negative bacteria with normal renal function group(G^-/NRF group), and gram-negative bacteria with impaired renal function group (including severely impaired) (G^-/IRF group). Levels of PCT among groups were compared, value of PCT level in predicting infection condition of patients with renal impairment and BSI was evaluated by receiver operating characteristic (ROC) curve. Results There were 23 cases in G⁺/NRF group, 27 in G⁺/IRF group (including 11 severely impaired cases), 63 in G^-/NRF group, and 74 in G^-/IRF group (including 23 severely impaired cases). PCT levels between G⁺/NRF group and G⁺/IRF group, as well as G^-/NRF group and G^-/IRF group were neither significantly different (both P>0.05); PCT level in G^-/NRF group was lower than that in severe G^-/IRF group (2.63[0.58-9.28]ng/mL VS 18.23[8.55-49.72] ng/mL, P<0.001). According to PCT break point, endogenous creatinine clearance rate (Ccr) of G^-/NRF group and severe G^-/IRF group was divided into two parts (PCT level>4.26 ng/mL and PCT level ≤ 4.26 ng/mL), ROC curve was drawn, and the area under curve (AUC) was 0.664 (P=0.009). When cutoff for Ccr was 71.81 mL/min, the sensitivity and specificity of positive predictive value of PCT level affected by severe impairment of renal function were 86.0% and 51.2% respectively. Conclusion When patient's renal function is severely impaired and G^- bacteria BSI occurs, the threshold value of PCT level for judging sepsis needs to be further improved than patient with normal renal function (>0.5 ng/mL).

Abstract:Objective To simulate the cleaning and disinfection process of endoscopes during the acceptance of new endoscopy center, find out the existing problems and put forward solutions. Methods Manual and automatic endoscope reprocessor(AER)washing methods were used to simulate the cleaning and disinfection process of endoscope during the acceptance process of new endoscopy center. Pure water used for end-rinse and endoscopes after cleaning and disinfection were performed microbial detection, according to detected results, causes for the unqualification were analyzed, the corresponding improvement was made. Results The qualified rates of pure water used for end-rinse of endoscopes before and after disinfection of pure water supply pipeline were 0% and 100% respectively, the median (quartile) of bacterial contamination were 200 (186, 213) and 1.5 (0, 6) CFU/100 mL respectively, with significant difference (P<0.01). The qualified rates of manual cleaned and disinfected endoscopes before and after adjusting enzyme concentration were 80.00% and 91.67% respectively. Before and after AER were disinfected, the qualified rates of water specimens from AER at on-load condition were 30% and 100% respectively, the median (quartile) of bacterial contamination were 97.5(8,175) and 4(1.75,6.00)CFU/100 mL respectively,with significant difference (P<0.01). After endoscope lumen with suspected biofilm formation was disinfected with 2 000 mg/L peracetic acid, the qualified rate was 100%. Conclusion Problems existed during the acceptance of new endoscopy center are non-disinfection of pure water supply pipeline, incorrect enzyme concentration for endoscopic cleaning, non-disinfection of AER, and formation of biofilm of endoscope lumen, after targeted improvement, these problems are solved. In order to ensure medical safety and quality, medical institutions should attach great importance to the acceptance before operation of new endoscopy center, and eliminate risk factors for unqualified endoscopy disinfection.

Abstract:Objective To summarize the clinical characteristics and treatment outcome of cryptococcal pulmonary infection after allogeneic hematopoietic stem cell transplantation (Allo-HSCT). Methods Clinical data of one case of cryptococcal pulmonary infection after Allo-HSCT were retrospectively analyzed, and the related literatures at home and abroad were reviewed for analysis. Results Fever occurred in patient on the 8th day after Allo-HSCT, after antimicrobial treatment, patient was removed from transplant room on the 21st day of Allo-HSCT, left lower pulmonary infection was showed by CT re-examination. On the 38th day of transplantation, patient still had fever, cough, and expectoration. Considering patient's disease condition, Cryptococcus pneumoniae after transplantation were diagnosed. Voliconazole was discontinued and replaced by fluconazole injection (0.6g, qd), cefoperazone/sulbactam sodium and amikacin were continued to be used as antimicrobial agents. After 3 days of fluconazole administration, patient's body peak temperature dropped. On the 55th day of transplantation, patient's body temperature was normal and treatment was effective. Patient recovered from pulmonary infection and leukemia was completely relieved. Conclusion Clinicians should analyze the causes of fever after Allo-HSCT, actively seek etiological evidence, and timely adopt empirical diagnosis and treatment.

Abstract:A retrospective analysis on one case of purulent perichondritis of auricle caused by Actinomyces was performed. Patient was admitted to a hospital due to acute swelling and pain in right auricle for 2 days, on the day of admission, patient underwent incision and drainage of auricle abscess, pus was performed bacterial culture. Pus culture result after 4 days was Actinomyces turicensis, actinomycosis of right auricle was diagnosed. Patient was given large dose of penicillin G intravenously drip, then oral administration of amoxicillin, treatment lasted three and a half months, auricular redness and swelling subsided, there was no deformation or residual scar, follow-up for 3 months after withdrawal of drugs showed no recurrence. It is suggested that the infection caused by Actinomyces turicensis should be diagnosed early, treated with antimicrobial agents of high dose and enough therapy course, timely incision and drainage during abscess formation can avoid scar, deformity and functional damage of external auricle caused by missed diagnosis and untimely treatment.

Abstract:Based on the analysis of current situation of management and disposal of medical waste in remote areas of China, this paper expounds the existing problems and demands of management and disposal of medical waste in remote areas of China from the aspects of collection, isolation packaging, storage, transportation, and disposal of medical waste, according to the characteristics of generation and discharge of medical waste in remote areas of China, from the point of view of the whole process management, this paper put forward the applicable disposal technique and management mode of medical waste based on the characteristics of long transportation distance, lack of disposal technique, high risk of environment and difficult supervision in remote areas.

Abstract:Foscarnet sodium is a broad-spectrum non-nucleoside antiviral drug which can effectively block the replication of various DNA viruses such as herpes virus, human papillomavirus, hepatitis B virus, human immunodeficiency virus and related infections. Foscarnet sodium is often used in combination with a variety of drugs in clinic to play a full role in antivirus. In this paper, the research on the combination use of foscarnet sodium in clinic, including the treatment of herpes, hepatitis B, human papillomavirus infection, and adverse reactions of combination therapy are reviewed.