Abstract:Gram-negative bacilli are the main resistant bacteria that threaten the safety of patients globally, but the treatment failure caused by gram-positive cocci infection also remains a clinical problem. With the insensitivity of resistant gram-positive cocci to glycopeptides and the increasingly upward drift in the minimum inhibitory concentration, the number of cases that are sensitive in vitro but fail in clinical treatment is increasing, there is an urgent need for effective and new antimicrobial agents to treat patients with gram-positive cocci infection. Daptomycin is a new cyclic lipopeptide antibiotic, which has a new antibacterial target, rapid bactericidal activity, and can penetrate the biofilm. It does not lead to the dissolution of bacteria, thus avoid the serious inflammatory reaction due to the release of inflammatory mediators in bacterial content, it has a good clinical application value in the treatment of bacteremia, infective endocarditis, as well as complicated skin and soft tissue infection. In order to treat patients effectively and rationally with daptomycin, professional committee of evidence-based and transformation of infectious diseases of Chinese Research Hospital Association organized domestic experts to write expert opinion on clinical application of daptomycin, so as to provide reference for clinical medical staff.

Abstract:Objective To evaluate the efficacy and safety of daptomycin in the treatment of hematopathy associated with skin and soft tissue infection(SSTI). Methods Clinical data, laboratory test results as well as efficacy and safety of daptomycin in the treatment of hematopathy associated with SSTI in patients in a hospital from March 2018 to March 2019 were analyzed retrospectively, according to whether there was agranulocytosis or not, patients were divided into agranulocytosis group and non-agranulocytosis group, difference in cure rate between two groups was compared. Results A total of 18 patients with hematopathy complicated with SSTI were treated with daptomycin, 14 of whom (77.8%) were clinically cured; there was no significant difference in the cure rate between agranulocytosis group and non-agranulocytosis group (75.0% vs 80.0%, P>0.05). The median time of patients' temperature dropped by 1℃ was 12 (4-24) hours, and the median time of abatement of fever was 1.65 (0.2-4) days, adverse reaction related to daptomycin was not found. Conclusion Daptomycin is safe and effective in the treatment of hematopathy with SSTI, with few adverse reaction.

Abstract:Objective To evaluate in vitro antimicrobial activity of tedizolid(TZD) against Enterococcus faecalis(E. faecalis), and explore antimicrobial resistance mechanism and distribution of multilocus sequence typing (MLST) of tedizolid-non-susceptible E. faecalis. Methods E. faecalis isolates from Nanshan People's Hospital of Shenzhen City between January 1, 2011 and June 30, 2016 were collected, antimicrobial resistance of isolates was tested by automatic instrument method and micro-broth dilution method. Polymerase chain reaction (PCR) was used to detect the carrying status of oxazolidinone antibiotic resistance genes, isolated strains were typed by MLST. Results A total of 289 strains of E. faecalis were obtained, strains were mainly from department of surgery (57.4%) and main specimen source was midstream urine (126 strains, 43.6%). Susceptibility rate of 289 E. faecalis strains to TZD was 94.1%, susceptibility rates to ampicillin, furacillin and vancomycin were all high (97.9%-99.7%). MLST results showed that there were 47 ST types, the dominant ST were ST16 and ST179, accoun-ting for 29.1% (84 strains) and 24.9% (72 strains) respectively, among TZD-non-susceptible E. faecalis, the proportion of ST16 was higher than that of ST179 (P<0.05). A total of 17 strains of TZD-non-susceptible E. faecalis strains were isolated, the proportion of optrA gene carried by them was higher than that of susceptible strains. Conclusion TZD is superior to linezolid in antimicrobial activity against E. faecalis, but it has no good antimicrobial activity against E. faecalis carrying optrA gene.

Abstract:Objective To assess risk of hepatitis C virus (HCV) transmission in hemodialysis clinics in Lanzhou City by weighted rank-sum ratio (WRSR). Methods Five indexes were selected according to WRSR, index weight was determined by variation coefficient, and divided into three grades:high, medium and low according to risk level, risk of HCV transmission in 17 hospital hemodialysis clinics in Lanzhou was assessed. Results There was a high correlation between WRSR and probability units (r=0.981, linear regression equation:WȒSR=0.164×Y-0.311). The results of classification showed that risk of HCV infection was low in outpatient hemodialysis clinics of Y16 and Y17 hospitals, high in outpatient hemodialysis clinic of Y1 hospital, and medium in 14 other hospitals. Conclusion The risk levels of HCV transmission in hospital hemodialysis clinics in Lanzhou City vary greatly, and most of them are at medium and low risk levels. Prevention and control of HCV transmission should be strengthened in hemodialysis clinics according to their own weak links.

Abstract:Objective To investigate the status of human immunodeficiency virus (HIV) infection among voluntary blood donors(VBDs) in Hainan area, provide evidence-based references for optimizing the recruitment of blood donation and strengthen management of blood safety. Methods Routine HIV test was carried out on blood screening specimens of VBDs in Hainan area from 2013 to 2017, and data of HIV positive donors were analyzed retrospectively. Results A totla of 470 975 VBDs were detected, of which 103(0.22‰) were confirmed HIV positive. There was no significant difference in HIV positive rate among VBDs in different years and regions (both P>0.05). Among 103 confirmed HIV positive VBDs, 65 (63.11%) were in 18-30 year-old group, with a positive rate of 0.33‰. There was a significant difference in the positive rate of HIV among VBDs of different age groups (χ²=22.379,P<0.001). Among 95 confirmed HIV positive VBDs, 95 were male and 8 were female, positive rate of HIV in male blood donors was higher than female (0.29% vs 0.06‰, χ²=23.003,P<0.001). The main occupation types of HIV positive persons were employees (n=20, 19.42%), followed by students (n=16, 15.53%) and unemployed persons(n=6, 5.83%). Conclusion HIV infection among voluntary blood donors in Hainan area is still serious, to ensure blood safety, multiple measures should be taken, including the intervention before blood donation, taking more advanced detection technology and establishing internet database.

Abstract:Objective To investigate the distribution and drug resistance of pathogens isolated from respiratory secretion of hematological patients with agranulocytosis accompanied by pulmonary infection in Shanghai. Methods Clinical data and drug susceptibility result of bacteria isolated from respiratory secretion of hospitalized patients with agranulocytosis and pulmonary infection in departments of hematology in 12 hospitals of Shanghai between January 2012 and December 2014 were retrospectively collected, distribution of pathogenic bacteria and drug susceptibility data were analyzed, difference among pathogenic bacteria in different primary diseases was compared. Results A total of 623 strains of pathogenic bacteria were isolated, 138 (22.2%) of which were gram-positive bacteria, 485 (77.8%) were gram-negative bacteria, 60.2% of (292 strains) gram-negative bacteria were non-fermentative bacteria. Constituent ratio of gram-positive bacteria isolated from patients with lymphoma (35.0%) was higher than patients with acute myeloid leukemia and acute lymphoblastic leukemia. The top five bacteria were Stenotrophomonas maltophilia (104 strains, 16.7%), Klebsiella pneumoniae (88 strains, 14.1%), Acinetobacter baumannii (62 strains, 10.0%), Pseudomonas aeruginosa (56 strains, 9.0%) and Staphylococcus aureus (48 strains, 7.7%). Susceptibility rate of Klebsiella pneumoniae to carbapenems was>98%, resistance rates of Pseudomonas aeruginosa to imipenem and meropenem were 24.3% and 8.9% respectively, susceptibility rate of Stenotrophomonas maltophilia to levofloxacin, minocycline and compound sulfamethoxazole was more than 90%, resistance rate of Acinetobacter baumannii to amikacin, cefoperazone/sulbactam was less than 10%. Isolation rate of methicillin-resistant Staphylococcus aureus was 71.4%, no vancomycin-resistant, teicoplanin-resistant and linezolid-resistant Staphylococcus aureus were found. Conclusion Gram-negative bacteria accounts for the majority of isolates from respiratory secretion of patients with agranulocytosis and pulmonary infection, non-fermentative bacteria accounted for more than 50%, the overall bacterial resistance rate is lower than that of CHINET nationwide large sample surveillance.

Abstract:Objective To understand the nationwide implementation of "Management specification of air cleaning technique in hospitals (WS/T 368-2012)", and provide scientific basis for the revision of the specification. Methods With stratified sampling method, 168 hospitals in 6 provinces (cities) were selected after the promulgation of the specification to investigate the formulation and revision of air purification management system, the training of air purification management, the use of air purification methods in different departments, and the maintenance of diffe-rent air purification methods. Results 162 available questionnaires were collected, 87.04% (n=141) of hospitals formulated or revised the air purification management system after the specification was promulgated, and 88.27% (n=143) of hospitals carried out air purification management training; in 2017, of 154 hospitals with operating departments, air cleaning technology was adopted in 124 hospitals (80.52%), the utilization rates of circulating air ultraviolet air disinfector in hemodialysis ward (51.00%), neonatal ward (43.37%), cardiac catheterization room (37.88%) and delivery room (37.90%) were high; cleaning and maintenance rate as well as standard replacement rate of key components of air purification equipment in hospitals were all over 90%. Conclusion The promulgation of "air specification" has played an important role in regulating the air purification management of hospitals.

Abstract:Objective To understand the basic situation and characteristics of healthcare-associated infection(HAI) in secondary and higher medical institutions in Guizhou Province, and provide basis for the prevention and control of HAI in all levels of hospitals. Methods By filling out questionnaires, the relevant indexes of HAI in participating hospitals from January 1 to December 31, 2017 were collected and analyzed. Results HAI surveillance data of 234 medical institutions in the whole province were collected, incidence and prevalence rate of HAI were 0.65% and 1.68% respectively, surgical site infection rate and antimicrobial prophylaxis rate in class I incision operation were 0.41% and 37.27% respectively, incidence of catheter-related bloodstream infection(CRBSI), ventilator-associated pneumonia(VAP), and catheter-associated urinary tract infection (CAUTI) per 1 000 days were 1.04‰, 6.81‰, and 1.99‰ respectively. Differences in the indexes of different regions and different levels of medical institutions were all significant (all P<0.05). Incidences of CRBSI, VAP and CAUTI per 1 000 days in patients in tertiary medical institutions were all lower than those of secondary medical institutions(0.92‰ vs 1.23‰, 5.91‰ vs 9.16‰, 1.64‰ vs 2.44‰ respectively, all P<0.001). Conclusion This survey has grasped the characteristics and differences of HAI in different regions and different levels of medical institutions in Guizhou Province, which provides a scientific basis for guiding all levels of hospitals to do well in the prevention and control of HAI. Secondary medical institutions should strengthen the prevention and control of HAI.

Abstract:Objective To understand the current situation of healthcare-associated infection(HAI) in children with hematological tumor, and provide basis for targeted prevention and control measures. Methods A cross-sectional survey was conducted to investigate the infection of patients in the department of hematology oncology of a children's hospital from 2014 to 2018. Results A total of 553 patients with hematological tumor were investigated, the prevalence of HAI ranged from 13.51% to 22.52%, with an average of 18.08%, prevalence of community-associated infection(CAI) ranged from 14.41% to 21.62%, with an average of 18.44%. There were no significant differences between HAI rates and CAI rates of each age group in different years, as well as HAI rates and CAI rates of diffe-rent age groups (all P>0.05); of different types of diseases, HAI prevalence rates in patients with aplastic anemia, acute lymphocytic leukemia, solid tumor, and lymphoma were 34.88% (15/43), 13.53% (28/207), 9.84% (12/122), and 2.27% (1/44) respectively, HAI prevalence rates and CAI prevalence rates in patients with different diseases were both significantly different (χ²=45.54, 18.58, respectively, both P<0.05). Among HAI cases, 33 were other site infection (33.00%), 31 of which had no definite site, but had fever and received effective anti-infection treatment; 22 strains of bacteria and 1 strain of virus were isolated, gram-negative bacteria accounted for 56.52%(13 strains). Conclusion Infection risk of acute leukemia and aplastic anemia is higher than that of solid tumor and lymphoma in children with hematologic tumor, which should be paid more attention. It is necessary to improve the ability of clinical examination, ability of localization and determination of infection, effectively prevent and treat HAI.

Abstract:Objective To understand the prevalence rate and changing trend of healthcare-associated infection(HAI) in a hospital from 2016 to 2018, and evaluate the effect of HAI management and control measures, so as to provide reference for improving HAI management level. Methods A cross-sectional survey was conducted through combination of bed-side investigation and medical record reviewing, prevalence of HAI among all inpatients in a hospital on November 24, 2016, April 27, 2017, and May 23, 2018 were investigated. Results A total of 790 patients were surveyed during three years, 12 patients had 13 cases of HAI, HAI rate and HAI case rate were 1.52% and 1.65% respectively;HAI prevalence rates of each year were 1.84%, 1.43%, and 1.36% respectively, difference was not significant (χ²=0.208,P=0.935); the main HAI site was lower respiratory tract (46.16%). The utilization rate of antimicrobial agents in the survey day was 53.67%, utilization rate of antimicrobial agents decreased from 69.12% in 2016 to 37.07% in 2018, difference was significant (χ²=57.554,P<0.001). Therapeutic use of antimicrobial agents accounted for 70.91%-79.33%, antimicrobial single use accounted for 73.33%-80.73%, bacterial culture rate for therapeutic use of antimicrobial agents increased from 38.85% in 2017 to 59.30% in 2018, there were significant differences in antimicrobial use purpose, combined antimicrobial use and bacterial culture for therapeutic antimicrobial use in each year (χ²=62.266, 69.774, 8.930, respectively, all P<0.05). Conclusion The prevalence of HAI has not changed significantly in the past three years, antimicrobial use has been standardized year by year, but bacterial culture rate for therapeutic antimicrobial use still needs to be improved.

Abstract:Objective To explore disinfection effect of one kind of bedding cleaning technology on cotton quilts, mattresses and so on. Methods From November 2018 to January 2019, partial cotton quilts, mattresses and pillow cores were randomly selected from the departments of neurosurgery, general surgery and neurology in a hospital, one kind of bedding cleaning technology was used to disinfect them, difference in bacterial colony after 10-day and 30-day use as well as before and after cleaning were compared. Results Cotton quilts, mattresses and pillow cores of 72 bed units were selected from three departments. After cleaned and disinfected with a kind of bedding cleaning technology, coliform bacteria and Staphylococcus aureus were not detected on cotton quilts, mattresses and pillow cores, bacterial contamination rates of cotton quilts and mattresses in department of general surgery were both 4.2%, bacterial colonies on cotton quilts, mattresses and pillow cores in other departments were all qualified. Bacterial colonies on cotton quilts, mattresses and pillow cores used by patients in departments of neurosurgery and neurology for 10 days and 30 days were both significantly different from those after cleaning and disinfection(all P<0.01); bacterial colonies on cotton quilts used by patients in departments of general surgery for 10 days and 30 days were not significantly different from those after cleaning and disinfection(both P>0.05); but bacterial colonies on mattresses and pillow cores used by patients for 10 days and 30 days were both significantly different from those after cleaning and disinfection(both P<0.01). Conclusion Disinfection effect of this kind of bedding cleaning technology on cotton quilts, mattresses and so on is reliable, which can prevent the occurrence of healthcare-associated infection caused by contamination of cotton quilts, mattresses and pillow cores.

Abstract:Objective To analyze the susceptibility of carbapenem-resistant Enterobacteriaceae (CRE) to polymyxin B by two different methods, so as to provide basis for the selection of antimicrobial susceptibility methods in laboratory and rational clinical amtimicrobial use. Methods 230 strains of CRE isolated from the First Affiliated Hospital of Kunming Medical University between January and December 2018 were collected, the susceptibility of CRE to polymyxin B was detected by E-test and broth microdilution(BMD) method respectively, differences between two methods were analyzed. Results The main source of bacteria was sputum (163 strains, 70.87%), followed by blood (33 strains, 14.35%) and secretion (15 strains, 6.52%), Klebsiella pneumoniae was the main pathogen (205 strains). Susceptibility rate and resistant rate of CRE strains detected by E-test were 96.52% and 3.48% respectively; susceptibility rate and resistant rate of CRE strains detected by BMD method were 95.65% and 4.35% respectively; the basic consistent rate of two methods was 95.65%, classification consistent rate was 99.13%, and very major error was 0.87%. Conclusion Polymyxin B has good antimicrobial activity against CRE, E-test method is easy to be operated and is well consistent with BMD method, it can be used in clinical routine antimicrobial susceptibility testing.

Abstract:Objective To observe the effectiveness of department of healthcare-associated infection(HAI) management actively participating in the management of clinical application of antimicrobial agents. Methods Changes in evaluation index of clinical application management of antimicrobial agents before(2012-2014) and after (2015-2017) department of HAI management actively participated in management was compared. Results After department of HAI management actively participated in management of clinical application of antimicrobial agents, the utilization rate of antimicrobial agents in hospitalized patients decreased from 17.18% before active management to 15.24%, the utilization rate of special used antimicrobial agents decreased from 1.45% to 1.02%, microbial detection rate before antimicrobial use in patients receiving special grade antimicrobial agents increased from 87.12% to 91.15%. After active management, antimicrobial prophylaxis rate in patients undergoing class Ⅰ incision operation was 10.86%, administration rate 0.5-1 hour before operation was 89.32%, 86.77% of patients received<24 hour course of antimicrobial prophylaxis, all were higher than 8.74%, 75.87%, and 57.81% respectively before active participation, differences were all statistically significant (all P<0.001). Before active management, surgical site infection(SSI) rates of class I, II, and III incision were 0.27%, 0.92%, and 1.29% respectively, after active management, SSI rates were 0.20%,0.67%,and 4.42% respectively. There was significant difference in SSI rate of class II incision before and after active management (P=0.011). Conclusion Active participation of the department of HAI management in antimicrobial management can obviously improve the evaluation index of clinical application of antimicrobial agents, and promote the rational use of antimicrobial agents.

Abstract:Objective To investigate the current status of nursing interns' needlestick injuries, and explore effective countermeasures against occupational exposure. Methods Occurrence of needlestick injuries among nursing interns in a hospital from 2016 to 2018 was investigated retrospectively. Before clinical internship, nursing students registered the basic data uniformly, received training on infection prevention and control knowledge, and were informed that they should report to the real-time healthcare-associated infection surveillance management blue-dra-gonfly system after the occurrence of needlestick injuries, relevant data of needlestick injuries were exported and analyzed through the blue-dragonfly system. Results A total of 2 099 nursing students were investigated, 256 were male students and 1 843 were female students; 1 117 were junior college students and 921 were undergraduate students, 34 were domestic master students and 27 were foreign master students. There were 232 cases of needlestick injuries, incidence was 11.05%. There were significant differences in the incidence of needlestick injuries among nursing students of different genders, education background, internship stage and department (all P<0.05). In terms of distribution of manipulation links, 28.88%, 21.55%, and 18.10% of needlestick injuries occurred during separation of needles, pulling out of needles, and recapping of needles respectively. In the distribution of exposure sources, HBV and syphilis TP accounted for 21.12% and 6.90% respectively. In the distribution of exposure locations, 32.33% of needlestick injuries occurred in the wards. Conclusion Incidence of needlestick injuries is lower among nursing students, but higher in the female interns, those with lower education, the first stage of internship, separation of needles, and recapping of needles, it is necessary to strengthen standardized trai-ning on safe injection and develop individual training programs.

Abstract:Objective To explore the application effect of plan-do-check-act (PDCA) video education on quality improvement of sputum culture specimens. Methods Sputum specimens collected from hospitalized patients in the infectious diseases department of a hospital between March 13 and April 2, 2017 were investigated (before improvement); PDCA countermeasures were implemented (countermeasure 1:establishing flow chart of sputum specimen collection; countermeasure 2:establishing examination standard of sputum specimen collection; countermeasure 3:making video of sputum specimen collection), May-July 2017 was as peri-improvement data, August-December 2017 was as post-improvement data, the qualified sputum specimens in different periods were compared. Results Before improvement, among 146 sputum specimens from hospitalized patients, 45 of which were qualified, qualified rate was 30.82%. "Failure to correctly understand the content of education" was the primary cause for the unqualified sputum specimens, accounting for 79.21% (80/101). Through PDCA cycle, the qualified rate of sputum specimens increased from 31.51% (45/146) before improvement to 67.33% (101/150) after implementation of three countermeasures, and the improvement range was 54.23%. The qualified rate of sputum specimen collected after video broadcast increased from 58.14% (25/43) to 81.82% (54/66), increased by 23.68%, the effect was most obvious. After improvement, the qualified rate of sputum specimens fluctuated around 65% for consecutive 5 months, which was significantly higher than before improvement, slightly lower than peri-improvement, and achieved good results. Conclusion Video education can effectively improve the quality of sputum specimen collection and qualified rate of sputum specimens, at the same time, it can save time and energy of nurses, optimize the workflow and improve the satisfaction of patients for nursing services.

Abstract:Objective To screen out high risk factors for multidrug-resistant organisms(MDROs) in intensive care unit (ICU) through failure mode and effect analysis (FMEA), and provide reference for prevention and control. Methods FMEA risk assessment method was used to screen out high risk factors for MDRO healthcare-associated infection(HAI) in ICU, improvement measures were put forward and implemented, effect before and after intervention was compared. Results The screened high-risk events were extra bed for excessive patients, weak consciousness of isolation among cleaners, interns and rotary students. Incidence of MDRO HAI was 4.78% (89/1 861) before intervention and 2.08% (34/1 636) after intervention, difference was statistically significant before and after intervention (χ²=18.76,P<0.05). Incidence of carbapenem-resistant Acinetobacter baumannii (CRAB) HAI was 0.31% after intervention, which was lower than 1.40% before intervention (P<0.05); there was no significant difference in HAI rates of methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamases (ESBLs)-producing Escherichia coli, ESBLs-producing Klebsiella pneumoniae and carbapenem-resistant Enterobacteriaceae before and after intervention (all P>0.05). Conclusion FFMEA can guide department of HAI management and ICU to find out the weak links in the prevention and control of MDRO infection, and carry out targeted prevention and control measures.

Abstract:

Abstract:Omadacycline is a novel tetracycline antibiotic, with intravenous and oral formulations. It has a broad-spectrum and high efficiency, and is resistant to bacterial resistance due to drug efflux and ribosome protection mechanisms, with potent activity against various pathogens,such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), drug-resistant Streptococcus pneumoniae, extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacteria, anaerobes, and atypical pathogens. Omadacycline is currently approved for the treatment of acute bacterial skin and soft tissue infection as well as community-acquired bacterial pneumonia in adults, it can also be used to treat uncomplicated urinary tract infection. This paper summarized the chemical structure, pharmacological effect, in vitro antibacterial activity, pharmacokinetics, clinical study, safety, and tolerability of omadacycline.