Abstract:Objective To understand the distribution of clinical isolates of Pseudomonas aeruginosa (PA), prevalence of multidrug-resistant PA (MDR-PA), extensively drug resistant-PA (XDR-PA), and carbapenem-resistant PA (CRPA) in a tertiary first-class hospital in Shanghai, so as to provide evidence for rational use of antimicrobial agents. Methods Specimen information and antimicrobial susceptibility data of PA isolated from cultured specimens of clinical departments from 2014 to 2017 were collected, sources of specimens and department of PA, relationship between PA and age as well as sex of patients were analyzed, isolation rates of MDR-PA, XDR-PA and CRPA were calculated. Results A total of 1 218 PA strains were isolated in the past four years, number of isolated PA increased year by year; strains were mainly isolated from sputum (75.0%), followed by urine (10.6%). PA was most common in department of geriatric medicine (44.9%), followed by intensive care unit (8.9%) and respiratory department (8.9%), PA was mostly isolated from people over 60 years old and mainly male. Among PA strains, percen-tage of MDR-PA was 30.5%, but XDR-PA was only 2.5%, while isolation rate of CRPA was up to 38.8%, which showed an increasing trend year by year. Specimen sources and department distribution of MDR-PR, XDR-PA and CRPA were similar to those of PA, that is, sputum and department of geriatrics medicine. Conclusion Isolation rate of MDR-PA and CRPA in this hospital is high, strains are mainly from sputum and department of geriatric medicine, prevention and control measures of healthcare-associated infection(HAI) should be strengthened accor-ding to different departments and populations, management of clinical use of antimicrobial agents should be strengthened to prevent and control the occurrence and prevalence of MDR-PA and CRPA.

Abstract:Objective To study the direct economic loss due to healthcare-associated infection (HAI) in hospita-lized patients, enhance health care workers' awareness on prevention and control of HAI, and improve the ability of prevention and control of HAI. Methods A retrospective survey was conducted on hospitalized patients with respira-tory tract HAI, bloodstream HAI, gastrointestinal tract HAI, surgical site infection and urinary tract HAI in a tertiary hospital of Inner Mongolia Autonomous Region from January 1 to December 31, 2017, case group (HAI) and control group (non-HAI) were 1:1 mached according to maching standard, Wilcoxon test was used to analyze the direct economic loss caused by HAI. Results 262 pairs of patients were matched successfully, direct economic loss due to HAI of each patient was 31 300 Yuan, and the highest direct economic loss was 100 857 Yuan in intensive care unit. Difference in total hospitalization expense, length of hospital stay between two groups of patients were both statistically significant (both P<0.05); differences in bed fee, nursing fee, western medicine fee, operation fee, treatment fee, laboratory test fee and examination fee between two groups of patients were all statistically significant (all P<0.05), the highest expense was western medicine (14 378 Yuan). Difference in average overall expense and length of hospital stay between two groups of patients of patients were both statistically significant (both P<0.05). The average overall expense of hospitalization in different HAI sites from high to low were as follows:surgical site (47 469 Yuan), bloodstream (42 498 Yuan), urinary tract (34 598 Yuan), gastrointestinal tract (33 296 Yuan), and respiratory tract (31 058 Yuan). The average length of hospital stay of patients in case group extended by 7 days,difference in average length of hospital stay between two groups of patients was statistically significant (P<0.05). Conclusion HAI can lead to the increase of medical expense and prolongation of average length of hospital stay, and bring about greater loss to patients.

Abstract:Objective To rapidly screen Staphylococcus aureus (SA) colonized in nasal cavity by using eSwab flocked nylon swab transport system and chromogenic culture medium, understand SA colonization in outpatients in department of otorhinolaryngology-head and neck surgery (ORL-HNS), and provide basis for prevention and control of SA infection as well as healthcare-associated infection(HAI). Methods eSwab was used to collect nasal vestibule specimens of patients in department of ORL-HNS in a hospital, specimens were inoculated on blood agar medium and methicillin-resistant SA(MRSA)/SA chromogenic culture medium by WASPLab microbial automated system, SA colonies were photographed and observed at 16 and 40 hours respectively, results were verified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF MS), antimicrobial susceptibility testing and mecA gene detection. Results A total of 200 nasal vestibule specimens were collected, 48 strains of SA were isolated, 23(47.9%) of which were methicillin-sensitive SA(MSSA), and 25(52.1%) were MRSA; nasal colonization rate of SA and MRSA were 24.0% and 12.5% respectively. The average reporting time of SA positive screening was (17.6±6.1) hours. Coincidence rate of screening culture with MALDI-TOF MS identification and drug-resistance phenotype detection were both 100.0%, coincidence rate with mecA gene detection was 97.9%. Conclusion The rapid screening method based on eSwab flocked nylon swab transport system combined with chromogenic culture medium has higher accuracy and shorter reporting time, which can be used for rapid screening of SA colonization.

Abstract:A case of tuberculous prostatic abscess(TPA) was reported, relevant literatures at home and abroad were searched, clinical characteristics of the disease were evaluated in combination with literature review, so as to provide help for the diagnosis and treatment of the disease. Among 26 cases of TPA, 18 cases (69.23%) were middle-aged and elderly patients, 7 cases (26.92%) were patients with low immunity, 11 cases (42.31%) received Bacillus Calmette-Guérin(BCG) perfusion therapy. There was no obvious specific manifestations in patients with TPA, the main manifestations were lower urinary tract symptoms (n=16, 61.54%), fever (n=6, 23.08%), elevation of prostate-specific antigen (n=5, 19.23%) and other non-specific symptoms. Transrectal prostate ultrasound and ultrasound-guided puncture are the most important diagnostic methods (n=17, 63.58%). TPA often occurrs in person with low immunity, without specific clinical manifestations, transrectal ultrasound and ultrasound-guided puncture are the most common diagnostic methods.

Abstract:Objective To understand the actual situation and changing trend of healthcare-associated infection(HAI), and analyze the risk factors for HAI. Methods A cross-sectional survey was carried out in a tertiary first-class hospital each year from 2014 to 2018, the survey period was one day, all patients in hospital and discharged on that day were investigated, data of HAI in five years were statistically analyzed. Results A total of 9 718 patients were investigated, prevalence rates of HAI and HAI cases were 4.55% and 5.01% respectively, prevalence rates of HAI and HAI cases decreased year by year in five years, differences were all statistically significant (all P<0.001). Lower respiratory tract was the main infection site(n=193, 39.63%), followed by surgical site (n=75, 15.40%), urinary tract (n=65, 13.35%) and upper respiratory tract (n=29, 5.95%). Department of hematology had the highest prevalence rate of HAI (15.73%), intensive care unit had the highest prevalence rate of HAI cases (16.72%). A total of 414 pathogens were isolated from patients with HAI, including 258 strains of gram-negative bacteria, 112 gram-positive bacteria, 38 fungi and 6 other pathogens. The most common pathogens were Pseudomonas aeruginosa (51 strains), followed by Escherichia coli (49 strains), Acinetobacter baumannii (43 strains), Staphylococcus aureus (43 strains) and Klebsiella pneumoniae (42 strains). Conclusion Investigation on prevalence of HAI is conducive to understanding the incidence of HAI, prevention and control of HAI are the key points of device-related infection and surgical site infection.

Abstract:Objective To analyze the risk factors for death in septic shock patients in pediatric intensive care unit (PICU), so as to provide basis for formulating early prevention and treatment measures to reduce death in septic shock. Methods Clinical data of children with septic shock who were admitted to PICU of a hospital from May 2015 to May 2018 were analyzed retrospectively, according to shock outcome, they were divided into survival group and death group, risk factors for death were analyzed by univariate and multivariate logistic regression analysis. Results A total of 62 children with septic shock were collected, of which 31 survived (survival group), 23 died (death group), 8 gave up treatment, mortality of children with septic shock was 42.6%. Multivariate logistic regression analysis showed that the independent risk factors for death in septic shock were decrease of albumin, the number of organ dysfunction more than 3, increase of blood glucose, increase of C-reactive protein, effective resuscitation time more than 6 hours, maintenance of blood pressure with drug, positive bacterial culture, and low lactate clearance rate at 6 hours. Compared with the death group, lactate level in survival group was significantly lower (1.4[1.2-2.1]mmol/L vs 5.6[3.5-8.7] mmol/L) and the lactate clearance rate was significantly higher (0.4[0.23-0.52]% vs -0.16[-0.39-0.13]%) at 6 hours after resuscitation, with significant difference (both P<0.05). Procalcitonin level in survival group was lower than death group (1.1[0.5-1.6] ng/mL vs 23.5[12.9-55.1] ng/mL), procalcitonin clearance rate was higher than death group (0.47[0.27-0.69]% vs -0.9[-5.5-0.1]%), differences were both statistically significant (both P<0.05). Conclusion Children with septic shock have a high mortality, early monitoring of organ function, dynamic determination of lactic acid level and effective fluid resuscitation are conducive to improving prognosis.

Abstract:Objective To explore the effect of constructing the evaluation system of healthcare-associated infection(HAI) quality indicators on controlling HAI. Methods All inpatients who were hospitalized in a tertiary first-class hospital from January 2017 to December 2018 were selected as the research objects, differences in process and outcome indicators of HAI before (January-December 2017) and after intervention (January-December 2018) were compared. Results The numbers of inpatients during the same period before and after intervention were 106 558 and 111 094 respectively, HAI cases were 1 803 and 1 526 respectively, case incidence of HAI decreased from 1.69% to 1.36%, difference was statistically significant(χ²=38.040, P<0.001); compared with before intervention, case incidence of multidrug-resistant organism (MDRO) HAI, ventilator-associated pneumonia (VAP) and catheter-related urinary tract infection (CAUTI) all decreased significantly after the intervention, differences were all statistically significant (all P<0.05). After intervention, isolation rate of MDRO, utilization rate of antimicrobial agents, utilization rate of urinary catheter, and missing report rate of HAI were lower than before intervention, prevention rate of VAP, implementation rate of MDRO infection prevention and control measures, as well as pathogen detection rate before therapeutic antimicrobial use were all higher than before intervention, differences were all statistica-lly significant (all P<0.05). Conclusion Constructing the evaluation system of HAI quality indicators can promote the implementation of infection control measures and reduce the incidence of HAI.

Abstract:Objective To understand the risk factors for postoperative pneumonia in elderly patients with non-small cell lung cancer(NSCLC), and explore the preventive measures. Methods Clinical data of surgical patients aged>70 years and with NSCLC in a hospital from January 2016 to November 2018 were retrospectively analyzed, incidence of postoperative pneumonia, distribution of pathogens, and related risk factors were analyzed statistically. Results Among 398 lung cancer surgical patients, 36 had postoperative pneumonia, infection rate was 9.05%; 43 strains of pathogens were isolated, including 20 strains (46.51%) of gram-negative bacteria, 9 strains(20.93%) of gram-positive bacteria and 14 strains (32.56%) of fungi. Multivariate logistic regression analysis showed that age ≥ 75 years, chronic obstructive pulmonary disease (COPD), forced expiratory volume in one second (FEV₁)% <70, thoracotomy, lobectomy, duration of operation ≥ 180 minutes, serum albumin <35 g/L were independent risk factors for postoperative pneumonia (all P<0.05). Conclusion Incidence of postoperative pneumonia in elderly patients with NSCLC is high and with multiple influencing factors, corresponding preventive and control measures should be taken to reduce the incidence of postoperative pneumonia.

Abstract:Objective To understand the research hot topics of literatures published in the Chinese Journal of Infection Control (Chin J Infect Control) from the initial issue in 2002 to 2018. Methods The quantity, authors, scientific research institutes, key words, number of citations and fund items of literatures published in the Chin J Infect Control were performed bibliometric analysis. Results A total of 2 930 literatures were published in Chin J Infect Control from 2002 to 2018, the author who issued the most was Wu Anhua from Xiangya Hospital of Central South University, funded papers showed an increased tendency. High frequency key words, key words with the strongest citation bursts and bibliometric analysis result of high cited literatures were synthesized to predict that multi-center study on multidrug-resistant organisms would be research hot topics of literatures in this journal in the next five years. Conclusion Chin J Infect Control has become one of the most authoritative academic journals in the field of infection in China, bibliometric analysis directly reveal the hot topics of the journal and provide direction for professionals to select researching topics.

Abstract:Objective To evaluate the diagnostic and predictive value of combined detection of sex hormone-bin-ding globulin (SHBG) and serum amyloid A4 (SAA4) in smear-negative pulmonary tuberculosis(SNPT). Methods Serum specimens of 88 SNPT patients who were admitted to Lontan Hospital, Liuzhou, Guangxi from March to May, 2017 were collected, serum specimens of 56 healthy physical examination people in Liuzhou City collected at the same time were as control group. Serum levels of SHBG and SAA4 in SNPT group and control group were measured by enzyme-linked immunosorbent assay (ELISA), efficacy of single and combined diagnosis for SNPT was compared by receiver operating characteristic(ROC) curve, and compared with the diagnostic efficacy of T cell spot test of tuberculosis infection (T-SPOT TB) for SNPT in recent three years. Results Concentrations of serum SHBG and SAA4 were 52.32 (24.58-81.19) nmol/L and 56.71 (41.87-77.57) ng/mL in SNPT group, 25.97 (16.60-36.45) nmol/L and 35.79 (29.81-41.07) ng/mL in control group, expression levels of serum SHBG and SAA4 in SNPT group were both significantly higher than those in control group (both P<0.001). The area under ROC curve of single and combined diagnosis of SNPT by SHBG and SAA4 were 0.781, 0.829, and 0.906, respectively (all P<0.001), sensitivity and specificity of the combined diagnosis were 84.1% and 91.1% respectively, Jordan index was 0.752. Compared with T-SPOT TB detection method reported in recent three years, combined detection of SHBG and SAA4 has advantage for the diagnosis of SNPT. Conclusion SHBG and SAA4 has good auxi-liary diagnostic value for SNPT, and the combined detection can improve the diagnosis rate of SNPT.

Abstract:Objective To clarify the epidemiological characteristics of an outbreak of varicella among health care workers(HCWs) caused by nursing herpes zoster patient, provide evidence for the prevention and control of healthcare-associated infection(HAI) of varicella and herpes zoster. Methods HCWs who were clinically diagnosed with varicella in the intensive care unit (ICU) of a tertiary hospital in Yantai of Shandong Province in December 2018 were conducted epidemiological investigation, epidemiological characteristics and causes of disease were analyzed. Results On December 17-19, 2018, 4 HCWs in ICU of this hospital were reported suffering from varicella, including 3 nurses and 1 nursing attendant who had taken care of bed-2 patient with herpes zoster, but without contact with other varicella and/or febrile eruption cases during the longest incubation period, an outbreak of HAI of HCWs caused by herpes zoster was judged, through the implementation of active isolation, vaccination, training and other measures timely, no subsequent cases occurred. Conclusion As the source of varicella infection, herpes zoster patients can not be ignored, strict implementation of air isolation, contact isolation, standard prevention and other measures can effectively prevent and control the occurrence of varicella zoster virus HAI.

Abstract:Objective To explore the clinical characteristics of influenza complicated with Mycoplasma pneumo-niae(Mp) infection in children, and provide reference for diagnosis and prevention of influenza complicated with Mp infection. Methods 328 children with fever who met the screening criteria in a hospital from January to December 2017 were studied, according to the initial diagnostic results, children were divided into influenza combined with Mp infection group (n=87), simple influenza infection group (n=149) and simple Mp infection group (n=92), blood and serum immune markers of children in three groups were compared. Results Of 328 children with fever, 87 (26.5%) were with both influenza and Mp infection, mainly in children aged 1-6 years in autumn and winter. Compared with simple influenza group, symptoms of cough, expectoration and pneumonia in incldren in influenza combined with Mp infection group were significantly higher (P<0.05). Compared with simple Mp infection group, children in influenza combined with Mp infection group had more cough and expectoration. Compared with simple influenza group and simple Mp infection group, the number of children with moderate and high fever in influenza combined with Mp infection group was significantly higher, duration of fever and length of hospital stay were longer, percentage of monocyte and neutrophil increased significantly, percentage of lymphocyte reduced significantly, and proportions of abnormal IgG, IgA, IgM, C3, and C4 positive were significantly higher. Conclusion Influenza combined with Mp infection in this region occurs frequently in autumn and winter, clinical manifestations of influenza combined with Mp infection are characterized by prolonged symptoms of moderate and high fever, symptoms of cough and expectoration are more serious than those of common influenza, and immunological test results are obviously abnormal.

Abstract:Objective To understand current status of job burnout and effort-reward imbalance(ERI) of full-time staff who engage in healthcare-associated infection(HAI)management, and provide scientific basis for improvement. Methods Based on stratified random sampling method, 50 full-time staff in 16 secondary and 5 tertiary hospitals in Wuhu City were selected as the research objects, Chinese Maslach burnout inventory (CMBI)and ERI questionnaire were used in the survey, scores of three dimensions of job burnout in different work modes were compared. Results 50 questionnaires were distributed and 46 were available (3 persons failed to reply in time and 1 questionnaire was unqualified), the effective recovery rate was 92.00%. Job burnout rate of full-time HAI management staff in Wuhu City was 91.30%, rates of moderate and severe burnout were 43.48%; 89.13% of full-time staff were in ERI state (ERI index>1), 69.57% were in overload working state. There were significant differences in the scores of emotional exhaustion among full-time staff with different educational background and years of engaging in HAI management (both P<0.05); there were significant differences in the scores of depersonalization among full-time staff with different marital status, educational background, hospital level and monthly income level (all P<0.05); there were significant differences in the scores of low sense of achievement among full-time staff in different levels of hospitals (P<0.05). The scores of emotional exhaustion and depersonalization of full-time staff in ERI and overload working state were both higher than those with effort-reward balance and non-overload working state (both P<0.05). Conclusion Job burnout and ERI of full-time HAI management staff in Wuhu City are serious, which should be concerned.

Abstract:Objective To monitor the microbial contamination of flexible endoscopes at different storage time after disinfection, so as to explore the safe storage period of flexible endoscopes. Methods 27 flexible endoscopes were selected from the endoscopy center of a tertiary first-class hospital in Chongqing by convenient sampling, a prospective study was performed, from October 2017 to February 2019, endoscopes with qualified biological monitoring after disinfection were stored at room temperature for 24, 48, 72 and 168 hours, bacterial colonies and qualified rate of bacterial colonies in the lumen and surface of endoscopes as well as air and surface of endoscope cabinets were monitored. Results Qualified rates of bacterial colonies in lumen and surface of 108 times of endoscopes stored for 24, 48, 72 and 168 hours were all 100%, the number of surface colonies in 108 times of endoscopes stored for 24, 48, 72 and 168 hours were all 0; the number of lumen colonies in 108 times of endoscopes stored for 24, 48, and 72 hours were all 0; the number of lumen colonies in 107 times of endoscopes stored for 168 hours were all 0; the number of lumen colony in 1 endoscopes stored for 168 hours was 6 CFU/piece, but without pathogenic bacteria. Qualified rates of colonies in air and object surface of endoscope cabinets were both 100%. Conclusion It is safe to store flexible endoscope in the qualified environment for 168 hours after high level disinfection, and it is unnecessary to disinfect it before use.

Abstract:目的 探讨摄像质量追溯系统器械预处理检查模块（以下简称器械预处理模块），改善消毒供应中心去污区回收器械预处理质量的效果。方法 在原有电子追溯系统中，独立添加器械预处理模块，记录器械预处理质量的数据。比较器械预处理功能应用前（2017年1-3月）和应用后三个月（2017年4-6月）、半年（2017年7-9月）、一年（2018年1-3月）的效果，随机抽取每个阶段器械包，分别统计比较预处理不合格的发生率及科室工作人员的满意度。结果 四个阶段各检测器械包5 000个，其中模块建立前器械预处理质量检查不合格率为18.92%（946个），模块建立使用后三个月、半年、一年的不合格率分别为7.46%、5.18%、4.10%。各阶段器械预处理质量检查不合格率呈逐渐下降趋势，差异有统计学意义（χ_趋势²=672.56，P<0.001）。器械预处理追溯功能实施各阶段工作人员对缩短器械处理时间、器械返回二次清洗、器械返回除锈3个方面的满意度均逐渐提高，差异均有统计学意义（均P ≤ 0.001）。结论 在消毒供应中心去污区开发应用器械预处理模块功能，可提高回收器械的预处理质量，提高工作效率和消毒灭菌质量。

Abstract:

Abstract:Acinetobacter baumannii (A. baumannii) is one of the common pathogens causing healthcare-associa-ted infection(HAI). The formation of A. baumannii biofilm can lead to its long-term presence in hospital environment, increase drug resistance and pathogenicity, and repeated occurrence of infection. Biofilm formation and regulation is a complex dynamic process, which is influenced by multiple factors and regulated by various mechanisms. The study on influencing factors and regulatory mechanisms of biofilm formation is conducive to finding new targets and searching new antimicrobial agents for the treatment of A. baumannii infection. In this paper, the progress of biofilm formation, influencing factors and regulatory mechanisms of A. baumannii are reviewed in order to provide methods and references for controlling its infection.

Abstract:Legionella pneumophila (L. pneumophila) is a facultative intracellular pathogen which can cause Legionella pneumonia and Pontiac fever, it mainly infects amoeba and human macrophages, it can escape lysosomal degradation by relying on the effector protein produced by Dot/Icm IVB secretion system in host cells. In this paper, the pathogenic substances, intracellular survival and proliferation mechanism of L. pneumophila as well as biological function of its effector protein were reviewed, the virulence factors and pathogenesis of L. pneumophila were introduced in detail, which provide new ideas for the study of prevention and treatment of Legionella disease, and also provided important reference for the study of infectious diseases caused by other intracellular pathogens.