Abstract:Bacterial biofilm is a special existing mode of bacteria which is different from free state. Because of the unique physicochemical properties of bacterial biofilm, it is difficult to be detected and eliminated, which leads to a considerable number of refractory infectious diseases in clinical practice. There is dormant bacteria-persisters in biofilm which make infection more difficult to cure due to drug resistance. Actively exploring how to prevent and treat biofilm infection has practical guiding significance for clinical treatment. At present, there are many non-specific strategies to prevent biofilm-related infection, including:(1) preventing microbial contamination of medical devices; (2) minimizing microbial adherence to medical devices; (3) directly removing the source of infection. In addition, people have actively explored the treatment of biofilm infection by physical means, application of antimicrobial agents and antibacterial polypeptide, as well as inhibition and disintegration of biofilm. Resistance to conventional antimicrobial agents in persistent infection caused by biofilm suggests that biofilm prevention and control strategies need to be improved urgently, and new prevention and control strategies need to be explored urgently.

Abstract:Objective To explore the value of modified Hodge test (MHT), Carba NP test (CNPt) and modified carbapenem inactivation test (mCIM) in detecting carbapenemase-producing Klebsiella pneumoniae(K. pneumoniae). Methods 117 clinically isolated strains of K. pneumoniae were collected from a hospital between December 2016 and November 2017, all strains were performed antimicrobial susceptibility testing, 57 strains were carbapenem -resistant and 60 strains were carbapenem-susceptible. Carbapenemase gene detected by PCR was as gold standard, value of three methods for detecting carbapenemase in K. pneumoniae was evaluated. Results Of 57 carbapenem-resistant K. pneumoniae strains, 40 were positive for PCR, including 39 KPC strains and 1 NDM-1 strain, no other resistance genes were detected. Positive rates of MHT, CNPt, and mCIM were 87.7% (50/57), 89.5% (51/57), and 91.2% (52/57) respectively. No carbapenemase gene was detected among 60 strains of susceptible bacteria by PCR, results of three phenotypic screening tests were all negative. Taking PCR as the gold standard, sensitivity of MHT, CNPt, and mCIM were 97.5% (39/40), 100% (40/40), and 100% (40/40) respectively, specificity were 85.7% (66/77), 85.7% (66/77), and 84.4% (65/77) respectively. Conclusion CNPt is a reliable phenotypic screening method, which can be used in epidemiology and healthcare-associated infection surveillance. mCIM has the advantages of simple operation, easy to make a judgment and is more suitable for clinical microbiology laboratory to carry out routinely.

Abstract:Objective To investigate the changes and significance of dendritic cell-associated C-type lectin-1 (Dectin-1) in rat lung tissue as well as interleukin-17 (IL-17) and interleukin-23 (IL-23) in rat serum and alveolar lavage fluid by establishing rat invasive Candida glabrata(C. glabrata) infection model. Methods 54 SD rats were randomly divided into group A, B and C, with 18 rats in each group. Group A didn't receive any treatment, group B was directly intratracheally perfused with heat-treated C. glabrata solution, group C was first immunosuppressed and then intratracheally perfused with equal dose of heat-treated C. glabrata. On the 1st, 3rd, and 5th day after infection, pathological changes in rat lung tissue were observed, expression of Dectin-1 protein in rat lung tissue, as well as concentration of IL-17 and IL-23 in rat serum and alveolar lavage fluid were detected and compared. Results Inflammatory lesion and lung injury were most serious in group C, followed by group B, and no inflammatory changes were found in group A. Concentrations of IL-17 and IL-23 in serum and alveolar lavage fluid as well as expression of Dectin-1 protein in lung tissue of group A were the lowest at all time points; levels of IL-17 and IL-23, as well as expression of Dectin-1 protein in lung tissue of group B and group C increased progressively with time, concentrations of IL-17 and IL-23 as well as expression of Dectin-1 protein in group C were all higher than group A and B at different time points. Multivariate regression analysis showed that immunosuppression, fungal infection and the duration of infection in rats had effect on concentrations of IL-17 and IL-23 in rat serum and alveolar lavage fluid as well as expression of Dectin-1 protein in lung tissue respectively, application of immunosuppressive agents had the greatest effect on the concentrations of IL-17 and IL-23 in rat serum and alveolar lavage fluid as well as expression of Dectin-1 protein in lung tissue, followed by fungal infection and the duration of infection in rats. Conclusion Dectin-1 is an important receptor for identifying heat-treated C. candida infection, which induces IL-17 and IL-23 involving anti-fungal immune response and may lead to lung injury.

Abstract:Objective To establish the transmission dynamics model of human immunodeficiency virus (HIV) infection, evaluate HIV infection status of men who have sex with men (MSM), and predict HIV epidemic trend of MSM population in Urumqi of Xinjiang in the next decade, so as to provide quantitative basis for formulating appropriate prevention and control measures. Methods Based on HIV surveillance data of MSM population in Urumqi from 2009 to 2017, a dynamic model of HIV transmission was established. Through the model analysis, basic reproductive number R₀ which determined disease spread was obtained, model was numerically simulated with the collected and estimated parameters to analyze the prevalence of HIV among MSM in Urumqi. Results Fitting effect of the established HIV transmission dynamics model for MSM population was rational (mean absolute percentage error[MAPE]=10.89%, root mean square percentage error[RMSPE]=25.74%, basic reproductive number R₀≈0.2616[95%CI:0.2394-0.9299]), model predicted that the HIV positive rate of MSM population in Urumqi would decrease to 2% by 2027. Parametric sensitivity analysis found that the main factors affecting HIV prevalence in MSM population were the proportion of low-risk susceptible persons developing into high-risk susceptible persons, proportion of HIV-infected persons developing into acquired immunodeficiency syndrome (AIDS) patients, and proportion of high-risk susceptible persons developing into low-risk susceptible persons. Conclusion HIV infection among MSM population in Urumqi continues to be prevalent, relevant departments should strengthen the prevention and control of MSM population, promote condom use, strengthen publicity, education and other comprehensive intervention measures, so as to control HIV prevalence among MSM population.

Abstract:Objective To analyze changes in hematological erythrocyte lineage in patients with HIV/AIDS and Mycobacterium tuberculosis infection (HIV/AIDS-TB) during intensive period of antiretroviral therapy (ART) and different ART regimens combined with anti-tuberculosis drugs. Methods Patients who were confirmed with HIV/AIDS-TB in an infectious disease hospital from 2014 to 2017 were selected and divided into three groups:group A received combination therapy of anti-tuberculosis drugs on the basis of ART, group B started ART within 8 weeks of anti-tuberculosis drug therapy, group C started ART after 8 weeks of anti-tuberculosis drug therapy; changes in parameters of erythrocyte lineage, such as red blood cell(RBC), hemoglobin(HGB), mean corpuscular volume(MCV), and RBC distribution width (RDW-CV) before therapy(baseline, at 0 week) and 1, 2, 4, and 8 weeks after therapy were detected and compared. Results A total of 180 patients with HIV/AIDS-TB were enrolled, group A, B, and C were 71, 75, and 34 cases respectively; 85.00% (n=153) of patients developed mild anemia, 84.51% (60/71), 85.33% (64/75), and 85.29% (29/34) were in group A, B, and C respectively. After anti-tuberculosis drug therapy, changes in absolute value of RBC in group A, B, and C had no significant difference (all P>0.05); after 4 weeks of therapy, increase of HGB in patients in group B was higher than baseline (P<0.05); MCV and RDW-CV in group A, B, and C after therapy were all higher than baseline (all P<0.05), but RDW-CV in group C recovered to baseline level at 8 weeks of therapy. HGB of group A and B at 4 weeks of TDF/3TC/EFV regimen combined anti-tuberculosis drug therapy were both higher than that of baseline (both P<0.05), but there was no significant difference in other regimens (all P>0.05). Conclusion Patients with HIV/AIDS-TB should start ART as soon as possible after anti-tuberculosis drug therapy, preferably within 8 weeks, changes in erythrocyte parameters in patients treated with different ART regimens combined with anti-tuberculosis therapy are different, effect of TDF therapy is ideal.

Abstract:Objective To assess the disease burden and risk factors of healthcare-associated infection(HAI) caused by Stenotrophomonas maltophilia(S. maltophilia) in intensive care unit (ICU). Methods Patients with HAI caused by S. maltophilia in general ICU of Xiangya Hospital of Central South University from January 1 to December 31, 2017 were collected as case group, each case was matched with 2 non-infected patients of the same gender and age difference ≤ 3 years old as control group. Data about demographic information, disease severity, length of hospital stay, hospitalization expense, underlying diseases, invasive operations, and antimicrobial use were collected, risk factors were analyzed by logistic regression analysis. Results Incidence and case incidence of S. maltophilia HAI in ICU were 1.47% (29/1 973) and 1.57% (31/1 973) respectively. Duration from admission to infection was (17.86±16.51)days, duration from admission in ICU to infection was(7.34±9.12)days. The main infection site was lung (74.19%). Length of hospital stay and ICU stay, hospitalization expenses and antimicrobial expenses of case group were all higher than control group, while cure rate was lower than control group. Susceptibility rate of S. maltophilia to compound sulfamethoxazole and minocycline was more than 90%, while non-susceptibility rate to cefoperazone/sulbactam was more than 75%. In case group, 82 strains of other bacteria were isolated from 27 (93.10%) clinical specimens, including 59 strains (71.95%)of multidrug-resistant organisms; 13 strains of fungi were isolated from 10 cases of infection (34.48%). Univariate analysis showed that patients in case group were with older age, high proportion of males, long length of ICU stay, higher APACHE Ⅱ score and fasting blood sugar, lower hemoglobin, high proportion of mechanical ventilation, central venous catheterization, fiberoptic bronchoscopy, blood purification treatment, blood transfusion, chemotherapy, cephalosporins and enzyme inhibitors, penicillins+enzyme inhibitors, carbapenems, quinolones and glycopeptides treatment. Multivariate logistic analysis showed that the use of cephalosporins+enzyme inhibitors, carbapenems and glycopeptides were independent risk factors for S. maltophilia HAI. Conclusion S. maltophilia HAI mostly occurrs in patients with old age, serious illness, long length of hospital stay and use of broad-spectrum antimicrobial agents, it is necessary to strengthen surveillance, prevention and control. The burden of S. maltophilia HAI in ICU patients is heavy, antimicrobial resistance is increasing.

Abstract:Objective To analyze current status of chronic progression of hepatitis B virus (HBV) infection and its related diseases among Tibetan population in Ngari Prefecture of Tibet,and explore influencing factors for prognosis. Methods Clinical data of 2 043 Tibetan patients in Ngari Prefecture People's Hospital from March 2016 to March 2018 were selected, status of positive rate of HBsAg, hepatic cirrhosis, and hepatocellular carcinoma due to chronic progression of hepatitis B were analyzed, multivariate logistic regression was used to analyze the influencing factors for poor outcomes of liver disease due to progression of hepatitis B in Ngari Prefecture. Results The overall positive rate of HBsAg was 18.01% (368/2 043) in Tibetan population of Ngari Prefecture, positive rates of HBsAg were 17.13% (185/1 080) in males and 19.0% (183/963) in females, with no significant difference (χ²=1.213, P>0.05);positive rate of HBsAg in farmers and herdsmen was 23.26% (217/933), which was higher than 13.60% (151/1 110) of urban residents (χ²=31.91,P<0.05). Among HBsAg positive population, 64.13% (n=236), 16.58% (n=61), 10.60% (n=39), and 8.70% (n=32) were with hepatitis, compensated cirrhosis, decompensated cirrhosis, and primary hepatocellular carcinoma respectively. Patients at the age of 40-49 years had the peak incidence of compensated cirrhosis, and at the age of 50-59 years had the peak incidence of decompensated cirrhosis and primary hepatocellular carcinoma. Multivariate unconditional logistic regression analysis showed that age ≥ 50 years, HBsAg positive in patients' mothers, lack of knowledge of hepatitis B, drinking, irregular living habits and irregular treatment were influencing factors for hepatitis B progressed to decompensated cirrhosis and primary hepatocellular carcinoma in patients in Ngari Prefecture (all P<0.05, all OR>1). Conclusion Positive rate of HBsAg in Tibetan population in Ngari Prefecture is high, the progress of chronic disease is rapid, and incidence of poor outcome of liver disease is high. Prevention and intervention, especially antiviral treatment and follow-up mana-gement of HBV carriers and hepatitis B patients should be further strengthened.

Abstract:Objective To explore the experience of department of healthcare-associated infection(HAI) management in auditing and guiding the layout of painless endoscopy center. Methods Department of HAI management took an active part in the audit and guide of architectural design of painless endoscopy center, fully understood the demand of diagnosis and treatment of clinical departments, investigated the latest domestic and provincial architectural design standards, adopted suitable air-conditioning purification system and decorative material according to the actual situation, through repeated demonstration, the best layout and function of painless endoscopy center was ensured. Results Painless endoscopy center was well designed, reasonably laid out, air was well circulated, and decorative material was suitable, acceptance testing by the third party showed that the indoor air quality was qualified, air colony number conformed to national standard, the overall management of endoscopic instruments has been achieved, subjective feeling of medical staff after use was excellent. Conclusion Department of HAI management intervenes in the audit and guide of architectural layout of painless endoscopy center in advance, which is of great importance for endoscopy center to meet the requirements of relevant standards and increase of its practicability.

Abstract:Objective To survey the implementation of Technique Standard for Isolation in Hospitals (WS/T 311-2009)(referred to as isolation standard) at all levels of hospitals in China, and provide scientific basis for the revision of isolation standard. Methods In 2017, 253 hospitals in 12 provinces (municipalities) in China were selected to survey the implementation of isolation measures before and after the issuing of isolation measures, including revision of isolation system, training, supervision and other management work, building layout and installation of facilities, implementation of hand hygiene, implementation of standard prevention relevant work, use of protective equipment, and implementation of occupational exposure management. Results In 2017, of 253 surveyed hospitals, 99.21% (n=251) established isolation prevention system, 97.23% (n=246) regularly guided and supervised isolation work; implementation of hand hygiene reached peak in 2009; 76.28% (n=193) of hospitals set up intestinal outpatient clinics, 79.84% (n=202) set up fever clinics, 88.54% (n=224) set up outpatient and emergency pre-examination and triage; 99.21% (n=251) carried out standard prevention relevant work; compared with 2010, the use of medical personal protective equipment increased more than double; 98.02% (n=248) of hospitals had reporting procedure and system of needle stick injury. Conclusion Issuing of isolation standard has played a promoting role in standardizing the isolation work of hospitals.

Abstract:Objective To identify risk factors for multidrug-resistant organism(MDRO) infection in patients with diabetic foot ulcer(DFU) by Meta-analysis. Methods Literatures on risk factors for MDRO infection in patients with DFU were retrieved and screened according to inclusion and exclusion criteria, data were extracted and performed quality assessment independently by two researchers, Meta-analysis was performed using RevMan 5.3 statistical analysis software. Results A total of 20 articles were included, with a total samples of 2 568 cases. There were 13 risk factors were included in the analysis, Meta analysis showed that risk factors for MDRO infection were course of foot ulcer (WMD, 5.25[95%CI, 0.13-10.37], P=0.04), ischemic ulcer (OR, 2.84[95%CI, 2.25-3.60], P<0.001), ulcer area (OR, 2.43[95%CI, 1.58-3.72], P<0.001), number of hospitalization due to the same ulcer>2 times(OR, 16.82[95%CI, 10.85-26.09], P<0.001), history of antimicrobial exposure(OR, 5.86[95%CI, 3.79-9.07], P<0.001), use of third generation cephalosporins (OR, 5.15[95%CI, 3.51-7.56], P<0.001), complicated osteomyelitis(OR, 7.22[95%CI, 4.45-11.69], P<0.001), diabetic nephropathy(OR, 1.41[95%CI, 1.12-1.76], P=0.003), and anemia(OR, 3.18[95%CI, 2.04-4.95], P<0.001). Conclusion Risk of MDRO infection is higher in DFU patients with long course of foot ulcer, ischemic ulcer, larger area of ulcer, the more times of hospitalization, history of antimicrobial use, combined osteomyelitis, diabetic nephropathy, and anemia, health care workers should identify relevant risk factors in time and take active measures to prevent the occurrence of MDRO infection.

Abstract:Objective To assess the quality of literatures about healthcare-associated infection (HAI)outbreaks in China in recent 10 years,so as to standardize the research process and reporting methods. Methods HAI outbreak and intervention literature reports published from January 1, 2007 to December 31, 2017 were searched systematically from Wan Fang Database, China National Knowledge Infrastructure (CNKI), two researchers independently screened literatures according to inclusion and exclusion criteria, data were cross-checked and extracted, quality of literature reports was evaluated according to on-line retrieval of information over a network (ORION) statement guidelines. Results A total of 166 literature reports on HAI outbreaks were included in study, with an average ORION score of 5.34. The top three provinces that published the most research were Guangdong (19 studies), Jiangsu (19 studies) and Hubei (18 studies). The top three provinces with higher quality of published study were Guangdong (17.0 points), Shaanxi (13.5 points) and Jiangsu (12.0 points). The main methodological flaws involved:the background of the study was not described in detail(80.72%), the purpose of study were not explained(87.95%), HAI outbreak-related economics research was not carried out (100%) and so on. Conclusion In the past 10 years, literature reports on HAI outbreaks in China are not standardized, and there is much room for quality improvement.

Abstract:Objective To investigate the causes of healthcare-associated infection(HAI) outbreak caused by extensively drug-resistant Acinetobacter baumannii (XDR-AB) in intensive care unit (ICU) of a hospital, and find out the sources and routes of transmission, so as to provide evidence for the prevention and control of HAI. Methods Epidemiological investigation of patients with XDR-AB infection and environmental hygiene monitoring on ICU of a hospital from January to February 2018 were carried out, comprehensive measures were taken to control the outbreak. Results XDR-AB infection occurred in 10 patients in ICU in a short period of time, antimicrobial susceptibi-lity testing results of AB isolated from B08, C08 and A02 beds were the same, which was a suspected clone, antimicrobial susceptibility testing results of AB isolated from C09, B09 and A03 beds were the same, which was another suspected clone. Through environmental hygiene monitoring, similar AB clones were isolated from the specimens of infusion pump, bedside table, bedside rail, infusion tower, nursing table, monitor, rack for hand disinfectant, equipment tower, hand-operated handle at the end of bed, and health care workers' paraphernalia. No new XDR-AB infection occurred after comprehensive control measures were taken, no drug-resistant AB was isolated from environment and health care workers' hands on March 5. Conclusion Poor hand hygiene of health care workers and incomplete environmental disinfection in ICU are the main causes for the outbreak of HAI.

Abstract:Objective To explore the effect of quality control circle (QCC) activities on reducing pulmonary infection in patients with severe craniocerebral injury. Methods Patients with severe craniocerebral injury and treated in the neurosurgery department of a hospital were selected for research, patients who were hospitalized from February 2016 to March 2017 were in pre-intervention group, QCC activities were initiated from April 2017, and patients who were hospitalized from April 2017 to May 2018 were in post-intervention group. Incidence of pulmonary infection and satisfaction for nursing service in patients as well as duration of antimicrobial use in patients with pulmonary infection were compared between two groups. Results A total of 224 patients with severe craniocerebral injury were investigated, each group were 112 cases. Incidence of pulmonary infection in post-intervention group was lower than pre-intervention group (21.42% vs 47.32%), duration of antimicrobial use in post-intervention group was shorter than pre-intervention group ([6.45±1.65] d vs[13.02±2.46] d), satisfaction for nursing service in post-intervention group was higher than pre-intervention group (82.14% vs 63.39%), difference were all statistically significant (all P<0.05). Conclusion Application of QCC is helpful to reduce the incidence of pulmonary infection in patients with severe craniocerebral injury, and has a good effect on promoting the recovery of patients and improving nursing satisfaction.

Abstract:This article systematically reviews the current situation of quality management,cleaning and sterilization of loaner medical devices at home and abroad, and compares the differences between them. All levels of medical institutions in China attach importance to the management of loaner medical devices, but management links and details need to be improved, medical institutions should incorporate loaner medical devices into procedural management of hospital, standardize the behavior of suppliers, attach importance to the quality management of devices in various processes and links, learn from foreign advanced management concepts and disposal methods, and improve management quality of loaner medical devices in China, effectively control healthcare-associated infection to ensure safety of patients.