Abstract:Objective To analyze the clinical characteristics, infectious complications and prognosis of patients with eosinophilic granulomatosis with polyangiitis (EGPA). Methods Basic data, clinicopathological data, laboratory examination, as well as treatment and prognosis of newly diagnosed EGPA patients in Xiangya Hospital of Central South University from January 2010 to April 2019 were retrospectively analyzed. According to positive and negative antineutrophil cytoplasmic antibody (ANCA), well as infection occurrence during treatment process, patients were divided into infection group and non-infection group, differences between two groups were compared. EGPA patients were followed up to evaluate the treatment response and survival status. Results Among 25 patients, 12 cases (48.0%) had allergic rhinitis and asthma, 15 (60.0%) had fever and/or muscle pain, 17 (68.0%) had nervous system involvement, and 17 (68.0%) had renal involvement. ANCA was positive in 8 patients (32.0%),incidence of fever and muscle pain in ANCA positive group was higher, but there was no significant difference between two groups (P>0.05). 15 patients had infection, among which 11 cases were lung involvement. Pathogens were isolated from sputum culture of 5 patients with pulmonary infection, predominantly were bacteria. Compared with patients in non-infection group, patients in infection group had higher levels of serum globulin when EGPA was diagnosed (P<0.05). One EGPA patients didn't receive immunosuppressive therapy, 1 received simple immunosuppressive therapy, 7 received simple glucocorticoid therapy, and 16 (64%) received glucocorticoid combined immunosuppressive therapy, 3 of whom received plasma exchange and 1 received gamma-globulin therapy. During the follow-up, 10 cases were lost to follow-up, the median follow-up time of the other 15 cases was 35 (9-70.5) months, all of them survived up to the last follow-up, 6 cases (24.0%) still had asthma symptom, and 12 cases (48.0%) still needed oral glucocorticoid therapy. Conclusion Clinical manifestations of EGPA are complex and diverse, involving multiple organs and systems of the whole body, incidence of infection is high during the treatment process, the most common lesion site is lung, bacteria is the main pathogen.

Abstract:Objective To analyze all-causes of death, survival time and influencing factors of human immunodeficiency virus-infected/acquired immunodeficiency syndrome (HIV-infected/AIDS) patients in Yuxi City, Yunnan Province from 1995 to 2018. Methods Retrospective cohort study was conducted, survival rate was calculated by life table method, influencing factors for survival time was analyzed by Cox proportional hazard model. Results 4 445 HIV-infected/AIDS patients were included in the cohort, the median follow-up time was 5.2 years (IQR:2.1-9.1), 1 054 of whom died, opportunistic infection was the main cause of death, followed by drug overdose and other cardiovascular diseases, the all-cause mortality was 4.00 (95% CI:3.76-4.25)/100 person-years, median survival time was 17.83 years (95% CI:15.81-19.86), and cumulative survival rates at 1, 5, 10, 15 and 20 years were 0.89, 0.78, 0.65, 0.46 and 0.26, respectively. Cox multivariate model showed that the risks for death were as follows:men was 1.423-fold of women, 30-, 40-, 50-and ≥ 60 years old groups were 1.677-, 2.171-, 3.096-and 5.150-fold of 15-year groups, other ethnic groups was 1.170-fold of Han nationality, divorced or widowed people was 1.214-fold of unmarried people, heterosexual transmission, transmission of injecting drug use, and other transmission were 1.769-, 3.326-and 2.532-fold of men who had sexual with men respectively, the specimen sources of premarital/pregnancy/prenatal check-up, supervision place, medical institution detection and other examination were 0.575-, 0.432-, 1.413-and 0.591-fold of voluntary consultation examination respectively, at the present stage, the course of disease of HIV-infected person was 1.561-fold of AIDS patients, the baseline CD4⁺ cell levels of 200-, <200 cells/μL and unknown groups were 1.363-, 2.180-and 3.638-fold of ≥ 500 cells/μL group respectively, patients who didn't receive antiretroviral therapy (ART) was 10.410-fold of those who had received ART. Conclusion The survival time of HIV-infected/AIDS patients is affected by multiple factors, it is necessary to strengthen the early detection and treatment, pay attention to non-AIDS related death causes, and give corresponding intervention, so as to prolong the survival time of HIV-infected/AIDS patients.

Abstract:Objective To explore the effect of incentive breathing training combined with oral decontamination on postoperative pneumonia (POP) in elderly patients with gastric cancer. Methods Elderly patients undergoing radical gastrectomy for gastric cancer at the Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine from January 2019 to June 2020 were prospectively collected and randomly divided into experimental group and control group. Control group received routine care during peri-operative period, experimental group used incentive spirometer training combined with chlorhexidine oral decontamination on the basis of routing care. Incidence of POP, oral and pharyngeal bacterial colonization and other indicators in two groups of patients were analyzed. Results A total of 96 elderly patients with gastric cancer were included, 48 cases in experimental group and 48 in control group. 13 patients (13.54%) had POP. Incidence of POP in patients in experimental group was 6.25%, which was lower than 20.83% in control group, with a significant difference (P<0.05). After intervention, isolation rate of oral-pharyngeal colonized bacteria in experimental group was lower than that in control group (6.25% vs 20.83%, P<0.05); after intervention, 6-minute walking test and compliance to respiratory training in patients in experimental group were both higher than control group (both P<0.05); duration of intra-operative mechanical ventilation, postoperative hospital stay, cost of antimicrobial agents and total hospitalization expenses in experimental group were all lower than those in control group (all P<0.05). Conclusion Peri-operative incentive breathing training and oral decontamination in elderly patients with gastric cancer can help to improve exercise tolerance, reduce respiratory tract microbial colonization, decrease incidence of POP, and promote recovery of patients.

Abstract:Objective To investigate the occurrence of healthcare-associated infection (HAI) after different types of neurosurgical operations in a tertiary first-class hospital, and provide ideas and basis for the monitoring, prevention and control of neurosurgery-related HAI. Methods Neurosurgery-related information of patients in department of neurosurgery of this hospital from January 1, 2016 to December 31, 2018 were analyzed retrospectively. Results A total of 6 688 neurosurgical patients were investigated, incidence of HAI was 8.22%, incidence of surgical site infection (SSI) was the highest (5.40%), followed by postoperative pneumonia (POP, 1.91%). There were significant differences in the incidence of HAI, SSI, POP, other site infection and organ cavity infection among diffe-rent types of operations (all P<0.05), after intracranial tumor resection and intracranial vascular intervention, incidence of HAI (11.35% and 8.46% respectively) and organ cavity infection (7.39% and 4.01% respectively) were higher. There were significant differences in the incidence of HAI, SSI, POP, and organ cavity infection among different types of intracranial tumor resection (all P<0.05), after neuroepithelial tumors and craniopharyngioma operation, incidence of HAI (23.19% and 20.79% respectively) and organ cavity infection (17.27% and 12.87% respectively) were higher. 74 strains of pathogens were isolated from cerebrospinal fluid, including 54 strains of Gram-positive bacteria, 19 strains of Gram-negative bacteria and 1 strain of fungus. Conclusion Incidence of HAI in different types of neurosurgical operation is quite different, in the case of limited resources, the monitoring of HAI needs to be focused on the surgical types with high incidence of HAI.

Abstract:Objective To investigate the therapeutic efficacy and side effect of polymyxin B-based combination therapy for the treatment of severe pneumonia caused by extensively drug-resistant Acinetobacter baumanii (XDR-AB)and XDR Klebsiella pneumoniae (XDR-KP), and provide support for clinicians in the treatment of severe pneumonia caused by XDR bacteria. Methods Patients who were admitted to the department of critical care medicine of a hospital from April 1, 2018 to April 30, 2019 and received polymyxin B-based combination therapy for pathogenic confirmed extensively XDR-AB and XDR-KP severe pneumonia were selected as research objects. Therapeutic efficacy, microbial treatment efficacy, liver and kidney function damage, pigmentation of skin and other side effects were observed. Results A total of 24 patients with XDR bacterial severe pneumonia were selected, 26 times of treatment were conducted, clinical therapeutic effective rate was 73.1%. A total of 139 sputum cultures were sent for examination, 138 times of antimicrobial susceptibility results showed that bacteria were sensitive to polymyxin B (MIC 0.5-1 μg/mL), only one time was resistant to polymyxin B (MIC=8 μg/mL). Bacterial clearance rate of Acinetobacter baumannii was higher than that of Klebsiella pneumoniae (60.9% vs 7.7%), difference was statistically significant (P=0.004). Incidence of acute kidney injury (AKI) was 42.3%, only one patient ended treatment in advance because of renal function damage; renal function of the survival patients with AKI (survival rate 60.0%) all recovered to normal, incidence of pigmentation of skin was 20.8%, drug-related liver damage and other complications were not found. Conclusion Efficacy of polymyxin B-based combination therapy for XDR-AB and XDR-KP severe pneumonia is high, although strains are sensitive to polymyxin B, bacterial clearance rate is relatively low, polymyxin B has certain nephrotoxicity, and the renal damage of patients who survived after active treatment of primary disease is generally reversible.

Abstract:Objective To understand the isolated strains and antimicrobial susceptibility testing results of strains from hospitalized patients before the first therapeutic use of antimicrobial agents, provide reliable microbiological basis for rational use of antimicrobial agents. Methods Based on the data in antimicrobial clinical decision support system as well as isolated strains and antimicrobial susceptibility testing results in laboratory information system in a hospital, clinically isolated strains before the first therapeutic use of antimicrobial agents after patients' admission and strains isolated from all clinical specimens during patients' hospitalization period from 2015 to 2018 were collected, distribution and drug resistance of bacterial strains before and after antimicrobial use were compared. Results From 2015 to 2018, 69 037 non-repetitive strains (including bacteria and fungi) were isolated from all specimens of hospitalized patients, including 17 900 (25.93%) strains of Gram-positive bacteria, 44 055 strains (63.81%) of Gram-negative bacteria and 7 082 strains (10.26%) of fungi. 15 017 non-repetitive strains were isolated from specimens collected before the first therapeutic use of antimicrobial agents after patients' admission, 4 661 strains (31.04%) of which were Gram-positive bacteria, 9 451 (62.93%) were Gram-negative bacteria and 905 (6.03%) were fungi. The top 5 isolated strains from specimens before therapeutic antimicrobial use were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa and coagulase negative Staphylococcus, the top 5 isolated strains from all specimens were Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Candida spp. and Escherichia coli; the proportion of fastidious bacteria such as Streptococcus spp., Haemophilus influenzae and Moraxella catarrhalis was lower among all detected specimens. The common clinical isolates included Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii. Drug resistance rates of strains from specimens after antimicrobial therapy were higher. Conclusion This study is the first report of clinically isolated strains from large sample before the first therapeutic use of antimicrobial agents, the common clinical isolates include Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, specimens shows higher drug resistance after antimicrobial therapy.

Abstract:Objective To investigate the distribution and antimicrobial resistance difference of Klebsiella pneumoniae (KP) causing healthcare-associated infection (HAI) and community-associated infection (CAI) in a tertiary first-class hospital for three consecutive years, and provide evidence for rational use of antimicrobial agents in clinical practice. Methods KP isolated from hospitalized patients with CAI and HAI between November 2016 and October 2019 were retrospectively analyzed, constituent ratio and antimicrobial resistance difference of KP in different departments and different specimen sources were compared, change trend of antimicrobial resistance was analyzed. Results A total of 1 104 strains of KP were isolated, including 410 strains in HAI group and 694 in CAI group. KP in both groups were mainly isolated from sputum specimens, and the main department was intensive care unit. Except that the resistance rates of KP to tigecycline were both 0 in two groups, resistance rates to other antimicrobial agents in HAI group were all higher than those in CAI group (all P<0.05). Antimicrobial resistance rates of KP in CAI group were all <30%, resistance rates of KP to ceftriaxone and compound sulfamethoxazole in HAI group were more than 50%, resistance rate to imipenem was 18.54%. By trend χ² test, resistance rates of KP to ceftria-xone, cefepime, cefoxitin, cefoperazone/sulbactam, imipenem, amikacin, tobramycin, levofloxacin, and ciprofloxacin in HAI group all showed an upward trend (all P<0.05); resistance rates of KP to piperacillin/tazobactam, cefoxitin, cefoperazone/sulbactam, imipenem, and ciprofloxacin showed an upward trend in CAI group (all P<0.05), while resistance rate to gentamicin showed a downward trend (P=0.004). Conclusion Antimicrobial resis-tance rates of KP in HAI are higher than those in CAI, resistance rates to multiple antimicrobial agents in HAI group increase year by year, KP HAI and CAI should be treated differently.

Abstract:Objective To analyze carrying status of drug-resistant genes of clinically isolated imipenem-resistant Acinetobacter baumannii (IRAB) in a hospital, provide laboratory basis for prevention and control as well as gui-dance for clinical treatment of HAI. Methods Polymerase chain reaction (PCR) was used to detect carrying status of carbapenem-resistant genes (blaIMP, blaKPC, blaNDM-1, blaOXA-23, blaOXA-50, blaOXA-51, and blaOXA-58), aminoglycoside-resistant genes (ant[3"]-Ⅰ, aac[6']-Ⅰ, armA) and disinfectant-resistant gene qacE△1 of 26 clinically isolated IRAB strains in this hospital. Results 26 strains of IRAB all carried carbapenem-resistant genes OXA-23 and OXA-51,detection rate was 100%,other carbapenem-resistant genes were not found. The detected rates of aminoglycoside-resistant genes ant (3")-Ⅰ, aac (6')-Ⅰand armA were all 96.15%, the carrying rate of disinfectant-resistant gene qacE△1 was 65.38%. 92.31% of clinically isolated IRAB strains were from sputum of patients. Conclusion The majority of clinically isolated IRAB strains in this hospital carry the same carbapenem-resistant gene and aminoglycoside-resistant gene, it is necessary to strengthen the prevention and control measures of HAI.

Abstract:Objective To understand the transmission mode of patients with different sites of Clostridium perfringens (C. perfringens) infection as well as prevention and control measures of healthcare-associated infection (HAI). Methods Clinical information, HAI prevention and control measures and environmental sampling results of three patients with different sites of C. perfringens infection in a hospital were retrospectively collected, and rela-ted literature was reviewed for analysis and summary. Results Three cases of C. perfringens infection were gas gangrene of pelvic cavity, liver abscess, and bloodstream infection. C. perfringens was isolated from air-returning outlet (fence + filter screen) of negative pressure laminar flow operating room and negative pressure laminar flow ward of a patient, environmental hygiene detection results of the other 2 cases were normal. Conclusion It is necessary to strictly carry out environmental cleaning, disinfection and isolation for patients infected with C. perfringens, long distance dissemination of C. perfringens from infected sites of patients with gas gangrene can be produced, it is recommended to use independent non-laminar flow operating room, patients with infection at other sites can be isolated in a single room or shared room with patients of the same disease.

Abstract:Objective To compare the differences of two sampling tools used for active screening on nasal bacterial carriage of health care workers (HCWs), evaluate colonization of multidrug-resistant organisms (MDROs) in the nasal cavity of HCWs in department of neurosurgery, and provide basis for the prevention and control of MDROs. Methods In July 2019, 110 HCWs in department of neurosurgery of a hospital were selected as the research objects, their nasal bacterial carriage was actively screened. 0.85% normal saline sampling tube (sponge swab) was used for the left nostril of HCWs, disposable nasal swab (cotton swab) was used for right nostril, sampling result of two tools was compared. The isolated MDROs were performed drug resistance analysis and decolonization, bundle intervention measures were taken in the ward, effect before and after the intervention was compared. Results There are 110 HCWs, including 31 doctors, 66 nurses, 7 attendants, 6 further-traning students and normative training of resident physicians participated in study. A total of 46 strains of bacteria were isolated, 10 of which were MDROs, isolation rates of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter baumannii (CRAB) were 8.18% and 0.91% respectively, carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus were not found. The specimens collected by two sampling methods were cultured for 24 hours, 48 hours and 72 hours, there were no significant differences in colony detection and semi-quantitative results between two groups (both P>0.05); there were significant differences in the sampling time, success rate of single collection, loss rate of consumables and staff's satisfaction between two sampling methods (all P<0.05). Cotton swab method was better than sponge swab method, and the cost was lower. Nine strains of MRSA had high resistance to erythromycin and clindamycin, drug susceptibility spectrum of 2 strains isolated from nurses were identical. After taking preventive and control measures, 8 HCWs with positive MRSA all turned negative, infection rate and isolation rate of MDROs, including MRSA and CRAB in wards decreased compared with those before intervention (P<0.05). Conclusion Colonization rate of MRSA in the nasal cavity of HCWs in department of neurosurgery is high, detection results of bacteria with normal saline sampling tube and disposable nasal swab are almost the same, from the comprehensive consideration of various aspects, especially cost-effectiveness, cotton swab is better than sponge swab. It is suggested to monitor bacterial colonization in nasal cavity of HCWs in key departments, timely de-colonize, and strengthen the comprehensive prevention and control measures with contact isolation as the core measure, so as to effectively reduce the incidence of MDROs colonization rate in HCWs.

Abstract:Objective To evaluate changes of main performance indicators of surgical masks after simulated reuse cleaning and disinfection. Methods Particle filtration efficiency (PFE) and bacterial filtration efficiency (BFE) were used as the key performance indicators of surgical masks, experimental conditions such as different wearing time, different drying methods as well as different washing methods were verified. Results The key performance indicators of surgical mask after experiment met the standard requirements. Conclusion After water washing, 56℃ hot water immersion and 100℃ boiling water immersion, the main performance indicators of surgical masks don't decrease significantly.

Abstract:Objective To investigate the continuous use time of water injection bottles. Methods Five sets of water injection bottles in the endoscopy center of a tertiary first-class hospital in Chongqing was monitored through prospective study, sterile water was injected into the water injection bottles from July 2019 to November 2019, water was collected for microbiological test on the 1st, 2nd, 3rd, 4th and 5th days after diagnosis and treatment every day, bacterial species and qualified rate of bacterial colony count in water injection bottle was monitored. Results Qualified rates of bacterial colony count on the 1st, 2nd, 3rd, 4th, and 5th days were 96.0%, 82.0%, 76.0%, 70.0%, and 38.0% respectively, difference was statistically significant (P<0.001). A total of 69 strains of bacteria were isolated, all were opportunistic pathogens, among which 29 strains were Ralstonia mannitolilytica and 10 strains were Pseudomonas aeruginosa. Conclusion Medical institutions should pay more attention to the microbial contamination of water for endoscopic diagnosis and treatment, water injection bottles have become a potential source of water contamination, in order to reduce potential risk of endoscopic diagnosis and treatment, continuous use of water injection bottles should not exceed one day.

Abstract:Objective To understand the anxiety and depression status of patients with coronavirus disease 2019 (COVID-19), explore appropriate nursing intervention mode of COVID-19 patients. Methods COVID-19 patients who were admitted in The Fifth Medical Center of PLA General Hospital between January 23 and February 10, 2020 were chosen for studied objects. Anxiety and depression score in patients were assessed by self-rating anxiety scale (SAS) and self-rating depression scale (SDS), nursing intervention measures were formulated and therapeutic efficacy was evaluated. Results A total of 40 patients were admitted, 10 of whom (25.00%) had anxiety, the average score of SAS was (42.94±8.33). 14 cases (35.00%) had depression, the average score of SDS was (46.41±13.37). The scores in anxiety and depression of patients were higher than the norm, difference was statistically significant (P<0.05). Score in anxiety of female patients was significantly higher than that of male patients (P=0.02). Scores in anxiety and depression of patients of different age and educational level were not significantly different (both P>0.05). After taking nursing intervention, the average score of SAS and SDS were (37.94±5.67) and (39.93±8.55) respectively, which decreased significantly compared with the score before taking nursing intervention (both P<0.05). Conclusion Anxiety and depression of COVID-19 patients are more serious than general population, effective nursing intervention can significantly reduce anxiety and depression, long term nursing intervention needs to be continued.

Abstract:Objective To evaluate the application effect of flipped classroom model in the course design system of healthcare-associated infection (HAI), so as to provide scientific basis for the combination of various teaching modes in the teaching course of HAI. Methods 116 students of 5-year program in Changzhi Medical College were selected as the research objects and were randomly assigned to experimental group and control group respectively, with 58 students in each group, control group adopted traditional classroom teaching method, experimental group adopted flipped classroom teaching method. During the clinical practice, the correctness and compliance of hand hygiene (HH) implementation were observed; questionnaires were used to evaluate the satisfaction degree of flipped classroom teaching mode; teaching effect was evaluated by testing. Results Students' total satisfaction degree with flipped teaching method was 63.79%. There was no significant difference in the correct rate of HH between flipped classroom mode and traditional teaching mode (P>0.05), but there were significant differences in the compliance rate of HH (88.05% vs 47.91%), passing rate of disinfection and isolation technology (86.21% vs 48.28%), as well as passing rate of occupational exposure protection (84.48% vs 36.21%) (all P<0.05). Conclusion Flipped classroom model has a high target achievement rate in the teaching course of HAI.

Abstract:目的 对医务人员个人防护用品（PPE）脱卸操作过程中的失误情况进行监测与评估，以确保医务人员在救治工作中的防护安全。方法 选取2020年1月26日—2月2日在武汉金银潭医院及2020年3月1—25日在武汉火神山医院的医务人员，调查医务人员在脱卸PPE操作过程中的失误情况。设计并采用"4G网络传输+云通话平台"的医院内局域网信息化、动态化感控监测模式，用可视监控系统实现24 h对医务人员PPE脱卸操作的实时监控指导，语音互动提醒防护安全操作。结果 共监测12个类别52个项目，共2 120人次，发现操作失误190人次，失误率为8.96%。失误率位于前5位的操作分别为：脱隔离衣（2.74%，未包裹好、提前解带、后背未遮盖、脱衣时污染等）、摘护目镜（1.65%，脱落、污染、乱撤）、脱防护服（1.60%，翻卷不倒位、与鞋套手套一次脱完、跌倒）、脱口罩（0.80%，未取、污染、掉下等）、手卫生（0.57%，未洗手、洗手液不够、未按操作步骤、洗手时间长、手套污染等）。金银谭医院医务人员的PPE脱卸操作失误率（9.64%）高于火神山医院（8.20%），差异有统计学意义（P<0.05）。火神山医院医务人员PPE脱卸操作失误率从2020年3月1日的60.00%下降至3月25日的5.26%。结论 医务人员PPE脱卸失误率最高的操作为脱隔离衣、摘护目镜、脱防护服。信息化监测与语音互动对医务人员完成PPE穿脱是一个值得推荐的方法。

Abstract:Vitamin D is a member of steroid hormone superfamily, in addition to its' classical function, such as regulating calcium and phosphorus metabolism as well as maintaining children's bone health,vitamin D also plays an important role in immune regulation. In recent years, a number of studies have shown that low level of vitamin D is associated with the occurrence and progress of various infectious diseases in children, vitamin D supplementation is used to treat and prevent a variety of infectious diseases in children. In this paper, the relationship between vitamin D nutritional status and infectious diseases in children as well as its anti-infection mechanism are briefly reviewed.