Abstract:Objective To understand antimicrobial resistance and distribution of virulence genes of New Delhi meta-llo-β-lactamase-1 (NDM-1)-producing Enterobacter cloacae (ECL). Methods ECL isolated from the First Affiliated Hospital of Kunming Medical University from January 2017 to November 2020 were collected, the trial group was 29 strains of NDM-1-producing carbapenem-resistant ECL (CRECL), control group was 32 strains of CRECL without producing NDM-1 and 35 strains of carbapenem-sensitive ECL(CSECL). Strains were identified and performed antimicrobial susceptibility testing with matrix assisted laser desorption ionization time-of-flight mass spectrometer(MALDI-TOF MS)and automated microbial identification system, NDM-1 resistance genes and 24 pairs of virulence genes were detected by polymerase chain reaction, change in distribution of virulence genes was compared with Chi-square test. Results Isolation rate of NDM-1 gene of CRECL strain isolated in this hospital was 47.5%, NDM-1-producing CRECL showed multiple resistance to common antimicrobial agents. Among 96 ECL strains, detection rates of virulence genes acrA, tolC, wcaA, wcaM, and wza were 80.2%, 90.6%, 87.5%, 75.0% and 92.7% respectively, detection rates of clpB, icmf, and VasD/Lip genes were also above 60%, virulence genes such as escV, nleB, pet, and hlyA were not found. Detection rates of clpB, icmf, VasD/Lip, and acrA genes in NDM-1-producing CRECL group were higher than those in CRECL group without producing NDM-1, detection rates of clpB, icmf, and VasD/Lip genes in CRECL group were higher than those in CSECL group, difference was statistically significant (P < 0.05). Conclusion Antimicrobial resistance of NDM-1-producing CRECL is severe, and the carrying rate of virulence genes also increased, antimicrobial resistance and virulence gene distribution of bacteria should be considered in clinical medication.

Abstract:Objective To explore the mechanism of resistance-nodulation-cell division (RND) efflux pump genes of multidrug-resistant Acinetobacter baumannii (MDR-AB) AYE strain in influencing biofilm formation. Methods RND efflux pump genes(adeB, adeFGH, adeIJK) of Acinetobacter baumannii AYE strain were knocked out by marker-free gene knockout method, real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) was used to verify the gene knockout of strain efflux pump genes, biofilm formation before and after gene knockout was detected by crystal violet staining, effect of 4 efflux pump inhibitors (PAβN, omeprazole, verapamil and CCCP) on biofilm formation of AYE strain was compared. Results qRT-PCR showed that RND efflux pump genes (adeB, adeFGH, adeIJK genes) of AYE strain were successfully knocked out, AYE△ adeB, AYE△ adeFGH, and AYE△ adeIJK strains were obtained, the amount of biofilm formation was 1.59±0.06, 2.15±0.19 and 1.91±0.02 respectively, the amount of biofilm formation after adeB and adeIJK gene knockout was lower than that before knockout (AYE: 2.31±0.01), difference were all statistically significant (all P < 0.05). Under the effect of PAβN, omeprazole, verapamil and CCCP, the amount of biofilm formation of standard strain AYE of Acinetobacter baumannii were 2.14±0.03, 2.24±0.02, 1.93±0.05 and 2.09±0.04 respectively, which were all lower than those in the control group (AYE: 2.31±0.01), difference was statistically significant (all P < 0.05), PAβN formation was the least. Conclusion Efflux pump genes adeB, adeFGH and adeIJK play important role in the formation of biofilm of MDR-AB AYE, efflux pump inhibitors PAβN, omeprazole, verapamil and CCCP have an inhibitory effect on biofilm formation of Acinetobacter baumannii AYE strain.

Abstract:Objective To explore the risk factors for pocket infection in patients with permanent pacemaker implantation (PPI), and construct a personalized risk prediction model. Methods Retrospective cohort study method was adopted to analyze clinical data and follow-up data of patients who received PPI in the department of cardiovascular diseases of a tertiary first-class hospital in Anhui Province from January 2016 to May 2018. According to the occurrence of pocket infection one year after operation, patients were divided into infection group and non-infection group. Independent risk factors for post-operative pocket infection in patients with PPI were analyzed with lasso regression and logistic regression analysis. Results A total of 322 patients with PPI were included in analysis, incidence of post-operative pocket infection was 7.45% (n=24). Lasso regression and multivariate logistic regression model analysis results showed that age, duration of operation, operation times and poor wound healing were independent risk factors for post-operative pocket infection (all P < 0.05). The constructed nomogram model was internally verified by Bootstrp self-sampling for 1 000 times, after internal verification, C-statistic of nomogram model was 0.869 (95%CI: 0.773-0.947), suggesting that the nomogram has good discrimination. Calibration curve analysis showed that the average absolute error between prediction probability of nomogram model and the actual occurrence of PPI in patients was 0.018, which indicated that nomogram has a good calibration degree. Decision curve analysis (DCA) showed that when probability threshold of nomogram model was 0.03-0.62, clinical net benefit rate of patients was the highest, which indicated that nomogram model had better clinical applicability. Conclusion The occurrence of post-operative pocket infection in patients with PPI is affected by multiple risk factors, nomogram can integrate the risk factors for post-operative pocket infection and be used to personalized prediction of risk of post-operative pocket infection in patients, which has high clinical application value.

Abstract:Objective To identify the risk factors for intra-abdominal infection (IAI) and establish a prediction model that can accurately predict IAI after anterior resection of rectal cancer. Methods Clinical and pathological data of patients who underwent anterior resection of rectal cancer in department of gastrointestinal surgery of a hospital from December 2017 to September 2020 were collected retrospectively, independent risk factors after anterior resection of rectal cancer were screened out by univariate analysis and multivariate logistic regression analysis. Based on the independent risk factors, nomogram risk prediction model was established, and performance of the model was evaluated. Results A total of 247 patients undergoing anterior resection of rectal cancer were included in the study, 32 patients developed IAI, with an infection rate of 13.0%. Univariate and multivariate logistic regression analysis showed that diabetes mellitus (OR=4.430, 95%CI: 1.177-16.668, P < 0.05), operation time ≥ 180 minutes (OR=5.502, 95%CI: 1.459-20.752, P < 0.05), post-operative anastomotic fistula (OR=18.171, 95%CI: 4.756-69.416, P < 0.05), and post-operative pulmonary infection (OR=7.689, 95%CI: 2.143-27.593, P < 0.05) were independent risk factors for IAI after anterior resection of rectal cancer. Nomogram prediction model was established based on above results, calibration curve showed that predicted occurrence probability of the nomogram model was consistent with the actual occurrence probability, C-index value calculated by Bootstrap method was 0.945, indicating a good degree of differentiation, the area under ROC curve was 0.945 (95%CI: 0.871-0.971), and decision analysis curve showed high value. Conclusion Nomogram prediction model based on the independent risk factors of IAI after anterior resection of rectal cancer in patients can directly predict the occurrence probability of post-operative IAI.

Abstract:Objective To analyze the clinical characteristics and influencing factors for prognosis of patients with severe fever with thrombocytopenia syndrome (SFTS) in Dalian, and provide reference for early treatment to reduce mortality. Methods 112 cases of SFTS in Dalian Center for Disease Control and Prevention from 2018 to 2020 were collected, including 79 survival cases and 33 death cases, clinical characteristics, laboratory indicators and prognostic factors of SFTS patients in survival group and death group were analyzed. Results A total of 112 patients were included in analysis, mortality was 29.5%. There were significant difference in age, diabetes mellitus, hypertension, atrial fibrillation, and length of hospital stay between survival group and death group (all P < 0.05). In clinical symptoms, the proportion of early neurological symptoms and bleeding in death group was higher than that in survival group; in laboratory indicators, including calcium ion, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatinine, urea nitrogen, prothrombin time, prothrombin activity, albumin, platelet, C-reactive protein, and virus load, difference between death group and survival group were all statistically significant (all P < 0.05). Multivariate logistic regression analysis showed that viral load, neurological symptoms, bleeding and creatine kinase>170 U/L can be used to predict the prognosis of SFTS patients. Conclusion The mortality of SFTS patients in Dalian is high, viral load, early neurological manifestations, bleeding and early creatine kinase >170 U/L can be used as prognostic indicators. Whether the cause of high mortality of SFTS patients in Dalian is related to the difference of virus strain and virulence, as well as clinical treatment needs to be further studied.

Abstract:Objective To evaluate the efficacy of intermittent urethral catheterization based on safety bladder capacity for the prevention of neurogenic bladder-related urinary tract infection. Methods Patients with neurogenic bladder after spinal cord injury or cauda equina nerve injury in a hospital from January 2017 to December 2018 were selected and randomly divided into intervention group and control group according to random number table method. Control group was given routine intermittent urethral catheterization, catheterization frequency was based on post-void residual urine volume. Intervention group was given intermittent urethral catheterization, and catheterization frequency was based on the safety bladder capacity. Urinary tract infection rate, bacterial colony count and constituent, adverse reactions, post-void residual urine volume, as well as safety bladder capacity and detrusor wall thickness were compared between two groups of patients. Results A total of 120 patients were included in study, 60 in intervention group and 60 in control group, one patient in intervention group withdrew catheterization because he could not complete treatment course. Urinary tract infection rate in intervention group was lower than that in control group (10.17% vs 28.33%, χ²=6.295, P=0.012);the number of bacterial colonies in urine culture in intervention group was significantly lower than that in control group ([4.71±0.13] lg CFU/mL vs[4.99±0.25] lg CFU/mL, t=2.538, P=0.019); Gram-negative bacteria were main pathogens isolated from urine culture of both groups. After 8 weeks, post-void residual urine volume and detrusor wall thickness in intervention group were both lower than those in control group (t=2.323 and 3.412, respectively, both P < 0.05); safety bladder capacity in intervention group was significantly higher than that in control group (t=2.496, P=0.014). There was no significant difference in adverse reactions between two groups of patients (P>0.05). Conclusion Intermittent urethral catheterization based on safety bladder capacity can reduce neurogenic bladder-related urinary tract infection rate after spinal cord injury.

Abstract:Objective To investigate the expression significance of microRNA-155 (miR-155) in peripheral blood of children with Mycoplasma pneumoniae pneumonia (MPP). Methods Children with MPP who admitted to a hospital from December 2016 to June 2019 were selected and divided into common MPP group (CMPP group) and refractory MPP group (RMPP group), according to whether there was extrapulmonary injury, children with RMPP were divided into extrapulmonary injury group and non-extrapulmonary injury group; miR-155, interferon-γ (IFN-γ) and interleukin-4 (IL-4) in peripheral blood of children in different groups were detected and compared. Results There were 136 children with MPP, 80 in CMPP group and 56 in RMPP group; among children with RMPP, there were 25 cases in extrapulmonary injury group and 31 in non-extrapulmonary injury group. Levels of IFN-γ, IL-4 and miR-155 in RMPP group were higher than those in CMPP group, IFN-γ/IL-4 was lower than those in CMPP group, differences were all statistically significant (all P < 0.05); miR-155 level and IFN-γ/IL-4 in RMPP group was negatively correlated (r=-0.307, P=0.021); the area under the receiver operating characteristic (ROC) curve of miR-155 for diagnosis of RMPP was 0.742, and miR-155 was an independent influencing factor for RMPP; compared with the non-extrapulmonary injury group, levels of IL-4 and miR-155 in extrapulmonary injury group increased, and IFN-γ/IL-4 decreased, differences were all statistically significant (all P < 0.05); the level of miR-155 and IFN-γ/IL-4 in extrapulmonary injury group was not correlated (P>0.05); the area under the ROC curve of miR-155 for the diagnosis of RMPP complicated with extrapulmonary injury was 0.724, and miR-155 was an independent risk factor for RMPP complicated with extrapulmonary injury. Conclusion miR-155 is highly expressed in peripheral blood of children with RMPP, which is closely related to T lymphocyte balance, and has certain diagnostic value for the diagnosis of RMPP and the early identification of extrapulmonary injury.

Abstract:Objective To explore the risk factors for pulmonary infection (PI) in acute stage of cervical spinal cord injury (CSCI). Methods Clinical data of 108 patients with CSCI (C1-C8 spinal cord injury) were analyzed retrospectively, according to whether PI occurred within 1 month after disease onset, patients were divided into PI group and non-PI group. Basic condition, injury type and relevant laboratory examination of two groups of patients were analyzed. Results Of 108 patients, 55 had PI, incidence of PI was 50.9%. Univariate analysis showed that low hemoglobin level, ASIA grade, hyponatremia and ventilator-assisted ventilation may be the influencing factors for PI in patients with CSCI (all P < 0.05). Multivariate logistic regression analysis showed that ASIA grade (OR=0.399, 95%CI: 0.227-0.702, P=0.001), ventilator-assisted ventilation (OR=77.564, 95%CI: 8.587-700.595, P < 0.001), and serum sodium ion level (OR=0.839, 95%CI: 0.735-0.958, P=0.009) were risk factors for PI in patients with CSCI. Conclusion ASIA grade A or B, ventilator-assisted ventilation and hyponatremia are independent risk factors for PI in patients with CSCI.

Abstract:Objective To explore the intervention efficacy of antimicrobial stewardship (AMS) on antimicrobial prophylaxis during peri-operative period of digestive endoscopy of patients. Methods A total of 1 006 patients who underwent digestive endoscopy in a hospital from January to June 2019 were included in the study, AMS strategy was adopted to manage antimicrobial prophylaxis during peri-operative period, these measures included establishing organization, improving policies, optimizing hospital information system, conducting education and training, as well as performing continuous intervention and supervision. 822 patients who underwent digestive endoscopy from January to June 2017 were as control group, changes in peri-operative prophylactic antimicrobial use rate, antimicrobial use density (AUD), as well as varieties, combination use and duration of antimicrobial use between two groups of patients were compared and analyzed; irrational use of antimicrobial agents and post-operative infection between two groups were also compared. Results Prophylactic antimicrobial use rate before and after intervention were 24.82% (204/822) and 17.10% (172/1 006) respectively, difference before and after intervention was statistically significant (P < 0.001); AUD was 2.18 after intervention, which was lower than 14.95 before intervention; proportion and duration of combined medication were also significantly lower than those before intervention. After the implementation of AMS strategy, irrational use rate of antimicrobial agents was lower than that before the implementation (P < 0.001); there was no significant change in the incidence of infection after operation (P>0.05). Conclusion AMS strategy can optimize antimicrobial prophylaxis during peri-operative period of digestive endoscopy.

Abstract:Objective To observe the occurrence of scratches in flexible endoscopic forceps channel, evaluate scratches on the quality of endoscopic reprocessing. Methods The lumens of 162 reprocessed endoscopic forceps channel in a general hospital were investigated, the occurrence of scratches in endoscopic forceps channel was observed with borescope, microorganisms in the lumen were detected, lumen with severe scratches and unqualified result of repeated culture was dismantled, scratch condition was observed under scanning electron microscope. Results Of 162 endoscopic forceps channels, 91.36% (n=148) had scratches, among which the black scratches accounted for 18.24%(27/148), the unqualified rate of microbial detection was 18.52%(5/27); yellow scratches accounted for 6.76%(10/148), the unqualified rate of microbial detection was 20.00%(2/10). After dismantling a severely scratched endoscopic forceps channel that was unqualified in repeated microbial detection, crisscross biofilms were observed under the scanning electron microscope. Conclusion Incidence of scratches in endoscopic forceps channel is high, which creates a good growth environment for the biofilm, affects the quality of endoscopic reprocessing. It is suggested to use the borescope to check the scratches in the forceps channel regularly, and to conduct microbial surveillance regularly.

Abstract:Objective To analyze the clinical features of nocardiosis, so as to provide experience for the diagnosis and treatment of nocardiosis. Methods Clinical data of 13 patients with nocardiosis in Sichuan Provincial People's Hospital from January 2016 to November 2020 were analyzed retrospectively. Results Among 13 patients, there were 5 cases of pulmonary infection, 2 cases of central nervous system infection, 4 cases of skin infection, 1 case of disseminated infection and 1 case of suppurative arthritis. 12 patients had underlying diseases, mainly bronchiectasis, autoimmune diseases, diabetes mellitus, and hypertension. All patients had increased leukocytes and C-reactive protein (CRP), only 3 patients detected procalcitonin (PCT), and PCT all decreased. Pathogenic examination results were Nocardia brasiliensis. Nine patients received compound sulfamethoxazole alone or in combination, 3 patients received levofloxacin alone, and 1 patient with disseminated infection received carbapenems combined with linezolid. Brain abscess and skin infection are treated surgically, operation or debridement. All 12 patients improved, and only 1 patient with suppurative meningitis aggravated. Conclusion Nocardiosis mainly includes pulmonary infection, central nervous system infection, skin infection and disseminated infection, patients with bronchiectasis or autoimmune diseases are more likely to be infected.

Abstract:Cat-scratch disease (CSD) is an infectious disease caused by the invasion of Bartonella henselae into the human body, its clinical manifestations are varied, and neurological manifestations are relatively rare, which is easy to be misdiagnosed. A 45-year-old male was admitted to a hospital with "right groin mass gradually increased for 10 days, limb numbness and weakness for 2 days". During the course of disease, patient developed fever, enlarged right inguinal lymph nodes, symmetrical paralysis of both lower extremities and sensory disturbance, cerebrospinal fluid examination showed protein-cell separation characteristics, which was diagnosed with Guillain-Barré syndrome (GBS), through pathologic examination, previous cat-scratch history and detection of Bartonella henselae by meta-genomic next-generation sequencing, diagnosis of CSD was finally confirmed. In this paper, a case of CSD complicated with GBS was reported and literature review was conducted, so as to improve the clinical understanding on cat-scratch disease.

Abstract:As of July 20, 2021, coronavirus disease 2019 (COVID-19) has resulted in more than 190 million confirmed cases of COVID-19, and the global confirmed cases and deaths are still growing at an alarming rate. Epidemiological survey result suggests that COVID-19 is transmitted through droplet and close contact as well as aerosol in closed environment. As close contacts of COVID-19 patients, health care workers (HCWs) are at high risk of being infected with COVID-19. New variant of virus is appearing in multiple countries, understanding the prevalence of COVID-19 infection among HCWs, analyzing the potential risk factors for COVID-19 infection, and preventing the future infection among HCWs is the key to maintain persistence of medical treatment as well as effectively prevent and control the epidemic situation. Therefore, this paper systematically describes the current status, risk factors for infection of HCWs and related protective measures, so as to provide reference for ensuring occupational safety of HCWs.

Abstract:Sepsis is a kind of critical disease caused by a variety of causes with high mortality, which leads to high mortality of patients in intensive care unit. Thrombocytopenia is very common in patients with sepsis, the greater the reduction, the higher the mortality of patients. Therefore, clarifying the pathogenesis of sepsis-related thrombocytopenia and selecting appropriate methods to correct thrombocytopenia in time is of great significance to improve the prognosis of patients. In this paper, research status of pathogenesis and treatment of sepsis-related thrombocytopenia is reviewed.

Abstract:The American Society of Health-System Pharmacists Midyear Clinical Meeting (ASHP Midyear) is one of the largest pharmaceutical meeting in the world, featuring as reporting international advanced clinical pharmaceutical research, which puts forward innovative and scientific suggestions aiming at hotspots and difficulties in the field of hospital pharmacy. At the recent ASHP Midyear meeting held in December 2019, anti-infective therapy and antimicrobial stewardship remained a focus, meaningful contents were issued, referring to bacteremia, methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile, penicillin allergy and antimicrobial stewardship program (ASP) in medical institutions, these are also hotspots in the field of anti-infection in domestic hospitals. This paper shares the enlightenment and feelings of the participants, and introduces the ASP carried out in the author's hospital.