Abstract:

Abstract:Objective To explore the clinical characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant in children and youth. Methods Patients infected with SARS-CoV-2 Delta variant and treated in Guangzhou Eighth People's Hospital, Guangzhou Medical University from May 21 to June 18, 2021 were selected, they were divided into children group (2-14 years old) and youth group (15-35 years old), differences in clinical, laboratory indicators and chest CT imaging between two groups of patients were compared. Results There were 21 cases in children group and 24 cases in youth group, there was no severe cases in two groups. Children were characterized by family aggregation, the common type was more frequent in youth group than in children group (66.7% vs 33.3%, P < 0.05). Compared with youth group, cough (33.3% vs 87.5%), expectoration (33.3% vs 66.7%) and throat discomfort (28.6% vs 70.8%) were all lower in children group (all P < 0.05), the duration of fever in children was shorter (2.5 d vs 4 d, P < 0.05), however, there was no significant difference in fever (76.2% vs 83.3%) between two groups of patients. Compared with biochemical indicators of youth group, levels of C-reactive protein (CRP), serum amyloid A (SAA) and interleukin-6 (IL-6) in children group were lower at baseline (all P < 0.05), but levels of lymphocyte (LYM), eosinophil (EOS), lactate dehydrogenase (LDH) and creatine kinase isoenzyme (CK-MB) were higher; at the first week, CRP and SAA were lower, but LYM, EOS, LDH and CK-MB were higher in children group (all P < 0.05). Elevation of CK-MB and LDH were more frequent in children at baseline (both P < 0.05). In children group, LYM decreased in 5 cases (23.8%) and EOS decreased in 3 cases (14.3%) at baseline, but both LYM and EOS returned to normal at the first week. Chest CT showed that 7 cases (33.3%) had pulmonary infection in children group, mainly unilateral involvement; in youth group, 16 cases (66.7%) showed pulmonary infection, mainly bilateral lung involvement. The median time of nucleic acid negative conversion of SARS-CoV-2 was 17 (12, 25) days in children group and 19 (15, 21) days in youth group, prognosis of two groups of patients were good. Conclusion SARS-CoV-2 Delta variant of children are mainly chara-cterized by family aggregation. Compared with youth patients, respiratory symptoms, inflammatory reaction, the injury of immune cells and lung in children patients are slighter, while immune cells recover faster. Elevation of CK-MB and LDH are more frequent in children at baseline, and attention should be paid to the possibility of acute myocardial injury. It takes a long time for virus nucleic acid of SARS-CoV-2 to turn negative in youth and children patients, so it is necessary to extend the time of monitoring nucleic acid of upper respiratory tract.

Abstract:Objective To analyze the clinical characteristics of patients with SARS -CoV-2 Delta variant infection, provide reference for the prevention and treatment of Delta infection. Methods Clinical characteristics of 76 patients with SARS -CoV-2 Delta variant infection in Zhangjiajie Hospital Affiliated to Hunan Normal University from July to August 2021 were analyzed retrospectively. Results The outbreak involved 76 infected persons in 17 families, 8 working settings, with an average age of (34.7±18.1) years old, as well as a high incidence among population aged 15-49 years old. There were 4 asymptomatic infected cases (5.26%), 17 mild cases (22.37%), 50 common cases (65.79%), 4 severe cases (5.26%) and 1 critical case (1.32%); among 76 cases of SARS -CoV-2 Delta variant infection, the lowest Ct value N value of SARS -CoV-2 nucleic acid was 17.5, Lab value was 16.25, the average duration of positive of SARS -CoV-2 nucleic acid was 34.5 days, 23 of whom were positive for Ct value of SARS -CoV-2 nucleic acid again 7 days after discharge. The main clinical manifestations were fever and cough. In the early stage of infection, 98.68% of patients had normal or decreased white blood cell count, 11.84% of patients had slightly increased aspartate aminotransferase/alanine aminotransferase (AST/ALT), and few patients with abnormal creatinine and myocardial enzymes; the proportion of elevation of erythrocyte sedimentation rate (ESR), procalcitonin (PCT) and C-reactive protein (CRP) were 58.21%, 5.26% and 31.58% respectively. Among them, 55 cases (73.37%) suffered from lung lesions, which were characterized by ground glass shadows, mainly distributed along the subpleura, and some cases were complicated with pleural effusion and consolidation. Conclusion Patients with SARS -CoV-2 Delta variant infection have high viral load and long negative conversion time of nucleic acid, the main clinical manifestations are fever and cough, and the early stage may be accompanied by the increase of AST/ALT.

Abstract:Objective To retrospectively analyze the changing trend of minimum inhibitory concentration (MIC) of vancomycin against methicillin-resistant Staphylococcus aureus (MRSA), provide reference for the clinical use of vancomycin in the treatment of MRSA infection. Methods 900 strains of non-repetitive MRSA from clinical specimens in 3 tertiary first-class general hospitals in Xuzhou City in 2015-2019 were selected according to the standard of healthcare-associated infection (HAI), MIC values were collected, MICs of vancomycin to MRSA between intensive care units (ICUs) and non-ICUs were compared, and related characteristics were analyzed. Results 900 strains of MRSA were all sensitive to vancomycin, the mean MIC values in 2015-2019 were (1.058±0.232), (1.100±0.272), (1.108±0.266), (1.122±0.273) and (1.147±0.298) μg/mL respectively, and there were significant differences among groups (P < 0.05); the mean MICs of ICU were (1.159±0.303), (1.253±0.344), (1.320±0.331), (1.413±0.289) and (1.451±0.278) μg/mL respectively, there were significant differences among groups (P < 0.05); the mean MICs of non-ICUs were (0.995±0.134), (1.005±0.135), (1.005±0.091), (1.016±0.155) and (1.006±0.142) μg/mL respectively, there were no significant differences among groups (P>0.05). The mean MICs between ICUs and non-ICUs in the same year of 2015-2019 were all significantly different (all P < 0.05); proportion of MIC ≥ 1.5 μg/mL of vancomycin against MRSA had an increasing trend year by year. Conclusion Vancomycin-resistant MRSA was not found in Xuzhou in 2015-2019; vancomycin has MIC drift to MRSA, which mainly comes from ICUs. MRSA strains with vancomycin MIC ≥ 1.5 μg/mL and infected patients in ICU should be given stress surveillance and active treatment to prevent infection outbreak.

Abstract:Objective To analyze the risk factors and construct prediction model for occult pneumonia (OP) in patients with senile dementia. Methods Medical records of patients with confirmed diagnosis of senile dementia complicated with pulmonary infection and treated in the Third Affiliated Hospital of Anhui Medical University from Ja-nuary 2019 to December 2020 were retrospectively analyzed. Some patients were randomly selected from the confirmed patients as the modeling group, they were divided into OP group, non-OP group, and other cases were as the verification group. Univariate and logistic regression multivariate analysis were used to analyze the risk factors for OP in patients with senile dementia, nomogram was constructed by R4.0.3 software and the model was verified. Results A total of 216 patients were included, 148 of whom (75 cases of OP and 73 cases of non-OP) were used for modeling, and 68 cases (37 cases of OP and 31 cases of non-OP) were used for verification. Diabetes mellitus (OR=2.565, 95%CI: 1.094-6.015), severe dementia (OR=3.079, 95%CI: 1.116-8.494), dementia duration ≥ 10 years (OR=5.782, 95%CI: 2.139-15.627), age ≥ 80 years (OR=2.737, 95%CI: 1.011-7.413), and long-term bedridden (OR=4.835, 95%CI: 1.716-13.625) were independent risk factors for senile dementia complica-ted with OP (all P < 0.05). The prediction model was constructed and verified through the five risk factors, the verification results showed that the area under the curve (AUC) in modeling group was 0.841 and that in verification group was 0.756, suggesting that the diagnostic ability of the model was good; Hosmer-Lemeshow test showed that the model had goodness of fit, decision curve analysis showed that this model had high benefit. Conclusion Age ≥ 80 years, severe dementia; dementia duration ≥ 10 years; diabetes mellitus, and long-term bedridden are independent risk factors for OP in patients with senile dementia, the individualization of nomogram model can predict the probability of OP in patients with senile dementia, so as to intervene as soon as possible and improve the prognosis.

Abstract:Objective To evaluate the application value of hypermucoviscous phenotype and virulence gene in predicting hypervirulent Klebsiella pneumoniae (hvKp). Methods Klebsiella pneumoniae isolated from four hospitals in Guangdong Province from November 2016 to April 2018 were collected, mucoviscous phenotypes were determined through string test, virulence genes and serotypes were detected, 50% lethal rate (LD₅₀) of strains was calculated by Galleria mellonella model, LD₅₀ of strains of different hypermucoviscous phenotypes and virulence genes were compared. Results A total of 194 strains of Klebsiella pneumoniae were collected, 40.2% (n=78) of which were positive for string test. Galleria mellonella test results showed that LD₅₀ of only iucA, iroB, and fimH positive strains was lower than that of corresponding negative strains(P < 0.05). LD₅₀ of strain group of all positive for iucA+iroB+fimH+hm (n=58), iucA positive+iroB positive+fimH positive+hm negative (n=23) and all negative for iucA+iroB+fimH+hm (n=28) were (5.39±0.71), (5.44±0.62), and (5.83±0.64) lg10CFU/mL respectively, there was no significant difference between the first two groups (P=0.786), but there was significant difference between the first two groups and the third group (P < 0.05), positive rates of serotypes K1, K2 and K57 in hypermucoviscous phenotype strains were significantly higher than those in non-hypermucoviscous phenotype strains, difference were all significant (all P < 0.001). Conclusion Accuracy of the prediction of hvKp based only on hypermucoviscous phenotype is low, compared with hypermucoviscous phenotype, virulence genes iucA+, iroB+ and fimH + are more accurate to prediction hvKp.

Abstract:Objective To explore the prevalence clone and molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) in China, provide practical data support for clinical trace as well as real-time monitoring on prevention and control of CRKP healthcare-associated infection. Methods Literatures related to CRKP strains in China from 2017 to 2019 were collected through literature retrieval, places where strains could be collected were included in analysis, literatures on drug resistance genes detected with polymerase chain reaction (PCR) and sequence type (ST) detected with multilocus sequence typing (MLST) were analyzed, BioNumerics was used to create minimum spanning tree. Results A total of 40 literatures were included in analysis, involving 2 094 CRKP strains, these strains distributed in 15 provinces and cities in 6 regions (northeast, north, east, south, central and southwest China), 1 631 (77.89%) CRKP strains carried KPC resistance genes; the main detected subtype was KPC-2 (n=1 014, 62.17%). 12 drug resistance genes were detected from 2 094 CRKP strains, of which KPC drug resistance genes accounted for more than 50% in 6 regions.Through MLST analysis on 859 CRKP strains, the dominant sequence type was ST11 (659/859, 76.72%), and distributed in 6 regions of China. KPC-2-producing ST11 strain (581/659, 88.16%) was the most prevalence type in China. Conclusion CRKP strains carrying drug resistance genes spread rapidly throughout the country, they have spread all over 6 regions of the country at pre-sent, comprehensive prevention and control measures against CRKP should be established to avoid the outbreak of CRKP in hospitals.

Abstract:Objective To investigate the current status of healthcare-associated infection (HAI) management in municipal public hospitals in Shanghai City, and put forward suggestions for improvement. Methods Questionnaires were used to interview deputy directors in charge of 39 municipal public hospitals and heads of HAI management departments of 39 municipal public hospitals in Shanghai City. The content of interview mainly included the organizational system construction of HAI management departments of municipal public hospitals, assignment of professionals and system construction of HAI management departments, difficulties and highlights in the implementation of HAI management, etc. Results 37 (94.9%) of the 39 municipal public hospitals have set up HAI mana-gement committees, established a complete municipal HAI management system and carried out corresponding work responsibilities. The composition of the department members of HAI management committees of 30 hospitals (76.9%) met the requirements, 38 hospitals (97.4%) appointed medical directors or medical deputy directors as chairman of HAI management departments. 37 (94.9%) municipal public hospitals have set up independent HAI management departments, 31 hospitals (79.5%) had HAI management departments directly managed by medical deputy director, and 28 hospitals (71.8%) were as functional departments. 39 municipal public hospitals had an average of one full-time HAI management professionals for every 239 beds, which met the standard requirements, but there were differences among different hospitals. The professional direction of heads of HAI management departments was mainly clinical medicine (59.0%), professional direction of full-time infection management professionals was nursing (41.9%). The highlights of HAI management in 39 municipal public hospitals were mainly the adoption of personalized and diversified training methods (100.0%), establishment of HAI case monitoring and early warning mechanism (89.7%), implementation of HAI control grid management and multi-disciplinary team (MDT) collaborative management mode (87.2%), etc.; the construction difficulties mainly focus on the limited development prospect and difficult promotion of employees (41.0%), insufficient fund investment from hospital (33.3%), and low income of HAI management professionals (23.1%), etc. Conclusion Municipal hospitals need to improve the construction of HAI management organization, improve HAI management system, optimize the training mechanism of HAI management team, implement staff promotion incentive measures, increase the fund investment in HAI management, ensure scientific and standardized resource allocation, and constantly promote the scientific, refinement and standardization of HAI management level.

Abstract:Objective To investigate the effect of native-valve infective endocarditis (IE) on long-term effect of surgical aortic valve replacement (SAVR). Methods Medical records of patients with native-valve IE who underwent SAVR in Beijing Anzhen Hospital, Capital Medical University from January 2013 to December 2017 were analyzed retrospectively, propensity score matching (PSM) was adopted to select patients as control group (non-IE), all patients were followed up for a long period to observe the post-operative survival rate and cumulative risk of complications, the median follow-up time was 69 months. Results A total of 2 821 patients were included in study, including 143 SAVR patients with IE (IE group) and 2 678 SAVR patients without IE (control group). The long-term survival rate of patients in IE group was lower than that of control group, difference was significant (P=0.044). Patients with IE were more likely to have ischemic stroke after SAVR, difference was significant (P=0.035), ischemic stroke was an independent risk factor affecting the survival of patients (P=0.014), patients with ischemic stroke had a higher risk of death (HR=2.811; 95% CI: 1.233-6.408). There was no significant diffe-rence in the cumulative incidence of massive hemorrhage and aortic valve re-operation rate between patients in IE group and control group (both P>0.05), and they were not independent risk factors affecting the survival of patients (all P>0.05). Conclusion Compared with patients in control group, patients with native-valve IE have a higher risk of death and ischemic stroke after SAVR. The close follow-up of IE patients after SAVR should be strengthened, focusing on the prevention of complications of stroke.

Abstract:Objective To investigate the role and mechanism of miR-216a-5p in high mobility group protein-B1 (HMGB1)-mediated peritoneal dialysis-associated peritonitis (PDAP) induced by Staphylococcus epidermidis infection in mice. Methods Healthy male C57BL/6J mice were selected and randomly divided into control group, infection group, and infection+HMGB1 inhibitor group, peritoneal effusion and peritoneal tissue was collected for detection of whit blood cell (WBC) count, HE and immunohistochemical staining; mRNA and protein expression levels of interleukin-1α(IL-1α), interleukin-6 (IL-6), tumor necrosis factors-α(TNF-α), HMGB1, NF-κB, and I-κBi were detected by real-time polymerase chain reaction (RT-PCR) and Western Blot; bioinformatics prediction found that miR-216a-5p may bind with HMGB1 and participate in the occurrence of HMGB1-mediated PDAP, and construct dinfection+miR-216a-5p mimics mice group, relationship between miR-216a-5p and HMGB1 was verified by double luciferase reporter gene assay, changes in expression of HMGB1 were detected by RT-PCR, Western blot and immunohistochemical staining. Results Compared with control group, WBC count of peritoneal effusion in mice in infection group increased, inflammatory infiltration was obvious, expression of mRNA and protein of IL-1α, IL-6, TNF-α and HMGB1 all increased (all P < 0.05); after intervention by HMGB1 inhibitor (glycyrrhizin), WBC count of mice peritoneal effusion decreased, inflammatory infiltration improved, expression of mRNA and protein of IL-1α, IL-6, TNF-α and HMGB1 all decreased (all P < 0.05). The expression of NF-κB in mice in infection group was higher than that in control group, I-κBi was lower than that in control group; after HMGB1 inhibitor intervention, NF-κB expression decreased, I-κB expression increased (both P < 0.05). RT-PCR results confirmed that the content of miR-216a-5p decreased significantly in infection group compared with control group; dual-luciferase reporter gene assay suggested that miR-216a-5p could directly act on the 3' UTR region of HMGB1; compared with infection group, the expression of mRNA and protein of HMGB1 decreased in mice in infection+miR-216a-5p mimics group (both P < 0.05). Conclusion HMGB1 plays an important role in PDAP induced by Staphylococcus epidermidis infection, inhibiting HMGB1 can improve the inflammatory response in mice, miR-216a-5p can participate in the occurrence of PDAP induced by Staphylococcus epidermidis infection through targeting HMGB1.

Abstract:Objective To understand the outbreak of healthcare-associated infection(HAI) in intensive care units (ICUs) at home and abroad, and provide basis for clinical targeted prevention and control of HAI outbreak. Methods Based on Worldwide Database for Nosocomial Outbreaks (Outbreak Database) and China National Knowle-dge Infrastructure (CNKI) database, data of HAI outbreak in ICUs were analyzed and compared. Results 1 091 cases of ICU HAI in Outbreak Database involved 68 countries and regions, 2000-2006 was the peak of publication of outbreak events, 590 cases (54.08%) of HAI outbreaks in ICUs were identified route, transmission through patients, environment, and contaminated medical device accounted for 37.46%, 22.88% and 15.09% respectively; 63.98% of the events identified the route of infection, transmission through contact, invasive manipulation, respiratory transmission and gastrointestinal intake accounted for 73.78%, 15.19%, 8.17%, and 2.86% respectively; pathogens of HAI were bacteria (83.68%), viruses (8.16%) and fungi (7.52%); control of outbreak cases mainly through taking corresponding measures according to the route of transmission and source of infection. Infection caused by invasive manipulation in China was higher than that in foreign countries (38.37% vs 15.17%). The main pathogens causing HAI outbreak in ICUs in China and abroad were Acinetobacter baumannii (32.56%) and methicillin-resistant Staphylococcus aureus (12.20%) respectively. Conclusion HAI outbreak has certain regularity, intervention measures should be formulated according to the characteristics of the outbreak to effectively prevent and control the outbreak of infection.

Abstract:Objective To evaluate the impact of application of electronic monitoring system (EMS) on hand hygiene (HH) compliance of health care workers (HCWs). Methods "Health care workers", "electronic system", and "hand hygiene" were used as key words, Ovid, Web of Science, PubMed, Cochrane, CINAHL, clinicaltrials.gov, China National Knowledge Infrastructure(CNKI), and Wangfang database were searched, effect and acceptability of EMS on HH compliance of HCWs were analyzed. Results 2 736 literatures were retrieved and 13 were included, 11 results showed that application of EMS could improve HH compliance, of which 9 studies detected an increase in the compliance rate ranging from 10% to 45%, 2 studies showed that the frequency of HH increased by 16.28 times and consumption of hand sanitizer increased by 2.215 liters respectively; the other study showed that the compliance rate decreased by 3.6%, and the compliance rate of one study basically did not change. The main reasons for HCWs' resistance to electronic system are infringement of privacy, impact on health and device defects. Conclusion Application of electronic system can improve the HH compliance of HCWs, but the potential impact of electronic system should be considered, in the future, effective implementation methods should be explored to correct the defects of electronic system and play a role to a greater extent.

Abstract:Objective To analyze the clinical characteristics of HIV-negative patients with Talaromycosis, and improve the level of early clinical diagnosis. Methods Clinical data of 8 HIV-negative patients with Talaromycosis in Guangxi Zhuang Autonomous Region Nationality Hospital from January 2016 to November 2020 were analyzed re-trospectively. Results Among the 8 patients, 6 were males and 2 were females, with an average age of 58 years. 6 patients had pulmonary infection, 4 had high fever, 3 had lymphadenopathy, 2 had hepatosplenomegaly, 4 had hypoproteinemia, 3 had bone destruction, and 2 had received anti-tuberculosis treatment. Auxiliary blood routine exa-mination showed that white blood cell of 7 cases increased significantly, 8 cases all had decreased hemoglobin, as well as increased erythrocyte sedimentation rate, C-reactive protein and procalcitonin in varying degrees. Three patients got better and discharged with medicine for maintenance treatment after receiving amphotericin B or itracona-zole treatment, 2 cases were transferred to superior hospital for treatment, 3 patients were with severe multiple organ failure, and voluntarily gave up treatment and discharged. Conclusion There is no specific clinical characteristics among HIV-negative patients with Talaromycosis, which lead to missed diagnosis, misdiagnosis and high mortality, clinicians should pay great attention to it.

Abstract:Objective To investigate and analyze an outbreak of healthcare-associated infection (HAI) with varicella among health care workers (HCWs), analyze the causes of hospital transmission of varicella zoster virus. Methods Through on-site interview and telephone inquiry, the demographic data, varicella and herpes zoster-rela-ted epidemiological history and vaccination history of HCWs in intensive care unit (ICU) of a hospital from October 5 to December 23, 2020 were investigated, the occurrence and prognosis of varicella and herpes zoster in all ICU patients were investigated, epidemiological characteristics and transmission route were analyzed. Results From October 26 to December 2, 2020, ICU reported 4 cases of varicella infection among HCWs, the outbreak lasted for 38 days. All infected HCWs were ICU nurses, including 2 nurses of ICU, 1 intern nurse and 1 rotation nurse; there are 1 case in the first generation, 2 cases in the second generation and 1 case in the third generation, all patients denied their co-habitation and recent exposure to varicella or herpes zoster cases. A 64-year-old female patient with post-herpetic neuralgia was hospitalized in ICU from September 28 to October 20, at the time of admission, the patient's right waist scattered herpes zoster had scabbed; the first case had cared for patient without wearing gloves. Infection rate of susceptible persons who used lounge-1 72 hours before the eruption of varicella was 66.7%, susceptible persons who used lounge-2 were not infected. This outbreak caused a total direct economic loss of 2 725 Yuan. Conclusion The first case may be caused by nursing a hypo-immunity case of herpes zoster without wearing gloves, and the subsequent case may be the outbreak of varicella caused by inhaling the high concentration of virus particle aerosol formed by respiratory secretions of infected cases in the lounge.

Abstract:Interleukin-23 (IL-23) has an important relationship with chronic inflammation, researches on IL-23 are mainly focused on autoimmune diseases, some IL-23 antagonists have been used in clinical practice. For hepatitis B virus(HBV) infection-related chronic liver diseases (CLD), most studies have shown that the expression of serum IL-23 is elevated, and it may play a pro-inflammatory effect together with Th17 cells in HBV-related CLD. Current researches on IL-23 and HBV infection are mainly correlation study of clinical data, there is little exploration on mechanisms. This paper summarizes the possible mechanism of IL-23/Th17 pathway in HBV-related CLD in relevant domestic and foreign studies in recent years.

Abstract:Allogeneic hematopoietic stem cell transplantation(allo-HSCT) is an effective therapy to cure hematological malignancies. However, recipient's risk of developing hepatitis B after transplantation is increasing due to receiving graft infected with hepatitis B virus (HBV) and seriously impaired immune function. Entecavir and tenofovir are currently recognized as effective drugs for the prevention and treatment of hepatitis B in recipient, significantly reducing liver damage after transplantation. The immune reconstitution of recipient takes a long time and has hete-rogeneity, so the best duration of post-operative monitoring and antiviral prophylaxis is not clear. This article reviews the mechanism of hepatitis B virus reactivation, the characteristics of hepatitis B and the recent advance in prevention and treatment of hepatitis B after allo-HSCT.

Abstract:Hypervirulent Klebsiella pneumoniae (hvKP) has become a pathogen of global concern, with strong virulence, more likely to cause community-associated infection, patients infected with hvKP have poor prognosis and high mortality. What is worrying is that high antimicrobial resistance hvKP has emerged, which presenting new challenge to clinical anti-infective treatment. This paper reviews the clinical identification and major virulence factors of hvKP, as well as the overlapping expression of antimicrobial-resistant and hypervirulent strains.