Abstract:China began to carry out healthcare-asssociatd infection (HAI) prevention and control since 1985, HAI prevention and control professionals have made great contribution to infection prevention and control since the national comprehensive implementation of HAI prevention and control. As one of the earliest full-time professionals in the prevention and control of HAI in China, the author summarizes the early practical exploration on HAI prevention and control in China through his own practical experience combined with literature analysis, 10 typical cases were listed, aiming to provide reference for the prevention and control of HAI in China.

Abstract:Objective To evaluate the risk factors for carbapenem-resistant Acinetobacter baumannii bloodstream infection (CRAB-BSI), evaluate the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) in patients with CRAB-BSI. Methods Patients with CRAB-BSI diagnosed in a hospital from January 2013 to August 2020 were as studied objects, according to their resistance to carbapenem, they were divided into drug-resistant group (CRAB group) and sensitive group (carbapenem-sensitive Acinetobacter baumannii, CSAB group), clinical data of two groups of patients were compared; according to the different prognosis, CRAB patients were subdivided into good prognosis group and poor prognosis group, levels of PCT and CRP within 48 hours after diagnosis of two groups of patients were compared, and predictive value of PCT and CRP for the prognosis was evaluated by receiver operating characteristic (ROC) curve. Results A total of 64 patients with CRAB-BSI were included in study, including 43 cases in CRAB group and 21 cases in CSAB group. Antimicrobial use>7 days was an independent risk factor for CRAB-BSI (OR=6.198, 95%CI: 1.280-30.023). Among 43 patients with CRAB-BSI, 13 cases had a good prognosis and 30 had a poor prognosis. ROC showed that the areas under the curve of PCT, CRP and PCT combined with CRP in predicting the adverse prognosis of patients with CRAB-BSI were 0.829 (95%CI: 0.658-1.000), 0.800 (95%CI: 0.610-0.990) and 0.895 (95%CI: 0.751-1.000) respectively. Conclusion Antimicrobial use>7 days is a risk factor for CRAB-BSI, levels of serum PCT and CRP have predictive value for the prognosis of patients with CRAB-BSI.

Abstract:Objective To understand the contact behavior between the hands of caregivers of patients with multidrug-resistant organism (MDRO) infection, environmental surfaces and caregiver themselves. Methods Caregivers of MDRO-infected patients in two university affiliated hospitals were directly observed from March 2019 to July 2020, self-designed observation scale was used by trained observers to record the contact situation and frequency of caregivers' hands with patients, environmental surfaces and caregiver themselves. Results Patients were most frequently contacted by caregivers (89.82%), followed by areas adjacent to patients (88.94%). The frequently contacted environmental surface by caregivers included bed-rail (80.09%) and bed surface (68.58%). 46.02% and 36.73% of the caregivers touched the mask and trunk during self-contact respectively. The total contact frequency between caregivers' hands and environmental surface was different in different departments, and the contact frequency of internal medicine was higher than that of surgery (P < 0.05). The contact frequency between caregivers' hands and patients was different in different nursing periods, contact frequency with patients in peak period of treatment and nursing as well as visit period was higher than that in morning and evening nursing period (P < 0.05). Conclusion When caregivers provide care for MDRO-infected patients, frequent contact with patients, environmental surface and caregiver themselves may lead to the spread of MDRO infection.

Abstract:Objective To construct the early warning model of lower respiratory tract (LRT) infection in chemotherapy tumor patients based on synthetic minority over-sampling technique (SMOTE) algorithm. Methods 2 384 tumor patients treated with chemotherapy in 4 tertiary hospitals in Xining City from January 2019 to June 2021 were investigated, patients were randomly divided into modeling group (n=1 668) and validation group (n=716) accor-ding to the ratio of 7:3, data of modeling group was used to construct the model, data of validation group was used to verify the constructed model, influencing factors for LRT infection were screened by univariate comparison and logistic regression analysis, the early warning model of LRT infection of chemotherapy tumor patients was constructed based on SMOTE algorithm. Results Logistic regression analysis showed that age (x₁), whether body mass index was normal (BMI, x₂), stage of malignant tumor (x₃), smoking history (x₄), combined diabetes mellitus (x₅) and combined pulmonary disease (x₆) were all risk factors for LRT infection in chemotherapy tumor patients (all P < 0.01), the original data warning model: Logit (P)=0.055x₁+0.967x₂-0.195x₃+1.383x₄+0.968x₅+0.939x₆-14.073 and early warning model based on SMOTE algorithm: Logit(P)=0.090x₁+1.092x₂-0.249x₃+1.724x₄+1.136x₅+1.344x₆-14.859 were obtained. The AUC of early warning model based on SMOTE algorithm was higher than original data warning model (0.949[95%CI: 0.937-0.961] vs 0.780[95%CI: 0.734-0.846]). Conclusion The early warning model based on SMOTE algorithm can more accurately warn LRT infection in chemotherapy tumor patients, and effectively solve the warning error caused by the imbalance of the sample data of infected and non-infected patients, the corresponding countermeasures can be selected based on the warning model.

Abstract:Objective To evaluate the efficacy and safety of bedaquiline (BDQ-containing) regimen for the treatment of multidrug-resistant tuberculosis (MDR-TB)/extensively drug-resistant tuberculosis (XDR-TB), and provide clinical data for the use of BDQ in drug-resistant TB patients in China. Methods Clinical data of tuberculosis patients receiving BDQ-containing regimen in a hospital from March 2018 to September 2019 were collected, efficacy and adverse reactions during treatment were analyzed. Results Sixty-nine patients were enrolled, 10 (14.5%) of whom had XDR-TB, 63 cases (91.3%) completed 24 weeks of BDQ-containing treatment, two patients died of cardiac arrest and respiratory failure during treatment, three were transferred, one was lost to follow-up, 39 patients (56.5%) reported 108 times of adverse events, most adverse events were classified as grade 1 or grade 2 (75 times, 69.4%), and the most common grade 3 and above adverse events were QT interval prolongation. 29 cases (46.0%) were positive in sputum culture at baseline, the negative conversion rates of sputum culture at week 8, 12 and 24 were 93.1% (27 cases), 100.0% (29 cases) and 93.1% (27 cases) respectively, sputum culture of 2 patients returned to positive at week 24; the median time of negative conversion of sputum culture was 24 days (interquartile interval: 14-61 days). Among 52 patients with pulmonary cavity, 48 (92.3%) completed 24 weeks of BDQ-containing treatment, the cavity closure rates at week 12 and 24 were 37.5% and 64.6% respectively. Conclusion Compared with the traditional treatment regimen, BDQ-containing treatment regimen for 24 weeks can improve the negative conversion rate of sputum culture and cavity closure rate in patients with MDR/XDR-TB, but attention should be paid to the monitoring and management of QT interval.

Abstract:Objective To explore clean and disinfection effect of improved whole-pipe irrigation device on endoscope with auxiliary water supply. Methods The Olympus colonoscopes with auxiliary water supply used by patients in a digestive endoscope cleaning and disinfection workstation in a hospital was selected and randomly divided into three groups according to random number table method: group A, B, and C were 30, 32, and 30 respectively. Group A used the pre-improvement conventional irrigation device, and didn't perform special treatment to the auxi-liary water pipe; group B used the pre-improvement conventional irrigation device, but used the external connecting pipe (MAJ-855), for each cleaning and disinfection step, 30mL syringe was used to manually inject gas and liquid into the auxiliary water pipe for at least three times; group C used the improved whole-pipe irrigation device. Three groups of endoscopes were cleaned, disinfected and dried according to the standard steps, disinfection qualification rate of each pipe of three groups of endoscopes, as well as manual operation time and degree of physical fatigue of cleaning and disinfection staff and were compared. Results The overall qualified rate of endoscope disinfection in group A, B, and C were 30.0%, 78.1%, 100.0% respectively. There was significant difference in the overall disinfection qualified rate of endoscopes among three groups (χ²=36.414, P < 0.001). There was no significant difference in the disinfection qualified rate of endoscopic air and water supply pipe and forceps pipe among three groups (all P>0.05). There was significant difference in the disinfection qualified rate of endoscopic auxiliary water supply pipe among three groups (χ²=33.473, P < 0.001). The manual operation time of cleaning and disinfection staff in group A, B, and C were (4.81+0.63), (6.72+0.42), and (4.88+0.66) minutes respectively, difference was statistically significant (F=105.149, P < 0.001). The scores of physical fatigue scale of cleaning and disinfection staff for endoscope cleaning and disinfection in group A, B, and C were (4.67+1.32), (5.83+0.91), and (4.33+1.03) respectively, difference was significant among three groups (F=15.348, P < 0.001). Conclusion The improved whole-pipe irrigation device can improve the disinfection qualification rate of auxiliary water supply pipe, save the manual operation time of cleaning and disinfection staff and reduce their physical fatigue.

Abstract:Objective To investigate the causes for number of bacterial colonies exceeding the standard in the pure water system found during the acceptance of newly built endoscopy center, and put forward solutions. Methods Water specimens were collected from all steps of pure water preparation and use, the causes for number of bacterial colonies exceeding the standard were identified, disposal measures according to the causes were formulated, and the maintenance time of intensive disinfection effect was monitored. Results The investigation result inferred that the newly laid water pipeline between the outlet of pure water tank and inlet of the endoscope before entering the endoscopic decontamination equipment is the main cause for the bacteria exceeding the standard. According to the causes, combined disposal measures such as pipeline transformation, adding disinfection facilities, cleaning and disinfection of water pipeline and decontamination equipment are formulated. After comprehensive intervention, no bacteria were detected at each sampling point, the endoscopy center was successfully put into use, and the interval of waterline intensive disinfection was determined to be 12 weeks. Conclusion The acceptance before operation of the newly built endoscope center is very important, the new pure water pipeline needs to be flushed before laying to ensure the quality of final rinsing water.

Abstract:Objective To investigate the economic burden of healthcare-associated infection (HAI) caused by multidrug-resistant organism (MDRO) in general intensive care unit(GICU), analyze the cost-benefit of prevention and control of MDRO HAI. Methods HAI in patients in a GICU from 2016 to 2017 were investigated retrospectively, 2016 and 2017 was as pre- and post-implementation group of infection prevention and control measures respectively, incidence of MDRO infection in two groups of patients was compared. A matched case-control study was used to compare the hospitalization expense and length of hospital stay between patients in MDRO HAI group and non-infection group, economic loss caused by MDRO HAI was evaluated, cost-benefit of prevention and control was analyzed. Results Incidence of MDRO HAI decreased from 4.4% to 1.9% after the implementation of HAI prevention and control measures. Compared with non-infected patients, hospitalization expense of MDRO-infected patients increased by 116 147.0 Yuan and length of hospital stay extended by 26.0 days. In 2016 and 2017, direct economic loss caused by MDRO HAI were 8 246 437.0 and 3 716 704.0 Yuan respectively, the profit loss due to the decrease of admission of patients were 232 328.2 and 90 561.1 Yuan respectively, and charge for loss of working time due to extension of length of hospital stay were 122 389.8 and 59 238.4 Yuan respectively. In 2017, the investment in prevention and control measures increased by 110 469.0 Yuan, direct and indirect economic loss reduced by 4 734 651.5 Yuan, ratio of benefit to cost was 42.9:1; economic loss of hospital reduced by 141 767.1 Yuan, ratio of benefit to cost was 1.3:1. Conclusion Effective implementation of prevention and control of HAI can not only reduce the incidence of HAI, but also bring huge social and economic benefit.

Abstract:Objective To understand the multidrug-resistant organism (MDRO) infection in different specialized intensive care units (ICUs) for 5 consecutive years, and provide reference basis for the rational use of antimicrobial agents in different specialized ICUs. Methods Data of MDROs isolated from inpatients in 9 different specialized ICUs in a tertiary first-class hospital between January 2016 and December 2020 were retrospectively studied, isolation rate, discovery rate, infection site and antimicrobial resistance rate of MDROs in different specia-lized ICUs were analyzed. Results From 2016 to 2020, 30 030 inpatients in different specialized ICUs were monitored, 2 744 strains of MDROs were isolated, including 1 235 strains of healthcare-associated infection (HAI) pathogens, there was significant difference in the isolation rates of different kinds of MDROs during 5 years (P < 0.05); there were significant differences in the isolation rates of carbapenem-resistant Pseudomonas aeruginosa (CRPA) and carbape-nem-resistant Klebsiella pneumoniae (CRKP) in different years (all P < 0.05), and there was an annual upward trend. Discovery rate of MDRO infection in 5 years was 3.86%, and case infection rate was 4.11%; there were significant difference in the case incidence of MDRO infection in different specialized ICUs in different years and 5 years (all P < 0.05); there was no significant difference in the case incidence of MDRO infection in all ICUs in different years (P>0.05). The top 3 sites of MDRO infection were lower respiratory tract (578 cases), blood (240 cases) and urinary tract (170 cases). Resistance rates of CRAB isolated from general ICU, cardiovascular surgery ICU, neurosurgery ICU and emergency ICU to gentamicin and ciprofloxacin were all significantly different (all P < 0.05), resistance rates of CRPA to gentamicin were significantly different (all P < 0.05). Resistance rates of CRAB to ce-foperazone/sulbactam and CRPA to piperacillin, piperacillin/tazobactam as well as cefo-perazone/sulbactam were all significantly different (all P < 0.05). Conclusion During the process of clinical diagnosis and treatment, infection prevention and control measures and rational use of antimicrobial agents should be guided according to the characte-ristics of MDRO infection in different specialized ICUs.

Abstract:Objective To explore how to build a scientific management mechanism of antimicrobial stewardship (AMS), provide reference for strengthening the management of antimicrobial agents and curbing the trend of bacterial resistance in medical institutions. Methods Based on the strategy AMS, the AMS team was established in Xiangya Hospital of Central South University to standardize the clinical use of antimicrobial agents. Nine indexes in three dimensions were selected to build assessment system for clinical application of antimicrobial agents, and changes in nine indexes of clinical application of antimicrobial agents before (2016) and after (2017-2020) the implementation of AMS were comprehensively assessed and analyzed by technique for order preference by similarity to ideal solution (TOPSIS). Results From 2016 to 2020, the evaluation index of antimicrobial application in the hospital was significantly improved, antimicrobial use density (AUD) in hospitalized patients decreased from 53.39 in 2016 to 36.55 in 2020, with a decrease of 31.54%; antimicrobial use rate in hospitalized patients decreased by 10.76%, the average cost of antimicrobial agents in hospitalized patients decreased by 41.45%, antimicrobial use rate in outpatient and emergency patients decreased by 31.59% and 43.53% respectively, utilization rate of special use antimicrobial agents decreased by 47.89%, AUD of special use antimicrobial agents decreased by 38.52%, detection rate of multidrug-resistant organism decreased by 9.89%, prevalence rate of HAI decreased by 37.50%. TOPSIS evaluation results showed that the application of antimicrobial agents in 2020 was the best during five years. Conclusion AMS is helpful to promote the rational application of antimicrobial agents in medical institutions, and curb the development of resistance of bacteria.

Abstract:Objective To analyze the indexes of healthcare-associated infection (HAI) management based on HAI monitoring data, evaluate the quality of HAI management, and provide objective basis for evaluating HAI management level. Methods Three comprehensive evaluation methods (technique for order of preference by similarity to ideal solution[TOPSIS], rank sum ratio[RSR] method and grey relational analysis[GRA]) were adopted to analyze the quality management indexes of HAI from 2014 to 2020, the single comprehensive evaluation results were combined for evaluation through fuzzy Borda method, and the fuzzy Borda number Bi value was obtained for ran-king, the higher the Bi value, the better the management quality. Results Evaluation results showed that the quality management of HAI was poor in 2014-2017, lowest in 2016, after the implementation of refined management in the second half of 2017, quality management of HAI was significantly improved in 2018-2020, which was the best in 2020, the quality ranked second and third respectively in 2018 and 2019. Conclusion Improving HAI monitoring information system is the basis of HAI management, which provides data basis for the quality evaluation of HAI management and finding management weak points of management.

Abstract:Objective To explore the role of ASA score (American Society of Anesthesiologists physical status classification) and operation time in risk assessment of surgical site infection (SSI) in patients with colorectal cancer. Methods Clinical data of patients undergoing colorectal cancer surgery from January 2018 to December 2019 were retrospectively collected, correlation between ASA score and post-operative SSI was analyzed, receiver opera-ting characteristic (ROC) curve was used to test the efficiency of ASA score in risk assessment of patients with SSI, and to compare the effect of length of operation time on SSI under different ASA grades. Results A total of 430 patients undergoing surgery of colorectal cancer were included in study, 243 cases of colon cancer and 187 cases of rectal cancer, 238 males and 192 females. 57 patients had SSI, incidence of SSI was 13.26%. With the increase of ASA score, incidence of SSI in patients gradually increased. ROC curve analysis showed that area under the curve of ASA score was 0.706, which was statistically significant (P < 0.05). For the medium-risk ASA score group, incidence of SSI in patients with operation time ≥ 180 minutes was higher than those with operation time < 180 minutes, difference was statistically significant (P < 0.05). Conclusion ASA score can assess the risk of post-operative SSI in patients with colorectal cancer, surgeons should pay attention to and improve the systemic status of patients before surgery, and shorten the operation time as much as possible to reduce the incidence of SSI.

Abstract:Objective To study the in vitro antimicrobial susceptibility testing results of fosfomycin (FOS) combined with other antimicrobial agents against multidrug-resistant Pseudomonas aeruginosa (MDR-PA), and provide guidance for clinical combination antimicrobial use. Methods Patients with healthcare-associated pneumonia (HAP) and admitted to the department of critical care medicine of a hospital from January 2018 to December 2019 were selected, 50 strains of MDR-PA were screened out by microbiological laboratory, antimicrobial susceptibility testing was performed with agar dilution combined with disk diffusion method, fosfomycin (FOS)-containing agar plates were prepared, with antimicrobial concentrations of 50, 100, 150, 200 and 250 μmg/L respectively; disks containing piperacillin/tazobactam, ceftazidime, meropenem, amikacin, and ciprofloxacin were pasted on the antimicrobial-containing plate for routine culture. Results FOS had no synergistic effect with piperacillin/tazobactam and ceftazidime (both P>0.05), but had synergistic effect with meropenem, amikacin and ciprofloxacin (all P < 0.05). Comparison of FOS+ meropenem combination and FOS+ ciprofloxacin combination, difference was not significant (both P>0.05); comparison of FOS+ meropenem combination and FOS+ amikacin combination, difference was significant (P < 0.05); comparison of FOS+ ciprofloxacin combination and FOS+ amikacin combination, diffe-rence was significant (P < 0.05). Conclusion For MDR-PA, FOS has synergistic effect with meropenem, amikacin and ciprofloxacin, the synergistic effect of FOS+ meropenem combination and FOS+ ciprofloxacin combination is better than that of FOS+ amikacin combination.

Abstract:Objective To investigate the cause of an outbreak of peritonitis in peritoneal dialysis patients. Methods A case-control study was conducted to explore the risk factors for the outbreak of peritoneal dialysis-related peritonitis in the renal disease center of a tertiary first-class hospital from June 1 to August 17, 2019; high risk factors were further verified by cohort study. Microbial culture of dialysis products of patients with peritonitis was performed to explore possible pathogens. Results The case-control study showed that the use of "YW" brand iodophor cap was an independent risk factor for this outbreak of peritoneal dialysis-related peritonitis, the adjusted OR was 15.40 and the 95%CI was 2.93-80.95. The cohort study confirmed that the use of "YW" brand iodophor cap was the cause of this outbreak, with an HR of 6.81 and the 95%CI of 2.61-17.77. Bacterial culture and endotoxin test results of specimens of "YW" brand iodophor cap and peritoneal dialysate were all negative, stopping the use of "YW" brand iodophor cap, incidence of peritoneal dialysis-related peritonitis decreased to the average level in the past 4 years, and it was determined that this peritoneal dialysis-related peritonitis was chemical peritonitis. Conclusion The outbreak is peritoneal dialysis-related chemical peritonitis in peritoneal dialysis patients due to the use of "YW" brand iodophor cap.

Abstract:Appendicular abscess and gangrene is one of the serious complications of acute appendicitis. Kerstersia gyiorum (K. gyiorum) is a rare bacteria, one patient with acute appendicitis was admitted to a hospital, patient's appendicular pus cultured and isolated a kind of flat, pale grey, dry, opaque, marginal diffuse bacterial colony, which was identified as K. gyiorum by mass spectrometry and 16S rRNA gene sequencing, after emergency surgery and sensitive drug treatment, patient was successfully cured. This paper reports and conducts literature review on a rare case of appendicular abscess caused by K. gyiorum.

Abstract:

Abstract:Antibiotic-associated diarrhea (AAD) refers to the diarrhea related to antibiotics after the application of antibiotics, it is a common adverse drug reaction, and its pathogenesis has not been fully elucidated. Clostridium difficile (CD) is an anaerobic enteropathogen with spore structure, which is considered to be a common cause of AAD, more and more studies have shown that AAD is related to CD infection (CDI), but the mechanism of CD-induced AAD is not very clear. This paper elucidates the relationship between AAD and CD, analyzes the possible mechanism of CD-induced AAD and some currently existing treatment methods from multiple aspects, so as to improve the treatment and prevention of AAD.

Abstract:Acinetobacter baumannii is one of the common pathogens causing healthcare-associated infection, the emergence of multidrug-resistant organisms, even pandrug-resistant organisms, poses a great threat to the world public health security. In recent years, a number of experimental studies have proved that bacteria can regulate the expression of relevant antimicrobial resistance genes by generating specific non-coding RNAs (ncRNAs) or changing their conformation under the pressure of antimicrobial agents, and play an important role in regulating antimicrobial resistance of bacteria. This review summarizes the research on regulatory role of regulatory ncRNAs on antimicro-bial resistance of Acinetobacter baumannii and ncRNAs as drug targets, in order to provide help to deal with the problem of antimicrobial resistance of Acinetobacter baumannii.