Abstract:Objective To analyze the epidemiology and change in antimicrobial resistance of clinically isolated pathogens causing intra-abdominal infection(IAI) in intensive care unit (ICU), and provide reference for clinicians to manage intra-abdominal infection and optimize the initial empirical anti-infection treatment. Methods IAI cases in department of critical care medicine of Nanfang Hospital from January 2011 to December 2018 were retrospectively analyzed. Two research periods were divided (the former 4 years and later 4 years), distribution of IAI bacterial flora and change in antimicrobial resistance of two periods were compared and analyzed. Results A total of 522 patients with IAI were investigated, 431 patients (181 in the former period and 250 in the later period) were finally included, a total of 527 strains of pathogens causing IAI were isolated. Epidemiological characteristics and antimicrobial resistance of isolated strains from patients with IAI were as follows: The proportions of Gram-negative bacteria, Gram-positive bacteria and fungi were 48.2%, 34.0% and 17.8% respectively; the top 5 strains were Escherichia coli, Enterococcus faecium, Klebsiella pneumoniae, Candida albicans and Enterococcus faecalis, accounting for 63.0% of all isolates; isolation rate of ESBLs-producing strains of Escherichia coli decreased in the later period than the former period (68.1% vs 45.9%, χ²=5.291, P=0.021), susceptibility rates to cephalosporins and piperacillin/tazobactam increased, resistance rate to carbapenem antibiotics remained at a low level and unchanged; isolation rate of ESBLs-producing strains of Klebsiella pneumoniae didn't change (28.6% vs 23.1%, χ²=0.212, P=0.645), but rate of carbapenem-resistant Klebsiella pneumoniae increased (14.3% vs 38.5%, χ²=4.103, P=0.043), antimicrobial susceptibility rates generally showed a downward trend; Acinetobacter baumannii was one of the most common non-fermentative bacteria, pandrug resistance was serious in the former period, resistance rate to imipenem and meropenem was 100%, and susceptibility rate was about 50% in the later period; vancomycin-resis-tant Enterococcus faecium and Enterococcus faecalis were not found, there was no significant change in resistance rate between the former and later periods. Conclusion Gram-negative bacteria are the main pathogens causing adult IAI. Although ESBLs-producing Enterobacterales and pandrug-resistant Acinetobacter baumannii are controlled to a certain extent, carbapenem-resistant Klebsiella pneumoniae is increasing gradually, antimicrobial resistance situation is still not optimistic, surveillance on epidemiology and antimicrobial resistance trend of pathogens causing IAI still need to be continued.

Abstract:Objective To establish the risk prediction scoring model of pulmonary infection(PI) in cerebral hemo-rrhage patients undergoing surgery, identify the high-risk population of PI, and provide basis for health care wor-kers(HCWs) to take early effective prevention and control measures. Methods Clinical data of cerebral hemorrhage patients undergoing surgery in a hospital in Shandong Province in 2016-2018 were collected prospectively, patients were randomly divided into modeling group and validation group based on a ratio of 7∶3, logistic regression model was established based on data of modeling group, factors were assigned according to β value, risk prediction scoring model of PI was established. The established risk scoring model was used to score the risk of patients in modeling group and validation group, and the predictive ability of the model was judged by receiver operating characteristic (ROC) curve and Hosmer-Lemeshow(H-L) test. Results Logistic regression analysis showed that endotracheal intubation, indwelling gastric tube, venous thrombosis and ASA were independent risk factors for PI in cerebral hemorrhage patients undergoing surgery, and corresponding scores in the risk scoring model were 5, 6, 4, and 2 points (per stratification) respectively. AUC under ROC curve of the risk scoring model in the modeling group was 0.864 (95%CI: 0.825-0.904, P < 0.001), H-L test was P=0.404; AUC under ROC curve in validation group was 0.861(95%CI: 0.800-0.921, P < 0.001), H-L test was P=0.452. Conclusion The established risk prediction scoring model can better predict the risk of PI in cerebral hemorrhage patients undergoing surgery, which can early identify high-risk population and optimize the prognosis of patients.

Abstract:Objective To analyze the perinatal risk factors and pathogen distribution of neonatal early-onset septicemia(EOS). Methods 168 neonates with EOS in the neonatal intensive care unit (NICU) of a hospital from 2016 to 2019 were selected as infection group, and 168 neonates without septicemia in NICU were randomly selected as control group, data about general condition and perinatal infection of neonates' mothers, as well as general condition, invasive procedure and complications of neonates were collected and compared. Results Neonates with EOS were mainly extremely premature neonates (n=65, 38.69%), neonates in control group were mainly full-term (n=75, 44.65%). In EOS group, most were extremely low birth weight neonates (n=67, 39.88%) and low birth weight neonates (n=54, 32.14%), while in control group, majority were normal weight neonates (n=98, 58.33%). Univariate analysis showed that mothers' gestational age, the number of induced abortion, placental abnormalities, amniotic fluid abnormalities, premature rupture of membrane, prenatal fever, as well as neonatal gender, gestational age, birth weight, and moist lung were influencing factors for neonatal EOS (all P < 0.05). Multivariate logistic regression analysis showed that mothers' gestational age>35 years, induced abortion, premature rupture of membrane, prenatal fever, neonatal birth weight lower than normal, and moist lung were independent risk factors for EOS. The main pathogens of neonatal EOS were Escherichia coli, Staphylococcus epidermidis and Klebsiella pneumoniae. Conclusion Early intervention should be carried out according to the risk factors for neonatal EOS, the appropriate treatment scheme should be selected according to the main pathogens.

Abstract:Objective To explore the incidence of catheter-related bloodstream infection (CRBSI) in the process of intravenous infusion therapy through midline catheters (MC) and peripherally inserted central catheters (PICC) by Meta-analysis, so as to provide reference for clinical prevention and treatment of CRBSI in the process of intravenous infusion therapy. Methods Web of Science, PubMed, Scopus, Embase, Cochrane Library, ProQuest, China National Knowledge Infrastructure (CNKI), Wanfang, VIP and China Biology Medicine (CBM) were searched to collect the related studies of CRBSI in the process of intravenous infusion therapy through MC and PICC, the retrieval time was from the establishment of the database to January 2020. According to the inclusion and exclusion criteria, two researchers independently searched and screened literatures as well as evaluated and extracted data, Revman 5.3 software was used for analysis. Results A total of 15 studies were collected, involving 34 235 patients, incidence of CRBSI in MC and PICC groups were 0.58% (43/7 392) and 0.53% (142/26 843) respectively. Meta-analysis showed that incidence of CRBSI in MC group was lower than that in PICC group (RR=0.63, 95%CI=0.43-0.93, P=0.02). Except that there was no significant difference in incidence of CRBSI between MC group and PICC group in other country subgroups (P>0.05), incidence of CRBSI in MC group was lower than that of PICC group in Chinese subgroup (RR=0.21, 95%CI=0.07-0.64) and American subgroup (R=0.53, 95%CI=0.31-0.89), but in British subgroup was higher than PICC group (RR=3.67, 95%CI=1.18-11.37), diffe-rences were all significant (all P < 0.05). There were no significant differences in the incidence of CRBSI between MC group and PICC group in adult subgroup and other subgroups (all P>0.05). Incidence of CRBSI in MC group was lower than PICC group in randomized controlled study subgroup (RR=0.12, 95%CI=0.02-0.66, P=0.01), but incidence of CRBSI in MC group and PICC group was not significantly different in retrospective cohort study subgroup(P>0.05). The overall stability of each study was common, stability among the studies with good and moderate quality was general, without significant publication bias. Conclusion Meta-analysis on the risk of CRBSI in the process of intravenous infusion therapy through MC and PICC is firstly systematically reviewed, incidence of CRBSI in MC group is lower than that in PICC group in the process of intravenous infusion therapy, MC is preferentially selected for intravenous infusion for patients under the same conditions. More high-quality studies and studies about children are needed to explore the risk of CRBSI in the process of intravenous infusion therapy through MC and PICC.

Abstract:Objective To investigate the psychological coping ability and influencing factors of health care workers(HCWs) in designated hospitals for coronavirus disease 2019(COVID-19) during anti-epidemic process, and provide theoretical basis for improving the psychological intervention of medical institutions and HCWs in dealing with sudden infectious diseases. Methods A stratified random sampling method was used to investigate HCWs who participated in first-line anti-epidemic of COVID-19 in designated hospitals in 3 districts and 5 counties in Fuyang City from 25 to 29, February 2020. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to investigate the anxiety and depression of HCWs, influencing factors of anxiety and depression of HCWs was compared and analyzed. Results A total of 1 426 HCWs were investigated, 194 of whom had anxiety, incidence was 13.60%; incidence of anxiety in female was higher than that in male (15.48% vs 8.55%, P=0.001), incidences of anxiety in nurses (15.59%) and medical technicians (15.09%) were higher than that in doctors (9.09%), diffe-rence was statistically significant (P=0.008). 395 HCWs (27.70%) suffered from depression, incidence of depression in female was higher than that in male (29.13% vs 23.83%, P=0.038), incidences of depression in nurses (29.25%) were higher than that in doctors (21.53%), difference was statistically significant (P=0.001). SAS score and SDS score of 1 426 HCWs were (39.20±9.42) and (42.57±11.78) respectively. SAS and SDS scores of female were both higher than male; SAS and SDS scores of nurses and medical technicians were both higher than doctors, differences were both statistically significant (both P < 0.05). SDS score in HCWs with junior college degree or below was higher than that of HCWs with bachelor degree or above; SDS score of HCWs with junior professional title was higher than that of HCWs with intermediate and senior professional title, differences were all statistically significant (all P < 0.05). Conclusion HCWs participating in the first-line anti-epidemic all had different degrees of psychological pressure, medical institutions should pay attention to the establishment of the disposal system of public health emergencies and the training of HCWs' coping ability.

Abstract:Objective To explore the application efficacy of the predictive three-level material management mode in the ward of coronavirus disease 2019 (COVID-19) in medical team assisting Hubei Province. Methods The predictive three-level material management mode was adopted to manage the medical materials of the third batch of Xinjiang medical teams assisting Hubei Province, timeliness rate of material taken, material redundancy rate, material handover time, and the time for one-time preparation of materials for diagnosis and treatment before and after the implementation of the management mode was compared. Results After the implementation of predictive three-level material management mode, timeliness rate of material taken enhanced, material redundancy rate decreased in each region, differences were both statistically significant (both P < 0.05); material handover time, time required for item preparation for blood collection and oxygen inhalation was shorter than before implementation, satisfaction of health care workers was higher than before implementation (80.13% vs 96.15%), differences were all statistically significant (all P < 0.05). Conclusion The predictive three-level material management model can strengthen the prospective treatment strategy, achieve precise and scientific management on materials in COVID-19 ward, effectively improve the management efficiency of aid materials in Hubei Province, achieve the satisfaction of both doctors and nurses, which is worth promoting and applying.

Abstract:Objective To investigate the prevalence of healthcare-associated infection(HAI) of inpatients at all levels of hospitals in Hainan Province from 2014 to 2018, provide scientific guidance for reducing the incidence of HAI in Hainan. Methods Cross-sectional survey method was used to conduct bedside survey and medical record survey for inpatients participated in HAI prevalence survey in Hainan at survey day in 2014, 2016 and 2018, survey data was analyzed with SPSS 20.0 software. Results A total of 17 497, 18 509 and 22 705 patients were surveyed in 2014, 2016 and 2018, HAI prevalence rates were 1.88%-3.26%, showing a downward trend(P < 0.001); there were 1 612 infection sites, the main infection were lower respiratory tract infection (813 times, 50.43%) and urinary tract infection (242 times, 15.01%); general intensive care unit was the department with the highest prevalence rate(22.46%-34.53%). A total of 892 pathogenic strains were isolated, Gram-negative bacteria were the main pathogen(n=664, 74.44%), mainly Pseudomonas aeruginosa(n=169, 18.95%) and Escherichia coli(n=122, 13.68%), Staphylococcus aureus accounted for the highest proportion(n=48, 5.38%) among Gram-positive bacteria. Utilization rates of antimicrobial agents were 32.87%-34.95% in three years, showing a downward trend(P=0.001). Conclusion Although the prevalence rate of HAI in Hainan Province has decreased, it is still necessary to strengthen the prevention and control of key departments, key site, key links and high-risk population, gradually reduce the incidence of HAI.

Abstract:Objective To evaluate the effect of bundle intervention on reducing catheter-associated urinary tract infection (CAUTI). Methods From January to June 2017, the baseline survey was conducted on targeted monitoring of patients with urinary catheterization in a hospital (pre-intervention period); from July to December, combined with plan-do-check-act (PDCA) tool, the main causes were find out and bundle intervention measures were formulated (transitional period); from January to June in 2018, intervention measures were implemented (post-intervention period), difference in urinary catheter utilization rate, average urinary catheterization days, and incidence of CAUTI per 1 000 catheter-days before and after intervention were compared. Results After intervention, compliance rate of hand hygiene, implementation rate of prevention and control measures, as well as awareness rate of prevention and control measures were 81.94%, 95.37% and 97.98% respectively, which were higher than 64.66%, 66.31% and 65.02% before the intervention, implementation rate of daily assessment reached 96.15% after intervention. Incidence of CAUTI per 1 000 urinary catheter-days decreased from 1.71‰ before intervention to 1.22‰ after intervention, catheter utilization rate dropped from 10.02% before intervention to 7.69% after intervention, incidence of CAUTI per 1 000 urinary catheter-days in internal medical wards dropped from 3.73‰ before intervention to 1.56‰ after intervention, differences between these indexes before and after intervention were all statistically significant (all P < 0.05). Conclusion CAUTI target monitoring combined with PDCA tool can identify the weak links of HAI prevention and control, provide evidence for formulating specific prevention and control measures, and implement bundle intervention measures to reduce the incidence of CAUTI effectively.

Abstract:Objective To explore the assessment modes of outpatient and emergency antimicrobial prescriptions, and provide reference for the use and management of antimicrobial agents. Methods Outpatient and emergency antimicrobial prescriptions in a hospital from February 2015 to August 2019 were randomly selected by prescription assessment software. The irrational prescriptions of antimicrobial agents and involved problems were initially assessed by dispensing pharmacists and clinical pharmacists and then re-assessed by experts, the irrational prescriptions of antimicrobial agents in different years and inconsistent assessment between clinical pharmacists and experts were compared. Results The inappropriate prescription rate of outpatient antimicrobial agents decreased from 1.05% (372/35 446) in 2015 to 0.18% (73/39 719) in 2019, and that in emergency department decreased from 0.43% (75/17 432) in 2015 to 0.13% (24/18 657) in 2019, presenting a downward trend year by year. The main inappropriate prescription of antimicrobial agents was inappropriate usage and dosage (1 209/1 468, 82.36%). From 2015 to 2019, the inconsistency rates of initial assessment of clinical pharmacists and the re-assessment of experts were 10.29%-12.46%. Conclusion Management of antimicrobial agents is quite effective, and assessment process and method of prescription should be improved in the future.

Abstract:Objective To evaluate the diagnostic value of fiberbronchoscopy combined with rapid on-site evaluation (ROSE) in pulmonary infection. Methods Patients with pulmonary infection in a hospital from July 2017 to June 2018 (fiberbronchoscopy group: performed routine fiberbronchoscopy) and from July 2018 to June 2019 (fiberbronchoscopy+ROSE group: performed fiberbronchoscopy combined with ROSE examination) were selected, the examination results of two groups of patients were compared, confirmed diagnostic results of 6-month follow-up were compared with on-site evaluation results of two groups, Kappa value was calculated and receiver operating characteristic (ROC) curve were plotted to evaluate diagnostic efficacy. Results A total of 438 patients were enrolled, 207 were in fiberbronchoscopy group and 231 in fiberbronchoscopy+ROSE group. Compared with fiberbronchoscopy group, the time of the first examination was longer in fibrobronchoscope+ROSE group(χ²=1.965, P < 0.001), but the proportion of patients who needed to choose the second examination due to the unclear diagnosis in the first examination was lower(χ²=24.533, P < 0.001), diagnostic efficiency of fiberbronchoscopy+ROSE group was higher than that of fiberbronchoscopy group (Kappa: 0.411 vs 0.164; AUC: 0.904 vs 0.759). Conclusion ROSE technique can provide a clear cytological background and help to facilitate the etiological classification of pulmonary infection, compared with simple fiberbronchoscopy, the combination of fiberbronchoscopy and ROSE technique has higher diagnostic efficacy and can effectively reduce the number of second examination, it is worthy of clinical application.

Abstract:Objective To analyze the clinical characteristics of patients with influenza A virus infection complicated with pneumonia during the peak period of influenza. Methods From December 2018 to April 2019, hospitalized patients with influenza A virus infection complicated with pneumonia in the respiratory department of a hospital were classified as influenza A complicated with pneumonia group, patients only with influenza A virus infection in internal medicine outpatient department were classified as influenza A group, and the healthy physical examinees in physical examination center were classified as physical examination group, clinical manifestations and characteristics of patients were retrospectively analyzed. Results There were 57 cases in influenza A complicated with pneumonia group, 42 cases in influenza A group, and 33 in physical examination group, difference in age among three groups was significant (F=16.57, P < 0.001). The age of patients in influenza A complicated with pneumonia group was the oldest, which was (61.65±16.92) years. White blood cell (WBC) count, neutrophil percentage, C-reactive protein (CRP), procalcitonin (PCT) and serum amyloid A protein (SAA) of patients in influenza A complicated pneumonia group were higher than those of patients in influenza A group and persons in physical examination group (all P < 0.05). Cycle threshold (CT) value of influenza A virus load nucleic acid detection in patients in influenza A complicated with pneumonia group was lower than that in patients in influenza A group ([16.18±2.53] vs [19.30±4.12], t=2.100, P=0.039); correlation coefficients (r) between CT value and CRP as well as PCT in patients in influenza A complicated with pneumonia group were -0.51 and -0.55 respectively, both were negatively correlated. Conclusion Patients with influenza A virus infection are elderly people with high influenza A virus load, the increase of CRP and PCT suggests the risk of pneumonia for patients with influenza A virus infection, which can provide the basis for clinical diagnosis and treatment.

Abstract:Objective To investigate species distribution and antimicrobial resistance of non-tuberculous mycobacterial pulmonary disease (NTMPD), and provide basis for clinical diagnosis and treatment. Methods Positive clinical isolates cultured with BACTEC MGIT 960 system in a chest hospital in Hunan Province from 2017 to 2019 were collected, non-tuberculous mycobacteria (NTM) was isolated by MPB64 detection and PNB/TCH medium growth testing, NTM species were identified by 16Sr RNA, Hsp65 and ITS gene sequencing, resistance of Mycobacterium abscessus to 10 kinds of antimicrobial agents was detected with minimal inhibitory concentration (MIC) method. Results Among 10 443 positive strains reported by MGIT 960, 1 227 NTM strains were isolated, isolation rate was 11.7%. The top 4 strains were Mycobacterium intracellulare (27.8%), Mycobacterium abscessus (25.3%), Mycobacterium gordonae (16.5%) and Mycobacterium avium (16.1%). Susceptibility rates of Mycobacterium abscessus to amikacin, clarithromycin and linezolid were high, which were 94.6%, 87.5% and 82.1% respectively, while susceptibility rates to other antimicrobial agents were all lower than 50%. Conclusion Mycobacterium abscessus and Mycobacterium intracellular are the most prevalent strains of NTM in Hunan Province, amikacin and clarithromycin can be used as the preferred antimicriobial agents for clinical treatment of patients with Mycobacte-rium abscessus infection in Hunan Province.

Abstract:Objective To investigate blood and microbial contamination of surgical shoes of health care workers(HCWs), and provide theoretical basis for the cleaning and disinfection of surgical shoes. Methods From April to May in 2020, 80 pairs of surgical shoes after cleaning and disinfection were randomly selected from the operating room of a hospital for three consecutive weeks, according to shoes used by different staff (surgeons, nurses, anesthesiologists and cleaners), shoes were divided into four categories, blood contamination on instep of shoes was investigated by naked eye observation and occult blood test, specimen of sole taken by contact imprinting method were performed bacterial and fungal culture. Results Occult blood test result showed that 50.00% (40/80) of the surgical shoes were contaminated by blood, contamination rate of instep of surgeons' shoes were the highest, accounting for 63.33%. Bacterial colony count showed that operating shoes of the cleaners were seriously contaminated by microorganisms, bacterial and fungal counts were the highest, which were 93 CFU/cm² and 58 CFU/cm² respectively. Occult blood test and naked eye observation were evaluated, thee results showed that sensitivity and specificity of detection of occult blood by colloidal gold immunochromatography assay were 85.00% and 70.00% respectively. Six shoes were false negative and 12 shoes were false positive. The positive rate of naked eye observation was 57.50%, and that of occult blood test was 50.00%, there was no significant difference between two methods (P>0.05). Conclusion Blood and microbial contamination of HCWs' operating shoes is serious, it is necessary to strengthen cleaning and disinfection, and pay attention to the risk that operating shoes may be the hidden host of pathogenic microbial transmission.

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Abstract:Platelet has the basic function of hemostasis and maintaining vascular integrity, recent studies have proved that it plays an important role in immune defense against bacterial infection. When bacterial infection occurs, platelet firstly migrate to the infection frontline to identify, bind, endocytose pathogens or release a variety of platelet microbicidal protein, which can directly kill bacteria, strengthen the innate immune function of neutrophil, monocyte and complement system, promote T lymphocyte and B lymphocyte to initiate adaptive immune responses against bacteria.

Abstract:In recent years, the widespread use of antimicrobial agents has led to the emergence of multidrug-resistant Staphylococcus aureus, which pose a serious challenge to clinical therapy. The use of antimicrobial agents increases bacterial resistance, so it is necessary to find alternative therapy. In this paper, the potential alternative therapy to antimicrobial agents in recent years was reviewed, which including anti-biofilm activity agents (biosurfactant, magnetic nanoparticle, bacteriophage lysin, bacteriocin, histones, lysophosphatidylcholine, essential oil), antimicrobial photodynamic therapy, and immunomodulator, so as to help to reduce bacterial resistance.

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