• Issue 2,2023 Table of Contents
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    • 论著·医院感染监测专题
    • Construction and evaluation of a machine-learning-based model for predicting healthcare-associated infection in patients with acute ischemic stroke

      2023(2):129-135. DOI: 10.12138/j.issn.1671-9638.20233300

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      Abstract:Objective To construct a machine-learning-based model through diagnosis and treatment data of patients with acute ischiic stroke (AIS) to predict healthcare-associated infection (HAI) in AIS patients and provide support for early intervention of clinical treatment. Methods 2360 inpatients with stroke from October 2020 to Deciber 2021 in department of neurology of a tertiary first-class hospital in Jiangxi Province were selected as study subjects and randomly divided at 8 ∶2 ratio into training set (n=1888) and testing set (n=472). Diographic data as well as clinical diagnosis and treatment data within 48 hours of admission were included to analyze the indepen-dent risk factors for HAI in AIS patients. Prediction model of HAI in AIS patients was constructed with logistic regression and three machine-learning algorithms (RandomForest, XGBoost, LightGBM). Area under the receiver operating characteristic curve (AUC) was adopted to evaluate the prediction efficacy of four prediction models. Results HAI occurred in 574 patients, incidence of HAI was 24.32%. Logistic regression analysis showed that age>65 years old, NIHSS score >5 points at admission, white blood cell count >10×109/L, serum sodium ≤135 mmol/L, invasive operation and dysphagia were risk factors for HAI. AUC values of logistic regression, RandomForest, XGBoost and LightGBM prediction models for predicting HAI in AIS patients in the test set were 0.854, 0.850, 0.881 and 0.870 respectively. Conclusion Machine-learning-based model for predicting HAI is conducive to the early identification of HAI and relevant risk factors, and facilitates timely preventive and control measures in AIS patients, thus reduces the incidence of HAI.

    • Construction and validation of the prediction model for the bloodstream infection caused by third-generation cephalosporin-resistant Escherichia coli

      2023(2):136-141. DOI: 10.12138/j.issn.1671-9638.20233184

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      Abstract:Objective To construct and validate the prediction model for the third-generation cephalosporin-resis-tant (3GCR) Escherichia coli (E. coli) bloodstream infection. Methods 494 patients with E. coli bloodstream infection in a hospital from January 2014 to Deciber 2021 were selected as studied subjects, of which 434 cases were divided as the modeling group and 60 cases as the validation group. According to 3GCR resistance, subjects were classified into the 3GCR group and the third-generation cephalosporin sensitive (3GCS) group. Clinical data and laboratory results of the subjects were recorded, and the independent risk factors were screened by logistic regression analysis. Nomogram was constructed to validate the accuracy of the model. Results Logistic regression analysis showed that invasive operation (OR=19.482, 95%CI: 11.434-33.194), use of cephalosporin (OR=1.843, 95%CI: 1.070-3.173), high level procalcitonin (OR=1.272, 95%CI: 1.159-1.396) and high level C-reactive protein (CRP, OR=1.006, 95%CI: 1.002-1.011) were independent risk factors for 3GCR E. coli bloodstream infection. Nomograph model was constructed. The Hosmer-Lieshow method showed good fitting results of the model with the modeling group P=0.562 and the validation group P=0.742. The area under the receiver operating characteristic (ROC) curve of the modeling group and validation group were 0.883 (95%CI: 0.851-0.914) and 0.857 (95%CI: 0.807-0.907) respectively, indicating that the model has good discrimination. The decision curve analysis showed that the prediction model was of high value. Conclusion The predictive model based on invasive manipulation, use of cephalosporins, PCT and CRP levels has certain practical value in distinguishing 3GCR strain.

    • Predictive value of routine testing data mining for acute ischemic stroke complicated with stroke-associated pneumonia

      2023(2):142-149. DOI: 10.12138/j.issn.1671-9638.20233331

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      Abstract:Objective Through mining and analyzing the routine test data to develop its residual value and provide auxiliary predictive value for acute ischiic stroke (AIS) complicated with stroke-associated pneumonia (SAP). Methods AIS patients admitted to a hospital from June 2019 to June 2021 were retrospectively analyzed, divided into SAP group and non-SAP group according to whether they were complicated with SAP, and subdivided into trai-ning set and testing set at a ratio of 7 ∶3. AIS patients admitted to hospital from July 2021 to June 2022 were collected as the validation set. SAP-related test parameters were screened by the least absolute shrinkage and selection operator (LASSO). Nomogram model of the combined prediction was constructed and validated with training set, testing set and verification set. Discrimination and calibration of prediction model were assessed by receiver operating chara-cteristic (ROC) curve and calibration curve respectively, clinical practicability was assessed by decision curve analysis (DCA). Nomograph model was arranged into a web calculator to improve the clinical practical value. Results A total of 379 patients with AIS were taken as the basic population of the study, including 42 cases (incidence 11.08%) in SAP group. According to the 7 ∶3 distribution method, 265 cases were divided in training set and 114 in testing set.157 cases of AIS admitted from July 2021 to June 2022 were used as validation set, including 24 cases (incidence 15.29%) in SAP group. Five test parameters related to SAP were screened out by LASSO, namely neutrophil, lymphocyte, prealbumin, fibrinogen, and D-dimer. The calibration curve showed good calibration that the predicted probability of training set and testing set was consistent with the actual probability. DCA curve showed that the high risk threshold of training set was 0-0.75 and the net benefit was 0-0.11. The high risk threshold of testing set was 0-0.65, the net benefit was 0-0.11, with good clinical practicability. ROC curve showed that area under curve (AUC) predicted by full data set was 0.924, the sensitivity and specificity were 83.33% and 87.24% respectively. AUC predicted by training set was 0.922, the sensitivity and specificity were 79.31%, and 91.95% respectively. AUC predicted by testing sets was 0.919, sensitivity and specificity were 84.62% and 86.14% respectively, all of which had good discrimination performance. AUC predict by validation set was 0.850, sensitivity and specificity were 66.67% and 89.47% respectively. The model has good external applicability. The web calculator was arranged at https://ww-rstudiomn.shinyapps.io/SAP-nomgram/, which can be accessed via QR code. Test showed that the performance was stable. Conclusion The mining of routine test data provides a clinical value for the prediction of AIS complicated with SAP, thus provides a basis for early treatment and intervention.

    • Construction and validation of a risk prediction model for the infection after transcatheter arterial chemoembolization in patients with liver cancer

      2023(2):150-158. DOI: 10.12138/j.issn.1671-9638.20233028

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      Abstract:Objective To construct and validate the risk prediction model of infection in patients with liver cancer after transcatheter arterial chioibolization (TACE). Methods Clinical data of 1043 liver cancer patients underwent TACE in a hospital from January 2016 to March 2018 were collected retrospectively. According to whether infection occured after TACE, patients were divided into infected group and non-infected group. Risk factors for the infection after TACE were screened by logistic regression analysis, and nomograph model was constructed and internally verified by Bootstrap method. 349 liver cancer patients underwent TACE from January to July 2020 in this hospital were collected as the validation set for external validation of the model. C-statistics and calibration curves were used to evaluate the prediction performance of the model. Results Among 1043 liver cancer patients, 105 were infected after TACE, thus infection incidence was 10.07%. History of biliary tract interventional surgery, largest tumor diameter >5 cm, ascites, tumor rupture hiorrhage, dosage of lipiodol >12 mL and the use of additional ibolic materials were independent risk factors for the infection after TACE (all P < 0.05). Previous TACE history was the protective factor for the infection after TACE (P < 0.05).The risk prediction model for the infection after TACE in liver cancer patients were Logit(P)=-4.403+1.874×(history of biliary tract interventional surgery) -1.101×(history of previous TACE surgery) +1.253×(largest tumor diameter >5 cm) +1.163×(ascites) +1.346×(tumor rupture hiorrhage) +0.901×(dosage of lipiodol >12 mL) +1.369×(use of additional ibolic materials). C-statistic of the model was 0.857 (95% confidence interval [CI]: 0.822-0.892). The maximal index of Youden, critical value, sensitivity and specificity were 0.596, 0.109, 84.8%, and 74.8% respectively. C-statistics of internal and external validation were 0.847 and 0.829 respectively. Calibration curve and Brier score showed that the model fit well. Conclusion The prediction model of infection risk of liver cancer patients after TACE constructed in this study has good discrimination and calibration, thus can be used to predict the infection of liver cancer patients after TACE.

    • Construction and validation of risk prediction model for umbilical vein catheterization bloodstream infection in neonates in neonatal intensive care unit

      2023(2):159-166. DOI: 10.12138/j.issn.1671-9638.20233383

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      Abstract:Objective To construct a risk prediction model for neonatal umbilical vein catheterization (UVC) bloodstream infection (BSI) in neonates in a neonatal intensive care unit (NICU), and validate the application effect. Methods Neonates underwent UVC in NICU of a hospital from July 2020 to Deciber 2021 were selected retrospectively as the modeling group and divided into the infection group and non-infection group according to whether UVC BSI occurred. Bacteria isolated from blood microbial culture of neonates in infection group was statistically analyzed. Risk factors for BSI were screened by univariate and multivariate logistic regression analysis. R language was used to construct a nomograph model to predict the risk. In addition, neonates underwent UVC from January to July 2022 were selected as the validation group for external validation of the model. Results From July 2020 to Deciber 2021, 447 neonates were selected as modeling group, including 34 in infection group and 413 in non-infection group, with an infection rate of 7.6%. 225 neonates from January to July 2022 were as the validation group. Logistic regression analysis on modeling group showed that the total catheterization time >7 days, birth weight < 1500 g, puncture opportunities >2 times, albumin < 35 g/L, history of mechanical ventilation and peripherally inserted central catheter (PICC) treatment were independent risk factors for UVC BSI in NICU neonates. Nomograph prediction model was constructed based on the regression analysis results. The area under the receiver operating characteristic (ROC) curve of subjects in the modeling group was 0.866 (95%CI: 0.784-0.947), the Youden index, sensitivity, and specificity were 0.642, 0.853, and 0.789 respectively. Hosmer-Lieshow test showed P=0.323. The area under the ROC curve of the validation group was 0.837 (95%CI: 0.744-0.930). The Youden index, sensitivity, and the specificity were 0.549, 0.700, and 0.849 respectively, which suggested that the model has good discrimination and degree of fitting. Conclusion The model constructed in this study can well predict the risk of UVC BSI in NICU neonates, thus can be used as an evaluation tool for clinical medical staff to predict the risk of UVC BSI in neonates.

    • 论著&#183;手术部位感染专题
    • Influence of peri-operative blood glucose control level on surgical site infection and pathogen distribution in patients with diabetes undergoing bone and joint replacement

      2023(2):167-174. DOI: 10.12138/j.issn.1671-9638.20233602

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      Abstract:Objective To investigate the effect of peri-operative blood glucose control level on surgical site infection (SSI) and pathogen distribution in patients with diabetes undergoing bone and joint replacient. Methods From May 2014 to May 2022, patients with type 2 diabetes undergoing bone and joint replacient in 7 hospitals were selected as studied subjects. According to peri-operative level of hioglobin A1c (HbAlc), patients were divided into good blood glucose control (GBGC) group and poor blood glucose control (PBGC) group. Incidence of SSI, wound healing time, length of hospital stay, total medical expense, distribution of infection pathogens and antimicrobial resistance were compared between two groups. Univariate and multivariate analyses were used to analyze the risk factors for PBGC. Results A total of 1 480 patients were recruited, including 768 in GBGC group and 712 in PBGC group. Incidence of SSI were 7.16% and 14.89% in GBGC group and PBGC group respectively. Wound healing time, length of hospital stay, infection course and total medical expense in GBGC group were all lower than PBGC group (all P < 0.01). Constituent rate of isolated Gram-positive (G+) bacteria in GBGC group was higher than that in PBGC group, while constituent rate of isolated Gram-negative (G-) bacteria in GBGC group was lower than that in PBGC group (P < 0.05). The course of diabetes >10 years (OR=1.826, 95%CI [1.664-2.005]), pre-operative Hamilton Anxiety Scale (HAMA) >14 points (OR=3.301, 95%CI [1.756-6.215]), general anesthesia (OR=1.941, 95%CI [1.057-3.563]), and duration of operation >3 hours (OR=2.308, 95%CI [1.134-4.657]) were independent risk factors for PBGC during peri-operative period of bone and joint replacient (all P < 0.05). Conclusion The peri-operative blood glucose control of diabetes patients with bone and joint replacient has certain impact on SSI and pathogen distribution. Pre-operative anxiety state of patients, course of diabetes, mode of anesthesia and duration of surgery are independent risk factors for poor peri-operative blood glucose control.

    • Epidemiological investigation on clustered surgical site infection after arthroscopic surgery

      2023(2):175-180. DOI: 10.12138/j.issn.1671-9638.20233576

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      Abstract:Objective To conduct an epidiiological investigation of clustered surgical site infection (SSI) after arthroscopic surgery in orthopedic ward, and provide evidence for the prevention and control of healthcare-associated infection (HAI). Methods Epidiiological investigation was carried out on 3 cases of SSI after arthroscopic surgery in the orthopedics department of a tertiary hospital from Septiber to October 2020. Evidence-based intervention was performed. Prevention and control effect was evaluated. Results There were 3 cases of SSI after arthroscopic surgery in the orthopedic ward in a short time. Pseudomonas aeruginosa (P. aeruginosa) was isolated from incision secretion culture, and drug sensitivity spectrum phenotypes of isolated strains were identical. Arthroscopic surgery was suspended. Multiple sampling was conducted on hands of the relevant medical staff, ward environment, and surgical instruments. P. aeruginosa was isolated from flushing fluid specimen of arthroscopic trocar by simulating surgical operation, and corresponding drug sensitivity results were consistent with P. aeruginosa isolated from the patient's incision secretion. Intervention was carried out according to epidiiological investigation results. Low tiperature plasma sterilization on trocar was changed into high tiperature and pressure sterilization. Specimens of lumen flushing fluid were collected and cultured by simulating the arthroscopic surgery again, and no P. aeruginosa was detected. One month after the resumption of arthroscopic surgery, no SSI case was found, thus confirmed the effectiveness of the prevention and control measures. Conclusion Biofilm may form in the lumen of the arthroscopic trocar, which is difficult to riove during cleaning. Low tiperature plasma sterilization can not penetrate the biofilm, resulting in clustered SSI event of arthroscopic operation. Thermodynamic sterilization method can effectively sterilize the pathogenic bacteria in biofilm.

    • Meta-analysis on risk factors for post-operative surgical site infection in patients with gastric cancer

      2023(2):181-188. DOI: 10.12138/j.issn.1671-9638.20233507

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      Abstract:Objective To analyze the risk factors for surgical site infection (SSI) in patients with gastric cancer through Meta-analysis. Methods Data from relevant databases at home and abroad from Noviber 29, 2012 to Noviber 29, 2022 were retrieved. Meta-analysis was performed using RevMan 5.4 software. Results A total of 17 articles were included, involving 13953 patients. Risk factors with statistical significance included male (OR=1.66), elderly (OR=1.96), body mass index (BMI) > 25 kg/m2 (OR=2.70), diabetes (OR=2.41), tumor stage (OR=2.38), laparotomy (OR=2.04), duration of operation (OR=3.41), total gastrectomy (OR=1.97), and peri-operative blood transfusion (OR=3.71). Conclusion Patients with the following characteristics such as male, elderly, BMI > 25 kg/m2, diabetes, tumor stage, laparotomy, duration of operation, total gastrectomy or peri-operative blood transfusion are prone to develop SSI, therefore, health care workers should pay more attention in SSI prevention.

    • Influencing factors for surgical site infection based on propensity score matching: a real-world study

      2023(2):189-194. DOI: 10.12138/j.issn.1671-9638.20232299

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      Abstract:Objective To analyze the influencing factors for surgical site infection (SSI) based on real-world data (RWD) from healthcare-associated infection (HAI) monitoring system. Methods From January 2019 to December 2021, inpatients of a tertiary first-class hospital in Nanchang were selected as the study subjects. Differences between the covariates of SSI group and the non-infected group were balanced by 1∶1 propensity score matching (PSM), and the influencing factors for SSI were analyzed by multivariate logistic regression. Results 24 507 subjects were contained in the study, out of which 210 cases had SSI (incidence 0.86%), including 141 cases (67.14%) of superficial incision tissue infection. A total of 94 pathogenic strains were isolated, including 64 (68.08%) Gram-positive bacteria, 28 (29.79%) Gram-negative bacteria and 2 (2.13%) fungi. 210 pairs were successfully matched with PSM. After matching, there was no statistically significant difference between two groups in terms of age, gender, year, department, and whether or not with emergency treatment (all P>0.05). Multivariate logistic regression analysis showed that risk factors for SSI were pre-operative hospital stay ≥6 days, operation duration ≥3 hours, clean-contaminated incision and contaminated incision, whereas endoscopic surgery and prophylactic use of antimicrobial agents were the protective factors. Conclusion PSM can reduce the selection bias of routine data collection research, balance group differences of baseline data, and help hospital to make full use of the big data of HAI management system to explore the management indicators of individualized control.

    • Effect of doctor-nurse integrated infection control management on prevention and control of infection in ophthalmic surgery

      2023(2):195-199. DOI: 10.12138/j.issn.1671-9638.20231408

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      Abstract:Objective To evaluated the effect of doctor-nurse integrated infection control management in operating room on prevention and control of healthcare-associated infection (HAI) in patients undergoing ophthalmic surgery. Methods 4612 patients with ophthalmic surgery from August 2019 to January 2020 were selected as the control group and implemented routine medical management mode; 4905 patients with ophthalmic surgery from May to October 2020 were selected as the intervention group and implemented doctor-nurse integrated infection control mana-gement mode, HAI prevention and control attitude and behavior of health care workers (HCWs) before and after the intervention as well as HAI after ophthalmic surgery were investigated and analyzed. Results HAI rates of patients before and after the implementation of doctor-nurse integrated infection control management were 1.22‰ (n=6) and 0.22‰ (n=1) respectively, there was significant difference between two groups (χ2=3.892, P=0.049). After the implementation of integrated infection control management mode, scores of HCWs' HAI prevention and control attitude on mask wearing, hand hygiene, aseptic operation, medical waste disposal and occupational protection were all higher than those before the intervention, scores of HCWs' HAI prevention and control behavior on mask wearing, hand hygiene, aseptic operation, medical waste disposal, occupational protection and operating room environmental management were all higher than those before the intervention (all P < 0.05). Conclusion The doctor-nurse integrated infection control management can effectively decrease HAI in patients undergoing ophthalmic surgery, improve the attitude and behavior of HCWs towards HAI prevention and control.

    • Articles
    • Value of National Early Warning Score 2 combined with blood lactic acid in predicting short-term prognosis of patients with severe community-acquired pneumonia

      2023(2):200-207. DOI: 10.12138/j.issn.1671-9638.20233398

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      Abstract:Objective To evaluate the value of National Early Warning Score 2 (NEWS2) combined with arterial blood lactic acid (Lac) level in predicting short-term prognosis of patients with severe community-acquired pneumonia (SCAP). Methods Data about neutrophil-to-lymphocyte ratio (NLR), oxygenation index, NEWS2 as well as acute physiology and chronic health score (APACHE Ⅱ) of adult patients with SCAP admitted to a tertiary first-class hospital from May 2017 to May 2022 were collected retrospectively. According to the 28-day prognosis, patients were divided into survival group and death group. Differences between two groups were compared, and correlation of main indicators were analyzed. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were adopted to analyze the predictive value of NEWS2, Lac and their combination on the risk of death in SCAP patients. Results A total of 97 SCAP patients were enrolled, 65 survived and 32 died, with a 28-day mortality of 32.99%. Compared with survival group, NEWS2 score, APACHE Ⅱ score, procalcitonin (PCT), NLR and blood Lac increased significantly in death group, while CD3+CD4+ T lymphocyte and oxygenation index decreased significantly, with significant differences. Blood Lac had a good correlation with NEWS2 and APACHE Ⅱ (r=0.411, 0.709, both P < 0.01). Multivariate logistic regression analysis showed that NEWS2 and blood Lac were independent risk factors for 28-day mortality in SCAP patients (OR=1.422, 95%CI 1.043-1.938; OR=1.635, 95%CI 1.072-2.492, both P < 0.05). ROC curve analysis showed that compared with the traditional APACHE Ⅱ score, NEWS2 and blood Lac had good predictive value for 28-day mortality of SCAP patients (area under the curve [AUC]: 0.740, 0.721 vs 0.772, Z=0.506, 1.141, both P>0.05). When the best cut-off values of NEWS2 and blood Lac were 7 points and 1.96 mmol/L respectively, the sensitivity were 81.3% and 68.7%, the specificity were 63.1% and 75.4% respectively. The combination of NEWS2 and Lac showed higher predictive va-lue (AUC: 0.776 vs 0.772), with higher sensitivity (84.4%) and specificity (70.8%). Conclusion NEWS2 and blood Lac at admission are independent risk factors for the 28-day mortality of SCAP patients, both had high predictive value. NEWS2 combined with blood Lac has higher predictive value in short-term prognosis of SCAP patients than single score.

    • Clinical characteristics and risk factors of Staphylococcus aureus bloodstream infection in hospitalized children

      2023(2):208-216. DOI: 10.12138/j.issn.1671-9638.20233162

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      Abstract:Objective To understand the clinical characteristics of bloodstream infection (BSI) of Staphylococcus aureus (SA) in children and antimicrobial susceptibility characteristics of the pathogenic strains, and explore the susceptibility factors of methicillin-resistant SA (MRSA) BSI and SA healthcare-associated infection (HAI). Methods Medical records of hospitalized children with SA isolated from blood culture in a children's hospital from January 2014 to December 2019 were retrospectively analyzed. According to antimicrobial susceptibility test results and sources of SA, patients were divided into MRSA group, methicillin-sensitive SA (MSSA) group, as well as healthcare-associated BSI group (HA group) and community-associated BSI group (CA group). Chi-quare test and logistic regression were used to analyze the risk factors for MRSA BSI and HA-BSI. Results A total of 143 cases were included, the ratio of male to female was 1.8 ∶1, 71 cases (49.6%) were < 1 year old, and 90 cases (62.9%) were with focal BSI. 50 cases (35.0%) were in MARS group and 93 cases (65.0%) in MSSA group; 73 cases (51.0%) were in HA group and 70 cases (49.0%) in CA group. Mechanical ventilation (OR=17.320, 95%CI [1.576-190.399]) and combined use of antimicrobials (OR=0.580, 95%CI [0.359-0.938]) were independent risk factors for MRSA BSI (both P < 0.05). Mechanical ventilation (OR=31.466, 95%CI [1.434-690.538]), use of antimicrobials before admission (OR=24.524, 95%CI [1.699-353.915]), length of hospital stay >7 days (OR=1.090, 95%CI [1.010-1.176]), use of antimicrobials >7 days (OR=0.910, 95%CI [0.842-0.984]) were independent risk factors for HA BSI (all P < 0.05). Resistance rates of MRSA to erythromycin, clindamycin and rifampicin were 82.0%, 76.0% and 32.0% respectively, all were higher than those of MSSA (all P < 0.05). 6 cases (8.2%) in HA group and 4 cases (5.7%) in CA group died/not cured, with no statistically significant diffe-rence between two groups (P > 0.05). Intravenous catheterization, mechanical ventilation and admission to ICU were risk factors for poor prognosis of children with SA BSI (all P < 0.05). Conclusion The majority of children with SA BSI are male, mainly at the age of < 1 year old, and focal BSI is more common. Mechanical ventilation and combined use of antimicrobials are risk factor for MRSA infection. HA BSI often occurs in patients with mechanical ventilation, use of antimicrobials before admission, length of hospital stay >7 days, and use of antimicrobials >7 days. Targeted treatment as well as prevention and control measures should be taken according to antimicrobial susceptibility test results and infection types.

    • Application of mercury sphygmomanometers and thermometers and their substitutes in 212 medical institutions in Shaanxi Province from 2017 to 2020

      2023(2):217-223. DOI: 10.12138/j.issn.1671-9638.20233048

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      Abstract:Objective To investigate the application of mercury sphygmomanometers and thermometers and their corresponding substitutes in 212 medical institutions (MIs) in Shaanxi Province from 2017 to 2020, and provide suggestions on the substitutes of mercury-containing products in medical and health industry in Shaanxi Province based on the implementation status of Minamata Convention. Methods Hospitals as well as primary medical and health institutions in Shaanxi Province were selected by stratified random sampling. Application of mercury sphygmomanometers, thermometers and corresponding substitutes in MIs of different levels from 2017 to 2020 were investigated. Results A total of 212 MIs in Shaanxi Province were investigated, including 57 hospitals and 155 primary medical and health institutions. From 2017 to 2020, mercury sphygmomanometers usage amount per bed in MIs were 0.073, 0.068, 0.066 and 0.059 pieces respectively. 2020 was lower than other years. Usage amount per bed in primary MIs was higher than hospitals, with statistical difference (all P < 0.05). Mercury thermometers usa-ge amount per bed each year were 2.185, 2.121, 1.916 and 2.631 pieces respectively, 2019 was lower than 2017, with statistical difference (P=0.027). Mercury-free sphygmomanometers usage amount per bed each year were 0.014, 0.015, 0.028, and 0.038 pieces, 176, 325, 468 and 511 pieces were purchased, respectively. In 2019 and 2020, mercury-free sphygmomanometers usage amount per bed in hospitals was higher than that in primary MIs, with statistical difference (P < 0.05). Mercury-free thermometer usage amount per bed were 0.010, 0.011, 0.013, and 0.028 pieces, 173, 221, 227 and 684 pieces were purchased respectively. Mercury-free thermometer usage amount per bed in hospitals was higher than that in primary MIs, with statistical difference (P < 0.05). In the survey on temporary storage of mercury-containing waste, 50.88% hospitals and 46.45% primary medical and health institutions mixed mercury-containing waste with other medical waste for direct disposal. In the survey on the disposal methods of mercury-containing waste, 19.30% hospitals and 16.77% primary medical and health institutions disposed mercury-containing waste by themselves (landfill, stockpiling and recycling). Conclusion Usage of mercury sphygmomanometers and thermometers in MIs in Shaanxi Province has been decreasing year by year, and usage of corresponding substitutes has been increasing. The provincial MIs are actively implementing the Minamata Convention, fulfillment effect appears initially.

    • Bioinformatics analysis of ORF3a protein of SARS-CoV-2

      2023(2):224-228. DOI: 10.12138/j.issn.1671-9638.20233032

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      Abstract:Objective To analyze ORF3a protein in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by bioinformatics. Methods Amino acid sequence of ORF3a was obtained from UniProt. Physicochemical properties of the protein were analyzed by ProtParam tool. Secondary and tertiary structures were predicted by SOPMA and SWISS-MODEL. Hydrophobicity, signal peptide, and transmembrane region of ORF3a protein were analyzed by PortScale, Signal IP 4.0 Server, and TMHMM Server 2.0. B cell and T cell surface epitopes as well as phosphorylation sites were predicted by ABCpred, SYFPEITHI and NetPHos 3.1 Server. Antigenicity and allergenicity were predicted by VaxiJenv 2.0 and AlgPred server. Results ORF3a is a stable, hydrophobic protein with 3 transmembrane helical regions and 29 phosphorylation sites. It contains 275 amino acids and multiple T and B cell epitopes, and is antigenic and non-allergenic. Conclusion ORF3a protein is structurally stable. It contains multiple T and B cell epitopes, thus can provide basis for the study of SARS-CoV-2 multi-epitope vaccines.

    • Case Report
    • Cerebral venous sinus thrombosis caused by Listeria monocytogenes me-ningitis: a case report

      2023(2):229-232. DOI: 10.12138/j.issn.1671-9638.20233081

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      Abstract:Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease. Intracranial infection is one of the important causes of CVST, while intracranial infection caused by Listeria monocytogenes (LM) is relatively rare in clinic. This paper reports a case of CVST secondary to LM meningitis, which was improved and discharged from hospital after anti-infection and anti-coagulation treatment, so as to provide reference for the clinical diagnosis and treatment of such patients.

    • 专家共识
    • Chinese expert consensus on terminal disinfection and effect evaluation of medical institutions for patients infected with SARS-CoV-2

      2023(2):233-238. DOI: 10.12138/j.issn.1671-9638.20233389

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      Abstract:In order to scientifically guide infection prevention and control in medical institutions for patients infected with severe acute respiratory syndrom coronavirus 2 (SARS-CoV-2), and to effectively prevent cross transmission through terminal disinfection, domestic experts in the field of infection control and disinfection were specially organized and jointly formulate this consensus. The consensus is applicable to the terminal disinfection of all medical institutions that may treat SARS-CoV-2 infected persons. The contents of the consensus include the principles and methods for the terminal disinfection and effect evaluation of environmental materials, medical instruments, air conditioning pipeline, etc. The focus of the consensus is mainly on disinfection principles, disinfection products, personal protection, disinfection scheme and disinfection effect evaluation methods.

    • Review
    • Research progress in epidemiology of human brucellosis

      2023(2):239-243. DOI: 10.12138/j.issn.1671-9638.20232094

      Abstract (83) HTML (257) PDF 834.57 K (168) Comment (0) Favorites

      Abstract:In recent years, the reported incidence of human brucellosis has been increasing year by year, and the epidemic range has been spread continuously. It has gradually spread from animal husbandry areas with high incidence to world wide, and become an important public health problem in China. Research on the epidemiological characteristics of brucellosis is of great significance for the effective prevention and control of brucellosis epidemic. This paper systematically reviews brucellosis at home and abroad, especially the domestic epidemic situation and hotspots of brucellosis, understands the incidence situation in various regions, and analyzes the causes of brucellosis based on literature research, so as to provide a theoretical basis for the early warning, monitoring, as well as adjustment of prevention and control policy of brucellosis.

    • Research progress on the mechanism of drug resistance of Staphylococcus aureus biofilm

      2023(2):244-248. DOI: 10.12138/j.issn.1671-9638.20233135

      Abstract (77) HTML (329) PDF 834.41 K (132) Comment (0) Favorites

      Abstract:Staphylococcus aureus (S. aureus) is one of the common pathogens causing healthcare-associated infection (HAI) and community-associated infection (CAI). In recent years, there are more and more failure cases in the anti-infection treatment of S. aureus in clinical practice, and the formation of biofilm is considered the main cause for the failure of antimicrobial treatment. However, drug resistance mechanism of S. aureus biofilm has not been fully elucidated. Evidence shows that S. aureus biofilm infection is difficult to cure and easy to reoccur, and repea-ted treatment after infection greatly increases the pain and economic burden of patients. In this paper, research progress of drug resistance mechanism of S. aureus biofilm is reviewed, so as to provide reference for the development of new antimicrobial agents.

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