Abstract:Objective To investigate Candida auris(C. auris) infection/colonization in patients and environmental contamination in intensive care unit (ICU) of a hospital, and evaluate the effect of healthcare-associated infection(HAI) prevention and control measures. Methods In June 2022, C. auris was isolated from the blood culture of a long-term hospitalized patient in the ICU of a hospital. Multiple sampling and bacterial culture (once for every two weeks) were immediately performed on different sites of patient's body surface and ward environment. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was adopted for analysis. For patients with C. auris, measures such as single room isolation, warm water bathing, chlorhexidine scrubbing were taken. Ward environment was wiped and disinfected. The effect of prevention and control measures was evaluated by active screening. Results 14 patients in ICU were actively screened initially, 9 C. auris strains were isolated from 8 patients. C. auris was not detected in the 3 patients who were transferred out of ICU one week before the first detection of C. auris. 2 C. auris strains were isolated from 2 patients in the second active screening of 13 patients in ICU. In the third active screening of 8 patients in ICU, C. auris was found in the groin and armpit of 1 patient, other patients were all negative. The fourth and fifth active screening didn't detect C. auris. Environmental monitoring result showed that 6 C. auris strains were isolated from the ground and medical equipment in the first active screening of 80 environmental specimens. No C. auris was detected in the second and third screening. After taking comprehensive prevention and control measures, only 1 of the 14 patients suffered from healthcare-associated septicemia due to C. auris. The rest patients were confirmed with C. auris colonization and decolonized at the late stage. Conclusion C. auris is easy to spread in hospital wards, but can be prevented and controlled by taking active HAI prevention and control measures.

Abstract:Objective To explore the clinical characteristics as well as diagnosis and treatment scheme of an adult patient with mucormycosis caused by Cunninghamella bertholletiae (C. bertholletiae) infection. Methods Clinical diagnosis and treatment process of an adult patient who was admitted to the department of hematology of a hospital due to invasive mucormycosis caused by C. bertholletiae infection were summarized. Relevant literatures were retrieved from databases for reviewing. Results A 54-year-old male patient was admitted to hospital due to "repea-ted fatigue for more than one year aggravated, and fever for one week". Pathological examination of lung tissue showed broad, irregular and undivided hyphae, thus morphologically identified as Mucor. Metagenomic next-genera-tion sequencing (mNGS) of alveolar lavage fluid and peripheral blood detected C. bertholletiae, thus patient was diagnosed as invasive mucormycosis caused by C. bertholletiae infection. Infection was controlled after treatment with liposome amphotericin B combined with posaconazole and caspofungin. 37 literatures were retrieved and 44 patients were involved (including the case in this study). There were 26 males and 18 females, with a median age of 52.5 (18-79) years. Underlying diseases were mainly hematological diseases (65.9%, n=29), and 14 cases underwent hematopoietic stem cell or solid organ transplantation. The most common sites of invasion were lung, brain and skin, with 36, 9 and 9 cases respectively. Number of cases with positive results of histopathology, fungal culture, direct microscopy and molecular detection were 28, 37, 29 and 17, respectively. 41 patients received antifungal therapy, 8 of whom underwent surgery. 30 cases died, with a mortality of 68.2%. The survival rate of patients receiving antifungal therapy combined with surgery (62.5%, 5/8) was higher than those with antifungal therapy alone (24.2%, 7/33). Conclusion Adult mucormycosis caused by C. bertholletiae infection is most common in patients with hematological diseases. Hematopoietic stem cells or solid organ transplantation are high-risk factors. The common infection site is lung and can invade multiple organs of the body, with high mortality. Pathogenic diagnosis is very important. Antifungal combined surgery can improve the survival rate.

Abstract:Objective To report the diagnosis and treatment of a patient with bloodstream infection (BSI) caused by Trichoderma koningiopsis (T. koningiopsis). Methods Clinical diagnosis and treatment processes of an adult patient admitted to a hospital due to BSI caused by T. koningiopsis were summarized. Relevant reports were retrieved from databases for reviewing. Results A 60-year-old male patient was admitted to hospital due to "intermittent fever with lumbago and knee pain for more than half a month". According to the examination results, the patient was treated with ceftriaxone sodium, levofloxacin and ganciclovir, but didn't achieve obvious improvement. T. koningiopsis was identified by next-generation sequencing (NGS) of peripheral blood, thus T. koningiopsis BSI was considered. After oral administration of voriconazole, the interval between episodes of patients gradually prolonged, from one episode every 2-3 days to one episode every 4-5 days, peak temperature of the patient decreased, and the lumbago and knee pain alleviated. After discharge, the patient continued taking voriconazole orally. After a follow-up of more than 1 month, fever gradually subsided, lumbago and knee pain was relieved, but the patient died suddenly 2 months after discharge. A total of 40 cases were retrieved from literatures, out of which 38 cases were reported by foreign literatures and 2 reported in Chinese. According to the literature retrieval statistics, the under-lying diseases of patients with Trichoderma infection were mainly organ transplantation (n=12), hematological di-sease (n=9), and peritoneal dialysis (n=6). The main clinical manifestations of patients were mainly pulmonary infection (n=8), peritonitis (n=6), and disseminated infection (n=5). The regional distribution was mainly in European and American countries (n=26), 5 cases in Asia, 2 cases in Africa, 1 case in South America, and 6 cases in unknown regions. Trichoderma longibrachiatum was as the main detected pathogen (n=24). Conclusion Trichoderma is an opportunistic pathogen, whose infection often occurs in patients with low immunity, and is easy to be misdiagnosed. It is recommended to conduct NGS to identify the pathogen as soon as possible for timely treatment and reduce mortality.

Abstract:Objective To explore the effect of three surfactants (dodecyl hydroxypropyl sulfobetaine, sodium dodecylbenzene sulfonate and cetyl pyridine bromide) on the permeability of Staphylococcus epidermidis (Se) biofilm and the expression of the key biofilm formation gene agr, and provide reference for the clinical use of surfactants to control Se biofilm relevant infection. Methods Se biofilm permeability model was constructed to detect the effect of surfactant treatment on biofilm permeability. The effect of three surfactants on agr transcription in biofilm-forming Se in the suspension state was observed at different time periods, and the possible effect of surfactants on the adhesion and virulence of biofilm-forming Se was assessed at molecular level. Results All three types of surfactants significantly affected the permeability of Se biofilm at minimum inhibitory concentration (MIC) of 2, 1, and 1/2 (P < 0.001), enhancing drug permeability to biofilm. Compared with negative control group, dodecyl hydroxypropyl sulfobetaine had a significant up-regulation effect on agr expression at 0.5, 4 and 12 hours (P < 0.001). Sodium dodecylbenzene sulfonate had a significant down-regulation effect on agr expression at 0.5, 4 and 24 hours (P < 0.001) and a significant up-regulation effect at 12 hours (P < 0.001). Cetyl pyridine bromide had a significant up-regulation effect on agrexpression at 0.5 hours (P < 0.01) and a significant down-regulation effect at 12 and 24 hours (P < 0.001). Conclusion All three surfactants had strong effects on the permeability of Se biofilm, with significant modulating effect on agr expression at different time periods, which may play a role in the formation of Se biofilm, thus preventing the spread of infection and leading to the reduction of bacterial virulence.

Abstract:Objective To understand the genotypes and drug resistance of Mycobacterium avium (MAV) from persons with HIV/MAV double infection in southwest region of Yunnan Province. Methods 12 specific loci of variable-number tandem repeat (VNTR) were chosen, and genotyping of MAV was performed with MAV tandem repeats (MATR-VNTR). DNA of the strains was amplified by polymerase chain reaction (PCR), and DNA fingerprint of MAV was obtained by agarose gel electrophoresis. The electrophoresis result was digitized by Quantity One and BioNumerics 6.7 software, and cluster analysis was carried out by unweighted pair-group method with arithmetic means (UPGMA). Susceptibility of 44 MAV strains to 10 different antimicrobial drugs was tested by proportional test method. Results The Hunter-Gaston discriminatory index (HGDI) of VNTR genotyping of each locus was different. MATR-5 was the highest (0.68). HGDI values of MATR-1, 2, 3, 4, 6, 7, 9, 13, and 15 were all ≥ 0.5. Through cluster analysis, 44 MAV strains were divided into 6 clusters. Antimicrobial susceptibility results showed that rifabutin had the best in vitro antimicrobial activity against MAV (resistance rate 0), followed by ethambutol (resistance rate 86.4%, 38/44). All strains were resistant to the other 8 antimicrobial agents. Conclusion VNTR genotyping method of the selected 12 loci has high resolution in southwest Yunnan, and antimicrobial resistance of MAV strains from different regions in southwest region of Yunnan Province is serious.

Abstract:Objective To analyze the mutation characteristics of isoniazid (INH) resistance gene of Mycobacterium tuberculosis (MTB)in Guangxi region, and provide basis for molecular diagnosis of drug-resistant tuberculosis. Methods 122 INH-resistant strains and 530 susceptible strains were obtained from the MTB strain library collected from 30 tuberculosis drug resistance monitoring points in Guangxi region, and underwent whole genome sequencing. Results Among 652 strains of MTB complex group, 127 (19.48%) had INH resistance gene mutations, including katG (15.64%, n=102), fabG1 (1.69%, n=11), ahpC (1.07%, n=7), kasA (0.61%, n=4) and inhA (0.46%, n=3) gene mutations. The coincidence rate of INH resistance phenotype and gene mutation was 90.03%, and the coincidence rate of INH resistance detected by proportional method and gene mutation detected by gene sequencing was not high (Kappa=0.677). There are 19 types of mutations, with single locus mutation accounting for 96.85% and combined mutation accounting for 3.15%. The locus with the highest mutation rate was katG315 (71.65%). The proportion of base change in the form of AGC-ACC was the highest (12.13%). The proportion of mutations in katG, ahpC and kasA genes in INH-resistant strains was higher than that in susceptible strains (all P < 0.05). There was no significant difference in the proportion of mutations in inhA and fabG1 genes between INH-resistant strains and susceptible strains (all P>0.05). Beijing strains and non-Beijing strains had the highest mutation rates of katG315, which were 18.75% (81/432) and 4.55% (10/220) respectively. Difference in distribution of mutation loci of katG gene in two genotypes of strains was statistically significant(χ²=16.253, P=0.039). Conclusion The mutation of INH resistance gene in Guangxi region is mainly at katG315 locus, and the INH resistance phenotype and gene mutation are not consistent. Mutations in katG, ahpC and kasA genes are associated with INH phenotypic resistance. Beijing genotype is associated with the mutation of katG gene.

Abstract:Objective To observe the in vitro susceptibility test result of ceftazidime/avibactam (CZA) combined with aztreonam (ATM), as well as imipenem (IPM) and meropenem (MEM) respectively combined with ceftazidime (CAZ), cefoperazone/sulbactam (SCF), amikacin (AK), levofloxacin (LEV) and fosfomycin (FOS) to KPC-, NDM- and IMP-producing carbapenem-resistant Enterobacterales (CRE). Methods 38 non-repetitive CRE strains were isolated from clinical specimens. The minimal inhibitory concentration (MIC) of antimicrobial agents against CRE strains was determined by micro-broth dilution method. Combined antimicrobial susceptibility test was performed by the chessboard dilution method. Fractional inhibitory concentration (FIC) index was calculated to determine the combined effect. Results The MICs of CZA to 22 KPC-producing strains were ≤ 4 μg/mL, to 16 class B metallo-enzyme(NDM and IMP)-producing strains were >128 μg/mL. The synergy rate of CZA was 100% after combined with ATM. The synergy rate of IPM or MEM combined with SCF was the highest, which were 63.2% and 68.4% respectively, and the sum of synergy rate and addition rate was 100%, while the sum of synergy rate and addition rate of IPM combined with FOS was the lowest (40.5%). Among Klebsiella pneumoniae (KP) strains, the synergy rates of IPM or MEM combined with SCF were both 68%, the sum of synergy rate and addition rate was 100%, the sum of synergy rate and addition rate of IPM combined with FOS was the lowest (24%). Among Escherichia coli (ECO), the synergy rates of IPM or MEM combined with SCF were 44.4% and 77.8% respectively, the sum of synergy rate and addition rate was 100%, the sum of synergy rate and addition rate of IPM combined with FOS was the lowest (66.7%). Among genotype KPC strains, the synergy rates of IPM or MEM combined with SCF were 72.7% and 63.6% respectively, the sum of synergy rate and addition rate was 100%, the sum of synergy rate and addition rate of IPM combined with FOS was the lowest (22.7%). Among genotype NDM strains, the synergy rates of IPM or MEM combined with SCF were 46.7% and 80.0% respectively, the sum of synergy rate and addition rate was 100%, the sum of synergy rate and addition rate of IPM combined with FOS was the lowest (64.3%). All combined schemes had no antagonistic effect. Conclusion CZA alone or in combination with ATM is effective for CRE strains. Among all the combinations of IPM and MEM respectively with other antimicrobial agents, the sum of synergy rate and addition rate of IPM and MEM combined with SCF is the highest, and the sum of synergy rate and addition rate of IPM combined with FOS is the lowest. Not all combination schemes are effective. The effect of different combination schemes on the same strain is different, and the effect of the same combination scheme on different strains is also different. The dose ratio between two agents is also important.

Abstract:

Abstract:Objective To evaluate the disinfection efficacy of an autonomous mobile direct-radiation high-intensity ultraviolet disinfection robot on multidrug-resistant organisms (MDROs) on environmental object surface. Methods Slides smeared with 0.5×10⁶ CFU/mL carbapenem-resistant Klebsiella pneumoniae (CRKP) and methicillin-resistant Staphylococcus aureus (MRSA) were prepared and disinfected by irradiation of disinfection robot at diffe-rent duration, distances, angles, shielding and moving status. After disinfection, bacterial slides were scraped with sterile cotton swabs and smeared on blood agar plates, plates were then cultured at 35℃ for 48 hours. Bacteria count as well as killing rate and killing logarithm value under different conditions were calculated. Results Under static status, the killing rates of both CRKP and MRSA at an irradiation distance of 1 m for 5 minutes and 10 minutes were 100%, and all killing logarithms were ≥ 3. With irradiation at a distance of 1 m for 5 minutes and 10 minutes respectively, the killing rates of both CRKP and MRSA with and without plastic wrap were 100%, and all killing logarithms were ≥ 3, disinfection efficacy reached the standard. In moving state, the killing rates of CRKP and MRSA at all detected angles were 100%, all killing logarithm value were ≥ 3, and the disinfection efficacy reached standard. Conclusion High-intensity ultraviolet disinfection robot can achieve good disinfection efficacy on MDROs in a short time, the disinfection efficacy remains in case of materials with high penetration rate.

Abstract:Objective To discuss the clinical manifestations and epidemiological characteristics of patients with intestinal taeniasis. Methods Clinical manifestations of 35 patients with intestinal taeniasis in a hospital in Beijing from January 2012 to July 2022 were summarized, and the epidemiological characteristics of the patients were analyzed. Results 35 cases of intestinal taeniasis all expelled proglottides, in which 18 cases (51.43%) were infected with Taenia saginata, and 17 cases (48.57%) with Diphyllobothrium latum. 11 cases (31.43%) had clinical manifestations including abdominal pain and abdominal distension; 2 cases each had perianal itching or dizziness (5.71% for each); 1 case each had nausea and vomiting, diarrhea, fever or weight loss (2.86% for each); 16 cases (45.71%) were asymptomatic. 21 cases (60.00%) were local cases in Beijing, and the rest were from other provinces. 31 patients (88.57%) had a history of eating raw or half-raw food. Conclusion Most patients with intestinal taeniasis have no clinical symptoms or only slight gastrointestinal symptoms, and are prone to be misdiagnosed. Paying attention to the inquiry of epidemiological history can improve the diagnosis rate of the disease.

Abstract:Objective To evaluate the predictive value of intestinal fatty acid-binding protein (I-FABP) in the prognosis of patients with liver cirrhosis. Methods A prospective study method was used to continuously collect patients with liver cirrhosis, who were hospitalized in a hospital from September 2020 to May 2022. Patients were stratified according to the Child-Pugh score, and followed up 12 months to evaluate their survival and bacterial infection. Serum I-FABP level of patients at admission was measured by enzyme-linked immunosorbent assary (ELISA). The correlation between two variables was analyzed by Spearman correlation analysis. Risk factors for bacterial infection and death during follow-up was predicted with multivariate Cox regression model. Predictive efficacy of I-FABP for cirrhosis-related death was evaluated with time-dependent receiver operating characteristic (ROC) curve. Results A total of 131 patients with liver cirrhosis were included. During the follow-up period, 45 patients were hospitalized due to bacterial infection or infection progress. The median length of hospital stay due to infection was 115 (42, 251) days, and the average length of hospital stay was 15 days. The most common infection is spontaneous bacterial peritonitis (SBP), accounting for 20.6% (n=27). I-FABP was correlated with serum IL-6 (r=0.270, P < 0.001) and MELD score (r=0.364, P < 0.001), and increased with the severity of the disease (Child-Pugh A=1.18 μg/L, Child-Pugh B=1.51 μg/L and C=2.29 μg/L). During the follow-up period, 45 patients (34.4%) were hospitalized for 71 times due to bacterial infection. The median I-FABP of 27 patients with SBP was higher than those without SBP (2.26 vs 1.25, P=0.001). In addition, 29 patients died during the observation period. The mortality at 3 months, 6 months, 9 months and 12 months were 4.6%, 13.7%, 19.8% and 22.1%, respectively. Multivariate Cox regression analysis showed that baseline I-FABP could predict SBP and 1-year survival rate, and the I-FABP quartile showed good prognostic differentiation. Time-dependent AUC showed no difference in predicting mortality of liver-related death between I-FABP and MELD score. The combined model of the two parameters showed a high predictive value. Conclusion I-FABP can predict the occurrence of cirrhosis-associated SBP and the long-term survival in patients with liver cirrhosis.

Abstract:Objective To explore the direct economic loss caused by surgical site infection (SSI) in patients with hepatic echinococcosis, and provide reference for the effective implementation of infection prevention and control measures as well as the formulation of health policy. Methods Medical data of 681 surgical patients with hepatic echinococcosis in a tertiary first-class hospital from January 1, 2017 to December 31, 2020 in Qinghai Province were collected retrospectively. 59 patients with SSI were included in the SSI group, and the other 622 patients without SSI were 1:1 matched with patients in SSI group. After matching, 50 patients were included in the control group. The average length of hospital stay and hospitalization expenses of patients between two groups, as well as among different types of SSI were compared. Results Compared with the control group, the average total hospitalization cost in the SSI group increased by 38 630.00 Yuan, and the average hospitalization days extended by 21.87 days. The average total hospitalization cost of abdominal infection increased by 43 045.11 Yuan, the average hospitalization days extended by 22.98 days. The average total hospitalization cost of patients with SSI increased by 34 117.69 Yuan, the average hospitalization days extended by 20.97 days. Conclusion SSI in patients with hepatic echinococcosis after operation can prolong the length of hospital stay, increase the cost of hospitalization, and bring serious economic burden. Therefore, it is of great significance to implement effective SSI intervention measures to reduce the economic burden of patients and improve the medical care quality.

Abstract:Objective To explore the sealing effect of pre-filled catheter irrigator on central venous catheter. Methods Patients treated with hemodialysis through jugular vein catheterization in the blood purification center of a tertiary first-class hospital from January 2020 to June 2021 were selected. Patients who met the inclusion criteria were divided into the observation group and the control group according to the random number table method. Patients in the observation group used the pre-filled catheter irrigator to seal the central venous catheter, and those in the control group used heparin sodium sealing fluid to seal the catheter. The occurrence of catheter-related blood-stream infection (CRBSI), patency and sealing cost of catheter, duration of catheter irrigation and occurrence of needle-stick injury during catheter sealing were analyzed. Results A total of 85 patients were included, including 42 in the observation group and 43 in the control group. Incidence of CRBSI in the observation group (0.79 ‰, 1/1 260) was lower than that in the control group (5.43 ‰, 7/1 290), and the catheter irrigation time in the observation group ([6.44±1.11] seconds) was shorter than that in the control group ([220.04±5.98] seconds). Diffe-rences between two groups were statistically significant (both P < 0.05). There were 3 cases of catheter blockage in the observation group and 4 cases in the control group, without statistically significant difference between two groups (P=0.728). There was no needle-stick injury in the observation group when the catheter was sealed, however, 5 cases of needle-stick injury occurred in the control group, difference between two groups was statistically significant (P < 0.05). The average costs of catheter sealing for patients in the observation group and control group were 11.40 Yuan and 15.14 Yuan, respectively. Conclusion Pre-filled catheter irrigator can effectively reduce the incidence of CRBSI in patients undergoing hemodialysis through jugular vein catheterization, save costs, reduce needle-stick injury, and improve work efficiency.

Abstract:Objective To understand the pathogen detection of inpatients in a hospital before antimicrobial treatment, take comprehensive intervention measures, and improve pathogen detection rate before antimicrobial treatment in this hospital. Methods Patients who received antimicrobial treatment from October to December of 2021 in a tertiary first-class hospital in Changzhi City of Shanxi Province were selected as the control group, comprehensive intervention measures were taken from January 1, 2022, patients who received antimicrobial treatment from April to June of 2022 were selected as the intervention group. Pathogen detection rate before antimicrobial treatment, pathogen detection rate before antimicrobial treatment in key departments, detection rate of sterile specimens and detection rate of important multidrug-resistant organisms between two groups were compared. Results Pathogen detection rate before treatment in the intervention group was higher than that in the control group (53.06% vs 30.61%, P < 0.01). Detection rate in 5 key departments after intervention was improved, difference was statistically different (all P < 0.05). Detection rate of sterile specimens in the intervention group was higher than that in the control group (15.58% vs 7.52%, P < 0.01). Detection rate of carbapenem-resistant Acinetobacter baumannii in the intervention group was significantly lower than that in the control group (64.94% vs 84.00%, P < 0.01). Detection rates of methicillin-resistant Staphylococcus aureus and carbapenem-resistant Pseudomonas aeruginosa in the intervention group were not significantly different from those in the control group (both P>0.05). Conclusion The comprehensive intervention measures can improve the pathogen detection rate and the sterile specimen detection rate of inpatients in this hospital before antimicrobial treatment, but fail to effectively reduce the detection rate of important multidrug-resistant organism, thus need to be improved.

Abstract:Objective To explore the on-the-job training mode for infection prevention and control full-time staff in basic-level hospitals, and provide reference for managers to improve on-the-job training program. Methods 109 trainees participated in the second session of professional training course for infection prevention and control full-time staff in basic-level hospitals in Suqian City were selected as research objects. Competency-oriented professional training mode with diversified training forms (including panoramic case teaching, clinical infection prevention and control manipulation skill training, clinical practice, theoretical and technical assessment before and after training, and self-assessment by adopting the core competence scale of full-time staff in healthcare-associated infection[HAI] management) supplemented to the traditional training (theoretical teaching for 2-3 days) were adopted. Results 109 trainees were from 31 township healthcare centers and 10 from community health service centers, all with full-time or part-time work experience in HAI management ≥ 6 months. After the competency-oriented training for infection prevention and control staff, the core competence, theoretical achievement and comprehensive emergency response ability of the infection prevention and control full-time staff were all higher than before training, difference was statistically different (all P < 0.001). The total score of the core competence of infection prevention and control full-time staff after training was (11.16±4.96) points higher than before training. The total satisfaction degree of the training effect of infection prevention and control staff in basic-level hospitals was 94.50% (103/109). Conclusion The competency-oriented on-the-job training mode for infection prevention and control full-time staff in basic-level hospitals achieved training according to professional requirements, implemented assessment according to professional competence, which can improve the work ability of infection prevention control full-time staff in basic-level hospitals.

Abstract:Objective To investigate and analyze the current situation and causes of occupational exposure to acupuncture needles among health care workers (HCWs). Methods A self-designed questionnaire was used to retrospectively investigate the occurrence of occupational exposure to acupuncture needles among HCWs in 27 clinical departments of a tertiary traditional Chinese medicine hospital within the past three years, and to compare and analyze the relevant information. Results Among 1 585 HCWs surveyed, a total of 164 HCWs experienced 231 times of occupational exposure to acupuncture needles, with an incidence of 10.35%. Incidences of occupational exposure of HCWs of different ages, work experience, and professional categories showed statistical differences (P < 0.001), with the highest incidences occurred among medical students (including interns, visiting scholars, and resident physicians), HCWs under 25 years old, and HCWs with less than one year of work experience. The main type of puncture needle involved in the 231 incidents was the fine needle (106 times, 45.88%). Injury occurred mostly during the process of removing needle (68 times, 29.44%) and mainly in the ward (82 times, 35.50%). Among all the incidents, 176 cases (76.19%) were properly treated according to regulations, and 148 cases (64.07%) were reported timely. Conclusion Incidence of occupational exposure to acupuncture needles among HCWs in traditional Chinese medicine hospital is relatively high. Measures should be taken to strengthen the occupational protection training and assessment for medical students and new staff, to standardize the operating procedures for using needles, thus further prevent and reduce the incidence of occupational exposure to acupuncture needles among HCWs.

Abstract:The symptoms and signs of Strongyloides stercoralis infection are atypical, however, people with underlying diseases and low immunity are easy to develop into severe cases after infection. This paper analyzed the symptoms, signs, auxiliary examination and treatment process of a case of Strongyloides faecalis complicated with fungal infection in a hospital recently, so as to improve the understanding of clinicians and laboratory workers on the disease, thus reduce missed diagnosis and misdiagnosis.

Abstract:Fungal infection of bone and joint is a rare disease, but in recent years, due to the abuse of corticosteroids or other immunosuppressive agents, risk of such infection is increasing year by year. Fungal infection of bone and joint is undoubtedly a challenge for orthopedics. Based on domestic and foreign literatures, clinical characteristics as well as current diagnosis and treatment status of fungal arthritis are reviewed, so as to improve clinicians' understanding on the pathogenesis and related factors of fungal arthritis, and take positive and effective measures to strengthen the early diagnosis and treatment of fungal arthritis.

Abstract:Candida albicans (C. albicans) is an opportunistic pathogen that can cause fungal infection at different sites. At present, drugs for the treatment of C. albicans is single. With the irrational use of clinical drugs, drug resistance of C. albicans is becoming increasingly serious. Histatins 5 (Hst-5) is the most abundant antimicrobial peptide (AMP) secreted from oral saliva. As the first defense line of the host, it has strong antibacterial activity against C. albicans. Its mechanism of action is different from that of traditional antifungal drugs and other antimicrobial peptides, which involves a variety of transport proteins on the surface of C. albicans, MAPK pathway, and various metal ions in vitro. With the in-depth study of Hst-5, it is found that a variety of derivative peptides of Hst-5 (K11R-K17R, P-113Tri, etc.) can play a more vital role in improving antimicrobial efficacy. Therefore, it is particularly important to study the antimicrobial mechanism of Hst-5 and its derived peptides in C. albicans, which will provide a new strategy for the therapy of clinical fungal infections at present.