Abstract:Objective To analyze the influencing factors for intestinal colonization and secondary infection of carbapenem-resistant Klebsiella pneumoniae (CRKP) in neonates, and provide a basis for formulating prevention and control strategies for CRKP infection. Methods Neonates who were admitted to the neonatal ward of a hospital from January 2021 to October 2022 were selected as the study subjects, and the first screening of CRKP was conducted within 48 hours after admission. In addition, active anal swab screening for carbapenem-resistant Ente-robacterales (CRE) was performed weekly during hospitalization, and the infection status of CRKP strains was monitored. Clinical data of neonates in the colonization group, non-colonization group, and infection group were analyzed. Intestinal colonized strains and the non-repetitive CRKP strains isolated from clinical specimens of neonates with secondary infection after colonization were performed carbapenemase gene detection, multilocus sequence ty-ping (MLST) and pulsed-field gel electrophoresis (PFGE) analysis. Results A total of 1 438 neonates were actively screened for CRE, 174 were CRKP positive, CRKP colonization rate was 12.1%. Among 174 neonates, 35 were with secondary infection, with the incidence of 20.1%. The independent risk factors for neonatal CRKP intestinal colonization were cesarean section (OR=2.050, 95%CI: 1.200-3.504, P=0.009), use of cephalosporins (OR=1.889, 95%CI: 1.086-3.288, P=0.024), nasogastric tube feeding (OR=2.317, 95%CI: 1.155-4.647, P=0.018). Protective factors were breast-feeding (OR=0.506, 95%CI: 0.284-0.901, P=0.021), oral probiotics (OR=0.307, 95%CI: 0.147-0.643, P=0.002), and enema (OR=0.334, 95%CI: 0.171-0.656, P=0.001). Independent risk factors for secondary infection after intestinal colonization of neonatal CRKP were carbapenem antibiotic use (OR=19.869, 95%CI: 1.778-222.029, P=0.015) and prolonged hospital stay(OR=1.118, 95%CI: 1.082-1.157, P < 0.001). The detection results of drug resistance genes showed that carbapenemase-producing genes of CRKP strains were all bla_KPC-2, all belonged to type ST11. Homologous analysis showed that intestinal CRKP colonization was highly homologous with the secondary infection strains after colonization. Conclusion CRKP intestinal colonization during neonatal hospitalization may increase the risk of CRKP infection. Risk and protective factors of neonatal intestinal colonization and secondary infections after colonization should be paid attention, and corresponding preventive and control measures should be taken, so as to reduce the occurrence and transmission CRKP healthcare-associated infection.

Abstract:Objective To explore and analyze the expression and prognostic value of serum vitamin D (VitD), ferritin (FRT) and heparin-binding epidermal growth factor (HB-EGF) in sepsis patients. Methods 86 sepsis patients who were admitted to the intensive care unit (ICU) of a hospital from January 2021 to January 2022 were selected as the case group, and 60 non-sepsis patients in the ICU were selected as the control group. According to the prognosis of sepsis patients one month later, patients were divided into survival group and death group. Patient's serum upon admission was taken, levels of serum VitD, FRT and HB-EGF were detected, the correlation with the prognosis of sepsis patients was analyzed, and the prognostic value was evaluated by area under curve (AUC) of receiver opera-ting characteristic curve. Results Levels of white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), tumor necrosis factor-α(TNF-α), interleukin (IL)-6, IL-1β and FRT of case group were all higher than those of non-sepsis patients in the control group, while the VitD and HB-EGF levels were lower than those of non-sepsis patients in the control group, differences were all statistically significant (all P < 0.05). One month follow-up on the prognosis of sepsis patients showed that 55 patients survived and 31 died. Acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, PCT, TNF-α, IL-1β and FRT score in patients in the death group were all higher than those in patients in the survival group, while VitD and HB-EGF were lower than patients in the survival group, differences were all statistically significant (all P < 0.05). The Pearson correlation analysis results showed that VitD were negatively correlated with APACHE Ⅱ score, SOFA score, WBC, CRP, PCT and TNF-α(all P < 0.05), HB-EGF was negatively correlected with APACHE Ⅱ, score, CRP, PCT, TNF-α, IL-6 and IL-1β (all P < 0.05); while FRT was positively correlated with APACHE Ⅱ scores, CRP, PCT, TNF-α, IL-6 and IL-1β (all P < 0.05). The AUC, sensitivity, and specificity of combined detection of serum VitD, FRT and HB-EGF in predicting the prognosis of sepsis patients were 0.82 (95%CI: 0.72-0.86), 84.39%, and 69.35%, respectively. Conclusion Serum levels of VitD and HB-EGF are lower and FRT is higher in sepsis patients, their expression levels are closely related to patient prognosis, and have good predictive value for predicting the prognosis of sepsis patients.

Abstract:Objective To explore the efficacy of T-cell spot test of tuberculosis infection (T-SPOT. TB) in the differential diagnosis of spinal tuberculosis (STB), and optimize diagnostic efficacy through the optimal cut-off value of receiver operating characteristic (ROC) curve. Methods Clinical data of patients with spinal infection in a hospital from January 2010 to May 2019 were collected, including preoperative T-SPOT. TB test results, white blood cell count, C-reactive protein, erythrocyte sedimentation rate, procalcitonin, and tuberculosis antibodies, et al. Clinical diagnosis was conducted based on diagnostic criteria. The sensitivity and specificity of T-SPOT. TB in preoperative diagnosis of STB and other spinal infection was analyzed, and the diagnostic efficacy of the optimized T-SPOT. TB indicators was evaluated. Results A total of 132 patients were included in this study, out of whom 78 patients (59.09%) were diagnosed with STB, and 54 (40.91%) were diagnosed with non-tuberculosis (non-TB) spinal infection. The sensitivity and specificity of T-SPOT. TB in differential diagnosis of STB were 67.68% and 66.67%, respectively. Univariate logistic regression analysis showed that compared with non-TB spinal infection, the OR va-lue of T-SPOT. TB test in diagnosing STB was 4.188 (95%CI: 1.847-9.974, P < 0.001). The optimized T-SPOT. TB evaluation index through ROC curve to determine the optimal cut-off values of ESAT-6, CFP-10, and CFP-10+ESAT-6 for differential diagnosis of STB and non-TB spinal infection were 12.5, 19.5, and 36, respectively, and area under curve (AUC) values were 0.765 6, 0.741 5, and 0.778 6, respectively, all with good diagnostic efficacy. CFP-10+ESAT-6 had the highest AUC. CFP-10+ESAT-6 specific spot count had higher efficacy in the diagnosis of STB, with a diagnostic accuracy of 75.56%, higher than 67.42% of pre-optimized T-SPOT. TB. Conclusion T-SPOT. TB test has high diagnostic efficacy in differentiating STB from non-TB spinal infection. Positivity in T-SPOT. TB test, especially with spot count of CFP-10+ESAT-6 over 36, indicates a higher likelihood of STB.

Abstract:Objective To assess the risk factors for carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection (BSI) and 28-day short-term mortality in elderly patients, and provide reference for the prevention and treatment of CRAB BSI. Methods Clinical data of patients aged ≥ 60 years and diagnosed with AB BSI in a hospital in Yulin City from January 2013 to December 2022 were retrospectively analyzed, including demogra-phic and microbiological characteristics, as well as clinical outcomes of the patients. Variables which were significant in univariate analysis were selected for multivariate analysis using binary logistic regression model and Cox proportional hazards model. Independent risk factors for infection were further determined, and survival analysis was performed using Kaplan-Meier curve. Results A total of 150 patients were included in the study, out of which 16 patients (10.7%) had CRAB BSI and 134 had carbapenem-sensitive AB (CSAB) BSI. The 28-day short-term mortality of AB BSI in elderly patients was 15.3% (23/150, 95%CI: 9.6%-21.1%), and the short-term mortality of CRAB BSI was higher than that of CSAB ([56.3%, 9/16] vs[10.4%, 14/134]). Deep venous catheterization (OR: 15.598, 95%CI: 1.831-132.910) and combined infections of other sites (OR: 15.449, 95%CI: 1.497-159.489) were related to CRAB BSI in elderly patients. The independent risk factors for 28-day mortality in elderly patients with AB BSI were hemodialysis (OR: 11.856, 95%CI: 2.924-48.076), intensive care unit admission (OR: 9.387, 95%CI: 1.941-45.385), and pulmonary infection being suspected source of bacteremia (OR: 7.019, 95%CI: 1.345-36.635). Conclusion The occurrence of CRAB BSI in elderly patients is related to the combined infection of other sites and deep vein catheterization. Hemodialysis, admission to ICU, and pulmonary infection being suspected source of bacteremia are independent risk factors for the prognosis of AB BSI in elderly patients.

Abstract:Objective To assess the value of acute gastrointestinal injury (AGI) and intestinal fatty acid-binding protein (I-FABP) in the prognosis of liver cirrhotic patients with sepsis. Methods Clinical data of 84 liver cirrhosis patients with sepsis who were admitted to the intensive care unit (ICU) of a hospital from September 2020 to March 2023 were analyzed retrospectively, and 41 patients with decompensated liver cirrhosis during the same period were selected as the control group. Serum I-FABP level in patients was determined with enzyme-linked immunosorbent assay (ELISA). Scores of the model of end-stage liver disease (MELD) and sequential organ failure assessment (SOFA) were calculated. AGI was evaluated based on medical records. 30-day and 90-day survival was observed. Correlation among variables was analyzed by Spearman correlation. Risk factors for death in patients with liver cirrhosis and sepsis was determined by multivariate Cox regression analysis. The optimal cut-off value was determined by receiver operating characteristic (ROC) curve, and the diagnostic efficacy was compared through the area under the ROC curve (AUC). Results Both AGI grading and I-FABP level in liver cirrhosis patients with sepsis were higher than those in the control group (both P < 0.05). I-FABP level was correlated with procalcitonin (PCT), MELD, and SOFA scores in patients with liver cirrhosis and sepsis (all P < 0.05). AGI grading was positively correlated with SOFA score (P=0.038). The 30-day and 90-day mortality of patients in the liver cirrhosis with sepsis group were 25.0% (n=21) and 35.7% (n=30), respectively. Multivariate Cox regression analysis showed that baseline I-FABP and SOFA scores were independently correlated with 30-day and 90-day survival, and the I-FABP quartile showed good prognostic differentiation efficacy. ROC curve showed that I-FABP could significantly improve the predictive effect of SOFA score on the prognosis of patients. Conclusion AGI grading and I-FABP level in liver cirrhosis patients with sepsis are elevated significantly. Serum I-FABP is associated with the prognosis of patient and can improve the predictive efficacy of SOFA score for survival.

Abstract:Objective To understand the application of skin disinfectant in neonatal intensive care units (NICUs) nationwide. Methods From April to May 2023, application of skin disinfectant in 93 NICUs nationwide was surveyed with convenience sampling method by a self-designed questionnaire. Questionnaire contents included types of disinfectant, disinfection tools, cleaning and disinfection frequency, disinfectant drying status, removal of disinfec-tant, and adverse reactions caused by disinfectant. Results A total of 93 nursing units in 71 medical institutions from 25 provinces/municipalities were included in this study. In NICUs, three most commonly used disinfectants were ethanol (79.57%), iodophor (74.19%), and anerdian (62.37%). In nursing units for neonates < 2 months of age, chlorhexidine was prohibited in 28 units(30.11%), used with caution in 23 units (24.73%), allowed in 9 units (9.68%), and there was no unified requirement in 33 units (35.48%). When using ethanol, staff only wiped once in 13 (17.57%) nursing units. In some nursing units, there was no unified requirements on the wiping frequency of disinfectant. As for the removal of residual iodine, saline was used in 29 (42.03%) nursing units, ethanol in 8 (11.59%), and 19 (27.54%) did not have unified requirements. The adverse reactions of disinfectant mainly included rash and contact dermatitis. Disinfectants that caused adverse reactions included ethanol, iodophor, aner-dian, and chlorhexidine. Conclusion In clinical practice, unified standards for the use of neonatal skin disinfectant remain absent. Selection and use of neonatal skin disinfectant vary considerably. Neonatal skin disinfectants have common adverse reactions. It is necessary to strengthen the training of health care workers on the standardized use of disinfectant, as well as carry out large-scale and rigorous randomized controlled trial designs to provide scientific basis for the correct selection of disinfectant.

Abstract:Objective To understand the current situation of healthcare-associated infection (HAI) and community-associated infection (CAI) in medical institutions in Wuhan City, and analyze the epidemic trend and key management of HAI. Methods The combination of medical record and bedside survey was adopted to conduct a survey according to the table of cross-sectional survey formulated by National HAI Monitoring and Management Training Base. Survey data from 2016, 2018, and 2020 were analyzed. Results HAI prevalence rates in Wuhan City in 2016, 2018, and 2020 were 2.66%, 2.21%, and 1.85%, respectively. CAI prevalence rates were 17.81%, 17.82%, and 16.29%, respectively. Both showed decreasing trends (both P < 0.05). Departments with high pre-valence rates of HAI were the intensive care unit (ICU), departments (groups) of hematology, neurosurgery, thoracic surgery, and pediatric neonatal. Departments with high prevalence rates of CAI were the departments (groups) of pediatric non-neonatal, respiratory diseases, infectious diseases, general ICU, and pediatric neonatal. The main infection sites of HAI and CAI were lower respiratory tract. The proportions of postoperative HAI at lower respiratory tract in 2016, 2018, and 2020 were 12.85%, 18.39%, and 22.09%, respectively. HAI rates at surgical site in 2016, 2018, and 2020 were 0.99%, 0.82%, and 0.69%, respectively. HAI and CAI were mainly caused by Gram-negative bacteria. Conclusion The management of HAI in medical institutions in Wuhan City in 2016, 2018, and 2020 have made achievements. However, infection control in general ICU and of HAI at lower respiratory tract still need to be strengthened and improved.

Abstract:Objective To explore the application of metagenomic next-generation sequencing (mNGS) technology in the investigation of healthcare-associated infection (HAI) outbreaks of carbapenem-resistant Acinetobacter baumannii (CRAB). Methods Pathogenic detection by mNGS and conventional pathogen culture were performed on 5 patients in the intensive care unit (ICU) of a hospital from June 8 to 22, 2023 from whom CRAB were detected. Microbial sampling was carried out in potentially contaminated environment. Bacterial culture, identification, and antimicrobial susceptibility testing were conducted. Comprehensive control measures were taken, and the effect was evaluated. Results The time required for reporting results by mNGS was shorter than the culture time ([3.92 ± 1.05] days vs[6.24 ± 0.25] days, P<0.001). CRAB was isolated from the specimens of 5 patients. mNGS detected OXA-23 resistance genes from all patients. After comprehensive assessment by experts, 4 patients were HAI and 1 patient was due to specimen contamination. According to the definition from Guidelines for HAI outbreak control, this event was considered an outbreak of HAI. The monitoring results of environmental hygiene showed that the detection rate of CRAB in the environment during the outbreak was 51.30% (59/115), mainly from the hands of health care workers and the surface of ventilators. After implementing multidisciplinary infection control measures, clinicians' hand hygiene compliance rate and implementation rate of ventilator disinfection increased from 40.83% (49/120) and 33.33% (16/48) to 82.61% (95/115) and 83.33% (30/36), respectively. The prognosis of patients was good, and no new case emerged during subsequent monitoring. The outbreak of HAI in this hospital has been effectively controlled. Conclusion mNGS is characterized by high precision, less time consumption, and high accuracy, and can be applied to the prevention and control of HAI outbreak and the study of antimicrobial-resistant genomes. It is of great significance for the anti-infection treatment of patients with multidrug-resistant orga-nism infection as well as the formulation of HAI prevention and control measures. Continuous improving disinfection effectiveness and hand hygiene compliance is important for preventing and controlling CRAB infection.

Abstract:Objective To systematically evaluate the influencing factors for pulmonary infection after cardiac surgery. Methods Literatures were retrieved from PubMed, Embase, Web of Science, the Cochrane Library, CBM, Wanfang, CNKI and VIP databases. The retrieval time was from the establishment of databases to November 22, 2022. Meta-analysis was performed with RevMan 5.4 and Stata 15.0 softwares. Results A total of 20 literatures were included in the analysis. Meta-analysis showed that age (≥ 65 years), mechanical ventilation time (≥ 5 days), smoking, acute renal damage, perioperative blood transfusion, operation time (≥ 240 minutes), secondary thoracotomy, and oxygenation index (PaO₂/FiO₂ ≤ 300 mmHg) were risk factors for postoperative pulmonary infection. Conclusion The existing evidence shows that all of the above 8 factors are risk factors for pulmonary infection after cardiac surgery, which can provide a theoretical basis for health care workers to prevent and treat infection.

Abstract:Objective To understand the spectrum and changes of pathogens causing healthcare-associated infection (HAI) in neonatal intensive care unit (NICU). Methods Clinical medical records of neonates with HAI in a hospital from January 2018 to December 2022 were collected, spectrum of pathogens causing HAI were and analyzed retrospectively. Results A total of 7 597 hospitalized neonates were investigated, and 240 of whom had 263 cases of HAI, with an HAI incidence of 3.16% and healthcare-associated case infection incidence of 3.46%. 96 cases (36.50%) were bloodstream infection, 70 (26.62%) were respiratory system infection, and 57 (21.67%) were infection without clear sites. A total of 170 pathogens were detected from specimens, 78 (45.88%) of which were Gram-positive bacteria, with Staphylococcus spp. accounting for the highest proportion, 78 (45.88%) were Gram-negative bacteria, mainly Klebsiella pneumoniae, and 14 (8.24%) were fungi. The detection rate of Gram-negative bacteria showed an upward trend from 2018 to 2022 (P<0.01). Conclusion The majority of HAI in NICU is bloodstream infection. In recent years, the detection rate of Gram-negative bacteria has been increasing year by year, and it is necessary to streng-then the prevention and control of HAI in clinical practice.

Abstract:Objective To analyze the influencing factors for catheter-associated infection (CAI) in chemotherapy treated patients after indwelling peripherally inserted central catheter (PICC) based on a random forest model. Methods 400 tumor patients who received chemotherapy and PICC were selected and divided into the training set (n=300) and the test set (n=100) in a 3:1 ratio through computer-generated random number. Patients in the training set were subdivided into the non-infection group and the infection group based on the occurrence of infection. Clinical data from two groups of patients were compared. Influencing factors for the occurrence of CAI after PICC were analyzed with multivariate logistic regression model and the integrated classification algorithm of random forest model, and the predictive performance of the two methods was compared. Results Among 300 chemotherapy treated patients in the training set, 32 cases (10.67%) experienced CAI. Compared with the non-infection group, patients in the infection group had more single punctures for catheterization, longer PICC retention time, larger proportion of catheter movement, larger proportion of complication with diabetes, higher frequency of dressing changes, lower white blood cell count and immune function (all P<0.05). PICC retention time, catheter movement, complication with diabetes, dressing change frequency, white blood cell (WBC) and immune function were independent influencing factors for CAI after PICC (all P<0.05). The random forest model showed that ranking by the importance of different influencing factors was as following: PICC retention time, catheter movement, complication with diabetes, WBC, dressing change frequency and immune function. The integrated classification algorithm of random forest model for predicting the occurrence of CAI in chemotherapy treated patients showed that the area under the receiver operating characteristic (ROC) curve (AUC) was 0.872, which had better prediction performance compared with the logistic regression model (AUC=0.791). Conclusion PICC retention time, catheter movement, complicated with diabetes, dressing change frequency, WBC level and immune function are independent influencing factors for CAI in chemotherapy treated patients. The integrated classification algorithm of random forest model can be used to predict CAI in chemotherapy treated patients, and its prediction performance is better than that of the logistic regression model.

Abstract:Objective To observe the effect of multi-modal hand hygiene (HH) intervention on HH compliance, as well as the relationship between HH compliance and the healthcare-associated (HA) case infection incidence. Methods From 2014 to 2022, the infection control team in a tertiary first-class hospital implemented multi-modal HH intervention for health care workers (HCWs). The changing trend of HH monitoring data, the correlation between HH compliance rate and HA case infection incidence were analyzed retrospectively. Results The consumption of HH products in the wards showed a stable upward trend; HH compliance rate increased from 64.98% in 2014 to 85.01% in 2022 (P<0.001), and HA case infection incidence decreased from 1.21% to 0.83% (P<0.05). HH compliance rate was negatively correlated with HA case infection incidence (r=-0.369, P=0.027). HH compliance rates in different regions and job posts in each quarter were increased (P<0.001). For 5 different HH moments in each quarter, HH compliance rate fluctuated slightly before sterile manipulation and after touching patient; presented rising trend after touching surroundings around patient, and decreased before touching patient and after touching patient's body fluid since 2020 (P<0.001). Conclusion Multi-modal HH intervention can improve the HH compliance of HCWs, improving their HH awareness is conducive to reducing HA case infection incidence.

Abstract:Objective To conduct risk assessment analysis through risk assessment model for postoperative pneumonia (POP) in surgical departments constructed according to analytic hierarchy process (AHP)-risk matrix, and evaluate the application effectiveness of the model. Methods Taking a tertiary comprehensive teaching hospital as an example, a risk assessment was conducted on the occurrence of POP in 15 surgical departments in 2022. The application effect of POP risk assessment model for the surgical departments constructed based on the AHP-risk matrix was evaluated, and the POP risk level of the surgical departments was determined. Results Through application of risk assessment model, the POP risk level of the surgical departments was divided into 5 levels, namely extremely high risk (n=3), high risk (n=1), medium risk (n=5), low risk (n=4), and extremely low risk (n=2). Conclusion The application effect of the surgical POP risk assessment model based on AHP-risk matrix method is good, achieving quantitative assessment of healthcare-associated infection risk, and providing data basis and support for further targeted risk control.

Abstract:Objective To investigate the environmental contamination related to first patient with carbapenem-resistant Acinetobacter baumannii (CRAB) infection and the infection status of relevant patients in a newly established intensive care unit (ICU) of a hospital in Tibetan area, and analyze the transmission risk. Methods From the admission in ICU of a patients who was first detected CRAB on November 15, 2021 to the 60th day of hospitalization, all patients who stayed in ICU for >48 hours were performed active screening on CRAB. On the 30th day and 60th day of the admission to the ICU of the first CRAB-infected patient, environment specimens were taken respectively 2 hours after high-frequency diagnostic and therapeutic activities but before disinfection, and after disinfection but before medical activities. CRAB was cultured with chromogenic culture medium. Results Among the 13 patients who were actively screened, 1 case was CRAB positive, he was transferred from the ICU of a tertiary hospital to the ICU of this hospital on November 19th. On the 40th day of admission to the ICU, he had fever, increased frequency for sputum suction, and CRAB was detected. The drug sensitivity spectrum was similar to that of the first case, and he also stayed in the adjacent bed of the first case. 64 environmental specimens were taken, and 9 were positive for CRAB, with a positive rate of 14.06%, 8 sampling points such as the washbasin, door handle and bed rail were positive for CRAB after high-frequency diagnostic and therapeutic activities. After routine disinfection, CRAB was detected from the sink of the washbasin. Conclusion For the prevention and control of CRAB in the basic-level ICU in ethnic areas, it is feasible to conduct risk assessment on admitted patients and adopt bundled prevention and control measures for high-risk patients upon admission. Attention should be paid to the contaminated areas (such as washbasin, door handle, and bed rail) as well as the effectiveness of disinfection of sink of washbasin.

Abstract:Objective To observe the effectiveness of fluorescence labeling-based assay bundle intervention in the prevention and control of multidrug-resistant organism (MDRO) infection. Methods Patients who were detected MDRO in a hospital from January to December 2022 were selected as the research subjects. MDRO monitoring data and implementation status of prevention and control measures were collected. Fluorescence labeling assay was adopted to monitor the cleaning and disinfection effectiveness of the surrounding object surface of the bed units. Based on the bundled prevention and control measures as well as management mode of the pre-intervention group, the post-intervention group implemented enhanced rectification measures for the problems found by the pre-intervention group. Changes in relevant indicators between January-June 2022 (before intervention) and July-December 2022 (after intervention) were compared. Results There were 136 MDRO-infected patients in the pre-intervention group, 208 MDRO strains were detected and 10 healthcare-associated infection (HAI) occurred. There were 128 MDRO-infected patients in the post-intervention group, 198 MDRO strains were detected and 9 HAI occurred. After intervention, the total detection rates of methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter baumannii (CRAB), and total MDRO from patients decreased significantly compared to before intervention (all P < 0.05). After intervention, the detection rates of MRSA, carbapenem-resistant Pseudomonas aeruginosa (CRPA), CRAB, and total MDRO from the surrounding object surface were all lower than those before intervention (all P < 0.05). The detection rate of MDRO from surrounding object surface before intervention was 34.52%, which showed a decreased trend after intervention (P < 0.05). The clearance rate of fluorescent labeled markers before intervention was 41.84%, which showed an upward trend after implementing intervention measures (from July to December), and increased to 85.00% at the end of intervention (November-December). The comp-liance rates of issuing isolation medical orders, placing isolation labels, using medical supplies exclusively, and correctly handling medical waste after intervention have all increased compared to before intervention (all P < 0.05). Conclusion Adopting fluorescence labeling-based assay bundle intervention can effectively improve the effectiveness of MDRO infection prevention and control.

Abstract:Objective To explore the clinical characteristics and treatment scheme of periprosthetic joint infection (PJI) caused by Cutibacterium avidum (C. avidum). Methods The diagnosis and treatment process of a patient with PJI caused by C. avidum was summarized, and relevant literatures in the database were retrieved for review. Results A 65-year-old female patient with body mass index (BMI) of 31.1 kg/m² underwent left humeral head prosthesis replacement surgery following a left proximal humerus fracture. Ten months after the surgery, the patient exhibited poor wound healing and oozing, along with limited movement of the left shoulder joint, and was diagnosed infection following shoulder arthroplasty. Patient underwent debridement of the infected lesion and removal of the prosthesis. The tissue, bone cement and prosthesis were cultured for C. avidum. Four literatures were retrieved and screened, a total of 30 patients with PJI (28 cases hip joint infection and 2 cases shoulder joint infection) caused by C. avidum were reported through literature retrieval, and 78.6% (n=22) total hip arthroplasty (THA) surgeries were performed using direct anterior approach (DAA). The positive rate of preoperative joint fluid culture was 71.4%, 29 cases underwent surgical combined with sensitive antimicrobials treatment. Except for one patient who had repeated infection and underwent three surgeries, other patients had a good prognosis. Conclusion PJI caused by C. avidum is mostly seen in THA patients who are obese and undergo DAA, with a few cases reported after shoulder arthroplasty. The high sensitivity of preoperative joint fluid culture provides an important basis for the development of surgical strategies and anti-infection protocols.

Abstract:Melioidosis is an infectious disease caused by Burkholderia pseudomallei. Its clinical manifestations are diverse, often recurring and accompanied by sepsis, and it is prone to misdiagnosis and mistreatment, resulting in a high mortality. This paper analyzes a case of melioidosis sepsis combined with hemophagocytic syndrome, and further summarizes the clinical characteristics, diagnosis and treatment of the disease based on domestic and foreign li-teratures, so as to reduce misdiagnosis and mistreatment of the disease and improve survival rate of patient.

Abstract:Objective To clarify the responsibilities and influencing factors of infection control liaison nurses (ICLNs) in general hospitals. Methods Relevant databases were systematically retrieved with scoping review method from establishment to March 18, 2023, and the included literatures were reported standardizedly. Results A total of 36 literatures were included in the analysis. Responsibilities of ICLNs included admittance criteria, selection methods, and job responsibilities. Influencing factors of ICLNs included training, empowerment, performance evaluation, continuous improvement measures, and personnel allocation. After the establishment of ICLNs, incidence of healthcare-associated infection and detection rate of multidrug-resistant organisms were reduced, compliance rate of health care workers' hand hygiene and monitoring rate of hospital environment were improved, and the cleaning and disinfection of hospital environment was standardized. Conclusion ICLNs play a role in preventing and controlling the occurrence of healthcare-associated infection. The management and application should be further standardized and improved, the effectiveness of ICLNs needs to be thoroughly studied, so as to promote the deve-lopment of ICLNs, and improve the quality of healthcare-associated infection management.

Abstract:In recent years, the isolation rate of carbapenem-resistant Klebsiella pneumoniae (CRKP) in China has increased year by year. Due to its multidrug resistance and high mortality in patients, CRKP brings severe challenges to the clinical treatment. The major mechanism of drug resistance in CRKP is the production of carbapenemases, with Ambler A, B, and D being the common types while Ambler type C comparativly rare. Klebsiella pneumoniae carbapenemase (KPC) is the most common carbapenemase, which belongs to type A. KPC-producing Klebsiella pneumoniae (KPC-KP) widely spreads in the world, with very limited number of effective clinical drugs. In this review, advances in the treatment KPC-KP were summarized to provide reference for clinical treatment.