Abstract:Objective To explore the efficacy and safety of recombinant human anti-severe acute respiratory syndrome coronavirus 2 (anti-SARS-CoV-2)monoclonal antibody injection (F61 injection) in the treatment of patients with coronavirus disease 2019 (COVID-19) combined with renal damage. Methods Patients with COVID-19 and renal damage who visited the PLA General Hospital from January to February 2023 were selected. Subjects were randomly divided into two groups. Control group was treated with conventional anti-COVID-19 therapy, while trial group was treated with conventional anti-COVID-19 therapy combined with F61 injection. A 15-day follow-up was conducted after drug administration. Clinical symptoms, laboratory tests, electrocardiogram, and chest CT of patients were performed to analyze the efficacy and safety of F61 injection. Results Twelve subjects (7 in trial group and 5 in control group) were included in study. Neither group had any clinical progression or death cases. The ave-rage time for negative conversion of nucleic acid of SARS-CoV-2 in control group and trial group were 3.2 days and 1.57 days (P=0.046), respectively. The scores of COVID-19 related target symptom in the trial group on the 3rd and 5th day after medication were both lower than those of the control group (both P < 0.05). According to the clinical staging and World Health Organization 10-point graded disease progression scale, both groups of subjects improved but didn't show statistical differences (P>0.05). For safety, trial group didn't present any infusion-related adverse event. Subjects in both groups demonstrated varying degrees of elevated blood glucose, elevated urine glucose, elevated urobilinogen, positive urine casts, and cardiac arrhythmia, but the differences were not statistica-lly significant (all P>0.05). Conclusion F61 injection has initially demonstrated safety and clinical benefit in treating patients with COVID-19 combined with renal damage. As the domestically produced drug, it has good clinical accessibility and may provide more options for clinical practice.

Abstract:Objective To investigate the current situation and influencing factors of latent tuberculosis infection (LTBI) among close contacts of positive etiology pulmonary tuberculosis (PTB) patients, provide basis for formulating intervention measures for LTBI. Methods A multi-stage stratified cluster random sampling method was used to select close contacts of positive etiology PTB patients from 39 districts and counties in Chongqing City as the study objects. Demographic information was collected by questionnaire survey and the infection of Mycobacterium tuberculosis was detected by interferon gamma release assay (IGRA). The influencing factors of LTBI were analyzed by χ² test and binary logistic regression model. Results A total of 2 591 close contacts were included, the male to female ratio was 0.69:1, with the mean age of (35.72±16.64) years. 1 058 cases of LTBI were detected, Mycobacterium tuberculosis latent infection rate was 40.83%. Univariate analysis showed that the infection rate was different among peoples of different age, body mass index (BMI), occupation, education level, marital status, whether they had chronic disease or major surgery history, whether they lived together with the indicator case, and whether the cumulative contact time with the indicator case ≥ 250 hours, difference were all statistically significant (all P < 0.05); infection rate presented increased trend with the increase of age and BMI (both P < 0.001), and decreased trend with the increase of education (P < 0.05). Logistic regression analysis showed that age 45-54 years old (OR=1.951, 95%CI: 1.031-3.693), age 55-64 years old (OR=2.473, 95%CI: 1.279-4.781), other occupations (OR=0.530, 95%CI: 0.292-0.964), teachers (OR=0.439, 95%CI: 0.242-0.794), students (OR=0.445, 95%CI: 0.233-0.851), junior high school education or below (OR=1.412, 95%CI: 1.025-1.944), BMI < 18.5 kg/m² (OR=0.762, 95%CI: 0.586-0.991), co-living with indicator cases (OR=1.621, 95%CI: 1.316-1.997) and cumulative contact time with indicator cases ≥ 250 hours (OR=1.292, 95%CI: 1.083-1.540) were the influential factors for LTBI (all P < 0.05). Conclusion The close contacts with positive etiology PTB have a high latent infection rate of Mycobacterium tuberculosis, and it is necessary to pay attention to close contacts of high age, farmers, and frequent contact with patients, and take timely targeted interventions to reduce the risk of occurrence of disease.

Abstract:Objective To study the activity of ten kinds of antipyretic-antidotal traditional Chinese medicine (TCM), including radix tinosporae, herb of blin conyza and turmeric, against extensively drug-resistant Acinetobacter baumannii (XDR-AB) infection, screen out the extracts of antipyretic-antidotal TCM which have in vivo anti-infection activity, provide a research basis for the discovery of novel antimicrobials against XD-RAB infection. Methods Ten antipyretic-antidotal TCM were extracted with water, 50% ethanol and 95% ethanol respectively, and TCM extracts with different concentrations were prepared, which were co-incubated with the model of XDR-AB-infected Caenorhabditis elegans previously optimized by the research group. The in vivo activity of antipyretic-antidotal TCM against XDR-AB infection was judged through the survival rate of Caenorhabditis elegans. Results With the increase of concentration of turmeric and cortex pseudolaricis extracts, the survival rate of XDR-AB-infected nematodes continued to improve. The water extract, 50% ethanol extract, and 95% ethanol extract of turmeric at a concentration of 1 000 μg/mL could increase the survival rates of XDR-AB-infected Caenorhabditis elegans to 54.2% (compared to the negative control group, P < 0.001), 18.8%, and 13.3%, respectively. The water extract, 50% ethanol extract, and 95% ethanol extract of cortex pseudolaricis at a concentration of 1 000 μg/mL could increase the survival rates of XDR-AB-infected Caenorhabditis elegans to 47.4% (compared to the negative control group, P < 0.001), 23.8%, and 15.8%, respectively. Conclusion The water extracts of turmeric and cortex pseudolaricis have good activity against XDR-AB infection, and their main chemical components can be tested for in vitro antimicrobial efficacy to discover novel antimicrobial agents against XDR-AB infection.

Abstract:Objective To explore the clinical significance and antimicrobial resistance of group B Streptococcus (GBS) isolated from midstream urine culture, aiming to provide a basis for the diagnosis and treatment of clinical urinary tract infection (UTI). Methods Information about GBS strains isolated from midstream urine culture of inpatients and outpatient in a hospital in Nanjing from February 2020 to December 2022 were retrieved through laboratory information system, strains with complete data were screened out. Case data, urine routine, and antimicrobial susceptibility testing results were reviewed. Results A total of 9 081 non-repetitive bacterial strains were detected from midstream urine culture, including 425 GBS strains, accounting for 4.7%, ranking sixth. Strains with incomplete data were excluded, a total of 365 patients were included in the study. 169 (46.3%) were males and 196 (53.7%) were females, with an average age of (55.4±15.2) years. 365 patients who were detected GBS were from 17 departments, with the highest proportion being department of urology (n=237, 64.9%). The underlying diseases of patients mainly included hypertension (n=136), diabetes(n=95), urolithiasis (n=120) and urinary tumors (n=98). 211 patients underwent urological surgery, all were treated with antimicrobial agents before surgery, and 205 patients underwent indwelling urinary catheters after surgery; 9 patients were detected GBS from urine during the middle and advanced stage of pregnancy. 36.4% (n=133), 38.9% (n=142) and 24.7%(n=90)patients had GBS colony count ≤ 10⁴ CFU/mL, 10⁴-10⁵ CFU/mL, and ≥ 10⁵ CFU/mL, respectively. Patients with symptoms of UTI accounted for 24.9% (n=91), and asymptomatic bacteriuria accounted for 75.1% (n=274). The incidence of UTI symptoms in males was lower than that in females (19.5% vs 29.6%, P < 0.05). As the GBS colony count in urine culture increased, the proportion of patients with symptoms of UTI showed an upward trend (P < 0.05). On the day of urine culture, the positive rates of urine routine white blood cells, leukocyte esterase, and nitrite were 53.2%, 50.1%, and 3.8%, respectively. The positive rates of urine occult blood, leukocyte esterase, white blood cells, and urine protein in patients with symptomatic UTI were all higher than those with asymptomatic bacteriuria patients (all P < 0.05). No GBS were found to be resistant to penicillin, ampicillin, vancomycin, linezolid, and tigecycline. The resistance rate to levofloxacin and moxifloxacin was about 40%, and resistance rate to tetracycline and clindamycin was over 60%. Conclusion GBS isolated from urine is more common in non-pregnant adults, and only a small percentage have symptoms of UTI. The results of urine culture and urine routine should be comprehensively judged based on patient's clinical symptoms and signs. GBS in urine is susceptible to multiple antimicrobial agents, and clinical medication should be adopted rationally based on antimicrobial susceptibility testing result.

Abstract:Objective To analyze the cognition level of health care workers (HCWs) and the management status of various levels of medical institutions towards allergy reactions to commonly used antimicrobial agents. Methods HCWs and clinical pharmacists who were related to the diagnosis and treatment of antimicrobial agents in 14 medical institutions of city-level and autonomous prefectures in Gansu Province were randomly selected for a questionnaire survey. The survey contents included respondents' basic information, criteria for judging antimicrobial allergy, awareness on procedures related to antimicrobial allergy, and antimicrobial management level of different levels of medical institutions. Results A total of 8 670 valid questionnaires from HCWs were collected, including 3 300 physicians, 5 024 nurses and 328 pharmacists. 160, 775, 2 123 and 5 612 HCWs were with senior, associate, intermediate and junior professional titles, respectively. 87.66% of the HCWs received relevant training on antimicrobial management in the past two years, the proportion of HCWs from different levels of medical institutions who have received training on antimicrobial management in the past two years was statistically significant different(χ²=42.668, P < 0.001). HCWs with senior professional titles had the highest proportion of receiving relevant training (93.75%), there was a statistically significant difference in the proportion of receiving antimicrobial management training among HCWs with different professional titles in the past two years(χ²=69.782, P < 0.001). 50.98% of HCWs were not clear about penicillin allergy, and most of whom were with junior professional titles, accounting for 68.52%. 25.19% of HCWs expressed uncertainty about whether patients with penicillin allergy could use cephalosporins, 225 of whom were with associate professional titles, accounting for 29.03% of the total number of HCWs with associate profe-ssional titles. 6.11% of HCWs had no experience in skin test procedure; 46.94% of HCWs expressed that their medical institutions had no or unclear about whether their medical institutions had an antimicrobial allergy assessment team. Conclusion HCWs' judgment on allergy reactions to commonly used antimicrobial agents and awareness on antimicrobial application is not high enough, and the overall management level of antimicrobial allergy in all levels of medical institutions is poor. The popularity of antimicrobial allergy assessment teams is not high, and there is an urgent need to strengthen supervision, management, training, et al.

Abstract:Objective To understand the consumption of hand hygiene(HH) products and HH compliance in intensive care units (ICUs) of secondary and higher grade medical institutions (MIs) in Shanghai, and provide basis for further monitoring of HH among health care workers (HCWs). Methods Through healthcare-associated infection surveillance system, the consumption of HH products and HH compliance in ICUs from secondary and higher grade MIs in Shanghai in 2017-2021 were analyzed. Results 105 ICUs from 74 MIs were included in analysis, the average consumption of HH products was 79.24 (44.88-258.63) mL/(bed·day), with statistically significant difference among different types of ICUs (P < 0.001). The average consumption of HH products increased from 65.75 mL/(bed·day) in 2017 to 87.55 mL/(bed·day) in 2021, showing an increasing trend year by year (P < 0.001). HCWs' HH compliance rate was 82.13%, with the highest in nurses (86.59%) and the lowest (48.90%) in medical technicians, HH compliance rates of HCWs of different occupations were statistically significant different (P < 0.001). Among the implementation modes of HH, 39.86% used running water for hand washing, 42.27% used alcohol-based hand rub to wipe hands, 13.22% didn't take HH measures, and 4.65% didn't take HH mea-sures when wearing gloves, with statistically significant differences among different HH implementation modes of HCWs (P < 0.001). There was a positive correlation between the average consumption of HH products per bed·day and HCWs' HH compliance rate (r=0.703, P < 0.05). Conclusion The average consumption of HH products per bed·day and HH compliance rate of HCWs in ICUs in Shanghai presents an increasing trend year by year. There are differences in the average consumption of HH products per bed· day and HH compliance rate among different types of ICUs. The implementation of HH can be evaluated by continuously surveillance on the average consumption of HH products per bed·day.

Abstract:Objective To study the compliance and correctness of hand hygiene(HH) of staff in intensive care units (ICUs) of a tertiary first-class hospital, and provide theoretical basis for HH intervention. Methods In April 2023, staff in 17 ICUs of this hospital were performed on-site survey by infection control staff, and monitoring forms about HH compliance and correctness were filled out. Results A total of 874 HH opportunities were observed with the concealed observation method, 501 HH opportunities were implemented, the compliance rate was 57.32%, 273 HH opportunities were correctly implemented, with an correct rate of 54.49%. The compliance and correct rate of HH among staff in different ICUs varied significantly. Compliance and correct rates of HH among staff with different jobs were statistically different: HH compliance rate of cleaners (31. 97%) was lower than that of nurses (63. 83%), doctors (58.77%) and other personnel (58.14%); HH correct rate of cleaners (30.77%) was lower than that of nurses (58.17%). The causes for not implementing HH among staff with different jobs and at different HH opportunities were statistically different: the rate of not implementing any HH measures after contact with patients (84.75%) was higher than before contact with patients (41.27%), before clean and sterile manipulation (30.00%), as well as after contact with blood and body fluid (45.45%). The rate of not implementing any HH measures after contact with the patient's surrounding environment (66.67%) was higher than before contact with patient as well as before clean and sterile manipulation. The rates of incomplete HH steps and insufficient HH time among staff with different jobs were statistically different: The rates of incomplete HH steps of other personnel (82.35%) was higher than that of doctors (52.63%). The rates of insufficient HH time of doctors (82.46%) and nurses (78.18%) were higher than that of cleaners (51.85%). Conclusion The implementation of HH among different occupational groups and at different HH implementation opportunities in ICU is significantly different, which should be intervened based on their characteristics.

Abstract:Objective To improve clinicians' understanding on Prevotella bloodstream infection (BSI), reduce the rate of misdiagnosis and missed diagnosis, and broaden the ideas of diagnosis and treatment. Methods Clinical data of patients with Prevotella BSI at a hospital affiliated to a medical school of Nanjing University from May 2013 to May 2023 were collected. Risk factors, sources of infection, strains of infection, clinical manifestations, laboratory test results, treatment, and outcomes of patients with Prevotella BSI were retrospectively analyzed. Results A total of 23 patients diagnosed with Prevotella BSI were included in analysis, 15 (65.2%) were males and 8 (34.8%) were females. Most patients had related predisposing factors before BSI, such as surgical procedures (n=11, 47.8%), malignant tumors (n=10, 43.5%), diabetes (n=9, 39.1%), and indwelling urinary catheter (n=10, 43.5%), etc. There were 9 types of infected bacteria, mainly Prevotella buccalis (n=6, 26.1%), Prevotella bivia (n=5, 21.7%) and Prevotella intermedia (n=4, 17.4%). The main sources of infection were hepatobiliary system (n=6, 26.1%), abdominal and thoracic cavities (n=4, 17.4%), as well as urogenital tract (n=4, 17.4%). All patients showed symptoms of chills and fever, with significantly elevated blood inflammation indicators. Four cases (17.4%) developed septic shock, and 18 cases (78.3%) had a good prognosis after appropriate anti-infection treatment. Conclusion When atypical BSI caused by Prevotella is suspected, predisposing factors should be removed as soon as possible, blood should be actively collected and performed culture, rational use of antimicrobial agents based on antimicrobial susceptibility testing is beneficial for rapid control of infection and improvement of prognosis.

Abstract:Objective To explore the clinical efficacy and cost-effectiveness of honey, low-temperature oxygen atomization and conventional mouthwash on chemotherapy-induced oral mucositis (CIOM) in patients with acute lymphoblastic leukemia (ALL). Methods 129 ALL patients who were hospitalized in the hematology department of a tertiary first-class hospital in Yinchuan City of Ningxia from February to May 2023 and met the inclusion and exclusion criteria were selected, they were randomly divided into honey group, low-temperature oxygen atomization group, and conventional mouthwash group, with 43 cases in each group. During chemotherapy period, the honey group applied honey to oral mucosa surface, the low-temperature oxygen atomization group inhaled granulocyte stimulating factors through low-temperature oxygen atomization, the conventional mouthwash group gargled with prescribed mouthwash. Results There were 7(16.28%), 9(20.93%), and 20(46.51%) patients with CIOM in honey group, low-temperature oxygen atomization group, and conventional mouthwash group, respectively. The incidence and severity of CIOM among three groups of patients were statistically different (H=11.598, P=0.003). Honey and low-temperature oxygen atomization were superior to conventional mouthwash in the prevention and treatment efficacy on CIOM in ALL patients (both P < 0.05), but the efficacy was no statistically different between honey and low-temperature oxygen atomization (P>0.05). The cost of honey group was lower than low-temperature oxygen atomization group and conventional mouthwash group (both P < 0.05), although the low-temperature oxygen atomization group has certain therapeutic effect, its cost was much higher than that of the honey group and the conventional mouthwash group(both P < 0.05). Conclusion Honey has a better prevention and treatment effect on CIOM in ALL patients, and can also reduce the hospitalization cost of patients.

Abstract:Objective To investigate a suspected outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) healthcare-associated bloodstream infection (HA-BSI), provide reference for effective control of CRKP infection. Methods The characteristics of CRKP infected patients and the risk factors for the event transmission in an adult hematology department of a teaching hospital in June 2022 were obtained by field epidemiological investigation. The specimens of environmental target strains were co-llected by blood nutrient agar inoculation, the removal status of environmental microorganisms and the effect of infection control after implementing control measures were compared. Results There were a total of 6 cases of CRKP HA-BSI, with an attacking rate of 1.29% (6/464), which was significantly higher than 0 during the same period in 2021, and difference was statistically significant (P=0.011). In environmental hygiene monitoring, the detection rate of CRKP was 2.27% (1/44), which was from the surface of bed curtain in the living unit of infected patients, homology analysis with CRKP detected from 2 patients revealed that the 16s RNA of 3 CRKP strains was completely identical, with a similarity of 100%. Seven housekeeping genes of 3 CRKP strains were all identical and belonged to the ST11 type. Comprehensive control measures were taken: appropriate closure of the ward, centralized isolation of patients, terminal disinfection of the ward, regular health care workers and relative restriction of their activity areas. After the measures were taken, the qualified rate of microbial colony count in the ward increased compared to before taking the measures (2.27% vs 68.89%, P < 0.001), with a statistically significant difference, there were no more CRKP infected cases after the intervention, indicating that the control measures were effective. Conclusion This outbreak was caused by ST11 type of common CRKP in China, and laminar bed curtains are carriers of pathogen transmission. It is speculated that non-standard cleaning and disinfection, as well as inadequate implementation of hand hygiene are the main causes for transmission. Adopting an appropriate strategy of closing the ward and concentrating patient isolation can quickly and effectively prevent the transmission of the event.

Abstract:Objective To investigate the implementation of surveillance, prevention and control measures for healthcare-associated infection (HAI) in maternal and child healthcare (MCH) institutions, and provide policy evidence for optimizing HAI prevention and control in MCH institutions. Methods Stratified sampling was conducted among the MCH institutions at provincial, municipal and county levels in 8 provinces/autonomous regions. A unified questionnaire was designed and the online survey was conducted through "Questionnaire Star". Results The data from 123 MCH institutions were included in the analysis. 90.24% of the MCH institutions carried out comprehensive surveillance on HAI. The ratios of MCH institutions which implemented targeted surveillance on HAI in neonatal intensive care unit (NICU), surgical site infection, multidrug-resistant organisms (MDROs) and HAI in intensive care units (non-NICU excluded) were 89.66%, 85.96%, 80.77%, and 74.19%, respectively. 51.22% MCH institutions adopted information surveillance system on HAI cases. 94.31% MCH institutions carried out surveillance on hand hygiene compliance. Over 90% MCH institutions carried out surveillance on environment hygiene in high-risk departments. 71.54% MCH institutions conducted centralized cleaning, disinfection, sterilization and supply for reusable medical instruments in the central sterile supply department (CSSD). Over 90% MCH institutions established three-level pre-examination triage systems. 86.18% set up transitional wards. MCH institutions generally adopted a management model with established effective communication, full appointment visits, and separate visits for special medical groups, such as registered pregnant women, high-risk newborns, healthcare groups, and long-term rehabilitation patients. However, the ratio of institutions conducting on-line follow-up visits was less than 50%. Conclusion MCH institutions have generally carried out comprehensive and targeted surveillance on HAI. Information surveillance need to be facilitated. Hand hygiene and environmental hygiene surveillance has been popularized to a certain extent at all levels of MCH institutions. The cleaning, disinfection, sterilization, and supply processes of reusable medical devices in a few MCH institutions are not standardized. Special medical populations get effective management. On-line healthcare is to be further promoted.

Abstract:Objective To improve the efficiency of hospital antimicrobial management and ensure rational clinical use of antimicrobial agents with the aid of antimicrobial stewardship (AMS) empowered by digital intelligence technology in hospital. Methods Information systems such as early warning of antimicrobial indexes, closed-loop management of microbial detection information, and decision-making system of antimicrobial resistance monitoring data were applied to the traditional AMS system. Through hospital information systems (HIS) to collect data about therapeutic antimicrobial use and healthcare-associated infection (HAI) quality control indexes of hospitalized patients in a tertiary first-class public hospital in Shenzhen City before and after digital technology improvement, indexes of 2021 and 2022 were as control group (before improvement) and observation group (after improvement) respectively, improvement trend of antimicrobial management was compared. Results After upgrading and renovating the hospital information system, hospital antimicrobial management indexes improved significantly compared to before the renovation. The use rate of antimicrobial agents and the preventive use rate of antimicrobial agents in class Ⅰ incision surgery in patients in the observation group were both lower than those in the control group (27.0% vs 38.8%, 20.9% vs 23.8%, respectively, both P < 0.05). Antimicrobial use density in hospitalized patients in the observation group was lower than that in the control group ([33.27±3.03] DDDs vs [42.06±4.42] DDDs), difference was statistically significant (t=13.11, P < 0.001). The observation group had a higher qualified rate for evaluating antimicrobial medical orders compared to the control group (98.5% vs 96.8%). The pathogenic detection rate of hospitalized patients before therapeutic antimicrobial use and pathogen detection rate related to HAI diagnosis were both higher than those in the control group (87.1% vs 84.5%, 99.0% vs 95.4%, respectively), differences were both statistically significant (both P < 0.05). Conclusion Empowering the hospital's AMS system with digital technology can promote more scientific, standardized, efficient, and rational antimicrobial management in hospitals.

Abstract:Objective To systematically evaluate the effectiveness of failure mode and effect analysis (FMEA) in the prevention of intensive care unit (ICU)-acquired infection. Methods Two researchers independently searched relevant literatures from foreign and Chinese databases, with a search deadline of July 15, 2022. Independent screening of literatures, extraction of data and evaluation on overall quality were performed according to inclusion and exclusion criteria. RevMan 5.4 software was used to conduct Meta-analysis on the preventive effect of the included literatures. Results A total of 19 literatures were included in analysis. Meta-analysis results showed that application of FMEA method reduced the incidences of ventilator-associated pneumonia (OR=0.40, 95%CI [0.31-0.51], P < 0.01), catheter-associated urinary tract infection (OR=0.29, 95%CI [0.17-0.51], P < 0.01), central line-associated bloodstream infection (OR=0.28, 95%CI [0.18-0.46], P < 0.01), and multidrug-resistant organism infection (OR=0.46, 95%CI [0.37-0.58], P < 0.01) in ICU patients, as well as incidence of healthcare-associated infection(HAI) in ICU (OR=0.46, 95%CI [0.37-0.59], P < 0.01), and significantly improved the satisfaction of ICU patients and their families (OR=2.34, 95%CI [1.72-3.17], P < 0.01). Conclusion FMEA can effectively prevent ICU-acquired infection and improve the quality of HAI management.

Abstract:Objective To analyze the economic burden due to healthcare-associated infection (HAI) in low birth weight (LBW) infants, and provide theoretical basis for formulating HAI related policies. Methods The data of LBW infants in a tertiary first-class hospital from January 2018 to December 2022 were retrospectively collected. Propensity score matching method and marginal analysis were adopted to evaluate the economic losses in LBW infants and hospitals due to HAI. Results A total of 1 048 LBW infants were included in analysis, 124 of whom had HAI, with HAI incidence of 11.8%. A total of 109 pairs were successfully matched using the propensity score matching method. The median length of hospital stay for LBW infants in the HAI group and non-HAI group were 34.0 and 11.0 days, respectively, the length of hospital extended 23 days in LBW infants in the HAI group (P < 0.001). The median hospitalization expenses for LBW infants in HAI group and non-HAI group were 38 067.6 and 12 375.7 Yuan, respectively, the hospitalization expense for LBW infants in HAI group was 25 691.9 Yuan more than non-HAI group (P < 0.001). The major increased expenses were examination, treatment and medication fees. The total hospitalization expenses in different birth weight LBW infants in HAI group were all higher than non-HAI group, and the differences were all statistically significant (all P < 0.05). LBW infants with gestational age < 32 weeks had longer length of hospital stay and higher total hospitalization expense, differences were all statistically significant (all P < 0.05). When the marginal profit ratios were 5%, 10%, and 15%, respectively, the economic losses caused by HAI were 371 000 Yuan, 742 000 Yuan, and 1 114 000 Yuan, respectively; The ratios of loss-profit and loss-profit to infection coefficient were 0.33 and 2.79, respectively. Conclusion HAI cause significant economic losses to both LBW infants and hospitals. Infants with a birth weight ≤ 1 000 g and those with a gestational age < 32 weeks are key populations for prevention and control. The lost-profit to infection coefficient can be used to estimate the economic loss of the hospital, timely adjust infection control measures, and reduce the incidence of HAI.

Abstract:Objective To clarify the high-touch surface in oral diagnosis and treatment procedures, provide basis and guidance for cleaning and disinfection. Methods The direct observation method was used to investigate the touch time and frequency of environmental surfaces in 7 outpatient departments of a tertiary stomatology hospitals in Beijing. The average touch frequency, 95% confidence interval and cumulative touch rate were calculated. Results In oral diagnosis and treatment procedures, the average touch frequency of the environmental surface was 26.75 times per procedure, with the highest in endodontics (46.25 times per procedure) and the lowest in the oral mucosal specialty (10.19 times per procedure). The high-touch surface consisted of the shadowless lamp handle, manipulation panel and handle on dental unit (doctor's side), computer keyboard and mouse, handle and line front end of three way syringe, as well as dental high speed handpiece and line front end, with average touch frequencies of 3.99, 3.85, 2.65, 1.86, and 1.40 times per procedure. The high-touch surface in all stomatology specialties included the manipulation panel and handle on dental unit (doctor's side), 75% of specialties included computer keyboard and mouse, and the shadowless lamp handle has the highest touch frequency in 50% of specialties. The ave-rage touch frequency of the environmental surface was highest (113.50 times per procedure) during crown preparation procedure, and the lowest (8.50 times per procedure) during the orthodontic consultations. Conclusion The high-touch surface of different dental specialties and different diagnosis and treatment procedures are different. Me-dical institutions should take corresponding cleaning, disinfection and management measures according to the actual situation of high-touch surface in stomatology departments, so as to effectively improve the quality of environmental cleaning and disinfection.

Abstract:Objective To explore the diagnosis and clinical characteristics of atypical severe pneumonia caused by Chlamydia abortus(C. abortus). Methods Clinical data of 4 patients diagnosed with atypical severe pneumonia caused by C. abortus in a hospital from January 2021 to November 2022 were collected. Clinical characteristics, dia-gnosis and treatment, and precautions of the disease were comprehensively analyzed. Results All 4 patients were male, aged 63-73 years old, with acute onset, high fever, cough and expectoration. Three patients had a history of contact with poultry, one patient had a history of contact with abortion goat. The interval between the emerging of clinical symptoms and the onset of acute respiratory failure in 4 patients was 1-6 days, and the oxygenation index (PaO₂/FiO₂) at admission was less than 200 mmHg, which gradually decreased with the progression of the disease, active support with a ventilator was necessary. Two patients had an increase in white blood cell count, 4 had an increase in neutrophil percentage, 3 had a mild decrease in platelet count. Among 4 patients, 2, 2, 3 and 4 patients showed elevated levels of aspartate aminotransferase, alanine aminotransferase, creatine kinase, and serum creatinine respectively, 2 patients had mild hyponatremia, 4 patients showed significant increase in C-reactive protein, procalcitonin, and interleukin-6 levels. Four patients' chest CT findings showed main involvement of single or multiple lung lobes, with exudation and consolidation, and later involvement of multiple lobes of lung. The metageno-mic next-generation sequencing of bronchoalveolar lavage fluid detected the DNA sequence of C. abortus. Based on the clinical manifestations, contact history, chest CT, and metagenomic next-generation sequencing results of 4 patients, the diagnosis was C. abortus. atypical severe pneumonia. After timely adjustment of the treatment of anti-infection regimen based on doxycycline, the patients' condition improved and were discharged. Conclusion C. abortus may also cause human pneumonia, which can lead to serious clinical outcome after infection. Patient had a history of animal contact should be alert to such diseases. Metagenomic next-generation sequencing can detect C. abortus.

Abstract:Objective To understanding the current situation and influencing factors of healthcare-associated infection(HAI)in premature infants, provide theoretical and practical basis for the prevention and control of HAI in premature infants. Methods Premature infants who were admitted to the neonatal ward of a hospital from January 2016 to December 2021 were investigated and analyzed retrospectively. Medical records of premature infants were consulted to collect basic information as well as diagnosis and treatment information of premature infants during hospitalization. Results A total of 3 559 premature infants were included in analysis, including 1 964 males and 1 595 females. The average birth weight was (2 108.66 ± 631.17) g. 109 (3.06%) infants had HAI infection. The main infection types were lower respiratory tract infection (44.04%), bloodstream infection (28.44%), and gastrointestinal tract infection (14.68%). 38 strains of HAI-related pathogens were detected, including 33 strains (86.84%) of Gram-negative bacteria, 3 strains of Gram-positive bacteria, and 2 strains of fungi. The main isolated pathogens were Enterobacter aerogenes (28.95%) and Klebsiella pneumoniae (28.95%). Univariate and unconditional multivariate logistic regression analysis showed that amniotic fluid contamination, birth weight < 2 500 g, ventilator use, and central venous catheterization were independent risk factors for HAI in premature infants (OR values were 2.424, 3.805, 3.776, 5.412, respectively, all P < 0.05). Cesarean section was a protective factor for HAI in premature infants (OR=0.362, P < 0.05). Conclusion Premature infants have a high risk of HAI and multiple influencing factors. Clinical attention should be paid, evidence-based prevention and control measures should be actively adopted to reduce exposure to risk factors and protect the health of premature infants.

Abstract:Objective To understand the pathogen detection of hospitalized patients before antimicrobial therapy in a hospital through implementation of comprehensive intervention measures, and provide reference basis for the development of targeted measures. Methods Hospitalized patients who received therapeutic antimicrobial agents in this hospital were selected as the research subjects. Patients who were hospitalized from January to May 2022 were selected as the pre-intervention group, comprehensive intervention measures were taken from June to October 2022, and those who were hospitalized from November 2022 to March 2023 were selected as the post-intervention group. The pathogen detection rate before antimicrobial therapy, sterile specimen detection rate, antimicrobial use rate, detection rate of key multidrug-resistant organisms of patients before and after the intervention were analyzed. Results Compared to before intervention, the proportion of pathogen detection rate before antimicrobial therapy (62.09% vs 74.04%), detection rate of healthcare-associated infection diagnosis-related pathogens (62.82% vs 92.73%), and sterile specimen detection rate (35.17% vs 41.06%) of hospitalized patients after intervention all increased significantly, with statistically significant differences (all P < 0.05). After intervention, pathogen detection rate before the combination use of key antimicrobial agents was not statistically different from before intervention (93.33% vs 90.48%, P>0.05), while antimicrobial use rate was lower than before intervention (39.93% vs 44.95%, P < 0.05). There was no statistically significant difference in the detection rate of key multidrug-resistant organisms before and after intervention (all P>0.05). Conclusion Adopting scientific and rational intervention measures can improve the pathogen detection rate, provide a reference basis for the rational use of antimicrobial agents. There was no significant improvement in the pathogen detection rate before the combination use of key antimicrobial agents and the detection rate of key multidrug-resistant organisms, indicating that relevant measures still need to be further optimized.

Abstract:Intestinal flora plays an important role in the process of resisting infectious diseases. Fecal microbiota transplantation (FMT) is an important method for reconstructing intestinal microbiota, mainly includes washed microbiota transplantation, transendoscopic enteral tubing, and spore group transplantation. In 2022, the Standardization Administration of China released the technical standards for Quality control of fecal microbiota washing and grading of fecal microbiota specimens, aiming to reduce adverse events related to FMT and improve the acceptance of FMT by patients and medical personnel. After the success of FMT in the treatment of recurrent Clostridioides difficile infection, its application in the treatment of other infectious diseases has also become a global research hotspot. This paper reviews the development of FMT and its application in various infectious diseases.

Abstract:Early/late onset sepsis (EOS/LOS) and necrotizing enterocolitis (NEC) are common diseases during the neonatal period, with poor prognosis in severe cases. The early clinical manifestations are not specific, the diagnosis is difficult, currently-used non-specific laboratory tests (C-reactive protein, procalcitonin, etc.) have disadvantages, which may lead to missed diagnosis or misdiagnosis. Serum amyloid A (SAA) is a novel acute phase reactant that increases significantly in the early stage of EOS/LOS and NEC, and lasts for a long time, it is related to the severity of the disease and can reflect the therapeutic effect, thus it can be used as a biomarker for diagnosis and treatment of these two diseases. This paper reviews SAA and its value in the early diagnosis of EOS/LOS and NEC, providing new references for the diagnosis and treatment of such diseases.

Abstract:In recent years, the incidence of Elizabethkingia infection has increased significantly. Elizabethkingia can cause pneumonia, meningitis, and bacteremia, etc. The high rate of drug resistance leads to prolonged hospital stay and increased mortality, posing a heavy burden to patients and society. This paper reviews the epidemiology, pathogenesis and drug resistance of Elizabethkingia, with a view to providing a reference for the clinical diagnosis, treatment, prevention and control of Elizabethkingia infection.