Abstract:Infection prevention and control in healthcare buildings is important in blocking the spread of infectious diseases. As the most common form of ventilation, natural ventilation can reduce the infection risk in healthcare workers, patients and visitors in healthcare buildings. This study summarizes the recommendations from the World Health Organization on natural ventilation in healthcare buildings during the epidemic period from severe acute respiratory syndrome (SARS) to coronavirus disease 2019 (COVID-19) (2003-2022), the current situation of such issues in China, and the enlightenment from the recommendations. The recommendations proposed by the World Health Organization are relatively clear and specific, and worthy for reference learning for relevant management departments and research institutions in China. Some of these experiences can provide useful references for the future revision of Chinese standards or codes such as Technique standard for isolation in hospitals, Management specification of air cleaning technique in hospitals, Code for design of infectious diseases hospital and Code for design of general hospital.

Abstract:Objective To compare the clinical and molecular epidemiological characteristics between NDM-1-procucing and KPC-2-procucing carbapenem-resistant Klebsiella pneumoniae (CRKP). Methods Clinically isolated non-repetitive CRKP strains from children in a children's hospital from 2017 to 2020 were retrospectively analyzed. Basic clinical characteristics of the patients from whom strains were detected were obtained by referring to their medical records. Antimicrobial susceptibility testing and multilocus sequence typing (MLST) analysis on CRKP were performed. Clinical and molecular epidemiological characteristics of NDM-1-procucing and KPC-2-producing CRKP were compared. Results A total of 164 CRKP strains were collected from 2017 to 2020, among which 96 strains carried bla_NDM-1 and 68 strains carried bla_KPC-2. NDM-1-producing CRKP were mainly from neonatal department, while KPC-2-producing CRKP were mostly from non-neonatal departments. There were statistically significant differences in specimen sources, patient's age, department distribution, and prognosis between the two groups (all P < 0.05). NDM-1-producing CRKP strains were mainly ST 17 and ST 278, accounting for 40.63% and 18.75% respectively, while KPC-2-producing CRKP strains were mainly ST 11 (73.53%). Resistance rates of KPC-2-producing CRKP to cefepime, aztreonam, imipenem, amikacin, gentamicin, furanotoin and fosfomycin were higher than those of NDM-1-producing CRKP, all with statistical significance (all P < 0.05). Conclusion Clinical and molecular epidemiological characteristics of NDM-1-procucing and KPC-2-producing CRKP strains are different. KPC-2-producing CRKP strains show more serious antimicrobial resistance and poor prognosis in patients, thus should be paid more attention in clinic and infection control.

Abstract:Objective To analyze the clinical efficacy and safety of glecaprevir/pibrentasvir in the treatment of patients with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection, and provide scientific basis for clinical treatment. Methods 89 initially treated non-cirrhotic patients with HCV/HIV co-infection in a hospital of Butuo County of Liangshan Prefecture from January 2021 to January 2022 were selected. All patients received glecaprevir/pibrentasvir treatment for 8 weeks and were followed up for 12 weeks. Virological response rate at the end-of-treatment and sustained virological response rate after 12 weeks (SVR12) of treatment as well as occurrence of adverse reaction were recorded. Results Among 89 initially treated non-cirrhotic patients with HCV/HIV co-infection, most were middle-aged and young married men (n=79, 88.8%). HIV was mainly transmitted through sexual contact (n=62, 69.7%) and intravenous drug use (n=27, 30.3%). The most common HCV geno-types were genotype 1b (n=33, 37.1%) and genotype 3b (n=25, 28.1%). All patients completed 8 weeks of treatment successfully and HCV RNA load at the end of treatment was below the detection limit (< 25 IU/mL). Eight patients failed to complete the follow-up, and the remaining 81 (100%) patients achieved a sustained virologic response. There were no serious adverse reactions during the observation period, but 11 patients had mild adverse reactions. Conclusion The 8-week treatment regimen of glecaprevir/pibrentasvir for non-cirrhotic patients with genotype 1, 3, and 6 HCV/HIV co-infection can achieve 100% SVR12, with high safety and tolerability, which can be used as a good choice for clinical treatment of these patients.

Abstract:Objective To investigate the effect and mechanism of andrographolide (AG) on lipopolysaccharide (LPS)-induced ferroptosis in renal tubular epithelial cells (HK-2 cells). Methods HK-2 cells were treated with LPS to simulate the in vitro HK-2 injury model of sepsis. The cells were further treated with AG of 5, 10, 20, 40 μmol/L and randomly divided into control group, LPS group, LPS+dimethyl sulfoxide group (DMSO group), and AG group. Cell viability was detected by the CCK-8 method, and the optimal concentrations of LPS and AG were screened. Cell morphological change, the levels of kidney injury markers, including neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), malondialdehyde (MDA), glutathione (GSH) and reactive oxygen species (ROS), as well as the expression levels of ferroptosis regulatory proteins such as solute carrier family 7 member 11 (SLC7A11), glutathione peroxidase 4 (GPX4) and ferritin in each group were compared, and the protective effect of AG treatment on the cells was evaluated. Results Compared with the control group, the cell viabi-lity and GSH content decreased significantly in HK-2 cells treated with 10 μg/mL LPS; cell shrinkage and adhesion ability were poor; the contents of oxidative products MDA and ROS, as well as the levels of kidney injury markers NGAL and KIM-1 increased significantly, while expression levels of SLC7A11 and GPX4 protein decreased; ferritin expression level increased; differences were all statistically significant (all P < 0.05). Compared with LPS group, the cell viability, GSH content, as well as protein expression levels of SLC7A11 and GPX4 increased significantly after AG intervention, while ferritin expression level decreased, differences were all significant (all P < 0.05). MDA content, ROS fluorescence intensity, and the levels of kidney injury markers NGAL and KIM-1 decreased significantly, difference were all significant (all P < 0.05). Conclusion AG has a protective effect on LPS-induced HK-2 cell injury, possibly by activating SLC7A11/GPX4 pathway, reducing oxidative stress, up-regulating antioxidant enzyme activity, and alleviating ferroptosis.

Abstract:Objective To understand the effect of astaxanthin on intestinal injury of septic mice, and explore the mechanism. Methods Septic mice model was constructed by cecum ligation and puncture (CLP). Sixty-two male Balb/c mice were randomly divided into 4 groups by random number method: Sham surgery+solvent control group (Sham+Vehi group, n=11), Sham surgery+astaxanthin group (Sham+Asta group, n=11), sepsis model+solvent control group (CLP+Vehi group, n=20), and sepsis model+astaxanthin group (CLP+Asta group, n=20). In astaxanthin-containing groups, astaxanthin was dissolved in edible olive oil (40 mg/mL), and 100 mg/(kg·d) was gavaged for 7 days before surgery. In solvent-containing groups, the solvent was treated with an equal amount of olive oil by gavage (2.5 mL/kg). Five mice from the Sham groups and 12 mice from the CLP groups were randomly selected to observe their 7-day survival after surgery. The remaining mice were given fluorescent isothiocyanate dextran (FD-40) gavage at 18 hours after surgery. Changes in mice intestinal tissue morphology, intestinal functional injury indicators, intestinal tissue oxidative stress indicators, inflammatory factors expression, and expression of key protein of peroxisome proliferator-activated receptor γ (PPARγ)/nuclear factor kappa B (NF-κB) were detected 24 hours after surgery. Results There were no statistical differences in mice survival rate, intestinal injury indicators, intestinal inflammatory factor levels, oxidative stress indicators, and intestinal tissue injury scores between Sham+Vehi and Sham+Asta groups (all P>0.05). Compared with the Sham+Vehi group, the survival rate of mice in the CLP+Vehi group decreased significantly; serum diamine oxidase (DAO) activities, levels of intestinal fatty acid binding protein (I-FABP), D-lactate, and FD-40 increased significantly; levels of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6) and malondialdehyde (MDA) in intestinal tissue increased significantly; superoxide dismutase (SOD) activity decreased; intestinal morphological injury score was higher; the expression of PPARγ in intestinal tissue increased, and the ratios of both p-IκBα/IκBα and p-p65/p65 increased (all P < 0.05). Compared with the CLP+Vehi group, the survival rate of mice in the CLP+Asta group improved; serum DAO activities, levels of I-FABP, D-lactate and FD-40 all decreased significantly; levels of TNF-α, IL-1β, IL-6 and MDA in intestinal tissue decreased significantly; SOD activity increased; intestinal morphological injury score decreased; PPARγ expression in intestinal tissue increased, and the ratios of both p-IκBα/IκBα and p-p65/p65 decreased (all P < 0.05). Conclusion Astaxanthin decreases intestinal injury in CLP-induced septic mice, and its mechanism may be related to the regulation of PPARγ/NF-κB signaling pathway, as well as the inhibition of inflammatory response and oxidative stress.

Abstract:Objective To investigate the changes and clinical significance of peripheral blood mucosal-associated invariant T (MAIT) cells in children with influenza. Methods Children with influenza who received treatment in the outpatient and inpatient departments of a children's hospital from January to May 2023 were selected and divided into the common type group and the severe type group. Healthy children who underwent physical examination in this hospital during the same period were selected as the healthy control group. Within 24 hours after admission, children's venous blood was drawn for testing; ratios of MAIT cells (CD3⁺CD161⁺TCRVα7.2⁺cells)and MAIT cells expressing PD-1, CD69, perforin, and CD107 α were tested by flow cytometry, respectively. Differences among all the groups were compared. Results Compared with the control group, the proportion of peripheral blood MAIT cells in children with common and severe influenza gradually decreased, while the proportion of CD69-expressing and perforin-positive MAIT cells increased gradually. Differences were statistically significant (all P < 0.05). There was no statistically significant difference in the proportion of MAIT cells expressing CD107 (P>0.05). The proportion of PD-1 positive MAIT cells increased (P < 0.05), but there was no statistically significant difference between the common type and severe type groups (P>0.05). Conclusion The decrease of peripheral blood MAIT cells accompanied with immune activation plays a role in the pathogenesis of influenza.

Abstract:Objective To analyze the distribution characteristics and antimicrobial resistance of pathogens causing periprosthetic joint infection (PJI) after hip and knee arthroplasty, and provide reference for clinical prevention and rational use of antimicrobial agents. Methods Clinical data of patients with PJI after hip and knee arthroplasty in a hospital from January 2020 to December 2022 were retrospectively collected and analyzed. Distribution of pathogens and resistance to commonly used antimicrobial agents were analyzed. Results A total of 105 patients with PJI after joint arthroplasty were included in the analysis. There were 67 and 38 cases underwent hip and knee arthroplasty, respectively. A total of 124 strains of pathogenic bacteria were detected, with Gram-positive strains accounting for 74.19% (n=92), followed by Gram-negative bacteria (16.13%, n=20). The most common pathogen was Staphylococcus aureus (37.90%, n=47) and coagulase-negative Staphylococcus (22.58%, n=28). Antimicrobial susceptibility testing result showed that among Gram-positive coccus, resistance rates of Staphylococcus aureus and coagulase-negative Staphylococcus to oxacillin were 26.67% and 73.08%, respectively, while both were sensitive to vancomycin. Resistance rates of Gram-negative bacteria to ciprofloxacin, piperacillin/tazobactam, and ceftriaxone were 33.33%, 41.18%, and 55.56%, respectively, while sensitive to meropenem. Conclusion Staphylococcus aureus and coagulase-negative are the main pathogens causing PJI after joint arthroplasty, the latter has a higher resistance rate to oxacillin. Empirical treatment may be effective for Staphylococcus aureus PJI, but not sufficient for coagulase negative Staphylococcus PJI.

Abstract:Objective To systematically evaluate the incidence of healthcare-associated infection (HAI) in adult cases with carbapenem-resistant Enterobacterales (CRE) colonization in intestine, and provide referential basis for the prevention and control of HAI in cases colonized with CRE intestinally. Methods Literatures on the incidence of HAI in cases with intestinal CRE colonization were retrieved from 8 databases, including Embase, Cochrane, PubMed, Web of Science, CNKI, Wanfang, VIP, and China Biomedical Literature Database (CBM), dating back from the establishment of the databases to June 2023. Meta-analysis was conducted by Stata 17.0 software. Stability of the research results was evaluated by sensitivity analysis, and publication bias was evaluated by Egger's test. Results A total of 16 articles were included in the study, with in total 2 151 cases from 5 Chinese articles and 11 English articles. Meta-analysis results showed that the incidence of HAI in adult cases with intestinal CRE colonization was 23.1% (95%CI: 14.8%-32.5%). Subgroup analysis was conducted based on grouping factors, such as different research design types, publication years, as well as research regions, departments, and infection sites. The differences in the combined effects among subgroups were not statistically significant (all P>0.05). Among the CRE developed from colonization to HAI, the proportion of carpabenem-resistant Klebsiella pneumoniae (CRKP) was 96.0% (95%CI: 86.8%-100%), and the incidence of bloodstream infection in colonized cases was 18.2% (95%CI: 10.3%-27.6%). The 30-day mortality of CRE colonized cases was 32.6% (95%CI: 20.5%-45.9%), and the 30-day mortality of CRE infected cases was 36.9% (95%CI: 16.0%-60.2%). Conclusion In recent years, the incidence of HAI in cases with CRE colonization is high, it is necessary to actively screen and focus on intervention in high-risk departments, so as to decrease the incidence of HAI in CRE colonized cases.

Abstract:Objective To explore the effect of applying comprehensive interventions on promoting pathogen detection before antimicrobial therapy in hospitalized patients. Methods Hospitalized patients who received therapeutic use of antimicrobial agents in a tertiary first-class hospital from January 2020 to December 2021 were selected as the research subjects. Comprehensive intervention measures were implemented from January 2021. The pathogen detection rates, detection classification, and detection rates of key monitored departments before antimicrobial therapy were compared between the pre-intervention group (January-December 2020) and the post-intervention group (January-December 2021). Results A total of 10 239 hospitalized patients who received therapeutic use of antimicrobial agents were included in analysis, 4 526 cases were in the pre-intervention group and 5 713 cases in the post-intervention group. The pathogen detection rates before antimicrobial therapy, before restricted grade antimicrobial therapy, and before special grade antimicrobial therapy after intervention were 94.56%, 94.72%, and 96.03%, respectively, which were higher than 83.74%, 84.47%, and 84.95% before intervention, with statistical significance (all P < 0.05). The detection rate of targeted pathogens after intervention was 64.87%, higher than that before intervention (28.04%), with statistically significant difference (P < 0.05). The pathogen detection rates before therapeutic use of antimicrobial agents in departments of critical care medicine, pulmonary and critical care medicine, pediatrics, neurosurgery, and general surgery after intervention were 93.20%, 91.17%, 92.20%, 94.12%, and 91.15%, respectively, higher than the rates before intervention, namely 85.00%, 82.19%, 83.20%, 83.33%, and 83.03%, respectively, with statistical significance (all P < 0.05). Conclusion The application of comprehensive intervention measures can improve the pathogen detection rate before antimicrobial therapy of hospitalized patients. Close attention should be paid to the pathogen detection indicators related to healthcare-associated infection diagnosis and for the detection of sterile body fluid.

Abstract:Objective To summarize the distribution characteristics of healthcare-associated infection (HAI) after esophageal cancer surgery, analyze the relevant risk factors for HAI, provide reference for reducing HAI after esophageal cancer surgery, and improve patients' life quality. Methods Clinical data of patients with esophageal cancer who underwent surgery in a hospital from January to December 2022 were analyzed retrospectively. Postope-rative HAI sites and distribution were summarized. Chi-square test, univariate analysis and multivariate analysis were adopted to conduct correlation analysis on the basic characteristics, surgery-related influencing factors, antimicrobial use, risk factors and the occurrence of HAI in patients during hospitalization period. Results A total of 404 patients underwent esophageal cancer surgery were included in the analysis, among which 102 cases had 118 episodes of HAI, leading to an incidence and a case incidence of HAI of 25.25% and 29.21% respectively. The major infection sites were lower respiratory tract (n=57, 48.31%), pleural cavity (n=31, 26.27%), and organ space (n=16, 13.56%). Multivariate logistic regression analysis showed that age ≥60 years (OR=2.115, 95%CI: 1.150-3.890), length of hospital stay ≥25 days (OR=8.388, 95%CI: 4.491-15.667) and duration of postope-rative antimicrobial use ≥10 days (OR=2.885, 95%CI: 1.506-5.527) were independent risk factors for the occurrence of postoperative HAI (all P<0.05). Conclusion The major HAI in patients after esophageal cancer surgery is lower respiratory tract infection, and is caused by multiple factors. Patients aged ≥60 years, with a length of hospital stay ≥25 days, and duration of postoperative antimicrobial use ≥10 days are more likely to develop postoperative HAI. In order to improve the life quality of patients underwent esophageal cancer surgery, it is recommended to further strengthen perioperative management, optimize the nursing quality for patients during hospitalization, and use antimicrobial agents rationally to reduce the occurrence of HAI.

Abstract:Objective To construct and validate a nomogram prediction model for the high-risk human papillomavirus (HPV) infection and its natural clearance in professional women. Methods Women with regular professions, who underwent professional medical examination and were confirmed with high-risk HPV infection without cervical cancer and cervical epithelial neoplasia in a hospital from March 2020 to March 2021 were studied. Patients were divided into the model group and the validation group in a 7:3 ratio. The model group were subdivided into the natural clearance group and the persistent infection group based on follow-up results. The general information, reproductive-related treatment, sexual partner-related information, and examination results of the two groups of patients were compared. Potential factors for natural clearance of high-risk HPV infection in professional women were screened out by LASSO regression. Independent influencing factors were screened out with multivariate logistic regression. Based on multivariate logistic regression results, a nomogram prediction model was constructed and validated using R programming language. Results A total of 329 cases were included, 230 in the model group and 99 in the validation group. There was no statistically significant difference in general information between the two groups of patients (all P>0.05). Among the 230 high-risk HPV infection patients in the model group, 165 turned negative at the end of follow-up, with a natural clearance rate of 71.74%. Based on LASSO regression analysis, multivariate logistic regression analysis showed that age, contraceptive method, number of sexual partners, excessive foreskin of sexual partners, initial viral load, HPV infection type, and reproductive tract inflammation were independent influencing factors for the natural clearance of high-risk HPV infection in professional women (all P < 0.05). The receiver operating characteristic (ROC) curve analysis showed that the areas under the curve (AUC) of natural clea-rance of high-risk HPV infection in professional women in the model group and validation group were 0.834 (95%CI: 0.776-0.893) and 0.817 (95%CI: 0.755-0.879), respectively. H-L goodness-of-fit test result showed that the difference between the nomogram model and the ideal model was not statistically significant (P>0.05). The calibration curve results showed that the predicted curves of the model group and validation group were basically fit with the standard curve, indicating a high predictive accuracy of the model. The decision curve analysis results of the model group showed that when the probability threshold of natural clearance of high-risk HPV infection in professional women predicted by the nomogram model was 0.15-0.95, the net benefit rate of patients was >0. Conclusion The natural clearance rate of high-risk HPV infection in professional women is high, mainly influenced by factors such as age, contraceptive method, and number of sexual partners. The nomogram model constructed in this study has high accuracy and discrimination in predicting the natural clearance rate of high-risk HPV infection in professional women.

Abstract:Objective To investigate the length of hospital stay, hospitalization expense and mortality attributable to the occurrence of carbapenem-resistant Enterobacterales (CRE) infection in patients in intensive care unit (ICU). Methods Patients admitted to the ICU in a tertiary first-class hospital from 2017 to 2022 were selected for the study. According to whether CRE infection occurred, patients were divided into infected group and non-infected group. Propensity score matching method was used to conduct a 1:1 match between the infected group and non-infected group. Length of hospital stay, hospitalization expense and mortality of patients after matching were analyzed statistically. A generalized linear model was established to recalculate the odds ratio (OR) of length of hospital stay, hospitalization expense and mortality of patients after matching. Results After propensity score matching, length of hospital stay of patients in the infected group extended by 10.56 days (P < 0.001), hospitalization expense increased by 36 021.02 Yuan (P < 0.001), and mortality increased by 6.70% (P=0.035). The results of the gene-ralized linear model indicated that OR for length of hospital stay, hospitalization expense, and mortality were 1.187(95%CI: 1.013-1.393), 1.134(95%CI: 0.975-1.318), and 1.130(95%CI: 1.049-1.218) respectively for CRE infected patients, compared with non-infected patients, except for hospitalization expense, length of hospital stay and mortality between two groups were statistically significant (both P < 0.05). Conclusion CRE infection in ICU patients will increase the length of hospital stay, economic burden, and mortality of patients. Measures should be taken to prevent and control CRE infection.

Abstract:Q fever is a zoonotic disease caused by Coxiella burnetii, with diverse and non-specific clinical manifestations. Intracranial infection caused by Coxiella burnetii is rare and is often misdiagnosed and underdiagnosed, leading to poor prognosis in some patients. This article reports a case of central nervous system intracranial infectious vasculitis caused by Coxiella burnetii through diagnosis assisted by metagenomic next-generation sequencing (mNGS) technique, indicating that mNGS technique plays an important role in rapid diagnosis of Q fever. After early diagnosis and precise treatment, the prognosis of patient was improved significantly. On this basis, relevant literatures at home and abroad are reviewed to summarize the clinical manifestations as well as diagnosis and treatment experience of intracranial infection caused by Coxiella burnetii, providing reference for domestic and foreign peers.

Abstract:Enterogenic Candida albicans (C. albicans) infection refers to the translocation of intestinal colonized C. albicans under certain conditions, breaking through the intestinal tract, causing tissue infection or even invasive C. albicans infection. As the first contact point of Candida, the intestinal mucosa is the first line defending colonization or invasion of C. albicans, often inhibiting infection by physical barrier and activating host immunity. As another defense mechanism, the intestinal microbiota jointly resists the invasive infection of C. albican through regulating pH, secreting antimicrobial peptides, and competing for adhesion points. This review summarizes the roles of three key factors, namely intestinal mucosa, intestinal immunity and microbiota, in enterogenic C. albicans infection, providing new ideas for scientific research on invasive candidiasis caused by intestinal colonization.

Abstract:Influenza is an acute respiratory infectious disease caused by influenza virus infection. After influenza virus invades the human body through the respiratory tract, the epithelial cells of the respiratory tract react first and produce a variety of cytokines to induce immune responses of human body. CC chemokines and CXC chemokines regulate a variety of immune cells in the process of influenza virus infection, and play important roles in the control of inflammatory response and maintenance of homeostasis in human body at the early stage of influenza virus infection. Analyzing the role of chemokines in regulating immune cells in host's body during the process of influenza virus infection can provide new strategies for treating against influenza. In this paper, the regulatory effects on various types of immune cells by CC and CXC chemokines as well as their related receptors during influenza virus infection are reviewed.

Abstract:Leukemia has become an important threat to human health, and infection complications are the main obstacle to the clinical leukemia treatment. The intestinal barrier integrity was damaged due to the tumor characte-ristics of leukemia and high-intensity chemotherapy, intestinal bacterial translocation is an important cause for bloodstream infection. Mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) is an important component of bloodstream infection in patients with acute leukemia, but relevant research is very limited. The paper reviews the mucosal barrier injury, bacterial translocation, as well as the definition, diagnosis and prevalence of MBI-LCBI, analyzes the mechanism of intestinal microecology in regulating intestinal mucosal barrier integrity and effect of MBI-LCBI, aiming to provide theoretical basis for prevention, treatment and management of chemotherapy-induced mucositis and MBI-LCBI.

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