Abstract:To analyze the clinical data of patients with recurrent Clostridioides difficile infection (rCDI) in the southwestern region, and help clinicians identify high-risk populations early and adopt appropriate treatment strategies. Methods Clinical data of rCDI cases from a tertiary first-class hospital in southwest China from July 2019 to June 2024 were collected, and their host-related risk factors, exogenous risk factors, treatment schemes, and endpoint outcomes were analyzed. Results In the past five years, a total of 26 cases of rCDI were detected from a ter-tiary first-class hospital in southwest China, accounting for 4.04% of the total positive cases (n=643) detected during the same period. 19.23% of the recurrent patients experienced a second recurrence. The median age of rCDI patients was 66.5 years old, with males accounting for 73.08%.The major comorbidity included diabetes mellitus (34.62%), malignant tumors (30.77%), and chronic renal diseases (23.08%). In the 8 weeks before the first onset of rCDI in patients, the top three drugs used were β-lactam and enzyme inhibitor compound (69.23%), proton pump inhibitors (65.38%), and carbapenems (46.15%). In the initial treatment of recurrent patients, 3.85% (1/26) of the cases were treated with metronidazole, 19.23% (5/26) of the cases received non-standard vancomycin/norvancomycin treatment in usage or dosage, 46.15% (12/26) of the cases received treatment with course less than 10 days. In the treatment of the first recurrence, 34.78% (8/26) of the cases received treatment with course less than 10 days. Conclusion For elderly patients and patients with diabetes mellitus, malignant tumors, and chronic renal diseases, who have used β-lactam and enzyme inhibitor compound, proton pump inhibitors, carbapenems within 8 weeks before disease onset, standard dose and treatment course of vancomycin or norvancomycin are recommended under permitted conditions, so as to reduce the risk of recurrence.

Abstract:Objective To construct an operational indicator system for infectious disease monitoring and early warning, and provide data support and decision-making basis for monitoring and early warning. Methods A preli-minary indicator framework was constructed through literature analysis and expert interviews, and expert consultation was conducted using the Delphi method. A total of 30 experts were selected. The score of the importance of indicators based on the consultation results was calculated, and the weight was determined. Results The response rates of expert consultation questionnaires from two rounds were both 100%, with expert authority coefficients (reliability coefficient) being 0.87 and 0.88 for the first and second rounds, respectively. Kendall’s W coefficients ranged from 0.137 to 0.424, with statistically significant differences (all P<0.001). Coefficients of variation for all indicators were <0.25, indicating that expert opinions tend to be consistent and the results were authoritative and reliable. The finally constructed indicator system encompassed 4 first-level, 25 second-level, and 68 third-level indicators. Conclusion The operational indicator system for infectious disease monitoring and early warning developed in this study can provide a basis for the practice of infectious disease monitoring and early warning as well as related scientific decision-making.

Abstract:Objective To analyze the incidence trend and epidemiological characteristics of pulmonary tuberculosis (PTB) among healthcare workers (HCWs) in Chongqing City from 2019 to 2023, and provide reference for the prevention and control of tuberculosis among HCWs. Methods The registered data of PTB cases in Chongqing from 2019 to 2023 were collected from China Information System for Disease Prevention and Control. The three-dimensional distribution of registration rate, changing trend, and treatment characteristics of PTB among HCWs were analyzed using retrospective descriptive analysis method. Results A total of 646 HCWs PTB cases were registered in Chongqing from 2019 to 2023, and the average annual registration rate was higher than that of the entire population (52.34/100 000 vs 46.00/100 000). The registration rate in 2019-2023 showed an overall downward trend. The average annual registration rate of PTB among HCWs in hospitals was the highest (59.87/100 000), followed by primary medical institutions (41.62/100 000) and other medical institutions (35.21/100 000). The epidemic period of PTB among HCWs was March-June each year, with seasonal indices of 133.75%, 100.31%, 113.31%, and 117.03%, respectively. The average annual registration rate of PTB among HCWs in the southeast town of Chongqing was the highest (121.21/100 000), followed by the northeast town of Chongqing (89.51/100 000), while the lowest was in the main urban area (34.47/100 000). The registration rate of PTB among HCWs gradually decreased with the increase of age (P＜0.05). Compared with the whole population, the proportions of female PTB cases among HCWs (76.01%), 25-＜35 age group (57.89%), pathogen negative (48.14%), active detected cases (5.73%), initial treatment cases (95.82%), and cases using fixed-dose combination of PTB (74.15%) were all higher (all P<0.05). The delay rate of seeking medical treatment was lower in HCWs than that in the entire population (52.63% vs 69.12%), and the success rate of treatment was higher (91.49% vs 84.19%) (both P<0.05). Conclusion The registration rate of PTB among HCWs in Chongqing has been declining year by year, with diffe-rential distribution in different medical institutions and regions, presenting seasonal changes. The majority of cases are aged <35 years old, and have high pathogen negative rate and high initial treatment rate. Targeted prevention and control strategies need to be developed based on occupational exposure characteristics.

Abstract:Objective To evaluate the effectiveness of active screening in improving the detection rate of carbape-nem-resistant Enterobacterales (CRE) in the intensive care units (ICUs). Methods From July 2023 to June 2024, active screening of rectal swab CRE was conducted on ICU patients in 10 hospitals. ICU patients who underwent active screening from July 2023 to June 2024 were selected as the study group, while those who did not undergo active screening from July 2022 to June 2023 were selected as the control group. Difference in CRE detection rates between the two groups of patients was compared. Results A total of 7 803 ICU patients were included in the study group, 744 CRE strains were detected, with a detection rate of 9.53%, out of which 304 CRE strains were detected through routine detection (detection rate 3.90%), 3 707 patients underwent active screen, 440 CRE strains were detected (detection rate 11.87%). 7 561 ICU patients were included in the control group, out of which 250 CRE strains were detected through routine detection, with a detection rate of 3.31%. There was a statistically significant difference in the overall detection rate of CRE between two groups of patients (χ²=246.18, P<0.001). In the study group, CRE detection rate of active screening (11.87%) was higher than that of routine detection (3.90%), with statistically significant difference (χ²=264.26, P<0.001). A total of 17 CRE strains were detected from the study group. The proportions of Klebsiella pneumoniae (80.92% vs 73.41%) and Serratia marcescens (2.30% vs 0.23%) in the routine detection group were both higher than in the active screening group, while the proportion of Escherichia coli in the routine detection group was lower (8.22% vs 19.55%), all with statistically significant differences (all P<0.05). Conclusion The prevalence of CRE in ICUs is relatively high, with a wide range of bacterial species. Active screening can improve the detection rate of CRE.

Abstract:Objective To re-assess the Meta-analyses/network Meta-analyses on baloxavir marboxil in the treatment of influenza, and provide evidence-based reference for clinical use of baloxavir marboxil. Methods Meta-analyses/network Meta-analyses on baloxavir marboxil in the treatment of influenza were retrieved from PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases, with retrieval time from the inception of each database to December 11, 2023. Literatures were screened according to the inclusion and exclusion criteria. Information of included literatures was extracted, and the methodological quality, reporting quality and evidence quality of the included literatures were assessed by assessment of multiple systematic reviews 2 (AMSTAR-2) scale, preferred reporting items for systematic reviews and Meta-analyses (PRISMA) statement, as well as grading of recommendations, assessment, development, and evaluation (GRADE) system, respectively. Results A total of 7 Meta-analyses/network Meta-analyses were included. The results showed that in terms of alleviation time of influenza symptoms, the efficacy of baloxavir marboxil was not inferior to oseltamivir, peramivir, and zanamivir. In terms of the decrease in influenza virus titer 48 hours after medication, baloxavir marboxil was superior to oseltamivir and zanamivir. In terms of safety, baloxavir marboxil had a lower risk of drug-related adverse events than oseltamivir, and was comparable to peramivir and zanamivir. The overall assessment result of methodological quality of AMSTAR-2 scale was relatively low, with 2 literatures being classified as low-level and 5 as extremely low-level. PRISMA scores ranged 15.5-22. The quality of overall report was moderate. Two lite-ratures were scored >21, and the reports were relatively complete. There were 5 literatures with scores ranging 15-21, and the reports had certain deficiencies. The GRADE evidence quality grading results showed that among the included 199 outcome indicators, 4 indicators were high-level evidence, 49 were moderate-level evidence, 118 indicators were low-level evidence, and 28 indicators were extremely low-level evidence. Conclusion Baloxavir marboxil is comparable to neuraminidase inhibitors in the alleviation time of influenza symptoms, superior to oseltamivir and zanamisvir in decreasing virus titer, and has a lower risk of adverse drug events (especially nausea) than oseltamivir.

Abstract:Objective Tetanus is a serious infectious diseases with high mortality, which is an important global public health issue. This study aims to analyze the epidemiological burden and changing trends of tetanus in China from 1990 to 2021, providing a basis for disease prevention and control. Methods Epidemiological indicators and global socio-demographic index (SDI) related to tetanus in China were retrieved and collected from the 2021 Global Burden of Disease database (GBD 2021). The trend analysis of the incidence rate, mortality rate and disability-adjusted life years (DALYs) rate of tetanus in China from 1990 to 2021 was conducted by Joinpoint 5.3 software. Results From 1990 to 2021, the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate of tetanus in China decreased significantly (average annual percent change ［AAPC］<0, P<0.001), with males being significantly higher than females. The crude incidence rate, crude mortality rate, and crude DALYs rate for all age groups showed overall declining trends, with the largest decline in the 0-14 years age group. In 2021, the crude incidence rate, crude mortality rate, and crude DALYs rate of tetanus in the population aged 70- years were higher than those in the population aged 0-14, 15-49, and 50-69 years groups. The ASIR, ASMR, and age-standardized DALYs rate of tetanus in China in 2021 were lower than the global level, only higher than those in the high SDI regions. Conclusion From 1990 to 2021, the disease burden of tetanus in China varied with gender and age, with an overall declining trend over time. It is necessary to strengthen tetanus health education for males and the ≥70 years population, and to improve the overall level of primary prevention measures for tetanus.

Abstract:Objective To investigate the clinical characteristics of severe pertussis in children. Methods Clinical data of 55 children with severe pertussis and admitted to the pediatric intensive care unit (PICU) of Maternal and Child Heath Hospital of Hubei Province from January 2022 to May 2024 were retrospectively analyzed. Patients were grouped according to age (≤3-month group and ＞3-month group), vaccination status, and mixed infection status, differences in clinical characteristics among different groups of pediatric patients were compared. Results 55 children with severe pertussis were aged 1 month and 5 days-9 years, all had severe pneumonia, 54 children were improved and discharged from hospital, 1 died. 26 children (47.3%) were aged ＜3 months, 45 children (81.8%) were unvaccinated, and 47 children (85.5%) had mixed infection. The rates of post-vomiting cough and blood exchange transfusion in children in ≤3-month group were lower those in ＞3-month group (30.8% vs 58.6%; 11.5% vs 34.5%, respectively); The rate of elevation of cerebrospinal fluid protein in children in ≤3-month group was higher than that in ＞3-month group (61.5% vs 31.0%); The pre-admission disease course of children in ≤3-month group was shorter than that in ＞3-month group (［10.15±5.64］ days vs ［14.24±8.90］ days), differences were all statistically significant (all P≤0.05). The absolute counts of lymphocyte in the vaccinated group was lower than that in the unvaccinated group (［9.92±5.92］×10⁹/L vs ［17.93±11.41］×10⁹/L, P＜0.05). The usage rate of gamma-globulin in children in the mixed infection group was higher than that in the simple infection group (87.2% vs 50.0%). The length of hospital stay (［15.11±6.53］ days vs ［9.50±4.69］ days), length of PICU stay (［10.53±5.26］ days vs ［5.88±4.16］ days), and macrolides antibiotic use days (［8.36±4.21］ days vs ［5.00±2.73］ days) in children in the mixed infection group were all longer than those in the simple infection group, differences were all statistically significant (all P<0.05). No independent influencing factors were found to prolong the length of PICU stay in children with severe pertussis. Conclusion Severe pertussis mostly occurs in unvaccinated children aged ≤3 months, with a high incidence of mixed infection, all presenting as severe pneumonia. Vaccination status, mixed infection, and complications are key factors affecting prognosis.

Abstract:Objective To investigate the clinical application of ceftazidime/avibactam (CAZ/AVI) in lung transplant recipients with pulmonary infection caused by carbapenem-resistant Gram-negative bacilli (CRGNB), and analyze the factors affecting the prognosis. Methods Lung transplant recipients who had CRGNB pulmonary infection and were treated with CAZ/AVI were included in the analysis. Based on 14-day clinical response, 14-day microbial response, and 30-day survival status, the recipients were divided into a clinical response group and a clinical failure group, a microbial response group and a microbial failure group, as well as a survival group and a death group, respectively. Univariate analysis was conducted on various data from the two groups. Factors affecting therapeutic efficacy and survival were included in a binary logistic regression model. Independent risk factors for CAZ/AVI anti-infective efficacy and all-cause mortality outcomes were analyzed. Results A total of 43 recipients were included. After 14-day anti-infective treatment, 32 recipients (74.42%) achieved clinical response, and 30 recipients (69.77%) achieved microbial response. 34 recipients (79.07%) survived 30 days after CAZ/AVI treatment. The Charlson comorbidity index (CCI), proportion of renal dysfunction, and incidence of shock in recipients in the clinical response group were all lower than those in the clinical failure group (P<0.05), while the serum albumin (ALB) level was higher (P<0.05).The incidence of shock in recipients in the microbial response group was lower than that in the microbial failure group (P<0.05). CCI, proportion of renal dysfunction, and incidence of shock in recipients in the survival group were all lower than those in the death group (all P<0.05), while ALB level was higher during treatment period (P<0.05). Multivariate analysis of 14-day clinical response and 30-day survival showed that higher CCI was an independent risk factor affecting 14-day clinical response of recipients (OR=2.22, 95%CI: 1.07-4.63), while lower ALB levels (OR=0.72, 95%CI: 0.54-0.98) and higher CCI (OR=5.27, 95%CI: 1.18-23.58) were independent risk factors for 30-day all-cause mortality in recipients with pulmonary infection after lung transplant. Conclusion CAZ/AVI may be an effective drug for treating pulmonary infection caused by CRGNB in lung transplant recipients. Higher CCI is an independent risk factor for 14-day clinical failure in recipients after CAZ/AVI treatment. Lower ALB level and higher CCI are independent risk factors for increased 30-day mortality in recipients.

Abstract:Objective To evaluate the medical resource consumption due to healthcare-associated infection (HAI) in patients with tumor based on disease diagnosis-related grouping (DRG). Methods Medical records of discharged patients from a tumor center of a hospital in 2022 were analyzed retrospectively, and differences in indicators such as average length of hospital stay and average expenses per hospitalization between the HAI group and the non-HAI group were compared. Results A total of 10 674 cases were included in the analysis, and 217 cases (2.03%) were in the HAI group. The average expense per hospitalization (5.10［2.38, 8.43］ 10 000 Yuan vs 1.16［0.74, 2.04］ 10 000 Yuan) and average length of hospital stay (25 ［13, 40］ days vs 6 ［4, 11］ days) of patients in the HAI group were both higher than those in the non-HAI group, both with statistically significant differences (both P<0.05). The most common infection was bloodstream infection and pulmonary infection, accounting for 23.96% and 22.58%, respectively. In the three DRG groups, namely, RC19 (radiotherapy for malignant proliferative diseases), RU12 (supportive treatment for malignant proliferative diseases ［length of hospital stay 7-29 days］), and RB19 (high-dose chemotherapy and/or other treatments for acute leukemia), patients in the HAI group had higher average expenses per hospitalization and average length of hospital stay than patients in the non-HAI group, diffe-rences were all statistically significant (all P<0.05). Conclusion DRG assessment can effectively identify key po-pulations for HAI prevention and control, contribute to implement precise infection prevention and control strategies, and reduce HAI incidence and related medical resource consumption.

Abstract:Objective To explore the value of dual factor combined detection using tuberculosis (TB) specific cytokines interferon-γ (IFN-γ) and interleukin-2 (IL-2) in TB diagnosis in patients with human immunodeficiency virus (HIV) infection, and the influencing factors for underdiagnosis. Methods HIV-infected patients admitted to and underwent TB-related examination in the Department of Infectious Diseases in Hezhou People’s Hospital from July 2022 to September 2024 were collected. According to the clinical diagnosis criteria, patients were divided into the HIV infection with TB group (HIV/TB group) and the HIV infection without TB group (control group). Diagnostic efficacy of dual factor combined detection was evaluated. HIV/TB group was further divided into a true-positive group and a false-negative group based on the detection results. The independent influencing factors for underdia- gnosis was analyzed using multivariate logistic regression. Results A total of 306 patients were included in the analysis, with an average age of (55.69±14.02) years. There were 105 patients in the HIV/TB group and 201 in the control group. The sensitivity and specificity of dual factor combined detection for TB in all HIV-infected patients were 72.4% (76/105) and 87.1% (175/201), respectively. There was a statistically significant difference in sensitivity (χ²=9.488, P=0.009) and no statistically significant difference in specificity (χ²=5.846, P=0.054) among the three CD4⁺T lymphocyte count gradients in the dual factor detection. Among them, patients with CD4⁺T cell count <100 cells/μL had lower sensitivity (58.8%) in dual factor detection than patients with CD4⁺T cell count ≥200 cells/μL (88.9%) and 100-199 cells/μL (81.5%), differences were both statistically significant (both P<0.05). In HIV/TB co-infected patients with CD4⁺T lymphocyte count ≥100 cells/μL, the general sensitivity and the specificity of dual factor combined detection were 85.2% (46/54) and 82.0% (91/111), respectively. Multivariate analysis showed that CD4⁺T lymphocyte count was an independent influencing factor for the underdia-gnosis in HIV/TB patients conducting dual factor combined detection (P<0.05), while age, gender, pathogen results, and the presence or absence of TB had no statistically significant impact on the results of dual factor combined detection (all P>0.05). Conclusion Dual factor combined detection using tuberculosis-specific cytokines IFN-γ and IL-2 has a high diagnostic value in the diagnosis of TB in HIV-infected patients, especially in those with CD4⁺T lymphocyte count ≥100/μL, which can provide auxiliary diagnostic value for the clinical diagnosis of HIV infection combined with TB.

Abstract:Objective To analyze the risk factors of fluconazole resistance in Candida tropicalis (C. tropicalis) urinary tract infection (UTI), and evaluate the efficacy of different treatment regimens. Methods Patients with C. tropicalis UTI at Xiangya Hospital of Central South University from January 2021 to December 2023 were included for single center retrospective study. The minimum inhibitory concentration (MIC) of fluconazole was determined by microbroth dilution. Patients were divided into a fluconazole-resistant group and a fluconazole-sensitive group based on fluconazole resistance. Risk factors for fluconazole resistance were analyzed based on clinical data, and therapeutic efficacy in patients in fluconazole-resistant group was analyzed. Results A total of 198 patients were included in the study. 133 (67.2%) C. tropicalis strains were detected to be sensitive to fluconazole, while 65 (32.8%) strains were resistant, and 63.1% (n=41) had MIC values ≥128 μg/mL. Compared with fluconazole-sensitive group, fluconazole-resistant group had a higher proportion of pulmonary infection (P=0.019). Pulmonary infection (OR=3.282) was a risk factor for fluconazole resistance in C. tropicalis UTI, while urinary system obstruction (OR=0.269) was a protective factor for fluconazole resistance in C. tropicalis UTI. There was no statistically significant difference in the usage rate of different antimicrobial agent types between the two groups (all P>0.05). The therapeutic efficacy analysis showed that the effective rates of treatment with fluconazole dosage regimens of ≤200 mg/d, ≥400 mg/d, and fluconazole monotherapy against fluconazole-resistant strains were 66.7% (6/9), 83.3% (5/6), and 100% (6/6), respectively. For patients treated with monotherapy using other drugs or with multidrug sequential treatment regimens, the treatment effective rate was 60.0% (3/5). The proportion of patients in the effective treatment group who removed their urinary catheters after detecting C. tropicalis was higher than that in the ineffective treatment group (P<0.001). Conclusion The fluconazole resistance of C. tropicalis is related to urinary tract obstruction and concurrent pulmonary infection. When treating UTI caused by fluconazole-resistant strains, the catheter should be removed as early as possible. In addition to increasing the dosage of fluconazole, other antifungal drugs such as flucytosine alone or sequential treatment with multiple drugs can also be considered.

Abstract:Objective To analyze the clinical and pathogenic characteristics, as well as influencing factors for the prognosis of patients with Candida bloodstream infection (CBSI). Methods Clinical data of 47 CBSI patients in a hospital from January 2015 to September 2024 were collected. Distribution of departments and infection strains, antimicrobial resistance, and influencing factors for the poor prognosis of patients were analyzed. Results A total of 51 strains of Candida were detected from 47 CBSI patients, mainly from the intensive care unit (ICU; n=25, 53.2%), department of intestinal fistula surgery (n=8, 17.0%), and department of respiratory medicine (n=4, 8.6%), et al. The main detected pathogens were Candida albicans (n=29, 56.9%), Candida tropicalis (n=7, 13.7%), Candida glabrata (n=6, 11.8%), and Candida parapsilosis (n=6, 11.8%). Resistance rate of Candida albicans to fluconazole was 11.5% (3/26). According to the prognosis results, patients were divided into a good prognosis group(n=26, 55.3%) and a poor prognosis group (n=21, 44.7%). Univariate analysis showed statistically significant differences between patients in the good prognosis group and the poor prognosis group in terms of absolute neutrophil count, ICU admission, mechanical ventilation, tracheal intubation, gastrointestinal hemorrhage/perforation, and surgical treatment (lesion clearance, drainage or unblocking for obstruction) (all P<0.05). Preliminary multivariate logistic regression analysis showed that gastrointestinal hemorrhage/perforation was a potential risk factor for the poor prognosis in CBSI patients (OR=11.156, 95%CI: 1.434-86.809, P=0.021). Conclusion The detected CBSI strains are mainly Candida albicans, and gastrointestinal hemorrhage/perforation may be one of the potential risk factors affecting the prognosis of CBSI patients. These patients are generally in critical condition and should be detected and treated as early as possible to improve their prognosis. Due to the small amount of specimens, further research is still needed for confirmation.

Abstract:Objective To explore the therapeutic effect and potential mechanism of CA330 and OXIRIS adsorbent columns in septic shock. Methods Patients who met the diagnostic criteria for septic shock and admitted to the Department of Critical Care Medicine of Shenzhen Third People’s Hospital from February 2022 to June 2024 were selected. They were randomly divided into an OXIRIS group and a CA330 group according to the random number table method. The CA330 group received hemoperfusion combined with hemodiafiltration using CA330 adsorbent co-lumn, while the OXIRIS group was treated with OXIRIS adsorbent column. Relevant markers of the two groups of patients before and after treatment were collected and compared, including inflammatory markers, bilirubin (total bilirubin ［TBil］, direct bilirubin ［DBil］), coagulation functions (prothrombin time ［PT］, activated partial thromboplastin time ［APTT］, etc), endotoxin (ETX), organ function scores (acute physiology and chronic health score Ⅱ ［APACHE Ⅱ］, sequential organ failure assessment ［SOFA］, etc). Molecular biology techniques were adopted to detect changes in inflammation-related gene expression (nuclear factor kappa B ［NF-κB］, toll-like receptor 4 ［TLR4］, myeloid differentiation factor 88 ［MyD88］), and oxidative stress factors (glutathione peroxidase ［GSH-Px］, superoxide dismutase ［SOD］) in the blood of patients before and after treatment. The safety and effectiveness of two types of adsorbent columns during the treatment process was evaluated. Results A total of 92 patients were included and randomly divided into the OXIRIS group and the CA330 group, with 46 cases in each group. After treatment, the levels of TBil, DBil, and ETX in two groups of patients all showed significant decreases compared with before treatment (all P<0.01), the levels of TBil, DBil, and ETX in patients in the OXIRIS group after treatment were all lower than those in the CA330 group during the same period (all P<0.05); PT and APTT in both groups shortened significantly compared with before treatment (both P<0.01), PT and APTT in the OXIRIS group after treatment were both shorter than those in the CA330 group during the same period (both P<0.05); The APACHE Ⅱ score and SOFA score in patients in the OXIRIS group after treatment were both lower than those in the CA330 group during the same period (both P<0.05); The levels of serum high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-5, and IL-8 in patients in both groups showed significant decreases compared with before treatment (all P<0.05), and the levels of these serum markers in the CA330 group after treatment were all lower than those in the OXIRIS group during the same period (all P<0.05). The gene expression levels of NF-κB, TLR4, and MyD88 in patients in the CA330 group after treatment were all lower than those in the OXIRIS group during the same period (all P<0.05); The levels of GSH-Px and SOD in patients in the OXIRIS group after treatment were both higher than those in the CA330 group (both P<0.01). No serious adverse event occurred in patients in the CA330 group and the OXIRIS group during the treatment process. Conclusion OXIRIS may be better in clearing bilirubin and endotoxin, improving coagulation function, protecting organ function, and regulating oxidative stress response in patients, while CA330 may be more prominent in clearing inflammatory markers and regulating inflammation-related gene expression in patients.

Abstract:Objective To enhance the accessibility of hand hygiene (HH) facilities and HH compliance, and reduce the risk of healthcare-associated infection (HAI) of psychiatric patients in specialized psychiatric hospitals by designing and installing personalized HH facilities. Methods 12 wards in a tertiary first-class specialized psychiatric hospital in Beijing were selected. Personalized HH facilities were designed and installed at corresponding locations in the wards according to patients’ accessibility. Using direct observation method and with the installation date (February 1, 2024) of HH facilities as the node, HH compliance of hospitalized patients before (October 2023 to January 2024) and after (February to May 2024) the installation of facilities was investigated. Changes before and after the installation of HH facilities were evaluated. Results The compliance rate and accuracy rate of patients’ HH before HH facilities installation were 51.85% and 34.49%, respectively. While those after the installation were 59.96% and 46.26%, respectively, both higher than before the installation (both P<0.05). After the installation, HH compliance rates of patients before and after eating, before defecation and urination, before and after leaving the ward, before and after touching public goods, as well as before and after contacting with other patients or items were all higher than those before installation (all P<0.05). The compliance rate and accuracy rate of HH of male and female patients after installation were both higher than those before installation (both P<0.05). Conclusion The accessibility of HH facilities in specialized psychiatric hospitals is poor. HH compliance rate and accuracy rate of patients are low. Installing personalized HH facilities can enhance HH compliance rate and accuracy rate of patients while ensuring patients safety.

Abstract:Objective To investigate the current status of cleaning and disinfection of endoscopic biopsy valves in three digestive endoscopy centers in Jiangxi Province, and evaluate the effectiveness of establishing a standard operational procedure (SOP) of cleaning and disinfection for flexible endoscopic biopsy valves. Methods The cleaning and disinfection procedures of biopsy valves in three digestive endoscopy centers were recorded using on-site investigation method (the control group). Based on relevant literature and manufacturer manuals at home and abroad, SOP was established and cleaning and disinfection training for cleaning professional was provided (the trial group). Biopsy valve specimens from two groups were taken. The disinfection qualified rate, microbial positivity rate before disinfection, and microbial load after disinfection before and after procedure improvement were compared between two groups. Results A total of 180 biopsy valve specimens were taken from two groups (60 specimens from endoscopy centers A, B, and C each). On-site investigation showed that the cleaning and disinfection procedure for biopsy valves was inconsistent among the three endoscopy centers. The total qualified rate of disinfection in the trial group was higher than that in the control group (95.5% vs 83.3%), with statistically significant difference (P<0.05). The total microbe positive rate of biopsy valves from the trial group was lower than that from the control group (25.0% vs 57.2%), with statistically significant difference (P<0.05). The difference in microbial load after disinfection between two groups of biopsy valves was statistically significant (Z=-6.47, P<0.05). Conclusion Although being a tiny accessory, the flexible endoscopic biopsy valve can be a potential source of infection if not tho-roughly cleaned and disinfected. Developing SOP can help improve the cleaning effectiveness of biopsy valves. At present, there is no unified standards for the cleaning and disinfection procedure of endoscopic biopsy valves. In the future, standardization of the SOP for biopsy valves should be continuously explored, so as to reduce the risk of cross infection.

Abstract:Objective To explore the effect of project-based learning on the training of sharp injury prevention skills in the pre-job training for nursing interns and its impact on the incidence of sharp injuries during internship. Methods Two classes (class A and B), majoring in nursing at Medical College of Nanchang Institute of Technology in March 2023 were selected as the research subjects by convenience sampling method. Coin flipping method was used to designate class A as the routine group and class B as the intervention group. The routine group received routine pre-job training which mainly focused on retrospective intensive training on nursing operation skills. On this basis, the intervention group integrated project-based learning as compensation education on sharp injury prevention skills. Kirkpatrick’s four level training evaluation model was adopted to comprehensively evaluate the educational effectiveness at the four progressive levels of "reaction, learning, behavior, and outcome" at corresponding stages. Results 56 nursing interns were included in the class A routine group and class B intervention group, respectively. The course evaluation score (128.67±4.39 vs 117.28±6.55), needlestick protection knowledge cognition score (109.11±4.38 vs 96.44±6.72), safe injection behavior score (38.45±4.91 vs 32.30±5.62), occupational identity score (58.02±8.55 vs 51.77±15.86), and job competency score (82.59±13.35 vs 75.61±15.09) of nursing interns in the intervention group were all higher than those in the routine group, differences were all statistically significant (all P<0.05). The incidence of sharp injuries (19.64% vs 57.14%) and the average frequency of occu-rrence (1.45 vs 2.13) in nursing interns in the intervention group were both lower than those in the control group. The case intervention rate (87.50% vs 45.59%) and case reporting rate (93.75% vs 32.35%) after sharp injury were both higher than those in the routine group, and the differences were both statistically significant (both P<0.05). Conclusion Introducing project-based learning in pre-job training for nursing interns can effectively improve their mastery of protection skills, reduce the incidence of sharp injuries during internships, and have important practical value in cultivating their occupational protection abilities.

Abstract:Objective To analyze the epidemiological characteristics and risk factors of an outbreak of influenza A H1N1 in a specialized psychiatric hospital in Shantou City, Guangdong Province, provide scientific basis for the prevention and control of respiratory infectious diseases in psychiatric health institutions. Methods Data of infection cases in this hospital in May 1-27, 2024 were collected with on-site epidemiological investigation method, and were analyzed with descriptive epidemiological methods. The specimens of the cases were performed nucleic acid testing by reverse transcription polymerase chain reaction (RT-PCR) method. Results A total of 43 influenza-like cases in this outbreak have been reported, with an incidence of 16.67%, including 42 hospitalized patients and 1 healthcare worker. Among the 42 hospitalized patients, there were 41 males, with an incidence of 35.04% and 1 female with an incidence of 2.22%, there was a statistically significant difference in incidence between hospitalized patients of different genders (χ²＝18.23, P＜0.001). The epidemic curve shows that after the first case appeared on May 8, 2024, the number of cases increased significantly from May 13, and reached its peak on May 17 (n=17). 31 patients’ throat swab specimens were collected, out of which 29 (93.55%) were positive for influenza A H1N1 virus nucleic acid and 2 (6.45%) were negative. Conclusion This epidemic is an outbreak of influenza A H1N1 in a psychiatric health institution, the epidemic curve shows a point source human-to-human transmission mode. Failure to effectively identify and isolate cases in the early stage can lead to the spread of the epidemic across floors and wards. It is necessary to regularly organize hospitalized patients and healthcare workers to receive influenza vaccines, strictly implement the health monitoring system, strengthen the control of external personnel, and enhance the early detection and emergency response capabilities for infectious disease outbreaks.

Abstract:Broncholithiasis complicated with actinomycosis is a rare clinical disease. This paper reports a patient presenting cough and shortness of breath as the major symptoms. The diagnosis of broncholithiasis complicated with pulmonary actinomycosis was confirmed by chest CT, fiberoptic bronchoscopy, and biopsy of the lesion. The broncholiths in the anterior segment of the right upper lobe were removed by repeated lavage, cryotherapy as well as the use of electrocautery snare and forceps under general anesthesia intubation bronchoscopy. After combined with anti-infection treatment, the patient’s cough and shortness of breath improved significantly. Combined with reviewing the literature, this paper explores the pathophysiological mechanism, clinical manifestations, diagnosis and treatment of broncholithiasis complicated with actinomycosis, aiming to enhance the understanding and treatment of this disease.

Abstract:As the location with special public health environments, funeral parlors are of paramount importance in the prevention and control of infectious diseases as well as disinfection practices. This paper analyzes the unique hygienic characteristics of funeral parlors, summarizes relevant laws, regulations, standards, and literatures in funeral parlors at home and abroad, and elaborates the problems relevant to infection prevention and control in funeral parlors from perspectives of body disposal risks, microbial contamination characteristics in funeral parlors, and the current status of staff’s knowledge on infectious diseases. It aims to enhance the professional prevention and control capabilities of funeral service personnel and management personnel, ensure the health and safety of service recipients and staff, optimize service quality, provide theoretical basis and practical guidance for forming a sound infectious disease prevention and control system for funeral service institutions, and clarify research directions for the prevention and control of infectious diseases in funeral parlors in the future.

Abstract:The application of artificial intelligence (AI) technology in healthcare-associated infection prevention and control deepens continuously. It demonstrates a potential for achieving precise prevention and control of infection through data integration, model construction, and dynamic analysis, and provides scientific support for optimization of decision-making in relevant departments. However, the application of related technologies still faces multiple challenges, such as data quality, system compatibility, and adaptation to actual scenarios, which limits its comprehensive promotion in clinical settings. Based on this, this study systematically summarizes the research progress of AI application in infection prediction, diagnosis support, behavior optimization, and resource management in recent years, deeply analyzes its key technical advantages and limitations, and proposes improvement strategies for existing problems and future development directions, with a view to providing theoretical support and practical refe-rences for the intelligent transformation of infection prevention and control in hospitals in China.