ObjectiveTo investigate the epidemiological and clinical characteristics, pathogen species, and antimicrobial resistance of bacillary dysentery in children in recent three years.MethodsClinical data of 175 children with bacillary dysentery in a hospital in 20102012 were analyzed retrospectively. ResultsPeaks month of occurrence of bacterial dysentery in children was in JulySeptember (74.86%), incidence in children in 1-3 years old group (1 year old was excluded, 3 years old was included) was 23.43%, and  in  3-5 years old group (3 years old was excluded, 5 years old was included) was 25.14%. The main clinical manifestations were diarrhea （100%）, paroxysmal abdominal pain(94.29%),and fever (77.14%), but the typical symptoms of bloody purulent stool and tenesmus were less than the previous. The isolation rate of Shigella flexneri and Shigella sonnei was 64.57% (n=113) and 35.43% (n=62) respectively. Antimicrobial susceptibility test result revealed that the resistance rate of 175 Shigella isolates  to ampicillin, ampicillin/sulbactam, and compound sulfamethoxazole  was 97.14%, 72.57%, and 78.29% respectively; sensitivity rate to gentamicin, ciprofloxacin, norfloxacin,  and  levofloxacin  were  still  high ,  resistance rates were 4.57%-16.57%,  sensitivity rate to cefotaxime and ceftazidime were up to more than 95%. ConclusionAtyptical bacillary dysentery in children increases gradually; the major Shigella in local area is Shigella flexneri; Susceptibility of Shigella to some antimicrobial agents changed obviously, antimicrobial use should be paid attention.

ObjectiveTo compare disinfectant efficacy of different disinfectants on the skin of blood donors before donation.MethodsFrom May 2008 to April 2011, 240 volunteer blood donors were divided into 3 groups according to the different skin disinfectants used : iodine tincture and alcohol group, iodophor group, and Anerdian group, there were 80 donors in each group. Samples were taken respectively  before and after skin was disinfected , and disinfectant efficacy as well as disinfectant drying time were  compared.ResultsThe total number of bacteria on the skin was not significantly different among three groups before and after disinfection respectively （all P＞0.05）, after disinfection, bacteria number on the skin of iodine tincture and alcohol group, iodophor group, and Anerdian group were  （0.74±0.36）CFU/cm2  ,（0.82±0.38）CFU/cm2 and （0.65±0.31）CFU/cm2  respectively；the qualified  rates of disinfection were all 100%; disinfectant drying time of three group  were （76.23±5.31）seconds, （104.64±6.82）seconds and（20.41±3.53）seconds,  respectively（F=5.703，P＜0.05）, Anerdian group was  remarkably shorter  than  the other two groups.ConclusionAnerdian disinfectant is suitable for skin disinfection of blood donors before donation，disinfectant efficacy is ideal and disinfectant drying time is short.

ObjectiveTo investigate the antimicrobial use in patients at different scales of hospitals of China in 2010.MethodsAn oneday pointprevalence survey on antimicrobial use in hospitalized patients was conducted with crosssectional investigation method.ResultsThe daily antimicrobial use rate in 407 208 inpatients at 740 hospitals was 49.63%, 49. 99% of which were for therapeutic use, 39.17% for prophylaxis, and 10.84% for both. Of all patients receiving antimicrobial agents, 67.96% received monotherapy regime, 30.08% received two combined and 1.96% received three or more drug combined. 29. 21% of patients receiving therapeutic antimicrobial agents sent samples for pathogenic detection. Antimicrobial usage rate in teaching hospitals was lower than nonteaching hospitals(χ2=100.53，P=0.00), antimicrobial usage rate had a “stepbystep” rise among hospitals with ≥900,600899,300599,＜300 beds(χ2=571.90，P=0.00；χ2=579.38，P=0.00；χ2=36.11，P=0.00). Departments with high use of antimicrobial agents were pediatrics（85.50%）, general intensive care unit（81.95%） and respiratory diseases department（76.99%）.ConclusionInpatients in 740 hospitals had high usage rate of antimicrobial agents, prophylactic and combined use is more, sample for pathogen detection was less, it is necessary to strengthen the management of antimicrobial rational use.

ObjectiveTo study resistant mechanisms of two clinical strains of Enterobacter aerogenes (Ea293 and Ea2880)to ertapenem. MethodsThe minimum inhibitory concentrations (MICs) of antimicrobial agents were determined by microbroth dilution method, drug resistance of strains to imipenem，meropenem，and ertapenem were determined by KB test; carbapenemase was confirmed by modified Hodge test, carbapenemase genes（KPC，IMP1 group，IMP2 group，VIM）, broadspectrum and extendedspectrum βlactamases genes（TEM，SHV，CTXM1 group，CTXM2 group，CTXM9 group） were amplified by polymerase chain reaction (PCR), and sequences were analysed; Outer membrane protein (Omp) was analyzed by sodium dodecylsulfatepolyacrylamide gel electrophoresis (SDSPAGE) and the coding gene OmpE36 was amplified by PCR. ResultsAntimicrobial susceptibility test showed that Ea293 and Ea2880 were all resistant to ertapenem. Among amplified 4 carbapenemase genes and 5 broadspectrum and extendedspectrum genes, only  blaSHV and blaCTXM9 group ESBLs in Ea2880 were positive, BlaSHV DNA sequence was SHV11 type. SDSPAGE showed that compared with ertapenemsensitive isolate Ea1885, ertapenemresistant isolate Ea293 and Ea2880 lacked the protein band with 42kD which might be the outer membrane protein gene OmpE36. OmpE36 was amplified by PCR, Ea2880 appeared the excepted bands, but Ea293 didn’t. The similarity of DNA and amino acid sequences of OmpE36 of Ea2880 with the standard Enterobacter aerogenes ATCC13048 from GenBank were both 87%.ConclusionThe resistance of clinical strains of Enterobacter aerogenes Ea293 and Ea2880 to ertapenem might be associated with the loss of outer membrane protein gene OmpE36. Furthermore，Ea2880 might be associated with production of CTXM9 group ESBLs.

ObjectiveTo investigate the distribution and antimicrobial resistance of major gramnegative bacilli isolated from patients in intensive care unit (ICU) and nonICU wards，and provide reference for rational clinical antimicrobial  application. MethodsSpecimen sources and antimicrobial resistance of gramnegative bacilli from hospitalized patients in ICU and nonICU wards between 2011 and 2013 were analyzed statistically and compared.ResultsA total of  3 875 gramnegative bacterial isolates were detected among 25 153 specimens, isolation rate was 15.41%; 1 121 specimens from ICU were isolated 527 isolates of gramnegative bacilli， isolation rate was  47.01%; 3 348 isolates of  gramnegative bacilli were isolated from 24 032 specimens of nonICU, isolation rate was 13.93%, there was significant difference between the two（χ2=899.32，P＜0.001）. Extendedspectrum βlactamases (ESBLs)producing rate of Escherichia coli and Klebsiella pneumoniae in ICU patients was 56.00%（28/50） and 70.65%（65/92） respectively, in nonICU patients was 52.81%（517/979） and 40.37%（241/597）respectively. The imipenemresistant rate of Pseudomonas aeruginosa， Acinetobacter baumannii,  Escherichia coli, and Klebsiella pneumoniae from ICU was 36.59%, 88.54%, 10.00%, and 10.87% respectively， while from nonICU was 20.21%, 61.15%, 1.74%, and 2.85% respectively，the resistant rates of strains from ICU were higher than nonICU.ConclusionAntimicrobial resistant rates of major gramnegative bacilli from ICU are higher than those from nonICU, and the main strains are multidrugresistant nonfermentative bacteria. Clinical treatment should be different to reduce the emergence of drugresistant bacteria.

ObjectiveTo observe the adverse drug reactions of ganciclovir in treating infants with cytomegalovirus (CMV) hepatitis, and to analyse the influencing factors. MethodsInformation of the infants who suffered from CMV hepatitis and administered with ganciclovir from January,2005 to December, 2009 was collected, and the incidence of adverse reactions was calculated. The SPSS statistical software was used to analyse the influencing factors.ResultsThe total incidence of adverse reactions during the treatment of ganciclovir was 29.46%（71/241, 95%CI: 23.70%-35.21%）,the incidence of bone marrow suppression was 22.08%（51/231，95%CI: 16.73%-27.43%）, and the incidence of liver damage was 9.71 % (20/206, 95%CI: 5.67%-13.75%). Among 71 infants with adverse reaction , 46(64.79%)had effective treatment of ganciclovir; among 170 infants without adverse reaction, 120(70.59%) had effective treatment of ganciclovir, there was no significant difference in effective rate between two groups (χ2=0.79, P=0.38). There was no correlation between adverse reaction and infants’ genders, jaundice, premature delivery, cesarean section,and infection (all P>0.05).ConclusionGanciclovir can induce the bone supression and liver damage, but the treatment effect is not affected, there is no correlated influencing factor with adverse reaction.

ObjectiveTo realize drug resistance pattern and disinfectantresistant genes  (qacA/B)  of Staphylococcus aureus (S. aureus) from neonates at a neonatal ward.MethodsS. aureus from neonates between January and December 2013 were identified and performed antimicrobial susceptibility testing by VITEK 2 Compact system, qacA/B gene was detected by polymerase chain reaction (PCR). Results225 S. aureus strains were isolated,which were mainly from respiratory tract (72.44%) and umbilical  secretion (14.33%); isolation rate of methicillinresistant S.aureus (MRSA) was 8.89%(n=20); antimicrobial resistant rate of MRSA was generally higher than methicillinsensitive S.aureus (MSSA)；levofloxacin, moxifloxacin, tigecycline, vancomycin, linezolid， and nitrofurantoin were all had high antimicrobial activity against all S.aureus， susceptibility rates were all 100%. 21( 9.33%) S.aureus carried qacA/B, 3(15.00%) of which were MRSA, and 18(8.78%) were MSSA.ConclusionDrug resistance of MRSA isolated from neonates in neonatal ward is serious, MRSA strains carry qacA/B, which should be paid more attention.

目的调查某三级综合医院医务人员职业暴露发生情况，探讨职业暴露相关危险因素及预防对策。方法对该院2009年1月—2014年6月上报的106例次职业暴露人员的暴露途径、程度、暴露后处理及随访等相关情况进行调查分析。结果106例次职业暴露中科室分布以普通外科居多，18例次（16.98%）；职业分布以护士居多，50例次（47.17%）；工作年限以≤2年居多，55例次（51.89%）。发生职业暴露的锐器初始用途中以静脉注射居多，16例次（15.09%）；引起损伤的锐器以针头居多，76例次（71.70%）；发生时机中以使用后处理前居多，44例次（41.51%）；锐器伤后以表面少量出血或无出血居多，57例次（53.77%）。 暴露源明确且完成检测者85例次，占80.19%；按照流程进行紧急处理者96例次（90.57%），经评估无需进行血液监测和预防用药处理者27例次（25.47%），监测追踪未发现职业暴露后相关感染者。结论加强职业安全防护教育，实施标准预防，暴露后正确处理局部伤口，及时上报并采取相应干预措施，有助于降低职业暴露感染风险。

ObjectiveTo study gene transcriptions of pathogenicity locus (PaLoc) and toxin B expressions of A-B+ Clostridium difficile （C. difficile）strain BJ08 isolated in China and strain US1 isolated in C. difficile infection outbreak regions in the United States, and provide theoretical support for prevention and control of possible outbreak of C. difficile infection in China.MethodsCells and supernatants of C. difficile were collected every 3 hours, gene expressions of PaLoc domain, including tcdA, tcdB, tcdC, tcdR and tcdE genes, were detected by realtime polymerase chain reaction (PCR), the expressions of toxin B in cells and supernatants were detected by enzymelinked immunosorbent assay (ELISA).ResultsThe growth rate of strain US1 was slightly faster than that of BJ08, and the degradation rate of US1 was significantly faster than that of BJ08（P＜0.05）; No toxin A was detected but mRNA of tcdA were detected in both BJ08 and US1, and there was no significant difference in tcdA expression between BJ08 and US1. The transcriptions of tcdB,tcdC and tcdE of BJ08 were 3 hours earlier than those of US1. There was no significant difference in the production of toxin B in supernatants and cells between strain BJ08 and US1.ConclusionCompared with US1, there is similar virulence or stronger gene regulation of BJ08, possible outbreak of C.difficile infection in China should be alerted.

美国疾病控制与预防中心2008版《医疗机构消毒灭菌指南》已出版，本指南最终目标是通过适当选择消毒灭菌方法，减少医院感染的发生。以下节选关于医疗机构环境表面的清洁与消毒内容，每条建议均根据科学证据、基本原理、实用性和联邦法律制定。其建议分级系统如下。

比较不同消毒剂对血管留置针注射帽的消毒效果，探索简单有效的消毒方法。采用实验方法，将临床分离的金黄色葡萄球菌实验性污染血管留置针注射帽，分1.0×102 CFU、5.0×103CFU及1.0×105CFU 3个数量级；设乙醇棉签、碘伏棉签和洗必泰乙醇棉签消毒3个实验组，同时设生理盐水组为对照组，每组40份样本。采样后所有标本接种于血平板，37℃培养48 h，计算菌落数。当金黄色葡萄球菌污染量为1.0×102 CFU时，对照组细菌生长量为（52.12±4.31 ）CFU，实验组3种消毒方法消毒后注射帽均无细菌生长；污染量为5.0×103CFU时，对照组细菌生长量为（116.25±10.52） CFU，洗必泰乙醇组和乙醇组所有注射帽无细菌生长，碘伏组注射帽细菌生长量为（6.78±3.60） CFU，碘伏组与洗必泰乙醇组和乙醇组消毒后注射帽细菌数量间差异有统计学意义（F=1.84，P＜0.05）；污染量为1.0×105CFU时，对照组细菌生长量为（283.34±16.41）CFU，洗必泰乙醇组无细菌生长，乙醇组细菌生长量为（10.12±3.42）CFU，碘伏组细菌生长量为（63.26±10.63）CFU，三组间细菌数量差异有统计学意义（F=4.23，P＜0.01）。提示洗必泰乙醇组对血管留置针注射帽的消毒效果最好，是最佳选择。

ObjectiveTo compare the bacteriostasis effect of two disinfectants on frequently touched object surfaces in laminar flow general intensive care unit (GICU), and investigate bacterial contamination on the object surfaces, so as to provide reference for proper disinfection method and control of infection. MethodsSpecimens from surfaces of bed rails and bedside tables were taken for bacterial culture before being disinfected. Then object surfaces around bed units were disinfected with disinfectant containing 500 mg/L of available chloride (routing group) and GammaTM disinfecting wet wipes (control group)respectively, bacteriostasis rate and qualified rate of bacterial count on object surfaces between two kinds of disinfection methods were compared. ResultsBefore routine disinfection, a total of 87  pathogens were isolated from 200 specimens of object surfaces,bacterial contamination rate was 43.50%. Detection rate of  grampositive bacteria was 78.16%% (n=68),the major were Corynebacterium (26.47%,n=18), Staphylococcus aureus (23.53%,n=16) and  Staphylococcus epidermidis (23.53%,n=16）; detection rate of  gramnegative bacteria was 21.84%(n=19),the major was Acinetobacter baumannii (63.16%,n=12）. After a 10minute disinfection on surfaces, bacteriostasis rate of routine group and control group was （94.89±7.72）% and（96.33±12.88）% respectively，there was  no significant difference between two groups(P>0.05); qualified rates of bacterial count of object surfaces of two groups were both 100%. ConclusionRegular disinfection of object surfaces around bed units, standardization of the manipulation  and hand hygiene compliance of  medical personnels are simple and effective method of cutting off bacteria dissemination and preventing healthcareassociated infection.

ObjectiveTo study the distribution and drug resistance of coagulase negative Staphylococcus (CNS) isolated from the object surface and hands of healthcare workers in medical settings, and to provide scientific basis for controlling healthcareassociated infection.MethodsCNS were isolated and identified with bacterial biochemical identification instrument WalkaWay40s1 and microbiochemical tube, antimicrobial susceptibility testing was performed with disk diffusion method, drugresistant gene mecA was detected by polymerase chain reaction method.ResultsA total of 63 isolates of CNS were isolated from 478 object surface samples and 363 hand samples, the isolation rate was 7.49%, 15 CNS isolates were from object surface, 38 were from nurses’ hands and 10 were from doctors’ hands. 24 (38.09%) isolates carried mecA gene and were methicillinresistant CNS (MRCNS),12 of which were Staphylococcus epidermidis, 6 were Staphylococcus haemolyticus, 5 were Staphylococcus warneri，and 1 was Staphylococcus capitis subsp.capitis; drug resistant rate of Staphylococcus epidermidis, Staphylococcus haemolyticus, and Staphylococcus warneri to penicillin, amoxicillin, ampicillin/sulbactam, erythromycin, cefazolin, and imipenem was above 87.50% respectively, the resistant rate to trimethoprim/sulfamethoxazole， levofloxacin, clindamycin,ciprofloxacin,tetracycline, and gentamycin were 20.83%-45.83%. ConclusionCNS carried by object surface and hands of healthcare workers in medical settings are multidrugresistant and should be paid attention.

ObjectiveTo evaluate the effectiveness of healthcareassociated infection(HAI) monitoring team on preventing ventilatorassociated pneumonia (VAP) in patients undergoing mechanical ventilation in an intensive care unit(ICU).MethodsFrom January to December, 2011, 480 ICU patients receiving mechanical ventilation for >48 hours were studied. Patients were divided into two groups, control group included 233 patients who admitted to ICU between January and June received VAP prevention bundle, but without being monitored by HAI monitoring team; intervention group included 247 patients who admitted to ICU between July and December received routine preventive measures and were supervised the implementation of VAP prevention measures by HAI monitoring team. The elevation rate of the head of bed, incidence of VAP, duration of mechanical ventilation and mortality in two groups were compared and analyzed.ResultsThe elevation rate of the head of bed of intervention group was significantly higher than control group (93.79% vs 61.11‰, χ2=703.43, P<0.001）; duration of mechanical ventilation in intervention group was significantly lower than control group (［5.56±4.43］d vs ［6.87±6.76］d, t=2.49，P=0.013）; the incidence of VAP in intervention group was significantly lower than control group (11.00‰ vs 24.62‰, χ2=6.87, P=0.009）; there was no significant difference in mortality of two groups （6.07% vs 9.44%, χ2=1.91，P=0.142）.ConclusionThe preventive measures of VAP can be carried out effectively by the strict supervision of infection monitoring team, VAP can decrease through effective work of infection monitoring team.

ObjectiveTo understand the distribution of Pseudomonas aeruginosa (PA) in healthcareassociated infection (HAI) as well as the environment, and to evaluate their relation.MethodsBacteria in clinical samples from a hospital from June, 2006 to June, 2009 were cultured and isolated with routine method, and strains were identified by using VITEK32 system.Serotyping of PA were performed by using standard serum of PA.ResultsOf 196 clinically isolated PA, serotyping rate was 90.82% (178 isolates), the main serotypes were type G（26.02%）, E（15.31%）,F（14.29%）, B（10.21%）,H（9.69%）, and I（7.14%）, but type A, J,and K were not found; Of 25 environmentally isolated PA, serotyping rate was 96.00%（24 isolates）, the main serotypes were type G（32.00%）,F（24.00%）,B（16.00%）, and E（12.00%）.ConclusionPA isolated from patients and environment has similar serotypes, it shows that there is certain relation; Bacterial serotyping can combine bacterial detection with HAI surveillance, and can be used for clinical epidemiological investigation.

目的方法结果结论采用常规现场抽检采样和检测的方法对某院环境卫生学及消毒灭菌效果进行监测。2005年1月—2007年7月各监测项目总合格率分别为：室内空气97.71%，物体表面95.80%，医护人员手97.21%，使用中消毒液98.30%，无菌器械保存液96.60%，无菌物品100.00%，灭菌器97.05%，紫外线灯辐照强度99.82%，透析用水和透析液91.11%。2005—2007年各年度消毒监测总合格率分别为：98.72%、96.27%、97.88%，三者比较，差异有显著性（χ2=28.74，P＜0.05）。2005年消毒监测总合格率与2006年比较，差异有显著性（P＜0.05）；与2007年比较，差异无显著性（P＞0.05）。2006年消毒监测总合格率与2007年比较，差异有显著性（P＜0.05）。提示该院消毒灭菌质量整体较好，但存在消毒液质量和使用不规范等现象，应加大消毒管理和监督力度。

艰难梭菌(Clostridium difficile)是专性厌氧革兰阳性芽孢杆菌，主要通过粪口途径进行传播，并可导致艰难梭菌感染（Clostridium difficile infection CDI）［1］。该菌于1935年首次报道，直至1978年被认为是引起假膜性肠炎的病原菌之一［23］。其致病机制主要是产生A、B两种毒素(TcdA,TcdB)，临床表现可从轻度的自限性腹泻到严重的假膜性肠炎的腹泻［4］。近年，由于艰难梭菌高产毒株(027/NAP1/BI型)在世界几个地区的暴发流行，且在中国香港和广东省已有027型散发的个案报道，艰难梭菌已成为医院获得性感染的主要病原菌之一［59］。我们曾对石家庄地区医院住院患者分离的33株艰难梭菌进行多位点序列分型，发现以ST37和ST54为主，与我国北京的报道［10］一致。近年，儿童及成人社区获得性CDI呈上升趋势［1114］，在美国、加拿大和欧洲地区社区获得性CDI占总CDI发病人数的20%~50%［15］，其越来越受到人们的关注［16］。但是，社区艰难梭菌传播途径，尤其是无症状携带艰难梭菌的健康人群在CDI的流行中所发挥的作用还未知。因此，本文对健康人群艰难梭菌的定植、传播及感染防控做一详细综述