Objective To analyze the epidemiological characteristics of methicillin resistant Staphylococcus aureus (MRSA) in nosocomial infection with pulsed field gel electrophoresis (PFGE) and PCR SCCmec typing.Methods Forty strains  of MRSA  collected from Tianjin Nankai Hospital between January, 2007 and December, 2008  were performed  antimicrobial susceptibility analysis, PFGE and SCCmec genotyping.Results Antimicrobial susceptibility patterns of  40 strains of MRSA were highly similar,  isolates were classified into AE five types by PFGE typing，type A, B, C, D, E were 21, 8, 4, 6, 1 strains respectively； SCCmec typing showed that 1 strain was SCCmecⅠ,33 were SCCmecⅢ, 1 was SCCmecⅣ，and 5 were  SCCmecV. Sporadic infection of MRSA occurred in the hospital during the studied period. Conclusion Epidemiological analysis indicates that PFGE typing can identify the genetic relationship between isolates, SCCmec typing can  suggest whether  MRSA isolates are hospitalacquired .Combination of  two genotyping methods can show characteristics of epidemic strains, and provide reference for nosocomial infection surveillance.



ObjectiveTo investigate an outbreak of nosocomial infection(NI) with multidrugresistant(MDR) Acinetobacter baumannii (A.baumannii) in an intensive care unit (ICU). MethodsNine strains isolated from patients and 24 strains isolated from   ICU environment during NI outbreak with MDR A.baumannii were typed by repetitive extragenic palindromicpolymerase chain reaction (repPCR) and antimicrobial susceptibility  was tested by KirbyBauer method. ResultsNine strains isolated from patients were    divided into 4 genotypes by repPCR,  type E1 and E2 had 4 and 3 strains respectively, both type E3 and E4 had 1 strain. 24 strains of  A .baumannii  were  isolated from the environmental samples, 17 of which belonged to type E1. Antimicrobial sensitivity test results showed that all clinical isolates and 19  environmental isolates  were  multidrugresistant strains.ConclusionThe MDR A.baumannii outbreak in ICU   was caused by transmission of E1 and E2 genotype A.baumannii among patients， and environment was also contaminated.

ObjectiveTo study the distribution and change of microbial population of clinical isolated bacteria from a hospital in recent 10 years. MethodsBacterial culture results of  60 846 clinical samples (blood, urine ,throat swab,sputum,stool , vagina swab,and sterile body fluid) from  inpatients and outpatients between January,1999 and December,2008 were analysed retrospectively.ResultsThese isolates included 67 genus 207 species 18 674  strains of bacteria, the isolation rate was 30.69%(18 674/60 846), the ratio of gramnegative bacillus to grampositive coccus and fungus was 54.42∶32.21∶11.56. The major bacteria were Salmonella paratyhi A, Viridans streptococci, Escherichia coli, yeastlike fungi ,coagulase negative Staphylococcus and Staphylococcus aureus. The proportion of gramnegative bacillus rose obviously, so did the opportunistic pathogens.  The isolation rates of Viridans streptococcus and enteric pathogens and Salmonella paratyhi A  decreased (P<0.01). ConclusionChange in  floral  is in accordance with fundamental characteristics  of presentday infection; The increase of opportunistic pathogens  is disadvantageous to the prevention and treatment of multiple  infectious diseases.

 Objective   To understand the colonization and resistance characteristics of multidrugresistant bacteria  isolated from ICU patients. Methods  Nasal vestibular  and rectal swabs of 82 patients  admitted in a hospital ICU from November, 2008 to April, 2009 were screened by bacteriological surveillance method, and antimicrobial susceptibility were performed. Data were analyzed by WHONET5.4 software. Results  Multidrugresistant strains were detected among 38 patients , the colonization rate was 46.34%, which including 62 strains of extendedspectrum β lactamases (ESBLs) producing Enterobacteriaceae bacteria and 4 strains of methicillinresistant Staphylococcus aureus(MRSA),  and multidrugresistant Acinetobacter baumannii and Pseudomonas aeruginosa was not detected. 62  strains of ESBLsproducing strains had lower drugresistant rates (4.84%)  to imipenem and meropenem,but had high sensitive rates to the other antimicrobial agents, resistant rates varied with different  bacteria; 4  MRSA strains were all sensitive to vancomycin, teicoplanin and linezolid, some were sensitive to clindamycin, fosfomycin and gentamicin, and all were resistant to other antimicrobials.Conclusion  Colonization rate of multidrugresistant bacteria is high in patients in  ICU, and drugresistance is serious, which should be paid attention by clinicians , surveillance should be intensified , so as to avoid the outbreak of multidrugresistant bacteria infection in hospital.

随着广谱抗菌药物及免疫抑制剂的使用，人口老龄化社会现象，抗菌药物耐药问题日益严重。和抗菌药物耐药相比，研制一种新型的抗菌药物的速度远远落后于前者。耐药的革兰阳性（G+）球菌是导致临床抗感染治疗失败的主要原因之一。达巴万星(dalbavancin)为Vicuron Pharmaceuticals公司开发的一种新型半合成糖肽类抗生素，为替考拉宁类似物A40926的衍生物，其化学结构式见图1。目前已完成了Ⅲ期临床试验，它对各类临床常见G+菌具有高度抗菌活性。达巴万星具有和替考拉宁相似的分子结构，但羧基肽基团末端的酰胺基修饰提高了达巴万星对葡萄球菌属，特别是凝固酶阴性葡萄球菌的抗菌活性；而亲脂支链和二聚体的形成提高了达巴万星的组织穿透性和与细菌细胞膜的亲和力。和替考拉宁等糖肽类抗生素一样，达巴万星通过与细菌细胞壁肽聚糖上D丙氨酰丙氨酸末端特异性结合，抑制细菌细胞壁肽聚糖的延伸和交联，阻止细胞壁合成而发挥杀菌作用。

近一个世纪以来，抗菌药物在人类战胜各种感染性疾病的过程中发挥了关键作用，但日益突出的多重耐药菌问题已给临床抗感染治疗带来了严峻挑战。如何有效减缓多重耐药菌的产生，阻断多重耐药菌传播，已引起医学界、政府与社会的广泛关注。为加强多重耐药菌的医院感染管理，有效预防和控制多重耐药菌在医院内的产生和传播，保障患者的安全，由中国感染控制杂志组织，58位国内知名专家共同发起,邀请全国165位专家参与,历时10个月,召开了9场专题讨论会,在充分收集意见和讨论的基础上,最终形成了《多重耐药菌医院感染预防与控制中国专家共识》。共识荟萃了国内外多重耐药菌医院感染防控的最新进展,总结了我国大多数权威专家防控方面的宝贵经验,旨在规范和指导我国多重耐药菌医院感染的防控，提高我国多重耐药菌感染防控水平。

ObjectiveTo explore the risk factors for nosocomial infection （NI）of Acinetobacter baummanii (A. baumannii) in patients in the internal medicine intensive care units (ICUs).MethodsA 1：2 matched casecontrol study was carried out in ICUs in a hospital between January 1,2007 and December 31,2008. Cases were patients with A. baumannii infections and controls were those without NI. Conditional Logistic regression analysis was performed to identify independent risk factors.ResultsThe independent risk factors were the number of the underlying diseases（OR=4.03）, duration of nasal feeding tube（OR=11.37）, using respirators（OR=9.83）and acute physiology and chronic health evaluation Ⅱ score system（OR=1.20）;  the protective factor was using vitamin（OR=0.05）.ConclusionImproving patients’ body state and immunity and reducing invasive procedures are helpful for the control and prevention of NI with A. baumannii in  patients in ICUs.
［Key words］intensive care unit；Acinetobacter baumannii；nosocomial infection；risk factors；casecontrol study

To evaluate in vitro activity of linezolid and other antimicrobial agents against Enterococci spp. isolated from clinic.MethodsIdentification and  antimicrobial sensitivity test of Enterococci spp. was carried out by Microscan WalkAway40 system.ResultsNo  linezolidresistant strain was detected in 117 Enterococci spp. strains. Resistant rate of Enterococcus faecium and Enterococcus faecalis against vancomycin was 4.41% and 5.71% respectively, the resistant rates to  penicillin, ampicillin, erythromycin, high concentration  gentamycin, levofloxacin  and ciprofloxacin were all above 70%.ConclusionLinezolid has  high activity against Enterococci spp., especially the control of infections caused by multidrugresistant  isolates.

To investigate the change in  drugresistance of Pseudomonas aeruginosa (P. aeruginosa) to βlactam antibiotics in a hospital, so as to provide reference for treatment of P. aeruginosa infection.MethodsDrug sensitivity tests of 2 127 strains of P. aeruginosa isolated fom clinic between 1999—2007 to 18 kinds of antibiotics were analysed.ResultsResistance of P. aeruginosa to 18 kinds of βlactam antibiotics  increased year by year during  the past 9 years, there was significant difference between each year (P<0.05 or P<0.01). The total resistant rates to meropenem, imipenem and ceftazidime were below 30%. ConclusionP. aeruginosa was resistant to many kinds of βlactam antibiotics, and resistant rate increased year by year, in order to control and slow down the emergence of the resistant strains , the use of third generation cephalosporins and carbapenems should be properly controlled .

ObjectiveTo realize the status and causes of catheterassociated nosocomial infection (CANI) in surgical intensive care unit (SICU) , so as to decrease the incidence by taking proper measures.MethodsSix hundred and fifteen patients with catheters  in SICU between  2005 and 2009 were  monitored prospectively,  including the occurrence of CANI, patients’ age, length of hospital stay, invasive procedures, and pathogens.ResultsOne hundred and ninetyseven of 615 patients (32.03%) developed CANI,  and CANI rate was 2.60%,12.85% and 56.40% in patients with 1 kind , 2  or 3 kinds of catheters simultaneously respectively, there were significant difference among three groups (χ2=151.55,P<0.001). The rate of ventilatorassociated pneumonia (VAP), catheterassociated urinary tract infection (CAUTI) , and  central venous catheter (CVC)associated bloodstream infection (CVCBSI) per 1 000 catheter days was 15.51, 13.70 and 5.79 respectively. The average catheter  utilization days before the occurrence of CANI were as follows:  ventilator (12.22±11.29) days, urinary catheter (13.09±13.29) days , CVC (20.64±18.39) days respectively. The major pathogen in  VAP , CAUTI and  CVCBSI  was Acinetobacter spp.(18.80%), Candida albicans (36.46%) and Acinetobacter spp.(18.75%) respectively.ConclusionPatients with more catheters , long hospital stay and long duration of catheters are prone to develop nosocomial infection . The key to the prevention of emerging of drugresistant strain and decrease in NI are strengthening of  disinfection and isolation, shortening  the time of catheter  retaining, implementing hand hygiene, and using antimicrobial drug rationally.

ObjectiveTo analyze the  clinical characteristics and drug resistance of Acinetobacter baumannii (A.baumannii)  pulmonary infection. MethodsClinical data of 65 cases of A.baumannii pulmonary infections in a hospital from June, 2006 to June, 2008 were analyzed.ResultsThe incidence rate of A.baumannii infections were high in general  intensive care unit (ICU, 41.54%), neurological ICU （29.23%）,  neurosurgical ICU (10.77%), and respiratory department(10.77%);Resistant rates to many kinds of antimicrobial agents were >70%.The infected patients were almost aged, with many underlying diseases, with long hospitalization time and various invasive treatment, as well as receiving  at least 2 kinds of antimicrobial agents before developing infection; some patients complicated with infections caused by the other pathogens,  most were Pseudomonas aeruginosa (34.55%) and Stenotrophomonas maltophilia(20.00%) infections.  ConclusionPatients with A.baumannii infections are in serious condition, antimicrobial  resistance is high, realization of  the clinical characteristics, infection distribution and drug resistance pattern are important to prevent and treat  infections .

目的调查某院消毒灭菌效果与环境卫生学监测情况。方法回顾性分析该院1997—2008年间消毒灭菌及环境卫生学监测资料。结果12年共采集48 497份样本，合格39 161份，合格率80.75%。样本量与其合格率整体呈上升趋势，空气合格率由60.04%升至97.91%；物体表面合格率由85.65%升至98.70%；医务人员手采样合格率由78.75%升至99.62%；使用中消毒液合格率由88.92%升至98.83%；紫外线灯合格率由77.62%升至97.13%；消毒灭菌物品合格率由97.27%升至100.00%（均P＜0.01）。压力蒸汽灭菌器、污水处理在每年的监测中，合格率均为100.00%。结论该院消毒灭菌工作质量及环境卫生质量得到不断提高。

To evaluate the clinical efficacy and safety of high dosage levofloxacin injection in the treatment of hospitalacquired pneumonia(HAP) in intensive care unit (ICU).MethodsEightyfour  patients with HAP  in ICU from September ,2007 to December, 2008 were randomly divided into high dosage (HD group, n=50 ) and routine dosage levofloxacin injection treated group (control group, n=34), HD and control group both received  intravenous drip of levofloxacin 500mg, once per 16 hours and once per 24 hours respectively, therapeutic efficacy and adverse reactions in both groups were observed.ResultsThe total efficacy rate of HD and control group  was 88.00% and 76.47% respectively, there was  no significant difference between the two (χ2=1.94, P>0.05);  The effective time were (4.18±2.62)d and (5.64±2.72)d, the course of treatment  were (7.87±3.66)d and (9.64±3.52)d, bacterial eradication rate was 86.00% and 64.71%, respectively, there were  significant difference between  two groups (t=2.47, P<0.01; t=2.19, P<0.05; χ2=4.10, P<0.05); adverse reactions were observed in 12.00% and 8.82% of patients in  two groups respectively, there was  no statistical significance (χ2=0.01, P>0.05). ConclusionHigh dosage levofloxacin is effective and safe for HAP in patients in ICU,  and can save time for saving life, maybe widespread used.

手术部位感染（surgical site infection, SSI）指无植入物手术后30天内、有植入物（如人工心脏瓣膜、人造血管、机械心脏、人工关节等）手术后1年内发生的与手术相关感染，包括浅表切口感染、深部切口感染以及器官/组织间隙感染；SSIs是手术患者常见的并发症，常可致病情复杂化，影响患者康复，增加死亡率，延长住院时间和增加医疗费用［1］。因此，深入了解SSIs的危险因素，逆转促进SSIs发生的病理生理条件，对降低SSIs发生率，保障手术患者顺利康复具有至关重要的意义。

realize the detection and drug resistance of nonfermentative bacteria from clinical samples between January and December, 2008, so as to provide evidence for rational use of antimicrobial agents in clinic. MethodsBacteria were identified by ATB identification system, antimicrobial susceptibility tests were performed by KirbyBauer method. Results215 strains of nonfermentative bacteria were isolated from 3 555 samples, the isolation rate was 6.05%, which accounting for 19.15% (215/1 123) of total isolated bacteria; the most common isolated bacteria was Pseudomonas aeruginosa, which accounting for 41.86% of total nonfermentative bacteria, the next was Acinetobacter baumannii and Burkholderia cepacia, the constitutional ratio was 29.30% and 16.74% respectively. The isolation rates of nonfermentative bacteria varied with different infection sites, the isolation rates were high in  samples of sputum and throat swabs, and excretion of subcutaneous tissue, which was 15.32% and 9.17% respectively. Pseudomonas aeruginosa, Acinetobacter baumannii, Burkholderia cepacia and Stenotrophomona maltophilia were all had obvious drug resistance. ConclusionThe isolation rate of nonfermentative bacteria in clinical infected patients are high, and drugresistance is strong. In order to control nonfermentative bacteria infection and  emergence of drug resistant strain, antimicrobial agents for treatment of infection should be chosen according to antimicrobial susceptibility test results.

ObjectiveTo get information about pathogenic distribution and bacterial resistance .MethodsData about bacteria isolated from inpatients who were hospitalized  between January 1st, 2006 to  December 31st, 2008 were collected and analysed with WHONET 5.4 software.Results5 697 pathogenic bacteria were isolated within 3 years,  which included 3 627 (63.67%) gramnegative and 1 536（26.96%）grampositive strains. Escherichia coli (895 strains,15.71%), Pseudomonas aeruginosa (873 strains, 15.32%), Klebsiella pneumoniae (446 strains,7.83%), Acinetobacter baumannii(366 strains, 6.43%) were the most common gramnegative isolates; Staphylococcus aureus(648 strains,11.37%), Enterococcus spp.(373 strains, 6.55%), and coagulasenegative Staphylococcus(349 strains,6.13%) were the top three grampositive isolates. The prevalence of extended spectrum βlactamases ( ESBLs) producing bacteria, methicillinresistant Staphylococcus aureus (MRSA) and methicillinresistant coagulasenegative Staphylococcus(MRCNS)  increased year by year. Bacteria were isolated from various specimens, the top three were  sputum (45.97%), secretion (16.54%) and urine (10.65%). Resistant rates of Escherichia coli, Klebsiella pneumoniae to carbapenems were all 0.00%, but 23.85%~31.76% of Pseudomonas aeruginosa isolates were carbapenemsresistant. Less than 15.52% of the above four kinds of bacteria were resistant to cefoperazone/ sulbactam, but they were highly resistant to other antimicrobial agents; more than 70% of Escherichia coli were quinoloneresistant. No Staphylococcus were detected to be resistant to glycopeptides, such as vancomycin and linezoid , but the resistant rates to the other commonly used  antimicrobial agents were relatively high, more than 78.57% Staphylococcus were clindamycinresistant. ConclusionPathogenic bacteria are mainly isolated from sputum, secretion and urine， the main pathogens are gramnegative bacteria； Antimicrobial resistance is very severe in hospitalized patients. Surveillance of antimicrobial resistance is important and valuable for rational antimicrobial therapy.

ObjectiveTo understand the pathogenic characteristics and drug sensitivity of 8 strains of Neisseria meningitidis isolated in Hunan province between 2007—2008.MethodsNeisseria meningitidis strains were identified and clustered by serology and PCR test, drug sensitivity test was carried by minimum inhibitory concentration (MIC) agar dilution method.ResultsAmong  8 strains of Neisseria meningitidis, 5 strains were in serogroup C, 1 in serogroup B, 1 in serogroup Y and 1 was unidentified. All 8 strains were sensitive to penicillin, ampicillin, minocycline, ceftriaxone, cefotaxime, meropenem, rifampicin, but resistant to sulfamethoxazole/trimethoprim,  4 strains were resistant to ciprofloxacin and levofloxacin respectively, and 1 strain was resistant to chloramphenicol and azithromycin respectively.ConclusionEight epidemic strains of Neisseria meningitidis are mainly in serogroup C; penicillin, ceftriaxone, cefotaxime and meropenem should be used as the firstline drugs for the treatment of epidemic cerebrospinal meningitis, the resistance to quinolones and macrolides should be paid attention.

ObjectiveTo explore the risk factors for nosocomial methicillinresistant Staphylococcus aureus (MRSA) infection, so as  to provide a scientific basis for  taking effective measures to reduce nosocomial MRSA infection rates.Methods1:1 casecontrol study was performed, 108 pairs of research subjects were included in the research. Questionnaires were designed to study the history of case and control data. Multivariate nonconditional Logistic regression and chisquare test were used to analyze the data.ResultsAnalysis showed that the following factors were associated with nosocomial MRSA infection:  old age (≥ 65 years old, P= 0.013), length of stay in hospital (P<0.001), the types of underlying disease (P<0.001), the number of invasive procedures (P<0.001), broadspectrum antimicrobial  use(P<0.001), types of antimicrobial agents (P= 0.004) and duration use of antimicrobial agents (P<0.001). Multivariate analysis showed that the main risk factors related to nosocomial MRSA infection included length of stay in hospital (P<0.001), the number of invasive procedures (P= 0.001), types of used antimicrobial  (P= 0.001) and duration use of antimicrobials  (P<0.001).Conclusion Risk factors for nosocomial MRSA infections are long length of stay in hospital , frequent invasive operations , and longterm  as well as multiple use of broadspectrum antimicrobial agents.

To explore  the effective intervention measures  to raise the curative effect of bacterial infections by promoting  the pathogenic detection.MethodsPathogenic delivering rates, curative or improving rates, and average hospitalization days before and after performing intervention measures on pathogenic detection were compared and analysed.ResultsThe rate of sample delivering, positive rates, and the coincident rate of positive results and clinical manifestations increased from 44.23%, 43.48% and 72.50% before  interposing to 58.82%, 55.79% and 89.74% after interposing respectively,  the curative or improving rate increased form 93.27% to 97.48%, and the average hospitalization  days shortened from 9.94d to 8.97d.ConclusionScientific and effective administrative and technical intervention measures is help for raising pathogenic delivering rate, promoting curative effect of antiinfection and shortening hospitalization days.

Objective To realize the incidence of surgical site infection (SSI) monitored with different methods, so as to provide reference for reducing infection rate and making infection control measures. Methods SSI  occurred in patients with gastrointestinal tract operation in a hospital between July, 2007 （before performing targeted monitor, control group） and June, 2008 （after performing targeted monitor, monitored group）was compared. Results SSI in control and monitored group was 12.30% and 7.00% respectively, there was significant difference between two groups( χ2=3.98, P<0.05). Conclusion Targeted monitor can effectively reduce nosocomial infection rate.