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ObjectiveTo investigate the incidence of perianal surgical site infection（SSI）in patients with anorectal diseases in hospitals in Wuhan on the basis of “The diagnostic criteria for perianal SSI in anorectal diseases”. MethodsEpidemiological prospective survey was adopted, five  hospitals in Wuhan were selected to collect information, the relevant factors for perianal SSI, including age, sex, occupation, obesity, history of diseases, duration of operation, anaesthesia, change in the number and species of bacteria at incisional site（including perianal）, and hospitalization time and costs were analysed, SSI was evaluated according to the newly established “diagnostic criteria”. ResultsThe overall rate of perianal SSI in anorectal diseases was 32.98 %（124/376）. SSI in hemorrhoid (including internal and external hemorrhoid, mixed hemorrhoid, rectal polyp,and anal fissure) was 29.06％（77/265）, SSI in perianal abscess and  anal fistula was 38.46％（15/39） and 44.44％（32/72）respectively.Statistical analysis showed that perianal SSI was relevant to patients’ hospital stay （P<0.05）, the percentage of changes in the number and species of bacteria at surgical sites was 24.50% and 30.46% respectively.ConclusionThis survey acquired the epidemiological data about perianal SSI in patients with anorectal diseases in Wuhan, which provide the scientific basis to prevent and control perianal SSI in anorectal diseases.

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ObjectiveTo detect aminoglycosidemodifying enzyme (AMEs) genes and drugresistance among extendedspectrum βlactamases (ESBLs)producing Escherichia coli (E.coli) in an area.MethodsESBLsproducing strains were detected by confirmatory test in 75 strains of E.coli; the susceptibility of 75 strains to 6 kinds of aminoglycosides (AGs) were detected by disk agar diffusion method; and the genotypes of AMEs genes were detected by PCR.ResultsIn 75 strains of E.coli, 37 (49.33% ) ESBLsproducing strains were confirmed. The resistant rates to AGs in ESBLsproducing strains were as follows: gentamycin 78.38%, streptomycin 75.68%, kanamycin 67.57%, tobramycin 64.86%, netilmicin 24.32%, and  amikacin 13.51%; Five kinds of AMEs genes were detected in ESBLsproducing strains and the main genes were aac(3)Ⅱ(64.86%) and aac(6′)Ⅰ(45.95%); the next were ant(3＂)Ⅰ（29.73%）, ant(2＂)Ⅰ（10.81%） and aac(3) Ⅰ（5.41%）, aac(6′)Ⅱ wasn’t  found. Except ant(2＂)Ⅰand aac(3)Ⅰ, the detection rates of the other 3 genes in ESBLs strains were higher than that of nonESBLs strains, and the carrying rates of 2 kinds of gene were also higher than nonESBLs strains (P<0.05). ConclusionThe carrying rates of  AMEs in ESBLsproducing E.coli are high in this area, and resistant rates to AGs are also high, the monitor should be intensified.

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ObjectiveTo evaluate the gene types and drugresistance mechanism of imipenemresistant Acinetobacter baumannii (A. baumannii) causing infection outbreak in an intensive care unit (ICU) . MethodsA. baumannii isolates were identified by API20 NE, antimicrobial susceptibility were detected by disc agar diffusion methods. Three genes including OXA, IMP, and VIM were amplified by polymerase chain reaction (PCR), sequences were analysed using BLAST 2.0. ResultsSeven imipenemresistant A. baumannii isolates all carried OXA23 gene, IMP and VIM genes were not detected.ConclusionThe outbreak was mainly caused by A.baumannii which carried OXA23 gene.

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ObjectiveTo analyze the homology of 8 strains of Comamonas acidovorans (C. acidovorans ) isolated from a clinical department of a hospital, and evaluate the routes of bloodstream infections caused by C. acidovorans.MethodsEight strains of C. acidovorans were isolated from samples collected from patients and medical devices. C. acidovorans were identified with biochemical analysis, and their homology were determined with randomly amplified polymorphic DNA (RAPD) .ResultsEight strains of C. acidovorans had the same genotype, no C. acidovorans was isolated from hospital environment and medical devices.ConclusionBloodstream infection with C. acidovorans in hospital is concentrative and cryptogenic, pathogens were of the same genotype.

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ObjectiveTo study the efficacy and safety of domestic oseltamivir phosphate in the treatment of patients during pandemic influenza A (H1N1) outbreak.MethodsAmong 391 clinical diagnosed cases within 48 hours after the onset of illness, 199 (treatment group) were given domestic oseltamivir phosphate and 192 (control group) were given compound pseudoephedrine hydrochloride sustained release capsules. In the next 10 days, symptoms, body temperature, adverse reaction of drugs, secondary diseases and combined drug use (including antimicrobial agents) were recorded .ResultsTwenty (10.05%) and 33 cases (17.19%) in treatment and control group needed to stay for observation, 5(2.51%) and 13 cases (6.77%) needed to be hospitalized in treatment and control group respectively, there were significant difference between two groups (0.01＜P＜0.05）; Average fever remission time were (40.15±21.86) h in treatment group and (65.92±29.08) h in control group respectively（P<0.0001）; Average flu symptoms remission time were (42.21±28.96) h in treatment group and (63.06±34.85) h in control group respectively（P<0.0001）; Average duration of flu symptoms in treatment group were 21 h shorter than control group. 92 of 481 (19.13%) close contacts in treatment group and 157 of 415 (37.83%) close contacts in control group developed influenza A (H1N1) (P<0.001), there was significant difference between the treatment and control group（ P＜0.001）. In observation period, the incidence of adverse drug reaction was 5.52% and 4.92% in treatment and control group respectively, there was no significant difference（P＞0.05）.ConclusionDuring pandemic influenza A (H1N1) outbreak, early use of domestic oseltamivir phosphate for treatment can relieve clinical symptoms effectively, reduce the hospitalization and observation rate, shorten treatment course, and reduce the incidence of the second generation influenza A (H1N1) in close contacts. Domestic oseltamivir phosphate has low incidence of adverse reactions, clinical application is safe and effective.

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ObjectiveTo investigate  nosocomial infection (NI) prevalence in a hospital, so as to provide reference for NI control ．MethodsThe bedside survey  and hospital records checkup were taken to survey NI prevalence rates in inpatients with a crosssectional method on November 26, 2009．Results1 765 inpatients were investigated， NI prevalence rate was 4.19%， case prevalence rate was 4.42%. The main site of NI was lower respiratory tract ( 35.90%); The usage rate of antimicrobial agents was 50.20%, 53.05% of which was prophylactic use, 26.92% of inpatients who received antimicrobial agents were delivered samples for pathogenic detection. Univariate analysis showed that immunosuppressant, chemotherapy, tracheotomy, indwelling drainage, urinary catheterization, glucocorticoid, and cancer were the risk factors for NI.ConclusionThe crosssectional investigation can offer evidence for target surveillance of NI．

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ObjectiveTo realize effect and impact factors of intervention in hand hygiene of health care workers (HCWs) in intensive care units (ICUs)， and evaluate rational and practical hand hygiene intervention methods, so as to enhance the compliance with hand hygiene among HCWs.MethodsThe first intervention stage was in 2008, educational and productive intervention were implemented in general, neurosurgical and neonatal ICUs; The second intervention stage was in 2009, individualized intervention was performed in addition to the above basic intervention strategies. HCWs’ compliance with hand hygiene was investigated based on the questionnaires and onthespot observation of hand hygiene process, the compliance rates before and after implementation of intervention was analysed. ResultsHCWs’ compliance rate of hand hygiene before and after implementing intervention was 25.06% and 41.52% respectively, the compliance rate increased most obviously between medical care activities, which enhanced from 10.11% before implementing intervention to 28.33% after implementing intervention (P=0.01).Compliance rates of hand hygiene were all improved in HCWs in 3 ICUs, and there was significant difference in compliance rate among 3 types of education (P=0.01).ConclusionIntervention with hand hygiene product, basic and individualized education can promote ICU HCWs’ compliance with hand hygiene.

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ObjectiveTo investigate the distribution and the drug resistance of pathogens in nosocomial infection (NI) in a surgical intensive care unit (SICU).MethodsNI prevalence was surveyed retrospectively in SICU of a hospital from October 2004 to September 2009.ResultsThe average NI rate was 9.79% (119/1 216), the major sites of NI were lower respiratory tract (40.25%), abdominal cavity (28.39%) and  bloodstream (9.32%). Among isolated pathogens, 67.03% (185/276) were gramnegative bacteria, 22.83% (63/276) were grampositive cocci, and 10.14% (28/276) were fungi. Pseudomonas aeruginosa and coagulasenegative Staphylococci (CNS) were the most frequent gramnegative and positive organism, respectively. 38.46% of Klebsiella pneumonia and 34.78% Escherichia coli were tested positive for extendedspectrum βlactamase; 60.00% of Staphylococcus aureus and 58.82% of CNS were methicillinresistant. Enterobacteriaceae were susceptible to carbapenems, amikacin and levofloxacin， sensitive rate was up to more than 86%; nonfermentative bacteria were seriously resistant to most antimicrobial agents， the resistant rate to carbapenems was more than 45%; all grampositive cocci were sensitive to both teicoplanin and vancomycin， the sensitive rate was 100%.ConclusionNI and drugresistance of pathogens in SICU are serious, rational use of antimicrobial agents  as well as constant surveillance on microbial trends are essential to control NI effectively.

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ObjectiveTo realize the prevalence and antimicrobial use of nosocomial infection (NI) and communityacquired infection (CAI) in hospitalized patients .MethodsCrosssectional investigation on infection in patients who admitted in a hospital on October 29, 2008 were surveyed through bedside examination and medical records checkup.ResultsA total of 2 413 patients were investigated, NI prevalence rate was 4.06% (98 cases), NI case prevalence rate was 4.52% (109 cases); the prevalence rate of CAI was 23.79% (574 cases), CAI case prevalence rate was 25.24% (609 cases). The main infection sites of both NI and CAI was respiratory tract, which was 45.87% and 31.53% respectively. The main  bacteria in NI were Staphylococcus aureus (20.00%) and Acinetobacter (10.00%); The main bacteria causing CAI were coagulase negative Staphylococcus (15.38%) and Staphylococcus aureus (13.85%). Antimicrobial application rate was 39.33%, antimicrobial application rate in internal medicine department was 28.66% (364/ 1 270), which was significantly lower than that of surgical department (51.18%, 585/1 143) (χ2=127.85, P<0.01); the culturing rate of pathogens in patients with curative use of antimicrobial agents was 23.46% (137/548) in surgical department, and 36.88% (97/263) in internal medicine department, which was significantly higher than that of surgical department (12.46% ,40/321) (χ2=48.01,P<0.01).ConclusionCommunityacquired infection in this hospital is high, surveillance of high risk sites for infection should be intensified, and antimicrobial use should be standarded, so as to control the occurrence of infection.

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ObjectiveTo realize the clinical data and related risk factors of ventilatorassociated pneumonia (VAP) in patients in an intensive care unit ( ICU) .MethodsClinical data and bacterial culture results of secretion in respiratory tract of patients with VAP in ICU from May 2007 to May 2009 were retrospectively analyzed. ResultsA total of 263 strains of pathogens were isolated from 120 patients, gramnegative bacilli, grampositive cocci, and fungi accounted for 58.56%, 25.09% and 16.35% respectively. The main pathogens of VAP included Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii and Candida glabrata. Ninetyfive cases（79.17%） had infections with at least 2 kinds of pathogens. Pathogens had high resistance to antimicrobial agents. The increase of the incidence of VAP was associated with the long duration of ventilation (P<0.05), as well as delayed disinfection and change in ventilators canalis, and indwelling nasogastric intubation (P<0.001). ConclusionThe main pathogens in VAP is gramnegative bacilli, mixed infection is high, and antimicrobial resistance is increasing. Patients with mechanical ventilation should be given comprehensive prevention and intensive care .

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ObjectiveTo study the clinical value of toxin A & B (CDAB) assay in diarrheal inpatients. MethodsFaecal specimens from 47 inpatients with diarrhea were tested by the VIDAS Clostridium difficile (C. difficile) toxin A & B (CDAB) assay, and the results were analyzed together with the bacterial routine culture, clinical data and treatment.ResultsAmong 47 cases of diarrhea patients, 7  (14.89%) were VIDAS CDAB+, the results conformed with clinical diagnosis and/or treatment.ConclusionThe situation of C. difficile infection in this hospital is severe. VIDAS C. difficile Toxin A & B (CDAB) assay is simple, rapid and accurate, which is recommended to be used clinically.

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ObjectiveTo monitor and analyse the distribution and drug resistance of pathogens isolated from blood culture samples in a hospital , so as to  provide  evidence for the clinical therapy of infections.Methods10 941 blood  samples were detected by BacT/ALERT 3D automated blood culture system , and antimicrobial  susceptibility tests  were performed   with  KirbyBauer disk diffusion method, results were analyzed by WHONET5.4 software.ResultsAmong 10 941 samples, 673 (6.15%) were blood culture positive, 688 pathogens were isolated, 37.94% (261/688) of which were Enterobacteriaceae, 30.67%(211/688) were nonfermentative bacteria, 10.17% (70/688) were Staphylococcus spp.,8.58% (59/688) were Enterococcus spp., 5.23% (36/688) were fungi, 6.54% (45/688) were contaminated bacteria, 0.87%(6/688) were Brucella. The  resistant rate of Escherichia coli to ampicillin/sulbactam, ceftriaxone, cefuroxime, ceftazidime, and ciprofloxacin were 48.27%, 55.17%, 82.76%, 53.10%, and 68.97% respectively; The resistant rate of Acinetobacter baumannii to amikacin, ceftazidime, piperacillin / tazobactam and ciprofloxacin were 35.06%, 38.96%, 32.47%,and 64.94% respectively; The resistant rate of Staphylococcus aureus to erythromycin, clindamycin, levofloxacin were 80.77%, 46.15%, and 75.00% respectively; The resistant rate of Enterococcus feacium to penicillin, erythromycin, rifampicin, and levofloxacin were 94.74%, 97.37%, 97.36%, and 89.47% respectively.ConclusionThe pathogens causing bloodstream infection are widely distributed and highly drug resistant.Detection of clinical specimens of blood culture should conform to the standard in order to avoid contamination and enhance detection quality  .

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ObjectiveTo study the antimicrobial resistance of extendedspectrum betalactamase(ESBLs)producing bacteria isolated from children, so as to provide reference for treating infections with ESBLsproducing bacteria. MethodsOne hundren ESBLsproducing strains and 100 nonESBLsproducing strains were randomly selected from Children’s Hospital of Shanxi Province between January 2007 and April 2009, and their antimicrobial resistance were campared. ResultsAll 200 strains were sensitive to imipenem; the resistance of ESBLspositive strains to the other 11 kinds of antimicrobial agents were higher than that of ESBLsnegative strains (P≤0.001). Except resistance to cefoperazone/sulbactam was low (13.00%), the resistance of ESBLspositive strains to the other cephalosporins were all>98%; The resistant rate to gentamycin and ciprofloxacin was 69.07% and 59.18% respectively. ConclusionESBLsproducing strains isolated from children are sensitive to carbapenems or antimicrobial compound inhibitors (such as cefoperazone /sulbactam).

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目的了解医院下呼吸道感染患者病原菌分布及其耐药性变化。方法对某医院2006年1月—2009年12月下呼吸道感染患者标本分离的细菌及其耐药情况进行统计分析。结果4年间共收集下呼吸道标本 24 778份，分离细菌7 728株（31.19%），其中革兰阴性（G-）菌4 562株（59.03%），主要为铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌和大肠埃希菌；革兰阳性（G+）球菌1 737株（22.48%），主要为金黄色葡萄球菌、凝固酶阴性葡萄球菌和肺炎链球菌；真菌1 429株（18.49%），主要为白假丝酵母菌、光滑假丝酵母菌和热带假丝酵母菌。药敏结果显示，肺炎克雷伯菌、大肠埃希菌对碳青霉烯类抗菌药物敏感率达100%，铜绿假单胞菌对多种抗菌药物的敏感率较低，为36.47%～49.41%；主要G+球菌对万古霉素敏感率为100%，对苯唑西林、红霉素、克林霉素等敏感率低，为4.11%～33.16%。结论下呼吸道感染病原菌以G-菌为主，对临床常用抗菌药物的敏感性降低。真菌的检出率增加。

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目的探讨用儿童专用血培养瓶提高脑脊液培养阳性率的应用。方法选用儿童专用血培养瓶对344份脑脊液标本进行增菌培养，以Bact/Alert120全自动血培养仪进行检测。结果儿童专用血培养瓶培养脑脊液阳性率为27.91％(96/344)，显著高于成人培养瓶脑脊液培养阳性率10.80%(46/426) （P<0.01）；24 h内阳性检出率亦显著提高，前者为65.62%（63/96），后者为47.83%（22/46）（P<0.01）。儿童专用血培养瓶培养脑脊液假阳性率为1.74％。结论用儿童专用血培养瓶进行脑脊液培养能提高脑脊液培养阳性率，缩短培养时间。

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目的探讨新生儿机械通气并发下呼吸道感染的主要临床因素及病原菌感染特征。方法对某院新生儿重症监护室内由机械通气导致下呼吸道感染的46例新生儿，于气管插管后不同时间点采取下呼吸道分泌物进行细菌培养及药敏试验。结果46例新生儿共进行痰培养59例次，41例次(69.49%)细菌培养阳性。在5份取自机械通气时间＜1 d患者的标本中，有2份（40.00%）标本即检出病原菌，而机械通气时间＞7 d者的12份标本中，病原菌阳性率达100.00%。检出病原菌47株，大肠埃希菌（29.79%）、肺炎克雷伯菌（17.02%）、铜绿假单胞菌(14.89%)、表皮葡萄球菌(10.64%)为主要病原菌。结论新生儿机械通气时间越长，细菌感染率越高。在机械通气的治疗过程中，应采取多种措施积极预防并控制细菌感染。

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目的分析感染性腹泻患儿的发病情况及病原分布，探讨引起儿童感染性腹泻的常见病原体，为临床治疗提供参考。方法回顾性分析2003年1月—2009年1月某院儿科收治的468例感染性腹泻患儿的临床及病原学资料。结果468例感染性腹泻患儿，11 d～3岁285例（60.90%）， ～ 6岁111例(23.72%)，～ 14岁72例（15.38%）；夏季发病率最高，占29.27%,其次为秋季26.50%。大便培养阳性118例（25.21%），其中病原菌构成比前3位分别为大肠埃希菌30.51%（36/118）、痢疾杆菌23.73%（28/118）和肠球菌属11.02%（13/118）；轮状病毒检测阳性47例（10.04%）。婴幼儿感染性腹泻以轮状病毒为主要病原，学龄前期儿童以大肠埃希菌和痢疾杆菌为主要病原。结论儿童感染性腹泻发病以婴幼儿多见，季节以夏秋季为主，病原复杂多样，临床诊治过程中应重视病原学诊断，以合理用药。

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目的了解颅脑损伤合并医院获得性肺炎（hospital acquired pneumonia，HAP）患者常见病原菌及其耐药性。方法回顾性分析某院神经外科2004年1月—2009年6月收治的161例颅脑损伤合并HAP患者痰标本分离的病原菌及其药敏资料。结果161例患者分离病原菌274株,其中革兰阴性杆菌221株（80.66%)，以肺炎克雷伯菌（25.18%）、铜绿假单胞菌（14.23%）、大肠埃希菌（13.50%）为主；革兰阳性球菌42株(15.33%)，以金黄色葡萄球菌（5.11%）、凝固酶阴性葡萄球菌（4.38%）为主；真菌11株（4.01%)。产超广谱β内酰胺酶（ESBLs）株68株，其中大肠埃希菌产ESBLs株检出率为78.38%(29/37)，肺炎克雷伯菌为43.48%(30/69)，阴沟肠杆菌为56.25%(9/16)；检出耐高浓度庆大霉素肠球菌4株（66.67%）。病原菌耐药率均较高, 革兰阴性杆菌普遍呈现多药耐药性。结论颅脑损伤合并HAP病原菌仍以革兰阴性菌为主，耐药率高，应加强监控。

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目的探讨肿瘤医院住院患者医院深部真菌感染情况。方法采用前瞻性及回顾性调查方法, 调查某肿瘤医院2008年1—12月间医院感染病例资料521份。结果521例医院感染病例中发现深部真菌感染者179例（34.36%）， 其中＞60岁者占59.22%（106例）；恶性肿瘤患者居多，占94.41%（169例）；感染部位以呼吸道最常见，占53.07% (95例)；分离真菌以白假丝酵母菌为主，占57.54%（103株），其次为光滑假丝酵母菌(43株，24.02%)、 热带假丝酵母菌(23株，12.85%)、 克柔假丝酵母菌(9株，5.03%)、 毛孢菌属(1株，0.56%)。结论肿瘤医院的医院深部真菌感染情况较严重，以高龄、恶性肿瘤患者多见。增强患者免疫功能，合理使用抗菌药物是预防肿瘤医院住院患者医院深部真菌感染的关键措施。

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目的研究重症监护室(ICU)集束化护理策略在预防呼吸机相关性肺炎(VAP)中的效果，探讨预防VAP更有效的护理方法。方法某院ICU 2008年7月—2009年12月收治的136例行机械辅助通气治疗的患者，随机分为集束化护理组（实验组，76例）和常规护理组（对照组，60例），以机械通气时间、住ICU时间、VAP发生率、病死率为观察指标，分析集束化护理对呼吸机辅助通气患者的护理效果。结果两组患者清洁口腔后共培养出病原菌10种（肺炎克雷伯菌、铜绿假单胞菌、不动杆菌属、嗜麦芽窄食单胞菌、热带假丝酵母菌、大肠埃希菌、阴沟肠杆菌、白假丝酵母菌、金黄色葡萄球菌、肺炎链球菌）。对照组行常规口腔护理，3次/d，分离出细菌314株；实验组行常规口腔护理后，在口腔内喷洁悠神纳米长效抑菌液，3次/d，分离出细菌37株。行纤维支气管镜检查取深部痰液培养，对照组分离病原菌268株，实验组分离33株，两组比较，差异有高度显著性（P＜0.001）。结论集束化护理策略较常规的护理方法临床护理效果更佳，对预防VAP有重要的意义。

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目的分析重症监护室(ICU)医院感染的特点，探讨有效预防和控制医院感染的措施。方法采用目标性监测方法，对2008年1—12月入住某院综合ICU的患者进行实时监测，并对监测结果进行分析。结果调查期间ICU医院感染率为15.73%，感染例次率为29.87%；呼吸机相关性肺炎发生率64.80‰，导尿管相关泌尿道感染率5.83‰，中心静脉插管相关血流感染率4.89‰。感染易发部位为下呼吸道（70.09%）、泌尿道（11.61%）、血液（5.80%）。病原菌以革兰阴性杆菌为主，占66.67%，大多数为条件致病菌，检出多重耐药菌株32株。结论 ICU患者医院感染发病率高，感染部位以下呼吸道居多，应重视目标性监测，对患者实时监控，采取干预措施，以及时有效地预防和控制医院感染。

Abstract:

目的了解河北省各综合医院新生儿重症监护室（NICU）的医院感染及医疗安全管理工作现状。方法以《医院感染管理办法》和《河北省新生儿室医院感染管理考核标准》为依据，对河北省A、B两市的5所三级医院和6所二级医院NICU的医院感染管理现状进行考核评估。结果发现各级医院普遍存在NICU环境布局不合理、手卫生设施不符合要求、治疗室和沐浴间管理不规范、未严格执行消毒隔离等规章制度的问题，且在二级医院这些问题更加明显。结论应加强NICU环境布局和工作流程及手卫生设施的合理化建设，提高医院感染管理的执行力，推进NICU的规范化管理进程。

Abstract:

目的了解边远地区某三甲医院手卫生设施的配置、医务人员对手卫生知识的认知及洗手依从性状况。方法对120 名医务人员进行随机抽样问卷调查，对全院洗手设施进行实地察验。结果共发出问卷120份，回收有效答卷112份，回收率93.33%；其中医生37名，护士75名。医护人员普遍对手卫生相关知识知晓率不高；不能按规范洗手的原因主要为洗手后无干手设施（医生占48.65%，护士占61.45%）、工作忙（医生占32.43%，护士占51.81%）；最常用的干手方法是自然晾干（48.39%），其次是在白大衣上擦干（26.45%）。洗手设施配置较差。结论该院医务人员手卫生相关知识缺乏，亟需加强培训教育；洗手及干手设施配置有待完善。

Abstract:

目的了解某院门诊患者甲型H1N1流感防控知识知晓情况,为医院制定相关应对措施，控制医院感染的发生提供依据。方法随机抽取周一至周五病历号为单号的150例门诊患者，由经过统一培训的调查员进行问卷调查。结果发放问卷150份，收回有效问卷135份（90.00%）。135例患者中，症状知晓率17.78%（24例），传播途径知晓率3.70%（5例），预防措施知晓率34.07%（46例），咳嗽礼节知晓率6.67%（9例）；获取甲型H1N1流感信息的主要途径是电视，占93.33%。结论该院门诊患者甲型H1N1流感防控知识知晓率非常低，应采取多种方式加强健康教育。

Abstract:

“以学生为中心”教学模式是美国医学教育的基本点，是一种比较成功和有特色的教育模式［1］。笔者在美国加洲大学San Diego分校(UCSD)工作期间，通过与美国大学教师和学生的广泛接触，亲身感受到了中国医学教育与美国医学教育的差别，认为我国目前传统的医学教育与发达国家还存在很大的差别，主要表现在我国目前的教育模式从小学到大学，仍然为传统的“填鸭式”教学，即“以教师为中心”的教学模式，学生缺乏独立思考，自我表现，自我创新的机会。这在医学教育中表现尤其明显，学生很多时候并没有真正理解所学内容，为了考试去死记硬背。这样培养出来的学生往往高分低能，而很多有创造性的医学人才也不能脱颖而出。在美国笔者所在的大学，在生物和医学研究方面，有4位诺贝尔奖获得者，笔者感觉我们很多硬件并不逊于国外大学，而我们为什么没有诺贝尔奖获得者呢？其中一个很重要的原因就是我们培养的学生缺乏独立创造能力，在素质和能力方面远逊于国外大学。
鉴于“以教师为中心”的教学模式存在很多弊端，笔者在我校2004级临床医学7年制49名学生的传染病学临床教学中，大力推行了“以学生为中心”的教学模式，主要体现以下几方面。

Abstract:

结核病自古以来就威胁着人类的健康，每年导致约200万人死亡。特别是近年来，耐多药结核病、广泛耐药结核病以及结核分枝杆菌与人免疫缺陷病毒（HIV）共感染的出现，给结核病的临床治疗带来了新的困难。耐多药结核病是耐受2种抗结核病一线药物的结核病，广泛耐药结核病是在耐多药的基础上至少耐受3种二线药物的结核病。耐药结核病的蔓延已经成为全球性的公共卫生问题，据世界卫生组织（WHO）最新的2009年度报告，2007年全球新发结核病病例927万例，死亡175万例，现有的1 370万例活动性结核病患者中，耐多药者达50万［1］。外排泵系统的泵出作用是导致结核分枝杆菌耐药的重要机制之一。本文综述了近年来国际上在结核分枝杆菌外排泵及其抑制剂方面的研究进展。

Abstract:

手术部位感染是开放性骨折的常见并发症，也是开放性骨折治疗的主要问题之一，如果出现深部感染，可造成骨折延期愈合或不愈合［1］、慢性骨髓炎［2］等后果，严重时可致肢体残废，甚至危及生命［3］。近年由于抗菌药物的滥用以及肾上腺糖皮质激素、免疫抑制剂等的广泛应用，细菌对抗菌药物产生多重耐药性，医院感染率增高，给临床治疗带来很大的不利［4］。因此，许多学者对开放性骨折手术部位感染的原因及防治等方面进行了大量的研究，现综述如下。

Abstract:

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，该指南最终目标是通过选择适当的消毒灭菌方法，减少医院感染的发生。以下节选消毒灭菌方法的选择建议（表1）。

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