Abstract:

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。

Abstract:

Objective To explore  hepatitis C virus (HCV) persistent infection on biological characteristics, matrix metalloproteinase2 (MMP2) and MMP9 synthesis and secretion of cultured human placental syncytiotrophoblast(HPS).Methods The artificial reconstruction basement membrane Matrigel invasion assay, MTT  cell adhesion and cell motility experiments were used to study the change in invasion, invasionrelated adhesion and mobility of HPS(infected group) infected by serum of HCV RNA positive patients in vitro; concentrations of  human chorionic gonadotropin (HCG) cultured in supernatant was detected  to assess the impact of infection on cell  hormone synthesis and secretion. MMP2 and MMP9 levels in  cell culture supernatant were detected by enzyme linked immunosorbent assay(ELISA), the differences between  data of infected  and control group(serum culture of healthy persons)was compared, the results of ELISA was further validated by gelatin zymography, impact of infection on cell proMMP2 and proMMP9 mRNA expression was  analyzed by  RTPCR.Results The cell invasion, adhesion, motility as well as the ability of synthesis and secretion of hormone in infected group decreased  significantly  than those of  control group  (P<0.05). Secretion  of MMP2 and MMP9 in infected group decreased obviously compared with control group (MMP2: t=4.186,P<0.05; MMP9: t=2.325,P<0.05); RTPCR results showed that expression of  proMMP2 and proMMP9 mRNA in infected group was lower than  control group, but the difference was not significant(proMMP2: t=1.196, P>0.05; proMMP9: t=1.417, P>0.05). 
Conclusion The capacity  of HCV persistent infected HPS to synthesize and secrete MMP2 and MMP9 reduced. Persistent infection with HCV can inhibit  a variety of biological functions, including invasiveness and hormone synthesis and secretion of HPS cultured in vitro.

［Key words］hepatitis C virus；placenta； syncytiotrophoblast; molecular biology; MMP2;MMP9; in vitro test

［Chin Infect Control，2010，9（2）：76-80］

Abstract:

Objective To study  the expression  of  forkhead  boxcontaining protein O subfamily1 (FOXO1) in patients with nonalcoholic fatty liver disease （NAFLD） and relationship with expression of phosphoenolpyruvate carboxykinase (PEPCK) and glucose6phosphatase catalytic subunit（G6PC）， and to evaluate the effect of FOXO1 on the pathogenesis of  NAFLD. Methods NAFLD patients were confirmed by clinical and pathological methods. Localization of  FOXO1 was observed by  immunocytochemistry；FOXO1, PEPCK and G6PC mRNA levels were observed  by RTPCR.
Results The homeostasis model assessment of insulin resistance (HOMAIR) were higher in nonalcoholic steatohepatitis (NASH ) and simple steatosis (SS) group compared with control group （P＜0.001);alanine transaminase (ALT) was higher in NASH group compared with SS and control group（both P＜0.001,or P<0.05), but  there  was  no  significant difference  between SS and control group (P>0.05); With the progress of disease, there were a gradual increase of percentage of  hepatocytes with FOXO1 and mRNA levels of  FOXO1, PEPCK and G6PC in three  groups, there was significant difference between each group (P<0.001). FOXO1 mRNA levels were positive correlated with  HOMAIR, the degree of steatosis and necroinflammatory activity, the expression of both PEPCK mRNA  and G6PC mRNA.
 Conclusion NAFLD patients with normal ALT should also undergo liver biopsy. Expression and activity of FOXO1 are increased in hepatocytes in NASH. FOXO1 mediates the effect of insulin on the gluconeogenic genes PEPCK and G6PC. Steatosis and inflammation are involved in FOXO1 regulation.

［Key words］fatty liver; nonalcoholic fatty liver disease; forkhead  boxcontaining protein O subfamily1; insulin resistance

［Chin Infect Control，2010，9（2）：81-84

Abstract:

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.



Abstract:

Objective To investigate the infection with methicillin resistant Staphylococcus (MRS) and isolation rate of heterogeneous vancomycinintermediate Staphylococcus(hVIS) in hospitalized patients .MethodsStaphylococcus strains isolated from samples of infected inpatients were selected, bacteria  were identified and performed antimicrobial susceptibility test by BDphoenix100 microbial autoanalysis system, MRS were detected by cefoxifin disk diffusion method, 41 strains of MRS isolated from aseptic body fluids and secretions were selected for detecting the susceptibility to vancomycin by the broth dilution; The hVIS strains induced on the brain heart infusion (BHI) agar plate were studied by Etest method to investigate their sensitivity to vancomycin.Results There were 160 strains of MRS in 239 isolated Staphylococcus strains. MRS were mainly isolated from patients’ sputum, pus, blood, pleural effusion, and hydrops abdominis . Both methicillin resistant Staphylococcus aureus(MRSA) and coagulasenegative Staphylococcus (CNS) were multidrugresistant, but the sensitive rates to linezolid and furadantin were 100.00%, no highly vancomycinresitant strains  was found. The detection rate of hVIS in  aseptic body fluid and secretion was 14.63%(6/41), the isolation  rate of Staphylococcus aureus and CNS was 7.14%(1/14) and  18.52%(5/27) respectively . Conclusion Accurate detection of MRS and hVIS is  important to control clinical infection efficiently .



Abstract:

Objective To study the  carrying of  type III secretion systems toxin gene exoS and exoU in 43 clinical isolates of Pseudomonas aeruginosa (P. aeruginosa) and drug resistance. Methods The distribution of toxin gene was  detected  by PCR， antimicrobial resistance of clinical strains was   detected  by  KirbyBauer method.
Results Each P. aeruginosa isolate contained either exoS or exoU gene, exoS and exoU was harbored by 37(86.05%) and 6(13.95%) isolates respectively. Resistant rates of exoUharbouring isolates  to 9 kinds of antimicrobial agents were higher than exoSharbouring isolates, and there were significant difference in resistance to ceftazidime, ciprofloxacin and levofloxacin between exoU and exoSharbouring isolates （P＜0.05）.
ConclusionexoUharbouring isolates are far less than exoSharbouring isolates, and exoUharbouring isolates appear high drugresistance.

bial

Abstract:

Objective To evaluate the role of smear examination of wound secretion in diagnosis and treatment of gaseous gangrene in open earthquake  injury.
Methods Smear bacteriological examination of patients’ wound secretion were performed, patients who were suspected gaseous gangrene were isolated,  operation and antiinfection treatment were offered according to patients’ condition. Further smear were performed after the wound were treated, and patients with positive smear results received  operation on wound. Results 468 wound smear bacteriological examination were performed in   376 patients, 25 patients were diagnosed as gaseous gangrene combined with clinical manifestations, 20 of 25 showed  enlargement of grampositive bacilli at initial smear, 12 of whom  were confirmed by bacterial culture as gaseous gangrene(including 5 cases of negative smear); another 12 patients remained positive by smear examination of exudation after treatment ，and no grampositive bacilli  was found after redébridement. The wounds of 25 patients infected by gaseous gangrene have been healed by the end of July,2008. During the period of  earthquake remedy, all gaseous gangrene were diagnosed in emergency department, no missed diagnosis, and no  nosocomial infection.
Conclusion Smear examination of wound secretion  is helpful  in the diagnosis of gaseous gangrene promptly, conveniently and accurately, which can improve the effects of treatment, and reduce nosocomial  infection rate.

Abstract:

Objective To analyze the clinical features of patients with infective endocarditis ( IE) , so as to improve its diagnosis and treatment. Methods Clinical data of  182 patients with IE  were analyzed retrospectively. ResultsThe incidence of  underlying heart diseases for IE in  all patients were congenital heart diseases(35.17%),  mitral valve prolapse with mitral insufficiency (24.73%), and rheumatic heart disease(13.19%). The most common clinical manifestations were fever (97.25%) and anemia(88.46%);  Streptococcus sanguis (11.76%) was the most common pathogen in blood culture followed by Staphylococcus aureus (11.03%). 173 (95.05%) cases were detected to have vegetation by the transthoracic echocardiography. Two of 119 patients (1.68%) with surgical operation  and 6 of 63 patients (9.52%) with internal medical treatment died, the primary causes for death were cerebral embolism and acute heart failure. Conclusion The risk factors for IE in recent years are different from those in the past years. The proportion of congenital heart diseases are increasing while that of the rheumatic heart disease is decreasing; Streptococcus spp. and Staphylococcus spp. are major pathogens of IE, the species of pathogens are characterized to be diversified and complex as well. The positive rate of blood culture needs to be improved. Surgical operation in time can improve the prognosis of IE.

Abstract:

Objective To explore hospital infection monitoring system (HIMS), so as to monitor nosocomial infection effectively. Methods According to the real requirements of hospital infection management, an infection monitoring system was designed ,and corresponding IMS was developed and put into hospital information system. Results The HIMS has been applied to hospital infection surveillance and achieved good results.Conclusion The applied experience shows that the infection monitoring system can meet with the real demands of hospital infection surveillance, and takes good effect.

Abstract:

Objective To study the factors which cause  incisional wound infection after bone surgery, and take effective measures  to prevent and control bone surgical infection.
Methods Bone surgical incision performed in clean operating room were monitored during two stages, the first stage was March 1, 2008-December 31, 2008 ( investigation stage), the occurrence of infection and related factors were investigated; the second stage was January 1,2009-May 31,2009 (intervention stage), related factors according to  the investigated results were intervened. Infection rates in two stages were compared.
Results Incisional wound infecton rate in investigation  and intervention stage was 5.07% (23/454) and 1.41% (3/213) respectively,  infection rate in intervention stage decreased obviously (χ2=4.25, P<0.05).Conclusion Effective prevention and control of bone surgical  incisional wound infection can achieve through management of clean operating room, qualified  sterilization of  operation instruments and relative material, rational use of perioperative antimicrobial agents, correct surgical hand disinfection, strict rules of dressing, and raising of  health care workers’ awareness about infection control

Abstract:

Objective To investigate the surgical site infection（SSI） and related  risk factors  following orthopaedic operations, so as to offer reference for reducing SSI．Methods Data of 3 326 patients receiving orthopaedic operations were surveyed retrospectively. Results Among 3 326 patients receiving orthopaedic operations, 116 developed SSI, infection rate was 3.49%. Patients with amputation had the highest infection rate, which was 30.39% (31/102). SSI in patients with orthopaedic operations was closely related with patients’age, underlying diseases, length of  hospital stay  before operation, surgical sites, duration of operation, invasive operation,  use of adrenocortical hormone. Conclusion Paying adequate attention to the factors for SSI following orthopaedic operations and continuously improving on the quality of operation may efficiently reduce and prevent the occurrence of SSI infection.

Abstract:

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.

Abstract:

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 .

Abstract:

ObjectiveTo evaluate characteristics and related risk factors of nosocomial infection (NI) in patients with cerebral infarction (CI), so as to find effective control measures. MethodsData of 1 192 hospitalized patients with CI between  January, 2003 and  December, 2008  were analyzed retrospectively.ResultsAmong 1 192 patients, 225 developed 238 cases of NI, NI rate was 18.88%, NI cases rate was 19.97%, which  was significantly increased compared with 4.3% of  average NI rate (χ2=550.11, P<0.01). The main infection sites were respiratory tract (58.92%), urinary tract (15.55%),  gastrointestinal tract (10.93%), and skin and soft tissue(10.08%). The related factors for NI were the elderly, long length of hospitalization time, disturbance of consciousness, complications, and invasive operation. The mortality and disability occurred in patients with CI increased significantly (P<0.01). ConclusionCerebral infarction has a high incidence of NI, and the prognosis after developing NI is poor;  in order to reduce the occurrence of NI,  relevant risk factors should be controlled on the basis of active treatment for primary diseases and complications .

Abstract:

ObjectiveTo realize the distribution and drug resistance of nonfermentative bacteria isolated from clinic, so as to provide reference for  antimicrobial use in clinic. MethodsData of 990 strains of nonfermentative bacteria isolated from clinical departments between January, 2004 and December, 2008 were  analyzed retrospectively. ResultsNine hundred and ninety nonfermentative bacteria strains were divided into 11 genera, most were Acinetobacter spp., which accounting for 43.43% (430/990); the next were Pseudomonas spp. and Stenotrophomonas spp., which was 34.75% (344/990) and 10.71% (106/990) respectively. The most common isolated bacteria were Pseudomonas aeruginosa (29.19%), Acinetobacter lwoffii (20.61%), Acinetobacter calcoaceticusbaumannii complex (13.74%) and Stenotrophomonas maltophilia (10.71%). Most strains were isolated from sputum, which accounting for 79.80% (790/990), the next were throat swab and body fluid, which was 7.88% (78/990) and 6.87% (68/990) respectively. During the recent 5 years, the difference in drug resistance of Pseudomonas aeruginosa to ticarcillin, cefoxitin, cefotaxime, imipenem, netilmicin, trimethoprim/sulfamethoxazole,  pefloxacin, gentamycin, nitrofurantoin and tobramycin  were significant (P<0.005 or P<0.05), drug resistant rates <30% were ceftazidine and imipenem; the change in drug resistance of Acinetobacter spp. to amoxicillin/clavulanic acid, gentamycin, tobramycin and trimethoprim/sulfamethoxazole were significant (P<0.005 or P<0.05), drug resistant rates <30% were ticarcillin, imipenem  and netilmicin. ConclusionNonfermentative bacteria are main pathogens in nosocomial infection, drug resistant rates to commonly used antimicrobial agents are high, and multidrug resistance are serious, periodical monitor of change in bacteria and drug resistance should be carried out to guide rational use of antimicrobial agents in clinic.

Abstract:

The Second People’s Hospital of Liaocheng， Taishan Medical College， Linqing 252601， China )［Abstract］ObjectiveTo analyze the correlation  between  sputum smear examination (microscopy ) and bacterial culture results. MethodsSputum specimens were performed sputum smear and Gram’s staining before bacterial culture , and sputum cultured bacteria were also performed sputum smear and Gram’s staining, then observed under microscope. The staining characteristics and appearance of  two groups were evaluated; then further identification and antimicrobial susceptibility tests were carried out. ResultsFive hundred and forty pathogens were isolated from 786 qualified samples, the positive rate was 68.70%,  there were 185 strains of Grampositive cocci, 316 strains of Gramnegative bacilli and 39 strains of fungi. The coincidence between the results of two groups was  72.01%(566/786). The sensitivity of sputum smear was 77.78%, specificity 59.35%, positive predictive value 80.77%, negative predictive value 54.89%.ConclusionThere is a high coincidence rate between the results of sputum smear and bacterial culture, which can improve the detection rate of pathogenic bacteria.

Abstract:

目的调查分析和评价某医院外科手术患者围手术期预防性使用抗菌药物情况。方法2009年2月1日—5月30日，从该院外科出院归档病历中每月抽取50份调查，从中筛选手术病例158例进行回顾性分析。结果158例手术患者均预防性使用抗菌药物，预防用药率达100%。其中，单一用药占31.65%，联合用药占68.35%；用药时间1~27 d，平均(5.86±3.43) d；术前2 h内用药者占77.22%，22.78%的病例给药时机不合理。结论该院围手术期预防性使用抗菌药物存在用药指征把握不严、抗菌药物种类选择欠妥、盲目联合用药、给药时机不当和用药时间长等问题，亟需加强规范化管理。

Abstract:

目的了解某院临床分离的铜绿假单胞菌产超广谱β内酰胺酶(ESBLs)情况及其耐药性。方法对2007年7月1日—2008年6月30日间分离的细菌，采用API半自动微生物鉴定系统进行鉴定和药敏试验；采用改良三相水解试验检测产ESBLs铜绿假单胞菌。结果共收集64株铜绿假单胞菌，其中ESBLs阳性株33株，占51.56%；ESBLs阳性菌株对青霉素及头孢菌素类抗生素大多耐药，而对美罗培南敏感（耐药率18.18%）；ESBLs阳性菌株对多种抗菌药物的耐药率显著高于ESBLs阴性菌株（P＜0.01或P＜0.05）。结论铜绿假单胞菌产ESBLs率较高，这也是其对青霉素及头孢菌素类抗生素耐药的重要机制；及时监测产ESBLs铜绿假单胞菌的发生率及耐药趋势对指导临床用药至关重要。

Abstract:

目的探讨国产过氧化氢低温等离子体灭菌器灭菌临床应用效果。方法回顾性分析某院手术室2004年7月—2008年12月间国产过氧化氢低温等离子体灭菌器运行情况。结果调查期间过氧化氢低温等离子体灭菌器共运行6 623锅次， 其中达标（低温化学指示卡和指示胶带均变色良好）6 519锅次，不合格104锅次，不合格率1.57%。每周1次（每周一的第1锅次)的生物学监测——嗜热脂肪杆菌芽孢微生物学培养结果均为阴性。结论应用国产过氧化氢低温等离子体灭菌器进行高水平消毒、灭菌，具有价格低廉、安全、无毒、快速等优点。

Abstract:

目的探讨基层医院康惠尔透明贴治疗多巴胺所致静脉炎的疗效。方法选择上肢浅静脉通过留置针泵入多巴胺引起的静脉炎患者60例，随机分为观察组、对照组各30例。观察组采用康惠尔透明贴覆盖所有病变，每24 h更换1次；对照组采用50%硫酸镁湿敷，每4 h更换1次；余处置两组相同。观察两组疼痛缓解时间和炎症消除情况。结果观察组经治疗后疼痛缓解时间为(24.50±16.90)min、红肿消除时间为（152.70±92.30）min,分别优于对照组的(67.40±53.20)min、（464.70±382.00）min，两两比较，差异均有高度显著性(均P＜0.01)。结论康惠尔透明贴治疗通过留置针泵入多巴胺所致的静脉炎效果优于50%硫酸镁湿敷，值得临床推广应用。

Abstract:

目的了解沟通机制在消毒供应中心管理中的应用及效果。方法对某院2005年1月—2008年6月消毒供应中心与临床科室进行的42次定期沟通与132次非定期沟通效果进行评价。结果定期沟通42次，发放“临床科室对消毒供应中心工作满意度调查表”140份，调查总票数4 183票，满意3 987票，满意度95.31%，高于建立沟通机制前（89.72%）；非定期沟通132次，其沟通次数和发挥的作用大于正式沟通，且具有即时、快速、便捷，双向性好，时效性好的特点。结论建立有效的沟通机制后，临床科室对消毒供应中心的满意度明显提高，消毒供应中心工作质量显著改进。

Abstract:

疱疹病毒依赖于宿主细胞骨架有效地进入细胞、复制以及从细胞中释放出来。为促使这一过程顺利完成，在细胞质和细胞核中，病毒蛋白必须与宿主细胞分子马达相互作用，以便使病毒在感染细胞中正确定位。本文就疱疹病毒如何利用宿主细胞骨架、相关的分子马达和重塑蛋白将复杂的病毒结构高效地转入或转出细胞进行简要综述。

Abstract:

医院感染伴随医院产生，无论是在发展中国家还是在发达国家，都是当前医院管理中的难题。医院感染不仅威胁患者的健康和生命，同时也影响医院的医疗质量，阻碍高新技术的开展，延长住院时间和增加医疗费用，给患者、医院和国家造成巨大经济损失。加强医院感染研究，有效预防与控制医院感染势在必行。