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ObjectiveTo study the relationship between the mutations in rpoB gene of rifamycinresistant Mycobacterium tuberculosis(M. tuberculosis) and the level of rifabutin resistance.MethodsThe minimal inhibition concentrations(MICs) of 64 rifamycinresistant isolates and 6 sensitive isolates of M. tuberculosis to rifabutin were determined by the dilution method, their isonicotinyl hydrazide (INH) resistance were analyzed. The whole rpoB gene were amplified and sequenced, then the relationship between the mutations in rpoB gene and the level of rifabutin resistance and multidrug resistance were analyzed.ResultsThe sensitive isolates had no mutations in rpoB gene and their MICs were 0.25 mg/L -0.50 mg/L. All rifamycinresistant isolates had mutations in rpoB gene. Among 37 highlevel rifabutinresistant strains (MICs≥4 mg/L), mutations of S531L, H526R, and Y389C were found in 27,2 and 2 isolates respectively, comutation of S531W, H526Y, Q513K, V176F, D516Y and Q253R was in 1 strain, comutation of D516G and L511P was in 1 strain. Of 17 intermediatedlevel rifabutinresistant strains (MICs 2-4 mg/L), 16 isolates were with S531L mutation and 1 with D516G combined with L511P and S509R mutation,respectively . Of 10 lowlevel rifabutinresistant strains (MICs 0.25-1 mg/L), single mutation of L533P, H526L, H526S, D516V, and D516Y were found in 2 isolates respectively. 93.75％(60/64) of rifamycinresistant isolates were also resistant to INH.ConclusionDetection of rpoB mutation can preliminarily screen multidrugresistant M. tuberculosis; The predominant mutations of rpoB gene in highand middlelevel rifabutinresistant isolates are S531L, the mutation positions and types of rpoB gene in M. tuberculosis correlates with the level of rifabutin resistance.

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ObjectiveTo study the biofilm forming ability and effect on antimicrobial resistance of 50 uropathogenic Escherichia coli (UPEC) strains isolated from clinic. MethodsScreening of biofilm formation was performed by crystal violet staining, the susceptibility of 50 UPEC isolates to 8 kinds of antimicrobial agents was determined by KirbyBauer method, the correlation between antimicrobial resistance and biofilm formation was analyzed statistically.ResultsAmong 50 UPEC isolates, 34(68.00%) were biofilmpositive strains. All UPEC strains showed different resistance to 8 kinds of antimicrobial agents; the resistant rates of biofilmpositive strains to ampicillin (76.47%) and gentamicin （55.88%) were significantly higher than those of biofilmnegative strains (43.75%，18.75% respectively) (P<0.05). ConclusionThe formation of biofilm in UPEC is common, the formation of biofilm correlats with its resistance to ampicillin and gentamicin.

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Objective To evaluate the effect of antirespiratory syncytial virus of water extract liquid of Scutellaria Baicalensis Georgi,and to find the new drug for treatment of respiratory syncytial virus(RSV) infection.MethodsChinese medicine Scutellaria Baicalensis Georgi was turned into water extract liquid . Using in vitro cell culture technique ，the cytotoxicity of Scutellaria Baicalensis Georgi water extract was detected by 3（4，5dimethylthiazole2yl）2,5diphenyltetrazolium bromide (MTT) method. With ribavirin as the positive control drug, antiviral activity of Scutellaria Baicalensis Georgi water extract was detected with cell culture method.ResultsThe median cytotoxicity concentration(50% cytotoxicity concentration,CC50)of Scutellaria Baicalensis Georgi was 16.32 mg/mL, the median effective concentration (50% effective concentration,EC50) of the extraction of Scutellaria Baicalensis Georgi was 2.43 mg/mL. Scutellaria Baicalensis Georgi and ribavirin gave a dosedependent response in inhibiting RSV（P<0.05）.ConclusionScutellaria Baicalensis Georgi shows potent inhibition on RSV in vitro.

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ObjectiveTo realize hepatitis C virus (HCV) infection in patients undergoing continuous hemodialysis, and to put forward strategies for preventing and controlling HCV infection.MethodsCrosssectional survey were performed on HCV infection and related factors among patients undergoing continuous hemodialysis in hospitals that voluntarily participated in the survey between March 10,2010 and April 10,2010.ResultsA total of 423 hospitals participated in the survey, 395(93.38%) of which were qualified for statistical analysis. A total of 21 918 patients were surveyed,448 of whom didn’t perform HCV detection, 1 506 patients were HCV positive, positive rate was 7.01%(1 506/21 470). 1 060 patients were detected positive HCV during initial dialysis, the positive rate was 5.04%(1 060/21 024). Stratification was undertaken according to the number of dialysis patients,the number of dialysis cases by each dialysis machine per month, and the number of dialysis cases performed by each nurse per month, there was significant difference in HCV positive rate between each group(all P<0.01); the difference among different dialysis duration and HCV positive rate in patients receiving dialysis at different hospitals was statistically significant(P<0.01). ConclusionHCV infection rates are high at hospital with more dialysis, in patients with long duration of dialysis,and patients receiving dialysis at multiple hospitals.

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ObjectiveTo analyze risk factors for surgical site infection（SSI） in digestive tract surgery.MethodsTargeted monitoring data of SSI in a hospital between January 2009 to December 2010 were analyzed retrospectively, univariate and multivariate analysis were conducted on 20 suspected risk factors, including types of diseases(surgical sites), operation season,gender, age,types of surgery,modes of anaesthesia, wound class, blood transfusion, ASA score, risk index, operation time, underlying diseases, invasive operation, and perioperative use of antimicrobial agents.ResultsSSI in digestive tract surgery was closely related with multiple factors, such as surgical sites, gender, types of surgery, wound class, blood transfusion, ASA score and risk index(all P<0.05), among which gender and risk index were 2 independent risk factors.ConclusionMultiple factors contribute to SSI in digestive tract surgery, and comprehensive preventive measures should be taken to reduce SSI rate.

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ObjectiveTo evaluate the status of nosocomial infection in a neonatal intensive care unit(NICU), so as to determine risk factors and effective preventive and control measures.MethodsAll neonates who were hospitalized between March 1, 2010 to February 28, 2011 were monitored based on Nosocomial Infection Surveillance Standard and the monitored results were analyzed statistically.Results368 neonates were monitored, 43 of whom developed 52 times of infection, infection rate was 11.68%, infection case rate was 14.13%. Premature neonates and verylow birth weight neonates were high risk population for nosocomial infection.ConclusionTargeted monitoring can reflect the weak link of infection control work, and promote nosocomial infection control.

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ObjectiveTo explore the economic loss caused by nosocomial infection (NI) in patients with 6 kinds of diseases (simple appendicitis, cholecystolithiasis with cholecystitis,cesarean section, hysteromyoma, bronchopneumonia, and hyperthyroidism). MethodsBased on stratified random sampling, 42 324 case data from 30 differentlevel hospitals in Xinjiang were reviewed retrospectively. ResultsFrom point of disease, NI of appendicitis brought about the highest economic loss among the different diseases ，each patient spent extra ￥1 508.89 yuan; and the direct extra medical cost due to lower respiratory tract infection was the highest among all sites of infection (average ￥3 299.95 yuan); from social point of view, economic loss due to NI of cesarean section was the highest, which were ￥364 279.02 yuan ; from the point of different site, economic loss caused by upper respiratory infection was the highest (￥1 738 870 yuan). ConclusionEconomic loss caused by NI are remarkable, it is of great economic and social benefit to prevent and control NI.

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ObjectiveTo survey infectious diseases among practitioners in food hygiene and public places in Changping District of Beijing based on physical examination result.MethodsPhysical examination results of practitioners in food hygiene and public places in Changping District between 2006 and 2010 was analyzed retrospectively.ResultsThe annual detection rate of infectious diseases among food hygiene and public place practitioners from 2006 to 2010 was 2.38%, 2.19%, 2.18%, 2.00%, and 0.37% respectively. Total HBsAg carrying rate of local practitioners was obviously lower than practitioners from other cities(0.85% vs 2.45%; χ2=763.18,P<0.01); Active pulmonary tuberculosis detection rate of local practitioners in each year was 0.000%, 0.044%, 0.155%, 0.048%, and 0.265% respectively, and the other cities practitioners was 0.002%, 0.041%, 0.152%, 0.149%, and 0.216% respectively, there was an increasing tendency of active pulmonary tuberculosis detection rate in both the local and other cities practitioners (local: χ2=82.08, P<0.01; other cities:χ2=145.99, P<0.01); Total detection rate of active pulmonary tuberculosis in local practitioners was significantly lower than that of other cities (0.103% vs 0.115% ;χ2=13.50, P<0.01). ConclusionAdhering to the annual physical examination of practitioners in food hygiene and public places, strengthening the prevention of hepatitis B and pulmonary tuberculosis are important for ensuring food hygiene and safety of public places.

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ObjectiveTo investigate the incidence, clinical characteristics, treatment and prognosis of AIDS patients with deep fungal infection in Changsha.MethodsClinical data of 480 cases of AIDS treated in a hospital between April 2003 and December 2009 were reviewed retrospectively.ResultsOf 480 AIDS cases,58(12.08%) had complications of deep fungal infection. The main clinical characteristics of these patients were:fever, cough(dry cough without sputum or less sputum), abdominal pain, diarrhea(watery diarrhea),skin lesion(papular eruption,exanthema haemorrhagicum,ecchymosis), pathogenic leanness, disturbance of consciousness, anemia,hepatosplenomegaly, and lymphadenectasis .The major pathogens were Penicillium marneffei （27 cases，46.55%）, followed by Cryptococcus neoformans (16 cases, 27.59%, cryptococcal meningitis). All 58 patients were treated with amphotericin B, fluconazole,and flucytosin based on drug susceptibility testing result, 50 (86.21%) patients were cured after treatment.ConclusionThe incidence of deep fungal infection in AIDS patients are high. The key to the improvement of prognosis are early diagnosis, timely and effective antifungal treatment and highly active antiretroviral therapy.

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ObjectiveTo evaluate clinical and laboratory features of children with severe handfootandmouth disease(HFMD).MethodsData of 80 severe HFMD patients diagnosed and treated in a hospital from March to October 2010 were analyzed retrospectively, and compared with 98 mild HFMD cases over the same period of hospitalization.ResultsOf 80 severe HFMD children, the average age were (18.52±3.23) months, 70 (87.50%) were<3 years old; all patients had fever,36 cases (45.00%) were with persisten high fever; 10 (12.50%) were with severe pneumonia,70 (87.50%) had nervous system damage,42 (52.50%) had increase in blood pressure ; 73 (91.25%) were with positive enterovirus 71; average peripheral blood white blood cell count were (14.24±3.87)×109/L, average blood glucose were (8.45±1.21) mmol/L; 71 cases (88.75%) had increased enzyme CKMB, the average value of CKMB were (69.71±18.26) IU/L, there were significant difference compared with mild cases (P<0.01). ConclusionSevere HFMD children can easily develop persistent high fever, and nervous system damage. HFMD children with small age, long course of fever, sleepiness, high white blood cell count, hyperglycemia, and hypertension are more prone to become severe HFMD and should be paid attention.

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ObjectiveTo evaluate the features of infection after kidney transplantation, so as make effective prevention and control measures.MethodsFollowup study was conducted on 351 patients who received kidney transplantation in a hospital from June 2007 to June 2010. ResultsPostoperative infection rate in kidney transplant patients was 18.80%(66/351), 2.85%(10/351) of whom were infected during hospital stay, 15.95%(56/351) were infected after discharged from hospital. Among patients who were infected after discharged from hospital, 73.21%(41/56) developed infection within 3 months after discharged. The initial symptom of all patients was fever. Among 55 patients with respiratory tract infection after discharged from hospital, positive detection rate of pathogens was only 16.36%(9/55), sputum culture of 3 patients were detected coagulasenegative Staphylococcus, 1 patient was detected Klebsiella pneumoniae, 1 patient was detected Pseudomonas aeruginosa, and 4 were detected Pneumocystis carinii.ConclusionPatients are at the biggest risk of infection within 3 months after discharge, which is the key period for controlling infection.

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ObjectiveTo evaluate the intervention effect on perioperative antimicrobial prophylaxis (PAP) in gynecologic operation through surgical site infection surveillance.MethodsPAP for 696 patients with gynecological operation was supervised according to the Guidelines of Perioperative Antimicrobial Prophylaxis, feedback of surveillance results and antimicrobial application were performed. PAP in gynecologic operation before and after intervention was compared.ResultsThe rate of rational choice of antimicrobial agents within 3060 minutes before surgery increased from 78.59% (334/425) of preintervention to 89.26%(241/270) of postintervention (χ2=13.20, P<0.05). The rate of prophylactic duration ≤ 48 hours increased from 3.32% (12/362) of preintervention to 44.98% （103/229） of post intervention， the rate of duration >72 hours decreased from 84.53% (306/362) to 41.92%(96/229) (P<0.05).ConclusionIntervention can standardize perioperative antimicrobial prophylaxis,enhance the rational choice of antimicrobial agents and shorten the prophylactic duration.

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ObjectiveTo realize situation of nosocomial infection （NI） in different scale hospitals in Inner Mongolia Autonomous Region.MethodsPrevalence rate of NI in patients in 40 hospitals were surveyed with the method of bedside checking and case history review.ResultsA total of 18 172 patients were surveyed, prevalence rate was 2.54% (462/18 172), case infection rate was 2.61% (474/18 172). NI sites were common in lower respiratory tract (42.14%), upper respiratory tract (22.15%), urinary tract (12.66%), superficial incision (9.28%), and gastrointestinal tract (3.80%). Prevalence rate was high in general intensive care unit (20/85, 23.54%). Antimicrobial use rate was 49.69% (9 029/18 172), rate for monotherapy and therapeutic usage was 66.94% and 47.56% respectively; Bacterial culture rate in patients with therapeutic usage was 14.63% (787/5 381).ConclusionThe average prevalence rate was 2.54% in 40 hospitals, lower respiratory tract was the major infection site, the main pathogen was gramnegative bacteria. Training on rational use of antimicrobial agents should be intensified, and pathogenic detection rate should be enhanced.

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ObjectiveTo evaluate the value of serum procalcitonin (PCT) levels for differentiating grampositive and gramnegative bacterial infection.Methods133 samples of blood, sputum, urine, or the others were performed bacterial culture, and serum PCT levels were measured and analyzed to find whether there was difference in PCT levels between grampositive and gramnegative bacteria infected patients.ResultsWhen bacteria were isolated from blood culture, serum PCT levels in patients with gramnagetive bacterial infection were obviously higher than that of grampositive group (［38.45±60.30］)ng/mL vs ［4.64±7.81］)ng/mL, P<0.001) ; According to receiver operating characteristic curve, if 5.61 ng/mL was taken as critical value, PCT sensitivity in the diagnosis of infection was 73.70%, and specificity was 81.80%. When sputum and the other samples were isolated bacteria, there was no statistical difference in patients’ serum PCT levels (P>0.05). PCT level in positive blood culture group was significantly higher than those of the other groups (P<0.001). ConclusionSerum PCT level is valuable to discriminate blood stream infection caused by gramnegative from grampositive bacteria, but the value to discriminate lung and the other local infection need to be further studied.

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ObjectiveTo evaluate the distribution and antimicrobial resistant characteristics of pathogens isolated from female patients with urinary tract infection (UTI).MethodsPathogens isolated from urine of female patients with UTI were identified and performed antimicrobial susceptibility test from January 2008 to October 2010.ResultsA total of 182 strains of pathogens were isolated and the top six pathogens were Escherichia coli(46.70%), Staphylococcus spp.(13.74%), Enterococcus spp.(9.34%), Klebsiella pneumoniae(8.24%), Pseudomonas aeruginosa（4.95%）, and fungus（4.95%）. 22.35% of Escherichia coli and 26.67% of Klebsiella pneumoniae produced extendedspectrum βlactamases; 50% of coagulasenegative Staphylococcus and 44.44% of Staphylococcus aureus were methicillinresistant. Isolated bacteria had different resistance to antimicrobial agents, and were multidrugresistant.ConclusionPathogens and antimicrobial resistance detection in urinary infection is important for controlling drugresistant strains transmission and guide rational use of antimicrobial agents.

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ObjectiveTo realize the detection and drug resistance of Stenotrophomonas maltophilia (Sma) isolated from clinical samples, so as to provide evidence for preventing and treating Sam infection.MethodsClinical and laboratory data of 230 Sma strains isolated from clinical departments between 2004 and 2009 was analysed retrospectively.Results230 strains of Sma were isolated from 53 811 clinical samples, the total isolation rate was 0.43%; The annual isolation rate increased by 14fold within 6 years(from 0.06% in 2004 to 0.84% in 2009). The detection rates were high in patients in respiratory department（125 isolates,54.35%）, old patients aged ≥60 (159 isolates, 69.13%), and sputum sample (215 isolates, 93.48%). Antimicribial susceptibility test results showed that Sma was highly and multiply resistant to ampicillin, amikacin, aztreonam, gentamicin, imipenem, meropenem, cefazolin,cefoxitin, cefotaxime, cefuroxime, and cefepime, the resistant rates was between 66.20% and 100.00%; The resistant rates to minocycline, ciprofloxacin, levofloxacin, sulfamethoxazole/trimethoprim, ceftazidime, piperacillin/tazobactam and cefoperazone /sulbactam was between 0.00% and 23.08%.ConclusionThe rapid increase in isolation rate of Sma from clinical samples and multiple drugresistance to commonly used antimicrobial agents can bring about enormous difficulty to the prevention and treatment of infection, which should pay high attention .

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目的调查某院心脏外科病房一起疑似医院感染暴发事件，为诊断与控制医院感染提供参考。方法对该院心脏外科2010年7月5日—26日期间发生的6例手术切口疑似感染病例进行流行病学调查与相关因素分析。结果6例疑似切口感染病例除1例术后第2天发热外，余无发热等症状；切口无红肿等炎性表现，无脓性分泌物，分泌物培养均无细菌生长。在未加用抗菌药物，仅采取换药引流3～5 d的措施下即痊愈。医院专家组诊断为切口愈合不良。但调查中发现临床医生医院感染防控意识淡薄，抗菌药物使用、消毒隔离及无菌操作、集中空调和净化设备的维护保养等存在医院感染隐患。结论此次医院感染暴发虽被排除，但强化医院感染防控意识，建立医院感染暴发预警机制，有效预防控制医院感染不容忽视。

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目的提高突发感染事件的应急管理能力。方法预见性地制定一系列感染事件应急管理预案，当感染事件突然发生时立即按流程启动：调集应急小组成员，按分组各行其责，如进行感染发生地的环境卫生学监测和消毒、流行病学调查和诊断、果断隔离治疗感染者、监测暴露人员和保护易感者。结果成功处置了一起医务人员群体呼吸系统感染事件，感染人群未扩大，未引起患者感染。结论应急管理预案的制定在有效应对突发感染事件中发挥了非常重要的作用。

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目的分析某院痰培养阳性标本病原菌的分布及其耐药情况，为临床合理选择抗菌药物提供参考依据。方法回顾性分析该院2010年1月1日—12月31日下呼吸道感染标本分离病原菌的分布及其药敏试验结果。结果共收集痰标本2 427份，分离病原菌979株,阳性率40.34%。其主要病原菌中，白假丝酵母菌居首位(18.59%)，其次为副流感嗜血杆菌(11.03%)、铜绿假单胞菌(10.01%)、鲍曼不动杆菌(9.19%)和肺炎克雷伯菌(8.07%)。未发现耐万古霉素葡萄球菌属细菌；肠杆菌科细菌对美罗培南、亚胺培南和厄他培南较敏感；非发酵菌中，铜绿假单胞菌对大部分抗菌药物耐药，仅对哌拉西林/他唑巴坦、阿米卡星较敏感，敏感率分别为88.17%、91.75%；不动杆菌属对阿米卡星较敏感，敏感率93.33%，对亚胺培南耐药率为34.45%。结论下呼吸道感染病原菌菌谱不断变化，耐药问题日益严重，应引起重视；定期监测医院常见病原菌的变迁及其耐药变化，对指导临床用药有重要意义。

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目的研究儿童医院产超广谱β内酰胺酶（ESBLs）细菌感染的干预策略。方法2009年4月，对全院医务人员、保洁员、ESBLs阳性患儿及其家属进行ESBLs相关知识培训及宣传教育（干预措施），并检测产ESBLs细菌感染控制效果。结果干预前3个月（1—3月份）住院患儿ESBLs总阳性率为2.42%（70/2 890）；干预后4个月（4—7月份）住院患儿ESBLs总阳性率下降为1.85%（82/4 444）。2009年1—4月，91例ESBLs阳性患儿的床头柜或床栏杆消毒前细菌菌落数为8～3 000 CFU/m2，消毒后为0～20 CFU/m2，消毒前后菌落数比较，差异有统计学意义（Z=-5.18，P=0.00）。结论不定期对医务人员、保洁员、产ESBLs菌感染患儿及其家属进行ESBLs相关知识培训和宣传教育，可降低其感染率。

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目的调查临床医生进出呼吸道传染病病区穿脱防护用品技能掌握情况，了解其进出呼吸道传染病病区职业防护的薄弱环节。方法制定《医务人员进出呼吸道传染病病区穿脱防护用品标准流程》，对临床医生进行培训，并对培训后的临床医生进行现场实际操作考核，记录其错误环节。结果发生率最高的错误环节为摘手套后未进行手消毒，其次是脱防护用品的区域错误，脱防护服或摘手套时手碰到污染面等。结论虽然经过严格的培训，临床医生在进出呼吸道传染病病区的职业防护流程上仍存在薄弱环节，需加强宣教，以降低传染病医院感染的发生风险。

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目的探讨军队小规模医院医院感染管理专职人员的职业危害因素。方法分析某军队医院医院感染管理专职人员的职业危害因素并采取相应的防护措施。结果医院感染管理专职人员工作面广，容易遭受各种职业危害，如心理压力大（专业跨度大、工作负荷重、成就感低等）、物理因素伤害（接触紫外线、臭氧、酒精灯，有灼伤和烧伤风险）、化学因素伤害（接触化学消毒剂等）以及生物性因素伤害（污水、污物的病原菌及接触特殊感染和传染病患者的潜在威胁）。结论应从改善专职人员工作环境、增加医院感染管理经费、配备必要的防护设施及采取积极有效的防护措施入手，提高医院感染管理专职人员职业安全保障。

Abstract:

目的探讨造成目前国内医院感染暴发及恶性事件频发的本质，寻找突破制约医院感染管理的对策，推动医院感染管理的发展。方法检索国内近年来医院感染及伦理学相关文献，从医学伦理学的视角理性分析感染事件，用医学伦理学的评价标准对感染恶性事件进行定性判断。结果医院感染恶性事件的本质是医疗机构伦理经营理念的严重缺位，暴露出伦理经营失范。结论构建医院感染管理文化，倡导伦理经营；构建医院感染付费机制，是促进感染管理健康持续发展的必经之路。

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Kaposi水痘样疹(Kaposi varicelliform eruption) 是一种在原有皮肤病基础上感染单纯疱疹病毒(HSV)、牛痘病毒或柯萨奇A16病毒而发生的一种感染性皮肤病［1］，临床较少见，好发于婴幼儿。2010年11月期间，本院病房出现4例Kaposi水痘样疹成人患者，经采用抗病毒治疗及感染控制措施，效果满意，未出现医院感染进一步扩散，并且未出现不良反应。现总结报告如下。

Abstract:

2009年2月，本院重症监护室（ICU）先后有3名护士出现低热，面部及躯干有散在的疱疹，经皮肤科医生确诊为水痘。确诊前，3名护士曾共同护理过一位多脏器衰竭合并带状疱疹的患者。自该患者出现带状疱疹17 d后，3名直接参与护理的护士陆续被感染水痘，且均处于月经期；其他接触该患者的医务人员未发现相同症状。1周后，3名护士发热症状消失，面部及躯干部疱疹结痂干燥。