• LIU Jianfeng,LI Fen,JIAO Zhihai,LI Yanhua,TANG Zhijie,CHENG Yun,XIE Ruoqing,CEN Changtao,CHEN Jie , TANG Qiang
•2016, 15(10):719-725. DOI: 10.3969/j.issn.1671-9638.2016.10.001
Abstract:
ObjectiveTo investigate antimicrobial application in 56 township hospitals in Hunan Wuling mountain area. Methods13 348 outpatient prescriptions,1 288 medical records of nonoperated patients, and 280 medical records of operated patients in 56 township hospitals in Hunan Wuling mountain area were selected randomly, antimicrobial application was surveyed. ResultsAntimicrobial usage rates in outpatients, nonoperated inpatients, and operated inpatients were 53.01%, 87.97%, and 98.57% respectively, and the percentage of combined antimicrobial agents were 19.57%, 46.96%, and 39.86% respectively. The percentage of antimicrobial prophylaxis in patients undergoing type I incision surgery was 96.94%, combined antimicrobial usage rate was 36.84%. Antimicrobial use density in hospitalized patients was 124.92 DDDs/100 patient days. 8 573 antimicrobial agents were prescribed in outpatient prescriptions of 56 hospitals, the top 5 frequently used antimicrobial agents were amoxicillin, ceftriaxone, amoxicillin/clavulanate potassium, levofloxacin, and clindamycin. ConclusionAntimicrobial agents are overused and irrationally used in township hospitals in Hunan Wuling mountain area. Health care workers should strengthen learning, conscientiously implement the relevant regulations on antimicrobial management; health administrative departments should strengthen the supervision and management on clinical application of antimicrobial agents, and promote the rational use of antimicrobial agents in township hospitals.
• XU Zhongyu , GUO Jianlian , XIAO Binlong , LIU Huina , JIANG Xianhai
•2016, 15(10):726-729. DOI: 10.3969/j.issn.1671-9638.2016.10.002
Abstract:
ObjectiveTo understand the distribution and antimicrobial resistance of pathogens causing wound infection in army officers and soldiers following military training injury, and provide reference for antimicrobial use in clinical antiinfection treatment. MethodsWound secretion from injured army patients who were admitted to a military hospital between January 2014 and June 2015 was performed bacterial culture and antimicrobial susceptibility testing. Results647 pathogenic bacteria strains were isolated from 1 029 wound secretion specimens , isolation rate was 62.88%, the top 6 isolated bacteria were Staphylococcus aureus(S. aureus, 29.99%, n=194), Escherichia coli(E. coli, 19.32%,n=125), Pseudomonas aeruginosa(19.17%,n=124),Enterococcus spp.(13.60%,n=88),Klebsiella pneumoniae(K. pneumoniae, 7.73%,n=50), and Acinetobacter baumannii (A. baumannii, 5.87%,n=38). S. aureus and Enterococcus spp. had high susceptibility to vancomycin, linezolid , and daptomycin (resistance rates ≤3.41%), 44.33% of S. aureus were methicillinresistant, 2.27% of Enterococcus spp. were vancomycinresistant . E.coli and K. pneumoniae had high susceptibility rates to piperacillin/ tazobactam (resistance rates were 1.60% and 0 respectively), except A. baumannii, resistance rates of gramnegative bacteria to carbapenems were all low (resistance rates ≤4.00%). ConclusionMilitary clinicians should select appropriate antimicrobial agents according to antimicrobial susceptibility testing results, reduce the disability rate due to infection in trauma patients, and provide clinical support for the treatment of the wounded.
• LI Jiao , SHANG Linping , GUO Hongju , LI Wei , SU Danxia , ZHANG Xin , PAN Wei , HAO Chunxia , CHE Sha
•2016, 15(10):730-734. DOI: 10.3969/j.issn.1671-9638.2016.10.003
Abstract:
ObjectiveTo construct the risk model for healthcareassociated infection (HAI) with multidrugresistant organisms(MDROs) in intensive care unit (ICU).Methods836 patients who were admitted to ICU for more than 48 hours between October 2012 and September 2015 were analyzed retrospectively, logistic regression model of HAI was constructed, the model was conducted goodness of fit tests and the area under ROC curve analysis.ResultsAmong 836 patients, incidence of HAI with MDROs was 14.23%(n=119). 15 variables that were statistically significant in univariate analysis were included in logistic multivariate analysis, the results showed that the following variables entered into logistic regression equation: length of ICU stay(OR,2.493 [95%CI,1.816-3.494]), underlying diseases(OR,1.536 [95%CI, 1.243-1.898]), hypoproteinemia(OR,87.211 [95%CI,36.165-210.304]), ventilator days (OR,1.723 [95%CI,1.399-2.121]), fever(OR,20.639 [95%CI,3.462-123.043]), and primary pulmonary infection (OR,0.295 [ 95%CI,0.133-0.664]). Evaluation of model effect: sensitivity 95%, specificity 87.9%, the area under ROC curve 0.973. ConclusionLogistic regression model has a high goodness of fit in predicting HAI among ICU patients.
• WANG Sihai , HAN Ninglin , LI Xueling , DOU Hongman , WU Qian , XING Xuewei
•2016, 15(10):735-738. DOI: 10.3969/j.issn.1671-9638.2016.10.004
Abstract:
A 27yearold woman was admitted to a hospital due to intermittent fever for 20+ days and swelling pain in knee joint for 7 days. Patients was with persistent fever, the highest temperature to 40.1°C, the double knee joint swelling pain, a large number of scattered red needlelike rash were visible on bilateral hands and legs, lymphadenectasis, splenectasis, bilateral hands interphalangeal joint and knee joint swelling pain, lymph nodes were confined to the bilateral axillary with soft texture, local tenderness, and good activity. Pathological results of left axillary lymph node showed the following finding: fragmental lymph node tissue with incomplete structure, lymphoid follicles existed, there were diffuse histocytes, immunoblasts, and a few small lymphocytes proliferation in the reduced or disappeared area of follicular, caryokinesis could be easily seen, there were patches of necrosis foci with varied size, nucleus disintegrated, fibrinoid necrosis blood vessel with bleeding could be seen. Immunohistochemical detection showed the following results: CD3 (diffuse +); CD20 (follicular +); CD79α(follicular +); CD68 (+); EMA (-); ALK (-); CD15 (a small amount of cells +); CD30 (+), CD4 (-), CD5 (+); CD10 (-);bcl-2 (+); CD21 (+); telomerase B (-); TIA-1 (-); EBV(-)Ki-67 (+) . Through a combination of clinical and immunohistochemical detection results, the diagnosis of histiocytic necrotizing lymphadenitis was made. Patient discontinued antimicrobial drugs, after she was treated with 5% glucose 100 mL + hydrocortisone sodium succinate 200 mg intravenous drip for 3 days, patients had no fever, axillary lymph node gradually dwindled. Then patients was treated with methylprednisolone 8 mg/d, twice a day, reduced 1 tablet every two weeks, and stopped eventually. Patients was followed up for two years, repeated examination of blood routine, liver and kidney function were in the normal range, bilateral knee didn’t swell, could walk freely, there appeared no enlargement of lymph node.
• WANG Jing , LV Jing , LI Wendong , XIN Xiaolong
•2016, 15(10):739-743. DOI: 10.3969/j.issn.1671-9638.2016.10.005
Abstract:
ObjectiveTo investigate the bacterial spectrum and antimicrobial resistance of peritoneal dialysis (PD)related peritonitis, and provide evidence for rational antimicrobial use. MethodsClinical data of 120 patients with PDrelated peritonitis in a hospital from January 2013 to December 2014 were retrospectively analyzed. Results91 cases (75.83%) showed positive result in bacterial culture, 93 pathogenic strains were cultured, including 73 (78.49%) grampositive and 13 (13.98%) gramnegative bacterial strains, the most common grampositive bacteria was Staphylococcus epidermidis (n=38, 40.86%), and the main gramnegative bacteria was Escherichia coli (n=3, 3.23%). Grampositive strains had high resistance rates to penicillin, erythromycin, and oxacillin (93.65%, 69.57%, and 64.41% respectively), while resistance rates to vancomycin and linezolid were both low (2.90% and 1.47% respectively), and were sensitive to teicoplanin, tigecycline, and nitrofurantoin. Gramnegative bacteria had high resistance rates to cefazolin, cefuroxime, and ampicillin(50.00%, 37.50%, and 37.50% respectively), but were sensitive to imipenem, tobramycin, and piperacillin. Resistance rates of grampositive and gramnegative bacteria to gentamicin and levofloxacin were both low. Nonstandard operation during dialysate exchange was the most common cause of peritonitis (56.67%), most peritonitis were grampositive bacterial infection(79.41%);while gramnegative bacteria were the main pathogens of diarrheainduced peritonitis (52.63%). The cure rates of grampositive bacteria, gramnegative bacteria,and negativecultured peritonitis were 92.96%, 76.92%, and 86.21% respectively, difference was not statistically significant(χ2=3.39,P=0.18). ConclusionGrampositive bacteria are major pathogens in PDrelated peritonitis, and are usually caused by the bacteria through dialysis catheter due to nonstandard operation during dialysate exchange. Firstgeneration cephalosporins are not recommended as empirical therapy against grampositive bacteria, while vancomycin is still the best choice. Thirdgeneration cephalosporins and aminoglycosides are recommended as empirical therapy against gramnegative bacteria. Gentamicin and levofloxacin can be used alone as empirical therapy in special circumstances.
• ZHAO Yue , ZHANG Liyan , CHEN Lian , YE Qianjun
•2016, 15(10):744-747. DOI: 3969/j.issn.1671-9638.2016.10.006
Abstract:
ObjectiveTo understand the antimicrobial resistance of common clinical pathogens to antimicrobial disks containing different ratios of cefoperazone/sulbactam, so as to provide basis for rational application of cefoperazone /sulbactam in clinic. Methods1 141 pathogens isolated from clinical specimens in a hospital in the first half year of 2014 were collected, disk diffusion method was adopted to detect antimicrobial activity of two kinds of cefoperazone/sulbactam disks (70/35 μg and 75/75 μg).ResultsOf 1 141 pathogenic strains, 675 (59.16%)were Enterobacteriaceae, 447 (39.18%) were nonfermentative bacteria, and 19 (1.66%) were other gramnegative bacilli. Resistance rates of pathogens to 70/35μg and 75/75 μg cefoperazone /sulbactam antimicrobial disks were as follows: extendedspectrum βlactamases(ESBLs)producing Escherichia coli (n=221) were 7.69% and 2.26% respectively, ESBLsproducing Klebsiella pneumoniae(n=92) 10.87% and 3.26% respectively, imipenemresistant Acinetobacter baumannii(IRAB,n=295)54.92% and 11.19%respectively;there were significant differences in antimicrobial activity between two ratios of antimicrobial disks(P<0.05). While antimicrobial resistance rates of ESBLsnegative Enterobacteriaceae (Escherichia coli,n=135; Klebsiella pneumoniae, n=98), imipenemsensitive Acinetobacter baumannii (ISAB, n=51), Pseudomonas aeruginosa (n=48 ), and Stenotrophomonas maltophilia (n=22) were not significantly different (all P>0.05). ConclusionAntimicrobial activity of two different ratios of cefoperazone/sulbactam antimicrobial disks to ESBLsproducing Enterobacteriaceae and IRAB is different, attention should be paid to ratios of cefoperazone/sulbactam during the treatment , so as to achieve the desired therapeutic effect.
• GUO Jianlian,LIU Huina,XIAO Binlong,XU Zhongyu,LI Qiang
•2016, 15(10):748-751. DOI: 10.3969/j.issn.1671-9638.2016.10.007
Abstract:
ObjectiveTo compare changes in infectious markers in blood of patients with coronary heart disease (CHD), analyze clinical diagnostic value of procalcitonin (PCT) and highsensitivity Creactive protein (hsCRP) in bacterial infection in patients with CHD. MethodsPatients with CHD admitted to a hospital between January 2013 and December 2014 were studied. PCT, hsCRP, white blood cell (WBC), and neutrophil (NEU) count were detected before treatment and on the 5th day after treatment, differences between bacterial infected group and noninfected group, infection sites, as well as survival and death groups were compared respectively. ResultsSerum levels of PCT,hsCRP,WBC, and NEU in bacterial infected group were all significantly higher than noninfected group; PCT and hsCRP in infection of different sites were statistically significant (all P<0.001), patients with bloodstream infection had the highest levels ([45.148±46.341] ng/mL, [137.000±87.367]mg/L, respectively),followed by thoracic and abdominal infection,as well as respiratory system infection,while patients with urinary system infection had the lowest levels([0.769±1.747]ng/mL, [53.006±45.450]mg/L, respectively). After treatment, makers in survival group were all lower than before treatment, but in death group were all higher than before treatment. The area under the curve of PCT, hsCRP, WBC, and NEU were 0.934, 0.856, 0.782, and 0.784 respectively. ConclusionThe combined detection of PCT and hsCRP is effective for early diagnosis of bacterial infection in elderly patients with CHD, it is also helpful for assessing disease condition, curative efficacy, and prognosis.
• YANG Fang , LIU Wenen , ZHONG Yiming , YAN Qun , LIU Qingxia , LI Hongling , LI Yanming , ZOU Mingxiang
•2016, 15(10):752-756. DOI: 10.3969/j.issn.1671-9638.2016.10.008
Abstract:
ObjectiveTo understand clinical distribution and antimicrobial resistance of clinically isolated Serratia marcescens(S. marcescens), and provide basis for rational use of antimicrobial agents, as well as prevention and control of infection. Methods427 S. marcescens strains isolated between January 1, 2012 and December 31, 2015 were analyzed, antimicrobial susceptibility testing were performed by disk diffusion method. Results427 S. marcescens strains were mainly from respiratory tract (70.26%), among which the majority were from sputum(64.87%). S.marcescens were primarily from intensive care unit(ICU, 19.44%), department of integrated traditional Chinese and Western medicine(15.46%) as well as rehabilitation department (13.58%). The resistance rates of S. marcescens to cefoperazone/sulbactam, ertapenem, cefepime, ceftazidime, amikacin, imipenem, levofloxacin, and piperacillin/tazobactam were all<10%; resistance rates to ciprofloxacin, gentamicin, tobramycin, ceftriaxone, sulfamethoxazole/ trimethoprim (SMZ/TMP), and aztreonam were 10%-30%. Difference in the resistance rates of S. marcescens to cefoperazone/sulbactam, ciprofloxacin, ceftriaxone, amikacin, aztreonam, and SMZ/TMP during 4 years were statistically significant (P<0.05). In 2012-2013, resistance rates of S. marcescens to cefoperazone/sulbactam, ciprofloxacin, ceftriaxone, aztreonam, and SMZ/TMP increased obviously, then resistance rates tend to be stable, while resistance rates to cefoperazone/sulbactam decreased. ConclusionSusceptibility of S. marcescens
to most antimicrobial agents are high, but resistance had increasing tendency;susceptible rates of S. marcescens to ertapenem, ceftazidime, levofloxacin, and piperacillin/tazobactam are all high, and can be used as the empirical medication for the treatment of related infection.
• HUA Chaoyang , HAN Zhongjiang , LI Yanwei , LIU Xinjian , LIU Caihong , WEN Jianguo
•2016, 15(10):757-759. DOI: 10.3969/j.issn.1671-9638.2016.10.009
Abstract:
ObjectiveTo investigate the current situation and existing problems of healthcareassociated infection(HAI) management in primary medical institutions in Henan Province. Methods36 primary medical institutions in 18 regions were investigated with random sampling method, development of HAI management in primary medical institutions before and after 2013 were compared. ResultsAmong 36 primary medical institutions, 31 (86.11%) had cleaning, disinfection, sterilization, and isolation systems, 13 (36.11%) implemented HAI monitoring system, 31 (86.11%) performed regular training on hand hygiene knowledge, 6 (16.67%) allocated antimicrobial management professionals. The development rates in HAI management group, hand hygiene system, training on related knowledge among staff, HAI monitoring, and antimicrobial management in 36 primary medical institutions before 2013 were all lower than those after 2013 (41.67% VS 75.00%;2.78% VS 30.56%;22.22% VS 69.44%;5.56% VS 33.33%;25.00% VS 66.67%, all P<0.05). ConclusionHAI management level in primary medical institutions has improved than before, but deficiencies still exists and needs further improvement.
• JIANG Wei , WANG Simiao , JIN Xin , LI Jiajia
•2016, 15(10):760-763. DOI: 10.3969/j.issn.1671-9638.2016.10.010
Abstract:
ObjectiveTo investigate clinical distribution and antimicrobial resistance genes of CTXM extendedspectrum βlactamases (ESBLs) and Klebsiella pneumoniae carbapenemases (KPCs)producing Escherichia coli (E. coli) isolated from patients with infection. MethodsMultidrugresistant E. coli (MDRE. coli) isolated from clinical specimens in a hospital in 2011-2012 were collected, minimal inhibitory concentrations (MICs) were detected by microbroth dilution method; ESBLs and KPC genes were amplified by polymerase chain reaction (PCR), CTXM and KPC genotypes,as well as multilocus sequence types (MLST) were identified. ResultsOf 48 MDRE.coli, 45(93.75%) only produced ESBLs, 44(91.67%) carried blaCTXM gene, 20(41.67%) of which were blaCTXM1 gene and 32(66.67%)were blaCTXM9 gene,8(16.67%)carried both genes. The following subtypes were identified through gene sequencing: CTXM14(65.91%,29/44), CTXM55(31.82%,14/44), CTXM15(11.36%,5/44), CTXM3(2.27%,1/44), CTXM24(2.27%,1/44),and CTXM65(2.27%,1/44). The detection rates of CTXM14+CTXM55, CTXM14+CTXM15, and CTXM55+CTXM65 were 11.36% (5/44), 4.55%(2/44), and 2.27%(1/44)respectively. PCR showed that 2(4.17%) ESBLs+KPCproducing strains carried blaKPC and blaCTXM genes, sequencing analysis showed that 1 was CTXM14+KPC2,and the other was CTXM3+KPC2. ST 131 (53.66%)was the main type of MLST, ST648, ST405, ST167, and ST1193 were also detected. ConclusionCTXM14, CTXM55 and CTXM15 are the most common genotypes of ESBLsproducing E. coli isolates, different subtypes exists, ST131 is the predominant MLST, KPC2producing isolate of E.coli has been detected.
• QIAN Xuefeng , Krupakar Jyothi , ZHAO Ye , LING Chunhua , HUANG Jianan , JI Cheng
•2016, 15(10):764-768. DOI: 10.3969/j.issn.1671-9638.2016.10.011
Abstract:
ObjectiveTo provide reference for establishing diagnosis and differential diagnosis methods of rare yeastlike fungal bloodstream infection for clinical microbiology laboratory. MethodsTrichosporon asahii (T. asahii) and Geotrichum capitatum(G.capitatum) bloodstream infection was diagnosed and differentially diagnosed through clinical data analysis, morphological examination, biochemical reactions,and molecular biology technology.ResultsTwo types of yeastlike fungal bloodstream infections in case 1 and case 2 both occurred in leukemia agranulocytosis phase after chemotherapy, such infections were serious and highly similar. The cultivated colonies on blood agar plates of case 1 and case 2 were performed gram stain and microscopic examination. Hyphae, arthrospores and microconidia were visible in the former, thickness of hyphae branches and length of arthrospores were different, most presented rectangular and barrel shape; the latter can be seen hyphae with transparent septum broken up into arthrospores, presented rectangular shape, did not produce blastoconidia. Identification with API 20C AUX showed that they were T. asahii and G. capitatum. The PCR product sequences were compared with NCBI, suggesting that T. asahii and G. capitatum were at sexual stage. ConclusionComprehensive application of a variety of technical methods is helpful for improving the diagnosis accuracy of bloodstream infection with yeastlike fungi, identifying Trichosporon and Geotrichum to the species level may help physicians to understand such rare fungal infection, choose antifungal agents rationally, and improve clinical prognosis.[Key words]bloodstream infection; Trichosporon asahii; Geotrichum capitatum; yeastlike fungus; differential diagnosis
• LI Haifeng , ZHANG Yandong , YU Lina , ZHENG Dongchun , ZUO Yue , DUAN Liping , JIA Chen , SUN Jinke
•2016, 15(10):769-772. DOI: 10.3969/j.issn.1671-9638.2016.10.012
Abstract:
ObjectiveTo investigate the current situation and related risk factors of healthcareassociated infection (HAI), so as to provide evidence for making prevention and control measures of HAI. MethodsOn November 26, 2014, a combination method of bedside visiting and medical record reviewing was adopted to survey HAI status, pathogen examination, and antimicrobial application in all hospitalized patients in a tertiary first class military hospital. ResultsA total of 1 657 hospitalized patients were investigated, 66 patients developed 71 times of HAI, HAI rate and HAI case rate were 3.98% and 4.28% respectively. The top 4 departments with HAI prevalence rates were departments of neurosurgery (24.49%), hematology(19.05%), cadre ward(13.73%), and burn surgery(10.91%). The top 5 HAI sites were lower respiratory tract (40.85%), urinary tract(23.94%), upper respiratory tract(12.68%), surgical site(9.86%), and gastrointestinal tract(5.63%). Of 66 cases of HAI, 39 (59.09%) patients sent specimens for culture, a total of 48 pathogens were cultured, the major isolated bacteria was Escherichia coli (n=10, 20.84%), followed by Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa, each was 7 (14.58 %) respectively. The usage rate of antimicrobial agents was 34.40%, specimen detection rate in patients receiving therapeutic and therapeutic+prophylactic antimicrobial agents was 59.28%. Risk factors for HAI were age <2 years old or >60 years, with respirator, tracheotomy, urinary tract catheterization, arteriovenous catheterization, hemodialysis, and surgery, difference was significant(all P<0.05). ConclusionMonitoring on key departments and key sites of HAI should be strengthened, antimicrobial agents should be used rationally based on pathogenic detection results, specimen pathogenic detection rate should be improved, and effective prevention and control measures needs to be taken according to the risk factors of HAI.
• CHEN Zhong , XIAO Gang , ZHOU Quan , HE Yan
•2016, 15(10):773-776. DOI: 10.3969/j.issn.1671-9638.2016.10.013
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ObjectiveTo understand the therapeutic effect of clindamycin combined with compound sulfamethoxazole tablets on pneumocystis pneumonia(PCP) associated with acquired immunodeficiency syndrome (AIDS). Methods97 AIDS patients with PCP in a hospital from January 2014 to March 2015 were randomly divided into control group (n=49, received compound sulfamethoxazole ) and trial group(n=48, received clindamycin on the basis of compound sulfamethoxazole ) , levels of partial pressure of oxygen in arterial blood (PaO2), arterial blood oxygen saturation(SaO2), serum albumin(ALB), and lactic dehydrogenase (LDH)in two groups of patients before and after treatment were recorded. ResultsLevels of PaO2, SaO2, ALB, and LDH between two groups of patients before treatment was not significantly different(all P>0.05). After treatment, PaO2 in control group and trial group were(73.01±4.62)mmHg and(84.92±5.34)mmHg respectively,SaO2 were (75.81±4.28)% and(90.86±5.94)% respectively,ALB were (32.62±4.41)g/L and(43.95±5.03)g/L respectively,LDH were(416.53±30.77)U/L and(331.58±20.86)U/L respectively,levels of PaO2 and SaO2 in trial group were both higher than control group , difference in ALB and LDH between two groups of patients after treatment were both statistically significant( both P<0.05). The total effective rate of trial group was 89.58% (n=43), which was higher than 69.39%(n=34) in control group (χ2 =6.04,P=0.014). ConclusionClindamycin combined with compound sulfamethoxazole tablets has good therapeutic effect on AIDS and PCP, which is worthy of clinical popularization and application.
• TAN Li , LAI Xiaoquan , TAN Kun , XU Min , XIONG Wei , HU Qiongjie
•2016, 15(10):777-779. DOI: 10.3969/j.issn.1671-9638.2016.10.014
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ObjectiveTo explore the effect of ATP fluorescence detection on onsite monitoring and supervision of healthcareassociated infection management . MethodsATP bioluminescence analyzer was used to detect the contamination status of hands of health care workers(HCWs), the object surfaces, and the cleaning tools in all quarters of 2015, the detection results were timely given feedback, and improvement measures were put forward. ResultsA total of 1 294 specimens were detected, the overall qualified rate was 62.75%. The qualified rates of hands of HCWs, object surfaces, and cleaning tools increased from 54.35%, 50.30%, and 60.26% in the first quarter to 76.42%, 64.80%, and 79.52% in the fourth quarter respectively,tendency chisquare test showed that difference was statistically significant (all P<0.05). The median of relative light unit (RLU) of hands of HCWs, object surfaces, and cleaning tools were 20.00, 85.00, and 35.00, respectively. ConclusionATP fluorescence detection for onsite monitoring and supervision for cleaning and disinfection effect can promote the continuous quality improvement of hand hygiene and environmental cleanliness.
• ZHANG Jingbo , WANG Jinghui , CUI Jinghui , YU Xiali , CHEN Meng
•2016, 15(10):780-784. DOI: 10.3969/j.issn.1671-9638.2016.10.015
Abstract:
ObjectiveTo understand the genotypes of measles virus isolated from patients with measles in Beijing Xicheng District in 2014, and timely find out imported measles cases. MethodsMeasles virus nucleic acid was identified with fluorescent polymerase chain reaction (PCR), then amplified by realtime PCR (RTPCR), amplified products were sequenced and analyzed. Results82 specimens from 81 suspected measles patients in Beijing Xicheng District in 2014 were taken, 63 were throat swab specimens and 19 were urine specimens. 70 cases were positive for measles virus nucleic acid, 40 of which were obtained gene sequence through sequencing, 37 were positive culture for measles virus. The phylogenetic tree analysis showed that gene sequences of 40 measles virus isolates were belonged to the same branch as H genotype representative strain Chin9322/H1a and MVi/Hunan.CHN/0.93/7/H1 recommended by World Health Organization. The homology of nucleotide were 98%-98.9% and 96.9%-97.8% respectively, homology of amino acid were 97.3%-99.3% and 95.3%-98% respectively. ConclusionThe main genotype of measles cases in Beijing Xicheng District in 2014 was the local genotype (H1), surveillance of measles cases should be strengthened further to control and prevent the imported measles cases.
• LIU Yunhong , WANG Shuhui , WANG Jingna , WU Xiaohui,LI Yingxia
•2016, 15(10):785-787. DOI: 10.3969/j.issn.1671-9638.2016.10.016
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ObjectiveTo investigate the direct economic loss caused by oral infection in patients with acute leukemia. MethodsAcute leukemia patients with oral infection in a tertiary firstclass hospital in Shandong Province between January 2011 and December 2013 were investigated, the 1:1 matched case control method was used for comparing hospitalization expense and length of hospital stay between oral infected (case group) and uninfected patients(control group). ResultsA total of 994 patients with acute leukemia were monitored, 277 had healthcareassociated infection, 17 (5.56%)of whom were with oral infection. The median hospitalization expense of patients in case group and control group was¥37 327 and¥13 176 respectively, the total hospitalization expense of patients in case group was 2.83 times more than control group, difference was statistically significant (Z=-3.621,P<0.001). Each hospitalization expense of case group was higher than control group, especially expense for medicine, blood transfusion, laboratory examination, and therapy. The median length of hospital stay in case group and control group were 17 days and 11 days respectively, rank sum test showed that difference in median length of hospital stay between two groups was statistically significant (Z=-3.627, P< 0.001). ConclusionAcute leukemia patients with oral infection have increased hospitalization expense, prolonged length of hospital stay, and increased the financial burden.
• DENG Guiyuan , REN Nan , HUANG Yan , JING Ran
•2016, 15(10):788-790. DOI: 10.3969/j.issn.1671-9638.2016.10.017
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ObjectiveTo summarize the nursing experience in the prevention and control of Ebola virus disease(EVD), and provide reference for nursing practice on infection control management of further epidemic situation. MethodsPersonal experience in 53day fighting against EVD was retrospectively analyzed, nursing experience in the prevention and control of EVD was summarized by author who was one of 5th China (Hunan) medical team members and head of nursing. ResultsThe whole medical team consisted of 40 health care workers(HCWs), none of them infected with Ebola virus; there was no cross infection among 105 HCWs of Sierra Leone, either, 100% of Ebola patients were cured. ConclusionBuilding up team work, strictly training and implementing standard working process, focusing on infection control and management of treatment center are important factors that ensure zero infection among nursing staff during the process of diagnosis and treatment.
• DI Hongjun , SHI Yuexian , SI Wei , WU Qiuxia
•2016, 15(10):791-795. DOI: 10.3969/j.issn.1671-9638.2016.10.018
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ObjectiveTo investigate nursing interns’ knowledge and attitude towards needle stick injury before clinical practice. MethodsIn 2023 June,2015, nursing interns who were about to start clinical practice in a hospital were investigated, nursing interns’ knowledge and attitude towards needle stick injury were surveyed through questionnaire. ResultsA total of 350 questionnaires were distributed, 324 (92.57%) responded questionnaires were available. 40(12.35%)questionnaires were responded by male interns,and 284(87.65%)were by female interns;34(10.49%)interns had bachelor degree;the mean age of interns were (20.83 + 1.24) years old. The correct answer rates about questions related to injury occurring during needle recapping and wearing gloves were low (about 60%). About 70% of the interns gave the correct answers to questions about hepatitis B infection due to needle stick injury following hepatitis B vaccination, as well as medication after injury. Score for individual question about attitude towards needle stick injury was ≤3, the major related problems were susceptibility of blood borne diseases and recapping needles.ConclusionNeedle stick injuryrelated knowledge and attitude among nursing interns is inadequate, including recapping needles, timely report, susceptible to infectious diseases, and so on. It is necessary for schools and teaching hospitals to strengthen the education about occupational protection among nursing interns, so as to improve the attitude and ability of professional protection.
• DING Siyan , SHAO Xiaoqing , MAO Yiping , ZHU Dongping
•2016, 15(10):796-799. DOI: 10.3969/j.issn.1671-9638.2016.10.019
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ObjectiveTo understand current status of occupational protection awareness and behavior among different professional medical interns, and provide basis for strengthening the education about occupational protection among medical interns .MethodsQuestionnaire survey was used to survey medical interns at the end of their clinical internship. ResultsA total of 385 cases of occupational exposure occurred during internship period, occupational exposure rate was 42.31% (385/910),occupational exposure mainly occurred in nursing interns (n=190). 358(39.34%)medical interns understood selfprotective antibody (hepatitis B surface antibody); difference in occupational exposure rates and awareness of selfprotective antibody among different professional medical interns was statistically significant (all P<0.05); 222 (57.66%)medical interns sustained occupational exposure more than once, 45.45% of occupational exposure occurred during the process of diagnostic and therapeutic procedure, exposure mainly occurred in the wards(32.21%). After occupational exposure, 46.75% of medical interns felt nervous, 35.06% were worried,18.18% appeared serious psychological reaction, only 14.03% sought support and help from others. ConclusionAwareness of occupational protection among medical interns is insufficient, education and awareness of occupational protection should be intensified, psychological behavioral after occupational exposure should be paid attention among medical students.
•2016, 15(10):800-801. DOI: 10.3969/j.issn.1671-9638.2016.10.020
Abstract:
目的 探讨血清降钙素原(PCT)在小儿细菌性肺炎早期诊断中的意义,为临床合理使用抗菌药物提供实验室依据。方法采用酶联免疫荧光法,检测某院2013年1月—2014年12月658例小儿肺炎患儿血清PCT水平。 结果658例小儿肺炎患儿,其中细菌性肺炎196例,病毒性肺炎355例,支原体肺炎107例。细菌性肺炎患儿中PCT阳性181例(92.35%),病毒性肺炎患儿中PCT阳性49例(13.80%),支原体肺炎患儿中PCT阳性9例(8.41%)。3组患儿血清中PCT阳性率比较,差异有统计学意义(P<0.001)。细菌性肺炎患儿血清中PCT阳性率高于病毒性肺炎、支原体肺炎患儿(均P<0.001)。结论血清PCT含量是小儿细菌性肺炎的早期敏感标志物之一,血清PCT检测有助于小儿细菌性肺炎的早期诊断和鉴别诊断,可为临床使用抗菌药物提供依据。
•2016, 15(10):802-806. DOI: 10.3969/j.issn.1671-9638.2016.10.021
Abstract:
人乳头瘤病毒16型(human papillomavirus type 16,HPV16)是一类广泛感染人类上皮组织的小DNA病毒,能引起人体各种黏膜和皮肤的增生性疾病与肿瘤,与人宫颈癌的发生密切相关。疫苗接种是防治HPV16感染的有效途径之一,现有疫苗的种类包括死疫苗、减毒活疫苗、分子疫苗和DNA疫苗等,但存在一定的毒副作用,因此尚需研究新型HPV16疫苗。
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