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ObjectiveTo analyze the genomic evolution characteristics of pathogenicity islands (PAIs) in Deng strain of enteropathogenic Escherichia coli (E. coli,EPEC Deng).MethodsEPEC Deng was isolated from infant stool specimen, serotypes were identified and antimicrobial susceptibility testing was performed; wholegenome sequencing was performed by Illumina 2000 system, the locations of prophages(PPs) in the chromosome were detected using PHAST software,  collinearity analysis was performed by MUMmer software, phylogenetic trees of homologous gene were constructed in order to understand the evolutional rule of homology gene. PAIs  prediction was performed using PAI_ finder software, the homologous evolutionary rule of PAIs core region(LEE)  and core genes were clarified, genetic polymorphism was analyzed.ResultsThe serotype of EPEC Deng  strain was O119:H6,  the strain was resistant to ciprofloxacin, levofloxacin, and ampicillin,but sensitive to other antimicrobial agents. The complete circular chromosome contained 5 025 482 bp with a GC content of 50.52 %,  and the plasmid contained 207 564 bp with a GC content of 49.50%.  A total of 17 PPs in the chromosomal genome were discovered, phylogenetic trees analysis suggested that EPEC Deng strain was highly homologous with O26: H11 and O111: H strains; PAIs and core genes were highly homologous with  RDEC1 and O26: H413/891 strains; genetic diversity analysis showed that the intimin (eae) and its receptor tir had high polymorphism, with the pi (π) value>0.10,  the genes in type III secretion system was relatively stable.ConclusionThe study clarified the genomic evolution characteristics of EPEC Deng genome and it’s PAIs, and is helpful for understanding genetic characteristics of native EPEC.

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ObjectiveTo investigate the current situation of healthcareassociated infection(HAI) in hospitals of Miao and Dong Autonomous Prefecture of Guizhou Province, and provide basis for formulating prevention and control measures of HAI.MethodsAccording to the unified plan of the National HAI Surveillance Network, 26 hospitals in Miao and Dong Autonomous Prefecture of Guizhou Province were performed crosssectional survey on HAI prevalence rate, antimicrobial use, and specimen bacterial culture rate.ResultsA total of 3 tertiary and 23 secondary hospitals were investigated, 7 799 inpatients were included, the prevalence rate of HAI was 2.54%(n=198), and case prevalence rate was 2.65% (n=205). HAI mainly distributed in intensive care unit (29.63%); the main infection site was lower respiratory tract (44.44%); HAI mainly caused by gramnegative bacteria, the major pathogens were Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. The usage rate of antimicrobial agents was 45.66%, secondary hospitals was higher than tertiary hospitals (53.65% vs 31.14%,χ2=148.53，P<0.001）.74.02% of antimicrobial agents were for therapeutic purpose, 19.77% for prophylaxis, and 6.21% for both prophylactic and therapeutic application; 81.02% of patients received one agent, 17.21% received two, and 1.77% received three and more agents; among patients who received antimicrobials for therapeutic as well as for both therapeutic and prophylactic purpose, only 29.37% were sent specimens for pathogenic detection.ConclusionThe prevalence rate in this region is lower than national average level, antimicrobial usage rate is lower than national standard, management of key departments and key sites should be strengthened, antimicrobial agents, especially used in secondary hospitals should be used rationally.

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ObjectiveTo understand the results and characteristics of targeted monitoring of healthcareassociated infection (HAI) in an intensive care unit (ICU) of a tumor hospital, so as to provide scientific basis for formulating measures of prevention and control of  HAI.MethodsPatients who admitted to an ICU from January to December 2013 were performed targeted monitoring, incidence of HAI was adjusted with an average severity of illness score (ASIS), three types of invasive procedurerelated infection, distribution of pathogens, and multidrugresistant organisms were monitored.ResultsA total of 455 patients were monitored, the total patientdays were 2 483 days, 52 cases of HAI occurred, incidence of HAI  was 11.43％，incidence of HAI per 1 000 patientdays was 20.94‰, after the adjustment with ASIS，incidence of HAI per 1 000 patientdays was 6.29‰. The main infection site was respiratory system(63.46%), followed by urinary system（19.23%）; Incidence of ventilatorassociated pneumonia per 1 000 ventilationdays, catheterrelated bloodstream infection per 1 000 catheterdays, and catheterassociated urinary tract infection per 1 000 urinary catheter days were 12.08‰, 0.95‰, and 4.07‰  respectively. A total of 181 pathogenic isolates were detected, 74.59% (n=135) of which were gramnegative bacteria, 18.23%(n=33) were grampositive bacteria, and 7.18%(n=13) were fungi; 18.23％(n=33) were multidrugresistant strains.ConclusionICU is the high risk department of the occurrence of HAI, the main infection is respiratory tract infection, the major pathogen is gramnegative bacteria. Targeted monitoring can timely reflect the deficiency in infection control practice, is helpful for formulating effective prevention and intervention measures, and reducing the occurrence of HAI.

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ObjectiveTo evaluate the incidence and influencing factors for postoperative healthcareassociated  infection(HAI) in Uyghur patients undergoing cardiothoracic surgery in a hospital.MethodsClinical data of Uyghur patients hospitalized in the department of cardiothoracic surgery in a hospital of  Kashgar region between June 2010 and June 2014 were collected, incidence of postoperative HAI was surveyed.  Influencing factors for postoperative HAI were analyzed by univariate and multivariate logistic regression models.ResultsA total of 779 patients’ clinical data were collected, 53 patients (6.80%) developed postoperative HAI. The major infection sites were lower respiratory tract (2.44%), digestive tract(1.28%), urinary tract(1.16%), upper respiratory tract(1.03%), and surgical sites(0.51%). Multivariate logistic regression analysis showed that history of diabetes, body mass index (BMI) ≥30 kg/m2, duration of operation ≥ 160 minutes, and invasive procedure were risk factors for postoperative HAI in Uyghur patients undergoing cardiothoracic surgery.ConclusionIncidence of postoperative HAI in Uyghur patients undergoing cardiothoracic surgery in this hospital is high, risk factors for HAI are history of diabetes, high BMI, long duration of operation, and invasive procedure.

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ObjectiveTo understand the empiric antimicrobial use in patients with pyelonephritis in a hospital, and provide reference for clinical rational antimicrobial use.  MethodsData of 620 patients with pyelonephritis admitted to the nephrology department of a hospital between January 2011 and September 2014 were collected, application of antimicrobial agents，coincidence between empiric antimicrobial use and antimicrobial  susceptibility testing results in patients with different diseases and different ages were analyzed. ResultsBefore antimicrobial susceptibility testing results were reported, 620 patients use 625 times of antimicrobial agents, 5 of whom used two kinds of antimicrobial agents at the same time, 8 varieties in 15 types of antimicrobial agents were involved, the most frequently used antimicrobial agents were third generation cephalosporins,  cephamycins, and fluoroquinolones. The overall, partial, and non coincidence rate between antimicrobial use and antimicrobial susceptibility testing results were 64.32%(n=402), 8.32%(n=52), and  27.36%(n=171) respectively. The overall coincidence rate in patients with acute pyelonephritis  was higher than those with chronic pyelonephritis (77.61% ［n=357］ vs 58.79%［n=97］，P<0.05). The overall coincidence rate in patients  ＜50 years old and ≥50 years old were 68.12%（156/229）and 75.25%（298/396） respectively，there was no significant different between two groups (χ2=2.93,P=0.09). ConclusionThe noncoincidence rate between empiric antimicrobial use and antimicrobial susceptibility testing results is high, measures needs to be taken to improve the empiric antimicrobials use.

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ObjectiveTo analyze the distribution and change of antimicrobial resistance of common pathogenic bacteria from geriatric ward, and provide  reference for rational use of antimicrobial agents.MethodsSpecimens from hospitalized patients in a geriatric ward from 2009 to 2013 were analyzed, the isolated pathogenic bacteria and antimicrobial resistance of bacteria were analyzed statistically.ResultsFrom 2009 to 2013, a total of 7 426 pathogenic bacteria were isolated, the percentage of gramnegative bacilli, grampositive cocci, and fungi were  90.96%（n=6 755），7.23%（n=537），and 1.81%（n=134）,respectively. The top 5 detected bacteria  were  Pseudomonas aeruginosa (39.16%), Escherichia coli (16.47%), Stenotrophomonas maltophilia (10.65%), Klebsiella pneumoniae (7.22%), and Acinetobacter baumannii (6.21%), these strains were mainly isolated from sputum(94.15%,n=5 573). Resistance rates of Acinetobacter baumannii to all detected antimicrobial agents, Pseudomonas aeruginosa to 8 kinds of common antimicrobial agents (piperacillin / tazobactam, ceftazidime, aztreonam, imipenem, et al), Escherichia coli to 5 kinds of common antimicrobial agents (piperacillin / tazobactam, cefoperazone/sulbactam, aztreonam, levofloxacin, and ciprofloxacin), and Stenotrophomonas maltophilia to ceftazidime and levofloxacin all showed an increased tendency (all P<0.01); there was no obvious change in resistance rates of Klebsiella pneumoniae to all detected antimicrobial agents (all P>0.05).ConclusionThe major pathogenic bacteria isolated from geriatric ward is Pseudomonas aeruginosa, which is highly resistant to multiple antimicrobial agents, antimicrobial agents should be chosen based on antimicrobial susceptibility testing results.

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ObjectiveTo evaluate the effect of bundle intervention measures on preventing ventilatorassociated pneumonia (VAP).MethodsPatients who were admitted to an intensive care unit(ICU) of a hospital from January 2012 to December 2013 were monitored, patients from January to December 2012  were as control group,  while from January to December 2013 were as intervention group (bundle intervention measures were implemented). Usage rate of ventilators and incidence of  VAP  between two groups were compared.ResultsA total of 4 560 patients were monitored, 2 608  in  intervention group and 1 952 in control group. Usage rate of ventilators in intervention group was lower than control group (53.95% vs 61.17%； χ2=65.756，P＜0.01）. Incidence of VAP per 1 000 ventilator days in intervention group was lower than control group (13.00‰ vs 19.56‰； χ2=4.649，P=0.031）. Percentage of lateonset VAP per 1 000 ventilator days in tervention group was higher than control group（41.82‰ vs 24.59‰）.ConclusionBundle intervention measures are helpful for reducing the incidence of  VAP in ICU patients.

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ObjectiveTo explore risk factors for healthcareassociated infection(HAI) in patients undergoing craniocerebral operation, and provide guidance for the prevention of HAI in patients in  department of neurosurgery.Methods200 patients who underwent craniocerebral operation in a department of neurosurgery from November 2013 to November 2014 were surveyed, risk factors for HAI were analyzed.ResultsAmong 200 patients undergoing craniocerebral operation, 81 patients developed 99 cases of HAI, HAI rate was 40.50%, HAI case rate was 49.50%; the top five HAI sites were lower respiratory tract, urinary tract, intracranial site, bloodstream, and intestinal tract. Univariate analysis showed that patients’ age ≥60, Glasgow Coma Scale (GCS)＜15, intraoperative blood loss ≥800 mL, staying in intensive care unit(ICU), indwelling gastric tube, ventricular drainage, using ventilator, tracheotomy, and using H2 receptor antagonists were important risk factors for HAI in patients undergoing craniocerebral operation (all P<0.05). Multivariate logistic regression analysis showed that patients’ age ≥60, GCS＜15,  staying in ICU, and using H2 receptor antagonists were independent risk factors for HAI in patients undergoing craniocerebral operation.ConclusionStrengthening  the surveillance of HAI patients undergoing craniocerebral operation and realizing risk factors for HAI are helpful for taking comprehensive prevention measures and reducing the incidence of HAI.

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ObjectiveTo evaluate the effect of comprehensive intervention measures on preventing and  controlling  surgical site infection (SSI) in patients undergoing total abdominal hysterectomy.MethodsPatients undergoing total abdominal hysterectomy in a hospital between January 2011 and December 2014 were investigated retrospectively, patients in 2011 were as control group, from January 2012, a prospective monitoring on SSI was initiated, comprehensive intervention measures were taken, patients between January 2012 and December 2014 were as intervention group, SSI before and after the intervention  was compared.ResultsA total of 1 052 patients undergoing total abdominal hysterectomy were investigated, 267 cases were monitored before intervention, 25 patients (9.36%) developed healthcareassociated infection (HAI), 12(4.49%) of whom were with SSI;  785 cases were monitored after intervention, 13(1.66%) of whom were with SSI, incidence of  SSI in  2012, 2013,and 2014  were  2.31%, 1.89%, and 0.77% respectively, there was a decreasing tendency（χ2=7.30, P＜0.01）.ConclusionProspective monitoring on SSI and comprehensive intervention can reduce the incidence of SSI in patients undergoing total abdominal hysterectomy.

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ObjectiveTo explore the value of procalcitonin (PCT) and lipopolysaccharide (LPS) in identifying pathogens and evaluating therapeutic efficacy of hospitalacquired pneumonia (HAP).MethodsA total of 110 HAP patients were enrolled in a prospective study, patients were divided into gramnegative bacterial infected HAP group (G- infected group, n=50), grampositive bacterial infected HAP group (G+ infected group, n=30),and control group (nontypical pathogen or virus infected group, n=30).  Serum levels of PCT, LPS and Creactive protein (CRP) of  patients were dynamically detected, receiver operating characteristic (ROC) curve and area under the curve (AUC) were adopted to assess the value of PCT and LPS in predicting pathogenic bacteria causing HAP.ResultsPCT and LPS levels of G - infected group were （3.43±1.15）ng/mL and （0.20±0.08）EU/mL respectively, which were higher than G+ infected group （［0.42±0.12］ng/mL and ［0.05±0.02］EU/mL respectively）and control group（［0.14±0.08］ ng/mL and ［0.02±0.01］EU/mL respectively)(all P＜0.05). Levels of PCT and CRP of G-  infected group before and after therapy were both significantly different (［3.43±1.15］ ng/mL vs ［0.63±0.22］ng/mL, ［47.26±30.35］ mg/L vs ［9.21±6.54］ mg/L, respectively)(both P＜0.01).The levels of PCT, LPS, and CRP in moderate and severe patients were all significantly higher than mild patients (［5.43±1.05］ng/mL vs ［0.72±0.32］ng/mL, ［0.33±0.07］ EU/mL vs ［0.09±0.04］ EU/mL, ［57.46±20.15］ mg/L vs ［8.25±5.24］ mg/L,respectively)(all P＜0.05）. Sensitivity and specificity of combined detection of PCT and LPS in differentiating gramnegative bacteria infected VAP from grampositive bacteria infected VAP were 95.83% and 96.15% respectively, AUC was 0.95.ConclusionPCT and LPS have certain value in identifying pathogens of HAP, combined  detection of PCT and LPS can increase specificity in identifying HAP type, and assess the efficacy of antimicrobial therapy in accordance with the dynamic change.

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ObjectiveTo understand the distribution of multidrugresistant organisms (MDROs) in a cancer hospital, and provide basis for the prevention and control of healthcareassociated infection (HAI).MethodsMonitored data of MDROs from clinical specimens in Guizhou Cancer Hospital in 2011-2013 were analyzed retrospectively.ResultsA total of 1 165 MDRO strains were isolated in 2011-2013, most of which were extendedspectrum betalactamaseproducing Escherichia coli (n=626,53.73%), followed by methicillinresistant coagulase negative staphylococcus (MRCNS, n= 209,17.94%); MDRO detection rate increased year by year. MDROs were mainly isolated from sputum/throat swabs（n=346,29.70%）, secretion（n=322,27.64%）, and urine（n=227,19.48%）; intensive care unit and department of urology were the major departments of emergence of MDROs, accounting for 18.03% (n=210) and 14.85% (n=173) respectively.ConclusionMDROs in this hospital are mainly isolated from respiratory tract, surgical wound, and urinary system, monitoring of highrisk departments and susceptible population should be strengthened, targeted prevention and control measures should be developed to curb the infection and spread of MDROs.

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ObjectiveTo investigate medical students’ demand for knowledge about healthcareassociated infection(HAI), explore the opportunity and method of setting up curriculum about nosocomiology.Methods447 medical students who were about to start clinical practice were investigated through questionnaires.Results434  (97.09%) questionnaires were available. 152 (35.02%) medical students had access to knowledge about HAI, 148 (34.10%) knew or learnt sixstep handwashing method, 80 students understood sixstep handwashing method through media and society (n=65, 81.25%) or school curriculum (n=15, 18.75%). 95.62% of students hoped to set up curriculum about nosocomiology, 354 (81.57%) students preferred this discipline to be set up before clinical probation; 55.07% of students hoped this course should be set up as a practice course, 44.93% thought that theory and practice should be combined. Occupational precaution measures as well as methods of disinfection and isolation were the most interesting knowledge among them.ConclusionNosocomiology should be an obligatory course in medical colleges, the semester before clinical practice is the best time for this course, the curriculum should combine theory with practice.

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ObjectiveTo investigate cleanliness of hospital environmental object surfaces and hands of health care workers(HCWs).MethodsThe adenosine triphosphate (ATP) bioluminescence assay was used to detect object surfaces and hands of HCWs in a hospital, onthespot intervention was conducted.ResultsThe qualified rates of hospital environmental object surfaces and ventilatorrelevant object surfaces were 58.14% (200/344) and 69.88% (116/166) respectively, the qualified rate of ventilator tracheal intubation site was low (29.17%)；the qualified rate of telephone surfaces was the lowest (27.27%）. The qualified rates of  ventilatorrelevant object surfaces used continuously for ≥48h and <48 h were 56.70%（55/97）and  88.41%（61/69） respectively，there was significant difference between the two（χ2=19.26，P<0.01）.The qualified rates of HCWs’ hands before and after intervention were 34.18% and  85.58% respectively, relative light unit (RLU) values were （1 033.46±106.20）and （80.46±10.68）respectively，the qualified rates and RLU before and after intervention were both significantly different （both P<0.01）.ConclusionContamination of object surfaces and hands’ of HCWs in hospital dynamic environment is serious, ATP bioluminescence detection and onthespot intervention is helpful for improving cleanliness of hospital environment object surfaces and HCWs’  compliance to hand hygiene.

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ObjectiveTo evaluate efficacy of routine cleaning and disinfection methods for incubators, and put forward a feasible  improvement solution. Methods30 incubators used in a neonatal intensive care unit of a hospital between December 2013 and June 2014 were chosen and randomly divided into baseline, control, and trial groups(10 incubators in each group). Baseline group and control group were disinfected by routing disinfection method (wiping internal and external surfaces of incubators with water and chlorinecontaining disinfectant), trial group adopted intensified disinfection method (wiping internal surfaces of incubators with alcohol) on the basis of routine disinfection, disinfectant efficacy of three groups were compared. ResultsIn baseline group, unqualified incubators were initially detected on the fourth day of monitoring, all incubators were contaminated in varying degrees on the seventh day of monitoring, the detection rate of unqualified specimens was 31.43% (88/280). The median  time for the initial detection of unqualified incubators in control group  and trial group were on the fifth day and seventh day respectively, there was significant difference between two groups（χ2=12.38，P＜0.05）; The unqualified rate of trial group was significantly lower than control group (15.36%［43/280］ vs 32.86%［92/280］，χ2=23.43，P＜0.05）. ConclusionIntensified disinfection with alcohol on the basis of routine disinfection method can effectively improve the disinfectant efficacy of the surface of incubators, it is convenient, inexpensive and safe, and worth to be popularized in primary hospitals.

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ObjectiveTo explore the application of adenosine triphosphate (ATP) bioluminescence assay in evaluating cleaning quality of medical devices.  MethodsManual and machine cleaned medical devices were randomly selected from central sterile supply department of a hospital in 2011-2013, cleaning quality was detected with ATP bioluminescence assay, relative light unit (RLU) value was determined to assess the cleaning quality. ResultsA total of 460 pieces of cleaned devices were detected in 2011-2013, 404 (87.83%) were qualified. The qualified rates of manual  cleaning and machine cleaning were 70.73% and 94.07% respectively, the qualified rates of general surgical devices and lumen devices were 90.71% and 81.76% respectively, there were significant differences in qualified rates of different cleaning methods and different categories of medical devices (both P<0.01). The qualified rates of manual  cleaning in 2011-2013 were 32.35%, 79.63%, and 94.29% respectively, machine cleaning were 79.45%, 98.15%, and 98.08% respectively；differences in qualified rates of manual  cleaning and machine cleaning in different years were significant (all P<0.01). ConclusionATP bioluminescence assay can be used for evaluating cleaning quality of medical devices.

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目的了解心胸外科手术部位感染（SSI）的危险因素。方法采用查阅病历资料、床旁调查及出院后电话随访等方式对2014年1月1日—12月31日某院心胸外科手术患者SSI进行调查，对调查结果进行分析。结果共监测手术患者953例，发生SSI 21例，SSI发病率为2.20%。单因素分析结果显示，SSI与年龄、切口类型、手术持续时间、住院时间、引流管留置时间及恶性肿瘤6项因素有关（均P＜0.05）；logistic回归分析结果显示，住院时间和引流管留置时间是SSI的独立危险因素（均P＜0.05）。结论建议针对心胸外科SSI的危险因素采取相关干预措施，预防和控制SSI的发生。

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目的探讨碘伏治疗经外周静脉置入中心静脉导管（PICC）穿刺点感染的效果。 方法采用随机数字分组方法将某院2013年4月—2014年5月PICC门诊就诊的106例PICC穿刺点感染患者分为对照组与实验组，各53例；对照组采用百多邦涂抹治疗，实验组采用碘伏治疗，比较两组的治疗效果及治愈时间。结果实验组显效48例、有效5例，对照组显效46例、有效6例、无效1例，两组患者的治疗效果比较，差异无统计学意义（u=0.56，P=0.58）；实验组患者治愈时间为（7.58±2.41）d，短于对照组的（11.55±3.66）d（t=5.27，P＜0.01）。结论碘伏用于治疗PICC穿刺点感染，操作简单，疗效好，治愈时间短，成本低廉，值得临床推广应用。

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目的了解天门市首例布鲁菌病的流行病学特征，查找该病例感染源和感染途径，为卫生行政部门制定有效的防控措施提供科学依据。方法采用查阅原始病例资料，咨询临床医生和实验室人员，以及现场流行病学调查方法对该市首例布鲁菌病患者进行调查。结果患者血培养结果示布鲁菌阳性，门诊医生结合流行病学史及临床表现确诊为布鲁菌病。同济医院公共卫生科及时向武汉市硚口区疾病预防控制中心电话报告，并进行网络直报。畜牧部门采集患者饲养羊群的血样本，经检测132只山羊中，34只血样本试管凝集试验检测阳性；患者密切接触者（其妻儿）布鲁菌血清抗体检测阴性。对患者房屋及养羊厩舍进行消毒处理，监督患者按疗程服药，对其家庭成员进行医学观察，最终疫情得到有效控制，未造成暴发流行。结论该例为天门市首例确诊布鲁菌病，可能与隐性感染疫羊接触有关。

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巨细胞病毒（cytomegalovirus，CMV）属于β疱疹病毒亚科的双链DNA病毒，人类普遍易感，世界范围内CMV感染率为40%～90%［1］，是引起先天和围产期感染,导致新生儿先天畸形［2］、智力低下、发育迟缓等后遗症的最常见病原体。在免疫功能低下人群，如人类免疫缺陷病毒（HIV）感染和接受器官移植的患者中，CMV感染发病率很高，可导致视网膜炎、肺炎、胃肠炎等疾病，是该患者人群的主要致死性并发症之一。在免疫正常的个体中，主要引起无症状感染，并且持续潜伏在机体中。本文对CMV感染导致糖尿病的发病机制予以综述。