Abstract:

ObjectiveTo investigate status and risk factors of drug resistance of smearpositive pulmonary tuberculosis (TB) patients in Hunan Province, and provide reference for the prevention and control of drugresistant TB.Methods1 935 Mycobacterium tuberculosis (MT) complex strains identified by 20 TB prevention and control institutes in Hunan Province between 2012 and 2014 were collected and performed drug susceptibility testing，and influencing factors associated with drug resistance of TB were analyzed statistically.ResultsOf 1 935 MT complex strains, 1 207 （62.38%）were sensitive to 6 kinds of antituberculosis drugs, 728 were drugresistant strains, overall drug resistance rate was 37.62%；467 (24.13%) were multidrugresistant (MDR) strains, 64 of which were extensively drugresistant (XDR) strains, XDR rate was 3.31%, resistance rates from high to low were as follows: isoniazid（INH）29.32%, rifampicin(RFP) 25.84%, streptomycin（SM）20.73%,thambutol（EMB）9.00%, ofloxacin（OFX）7.83%, and kanamycin（KM）2.21%. Multivariate logistic regression analysis showed that patients having a history of treatment, aged 20-39 and 40-60 years old were risk factors for drug resistance and MDR of pulmonary TB. Among patients who failed in retreatment, OR (95% CI) of resistance to INH, RFP, SM, EMB, OFX, KM, and MDR were 13.5(9.9-18.4), 21.2(15.2-29.5), 5.3(3.9-7.2),11.9(7.6-18.7), 7.6(4.6-12.6), 7.9(3.6-17.5), and 25.0(17.7-35.1) respectively; among patients who had recurrence, OR(95% CI) of resistance to INH, RFP, SM, EMB, OFX, and MDR were 7.4(5.5-10.0), 10.3(7.4-14.2), 3.5(2.5-4.8), 7.3(4.5-11.9), 4.1(2.5-6.8), and 12.2(8.7-17.1) respectively；among patients who failed in initial treatment, OR (95% CI) of resistance to INH,RFP,SM,EMB, and MDR were 7.6(4.7-12.3), 9.8(5.9-16.0), 4.1(2.5-6.8), 12.1(6.5-22.7), and 11.4(6.9-18.9) respectively. Among patients aged 20-39 years old, OR (95% CI) of resistance to INH,RFP,SM, and MDR were 2.5(1.8-3.4), 3.6(2.5-5.2), 2.9（2.0-4.1）, and 4.1（2.8-6.1） respectively；among patients aged 40-60 years old, the OR(95% CI) of resistance to INH,RFP,SM, and MDR were 2.2(1.6-3.0),3.1(2.2-4.4),2.3（1.6-3.2）, and 3.3（2.3-4.7）respectively.ConclusionDrug resistance of smearpositive pulmonary TB patients is serious in Hunan Province, patients receiving antituberculosis treatment and aged between 20-60 years old have high risk for drug resistance and MDR.

Abstract:

ObjectiveTo explore the application value of cellular automata(CA) in simulating the epidemic spread of outbreak of influenza A(H1N1).MethodsThe publications regarding influenza A(H1N1) from January 2009 to March 2015 were collected from the China National Knowledge Infrastructure(CNKI), epidemiological data of H1N1 were retrieved according to inclusion criteria, the Matlab 7.0 software was adopted to construct CA model for simulating and analyzing the epidemic of H1N1 occurred in a university in Chongqing between October 12 and November 20,2009.ResultsThere were a total of 17 820 students in this university, the epidemic of influenza lasted 40 days in 2009; When the parameter, the effective infection rate was 0.04, the model of CA fit well, and gave estimate for basic reproduction number (R0) 1.202.ConclusionCA has certain reliability in simulating epidemics of airborne infectious diseases, it can provide reference for the prevention and control of disease.

Abstract:

ObjectiveTo investigate the nationwide prevalence of healthcareassociated infection (HAI), and establish the related indexes of HAI.MethodsA crosssectional survey was conducted through combination of bedside investigation and medical record reviewing, the prevalence of HAI in hospitals of National HAI Surveillance System and other hospitals voluntarily participated in the survey were investigated according to unified survey program.ResultsA total of 1 008 584 patients in 1 766 hospitals participated in the survey, 26 972 cases of HAI occurred, prevalence rate of HAI was 2.67%, antimicrobial usage rate was 35.01%. Difference in prevalence rates of HAI and antimicrobial usage rates among hospitals with different number of beds were both significant (χ2=1 599.21, 3 458.40，respectively, both P＜0.01）. The main infection sites were lower respiratory tract (47.53%), urinary tract (11.56%) and surgical site(10.41%). A total of 13 784 pathogenic strains were isolated, the top five pathogens were Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus. Prevalence rate of HAI and prophylactic antimicrobial usage rate in patients receiving operation of class Ⅰincision were 1.01% and 27.99% respectively, difference in prophylactic antimicrobial usage rates in patients receiving operation of class Ⅰ incision at hospitals with different number of beds were significant (χ2=400.34，P＜0.01）；among patients receiving antimicrobial prophylaxis, percentage of specimens sending for bacterial detection was 45.89%, difference in bacterial detection rates in hospitals with different number of beds were significant (χ2=9 189.90，P＜0.01）. Hospital with more than 900 beds had the highest prevalence rate of HAI（3.36%）, lowest usage rate of antimicrobial agents（32.35%）, and highest bacterial detection rate（56.03%）.ConclusionMultiple indexes of this crosssectional survey revealed that HAI management in China has achieved remarkable results; meanwhile, calculation of the percentile distribution of each index is convenient for selfevaluation for HAIrelated work in each hospital.

Abstract:

ObjectiveTo investigate the distribution and antimicrobial resistance of pathogens from lower respiratory tract in patients in intensive care unit (ICU), so as to provide reference for clinical treatment.MethodsDistribution and antimicrobial susceptibility of pathogens isolated from ICU patients’ sputum obtained through fiberbronchoscope between 2011 and 2014 were analyzed retrospectively.ResultsA total of 3 454 pathogenic strains were isolated between January 1,2011 and December 31,2014, the percentage of gramnegative bacteria, grampositive bacteria,and fungi were 84.11%, 14.50%, and 1.39% respectively. The detection rates of extendedspectrum βlactamaseproducing Escherichia coli and Klebsiella spp. in 2011-2014 were 38.46%-73.33% and 26.95%-37.06% respectively. Enterobacteriaceae strains had low resistance rates to imipenem and meropenem (<20.00%); resistance of Acinetobacter baumannii was higher than Pseudomonas aeruginosa, both had low resistance rates to amikacin(3.32%-37.16%); vancomycin and linezolidresistant strains were not found among Staphylococcus. In 2011-2014, detection rates of methicillinresistant Staphylococcus aureus(MRSA) were 42.86%-61.22%, methicillinresistant coagulasenegative staphylococcus (MRCNS) were 86.96%-91.67%; resistance rates of Enterococcus faecium was higher than Enterococcus faecalis, vancomycinresistant strains were not found among Enterococcus faecalis and Enterococcus faecium; the major fungus was Candida albicans.ConclusionAntimicrobial resistance of pathogens isolated from lower respiratory tract is getting more serious, clinicians should pay attention to nonantimicrobial infection control strategies in addition to rational use of antimicrobial agents.

Abstract:

ObjectiveTo investigate the status of tuberculosis (TB) infection among health care workers (HCWs) in an infectious diseases hospital, and explore the risk and influencing factors of TB infection.MethodsAll HCWs in an infectious diseases hospital were surveyed through questionnaire and purified protein derivative (PPD) testing.ResultsIncidence of TB infection among all HCWs in this hospital was 48.18%. There was no significant difference in TB infection among HCWs in different departments（P＞0.05）. TB infection among HCWs of different working seniority, different ages, and different job titles were all significantly different （all P＜0.05）. Risk factors for TB infection were education level, job title, living condition, and working time in TB clinics or wards, OR (95%CI) were 1.70（1.03-2.80）, 1.95（1.10-3.45）,1.84（1.03-3.28）,and 2.38（1.40-4.04）respectively；personal protection was a protective factor for TB infection (OR,0.92 ［95% CI, 0.85- 0.99］）.ConclusionHCWs in infectious diseases hospital are at high risk of TB infection, they should improve their selfprotection consciousness, and take protective measures as early as possible.

Abstract:

ObjectiveTo observe the clinical efficacy and adverse reactions of tigecycline in treatment of healthcareassociated pneumonia (HAP) caused by extensively drugresistant Acinetobacter baumannii (XDRAB).MethodsClinical data of patients who used tigecycline for the treatment of XDRAB HAP in intensive care units of a hospital from March 2013 to June 2014 were retrospectively analyzed.ResultsXDRAB isolated from 31 patients with HAP were all sensitive to tigecycline, the resistance rates to carbapenems and sulbactams (including cefoperazonesulbactam, SCF) were all 100%，17 cases （54.84%）were mixed infection. Combined use rates of tigecycline and SCF were 85.71%（12/14）in respiratory intensive care unit(RICU) and 47.06%（8/17） in general intensive care unit(GICU). Of 31 patients, the cure rate, effective rate, bacterial clearance rate, and antimicrobial adverse reaction rate were 29.03%，45.16%, 61.29%, and 16.13% respectively, no serious adverse drug reactions occurred. In RICU group and GICU group, the cure rates were 42.86% and 17.65% respectively, effective rates were 71.43% and 23.53% respectively, and bacterial clearance rates were 78.57 % and 47.06% respectively, difference in effective rate between two groups was significant (P<0.05).Among patients receiving combination of tigecycline and SCF as well as not receiving combined SCF, the cure rates were 35.00% and 18.18% respectively, effective rates were 60.00% and 18.18% respectively, and bacterial clearance rates were 65.00% and 54.55% respectively, difference in effective rate between two groups was significant (P<0.05).ConclusionTigecycline has a good clinical efficacy and little adverse reaction in treating XDRAB HAP; tigecycline combined with SCF is a good choice.

Abstract:

ObjectiveTo investigate the distribution and antimicrobial resistance of gramnegative bacilli isolated from wound specimens of orthopedic patients, and provide reference for the rational use of antimicrobial agents. Methods682 isolates of gramnegative bacilli were collected from orthopedic department in a comprehensive hospital between January 2011 and December 2013, antimicrobial susceptibility testing results were analyzed. ResultsThe main gramnegative bacilli isolated from wound specimens of orthopedic patients were Pseudomonas aeruginosa (P.aeruginosa) (16.72%), Escherichia coli (E.coli)(15.40%), and Enterobacter cloacae (E. cloacae)(12.76%). The detection rates of extendedspectrum betalactamase  producing E. coli and Klebsialla pneumoniae (K.pneumoniae) were 54.29%（57/105) and 31.43% （22/70） respectively, and mainly distributed in the trauma orthopedic department, accounting for 49.12% and 45.45% respectively.The susceptibility rates of E. coli, K. pneumoniae,and E. cloacae to meropenem and imipenem were all 100.00%. The susceptibility rates of E. coli and K. pneumoniae to amikacin, piperacillintazobactam and amoxicillin/clavulanic acid were all >80%. Susceptibility rate of E. cloacae to most antimicrobial agents were 71.26%-100.00% except for piperacillin(64.37%). Susceptibility rates of P. aeruginosa to most antimicrobial agents were >85% except for cefepime (78.95%) and aztreonam (65.79%).ConclusionGramnegative bacilli are the most common pathogens in wound infection of orthopedics patients. In order to use antimicrobial agents rationally and improve clinical treatment effect, it is important to realize the distribution of pathogens and antimicrobial resistance.

Abstract:

ObjectiveTo study infection status of hepatitis C virus(HCV) in patients at a tertiary firstclass hospital in Hubei Province.MethodsDetection results of HCVIgG in hospitalized patients with nondigestive system diseases and patients in infectious diseases department between May 2012 and April 2014 were collected, HCV infection rates in patients of different genders and age groups were analyzed statistically.ResultsA total of 104 487 patients were conducted HCV detection, 1 619 (1.55%) were positive for HCV; HCV infection rates in male and female patients were 1.56% and 1.54% respectively, HCV infection rate was not significantly different between different genders, and different age groups（both P＞0.05）.ConclusionPositive rate of HCV in this study is lower than average national level, prevention and control of healthcareassociated infection caused by HCV should be intensified.

Abstract:

ObjectiveTo analyze the isolation rates and antimicrobial resistance of Acinetobacter baumannii(AB) from intensive care unit(ICU) between 2010 and 2013, and provide evidence for clinical antiinfective therapy.MethodsThe isolation and antimicrobial resistance of AB from ICU between 2010 and 2013 were analyzed retrospectively.ResultsA total of 1 413 pathogenic strains were isolated, 556(39.35%) of which were AB, isolation rates in each year were 39.45%,41.35%,29.44%,and 40.53% respectively. AB were mainly isolated from lower respiratory tract (75.72%). Antimicrobial susceptibility testing results showed that AB had low resistance rates to cefoperazone/sulbactam（5.85%）and amikacin （17.45%）；detection rates of multidrugresistant and extensively drugresistant AB increased from 9.63% and 3.70% to 42.50% and 31.88%，respectively（both P＜0.001）.ConclusionAB is the common pathogen in ICU, antimicrobial resistance is serious, isolation of multidrugresistant and extensively drugresistant AB increased year by year； intensifying the monitoring of drug resistance is helpful for the treatment and prevention of AB infection.

Abstract:

ObjectiveTo evaluate the effect of comprehensive intervention on perioperative antimicrobial prophylaxis in clean incision surgery in a hospital.MethodsFrom 2011, clean incision surgery cases were performed comprehensive intervention, antimicrobial use in 2011-2013 were compared.ResultsA total of 5 945 cases of clean incision surgeries were investigated between 2011 and 2013, 3 827 cases (64.37%) received prophylactic use of antimicrobial agents. Prophylactic antimicrobial usage rates in 2011-2013 were 84.95%, 69.99%, and 52.97% respectively（χ2=380.94， P＜0.001）；the correct rates of medication time were 50.97%, 79.99%, and 98.95% respectively（χ2=827.02， P＜0.001）；the percentages of prophylactic antimicrobial use ≤24 hours were 24.91%,39.96%, and 64.95% respectively（χ2=422.55,P＜0.001）；additional antimicrobial usage rates during surgery were 50.00%, 60.00%, and 80.00% respectively（χ2=59.47，P＜0.001）.ConclusionThe implementation of comprehensive intervention measures can standardize antimicrobial use, reduce prophylactic antimicrobial usage rate, improve the correct rate of medication time, shorten the duration of antimicrobial use, and implement additional use of antimicrobial agents during surgery.

Abstract:

ObjectiveTo evaluate the correlation between occupational exposure and work intensity of health care workers(HCWs) in an infectious diseases hospital for 5 consecutive years, and provide reference for occupational precaution.MethodsOccupational exposures cases reported between January 2010 and December 2014 were analyzed retrospectively, occupation types, exposure routes, and exposure sources were analyzed.ResultsA total of 228 cases of occupational exposure were reported, nurses and doctors were the major exposure population(75.44% and 19.30% respectively); occupational exposure mainly occurred during the infusion process(52.19%); hepatitis B was the main exposure source (71.05%),followed by human immunodeficiency virus (10.09%).The Pearson correlation coefficient between the occupational exposure rate of doctors and the ratio of doctors to patients was -0.849 (P＜0.05), and for nurses, the correlation coefficient was -0.823 (P＜0.05).ConclusionNurses are high risk population of occupational exposures, occupational exposure is most likely to occur during transfusion process, occupational exposure of doctors and nurses has a strong correlation with the work intensity.

Abstract:

ObjectiveTo understand the infection caused by multidrugresistant organisms(MDROs) in a neurological intensive care unit (NeuroICU), and evaluate the effect of comprehensive intervention measures.MethodsTargeted monitoring on MDROs among patients who hospitalized in a NeuroICU for ＞48 hours between March and December 2011 was implemented, comprehensive intervention measures were taken, MDRO infection before and after intervention was compared.ResultsA total of 932 patients were monitored, 72 (7.73%) developed MDRO healthcareassociated infection(HAI); the top five MDROs were Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli. The main infection site of MDRO infection was lower respiratory tract, followed by urinary tract and bloodstream. Detection rates of MDROs before and after intervention were 11.70%(n=55) and 3.68%(n=17) respectively(χ2=16.675, P＜0.001).ConclusionPatients in NeuroICU are prone to develop MDRO infection, comprehensive intervention measures can reduce the incidence of HAI.

Abstract:

ObjectiveTo explore the effect of quality control circle (QCC) activities on decreasing postoperative intracranial infection in patients with intracranial tumor.MethodsQCC activity group was set up and the activity theme was established, postoperative intracranial infections in patients with intracranial tumor in a hospital from May 2011 to June 2012 were analyzed retrospectively, causes of postoperative intracranial infection were analyzed, goals were set, feasibility was analyzed, effective rectification measures were made, and were compared with postoperative intracranial infection in patients after implemented QCC from January to December 2013.ResultsPostoperative intracranial infection rate in patients with intracranial tumor decreased from 11.01%（12/109） before implementing QCC activities to 3.64% （4/110）after implementing QCC activities（χ2=4.395，P=0.036）; antimicrobial usage rate elevated from 15.63%（5/32） to 36.36%（16/44）（χ2=3.985，P=0.046）when operation time ＞4 hours; qualification rate of surgical hand disinfection elevated from 50.00% （50/100）to 75.00%（75/100）（χ2=11.163，P=0.001）.ConclusionQCC activity can not only reduce the incidence of postoperative intracranial infection in patients with intracranial tumor, but also make participants master the skills of quality management.

Abstract:

ObjectiveTo evaluate the effect of controlling cost by introducing hand hygiene products with lower price on promoting hand hygiene compliance.MethodsThe application status and cost of hand hygiene products in 2012 was as preintervention group，2013 was as postintervention group. Effective and lower price hand hygiene products were introduced in 2013, consumption and cost of hand hygiene products before and after the intervention was compared.ResultsConsumption of hand hygiene products per patientday before and after the intervention was significantly different (［10.56±16.46］ mL vs ［13.79±16.93］ mL，Z=4.14,P<0.01); cost of hand hygiene products per patientday before and after the intervention was not significantly different (［1.23±2.07］ yuan vs ［0.92±0.59］ yuan， P>0.05).ConclusionIntroduction of hand hygiene products with lower price in this hospital can improve hand hygiene compliance to certain degree without increasing the cost of hand hygiene.

Abstract:

目的了解社区卫生服务中心的医院感染管理现状，为进一步规范管理提供依据。方法随机抽取某市22所社区卫生服务中心，自行设计调查表，于2014年6月采用实地查看、资料查阅、人员访谈的形式收集资料，并与2012年调查结果进行比较。结果共调查社区卫生服务中心22所，均有医院感染管理制度及操作流程，但相对比较完善者仅占22.73%；2014年21所（95.45%）中心设有兼职人员，其中18名（81.82%）持证上岗；2012年仅3所（13.64%）中心设兼职人员，无1人持证上岗。21所（95.45%）中心不定期开展医院感染知识培训，培训次数以1次/季度为主（9所，占40.91%）；建筑布局与流程基本合理者9所（占40.91%），设供应室的单位11所（50.00%）；仅9所（40.91%）手卫生设施齐全；均配置有紫外线消毒灯管，使用、安装合格者仅13所（59.09%），7所（31.82%）配置有动态空气消毒机； 9所（40.91%）社区卫生服务中心配置有污水处理设备或设施。结论该市社区卫生服务中心的医院感染管理水平较2012年有所提高，但在制度落实、人力资源配备及培训、重点部门及手卫生的管理、消毒设备的配置与管理等方面仍需加强与改进。

Abstract:

目的检测1 mL洁芙柔消毒凝胶进行手消毒的效果，以及其对多重耐药菌（MDRO）的杀灭效果。方法在Ⅱ类工作区域（重症监护病房）、Ⅲ类工作区域（供应室检查包装灭菌区、中心门急诊）各放置25瓶洁芙柔消毒凝胶，并于该医疗区域随机抽取手部无可见污染的工作人员各50名，取用1 mL进行手卫生，对工作人员手进行采样和悬液定量杀菌试验。结果50瓶使用中消毒凝胶在开启第30 天均无细菌生长；100名被检医务人员消毒前手菌落数中位数为3.28 CFU/cm2，消毒后中位数为0.32 CFU/cm2，差异有统计学意义（S=2 232.50，P＜0.01）；随机抽取的1瓶开启后第30 天的消毒凝胶对MDRO作用1、3、5 min后的细菌杀灭率均为100%。结论使用1 mL洁芙柔消毒凝胶进行手消毒能达到手卫生规范要求的消毒效果，开启后的消毒凝胶使用有效期有待进一步研究。

Abstract:

目的了解某中医院临床分离鲍曼不动杆菌及其耐药性情况。方法对2012—2014年该中医院住院患者的临床标本分离培养、细菌鉴定和药敏结果进行回顾性分析。结果2012—2014年临床分别分离病原菌307、565、600株，其中共检出鲍曼不动杆菌79株，2012—2014年分别为14株（4.56%）、27株（4.78%）、38株（6.33%）。临床标本类型主要为痰（占68.36%）和尿标本（占20.25%）；分离鲍曼不动杆菌最多的科室为脑外科和呼吸内科；鲍曼不动杆菌对限制级和特殊级抗菌药物耐药率大多呈下降趋势，非限制级抗菌药物的耐药率则呈上升趋势。结论该中医院临床标本鲍曼不动杆菌分离率较低，抗菌药物耐药率控制较好。

Abstract:

目的了解某大型中医院重症监护病房（ICU）患者医院感染的特点，探讨有效预防和控制医院感染的措施。方法确定 ICU医院感染监测方案，设计调查表（病例监测表和患者日志表），调查2012年1月—2013年12月入住该院ICU的患者。结果2012—2013年ICU患者医院感染发病率分别为32.56%、19.11%，差异有统计学意义（χ2=13.66，P<0.001）；医院感染调整日发病率分别为8.88‰、4.65‰，差异有统计学意义（χ2=4.88，P=0.03）；2012、2013年呼吸机使用率、泌尿道插管使用率、中心静脉插管使用率比较，差异均有统计学意义（均P<0.001）；2012、2013年呼吸机相关肺炎（VAP）发病率比较，差异有统计学意义（χ2=6.64，P=0.01）；ICU患者医院感染居首位的病原菌为鲍曼不动杆菌。结论ICU患者是医院感染的易感人群，目标性监测可以有效降低ICU患者医院感染发病率。

Abstract:

金黄色葡萄球菌脓毒症常出现多脏器功能损伤和迁徙性脓肿。我院诊治了1例金黄色葡萄球菌脓毒症并下肢深静脉血栓形成（deep venous thrombosis, DVT）的患儿，现将其临床表现、诊治经过报告并文献复习如下。1

Abstract:

宫腔镜是一项新型、微创型妇科诊疗技术，具有创伤小、手术时间短、疗效满意等优点，可用于诊断、治疗和探查子宫腔内病变，现已广泛应用于临床妇产科。但是，在宫腔镜的诊治过程中，也会出现一些并发症，如宫颈损伤、子宫穿孔、阴道出血、感染、静脉空气栓塞、过度水化综合征［1-3］等。因此，掌握适应证和禁忌证，严格消毒器械和遵守无菌原则，早期发现并正确处理宫腔镜并发症，对提高手术的安全性具有重要意义。本文就近年来宫腔镜手术医院感染管理进展情况作一综述。