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ObjectiveTo establish an extensively drugresistant Acinetobacter baumannii(XDRAB) infection model using Caenorhabditis elegans(C. elegans), and evaluate the effect of efflux pump inhibitors(EPIs) on reversal of ciprofloxacin resistance in XDRAB. MethodsXDRAB infection model of C. elegans was established, six EPIs(CCCP, PAβN, NMP, omeprazole, reserpine, and verapamil）combined with ciprofloxacin were used to treat the infected model, the survival rate of C. elegans was recorded to evaluate the in vivo activities of drugs, toxicity test and in vitro drug susceptibility test were also performed.ResultsLethal effect of different concentrations of XDRAB on C. elegans was varied, 5×106 CFU/mL of XDRAB was selected to infect C. elegans. C. elegans survival test showed that survival curves of C. elegans infected with XDRAB for 3 hours and curves of control group (polymixin B was added) were not significantly different （χ2=3.154，P＞0.05）; compared with control group, survival curves of C. elegans infected with XDRAB for 6 hours or 9 hours were significantly different (both P<0.001), but 6 hours and 9 hours were not significantly different（χ2=0.669，P＞0.05），6 hours was chosen as the duration of infection, 36 hours was appropriate for the duration of antimicrobial therapy. Ciprofloxacin with EPIs for infection model revealed that low concentration of PAβN, NMP, omeprazole, and reserpine could improve the survival rate of C. elegans by 30%-40%, 15%-20%, 20%-30%, and 20% respectively, high concentration of verapamil could improve the survival rate of infected C. elegans by about 30%. In vitro susceptibility test and toxicity test results showed that ciprofloxacin combined respectively with CCCP, omeprazole, and verapamil could reduce minimum inhibitory concentration(MIC) to the original 1/4, combined respectively with PAβN，NMP, and reserpine could reduce MIC to the original 1/2, CCCP had the best bacterial inhibitory effect in vitro, but the toxicity was large, and was not suitable for the study of pharmacodynamics in vivo. ConclusionThe infection model of C. elegansXDRAB is initially and successfully established, which is used to evaluate the efficiency of six EPIs for reversing ciprofloxacin resistance.

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ObjectiveTo evaluate the effect of personnel activities and air purifiers on airborne microorganisms and particulate matter in bronchoscopy room.MethodsAccording to whether there was personal activity and air purifier in the bronchoscopy room, the experiment was divided into four groups：dynamic nonpurification group, dynamic purification group, static nonpurification group, and static purification group, indoor air samples were collected and analyzed at five different time points (0, 0.5, 1, 2, 4 h), microorganisms in the air were collected by planktonic method, then cultured and counted, concentration of particulate matter was determined by DT9881M laser dust particle counter, variance analysis of factorial design was used for statistical analysis. ResultsColony count/concentration of airborne bacteria, fungi, total microorganisms (bacteria+fungi), PM2.5, and PM2.5-10.0 in dynamic nonpurification group were (113.53±7.78) CFU/m3，(89.67±7.17) CFU/m3，(203.20±10.92) CFU/m3，(86 557.20±4 158.29) counts/m3，and (659.69±38.91) counts/m3 respectively, in static nonpurification group were (84.33±3.65) CFU/m3, (65.00±2.65)CFU/m3, (149.33±4.98) CFU/m3, (45 812.64± 1 279.61) counts/m3, and (189.15±4.64) counts/m3 respectively, in dynamic purification group were (84.80±8.08) CFU/m3，(90.40±5.50) CFU/m3，(175.20±9.22) CFU/m3，(49 336.38±2 039.16) counts/m3, and (218.36±7.02) counts/m3 respectively，in static purification group were (67.80±5.63) CFU/m3, (38.27±3.70) CFU/m3, (106.07±6.76) CFU/m3, (29 772.53±2 212.93) counts/m3, and (124.80±7.16) counts/m3 respectively. Colony count/concentration of airborne bacteria, total microorganisms, PM2.5, and PM2.5-10.0 in dynamic group were all higher than those in static group, nonpurification group were higher than purification group(both P<0.05)，colony count of fungi in dynamic nonpurification group was higher than static nonpurification group, in static purification group was lower than static nonpurification group(both P<0.05)，there was no significant difference between dynamic purification group and dynamic nonpurification group （P=0.936）.ConclusionPersonal activities can increase colony count/concentration of microorganisms and particulate matter in bronchoscopy room, air purifier can reduce the bacteria, total microbial count, and particulate matter in the air of bronchoscopy room.

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ObjectiveTo study the bactericidal efficacy of hospital commonly used disinfectants such as ethanol, 3" chlorine tablets, iodophor, glutaraldehyde, and avagard instant hand antiseptic on Staphylococcus aureus(S. aureus) from different sources of hospital, and provide scientific basis for effective control of healthcareassociated infection(HAI).MethodsA total of 48 strains of S. aureus from inpatients, hands of health care workers, and environment surface in the First Affiliated Hospital of Nanchang University were collected. Disinfectant was directly contacted with bacteria, in vitro killing efficacy of disinfectant on S. aureus from different sources at different diluted concentrations, and different contact time were studied.ResultsThe killing rate of 5g/L iodophor, 20g/L glutaraldehyde, and avagard instant hand antiseptic(0.5% chlorhexidine+70% ethanol) to S. aureus with a 5minute contact time was 100%; killing rates of 70% ethanol and 1g/L 3" chlorine tablets to S. aureus with a 5minute contact time were 96.5%-99.8%；but highly diluted iodophor, glutaraldehyde, and avagard instant hand antiseptic still could not completely kill S. aureus even the contact time was extended.ConclusionThe routine use of disinfectants in the hospital can meet the clinical bactericidal efficacy, it is necessary to monitor concentration routinely, avoid decreasing sterilization ability.

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ObjectiveTo evaluate the role and significance of Treg/Th17 cells imbalance in pathogenesis and recurrence mechanism of condyloma acuminatum (CA).Methods52 patients with CA were selected as study group(CA group， 27 with initial occurrence of CA, 25 with recurrence of CA), 30 healthy persons were as control group, flow cytometry was used to detect the proportion of Treg cells and Th17 cells in the peripheral blood, the expression level of Foxp3 mRNA and RORγt mRNA in peripheral blood mononuclear cells was determined by realtime quantitative polymerase chain reaction.ResultsThe proportion of Treg cells and the expression level of Foxp3 mRNA in peripheral blood in CA group was higher than that in control group, recurrence CA group was higher than initial occurrence CA group, difference was significant(both P＜0.05); the proportion of Th17 cells and expression level of RORγt mRNA in CA group was significantly lower than that in control group, proportion of Th17 cells in recurrence CA group was lower than initial occurrence CA group, there was significant difference (both P<0.05). The proporation of Treg/Th17 in CA group was higher than that in healthy controls(4.60［3.20,8.68］ vs 1.39［1.05，2.05］, P＜0.05）, recurrence CA group was higher than initial occurrence CA group (8.19［4.21,10.81］ vs 3.52［2.47，4.85］, P＜0.05）.ConclusionThere is an imbalance between Treg cells and Th17 cells in patients with CA, especially in patients with reccurrence of CA， the imbalance of Treg/Th17 cells may play an important role in the pathogenesis and recurrence mechanism of CA.

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ObjectiveTo investigate prevalence of healthcareassociated infection(HAI) and communityassociated infection(CAI) in hospitalized patients in Hebei Province. MethodsA certain day from August 17 to August 28, 2015 was selected as the survey day, unified questionnaires were formulated, the prevalence of HAI and CAI in hospitalized patients in secondary and above comprehensive hospitals in Hebei Province was surveyed, pathogens causing infection were analyzed and compared. ResultsA total of 65 065 patients in 253 hospitals were surveyed, prevalence rates of HAI and CAI were 2.89% and 16.84% respectively. The top three sites of HAI were respiratory tract(61.32%), urinary tract(12.49%), and surgical site(9.83%), the top three sites of CAI were respiratory tract (56.70%), urinary tract(10.89%), and gastrointestinal tract(8.35%). Distribution of sites of HAI and CAI was significantly different(P<0.01). The top 5 pathogens were of the same species, but ranked differently, the main bacteria causing HAI was Pseudomonas aeruginosa(22.69%), CAI was Escherichia coli(23.79%). There was significant difference in the distribution of pathogens between HAI and CAI (P<0.01). There were significant differences in pathogenic species causing respiratory tract, gastrointestinal tract, urinary tract, and intraabdominal infection(all P<0.05). Isolation rates of extendedspectrum βlactamaseproducing/carbapenemresistant Klebsiella pneumoniae, methicillinresistant Staphylococcus aureus between HAI and CAI were all significantly different(all P<0.001). ConclusionIncidence of infection, infection sites, as well as constituent of pathogens and multidrugresistant organisms between HAI and CAI are varied, besides monitoring on HAI, monitoring on drug resistance of pathogens causing CAI should be paid attention, so as to provide scientific basis for rational antimicrobial use in clinical practice.

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ObjectiveTo evaluate the occurrence of surgical site infection (SSI) after cesarean section in secondary and above medical institutions in China since 2009, and provide data support for monitoring healthcareassociated infection(HAI). MethodsLiteratures on SSI following cesarean section published after 2009 were retrieved from China National Knowledge Infrastructure (CNKI), Chinese Science&Technology Journal Database (VIP), Wanfang Database, and PubMed, quality of literatures was evaluated by referring to disease incidence or morbidity quality evaluation criteria, combined incidence of SSI was estimated by Meta analysis, subgroup analysis was performed according to the levels of the medical institutions. ResultsA total of 61 literatures were included in the study, 19, 36, and 6 literatures were with quality scores of 7, 6, and 5 respectively, the overall quality of literatures was better. The total sample size was 173 319 cases, 2 860 cases occurred SSI, incidence of SSI after cesarean section was 1.8%(95%CI［1.6%，2.0%］）. Subgroup analysis showed that incidence of HAI in secondary medical institutions was 2.3%(95% CI［1.8%，2.7%］）, which was higher than 1.4%(95%CI［1.2%，1.7%］）of tertiary medical institutions. ConclusionIncidence of SSI after cesarean section in secondary and above medical institutions in China is high, and is different among different levels of medical institutions. Different monitoring baselines should be established according to actual condition, so as to guide HAI control work scientifically.

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［Abstract］ObjectiveTo investigate anorectal infection with Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) among men who have sex with men (MSM) with anorectal condyloma acuminatum(CA), and provide evidence for the clinical diagnosis and treatment of anorectal CA.MethodsAnorectal swabs were obtained from MSM who were diagnosed with anorectal CA(trial group) and without CA(control group), nucleic acid fragments of NG and CT were detected by fluorescent quantitative polymerase chain reaction. Data about social demographic characteristics and sexual behaviors of investigated people were collected, compared and analyzed.ResultsA total of 158 patients were enrolled in this study, 63 were in trial group and 95 in control group. Among 63 patients in trial group, infection rate of NG and CT were 17.46% and 28.57% respectively, coinfection rate of NG and CT was 12.70%；in control group, infection rate of NG and CT were 6.32 % and 9.47 % respectively, coinfection rate of NG and CT was 2.16%；infection rate of NG and CT, as well as coinfection rate of NG and CT in trial group were all significantly higher than control group(all P<0.05).ConclusionInfection rate of NG and CT is high in MSM with anorectal CA，suggesting that more attention should be paid to the screening of NG, CT and other sexually transmitted infection among those who were clinically diagnosed with anorectal CA.

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ObjectiveTo understand the status of mobile phone use and  bacterial carriage on surface of mobile phones used by health care workers(HCWs) in municipal hospitals in a city, explore the influencing factors of mobile phone use behavior and bacterial carriage status. MethodsIn AprilJune, 2016, 111 HCWs in 24 hospitals in a city were performed questionnaire survey, onsite observation, and sampling of mobile phone surface. ResultsA total of 111(100.00%)  available questionnaires were distributed and returned. The average age of  the respondents were （32.00±9.03）years old, female and nurses were predominant. 95.50% of respondents used touch screen mobile phones, 24.32% used mobile phones during diagnosis and treatment, 65.77% used mobile phone >2 hours every day, 93.69% cleaned and disinfected mobile phones, 98.20% thought that pathogenic microorganisms exited on the surface of mobile phones. A total of 111 mobile phone surface specimens were collected, the qualified rate was 80.18%, contamination rate was 95.50%, average colony number was 2.90 CFU/cm2, the maximum bacterial content was 111.60 CFU/cm2. Among 44 specimens of mobile phone surface, 55 strains of 18 species of pathogenic bacteria or opportunistic pathogenic bacteria were detected. Age, gender, and occupation were the influencing factors of mobile phone use behavior and attitude; qualified rates were all significantly different among  mobile phones used by HCWs of different gender, occupation, and duration of mobile phone use (all P<0.05); bacterial contamination on the surface of mobile phones used by HCWs of different age, gender, occupation, duration of mobile phone use, and whether to use the phone shell/set were significantly different respectively(all P<0.05). ConclusionPotential pathogens on the surface of mobile phones may cause healthcareassociated infection through the use of mobile phones by HCWs during the process of medical diagnosis and treatment.

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ObjectiveTo explore risk factors for surgical site infection(SSI) in colorectal surgery, and provide evidence for formulating measures for preventing SSI. MethodsPatients who underwent colorectal surgery in the department of gastrointestinal surgery of a hospital from June 2013 to June 2016 were surveyed retrospectively, the related risk factors for SSI were analyzed by unconditional logistic regression analysis. ResultsAmong 397 patients who underwent colorectal surgery, 67 (16.88%) had SSI. Logistic regression analysis showed that smoking, low albumin, seniority of surgeons less than 5 years, irrational use of antimicrobial agents during perioperative period, and high National Nosocomial Infection Surveillance (NNIS) score were independent risk factors for SSI after colorectal surgery (all P<0.05). ConclusionThere are multiple risk factors for SSI after colorectal surgery, it is necessary to pay attention to it and formulate preventive measures, so as to reduce the occurrence of SSI effectively.

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ObjectiveTo evaluate the effect of different subclavian vein catheterization methods on catheterrelated bloodstream infection(CRBSI) in critically ill patients. MethodsPatients with subclavian vein catheterization for more than 7 days in the intensive care unit of a hospital between May 2008 and December 2015 were investigated retrospectively. They were divided into three groups: ultrasoundguided catheterization group(group A), conventional single lumen subclavian vein catheterization without skin expansion group(group B), conventional  double lumen subclavian vein catheterization group(control group). The survey included name, age, diagnosis, APACHE II score, catheterization sites and methods, whether or not succeeded in single catheterization, duration of catheterization, occurrence of CRBSI, and isolation of pathogens. Incidence of CRBSI, CRBSI per 1 000 catheterdays, and distribution of pathogens causing CRBSI were compared respectively among patients with different catheterization methods. ResultsA total of 2 366 patients were surveyed (group A, n=789; group B, n=786; control group, n=791). In group A, B, and control group, 13,15, and 40 cases developed CRBSI respectively, incidence of CRBSI were 1.65%, 1.91%, and 5.06% respectively，incidence of CRBSI per 1 000 catheterdays were 1.09‰, 1.27‰, and 3.36‰ respectively， the percentage of success in single catheterization were 97.47%, 88.80%, 87.23% respectively. There were significant difference in incidence，incidence of CRBSI per 1 000 catheterdays, and percentage of success in single catheterization among three groups(all P<0.01). Pairwise comparison showed that percentage of success in single catheterization in group A was higher than group B and control group, difference were significant (χ2 =46.25, 58.50，both P＜0.01）；incidence of CRBSI in control group was higher than group A and B(χ2 =12.82, 18.35 respectively，both P＜0.01）；incidence of CRBSI per 1 000 catheterdays in control group was higher than group A and B(χ2 =13.74, 11.22 respectively， both P＜0.01）. 13, 15, 40 strains of pathogens were isolated from three groups, Staphylococcus epidermidis and Staphylococcus aureus were the main pathogens in three groups, the proportion of coagulase negative staphylococcus infection in control group was higher than group A and B. ConclusionCompared with conventional catheterization methods (single lumen, double lumen), ultasoundguided subclavian vein catheterization can effectively improve the success rate of puncture. Ultrasoundguided catheterization and conventional single lumen subclavian vein catheterization without skin expansion can reduce the occurrence of CRBSI compared with double lumen subclavian vein catheterization.

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ObjectiveTo investigate the clinical significance of 5 kinds of inflammatory factors (MCP1, IL1β, IL18, HMGB1, and IL10) in severe EV71 handfootandmouth disease (HFMD).MethodsHospitalized children who were diagnosed with severe EV71 HFMD in a hospital in MarchAugust, 2014 were as HFMD group, healthy children who underwent physical examination in outpatient department of the same hospital during the same period were as control group, changes in expression levels of peripheral blood MCP1, IL1β, IL18, HMGB1, and IL10 of both groups were dynamically observed, clinical data of HFMD group were collected.ResultsThere were 102 children in HFMD group, the average age was (2.18±0.91) years old, 80.39% of whom were ≤3 years old; there were 77, 16, and 9 cases in HFMD group at stage 2, 3, and 4 respectively at admission. 77, 52, 21, and 88 cases went through stage 2, 3, 4, and 5 respectively. Expression levels of 5 kinds of inflammatory factors at stage 2, 3, and 4 in HFMD group were compared respectively with control group, differences were all statistically significant(all P<0.05); expression levels of IL10 at stage 3 and 4 in HFMD group were not significantly different (P>0.05). In HFMD group,the expression levels of HMGB1 of stage 2, 3 progression groups were both higher than recovery group(both P<0.05). The expression levels of 5 kinds of inflammatory factors in the death group and survival group at admission were all significantly different (all P<0.05).ConclusionThe expression levels of MCP1, HMGB1, IL1β, IL10, and IL18 are closely related to the severity of HFMD, and has certain clinical significance for the prognosis of children. HMBG1 has certain predictive value in the prognosis of HFMD.

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ObjectiveTo investigate the distribution and drug susceptibility of vaginal pathogens in pregnant women during perinatal period.MethodsVaginal discharge specimens of 10 800 women (5 400 were pregnant women during perinatal period, 5 400 were nonpregnant women) were performed bacterial culture and drug susceptibility testing. ResultsThe isolation rate of pathogens from 5 400 perinatal pregnant women was 26.00% (n=1 404), including 759 strains of fungi, 611 strains of grampositive cocci, 32 strains of gramnegative bacilli, 2 strains of Neisseria gonorrhoeae; among 5 400 nonpregnant women, the isolation rate of pathogens was 7.87% (n=425), including 232 strains of fungi, 182 strains of grampositive cocci, 5 strains of gramnegative bacilli, and 6 strains of Neisseria gonorrhoeae. Resistance rates of Streptococcus agalactiae isolated from perinatal pregnant women to erythromycin and clindamycin were 84.85% and 80.81% respectively，resistance rate of Staphylococcus aureus to erythromycin was 40.91%, resistance rates of Escherichia coli to tetracycline and sulfamethoxazole/trimethoprim were 69.23% and 53.85% respectively, resistance rate of Neisseria gonorrhoeae to penicillin and sulfamethoxazole/trimethoprim was 100.00%. ConclusionVaginal infection rate in perinatal pregnant women is higher than nonpregnant women, screening of vaginal pathogens in perinatal pregnant women should be strengthened, so as to ensure the safety of mothers and infants. 

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ObjectiveTo optimize antimicrobial use process, ensure the rational use of preoperative antimicrobial prophylaxis during consecutive operations.MethodsAntimicrobial use process in a hospital in December 2015 was optimized, 6 072 cases of consecutive operations in MayNovember 2015 were selected as control group, 5 832 cases of consecutive operations in December 2015May 2016 were as trial group, the qualified rate of rational use of antimicrobial agents was compared between two groups, causes for delayed/prior use was analyzed.ResultsBefore and after the optimization of antimicrobial use process, rates of antimicrobial use were 77.16% and 78.80% respectively, there was significant difference between two groups（χ2=8.305，P=0.004）. After the optimization of antimicrobial use process, rate of antimicrobial use within 0.5-1 hour was significantly higher than that before the optimization (82.36% vs 41.11%）; rate of antimicrobial use <0.5 hour before skin incision decreased from 57.11% before optimization to 4.32% after optimization; but rate of antimicrobial use >1 hour before skin incision increased from 1.78% to 13.32%. Causes for delay/prior use of antimicrobial agents was due to the lack of effective communication between doctors and nurses, which resulted in circuit nurses’ inaccurate assessment on interval of consecutive operations（62.13%）, the duration of intubation or puncture was too long for anesthesiologists（13.57%）.ConclusionOptimizing antimicrobial use process in consecutive operations can improve prophylactic antimicrobial use rate within 0.5-1 hour, and is helpful for ensuring the efficacy of antimicrobial prophylaxis.

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ObjectiveTo explore the application efficacy of quality control circle（QCC） in hand hygiene(HH) management of laboratory staff.MethodsLaboratory staff in a hospital in Neijiang from January to December 2016 were selected as the studied objects, QCC group of HH management of laboratory staff was established, causes of correct rate of HH in laboratory staff were analyzed, corresponding countermeasures were formulated and implemented; data before and after performing QCC activity were compared and analyzed, efficacy of activities was assessed.ResultsAfter implementing QCC activity, correct rate of HH in laboratory staff increased from 29.73% to 91.04%, difference was significant(P<0.001). At the same time, circle members’ ability in QCC skill, responsibility, sense of honor, selfconfidence, cohesiveness were all promoted with varying degrees.ConclusionThe implementation of QCC activities can not only improve the correct rate of HH of laboratory staff, but also enhance team confidence and cohesiveness, it is worthy of further clinical application.

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ObjectiveRhodococcus equi(R. equi) belongs to Rhodococcus spp., and is a grampositive bacterium. R. equi infection is a rare complication in advanced stage of patients with acquired immunodeficiency syndrome (AIDS). Diagnosis and treatment of one case of AIDS complicated with R. equi infection in a hospital was summarized, related literatures about AIDS complicated with R. equis infection published at home and abroad between January 2007 and January 2017 were reviewed, so as to improve clinicians’ understanding on clinical characteristics of AIDS combined with R. equi infection, early diagnosis of the disease can be achieved, and at least 2 kinds of antibiotics are selected for antiinfective treatment, highly active antiretroviral therapy can be given as soon as possible, better clinical outcomes can be expected.MethodsResultsConclusion

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ObjectiveTo explore the effect of SixSigma management on prevention and control of catheterrelated bloodstream infection(CRBSI) in intensive care unit(ICU). MethodsPatients with indwelling central venous catheter in the ICU of a hospital in MarchDecember 2015 were selected, five phases of SixSigma(define, measure, analyze, improve, and control) were used to find out the key factors that affected CRBSI, targeted improvement measures were taken, incidence of CRBSI before and after adopting SixSigma was compared. ResultsAfter SixSigma management was adopted, incidence of CRBSI declined from 15.95‰（13/815） to 6.19‰(4/646), difference was significant(P＜0.05). ConclusionSixSigma management can reveal the defect in workflow, guide researchers to propose corresponding measures, and effectively reduce the incidence of CRBSI in ICU.

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ObjectiveTo evaluate the effect of fulltime infection control nurses’ supervision on the compliance to implementation of comprehensive intervention measures and incidence of ventilatorassociated pneumonia(VAP). MethodsFulltime infection control nurses in the general intensive care unit(ICU) of a hospital were assigned, compliance to comprehensive intervention measures among all patients who were admitted to ICU was monitored. September 2012April 2014 was preintervention stage, May 2014December 2015 was postintervention stage. Utilization of ventilator and occurrence of VAP before and after implementing intervention measures were analyzed statistically.ResultsA total of 1 373 patients were monitored before intervention, 1 477 were monitored after intervention. Utilization rates of ventilator before and after intervention were 31.89% and 40.95% respectively. Incidence of VAP before and after intervention were 31.97‰ and 17.82‰ respectively, incidence of MDRO infection were 11.99‰ and 6.41‰ respectively. Microbial monitoring results of environmental object surface after intervention were all qualified (all≤5 CFU/cm2）. Fluorescence labeling clearance rate and hand hygiene compliance rate increased gradually in each quarter, reached more than 80% in the latter period; compliance to semireclining position was all 100% from the fourth quarter of 2014 to the fourth quarter of 2015.ConclusionThrough implementation of comprehensive intervention measures by fulltime infection control nurses, incidence of VAP can be decreased significantly, quality of medical treatment is improved, and safety of patients is ensured.

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ObjectiveTo analyze the epidemiological characteristics and antimicrobial resistance of clinically isolated Pseudomonas putida(P. putida), and provide basis for rational prevention and treatment of P. putida infection. MethodsP. putida isolated between January 2010 and December 2015, as well as clinical data of patients infected with P. putida were collected, antimicrobial susceptibility of isolates was determined by KirbyBauer disk diffusion susceptibility testing of Clinical and Laboratory Standards Institute (CLSI) of America, susceptibility testing results of isolated strains were analyzed by WHONET 5.5 software.  ResultsA total of 91 strains of P. putida were isolated from clinical specimens, most were from elderly patients aged >60 years(70.33%); the major underlying disease was communityacquired pneumonia (23.08%)，followed by chronic pulmonary heart disease(15.38%); the main specimen was sputum(57.14%), followed by urine(27.47%); P. putida mainly distributed in department of respiratory medicine (28.57%), followed by department of cardiovascular medicine (13.19%). P. putida had high resistance rate to aztreonam (52.75%), while resistance rates to gentamicin, imipenem, levofloxacin, ceftazidime, meropenem, and ciprofloxacin were 7.78%, 9.89%, 2.20%, 9.89%, 7.69%, and 2.22% respectively, resistance rates to amikacin and polymyxin were both 0. ConclusionP. putida infection mainly occurs in elderly patients with underlying diseases, mainly respiratory tract infection, resistance rates to most antimicrobial agents were <10%.

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目的了解河南省医疗机构口腔科医疗用水的供水流程和微生物污染现状，分析可能影响因素。方法采用问卷调查方式收集口腔科综合治疗台供水流程、水质类型等信息，并采集水样进行微生物学检测。结果调查河南省43所医疗机构口腔科，共采集水样1 419份，合格率46.65%，菌落总数中位值为120 CFU/mL。三级医院水样合格率最低(39.28%)，且与二级、一级医院水样合格率差异均具有统计学意义（均P<0.01）。将所采集水样按水质划分，口腔科管道自来水水样合格率44.24%，净化用水合格率48.75%。所采集5种类型水样中，手机喷水合格率最低（39.94%）。结论河南省医疗机构口腔科医疗用水微生物污染状况严重，尤其是手机喷水水样合格率低，建议展开有针对性调查，明确原因，探索切实可行的解决方法。

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目的了解医务人员手卫生依从性实际情况，探讨改进观察模式和施行手卫生干预措施对医务人员手卫生依从性的影响。方法2014年4月—2015年12月对某院所有临床科室医务人员进行手卫生调查。其中2014年10月开始改进手卫生观察模式，采用直接观察法，观察人员由10名新入院实习生组成，分为10组交叉进行调查。2015年4月开始实施手卫生干预措施，分别比较改进观察模式前后和实施干预措施前后手卫生依从率。结果改进观察模式前（2014年4—9月）医务人员手卫生依从率为74.69%（484/648），改进观察模式后（2014年10月—2015年3月）医务人员手卫生依从率为65.63%（401/611）。观察模式改进前后医务人员手卫生依从率比较，差异有统计学意义（χ2=12.36，P＜0.01）。实施手卫生干预后（2015年4月—2015年12月），手卫生依从率提高至76.05%，高于干预前（2014年10月—2015年3月）的65.63%（χ2=24.78，P＜0.01）。医生的手卫生依从率由干预前的60.14%提高至干预后的71.12%，护士的手卫生依从率由干预前的70.79%提高至干预后的80.93%，差异均有统计学意义（χ2值分别为12.14、13.78，均P＜0.01）。结论改进观察模式可减少霍桑效应，获得手卫生依从性的真实水平，强化手卫生干预可有效提高医务人员手卫生依从性。

Abstract:

近十年来，广泛耐药(extensively drugresistant，XDR)肺炎克雷伯菌的出现给全世界健康卫生带来严峻挑战。碳青霉烯类药物的广泛应用使碳青霉烯类耐药肺炎克雷伯菌(carbapenemresistant Klebsiella pneumoniae, CRKP)开始出现并广泛传播，也是导致广泛耐药肺炎克雷伯菌（XDRKP）出现的重要原因［1］。近年来，希腊、意大利、美国等地相继出现CRKP流行的报道。CRKP感染28 d致死率高达40%［2］，相关研究［3］表明，碳青霉烯类药物联合其他抗菌药物治疗CRKP感染与单独使用碳青霉烯类药物治疗相比，联合治疗能够显著改善患者预后。