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ObjectiveTo understand the homology of clinical isolates from patients with carbapenemresistant Klebsiella pneumoniae(CRKP) infection and isolates from environment in a medical institution. MethodsOne CRKP strain isolated from a patient in this hospital and 4 strains of Klebsiella pneumoniae(K. pneumoniae) isolated from patient’s surroundings were collected, susceptibility of 5 strains to commonly used antimicrobial agents was detected, production of carbapenems in 5 strains were detected by modified Hodge testing and carbapenem inactivation method（CIM）, homology analysis was performed by pulsedfield gel electrophoresis (PFGE). ResultsAntimicrobial susceptibility testing results showed that 5 strains of K. pneumoniae (1 from patient, 4 from the patient’s ward surroundings, including hands of nursing aides, solution bottle opening, handle for lifting and dropping bed, and bedrail) were all resistant to other antimicrobial agents except to cephamycin and aminoglycosides. The modified Hodge testing and CIM confirmed that 5 strains all produced carbapenemases; PFGE results showed that electrophoretogram of CRKP isolated from solution bottle opening of ward, bedrail, and handle for lifting and dropping bed were the same as CRKP isolated from patient, while electrophoretogram of CRKP isolated from hands of nursing aides had 2 different bands, there was a close relationship between the strains. ConclusionThe same type of CRKP were isolated from patient and his surroundings, it is necessary to implement healthcareassociated infection(HAI) control system, isolate infected patient, and strengthen environmental cleaning and disinfection, so as to avoid the outbreak of HAI.

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ObjectiveTo evaluate detection effect of three methods on monitoring microbes in dialysate and dialysis water for hemodialysis. MethodsSeventytwo dialysate and dialysis water specimens were collected from 36 medical institutions, specimens were cultured with three methods: blood agar plate incubated at 35℃ for 72 hours, Tryptic soy agar（TSA）plate incubated at 35℃ for 72 hours, and Reasoner’s 2A agar (R2A agar) plate incubated at 23℃ for 168 hours, colony counts, isolation of colony, and detection rate of colony exceeding action level（≥50 CFU/mL） were compared among three methods. ResultsThe colony isolation rates of microbes in dialysate and dialysis water detected by blood agar plate, TSA plate and R2A plate were 40.28%, 63.89%, and 69.44% respectively, difference was significant（χ2=14.16，P＜0.05）；pairwise comparison showed that isolation rates of colony on R2A agar plate and TSA plate were higher than blood agar plate. There was significant difference in isolated colony count between blood agar plate and R2A agar plate, TSA plate and R2A agar plate respectively（Z=-4.515, -6.970 respectively，both P＜0.05）. The rates of isolated colony exceeding action level in dialysate and dialysis water detected by blood agar plate, TSA plate, and R2A agar plate were 1.39%, 4.17%, and 20.83% respectively, difference was significant（χ2=19.83，P＜0.05），detection rate of R2A agar plate was higher than the other two methods. ConclusionThe detection rate of colony by R2A agar plate and TSA plate are better than blood agar plate, detection rate of colony exceeding action level by R2A agar plate is higher than TSA plate and blood agar plate, R2A agar plate for microbial monitoring(23℃,168 h) on dialysate and dialysis water is superior to the other two methods.

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ObjectiveTo understand the distribution and change in drug resistance of common pathogens before and after the implementation of special rectification activity on antimicrobial use in 2011-2015, and provide guidance for clinical application of antimicrobial agents. MethodsAntimicrobial use in hospitalized patients and pathogens isolated from patients in a hospital from 2011 to 2015 were collected, changing trend of resistance rates of major pathogens to commonly used antimicrobial agents was analyzed. ResultsFrom 2011 to 2015, antimicrobial utilization rate in hospitalized patients dropped from 75.84% to 37.35%, antimicrobial use density decreased from 59.53 per 100 patient days to 33.63 per 100 patient days, both showed a downward trend (both P<0.05). A total of 10 091 strains of pathogens were isolated, 2 338 (23.17%) of which were grampositive bacteria, 7 110(70.46%) were gramnegative bacteria, and 643(6.37%) were fungi. The top five pathogens were Escherichia coli (20.85%), Klebsiella pneumoniae(15.90%), Pseudomonas aeruginosa (11.70%), Staphylococcus aureus (7.35%), and Acinetobacter baumannii(6.82%). Resistance rates of major pathogens to commonly used antimicrobial agents decreased year by year（P＜0.05）, resistance rates of Escherichia coli and Klebsiella pneumoniae to piperacillin/tazobactam, cefoxitin, and amikacin declined most obviously(all<4% in 2015); compared with Acinetobacter baumannii, Pseudomonas aeruginosa had higher sensitivity to commonly used antimicrobial agents, resistance rates to piperacillin/tazobactam, cefoperazone/sulbactam, ceftazidime, cefepime, amikacin, and ciprofloxacin decreased obviously, resistance rate to above antimicrobial agents was <20%, to carbapenems was higher than other commonly used antimicrobial agents. Resistance rates of Acinetobacter baumannii to amikacin, levofloxacin decreased most obviously, to meropenem and imipenem increased obviously, in 2015 were both above 50%. Resistance rate of Staphylococcus aureus to fluoroquinolones declined most obviously(<2%), vancomycinresistant strains were not found. ConclusionAfter the implementation of special rectification activity, resistance rates of common pathogens decreased with the decline of antimicrobial use, rational use of antimicrobial agents may be related to delaying bacterial resistance.

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ObjectiveTo analyze the epidemic characteristics of multidrugresistant tuberculosis (MDRTB) in Hunan Province from 2013 to 2016, and provide theoretical basis for the prevention and control of tuberculosis. MethodsInformation about TB patients in Hunan Province reported by China Information System for Disease Control and Prevention between January 2013 and December 2016 was analyzed retrospectively. ResultsFrom 2013 to 2016, the total drug resistance registration rate in Hunan Province was 5.53/million（1 496/270 330 000）, multidrug registration rate was 5.40/million（1 459/270 330 000）, drug resistance rate and multidrug resistance rate showed an upward  trends (trend χ2 =113.605, 96.590，respectively, both P<0.001）. Among MDRTB patients, male were more than females (74.09% vs 25.91%), most were more than 25 years of age, especially 45～ age group(27.07%); the proportion of patients with MDRTB retreatment was higher than that of the initial treatment (69.91% vs 30.09%). From 2013 to 2016, distribution range of MDR registration rates in different regions were 4.07/million - 7.23/million. ConclusionMDRTB in Hunan Province in 2013-2016 is increasing year by year, and mainly concentrate on young people over 20 years old. There are more cases of male and retreatment; it is necessary to strengthen regular treatment and prevention of key population, enhance the ability to identify and diagnose MDRTB patients, and reduce the spread of MDRTB.

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ObjectiveTo investigate the prevalence of healthcareassociated infection(HAI) in a tumor hospital, and provide evidence for prevention and control of HAI. MethodsAccording to requirement of cross sectional survey of nationwide HAI monitoring network, prevalence rates of HAI in hospitalized patients at a tumor hospital in 20132015 were surveyed, surveyed results were statistically analyzed. ResultsA total of 3 515 hospitalized patients were investigated from 2013 to 2015, 24 (0.68％) had HAI. The prevalence rates of HAI from 2013 to 2015 were 0.79％, 0.54％, and 0.76％ respectively, difference was not statistically significant(χ2＝0.65, P＞0.05). The main infection site was lower respiratory tract, accounting for 45.83%. The main pathogens causing HAI were gramnegative bacilli, accounting for 47.37%, followed by fungi(26.32%). ConclusionThe prevalence rate of HAI in tumor patients is low, targeted monitoring should be carried out according to the current situation, the prevention and control of lower respiratory tract infection should be focused on, fungal infection should be paid attention.

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ObjectiveTo understand the basic situation of healthcareassociated infection(HAI) management and prevention and control of multidrugresistant organism(MDRO) infection in medical institutions in Hubei Province. MethodsQuestionnaires were used to investigate the basic situation of HAI management and MDRO infection in 47 tertiary and secondary hospitals in Hubei Province.Results47 hospital were enrolled in this study, HAI management fulltime staff was allocated with a median of 0.90/250 beds; in 2015, the isolation rates of methicillinresistant Staphylococcus aureus, carbapenemresistant Enterobacteriaceae, carbapenemresistant Pseudomonas aeruginosa, carbapenemresistant Acinetobacter baumannii, and vancomycinresistant Enterococcus were 39.13%, 4.13%, 19.44%, 63.60%, and 2.77% respectively. 47 hospitals all carried out surveillance on MDROs, 28（59.57%） hospitals were installed HAI monitoring system software, could directly obtain data through collecting with the laboratory system. The diagnosis of MDRO infection was mainly based on the combined diagnosis by HAI fulltime personnel and clinicians(26 hospitals, 55.32%）. 44 (93.62%) hospitals regularly convened coordination meeting on prevention and control of MDROs, in 2015, hand hygiene compliance rate were 10.0%-89.2% by selfinspection; 42 (89.36%) hospitals routinely prescribed isolation orders for patients with MDRO infection, 33 (70.21%) hospitals conducted environmental clean and disinfection twice a day, 24 (51.06%) hospitals performed personal protection by using complete set of protective equipment. ConclusionThis investigation is helpful for understanding the general situation of HAI management in medical institutions, as well as the detection and control of MDROs in this area, and make continual improvement on the problems and weakness found in the investigated project, so as to promote the development of HAI management in this area.

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ObjectiveTo evaluate the effect of targeted monitoring and comprehensive intervention measures on reducing the occurrence of catheterassociated urinary tract infection(CAUTI) in patients in nonintensive care unit(NonICU). MethodsIn quarter 4 of 2015, patients with indwelling urinary catheter in clinical departments were conducted a baseline survey(before intervention), risk factors for CAUTI in patients were analyzed, targeted monitoring programmes and comprehensive intervention measures were initiated in 2016(after intervention), incidence of CAUTI before and after intervention was compared. ResultsAfter taking intervention measures, hand hygiene compliance rate increased from 78.51% in quarter 4 of 2015 to 92.99% in quarter 3 of 2016 and 90.73% in quarter 4 of 2016（χ2=7.342, 3.998，respectively, both P＜0.05），the correct disposal rate of patients’ urinary catheterization system increased from 72.83% in quarter 4 of 2015 to 95.44% in quarter 4 of 2016（χ2=30.267，P＜0.05）. A total of 12 067 patients with indwelling urinary catheter were monitored, incidence of CAUTI dropped from 1.03‰（24/23 313）in quarter 4 of 2015 (before intervention) to 0.53‰（14/26 595）in quarter 4 of 2016(after intervention), difference was statistically significant（χ2=4.126，P=0.042）. ConclusionImproving the quality of urinary catheterization system in patients with indwelling catheter through targeted monitoring can effectively reduce the incidence of CAUTI in patients in NonICU.

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ObjectiveTo understand the distribution and antimicrobial resistance of pathogens isolated from patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) in Ordos area, so as to provide guidance for rational antimicrobial use.MethodsSputum culture and antimicrobial susceptibility testing results of 372 patients with AECOPD in Ordos area in 20132015 were analyzed, and the quality of life before acute exacerbation was assessed.ResultsA total of 296 strains of pathogens were isolated from 372 patients, 252(85.14%) of which were gramnegative bacteria, the major were Pseudomonas aeruginosa(n=58, 19.59%), Klebsiella pneumoniae(n=51, 17.23 %), Acinetobacter baumannii(n=50, 16.89%), Stenotrophomonas maltophilia(n=22, 7.43%), Escherichia coli(n=19, 6.42%), and Enterobacter cloacae(n=16, 5.41%); 27(9.12%) were fungi, the major was Candida albicans(n=19, 6.42%); 17（5.74%） were grampositive bacteria, the predominant species was Staphylococcus aureus. Patients with CAT (COPD assement test) score≥10 had higher proportion of isolating Pseudomonas aeruginosa and Acinetobacter baumannii than those with CAT score<10. ConclusionThe main pathogens from patients with AECOPD are gramnegative strains, CAT score prior to exacerbation may be related to the emergence of pathogens at AECOPD.

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ObjectiveTo study clinical efficacy of ganciclovir in the therapy of infectious mononucleosis in adults. Methods66 adults with infectious mononucleosis in a hospital from January 2010 to December 2014 were studied retrospectively, according to drug therapy, patients were divided into ganciclovir therapy group (n=31) and symptomatic therapy group (n=35), clinical features before therapy, therapeutic efficacy, and EpsteinBarr virus(EBV) DNA negative conversion time were analyzed. ResultsThe time of defervescence, sore throat improvement, EBVDNA negative conversion, subside of enlarged lymph node, and transaminase recovery in ganciclovir therapy group were all shorter than symptomatic therapy group(all P<0.05). Blood routine recovery time between two groups was not significantly different(P>0.05). ConclusionGanciclovir has a good antiviral effect on the therapy of adult infectious mononucleosis, it can rapidly relieve patients from clinical symptoms including fever, sore throat and so on.
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ObjectiveTo describe clinical characteristics and antiinfective treatment of Listeria monocytogenes (L. monocytogenes) meningitis. MethodsClinical manifestations and cerebrospinal fluid (CSF) examination results of 6 patients with L. monocytogenes meningitis in a hospital were analyzed retrospectively. Evaluation methods were developed according to relevant guidelines and literatures, antiinfective treatment and prognosis of patients with L. monocytogenes meningitis were evaluated. ResultsTwo of 4 adults with L. monocytogenes meningitis had triad of fever, stiff neck, and altered mental status, the mean white blood cell count (WBC) of the initial CSF detection was 997×106/L, CSF/blood glucose ratio was 0.32, CSF protein was 1.43g/L; the other 2 neonates had fever, epilepsy, and hyponatremia, WBC were both>1 000×106/ L，CSF protein were both＞1 g/L, CSF/blood glucose ratio was＜0.5. Of 6 patients, none were treated with appropriate initial empiric antiinfection therapy, confirmed by CSF or blood culture, 5 cases were treated with ampicillin antiinfective therapy, 1 used compound sulfamethoxazole due to penicillin allergy; 1 neonate died, 1 elderly patient was with moderate disability, the remaining 4 cases were all recovered and discharged from hospital. ConclusionClinical manifestations and CSF findings of L. monocytogenes meningitis are not different from other purulent meningitis, commonly used antimicrobial agents for the treatment of purulent meningitis are not sensitive to L. monocytogenes, which should be paid attention in clinic.

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ObjectiveTo study the isolation and antimicrobial resistance of pathogens isolated from patients with brain damage in hyperbaric oxygenation department, so as to provide reference for clinical antiinfective treatment. MethodsBacterial culture and antimicrobial susceptibility testing results of pathogens isolated from blood, sputum, and urine specimens of 975 patients with brain damage in the hyperbaric oxygenation department of a hospital between January 2013 and December 2014 were analyzed retrospectively. ResultsA total of 1 328 strains of pathogens were detected, 877 (66.04%) of which were gramnegative bacteria, 213(16.04%) were grampositive bacteria, and 238(17.92%) were fungi. The top five isolated pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, and Candida albicans. Specimens mainly isolated from sputum and urine, accounting for 58.59% and 35.24% respectively, resistance rates of Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Escherichia coli to imipenem were 16.67%, 81.82%, 82.44%, and 4.65% respectively. Vancomycinresistant strains was not found among grampositive bacteria, resistance rates of Enterococcus faecalis to most antimicrobial agents were lower than those of Enterococcus faecium. ConclusionRespiratory and urinary tract infection account for most of the infection in patients with brain damage in hyperbaric oxygenation department, gramnegative bacteria are the predominant pathogens causing infection.

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ObjectiveTo explore the practice and efficacy of multidisciplinary collaborative management in the prevention and control of multidrugresistant organism (MDRO) healthcareassociated infection(HAI). MethodsMDROs isolated from clinical specimens and MDRO infection in hospitalized patients in April 2012March 2013 (before intervention) and April 2013March 2014 (after intervention) were analyzed retrospectively. Since April 2013, multidisciplinary collaborative management has been implemented, isolation of MDROs and MDRO HAI in hospitalized patients before and after intervention were compared and analyzed. Results798 and 833 MDRO strains were isolated before and after the intervention respectively, isolation rate of MDROs after intervention was lower than that before intervention (25.71% vs 31.89%, P＜0.001）. After the implementation of multidisciplinary collaborative management, incidence of MDRO HAI decreased from 0.94% before intervention to 0.63%； hand hygiene compliance rate of health care workers(HCWs) increased from 36.44% before intervention to 53.51%; compliance rate of contact isolation increased from 65.29% before intervention to 90.88%; rational usage rate of antimicrobial agents increased from 64.93% before intervention to 72.53%; specimen detection rate in patients with therapeutic antimicrobial use increased from 41.36% before intervention to 58.72%, differences were all statistically significant (all P<0.001). ConclusionThe practice of multidisciplinary collaborative management can effectively implement the prevention and control measures of MDRO HAI, effectively reduce the occurrence of MDRO HAI

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ObjectiveTo investigate the occurrence and risk factors of surgical site infection (SSI) in patients with colon or rectal cancer.MethodsPatients who were diagnosed with colon or rectal cancer and underwent emergency or elective surgery in a hospital between January 1, 2008 and December 31, 2013 were monitored prospectively. General data, operation condition, and antimicrobial use of patients were analyzed, occurrence of SSI was observed every day and followed up after operation, risk factors of SSI were analyzed by univariate and multivariate analysis. ResultsA total of 694 patients with colon cancer(n=380) or rectal cancer(n=314) were monitored, SSI occurred in 125 patients, including 15 incisional infection and 110 organ/space infection, incidence of SSI was 18.01%；incidence of SSI in colon cancer patients and rectal cancer patients were 17.11% (65/380) and 19.11%（60/314）respectively. Univariate analysis showed that among colon cancer patients, incidence of SSI was higher in those with coinfection of other sites during perioperative period, underlying diseases, phase Ⅰcancer, and relaxation suture(all P<0.05); among rectal cancer patients, incidence of SSI was higher in those with coinfection of other sites during perioperative period, underlying diseases, obstruction, operation time>2 hours, stoma, drainage, relaxation suture, rinsing during operation, and use of antimicrobial agents>72 hours (all P<0.05); logistic regression analysis showed that the independent risk factors for SSI in colon cancer patients were underlying disease, coinfection of other sites during perioperative period, and relaxation suture(all P<0.05); independent risk factors for SSI in rectal cancer patients were underlying disease, coinfection of other sites during perioperative period, and stoma(all P<0.05). ConclusionPrevention and control measures should be taken according to risk factors of SSI in patients undergoing colon cancer and rectal cancer surgery, especially those who with chronic underlying diseases and other site infection during perioperative period; in addition, patients with colon or rectal cancer should also pay attention to relaxation suture and stoma respectively.

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ObjectiveTo understand the epidemiological characteristics of a healthcareassociated infection（HAI） outbreak due to Norwegian scabies in a hospital, and provide basis for clinical prevention and control of HAI. MethodsThrough epidemiological investigation, all suspected patients and close contacts were investigated and traced, three dimensional distribution of patients was described, a series of effective comprehensive prevention and control measures were formulated and implemented. ResultsA total of 16 cases of Norwegian scabies infection occurred in November 316, 2015, the most frequent cases were in November 11 (n=5), the onset time of infection was concentrated in November 9-11(n=10), accounting for 62.50% of total cases. Spatial distribution of 16 cases: 12 cases were in general internal medicine department, 2 in nursing department, and 2 were relatives of employees. Population distribution: patients aged 50-59（n=7）, female (n=13), and nursing staff (n=9). After taking comprehensive prevention and control measures and medication treatment, 16 infected persons were all cured, the cure rate was 100%, there was no new cases occurred in the hospital, epidemic was under control. ConclusionNorwegian scabies is highly contagious, it can cause epidemic in local area. In order to avoid spread of scabies infection in hospital, health care workers should strengthen the diagnosis and precaution level of the disease.

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ObjectiveTo analyze the infection among nursing staff after occupational exposure to  human immunodeficiency virus (HIV) and status of HIVinfected nursing staff, provide basis for prevention of HIV infection among nursing staff. MethodsNurses who sustained HIV occupational exposure in a hospital between January 2004 and June 2015, nurses with positive antiHIV and admitted to this hospital, consulted in outpatient department, as well as consulted outside this hospital between January 2001 and December 2015 were and analyzed, HIV infection status among nurse’s mate was also analyzed. Results76 nurses who sustained HIV occupational exposure didn’t infect with HIV after received standard treatment and followup. Among 13 nurses infected with HIV, 3 might be with occupational exposure infection previously, 5 were with blood transfusionrelated infection in the 1990s, 4 were with sexually transmitted infection (including 2 male nurses who had sex with man, MSM), 1 case with infection of unknown transmission route; secondary transmission occurred in 2 cases; 9 nurses are still alive. The infected nurses have received effective antiretroviral treatment and then work at the logistic or administrative department. ConclusionNurses often suffer from occupational exposure to HIV, occupational exposure infection may occur in the absence of the implementation of standardized management, implementation of standardized management is essential to avoid the occupational exposure of HIV. Sexual transmission (including MSM) has become an important transmission route for HIV infection among nurses.

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ObjectiveTo understand the expiration date of alcoholbased hand disinfectant after it is opened for use, and provide reference for rational clinical application of alcoholbased hand disinfectant. Methods20 bottles of the same brand alcoholbased hand disinfectant which opened at the same time by the clinical departments were selected as the study object, hand hygiene compliance in theses departments ranked fourth from the end in the hospital, specimens were taken on the first day after opening, and repeated every 10 days until the disinfectant was used up. Hand specimens were also taken after disinfected by disinfectant. Qualified condition of disinfectant and hand specimens was detected. ResultsA total of 98 disinfectant specimens were collected, by naked eye observation, 20 bottles of alcoholbased hand disinfectant were free of discoloration, precipitation, and suspended matter during the whole study period. The qualified detection rates of alcoholbased hand disinfectant within 60 days after opening were all 100%. 44 hand specimens were taken and detected after disinfection, 3 of which were unqualified (all were disinfected by alcoholbased hand disinfectant 50 days after opening), then detected again after disinfected by the same batch of disinfectant, all were qualified, which suggested that unqualified detection result of hand specimens was not due to disinfectant. ConclusionAlcoholbased hand disinfectant still has a good bactericidal effect on the sixth day after opening.

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ObjectiveTo explore the association between the genetic polymorphism of CYP3A4, CYP2D6 and response to methadone maintenance treatment(MMT) among heroindependent patients. MethodsPatients undergoing MMT in 6 MMT clinics were randomly selected, information about general sociademographic characteristics, drug abuse history, and MMT data of patients were collected, genotypes of peripheral blood CYP3A4 and CYP2D6 polymorphic loci were detected. ResultsA total of 820 patients were enrolled in the study, 210 cases were with good response and 610 cases with poor response to MMT. Difference in age between different response groups was statistically significant(P＜0.05). Distribution of genotype frequency and allele frequency of CYP3A4 rs2242480 and CYP2D6 rs16947 between good response and poor response groups was not significantly different (both P>0.05). ConclusionThe association between CYP3A4 rs2242480, CYP2D6 rs16947 and response to MMT has not yet found in heroindependent patients.

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目的分析临床患者分离病原菌情况及其耐药性，为临床合理使用抗菌药物及医院感染防控提供依据。方法回顾性分析安康市中心医院2015年1—12月门诊和住院患者分离的病原菌，并对其药敏结果进行统计分析。结果共分离3 602株病原菌，其中革兰阴性菌占82.07%，主要为大肠埃希菌（20.43%）、肺炎克雷伯菌（19.32%）、铜绿假单胞菌（10.61%）；革兰阳性菌占17.93%，主要为金黄色葡萄球菌（3.75%）。主要来源于痰等呼吸道标本（46.28%）。葡萄球菌属细菌对青霉素G的耐药率为100%，对头孢呋辛、头孢西丁、红霉素的耐药率为 66.17%~94.83%。耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的检出率分别为71.11%和85.27%。未检出对万古霉素、利奈唑胺、替考拉宁耐药的肠球菌。大肠埃希菌、肺炎克雷伯菌中产超广谱β内酰胺酶（ESBLs）的检出率分别为61.55%、35.20%。铜绿假单胞菌和鲍曼不动杆菌中多重耐药菌（MDRO）检出率分别为13.87%和38.61%，铜绿假单胞菌对多粘菌素B的耐药率为7.20%。结论该院临床病原菌分布与全国数据比较，呈现地域性和自然气候性差异。MRSA和MRCNS检出率较高，应引起临床重视。铜绿假单胞菌对多粘菌素B的耐药率高于全国监测水平，同时非发酵菌多重耐药问题也不容忽视，需及时采取有效的防控措施。

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目的了解重症监护病房（ICU）医务人员耐甲氧西林金黄色葡萄球菌（MRSA）的定植情况。方法2014年5—8月，于每周一对某院ICU医务人员进行MRSA的主动筛查，监测MRSA的定植情况，对MRSA检出阳性医务人员使用莫匹罗星进行治疗并继续采样；并调查同期ICU住院患者临床标本MRSA阳性情况。结果共调查160名医务人员，共采样317份， 其中MRSA检出阳性人员7名，定植率为4.38%。主要检出于ICU护士（4名）、外科医生（2名）及ICU医生（1名）；经莫匹罗星治疗后仅有1名ICU护士仍为阳性。而同期ICU住院患者临床标本MRSA检出阳性率为4.54%（2/44）。结论应加强对ICU医务人员MRSA定植情况的主动筛查，主动筛查是减少MRSA医源性传播的有效措施。

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单核细胞增生李斯特菌（Listeria monocytogenes，Lm）是革兰阳性短小杆菌，隶属于李斯特菌属，是引起人畜共患李斯特菌病的病原菌［1］。近年来，李斯特菌病有增加趋势，而发展中国家报道较少［2］。虽然Lm感染在我国并不多见，但是在新生儿尤其早产儿中，病死率却较高［3］。本文对本院接诊的一例感染Lm新生儿的诊疗过程进行分析,并回顾相关文献，为临床诊治提供参考。

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气溶胶是固态或液态微粒悬浮在气体介质中的分散体系，其粒子直径在0.001~100 μm之间［1］。1968年Micik等［2］最先研究了口腔诊室中的气溶胶，并将此研究领域命名为牙科气溶胶学，主要的研究内容为口腔诊室中的细菌性气溶胶颗粒，以及这些气溶胶颗粒与患者及医务人员健康之间的关系。随着口腔设备学、材料学的进展，尤其是高速旋转设备和超声设备的出现，口腔医生的工作效率大大提高。但设备的使用也导致口腔治疗操作过程中产生大量细菌性气溶胶，气溶胶中可能含有菌斑、牙石碎片、牙科材料、血液、唾液、未消毒的牙科用水等［34］。口腔诊室空气污染威胁着医护工作者及患者的身体健康，因此多个国家及地区的口腔医疗机构感染控制指南中均涉及了诊疗环境的指标，其中包括空气清洁与消毒相关指标［5］。本文对口腔诊室细菌性气溶胶研究进展作一综述。

Abstract:

结核病是由结核分枝杆菌（Mycobacterium tuberculosis, MTB）感染引起的慢性传染病，仍然是全世界公共卫生面临的重大威胁。据世界卫生组织统计［12］，我国2014年的新发肺结核人数位居全球第三位，是22个全球结核病高负担国家之一。目前肺结核的诊断主要依靠痰涂片抗酸染色，但由于痰涂片对标本的含菌量要求高，导致其诊断结核病的敏感度较低。诊断结核病的金标准是MTB培养［3］，由于MTB生长缓慢的习性，导致培养所需时间较长（2～6周），仅用MTB培养诊断结核病可能延误治疗。耐多药结核病的传统诊断方法是药物敏感试验［4］，该方法有对实验室要求高及耗时长的缺点。因此，寻求快速诊断结核病和耐多药结核病的方法成为控制结核病的重点。近些年涌现出许多基于分子生物学或免疫学的方法，利福平耐药实时荧光定量核酸扩增检测技术（Xpert MTB /RIF）就是其中最有应用前景的方法之一。本文就Xpert MTB /RIF的发展、应用现状以及对特殊人群的诊断价值进行综述。

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