Abstract:

ObjectiveTo quantitatively analyze the epidemic situation of tuberculosis(TB) by modeling the data of tuberculosis in prefectures of Xinjiang, and predict the new cases of tuberculosis in prefectures of Xinjiang.MethodsA dynamic model was used to fit the data of TB in 14 prefectures in Xinjiang from 2005 to 2014, the results of the fitting were verified by tuberculosis data in 2015-2017, verified results were evaluated, estimated values and basic reproductive numbers (R0) of parameters in each region were obtained, data of new TB in 2018-2022 were predicted.ResultsThe verification of TB data in 2015-2017 showed that the actual values fell within the 95% confidence interval of the predictive value curve, model was fit well. R0 in Southern Kashgar was 11.38 (95%CI:11.33-11.50), R0 in Urumqi City in Eastern Xinjiang and Ili Kazak Autonomous Prefecture in Northern Xinjiang were 5.46 (95% CI: 5.28-5.50) and 2.22 (95% CI: 2.18-2.28) respectively. The epidemic situation of TB in Southern Xinjiang was more serious than that in Northern and Eastern Xinjiang, epidemic situation of TB in Kashgar Prefecture was most serious. The predicted results showed that the number of new TB from 2018 to 2022 will slowly grow in most prefectures.ConclusionThe dynamical model of TB fits well and is feasible in this study, it can be used for prediction of new TB cases, intervention and management in Southern Xinjiang should be strengthened to control the prevalence of TB.

Abstract:

ObjectiveTo detect the distribution of resistancenodulation (RND) efflux pump system of Acinetobacter baumannii(AB), and explore the relationship between its’ expression and antimicrobial resistance.MethodsFiftynine strains of multidrugresistant AB isolated from clinical specimens in The First Affiliated Hospital of Nanchang University were identified and performed antimicrobial susceptibility analysis, distribution of RND efflux system of AB was detected by polymerase chain reaction(PCR), expression of efflux pump genes in different drugresistant phenotypes of AB was compared, relationship between the expression level and drug resistance was analyzed, amplified products of RND efflux system were sequenced.ResultsResistance rates of AB to ampicillin/sulbactam, imipenem, gentamicin, ciprofloxacin, and levofloxacin were 93.2%, 94.9%, 88.1%, 96.6%, and 52.5% respectively. PCR detection results of efflux pump and integron genes of 59 AB strains revealed that the carrying rates of adeR, adeS, adeB, adeJ, and adeG genes were 81.4%, 91.5%, 93.2%, 100.0%, and 61.0% respectively. The expression of efflux pump genes in different strains was different, expression levels of adeB and adeJ genes among gentamicin, imipenem, ampicillin/sulbactam resistant AB group and nonresistant AB group were significantly different (all P<0.05). There was no mutation or insertion sequence in the base sequences of regulatory genes adeR and adeS of adeABC efflux pump.ConclusionRND efflux pump system is universally present in AB, the expression upregulation of adeB and adeJ genes in RND efflux pump system is related with antimicrobial resistance of bacteria to gentamycin, imipenem, and ampicillinsulbactam.

Abstract:

ObjectiveTo analyze clinical characteristics of patients suffered from nervous system involved severe fever with thrombocytopenia syndrome (SFTS). MethodsClinical data of SFTS patients who were admitted to Qingdao Sixth People’s Hospital between January 2016 and December 2017 were retrospectively analyzed. According to whether there was nervous system involvement, they were divided into two groups, clinical data of two groups of patients were compared and analyzed; SFTS patients with nervous system involvement were subdivided into death group and survival group according to the final outcome, clinical data of two groups were compared and analyzed.ResultsThe median date of occurrence of neurological symptoms in SFTS patients was at day 6 of disease process. There were statistical differences in age， skin ecchymosis/severe bleeding tendency， Creactive protein, procalcitonin, Ca2+ on admission, CD4+ cell count, myocardial enzymes (LDH, CK, CKMB, HBDH), pulmonary inflammation, liver function (ALT, Alb, AST), and activated partial thromboplastin time (APTT) between nervous system involvement group and nonnervous system involvement group（all P＜0.05）. Among patients with nervous system involvement, there were statistical differences in skin ecchymosis, the lowest value of PLT, positive rate of SFTSVIgM antibody, CD3+ cell count, CD4+ cell count, LDH, Alb, and APTT between death group and survival group (all P<0.05).ConclusionMost SFTS patients with nervous system involvement are elderly patients with seriously damaged coagulation function, liver function, myocardial enzymes and immune system, proportion of pulmonary infection is high. Among SFTS patients with nervous system involvement, impairment of coagulation function, immune function, liver function, and myocardial enzymes in deceased patients are more serious than those in survivors.

Abstract:

ObjectiveTo study the effect of operating rooms of two different cleanliness on surgical site infection(SSI) in neurosurgical craniocerebral operation, provide reference for the prevention and control of SSI.MethodsNeurosurgical craniocerebral operation undertaking in grade I and II operating rooms in a hospital between July 2015 and July 2016 was performed retrospective study, patients in grade I operating rooms were as control group and those in grade II operating rooms were as trial group, occurrence of SSI was compared between two groups of patients.ResultsA total of 454 patients undergoing craniocerebral operation were investigated, 212 patients were in control group (grade I operating rooms) and 242 in trial group (grade II operating rooms). Patients in control group had 25 cases of SSI, incidence of SSI was 11.79%; trial group had 31 cases of SSI, incidence of SSI was 12.81%. Nine cases of SSI were superficial incision infection, there was no deep incision infection, the other 47 cases of SSI were intracranial infection(organ space infection). There was no significant difference in the incidence of SSI between two groups of patients(P>0.05).ConclusionGrade I and II cleanliness operating rooms have no direct effect on SSI in patients undergoing neurosurgical craniocerebral operation, comprehensive prevention and control measures should be taken to prevent the occurrence of SSI.

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ObjectiveTo analyze the distribution of main pathogens, antimicrobial susceptibility, and clinical characteristics of osteoarticular infection, and provide evidence for clinical treatment.MethodsA retrospective survey was conducted on clinical data and pathogenic results of hospitalized patients with osteoarticular infection diagnosed by etiology and pathology in Peking University First Hospital from 2009 to 2016, surveyed data were analyzed statistically.ResultsA total of 99 cases of bacterial osteoarticular infection were enrolled, 100 strains of pathogenic bacteria were isolated, grampositive bacteria accounted for 67.00%, 49.00% of which were Staphylococcus spp., Enterobacteriaceae bacteria accounted for 67.74% of 31 strains of gramnegative bacteria. Isolation rate of methicillinresistant Staphylococcus aureus (MRSA) was 16.13%, resistance rates of Staphylococcus spp. to fluoroquinolones and rifampicin were both lower than 30%. Complication with other site infection (urinary tract infection, intestinal infection, bloodstream infection) was an independent risk factor for gramnegative bacterial steoarticular infection (P=0.027, OR=10.536, 95% CI: 1.300-85.417).ConclusionStaphylococcus spp. is still the main pathogen causing osteoarticular infection, proportion of MRSA is low. Patients with urinary tract infection and intestinal infection as well as long duration of implant should be considered the possibility of gramnegative bacterial infection when they develop steoarticular infection.

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ObjectiveTo investigate the changes in CD8+ T lymphocyte count and effect on immune function in patients with sepsis after continuous renal replacement therapy (CRRT).MethodsGeneral data of septic patients who admitted to the emergency department of a hospital between October 2015 and August 2016 were collected, peripheral blood was taken from patients before and after single CRRT, the total CD8+T cell count, interferonγ（IFNγ）secreting CD8+ T cell count, the levels of inhibitory molecules and costimulatory molecules as well as IFNγ and tumor necrosis factorα（TNFα）produced by CD8+ T cells were detected.ResultsA total of 37 hospitalized septic patients were infected with gramnegative bacteria, pathogens causing infection were Klebsiella pneumoniae (22 strains), Acinetobacter baumannii (11 strains), and Enterobacter cloacae (3 strains). After CRRT, the body temperature, heart rate, white blood cell count, urea nitrogen, and serum creatinine levels in septic patients were all lower than those before CRRT (all P<0.05). After CRRT, the total CD8+ T cell count in septic patients didn’t change significantly (P>0.05), but IFNγsecreting CD8+ T cell count increased (P<0.05). Levels of cytotoxic T lymphocyteassociated antigen 4(CTLA4）, programmed death1 (PD1), Tcell immunoglobulin and mucindomaincontaining molecule 3 (TIM3) after CRRT were all lower than those before CRRT (all P<0.05), while levels of costimulatory molecules CD28 and secreting IFNγ elevated after CRRT(all P<0.05).ConclusionCRRT can not only improve the vital signs and renal function of patients with sepsis, but also enhance the immune function of CD8+ T cells.

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ObjectiveTo study the characteristics of occupational exposure to bloodborne pathogens and the cost of prevention and control, and provide evidence for policy making in medical institutions.MethodsA prospective study was conducted to collect the data and followup data about occupational exposure of health care workers(HCWs) from the occupational exposure reporting system of a hospital between June 1, 2016 and May 30, 2017.ResultsThere were 95 cases of occupational exposure to bloodborne pathogens. Occupational exposure occurred mainly in June, July, and November, peak time for occurrence was 12∶00 at noon. The main occupations of HCWs who sustained occupational exposure were nurses (41.05%), doctors (28.42%), and practice nurses (15.79%). The main departments of occupational exposure were central operating room (21.05%), emergency department (11.58%), and interventional radiology department (6.32%). The total cost of prevention and control for 95 times of occupational exposures were 33 235.20 Yuan, with an average of 349.84 Yuan per case. The average cost per case after human immunodeficiency virus (HIV) exposure was the highest (2 787.50 Yuan); and cost of syphilis exposure was the lowest (58.88 Yuan).ConclusionIt is necessary to strengthen the training and education of highrisk time, highrisk population, and highrisk departments of occupational exposure to bloodborne pathogens, prevention of occupational exposure with high cost of prevention and control such as HIV should be especially paid attention.

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ObjectiveTo systematically evaluate risk factors for healthcareassociated infection(HAI) in patients with acute myocardial infarction（AMI）. MethodsLiteratures about risk factors for HAI in AMI patients were retrieved from PubMed, EMbase, the Cochrane Library, China Biological Medicine Disk (CBM), WanFang Data, China National Knowledge Infrastructure (CNKI), and VIP Database from the establishment of database to December 2017, two independent researchers screened literatures, extracted data, and evaluated quality according to inclusion and exclusion criteria, then performed Meta analysis using RevMan 5.3 software.ResultsThere are 12 literatures in accordance with the inclusion criteria, with a total sample size of 13 812 cases. According to Meta analysis, 12 risk factors were statistically significant (all P<0.05): age (OR, 3.45 ［95%CI, 1.02-7.95］), length of hospital stay(OR, 4.84 ［95% CI， 2.47-7.14］), tracheal intubation (OR, 7.74 ［95% CI, 3.73-9.02］), preventive use of antimicrobial agents (OR, 6.79 ［95% CI, 2.38-9.45］), mechanical ventilation (OR, 2.98 ［95% CI，1.05-4.78］), urinary catheterization (OR, 3.56 ［95% CI, 1.24-4.49］), heart failure(OR，3.82 ［95% CI, 2.53-5.74］), arrhythmia (OR, 2.47 ［95%CI,  1.28-4.63］), diabetes (OR， 2.23 ［95% CI, 1.62-3.27］), chronic obstructive pulmonary disease (OR， 2.14 ［95% CI, 1.83-3.91］), use of H2 blockers (OR, 2.61 ［95% CI, 1.87-4.36］), and left ventricular ejection fraction<30% (OR, 2.98 ［95% CI, 1.35-4.26］). The publication bias of each risk factor was analyzed, and the results showed that publication bias was not obvious.ConclusionHealth care workers should timely identify the highrisk population for HAI, strictly adhere to indications of invasive procedure, standardize the disinfection and isolation system, strengthen the process management of aseptic technique, and actively take preventive measures to reduce risk for HAI in AMI patients.

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ObjectiveTo promote the meticulous management on whole process of healthcareassociated infection (HAI) through the development of new media function.MethodsIn 2016, with the help of WeChat enterprise number of the new media network tool, existing procedures were deeply integrated and optimized by means of information push as well as image and questionnaire survey, HAI prevention and control information platform was constructed, participation rate of the missing reporting and reporting of HAI during the process of implementation and operation of the platform in 2014-2016 were compared.ResultsIn 2016, the participation rate of reporting of HAI cases was 90.43%, with an increase of 26.34% compared with 64.09% in 2014, there was significant difference in reporting rate of HAI in three years（χ2=104.53， P＜0.001）. From 2014 to 2016, missing reporting rate of HAI were 14.63%, 10.81%, and 4.24% respectively, difference was statistically significant （χ2=53.85，P＜0.001）. From 2014 to 2016, the active reporting rate of HAI increased from 0 to 14.22%, the normal reporting rate of HAI increased from 12.88% to 44.17%, and the delayed reporting rate of HAI decreased from 87.12% to 41.61%.ConclusionThe innovative management mode of HAI based on new media is helpful for conducting prospective prevention and control of HAI, achieve the active management and realtime monitoring on HAI, and promote the closedloop management on the whole process of HAI prevention and control.

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ObjectiveTo evaluate treatment strategies for fungal endocarditis after heart prosthetic valve surgery.MethodsTwo cases of severe fungal infection after heart prosthetic valves surgery were analyzed retrospectively, related literatures were reviewed.ResultsTwo patients had fungal endocarditis after surgery, the valve function was affected, patients were hospitalized repeatedly after surgery. In case 1, fever occurred 45 days after cardiac surgery and patient was returned to the hospital for reexamination, emergency mitral valve replacement was performed under cardiopulmonary bypass, the postoperative vegetation culture suggested Aspergillus flavus. In case 2, the aortic wall vegetation was removed 5 months after heart surgery under cardiopulmonary bypass, pathology of postoperative vegetation suggested mucor. Two patients were promptly removed infection foci through surgery and treated with standard antifungal agents, patient with Aspergillus infection died after rescue, and patient with mucor infection was cured, the latter was more powerful in antifungal therapy.ConclusionPrevention is the key to fungal endocarditis after heart prosthetic valve surgery, treatment should be prompt and effective, antifungal agents should be given in sufficient dose and course.

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ObjectiveTo investigate the occurrence of healthcareassociated infection(HAI) in different weight groups of neonates in neonatal intensive care unit (NICU) and general neonatal wards, and find out the high risk factors for HAI.MethodsTargeted monitoring on hospitalized neonates in the neonatal department of a hospital in 2016 and JanuaryNovember 2017 was prospectively surveyed, HAI rate, device usage rate and deviceassociated infection rate in different weight groups of neonates in NICU and general neonatal wards were compared.ResultsFrom 2016 to November 2017, a total of 3 872 neonates were monitored, the total hospitalization days were 42 427 days, 56 patients had 62 cases of infection, HAI rate and HAI case rate were 1.45% and 1.60% respectively. HAI rate and HAI case rate in NICU were 5.28% and 6.03% respectively；HAI rate and HAI case rate in general neonatal wards were both 0.46%, constituent ratio of septicemia ranked first of infection in both NICU and general neonatal wards, accounting for 43.75% and 50.00% respectively, followed by lower respiratory tract(LRT) infection, accounting for 27.08% and 21.43% respectively. HAI rate of different weight groups of neonates in NICU and general wards were both significantly different（χ2=107.78, 46.65，respectively, both P＜0.0001), the lower weight of the neonates, the higher HAI rate; ventilator usage rate in neonates was positively correlated with HAI(r=0.973, P=0.027), the higher device usage rate, the higher HAI rate. Fungal septicemia rate per 1 000 days in rainy season was higher than that of nonrainy season (0.53‰ vs 0.37‰). A total of 70 specimens were detected, 45 strains of bacteria and fungi were isolated, pathogens were all from LRT and blood system, Pseudomonas aeruginosa was the main pathogen from LRT, Klebsiella pneumoniae and Candida krusei were the main pathogens from blood system.ConclusionTargeted monitoring on neonatal HAI can timely find out high risk factors for neonatal HAI, analyze the causes of infection, formulate corresponding prevention and control measures, reduce HAI rate, and ensure the medical safety of neonates.

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ObjectiveTo investigate the occurrence and reporting of sharp injuries among health care workers(HCWs) at all levels of hospitals in Xuzhou City, provide evidences for formulating protective measures against sharp injuries and improving the reporting system.MethodsFrom July to August 2016, 13 hospitals in Xuzhou City were randomly selected by multistage stratified random sampling method, the general information, occurrence of sharp injuries, and reporting situation was performed questionnaire survey.ResultsA total of 2 694 valid questionnaires were collected, incidence, case incidence, and reporting rate of sharp injuries were 10.32%, 12.84%, and 30.64% respectively. Case incidence of sharp injuries among HCWs in primary, secondary, and tertiary hospitals were 44.83%, 11.53%, and 12.52% respectively, case incidences of sharp injuries in different levels of hospitals were significantly different （χ2=55.148，P＜0.001）. The main opportunity for sharp injuries was when HCWs returned needle cap (79 cases, 22.83%), the main device involving sharp injuries was hollowbore needle (297 cases, 85.84%). Incidences of sharp injuries among HCWs receiving different training were significantly different （χ2=66.760，P＜0.001）.ConclusionCurrent situation of sharp injuries among HCWs in this region is not optimistic, there are some problems such as poor training efficacy, low reporting rate and low use rate of safety devices, effective measures should be taken to establish an effective monitoring and tracking system for sharp injuries, so as to reduce the occurrence of sharp injuries.

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ObjectiveTo analyze the registration of pulmonary tuberculosis(PTB) among students in Hunan Province, understand the epidemiological characteristics, provide evidence for improving tuberculosis control strategy in schools in Hunan Province.MethodsRegistration rate and epidemiological characteristics of students with tuberculosis in Hunan Province were analyzed through data registered in China Tuberculosis Information Management System between 2012 and 2017.ResultsFrom 2012 to 2017, 7 940 students with PTB were found in Hunan Province, the registered incidence was 13.23/1 00 000, 2 203 cases were smear positive for PTB, registered incidence was 3.67/1 00 000. Registered incidence of active PTB students in 2012-2017 was significantly different （χ2=80.079，P<0.001）；registered incidence of smear positive PTB students in 2012-2017 was significantly different （χ2=112.213，P<0.001）. The number of registered PTB students in the second quarter was the largest (32.2%), mainly male (60.8%) and students aged 15-19 years (61.8%). There was a significant difference in the registration of PTB students in different cities from 2012 to 2017 (χ2=320.432, P<0.001). The top three regions of the total number of registrations were Changsha, Xiangxi and Hengyang. From 2012 to 2017, the registered PTB students were mainly referral (38.8%), 99.8% of the patients received antituberculosis treatment, diagnosis and treatment were mainly for smearnegative, nonsevere, nondrugresistant, and newly treated patients, accounting for 67.9%, 95.2%, 99.5%, and 99.3% respectively.ConclusionIt is necessary to strengthen the prevention and control of tuberculosis in schools, screen tuberculosis among freshmen in high schools and universities, publicize tuberculosis knowledge, and improve awareness of tuberculosis prevention and control in schools.

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ObjectiveTo explore scientific and effective management methods for safe injection, provide reference for improving compliance rate of safe injection behavior and achieving continuous improvement in safe injection.MethodsA special safety injection program was formulated, baseline survey and safe injectionrelated training were carried out, safe injection system and standard procedures were formulated, onsite supervision and examination were strengthened, quantitative indexes such as qualified rate of safe injection facilities, theoretical examination result, behavior compliance rate, and occurrence rate of sharp injury before intervention (baseline survey in May 2016) and after intervention (2017) were compared.ResultsThrough comprehensive intervention, facilities allocation rates of safe injection in whole hospital were all>97%, qualified rates of all medical waste disposal were all>93%, actual average consumption of alcoholbased hand rub in the whole hospital increased from (5.56±2.13)  mL/bedday to (9.95±5.38)mL/bedday; the average score of safety injection knowledge examination of health care workers(HCWs) increased from (71.20±12.22) before intervention to (92.59±5.99) after intervention; HCWs’ compliance rate to safe injection increased from 62.50% before intervention to 88.53% after intervention, difference were all statistically significant (P<0.05). Reporting rate of sharp injuries in the whole hospital within a week increased from 15.79% before intervention to 71.43% after intervention; occurrence rate of case incidence of sharp injuries in the whole year and 100day hospitalization decreased from 9.98% and 0.0276% before intervention to 5.31% and 0.0168% after intervention respectively, differences were both statistically significant (both P<0.05).ConclusionEffective comprehensive intervention measures can strengthen the awareness of safe injection, improve compliance rate of safe injection behavior, effectively prevent the occurrence of occupational injuries in HCWs caused by unsafe injection, and prevent the spread of healthcareassociated infection.

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ObjectiveTo understand the status of hand hygiene(HH) of health care workers(HCWs) in a tertiary hospital in Zhuhai.MethodsHH compliance of doctors, nurses, and cleaners randomly selected from 15 clinical departments in the whole hospital was observed through concealed observation by medical interns in OctoberNovember 2016. ResultsHH compliance rate and correct rate of clinical departments in the whole hospital were 33.44%(1 131/3 382) and 59.86%(677/1 131) respectively, there was a significant difference in the compliance rate of HH among different types of HCWs （χ2=12.610，P=0.002），HH compliance rate from high to low was  nurses (35.85%), cleaners (32.28%), and doctors (29.50%). Of five HH moments, HCWs’ HH compliance rate after patient’s body fluid exposure was the highest (69.74%), while after touching patient surroundings was the worst (25.03%). HH compliance rates of HCWs with different occupations at different HH moments were all significantly different (all P<0.05), HH compliance rates of doctors before aseptic procedure and after patient’s body fluid exposure were higher than nurses(71.25% vs 32.44%; 82.86% vs 69.78%, respectively), HH compliance rate of nurses was highest after touching a patient(40.06%).ConclusionHH status in this hospital is not optimistic, HH compliance rate and correct rate are low, HH compliance rates of HCWs with different occupations and at different HH moments are both different, which need to be improved.

Abstract:

ObjectiveTo explore the prospective monitoring and control methods for missing reporting of healthcareassociated infection(HAI) cases, analyze its implementation efficacy,  provide basis for formulating targeted strategy for monitoring missing report of HAI.MethodsFrom January 2016 to June 2017, the quality control circle(QCC) method was used to prospectively monitor HAI cases in hospitalized patients, missing reporting of HAI was controlled.Results“Information system intelligence screening+mobile messaging alerts+ HAI supervision” trinity monitoring model for avoid missing reporting of HAI cases was established, after the first round of PDCA(plan, do, check, action) cycle, missing reporting rate of HAI decreased from 79.16% before QCC to 59.75% after QCC, difference was statistically significant (χ2=208.821, P=0.000). Compared with missing reporting rate of HAI after the first round of PDCA, missing reporting rate of HAI after the second round of PDCA dropped to 26.18%, difference was statistically significant (χ2=200.075, P=0.002).ConclusionActive prospective prevention and control before missing reporting of HAI can effectively avoid missing reporting of HAI cases.

Abstract:

先兆流产是指妊娠28周前，出现下腹痛、宫颈口扩张、阴道出血症状，是妊娠过程中最常见的症状之一，不仅对孕妇的身心有较大的影响，而且对胎儿健康也有很大影响［1］。引起先兆流产的原因很多，主要有遗传因素造成的胚胎异常、脐带供氧不足、羊水疾病、胎盘病毒感染以及某些妇科炎症、孕妇营养不良等［2］，但未见寄生虫感染引起流产的报道，现将我院一例先兆流产孕妇感染迈氏唇鞭毛虫（Chilomastix mesnili）病例报告如下。

Abstract:

病原体的快速检测和准确鉴定在临床实验室检测、食品工业和环境监测方面至关重要，现有的细菌培养、核酸扩增和酶联免疫等病原体诊断方法或耗时费力，或需要复杂的仪器设备，不适合现场即时检测，因此，目前亟需一种快速有效检测病原体的新方法。

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抗菌药物耐药是对全球公共卫生的重大威胁。据美国疾病控制与预防中心（Centers for Disease Control and Prevention, CDC）2013年报道，美国每年耐药菌感染患者超过2百万人，造成超过23 000例患者死亡，导致超过200亿美元的直接医疗支出和350亿美元的生产损失［1］。为加强抗菌药物的有效管理和安全使用，抗菌药物管理项目（antibiotic stewardship programs, ASPs）应运而生，有效的抗菌药物管理（antimicrobial stewardship, AMS）在临床实践中可以改善患者结局，减少艰难梭菌感染等不良反应，提高特定抗菌药物的敏感性，有利于在连续性照护的过程中资源利用的最优化，减少医疗支出，减轻患者负担［2］。ASPs需要多学科团队合作参与执行，临床护士是住院患者的管理者、照顾者、教育者及咨询者，在AMS实践中具有重要的作用。