Abstract:ObjectiveTo explore stability of in vitro activity of vancomycin and fidaxomicin against Clostridium difficile (C. difficile).MethodsMultistep induction method was used to perform in vitro induction testing on 15 strains of clinically isolated C.difficile (2 were ribotype HB1/RT001，3 were HB5/RT017，3 were HB6/RT012，3 were HB3，1 was HB24，and 3 were HB25）and 5 standard C.difficile strains（ATCC 700057, ATCC 1382, ATCC 9689, ATCC 43598, and ATCC 1870）, after theses strains were passaged for 20 times on modified Brucella blood agar plate containing vancomycin and fidaxomicin of 1/2 fold minimum inhibitory concentration(MIC) and 1 fold MIC respectively, MICs before and after induction were determined by agar dilution method.ResultsMICs of vancomycin against all strains before induction were 0.125-0.50 μg/mL, after strains were passaged for 20 times, MICs were 0.50-2.00 μg/mL, MICs of 3 strains increased 4fold, 13 strains increased 2fold. MICs of fidaxomicin against all strains before and after induction were 0.015-0.50 μg/mL and 0.0075-0.50 μg/mL respectively，MICs of 3 strains increased 8fold, 4 strains increased 4fold.ConclusionVancomycin and amphotericin have good stability for in vitro activity against C.difficile, secondary drug resistance is not easy to produce.

Abstract:

ObjectiveTo understand the condom use and its influencing factors among female sex workers(FSWs) in Hechi City, provide evidence for formulating prevention and control measures on acquired immunodeficiency syndrome（AIDS）. MethodsAnonymous questionnaire survey was conducted among FSWs in different grades of locations in Hechi City. Chisquare test and KruskalWallis H test were used to analyze status of condom use, influencing factors for condom use were analyzed by logisitic regression analysis. ResultsFrom 2011 to 2015, a total of 10 867 FSWs in Hechi City were surveyed, the total awareness rate of AIDSrelated knowledge was 95.69%, awareness rate of AIDS knowledge enhanced with the increase of location grades (trend χ2=53.72, P<0.01). Analysis on influencing factors for condom use frequency showed that the possibility of condom use in higher grade locations (OR=3.034, 95.0%CI=2.410-3.818) and middle grade locations (OR=1.807, 95.0%CI=1.639-1.992) were higher than that in low grade locations. FSWs with high school and higher education(OR=1.403, 95.0%CI=1.183-1.665) were more likely to use condom than those with junior middle school and lower education. In addition, completely correct response to AIDS knowledge items (OR=2.521, 95.0%CI=2.291-2.773), receiving condom publicity and distribution/AIDS counselling and testing services (OR=2.019, 95.0%CI=1.568-2.599), and receiving peer education (OR=1.538, 95.0%CI=1.365-1.733) were all factors for promoting condom use, while age over 40 years (OR=0.835, 95.0%CI=0.737-0.945) was a risk factor for influencing condom use. ConclusionCondom use is mainly influenced by education degree of surveyed subjects, awareness on AIDSrelated knowledge and so on, strengthening publicity and education on AIDS knowledge as well as performing behavioral intervention in lowgrade locations and middleaged FSWs are beneficial to improving condom use rate.

Abstract:

ObjectiveTo investigate the current status of nurses’ occupational protection during venous blood sampling, and compare whether there are differences in specific occupational protective behaviors among different regions. MethodsAccording to stratification of six major geographical regions of China (East China, South China, West China, North China, Northeast China, Central China), nurses in 12 tertiary firstclass comprehensive hospitals in different regions of China were investigated, a questionnaire survey was performed on organization and management of occupational protection during venous blood sampling, implementation of specific behaviors, and pressing after pulling needles of blood sampling, surveyed results were statistically analyzed, difference among different regions was compared. ResultsA total of 3 176 nurses in 89 departments of 12 hospitals were surveyed. The average number of venous blood sampling by nurses was most in South China(299.88 times), and least in North China (102.03 times). 99.42% (2 910/2 927) of nurses knew the emergency countermeasures for needle stick injuries; only 65.71%（1 901/2 893）of nurses wore gloves while collecting blood, the highest was in West China (98.03%, 398/406), the lowest was in North China（25.00%，115/460）， difference among different regions was statistically significant （χ2=617.32，P＜0.01）； 49.47% （1 445/2 921） of nurses discarded the used needle with one hand, the highest was in Northeast China （66.16%，217/328），the lowest was in East China(40.83%，167/409），difference among different regions was statistically significant（χ2=70.28，P＜0.01）. 65.42%（1 831/2 799）of nurses guided patients to press blood vessel puncture point, the highest was in Central China（74.95%，380/507）， the lowest was in Northeast China(48.73%，154/316)， difference in correct guiding rate of pressing point among different regions was statistically significant （χ2=93.84，P＜0.01）. ConclusionIt is necessary to improve the occupational safety awareness of Chinese nurses during venous blood sampling, implement systematic safety precaution training and standardize occupational protection behaviors, so as to reduce bloodborne pathogen occupational exposure and promote safety of nurses.

Abstract:

ObjectiveTo compare disinfection effect of disinfectant wipes and chlorinecontaining disinfectant, provide basis for improving prevention and control measures for healthcareassociated infection.MethodsAccording to disinfection methods, three groups were divided: Clinell Universal Wipes group(Clinell group), Gelica Surface Disinfecting Towelettes group(Gelica group), and 84disinfectant group, bed units of neonatal ward were cleaned and disinfected, surface sampling of bed units before disinfection, as well as 5, 10, 30 and 60 minutes after disinfection was performed, 30 specimens were taken in each group at each time point, bacterial colony count, bacterial killing rate and qualified rate of disinfection among three groups were compared, methicillinresistant Staphylococcus aureus (MRSA) on object surface was screened.ResultsAfter 5, 10, 30 minute disinfection, there was no significant difference in bacterial colony count and bacterial killing rate of object surface of bed units among three groups(P＞0.05). After 60 minute disinfection, bacterial colony count in Clinell group (［2.61±0.41］CFU/cm2) and Gelica group (［2.71±0.42］CFU/cm2) were both lower than 84disinfectant group(［4.08±0.33］CFU/cm2), difference was significant(P＜0.05)；bacterial killing rate in Clinell group (［72.36±3.90］%) and Gelica group (［71.49±4.77］%) were both higher than 84disinfectant group(［55.92±3.22］%), difference was significant(P＜0.05). The qualified rate of disinfection of bed unit surface in Clinell group was higher than 84disinfectant group(86.67% vs 63.33%, P＜0.05）. All three disinfection methods can effectively remove MRSA from object surface.ConclusionDisinfection effect of disinfectant wipes is reliable, it can effectively kill multidrugresistant organisms on bed unit surface in neonatal ward, and is suitable for routine disinfection in highrisk environment, such as neonatal ward.

Abstract:

ObjectiveTo analyze the distribution and drug resistance of pathogens isolated from cardiac vegetations in patients with infective endocarditis(IE), so as to provide guidance for rational antimicrobial use in clinical treatment. MethodsA retrospective analysis was performed on distribution of pathogens isolated from cardiac vegetations and blood culture, as well as drug resistance of pathogens isolated from cardiac vegetations in patients with IE in a hospital form July 2012 to July 2017. ResultsThe positive rate of cardiac vegetation culture from 193 patients was 38.86%（75/193), 82 pathogenic strains were isolated from 75 patients’ cardiac vegetations, there were 58 strains(70.73%) of grampositive bacteria, 19 strains(23.17%) of gramnegative bacteria, and 5 strains (6.10%) of fungi. Grampositive bacteria were still highly sensitive to vancomycin, Streptococcus viridans had higher resistance rates to tetracycline(37.14%), clindamycin (51.43%), and erythromycin(68.57%); Staphylococcus spp. showed higher resistance rates to erythromycin(50.00%), oxacillin (60.00%), and penicillin (80.00%); resistance rates of Enterococcus spp. to levofloxacin, erythromycin, ciprofloxacin, and tetracycline were all≥75.00%; Pseudomonas spp. were highly resistant to ciprofloxacin(36.36%), levofloxacin(36.36%), and imipenem(45.45%); drug resistance rates of Ochrobactrum spp. to βlactam antibiotics were up to 100.00%; Acinetobacter spp. had high resistance rates to all detected antimicrobial agents (all>30.00%). ConclusionPathogens isolated from cardiac vegetations in patients with IE are mainly grampositive bacteria, cardiac vegetation culture can serve as an effective supplement and validation for blood culture, antimicrobial agents should be selected rationally in the clinical treatment according to antimicrobial susceptibility testing result.

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ObjectiveTo understand the mutation characteristics of rifampicin resistance gene rpoB as well as isoniazid resistance genes katG and inhA of Mycobacterium tuberculosis(MTB) in a hospital, and provide scientific basis for the prevention and treatment of drugresistant tuberculosis.MethodsMTB strains were isolated from sputum specimens of 83 patients with tuberculosis, rifampicin and isoniazid resistance was detected by BD960 liquid culture method, DNA of MTB was extracted, complete genome of rpoB, katG and inhA were amplified by polymerase chain reaction, the amplified product was sequenced and analyzed.ResultsAmong 83 strains from specimens, 39 strains were resistant to rifampicin and 51 were resistant to isoniazid. The mutation rate of rpoB gene of rifampicinresistant strain was 97.44% (38/39), mutation rate of locus 531 and locus 526 were 60.53% (23/38) and 23.68%（9/38）respectively, combined mutation of multilocus appeared in 32 strains. The mutation rate of katG gene in isoniazidresistant strains was 98.04% (50/51), a total of 16 types of mutations were found, the majority of which were point mutations at katG 315, accounting for 70.00% (35/50), and one isolate was combined mutation of katG and inhA.ConclusionResistance of multidrugresistant(MDR) MTB is related to mutation in rpoB and katG genes, detection of MDR gene mutation in MTB can provide reference for early and rapid diagnosis of tuberculosis.

Abstract:

ObjectiveTo study the serotype distribution, antimicrobial resistance, and characteristics of extendedspectrum βlactamases (ESBLs) resistance genes of clinically isolated Salmonella in Beijing from 2012 to 2015.MethodsAntimicrobial resistance of 677 Salmonella strains isolated from gastrointestinal clinic in Beijing to 16 kinds of antimicrobial agents was detected by minimal inhibitory concentration method, resistance genes in 244 βlactamase resistance strains were detected by polymerase chain reaction (PCR). Results677 Salmonella strains were divided into 68 serotypes, the top three were Salmonella enteritis, Salmonella typhimurium, and Salmonella senftenberg, antimicrobial resistance of Salmonella to ampicillin and amoxicillinclavulanic acid were 42.54% and 40.77% respectively, 57.16% of strains were resistant to at least 3 kinds of antimicrobial agents. Of 244 strains of ampicillin and amoxicillin/clavulanic acidresistant Salmonella, 174 (71.31%) carried at least one kind of ESBLs gene, 146 were for type blaTEM1, 30 for blaOXA1, and 18 for blaCTXM (7 were for blaCTXM15, 6 blaCTXM55, 5 blaCTXM14); 20 strains harbored two kinds of drug resistance genes at the same time. ConclusionSalmonella in this area has a high carrying rate of ESBLs resistance genes, mainly blaTEM1, accompanied by blaOXA1 and 3 kinds of blaCTXM subtypes, showing a genetic diversity.

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ObjectiveTo understand pathogens causing bloodstream infection(BSI) in patients with acute leukemia(AL), as well as trend of antimicrobial resistance of pathogens, and provide evidence for clinical antiinfection treatment. MethodsPathogens and antimicrobial susceptibility of pathogens isolated from blood culture of patients with AL in the department of hematology in a hospital from January 2011 to December 2016 were analyzed, distribution and antimicrobial resistance of pathogens between 2011-2013 and 2014-2016 were compared. Results229 strains of pathogens were isolated from 221 AL patients with BSI, including 68 strains(29.69%) of grampositive bacteria, 154(67.25%) gramnegative bacteria, and 7 (3.06%)fungus. Escherichia coli (E. coli) was dominant strain in both the first and second three years, followed by coagulasenegative staphylococcus (CNS) and Pseudomonas aeruginosa (P. aeruginosa). Constituent ratio of P. aeruginosa increased from 7.08% (8/113) to 12.07% (14/116), fungi increased from 1.77% (2/113) to 4.31% (5/116), difference in constituent ratio of pathogens and antimicrobial susceptibility between the first and second three years were not statistically significant (both P>0.05). Susceptibility of grampositive bacteria to vancomycin, linezolid, and quinupristin/dalfopristin were all 100%, 64.29%-69.57% of CNS and 55.56%-66.67% of Staphylococcus aureus were methicillinresistant strains. Resistance rates of E. coli and Klebsiella pneumoniae to cephalosporins were high, resistance rates to third generation cephalosporins were 25.00%-75.61%; imipenem and ertapenemresistant E. coli were detected. Resistance rates of Candida tropicalis to itraconazole and voriconazole increased from 0 in 2011-2013 to 25% in 2014-2016. All the detected fungi were susceptible to amphotericin B, ketoconazole, and nystatin. ConclusionE.coli is the major pathogen causing BSI in AL paptients, P. aeruginosa has a growing trend, proportion of fungal infection has increased, rational use of antimicrobial agents should be based on blood culture and antimicrobial susceptibility testing result.

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ObjectiveTo systematically assess risk factors for pulmonary infection in patients after tracheal intubation under general anesthesia.MethodsLiteratures published between the establishment of database and September 15, 2017 were retrieved from PubMed, China National Knowledge Infrastructure (CNKI),  Chinese Biology Medicine (CBM) database, Wanfang database (Wanfang), and VIP database, data about pulmonary infection in patients after tracheal intubation under general anesthesia were collected. Literatures were screened, extracted, and evaluated according to inclusion and exclusion criteria by two reviewers, Metaanalysis was conducted using RevMan 5.3 software.ResultsA total of 19 literatures were included for analysis. Metaanalysis showed that the following factors were associated with occurrence of pulmonary infection in patients after tracheal intubation under general anesthesia: age, smoking, emergency surgery, underlying disease, duration of tracheal intubation, duration of general anesthesia, method of intubation, depth of intubation, proficiency of intubation(whether intubation was repeated), indication of extubation, and delay of extubation. The combined OR values and 95%CI of each factor analysis were 3.19(2.58-3.95), 2.43(1.55-3.82), 2.45 (1.42-4.24), 4.85(2.36-9.94), 4.96 (2.08-11.84), 3.33 (1.15-9.70), 1.49(1.06-2.09), 4.67(2.74-7.96), 2.52 (2.14-2.98), 2.23(1.90-2.61), and 3.91(3.18-4.81), respectively.ConclusionIt is important to grasp strictly the indication of general anesthesia for tracheal intubation, standardize management of tracheal intubation and extubation after anesthesia resuscitation, seize the opportunity to remove tracheal catheter, and reduce risk of postoperative infection.

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ObjectiveTo analyze the species, distribution characteristics, and antimicrobial  susceptibility of pathogens from bile of patients with choledocholithiasis and biliary tract infection during and 48 hours after lithotomy under endoscopic retrograde cholangiopancreatography (ERCP), so as to provide guidance for clinical antimicrobial choice. MethodsPatients who performed lithotomy under ERCP for treating choledocholithiasis and biliary tract infection in a hospital between October 2015 and December 2016 were surveyed, bile from patients during lithotomy under ERCP (intraoperative group) and 48 hours after lithotomy by nasobiliary drainage (postoperative group) were performed bacterial culture and antimicrobial susceptibility testing. ResultsData of 117 patients were collected, positive bacterial culture rate of bile in intraoperative group and postoperative group were 73.50% and 47.86% respectively, there was significant difference between two groups (P<0.05). A total of 174 bacterial strains were isolated from 234 bile specimens in two groups, gramnegative bacteria, grampositive bacteria, and fungi were 138 (79.31%), 33 (18.97%), and 3 (1.72%) strains respectively; 105 strains were from intraoperative group and 69 were from postoperative group; there was no significant difference in the distribution of bacterial species between intraoperative group and postoperative group（P＞0.05）. The top 5 bacteria in intraoperative group and postoperative group were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis, and Enterobacter cloacae. Susceptibility rates of Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa to 10 kinds of antimicrobial agents were all≥60.00%， resistance rates of Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa to piperacillin/tazobactam, ceftazidime, and levofloxacin were relatively higher; susceptibility rates of these three bacteria to imipenem and meropenem were all 100.00%. Among grampositive bacteria, susceptibility rates of Enterococcus faecium and Enterococcus faecalis to teicoplanin, vancomycin, and linezolid were all 100.00%. ConclusionGramnegative bacteria is the main pathogen causing biliary tract infection, patients with choledocholithiasis and biliary tract infection should perform lithotomy under ERCP as early as possible in case of no contraindication, so as to relieve biliary obstruction; combined antimicrobial use is suggested for the empiric antimicrobial treatment.

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ObjectiveTo compare difference in antimicrobial resistance of Haemophilia influenzae(H. influenzae) causing pulmonary infection between returned migrant workers’ children(RMWC) and local resident farmers’ children(LRFC).MethodsChildren from a local area who diagnosed with pulmonary infection and performed sputum bacterial culture in a hospital from January 2012 to June 2015 were investigated, those who isolated H. influenzae were divided into RMWC group and LRFC group according to whether they had ever followed their parents to work or study outside the local area or only stayed in the local area. Infection characteristics of two groups of children were analyzed, resistance rate of H. influenzae between two groups was compared.ResultsA total of 6 989 patients were investigated, 635 strains of H. influenzae were isolated from sputum specimens, isolation rate was 9.09%; incidence of H. influenzae pulmonary infection in RMWC group was higher than that of LRFC group (12.11% vs 8.47%, P<0.01). 12 children（8.39%） had ever migrated across 4 provinces and municipalities, 24 children（16.78%） had ever migrated across 3 provinces and municipalities; regional distribution was mainly in Guangdong Province (n=92, 31.40%），followed by Zhejiang Province（n=87， 29.69%）and Jiangsu Province （n=66，22.53%）. The age of both RMWC group and LRFC group were mainly less than three years old, infection time was mainly 1-3 month. Resistance rates of H. influenzae from sputum specimens of RMWC group to cefotaxime, cefepime, cefaclor, tetracycline, chloramphenicol, clarithromycin, levofloxacin, ofloxacin, and ciprofloxacin were all higher than those of LRFC group（all P＜0.05）， βlactamaseproducing rate was also higher （χ2=24.35，P＜0.01）.ConclusionResistance rate of H. influenzae isolated from RMWC group is higher than that of LRFC group with pulmonary infection, which may be related to extensive migration, patients get drug resistance through respiratory tract transmission, and antimicrobial use rule in different migrated regions.

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ObjectiveTo analyze epidemiological characteristics of serotypes, virulence factors, and resistance genes of group B streptococcus (GBS) colonized in pregnant women in Shenzhen City.MethodsPositive strains of prenatal GBS screening for pregnant women in three tertiary hospitals in Shenzhen City from October 2015 to September 2016 were collected, antimicrobial susceptibility testing was performed with KirbyBauer disk diffusion method, GBS serological typing, αlike surface protein, pili protein, and antimicrobial resistance genes were detected with multiplex polymerase chain reaction (multiplex PCR).ResultsA total of 56 GBS strains were isolated, 5 serotypes were detected (Ia, Ib, II, III, V), which was dominated by type III (60.7%). There was correlation between different serotypes and specific surface protein as well as pili protein distribution, such as serotype Ia and eps, Ib and bca, III and rib, V and alp2/3, serotype Ib and PI2a, III and PI2b, as well as V and PI2a+PI1( all P<0.05). 56 strains of GBS were all sensitive to penicillin, resistance rates to chloramphenicol, levofloxacin, erythromycin, clindamycin, and tetracycline were 14.3%, 23.2%, 75.0%, 67.9%, and 85.7%, respectively.ConclusionThe main type of GBS in pregnant women in Shenzhen City is type III, there is a significant correlation between different serotypes and specific virulence genes. GBS is generally sensitive to penicillin, resistance rates to erythromycin, clindamycin, and tetracycline are high.

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ObjectiveTo analyze healthcareassociated infection(HAI) crosssectional survey results in a psychiatric hospital from 2005 to 2016, so as to provide a scientific basis for prevention and control of infection risk in psychiatric hospitals.MethodsA crosssectional survey was performed through combination of individual case survey, bedside survey, and medical records reviewing, occurrence of HAI and antimicrobial use in all hospitalized patients on a given day of each year from 2005 to 2016 were investigated.ResultsFrom 2005 to 2016, a total of 8 006 hospitalized patients were performed crosssectional survey, the actual investigation rate was 100.00%, average HAI prevalence rate was 3.46%; the main infection site was respiratory tract; 203 patients with HAI were aged≥55 years, accounting for 73.29%. The daily use rate of antimicrobial agents was 3.72%, mainly for therapeutic purpose (86.24%) and monodrug use(81.88%). Specimen submission rate in patients receiving therapeutic antimicrobial use was 45.91%. A total of 17 pathogenic strains were detected on the crosssectional survey day in 2005-2016, mainly Escherichia coli(41.18%), multidrugresistant organism was not found.ConclusionPsychiatric hospitals need to enhance management awareness of prevention of HAI risk, prevent and control HAI according to characteristics of psychiatric hospitals, and effectively prevent the occurrence of HAI.

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ObjectiveTo investigate the effect of 2% chlorhexidine daily bathing on  incidence of multidrugresistant organism (MDRO) infection in intensive care units (ICUs). MethodsFrom January 2016 to December, patients who were admitted to three ICUs in a hospital were selected for study. Patients who were admitted between January and June 2016 were as control group, between July and December 2016 were as trial group; patients in control group took a bath every day with warm water, trial group took a bath every day with 2% chlorhexidine; incidence of MDRO infection in two groups of patients were monitored.Results917 patients in control group and 953 patients in trial group were treated. There was no significant difference in gender, age, APACHE II score, invasive operation, intervention measure compliance, and adverse reaction between two groups of patients(all P>0.05). Incidence of MDRO infection in trial group and control group were 17.71 cases per 1 000 patientdays and 33.91 cases per 1 000 patientdays. Incidence of CRAB infection in trial group and control group were both higher（7.65‰ vs 13.82‰）. ConclusionDaily bathing with 2% chlorhexidine can significantly reduce the incidence of MDRO infection in patients in ICUs.

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ObjectiveTo evaluate the effectiveness of intervention measures for disinfection of lead clothes in orthopedic surgery. MethodsCleaning and disinfection efficacy, as well as application of lead clothes in operating room in an orthopedic hospital before and after the implementation of intervention measures were investigated and compared. Results488, 499, and 487 pieces of lead clothes were investigated before, three months after, and six months after intervention, application of lead clothes were 1 840, 1 901, and 1 801 times respectively. Before and three months after intervention, 12.55% and 0.26% of lead clothes were found visible blood stains respectively, difference was statistically significant(χ2=238.99，P=0.00）；six months after the intervention, 0.11% of lead clothes were found to be stained with blood, there was no significant difference compared with three months after the intervention（χ2=1.13，P=0.29）. Before and three months after intervention, the qualified rates of bacterial colony on lead clothes were 72.34% and 89.16% respectively, difference was statistically significant（χ2=171.24，P=0.00）；six months after intervention，qualified rate of bacterial colony on lead clothes was 90.62%, difference was not statistically significant compared with three months after the intervention （χ2=2.14，P=0.14）. Before and three months after intervention, rate of repeated use of lead clothes were 19.29% and 9.84% respectively, difference was statistically significant（χ2=70.08，P=0.00）；after six month intervention, rate of repeated use of lead clothes was 6.22%, which was significantly different from that after three month intervention（χ2=16.31，P=0.00）. ConclusionIntervention measures for lead clothes disinfection in department of orthopedic surgery can effectively improve the cleanliness of lead clothes, and the continuous effect of intervention measures is better.

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ObjectiveTo evaluate membrane filtration (MF) method and agar plate pouring (AP) method for detecting endoscopy disinfection efficacy. MethodsDisinfection efficacy of all endoscopes in a hospital were detected and evaluated with MF method and AP method. ResultsA total of 192 disinfected endoscopes were detected, 96 were detected with MF method and 96 were detected with AP method, according to the detected bacterial colony count, disinfected endoscopes were divided into 0, 1-10, 11-20, 21-300, and > 300 CFU/piece groups, ranksum test results showed differences in distribution of colony count of disinfected nasopharyngoscopes, bronchoscopes, gastroscopes, and enteroscopes were significant(all P<0.05), bacterial colony count detected by MF method was higher than AP method. Qualified rate of endoscope disinfection detected by AP method was 91.67%, MF method was 88.54%, there was no significant difference in qualified rate between two methods (χ2=0.53, P=0.630). ConclusionMF method is more accurate than AP method to detect bacterial colony count remained in the endoscope after disinfection, it is worth to be popularized.

Abstract:

皮疽奴卡菌又称鼻疽奴卡菌（Nocardia farcinica），隶属于奴卡菌属。1888年 Nocard首次分离出奴卡菌［1］，其后国内外陆续有临床病例报道。奴卡菌病临床少见，多见于免疫力低下者，近年有增长趋势。奴卡菌病由奴卡菌感染所致，病理表现为亚急性或慢性化脓性或肉芽肿性病变，病原菌通过呼吸道或受损的皮肤入侵，肺为主要受累脏器，以星形奴卡菌最为多见，其次为巴西奴卡菌［117］。我院1例左侧臀部脓肿患者检出1株皮疽奴卡菌，现报告如下。

Abstract:

伤口感染一直是严重影响人们生命健康的全球性卫生保健问题，在创伤、烧伤和手术等伤口中发病率较高，是不容忽视的问题［12］。促进伤口愈合，降低伤口的感染率，已成为医学研究中重点关注的方向［3］。伤口感染为伤口中存在的微生物持续增殖对宿主造成损害，是创伤手术后发生的主要并发症，严重时不仅导致手术失败，甚至造成患者截肢［4］。在引起伤口感染的微生物中，细菌占绝大多数。细菌广泛存在于人体和周围环境中，可以通过吸入带细菌的空气、伤口接触带菌的物体等方式引起伤口感染，尤以接触感染较为多见［5］。目前，无菌术和清创术是外科治疗伤口感染的主要手段，此两种方法主要是通过减少伤口部位的细菌数量，清除伤口部位微生物分泌的毒素及其他污染物来预防和治疗伤口感染［67］。与此同时，抗菌药物也广泛应用于伤口感染的治疗。在抗菌药物使用过程中存在一些不容忽视的问题，如药物使用方法不规范、给药时机不合理、用药时间过长等［89］。抗菌药物的不合理应用可以延长伤口感染的时间，导致耐药菌的产生，甚至在医院中出现感染的暴发，增加患者的病死率和经济负担［7］。此外，在全身使用抗菌药物治疗伤口感染时，伤口感染部位的抗菌药物浓度无法达到抑制或杀死病原体的水平，或者无法渗透进入细菌生物膜（bacterial biofilm，BF）抑制或杀死细菌［1011］。研究［1213］表明，伤口局部应用抗菌药物时可以使伤口部位药物浓度达到治疗水平，但是全身浓度较低，副作用少（如肾毒性和耳毒性），并减少病原体耐药性的产生。近年来，随着生物材料和生物医学领域的飞速发展，许多新型的医用抗菌材料已经被研究出来，研究者将抗菌材料添加到生物医用材料上，使其在原有的功能特性基础上增加了抗菌功能，从而起到局部防治感染的作用。在生物医用材料中由于其优良的生物特性被广泛应用，制造出很多丝素蛋白抗菌材料［1415］。本文重点从新型丝素蛋白抗菌材料分类的角度，对丝素蛋白生物材料的研究情况和其在抗菌领域的最新进展进行综述。