Abstract:Objective To evaluate in vitro antimicrobial effect of fosfomycin sodium single use and combination with other antimicrobial agents on clinically isolated Staphylococcus aureus (S. aureus), Klebsiella pneumoniae (K. pneumoniae) and Pseudomonas aeruginosa (P. aeruginosa) in China. Methods Combined antimicrobial susceptibility testing was performed with checkerboard method, minimal inhibitory concentrations (MICs) were detected by two-fold agar dilution method, susceptibility of S. aureus (n=113 strains), K. pneumoniae (n=108 strains), and P. aeruginosa (n=110 strains) isolated from 18 hospitals in China in recent three years was determined by single and combined antimicrobial susceptibility testing. Results MIC₅₀ value of fosfomycin sodium single use were all ≤ 32 mg/L against all tested strains, regardless of whether strains were resistant to other antimicrobial agents or not. The synergistic rate of fosfomycin sodium with levofloxacin, minocycline, oxacillin, and clindamycin against methicillin-resistant S. aureus (MRSA) was >43%. Synergistic rate of fosfomycin sodium with levofloxacin and imipenem against imipenem-nonsusceptible P. aeruginosa was >35%, synergistic rates of fosfomycin sodium with tested antimicrobial agents against imipenem-susceptible P. aeruginosa were all >35%. Conclusion Fosfomycin sodium still has good antimicrobial activity against common clinical drug-resistant bacteria, such as MRSA, extended-spectrum β-lactamase-producing K. pneumoniae and so on, it has synergistic effect with many other kinds of antimicrobial agents, suggesting that in the limited treatment of infection caused by drug-resistant bacteria, fosfomycin in combination with other antimicrobial agents may be a useful choice.

Abstract:Objective To study the prevalence of plasmid-mediated quinolone resistance (PMQR) genes in carbapenem-resistant Enterobacteriaceae (CRE) and its resistance mechanism. Methods Clinically isolated CRE strains in a hospital from March 2015 to March 2018 were collected, then identified and performed antimicrobial susceptibility test by VITEK 2 Compact analyzer, carriage of PMQR genes qnrA, qnrB, qnrS, qepA and acc (6')Ib-cr were determined by polymerase chain reaction (PCR) and sequencing, the horizontal transfer of PMQR genes were verified by plasmid conjugation test. Results Resistance rates of carbapenem-resistant Escherichia coli and carbapenem-resistant Klebsiella pneumoniae to quinolones were 100% and 15.56%-33.33% respectively. Detection rate of acc (6')Ib-cr gene was the highest (87.72%), followed by qnrB (77.19%) and qnrS (17.54%), 2 strains (3.51%) carried qnrA gene, qepA gene was not isolated, 84.21% of strains harbored 2 or 3 PMQR genes. PMQR gene was transfected into all the 8 conjugated strains, but minimum inhibitory concentration value of quinolones didn't change significantly. Conclusion The detection rate of PMQR genes in CRE in this hospital is high, but there is a certain sensitivity to quinolones.

Abstract:Objective To explore the method of real-time identification and early warning of drug-resistant bacteria through information technology, timely obtain information about drug-resistant bacteria in clinic. Methods Interface of Hospital Information System (HIS), Laboratory Information Management System (LIS) and healthcare-associated infection (HAI) surveillance system were reconstructed in 2015, HL7 was used as interface framework to design standard, LIS was as baseline data source and HIS as patient information database, multi-information exchange was implemented on the commonly used interface, identification and early warning of detected drug-resistant bacteria was conducted, identification of drug-resistant bacteria before and after informationization was compared. Results Through the information construction, the information interface showed that the rules of drug-resistant bacteria determination can be changed at will, data results were more accurate and timely. The judgment time of manual review was reduced from 30 minutes to 2 minutes every day, information of drug-resistant bacteria can be obtained timely and conveniently on any internal network computer by clinical staff. After timely identification and intervention of drug-resistant bacteria, 284, 289 and 309 strains of drug-resistant bacteria were detected in key departments of HAI control in 2015-2017, drug-resistant bacteria per 1 000 bed-day were 9.23‰ (284/30 773), 8.91‰ (289/32 429), and 8.34‰ (309/37 031)respectively, with a slight decrease. Conclusion Through information technology, drug-resistant bacteria can be found timely, and new drug-resistant bacteria can be identified and intervened in time, so as to effectively reduce the infection rate of drug-resistant bacteria.

Abstract:Objective To investigate and control the outbreak of infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in a gastroenterology intensive care unit (ICU), so as to provide reference for the prevention and control of clinical multidrug-resistant organisms (MDROs). Methods Epidemiological investigation was conducted on 3 patients with CRKP infection in a gastroenterology ICU on January 21-31, 2018, specimens were collected with environmental biology monitoring method, CRKP in environment was searched, homology between patients and environmental isolates were analyzed by pulsed-field gel electrophoresis (PFGE). Results Three patients were all isolated CRKP from sputum and blood specimens, all were male, with adjacent beds in the same ward, and treated by the same doctor. The number of isolated CRKP and infection rate in January 2018 were higher than those in other months, infection rate was significantly different (χ²=13.67, P<0.01). A total of 102 environmental specimens were collected, including air and surface of objects, only 1 of which (nurse's uniform) was isolated 1 strain of KP. PFGE typing of KP isolated from patients and environment showed that there were two genotypes A and B, KP isolated from uniform of a nurse, hydrops abdominis and blood specimen of patient at bed 07, blood specimen of patient at bed 08, as well as sputum and blood specimen of patient at bed 09 were all type A, KP isolated from sputum specimen of patient at bed 07 was type B, KP isolated from hydrops abdominis in patient at bed 09 was not be typed. After comprehensive intervention, CRKP was not no longer isolated from 3 patients, and there was no new case in the ward. Conclusion Imperfect implementation of prevention and control measures for MDROs by health care workers may be an important cause for the spread of CRKP.

Abstract:Objective To understand the clinical characteristics and changes in laboratory indicators of patients died of visceral leishmaniasis (VL). Methods Clinical data of 4 patients died of VL in Beijing Friendship Hospital from January 2013 to June 2018 were analyzed, differences in laboratory indicators were compared. Results Disease course of 4 cases of VL ranged from 3 to 12 months, all patients had multiple organ damage, including 3 cases with hepatomegaly and splenomegaly, 2 cases with central nervous system damage. IgG antibodies of leishmania were positive in 4 patients, Leishman-Donovan body was found in bone marrow smears. Routine peripheral blood test results in 4 patients decreased significantly, albumin decreased significantly and globulin increased; level of serum sodium ion in 4 patients was lower than 135 mmol/L. Conclusion Long disease course, multiple organ damage, involvement of central nervous system, significant reducing in peripheral blood routine test results, hypoproteinemia, and hyponatremia in patients with VL all indicate poor prognosis and high mortality.

Abstract:Objective To investigate current situation of Chinese clinical microbiological laboratories participating in management of healthcare-associated infection and antimicrobial use. Methods Fourteen provinces (municipalities), autonomous regions and army hospitals in seven regions of China were selected, the participation of clinical microbiological laboratories in the consultation of HAI diseases, specimen quality control, antimicrobial use, and management of multidrug-resistant organisms (MDROs) before 2000 and every five years from 2000 to 2015 were investigated, the surveyed results were analyzed statistically. Results A total of 187 hospitals were investigated, in 2015, 96 and 172 hospitals (51.34%, 91.98%) participated in the consultation of infectious diseases and multi-department collaborative management on MDROs respectively. However, 44 hospitals (23.53%) still manually performed statistical analysis on drug susceptibility, only 26 hospitals (13.90%) had the ability of identifying homology of pathogens. Rate of MDRO surveillance data feedbacked to clinical departments increased from 66.84% (n=125) in 2010 to 95.72% (n=179) in 2015, the frequency of feedback was mainly monthly and quarterly; rate of antimicrobial susceptibility results feedbacked to clinic departments increased from 62.03% (n=116) to 94.12% (n=176), 82.35% (n=154) of clinical microbiological laboratories conducted quarterly feedback; the quality control rate of microscopic sputum smear before sputum culture increased from 63.10% (n=118) to 87.17% (n=163); rate of bilateral double blood culture increased from 35.83% (n=67) to 72.73% (n=136); rates of other aseptic body fluid culture (except blood and urine) increased from 4.86% to 5.74%; differences were all significantly different between 2010 and 2015 (all P<0.05). Conclusion Clinical microbiological laboratories have played an important role in promoting the development of HAI management in China, especially during the period of 2011-2015. However, the homology analysis on HAI pathogens, informatization of result feedback, and sterile body fluid specimens detection need to be further strengthened.

Abstract:Objective To investigate the incidence of central line-associated bloodstream infection (CLABSI) in patients with hematopoietic stem cell transplantation (HSCT), explore risk factors for the occurrence of CLABSI. Methods Basic information of patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) who underwent HSCT in a hematology department from November 1, 2016 to October 31, 2017 was collected, incidences of original CLABSI (OCLABSI) and modified CLABSI (MCLABSI) were calculated, related risk factors were analyzed by multivariate Cox regression. Results A total of 218 patients with AML and MDS who underwent HSCT were enrolled, 19 of whom had OCLABSI and 10 had MCLABSI. Twenty-one strains of pathogens were isolated from 19 patients with OCLABSI, including 9 gram-positive bacteria, 11 gram-negative bacteria, 1 fungus; 9 strains were multidrug-resistant organisms. The main risk factors for OCLABSI included the female (HR=0.088;95%CI:0.017-0.440;P=0.003), age (HR=1.560;95%CI:1.066-2.530;P=0.034), bone marrow cell transplantation only (HR=4.408;95%CI:1.860-22.593;P=0.043), ATG/CSA/MMF/MTXG for preventing graft-versus-host disease (GVHD) (HR=0.101;95%CI:0.015-0.686;P=0.019), and MTX for preventing GVHD (HR=0.097;95%CI:0.011-0.816;P=0.032). Conclusion Definition of MCLABSI can provide more accurate monitoring on deep central venous catheter-related bloodstream infection. Incidence of CLABSI in HSCT patients can be reduced by early detection of high-risk population according to high-risk factors, strict adherence to the prevention and control measures of bloodstream infection, and implementation of immune recombination after enhanced transplantation.

Abstract:Objective To explore clinical characteristics of human cytomegalovirus (HCMV) and polyomavirus (BKV and JCV) infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods Clinical data of 53 patients with hematologic malignancies who underwent allo-HSCT from June 2016 to December 2017 were collected. HCMV, BKV and JCV loads in patients' peripheral blood and urine were monitored once a week from day 1 to day 100 after transplantation. Incidence, occurrence time, clinical manifestations, and risk factors of viral infection were analyzed. Results A total of 51 patients had viral infection, infection rate was 96.23%. HCMV, BKV, and JCV infection rates were 54.72% (29/53), 77.36% (41/53), and 28.30% (15/53) respectively. Incidences of pulmonary infection, acute graft-versus-host disease (aGVHD), and hemorrhagic cystitis (HC) were 54.72%, 58.49%, and 20.75% respectively. Analysis on risk factors showed that aGVHD (OR, 24.61[95% CI, 2.30-46.24]), pretreatment with total body irradiation (TBI) (OR, 33.39[95% CI, 1.57-79.13]), and use of antithymocyte globulin (ATG) (OR, 24.77[95% CI, 1.16-52.58]) were independent risk factors affecting HCMV. Human leukocyte antigen (HLA) coincidence (OR, 0.003[95% CI, 0.00-0.10]) could reduce the risk of HCMV viruria; pretreatment with TBI (OR, 15.10[95% CI, 1.14-39.27]) was an independent risk factor for BKV viruria, compatible blood group of donor and recipient (OR, 0.07[95% CI, 0.01-0.64]) could reduce the risk of BKV viruria. Conclusion HCMV and polyomavirus infection in blood and urine of recipient should be monitored as soon as possible after transplantation, so as to prevent and reduce complications in time.

Abstract:Objective To explore species distribution of bacteria colonizing the indwelling double J tube in pregnant women. Methods From March 2013 to December 2017, patients with double J tube during pregnancy in urology department of a hospital were collected. According to the time of indwelling double J tubes, they were divided into group A (indwelling time ≤ 1 month) and group B (indwelling time >1 month). All patients underwent bladder urine and double J tube bacterial culture before and after extubation. Species and positive detection rates of bacteria in bladder urine and double J tube between two groups were compared and analyzed. Results A total of 237 pregnant women with ureteral obstruction were included in the study, 129 cases in group A and 108 in group B. A total of 78 strains of bacteria were isolated in double J tube culture, 35 strains in group A and 43 in group B. Gram-negative bacilli were predominant in both groups, accounting for 54.29% and 67.44% respectively, followed by gram-positive cocci, accounting for 37.14% and 25.58% respectively; isolated bacteria were Escherichia coli (n=30), Enterococcus spp. (n=12), Staphylococcus spp. (n=12), Klebsiella pneumoniae (n=11), Pseudomonas aeruginosa (n=7) and so on. Positive rate of double J tube bacterial culture was higher than that of bladder urine culture in both group A and group B, difference were both statistically significant (both P<0.05). Positive rate of double J tube bacterial culture in group B was higher than that in group A (39.81% VS 27.13%, P<0.05), but there was no significant difference in the positive rate of bladder urine culture between group A and group B (P>0.05). Conclusion The main colonized bacteria for pregnant women who are inserted double J tubes are gram-negative bacilli, the longer time the double J tube is placed, the higher rate the bacteria colonize and the higher positive of bacterial culture.

Abstract:Objective To understand the cognition and influencing factors of hand hygiene (HH) among healthcare-associated infection (HAI) management staff in Gansu Province, and provide reference for enhancing the special competency of HAI management staff. Methods According to geographical area, natural and human characteristics, HAI management staff in 69 hospitals in different areas of Gansu Province were selected to conduct a questionnaire and field survey on their basic condition and knowledge of HH, current situation, and influencing factors for HH knowledge were analyzed. Results Among 69 surveyed hospitals, 82.61% were secondary hospitals, 17.39% were tertiary hospitals; among 125 surveyed HAI management staff, 82.40% were full-time staff and 17.60% were part-time staff. 33.60% and 66.40% of HAI management staff had complete and incomplete knowledge of HH respectively; the knowledge about importance of HH, use of hand disinfectant, installation of HH facilities, hand washing methods, hand drying methods, HH indications, and standard for judging qualified HH in tertiary hospitals were all higher than those in secondary hospitals (all P<0.05). Multivariate logistic regression analysis showed that independent protective factors for HH cognition were working for ≥ 5 years and <10 years in HH management (OR=3.067), bachelor's degree (OR=3.331), and full-time job (OR=10.309). Conclusion HAI management staff's cognition on HH among is low, especially those who have been engaged in HH management for less than 5 years, whose educational background is secondary school or lower, and part-time personnel. It is necessary to combine with actual condition to strengthen professional competence training for HH management staff.

Abstract:Objective To compare and evaluate the effect of different time series models in predicting incidence of healthcare-associated infection (HAI), and explore the best model for predicting incidence of HAI. Methods Seasonal autoregressive integrated moving average (ARIMA) model, nonlinear autoregressive neural network (NARNN), and ARIMA-back propagation neural network (ARIMA-BPNN) combination model were constructed based on fitting dataset of monthly HAI incidence from 2011 to 2016 (72 months) in a tertiary first-class hospital in Shanghai, predicting dataset of monthly infection incidence from January to December 2017 were used to test the predictive effect of model, the predictive effect of different models was evaluated and compared. Results For the fitting dataset, mean absolute percentage error (MAPE) of ARIMA, NARNN, and ARIMA-BPNN combination model were 13.00%, 14.61%, and 11.95% respectively; and for the predicting dataset, MAPE of ARIMA, NARNN, and ARIMA-BPNN combination model were 15.42%, 26.31%, and 14.87% respectively. Conclusion Three time series models can effectively predict the incidence of HAI, of which the ARIMA-BPNN combination model showed the best performance in fitting and predicting the occurrence of HAI in this hospital, and can provide data support for the hospital decision-making.

Abstract:Objective To understand the occurrence regularity and epidemic features of notifiable infectious diseases (NIDs) among children in a tertiary general hospital, provide scientific basis for the triage and referral of infectious diseases, as well as formulation of prevention and control measures of healthcare-associated infection (HAI) among children in a general hospital. Methods Descriptive epidemiological method was used to analyze the epidemiological data of reported NIDs in children in the hospital from 2013 to 2017. Results From 2013 to 2017, 1 170 children with infectious diseases were reported, the average annual reporting rate was 5.81‰, 670 cases (57.26%) were males and 500 (42.74%) were females. The population distribution was mainly students (n=503, 42.99%) and scatter lived children (n=433, 37.01%). The reported cases were mainly concentrated in the second quarter of each year, the top three diseases were chickenpox (n=423, 36.15%), hand-foot-mouth disease (n=332, 28.38%), and mumps (n=199, 17.01%). Conclusion Infectious disease in children is an important link in the prevention and control of infection in tertiary general hospitals, the report of infectious diseases of hand-foot-mouth disease, chickenpox and mumps, as well as implementation of prevention and control measures of HAI should be strengthened.

Abstract:Objective To explore the clinical characteristics of systemic disseminated infection caused by Mycobacterium fortuitum (M. fortuitum), and improve the diagnostic rate and understanding of the disease. Methods One case of systemic disseminated M. fortuitum infection was reported, and analyzed in combination with relevant literatures. Results Patient was with multiple systemic involvement (including lung, lymph node, skin, joint), lymph node tissue culture was positive for M. fortuitum, patient was given clarithromycin+levofloxacin+linezolid for treatment, disease was remitted. Conclusion Systemic disseminated M. fortuitum infection is rare, and patient with GATA2 deletion and IFN-γ autoantibody may be a potential mechanism, diagnosis is mainly based on patholo-gical morphology and microbiological detection, but positive rate is low, diagnosis is difficult.

Abstract:Objective To explore risk factors for healthcare-associated pneumonia (HAP) caused by carbapenem-resistant Enterobacter cloacae (CREC) in patients in intensive care unit (ICU). Methods From July 2013 to June 2017, 64 patients with CREC-HAP in ICU of a hospital were collected as case group, and 64 patients with carbape-nem-sensitive Enterobacter cloacae HAP (CSEC-HAP) were as control group, risk factors for the occurrence of CREC-HAP were analyzed retrospectively by 1:1 matched case-control study. Results Univariate analysis showed that APACHE Ⅱ score ≥ 20, long length of ICU stay, use of ventilator, long length of ventilator use, use of carbapenems, long duration of antimicrobial use, and at least 2 kinds of antimicrobial agents combined use were associated with the occurrence of CREC-HAP (all P<0.05). Multivariate logistic regression analysis showed that APACHE Ⅱ score ≥ 20, use of ventilator, long length of ventilator use, use of carbapenems, and long duration of antimicrobial use were independent risk factors for occurrence of CREC-HAP (all P<0.05). Conclusion Risk factors for occurrence of CREC-HAP in ICU patients include the use of carbapenems, long length of ventilator use, long duration of antimicrobial use, and APACHE Ⅱ score ≥ 20. Effective preventive and control measures can be formulated and taken in view of the above risk factors.

Abstract:Objective To analyze the effect of probiotics combined with early enteral nutrition on infection and gastrointestinal dysfunction in patients undergoing mechanical ventilation in intensive care unit (ICU). Methods Prospective cohort study was adopted to select patients who admitted to ICU in a hospital from February 2016 to October 2017, they were randomly divided into three groups:A, B, and C. Group A received early enteral nutrition combined with probiotics, group B received early enteral nutrition, and group C received early parenteral nutrition. Infection condition, level of infection indicators (on the 3rd, 7th and 14th day after treatment), occurrence of gastrointestinal dysfunction, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) on the 14th day after treatment were compared among three groups. Results Incidences of infection in group A, B, and C were 6.00%, 20.00%, and 22.00% respectively, difference among three groups was significant (χ²=8.57, P=0.01). C-reactive protein (CRP) and white blood cell count (WBC) in group A on the 7th and 14th day were both lower than those in group B and C; procalcitonin (PCT) in group A and B on the 3rd day were both lower than that in group C; PCT in group A on the 7th and 14th day were both lower than those in group B and C; difference were all statistically significant (all P< 0.05). Incidence of abdominal distension (8.00%), diarrhea (4.00%) and gastric retention (4.00%) in group A were the lowest among three groups. APACHE Ⅱ score in group A on the 14th day after treatment was lowest. Conclusion Early enteral nutrition combined with probiotics for treatment of ICU patients with mechanical ventilation can effectively reduce the incidence of infection and gastrointestinal dysfunction, promote rehabilitation, which is worth promoting the application.

Abstract:Objective To explore risk factors for infection after subtotal gastrectomy in patients with gastric cancer, and provide reference for prevention of infection. Methods Clinical data of gastric cancer patients who were admitted to a hospital from July 2010 to June 2014 for subtotal gastrectomy were analyzed retrospectively, related factors for post-operative infection were explored. Results A total of 210 gastric cancer patients who underwent subtotal gastrectomy were enrolled, 36 patients had healthcare-associated infection (HAI) after operation, incidence of HAI was 17.14%, the main HAI were abdominal infection (n=10) and surgical site infection (n=9). Univariate analysis showed that incidence of post-operative infection was higher in gastric cancer patients who were older than 55 years, malnutrition, laparotomy, tumor-nodes-metastasis (TNM) stage Ⅲ-Ⅳ, and bedridden time >4 days after operation (all P<0.05). Logistic regression analysis showed that patients' age >55, malnutrition, and laparotomy were independent risk factors for infection after subtotal gastrectomy (all P<0.05). Conclusion Old age, poor nutritional status, and laparotomy are risk factors for infection after subtotal gastrectomy in patients with gastric cancer, effective prevention and control measures should be formulated according to these factors before and after operation.

Abstract:Healthcare-associated pneumonia (HAP) is a key factor affecting the clinical prognosis of critically ill patients undergoing long-term mechanical ventilation. In the past, ventilator-associated pneumonia (VAP) was an important mean of monitoring complications of ventilator-associated infection, but it is highly controversial because of its high subjectivity, low specificity and poor sensitivity. Therefore, the definition of ventilator-associated event (VAE) was proposed by Centers for Disease Control and Prevention of USA in 2013, the monitoring definition adopts objective and quantitative criteria, which can better predict the clinical outcomes of patients. This paper summarizes the research progress of VAE in recent years, and provides some new ideas for better prevention and control of VAE.

Abstract:Sharp injury is a common occupational injury occurs in hospital, it is also an important way for health care workers to be infected with blood-borne pathogens, standardized use of sharps containers can effectively prevent the occurrence of sharp injury. Sharps containers are widely used in China, but the specifications are limited and the products are single, there is still room for improving safety performance. In view of the problems existing in clinical use, Chinese scholars have made a lot of improvements on sharps containers. The author suggests that relevant units should consider the design concept of clinic to develop and popularize more reasonable safe sharps containers for clinical application, and take other comprehensive behavioral control measures, so as to effectively reduce the occurrence of sharp injury.