Abstract:Objective To analyze the effect of caspofungin on inhibiting the formation of Enterococcus faecalis(E. faecalis) biofilm. Methods One strain of clinically isolated E. faecalis with strong positive biofilm and 10 strains of E. faecalis with different biofilm forming ability were selected, caspofungin intervention group and control group were set up at the same time, intervention group used caspofungin with the concentration of 20 μmol/L, control group used normal saline. Growth of planktonic strains and biofilm formation of E. faecalis in two groups were detected by crystal violet staining and microplate reader. Results Caspofungin had no inhibitory effect on the growth of planktonic clinical E. faecalis strains, but can significantly inhibit the formation of biofilm. Conclusion Caspofungin has a significant inhibitory effect on biofilm formation of E. faecalis.

Abstract:Objective To analyze the data of imported yellow fever in acute phase as well as half a year and one-year follow-up in Beijing Ditan Hospital in 2016, so as to improve understanding of epidemic situation and treatment level of imported yellow fever. Methods Epidemiological history, etiology and clinical data of 5 patients were collected and analyzed. Results There are 5 cases of imported yellow fever, 2 of which were severe disease, 3 were mild type, 1 patient died. Severe patients had fever complicated with severe liver and kidney failure, coagulation dysfunction and so on; and mild patients were with liver and pancreatic damage, and thrombocytopenia. Mild patients recovered after half a year follow-up, and severe patients recovered after one-year follow-up. Conclusion Yellow fever is mainly caused by liver and kidney damage, it can damage heart, pancreas and other organs, even endanger life, the recovery time of liver function is long, recovery time of mild disease is half a year, severe disease needs more than one year, and the occurrence of fatty liver should be vigilant.

Abstract:Objective To develop a predictive model for healthcare-associated lower respiratory tract infection(HA-LRTI) in hospitalized patients, and establish a simple risk scoring method. Methods Survey data of healthcare-associated infection(HAI)in a few hospitals in 2014 was as training dataset, a Lasso-logistic regression model for predicting HA-LRTI in hospitalized patients was established, minimum model of Bayesian information criterion (BIC) was chosen as the final model, scoring method was established by magnifying regression coefficient by the same scale, survey data of 2015 and 2016 were used as the validation dataset, and was compared with risk scoring method established in the literatures. Results Among the 360 steps of Lasso, smallest BIC (6 690.4) occurred at step 24 with regularization parameter λ=130.8. The risk scoring method consisted 17 items, which was 1/4 of the amount of literature risk scoring method, DeLong's test showed that there was no significant difference in area under the curve of receiver operating characteristic between two scoring methods (Z=0.371,P=0.710), decision curve analysis almost overlaid, the net reclassification index was -0.0149, with no significant difference (Z=-1.301,P=0.193), the integrated discrimination index was 0.006, and difference was significant (P=0.014). Conclusion Lasso-logistic regression model established a simple scoring method of HA-LRTI risk for inpatients, the items of the method is relatively concise and the predictive effect is accurate.

Abstract:Objective To evaluate the accuracy of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) in identifying common clinical fungi, and provide evidence for the diagnosis and treatment of fungal infection. Methods Literatures about the accuracy of MALDI-TOF MS in fungal detection were searched through databases by computer, after quality evaluation and data extraction of the included literatures were performed, bias risk of included literatures was evaluated by QUADAS-2 tool, Meta-Disc 1.4 software was used for Meta-analysis, diagnostic efficacy of different sources of strains, species of strains, reference methods and instrument use in each subgroup were compared. Results A total of 26 articles and 9 708 strains of fungi were included, covering the common clinical yeasts and filamentous fungi. Meta-analysis showed that the combined sensitivity (95% CI), combined specificity (95% CI), combined positive likelihood ratio (95% CI), and combined negative likelihood ratio (95%CI) were 0.97 (0.97-0.97), 0.85 (0.81-0.88), 5.60 (4.55-6.90), 0.02 (0.01-0.04), and 282.40 (149.50-533.46) respectively, the area under summary receiver operating characteristic (SROC) curve was 0.9078. The results of subgroup analysis showed that MALDI-TOF MS technique has a good effect on identifying clinical yeasts and filamentous fungi, which is not affected by the source of strains, instrument brand and other factors. Conclusion MALDI-TOF MS is highly accurate for the identification of clinical pathogenic fungi, it is suitable for wide clinical application.

Abstract:Objective To analyze the diagnosis, treatment and prognosis of group B streptococcus (GBS) septicemia or combined with meningitis in newborns whose mothers were with negative GBS screening during pregnant period. Methods Clinical data of 10 cases of maternal negative GBS screening but neonatal GBS septicemia or combined with meningitis in department of neonatology from June 2014 to October 2016 were retrospectively analyzed. Results Of the 10 newborns, 7 had early onset and 3 had late onset. Neonatal procalcitonin increased in all cases, including 7 cases of septicemia or combined with meningitis, brain MRI showed 2 cases were with meningeal enhancement, and 1 case had decreased white matter density. One case was treated with amoxicillin/sulbactam alone, others were treated with combination of drugs. One case died 24 hours after birth, others were followed up for 24 months, 2 cases were underdeveloped and the other 7 cases were normal. Ten strains of GBS were sensitive to ampicillin, vancomycin, furantoin, tigecycline and penicillin, but resistant to clindamycin and tetracycline, levofloxacin-and ciprofloxacin-resistant isolates were both 3 strains. Conclusion Prenatal screening during pregnancy is still likely to be missed, neonatal GBS septicemia or combined with meningitis is serious and progresses rapidly, it is necessary to detect and give targeted anti-infective treatment, give combined anti-infective treatment if necessary.

Abstract:Objective To investigate the incidence of hemodialysis events in an outpatient department on the basis of application of monitoring software. Methods According to National Healthcare Safety Network (NHSN) hemodialysis event monitoring manual, and relying on the outpatient hemodialysis event monitoring software, the occurrence of hemodialysis events in patients undergoing hemodialysis maintenance in hemodialysis center in a hospital at the first two working days in each month from January to December 2017 were monitored. Results From January to December 2017, a total of 4 006 hemodialysis patients were monitored, 138 dialysis events occurred, incidence of hemodialysis events was 3.44%, 130 of which were treated with antimicrobial agents (52 intravenously, 78 orally), 4 cases were positive for blood culture, and 4 cases were infected at blood vessel puncture site. Accor-ding to different types of vascular access, the highest incidence of hemodialysis events was non-tunnel central catheter (7.33%). Among 130 patients who received antimicrobial agents, a total of 179 cases of infection occurred, mainly upper respiratory tract infection (94 cases). Incidence of hemodialysis events increased firstly and then decreased in each month of 2017, with the highest rate (19.02%) in April. Conclusion Outpatient hemodialysis events are mainly caused by systemic use of antimicrobial agents, incidence of hemodialysis events in non-tunnel central venous catheter patients is high, information monitoring can be used as a mean of monitoring outpatient hemodialysis events.

Abstract:Objective To analyze carbapenemase production and molecular epidemiological characteristics of clinically isolated carbapenem-resistant Klebsiella pneumoniae (CRKP) from two hospitals in Wuhan City. Methods 42 non-repetitive CRKP strains were collected from two hospitals in Wuhan City from January to October 2018, carbapenemase production was screened by Carba NP test, carriage of carbapenemase genes was detected by polyme-rase chain reaction (PCR), horizontal transfer of drug resistance genes was analyzed by plasmid conjugation test, phylogenetic relationship was analyzed by pulsed-field gel electrophoresis (PFGE). Results Of 42 CRKP strains, 14 were positive for Carba NP test, 10 of which were amplified NDM-1 gene and 3 amplified KPC-2 gene. A total of 13 CRKP strains were positive for carbapenem gene detection, 12 of which were successful in plasmid conjugation test. PFGE showed that CRKP strains carrying NDM-1 gene were classified into 6 types, there was no dominant type; CRKP strains carrying KPC-2 gene were of the same type. Conclusion NDM-1 and KPC-2-producing CRKP strains were detected, plasmid conjugation test suggested that plasmid-mediated horizontal transfer might play an important role in the dissemination of carbapenemase genes.

Abstract:Objective To investigate the occurrence of healthcare-associated infection(HAI) caused by multidrug-resistant organisms (MDROs) and economic burden due to MDRO HAI in an intensive care unit (ICU). Methods MDRO HAI occurred in patients in the general ICU of a hospital from 2016 to 2017 was investigated retrospectively, infection rate, infection site, and drug-resistant bacteria were analyzed, difference in length of hospital stay and hospitalization expenses between patients with MDRO HAI and patients without infection were compared by matched case-control study. Results MDRO HAI rate in patients in general ICU in 2016-2017 was 7.5%, MDRO HAI rate in 2017 was lower than that in 2016 (4.5% vs 10.7%). The main MDRO HAI was lower respiratory tract infection (non-ventilator-associated pneumonia), ventilator-associated pneumonia,and surgical site infection, accounting for 50.0%, 16.9%, and 10.8% respectively. The main MDROs were carbapenem-resistant Acinetobacter baumannii (CRAB), methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Pseudomonas aeruginosa (CRPA), accounting for 42.9%, 24.8%, and 24.0% respectively. The length of hospital stay of patients with MDRO infection were 26.0 days longer than patients without infection, and total hospitalization expenses increased by 116 147.0 yuan (all P<0.001). Patients with CRPA infection had the longest length of hospital stay and the highest hospitalization expenses. Conclusion MDRO HAI in general ICU patients can increase length of hospital stay and hospitalization expenses, and bring huge economic burden to patients, effective measures for prevention and control of MDRO infection should be taken to standardize the rational use of antimicrobial agents.

Abstract:Objective To explore risk factors and prevention and control measures of healthcare-associated infection(HAI) in hospitalized patients with chronic obstructive pulmonary disease (COPD). Methods A retrospective analysis on HAI in hospitalized patients with COPD in department of respiratory medicine of a tertiary hospital from July 1, 2014 to June 30, 2017 was conducted, 1:1 HAI case and non-infectious case was matched, risk factors were analyzed by univariate chi-square test and multivariate logistic regression analysis. Results A total of 1 499 COPD patients were investigated, 118 cases of HAI occurred, and all matched cases were found, HAI rate and HAI case rate were 7.87% and 8.27% respectively. Univariate analysis showed that risk factors for HAI in COPD patients were recent stay in intensive care unit(ICU), severe or extremely severe pulmonary function grading, malignant tumor, combined with other pulmonary diseases, indwelling urinary catheter, indwelling central venous catheter, antimicrobial use time>14 days, antimicrobial use>2 kinds, non-invasive ventilation, and hypoproteinemia, diffe-rences were all statistically significant (all P<0.05). Multivariate logistic analysis showed that there were 6 independent risk factors for HAI in COPD patients:pulmonary function grading, malignant tumor, combined with other pulmonary diseases, antimicrobial use>2 kinds, hypoproteinemia, and non-invasive ventilation. Conclusion Health care workers should rationally use antimicrobial agents, actively treat complications, strengthen nutritional support, pay attention to the evaluation of pulmonary function, master the best weaning time of non-invasive ventilator and implement disinfection, so as to reduce the incidence of HAI in COPD patients.

Abstract:Objective To investigate intracranial infection in patients with lumbar cistern catheter drainage after surgery for Hunt-Hess high-grade ruptured cerebral aneurysm, and analyze the influencing factors. Methods Clinical data of patients who underwent surgery for Hunt-Hess high-grade ruptured cerebral aneurysm in the cerebrovascular disease diagnosis and treatment center of a hospital between March 2017 and May 2018 were collected. The social demography, disease condition, treatment process, post-operative intracranial infection, and risk factors were analyzed. Results There were 72 patients with lumbar cistern catheter drainage after surgery for Hunt-Hess high-grade ruptured cerebral aneurysm, 30 (41.67%) had intracranial infection. Univariate analysis showed that there were significant differences in intracranial infection rates among patients of different ages, mRS score at admission, preoperative use of antimicrobial agents, cerebrospinal fluid leakage and drainage tube contamination (all P<0.05). Logistic regression analysis showed that the main factors affecting the infection were cerebrospinal fluid leakage (OR=3.68), without preoperative use of antimicrobial agents (OR=3.18), drainage tube contamination (OR=2.82), mRS score ≥ 4 at admission (OR=2.51), and age ≥ 61 years (OR=1.06). Conclusion Intracranial infection rate in patients with lumbar cistern catheter drainage after surgery for Hunt-Hess high-grade ruptured cerebral aneurysm is high, control of cerebrospinal fluid leakage, preventive use of antimicrobial agents, strengthening aseptic operation when using drainage tube can effectively reduce the incidence of intracranial infection in patients with lumbar cistern catheter drainage after surgery.

Abstract:Objective To investigate the characteristics of healthcare-associated infection(HAI) in neonatal intensive care unit (NICU), and provide scientific basis for the prevention and control of HAI in NICU. Methods The occurrence of HAI in newborns who were hospitalized in NICU for >48 hours from January 2013 to December 2017 was monitored, and characteristics of HAI and types of pathogens were analyzed. Results From January 2013 to December 2017, a total of 10 551 newborns in NICU were monitored, 257 newborns had 270 cases of HAI; incidence and case incidence of HAI were 2.44% and 2.56% respectively, incidence of HAI per 1 000 day was 2.31, There was no significant difference in the incidence of HAI between different genders (P>0.05). Incidence of HAI in newborns with different birth weight as well as with or without tracheal intubation was significantly different (all P<0.001). Case incidences of HAI among different years were significantly different (P<0.05). The main HAI site was lower respiratory tract, accounting for 65.19% (ventilalor-associated pneumonia accounted for 36.30%), followed by blood stream(22.22%). A total of 169 strains of pathogens were isolated, mainly gram-negative bacteria, the top three were Acinetobacter baumannii (26.03%), Klebsiella pneumoniae (22.49%) and Escherichia coli (19.53%). Conclusion Low birth weight and invasive operation are risk factors for HAI in newborns in NICU. Reducing invasive operation, strictly mastering various indications of catheterization, strengthening prenatal education and nutritional guidance, and maintaining fetal birth weight in a reasonable range are the key to prevent HAI in NICU patients.

Abstract:Objective To understand the influencing factors for disinfection efficacy of gastroscope in county-level medical institutions of a province. Methods Nine secondary county-level comprehensive medical institutions were selected, questionnaire survey and on-site inquiry were adopted to fill in the questionnaire, on-site observation on cleaning and disinfection was conducted, intervention measures were taken against possible risk factors. Cleaning and disinfection efficacy of gastroscope before and after intervention was compared. Results 45 specimens of gastroscope were taken before and after intervention, qualified rates of gastroscope cleaning and disinfection before and after intervention were 11.11% and 100% respectively, difference was statistically significant (χ²=72.00,P<0.001). Multivariate logistic regression analysis showed that whether installed rational cleaning and disinfection equipment (OR=23.813), whether the cleaning and disinfection process met the specifications (OR=13.223), whether knowledge and skills of gastrocope were mastered proficiently (OR=9.265), whether cleaning and disinfection tools were equipped rationally (OR=7.745), whether detergent and disinfectant were used correctly (OR=0.076) were independent influencing factors for gastroscope disinfection efficacy. Conclusion The qualified rate of gastroscope cleaning and disinfection in county-level medical institutions is low, it is necessary to rationally equip cleaning and disinfection equipment and tools, strengthen training, standardize the cleaning and disinfection process as well as the use of detergent and disinfectant, and improve the relevant knowledge level of staff.

Abstract:Objective To evaluate efficacy of cleaning, disinfection and drying of new material medical mattress. Methods Referring to the Disinfection Technical Specifications (2002 version) and Hygienic Requirement for Medical Detergent (revision for approval), a test method for evaluating the efficacy of cleaning, disinfection and drying of medical mattress materials was established. Cleaning efficacy was determined by visual observation and residual protein detection method, disinfection and drying efficacy were determined by bacterial counting method and weighing method respectively. Results After the mattress carrier passed through a specific process, the qualified rates of cleaning efficacy were both 100% by visual observation method and residual protein detection method, mattress carrier after cleaning was not deformed, the contaminated mattress carrier was immersed in two disinfectants for 15 minutes, disinfection efficacy was qualified without deformation; water residue rate was 0.24% after hanging water mattress carrier for 1.5 hours. Conclusion The new material mattress can meet the requirements of overall cleaning, disinfection and drying, it opens up a new way for cleaning and disinfection of medical mattress, but on-site cleaning and disinfection efficacy, material washing resistance and cost-effectiveness need further research and verification.

Abstract:Objective To check whether the status of performance operation of pre-vacuum team sterilizers is normal after displacement. Methods The temperature and pressure detector as well as chemical, physical, and biological monitoring methods were used to evaluate the operating status of sterilizers, the unqualified sterilizers were repaired and operation status of sterilizers after loading was monitored until all indicators shown as qualified. Results Among the four sterilizers that were moved, sterilizers No. 2, 3, and 4 were in good working condition, while sterilizer No. 1 had problems. The physical, biological monitoring, and lumen process challenge device (PCD) detection in sterilizer No. 1 before loading were qualified, the sterilizer fault was found by PCD (type 6) and B-D tests, temperature and pressure detector failed to pass the test. The potential causes of failures were examined by the engineers from the manufacturers of sterilizer as well as temperature and pressure detector. After three repairs, sterilization temperature and pressure of sterilizers were improved, sterilizer detection parameters were significantly improved and became qualified, the No. 1 sterilizer was finally adjusted to the optimum operating state. Conclusion In addition to routine monitoring, it is necessary to use temperature and pressure detector to measure the temperature, pressure, and time of sterilizer according to the Standard WS 310.3-2016. At the same time, it is also recommended to use the temperature and pressure detector as mandatory procedure after each new installation, displacement and overhaul of the sterilizer.

Abstract:目的 调查某院一起灭菌后手术器械表面出现液体珠现象的原因。方法 采用现场调查、缺陷包观察、根本原因分析和实验验证相结合方法，对某院灭菌后手术器械表面出现液体珠现象进行调查。结果 现场调查抽检拆开无菌包43个，有液体珠的包5个，发现率为11.63%。5个有液体的缺陷包空气中暴露12 h后，所有器械表面液体仍存在。将其不做处理重新包装后用一号灭菌器灭菌，5个包内器械均仍有液体珠附表面。人工清洗中现配现用润滑剂和机械清洗后灭菌的包未查到油斑、油渍，合格率100%；连续使用7日润滑剂润滑器械灭菌后，合格率仅43.33%；现配3倍浓度润滑剂润滑器械灭菌后，合格率为56.67%。根因分析结果显示，供应室人员存在知识知晓欠缺，且操作不当的问题。结论 器械表面液体珠为器械润滑剂使用不当产生的油珠，操作人员知识缺乏，未按要求操作是事件的主要原因，医院应加强专业人员对手术器械润滑剂相关知识的规范管理。

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Abstract:Fosfomycin is an early discovered natural antibiotic with unique antimicrobial mechanism, by blocking the first step in the synthesis of bacterial cell wall, it can act on gram-positive bacteria and gram-negative bacteria, and is a rapid bactericide in reproductive period of bacteria and can destroy or inhibit formation of bacterial biofilm. In recent years, under the current severe drug resistance situation, fosfomycin has become a widely studied and applied antibiotic because of its unique antimicrobial mechanism, pharmacokinetic characteristics and low cross-resis-tance, especially for multidrug-resistant organisms, as an important combined used antibiotic, fosfomycin has been applied more and more widely in clinical practice.

Abstract:Chronic hepatitis B(CHB) is a chronic inflammatory disease of liver caused by persistent infection with hepatitis B virus. Abnormal glucose metabolism refers to the disorder of metabolism of carbohydrate, protein, fat, etc., which leads to the disorder of the regulation of blood sugar and eventually develops into diabetes mellitus. A large number of studies have confirmed that CHB patients are closely related to abnormal glucose metabolism in different stages of viral infection and post-hepatitis cirrhosis, this article reviews the related research progress in recent years.