Abstract:Objective To evaluate the value of next-generation sequencing (NGS) technique in detecting potential pathogens in valves of patients with infective endocarditis (IE), and provide help for the diagnosis and postoperative treatment of IE. Methods According to modified Duke criteria, valve tissues of IE patients and patients who were excluded IE were performed culture conventionally,pathogens in valve tissues were detected directly by NGS technique, results were compared with blood culture and pathological smear staining. Results The sensitivity, specificity, positive predictive value, and negative predictive value of NGS were 95.0%, 85.7%, 95.0%, and 85.7% respectively, blood culture were 30.0%, 100.0%, 100.0%, and 30.0% respectively, valve culture were 10.0%, 100.0%, 100.0%, and 28.0% respectively. Conclusion Compared with conventional culture method, NGS technique has higher sensitivity and shorter time in detecting IE valve vegetation. NGS is of great value in the diagnosis and treatment of IE, especially in suspected IE with negative culture results.

Abstract:Objective To explore the application value of gene chip method and linear probe method in detecting Mycobacterium tuberculosis (MTB) in sputum specimens. Methods 106 suspected pulmonary tuberculosis outpatients and inpatients in the Second Affiliated Hospital of Hainan Medical University in March-July 2018 were enrolled in the study, sputum specimens were detected by gene chip method and linear probe method, then compared with the modified Roche culture method; proportional susceptibility test was as gold standard to analyze the efficacy of above two methods in detection of rifampicin and isoniazid resistance. Results 106 sputum specimens were cultured by modified Roche culture method, positive rate was 52.83%(56/106), 46 specimens were identified as MTB positive. 46 and 53 strains of MTB were detected by gene chip method and linear probe method respectively, there was no significant difference in MTB detection results between gene chip method, linear probe method, and modified Roche culture method (all P>0.05). There was no significant difference but good consistency in detection of rifampicin resistance of MTB between gene chip method, linear probe method, and proportional method (all P>0.05, all Kappa>0.75). For rifampicin resistance detection, the sensitivity and specificity of gene chip method were 84.62% and 90.00% respectively, and the linear probe method were 84.62% and 85.00% respectively. There was no significant difference but general consistency in detection of isoniazid resistance of MTB between gene chip method, lin-ear probe method, and proportional method (all P>0.05, all Kappa<0.75). For isoniazid resistance detection, the sensitivity and specificity of gene chip method were 69.23% (18/26) and 95.00% (19/20) respectively, linear probe method were 65.38% (17/26) and 85.00% (17/20) respectively. Conclusion Both gene chip method and linear probe method can accurately and rapidly identify MTB from sputum specimens of most suspected tuberculosis patients, they can also be used for rapid detection of rifampicin and isoniazid resistance, thus guiding clinical antimicrobial use, which are worthy of clinical promotion.

Abstract:Objective To explore the correlation between single nucleotide polymorphisms(SNPs) of high-mobility group box 1 protein (HMGB1) and susceptibility of pulmonary tuberculosis(PTB) patients in northern Henan. Methods 320 patients who were diagnosed with PTB in the First Affiliated Hospital of Xinxiang Medical University from January to December 2017 were selected as the tuberculosis group, and 300 healthy people who underwent physical examination during the same period were selected as the control group. Genotyping of HMGB1 rs1412125(-1615A/G), rs1045411(+1177G/A) and rs2249825(+3814C/G) loci in tuberculosis group and control group was performed by PCR and Sanger sequencing. Association between HMGB1 gene polymorphism and susceptibility to PTB in two groups was studied with allele frequency, genotype frequency, and four genetic models (co-dominance, dominance, recessiveness and over-dominance). Results Genotype distribution of all loci conformed to Hardy-Weinberg equilibrium. There was significant difference in allele frequency at +1177G/A locus between two groups (OR, 1.485[95%CI, 1.110-1.986], P=0.007), there was significant difference in genotype distribution between two groups (P<0.05); in the co-dominance model of 1177G/A locus, AG genotype (OR,1.447[95% CI, 1.025-2.041], P=0.035) and AA genotype (OR, 2.812[95%CI, 0.985-8.033], P=0.045) were associated with susceptibility to PTB compared with GG genotype; the dominant model of +1177G/A locus ([AG+AA] vs GG, OR, 1.524[95% CI, 1.090-2.131], P=0.014) was also associated with the susceptibility to PTB; there was no significant difference between the recessive model and the over-dominant model of +1177G/A locus (P>0.05). There was no significant difference in allele and genotype distribution between -1615A/G and +3814C/G loci (P>0.05). Conclusion The polymorphism of rs1045411 (+1177G/A) of HMGB1 gene may be associated with the susceptibility to PTB, allele A of HMGB1 gene may be a susceptible gene of PTB, and carrying of rs1045411(+1177G/A) allele A may increase the risk of developing PTB.

Abstract:Objective To search biochemical marks for evaluating the prognosis of acquired immunodeficiency syndrome(AIDS) complicated with Talaromyces marneffei (T. marneffei) infection. Methods AIDS patients with T. marneffei infection in a hospital from January 2016 to December 2017 were selected, they were divided into death group and survival group according to the prognosis, laboratory biochemical marks such as white blood cell count (WBC), platelet count(PLT), hemoglobin(HGB), adenosine deaminase(ADA), creatine kinase isoenzyme(CK-MB), lactate dehydrogenase(LDH), aspartate aminotransferase(AST), total bilirubin(TBIL), and CD4⁺T cell count were performed univariate and multivariate analysis. Results A total of 140 AIDS patients with T. marneffei infection were included, 32 were in death group and 108 in survival group. Univariate analysis showed that there were significant differences in WBC, PLT, ADA, CK-MB, LDH, AST, and TBIL between patients in death group and survival group(all P<0.01). Multivariate logistic regression analysis showed that ADA (OR, 0.056[95%CI, 0.013-0.252]) and LDH (OR, 0.135[95%CI, 0.032-0.566]) had statistical significance on the outcome of AIDS complicated with T. marneffei infection. Conclusion Serum ADA and LDH levels are important markers for evaluating prognosis of AIDS patients with T. marneffei infection, and their elevation suggests poor prognosis.

Abstract:Objective To explore the risk factors and preventive strategies of postoperative pneumonia in patients undergoing craniotomy. Methods Medical records of patients who underwent craniotomy in the neurosurgery department of a large teaching hospital from January 2014 to December 2015 were surveyed retrospectively. The survey included general information, surgical conditions, and occurrence of postoperative pneumonia. Risk factors for pneumonia after craniotomy were analyzed. Results A total of 880 patients undergoing craniotomy were investigated, 178 patients (20.23%) had pneumonia after craniotomy. Univariate analysis showed that incidences of pneumonia were higher in patients with older age, preoperative complications of underlying diseases, ASA grade Ⅲ-IV, large blood loss, long duration of operation, long length of hospital stay before operation, intraoperative blood transfusion, indwelling gastric tube, mechanical ventilation time ≥ 4 hours, tracheotomy, and emergency surgery, difference were all significant (all P<0.05). Unconditional multivariate logistic regression analysis showed that six variables were independent risk factors for postoperative pneumonia. The OR from high to low were as follows:tracheotomy (OR, 27.73[95%CI, 2.49-30.83]), postoperative indwelling gastric tube (OR, 4.55[95%CI, 2.54-8.16]), emergency surgery (OR, 4.34[95%CI, 1.49-12.63]), mechanical ventilation time (OR, 2.81[95%CI, 1.37-5.75]), preoperative hospitalization time (OR, 1.06[95%CI, 1.02-1.10]), and age (OR,1.03[95%CI, 1.01-1.04]). Conclusion Incidence of postoperative pneumonia in patients undergoing craniotomy is high, effective prevention and control measures should be taken to reduce the incidence of infection according to risk factors.

Abstract:Objective To systematically assess the risk factors for pulmonary infection(PI) following hepatectomy. Methods The published literatures concerning risk factors for PI following hepatectomy from the establishment of database to May 2018 were retrieved from China National Knowledge Infrastructure (CNKI), VIP database (VIP), Wanfang database(Wanfang), Baidu Academic, and PubMed. Literatures were screened according to inclusion and exclusion criteria, Meta-analysis was performed by RevMan 5.3 software. Results A total of 9 case-control studies were included, 7 and 2 were domestic and foreign literatures respectively, 383 and 2 030 were in case group and control group respectively. Meta-analysis showed that the major risk factors for PI in patients following hepatectomy were old age, obesity, history of smoking, history of cerebrovascular accident, long duration of operation (>3 hours), large amount of bleeding during operation(>1 000 mL), intraoperative blood transfusion, without prophylactic use of antimicrobial agents, long duration of indwelling abdominal drainage tube(>10 days), without using analgesic pump after operation, and use of ventilator after operation. The combined OR/MD values and 95%CI of each factor were 13.55(3.15, 23.94), 3.14(1.97, 5.01), 3.01(1.50, 6.07), 7.08(2.32, 21.57), 52.12(8.67, 95.58), 326.89(23.06, 630.71), 2.68(1.85, 3.89), 4.67(2.93, 7.45), 1.89(0.77, 3.01), 2.98(2.04, 4.35), and 8.58(4.30, 17.12) respectively. Conclusion Incidence of PI following hepatectomy can be reduced through taking corresponding preventive measures against the main risk factors and strengthening management of respiratory tract.

Abstract:Objective To investigate the clinical efficacy of continuous blood purification (CBP) in the treatment of severe sepsis in children and its effect on cellular immune function. Methods 40 children with severe sepsis who were admitted to a hospital from January 2016 to January 2017 were randomly divided into control group and trial group, 20 cases in each group, control group was given routine treatment, trial group was given CBP treatment on the basis of routine treatment. Inflammatory markers, immune markers, and prognosis were compared between two groups before and after treatment. Results There were no significant differences in inflammatory markers (IL-6, IL-10, TNF-a, CRP, PCT, WBC) and immune markers (CD3⁺, CD4⁺, CD4⁺/CD8⁺) between trial group and control group before treatment (all P>0.05). Inflammatory markers of trial group were all lower than control group after treatment; inflammatory markers of trial group and control group after treatment were all lower than those before treatment; differences were all statistically significant (all P<0.05). Immune markers of trial group were all higher than control group after treatment; immune markers of trial group and control group after treatment were all higher than those before treatment; differences were all statistically significant (all P<0.05). The pediatric critical illness score(PCIS score) of trial group was higher than control group; length of ICU stay and duration of mechanical ventilation of trial group were both shorter than control group; the 28-day survival rate of trial group was higher than control group (95% vs 65%); complication rate of trial group was lower than control group (10% vs 45%); difference were all statistically significant (all P<0.05). Conclusion CBP can effectively improve inflammatory response, enhance suppressed cellular immune function, alleviate the severity of disease, and improve prognosis of children with severe sepsis.

Abstract:Objective To understand the prevalence of infection caused by 7 common respiratory tract virus, and provide reference for clinical diagnosis and treatment. Methods Clinical data of patients with acute respiratory tract infection (ARTI) from March 2015 to February 2018 in Nanping First Hospital Affiliated to Fujian Medical University were retrospectively analyzed, antigens of 7 common respiratory virus were detected by direct immunofluorescence assay (DIA). Results A total of 5 874 ARTI patients were enrolled. The positive detection rate of virus was 19.58%(n=1 150). Detection rates in 2015-2017 were 11.48%, 21.71%, and 21.54% respectively. 1 131 patients (98.35%) were with single virus infection, 19 patients (1.65%) were with mixed infection. Among 7 detected common virus, respiratory syncytial virus (RSV) had the highest positive rate (11.29%). There was significant difference in the positive detection rate of ARTI virus among different age groups (P<0.05). Respiratory virus detection rate was the highest in~6 months group (26.37%), accounting for 39.83% of the positive patients. Positive rate of ARTI patients in different seasons was significantly different (P<0.05). Positive detection rate of respiratory virus was the highest in winter (25.01%), followed by autumn (23.23%). There was significant difference in the positive detection rate of virus among ARTI patients with different clinical diagnosis(P< 0.05), positive detection rate of virus in patients with bronchopneumonia was the highest (28.60%). Conclusion In the past three years, infection rate of common respiratory tract virus in ARTI patients increased year by year, RSV infection is most common among 7 respiratory tract virus infection. Respiratory tract virus infection mostly occur in autumn and winter, and children under the age of 1 year are the main infected population, bronchopneumonia is the main clinical manifestation.

Abstract:Objective To evaluate the accuracy and efficiency of early warning strategy for cases by real-time healthcare-associated infection(HAI) surveillance system(HAISS), and propose scientific suggestion for the improvement of early warning strategy. Methods By investigating the early warning information and final confirmation of HAI generated by HAISS in a tertiary first-class general hospital in 2017, the sensitivity and positive predictive value of early warning of HAI as well as positive predictive value of early warning of infection were calculated to evaluate the accuracy and efficiency of early warning. Results 832 cases of HAI were confirmed in this hospital in 2017, 715 cases were HAI effectively warned by HAISS, with a sensitivity of 85.94%. A total of 8 468 cases were warned by HAISS in the whole year, 2 817 were infection cases, positive predictive value of early warning of infection cases was 33.27%, 772 cases were HAI, and positive predictive value of early warning of HAI cases was 9.12%. There were 14 857 early warnings in HAISS in the whole year, of which 4 135 were confirmed as infection, positive predictive value of early warning of infection was 27.83%, 1 199 were confirmed as HAI, positive predictive value of early warning of HAI was 8.07%. Conclusion HAISS is an important technical mean for identifying HAI cases, specificity and efficiency of case identification need to be improved, the ability of early warning for high-risk infection cases need to be strengthened.

Abstract:Objective To investigate the current situation of disinfection of high-touched object surface in neurosurgical intensive care unit (ICU), and explore the optimal frequency of disinfection. Methods Six kinds of high-touched objects, including bed bar, micro-pump, monitor button, hand sanitizer button, mouse and medical history, were selected as the research objects in neurosurgical ICU of The First Hospital of Jilin University. Specimens were taken at 2, 4, 6 and 8 hours after disinfection, and colony counts were calculated after 48 hours of culture. The number of colonies at different time points after disinfection were compared. Results There was no significant difference in the numbers of colonies on bed bar and monitor button at different sampling time points after disinfection(all P>0.05), the average number of colonies was<5 CFU/cm². There were significant differences in the numbers of colonies on micro-pump, hand sanitizer button, mouse and medical history at different sampling time points after disinfection (all P<0.05); the number of colonies at 8 hours after disinfection were all higher than that at 6 hours after disinfection (all P<0.05). Conclusion There are some differences in surface contamination of different high-touched object surface in ICU, the best disinfection frequency should be determined according to the actual condition of high-touched object surface.

Abstract:One patient developed intracranial infection caused by extensively drug-resistant(XDR) Acinetobacter baumannii after intranasal endoscopic optic nerve decompression, intravenous combined intrathecal injection of tigecycline was given, treatment plan was finally determined through comprehensive analysis on relevant literatures in the past five years. Patient received intravenous drip of tigecycline (100 mg initially, followed by 50 mg, q12h) combined with cefoperazone sodium/sulbactam sodium (3.0 g, q8h); intrathecal injection of tigecycline 2.5 mg combined with 5 mL saline, q12h through lumbar cisterna drainage tube, clipping for 2 hours. After intrathecal injection of tigecycline for 15 days, four consecutive routine cerebrospinal fluid examination of patients were all within the normal limits, the culture result was negative, patient was finally cured.

Abstract:Objective To investigate antimicrobial susceptibility of Cryptococcus neoformans (C. neoformans) isolated from patients with acquired immunodeficiency syndrome(AIDS) in Yunnan Province. Methods 304 strains of C. neoformans isolated from AIDS patients in Yunnan Infectious Diseases Hospital between August 2007 and July 2018 were performed antimicrobial susceptibility testing by colorimetric microdilution method, susceptibility to 6 commonly used anti-cryptococcal agents was detected. Results Antimicrobial susceptibility testing results showed that MIC₅₀ of amphotericin B, 5-fluorocytosine, fluconazole, voriconazole, itraconazole, and posaconazole were 1, 2, 4, 0.03, 0.06, and 0.12 μg/mL respectively, and the MIC₉₀ were 1, 4, 8, 0.06, 0.12, and 0.25 μg/mL respectively, with geometric mean values of 0.75, 2.32, 3.28, 0.039, 0.053, and 0.09 μg/mL respectively. Among 6 antifungal agents, resistance rate of C. neoformans to voriconazole and amphotericin B was 1.32%, and to 5-fluorocytosine was 0.33%, no strain was found to be resistant to itraconazole and fluconazole. Conclusion C. neoformans isolated from AIDS patients in Yunnan Province have different susceptibility to different antimicrobial agents, which can provide reference for clinical antimicrobial choice.

Abstract:Objective To apply infection control workshop APP-assisted concealed on-the-spot observation method in surveying hand hygiene(HH) compliance of health care workers(HCWs). Methods All HCWs in a hospital from January 2016 to October 2018 were surveyed, infection control workshop APP-assisted concealed on-the-spot observation method was adopted to survey HH compliance rates of HCWs since January 2017, difference in HH compliance rates in 2016 (adopting paper questionnaire-assisted concealed on-the-spot observation method), 2017, and January-October of 2018 were compared. Results In 2016, 2017, and January-October of 2018, 1 201, 1 237, and 1 234 HCWs were surveyed respectively, 6 539, 22 708, and 17 509 HH indications were surveyed respectively. HH compliance rate was 89.45% in 2016 revealed by paper questionnaire-assisted concealed on-the-spot observation method, 60.76% in 2017 revealed by APP-assisted concealed on-the-spot observation method, and increased to 69.06% in January-October of 2018. Compliance rates of HH among HCWs in different years were significantly different (P<0.001). Conclusion Compared with paper questionnaire-assisted concealed on-the-spot observation, infection control workshop APP-assisted concealed on-the-spot observation method can obtain more accurate data of HH compliance of HCWs, which is of guiding significance for improving HH compliance.

Abstract:Objective To perform hand hygiene(HH) education and training for health care workers(HCWs) by adopting standard demonstration and scenario demonstration method, improve compliance rate and correct rate of HH of HCWs in department of neurosurgery. Methods All HCWs in department of neurosurgery in a hospital were selected as the studied object, according to the method of Dreyfus Health Foundation Project of America, HH surveillance results from January 2015 to November 2016 were analyzed, problems were identified, and the expected goals were formulated. From December 2016 to September 2017, standard demonstration and scenario demonstration method were adopted to performe HH education and training for HCWs, HH of HCWs before and after training was investigated by direct investigation method and concealed investigation method, result was compared. Results HH compliance rate of HCWs in department of neurosurgery before training was 31.51%, compliance rate of HH revealed by concealed investigation method and direct investigation method after training were 45.21% and 80.79% respectively, there was significant difference in compliance rate of HH among three groups (χ²=363.46,P<0.001). HH correct rate was 69.26% before training, correct rate of HH revealed by concealed investigation method and direct investigation method after training were 79.20% and 84.41% respectively; there was significant difference in the correct rate of HH among three groups (χ²=24.62,P<0.001). The average daily comsumption of liquid soap and alcohol-based hand rub for HCWs in department of neurosurgery before and after training were 5.06 mL/bed-day and 10.06 mL/bed-day respectively. Conclusion By adopting standard demonstration and scenario demonstration methods for HCWs' HH training and education, compliance and correctness of HCWs' HH can be improved. The combination of direct investigation method and concealed investigation method can effectively eliminate the existence of human tendency factors.

Abstract:Objective To investigate a suspected outbreak of healthcare-associated infection(HAI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in department of neurosurgery of a hospital, find out the source and transmission route of infection, and put forward corresponding preventive and control measures. Methods From June 12 to July 2, 2018, 11 patients with CRKP infection in department of neurosurgery were investigated, comprehensive measures were taken to control CRKP infection. Results Seven of 11 patients with CRKP infection were dia-gnosed as HAI. Enterobacterial repetitive intergenic consensus polymerase chain reaction(ERIC-PCR) was used to perform homology analysis of 6 strains of CRKP, two genotypes A and B were detected, CRKP strains infected by 2 patients were type A gene, and infected by 4 patients (including 3 patients with HAI) were type B gene. CRKP was also isolated from patients' environmental object surface, as well as hands and throat swabs of partial health care workers(HCWs). Conclusion There is an outbreak of HAI in this hospital, which may be caused by contamination of environment by CRKP from infected patients and hands of HCWs. Early identification of infection outbreak, implementation of hand hygiene, cleaning and disinfection of environmental surface, as well as isolation measures are the key to control the outbreak of HAI caused by multidrug-resistant organisms.

Abstract:Objective To investigate and control a suspected outbreak of Enterobacter cloacae(E. cloacae) bloodstream infection in hemodialysis patients in department of nephrology of a tertiary hospital, provide reference for clinical prevention and treatment. Methods Epidemiological investigation was carried out on hemodialysis patients in department of nephrology of a hospital from May 21 to June 6, 2018. Environmental hygiene detection were performed on hospital air, dialysis water and dialysate, dialysis materials, in-use disinfectant, hands of health care workers(HCWs), object surface, as well as hands and skin at deep vein catheterization sites of patients, causes of infection were analyzed, strict prevention and control measures were taken. Results From May 21 to June 6, 2018, a total of 6 patients suffered from catheter-related bloodstream infection(CRBSI), all were isolated E. cloacae from blood culture, incidence of CRBSI was 3.03‰(6/1 980). 133 spcimens were collected for environmental hygiene monitoring, detection results of air, dialysis water and dialysate, disposable dialysis pipeline, and in-use disinfectant were all qualified; qualified rate of hand sampling of HCWs was 61.54% (8/13); qualified rate of object surface sampling was 80.28% (57/71), 6 specimens of hands and skin at deep venous catheterization sites of patients were taken, 1 specimen was unqualified; E. cloacae was not detected in environmental hygiene monitoring. Risk factors analysis showed that incidence of E. cloacae CRBSI was higher in patients with diabetes mellitus and those who needed thrombolysis before dialysis, difference were both statistically significant (both P<0.05). After 2-week treatment during hospitalization, blood cultures of 6 infected patients were all negative, patients continued hemodialysis treatment in outpatient departmen after discharged. No new infection case was observed in the blood purification center for 2 months. Conclusion Blood purification center should strengthen hand hygiene of HCWs, clean and disinfect environment, and cut off the route of exogenous infection. Strengthening the management of vascular catheterization site and blood sugar of hemodialysis patients, as well as avoidance of thrombolysis before hemodialysis can reduce the occurrence of CRBSI.

Abstract:Surgical site infection(SSI) is one of the most common complications following cesarean section, incidence is 3%-15%, which brings great physical and psychological burden to parturient women as well as huge economic pressure to medical health care system.In addition, 3% of maternal deaths were related to SSI following cesarean section. This review elaborated the definition, risk factors, and the latest preventive measures of SSI follo-wing cesarean section, explored the bundle management measures for preventing SSI following cesarean section, as well as the effective implementation mode for reducing the incidence of SSI in patients with cesarean section.