Abstract:Objective To understand the species distribution, antimicrobial resistance and clinical infection characteristics of non-tuberculous Mycobacteria (NTM) from suspected tuberculosis patients in Hainan area. Methods Sputum, alveolar lavage fluid and other respiratory tract specimens of suspected tuberculosis patients in a hospital of Hainan Province between January 2015 and August 2018 were collected, cultured and performed bacterial identification, NTM infection, antimicrobial susceptibility testing result and clinical data of patients with NTM pulmonary infection were analyzed. Results A total of 833 positive respiratory tract specimens were isolated from suspected tuberculosis patients, 126 of which were initially identified as NTM, identification of species showed that 3 strains were Mycobacterium tuberculosis, 3 were non-Mycobacterium, 4 were unable to be identified to species, among the other 116 pecimens, 118 strains of NTM were isolated. 109 cases were single NTM infection and 7 cases were mixed infection. There are 8 species of NTM, mainly Mycobacterium chelonae/Mycobacterium abscessus (41.5%) and Mycobacterium intracellular (37.3%). Eight NTM strains showed different degrees of resistance to 8 first-and second-line anti-tuberculosis drugs, the highest overall resistance rate was to isoniazid (96.6%), resistance rate to all 8 anti-tuberculosis drugs was as high as 32.2%. Incidence of NTM pulmonary infection in males was less than females, mainly in middle-aged and elderly people in Hainan coastal areas. The main clinical manifestations of patients with NTM pulmonary infection were cough and expectoration, chest tightness and shortness of breath, blood sputum or hemoptysis, loss of appetite and weight loss, underlying diseases included previous history of tuberculosis, bronchiectasis, pulmonary infection and hemoptysis, imaging manifestations showed secondary pulmonary tuberculosis, pulmonary cavity, pleural hypertrophy, bronchiectasis with emphysema and pulmonary infection. Conclusion NTM pulmonary infection in Hainan area is mainly caused by Mycobacterium chelonae/Mycobacterium abscessus and Mycobacterium intracellular, NTM is highly resistant to commonly used anti-tuberculosis drugs, NTM pulmonary infection and tuberculosis should be differentiated according to etiological examination.

Abstract:Objective To reveal characteristics of molecular typing of clinically isolated Enterococcus faecalis (E. faecalis) and its relationship with susceptibility to telithromycin. Methods 320 strains of E. faecalis isolated from different clinical specimens in Nanshan Hospital of Shenzhen City from 2010 to 2016 were collected, genotyping of E. faecalis was performed by multilocus sequence typing (MLST), minimum inhibitory concentration of telithromycin to strains was determined by broth microdilution method, and distribution of drug-resistant gene ermB was detected by polymerase chain reaction (PCR). Results 320 strains of E. faecalis were divided into 48 ST types and 56 new ST types, mainly ST16 and ST179. 85 strains (26.6%) were ST16, 72 (84.7%) of which were positive for ermB, 29 (34.1%) were susceptible to telithromycin, 10 (11.8%) were intermediate, 46(54.1%) were resistant to telithromycin; 80 strains (25.0%) were ST179, 71(88.8%) of which were positive for ermB, 15(18.8%) were susceptible to telithromycin, 4 (5.0%) were intermediate, and 61 (76.3%) were resistant to telithromycin. Conclusion ST16 and ST179 are dominant strains of E. faecalis in this hospital, they carry ermB gene in a high proportion and have high resistance rate to telithromycin.

Abstract:Objective To understand the viral pathogen infection and epidemiological characteristics of children with acute respiratory tract infection(ARTI) in Tongzhou District of Beijing, and provide evidence for making strategies for disease surveillance, prevention and control. Methods ARTI in children in Beijing Luhe Hospital affiliated to Capital Medical University between January 2011 and June 2018 were selected, nine kinds of respiratory viral pathogens were detected by multiplex real-time fluorescent polymerase chain reaction, and the infection status of each respiratory viral pathogen was analyzed. Results Among 544 children with ARTI, 174 were positive for respi-ratory tract viral pathogens, positive rate was 32.0%. Positive rates of rhinovirus and influenza virus were 9.4% and 8.6% respectively, which were higher than those of other pathogens. There was no significant difference in the positive rate of respiratory tract pathogens in different seasons; constituent of respiratory tract pathogens in different seasons was significant. Incidence of runny nose in children with positive pathogens was higher than that in children with negative pathogens (P=0.015); positive rate of respiratory pathogens in children with acute upper respiratory tract infection was higher than that in children with pneumonia(43.9% vs 22.3%,P<0.001). Compared with pneumonia, influenza virus, rhinovirus, metapneumovirus, coronavirus and enterovirus were more likely to be isolated from acute upper respiratory tract infection. Conclusion Acute respiratory tract infection in children in Tongzhou District are mainly caused by rhinovirus and influenza virus, respiratory virus is more likely to cause acute upper respiratory tract infection.

Abstract:Objective To analyze the distribution and antimicrobial resistance of pathogens isolated from patients with acute pancreatitis (AP) and infection, and guide rational use of antimicrobial agents in clinic. Methods Pathogens and antimicrobial resistance of patients with AP and infection from 2016 to 2018 were retrospectively analyzed, AP patients were divided into severe acute pancreatitis (SAP) group and non-SAP group according to the severity of disease, distribution of pathogens and isolation of multidrug-resistant organisms (MDROs) were compared between two groups. Results 262 patients with AP and infection were enrolled in study, 144 (54.96%) of whom were with mixed infection. A total of 291 strains of pathogens were isolated, 207 (71.13%) of which were gram-negative strains and 84 (28.87%) were gram-positive strains; the top three pathogens were Escherichia coli (n=71), Klebsiella pneumoniae (n=45) and Acinetobacter baumannii (n=40). Acinetobacter baumannii infection rate and MDRO infection rate in SAP group were higher than those in non-SAP group (P<0.05). Biliary AP patients were more susceptible to MDRO infection than non-biliary AP patients (P<0.05). Resistance rates of Escherichia coli and Klebsiella pneumoniae to the third generation cephalosporins and fluoroquinolones were all over 50%, and to imipenem were 9.86% and 35.56% respectively; resistance rates of Acinetobacter baumannii to ampicillin/sulbactam and amikacin were both<35%,but to other antimicrobial agents were all >60%; no gram-positive strains were found to be resistant to linezolid, vancomycin, tegacycline and teicoplanin. Conclusion Gram-negative bacteria are the main pathogen causing infection in AP patients, which are highly drug resistant and multi-resistant, MDRO infection poses a serious threat to the treatment of SAP patients.

Abstract:Objective To investigate whether the intensive care unit (ICU) is still a high-risk unit for healthcare-associated lower respiratory tract infection(HA-LRTI)caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) when infection prevention and control measures are implemented. Methods HA-LRTI caused by AB in a hospital from August 2017 to August 2018 were investigated, patients with MDR-AB infection were selected as case group, with sex and age±2 years old as matching factors, a 1:1 matched case-control study was adopted, patients without MDR-AB infection during the same period were selected as control group, logistic regression was used to control other confounding factors, whether ICU was still a high-risk unit for MDR-AB HA-LRTI was explored. Hand hygiene of health care workers(HCWs) in ICU and general wards during the same period was investigated and compared. Results A total of 227 patients confirmed with HA-LRTI caused by AB, including 66 cases of MDR-AB infection and 161 cases of non-MDR-AB infection. After 1:1 matching,binary antimicrobial use before infection, urinary catheterization days and central venous catheterization day in petients in control group were all higher than those in case group (all P<0.05); ICU occupancy rate, central venous catheterization rate and urinary catheterization rate in patients in case group before infection were all higher than those in control group (all P<0.05); logistic regression analysis showed that ICU stay and urinary catheterization were independent risk factors for MDR-AB HA-LRTI (both P<0.05). Resistance rates of AB to cefuroxime/sulbactam in patients in case group and control group were both >90%, and the sensitivity rates to polymyxin B were all 100%. Hand hygiene compliance rate of HCWs in ICU was higher than that in general wards (86.96% vs 71.94%, P<0.05). The awareness rate of hand hygiene knowledge of HCWs in ICU was also higher than that of general wards (90.77% vs 84.47%, P<0.05). Conclusion ICU is a high-risk unit for MDR-AB HA-LRTI, patients with urinary catheterization are the high-risk population for MDR-AB infection.

Abstract:Objective To systematically evaluate the effect of needleless connectors on central venous catheterization(CVC)-related complications in patients. Methods Randomized controlled trials (RCT) on effect of needleless connectors on CVC-related complications in patients were retrieved from PubMed, The Cochrane Library, Web of Science, Embase, China Biomedical Literature Database, China National Knowledge Infrastructure(CNKI)and Wanfang Database, the retrieval time was from establishment of database to March 2018. Two researchers independently screened literatures according to inclusion and exclusion criteria, data were extracted, bias risk of included literatures were evaluated, Stata 12.0 software was used for statistical analysis. Results 29 RCTs,4 052 patients were included in the study, 27 literatures compared complications related to needleless collectors and heparin cap, and 2 literatures compared complications related to needleless connectors and tee connectors. Meta-analysis showed that the incidences of catheter-related blood stream infection (CRBSI)(RR, 0.25[95%CI, 0.18-0.35]), occlusion of catheter (RR, 0.17[95%CI, 0.13-0.23]), return blood (RR, 0.11[95%CI, 0.08-0.15]), phlebitis (RR, 0.21[95%CI, 0.11-0.41]), needle stick injury (RR, 0.12[95%CI, 0.03-0.43]), and extubation (RR, 0.100[95%CI, 0.038-0.259]) in patients with needleless CVC were all lower than those in heparin cap/tee connector group, difference were all statistically significant (all P<0.01). Conclusion Needleless connector can reduce the incidence CVC-related complications in patients.

Abstract:Objective To understand the current situation of healthcare-associated infection (HAI) management in old-age care institutions in Changsha. Methods On-site and written survey were adopted to investigate current situa-tion of HAI prevention and control in old-age care institutions in Changsha, questionnaire on HAI management in old-age care institutions was filled in, knowledge about HAI among health care workers (HCWs) was evaluated and relevant data were analyzed. Results A total of 40 old-age care institutions were surveyed, 148 HCWs filled in the questionnaire. Only 3 of 40 old-age care institutions (7.5%) had independent HAI management departments and full-time HAI management personnel. There was a significant difference in the scores of HAI management system in different scales of old-age care institutions (F=12.058, P<0.001). The higher scores in the scoring system of HAI were:safe injection system (5.08±0.66), aseptic operation system (4.35±0.48), occupational exposure and protection system (3.38±0.77). Except for aseptic operation system and infection reporting system, there were significant differences in scoring of implementation of other core systems in different scale of old-age care institutions (all P< 0.05). The total qualified rate of knowledge assessment of HAI among HCWs was 62.2%, and the total score was (55.58±8.52). The high scores were as follows:prevention and control of HAI (13.00±4.33), basic knowle-dge of HAI (12.30±3.45), and management of medical waste (10.96±3.80). Except for occupational exposure and standard prevention as well as HAI surveillance and report, scores of other knowledge among HCWs in diffe-rent occupations were all significantly different (all P<0.05). Conclusion HAI management organization of old-age care institutions is not perfect, and core system is not implemented. Support and supervision should be enhanced, training for HCWs should be strengthened, and formulation of HAI control standard in local old-age care institutions should be completed as soon as possible.

Abstract:Objective To compare results of healthcare -associated infection(HAI) prevalence rate survey conducted through bedside survey and medical records consulting (referred to as manual survey) and HAI real-time monitoring system (referred to as RT-HAI survey), so as to provide reference for improving the investigation method and quality of HAI. Methods From 2014 to 2016, according to cross-sectional survey theory, prevalence rate of HAI in a hospital was investigated by manual survey and RT-HAI survey methods respectively, results were analyzed statistically. Results From 2014 to 2016, a total of 4 821 inpatients were investigated, the prevalence of HAI by manual survey were 3.98%, 3.94% and 3.61% respectively, prevalence of HAI by RT-HAI survey were 4.35%, 4.63% and 4.14% respectively, there was no significant difference in the prevalence of HAI between two methods in the same year (all P>0.05). After analyzed and discussed by HAI control expert group, the actual number of HAI on the survey day from 2014 to 2016 were 70, 68 and 75 cases respectively, with the prevalence rates of 4.22%, 4.70% and 4.37% respectively. Manual survey result and RT-HAI survey result were highly consistent with actual HAI on the same day of the annual survey, with statistical significance (all P<0.05). The sensitivity, Youden index, total coincidence rate and odd product of RT-HAI survey were all higher than those of manual survey, missed diagnosis rate was lower than that of manual survey. Conclusion RT-HAI is advantageous to improve HAI surveillance level.

Abstract:Objective To investigate characteristics of clinical distribution and change in antimicrobial resistance of Group B Streptococcus(GBS), and provide scientific basis for the prevention and treatment of GBS infection in clinical patients. Methods The isolation of GBS from clinical specimens from an obstetrics and gynecology hospital in Shijiazhuang City between January 1, 2014 and December 31, 2017 was retrospectively analyzed, clinical distribution characteristics of GBS were analyzed, detection and antimicrobial resistance rates of GBS in different years were compared. Results A total of 2 368 strains of GBS were isolated, the main specimens were vaginal and anal sphincter swabs (2 229 strains, 94.13%), obstetric clinics and wards were the main detected wards (94.97%). A total of 2 229 strains of GBS were isolated from vaginal and anal sphincter swabs of pregnant women at 35 to 37 weeks of gestation, with a isolation rate of 3.68%. Isolation rate of GBS in vaginal and anal sphincter swabs of pregnant women during perinatal period was increasing year by year, difference was statistically significant (χ_trend²=44.78,P<0.05). Isolation rate of GBS was the highest in vaginal and anal sphincter swabs of pregnant women aged 25-34 years (3.69%). 2 368 strains of GBS had the highest resistance rate to azithromycin (78.21%), followed by erythromycin (77.62%), clindamycin (77.15%) and levofloxacin (47.68%), but all were sensitive to penicillin, vancomycin, linezolid, cefuroxime and ceftriaxone. Trend chi-square test results showed that resistance rates of GBS to erythromycin, azithromycin, clindamycin and levofloxacin increased year by year, with statistical significance (all P<0.05). Conclusion GBS isolated from pregnant women at 35-37 weeks of gestation in this hospital as well as antimicrobial resistance rate of GBS is increasing year by year, penicillin can be used as the preferred antimicrobial agent for treatment of GBS infection, clinicians should pay attention to the detection of GBS and the changing trend of antimicrobial resistance.

Abstract:A 58-year-old male patient was admitted to hospital because of repeated double hip pain for 20 days. After repeated "double hip incision and drainage" in the local hospital, patient was transferred to another hospital. The results of secretion and joint fluid culture showed Burkholderia pseudomallei(B. pseudomallei). Patient experienced the failure of conservative treatment, such as antimicrobial treatment, dressing change, as well as catheter lavage and drainage. Double hip X-ray re-examination showed that double hip joint was severely damaged, exclusion treatment of bilateral hip resection and phase Ⅱ total hip arthroplasty were performed, sensitive antimicrobial agents were given at the same time. After 2 years of post-operative follow-up, joint function recovered and no infection recurred. Therefore, in the clinical treatment of chronic suppurative arthritis, first of all, it requires active bacterial culture and identification as well as selection of sensitive antimicrobial agents, secondly, it is necessary to strictly abide by indications of surgery, in view of bone and joint infection, debridement, lavage and drainage should be performed thoroughly in time, phase I and Ⅱ arthroplasty can be performed as long as severe joint damage or loss of function occur.

Abstract:Objective To explore infection control and implementation scheme under ventilator sharing management mode. Methods Demand of ventilator use and management in a hospital was investigated, infection prevention and control module as well as healthcare-associated infection survey module and so on for ventilator sharing were designed, information management of end sterilization of shared ventilators was achieved by intelligent APP on mobile phone and computer, actual operation test and efficacy detection of infection control module for 12 shared ventilators was conducted since November 2018. Results From November 14, 2018 to January 8, 2019, 7 ventilators were shared by 5 departments, the borrowing time was 24-1 288 hours, the total borrowing time was about 1 698 hours, the average borrowing time was 242.57 hours per time. The average daily use time of 12 shared ventilators was 2.62 hours/day. All 12 ventilators were idle in the department before sharing, and the average daily use time was 0 hour/day. Under the visual automatic prompt of infection prevention and control module, 12 shared ventilators were all qualified for disinfection after use, and all the self-testings were passed. Conclusion Ventilator sharing can save cost, meet clinical needs and improve infection management efficiency.

Abstract:Objective To understand the formation of bacterial biofilm in polyvinyl chloride(PVC) hoses pipeline at the connection end of hemodialysis device and water supply loop, and control bacterial biofilm in water treatment system. Methods The hoses were divided into two groups(group A and B) according to their service life and material, group A was transparent hoses used for 7 years and group B was red opaque hoses used for 5 years, specimens of group A and B were conducted different experimental treatment (group A₁ and B₁ didn't undergo any treatment; group A₂ and B₂ immersed in hydrogen peroxide disinfectant for 20 minutes; group A₃ and B₃:the inner wall of hoses were stirred with sterile cotton swabs and immersed in hydrogen peroxide disinfectant for 20 minutes), bacterial biofilm was observed under electron microscope. Results Group A₁ showed formation of overlapped and reticulated biofilm; group A₂ and A₃ showed that there were fissure and crack in bacterial biofilm, which could not completely fall off. In group B₁, the planar bulges were bacterial biofilm; group B₂ showed scattered globules; group B₃ showed the presence of free rod-like bacteria. Group A hoses (without any experimental treatment) were scanned by electron microscope at different multiples, showing that they were mainly composed of clustered bacteria. Conclusion The removal efficiency of bacterial biofilm is closely related to the complexity and overlapping degree of its morphology and structure. The study on hose material, time point of bacterial biofilm formation and disinfection treatment method for the connection of hemodialysis device and water supply loop can better carry out the control strategy research of bacterial biofilm in water treatment system.

Abstract:Objective To explore the application value of seamless management mode in the management of loaner devices and implants in central sterile supply department (CSSD). Methods 2 762 loaner devices and implants received with conventional method by a hospital from January 1 to December 31, 2017 were selected as control group, 1 349 loaner devices and implants received after the implementation of seamless management mode from January 1 to June 30, 2018 were as intervention group, nurses' overtime, backwash rate and loss rate of devices were compared between two groups. Results The overtime time of nurses in intervention group was shorter than that of control group ([125.7±36.8]min vs[29.5±43.2]min, t=28.116, P<0.001). In the control group, loaner devices and implants were placed for a long time after operation, management was not enough, nurses didn't check and pack in time after cleaning, which resulted in confusion and loss of devices. In intervention group, after standardized the process, all loaner devices and implants could be delivered to CSSD and handed over the prescriptive time, and all were cleaned by automatic spray cleaner. Backwash rate and loss rate of devices were both lower than those in control group (0.74% vs 1.74%; 0.30% vs 0.91% respectively). Conclusion Seamless management mode applied to the management of loaner devices and implants in CSSD can improve the management and cleaning quality of loaner devices and implants, and improve the work efficiency of nurses.

Abstract:Objective To explore the effect of failure mode and effect analysis (FMEA) on preventing blood-borne occupational exposure in surgical process. Methods According to baseline survey data of blood-borne occupational exposure in surgical process from January to December 2016, intervention in occupation exposure during surgery was performed by adopting FMEA management from January to December 2017, failure modes with risk priority number(RPN)>125 were selected for targeted rectification and continuous quality improvement. RPN score of fai-lure mode and the occurrence of blood-borne occupational exposure in surgical process before and after FMEA intervention were compared. Results After FMEA intervention, the overall RPN scores of 9 rectified failure modes in surgical process decreased by 67.68%, and RPN scores of all failure modes decreased by 50%; incidence of blood-borne occupational exposure decreased from 48.48% before FMEA intervention to 13.87% after intervention (χ²=65.78,P<0.01),incidence of exposure and per capita exposure times of each high-risk operation link of blood-borne occupational exposure were lower than those before intervention(all P<0.05). Incidence of blood-borne occupational exposure among surgeons, nurses and anaesthetists decreased from 45.86%, 55.00% and 70.00% before intervention to 14.52%, 14.29% and 0 after intervention respectively, with significant differences(all P<0.01). Conclusion Application of FMEA can effectively reduce the risk of blood-borne occupational exposure in the surgical process, standardize the operation behavior of medical personnel, and improve the awareness of occupational protection and compliance to standard prevention.

Abstract:Babesiosis is a zoonotic disease caused by Babesia protozoa, transmitted through tick bites or blood transfusion, parasitized in mammalian red blood cells. The disease is rare in clinic and clinicians still lack sufficient knowledge, it is easy to confuse with malaria and other diseases, resulting in missed diagnosis and misdiagnosis, seriously affect the prognosis of disease. Therefore, clinical diagnosis and treatment process of a case of Babesiosis is reported, and the relevant literatures are reviewed for reference.

Abstract:Objective To explore the necessity of antimicrobial use in patients with pleomorphic adenoma of parotid gland during perioperative period. Methods A retrospective analysis was made on the occurrence of surgical site infection(SSI) in patients with pleomorphic adenoma of parotid gland after head and neck surgery from January 2015 to January 2017, patients were divided into trial group and control group according to whether they used antimicrobial agents during perioperative period. Incidence of SSI was compared between two groups. Results A total of 92 patients were enrolled, including 45 in trial group and 47 in control group. There were no significant difference in maximum body temperature, drainage volume, and extubation time between two groups of patients within 1 week after operation (all P>0.05). Incision of SSI in trial group and control group were 11.11% (5/45) and 14.89% (7/47) respectively, there was no significant difference in SSI incidence between two groups(χ²=0.76,P=0.41). Conclusion Perioperative use of antimicrobial agents in patients with pleomorphic adenoma of parotid gland can not further reduce the incidence of SSI after operation.

Abstract:Heteroresistance refers to various susceptibility to a particular antimicrobial agents exhibited by different subpopulations of bacteria, which has been reported frequently in the vancomycin-intermediate Staphylococcus aureus. In recent years, this phenomenon has been revealed in gram-negative bacteria, such as Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa, and it is gradually recognized that this may be one of the causes for the failure of anti-infective treatment. Once heteroresistance occurs, even a small part of subpopulations of drug-resistant bacteria can exhibit high level phenotypic resistance under the selective pressure of antimicrobial agents, which leads to the failure of clinical antimicrobial anti-infective therapy. Heteroresistance reflects the transformation of bacterial population from partial drug resistance to complete drug resistance. Research on heteroresistance is of great significance for understanding the development process of drug resistance of common clinical pathogens, evaluating treatment options and guiding clinical antimicrobial use. In this paper, the research status of heteroresistance of Acinetobacter baumannii is reviewed.