Abstract:Objective To investigate the clinical drug resistance of carbapenem-resistant Gram-negative bacilli and molecular characteristics of drug resistance gene blaKPC. Methods Clinically isolated carbapenem-resistant Gram-negative bacilli in a hospital from January 2017 to December 2018 were analyzed. Antimicrobial susceptibility testing data were statistically analyzed by WHONET 5.6 software, carbapenem-resistant genes blaKPC, blaNDM, blaIMP, blaVIM, and blaOXA-48 were detected by polymerase chain reaction (PCR), PCR positive products were performed DNA sequence to analyze the molecular structure of drug resistance genes. Results A total of 510 strains of carbapenem-resistant Gram-negative bacilli were collected, including 420 strains of carbapenem-resistant Enterobacteriaceae (CRE) and 90 strains of carbapenem-resistant non-Enterobacteriaceae. Strains were mainly from intensive care unit (ICU), departments of neurosurgery and respiratory, accounting for 60.8%, 11.8% and 5.3% respectively; specimens were from sputum, purulent secretion, venous blood, and sterile midstream urine, accounting for 66.9%, 8.8%, 8.2% and 6.5% respectively. Carbapenem-resistant Gram-negative bacilli were highly resistant to commonly used antimicrobial agents. PCR results showed that among 420 strains of CRE, positive rates of blaKPC, blaNDM, and blaIMP were 54.3% (228/420), 1.2% (5/420), and 1.4% (6/420) respectively. blaVIM and blaOXA-48 genes were not found, Klebsiella pneumoniae, Enterobacter aerogenes, and Escherichia coli accounted for 83.8%, 11.8%, and 2.6% of blaKPC-carrying CRE respectively; blaKPC was also detected in other rare strains. blaKPC was detected in only 2 strains of Acinetobacter baumannii in non-Enterobacteriaceae. DNA sequencing showed that among 174 strains carrying blaKPC, 173 strains were found blaKPC-2 and 1 strain was found blaKPC-1. Conclusion CRE is the main Gram-negative bacteria resistant to carbapenems in this area, dominantly Klebsiella pneumoniae carrying blaKPC-2, and other strains are also found. It is suggested that the monitoring and prevention of carbapenem-resistant Klebsiella pneumoniae should be strengthened to prevent and control the spread of blaKPC.

Abstract:Objective To construct the standard plasmid and detection system for copy number of Norovirus GⅡ (NoV GⅡ). Methods The synthesized highly conserved NoV GⅡ gene sequence was cloned into pUC57 vector for constructing NoV GⅡ standard plasmid, then plasmid was verified by polymerase chain reaction (PCR). The standard curve of Ct value and copy number of NoV GⅡ was drawn according to real-time fluorescence quantitative PCR amplification curve, and corresponding standard curve equation was obtained. Four clinical fecal specimens obtained from the Children's Hospital of Kunming in December 2018 were detected by the constructed NoV GⅡ standard plasmid and detection system. Results PCR proved that the standard plasmid for detecting copy number of NoV GⅡ was constructed correctly. Standard curve equation of Ct value and viral copy number based on amplification curve of real-time fluorescence quantitative PCR was obtained as follows:Y=-3.972X+39.03, R²=0.991. Viral copy numbers in 4 fecal specimens were 30 443.45, 9 468.40, 53 176.69, and 4 493.12 copies/μL respectively. Conclusion The standard plasmid and its detection system for detecting the copy number of NoV GⅡ virus in fecal specimens are successfully established, which can provide an effective quantitative detection method for disease prevention and control and related experimental research.

Abstract:Objective To comprehensively understand the research status and trend of fulminating infectious di-seases(FIDs) virus of world Arenaviridae family, provide information and reference for the prevention and control as well as biosafety of emerging infectious diseases and FIDs in China. Methods Using bibliometrics and scientific knowledge map analysis method, 8 kinds of FIDs virus of Arenaviridae classified as the first category according to hazard degree in the list of Pathogenic microorganisms of human infection were selected as the research objects for hot spot and trend analysis. Results A total of 1 840 articles in the field of 8 kinds of FIDs virus of Arenaviridae were collected, 1 243 of which were about Lassa fever virus. The international research on FIDs virus of Arenaviridae began in 1960s, the United States, Argentina and Germany have highly participated in this field, with 892, 387 and 186 articles published respectively, there are 33 domestic research articles in this field, ranking the 13th; the top three research institutions which published related literatures were National Institutes of Health of the United Status, University of Buenos Aires of Argentina, as well as Centers for Disease Control and Prevention of the United Status, with 237, 229 and 164 articles published respectively. The research directions and hot spots in this field mainly include:viral epidemiology and biosafety, virus genetics and pathogenesis, anti-viral treatment, anti-viral drugs, vaccine development, and rapid detection technology of viruses. Conclusion Occurrence of FIDs caused by Arenaviridae viruses are less in China, but in the world, especially the western developed countries, close attention has been paid to it, China is still lagging behind in this field, it is necessary to strengthen relevant research to prevent the epidemic and potential national biosafety risks.

Abstract:Objective To understand epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19), and reveal the risk factors related to treatment outcome. Methods Clinical data of patients with COVID-19 admitted to a tertiary hospital in Wuhan from December 27, 2019 to January 30, 2020 were retrospectively analyzed, treatment outcome was followed up, according to the treatment outcome, patients were divided into survival group(improved and discharged)and death group, risk factors related to treatment outcome were identified through univariate and multivariate analysis. Results During the follow-up to March 3, 2020, among 100 patients with COVID-19 after treatment, 85 cases were improved and discharged (survival group), 15 cases died (death group). The median age of patients was 44.0 years old, female patients accounting for 60.0%, 1 patient with positive SARS-CoV-2 nucleic acid test showed no other clinical manifestation except chest CT finding of "right lung patch opacity". Univariate analysis showed that percentage of patients in death group were all higher than survival group in the following factors:age ≥ 60 years old, had a history of chronic heart disease, chronic lung disease, cerebrovascular disease, diabetes mellitus, hypertension, severe or critical clinical types at admission, laboratory tests of platelet count<100×10⁹/L, lymphocytic cell count<0.5×10⁹/L, lactate dehydrogenase ≥ 250 U/L, alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) ≥ 40 U/L, serum creatinine ≥ 97 μmol/L, fibrinogen ≥ 4 g/L, D-dimer ≥ 1 mg/L, without treatment of traditional Chinese medicine and mechanical ventilation (all P<0.05). Multivariate analysis showed that severe or critical clinical type and chronic heart disease are independent risk factors for death (P<0.01). Conclusion Treatment outcome of COVID-19 is related to multiple factors, severe or critical clinical types at admission and combines with chronic heart disease are independent risk factors for death.

Abstract:Objective To analyze disease causes, distribution and drug resistance of pathogens causing infective endophthalmitis(IE). Methods Clinical data of patients with IE in a hospital from January 2016 to December 2018 were retrospectively analyzed. Results 90 cases of IE were mainly caused by ocular trauma (56.7%), 20 (22.2%) were caused by eye surgery, 19 (95.0%) of which were caused by cataract surgery combined with artificial lens implantation. Among 52 strains of pathogens causing IE, Gram-positive bacteria accounted for 50.0% (26 strains), mainly Staphylococcus epidermidis (13 strains), Gram-negative bacteria accounted for 30.8% (16 strains), mainly Pseudomonas aeruginosa (6 strains) and Klebsiella pneumoniae (4 strains). Susceptibility rates of Staphylococcus epidermidis to vancomycin, linezolid, rifampicin and tigecycline were all 100.0%, while susceptibility rates to penicillin and oxacillin were both low (< 50%). Conclusion IE is mainly caused by ocular trauma and eye surgery, especially cataract surgery, the main pathogens are Staphylococcus epidermidis, Pseudomonas aeruginosa and Klebsiella pneumoniae.

Abstract:Objective To analyze the incidence and clinical characteristics of infectious endophthalmitis after different types of intraocular surgery/manipulation, provide reference for prevention and control of healthcare-associa-ted infection(HAI)in ophthalmology hospital. Methods Patients who underwent intraocular surgery/manipulation in a hospital from January 2017 to December 2019 were analyzed retrospectively, occurrence of infectious endophthalmitis was analyzed. Results A total of 36 107 patients (mean age 50.78±19.96 years) undergoing intraocular surgery/manipulation were collected; the main types of intraocular surgery were cataract surgery (52.10%), implantable contact lens(ICL) surgery for high myopia (19.67%) and vitrectomy (17.58%). A total of 20 patients developed infectious endophthalmitis, the overall incidence was 0.06%, of which 14 cases were postoperative acute endophthalmitis, 6 cases were delayed-onset endophthalmitis; among different surgical types, ICL surgery had the lowest incidence of infectious endophthalmitis (0.01%), and glaucoma surgery had the highest incidence of infectious endophthalmitis (0.12%). A total of 12 strains of pathogens were isolated from 20 patients with infectious endophthalmitis, including 8 strains of Gram-positive bacteria, 3 strains of Gram-negative bacteria and 1 strain of fungus; 12 patients (60.00%) were treated with pars-plana vitrectomy, and 18 patients were cured, the cure rate was 90.00%. Conclusion Incidence of infectious endophthalmitis is varied in different types of intraocular surgery/manipulation, prevention of infectious endophthalmitis should be conducted according to different types of operation.

Abstract:Objective To analyze the epidemiological and spatial distribution characteristics of adenovirus infection in Wuming District of Nanning City, so as to provide scientific basis for the prevention of adenovirus outbreak. Methods A unified epidemiological questionnaires on individual case were used to conduct one-to-one investigation, geographic information system (GIS) technology was adopted to explore the spatial distribution and clustering of the epidemic, spatial epidemiological distribution characteristics of the epidemic was analyzed by kernel density analysis and Moran's I index. Results A total of 228 children were infected with adenovirus in this outbreak, and none of them were seriously ill or died. The age of the infected patients was mainly 5-9 years old, and the onset time was mainly from July 28 to August 4, 2019. The major clinical manifestations were fever, cough, pharyngeal congestion and tonsillar enlargement. Moran's I Z=3.76 (P<0.05), suggesting that the spatial distribution of patients with adenovirus infection has a strong spatial clustering, and kernel density analysis showed that infected children in this epidemic were distributed in the whole region. Conclusion There is a strong population mobility during the summer vacation, spread of the epidemic in a large scale should be alerted. Parents should strengthen their own safety awareness and develop good hygiene habit when taking their children out to play in public places. The use of spatial analysis can comprehensively and intuitively show the clustering region of epidemic diseases, and provide scientific reference for the prevention and control of the epidemic.

Abstract:Objective To analyze the clinical characteristics and therapy of Listeria monocytogenes (L. monocytogenes) infection. Methods Clinical data of patients with L. monocytogenes infection in a hospital from January 2016 to December 2018 were collected retrospectively, clinical characteristics, laboratory test, antimicrobial use program and prognosis of patients were analyzed. Results A total of 15 patients with L. monocytogenes infection were collected, most of the non-pregnant adults were over 65 years old and with underlying diseases; 14 patients were with septicemia (including 1 case combined with suppurative meningitis), and 1 case with suppurative meningitis. All the adult patients with septicemia had fever, and only 1 neonate had fever; 2 patients with suppurative meningitis had headache, vomiting and other neurological symptoms besides fever. The levels of leukocyte, C-reactive protein and procalcitonin increased in most of the 15 patients, cerebrospinal fluid examination of 2 patients with suppurative meningitis was obviously abnormal. 14 patients improved after receiving penicillin or meropenem therapy alone, or combined use of two drugs, 1 patient was worsened. Conclusion L. monocytogenes mainly causes bloodstream infection or suppurative meningitis in neonates, pregnant women, the elderly, and immunocompromised person, penicillin, ampicillin, meropenem and compound sulfamethoxazole can be used for empirical therapy for L. monocytogenes infection.

Abstract:Objective To clarify high-touch surface of different departments, provide basis and guidance for cleaning and disinfection. Methods The direct observation method was used to investigate the touch frequency of environmental surface in 5 key management departments of healthcare-associated infection(HAI), including digestive endoscopy room, stomatology department, hemodialysis room, operating room and department of laboratory medicine of a tertiary general hospital in Xi'an, the cumulative touch frequency and touch rate were calculated. Results There were 5-9 high-touch surface in 5 key departments. Touch frequency of high-touch surface in digestive endoscopy room (3.57-13.29 times per manipulation) was significantly higher than those in other departments; touch frequency of high-touch surface in hemodialysis room was 0.56-3.44 times per manipulation, which was the lowest among the 5 departments. Surfaces with high-touch frequency were as follows:diagnosis and treatment bed in digestive endoscopy room (13.29 times per manipulation), manipulation panel on treatment unit in stomatology department (3.64 times per manipulation), touch screen of dialysis machine in hemodialysis room (3.44 times per manipulation), anesthesia computer keyboard and mouse in operating room (8.25 times per manipulation), and computer keyboard and mouse in department of laboratory medicine (4.80 times per manipulation). Treatment trolley was high-touch surface in digestive endoscopy room, operating room, and hemodialysis room. Conclusion Due to different medical manipulation, the high-touch surface of each department is also different. Computer mouse and keyboard, treatment trolley, diagnosis and treatment bed, equipment for diagnosis and treatment, and manipulation unit are all high-touch surface in key departments.

Abstract:Objective To understand the effect of installing alcohol-based handrub (ABH) devices on reducing the contamination of elevator buttons in hospital. Methods The public elevator buttons in outpatient department, surgical building and internal medicine building of a tertiary first-class hospital were investigated. One week, one month, one quarter, half a year and one year after installing ABH devices and putting up the hand hygiene bulletin were taken as test period, the integrity and utilization rate of ABH devices were investigated by random sampling, microbial contamination on elevator buttons before and after installation was compared. Results A total of 100 installation points (15 at outpatient department, 75 at surgical building and 10 at internal medicine building) of ABH devices were selected for investigation during the test period, with the extension of time, the integrity rate and availability rate of ABH devices gradually decreased. During the test period, 1 613 person-times of elevator button operators were randomly observed, within one month after the installation of ABH devices, disinfection rate of button operators before and after pressing the buttons both gradually increased, and non-disinfection rate gradually decreased; after one month, with the extension of time, disinfection rate before and after pressing the buttons both gradually decreased, and the non-disinfection rate gradually increased to 85.89%. There was significant difference in constituent of utilization rate of hand disinfectant among different periods (P<0.05). Among the 600 button specimens before installation and during the test period, only 7 specimens did not isolate microbes, microbial contamination rate was 98.83%. One week after the installation of ABH devices, microbial contamination rate and the average, median, maximum and over standard rate of total bacterial count were the lowest, and then gradually increased; the qualified rate of total bacterial counts were all low, the highest was 32.00%. A total of 1 411 strains of microbes were detected from 593 elevator button specimens, 1 178(83.49%) of which were Gram-positive bacteria, 222 (15.73%) were Gram-negative bacteria, and 11 (0.78%) were fungi, mainly mold. The main microbes on the surface of elevator buttons were Acinetobacter baumannii (30 strains), Staphylococcus aureus (18 strains), Ente-robacter cloacae (14 strains), and Klebsiella pneumoniae (9 strains). There was no significant difference in consti-tuent of microbes of elevator buttons in different periods (P>0.05). Conclusion The effect of installed ABH devices in this hospital is good during early period, but the management is not implemented in place in the later period, prevention effect is poor, it is necessary to combine the hardware, management and publicity to improve the humanized service level of hospital elevators.

Abstract:Objective To study factors influencing the efficiency of ultrasonic cleaning of medical devices, and provide reference for rational improvement in methods and processes of ultrasonic cleaning of medical devices in hospital central sterile supply department. Methods Ultrasonic energy detection bottle and ultrasonic intensity detector were used to detect the ultrasonic efficiency, lumen type cleaning effect detection cards were used to detect the ultrasonic cleaning efficiency. Results There were significant differences between degassing group and non-degassing group in the average discoloration time of the energy bottle, the ultrasonic intensity and average cleaning qualified time of detection cards (P<0.05); differences between device regular placement group and stacking placement group was statistically significant (P<0.05); there was significant difference between single-layer placement group and double-layer placement group (P<0.05), there was no significant difference in the same detection site between single basket group and double basket group under the condition of the same number of layer (P>0.05). Among 4 kinds of detergent, brand A had the best cleaning efficiency and the fastest cleaning speed, but there was no significant differences in the average discoloration time of energy bottle and ultrasonic intensity detection (P>0.05). The best cleaning efficiency was achieved when the amount of detergent was 1:100 and the cleaning temperature was at 45℃. Enzyme activity of detergent was about 1 600 U within 2 hour of ultrasonic time, difference was not statistically significant (P>0.05). Conclusion Degassing, device placement, device loading mode, different detergent and cleaning temperature can all lead to the change of ultrasonic cleaning efficiency, only by selecting rational cleaning conditions can achieve satisfactory results of ultrasonic cleaning of medical devices.

Abstract:Objective To analyze the effect of plan-do-check-action (PDCA) management mode on the management of healthcare-asssociated infection(HAI) in neonatal intensive care unit (NICU). Methods Children who were admitted to NICU in a hospital were selected as the research objects, those who were admitted between January and June 2018 were in control group, from July to December 2018 were in trial group. Trial group adopted PDCA cycle program to improve the quality of HAI management, HAI in two groups of neonates before and after the implementation of PDCA was compared, hand hygiene of health care workers(HCWs) before and after implementing PDCA was monitored. Results There were 1 254 neonates in control group, 228 were premature neonates, 1 368 neonates in trial group, 304 were premature neonates. Case incidence of HAI in neonates in NICU after implementing PDCA was lower than before implementation (4.09% vs 6.30%, χ²=6.521,P<0.05). Case incidence of HAI in premature neonates after implementing PDCA was lower than before implementation (4.28% vs 8.77%, χ²=4.526,P<0.05). After the implementation of PDCA, the qualified rates of hand hygiene of doctors and nurses were both higher than those before the implementation, difference was statistically significant (P<0.05). Before implementing PDCA, daily consumption of hand disinfectant and hand sanitizer in NICU were 16.94 mL/bed-day and 15.41 mL/bed-day respectively; after implementing PDCA, daily consumption were 25.95 mL/bed-day and 17.81 mL/bed-day respectively. Conclusion Application of PDCA management can improve the quality of HAI management in NICU, and reduce the incidence of HAI, which is worthy of clinical application.

Abstract:Objective To systematically evaluate the accuracy of infrared ear thermometer in measuring the temperature of the elderly. Methods Literatures about the accuracy of infrared ear thermometer in measuring temperature of the elderly from 1988 to 2019 were retrieved from PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), VIP Database and Wanfang Database, ngoing studies were searched through ClinicalTrials.gov. Literatures were screened according to the strict inclusion and exclusion criteria, data were extracted, bias risk of included literatures was evaluated, Stata12.0 software was adopted to perform analysis. Results Eight literatures were included in analysis, including 3 literatures which had the mean and standard deviation of temperature in patients in normal temperature group and fever group, 1 literature compared data about ear temperature and axillary temperature in fever group, 4 literatures only compared data about ear temperature and axillary temperature in normal group; 5 literatures compared the data of left ear and right ear temperature. Meta-analysis showed that there was no significant difference in ear temperature and axillary temperature in both normal temperature group and fever group (both P>0.05); there was no significant difference between left ear temperature and right ear temperature (P>0.05). Conclusion The accuracy of infrared ear thermometer is good, and it can be used as the best screening tool to determine the initial temperature of the elderly.

Abstract:To report a case of purulent meningitis caused by Streptococcus suis (S. suis), and provide reference for the diagnosis and treatment of S. suis infection. Diagnosis and treatment process as well as epidemiological data of a case of purulent meningitis caused by S. suis in a hospital was retrospected, and relevant literatures were reviewed. Clinical manifestation of this case was fever and headache with rapid progress, after effective anti-infective treatment, patient was improved and discharged from hospital, but there was serious hearing impairment, epidemiological survey proved that this was a single case. S. suis infection develops rapidly with severe sequela, timely and adequate dexamethasone combined with low ototoxicity antimicrobial agents can reduce the occurrence of hearing impairment.

Abstract:In order to prevent and control the epidemic of COVID-19, documents issued by China indicates that protective face masks are required to use when performing aerosol-generating procedures (AGPs). However, it is not explicitly mention that which medical procedures can produce aerosol and whether the AGPs are associated with increased risk of infection transmission. Therefore, according to domestic and foreign guidelines and related literatures, this paper conducts literature review on aerosol, AGPs, high-risk medical procedures, and protection strategy.

Abstract:Effective antiviral therapy and vaccine preventive measure for coronavirus disease 2019(COVID-19) is still not ascertained at present. Combined with the previous evidence and therapeutic plan formulated based on clinical first-line therapeutic experience of COVID-19, research progress in drug therapy for COVID-19 was reviewed from the aspect of antiviral drugs such as nucleoside reverse transcriptase inhibitors and nucleoside analogues, as well as convalescent plasma therapy.