Abstract:Objective To study the molecular epidemiological characteristics of carbapenem-resistant Enterobacter cloacae (CREC) and mechanism of carbapenem resistance, provide basis for clinical empirical antimicrobial use as well as prevention and control of healthcare-associated infection. Methods CREC isolated from a hospital between April and September 2019 were identified and performed antimicrobial susceptibility analysis, carbapenemase was screened by modified carbapenem inactivation method (mCIM) and EDTA-modified carbapenem inactivation method (eCIM), carbapenem-resistant genes were detected by polymerase chain reaction (PCR), molecular epidemiological characteristics were analyzed by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). Results Among 8 strains of CREC, 5 were from intensive care unit (ICU) and were highly resistant to cephalosporins and enzyme inhibitors commonly used in clinical practice. All strains carried metallo-β-lactamases, 7 strains carried bla_NDM-1 and 1 strain carried bla_IPM-4. MLST molecular typing and PFGE homology analysis showed 6 ST sequence types and 6 clone groups. ST596 (3 strains), ST121 (1 strain), ST993 (1 strain), ST91 (1 strain), ST794 (1 strain) B and ST88 (1 strain) belonged to groups A, C, F, E, B and D respectively. Conclusion CREC in this hospital mainly comes from ICU, producing of metalloenzyme bla_NDM-1 β-lactamase is the main resistance mechanism. ST596 group A Enterobacter cloacae has local epidemic in ICU for a short time, prevention and control measures of HAI should be strengthened to curb the outbreak.

Abstract:Objective To analyze strain distribution and clinical characteristics of non-tuberculous mycobacterial (NTM) pulmonary disease (NTM-PD) in Fuzhou City, provide reference and evidence for clinical diagnosis and treatment of NTM-PD. Methods Medical records of patients who were isolated Mycobacteria from culture of sputum or bronchoalveolar lavage fluid (BALF) specimens sent by Fuzhou Pulmonary Hospital of Fujian Province between January 2018 and January 2020 were analyzed retrospectively. Strain distribution and relevant clinical characteristics of patients with NTM-PD were analyzed. Results A total of 249 patients were confirmed with NTM-PD, 10 cases (4.0%) were co-infection of NTM and Mycobacterium tuberculosis. Among 249 patients with NTM-PD, the middle-aged and elderly were more common, and women were slightly more than men. The most common pathogen was Mycobacterium intracellulare (60.6%, 151 strains), followed by Mycobacterium avium (17.7%, 44 strains) and Mycobacterium chelonae/Mycobacterium abscessus (17.7%, 44 strains). The common susceptible factors for NTM-PD were bronchiectasis (70.3%, n=175), history of tuberculosis (28.5%, n=71), pneumoconiosis (14.5%, n=36), chronic obstructive pulmonary disease (COPD) (11.2%, n=28), history of tumor (4.8%, n=12), and diabetes mellitus (4.4%, n=11). Men were more likely to be complicated with COPD and women were more likely to be complicated with bronchiectasis. Clinical symptoms of NTM-PD were nonspecific, often manifested as cough, expectoration, hemoptysis, chest tightness and pain, shortness of breath, fever and so on, there is no correlation between clinical symptoms and species, but shortness of breath and hemoptysis were correlated with gender, men were more likely to have shortness of breath, while women were more likely to have hemoptysis. Pulmonary nodule was the most common imaging manifestation of NTM-PD, accounting for 90.8%; followed by bronchiectasis and pulmonary cavity, accounting for 70.3% and 62.7% respectively. NTM-PD was easily misdiagnosed as pulmonary tuberculosis (68.3%) and bronchiectasis (16.9%), the cure rate was low (34.6%). Conclusion Clinical symptoms and imaging manifestations of NTM-PD and pulmonary tuberculosis are very similar, which is easy to be misdiagnosed. For patients with history of tuberculosis, bronchiectasis, COPD, pneumoconiosis, diabetes mellitus and low immunity, those who are with pulmonary nodules, bronchiectasis and pulmonary cavity should be highly alert to the possibility of NTM-PD, timely and accurate identification of pathogen should be conducted to guide clinical treatment.

Abstract:Objective To explore the correlation between healthcare-associated infection (HAI) and venous thrombosis in stroke patients undergoing surgery, and provide scientific basis for health care workers to take targeted prevention and control measures. Methods Clinical data of all stroke patients in a hospital from January 2016 to December 2018 were prospectively collected, they were divided into infection group and non-infection group accor-ding to whether HAI occurred, two groups of patients were matched with 1:1 propensity score matching (PSM), relationship between post-operative HAI and venous thrombosis in stroke patients was analyzed. Results A total of 816 stroke patients were included in study, 213 cases (26.10%) of HAI occurred, after confounding factors were balanced by PSM, there was a correlation between HAI and venous thrombosis (P < 0.001), Pearson contingency coefficient C was 0.192. Incidence of venous thrombosis was different among different HAI sites (P=0.037). Conclusion After the confounding factors are balanced by PSM, there is a positive correlation between HAI and thrombosis in stroke patients undergoing surgery, and may have a synergistic effect on the adverse prognosis of patients, therefore, post-operative monitoring should be strengthened, early detection, early diagnosis, early treatment and early intervention measures should be taken to reduce the risk of complication occurrence and improve the prognosis of patients.

Abstract:Objective To isolate and identify microorganism contaminated in dental unit waterlines (DUWLs), evaluate current disinfection and infection control measures through the resistance of dominant pathogens to different disinfectants. Methods DUWLs in a tertiary first-class dental hospital were selected as the research object, microorganisms in DUWLs were cultured and conducted colony counting, dominant bacteria were isolated and identified by mass spectrometry, resistance of dominant bacteria to different disinfectants was evaluated by minimum inhibitory concentration (MIC) test and minimum bactericidal concentration (MBC) test, resistance of Mycobacterium mucogenicum was compared with that of standard strain (Mycobacterium chelonei subsp.abscessus) by suspension quantitative germicidal method. Results Detection rate of colonies in 48 water specimens from 24 DUWLs was 100.00%, the average number of colony was (2.25±1.43)×10⁵ CFU/mL, 9 kinds of contaminated microorganisms were isolated, the dominant pathogen was Mycobacterium mucogenicum (35.72%), followed by fungi (21.43%). MICs of the isolated Mycobacterium mucogenicum to chlorhexidine acetate, sodium hypochlorite, peracetic acid, and hydrogen peroxide were 1.5, 500, 5 and 100 mg/L respectively, and MBC were 3, 500, 10 and 200 mg/L respectively, resistance to sodium hypochlorite was close to the standard strain; 0.5% chlorhexidine acetate could not effectively kill the isolated Mycobacterium mucogenicum and standard strain Mycobacterium chelonei subsp.abscessus within 30 minutes, 0.1% sodium hypochlorite, 3% hydrogen peroxide and 0.1% peracetic acid could effectively kill the isolated Mycobacterium mucogenicum and standard strain Mycobacterium chelonei subsp.abscessus within 30 minutes. Conclusion Non-tuberculous mycobacterium, which has strong resistance to chlorine-containing disinfectant, has replaced Pseudomonas aeruginosa and Legionella as the dominant flora in DUWLs of the hospital selected in this study, appropriate disinfectant types, concentration, effective action time and use frequency should be selected for the disinfection of DUWLs.

Abstract:Objective To explore the application effect of information-based transparent supervision intervention model in the prevention and control of multidrug-resistant organism (MDRO) healthcare-associated infection(HAI). Methods 46 873 inpatients in a hospital From January to December 2019 were as pre-intervention group and 45 217 inpatients from January to December 2020 were as post-intervention group. Transparent supervision was implemented by intervention group for patients who were isolated MDRO and early warned through daily HAI real-time monitoring system. With the help of information, infection rate and isolation rate of MDRO, qualified rate of ATP detection on hand hygiene and environmental object surface cleaning and disinfection, as well as implementation rate of MDRO core prevention and control measures were transparently opened, effect before and after transparent supervision intervention was compared. Results After information-based transparent supervision intervention, infection rate of MDRO decreased from 0.96% to 0.51% (P < 0.001), isolation rate of MDRO decreased from 56.04% to 40.79% (P < 0.001), hand hygiene compliance rate increased from 53.31% to 70.25% (P < 0.001); qualified rate of environmental object surface cleaning and disinfection increased from 51.89% to 91.76% (P < 0.001); after intervention, detection rate of pathogenic organism before the therapeutic use of antimicrobial agents increased gra-dually (P < 0.001), utilization rate of special grade antimicrobial agents generally decreased (P < 0.05). Conclusion With the help of information-based real-time monitoring system, timely early warning MDRO infection cases, strengthening transparent supervision on the implementation of MDRO core prevention and control measures as well as applying information platform to promote the process controlling of rational use of special-grade antimicrobial agents can effectively reduce MDRO cross infection in hospital and reduce the outbreak of MDRO infection.

Abstract:Objective To explore the effect, cost and safety of pressure steam sterilization, low temperature plasma sterilization and ethylene oxide sterilization on laparoscopic device. Methods A total of 90 sets of laparoscopic device in a tertiary first-class hospital from November to December 2020 were selected. According to random number table method, laparoscopes after cleaning, drying and packaging were respectively sterilized by the above three sterilization methods, with 30 sets in each group. Sterilization effect was monitored, time and economic cost of three sterilization methods were analyzed, sterilization safety was compared. Results Qualified rates of physical, chemical and biological monitoring of sterilization effect of three groups of laparoscopes were all 100.00%, quality of optical imaging were all 100.00%. The average sterilization time of pressure steam sterilization, hydrogen peroxide low temperature plasma sterilization and ethylene oxide sterilization were 3, 21.7 and 320 minutes respectively; cost of sterilization and maintenance of each set of laparoscope were 1.32, 23.74 and 100.46 Yuan/set respectively; cost of consumables required for sterilization of each set of laparoscope were 15.60, 116.67 and 106.67 Yuan respectively; the required human cost were 1.55, 11.17 and 164.96 Yuan/set respectively. The average overall cost for sterilization of each set of laparoscope by three sterilization methods were 18.47, 151.58 and 372.09 Yuan/set respectively. There was no disinfectant residue in pressure steam sterilization method, and there was no adverse reaction among health care workers; there was disinfectant residues in hydrogen peroxide low temperature plasma and ethylene oxide sterilization, which had irritation to the eyes, respiratory tract and skin of health care workers. Conclusion Compared with the other two methods, pressure steam sterilization has obvious advantages in time, cost and safety, it is suitable for heat-resistant and moisture-resistant laparoscopic device sterilization.

Abstract:Objective To investigate the setting status of hand hygiene (HH) facilities in a tertiary first-class comprehensive teaching hospital based on the concept of point-of-care (POC). Methods A cross-sectional survey was conducted on the type, number, location, facility completeness of HH facilities and consumption of alcohol-based hand rub used by health care workers in each diagnosis and treatment section of this hospital. Results 102 sections were surveyed, there were 1 165 diagnosis and treatment rooms, setting rate of HH facilities was 96.48%, completeness rate of hand washing sink was 91.37%, there was significant difference in completeness rate in diffe-rent sections (P < 0.01). 80.53% of alcohol-based hand rub setting complied with the POC concept, 59.51% of alcohol-based hand rub setting in the general wards complied with the POC concept, consumption of hand disinfec-tant was relatively higher in departments with high conformity to POC concept for the setting of alcohol-based hand rub. Conclusion The setting and improvement of HH facilities should strengthen the POC concept to improve HH compliance and prevent the occurrence of healthcare-associated infection.

Abstract:Objective To explore the clinical effect of modified extraventricular drainage on severe tuberculous meningitis (TBM) and refractory hydrocephalus. Methods Clinical data of patients with severe TBM and refractory hydrocephalus in a hospital from 2013 to 2017 were analyzed, the modified extraventricular drainage was adopted, ventricular segment was punctured, then connected to the linear connector and abdominal segment shunt, pass through a subcutaneous incision in the abdomen, and continue to drain and purify the cerebrospinal fluid, after disease condition was stable, cerebrospinal fluid drainage device was removed or ventricular-abdominal shunt treatment was performed. The Evan's index, GCS score and GOS prognostic score of patients before and after treatment were compared. Results A total of 15 patients with severe TBM and refractory hydrocephalus were treated, aged from 19 to 64 years. Compared with before treatment, Evan's index and GCS score of patient after treatment were improved, differences were statistically significant (all P < 0.05). One case was removed extraventricular drainage tube after inflammation was controlled, and the other 14 cases underwent ventricular-abdominal shunt. According to the GOS classification at discharge, 13 cases (86.7%) recovered well (4-5 points), and 2 cases (13.3%) reco-vered poorly (3 points). Drainage time was 59-335 days, with an average of 173.3 days. There was no intracranial infection and shunt blockage complication during drainage. Patients were followed up for 2-5 years, with an ave-rage of 4.5 years, one case of ventricular segment of shunt tube was placed in the transparent septum space, which caused the ventricle to expand again, after fistulation through transparent septum and shunting again, it was cured, and the remaining cases were free of complications. Conclusion Modified extraventricular drainage can significantly improve the success rate of final shunt, especially for patients with severe TBM and refractory hydrocephalus after repeated treatment failure.

Abstract:Objective To compare and analyze economic burden of patients with healthcare-associated infection (HAI) based on the disease diagnosis-related group (DRG), and provide support for the prevention and control of HAI. Methods Hospitalization days and medical expense of all hospitalized HAI patients were analyzed retrospectively and compared with those of patients in the same DRG in a hospital from 2018 to 2020. Results From 2018 to 2020, the number of HAI cases were 694, 1 102 and 819 respectively, and the number of cases in the same DRG were 72 707, 92 837 and 59 398 respectively; the average hospitalization days of HAI patients were higher than those of patients in the same DRG (31.07 days vs 13.05 days, 65.98 days vs 47.51 days, 35.38 days vs 13.45 days), differences were all significant (all P < 0.01). The average hospitalization expense in each year was higher than that of patients in the same DRG (122 900 Yuan vs 38 400 Yuan; 171 800 Yuan vs 41 200 Yuan; 157 500 Yuan vs 44 300 Yuan), differences were all significant (all P < 0.01). In terms of infection site, the average hospitalization expense of catheter-related bloodstream infection(CRBSI) was the highest, which was 225 700, 358 800 and 268 000 Yuan in 2018-2020. The average length of hospital stay of patients with CRBSI was 102.00 days and the hospitalization expense was 284 200 Yuan during three-year, which increased by 88.78 days and 242 700 Yuan respectively compared with those of patients in the same DRG. Conclusion HAI in hospitalized patients will significantly increase the direct economic burden of patients, controlling CRBSI is the top priority of reducing economic burden of HAI, under the DRG payment method, it is imperative to strengthen the prevention and control of HAI.

Abstract:Objective To investigate and analyze an outbreak event of suspected rotavirus healthcare-associated infection (HAI), provide reference for the prevention and control of HAI. Methods Using on-site epidemiological investigation method, 6 children with rotavirus infection in a tertiary hospital from March 26 to April 5, 2021 were investigated, environmental hygiene was monitored, the main relevant factors were analyzed, and effective control measures were taken. Results From March 26 to April 5, 2021, 59 patients were admitted to department of pedia-tric internal medicine for more than 48 hours, 6 patients were infected with rotavirus, incidence was 10.17%. Among 6 children, 4 were males and 2 were females; the mean age was (1.61±1.21) years; admission time of children was on March 19-30, all children were isolated rotavirus on the 5th to 7th day of admission, 6 children were in the same nursing group, beds 22, 23 and 25 were in the same ward. Rotavirus screening was performed on the surface of environmental objects, hands of health care workers(HCWs) and caregivers of 6 children during hospita-lization period, a total of 22 specimens were taken, 20 were with negative and 2 were with weakly positive (bedside tables and bed rails) results, isolation rate was 9.09%. The event lasted for 11 days, and no relevant cases were found since the control measures were taken on April 5. Conclusion This event is a suspected outbreak of HAI caused by rotavirus infection in the department of internal medicine, infection is timely and effectively controlled through strengthening the management of patients and caregivers, stabling medical treatment personnel, strengthening the cleaning and disinfection of ward environment, improving the compliance and correctness of hand hygiene of HCWs, and paying attention to cleaning process.

Abstract:Objective To understand the targeted surveillance and risk factors for healthcare-associated infection (HAI) in a newly-built general intensive care unit (ICU), and provide basis for formulating relevant prevention and control measures of HAI. Methods Targeted surveillance on HAI in patients who were admitted to a newly-built general ICU in 2017-2019 was performed, risk factors and pathogens of HAI were analyzed. Results A total of 1 133 patients were monitored, 120 cases (174 times) of HAI occurred, HAI rate was 10.59%, case infection rate was 15.36%; incidence of HAI was 11.95‰ per 1 000 bed-day, case incidence was 17.32‰ per 1 000 bed-day, incidence of HAI adjusted by patient's average severity was 3.65‰ per 1 000 bed-day, case incidence was 5.30‰ per 1 000 bed-day. Utilization rates of respirator, urinary catheter and central venous catheter were 44.25%, 85.19% and 52.19% respectively, incidence of ventilator-associated pneumonia, catheter-associated urinary tract infection and central line-associated bloodstream infection (CLABSI) were 12.37‰, 0.35‰, and 6.10‰ respectively. The main HAI site was lower respiratory tract (64.94%), followed by blood (21.27%) and urinary tract (3.45%). Length of ICU stay ≥ 14 days (OR=0.122, 95% CI: 0.036-0.414, P=0.001), blood transfusion (OR=0.233, 95% CI: 0.104-0.522, P < 0.001), APACHE Ⅱ score ≥ 20 points (OR=0.358, 95% CI: 0.175-0.733, P=0.005) and tracheotomy (OR=0.158, 95% CI: 0.066-0.374, P < 0.001) were independent risk factors for HAI in ICU patients. The mortality of ICU patients with HAI was higher than that of patients without HAI (37.50% vs 28.04%, χ²=4.664, P=0.031). A total of 147 strains of pathogenic bacteria were isolated from 120 patients with HAI, predominantly Gram-negative bacteria (58.50%), the top 5 pathogens of HAI were Klebsiella pneumoniae (19.05%), Candida albicans (17.69%), Pseudomonas aeruginosa (15.65%), Staphylococcus aureus (10.89%) and Acinetobacter baumannii (6.80%). Resistance rates of Klebsiella pneumoniae and Pseudomonas aeruginosa to imipenem were 14.29% and 65.22% respectively, resistance rate of Staphylococcus aureus to oxacillin was 81.25%. Conclusion Incidence of device-associated infection in newly-built general ICU is high, especially CLABSI, antimicrobial resistance of the main pathogens is serious, corresponding prevention and control measures according to the characteristics of related infection should be formulated to reduce the occurrence of HAI.

Abstract:Objective To analyze the emergency dispatching management mode of trans-regional medical human resources in the event of epidemic of major infectious diseases, provide reference for the emergency management of medical resources. Methods A single case study method was adopted, the emergency dispatching of medical human resources by Hunan Province to fight against COVID-19 epidemic was taken as a typical case, manpower allocation and team formation mode for assistance to Wuhan, Huanggang as well as various cities and municipalities in Hunan Province were described and analyzed. Results Hunan Province has arranged a total of 14 medical teams to support Wuhan (461 persons) and Huanggang (619 persons), at the same time, two echelons of expert teams (225 persons) have been set up to guide medical treatment in Hunan Province. The rapid re-organization and re-allocation process of trans-regional medical human resources was divided into four periods: rapid response period, anti-epide-mic stalemate period, anti-epidemic decisive period and consolidation recovery period. A total of 94 health institutions in 13 cities and municipalities of Hunan Province received unified dispatching, including 86 medical institutions (91.49%) as well as 8 centers for disease control and prevention (8.51%); medical institutions that received dispatching were mainly public hospitals (96.51%); the majority of medical human resources assisting in Wuhan and Huanggang were nurses, accounting for 71.15% and 66.56% respectively, the titles of medical team personnel showed a "pyramid" structure from junior to senior; the majority of the people who assisted the cities and municipalities in Hunan Province were clinicians, accounting for 80.00%, and most of them had senior professional titles, 90.22% had associate professional titles or above. According to medical needs of different regions, there were 7 types of emergency medical teams and 2 types of operation modes: trusteeship and guidance. Conclusion Trans-regional medical human resources emergency dispatching of Hunan Province is characterized by rapid and timely response, sufficient resource input and accurate grasp of demands. It is suggested to further optimize the classification system of emergency medical teams, emergency human resources reserve system as well as emergency command and dispatching system on the basis of experience summary.

Abstract:Objective To explore the effect of application of plan-do-check-action (PDCA) cycle on improving health care workers' (HCWs) compliance to hand hygiene(HH) as well as the influence on incidence of healthcare-associated infection(HAI) in patients. Methods HH questionnaire was designed and used to survey HCWs in a tertiary hospital in December 2014, bundle intervention measures were formulated according to the survey results and routine supervision problems, measures were implemented by PDCA cycle management mode from January 2015. January 2015 to December 2020 was as a post-intervention period, HH-related indicators and incidence of HAI between January-December 2014 and post-intervention period were compared. Results In December 2014, 2 513 questionnaires were distributed and 1 806 were effectively recovered, 507 doctors (28.07%) and 1 185 nurses (65.61%) were surveyed. After the continuous improvement with PDCA cycle, facility completeness rate, compliance rate, correct rate and awareness rate of HH in 2020 were 99.36%, 86.87%, 86.55% and 96.24% respectively, which were higher than 41.19%, 49.90%, 13.46% and 62.65% respectively in 2014, difference were all significant (all P < 0.001). From 2014 to 2020, HH compliance rate (β=6.248, P < 0.001), bed-day consumption of alcohol-based hand rub + hand sanitizer (β=1.182, P=0.013) and paper towel(β=0.508, P < 0.001) increased year by year, case incidence of HAI (β=-0.326, P < 0.001) decreased year by year, HH compliance rate, bed-day consumption of salcohol-based hand rub + hand sanitizer and paper towel were negatively correlated with incidence of HAI (r=-0.977, -0.793, -0.951), difference were all significant (P < 0.05). Conclusion Application of continuous PDCA cycle to implement bundle intervention measures can effectively improve the compliance of HH and reduce the incidence of HAI.

Abstract:Objective To summarize the clinical characteristics of 2 cases of human immunodeficiency virus (HIV)-negative children suffered from Talaromycesis marneffei (TSM). Methods Clinical characteristics, laboratory data and underlying diseases of 2 HIV-negative children with TSM and treated in a children's hospital were analyzed, relevant literatures were reviewed to summarize the clinical characteristics as well as diagnosis and treatment experience of children with TSM. Results Among 2 HIV-negative children with TSM, case 1 presented the initial symptom of mass in the right lower limb, developed fever and cough more than 1 month later, and was misdiagnosed as tuberculosis infection; case 2 began with fever, with pancytopenia, hepatosplenomegaly and lymph node enlargement. Gene test of case 1 presented STAT1 gene mutation, case 2 had a history of recurrent onychomycosis and oral ulcer, which were confirmed by blood, bone marrow culture and lymph node biopsy. Case 1 was treated with intravenous drip of voriconazole and amphotericin B liposome as well as oral medications of itraconazole for maintenance therapy, medication was stopped after 1 year of treatment; case 2 had been treated with voriconazole (intravenous drip first, then oral medication) for 7 months, and there was no recurrence. Conclusion TSM can occur in HIV-negative children, and there may be STAT1 gene mutation. For children with poor treatment effect, culture or tissue biopsy should be performed as early as possible to make a confirmed diagnosis, and actively find the possible underlying diseases of TSM, so as to achieve early diagnosis, early treatment and prognosis improvement.

Abstract:Objective To investigate healthcare-associated infection (HAI) management professionals' awareness on disinfection knowledge, explore the possible influencing factors. Methods Questionnaire with good reliability and validity was used to investigate disinfection knowledge among 135 HAI management professionals. Results HAI management professionals' scores of knowledge dimension, behavioral dimension, and total score of knowle-dge-attitude-practice (KAP) towards disinfection in tertiary hospitals were all higher than those of secondary hospitals ([11.12±2.09] vs[10.00±1.47], [10.58±1.96] vs[9.34±1.64], [25.35±3.83] vs[23.61±2.52], respectively, all P < 0.05); there was no significant difference in the score of attitude dimension of KAP in different hospitals (P=0.359). KAP score of HAI management professionals in 40-49 years group was the highest (26.33±3.04); the higher the education background, the higher the KAP score; KAP score of chief nurse or associate chief nurse (26.90±2.71) was higher than that of other professional titles; KAP score of full-time HAI management professionals (27.61±2.52) was higher than that of part-time staff; disinfection KAP score of HAI management professionals with 5-10 working years (26.47±2.63) was higher (all P < 0.05). Conclusion Awareness rate of disinfection knowledge among HAI management professionals needs to be improved, especially training on disinfection knowledge in secondary hospitals should be strengthened, it is necessary to carry out targeted intervention measures in different groups of population.

Abstract:Heteroresistance refers to the co-existence of bacterial resistance and sensitivity to certain antimicrobial agents in the same clone. Carbapenems are the preferred drugs for the treatment of infection caused by Pseudomonas aeruginosa. With the increasing use of carbapenems, isolation rate of carbapenem-heteroresistant Pseudomonas aeruginosa (CHPA) gradually increased. However, there is no standard, efficient and low-cost detection method for CHPA that can be applied in clinical practice, leading to the failure of detection and treatment for CHPA infection. This paper reviewed the definition and detection methods of heteroresistance, as well as resistance mechanism, clinical and epidemiological characteristics of CHPA, provide references for clinical diagnosis and treatment of CHPA infection.

Abstract:Patients with systemic lupus erythematosus (SLE) have a high incidence of invasive fungal infection (IFI) and poor prognosis. The main infection sites are blood, respiratory system, skin soft tissue and central ner-vous system; most pathogens were Cryptococcus neoformans, Candida albicans, Aspergillus fumigatus and so on. Risk factors of IFI in SLE patients are very complex, the application of glucocorticoid and high score of SLE activity are definite risk factors. There is little progress in the detection of biomarkers of fungal infection in SLE patients, including detection of Candida albicans germ tube antibody and cryptococcal antigen, polymerase chain reaction, as well as detection of pathogen metagenome. Sensitivity and specificity of the relevant biomarkers, as well as the feasibility of the clinical application need further exploration and clinical practice. The accurate judgment can be made only through analysis on risk factors, biomarkers, clinical symptoms, signs and drug use of SLE patients.