Abstract:Objective To investigate the molecular epidemiological characteristics of carbapenem-resistant Entero-bacterales (CRE), study drug resistance characteristics and homology of CRE. Methods 158 strains of non-repetitive CRE isolated from a hospital in Ningxia from January 2018 to May 2021 were collected, drug resistance genes were detected by polymerase chain reaction (PCR), phenotypic confirmation was conducted by modified carbapenem inactivation method (mCIM) combined with EDTA-modified carbapenem inactivation method (eCIM), horizontal transfer of bla_NDM was analyzed by plasmid conjugation test, homology analysis was performed by multilocus sequence typing (MLST). Results 158 CRE strains were mainly Klebsiella pneumoniae (61 strains, 38.61%), followed by Enterobacter cloacae (37 strains, 23.42%) and Escherichia coli (23 strains, 14.56%), the departments with most detected CRE were intensive care unit as well as burn and plastic surgery department. The top four specimen sources of CRE strains were sputum, purulent secretions, drainage fluid and sterile midstream urine respectively, the detected drug-resistant gene was mainly New Delhi metallo-β-lactamase (NDM). Positive rate of 23 strains of Escherichia coli mCIM combined with eCIM test was 95.65%, plasmid conjugation test successfully transferred bla_NDM gene of 15 strains from 20 Escherichia coli to Escherichia coli J53AZ^R, resistance of the conjugated strains to imipenem, meropenem and cephalosporins was stronger than that of the recipient strains. Fourteen ST types were detected from 23 strains of Escherichia coli by multi-locus sequence typing (MLST), mainly ST10 and ST410. Conclusion CRE strains in the hospital mostly come from ICU, mainly carrying bla_NDM resistance gene, and have high resistance to commonly used antimicrobial agents in clinic, hospital should strengthen the supervision of antibiotics use and guide the rational drug use in clinical practice. NDM enzyme subtypes in this region gradually change, thus continuous monitoring should be carried out to find new subtypes in time.

Abstract:Objective To understand antimicrobial resistance and virulence gene carrying of clinically isolated carbapenem-resistant Klebsiella pneumoniae (CRKP), so as to provide basis for clinical prevention and treatment. Methods 36 strains of clinically isolated CRKP in a hospital from March 2020 to March 2021 were collected, antimicrobial susceptibility identification of strains were performed, antimicrobial resistance genes, capsular serotype genes and virulence genes were detected by polymerase chain reaction (PCR) amplification, sequence typing (ST) was performed by multilocus sequence typing, serotyping and molecular evolutionary tree analysis were performed based on wzi sequencing results. Results 36 CRKP strains were all detected bla_KPC gene, but bla_IMP, bla_VIM, and bla_OXA-48 genes were not found. String test was negative, four common capsule serotypes K1, K2, K5, K20, and K57 were not found, detection rates of rmpA2, wcaG, ybtS, aerobactin, iutA, iroN, ycf, mrkD, mrkA, silS, uge, Plvpk, fimH, and wzi genes of 36 CRKP strains were 100%; TerW was 86.11%; fimA and magA were both negative. MLST analysis showed that 36 strains were all ST11, only 32 strains were successfully sequenced wzi gene. wzi typing results were K14. K64 96.88% (31/32) and K24 3.12% (1/32). Molecular evolutionary tree analysis based on sequencing results showed that 31 of 32 strains were 100% homologous, and 1 strain was 99% homologous with Zhejiang strain KP18069. Conclusion The main mechanism of resistance of CRKP to carbapenems in this hospital is bla_KPC gene, the dominant ST is ST11, and wzi type is mainly K14.K64, which carries a large number of virulence genes. Molecular evolutionary tree indicates that there is homologous infection, and it is suspected that there is import transmission. Prevention and control measures should be taken in time to prevent the transmission of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) in the hospital.

Abstract:Objective To analyze the clinical use of amphotericin B in hospitalized patients with malignant hematological diseases combined with invasive fungal disease (IFD) in Chinese PLA General Hospital, and provide basis for guiding rational clinical use of drugs. Methods From January to December 2021, hospitalized patients with malignant hematological diseases complicated with IFD and treated with amphotericin B in the Hematology Department and Hematopoietic Stem Cell Transplantation Ward of Chinese PLA General Hospital were selected as studied objects, and their demographic characteristics, imaging examination, fungal laboratory examination, usage and dosage of amphotericin B were analyzed. Results A total of 131 patients were enrolled, 26 cases (19.85%)were clinically diagnosed IFD, 52 cases (39.69%)were suspected, and 53 cases (40.46%)were undetermined. 28.57% (34/119) patients had positive (1, 3)-beta-D-glucan assay, 13.45% (16/119) had positive Galactomannan test, and 44.64% (50/112) had positive fungal culture. A total of 64 strains of fungi were cultured, most were Candida spp. (n=55) Usage and dosage of amphotericin B: 111 cases (84.73%) were treated with amphotericin B deoxycholate (d-AmB), 61 (46.56%) were treated by intravenous drip, 13 (9.92%) were treated with 0.9% sodium chloride injection as solvent, and 55 (41.98%) were treated with dexamethasone sodium phosphate before treatment. 109 patients (83.21%) were treated with antifungal combination regimen, most were d-AmB combined with voriconazole. The drug utilization index (DUI) value of d-AmB for intravenous drip and atomization inhalation were both < 1.00, and the DUI value of amphotericin B liposome (L-AmB) for intravenous drip was 1.04. Conclusion Amphotericin B is rationally used in this hospital, and the choice of solvent needs to be improved in order to obtain higher clinical benefits.

Abstract:Objective To analyze the clinical characteristics and antimicrobial resistance of Acinetobacter bauma-nnii (A. baumannii) isolated from blood specimens of 75 hospitals in Hebei Provincial Bacterial Resistance Surveillance System from 2016 to 2021. Methods Clinical distribution and change in antimicrobial resistance of A. baumannii isolated from blood specimens in Hebei Province from January 2016 to December 2021 were retrospectively analyzed by WHONET 5.6 and SPSS 24.0 software. Results From 2016 to 2021, 1 739 strains of A. baumannii were isolated from blood specimens in Hebei Province. The median age of patients was 64 years old, the ratio of male to female was 1.7 ∶1. The number of A. baumannii isolated from department of critical care medicine ranked first (769 strains, 44.2%), resistance rates to cephalosporin, compound preparations of β-lactamase inhibitors and carbapenes exceeded 75%; resistance rates of the strains isolated from outpatient and emergency departments to the above antibiotics agents exceeded 65%, ranking second only to the department of critical care medicine. Isolation rate of carbapenem-resistant A. baumannii (CRAB) increased from 55.9% in 2016 to 69.6% in 2019, and decreased by 9.0% in the following two years, isolation rate was 60.6% by 2021, and the cumulative isolation rate of CRAB increased by 4.7% in 6 years. Except for minocycline and polymyxin B, resistance rates of patients in different age groups to other common antimicrobial agents were significantly different (all P < 0.001); resistance rates of A. baumannii isolated from blood cultures of adult patients (≥15 years old) to common antimicrobial agents is generally higher than that of neonates and children (≤14 years old). Conclusion From 2016 to 2021, resistance rates of A. baumannii isolated from blood specimens in Hebei Province to common antimicrobial agents were high, especially in the department of critical care medicine and emergency department. Isolation rate of CRAB is on the rise, rational use of antimicrobial agents as well as prevention and control of healthcare-associated infection should continue to be strengthened.

Abstract:Objective To understand direct medical expenses of patients with healthcare-associated infection (HAI) due to carbapenem-resistant Gram-negative organism (CRO) under different medical insurance payment modes. Methods Case control study was adopted, patients with CRO HAI in a tertiary first-class hospital from January 2019 to December 2021 were selected as infection group, after the 1 ∶1 conditional matching, control group was screened, length of hospital stay and average hospitalization expense of two groups of patients were described by median, direct medical expense of CRO HAI under different payment modes was analyzed by rank sum test. Results There were 75 CRO HAI patients in infection group; 75 cases were successfully matched as control group. Compared with control group, length of hospital stay in patients in infection group extended by 24.4 days, the average hospitalization expense increased by 104 000 Yuan, the average daily hospitalization expense increased by 6 000 Yuan, the self-paid expense amount increase by 71 000 Yuan, and expense of antimicrobial agents increased by 5 000 Yuan, differences were all significant (all P < 0.05). The average hospitalization expense in patients in infection group with different payment modes were significantly different from that of control group (all P < 0.05). The average hospitalization expense due to infection of municipal employee group increased most than that of control group, which was 145 000 Yuan; compared with control group, the average hospitalization expense due to infection of all self-paid group increased by 122 000 Yuan, the self-paid expense due to infection of patients with municipal residents medical insurance and provincial medical insurance increased by 55 000 Yuan and 14 000 Yuan respectively, with a significant difference (both P < 0.05), the average daily hospitalization expense due to infection of provincial employees increased by 3 000 Yuan, differences were all significant (all P=0.001). Conclusion Under different medical insurance payment modes, the average expense of each hospitalization, average length of hospital stay, average daily hospitalization expense and self-paid amount of CRO-infected patients are higher than those of non-infected patients, which cause a heavy economic burden on municipal employees, rural cooperative medical care and all self-paid patients.

Abstract:Objective To evaluate the clinical characteristics and surgical treatment effectiveness of blood culture-negative infective endocarditis (IE). Methods Clinical data of patients with IE who underwent surgical treatment in department of cardiothoracic surgery of a hospital from January 2014 to December 2021 were collected, patients were divided into positive group and negative group according to the results of blood culture pathogen, clinical characteristics and surgical treatment effectiveness of two groups of patients were analyzed retrospectively. Results A total of 88 patients were with IE, 61 of whom were negative for blood culture (negative group) and 27 were positive for blood culture (positive group), with a positive rate of 30.7%. 83 patients were found positive by echocardiography before operation, including vegetations, valve damage, perivalvular leakage of artificial valve, abscess, rupture of chordae tendineae, etc, all patients were treated by surgery. The ratio of fever in negative group was lower than that in positive group (36.1% vs 81.5%), the ratio of chest tightness and shortness of breath was higher than that in positive group (80.3% vs 74.1%), difference was significant (all P < 0.05). In 61 patients in negative group, the primary heart disease was mainly associated with bicuspid aortic valve malformation (16.4%); involving aortic valve (n=37), mitral valve (n=20) and tricuspid valve (n=2), 2 cases involving both aortic valve and mitral valve, proportion of valve deterioration and rupture of chordae tendineae were both higher than positive group (78.7% vs 63.0%, 47.5% vs 22.2%), difference were both significant (both P < 0.05). The main complications of both groups of patients were cardiac insufficiency and embolism; 18 patients with cardiac insufficiency were in negative blood culture group, incidence was 29.5%, and 7 patients were in positive blood culture group, incidence was 25.9%. Mortality of patients in negative group and positive group were 8.2% and 7.4% respectively, there was no significant difference between two groups (P>0.05). Conclusion Early diagnosis, early standardized treatment, selection of appropriate surgical opportunity and scheme, and strengthening perioperative management can achieve better therapeutic effect for IE patients with negative blood culture.

Abstract:Objective To observe the clinical characteristics of moderate coronavirus disease 2019 (COVID -19) patients infected with Omicron variant BA.2 in Quanzhou City, and analyze risk factors for nucleic acid negative conversion time. Methods Clinical data of 67 moderate COVID -19 patients infected with Omicron variant BA.2 in Quanzhou First Hospital Affiliated to Fujian Medical University from March 13, 2022 to April 5, 2022 were collected, clinical characteristics and influencing factors for nucleic acid negative conversion time were retrospectively analyzed. Results The male to female ratio of the enrolled patients was 1 ∶1.03, the age ranged from 9 to 97 (41.45±17.51) years old, 35.82% of patients had underlying diseases, and 83.58% received COVID -19 vaccine. The most common clinical symptom at the initial diagnosis was cough (62.69%), followed by fever (32.84%). The proportions of decreased white blood cell (WBC) count, increased neutrophil percentage and decreased lymphocyte count were 11.94%, 7.46% and 29.85% respectively, the increased proportions of aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine kinase and creatine kinase isoenzyme were 8.95%, 10.45%, 25.37%, 14.93% and 14.93% respectively, the increased proportions of C-reactive protein (CRP), interleukin-6, erythrocyte sedimentation rate and procalcitonin were 35.82%, 71.64%, 56.72% and 4.48%, respectively; the increased proportions of D-dimer, creatinine and ferritin were 8.95%, 28.36% and 13.43%, respectively, 46.27% of the patients were positive for IgG antibodies. Pulmonary CT mainly showed multiple and scattered lesions in the periphery of both lower lungs, patchy high-density shadow and ground glass shadow were more common, and 1.49% of patients had a small amount of bilateral pleural effusion. 10.45% of the patients had complications, the average time of nucleic acid negative conversion of SARS-CoV-2 was (18.12±5.37) days, the average time of hospitalization was (19.45±5.41) days. None of patients progressed to severe/critical disease, all were cured and discharged from hospital. Respiratory disease and elevated CRP were independent risk factors for prolonged SARS-CoV-2 nucleic acid negative conversion time(all P < 0.05). Conclusion Clinical symptoms of moderate COVID -19 patients infected with Omicron variant BA.2 in Quanzhou City were mild at the initial diagnosis, cough was the most common symptom, and some patients were complicated with underlying diseases, most of them completed COVID -19 vaccination, the prognosis was good after active treatment. SARS-CoV-2 nucleic acid negative conversion time is long, which is significantly related to respiratory diseases and elevated CRP.

Abstract:Objective To explore the clinical manifestations, risk of maternal-infant vertical transmission, as well as prevention and control of infection in pregnant patients with SARS-CoV-2 Omicron variant infection in a tertiary first-class hospital during later stage of pregnancy. Methods Clinical features, puerperae and infant outcomes as well as infection prevention and control measures of 3 pregnant women with SARS-CoV-2 Omicron variant infection and their newborns delivered in a tertiary first-class hospital were retrospectively analyzed. Results The average age of 3 pregnant women with SARS-CoV-2 Omicron variant infection was 29 years old and the average gestational age was 38⁺⁴ weeks. The initial clinical symptoms of 1 case were cough and expectoration, and the other 2 patients had no clinical manifestations of coronavirus disease 2019. All patients terminated their pregnancy with cesarean section, and the maternal milk, vaginal secretion, umbilical cord blood and amniotic fluid were tested for SARS-CoV-2 nucleic acid, results were all negative. The mother and baby were separated immediately after the delivery of the newborn, 2 newborns were transferred to isolation room of neonatal intensive care unit for treatment, SARS- CoV-2 nucleic acid test was performed daily during hospitalization, results were all negative; the third case had negative nucleic acid results for two consecutive times at an interval of 24 hours, and was transferred to isolation location for observation. The prognosis of parturients and neonates were good. Conclusion Evidence of maternal-infant vertical transmission of SARS-CoV-2 Omicron variant infection during late pregnancy was not found in this study. For pregnant women with full-term pregnancy or with aggravated respiratory symptoms, it is recommended to terminate the pregnancy in time. After delivery, the mother and baby should be separated and strictly isolated to ensure the safety of the newborn.

Abstract:Objective To systematically evaluate and analyze clinical efficacy of entecavir-sequential pegylated interferon-α (ETV-sequential Peg-IFN-α) and ETV alone for treatment of patients with chronic hepatitis B (CHB). Methods Randomized controlled trial on ETV and ETV-sequential Peg-IFN-α for treatment of CHB were searched from PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure Construction (CNKI) and Wanfang database by computer, clinical studies that met the inclusion criterion were systematically evaluated and analyzed by Stata 16.0 software. Results A total of 10 literatures were included, involving 1 250 patients, 553 of whom were treated with ETV-sequential Peg-IFN-α, 697 patients were treated with ETV alone, there was no significant difference in baseline characteristics between two groups of patients (all P>0.05). HBsAg conversion rate, HBsAg clearance rate, HBeAg conversion rate and HBeAg clearance rate in ETV-sequential Peg-IFN-α trial group were all higher than those in ETV control group, differences were statistically significant (all P < 0.05). Conclusion In the antiviral treatment of CHB, therapeutic effect of ETV-sequential Peg-IFN-α is better than that of ETV alone.

Abstract:Objective To investigate the current situation and influencing factors of the core competence of infection control nurses in Henan Province, and provide reference for improving the core competence of infection control nurses. Methods From March to April 2022, 374 infection control nurses from 205 secondary and above medical institutions in Henan Province were chosen by convenience sampling, questionnaires about general information and core competence of infection control nurses were adopted for investigation. Results The total score of the core competence of infection control nurses was (279.90±29.28), the average scores of each dimension ranging from high to low were infection control knowledge and skill training ability (4.35±0.47), organization and cooperation ability (4.26±0.47), healthcare-associated infection (HAI) prevention and control ability (4.18±0.44), HAI risk prediction ability (4.01±0.49), and infection control professional development ability (3.94±0.53). Univariate analysis showed that there were significant differences in the scores of each dimension of core competence among nurses of different ages, grades of work units, educational background, professional titles, years of infection management and whether participated in infection academic conferences inside and outside the province every year (all P < 0.05). Multiple linear stepwise regression analysis result showed that the grades of work units, professional titles, years of infection management and whether participated in infection academic conferences inside and outside the province every year entered the regression equation, which could explain the 13.8% variability of core competence. Conclusion The core competence of infection control nurses in Henan Province is above the medium level, and there is still much room for improvement in the ability of predicting the risk of HAI and the ability of professional develop-ment of infection control, it is suggested to strengthen the training of these abilities and provide corresponding policy support.

Abstract:Objective To evaluate the risk of healthcare-associated infection (HAI) of skin and soft tissue in patients receiving Chinese medicine leech therapy. Methods Clinical data of 100 hospitalized patients who received Chinese medicine leech therapy (therapy group) from January 1 to December 31, 2021 in the rheumatology department of a hospital and 666 patients who didn't receive leech therapy (non-therapy group) during the same period were collected retrospectively, incidence of skin and soft tissue infection between two groups of patients was compared, and the potential pathogens carried by leeches were found through pathogenic culture. Results One case of skin and soft tissue HAI occurred in both therapy and non-therapy groups respectively, incidence of HAI were 1.0% and 0.2% respectively, difference was not significant between two groups of patients (P=0.244). Specimens of 30 leech surface and nutrient fluid were collected, and 29 (96.7%) of them isolated Alcaligenes faecalis and Providencia rettgeri. Conclusion The risk of skin and soft tissue infection caused by Chinese medicine leech therapy is low, but leech body surface and nutrient fluid often contaminate opportunistic pathogens, it is still important to strengthen control and monitor on infection after therapy.

Abstract:Objective To investigate hand hygiene(HH)status of health care workers (HCWs) in private dental clinics in Shiyan City. Methods From September to November 2019, the convenient sampling method was used to conduct a covert survey on HH status of HCWs in private dental clinics in Shiyan City, compliance rate and accuracy rate of HH of HCWs in different post categories were analyzed and compared. Results A total of 26 private den-tal clinics were investigated, of which only 17 (65.38%) had special hand washing facilities, and 12 (46.15%) had alcohol-based hand rub. 102 HCWs were observed covertly, 2 183 times of effective HH opportunities were observed, HCWs actually performed 572 times of HH, HH compliance rate and accuracy rate were 26.20% and 25.52% (146 times) respectively. There were significant differences in HH compliance rate and accuracy rate among HCWs in different posts (all P < 0.001). HH compliance rate (30.80%) and accuracy rate (31.85%) of nurses were higher than HCWs in other posts. HH compliance rate (76.24%) and accuracy rate (40.26%) of HCWs after contacting patients' body fluids were higher than those at other times, HH compliance rate before and after contacting patients was the lowest, only 15.38% and 24.72% respectively. Compliance rate and accuracy rate of HCWs at different HH opportunities were statistically significant (all P < 0.001). Conclusion Compliance rate and accuracy rate of HH of HCWs in private dental clinics are low, and it is urgent for relevant departments to strengthen the management of HH in private dental clinics.

Abstract:Q fever is a zoonotic disease caused by Coxiella burnetii, which can cause pneumonia, hepatitis, myocarditis, endocarditis and so on, Q fever combined with rhabdomyolysis is relatively rare. Diagnosis of Coxiella burnetii infection is relatively difficult, while high-throughput sequencing, including Oxford Nanopore Technology (ONT) third generation sequencing, can be used as a more sensitive detection method to diagnose Q fever, early diagnosis and timely treatment can generally lead to a good prognosis of Q fever. This paper reports a case of acute Q fever complicated with rhabdomyolysis diagnosed by ONT, patient's condition improved and was discharged from hospital after treatment.

Abstract:Scrub typhus is an acute zoonotic infectious disease caused by Orientia tsutsugamushi. The clinical manifestations of the disease are fever, rash, lymph node enlargement, the presence of specific eschar and ulcer at the bitten site are the most important basis for diagnosis of the disease, patients without eschar and ulcer are often difficult to be identified. This article reports a 54 year old male patient with fever, lymph node enlargement and multiple organ damage as the main clinical manifestations, whose diagnosis was difficult due to the absence of cha-racteristic scabs and poor curative effect of empirical use of antimicrobial agents. The pathogen was clearly identified as Orientia tsutsugamushi after metagenomic next-generation sequencing (mNGS). After treated with levofloxacin and azithromycin, patient's symptoms improved quickly, finally recovered and discharged from hospital. mNGS has been proved more sensitive than traditional culture methods, and superior to traditional clinical methods in early diagnosis of tsutsugamushi disease, especially for patients without typical eschar.

Abstract:Sepsis is a life-threatening organ dysfunction caused by uncontrolled body reactions due to infection. Calprotectin (S100A8/A9), also known as myeloid-related protein MRP8/14, is an alarm element that plays a key role in the regulation of inflammation. In the process of occurrence and development of sepsis, it plays the role of anti-microorganism, regulating inflammation and immunity, as well as participating in intercellular signal transmission and anti-proliferation, thus has great potential to become a new diagnostic marker and therapeutic intervention target. In this paper, the distribution, structure, and biological functions of calprotectin S100A8/A9 are summarized, the mechanism of calprotectin S100A8/A9 in the occurrence and development of sepsis is discussed, and optimization and innovative application of research design in the future are prospected.

Abstract:Intestinal methanogens are anaerobic bacteria that produce methane from hydrogen and carbon dioxide, studies have confirmed that they are closely related to human intestinal diseases, therefore, it is of great significance to explore the mechanism of intestinal methanogens in intestinal diseases. This paper reviews the characteristics, types and colonization characteristics of intestinal methanogens as well as their relationship with obesity, irritable bowel syndrome, inflammatory bowel disease, colorectal cancer, diverticulosis and other diseases, focusing on the possible mechanism of intestinal methanogens in these diseases, so as to provide new ideas for the prevention, diagnosis and treatment of human intestinal diseases.